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Robinson E, Boyland E, Evans R, Finlay A, Halsall L, Humphreys G, Langfield T, McFarland‐Lesser I, Patel Z, Jones A. Energy labelling of alcoholic drinks: An important or inconsequential obesity policy? Obes Sci Pract 2023; 9:75-86. [PMID: 37034571 PMCID: PMC10073822 DOI: 10.1002/osp4.638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/28/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behavior are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behavior, suggest alcohol energy labelling may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity.
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Affiliation(s)
- Eric Robinson
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Emma Boyland
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Rebecca Evans
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Amy Finlay
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Lauren Halsall
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Gabrielle Humphreys
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Tess Langfield
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | | | - Zina Patel
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Andrew Jones
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
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Robinson E, Polden M, Langfield T, Clarke K, Calvert L, Colombet Z, O'Flaherty M, Marty L, Tapper K, Jones A. Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2023; 20:10. [PMID: 36747247 PMCID: PMC9903416 DOI: 10.1186/s12966-023-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP). METHODS Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups. RESULTS Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041]. CONCLUSIONS Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required. REVIEW REGISTRATION Registered on PROSPERO (CRD42022312532) and OSF ( https://doi.org/10.17605/OSF.IO/W7RDB ).
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Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Megan Polden
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Tess Langfield
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Katie Clarke
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Lara Calvert
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Zoé Colombet
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lucile Marty
- Centre Des Sciences Du Goût Et de L'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - Katy Tapper
- Department of Psychology, City, University of London, London, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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Agarwal D, Ravi P, Purohit B, Priya H. The effect of energy and fat content labeling on food consumption pattern: a systematic review and meta-analysis. Nutr Rev 2021; 80:453-466. [PMID: 34339509 DOI: 10.1093/nutrit/nuab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Consumption of high-energy food has increased globally, thereby leading to an increase in many diseases. One strategy for addressing this is to make people aware of their energy intake through energy and fat labels. However, the effectiveness of this remains debatable. OBJECTIVE This review aims to pool the mixed outcomes of recent studies assessing the effect of energy and fat content labeling on food consumption pattern. DATA SOURCES Google Scholar, MEDLINE, and Cochrane Library databases were searched. Randomized controlled and quasi-experimental controlled trials published from 2014 to 2019 were included. DATA EXTRACTION Two reviewers screened 413 abstracts independently. Qualitative and quantitative data was extracted from 10 articles; meta-analysis was carried out on 6 of those studies. RESULTS The majority of the included papers were conducted in the regions of America, the Western Pacific, and Europe. Overall, the 6 studies claimed that labeling did not reduce the consumption of energy or fat. However, meta-analysis showed that fat and energy content labeling of food had a statistically significant effect on consumption. Subgroup analysis showed no difference with respect to types of labels, ie, context labeling vs traffic-light labeling, but energy content labels seemed to be more effective than fat content labels in influencing healthy food choices. CONCLUSION Energy and fat content labeling were shown to reduce the consumption of each significantly. However, the outcome was influenced by the study setting and the population concerned. There is a need for research in other regions in order to assess the global effectiveness of nutrition labels on food consumption. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020172675.
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Affiliation(s)
- Deepali Agarwal
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Ravi
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Bharathi Purohit
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Priya
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Marty L, Franzon C, Jones A, Robinson E. Socioeconomic position, energy labelling and portion size selection: An online study comparing calorie and physical activity calorie equivalent (PACE) labelling in UK adults. Appetite 2021; 166:105437. [PMID: 34126162 PMCID: PMC8385415 DOI: 10.1016/j.appet.2021.105437] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/13/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
Limited research has examined the impact of energy labelling on portion size selection. It is also unclear whether physical activity calorie equivalent (PACE) is more effective than standard kilocalorie (kcal) energy labelling in promoting healthier dietary behaviour and whether effectiveness varies based on socioeconomic position (SEP). In the present online study, 1667 UK adults of lower and higher SEP made virtual portion size selections for 18 common main meal foods under one of four conditions: kcal labelling only, PACE labelling only, kcal and PACE labelling, no labelling. Contrary to predictions, participants in the kcal labelling condition (+55 kcal, p < 0.001) chose larger portion sizes compared to the no labelling condition, whereas the PACE labelling (−17 kcal, p = 0.065) and no labelling condition did not significantly differ. The presence of PACE information on labels was associated with selection of significantly smaller portions when compared to labels that only included kcal information. Effects of labels on portion size selection were not moderated by participant SEP in primary analyses. The present study of virtual portion size selections suggests that kcal labelling resulted in larger portion size selections than no labelling, but this counter-intuitive effect was attenuated when kcal and PACE labelling were combined. Further research examining the impact of PACE labelling on real-world food selection in participants of lower and higher SEP is now warranted.
