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

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

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

Taste or health: The impact of packaging cues on consumer decision-making in healthy foods

According to the theory of dietary regulation, consumers frequently encounter conflicts between healthiness and tastiness when selecting healthy foods. This study explores how packaging cue that highlight "tasty" versus "healthy" affect consumers' intentions to purchase healthy food. After an Implicit Association Test (IAT) confirmed a perceived lack of tastiness in health foods in the Preliminary study, Study 1 analyzed pricing and packaging details of the top 200 most-popular items in each of the ten healthy food categories on a major online shopping platform. Results showed that products with taste-focused cues commanded higher prices, indicating stronger consumer acceptance of healthy foods marketed as delicious. To address the causality limitations of observational studies, Study 2 used an experimental design to directly measure the impact of these cues on purchase intentions and perceptions of energy, healthiness, and tastiness. Findings revealed that taste-focused cues significantly boosted purchase intentions compared to health-focused cues, although they also diminished the perceived healthiness of the products. Moreover, in the control group exposed to unhealthy food options, health-emphasized packaging also increased purchase intentions, indicating that consumers seek a balance between healthiness and tastiness, rather than prioritizing health alone. Study 3 further explored the impact of cognitive load over these cue influences, revealing a heightened inclination among consumers to purchase healthy products with taste-focused cue under high cognitive load state. These insights have direct implications for food packaging design, suggesting that emphasizing a balance of taste and health benefits can effectively enhance consumer engagement. The study, which conducted in China, also opens avenues for future research to explore similar effects, maybe in different cultural contexts, different consumer groups, and under varied cognitive conditions.

Sociodemographic differences in nutrition labels effect on Chilean and Mexican youth

Objective

To examine sociodemographic differences in the awareness, understanding, use and effect of nutrition labels among Mexican and Chilean youth.

Methods

Online surveys among youth (10-17 years) were obtained in 2019 (n=2631). Participants reported their awareness, understanding, and use of their country-specific nutrition facts tables (NFT) and front-of-pack labels (FOPL) (Chile: warning labels [WLs]; Mexico: guideline daily amounts [GDA]). Additionally, participants reported their perceived healthfulness of a sweetened fruit drink after viewing one of six versions of it with different FOPL (no-label control, Health Star Rating, WLs, GDAs, Traffic Light, or Nutri-Score) during an experimental task.

Results

Higher self-reported nutrition knowledge was associated with higher NFT and FOPL awareness, understanding, and use, except for WL use. WLs were the most effective FOPL in decreasing the perceived healthfulness of the sweetened fruit drink compared to a no-label condition and other FOP labels. In Chile, the effect of GDA differed by income adequacy, while in Mexico Nutri-Score differed by age.

Conclusions

Results suggest that nutrition label awareness, use, understanding, and impact differ across demographics, favoring higher income and nutrition knowledge. Despite this, WLs are likely to have a positive impact on nutrition-related knowledge and behaviors among Mexican and Chilean youth, independently of their socio-demographic groups.

An advance in novel intelligent sensory technologies: From an implicit-tracking perspective of food perception

Food sensory evaluation mainly includes explicit and implicit measurement methods. Implicit measures of consumer perception are gaining significant attention in food sensory and consumer science as they provide effective, subconscious, objective analysis. A wide range of advanced technologies are now available for analyzing physiological and psychological responses, including facial analysis technology, neuroimaging technology, autonomic nervous system technology, and behavioral pattern measurement. However, researchers in the food field often lack systematic knowledge of these multidisciplinary technologies and struggle with interpreting their results. In order to bridge this gap, this review systematically describes the principles and highlights the applications in food sensory and consumer science of facial analysis technologies such as eye tracking, facial electromyography, and automatic facial expression analysis, as well as neuroimaging technologies like electroencephalography, magnetoencephalography, functional magnetic resonance imaging, and functional near-infrared spectroscopy. Furthermore, we critically compare and discuss these advanced implicit techniques in the context of food sensory research and then accordingly propose prospects. Ultimately, we conclude that implicit measures should be complemented by traditional explicit measures to capture responses beyond preference. Facial analysis technologies offer a more objective reflection of sensory perception and attitudes toward food, whereas neuroimaging techniques provide valuable insight into the implicit physiological responses during food consumption. To enhance the interpretability and generalizability of implicit measurement results, further sensory studies are needed. Looking ahead, the combination of different methodological techniques in real-life situations holds promise for consumer sensory science in the field of food research.

