Impact of nutrient warning labels on choice of ultra-processed food and drinks high in sugar, sodium, and saturated fat in Colombia: A randomized controlled trial

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

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

Impact of nutrient warning labels on Colombian consumers' selection and identification of food and drinks high in sugar, sodium, and saturated fat: A randomized controlled trial

OBJECTIVE

This study assessed the impact of nutrient warnings on product selection and ability to identify food products high in nutrients of concern in Colombia.

METHODS

In an online experiment (May-June 2023), Colombian adults were randomized to a nutrient warning, guideline daily amounts (GDA), Nutri-Score, or no-label condition (n = 8,004). Participants completed selection tasks between two fruit drinks labeled according to their condition, one high in sugar and one not. Next, participants answered questions about products high in sugar, sodium, and/or saturated fat ("high-in" product). Finally, they selected which label would most discourage them from consuming a high-in product.

RESULTS

Fewer participants (17%) exposed to the nutrient warning indicated they would purchase the high-sugar fruit drink compared to Nutri-Score (27%, Holm-adjusted (adj) p<0.001) and no label conditions (31%, adj p<0.001); there were no differences between the nutrient warning and GDA label (14%, adj p = 0.087). Compared to the nutrient warning, the GDA label was slightly more effective at helping consumers identify which drink was high in sugar (89% versus 92%, adj p<0.001), while the Nutri-Score and no-label conditions were less effective. Compared to all other conditions, nutrient warnings were more effective at helping participants identify that products were high in nutrients of concern, were more effective at decreasing intentions to purchase these high-in products and were perceived as more effective. Nutrient warnings were most often selected as the label that most discouraged consumption.

CONCLUSIONS

Nutrient warnings are a promising policy to help consumers identify and discourage consumption of products high in nutrients of concern.

TRIAL REGISTRATION

Trial Registration: NCT05783726.

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

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

Consumers' Perceptions of the Design of Front-of-Package Warning Labels-A Qualitative Study in China

The warning label is identified as a simple front-of-package labeling format that assists consumers in making healthier food choices at the point of purchase. The color and/or shape of the design elements of the packaging labels can influence the understanding and purchase intention outcomes. This study aimed to explore the perceptions of consumers regarding differently designed warning labels (WLs) to identify a possibly suitable warning label design in the Chinese context. Using a qualitative approach, we collected data through 12 focus group discussions consisting of 116 participants residing in 6 provinces. Participants were selected by purposive sampling. Data were coded following inductive thematic analysis and summarized into three themes: (1) perceived preference for the appearance of the WLs, (2) perceived benefits of the WLs, and (3) suggestions for promoting the WLs. Participants preferred the black shield label showing a high content of the nutrients of concern (e.g., sodium, added sugar, and saturated fat) in both Chinese and English. Consumers generally agreed that the WLs were easy to understand and offered a simple method for choosing healthier foods. They anticipated that WLs could encourage the food industry to reformulate their products. Our study results will support the design and facilitate the use of WLs in China.

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

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

Perceived effect of warning label on parental food purchasing and drivers of food selection among South African parents–An exploratory study

Household food purchasing decision is a complex process influenced by factors such as marketing, cost, children food preference and parental choices. Most food products targeted toward children are unhealthy and are aggressively marketed to increase desirability among parents and children making healthier food selection even harder. The warning label (WL) is identified as a simple front-of-package labeling format that assist consumers to easily identify unhealthy foods and reduce their purchasing. This was a qualitative study that aimed to investigate the perceived effect of the warning label (WL) on parental food purchasing and drivers of food selection among parents. The study was conducted in a mainly rural part of South Africa, in Limpopo Province. Data were collected from 44 adult participants, all parents with children aged below 16 years selected using the snowball sampling method. Seven focus groups diversified according to age, literacy, income and urbanicity were utilized for data collection. Using a focus group discussion guide, parents were shown images of six products (crisps, soda, juice, biscuits, cereals, and yogurt) superimposed with the WL and questions asked were based on those images. Thematic analysis revealed that although some parents felt undeterred by the WL, some felt they would alter their food purchasing in the presence of the WL. Other parents felt they would reduce the frequency or the amount purchased or completely stop purchasing labeled products for their children. Motives behind perceived behavior modification included children's health being perceived as a priority and labeled products being viewed as unhealthy. Factors such as pressure from children, taste, poor nutrition knowledge and affordability seemed to influence parental food selection. These findings have important policy implications by providing evidence to policymakers that the WL may alter parental food purchasing and also provide insight into drivers of food selection among South African parents.

Front-of-Package Labels on Unhealthy Packaged Foods in India: Evidence from a Randomized Field Experiment

Policies to require front-of-package labels (FOPLs) on packaged foods may help Indian consumers to better identify foods high in nutrients of concern, including sugar, saturated fat, and sodium, and discourage their consumption, which are outcomes that are critical for preventing rises in diet-related non-communicable disease. The objective was to test whether FOPLs helped Indian consumers identify “high-in” packaged foods and reduce intentions to purchase them. We conducted an in-person randomized experiment (n = 2869 adults between ages 18 and 60 years old) in six states of India in 2022. Participants were randomized to one of five FOPLs: a control label (barcode), warning label (octagon with “High in [nutrient]”), Health Star Rating (HSR), Guideline Daily Amount (GDA), or traffic light label. Participants then viewed a series of packaged foods high in sugar, saturated fat, or sodium with the assigned FOPL, and rated product perceptions and label reactions. Fewer than half of participants in the control group (39.1%) correctly identified all products high in nutrient(s) of concern. All FOPLs led to an increase in this outcome, with the biggest differences observed for the warning label (60.8%, p < 0.001), followed by the traffic light label (54.8%, p < 0.001), GDA (55.0%, p < 0.001), and HSR (45.0%, p < 0.01). While no FOPLs led to a reduction in intentions to purchase the packaged foods, the overall pattern of results suggested that warning labels are the most effective FOPL to help Indian consumers identify unhealthy foods.

Consumers' Response to Sugar Label Formats in Packaged Foods: A Multi-Methods Study in Brazil

Providing information about the sugar content of packaged foods on product labels is an important strategy to lower consumers' sugar intake. This study assessed the effect of exposure to different sugar labels on consumers' understanding of the sugar content of foods and their food choices. In the first phase, five focus groups were conducted with a convenience sample of Brazilian adults to explore their perceptions about food labelling in general and sugar labelling in particular. Based on the qualitative results, four sugar label formats were developed and subsequently tested in a five-arm study on 1,277 adults via a randomised controlled online survey. The formats were: (i) no sugar information—control, (ii) total and added sugar content displayed in the Nutrition Information Panel (NIP), (iii) a front-of-package (FoP) octagonal warning for “high-in-sugar” products, (iv) a FoP magnifying glass warning for “high-in-sugar” products, and (v) a “high-in-sugar” warning text embedded on the NIP. Participants from the focus groups reported being confused about the meaning of “sugar” and “added sugar” on food labels and indicated that more interpretive labels, such as the FoP warnings, would help them choose products with low sugar content. In the experiment, all intervention sugar label formats improved participants' understanding of the sugar content of the tested food products, with the FoP warnings (iii and iv) showing the best results. While non-significant differences among label conditions were observed for food choices, the FoP octagonal warning prompted participants to choose high-in-sugar products less often. Given current public policy agendas aiming to reduce added sugar intake, there is a need to strengthen food labelling policies and nutrition disclosure policies that target the display of added sugar and build consumer awareness in using these tools to avoid high-in-sugar products.