Regulating health claims on food labels using nutrient profiling: what will the proposed standard mean in the Australian supermarket?

The Prevalence and Compliance of Health Claims Used in the Labelling and Information for Prepacked Foods within Great Britain

In the EU and Great Britain (GB), all health claims (HCs) on food must be authorised before use and should comply with Regulation 1924/2006. In GB, all HCs, authorised or not, are listed in the Great Britain Nutrition and Health Claims Register. This study reviews the prevalence and compliance of HCs on prepacked foods sold within three GB supermarkets and via their grocery shopping websites. In June 2023, food labels and online product information of 440 products were evaluated across three food categories-dairy and dairy alternatives; fruit juices, fruit juice drinks and fruit smoothies; and teas and infusions. In store, 26.3% of products carried an HC and 28.3% online. The prevalence of HCs was higher when compared with data from 2016. Overall compliance was high, in store (94.3%) and online (90.0%), with no statistically significant difference in overall HC compliance between in store and online products (p = 0.724). The HC violations observed in the present study were due to non-compliant wording of HCs or use of non-authorised HCs. This study demonstrates changes in the HC landscape and the need for continued monitoring of the prevalence and compliance of HCs as consumer trends alter.

Consumer perceptions of nutrient content claims in Australia: A qualitative study

BACKGROUND

Nutrition and health claims influence consumer purchasing. Claims include content claims, which refer to the amount of a nutrient contained in a product, and health claims, which refer to health benefits of foods or nutrients in a product. Products that display a health claim must meet the Nutrient Profiling Scoring Criterion (NPSC). The present study aimed to explore consumer perceptions of content claims used on food and beverage labelling and advertisements.

METHODS

Semi-structured focus groups were conducted with Australian consumers. Analysis involved an inductive, reflexive approach to thematic analysis.

RESULTS

Six focus groups involving 26 participants were conducted. Four main interconnected themes were generated: (1) complex factors influence food choice; (2) content claim scepticism; (3) the difference between content and health claims is unclear; and (4) the regulation of content claims is not common knowledge. Content claims were used, although generally viewed through a lens of scepticism and mistrust, and seen as a promotional tool for the food industry. Product complexity appeared to increase content claim use as a result of consumer uncertainty of the content of complex products, such as ultraprocessed foods. Most participants were aware that content and health claims were in some way regulated. Overall, they did not know further detail, including the relevant regulatory body.

CONCLUSIONS

For content claims to support the consumer they need to be accurate and their use limited to healthier foods. This can be achieved by requiring products with content claims to meet NPSC thresholds, as required for products making health claims.

"Marketing through Claims": A Cross-Sectional Analysis of Child-Targeted Food Packaging Claims within the Spanish Market

Food advertising, especially on packaging, impacts children's choices. Food companies make different claims on packaging as a marketing techniques to make their products more appealing, enhancing their perceived healthiness, even in unhealthy products. Although the use of some claims is regulated, there are legal loopholes that could confuse young consumers and that concern global authorities. To shed light on the matter, it is necessary to have a comprehensive understanding of the performance of all types of claims made by food companies in food products targeting children. We examined 458 products from Spanish markets in two periods through a cross-sectional content analysis. Our findings reveal that existing policies are working due to the decrease in nutrition claims, but there is a growth in soft claims that are unregulated and potentially confusing and attractive to children. Considering that most of the products analyzed are unhealthy, this emphasizes the importance of implementing stricter regulations to create a healthier and more reliable food environment for children.

Nutritional quality of prepackaged foods carrying health or nutritional claims in KSA

Objectives

To evaluate the nutritional quality of products carrying health or nutritional claims to protect consumers from being misled and to ensure that they are provided with accurate information about food products that are associated with health or nutritional claims.

Methods

This was a cross-sectional survey of 1153 foods that were randomly sampled from 14 stores in Riyadh, KSA. The data were collected from nutritional facts presented on food labels and evaluated by comparing the mean level of nutrients between products that featured claims and those that did not use the UK nutrient profile model (UKNPM).

Results

Overall, 29% of products carried either health or nutritional claims. Only 19.2% of foods that carried health claims met Saudi Food and Drug Authority (SFDA) requirements, while 28.9% of all products that carried nutritional claims met SFDA criteria; however, the analysis indicated that products that carried health or nutritional claims were significantly lower in sugar (9.67 g/100 g), fat (9.2 g/100 g), saturated fat (3.2 g/100 g), and sodium (371.36 mg/100 g). According to the UKNPM, 46.9% of the products carrying claims were less healthy than those not carrying claims, and statistically significant differences were observed by product origin and category (p < 0.005 and p < 0.000, respectively).

Conclusion

The current representation of unregulated claims on food products may mislead the consumer. There is an urgent need for government legislation that limits their use except under certain conditions for the optimal protection of the population's health.

A Cross-Sectional Audit of Sorghum in Selected Cereal Food Products in Australian Supermarkets

Sorghum (Sorghum bicolor (L.) Moench) may play a role in mechanisms that elicit favourable health effects. In Australia, sorghum is successfully grown, but it is not widely consumed, and its presence in common food products is unknown. This study examined the utilisation of sorghum in common food products, specifically breakfast cereals and snack bars, in a cross-sectional study of five supermarkets in New South Wales, over a 7-day period in February 2020. Details relating to ingredients, food format, brand, and product name were recorded. Sorghum was present in 6.1% (23/379) of breakfast cereals in a variety of formats, such as extruded shapes, flour, and puffed grain. In 8.7% of these, sorghum was listed as the first ingredient (greatest contribution by weight). Sorghum was utilised in 2% (6/298) of snack bars mainly as puffed sorghum and was listed in the fourth or subsequent position in the ingredient lists for all. 'Sorghum' did not appear in the name of any products. In conclusion, this baseline study indicates that sorghum is present in a small proportion of breakfast cereals and snack bars, highlighting the opportunity for greater investment in sorghum food innovation and marketing that would encourage consumer recognition and expand the product range.