The neural model of front-of-package label processing

Front-of-package (FOP) labels have been adopted in many countries to battle the obesity pandemic and its serious health consequences by providing clearer and easier-to-understand nutrition and health information. The effectiveness of FOP labels has been generally confirmed, with some contextual and individual factors modifying their effectiveness. Existing theories (eg, the dual-process theory) and shifting priorities for self-control, provide some explanations for the FOP label effect. However, the cognitive and neural mechanisms underlying the processing of FOP labels remain unknown. Here, a new model, namely, the neural model of FOP label processing, has been proposed to fill this gap by providing an integrated account of FOP label processing while simultaneously considering multiple important situational and individual factors in the same framework. This neural model is built on the core eating network (ie, the ventral reward pathway and the dorsal control pathway) for food cue processing and actual food consumption. The new model explains how FOP labels may facilitate attention, influence the core eating network, and thus alter food choices. It also demonstrates how motivation may modify FOP label processing in 2 ways: affecting attention (the indirect way) and changing the process of evaluating the food (the direct way). It further explains how some contextual and individual factors (eg, ego depletion, time pressure, and health knowledge) influence the process. Thus, the neural model integrates evidence from behavioral, eye-tracking, and neuroimaging studies into a single, integrated account, deepening understanding of the cognitive and neural mechanisms of FOP label processing. This model might facilitate consensus on the most successful FOP label. Moreover, it could provide insights for consumers, food industries, and policy makers and encourage healthy eating behaviors.

Child-directed marketing on packaged breakfast cereals in South Africa

OBJECTIVE

Childhood obesity is on the rise in South Africa (SA), and child-directed marketing (CDM) is one of the contributing factors to children's unhealthy food choices. This study assessed CDM on packaged breakfast cereals available in SA supermarkets and their nutritional quality.

DESIGN

Photographic images were examined in a descriptive quantitative study. A codebook of definitions of CDM was developed for this purpose. REDCap, an online research database, was used for data capturing, and SPSS was used for data analyses including cross-tabulations and one-way ANOVA.

SETTING

The current study was set in the Western Cape province of SA.

SUBJECTS

Photographic images of all packaged breakfast cereals sold in major retailers in the Western Cape province of SA in 2019 were studied.

RESULTS

CDM strategies were classified as direct (to the child) or indirect (through the parent). A total of 222 breakfast cereals were studied, of which 96·9 % had a nutritional or health claim, 95·0 % had illustrations, 75·2 % had product and consumption appeals, 10·8 % had characters, 10·8 % consisted of different appeals, 8·6 % alluded to fantasy and 7·7 % had role models. In breakfast cereals with direct CDM, the protein and fibre content was significantly lower than in breakfast cereals without direct CDM. This study found a significantly higher total carbohydrate and total sugar content in breakfast cereals with direct CDM than those without direct CDM.

CONCLUSION

CDM was highly prevalent in breakfast cereals sold in SA. Regulations to curb the marketing of packaged foods high in nutrients of concern is recommended.

The conceptualisation and operationalisation of 'marketing' in public health research: a review of reviews focused on food marketing using principles from critical interpretive synthesis

BACKGROUND

Extensive public health research reports the nature, scope and effects of various marketing activities used by food and drinks companies to support the sale of their products. Such literature informs the regulation of food marketing that encourages unhealthy eating behaviours and poor diet-related health outcomes. However, it is not clear whether this literature consistently conceptualises and applies marketing, which could in turn influence the approach and efficacy of policies to regulate food marketing. We aimed to understand the conceptualisation and operationalisation of marketing in public health research of food marketing, eventually focusing on the conceptualisation of integrated marketing.

METHODS

We conducted a review of reviews that drew on scoping review methods and applied principles of critical interpretive synthesis. Five databases of peer-reviewed literature and websites of relevant organisations were searched in June - August 2020. Articles were screened against inclusion criteria to identify reviews examining food marketing in a health context. Informative text segments from included articles were coded using NVivo. Codes were grouped into synthetic constructs and a synthesising argument.

RESULTS

After screening against inclusion criteria, 60 publications were eligible for inclusion. Informative text segments from 24 publications were coded, after which no new codes were identified. Our synthesising argument was that the understanding of integrated marketing appeared inconsistent across publications, such as by differences in use of underlying conceptual frameworks and in the application of terms such as marketing strategy and tactics.

CONCLUSIONS

Using our synthesising argument, we suggest ways to improve the future study of food marketing in public health research, for example by using in-depth case studies to understand the integrated operation and effect of multi-component marketing strategies. Improving conceptual clarity in the study of food marketing in public health research has the potential to inform policy that is more reflective of the true nature of marketing, and thus more effective in combating food marketing effects and protecting public health.

PROTOCOL REGISTRATION

The review protocol was made publicly available on Open Science Framework prior to the start of the study (DOI: https://doi.org/10.17605/OSF.IO/VSJCW ).

Persuasive packaging? The impact of packaging color and claims on young consumers' perceptions of product healthiness, sustainability and tastiness

Following the increasing importance of healthiness and sustainability for many consumers, manufacturers increasingly try to give products a healthier or eco-friendlier image, for instance through packaging design. We conducted two experiments to investigate how visual (i.e., colors) and textual (i.e., claims) packaging elements shape perceptions of product healthiness, sustainability and tastiness. Additionally, the studies investigated whether these packaging elements impact the likelihood that these products are selected in a choice task. Study 1 (N = 202) had a mixed design, with packaging color (warm versus cool) and a nutrition claim (present versus absent) as within-subjects manipulations. Young consumers chose between four beverages, and subsequently evaluated these beverages. Study 2 (N = 211) had a similar design and procedure, but focused on the impact of an ecological claim on the evaluation of snacks. In line with our hypotheses, cool packaging colors (i.e., green and blue) increased perceptions that food and drinks were healthy and sustainable. However, in Study 1, cool packaging colors also resulted in lower tastiness expectations, and a lower likelihood that the product was selected. We also found that a simple nutrition/ecological claim made products seem overall healthier and more sustainable. Additionally, contrary to many previous studies, we did not find that these claims affected taste expectations. Our studies highlight the importance of package design as a factor that can influence perceptions of food and drink products.

