Impact of a front-of-pack nutritional traffic-light label on the nutritional quality and the hedonic value of mid-afternoon snacks chosen by mother-child dyads

How different goals drive attention: An interview study on how parental feeding goals influence the assessment of child-targeted food packaging cues

When making snack choices for children, parents are exposed to many child-targeted food packaging cues. This study aims to understand how different parental feeding goals (e.g. health versus fun versus taste) drive attention to these cues and how these cues help parents to make different snack choices. Qualitative interviews were conducted with 20 parents with at least one child between the ages of 3 and 12 years old. During the interviews, parents were primed with different feeding goals and asked to rank seven snack packages based on these goals. The interviews revealed three key takeaways regarding how parents consider snack packaging from a goal perspective. Firstly, packaging cues are interpreted (and thus used) differently when different feeding goals are salient. Secondly, cues are ignored when they do not offer valuable information for making goal-based assessments. Thirdly, when combining goals, parents either look for a combination of cues that fit their multiple goals, assess packaging based on a stepwise implementation of goals, or choose one dominant goal and rely on relevant packaging cues to rank snack packaging. This study widens the knowledge on how parental feeding goals can influence the food packaging choices parents make and the way in which they interpret packaging cues. The study can inspire policymakers by providing strategies to stimulate marketers to make the food environment healthier by steering consumers towards healthy food options and making these options more salient within environments where snacks are bought (e.g. supermarkets).

The Potential Effectiveness of Front-of-Pack Nutrition Labeling for Improving Population Diets

Nutrition labeling on the front of food packages can support more healthful purchase decisions and encourage favorable reformulation. This systematic literature review applied Cochrane methods to synthesize and appraise the evidence on the effectiveness of front-of-pack labeling (FOPL) on diet-related outcomes and food reformulation to inform policy recommendations. The search was conducted on 11 academic and gray literature databases, from inception to July 2022. Evidence was synthesized using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), vote counting, and meta-analyses, where appropriate. Overall, 221 articles were included in the review. The randomized controlled trial evidence suggested that, compared with when no FOPL was present, FOPL likely improved consumer understanding of the nutritional quality/content of foods (moderate certainty of evidence), and the healthfulness of food choices (moderate certainty) and purchases (moderate certainty). Interpretive FOPL had a greater effect on these outcomes compared with noninterpretive systems (moderate certainty). There was inconsistency in the best-performing interpretive FOPL system.

The combined effect of front-of-package labels and influencer recommendations on food choice decisions

Many governments have adopted front-of-pack nutrition labels (FOP labels) that give advice about how healthy a product is. An increasing number of digital food influencers are also informing consumers about the nutritional quality of products and promoting healthy consumption. In this context, the current study analyzes how both sources of information come together to affect purchase intention. Drawing on congruence theory, we propose that the influencer's recommendation reinforces the effect of the FOP label when there is congruence between the two; however, consumers clearly prefer to follow the recommendation of the influencer over the FOP label when the information sources are non-congruent. We develop a between-subjects experimental design in which the level of congruence between the two information sources is manipulated. The effect of the influencer on purchase intention is mediated by the credibility of the FOP label. A second study confirms the superiority of the influencer effect observed in the first study.

How Interdisciplinary Interventions Can Improve the Educational Process of Children Regarding the Nutritional Labeling of Foods

This research aimed to evaluate the effect of interdisciplinary educational interventions on children's attitudes, knowledge, preferences, and perceptions about different nutrition labels. Four hundred and ten elementary school children, aged between seven and ten years, participated in the research. The children completed questionnaires on attitudes, knowledge, and preferences about nutrition labeling and on perceived healthiness of a food product considering different types of nutrition labels (Pre-Intervention). They then participated in educational interventions as a strategy to address nutrition labeling of foods (Intervention). Finally, the Pre-Intervention questionnaires were reapplied (Post-Intervention). The intervention improved children's attitudes and knowledge about nutrition labeling. It also showed that this public has a greater preference for labels printed on the front of the food package. The label in the form of a warning was considered the most favorable for comparing the healthiness of the food product among children, while the table was the least preferred. It is concluded that interdisciplinary educational interventions are effective in improving children's attitudes, knowledge, preferences, and perceptions about different nutrition labels on a food product. The front label model is the most suitable for food packaging aimed at children.

