Mean Health Star Rating Research Articles

Energy, nutrient and overall healthiness of processed packaged foods in Fiji, a comparison between 2018 and 2020

In Fiji, packaged foods are becoming increasingly available. However, it is unknown if nutrition composition of these foods has changed. This study aims to assess changes in energy, nutrient content and healthiness of packaged foods by comparing data from five major supermarkets in Fiji in 2018 and 2020. Foods were categorised into 14 groups; nutrient composition information was extracted and healthiness assessed using Health Star Rating (HSR). Descriptive statistics and a separate matched products analysis was conducted summarising differences in nutrient content and HSR. There was limited evidence of change in the nutrient content of included products however, there was a small reduction in mean saturated fat in the snack food category (-1.0 g/100 g, 95% CI -1.6 to -0.4 g/100 g). The proportion of products considered healthy based on HSR, increased in the convenience foods category (28.4%, 95% CI 8.3 to 48.5) and decreased in non-alcoholic beverages (-35.2%, 95% CI -43.6 to -26.9). The mean HSR score increased in the fruit and vegetables category (0.1 (95% CI 0.1, 0.2)) and decreased for non-alcoholic beverages (-1.1 (-1.3, -0.9)) and the sauces, dressings, spreads, and dips category (-0.3 (-0.3, -0.2)). Strengthened monitoring of the food supply is needed to improve the healthiness of foods available.

Nutritional values of ready-to-eat snacks available in the Indian E-market—a comparative study based on the health star rating system

BackgroundThe popularity of ready-to-eat (RTE) foods has increased globally, especially among children, because they are readily available, convenient, tasty, and have attractive packaging designs. The number of packaged foods, drinks, and snacks has risen in the Indian market, and the presence of less-healthy packaged products is a significant cause of overweight and diseases related to diet. The Health Star Rating (HSR) System, initiated by the Australian and New Zealand governments, was designed to rank these packaged products based on fat, sugar, energy, salt, and other nutritional compositions. The study assessed the nutritional value of RTE snacks currently available in the Indian e-market using the HSR system.MethodsThis comparative study analyzed the nutritional values of RTE snacks from November 2022 to February 2023. The data were extracted from the Indian e-market, namely Amazon Fresh, Flipkart Grocery, and Big Basket, using specific keywords. The HSR system has been used to evaluate and compare the healthiness of RTE snacks, using a star rating scale of 0.5 stars = bad to 5 stars = excellent. The study assessed 294 RTE products, including chips, cocoa-based snacks, and baked snacks, with a price range of INR 50 and below.ResultsThe findings revealed that the mean HSR was low (1.46) stars [SD 0.63] out of (5) stars for the studied products, with significant concerns about high levels of energy, sugar, sodium, and saturated fat. Additionally, the study observed a limited utilization of fruits, vegetables, nuts, and legumes (FVNL) in the market products.ConclusionThe study highlights the unhealthiness of snack products available in the Indian e-market due to high levels of sugar, salt, and fat. These snacks also lack FVNL as nutritious ingredients. The data extracted can underscore public health concerns, highlight the importance of consumer awareness, and help snack manufacturers develop healthier snacks for society.

Chocolate unicorns and smiling teddy biscuits: analysis of the use of child-directed marketing on the packages of Australian foods.

The use of food packaging as a vehicle for marketing to children is under investigated. Our objective was to determine the prevalence and types of child-directed promotional techniques used on food packaging in Australia. Based on existing literature and regulations, we developed a framework to classify on-pack child-directed promotional techniques involving the use of characters and other elements that appeal to children. We analysed the packaging of all products in eight food categories available for sale from supermarkets in 2019 and recorded the use of child-directed promotions on pack. We assessed the number and proportion of products displaying child-directed promotional techniques overall and assessed the healthiness of products using child-directed promotions against four indicators of healthiness to provide summary data overall and for the manufacturers who most frequently employed child-targeted strategies. Data were collected from the FoodSwitch database in Sydney, Australia. 901/8006 (11·3 %) products displayed one or more child-directed on-pack element. Most frequent was on foods for infants and young children (n 315), confectionery (n 283), snack foods (n 172) and dairy (n 168). Personified characters were the most commonly used element (n 512). Products using child-directed promotional techniques scored poorly on all four indicators of healthiness: mean health star rating 2·34 (out of 5); 81 % ultra-processed and 6·1 % and 4·5 % products eligible to market to children under Western Pacific and Mexican nutrient profiling schemes, respectively. Australian children are targeted by promotional techniques on the packaging of unhealthy food products. Stronger regulation of these techniques is warranted to protect children's health.