Public Support for Nutrition-Related Actions by Food Companies in Australia: A Cross-Sectional Analysis of Findings from the 2020 International Food Policy Study

Unhealthy food environments contribute to unhealthy population diets. In Australia, the government currently relies on voluntary food company actions (e.g., related to front-of-pack labelling, restricting promotion of unhealthy foods, and product formulation) as part of their efforts to improve population diets, despite evidence that such voluntary approaches are less effective than mandatory policies. This study aimed to understand public perceptions of potential food industry nutrition-related actions in Australia. An online survey was completed by 4289 Australians in 2020 as part of the International Food Policy Study. The level of public support was assessed for six different nutrition-related actions related to food labelling, food promotion, and product formulation. High levels of support were observed for all six company actions, with the highest support observed for displaying the Health Star Rating on all products (80.4%) and restricting children's exposure to online promotion of unhealthy food (76.8%). Findings suggest the Australian public is strongly supportive of food companies taking action to improve nutrition and the healthiness of food environments. However, given the limitations of the voluntary action from food companies, mandatory policy action by the Australian government is likely to be needed to ensure company practices align with public expectations.

A Scoping Review of Observational Studies on Food and Beverage Advertising on Social Media: A Public Health Perspective

Popular social media platforms have been actively used by ultra-processed food companies to promote their products. Being exposed to this type of advertising increases the consumption of unhealthy foods and the risk of developing obesity and other non-communicable diseases (NCDs). Thus, monitoring commercial content on social media is a core public health practice. We aimed to characterize the methods used for monitoring food advertising on social media and summarize the investigated advertising strategies via a scoping review of observational studies. This study is reported according to the MOOSE Statement, and its protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration nº. CRD42020187740). Out of the 6093 citations retrieved, 26 met our eligibility criteria. The studies were published from 2014 to 2021, mostly after 2018. They focused on Australia, Facebook, strategies aimed at children and adolescents, and advertising practices of ultra-processed food companies. We grouped strategies in eight classes: post features (n = 18); connectivity and engagement (n = 18); economic advantages, gifts, or competitions (n = 14); claims (n = 14); promotional characters (n = 12); brand in evidence (n = 8); corporate social responsibility or philanthropy (n = 7); and COVID-19 (n = 3). We found similarities in the investigation of strategies regardless of the type of social media. Our findings can contribute to the designing of tools for monitoring studies and regulatory mechanisms to restrict the exposure of food advertising.

The effect of food packaging elements on children's food choices and intake: A systematic review

Little can be added about the worldwide concern over the exponential increase in obesity and child overweight problems. Much of the unhealthy eating habits occur at the time of food choice. The enormous influence of marketing strategies in general, and packaging in particular, has been highlighted here. In this respect, public policies that tend to direct choices toward healthier options have been developed. However, the usefulness of such policies will depend on evidence of how different packaging elements can influence children. This systematic review (SR) aims to compile the knowledge available to date on the influence of packaging on food choices and eating behaviours in children. Methodologically, the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines have been followed to select papers. We also assessed the risk of bias in the studies analysed using the Newcastle-Ottawa Quality Assessment Scale (NOS). The initial search strategy found 2,627 articles, although only 20 of them met the eligibility criteria. Data from the studies were extracted, categorised, and analysed. The results indicate that most of the packaging elements have some effect on children's food choices or food intake. The use of Cartoon is the element with the most consistent evidence of influence. Despite the number of studies and public initiatives developed to promote this informative and persuasive element, less consistency has been found regarding the effect of Nutrition Labelling. Therefore, the results found should be considered by both governments and organisations when promoting public policies that work for the wellbeing of children.

Marketing techniques, health, and nutritional claims on processed foods and beverages before and after the implementation of mandatory front-of-package warning labels in Peru

In June 2019, mandatory front-of-package warning labels (FOPL) were implemented in Peru. The aim of the study was to describe changes in marketing strategies on packaging: marketing techniques (MT), health claims (HC), and nutritional claims (NC) on the packaging of products frequently consumed by children before and after the FOPL implementation. Product photos were taken pre- (March 2019) and post-implementation (March-October 2020) in three supermarkets in Lima, Peru. Following INFORMAS protocols and Peruvian Technical Norms, the presence of MT, HC, and NC was assessed on all package sides. Products were classified as "high-in" and "not high-in" based on the regulation threshold for critical nutrients. Differences in the proportion of products with each strategy in both periods were evaluated. Also, a subsample of products was matched according to the barcode and exact McNemar test was used to compare proportions of strategies pre/post-implementation. We included 883 and 1,035 products in pre- and post-implementation, respectively. In both periods, MT appeared on almost 70% of all products. The presence of HC increased significantly only for beverages (24.5-38.1%, p < 0.001). In both phases, NC were commonly used on beverages (>80%). Overall, the prevalence of "high-in" products using MT increased (73.6-82.1%, p = 0.007), while use of HC increased among "not high-in" products (32.9-41.6%, p < 0.001). There is a high frequency of MT on all products and NC on beverages. The increase in MT in "high-in" products may be an industry response to minimize the impact of the FOPL on food choices and sales. New regulatory aspects regarding labeling should be implemented to strengthen the current policy.

