Product reformulation in the context of nutritional warning labels: Exploration of consumer preferences towards food concepts in three food categories

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.

Fruitful changes? Exploring household fruit purchase decisions following comprehensive food policy regulations in Chile

Changes in unprocessed healthy food purchases associated with the implementation of comprehensive food policy remain understudied. This study analyzes whether, following the announcement, modification, and implementation of Chile's Food Labeling and Advertising law targeting highly processed food (occurring in 2012, 2015, and 2016, respectively), households improved their fruit purchase decisions: purchase participation (i.e., buying likelihood) and purchase quantity. Expenditure data from a representative sample of Chilean households were employed, covering two consecutive survey waves conducted in 2011/2012 and 2016/2017. After controlling for socioeconomic factors (e.g., prices and income), results indicate that only purchase participation increased, providing weak support for positive spillover effects of a comprehensive food policy on fruit purchases. Subsample analyses reveal that this increase was driven by college-educated, childless, and low-income households and was stronger for sweeter and more convenient fruits. Considering that households in Chile do not meet health recommendations for daily fruit intake, additional policy efforts targeting healthy, unprocessed food consumption could be considered.

Consumer susceptibility to front-of-package (FOP) food labeling: Scale development and validation

Current research in food science has explored the influence of front-of-package (FOP) labeling systems on consumer decision-making, yielding mixed results. We suggest that these inconsistent findings regarding FOP labeling effectiveness stem from a failure to consider a pivotal individual-level variable: consumer susceptibility to FOP labeling (CSFL). In the present research, we define this focal construct and develop and psychometrically validate a seven-item instrument that captures the construct across six studies (N = 1134). The current research may assist in segmenting consumers based on their susceptibility to FOP labeling, thereby facilitating the creation of targeted interventions tailored to this individual difference. Notably, the CSFL scale is positively correlated with consumers' willingness to purchase food items with genuine, third-party FOP labels, but not products lacking labels or products with fictitious FOP labels. This supports the predictive validity of the scale in determining important consumption-related outcomes.

From the most to the least flexible nutritional profile: Classification of foods marketed in Brazil according to the Brazilian and Mexican models

Nutrient profiling is the science of classifying or ranking foods according to their nutritional composition, for reasons related to disease prevention and health promotion. To be effective, policies such as front-of-pack nutrition labeling (FoPNL) must have an adequate nutritional profile model, since it will determine which products will be eligible to receive a FoPNL. This study aimed to determine the percentage of packaged food and drink products available in Brazil that would be subject to FoPNL under two different legislations: Brazilian and Mexican. This is a cross-sectional study in which we collected information on food products (photos of the ingredients list, the front label, the barcode, and the nutrition facts table) from one of the largest stores of a supermarket chain in the city of Belo Horizonte-MG, Brazil, from March to May 2021 (~6 months after the publication of the Brazilian legislation about FoPNL and a year and a half before the legislation came into force). The products were classified in relation to the BNPM (added sugars, saturated fats, and sodium) and the MNPM (energy, free sugars, saturated fats, trans fats, sodium, non-sugar sweeteners, and caffeine). A total of 3384 products were collected and, after applying the exclusion criteria, 3,335 products were evaluated. Of these, 2,901 would be eligible to receive FoPNL in Brazil and 2,914 would be eligible to receive FoPNL in Mexico. According to the BNPM, 56.7% (95% CI 54.9; 58.5%) of the products were “high in” critical nutrients, 27.1% (95% CI 25.5; 28.7%) of the products in added sugars, 26.7% (95% CI 25.2; 28.4%) of the products in saturated fats, and 21.4% (95% CI 19.9; 22.9%) of the products in sodium. As for the MNPM, 96.8% (95% CI 96.1; 97.4%) of them were “high in” up to five critical nutrients and up to two warning rectangles (caffeine and non-sugar sweeteners), 45.8% (95% CI 44.0; 47.6%) of them in free sugars, 43.7% (95% CI 41.9; 45.5%) of them in saturated fats, and 47.9% (95% CI 46.1; 49.7%) of them in sodium. We concluded that the eligibility to receive FoPNL by BNPM and MNPM was relatively similar between products; however, almost all products would have at least one FoPNL and/or warning rectangles according to Mexican legislation, and nearly half of them would have at least one FoPNL, considering BNPM. The MNPM is much more restrictive than the BNPM. The Nutrient Profile Model (NPM) that regulates FoPNL, and other health policies, must be carefully defined to ensure that foods are properly classified according to their healthiness.