A Little Bird Told Me… Nutri-Score Panoramas from a Flight over Europe, Connecting Science and Society

Within the Farm to Fork Strategy, the European Commission ask for a unified Front Of Pack nutritional label for food to be used at the European level. The scientific debate identified the Nutri-Score (NS) as the most promising candidate, but within the political discussion, some Member States brought to attention several issues related to its introduction. This misalignment led to a postponement of the final decision. With the aim to shed some light on the current stances and contribute to the forthcoming debate, the objective of the present work is to understand to what extent scientific research addresses the issues raised by the general public. We applied a structural topic model to tweets from four European countries (France, Germany, Italy, Spain) and to abstracts of scientific papers, all dealing with the NS topic. Different aspects of the NS debate are discussed in different countries, but scientific research, while addressing some of them (e.g., the comparison between NS and other labels), disregards others (e.g., relations between NS and traditional products). It is advisable, therefore, to widen the scope of NS research to properly address the concerns of European society and to provide policymakers with robust evidence to support their decisions.

Poor conceptual knowledge in the food domain and food rejection dispositions in 3- to 7-year-old children

Previous research established that children with poorer taxonomic knowledge in the food domain display increased levels of food rejection. However, the food domain heavily lends itself to script and thematic conceptual knowledge (e.g., pancakes at breakfast), to which young children already attend. This series of studies investigated the development of conceptual knowledge, specifically in the food domain, and the link with food rejection. Study 1 used a nonconflicting triad task testing children's knowledge of four subtypes of script and thematic associations (food-food pairs, food-utensil pairs, event scripts, and meal scripts) with children aged 3-6 years living in the United States (18 males and 14 females). Study 2 employed the same design along with a measure of food rejection in 3- to 6-year-olds living in France (67 males and 62 females). There was significant conceptual development in both groups, but thematic food concepts are acquired earlier than meal script concepts. Study 3 investigated the link between thematic and script cross-classification and food rejection in 39 females and 33 males living in France (4- to 7-year-olds). Results demonstrate that children as young as 3 years old are already attending to thematic and script structures to inform food-based decision making. Even more critically, Study 3 showed that increased food rejection tendencies are negatively related to script and thematic understanding in the food domain. Such seminal studies illustrate the importance of conceptual knowledge in children's interpretation and acceptance of food, highlighting promising avenues for knowledge-based interventions to foster dietary variety.

Are Front-of-Pack Nutrition Labels Influencing Food Choices and Purchases, Diet Quality, and Modeled Health Outcomes? A Narrative Review of Four Systems

Front-of-Pack Nutrition labels (FOPNLs) aim to improve consumers' food purchases and prompt product reformulation by the food and beverage industry. Despite their widespread use, the effectiveness of FOPNL in achieving these goals is still a matter of debate. This review has gathered 65 original studies exploring the performances of four widely used FOPNLs (Multiple Traffic Light, Warning signs, Nutri-Score and Health Star Rating). Although FOPNLs have been associated with healthier food purchases, the magnitude of improvements was small and dependent on study settings. Any associated health effects were modeled rather than observed. None of the four FOPNLs clearly outperformed the other ones on any outcome. Few studies dealt with the impact of FOPNL on product reformulation. Some of those studies, but not all, found small reductions in energy, sodium, sugar and saturated fat content of foods in some food categories. Although global trends point to a small favorable effect of FOPNL, this conclusion is subject to caution since the evidence is inconsistent and comes from a wide variety of contexts and study designs. There remain numerous research gaps, notably with regard to the optimal characteristics of FOPNLs, the durability of FOPNL effects on consumer behaviors, and any possible unexpected consequences.

Effect of NUTRI-SCORE labeling on sales of food items in stores at sports and non-sports facilities

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Korean college students have inadequate daily caloric values.

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NUTRI-SCORE is an effective label for young consumers to choose healthy foods.

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An intervention has affected sales of B (relatively healthier grade) and C (middle quality grade) foods as in a sports-facility store.

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Grade E foods (bad nutritional quality) increased in a non-sports facility store.

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These findings reflect the characteristics of customers visiting stores.