Understanding obesity and addressing stigma: the role of healthcare professionals

The coronavirus disease 2019 (COVID-19) pandemic has further emphasised the importance of recognising obesity as a health issue for adults and children, with associated increases in obesity prevalence and risk of severe illness and death from COVID-19. Obesity is highly visible and highly stigmatised. It is frequently regarded as a result of lifestyle choices and behaviours, with a focus on personal responsibility rather than as a complex, multifactorial disease with a strong genetic component. Healthcare professionals, including nurses, have an important role in supporting behaviour changes, and discussing weight with patients in neutral and respectful ways. This article outlines the effects of the COVID-19 pandemic on weight and weight-related behaviours and discusses the complexity of obesity and weight stigma. It also emphasises the importance of nurses advocating for action to address the obesogenic environment.

“I Like the One With Minions”: The Influence of Marketing on Packages of Ultra-Processed Snacks on Children's Food Choices

Objective

This study aimed to assess the most consumed school snacks using the free listing and understand how marketing strategies on food labels influenced children's perceptions of snacks via focus groups.

Design

The study design involved free lists and semi-structured focus group interviews.

Setting

São Paulo, Brazil.

Participants

A total of 69 children were involved in this study.

Phenomenon of Interest

Children's perceptions of food labels.

Analysis

Food groups mentioned on the free lists were analyzed for their frequency and priority of occurrence. The focus groups were analyzed through content analysis.

Results

Juices and chips were the most salient snacks, with availability and flavor as reasons for their consumption. Children found images on labels appealing, which created a desire for the food, although could be deceptive. Snacks perceived as healthy were encouraged by parents, and children could more easily convince them to buy snacks with health claims. Colors and brands were important to catch children's attention and make the snack recognizable. Television commercials and mascots reinforced marketing strategies on labels.

Conclusions and Implications

Our results point to the need for public health strategies to deal with the obesity epidemic through creating and implementing specific legislation to regulate food labels to discourage the consumption of unhealthy snacks and prohibit food marketing targeted at children.

Association between Body Mass Index with Sugar-Sweetened and Dairy Beverages Consumption in Children from the Mexico-USA Border

The consumption of sugar-sweetened beverages has been associated with the onset of cardiometabolic diseases. The aim of this study was to describe consumption patterns of sugar-sweetened and dairy beverages and to evaluate their correlation with the body mass index in children residing at the Mexico−USA border. A total of 722 (370 girls, 352 boys) elementary school children aged 9 to 12 years from Tijuana, Mexico, participated in the study. Anthropometric measures were recorded, and a beverage intake questionnaire was completed by the children’s parents. Significant age by sex interactions were found on body mass index Z-scores (p < 0.01). Boys showed higher sugar intake (p < 0.05) and total relative energy consumption from sugar (p < 0.05) than girls. The energy consumption from sugar-sweetened and dairy beverages was similar between sexes (p > 0.05). Sugar intake from beverages was higher than the limit recommended by the World Health Organization in boys (66%) and girls (44%). A high frequency of consumption of sugar-sweetened beverages and similar intake of dairy beverages were found in children from the Mexico−USA border. The high consumption of sugar exceeds international recommendations and should be carefully monitored.

Adults' Exposure to Unhealthy Food and Beverage Marketing: A Multi-Country Study in Australia, Canada, Mexico, the United Kingdom, and the United States

BACKGROUND

Food marketing increases product appeal, purchasing, and consumption, using diverse strategies and locations to reach consumers.

OBJECTIVES

The aim of this study was to examine differences in adults' self-reported exposure to various marketing strategies (brand and licensed characters, celebrities, and sponsorship of sports and cultural events) and locations (television, radio, and digital media) across 5 countries: Australia, Canada, Mexico, the United Kingdom, and the United States.

METHODS

We analyzed cross-sectional survey data on self-reported exposure to food marketing strategies and locations collected in 2018 by the International Food Policy Study. Participants (n = 21,678) aged ≥18 years completed an online survey. Exposures to unhealthy food marketing strategies and locations in the prior 30 days were self-reported. Regression models examined differences in marketing exposure and locations across countries.

RESULTS

The average number of unhealthy food marketing strategies to which participants reported being exposed ranged from 0.5 in the United Kingdom to 2.3 in Mexico. Self-reported exposure to strategies across all countries was highest for brand characters (32%), followed by licensed characters (22%). In total, the reported mean exposure of marketing locations was 1.6 in the prior month. Television was the most prevalent location (44%), followed by digital marketing (32%). Adjusted models indicated that the odds of reporting exposure to marketing strategies and marketing locations were higher for Mexico compared to the rest of the countries.

