The science on front-of-package food labels
TL;DR: The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems’ abilities to influence consumer behaviour is needed.
Abstract: Objective The US Food and Drug Administration and Institute of Medicine are currently investigating front-of-package (FOP) food labelling systems to provide science-based guidance to the food industry. The present paper reviews the literature on FOP labelling and supermarket shelf-labelling systems published or under review by February 2011 to inform current investigations and identify areas of future research. Design A structured search was undertaken of research studies on consumer use, understanding of, preference for, perception of and behaviours relating to FOP/shelf labelling published between January 2004 and February 2011. Results Twenty-eight studies from a structured search met inclusion criteria. Reviewed studies examined consumer preferences, understanding and use of different labelling systems as well as label impact on purchasing patterns and industry product reformulation. Conclusions The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems’ abilities to influence consumer behaviour is needed.
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TL;DR: A new way to understand how food policies could be made to work more effectively for obesity prevention is proposed, drawing on evidence from a range of disciplines to develop a theory of change to understandHow food policies work.
599 citations
TL;DR: An overreliance on convenience samples relying on younger adults, limiting the understanding of how knowledge supports food label use in later life, and varied widely in terms of the dimensions they included and the extensiveness of the assessment are found.
345 citations
Additional excerpts
...Similarly, we omit studies investigating relatively new forms of nutrition information, namely, front-of-package symbols, which appear on some products (Hawley et al., 2013; Hersey, Wohlgenant, Arsenault, Kosa, & Muth, 2013; Vyth et al., 2012)....
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TL;DR: A traffic-light and choice architecture cafeteria intervention resulted in sustained healthier choices over 2 years, suggesting that food environment interventions can promote long-term changes in population eating behaviors.
266 citations
TL;DR: It is suggested that increases in food energy supply are sufficient to explain increases in average population body weight, especially in high-income countries.
Abstract: Objective We investigated associations between changes in national food energy supply and in average population body weight.Methods We collected data from 24 high-, 27 middle- and 18 low-income countries on the average measured body weight from global databases, national health and nutrition survey reports and peer-reviewed papers. Changes in average body weight were derived from study pairs that were at least four years apart (various years, 1971-2010). Selected study pairs were considered to be representative of an adolescent or adult population, at national or subnational scale. Food energy supply data were retrieved from the Food and Agriculture Organization of the United Nations food balance sheets. We estimated the population energy requirements at survey time points using Institute of Medicine equations. Finally, we estimated the change in energy intake that could theoretically account for the observed change in average body weight using an experimentally-validated model.Findings In 56 countries, an increase in food energy supply was associated with an increase in average body weight. In 45 countries, the increase in food energy supply was higher than the model-predicted increase in energy intake. The association between change in food energy supply and change in body weight was statistically significant overall and for high-income countries (P< 0.001).Conclusion The findings suggest that increases in food energy supply are sufficient to explain increases in average population body weight, especially in high-income countries. Policy efforts are needed to improve the healthiness of food systems and environments to reduce global obesity.
241 citations
TL;DR: The purpose of this editorial is to provide an update on the global policy environment regarding governmentendorsed FOP nutrition labelling and to examine realworld evidence of policy implementation.
Abstract: Nutrition labelling on food packages has been voluntarily implemented by food companies since the beginning of the 20th century. By the end of the 20th century, both governments and non-governmental organizations began to implement different front-of-package (FOP) nutrition labelling systems. FOP nutrition labels encompass a specific element of nutrition labelling postulated to allow for quick decision making about the nutritional content or relative healthfulness of a product provided through its simple, easily viewable and interpretable format. The policy objectives of FOP nutrition labelling are typically twofold: (i) to provide additional information to consumers to inform healthier food choices; and (ii) to encourage the industry to reformulate products towards healthier options. Recent reviews have summarized the implementation of nutrition labelling policies in general. However, there has been an exponential rise in both government and private-sector FOP nutrition labelling policy that deserves specific attention. While it has been argued that FOP nutrition labelling is a marketing, rather than a public health strategy, the purpose of this editorial is to provide an update on the global policy environment regarding governmentendorsed FOP nutrition labelling and to examine realworld evidence of policy implementation.
205 citations
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TL;DR: These studies help explain why the success of fastfood restaurants serving lower-calorie foods has not led to the expected reduction in total calorie intake and in obesity rates and suggest innovative strategies for consumers, marketers, and policy makers searching for ways to fight obesity.