The relationship between voluntary product (re) formulation commitments and changes in the nutritional quality of products offered by the top packaged food and beverage companies in Canada from 2013 to 2017

BackgroundFood companies shape Canada’s food supply through voluntary actions and commitments concerning product (re)formulation; however, the extent that these initiatives translate into actual improvements in nutritional quality is unclear. This study examined changes in the nutritional quality of products offered by the top 22 packaged food and beverage companies in Canada from 2013 to 2017, in relation to the strength of their product (re) formulation actions and commitments.MethodsThe Food Company Reformulation (FCR) scoring tool was used to quantify the strength of companies’ reported recent actions and commitments to reduce energy and nutrients of concern in their products, with higher scores signifying stronger voluntary actions/commitments. Nutritional information for products was sourced from the University of Toronto FLIP 2013 (n = 6490) and 2017 (n = 8277) databases (n = 4074 matched products). Changes in product healthfulness were assessed using the Health Star Rating (HSR) system (with higher HSRs denoting healthier products) and calories, sodium, saturated fat, trans fat, and total and free sugar levels per 100 g/mL. Generalized estimating equations examined changes in nutritional quality in relation to FCR scores.ResultsOverall, mean HSRs increased significantly for 5 companies’ product portfolios and were reduced in 1 company’s product portfolio. There were significant reductions in calories, sodium, saturated fat in 2 companies’ portfolios and increases in 4, 3, and 8 companies’ portfolios, respectively. Trans fats increased significantly in 2 companies’ portfolios. Total and free sugars decreased significantly in 4 and 5 companies’ portfolios, respectively, and increased in 1 company’s portfolio. There was little change in the healthfulness of matched products. Higher FCR scores were not associated with greater increases in HSRs, or reductions in calories or nutrient amounts. FCR scores were negatively associated with HSRs and positively associated with total and free sugars. No relationship was observed between FCR scores and calories, sodium, saturated fat or trans fat.ConclusionsReporting stronger voluntary product (re) formulation actions and commitments was not associated with greater improvements in the healthfulness of products offered by Canada’s leading packaged food and beverage companies from 2013 to 2017, suggesting a need for stronger industry initiatives or mandatory government interventions to improve the healthfulness of the food supply.

Availability, healthiness, and price of packaged and unpackaged foods in India: A cross-sectional study.

Background: Vulnerable populations are the most prone to diet-related disease. The availability, healthiness, and price of foods have established associations with diet-related disease in communities. However, data describing this in India are sparse, particularly in urban slums and rural areas. Aim: To quantify and compare availability, healthiness, and price of packaged and unpackaged foods and beverages in India, and to identify opportunities to improve diets and health of vulnerable populations. Methods: Nutrition data and price were collected on foods and beverages available at 44 stores in urban, urban slum, and rural areas in four states in India between May and August 2018. Healthiness was assessed using the Australasian Health Star Rating system and product retail prices were examined. Comparisons in the findings were made across state, community area type, and adherence to current and draft Indian food labeling regulations. Results: Packaged foods and beverages (n = 1443, 89%) were more prevalent than unpackaged (n = 172, 11%). Unpackaged products were healthier than packaged (mean Health Star Rating = 3.5 vs 2.0; p < 0.001) and lower in price (median price per 100 g/ml: 13.42 Indian rupees vs 25.70 Indian rupees; p < 0.001), a pattern observed across most community area types and states. 96% of packaged products were compliant with current Indian labeling regulations but only 23% were compliant with proposed labeling regulations. Conclusions: Unpackaged products were on average much healthier and lower in price than packaged foods and beverages. Food policies that support greater availability, accessibility and consumption of unpackaged foods, while limiting consumption of packaged foods, have enormous potential for sustaining the health of the Indian population.