How Do Nutritional Warnings Work on Commercial Products? Results From a Hypothetical Choice Experiment

A large body of evidence assessing the effectiveness of front-of-package (FOP) nutrition labeling exists. Most experimental studies have been conducted with fictitious products. However, consumers' perception depends on several products extrinsic factors such as brand. Understanding how strong brand associations influence the effectiveness of FOP nutrition labeling schemes may be crucial to informing policymaking. In this context, the aim of this work was to evaluate the effect of five different variants of nutritional warnings labels (black magnifier, red magnifier, black octagon, black triangle, and red circle) on consumers' choice of commercial products, compared with two FOP nutrition labeling schemes: the guidelines daily amounts (GDAs) system and the traffic light system (TLS). An online randomized controlled trial with 1,932 participants was used to evaluate the effect of FOP nutrition labeling on participants' choices in eight sets of three commercial products, available in the Brazilian marketplace. A multinomial logistic regression model was used to evaluate the influence of FOP nutrition labeling on participants' likelihood of selecting the different products in the choice task. Results showed that nutritional warnings and the TLS significantly increased the likelihood of selecting none of the products instead of the least healthful product, or a healthier product, in at least one of the product categories compared with the GDA. Warnings tended to have a larger effect, suggesting their potential to encourage healthier food choices.

Effect of Warning Labels on Consumer Motivation and Intention to Avoid Consuming Processed Foods

Nutritional warnings (NWs) as a front-of-package label were implemented as a public policy aiding consumers with recognizing processed foods with high levels of critical nutrients (sodium, saturated fats, carbohydrates, and calories). However, in spite of this tool being well positioned in consumer decision making, there is little extant knowledge about the relationship between the message sent by NW, nutritional knowledge, consumer motivation, and the intention to avoid consuming processed foods. To understand these dimensions’ relations, a theoretical model was created and subsequently tested through structural equations. We applied a survey to 807 home food purchasing decision makers. The results show that the direct effect of NW messages raises the intention to avoid processed foods, while eating motivation is negative in its direct effect on the same avoidance intention. However, the message sent by NWs had a mediating effect between the intentions to avoid processed food and eating motivation but showed no such effect on nutritional knowledge. This suggests that the message sent by NWs was able to turn negative eating motivation into positive eating motivation to avoid processed foods. In conclusion, NWs help mitigate eating motivations, as well as boost the intention to avoid processed foods.

Evaluation of the Mexican warning label nutrient profile on food products marketed in Mexico in 2016 and 2017: A cross-sectional analysis

BACKGROUND

Different nutrient profiles (NPs) have been developed in Latin America to assess the nutritional quality of packaged food products. Recently, the Mexican NP was developed as part of the new warning label regulation implemented in 2020, considering 5 warning octagons (calories, sugar, sodium, saturated fats, and trans fats) and 2 warning rectangles (caffeine and non-nutritive sweeteners). The objective of this cross-sectional study was to evaluate the Mexican NP and other NPs proposed or used in Latin America against the Pan American Health Organization (PAHO) model.

METHODS AND FINDINGS

Nutrition content data of 38,872 packaged food products available in the Mexican market were collected in 2016 and 2017. The evaluation of the Mexican NP, including its 3 implementation phases of increasing stringency (2020, 2023, and 2025), was conducted by comparing the percentage of products classified as "healthy" (without warnings) or "less healthy" (with 1 or more warnings), as well as the number and type of warnings assigned to food products, against the PAHO NP. Using the calibration method, we compared the classifications produced by the PAHO model against those produced by the NP models of Ecuador, Chile (3 phases), Peru (2 phases), Uruguay, and Brazil. Kappa coefficients and Pearson correlations were estimated, and proportion tests were performed. We found that the 3 implementation phases of the Mexican NP had near to perfect agreement in the classification of healthy foods (Mexico NP models: 19.1% to 23.8%; PAHO model: 19.7%) and a strong correlation (>91.9%) with the PAHO model. Other NPs with high agreement with the PAHO model were the Ecuador (89.8%), Uruguay (82.5%), Chile Phase 3 (82.3%), and Peru Phase 2 (84.2%) NPs. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models had the highest percentage of foods classified as healthy (49.2%, 47.1%, and 46.5%, respectively) and the lowest agreement with the PAHO model (69.9%, 69.3%, and 73%, respectively). Study limitations include that warnings considered by the Mexican NP models were evaluated as if all the warnings were octagon seals, while 2 out of the 7 were rectangular warnings (caffeine and non-nutritive sweeteners), and that our data are limited by the quality of the information reported in the list of ingredients and the nutrition facts table of the products.