“Even We Are Confused”: A Thematic Analysis of Professionals' Perceptions of Processed Foods and Challenges for Communication

Processed foods are increasingly under the spotlight since the development of classification systems based on proxies for food processing. Published critical reviews and commentaries suggest different views among professional disciplines about the definition and classification of processed food. There is a need to further understand perspectives of professionals on the conceptualisation of processed food and the agreements and disagreements among experts, to encourage interdisciplinary dialogue and aid communication to the public. The aim of this research was to elicit views and understandings of professionals on processed food, their perceptions of lay people's perceptions of the same, and their perspectives on the challenges of communicating about processed foods to the public. The online discussion groups brought together a range of professionals (n = 27), covering the fields of nutrition, food technology, policy making, industry, and civil society, mixed in 5 heterogenous groups. Through thematic analysis the following themes relating to the conceptualisation of processed food and challenges for communication were identified: (1) Broad concepts that need differentiation; (2) Disagreements on scope and degree of processing; (3) The role of food processing within the food system: the challenges in framing risks and benefits; and (4) The challenge of different perspectives and interests for risk communication. Throughout the discussions blurred lines in the characterisation of processing, processed foods, and unhealthy foods were observed. Participants agreed that consensus is important, but difficult. Participants identified a need for further interdisciplinary dialogue, including public engagement, to break down the observed issues, and work towards a mutual understanding and develop clear communication messages.

Nutrition and Health Claims Spectra of Pre-Packaged Foods on Serbian Supermarket Shelves: A Repeated Cross-Sectional Study

Nutrition and health claims (NHCs) are a powerful tool that influence consumers’ final decision on the choice of food products. The purposes of this repeated cross-sectional study were to (i) assess the prevalence of pre-packaged food products containing nutrition and health claims among different food categories, (ii) to determine the type of NHCs labelled on the examined food products, and (iii) to evaluate the trend in the use of NHCs in comparison to the 2012 survey. The survey was conducted immediately before the full enforcement of the new national legislation on NHCs in 2020. It comprised 3141 pre-packaged food products from 10 product categories. In total, 21.2% of food products contained any claim (19.4% contained any nutrition claim; 8.2% contained any health claim). In comparison to the 2012 survey, we observed a rising trend in the presence of NHCs; the use of nutrition claims on food products increased three times and the use of health claims increased 1.3 times in the 2020 survey. Bearing in mind that NHCs are a powerful tool guiding consumers’ food purchase decisions, NHCs should be supported by precise legislation and strict surveillance by the public health authorities.

A Cross-Sectional Audit of Nutrition and Health Claims on Dairy Yoghurts in Supermarkets of the Illawarra Region of New South Wales, Australia

Health and nutrition claims are used by consumers to guide purchasing decisions. In consequence, monitoring and evaluation of such claims to ensure they are accurate and transparent is required. The aim of this study was to investigate the use of nutrition and health claims on dairy-yoghurt products within select Australian supermarkets and assess their compliance with the revised Food Standards Code (FSC). Nutrition, health, and related claims on yoghurt products were assessed in a cross-sectional audit of five supermarkets in the Illawarra region of New South Wales. Claim prevalence, type, and compliance were assessed and products were compared against current rating measures. A total of n = 340 dairy yoghurt products were identified. Most products (97.9%) carried at least one nutrition and/or health claim, with nutrition-content claims (93.9%) the most prevalent. Most products (n = 277) met the nutrient profiling scoring criterion; while 87.9% of products did not carry the health star rating. Almost all claims surveyed (97.4%) were compliant with the FSC. Health and nutrition claims are highly prevalent across yoghurt categories, with the majority of these compliant with regulations. The ambiguity surrounding the wording and context of claims challenges researchers to investigate consumers’ interpretations of health messaging within the food environment.

Heart Images on Food Labels: A Health Claim or Not?

Health claims on food labels are used by food manufacturers to inform consumers about the health effects of a product, and such claims can have notable effects on consumer preferences. According to regulatory definitions, health claims can be either worded or presented as images, but it is not clear under which conditions an image on a food label should be considered a health claim. This question has important practical implications, as the use of health claims is strictly regulated. The objective of this study was to determine how commonly images of the heart are used on food labels, and to investigate consumers’ perceptions of products labelled with heart images, using different degrees of health relationships. Both a food supply study (N = 10,573 foods) and experiments with consumers (N = 1000) were performed in Slovenia. The use of heart imagery on food products was very common (9%). The consumer study was conducted using a web panel. Structure of the study population was comparable with Slovenian adult population (18–65 years), according to gender and age. The questionnaire was split into conjoint analysis with constructed elements, a choice-based task with real-life elements and a consumers’ association task. The experiments showed that a heart image as part of the brand name itself—without an additional (worded) health claim—did not cause most consumers to relate it to health. However, consumers tended to strongly relate an image of the heart as part of a brand with health benefits, where the image was accompanied by a worded health claim or if the heart image was designed specifically to imply health benefits. We can conclude that the use of heart images was very common on food products, but references to health were less common. Without a health-related context, heart images could not be considered as a health claim.

Comparison of requirements for using health claims on foods in the European Union, the USA, Canada, and Australia/New Zealand

Nutrition is recognized as one of the leading factors influencing the growing incidence of noncommunicable diseases. Despite society experiencing a global rise in obesity, specific populations remain at risk of nutrient deficiencies. The food industry can use health claims to inform consumers about the health benefits of foods through labeling and the broader promotion of specific food products. As health claims are carefully regulated in many countries, their use is limited due to considerable investments required to fulfill the regulatory requirement. Although health claims represent a driving force for innovation in the food industry, the risk of misleading of consumers need to be avoided. The health claim scientific substantiation process must be efficient and transparent in order to meet the needs of companies in the global market, but should be based on strong scientific evidence and plausible mechanisms of actions, to ensure highest level of consumer protection. The objective of this review is to compare the possibilities for using health claims on foods in the European Union, the USA, Canada, and Australia and New Zealand. In particular, we focused on differences in the classification of claims, on the scientific substantiation processes and requirements for health claims use on foods in the selected regions. Reduction of disease risk (RDR) claims are associated with relatively similar procedures and conditions for use, whereas several notable differences were identified for other types of claims. In all cases, RDR claims must be approved prior their introduction to the market, and only a few such claims have been authorized. Much greater differences were observed concerning other types of claims.

Prevalence and Credibility of Nutrition and Health Claims: Policy Implications from a Case Study of Mongolian Food Labels

Nutrition and health claims should be truthful and not misleading. We aimed to determine the use of nutrition and health claims in packaged foods sold in Mongolia and examine their credibility. A cross-sectional study examined the label information of 1723 products sold in marketplaces in Ulaanbaatar, Mongolia. The claim data were analysed descriptively. In the absence of national regulations, the credibility of the nutrition claims was examined by using the Codex Alimentarius guidelines, while the credibility of the health claims was assessed by using the European Union (EU) Regulations (EC) No 1924/2006. Nutritional quality of products bearing claims was determined by nutrient profiling. Approximately 10% (n = 175) of products carried at least one health claim and 9% (n = 149) carried nutrition claims. The credibility of nutrition and health claims was very low. One-third of nutrition claims (33.7%, n = 97) were deemed credible, by having complete and accurate information on the content of the claimed nutrient/s. Only a few claims would be permitted in the EU countries by complying with the EU regulations. Approximately half of the products with nutrition claims and 40% of products with health claims were classified as less healthy products. The majority of nutrition and health claims on food products sold in Mongolia were judged as non-credible, and many of these claims were on unhealthy products. Rigorous and clear regulations are needed to prevent negative impacts of claims on food choices and consumption, and nutrition transition in Mongolia.

