Multiple Traffic Light Labels Research Articles

Cross-Classification Analysis of Food Products Based on Nutritional Quality and Degree of Processing.

This study aims to compare the classification of foods available in the Portuguese market using Nutri-Score and NOVA classifications and to analyse their ability to discriminate the fat, saturated fat, sugar, and salt content of foods. A sample of 2682 food products was collected. The nutritional quality of foods was established using the Nutri-Score, classifying them into five categories (from A to E). The NOVA classification was used to classify foods according to the degree of food processing into unprocessed/minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods (UPF). The nutritional content of food products was classified using a Multiple Traffic Light label system. It was observed that 73.7% of UPF were classified as Nutri-Score C, D, and E, 10.1% as Nutri-Score A, and 16.2% as Nutri-Score B. Nutri-Score was positively correlated with NOVA classification (ρ = 0.140, p < 0.001) and with the Multiple Traffic Lights system (ρTotal Fat = 0.572, ρSaturated Fat = 0.668, ρSugar = 0.215, ρSalt = 0.321, p < 0.001). NOVA classification negatively correlated with the Multiple Traffic Lights system for total fat (ρ = -0.064, p < 0.001). Our findings indicate the presence of many UPFs in all Nutri-Score categories. Since food processing and nutritional quality are complementary, both should be considered in labelling.

The multiple ‘traffic light’ labels: are they a promising alternative for packaged foods and beverages sold in Turkey

ABSTRACT Food labeling is a suggested approach to guiding consumers to make healthy food choices by providing clear information at the point of purchase. The objective of this study was to examine how the multiple traffic light labels (MTL) scheme would look like if implemented in addition to evaluating the suitability of packaged products according to MTL in Turkey. Three supermarkets were chosen for this study. Data were analyzed using SPSS. Of the 2,969 food products analyzed, 49.57% of the products were found ‘unhealthy’ (total score ≥7). Packaged foods that were classified as ‘Green’ (Low) traffic light were found 31.7% for total fat, 40.7% for saturated fat, 47.5% for sugar, and 45.1% for salt, whereas these percentages for packaged beverages were 91.1%, 84.2%, 17.4%, and 97.6%, respectively. 30.7% of packaged foods for total fat, 17.2% for saturated fat, 19.7% for sugar and 31.2% for salt were classified as ‘Amber’ (Medium). Packaged foods classified as ‘Red’ (High) traffic light were found 37.6% for total fat, 42.1% for saturated fat, 32.8% for sugar, and 23.7% for salt. There were very few packaged beverages that were classified as ‘Red’. The groups with the most ‘Red’ products were oil, fat, nuts, and olive group for total fat; sugars, sweets and other desserts group for saturated fat and total sugar; sauces, ready-to-consume seasonings, and broths group for total salt. A color-coded traffic light labeling seems to be an alternative for implementation across the packaged food supply in Turkey to support consumers to make healthy food choices.

Objective understanding of five front-of-pack labels among consumers in Nelson Mandela Bay, South Africa

Objective: This study aimed to assess the objective understanding of five front-of-pack label formats, namely the Reference Intake, Multiple Traffic Light label, Nutri-Score, health endorsement logo and warning label, among consumers in Nelson Mandela Bay, South Africa. Design: This was a cross-sectional, exploratory study. Setting: Interviewer-administered surveys were conducted at 12 randomly selected food retail outlets in an urban setting. Subjects: A total of 359 adult participants were included in this study. Outcome measures: Objective understanding was measured by asking participants to rank food products according to their nutritional quality, using the displayed front-of-pack label. Results: The type of front-of-pack label significantly influenced ranking ability (p < 0.00001). All the evaluative front-of-pack labels significantly improved the participants’ ability to identify healthier food products compared with the no-label control. The reductive Reference Intake, however, showed no significant impact on consumer understanding. Conclusion: Evaluative front-of-pack labels significantly improved the participants’ ability to identify healthier food products, when compared with the Reference Intake and no-label control. Future research should test the objective understanding of culturally diverse groups in South Africa, particularly among rural populations.