CONCLUSIONS

Adults report a variety of exposures to unhealthy food marketing in all countries, but exposure was highest in Mexico. Special attention should be paid to regulating marketing strategies, such as brand characters and licensed characters, and locations, such as television and digital marketing.

Co-Creation with Consumers for Packaging Design Validated through Implicit and Explicit Methods: Exploratory Effect of Visual and Textual Attributes

Packaging is no longer a mere structural element that only aims to preserve foods, but it is also a powerful marketing tool able to affect product perception, purchase decision and consumers’ food choices. Incorporating consumers’ voices into packaging design through co-creation could maximise its impact on the market. The main goal of this exploratory study was to test the usefulness of co-creation with consumers for packaging design. For that purpose, a survey with 200 Spanish participants was conducted to find out which of the presented visual and textual packaging attributes were the most appropriate. A validation study with 40 participants using implicit (eye tracker, galvanic skin response and automatic facial expression analysis) and explicit measurements was used to test the packaging co-created by consumers against some of its possible competitors in the market. The co-creation process with consumers allowed for the identification of the visual and textual attributes, among the available options, that best fit their preferences, whereas the validation process confirmed that the packaging design co-created by consumers was equally or even preferred over the competitors. The information gathered might help designers and marketers to guide the packaging design for fish products in the Spanish market.

COVID-washing in U.S. food and beverage marketing on Twitter: A content analysis (Preprint)

Background

Food companies have increased digital and social media ad expenditures during the COVID-19 pandemic, capitalizing on the coinciding increase in social media use during the pandemic. The extent of pandemic-related social media advertising and marketing tactics have been previously reported. No studies, however, have evaluated how food and beverage companies used COVID-washing on social media posts in the United States or analyzed the nutritional content of advertised food and beverage products. This study was designed to address these gaps by evaluating how food and beverage companies capitalize on the COVID-19 pandemic to promote unhealthy foods and sugary beverages.

Objective

We aimed to document the types and frequencies of COVID-19–related themes in US food and beverage companies’ Twitter posts during the first wave of the pandemic in the United States, and assess the nutritional quality of food and beverage products featured in these tweets.

Methods

Research assistants visited the Twitter accounts of the most-marketed food and beverage brands, and screen-captured all tweets posted between March 1 and May 31, 2020. Researchers documented the date of the tweet; the number of likes, views, comments, and “retweets”; and the type of food and beverage products. We coded tweets for the following 10 COVID-19 themes: (1) social distancing, staying home, or working remotely; (2) contactless delivery or pick-up; (3) handwashing or sanitizing; (4) masks; (5) safety or protection; (6) staying connected with others; (7) staying active; (8) frontline or essential workers; (9) monetary relief, donations, or unemployment; and (10) pandemic, unprecedented, or difficult times. Researchers calculated the nutrient profile index scores for featured foods and sorted beverages into categories based on sugar content.

Results

Our final sample included 874 COVID-19–themed tweets from 52 food and beverage brands. Social distancing themes appeared most frequently (n=367, 42%), followed by pandemic, unprecedented, or difficult times (n=246, 28.2%), and contactless delivery (n=237, 27.1%). The majority of tweets (n=682, 78%) promoted foods and beverages. Among those tweets featuring foods and beverages, 89.6% (n=611) promoted unhealthy products, whereas 17.2% (n=117) promoted healthy products.

Conclusions

Our findings point to a concerning marketing tactic in which major food and beverage companies promote unhealthy foods and sugary beverages during the COVID-19 pandemic. Given that nutrition-related diseases such as obesity and diabetes are risk factors for COVID-19 morbidity and mortality, food and beverage companies should reduce the promotion of unhealthy products to help decrease the prevalence of health conditions that place people at higher risk for severe illness and death due to COVID-19.

Evaluation of Combinations of Nudging, Pricing, and Labeling Strategies to Improve Diet Quality: A Virtual Grocery Store Experiment Employing a Multiphase Optimization Strategy

BACKGROUND

Several intervention strategies have been shown to improve diet quality. However, there is limited evidence on the increase in effectiveness that may be achieved through select combinations of these strategies.

PURPOSE

This study aimed to identify an effective multicomponent intervention to improve diet quality of a grocery basket by applying a Multiphase Optimization Strategy framework and testing various combinations of four promising strategies using a fully functional web-based grocery store: (i) front-of-pack food labels and real-time feedback of the healthiness of the shoppers' grocery basket, (ii) a tax, (iii) ordering products by a nutritional quality score, and (iv) healthier substitute offers.

METHODS

We conducted a hypothetical shopping study (N = 756) with a randomized full factorial design (16 conditions) to estimate main and interaction effects of the four interventions.