Nutrition Claims Frequency and Compliance in a Food Sample of the Spanish Market: The BADALI Study

Nutrition claims (NCs) have been shown to affect customers' perceptions and behaviour. In Europe, they are regulated by Regulation (EC) No 1924/2006. The aim of this work was to analyse the prevalence and compliance of NCs according to this regulation in Spain. For this purpose, we used the BADALI database, which included 3197 foods present in the Spanish market. Our results show that 36.1% of all foods carried NCs, at a rate of 3.3 NCs/food. The prevalence was very heterogeneous among food groups. Nuts and seeds, legumes and non-alcoholic beverages were the groups with the highest prevalence. Micronutrients, fat, fibre and sugars were the nutrients most referred to in NCs. Overall, the compliance was low, with 49.2% NCs correct. Fibre and proteins were the nutrients with most correct NCs. Vegetables and non-alcoholic beverages were the food groups with the highest proportion of correct NCs. The main reason for incorrect NCs was because the amount of the nutrient was not stated in the label. The results of our study reveal that the aim of the European Commission to ensure a high level of protection for consumers regarding NCs has not been fulfilled. Therefore, we consider it crucial that European institutions invest in guaranteeing regulation compliance.

An Assessment of Three Carbohydrate Metrics of Nutritional Quality for Packaged Foods and Beverages in Australia and Southeast Asia

Carbohydrate quality is an aetiological factor of diet-related disease. Indices of carbohydrate quality featuring various ratios of carbohydrates-to-dietary fibre-to-sugar have been associated with improved product and/or diet quality in westernised countries. Carbohydrate intake is especially high in Asia Pacific. Thus, this study evaluated the ability of such carbohydrate metrics to discriminate the nutritional quality of carbohydrate-rich packaged foods and beverages in Australia, Malaysia, Singapore, Thailand and the Philippines, with an additional focus on beverages. This evaluation was conducted by comparing product nutritional composition and assessing products against three national nutrient profiling models. Results showed that Australia had the highest proportion of products meeting all metrics, compared to the Southeast Asian countries. Beverages had a low adherence to all metrics compared to solid foods. Across the five countries, both processed food and beverages meeting the metrics generally contained higher dietary fibre, protein, and certain vitamins and minerals whilst having lower energy, total sugars, free sugars, trans fat and cholesterol content compared to products not meeting the metrics. The metrics were also aligned with national nutrient profiling models to identify nutritious products. In conclusion, these metrics allowed us to discriminate product nutritional quality in the countries assessed and are applicable to beverages.

Evaluation of nutritional quality of biscuits and sweet snacks sold on the Italian market: the Food Labelling of Italian Products (FLIP) study

OBJECTIVE

The present study aimed at surveying the nutritional quality of prepacked biscuits and sweet snacks sold on the Italian market, and at identifying whether the product type and other information reported on the pack could discriminate the overall quality of products analysed.

DESIGN

Data on energy, nutrient and salt content of the products from two different categories of prepacked sweet cereal products (i.e. biscuits and sweet snacks) were collected from thirteen retailers present on the Italian market. Based on the product type, nutrition and health claim (NHC) and gluten-free (GF) declaration, a comparison of nutrient profile within each category was performed.

SETTING

This work is part of the Food Labelling of Italian Products (FLIP) study that aims at systematically investigating the overall quality of the prepacked foods sold on the Italian market.

RESULTS

A total of 1290 products were analysed (63 % biscuits and 37 % sweet snacks). After comparing different product types within each category, a high intra-type product variability was evidenced, which was more pronounced for biscuits. Overall, NHC-carrying products seemed to have a better nutrition profile than those without claims, except for salt content. Conversely, a comparison between GF and gluten-containing products did not show consistent results within the two categories analysed.

CONCLUSIONS

Due to the high intra-type variability within each category, the different characteristics and regulated information reported on the pack do not seem to be a clear marker of the overall nutritional quality of biscuits and snacks.

Prevalence of Product Claims and Marketing Buzzwords Found on Health Food Snack Products Does Not Relate to Nutrient Profile

Growth in the consumer health and wellness industry has led to an increase of packaged foods marketed as health food (HF) products. In consequence, a ‘health halo’ around packaged HF has arisen that influences consumers at point-of-purchase. This study compared product claims (nutrient content claims (NCC), health claims and marketing ‘buzzwords’) displayed on packaged HF snack products sold in HF stores and HF aisles in supermarkets to equivalent products sold in regular aisles (RA) of supermarkets. Product Health Star Rating (HSR), nutrient profile and price were also compared. Data were collected for 2361 products from three supermarket chains, two HF chains and one independent HF store in Sydney, Australia. Mann-Whitney U tests compared the product claims, HSR, nutrient composition and unit ($) price. HF snacks displayed significantly more product claims per product compared to RA foods (HSR ≤ 2.5), median (IQR) 5.0(4.0) versus 1.0(2) and (HSR > 2.5) 4.0(4.0) versus 3.0(4), respectively (p < 0.001). A significantly different HSR was evident between HF and RA snack products, median 2.5(0) versus 2.0(1.5), respectively (p < 0.001). HF snacks cost significantly more than RA snack foods, irrespective of product HSR (p < 0.001). These findings support the recommendation for revised labelling regulations and increased education regarding consumers food label interpretation.

Changes in nutrition content and health claims post-implementation of regulation in Australia

OBJECTIVE

To determine whether there were changes in the prevalence or healthiness of products carrying claims post-implementation of Standard 1.2.7: Nutrition, Health and Related Claims in the Australia New Zealand Food Standards Code.

DESIGN

Observational survey of claims on food packages in three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products to determine their eligibility to carry health claims under Standard 1.2.7. The Standard came into effect in 2013. The proportion of products carrying claims and the proportion of those not meeting the nutrient profiling criteria were calculated. A comparative analysis was conducted to determine changes between 2011 and 2016.

SETTING

Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in 2011 and 2016.