NUTRI-SCORE is a front-of-pack labeling method that relies of the computation of a nutrient profiling system by reconstructing and presenting nutritional information about food items. In particular, different scores are assigned to harmful (energy, sugars, saturated fatty acids, and salt) and beneficial (proteins, fibers, fruits, vegetables, nuts, rapeseed oil, walnut oil, and olive oil) nutrients. These scores are combined to assign a final five different ‘NUTRI-SCORE’ to the food item from healthiest A to most harmful E. This study examined the effect of NUTRI-SCORE labeling on the sales of food items in stores at sports and non-sports facilities. The NUTRI-SCORE label was attached to the price tag of food items sold in two food stores of Seoul National University (sports-related and non-sports-related facilities) for 5 weeks. Baseline sales data from the previous 2 years were obtained from the food stores. The predicted data based on baseline sales were compared to the new sales data during the study period. The data trends were analyzed using interrupted time-series analysis, which showed significant group differences. In the sports-facility store, sales were higher for relatively healthy food items than for less-healthy food items. Conversely, mixed results were observed for sales in the non-sports-facility store. First, sales of Grade A foods decreased but sales of Grade B and Grade E foods increased. Therefore, the results imply that NUTRI-SCORE labeling positively affected sales of healthy foods only in the sports facilities because few people in non-sports facilities sought to purchase healthy foods. These results will help to improve the nutrition-related behavior of food consumers and point to the differences in cognitive consumption patterns between consumers at sports and non-sports facilities.

Nutri-Score: Awareness, Perception and Self-Reported Impact on Food Choices among French Adolescents

To date, no studies have evaluated the appropriation of the front-of-pack Nutri-Score labeling among adolescents, although they are both consumers and buyers of food products. Therefore, the objectives of the present study were (1) to assess Nutri-Score awareness, perception and self-reported impact on food choices in French adolescents and (2) to identify the determinants associated with higher Nutri-Score awareness and self-reported impact on food choices. A web-based survey was conducted in November 2021 among 1201 adolescents. Multivariate logistic models were used to evaluate the relationships between individual factors and Nutri-Score awareness and self-reported impact on food choices. Almost all the adolescents reported to know the Nutri-Score (97.0%) and more than 9 out of 10 considered this logo easy to understand and easy to identify on food packages. Finally, 54% self-reported that the label had already impacted their food choices. Girls (2.28 (1.09−4.77), p = 0.028) and the 15−17-year-olds (3.12 (1.32−7.35), p = 0.0094) were more likely to be aware of the label compared with their respective counterparts (i.e., boys and the 11−14-year-olds). Regarding the impact of food choices, the use of the Nutri-Score by the parents was the most determinant criterion (7.74 (5.74−10.42), p < 0.0001). Thus, promotion campaigns should target both adolescents and parents.

Digital nudges to stimulate healthy and pro-environmental food choices in E-groceries

In response to the detrimental health- and environmental impacts of European consumers' dietary patterns, Nutri-Scores and Eco-Scores have been introduced on packages as guidance for choices. Whereas the scores are promising to improve food choices from a nutritional point of view, the scant available literature suggests very limited effects on the environmental impact of food choices. Therefore, there remains a need to explore ways to bring about improvements in both areas. As a growing share of consumers buys food groceries online, new opportunities to steer food choices are being created. This article explores the potential of several digital functionalities to further stimulate healthier and pro-environmental food choices amongst consumers. These functionalities included product recommendation agents, product scores, a real-time average impact score of the chosen food basket and a personalised social norm. Those were tested in a two-stage randomized controlled trial with 1000 Belgian household food decision makers in a mock-up E-grocery. Indices reflecting the nutritional quality (NQI) and environmental impact (EII) of the selected food baskets were calculated. The results indicate that at first, displaying a combined Nutri- and Eco-Score at product level led to improved NQI's, but not EII's. However, the scores also led to shifting behaviour in EII's when facilitated with recommendation agents. The display of the average impact scores of the selected basket and of social norms did not lead to additional improvements. Hence, a combined Nutri- and Eco-Score labelling system is recommended, but an enabling environment to consider both scores is important to realise a shift towards more healthy and environmentally friendly food choices. Apart from manifesting healthier and environmentally friendly products with a centralised labelling system, improving their accessibility should be considered at least as important for behavioural changes.