CONCLUSIONS

The 3 implementation phases of the Mexican NP were useful to identify healthy food products. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models may have limited usefulness for the classification of foods according to the content of ingredients of concern. The results of this study may inform countries seeking to adapt and evaluate existing NP models for use in population-specific applications.

Introducing the Front-Of-Pack Acceptance Model: the role of usefulness and ease of use in European consumers' acceptance of Front-Of-Pack Labels

In recent years, increasing attention to the utilisation of Front-Of-Pack Labels (FOPLs) as a tool to prompt individuals towards healthier food choices has been observed both in regulatory bodies and academic research. However, few theoretical models have been used to understand their role in consumer decision-making, as well as the antecedents that induce individuals to accept the information provided by the label, and to benchmark FOPL performance in different markets.Through a sequence of two studies conducted in Italy, France and the UK on 2812 primary grocery shoppers, we developed a new theoretical framework, the Front-Of-Pack Acceptance Model, applicable both in contexts in which FOPL are present, and in which they should be introduced. Our findings suggest a structural link between the usefulness and ease of use of the labels and the way consumers form their attitudes and intentions towards buying healthier products.

Comparing the Effects of Four Front-of-Package Nutrition Labels on Consumer Purchases of Five Common Beverages and Snack Foods: Results from a Randomized Trial

BACKGROUND

Front-of-package (FOP) nutrition labeling systems differ in how they rate food and beverage products. There is a need to examine the implications of these differences, including their focus on nutrients of public health concern.

OBJECTIVE

Our aim was to examine the impacts of 4 common FOP labels on consumers' purchases of products that received conflicting ratings across FOP systems.

DESIGN

In an experimental marketplace, participants were randomized to complete a series of purchases under 1 of 5 FOP conditions: no label, "high in" nutrient labels, multiple traffic light, Health Star Rating, or a 5-color nutrition grade.

PARTICIPANTS/SETTING

A final sample of 3,584 Canadians (13 years and older) were recruited from shopping centers in March to May 2018.

MAIN OUTCOME MEASURES

Probability of purchasing was assessed for 5 product categories (100% fruit juice, plain milk, chocolate milk, cheese snacks, and diet beverages), which received conflicting ratings across the FOP conditions.

STATISTICAL ANALYSES

Separate generalized linear mixed models estimated the influence of FOP condition on 5 binary outcomes (1 = purchased, 0 = not purchased) corresponding to the product categories.

RESULTS

Few differences were observed among the full sample. Among participants who noticed the labels (n = 1,993), those in the Health Star Rating condition were 4.5 percentage points (95% CI -7.0 to -1.9) more likely to purchase 100% fruit juice (compared to multiple traffic light) and 3.3 (95% CI 0.4 to 6.2) and 3.0 percentage points (95% CI 0.1 to 6.1) more likely to purchase cheese snacks (compared to no label and "high in"). "High in" labels produced fewer purchases of chocolate milk than no label.

CONCLUSIONS

Despite some similarities, existing FOP systems differ in the extent to which they promote or dissuade purchases of common product categories. Although the Health Star Rating might encourage purchases of products with certain positive nutritional attributes, "high in" and multiple traffic light systems might more effectively discourage purchases of products contributing nutrients of public health concern.

Calorie Labeling and Product Reformulation: A Longitudinal Analysis of Supermarket-Prepared Foods

INTRODUCTION

The 2010 Affordable Care Act required chain retail food establishments, including supermarkets, to post calorie information for prepared (i.e., ready to eat) foods. Implementation of calorie labeling could spur companies to reduce the calorie content of prepared foods, but few studies have explored this. This study evaluates the changes in the calorie content of prepared foods at 2 large U.S. supermarket chains after they implemented calorie labels in April 2017.