Healthiness of foods and non-alcoholic beverages according to store type: A population-based study of household food and drink purchases in New Zealand

BackgroundObesity and diet-related noncommunicable diseases (NCDs) account for the largest proportion of disease burden worldwide, and an unhealthy food environment is a key driver. Food retailers play an important role in food environments through the availability and purchases of healthy food products at various stores.ObjectivesTo assess whether the healthiness of food and non-alcoholic drink product purchases vary according to retail store type.MethodsWe undertook a cross-sectional analysis of Nielsen New Zealand Homescan® panel data, which is a nationally representative sample of 2500 households in terms of certain key household demographic and socioeconomic characteristics. Panel members were asked to record all food and beverage products that were purchased and brought back to the home between October 2018 and October 2019. Household food and non-alcoholic drink purchases were linked with two food composition databases (Nutritrack, a New Zealand packaged food composition database, and the FOODfiles New Zealand Food Composition Database) to extract data on the nutrient profile of products purchased. We developed a store classification tool, and classified stores as supermarkets, grocery stores, convenience stores, fruit and vegetable stores, meat and fish stores, or bakeries. We estimated the Health Star Rating (HSR) for all products and defined a product with HSR ≥ 3.5 as ‘healthy’. We computed estimated mean HSR and conducted multivariate regression analyses.ResultsIn total, 3,940,458 product purchases were included in the analyses, consisting of 20,491 unique products purchased at different stores over the one-year period by 1800 panellist households. Supermarket products made up the majority of household food and drink purchases (3,545,141 of 3,940,458; 90%). Overall, the estimated mean HSR was 3.5 stars. In comparison to the reference group of supermarkets, the odds ratio for healthy products purchased at fruit and vegetable stores was 4.62, at grocery stores it was 2.36, and at meat and fish stores it was 1.99. In contrast, the odds ratios from convenience stores and bakeries were 0.58 and 0.03. Except for convenience stores, these differences were statistically significant (p < 0.05).DiscussionWe found significant differences in household purchases of healthy food and beverages according to food retail store type, with healthier food much more likely to be purchased from fruit and vegetable stores, meat and fish stores and grocery stores, and much less likely to be purchased from bakeries and convenience stores as compared with supermarkets.ConclusionPolicies to improve healthy food retailing should consider all retail store types and focus particularly on increasing the availability of healthy food options at convenience stores and bakeries. Given that supermarkets are the source of most household food purchases (both healthy and unhealthy), strategies are also warranted to increase the relative availability and purchases of healthy foods from supermarkets.

Which companies dominate the packaged food supply of New Zealand and how healthy are their products?

Improvement of national food supplies are an opportunity to improve a country's health. Our aim was to identify the major food companies manufacturing packaged foods and non-alcoholic beverages available in New Zealand supermarkets in 2018; to assess the healthiness of products using (1) the Health Star Rating (HSR) system, (2) Australian Dietary Guidelines classification (core/discretionary), and (3) by level of processing; to compare the healthiness of products displaying and not displaying the HSR and; to assess potential for food reformulation within selected food sub-categories. Information on packaged foods was obtained from the Nutritrack supermarket database. Companies that manufactured each food and brand were identified using company websites and the New Zealand companies register. In total, 13,506 packaged products were mapped to 1,767 brands and 1,214 companies. Based on market share of products available for sale (Euromonitor data), there were 22 dominating companies producing 31% of products and 17% of brands. Fifty-nine percent of products were classified as unhealthy (HSR <3.5/5 stars), 53% as discretionary, and 69% as ultra-processed. Products displaying the HSR on the package had a higher mean HSR ±SD than if the HSR was not displayed (3.2±1.3 versus 2.5±1.4, p = 0.000). Efforts to improve the healthiness of products should be directed to the 22 food companies dominating this market share, particularly in the core foods groups which are currently less likely to meet Heart Foundation reformulation targets (bread, breakfast cereals, cheese, canned baked beans, yoghurt). The New Zealand supermarket packaged food supply included in the Nutritrack database is dominated by a small number of companies and is mostly unhealthy. Government leadership is required to improve the healthiness of the packaged food supply and provide adequate information to consumers. This includes interventions setting reformulation targets for core food groups, setting population nutrient intake targets and mandating that the HSR is displayed on all products.