Can traffic light nutritional labels induce healthier consumer choices? Experimental evidence from a developing country

AbstractIn a context of increasing health problems related to bad dietary habits in developing countries, simplified nutritional label formats may be a promising policy alternative. The aim of this study is to assess whether the multiple traffic light (MTL) system can improve the nutritional quality of consumer decisions. We conducted a selection experiment in Peru, where participants were offered a choice between three alternatives in two different food categories (crackers and beverages). Individuals were randomly assigned products with MTL labels on them. Our results reveal that exposure to MTL labels significantly increases the probability of avoiding the least healthy options and of choosing the healthiest items among the alternatives provided. These effects are large in magnitude and seem to be driven by individuals that are female, report average or above average dietary habits, and lack basic nutritional knowledge. However, our findings also suggest that the effectiveness of MTL labels may be sensitive to the specific characteristics of the set of options provided. These findings contribute to the emerging experimental literature on MTL labels in two ways. First, we provide evidence that this system can be effective in inducing consumers to make healthier choices in real‐life situations. Second, we explore which individuals are more likely to benefit from exposure to MTL labels, as well as potential limitations to their effectiveness. Overall, our results provide new insights on how to assess the issue of bad nutrition in emerging economies.

A red code triggers an unintended approach motivation toward sweet ultra-processed foods: Possible implications for front-of-pack labels

Front-of-package labels (FOPL) are recommended to reduce consumer intake of ultra-processed food products (UPP). The multiple traffic-light label is one example of FOPL that indicates the content of target nutrients in products by displaying red (high), amber (medium), and/or green (low) color-coding. The red code may implicitly enhance sweetness perception and approach dispositions toward sweet UPP via cross-modal visual-taste interactions. We conducted two experiments to examine the possibility of contradictory influence of explicitly learned and implicit cross-modal associations on the emotional responses evoked by UPP pictures. In both experiments, we first explicitly associated the color codes with health-related meanings. In Experiment I (n = 78), a psychometric tool estimated the emotional responses (pleasantness and arousal ratings) evoked by UPP pictures when preceded by red, amber, or green color-codes. In Experiment II (n = 24), we recorded participants’ electrocortical brain activity to assess the early posterior negativity (EPN) component as an index of the emotional responses to UPP. The reported pleasantness (Experiment I) and the EPN amplitude (Experiment II) were greater for sweet UPP relative to salty UPP when primed with red codes but not when primed with green or amber. A red code increased positive emotions toward sweet UPP despite its explicit association with increased health-risks. Thus, the use of multiple traffic-lights might lead to an unintended implicit approach behavior toward sweet UPP. Designers, researchers, and policy makers may consider color-taste cross-modal associations when designing, testing, and applying FOPL.

Nutrient‐Based Warning Labels May Help in the Pursuit of Healthy Diets

In this commentary we argue that the newest paradigm of front-of-package labels, represented by the characteristics found in the Chilean warning label, has the greatest potential to promote healthy diets compared with the Keyhole symbol, the multiple traffic light label, the Health Star Ratings system, and the 5-Color Nutrition label. Warning labels: (1) are consistent in the information they communicate; (2) discourage the purchase and consumption of noncore foods that characterize unhealthy diets; (3) are more likely to reinforce other regulatory measures; and (4) are more likely to encourage reformulation and are less likely to be used as a marketing tool by the food industry. Ongoing empirical evaluation of the impact of warning labels on consumer behavior and product reformulation is essential.

Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases-A Randomised Controlled Trial.

Background: Front-of-pack nutrition labelling may support healthier packaged food purchases. Australia has adopted a novel Health Star Rating (HSR) system, but the legitimacy of this choice is unknown. Objective: To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions. Design: Individuals were assigned at random to access one of four different formats of nutrition labelling—HSR, multiple traffic light labels (MTL), daily intake guides (DIG), recommendations/warnings (WARN)—or control (the nutrition information panel, NIP). Participants accessed nutrition information by using a smartphone application to scan the bar-codes of packaged foods, while shopping. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks. Results: The 1578 participants, mean age 38 years, 84% female recorded purchases of 148,727 evaluable food items. The mean healthiness of the purchases in the HSR group was non-inferior to MTL, DIG, or WARN (all p < 0.001 at 2% non-inferiority margin). When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all p > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; p = 0.04). HSR was perceived by participants as more useful than DIG, and easier to understand than MTL or DIG (all p < 0.05). Participants also reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all p < 0.03). Conclusions: These real-world data align with experimental findings and provide support for the policy choice of HSR. Recommendation/warning labels warrant further exploration, as they may be a stronger driver of healthy food purchases.