PARTICIPANTS

All claims on all available products in 2016 (n 1737). Nutrition composition and ingredients were collected from the packaging.

RESULTS

Overall in 2016, 76 % of products carried claims and there were 7367 claims identified in the three food categories. Of products in 2016 with health claims, 34 % did not meet nutrient profiling criteria. These may breach Standard 1.2.7. Comparison of 2011-2016 showed a significant increase in the number of products carrying claims (66 v. 76 %, P < 0·001).

CONCLUSIONS

The proportion of products carrying claims that do not meet nutrient profiling and consumers' tendency to infer health benefits from nutrition content claims warrants the regulation of all claims using the nutrient profiling. This will ensure consumers are not misled by claims on unhealthy food products.

An Audit of the Nutrition and Health Claims on Breakfast Cereals in Supermarkets in the Illawarra Region of Australia

Nutrition and health claims can promote healthier food choices but may lead to consumer confusion if misused. Regular monitoring of claims is therefore required. This study aimed to explore the prevalence of nutrition and health claims carried on breakfast cereals in supermarkets, and to assess claim compliance with regulations. Nutrition and health claims on breakfast cereal products across five supermarkets in the Illawarra region of New South Wales, Australia, were recorded in a cross-sectional audit. Prevalence of claim type and claim compliance was determined. Claims were compared across categories of breakfast cereal. Almost all (95.7%) products audited carried at least one nutrition or health claim; nutrition content (n = 1096) was more prevalent than health claims (n = 213). Most claims (91.6%) were compliant with regulations. Additionally, claim prevalence and type differed according to breakfast cereal category, with the highest proportion of claims appearing on ‘health and wellbeing’ and ‘muesli’ products. There is a high prevalence of nutrition and health claims on breakfast cereals, with most claims compliant with regulations. Research should investigate consumer interpretation of claims and the impact of applying nutrient profiling for all claims to assist consumers to make informed health choices.

Consumers' Views on the Importance of Specific Front-of-Pack Nutrition Information: A Latent Profile Analysis

Nutrition labelling can influence consumers’ assessments of food healthiness and their food choices. However, there is a lack of consensus about the optimal type and amount of nutrition information to provide on food packages. This study analysed consumers’ preferences for front-of-pack information relating to energy and various nutrients (sugar, saturated fat, sodium, fibre, carbohydrate, and protein). The aim was to identify discrete preference segments within the Australian market where the current Health Star Rating front-of-pack labelling system can be displayed with different levels of nutrition information. Adults (n = 1558) completed a survey assessing socio-demographics, self-reported nutrition knowledge, diet healthiness, special dietary requirements, and perceived importance of the provision of energy and nutrient information on the front of food packs. Latent profile analysis identified five consumer segments within the sample that ranged from groups exhibiting high levels of interest in various forms of nutrition information to one with very low interest and one with divergent scores according to whether nutrients were perceived as positive or negative for health. The results indicate that different forms of front-of-pack labelling featuring varying degrees of information about energy and specific nutrients are likely to be of interest and use to different market segments.

Positioning food standards programmes to protect public health: current performance, future opportunities and necessary reforms

OBJECTIVE

To assess current performance and identify opportunities and reforms necessary for positioning a food standards programme to help protect public health against dietary risk factors.

DESIGN

A case study design in which a food standards programme's public health protection performance was analysed against an adapted Donabedian model for assessing health-care quality. The criteria were the food standards programme's structure (governance arrangements and membership of its decision-making committees), process (decision-making tools, public engagement and transparency) and food standards outcomes, which provided the information base on which performance quality was inferred.

SETTING

The Australia and New Zealand food standards programme.ParticipantsThe structure, process and outcomes of the Programme.

RESULTS

The Programme's structure and processes produce food standards outcomes that perform well in protecting public health from risks associated with nutrient intake excess or inadequacy. The Programme performs less well in protecting public health from the proliferation and marketing of 'discretionary' foods that can exacerbate dietary risks. Opportunities to set food standards to help protect public health against dietary risks are identified.

CONCLUSIONS

The structures and decision-making processes used in food standards programmes need to be reformed so they are fit for purpose for helping combat dietary risks caused by dietary excess and imbalances. Priorities include reforming the risk analysis framework, including the nutrient profiling scoring criterion, by extending their nutrition science orientation from a nutrient (reductionist) paradigm to be more inclusive of a food/diet (holistic) paradigm.

Personalized Nutrient Profiling of Food Patterns: Nestlé's Nutrition Algorithm Applied to Dietary Intakes from NHANES

Nutrient profiling (NP) models have been used to assess the nutritional quality of single foods. NP methodologies can also serve to assess the quality of total food patterns. The objective of this study was to construct a personalized nutrient-based scoring system for diet quality and optimal calories. The new Nestlé Nutrition Algorithm (NNA) is based on age and gender-specific healthy ranges for energy and nutrient intakes over a 24 h period. To promote nutrient balance, energy and nutrient intakes either below or above pre-defined healthy ranges are assigned lower diet quality scores. NNA-generated diet quality scores for female 2007–2014 National Health and Nutrition Examination Survey (NHANES) participants were compared to their Healthy Eating Index (HEI) 2010 scores. Comparisons involved correlations, joint contingency tables, and Bland Altman plots. The NNA approach showed good correlations with the HEI 2010 scores. NNA mean scores for 7 days of two exemplary menu plans (MyPlate and DASH) were 0.88 ± 0.05 (SD) and 0.91 ± 0.02 (SD), respectively. By contrast, diets of NHANES participants scored 0.45 ± 0.14 (SD) and 0.48 ± 0.14 on first and second days, respectively. The NNA successfully captured the high quality of MyPlate and Dietary Approaches to Stop Hypertension (DASH) menu plans and the lower quality of diets actually consumed in the US.

What is known about consumer nutrition environments in Australia? A scoping review of the literature

OBJECTIVE

Food environments can influence food selection and hold the potential to reduce obesity, non-communicable diseases and their inequalities. 'Consumer nutrition environments' describe what consumers encounter within a food retail outlet, including products, price, promotion and placement. This study aimed to summarize the attributes that have been examined in existing peer-reviewed studies of Australian consumer nutrition environments, identify knowledge gaps and provide recommendations for future research.

METHODS

A systematic search of peer-reviewed literature was conducted. Sixty-six studies that assessed an aspect of within-store consumer nutrition environments were included.

