Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases-A Randomised Controlled Trial.

Bruce Neal, Michelle Crino, Elizabeth Dunford, Annie Gao, Rohan Greenland, Nicole Li, Judith Ngai, Cliona Ni Mhurchu, Simone Pettigrew, Gary Sacks, Jacqui Webster, Jason HY Wu

Journal: Nutrients 2018;9(12):1284

PMID: 29186803

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Plain Language Summary

Nutrition labelling on the front of packaged food is a policy tool to help promote healthier food choices. Current research on the effectiveness of package labelling food-purchasing behaviour is both limited and mixed in results. The aim of this large-scale randomised trial was to compare Australia's new Health Star Rating (HSR) with five other front-of-pack labelling schemes with a focus on usability and impact on food choices. The 1578 participants were randomised to one of six experimental groups or the control group and food purchases were tracked by a smartphone application for four weeks. This study demonstrated that the HSR system was as good as other front-of-pack labelling schemes in many outcomes, and superior in terms of usefulness, however there was no evidence to show HSR improved food purchasing behaviour. Based on these results, the authors conclude that various package labelling systems are effective and HSR is one they would recommend.

Abstract

BACKGROUND

Front-of-pack nutrition labelling may support healthier packaged food purchases. Australia has adopted a novel Health Star Rating (HSR) system, but the legitimacy of this choice is unknown.

OBJECTIVE

To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions.

DESIGN

Individuals were assigned at random to access one of four different formats of nutrition labelling-HSR, multiple traffic light labels (MTL), daily intake guides (DIG), recommendations/warnings (WARN)-or control (the nutrition information panel, NIP). Participants accessed nutrition information by using a smartphone application to scan the bar-codes of packaged foods, while shopping. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks.

RESULTS

The 1578 participants, mean age 38 years, 84% female recorded purchases of 148,727 evaluable food items. The mean healthiness of the purchases in the HSR group was non-inferior to MTL, DIG, or WARN (all < 0.001 at 2% non-inferiority margin). When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; = 0.04). HSR was perceived by participants as more useful than DIG, and easier to understand than MTL or DIG (all < 0.05). Participants also reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all < 0.03).

CONCLUSIONS

These real-world data align with experimental findings and provide support for the policy choice of HSR. Recommendation/warning labels warrant further exploration, as they may be a stronger driver of healthy food purchases.

Address: The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia; The Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; Royal Prince Alfred Hospital, University of New South Wales, Sydney, NSW 2050, Australia; Department of Epidemiology and Biostatistics, Imperial College London, London SW7 2AZ, UK; The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia; The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA; National Heart Foundation of Australia, Melbourne, VIC 3000, Australia; Bupa, Brisbane, QLD 4001, Australia; National Institute for Health Innovation, University of Auckland, Auckland 1010, New Zealand; School of Psychology and Speech Pathology, Curtin University, Bentley, WA 6102, Australia; School of Health and Social Development, Deakin University, Melbourne, VIC 3008, Australia

DOI: 10.3390/nu9121284

Patient Centred Factor

Mediators: Labelling

Physical Environment

Psychosocial influences

Clinical Imbalances

Gastro-intestinal

Allocation Concealment

Yes

Nutrition Evidence Keywords

Health education Nutrition labels Front of package labelling Smartphone applications

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https://scite.ai/reports/29186803

MeSH Terms: Adult, Australia, Choice Behavior, Consumer Behavior, Diet, Healthy, Double-Blind Method, Female, Follow-Up Studies, Food Labeling, Food Preferences, Health Behavior, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Mobile Applications, Recommended Dietary Allowances, Smartphone, Socioeconomic Factors, Treatment Outcome