Comparing five front-of-pack nutrition labels' influence on consumers' perceptions and purchase intentions

In 2011, a National Academy of Medicine report recommended that packaged food in the U.S. display a uniform front-of-package nutrition label, using a system such as a 0–3 star ranking. Few studies have directly compared this to other labels to determine which best informs consumers and encourages healthier purchases. In 2013, we randomized adult participants (N=1247) in an Internet-based survey to one of six conditions: no label control; single traffic light; multiple traffic light; Facts Up Front; NuVal; or 0–3 star ranking. We compared groups on purchase intentions and accuracy of participants' interpretation of food labels. There were no differences in the nutritional quality of hypothetical shopping baskets across conditions (p=0.845). All labels improved consumers' abilities to judge the nutritional quality of foods relative to no label, but the best designs varied by outcomes. NuVal and multiple traffic light labels led to the greatest accuracy identifying the healthier of two products (p<0.001), while the multiple traffic light also led to the most accurate estimates of saturated fat, sugar, and sodium (p<0.001). The single traffic light outperformed other labels when participants compared nutrient levels between similar products (p<0.03). Single/multiple traffic light and Facts Up Front labels led to the most accurate calories per serving estimations (p<0.001). Although front-of-package labels helped participants more accurately assess products' nutrition information relative to no label, no conditions shifted adults' purchase intentions. Results did not point to a clearly superior label design, but they suggest that a 3-star label might not be best for educating consumers.

Impact of explained v. unexplained front-of-package nutrition labels on parent and child food choices: a randomized trial.

The present study investigated whether parent/child pairs would select more healthful foods when: (i) products were labelled with front-of-package (FOP) nutrition labels relative to packages without labels; (ii) products were labelled with colour-coded Multiple Traffic Light (MTL) FOP labels relative to monochromatic Facts up Front (FuF) FOP labels; and (iii) FOP labels were explained via in-aisle signage v. unexplained. Participants were randomly assigned to one of five conditions: (i) FuF labels with in-aisle signs explaining the labels; (ii) FuF labels, no signage; (iii) MTL labels with in-aisle signage; (iv) MTL labels, no signage; (v) control group, no labels/signage. Saturated fat, sodium, sugar and energy (calorie) content were compared across conditions. The study took place in a laboratory grocery aisle. Parent/child pairs (n 153) completed the study. Results did not support the hypothesis that MTL labels would lead to more healthful choices than FuF labels. The presence of FOP labels did little to improve the healthfulness of selected foods, with few exceptions (participants with v. without access to FOP labels selected lower-calorie cereals, participants with access to both FOP labels and in-aisle explanatory signage selected products with less saturated fat v. participants without explanatory signage). Neither MTL nor FuF FOP labels led to food choices with significantly lower saturated fat, sodium or sugar. In-aisle signs explaining the FOP labels were somewhat helpful to consumers in making more healthful dietary decisions. New FOP labelling programmes could benefit from campaigns to increase consumer awareness and understanding of the labels.

Interpretive front-of-pack nutrition labels. Comparing competing recommendations

Many stakeholders support introducing an interpretive front-of-pack (FOP) nutrition label, but disagree over the form it should take. In late 2012, an expert working group established by the New Zealand government recommended the adoption of an untested summary rating system: a Star label. This study used a best–worst scaling choice experiment to estimate how labels featuring the new Star rating, the Multiple Traffic Light (MTL), Daily Intake Guide (DIG), and a no-FOP control affected consumers' choice behaviours and product perceptions. Nutrient-content and health claims were included in the design. We also assessed whether respondents who used more or less information during the choice tasks differed in their selection patterns. Overall, while respondents made broadly similar choices with respect to the MTL and Star labels, the MTL format had a significantly greater impact on depressing preference as a food's nutritional profile became less healthy. Health claims increased rankings of less nutritious options, though this effect was less pronounced when the products featured an MTL. Further, respondents were best able to differentiate products' healthiness with MTL labels. The proposed summary Stars system had less effect on choice patterns than an MTL label and our findings highlight the need for policy makers to ensure that decisions to introduce FOP labels are underpinned by robust research evidence. These results suggest that the proposed summary Stars system will have less effect on shifting food choice patterns than interpretive FOP nutrition label featuring traffic light ratings.