METHODS

The chains (≈1,200 stores) provided data on the calorie content and labeling status of all items sold between July 2015 and January 2019. In 2021, analyses used a difference-in-differences approach to examine the changes in the calorie content of prepared bakery, entree, and deli items introduced before calorie labeling to those introduced after the labeling compared with changes in similar foods not subject to the new labeling requirement. Primary analyses examined continuously available items; exploratory analyses examined items newly introduced to the marketplace.

RESULTS

Relative to changes in comparison foods not subject to the labeling requirement, continuously available prepared bakery items decreased by 7.7 calories per item after calorie labels were implemented (95% CI= -12.9, -2.5, p=0.004, ≈0.5% reduction). In exploratory analyses, prepared bakery items introduced after calorie labeling contained 440 fewer calories per item than those introduced before calorie labeling (95% CI= -773.9, -106.1, p=0.01, ≈27% reduction), driven by reductions in product size. No changes were observed in the calorie content of continuously available or newly introduced prepared entrees or deli items.

CONCLUSIONS

Implementing calorie labels could encourage product reformulation among some types of prepared supermarket foods. These supply-side changes could lead to reductions in caloric intake.

Influence of Intrinsic and Extrinsic Food Attributes on Consumers' Acceptance of Reformulated Food Products: a Systematic Review

Introduction

Reducing the salt, sugar and fat content of food is recognised worldwide as one of the strategies available for reducing the incidence of obesity and non-communicable diseases. The food industry has a major influence on achieving these goals by preserving intrinsic (chemical and sensory properties) and modifying extrinsic (food packaging and other external information) food attributes that can influence purchasing decisions. This article is a literature review of studies that analyse the influence of intrinsic and/or extrinsic attributes on consumer product preference and purchasing decisions.

Methods

A keyword search for relevant studies was conducted using Web of Science, an interdisciplinary electronic resource. Articles from other sources were also included and systematically reviewed.

Results

The search string identified 266 results. Thirty-eight articles were included in the final analysis and coded according to intrinsic and extrinsic food attributes, reformulated nutrient, food category, condition, research methods, consumer response, study location and sample size. There are several authors investigating the effect of intrinsic rather than extrinsic product attributes. Most research deals with processed foods in the category of milk and dairy products, followed by sweetened fruit juices, meat products, sweets and bread. Salt content is the attribute most often reduced, followed by sugar and fat.

Conclusions

Consumers find it hard to swap potential health benefits for hedonic attributes. When evaluating products in expected conditions, they usually rate the reformulated product more highly than the conventional one, while in informed conditions they usually choose the regular product. When products are labelled with a traffic light or nutritional warnings, consumers opt for a reformulated product, even in informed conditions. This review highlights the heterogeneity between food groups, and the fact that many factors influence consumers’ product preferences and purchasing decisions. The product should be analysed as a whole and tested in blind, expected and informed conditions, as each individual factor represents a phase of the consumer purchasing decision. The extent of nutrient reduction should be determined by calculating the difference threshold, and the industry should reformulate products gradually based on how consumers detect the reduction.

What Dimensions of Risk Perception are Associated with Avoidance of Buying Processed Foods with Warning Labels?

Nutritional Warning Labels (NWLs) inform consumers about processed foods that exceed critical nutrient levels activating the risk perception in consumers. However, this information is limited. The objective was to identify the dimensions of risk perception and to study their associations with avoidance of buying processed foods with warning labels. A survey was applied to 807 decision-makers who choose what to eat at home. The four dimensions of risk perception (performance, financial, physical, and psychological) were identified through exploratory factor analysis. Through a multiple regression model, we determined the dimensions of risk perception and sociodemographic variables that affect the intention to avoid buying processed foods with NWLs. The results show that the performance risk, physical risk, and psychological risk positively affect the intention of avoiding processed foods with NWLs. In addition, the female gender considers NWLs to purchase foods. Nevertheless, the high frequency of consumption and belonging to a lower-income socioeconomic group are barriers to the use of NWLs. In conclusion, NWLs help people to choose processed food that does not impact negatively their food expectations, as well as their mental and physical health. However, health authorities must invest in nutrition education. Specifically, in groups who pay less attention to NWLs. Such groups include people with high daily consumption of processed foods, males, and low-income socioeconomic groups.