RESULTS

The "food labels & real-time feedback" and "ordering" strategies had significantly positive main effects on overall diet quality of the shopping basket (both at p < .001). We found no effects on diet quality for the "tax" and "healthier substitute offers." None of the two-way interaction effects for different strategies on overall diet quality and nutrients were significant.

CONCLUSIONS

Having "food labels & real-time feedback" and "ordering" simultaneously seemed to be more effective at improving diet quality, compared to having only one of these interventions. These results suggest that a combination of food labels with real-time feedback and ordering interventions can be part of a promising multicomponent strategy to improve diet quality in online shopping platforms.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04632212.

What Works to Improve Nutrition and Food Sustainability across the First 2000 Days of Life: A Rapid Review

Informed by the Innocenti framework, this rapid review of systematic reviews (n = 60) and sentinel grey literature (n = 27) synthesises the evidence of what works to improve nutrition and food sustainability across the first 2000 days. Most systematic reviews focused on interventions targeting the behaviour of parents and caregivers (n = 49), with fewer reviews focusing on the personal (n = 7) and external (n = 4) food environments. No reviews focused on food supply-chain activities. Most reviews were rated as critically low (n = 28, 47%) or low (n = 21, 35%) quality using AMSTAR 2. Evidence supports the effectiveness of multi-component breastfeeding interventions, interventions delivered in home and child-care settings, particularly when involving parents, interactive skill building and repeated exposure to vegetables. Food vouchers and access to local farmers markets and community gardens have potential for improving access and availability to healthier foods, while evidence supports interventions improving the external food environment, including fiscal strategies such as the SSB tax, restrictions on marketing and advertising of discretionary products and improved food labelling. Overall, this review highlights the importance of action across a range of settings and sectors at the international, national and local levels to improve young children's diets.

Environmental Physical Activity Cues and Children's Active vs. Sedentary Recreation

Physical activity (PA) benefits health, and intensive environmental modifications can increase children’s PA. Research has not yet addressed if subtle environmental cues, such as posters depicting PA, increase child PA. In the current study, it was hypothesized that children exposed to active posters (vs. nature posters) would spend a larger proportion of free play time engaging with active toys (relative to sedentary toys). Participants were randomly assigned to one of two conditions in which posters on a laboratory wall depicted 1. People being active, or 2. Nature scenes. Children aged 5–10 years (N = 175) could play with up to eight toys (four active, four sedentary) while parents completed study-related surveys. The proportion of playtime that was active was compared between groups. Poster type did not have a significant effect on proportion of active playtime. Previous environmental interventions that increase children’s PA have done so through enhancing access to active opportunities, rather than via signage. It is possible that poster interventions such as this may not influence children’s PA, or perhaps other types of cues would have been more effective. Future research should investigate subtle environmental cues that match both the target audience and the accessible PA options (e.g., posters depicting children playing with available active toys) and explore other low-investment environmental modifications to boost children’s PA.

The Effect of Downsizing Packages of Energy-Dense, Nutrient-Poor Snacks and Drinks on Consumption, Intentions, and Perceptions-A Scoping Review

The single-serve packaging of discretionary foods is becoming increasingly popular, but evidence is limited on whether smaller package sizes can reduce food intake. The aim of this scoping review is to assess the effect of reducing the package size of energy-dense, nutrient-poor (EDNP) snacks and drinks on consumption, intentions, and perception, and to examine the effects of potential moderators or mediators. The search was conducted in six selected databases and grey literature sources, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review process (PRISMA-ScR) guidelines. After screening 5562 articles, 30 articles comprising 47 intervention studies were included. Twelve of 15 studies found a significant effect in lowering the actual or intended consumption when a single smaller package was offered compared with a single larger package. When the total serving size was held constant between varying package conditions, such as a multipack, single package, or unpackaged, the results on the actual and intended consumption were inconsistent and varied according to the presence of moderators. Overall, these findings suggest that an overall reduction in the size of a single package is a more promising strategy than providing multipacks to reduce consumption. Changes to the current food environment to promote single smaller packages of EDNP snacks and drinks are necessary to support the better selection of appropriate portion sizes and reduce consumption.

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

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

A human rights-based approach to non-communicable diseases: mandating front-of-package warning labels

Across the globe, the consumption of energy-dense and nutrient-poor foods and beverages has escalated rates of diet-related non-communicable diseases (NCDs), driven by deceptive marketing tactics from the food and beverage industry. The international community has increasingly recognized the need to provide consumers with accurate health information on food and beverage products as part of their right to health. In July 2020, the U.N. Special Rapporteur on the right to health released a powerful Statement calling for the adoption of front-of-package warning labeling to tackle NCDs. Just a few weeks after the Statement's release, the Pan American Health Organization published a report highlighting the relevance of front-of-package labeling as a policy tool for the prevention of NCDs in the Americas, demonstrating further support to this regulatory intervention.In this piece, we explain why front-of-package warning labeling should be part of a comprehensive strategy to promote healthier lives, delving into the human-rights aspects of front-of-package labels. In particular, we explore the role the food and beverage industry play in increasing the consumption of unhealthy foods and beverages, and the relevance of scientific evidence free from conflicts of interest to adequately protect the right to health and health-related rights.