RESULTS

Most studies were published from 2011 onwards and were conducted in capital cities and in supermarkets. Studies assessed the domains of product (40/66), price (26/66), promotion (16/66) and placement (6/66). The most common research themes identified were assessment of the impact of area socioeconomic status (13/66), remoteness (9/66) and food outlet type (7/66) on healthy food prices; change in price of healthy foods (6/66); variety of healthy foods (5/66); and prevalence of unhealthy child-orientated products (5/66).

CONCLUSIONS

This scoping review identified a large number of knowledge gaps. Recommended priorities for researchers are as follows: (1) develop consistent observational methodology, (2) consider consumer nutrition environments in rural and remote communities, (3) develop an understanding of food service outlets, (4) build on existing evidence in all four domains of product, price, placement and promotion and (5) determine effective policy and store-based interventions to increase healthy food selection.

Examining the Nutritional Quality of Canadian Packaged Foods and Beverages with and without Nutrition Claims

Nutrient content claims, health claims, and front-of-pack symbols (henceforth referred to as “nutrition claims” in the present study) are often found on food labels in Canada. However, it is currently unknown whether foods and beverages (F&Bs) carrying nutrition claims have a more favourable nutritional profile than those without such claims. This study examined differences in the global nutritional quality, as determined by the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (FSANZ-NPSC), of Canadian F&B bearing nutrition claims as compared to those without, as well as in their nutritional composition. Data (n = 15,184) was obtained from the University of Toronto 2013 Food Label Information Program. Forty-two percent of F&Bs carrying nutrition claims (n = 2930/6990) were found to be ineligible to carry claims based on the FSANZ-NPSC, in comparison to 66% of F&Bs without (n = 5401/8194, p < 0.001). Sugars and sweets, and miscellaneous products were the food categories with larger proportions of foods carrying nutrition claims not meeting the FSANZ-NPSC eligibility criteria. F&Bs with nutrition claims had fewer calories, less saturated fat, sodium, and sugar, and higher content of protein and fibre than comparable products without nutrition claims (p < 0.05 in all cases). In conclusion, nearly half of F&Bs carrying nutrition claims in Canada did not meet the FSANZ-NPSC threshold, although Canadian products carrying nutrition claims have an overall “healthier” profile than their counterparts without such claims.

Consumer and product-specific characteristics influencing the effect of nutrition, health and risk reduction claims on preferences and purchase behavior - A systematic review

The research on nutrition, health, and risk reduction claims (NHR claims) shows a lack of consensus as to whether these claims have a positive or negative effect on consumer's preferences and purchase behavior. This issue has been highlighted by many authors. Therefore, a comprehensive literature review was performed to find reasons for contradictory results. First, a theoretical framework was developed which divided the determinants of the effects of NHR claims on consumers' preferences and purchase behavior into consumer and product-specific characteristics. Additionally, a categorization for the different NHR claim types was constructed to make the studies comparable. Afterwards, the scientific literature from the 1980s until May 2017 was scanned and 66 articles were found to be relevant. Consumer-specific characteristics such as nutrition knowledge, health motivation, familiarity, and socio-demographic characteristics were found to influence the NHR claim effect. Important product-specific characteristics were the perceived healthiness of the food product, the interaction between the product and the nutrient in the NHR claim, and the interaction between the claimed benefit and the NHR claim type. The consumer's nutrition knowledge and the product's perceived healthiness were deemed to be the most promising determinants for further investigation.

The role of nutritional labelling and signposting from a European perspective

The past half-century has been characterised by major technological developments and massive societal change, which have profoundly changed how food is produced, processed, sold and consumed. These days we are faced with a huge choice of pre-packaged foods when we shop in modern supermarkets and we can buy seasonal food all year round, in and out of season. For decades now, the need to guide choice has been recognised, and retailers and many manufacturers have provided increasing amounts of on-pack information and signposting, and more recently UK retailers have led the way in championing front-of-pack information provision, to supplement the standard back-of-pack nutrient composition table. From a European perspective, the present paper summarises developments in nutrition labelling information and signposting, the legislation that controls on-pack declarations, and research conducted to assess whether or not the information is used, understood and supports healthier choices. It also considers whether more could be done to influence behaviour change positively, giving examples of approaches identified in the research.

Declaration of nutrition information on and nutritional quality of Thai ready-to-eat packaged food products

OBJECTIVE

The present study assessed the nutrition information displayed on ready-to-eat packaged foods and the nutritional quality of those food products in Thailand.

DESIGN

In March 2015, the nutrition information panels and nutrition and health claims on ready-to-eat packaged foods were collected from the biggest store of each of the twelve major retailers, using protocols developed by the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS). The Thai Nutrient Profile Model was used to classify food products according to their nutritional quality as 'healthier' or 'less healthy'.

RESULTS

In total, information from 7205 food products was collected across five broad food categories. Out of those products, 5707 (79·2 %), 2536 (35·2 %) and 1487 (20·6 %) carried a nutrition facts panel, a Guideline Daily Amount (GDA) label and health-related claims, respectively. Only 4691 (65·1 %) and 2484 (34·5 %) of the products that displayed the nutrition facts or a GDA label, respectively, followed the guidelines of the Thai Food and Drug Administration. In total, 4689 products (65·1 %) could be classified according to the Thai Nutrient Profile Model, of which 432 products (9·2 %) were classified as healthier. Moreover, among the 1487 products carrying health-related claims, 1219 (82·0 %) were classified as less healthy. Allowing less healthy food products to carry claims could mislead consumers and result in overconsumption of ready-to-eat food products.

CONCLUSIONS

The findings suggest effective policies should be implemented to increase the relative availability of healthier ready-to-eat packaged foods, as well as to improve the provision of nutrition information on labels in Thailand.

Consumers' responses to health claims in the context of other on-pack nutrition information: a systematic review

Context

The presence of health claims on food packaging can positively bias consumers' evaluations of foods. This review examined whether cognitive biases endure when other sources of nutrition information [the nutrition facts panel (NFP) and front-of-pack labels] appear on-pack with health claims. The following databases were searched: Web of Science, Ovid, Google Scholar, ScienceDirect, Scopus, ProQuest, and Wiley Online Library. The search terms ("health claim*" OR "nutri* claim") AND ("food label*" OR "front of pack") were used to identify studies. Twenty-four studies that examined health claims and front-of-pack labels or the NFP were included. The NFP can reduce bias, but only if consumers view it and interpret it correctly, which often does not occur. Front-of-pack labels show greater promise in reducing bias created by health claims. These findings are relevant to policymakers who are considering the effectiveness of mandating an NFP and/or a front-of-pack label alongside health claims.