Impact of different front-of-pack nutrition labels on online food choices

Front-of-pack nutrition labels (FOP-NL) are efficient tools for increasing consumers' awareness of the nutritional quality of food products, prompting healthier food choices. The main goal of this study was to evaluate the impact of four FOP-NL schemes - Traffic Light label (TL), Guideline Daily Amounts (%GDA), Nutri-Score (NS) and Health Star Rating (HSR) - on consumers' selection of food products according to perceived nutritional quality. A cross-sectional open-label crossover randomized controlled study was carried out among Portuguese consumers. A web-based questionnaire was used to assess participants' a) preferences regarding FOP-NLs and b) capacity to select healthy products in a food selection task using the information from FOP-NL schemes. When performing the selection task, participants had the option to indicate that they could not decide simply based on the presented FOP-NL (requiring more information). Overall, 357 adults participated in the study. Regarding consumers' preferences, TL received the most favorable responses, while NS received the fewest. All FOP-NLs performed better than the no-nutritional label control condition in the food selection task. The highest proportion of correct choices was obtained for TL (72.3%), followed by HSR (70.9%), %GDA (70.0%) and NS (62.2%), though no significant differences were found among FOP-NLs. Percentages of respondents indicating not being able to answer due to lack of information affected the proportion of correct choices, with 10.3% for TL, 12.9% for %GDA, 14.6% for HSR, and 25.8% for NS, indicating they were unable to choose without additional information. Although no particular FOP-NL system stood out as the most significantly effective, TL was the most preferred by Portuguese adults. Long-term real-world evidence is necessary to assess the impact of FOP-NL systems on individuals' food choices.

Changes in Nutrient Declaration after the Food Labeling and Advertising Law in Chile: A Longitudinal Approach

Chile has implemented several strategies to decrease the burden of obesity and chronic diseases. The Food Labeling and Advertising Law (Law 20.606) requires a front-of-package "high in" warning label when energy and nutrients of concern (ENC) (total sugar, saturated fats, sodium) exceed established limits. This study aims to evaluate the impact of Law 20.606 on the ENC declaration of packaged foods in Chile, before and after the law implementation. We analyzed food nutritional labeling declarations from 70% of the most consumed packaged foods in Chile. Data collection was conducted in 2013 and 2019 in Santiago. Pictures from all sides of the package were taken from 476 products, classified into 16 food groups. All food groups had changes in the ENC declaration during the study period. Total sugar content showed the highest reduction (-15.0%; p = 0.001). Dairy, confitures and similar and sugary beverages had the greatest reduction in energy and total sugar content (p < 0.01). Energy, total sugar and sodium front of package "high in" simulation was significantly reduced in dairy, sugary beverages, flour-based foods, confitures and similar, fish and seafoods, fats and oils, spices, condiments and sauces and sugars (p < 0.05). We observed that companies reformulated products to adapt to the new regulation.

Assessment of possibilities of strawberry jam reformulation

The prevalence of excessive weight gain, obesity, and associated diseases are permanently increasing. Therefore, the interest in food products with a composition suitable for people with the aforementioned health problems is also on the rise. The changes in food composition, nowadays often called reformulation, are mainly focused on reducing the amount of salt, sugar, or fat. Strawberry spreads with different sugar (10 – 40%) and strawberry (20 – 50%) content were prepared and the influence of strawberry jam composition on gel stiffness, colour, and sensory parameters was studied. This study aimed to determine the sensorial and technological limits (sugar and strawberry content) of strawberry jam reformulation. Carrageenan was chosen as a suitable gelling agent for the preparation of these reformulated strawberry products. strawberry spreads. The applicable concentration of carrageenan for the ideal stiffness of strawberry spreads was 2%. The results of the maximum compression force show a statistically significant increase of gel stiffness with increasing addition of strawberry puree, the effect of sugar content was also statistically significant (p = 0.05). This study showed that strawberry spreads with low strawberry and/or sugar content are sensorially acceptable.