Abstract: Why is America a land of low-calorie food claims yet high-calorie food intake? Four studies show that people are more likely to underestimate the caloric content of main dishes and to choose higher-calorie side dishes, drinks, or desserts when fast-food restaurants claim to be healthy (e.g., Subway) compared to when they do not (e.g., McDonald’s). We also find that the effect of these health halos can be eliminated by simply asking people to consider whether the opposite of such health claims may be true. These studies help explain why the success of fast food restaurants serving lower-calorie foods has not led to the expected reduction in total calorie intake and in obesity rates. They also suggest innovative strategies for consumers, marketers, and policy makers searching for ways to fight obesity.
675 citations
"The science on front-of-package foo..." refers background in this paper
...For example, this ‘health halo’ effect has been documented for products labelled as ‘low fat’((29))....
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TL;DR: This article found that people are more likely to underestimate the caloric content of main dishes and to choose higher-calorie side dishes, drinks, or desserts when fast-food restaurants claim to be healthy compared to when they do not (e.g., McDonald's).
Abstract: Why is America a land of low-calorie food claims yet high-calorie food intake? Four studies show that people are more likely to underestimate the caloric content of main dishes and to choose higher-calorie side dishes, drinks, or desserts when fast-food restaurants claim to be healthy (e.g., Subway) compared to when they do not (e.g., McDonald’s). We also find that the effect of these health halos can be eliminated by simply asking people to consider whether the opposite of such health claims may be true. These studies help explain why the success of fastfood restaurants serving lower-calorie foods has not led to the expected reduction in total calorie intake and in obesity rates. They also suggest innovative strategies for consumers, marketers, and policy makers searching for ways to fight obesity.
618 citations
TL;DR: Regression analysis showed that usage is mainly related to interest in healthy eating, whereas understanding of nutrition information on food labels is mainlyrelated to nutrition knowledge, which are in turn affected by demographic variables, but in different ways.
539 citations
"The science on front-of-package foo..." refers background in this paper
...Respondents in the UK reported that they most frequently look for fat, then sugar, calories, salt, saturates and additives((39))....
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...Grunert KG, Wills JM & Fernandez-Celemin L (2010)((39)) 26....
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TL;DR: In two studies, the impact of eight front-of-pack nutrition labelling formats that differed in complexity was investigated across four European countries as discussed by the authors, and the results indicated minor differences in consumer friendliness and usage intention between simpler (Healthier Choice Tick, Smileys and Stars) and more complex (Multiple Traffic Light, Wheel of Health and GDA scores).
452 citations
"The science on front-of-package foo..." refers background in this paper
...More recently, researchers investigating the impact of the ‘Guiding Stars’ shelf-labelling system found changes in sales of ready-to-eat cereals that translated into 2?...
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...However, when making selections between healthy and less healthy products in the food spreads category, the MTL label differentiated significantly less between products compared with a label with Smileys or with Stars(15)....
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...the MTL label differentiated significantly less between products compared with a label with Smileys or with Stars((15))....
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...Given that the Guiding Stars and the SDA shelf-label systems have had some impact on product sales, these should also be tested against the TL and Choices symbol as both a shelf-tag labelling system and a possible FOP graphic type....
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...> Shelf-labelling systems such as ‘Guiding Stars’ and ‘Special Diet Alert’ hold promise....
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TL;DR: Calorie labels on restaurant menus impacted food choices and intake; adding a recommended daily caloric requirement label increased this effect, suggesting menu label legislation should require such a label.
Abstract: Objectives. We assessed the impact of restaurant menu calorie labels on food choices and intake.Methods. Participants in a study dinner (n = 303) were randomly assigned to either (1) a menu without calorie labels (no calorie labels), (2) a menu with calorie labels (calorie labels), or (3) a menu with calorie labels and a label stating the recommended daily caloric intake for an average adult (calorie labels plus information). Food choices and intake during and after the study dinner were measured.Results. Participants in both calorie label conditions ordered fewer calories than those in the no calorie labels condition. When calorie label conditions were combined, that group consumed 14% fewer calories than the no calorie labels group. Individuals in the calorie labels condition consumed more calories after the study dinner than those in both other conditions. When calories consumed during and after the study dinner were combined, participants in the calorie labels plus information group consumed an averag...
402 citations
"The science on front-of-package foo..." refers background in this paper
...Furthermore, research on restaurant menu labelling has shown that the statement ‘The recommended daily caloric intake for an average adult is 2000 calories’ enhanced the effect of menu labelling by staving off overeating at a subsequent meal((17))....
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