Less healthy breakfast cereals are promoted more frequently in large supermarket chains in Canada

BACKGROUND

The majority of food expenditures are made in supermarkets and this environment influences our purchasing and food intake. Breakfast cereals are frequently marketed as healthy food choices. The objective of this study was to examine the frequency of in-store promotions for cold breakfast cereals in Canadian supermarkets and to determine whether healthier or less healthy breakfast cereals are promoted more frequently.

METHODS

Data was collected once per week over a four-week period from a convenience sample of the five largest Canadian supermarkets in the Ottawa/Gatineau area. Data collection included the number of shelf facings, promotional displays, and the cost of cereals/100 g. The UK Nutrient Profiling Model was used to determine the healthfulness of each breakfast cereal.

RESULTS

29.8% (n = 67) of the 225 unique cereals were classified as healthier and 70.2% (n = 158) were classified as less healthy. Less healthy cereals were displayed at eye level, in the profitable middle shelves, 2.9 times more frequently than healthier cereals. There were 5.3 times more breakfast cereal shelf facings, 4.2 more end cap displays, 1.7 more mid-aisle displays and 3.3 more special pricing signage for less healthy cereals compared to healthier cereals. Less healthy cereals had a significantly higher average total number of shelf facings compared to healthier cereals (t = -4.28 (280.8), p < .001).

CONCLUSIONS

Breakfast cereal manufacturers need to consider reformulation of their breakfast cereals to improve their healthfulness and supermarkets need to increase the marketing of healthy breakfast cereals within their stores.

What Is Nutritious Snack Food? A Comparison of Expert and Layperson Assessments

The term “nutritious” is being increasingly used by product manufacturers but the term is not currently regulated as a nutrition claim. It is unclear how lay consumers and experts define and interpret the term or how they evaluate the “nutritiousness” of various foods. To address this evidence gap, a mixed methods design was applied and both nutrition experts (n = 206) and lay participants (n = 269) provided definitions of the term “nutritious” and evaluated the “nutritiousness” of 20 different snack foods in a cross-sectional survey. Definitions were analysed using Leximancer and snack evaluations were compared both between groups and with nutrient profile scores (UK Ofcom and Australian Health Star Rating). Expert and lay definitions differed considerably, with experts using terms such as nutrient-density, macro- and micronutrients, kilojoules/Calories, while lay consumers used descriptions such as fuel, fresh, natural, body needs, and functioning. Snack evaluations were highly correlated between groups (R_s > 0.89, p < 0.001) and between nutrient profile scores (R_s > 0.75, p < 0.001). However, mean perceptions significantly differed for 18 out of 20 foods with the largest difference for yoghurts (p < 0.05). There are discrepancies between expert and lay perceptions of snack foods and the definition of the term “nutritious”. The results highlight the need for an agreed definition and the potential regulation of the term “nutritious” in food marketing.

Health and nutrition content claims on Australian fast-food websites

OBJECTIVE

To determine the extent that Australian fast-food websites contain nutrition content and health claims, and whether these claims are compliant with the new provisions of the Australia New Zealand Food Standards Code ('the Code').

DESIGN

Systematic content analysis of all web pages to identify nutrition content and health claims. Nutrition information panels were used to determine whether products with claims met Nutrient Profiling Scoring Criteria (NPSC) and qualifying criteria, and to compare them with the Code to determine compliance.

SETTING

Australian websites of forty-four fast-food chains including meals, bakery, ice cream, beverage and salad chains.

SUBJECTS

Any products marketed on the websites using health or nutrition content claims.

RESULTS

Of the forty-four fast-food websites, twenty (45 %) had at least one claim. A total of 2094 claims were identified on 371 products, including 1515 nutrition content (72 %) and 579 health claims (28 %). Five fast-food products with health (5 %) and 157 products with nutrition content claims (43 %) did not meet the requirements of the Code to allow them to carry such claims.

CONCLUSIONS

New provisions in the Code came into effect in January 2016 after a 3-year transition. Food regulatory agencies should review fast-food websites to ensure compliance with the qualifying criteria for nutrition content and health claim regulations. This would prevent consumers from viewing unhealthy foods as healthier choices. Healthy choices could be facilitated by applying NPSC to nutrition content claims. Fast-food chains should be educated on the requirements of the Code regarding claims.

The nutritional quality of foods carrying health-related claims in Germany, The Netherlands, Spain, Slovenia and the United Kingdom

Backgroung/Objectives:

Compares the nutritional quality of pre-packaged foods carrying health-related claims with foods that do not carry health-related claims.

Subject/Methods:

Cross-sectional survey of pre-packaged foods available in Germany, The Netherlands, Spain, Slovenia and the United Kingdom in 2013. A total of 2034 foods were randomly sampled from three food store types (a supermarket, a neighbourhood store and a discounter). Nutritional information was taken from nutrient declarations present on food labels and assessed through a comparison of mean levels, regression analyses and the application of a nutrient profile model currently used to regulate health claims in Australia and New Zealand (Food Standards Australia New Zealand's Nutrient Profiling Scoring Criterion, FSANZ NPSC).

Results:

Foods carrying health claims had, on average, lower levels, per 100 g, of the following nutrients, energy—29.3 kcal (P<0.05), protein—1.2 g (P<0.01), total sugars—3.1 g (P<0.05), saturated fat—2.4 g (P<0.001), and sodium—842 mg (P<0.001), and higher levels of fibre—0.8 g (P<0.001). A similar pattern was observed for foods carrying nutrition claims. Forty-three percent (confidence interval (CI) 41%, 45%) of foods passed the FSANZ NPSC, with foods carrying health claims more likely to pass (70%, CI 64%, 76%) than foods carrying nutrition claims (61%, CI 57%, 66%) or foods that did not carry either type of claim (36%, CI 34%, 38%).

Conclusions:

Foods carrying health-related claims have marginally better nutrition profiles than those that do not carry claims; these differences would be increased if the FSANZ NPSC was used to regulate health-related claims. It is unclear whether these relatively small differences have significant impacts on health.

Investigating nutrient profiling and Health Star Ratings on core dairy products in Australia

OBJECTIVE

To determine whether the ratings from the Australian front-of-pack labelling scheme, Health Star Rating (HSR), and the ability to carry health claims using the Nutrient Profiling Scoring Criterion (NPSC) for core dairy products promote foods consistent with the Australian Dietary Guidelines.

DESIGN

The Australian nutrient profiling model used for assessing eligibility for health claims was compared with the nutrient profiling model underpinning the HSR system to determine their agreement when assessing dairy products. Agreement between the extent to which products met nutrient profiling criteria and scored three stars or over using the HSR calculator was determined using Cohen's kappa tests.