Uptake of Australia's Health Star Rating System 2014-2019.

In June 2014, Australia and New Zealand adopted a voluntary front-of-pack nutrition label, the Health Star Rating (HSR) system. Our aim was to assess its uptake in Australia in the five years following adoption and examine the feasibility of proposed targets for future uptake. Numbers and proportions of products eligible to carry a HSR were recorded each year between 2014 and 2019 as part of an annual survey of four large Australian retail outlets. Uptake was projected to 2024. Mean HSR values were determined for products that were, and were not labelled with a HSR logo, and summary data presented overall, by HSR score, by major food category, by manufacturer and manufacturer group. Differences in mean HSR were assessed by independent samples t-test. HSR uptake continues to increase, appearing on 7118/17,477 (40.7%) of eligible products in 2019. Voluntary display of the HSR logo was increasing linearly at 6.8% annually. This would need to be maintained to reach 70% by 2024. Of those products displaying a HSR logo, more than three quarters (76.4%) had a HSR ≥ 3.0. Products displaying a HSR logo had a significantly higher mean HSR (3.4), compared to products not displaying a HSR logo (2.6) (p < 0.001). One hundred and thirty-nine manufacturers were using HSR, but retailers Coles, Woolworths and ALDI were together responsible for the majority of uptake (55.9%). Manufacturer members of the Australian Food and Grocery Council were responsible for 28.6% of uptake. Our findings illustrate the limits of commercial goodwill in applying HSR voluntarily. Ongoing implementation must pair clear targets and timelines for uptake with a firm pathway to make HSR mandatory if sufficient progress is not achieved.

Stars versus warnings: Comparison of the Australasian Health Star Rating nutrition labelling system with Chilean Warning Labels

ObjectiveThe Health Star Rating (HSR) is a voluntary front‐of‐pack nutrition labelling system that rates products from ½ to 5 stars (five being healthiest). The Chilean Warning Label system displays warnings on foods high in sugar, saturated fat, sodium, or energy. We aimed to evaluate alignment between the systems. MethodsNew Zealand packaged products (n=13,868) were classified according to the two systems. Alignment was assessed by cross‐checking the number of products meeting the criteria for warnings against star ratings. Products with no warnings but an HSR <2, or with >1 warning but an HSR of ≥3.5 were considered outliers. ResultsTwo‐thirds of products met the criteria for at least one warning. There was a significant positive relationship between the number of warnings and mean HSR: 0 warnings = HSR 3.77±.0166 (p<0.001), 1 warning = HSR 2.70±.0206 (p<0.001) and >1 warning = HSR 2.00±.0160 (p<0.001). The systems were non‐aligned for 1,117 products (8%). ConclusionHSR and the Chilean Warning Label systems are broadly aligned. Non‐alignment is due to the Chilean system restricting warnings to foods containing added ingredients and HSR awarding points for positive components. Implications for public healthThese results could be helpful in informing improvements to the HSR system.

Examining the nutritional quality of the product portfolios of major packaged food and beverage companies in Canada