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Affiliation(s)
- Lucile Marty
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK; Centre des Sciences Du Goût et de l'Alimentation, Agrosup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France.
| | - Caterina Franzon
- Centre des Sciences Du Goût et de l'Alimentation, Agrosup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Andrew Jones
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Eric Robinson
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
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Abstract
The satiating efficiency of food has been increasingly quantified using the Satiety Quotient (SQ). The SQ integrates both the energy content of food ingested during a meal and the associated change in appetite sensations. This systematic review examines the available evidence regarding its methodological use and clinical utility. A literature search was conducted in six databases considering studies from 1900 to April 2020 that used SQ in adults, adolescents and children. All study designs were included. From the initial 495 references found, fifty-two were included. Of the studies included, thirty-three were acute studies (twenty-nine in adults and four in adolescents) and nineteen were longitudinal studies in adults. A high methodological heterogeneity in the application of the SQ was observed between studies. Five main utilisations of the SQ were identified: its association with (i) energy intake; (ii) anthropometric variables; (iii) energy expenditure/physical activity; (iv) sleep quality and quantity and (v) to classify individuals by their satiety responsiveness (i.e. low and high satiety phenotypes). Altogether, the studies suggest the SQ as an interesting clinical tool regarding the satiety responsiveness to a meal and its changes in responses to weight loss in adults. The SQ might be a reliable clinical indicator in adults when it comes to both obesity prevention and treatment. There is a need for more standardised use of the SQ in addition to further studies to investigate its validity in different contexts and populations, especially among children and adolescents.
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Associations among eating behaviour traits, diet quality and food labelling: a mediation model. Public Health Nutr 2019; 23:631-641. [PMID: 31769383 DOI: 10.1017/s1368980019003203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the associations among eating behaviour traits, food label use and diet quality and to evaluate if the association between eating behaviour traits and diet quality is mediated by food label use. DESIGN Eating behaviour traits were assessed using the Three-Factor Eating Questionnaire (TFEQ), the Restraint Scale and the Intuitive Eating Scale, whereas food label use was measured with the Label Reading Survey. Diet quality (Canadian Healthy Eating Index) was assessed with an FFQ. SETTING Cross-sectional study. PARTICIPANTS Adults (n 385; mean (sd): BMI = 26·0 (4·9) kg/m2, age = 41·1 (15·0) years) involved in two previous experimental studies. RESULTS When controlling for potential covariates, general food label use (β = 1·18 (se 0·26), P < 0·0001) was the main determinant of diet quality, explaining 6·7 % of its variance. General food label use partly mediated the association between TFEQ-cognitive restraint and diet quality; the indirect effect (βindirect (se); 95 % CI) was stronger in men (0·32 (0·10); 0·15, 0·55) than women (0·16 (0·05); 0·08, 0·27). General food label use also partly mediated the negative association between unconditional permission to eat and diet quality; the indirect effect (βindirect (se); 95 % CI) was also stronger in men (-1·88 (0·55); -3·11, -0·96) than women (-1·03 (0·33); -1·81, -0·49). CONCLUSIONS General food label use was the main determinant of diet quality and partly mediated the association between eating behaviour traits and diet quality. The stronger mediating effect observed in men suggests they rely more on food labelling when attempting to restrained themselves, which translates into better diet quality.
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Brown HM, Rollo ME, de Vlieger NM, Collins CE, Bucher T. Influence of the nutrition and health information presented on food labels on portion size consumed: a systematic review. Nutr Rev 2019; 76:655-677. [PMID: 29767760 DOI: 10.1093/nutrit/nuy019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Context In recent decades, portion sizes have increased significantly. Although previous research indicates that food labels impact on product choice and healthiness perception, their impact on portion sizes consumed is less clear. Objective This systematic review examined whether food label information influenced portion size consumption. Data sources A search of 7 major electronic databases for studies published from 1980 to April 2016 was conducted. Data extraction Two reviewers independently screened 11 128 abstracts. Data were extracted from 32 articles (comprising 36 studies). Results Based on the test food used, the overall effects were found to be: no effect, a positive effect, or a negative effect. Labels displaying energy content (n = 15 studies, 17 effects) and fat content information (n = 13 studies, 14 effects) were evaluated most commonly, with exercise equivalent labels evaluated least (n = 2 studies, 2 effects). Conclusions Nutrition and health information presented on food labels has varying impacts on portion sizes consumed, from increased to decreased intake. Recommendations for future research include evaluating more recent food label types and achieving more consistent reporting standards.