SETTING

The four largest supermarket chains in Sydney, Australia.

SUBJECTS

All available products in the milk, hard cheese, soft cheese and yoghurt categories (n 1363) were surveyed in March-May 2014. Nutrition composition and ingredients lists were recorded for each product.

RESULTS

There was 'good' agreement between NPSC and HSR overall (κ=0·78; 95 % CI 0·75, 0·81; P<0·001), for hard cheeses (κ=0·72; 95 % CI 0·65, 0·79; P<0·001) and yoghurt (κ=0·79; 95 % CI 0·73, 0·86; P<0·001). There was 'fair' agreement for milk (κ=0·33; 95 % CI 0·20, 0·45; P<0·001) and 'very good' agreement for soft cheese (κ=0·84; 95 % CI 0·75, 0·92; P<0·001). Generally, products tended to have HSR consistent with other products of a similar type within their categories.

CONCLUSIONS

For dairy products, the HSR scheme largely aligned with the NPSC used for determining eligibility for health claims. Both systems appeared be consistent with the Australian Dietary Guidelines for dairy products, with lower-fat products rating higher.

Prevalence of Nutrition and Health-Related Claims on Pre-Packaged Foods: A Five-Country Study in Europe

This study is part of the research undertaken in the EU funded project CLYMBOL ("Role of health-related CLaims and sYMBOLs in consumer behaviour"). The first phase of this project consisted of mapping the prevalence of symbolic and non-symbolic nutrition and health-related claims (NHC) on foods and non-alcoholic beverages in five European countries. Pre-packaged foods and drinks were sampled based on a standardized sampling protocol, using store lists or a store floor plan. Data collection took place across five countries, in three types of stores. A total of 2034 foods and drinks were sampled and packaging information was analyzed. At least one claim was identified for 26% (95% CI (24.0%-27.9%)) of all foods and drinks sampled. Six percent of these claims were symbolic. The majority of the claims were nutrition claims (64%), followed by health claims (29%) and health-related ingredient claims (6%). The most common health claims were nutrient and other function claims (47% of all claims), followed by disease risk reduction claims (5%). Eight percent of the health claims were children's development and health claims but these were only observed on less than 1% (0.4%-1.1%) of the foods. The category of foods for specific dietary use had the highest proportion of NHC (70% of foods carried a claim). The prevalence of symbolic and non-symbolic NHC varies across European countries and between different food categories. This study provides baseline data for policy makers and the food industry to monitor and evaluate the use of claims on food packaging.

Nutrition and health claims in products directed at children via television in Spain in 2012

OBJECTIVE

To describe the use of nutrition and health claims in products directed at children via television in Spain and to analyse their nutrient profile.

METHODS

A cross-sectional study of television food advertisements over 7 days in five Spanish television channels popular among children. The products were classified as core, non-core or miscellaneous, and as either healthy or less healthy, according to the United Kingdom Nutrient Profile Model. We registered all claims contained on the product (packaging and labelling) and its advertisement. We calculated the frequency distributions of health and nutrition claims.

RESULTS

During the 420hours of broadcasting, 169 food products were identified, 28.5% in the dairy group and 60.9% in the non-core category. A total of 53.3% of products contained nutrition claims and 26.6% contained health claims; 62.2% of the products with claims were less healthy. Low-fat dairy products were the food category containing the highest percentage of health and nutrition claims.

CONCLUSION

Over half of all food products marketed to children via television in Spain made some type of nutrition or health claim. Most of these products were less healthy, which could mislead Spanish consumers.

Consumers' Exposure to Nutrition and Health Claims on Pre-Packed Foods: Use of Sales Weighting for Assessing the Food Supply in Slovenia

Insights into the use of health-related information on foods are important for planning studies about the effects of such information on the consumer’s understanding, purchasing, and consumption of foods, and also support further food policy decisions. We tested the use of sales data for weighting consumers’ exposure to health-related labeling information in the Slovenian food supply. Food labeling data were collected from 6342 pre-packed foods available in four different food stores in Slovenia. Consumers’ exposure was calculated as the percentage of available food products with particular food information in the food category. In addition, 12-month sales data were used to calculate sales weighted exposure as a percentage of sold food products with certain food information in the food category. The consumer’s in-store and sales-weighted exposure to nutrition claims was 37% and 45%, respectively. Exposure to health claims was much lower (13%, 11% when sales-weighted). Health claims were mainly found in the form of general non-specific claims or function claims, while children’s development and reduction of disease risk claims were present on only 0.1% and 0.2% of the investigated foods, respectively. Sales data were found very useful for establishing a reliable estimation of consumers’ exposure to information provided on food labels. The high penetration of health-related information on food labels indicates that careful regulation of this area is appropriate. Further studies should focus on assessing the nutritional quality of foods labeled with nutrition and health claims, and understanding the importance of such labeling techniques for consumers’ food preferences and choices.

How many foods in the UK carry health and nutrition claims, and are they healthier than those that do not?

Objective

The present study aimed to measure the prevalence of different types of health and nutrition claims on foods and non-alcoholic beverages in a UK sample and to assess the nutritional quality of such products carrying health or nutrition claims.

Design

A survey of health and nutrition claims on food packaging using a newly defined taxonomy of claims and internationally agreed definitions of claim types.

Setting

A national UK food retailer: Tesco.

Subjects

Three hundred and eighty-two products randomly sampled from those available through the retailer’s website.

Results

Of the products, 32 % (95 % CI 28, 37 %) carried either a health or nutrition claim; 15 % (95 % CI 11, 18 %) of products carried at least one health claim and 29 % (95 % CI 25, 34 %) carried at least one nutrition claim. When adjusted for product category, products carrying health claims tended to be lower in total fat and saturated fat than those that did not, but there was no significant difference in sugar or sodium levels. Products carrying health claims had slightly higher fibre levels than products without. Results were similar for comparisons between products that carry nutrition claims and those that do not.

Conclusions

Health and nutrition claims appear frequently on food and beverage products in the UK. The nutrient profile of products carrying claims is marginally healthier than for similar products without claims, suggesting that claims may have some but limited informational value. The implication of these findings for guiding policy is unclear; future research should investigate the ‘clinical relevance’ of these differences in nutritional quality.

Nutrient profile of 23 596 packaged supermarket foods and non-alcoholic beverages in Australia and New Zealand

OBJECTIVE

To compare the nutrient profile of packaged supermarket food products available in Australia and New Zealand. Eligibility to carry health claims and relationship between nutrient profile score and nutritional content were also evaluated.