AbstractCanada's food supply is abundant in energy-dense products containing excess amounts of sodium, saturated fat and free sugars, increasing Canadians' risk of developing obesity and non-communicable diseases. Food companies shape the food supply through their control over the formulation of their products; however, no studies have examined the healthfulness of products offered by different companies in Canada. This study aimed to assess and compare the nutritional quality of the product portfolios of major packaged food and beverage companies in Canada. Twenty-two top food companies were selected for study, representing a combined 50% and 73% of Canadian packaged food and beverage sales in 2018, respectively. This included 18 multinational companies, 2 Canadian manufacturers and 2 retailers with private-label brands. Nutritional information for products was sourced from the University of Toronto Food Label Information Program 2017 database. The nutritional quality of all products offered by the sampled companies that were included in the database (n = 8,211) were evaluated using the Health Star Rating (HSR) system, with HSRs ranging from 0.5 (less healthy) to 5 (healthier). Descriptive analyses and analysis of variance with post-hoc tests examined the HSRs of each company's products overall and by food category (n = 24). Mean HSRs of companies’ overall product portfolios ranged from 1.8 to 3.7 (μx̅ = 2.7, σx̅ = 0.5) and differed significantly between companies (p &lt; 0.001). Mean HSRs differed between companies for all food categories except eggs (p = 0.5), seafood (p = 0.2), legumes (p = 0.1), nuts and seeds (p = 0.4), and vegetables (p = 0.08). Variation in mean HSRs of products offered by different companies was greatest for beverages (range = 1.3–5.0, μx̅ = 2.0, σx̅ = 1.0), fats/oils (range = 0.7–4.4, μx̅ = 3.6, σx̅ = 1.6), fruit/fruit juices (range = 0.8–4.0, μx̅ = 2.6, σx̅ = 0.9), and sauces/dips/gravies/condiments (range = 0.5–3.4, μx̅ = 2.3, σx̅ = 1.0). These findings demonstrate that the nutritional quality of products offered by leading food manufacturers in Canada varies significantly overall and by food category, with many of these products considered less healthy according to the HSR system. Differences between companies may reflect the nature of their products; for example, products offered by dairy companies were healthier than those of confectionary and soft drink manufacturers, on average. Variation in nutritional quality within food categories illustrates the need and potential for many companies to improve the healthfulness of their products. By identifying companies that offer less healthy products compared with others in Canada, this study may prompt reformulation.

Uptake of Australia’s Health Star Rating System

In June 2014, Australia and New Zealand adopted a voluntary front-of-pack nutrition labelling scheme in the form of the Health Star Rating (HSR) system. Our aim was to assess its uptake in Australia while a formal five-year review of the system is underway. Numbers and proportions of products eligible to carry a HSR were recorded each year between 2014 and 2017 as part of an annual survey of four large Australian retail outlets. Mean HSR values were determined for products that were and were not labelled with a HSR logo, and summary data presented overall, by HSR score, by major food category, and for leading manufacturers. Results show that uptake is increasing: HSR appeared on 4348/15,767 (28%) of eligible products in 2017 and has now appeared on 7922 products since implementation. Of those products displaying a HSR logo, more than three-quarters (76.4%) displayed a HSR of ≥3.0. Products displaying a HSR logo had a higher mean HSR (3.4), compared to products not displaying a HSR logo (2.7). Uptake was highest on convenience foods (44%), cereals (36.7%), and fruit and vegetable products (35.9%). More than 100 manufacturers were using the system, but retailers Coles, Woolworths and Aldi were together responsible for 54% of uptake. For all except Coles, Woolworths and Campbell Arnott’s, the mean HSR of products displaying a logo on pack was higher than products made by that manufacturer not showing a HSR logo. We conclude that to ensure the consistent and widespread uptake required for consumers to make informed food purchases, HSR should be made mandatory at the conclusion of the five-year review.

Measuring the Healthiness of the Packaged Food Supply in Australia

The increasing availability of packaged foods plays a key role in nutritional transition. This study examined the healthiness of the Australian packaged food supply using a range of different metrics; 40,664 packaged products from The George Institute’s FoodSwitch database were included. Median and interquartile range (IQR) were determined for each measure of nutrient composition; mean and standard deviation (SD) for the measure based upon Health Star Rating (HSR); and proportions (%) for the measures based upon products with a higher HSR, classification of foods as either core or discretionary, extent of processing and proportions of foods that met reformulation targets for sodium, saturated fat and total sugars. Overall median (IQR) values were 1093 (1256) kJ/100 g for energy, 1.7 (6.3) g/100 g for saturated fat, 5.3 (21.4) g/100 g for total sugars, 163 (423) g/100 g for sodium and 50 (100) g or mL for serving size. Overall mean (SD) HSR was 2.8 (1.4), proportion with HSR < 3.5 was 61.8%, proportion of foods defined as discretionary was 53.0% and proportion of foods defined as highly processed was 60.5%. There were sodium targets set for 21,382/40,664 (53%) foods and achieved for 14,126/40,664 (35%). Corresponding figures for saturated fat were 328/40,664 (0.8%) and 130/40,664 (0.3%). Nutrient profiling, dietary guidelines and the extent of food processing provided comparable assessments of the nutritional quality of Australia’s packaged food supply. Individual measures of nutrient composition did not, but may be of value for identifying specific foods of concern.