Examining the Relationship between Sugar Content, Packaging Features, and Food Claims of Breakfast Cereals

Excessive free-sugar intake has become highly prevalent in numerous countries, and Portugal is not the exception. One product category that contributes to the daily intake of free sugars is breakfast cereals. In the current work, we identified 289 exemplars from two major retailers in Portugal and collected information on their nutritional profile (e.g., sugar, salt, fiber per 100 g), price, packaging features, type of food claims present (e.g., statements about the composition, sensory features, the origin of the product), and ingredients list. Overall, the sugar content of breakfast cereals was high (Mean = 19.9 g), and less than 10% of the products complied with the current national guidelines (i.e., 5 g of sugar per 100 g of product). Sugar (or other sugar sources) was listed in the top three ingredients for over 85% of the products. On average, each product included about four claims (Mean = 3.9), and sugar content was lower when the claims were related to the product composition. Critically, the sugar content was particularly high for children-oriented products (Mean = 26.4 g). Correlation analysis showed that breakfast cereals with higher sugar content also were cheaper and had lower quantities of fiber, proteins, and salt. Our findings suggest the need to implement strategies to reduce sugar in this product category (e.g., incentivize manufacturers to reformulate products). Also, our results may inform strategies aimed at promoting consumers' awareness about the sugar content in breakfast cereals and other processed foods, facilitating healthier decision-making.

Smiling faces on food packages can increase adults' purchase likelihood for children

Manufacturers often include smiling faces on food packages, especially those targeted towards children. Prior research suggests that anthropomorphized images in general, and smiling faces in particular, are an effective marketing tool that encourage food choice and consumption among children. However, it is not clear how adult consumers, who often make food purchases for children, respond to smiling faces on packaging when making decisions for a child recipient. The results of four experiments show that food packages with (vs. without) smiling faces activate child-related thoughts which leads to expectations of making a child happy with the food and ultimately greater purchase likelihood for the child recipient. The serial effects of smiling faces on purchase likelihood through child-related thoughts and the expectations of a child's emotional reaction are robust to an array of products with more and less appealing flavors. Further, a smile line in the absence of eyes does not catalyze the same serial mechanism. Overall, our findings suggest that marketers should exercise caution when utilizing smiling faces on food packages, especially when packages contain unhealthy foods; and, consumers should be aware of the effects that this seemingly innocent packaging feature can have on their product responses.

Hunger for Home Delivery: Cross-Sectional Analysis of the Nutritional Quality of Complete Menus on an Online Food Delivery Platform in Australia

Online food delivery (OFD) platforms have changed how consumers purchase food prepared outside of home by capitalising on convenience and smartphone technology. Independent food outlets encompass a substantial proportion of partnering outlets, but their offerings’ nutritional quality is understudied. Little is also known as to how OFD platforms influence consumer choice. This study evaluated the nutritional quality and marketing attributes of offerings from independent takeaway outlets available on Sydney’s market-leading OFD platform (UberEats^®). Complete menus and marketing attributes from 202 popular outlets were collected using web scraping. All 13841 menu items were classified into 38 food and beverage categories based on the Australian Dietary Guidelines. Of complete menus, 80.5% (11,139/13,841) were discretionary and 42.3% (5849/13,841) were discretionary cereal-based mixed meals, the largest of the 38 categories. Discretionary menu items were more likely to be categorised as most popular (OR: 2.5, 95% CI 1.9–3.2), accompanied by an image (OR: 1.3, 95% CI 1.2–1.5) and offered as a value bundle (OR: 6.5, 95% CI 4.8–8.9). Two of the three discretionary food categories were more expensive than their healthier Five Food Group counterparts (p < 0.02). The ubiquity of discretionary choices offered by independent takeaways and the marketing attributes employed by OFD platforms has implications for public health policy. Further research on the contribution of discretionary choices and marketing attributes to nutritional intakes is warranted.

Point-of-Decision Prompts Increase Dietary Fiber Content of Consumers' Food Choices in an Online Grocery Shopping Simulation

Only 5% of Americans consume the recommended amount of dietary fiber. In an online simulated shopping experiment, we examined whether a fiber-focused point-of-decision prompt (PDP) would influence consumers to choose food products that were higher in this important nutrient. We hypothesized that participants exposed to the dietary fiber PDP would choose products with more dietary fiber/serving than those who were not exposed to the PDP. The experiment was completed by 753 participants. Participants were randomly assigned to a condition in which they were not exposed to a PDP (the no-PDP condition), a personalized PDP, or PDP without personalization. Choices in the two PDP conditions were not significantly different. Therefore, the PDP conditions were pooled together into one condition and compared with control participants that did not receive the fiber-focused PDP. Across the three product categories, participants in the PDP condition chose products that had a greater amount of dietary fiber/serving (cereal: 22% increase; bread: 22% increase; crackers: 26% increase; p < 0.01) and products that had a greater healthiness rating (cereals (odds ratio (OR): 1.45, 95% confidence interval (95% CI): (1.10, 1.92)), bread (OR: 1.44, 95% CI: (1.09, 1.91)), and crackers (OR: 1.66, 95% CI: (1.25, 2.21)). Overall, the fiber PDP influenced participants to choose healthier products that contained greater amounts of dietary fiber.