DESIGN

Nutritional composition data were collected in six major Australian and New Zealand supermarkets in 2012. Mean Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC) scores were calculated and the proportion of products eligible to display health claims was estimated. Regression analyses quantified associations between NPSC scores and energy density, saturated fat, sugar and sodium contents.

RESULTS

NPSC scores were derived for 23,596 packaged food products (mean score 7.0, range -17 to 53). Scores were lower (better nutrient profile) for foods in Australia compared with New Zealand (mean 6.6 v. 7.8). Overall, 45% of foods were eligible to carry health claims based on NPSC thresholds: 47% in Australia and 41% in New Zealand. However, less than one-third of dairy (32%), meat and meat products (28%) and bread and bakery products (27.5%) were eligible to carry health claims. Conversely, >75% of convenience food products were eligible to carry health claims (82.5%). Each two-unit higher NPSC score was associated with higher energy density (78 kJ/100 g), saturated fat (0.95 g/100 g), total sugar (1.5 g/100 g) and sodium (66 mg/100 g; all P values<0.001).

CONCLUSIONS

Fewer than half of all packaged foods available in Australia and New Zealand in 2012 met nutritional criteria to carry health claims. The few healthy choices available in key staple food categories is a concern. Improvements in nutritional quality of foods through product reformulation have significant potential to improve population diets.

The Influence of Nutrition Labeling and Point-of-Purchase Information on Food Behaviours

Point-of-purchase information on packaged food has been a highly debated topic. Various types of nutrition labels and point-of-purchase information have been studied to determine their ability to attract consumers' attention, be well understood and promote healthy food choices. Country-specific regulatory and monitoring frameworks have been implemented to ensure reliability and accuracy of such information. However, the impact of such information on consumers' behaviour remains contentious. This review summarizes recent evidence on the real-world effectiveness of nutrition labels and point-of-purchase information.

Health-related on-pack communication and nutritional value of ready-to-eat breakfast cereals evaluated against five nutrient profiling schemes

Background

There is an ongoing debate regarding health-related on-pack information appearing on products with low nutritional quality. The purpose of the study was to contribute to this discussion by examining the relationship between health-related on-pack information and the overall nutritional value of highly processed ready-to-eat breakfast cereals (RTECs).

Methods

Maximum variation sampling was used to select 128 highly processed RTECs in Germany in 2010. In 2012, two additional samples were collected in Norway (n =38) and Germany (n =73) to allow for comparisons of products from countries with different regulations concerning nutrient profiles. All products were evaluated against five nutrient profiling models from government-related agencies. Mann–Whitney U Tests and Chi-square statistics was used to compare the nutrient profiles of different product categories. Logistic regression analysis was conducted to identify on-pack information on German products predicting a satisfactory nutritional profile.

Results

The majority of RTECs displayed health-related information on the packaging, but only 4–36% of German products met the criteria of the different nutrient profiles. The rate was lower for cereals marketed to children, Norwegian cereals performed better (36-64%). Health-related on-pack information was not consistently related to the nutrient profiles. The following on-pack criteria predicted a satisfactory nutrient profile on RTECs of the German 2010 sample: i) cereals not marketed to children, ii) clean labelling (free-from claims) and possibly organic labelling and whole grain claims.

Conclusions

Our results suggest that the implementation of a mandatory nutrient profiling scheme for products with health-related on-pack information could contribute to a consistent relationship between health-related information on RTECs and the overall nutritional value of the product. Improvements should also consider the provision of a simple nutritional labelling scheme on the front of the packaging, standardized serving sizes, accurate product names, and clearly defined whole grain claims.

Investigating fruit and vegetable claims on Australian food packages

OBJECTIVES

Fruit and vegetable claims on food packages are not regulated under Australian food standards. The present study aimed to: (i) investigate the number and healthiness of products carrying fruit and vegetable claims in Australia; and (ii) compare the nutrition composition of these products with fresh fruit and/or vegetables.

DESIGN

Content analysis of fruit and vegetable claims on food packages. The Australian food standards nutrient profiling model was used to determine the proportion of products not meeting nutrient profiling criteria. The nutrient composition of products carrying claims referencing the servings of fruit and vegetables in the product were compared with that of the dominant fruit and/or vegetables in each product.

SETTING

The five largest supermarket chains in Australia.

SUBJECTS

All available products in the fruit snacks, soups and fruit and vegetable juices/fruit drinks categories (n 762) were surveyed. Nutrition composition, ingredients and claims were recorded for each product.

RESULTS

Of the products surveyed, 48 % (n 366) carried at least one claim, of which 34 % (n 124) did not meet nutrient profiling. Products carrying claims referencing the number of servings of fruit and vegetables had more energy, sodium, saturated fat and sugar, and less fibre, than fresh fruit and/or vegetables (all P<0·001).

CONCLUSIONS

Many products carried fruit and vegetable claims and were significantly higher in energy, saturated fat, sugars and sodium than fresh fruit and vegetables. Marketing these products as a way of meeting fruit and vegetable intake is inaccurate and potentially misleading. Fruit and vegetable claims should be regulated using nutrient profiling.

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

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

Health-related claims on food labels in Australia: understanding environmental health officers' roles and implications for policy

OBJECTIVE

Health and related claims on food labels can support consumer education initiatives that encourage purchase of healthier foods. A new food Standard on Nutrition, Health and Related Claims became law in January 2013. Implementation will need careful monitoring and enforcement to ensure that claims are truthful and have meaning. The current study explored factors that may impact on environmental health officers' food labelling policy enforcement practices.

DESIGN

The study used a mixed-methods approach, using two previously validated quantitative questionnaire instruments that provided measures of the level of control that the officers exercised over their work, as well as qualitative, semi-structured, in-depth interviews.

SETTING

Local government; Australia.

SUBJECTS

Thirty-seven officers in three Australian states participated in semi-structured in-depth interviews, as well as completing the quantitative questionnaires. Senior and junior officers, including field officers, participated in the study.

RESULTS

The officers reported a high level of autonomy and control of their work, but also a heavy workload, dominated by concerns for public health and food safety, with limited time for monitoring food labels. Compliance of labels with proposed health claims regulations was not considered a priority. Lipsky's theory of street-level bureaucracy was used to enhance understanding of officers' work practices.

CONCLUSIONS

Competing priorities affect environmental health officers' monitoring and enforcement of regulations. Understanding officers' work practices and their perceptions of enforcement is important to increase effectiveness of policy implementation and hence its capacity to augment education initiatives to optimize health benefits.