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Affiliation(s)
- Hannah M Brown
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Nienke M de Vlieger
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Tamara Bucher
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
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Appleton KM, Pidgeon HJ. 5-a-day fruit and vegetable food product labels: reduced fruit and vegetable consumption following an exaggerated compared to a modest label. BMC Public Health 2018; 18:624. [PMID: 29764392 PMCID: PMC5952702 DOI: 10.1186/s12889-018-5528-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 05/01/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Food product labels based on the WHO 5-a-day fruit and vegetable (FV) message are becoming increasingly common, but these labels may impact negatively on complementary or subsequent FV consumption. This study aimed to investigate the impact of a '3 of your 5-a-day' versus a '1 of your 5-a-day' smoothie product label on subsequent FV consumption. METHODS Using an acute experimental design, 194 participants (90 males, 104 females) were randomised to consume a smoothie labelled as either '3 of your 5-a-day' (N = 97) or '1 of your 5-a-day' (N = 97) in full, following a usual breakfast. Subsequent FV consumption was measured for the rest of the day using 24-h recall. Usual FV consumption was also assessed via 24-h recall for the day before the study. RESULTS Regression analyses revealed a significantly lower subsequent FV consumption following smoothies displaying the '3 of your 5-a-day' label compared to the '1 of your 5-a-day' label (Beta = - 0.15, p = 0.04). Secondary analyses revealed these effects to be driven mainly by changes to consumption in usual high FV consumers, in females and in vegetable as opposed to fruit consumption. CONCLUSIONS These findings demonstrate a role for label information in food intake, and the potential negative impacts of an exaggerated food product label on healthy food consumption and healthy dietary profiles.
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Affiliation(s)
- K. M. Appleton
- Research Centre for Behaviour Change, Department of Psychology, Bournemouth University, Bournemouth, BH12 5BB UK
- Research Centre for Behaviour Change, Department of Psychology, Bournemouth University, Poole House, Fern Barrow, Poole, BH12 5BB UK
| | - H. J. Pidgeon
- Research Centre for Behaviour Change, Department of Psychology, Bournemouth University, Bournemouth, BH12 5BB UK
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Kaur A, Scarborough P, Rayner M. A systematic review, and meta-analyses, of the impact of health-related claims on dietary choices. Int J Behav Nutr Phys Act 2017; 14:93. [PMID: 28697787 PMCID: PMC5505045 DOI: 10.1186/s12966-017-0548-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/03/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Health-related claims are statements regarding the nutritional content of a food (nutrition claims) and/or indicate that a relationship exists between a food and a health outcome (health claims). Their impact on food purchasing or consumption decisions is unclear. This systematic review measured the effect of health-related claims, on pre-packaged foods in retail settings, on adult purchasing decisions (real and perceived). METHODS In September 2016, we searched MEDLINE, EMBASE, PsychINFO, CAB abstracts, Business Source Complete, and Web of Science/Science Citation Index & Social Science Citation Index for articles in English published in peer-review journals. Studies were included if they were controlled experiments where the experimental group(s) included a health-related claim and the control group involved an identical product without a health-related claim. Included studies measured (at an individual or population level); actual or intended choice, purchases, and/or consumption. The primary outcome was product choices and purchases, the secondary outcome was food consumption and preference. Results were standardised through calculating odds ratios and 95% confidence intervals (CI) for the likelihood of choosing a product when a health-related claim was present. Results were combined in a random-effects meta-analysis. RESULTS Thirty-one papers were identified, 17 of which were included for meta-analyses. Most studies were conducted in Europe (n = 17) and the USA (n = 7). Identified studies were choice experiments that measured the likelihood of a product being chosen when a claim was present compared to when a claim was not present, (n = 16), 15 studies were experiments that measured either; intent-rating scale outcomes (n = 8), consumption (n = 6), a combination of the two (n = 1), or purchase data (n = 1). Overall, 20 studies found that claims increase purchasing and/or consumption, eight studies had mixed results, and two studies found consumption/purchasing reductions. The meta-analyses of 17 studies found that health-related claims increase consumption and/or purchasing (OR 1.75, CI 1.60-1.91). CONCLUSION Health-related claims have a substantial effect on dietary choices. However, this finding is based on research mostly conducted in artificial settings. Findings from natural experiments have yielded smaller effects. Further research is needed to assess effects of claims in real-world settings. TRIAL REGISTRATION PROSPERO systematic review registration number: CRD42016044042 .
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Affiliation(s)
- Asha Kaur
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Mike Rayner
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, England
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Abstract
Healthy eating is an important determinant of health, but adherence to dietary guidelines remains a public health concern. Identifying factors that impact dietary habits is therefore important to facilitate healthy eating. One widely used strategy to help consumers make healthier food choices is nutrition information, such as labeling and claims. Despite the intention of these strategies to improve decision making, they can also be misunderstood or misinterpreted by consumers. The aim of this review is to explore food perceptions by examining how cognitive factors influence perceived healthiness of food, and the impact of perceived healthiness of food on food choices and intake. Overall findings of this review suggest that cognitive factors, such as type of food and branding, significantly contribute to judgmental bias and have an impact on perceived healthiness while not consistently or systematically influencing choice and intake.
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Affiliation(s)
- Véronique Provencher
- INAF (Institute of Nutrition and Functional Foods), Laval University, Pavillon des services, 2440 Boul. Hochelaga, Quebec City, QC, G1V 0A6, Canada.
| | - Raphaëlle Jacob
- INAF (Institute of Nutrition and Functional Foods), Laval University, Pavillon des services, 2440 Boul. Hochelaga, Quebec City, QC, G1V 0A6, Canada
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