Food Marketing as a Special Ingredient in Consumer Choices: The Main Insights from Existing Literature

The choices and preferences of food consumers are influenced by several factors, from those related to the socioeconomic, cultural, and health dimensions to marketing strategies. In fact, marketing is a determinant ingredient in the choices related to food consumption. Nonetheless, for an effective implementation of any marketing approach, the brands play a crucial role. Creating new brands in the food sector is not always easy, considering the relevant amount of these goods produced within the agricultural sector and in small food industries. The small dimension of the production units in these sectors hinders both brand creation and respective branding. In this context, it would seem important to analyse the relationships between food marketing and consumer choice, highlighting the role of brands in these frameworks. For this purpose, a literature review was carried out considering 147 documents from Scopus database for the topics of search “food marketing” and “choices” (search performed on 16 October 2020). As main insights, it is worth highlighting that the main issues addressed by the literature, concerning food marketing and consumer choices, are the following: economic theory; label and packaging; marketing strategies; agriculture and food industry; market segments; social dimensions; brand and branding. In turn, food marketing heavily conditions consumer choices; however, these related instruments are better manipulated by larger companies. In addition, this review highlights that bigger companies have dominant positions in these markets which are not always beneficial to the consumers’ objectives.

Effects of Advertising on Food Consumption Preferences in Children

(1) Background: Childhood obesity is a public health problem. The purpose of this study was to know if exposure to commercial messages which advertise food products exerts any effect on the short-term consumption preferences of 4- to 6-year-old children. (2) Methods: A double-blind and randomized experimental design. Sample consisted of 421 boys and girls from twelve schools in a city in Spain. (3) Results: In three of the four product pairs shown, the products advertised in the intervention were preferred. In the results of applying the model for the first product pair presented, sugared cereals, the predictive variable which best explains the behavior of the preferences expressed is gender (Odds Ratio 0.285 (0.19–0.42); p < 0.05). For the second pair, chocolate cookies, the family’s nationality has a strong weight in the model. As regards the regression model calculated for the last pair (filled rolls), the predictive variable which showed having more influence was gender. Boys had a 1.39 times higher risk of selecting the advertised product than girls. (4) Conclusions: The persuasive effect of commercials has shown to be influential in a general, immediate, and significant way only in the case of products with wide brand awareness. This study reinforces the importance of advertising and emphasizes the need to initiate measures to control the content of TV commercials.

The impact of the Nutri-Score nutrition label on perceived healthiness and purchase intentions

Making healthier food choices easier at the time of purchase is a challenge for public policy makers. The Nutri-Score can be an effective tool for guiding and steering consumers toward more informed, healthier purchasing decisions. This research investigates the impact of the presence of the Nutri-Score and its five categories on consumers' perceived healthiness perceptions and purchase intentions. Consumers in the EU took part in two online experiments, in which they rated products from different categories, with or without Nutri-Scores, in terms of their perceived healthiness and purchase intentions. The presence of the Nutri-Score enabled respondents to assess the healthiness of products better; furthermore, it offers the potential to boost sales of healthy products, without affecting sales of unhealthy products. Perceived healthiness mediates the relationship between Nutri-Score categories and purchase intentions, and focusing on the healthiness of products can give producers a competitive advantage, regardless of whether it is a manufacturer brand or a private label. These findings offer actionable insights for public policy makers and manufacturers; they also suggest the need to embrace the Nutri-Score as the standard front-of-pack label to help fight the increasing obesity pandemic.

Food Marketing in an Obesogenic Environment: a Narrative Overview of the Potential of Healthy Food Promotion to Children and Adults

Purpose of Review

There is abundant evidence that food marketing influences children’s and adults’ food preferences and consumption. As such, exposure to unhealthy food marketing is a widely acknowledged risk factor contributing to the development of overweight and obesity. Less is known about the effects of healthy food promotion on people’s dietary behavior. This narrative review describes research from the past 5 years focused on the effects of healthy food marketing on children’s and adults’ food preferences and dietary intake. Our aim is to gain insight into the potential effects and mechanistic underpinnings of healthy food promotion, thereby building on existing knowledge on underlying mechanisms of the effectiveness of unhealthy food marketing.

Recent Findings

Only a small number of studies directly examined the effects of healthy food promotion on children’s and adults’ dietary behavior. Most studies targeted children’s fruit and/or vegetable intake and used a variety of marketing techniques, ranging from television adverts to social media influencer marketing. Six out of ten studies found a positive effect of healthy food promotion, indicating that healthy food marketing has the potential to influence dietary behavior.

Summary

Food marketing is highly effective in stimulating and reinforcing food consumption, in particular for energy-dense foods. Further investigation and experimentation into the efficiency and effectiveness of healthy food promotion are needed to determine how marketing techniques could be used to improve dietary behavior. The healthy food promotion model provides a framework for future research in this area.