Nutritional Quality of Food and Beverages Offered in Supermarkets of Lima According to the Peruvian Law of Healthy Eating

The purpose of this paper was to determine the foods and beverages offered in the city of Lima, Peru, that would be subject to front-of-package warning labels (octagons) according to the thresholds for the two phases (6 and 39 months after the approval) for nutrients of concern (sugar, sodium, saturated fat, and trans-fat) included in the Peruvian Law of Healthy Eating. An observational, descriptive cross-sectional study was conducted that evaluated the nutritional composition of processed and ultra-processed foods that are sold in a supermarket chain in Lima. Of all the processed and ultra-processed foods captured, foods that report nutritional information and do not require reconstitution to be consumed were included. A descriptive analysis was carried out by food categories to report the nutrient content and the percentage of foods that would be subject to front-of-package warning labels. Results: A total of 1234 foods were evaluated, according to the initial thresholds that became effective 6 months after the law was implemented; 35.9% of foods had two octagons; 34.8% had one octagon; 15.8% had no octagons; 12% had three octagons; and no products had four octagons. At 39 months, when the final and more restrictive thresholds become effective, 4.8% did not have octagons. The majority of processed and ultra-processed foods that are sold in a Peruvian supermarket chain carry at least one octagon, and more than 10% of them carry octagons for three of the four nutrients of concern.

Ethical Considerations for Food and Beverage Warnings

Several countries have implemented warnings on unhealthy foods and beverages, with similar policies under consideration in the U.S. and around the world. Research demonstrating food warnings' effectiveness is emerging, but limited scholarship has evaluated the ethics of food warning policies. Using a public health ethics framework for evaluating obesity prevention policies, we assessed the ethical strengths and weaknesses of food warnings along multiple dimensions: 1) Health behaviors and physical health, 2) Psychosocial well-being, 3) Social and cultural values, 4) Informed choice, 5) Equality, 6) Attributions of responsibility, 7) Liberty, and 8) Privacy. Our analysis identifies both ethical strengths and weaknesses of food warnings, including that: 1) warnings are likely to generate important benefits including increased consumer understanding and informed choice, healthier purchases, and potential reductions in obesity prevalence; 2) warnings evoke negative emotional reactions, but these reactions are an important mechanism through which food warnings encourage healthier behaviors and promote informed choice; 3) warnings appear unlikely to have ethically unacceptable effects on social and cultural values, attributions of responsibility, liberty, or privacy. Current research suggests we continue to pursue food warnings as a policy option for improving public health while simultaneously conducting additional research on the ethics of these policies. Future research is especially needed to clarify warnings' effects on stigma and to characterize the balance and distribution of costs of and benefits from implementing warning policies.

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

OBJECTIVE

The 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.

METHODS

New 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.

RESULTS

Two-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%).

CONCLUSION

HSR 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 health: These results could be helpful in informing improvements to the HSR system.

Anticipatory effects of the implementation of the Chilean Law of Food Labeling and Advertising on food and beverage product reformulation

This study evaluated the anticipated food and beverage product reformulation by industry before the Chilean Law of Food Labeling and Advertising (Law 20.606) was implemented in June 2016 requiring a front-of-package (FOP) warning label for products high in sodium, total sugars, saturated fats, and/or total energy. Fieldworkers photographed a purposive sample of packaged food and beverage products in February 2015 (n = 5421) and February 2016 (n = 5479) from six different supermarkets in Santiago, Chile. The same products collected in both years (n = 2086) from 17 food and beverage categories with added critical nutrients (nutrients of concern: sodium, total sugars, and saturated fats) were included in this longitudinal study. The average change in energy and critical nutrient content was estimated by category. The number of warning labels potentially avoided because of reformulation was determined. Between February 2015 and February 2016, no category experienced reductions >5% average change in energy or critical nutrient content; and some increased in critical nutrient content. Few products (<2%) would have avoided at least one warning label with reformulation. In a diverse sample of food and beverage products, there was minimal reformulation by industry in anticipation of the implementation of the 2016 Chilean Law of Food Labeling and Advertising.

Are consumers willing to pay more for reformulated processed meat products in the context of the implementation of nutritional warnings? Case study with frankfurters in Chile

The aim of the present work was to assess consumers' willingness to pay for reformulated frankfurters in the context of the implementation of nutritional warnings. Images of frankfurter packages were designed using a fractional factorial design with 5 2-level variables: brand type, sodium reduction, saturated fat reduction, fibre claim and cholesterol claim. An online study with 548 consumers was implemented with Chilean participants, who were asked to indicate how much they would be willing to pay for each of the packages. Data were analysed using analysis of variance and hierarchical cluster analysis. Willingness to pay was significantly affected by brand type and sodium and fat reduction, whereas fibre and cholesterol claim did not have a significant effect. These results suggest that in the context of the implementation of nutritional warnings reformulation of processed meat products should focus on the reduction of key nutrients, although consumers may not be willing to pay a higher price for reformulated products.