Effect of reducing ultraprocessed food consumption on obesity among US children and adolescents aged 7-18 years: evidence from a simulation model

BACKGROUND

Children and adolescents in the USA consume large amounts of daily calories from ultraprocessed foods (UPFs). Recent evidence links UPF consumption to increased body fat in youth. We aimed to estimate the potential impact of reducing UPF consumption on childhood obesity rate in the USA.

METHODS

We developed a microsimulation model to project the effect of reducing UPF consumption in children's diet on reducing the prevalence of overweight or obesity among US youth. The model incorporated nationally representative data on body mass index (BMI) percentile and dietary intake of 5804 children and adolescents aged 7-18 years from the National Health and Nutrition Examination Survey 2011-2016, and the effect of reducing UPF consumption on calorie intake from a recent randomised controlled trial. Uncertainties of model inputs were incorporated using probabilistic sensitivity analysis with 1000 simulations.

RESULTS

Reducing UPFs in children's diet was estimated to result in a median of -2.09 kg/m² (95% uncertainty interval -3.21 to -0.80) reduction in BMI among children and adolescents aged 7-18 years. The median prevalence of overweight (BMI percentile ≥85th) and obesity (BMI percentile ≥95th percentile) was reduced from 37.0% (35.9%, 38.1%) to 20.9% (15.1%, 29.9%) and from 20.1% (19.2%, 21.0%) to 11.0% (7.86%, 15.8%), respectively. Larger BMI and weight reductions were seen among boys than girls, adolescents than children, non-Hispanic black and Hispanic youth than non-Hispanic white youth, and those with lower levels of parental education and family income.

CONCLUSIONS

Reducing UPF consumption in children's diet has the potential to substantially reduce childhood obesity rate among children and adolescents in the USA.

Nutri-Score and Nutrition Facts Panel through the Eyes of the Consumer: Correct Healthfulness Estimations Depend on Transparent Labels, Fixation Duration, and Product Equivocality

Research on front-of-pack labels (FOPLs) demonstrated that Nutri-Score is one of the most promising FOPLs regarding healthfulness estimation accuracy. Nevertheless, as consumers are exposed to both the Nutri-Score and the mandatory Nutrition Facts Panel (NFP) in the supermarket, it is key to understand if and how both labels interact. This study investigates the contribution of Nutri-Score and NFP regarding healthfulness estimation accuracy, whether this impact differs depending on the product, and what role visual attention plays. We set up an eye-tracking experiment in a controlled setting in which 398 participants rated the healthfulness of 20 products. The results confirmed the positive impact of the Nutri-Score on healthfulness estimation accuracy, though the impact was larger for equivocal (i.e., difficult to judge) products. Interestingly, NFP either had no effect (compared to a package without Nutri-Score or NFP) or a negative effect (compared to a package with Nutri-Score alone) on healthfulness estimation accuracy. Eye-tracking data corroborated that ‘cognitive overload’ issues could explain why consumers exposed to Nutri-Score alone outperformed those exposed to both Nutri-Score and NFP. This study offers food for thought for policymakers and the industry seeking to maximize the potential of the Nutri-Score.

That's My Cue to Eat: A Systematic Review of the Persuasiveness of Front-of-Pack Cues on Food Packages for Children vs. Adults

Packaging is increasingly recognized as an essential component of any marketing strategy. Visual and informational front-of-pack cues constitute salient elements of the environment that may influence what and how much someone eats. Considering their overwhelming presence on packaging of non-core foods, front-of-pack cues may contribute to the growing rates of overweight and obesity in children and adults. We conducted a systematic review to summarize the evidence concerning the impact of front-of-pack cues on choices and eating behaviors. Four electronic databases were searched for experimental studies (2009-present). This resulted in the inclusion of 57 studies (in 43 articles). We identified studies on children (3-12 years) and adults (≥ 18 years), but no studies on adolescents (12-18 years). The results suggest that children and adults are susceptible to packaging cues, with most evidence supporting the impact of visual cues. More specifically, children more often choose products with a licensed endorser and eat more from packages portraying the product with an exaggerated portion size. Adults' eating behaviors are influenced by a range of other visual cues, mainly, package size and shape, and less so by informational cues such as labels.