Inferring product healthfulness from nutrition labelling. The influence of reference points

Despite considerable research on nutrition labelling, it has proven difficult to find a front-of-pack label which is informative about product healthfulness across various situations. This study examines the ability of different types of nutrition labelling schemes (multiple traffic light label, nutrition table, GDA, logo) to communicate product healthfulness (a) across different product categories, (b) between options from the same product category, and (c) when viewed in isolation and in comparison with another product. Results of two experiments in Germany and The Netherlands show that a labelling scheme with reference point information at the nutrient level (e.g., the traffic light label) can achieve all three objectives. Although other types of labelling schemes are also capable of communicating healthfulness, labelling schemes lacking reference point information (e.g., nutrition tables) are less effective when no comparison product is available, and labelling schemes based on overall product healthfulness within the category (e.g., logos) can diminish consumers’ ability to differentiate between categories, leading to a potential misinterpretation of product healthfulness. None of the labels affected food preferences.

Front-of-pack nutrition labels. Their effect on attention and choices when consumers have varying goals and time constraints

Although front-of-pack nutrition labeling can help consumers make healthier food choices, lack of attention to these labels limits their effectiveness. This study examines consumer attention to and use of three different nutrition labeling schemes (logo, multiple traffic-light label, and nutrition table) when they face different goals and resource constraints. To understand attention and processing of labels, various measures are used including self-reported use, recognition, and eye-tracking measures. Results of two experiments in different countries show that although consumers evaluate the nutrition table most positively, it receives little attention and does not stimulate healthy choices. Traffic-light labels and especially logos enhance healthy product choice, even when consumers are put under time pressure. Additionally, health goals of consumers increase attention to and use of nutrition labels, especially when these health goals concern specific nutrients.

Nutrition labels: a survey of use, understanding and preferences among ethnically diverse shoppers in New Zealand

Effective nutrition labels are part of a supportive environment that encourages healthier food choices. The present study examined the use, understanding and preferences regarding nutrition labels among ethnically diverse shoppers in New Zealand. A survey was carried out at twenty-five supermarkets in Auckland, New Zealand, between February and April 2007. Recruitment was stratified by ethnicity. Questions assessed nutrition label use, understanding of the mandatory Nutrition Information Panel (NIP), and preference for and understanding of four nutrition label formats: multiple traffic light (MTL), simple traffic light (STL), NIP and percentage of daily intake (%DI). In total 1525 shoppers completed the survey: 401 Maori, 347 Pacific, 372 Asian and 395 New Zealand European and Other ethnicities (ten did not state ethnicity). Reported use of nutrition labels (always, regularly, sometimes) ranged from 66% to 87% by ethnicity. There was little difference in ability to obtain information from the NIP according to ethnicity or income. However, there were marked ethnic differences in ability to use the NIP to determine if a food was healthy, with lesser differences by income. Of the four label formats tested, STL and MTL labels were best understood across all ethnic and income groups, and MTL labels were most frequently preferred. There are clear ethnic and income disparities in ability to use the current mandatory food labels in New Zealand (NIP) to determine if foods are healthy. Conversely, MTL and STL label formats demonstrated high levels of understanding and acceptance across ethnic and income groups.

Impact of different food label formats on healthiness evaluation and food choice of consumers: a randomized-controlled study.

BackgroundFront of pack food labels or signpost labels are currently widely discussed as means to help consumers to make informed food choices. It is hoped that more informed food choices will result in an overall healthier diet. There is only limited evidence, as to which format of a food label is best understood by consumers, helps them best to differentiate between more or less healthy food and whether these changes in perceived healthiness result in changes of food choice.MethodsIn a randomised experimental study in Hamburg/Germany 420 adult subjects were exposed to one of five experimental conditions: (1) a simple "healthy choice" tick, (2) a multiple traffic light label, (3) a monochrome Guideline Daily Amount (GDA) label, (4) a coloured GDA label and (5) a "no label" condition. In the first task they had to identify the healthier food items in 28 pair-wise comparisons of foods from different food groups. In the second task they were asked to select food portions from a range of foods to compose a one-day's consumption. Differences between means were analysed using ANOVAs.ResultsTask I: Experimental conditions differed significantly in the number of correct decisions (p < 0.001). In the condition "no label" subjects had least correct decisions (20.2 ± 3.2), in the traffic light condition most correct decisions were made (24.8 ± 2.4). Task II: Envisaged daily food consumption did not differ significantly between the experimental conditions.ConclusionDifferent food label formats differ in the understanding of consumers. The current study shows, that German adults profit most from the multiple traffic light labels. Perceived healthiness of foods is influenced by this label format most often. Nevertheless, such changes in perceived healthiness are unlikely to influence food choice and consumption. Attempts to establish the informed consumer with the hope that informed choices will be healthier choices are unlikely to change consumer behaviour and will not result in the desired contribution to the prevention of obesity and diet related diseases.