Assessment of Packaged Foods and Beverages Carrying Nutrition Marketing against Canada's Food Guide Recommendations

Canadians' food purchases consist largely of packaged processed and ultra-processed products, which typically fall outside the "core" foods recommended by Canada's Food Guide (CFG). Almost half of packaged products in Canada carry nutrition marketing (i.e., nutrient content and health claims). This study assessed whether packaged foods carrying nutrition marketing align with recommendations outlined in the 2007 CFG. Label data (n = 9376) were extracted from the 2013 Food Label Information Program (FLIP). Label components (including nutrition marketing) were classified using the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) labelling taxonomy. The Health Canada Surveillance Tool (HCST) was used to assess the alignment of products to CFG. Each food or beverage was classified into one of five groups (i.e., Tier 1, Tier 2, Tier 3, Tier 4, "Others"). Products in Tier 1, 2 or water were considered "in line with CFG". Most products in the analyzed sample were classified as Tier 2 (35%) and Tier 3 (27%). Although foods with nutrition marketing were significantly more likely to align to CFG recommendations (p < 0.001), many products not "in line with CFG" still carried nutrition marketing. This study provides important baseline data that could be used upon the implementation of the new CFG.

The Food Supply Prior to the Implementation of the Chilean Law of Food Labeling and Advertising

This study aimed to evaluate the composition of the food supply ahead of the implementation of the Chilean Law of Food Labeling and Advertising (Law 20.606) in June 2016. The INFORMAS (International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support) framework for monitoring the composition of the food supply was used. The Law’s initial (2016) and final (2019) limits were used to evaluate if foods would receive a “High in” warning for Calories, Sodium, Sugars and/or Saturated Fats (initial/final, solids: >350/275 kcal; >800/400 mg; >22.5/10 g; >6/4 g; liquids: >100/70 kcal; >100/100 mg; >6/5 g; >3/3 g respectively). Foods were excluded if they required reconstitution, had missing information or if total labeled energy was estimated as incorrect (n = 942). In February 2015 and 2016, fieldworkers photographed a purposeful sample of packaged food and beverage products (n = 5421 and n = 5479) from 6 different supermarkets in Santiago, Chile. Seven percent of foods had no added critical nutrients (n = 720). Two-thirds of products had critical nutrients exceeding at least one initial limit indicative of a “high in” warning. Under the final phase limits, only 17% of foods would have zero warning labels. By 2019, 10 of the 17 food and beverage categories studied are predicted to have less than half of their products without a high in sodium warning label. While 8 of the 17 categories studied are predicted to have less than half their products without a high in total sugars or a high in total calories warning label, respectively; while even fewer food and beverage categories are predicted to be without a high in saturated fat warning label. Most products will have to be reformulated to avoid at least one front-of-package warning label.

Influence of nutritional warnings and other label features on consumers' choice: Results from an eye-tracking study

Nutritional warnings highlighting products with high content of nutrients associated with non-communicable diseases have emerged as a potentially efficient alternative to discourage consumption of unhealthful products. However, the relative influence of this front-of-pack nutrition information scheme compared to other label features is still under researched. In this context, the aim of the present work was to study the influence of nutritional warnings and other information commonly displayed on food labels to convey health associations on consumers' choice and visual attention. A choice-conjoint study using labels of cookies and crackers was implemented considering the following three variables: front-of-pack nutrition information (nutritional warnings vs. facts up front panel), nutrient claim (present vs. absent) and type of product (conveying health vs. hedonic associations). A total of 124 people completed the task using the monitor of an eye-tracker. Participants were asked to select the label they would prefer to buy if they were in a supermarket. Nutritional warnings were efficient in attracting consumers' attention and required less time and fewer fixations to process than the facts up front panel. In addition, their inclusion on the labels significantly discouraged consumers' choice of labels. However, type of product was the most important variable influencing the choice of both cookies and crackers. Results from the present work confirm the potential of nutritional warnings as directive front-of-pack nutrition labelling scheme and stress that they cannot be expected to cause radical changes in consumers' eating habits due to their competition with other product features. Instead, they are expected to encourage consumers to select the most healthful option within a product category.