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Robinson E, Polden M, Langfield T, Clarke K, Calvert L, Colombet Z, O'Flaherty M, Marty L, Tapper K, Jones A. Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2023; 20:10. [PMID: 36747247 PMCID: PMC9903416 DOI: 10.1186/s12966-023-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP). METHODS Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups. RESULTS Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041]. CONCLUSIONS Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required. REVIEW REGISTRATION Registered on PROSPERO (CRD42022312532) and OSF ( https://doi.org/10.17605/OSF.IO/W7RDB ).
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Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Megan Polden
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Tess Langfield
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Katie Clarke
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Lara Calvert
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Zoé Colombet
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lucile Marty
- Centre Des Sciences Du Goût Et de L'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - Katy Tapper
- Department of Psychology, City, University of London, London, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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"No Child or Adult Would Ever Probably Choose to Have 16 Teaspoons of Sugar": A Preliminary Study of Parents' Responses to Sugary Drink Warning Label Options. Nutrients 2022; 14:nu14194173. [PMID: 36235825 PMCID: PMC9571345 DOI: 10.3390/nu14194173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Front-of-pack (FoP) warning labels are a viable policy option with the potential to inform consumer choice and assist in reducing sugar-sweetened beverage (SSB) consumption as part of a multi-faceted approach. This study explored parents' perceptions and understanding of a range of SSB warning labels. Focus groups (n = 12) with 82 parents of school-aged children were conducted, stratified according to education level, sex and location. Health effects, exercise equivalents, sugar content (teaspoons in text and pictograms, "high in") and energy content labels were shown. Through thematic analysis we identified three themes. Theme 1 related to perceptions of effectiveness of labels, underpinned by four subthemes: perceptions of labels as credible, informative and useful, personally relevant and having the potential to change be haviour. Theme 2 related to participants finding opportunities for self-exemption (e.g., physically active) and message rejection (e.g., misinterpretation). Theme 3 encompassed the potential negative consequences of some labels (e.g., body image concerns). The text teaspoons label was perceived most favourably across all themes, with minimal negative issues raised. These results provide in-depth insight into potential responses to labelling as a policy intervention, providing important guidance for the development of labels to ensure optimal message content and framing for future testing and subsequent implementation.
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3
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Miller C, Wright K, Dono J, Pettigrew S, Wakefield M, Coveney J, Wittert G, Roder D, Durkin S, Martin J, Ettridge K. "You can't just eat 16 teaspoons of sugar so why would you drink 16 teaspoons' worth of sugar?": a qualitative study of young adults' reactions to sugary drink warning labels. BMC Public Health 2022; 22:1241. [PMID: 35733102 PMCID: PMC9219237 DOI: 10.1186/s12889-022-13648-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Several jurisdictions have introduced nutrient warning front of pack (FoP) labels in an effort to curb consumption of ultra-processed foods and beverages high in free sugars (sugars added to foods and beverages, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates). This study aimed to explore consumer understanding and perceptions of FoP warning labels that convey different nutritional and health information messages regarding the consumption of sugary drinks. Methods Sixteen focus groups were held with 4–8 young adults per group (aged 18–24; n = 105 participants in total) stratified by education level, location (rural centres, large cities) and gender (males, females) to ensure diversity. Labels shown to participants during group discussions included text warning labels of health effects, exercise equivalents, calorie/kilojoule information and sugar content as a “high in” label and as teaspoons (text and pictograms). Thematic analysis was undertaken. Results Four themes were identified related to participants’ perceived effectiveness of labels: the extent to which labels were perceived to be useful, relevant and credible; the extent to which a label elicited shock or disgust (perceived aversiveness); the extent to which the label message was resistant to self-exemption; and participants’ perceived potential of the label to reduce purchasing and consumption behaviour. Across all four themes, labels communicating the number of teaspoons of sugar in a sugary drink (whether by text or pictogram) were perceived as the most impactful, resistant to self-exemption and to have the greatest potential to reduce consumption, with enhanced reactions to the pictogram label. Labels depicting health effects, exercise equivalents, calorie/kilojoule information or a general ‘high in sugar’ warning were perceived by consumers to be less effective in one or more themes. Conclusions Labels conveying the amount of sugar in a beverage in teaspoons were perceived as highly factual, relatable and interpretable, and as having the greatest potential to impact consumption attitudes and intentions. Further quantitative studies are required to compare the potential effectiveness of the teaspoons of sugar labels in reducing purchasing and consumption behaviour than other alternative warning labels, such as health effects or “high in” sugar labels. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13648-1.
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Affiliation(s)
- C Miller
- The University of Adelaide's School of Public Health, Adelaide, Australia. .,Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - K Wright
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
| | - J Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
| | - S Pettigrew
- Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - G Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.,Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - D Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, Australia
| | - S Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Australia
| | - K Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
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4
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Ogundijo DA, Tas AA, Onarinde BA. Age, an Important Sociodemographic Determinant of Factors Influencing Consumers' Food Choices and Purchasing Habits: An English University Setting. Front Nutr 2022; 9:858593. [PMID: 35634371 PMCID: PMC9132226 DOI: 10.3389/fnut.2022.858593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
The purchasing behaviors of university staff (n = 188) and their use of nutrition labels in making food choices were investigated by an online survey. The age of the participants significantly impacted their purchasing behaviors. This effect was not observed with other sociodemographic characteristics studied (level of education, gender, employment status and ethnicity). The impact of age on the extrinsic factors affecting food choice (personal preference, previous knowledge, convenience, religion/beliefs) and intrinsic factors (quantity, country of origin, method of preparation/serving, fat, salt, protein and added sugar contents) were further explored. The use of nutrition labels among different age groups when buying for the first time was significant for breakfast cereals and fruit juices.
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Affiliation(s)
- Daniel A. Ogundijo
- National Centre for Food Manufacturing, University of Lincoln, Holbeach, United Kingdom
- *Correspondence: Daniel A. Ogundijo
| | - Ayten A. Tas
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Bukola A. Onarinde
- National Centre for Food Manufacturing, University of Lincoln, Holbeach, United Kingdom
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5
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Hall MG, Grummon AH, Higgins ICA, Lazard AJ, Prestemon CE, Avendaño-Galdamez MI, Taillie LS. The impact of pictorial health warnings on purchases of sugary drinks for children: A randomized controlled trial. PLoS Med 2022; 19:e1003885. [PMID: 35104297 PMCID: PMC8806063 DOI: 10.1371/journal.pmed.1003885] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/08/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pictorial warnings on tobacco products are promising for motivating behavior change, but few studies have examined pictorial warnings for sugary drinks, especially in naturalistic environments. This study aimed to examine the impact of pictorial warnings on parents' purchases of sugary drinks for their children in a naturalistic store laboratory. METHODS AND FINDINGS Parents of children ages 2 to 12 (n = 325, 25% identifying as Black, 20% Hispanic) completed a shopping task in a naturalistic store laboratory in North Carolina. Participants were randomly assigned to a pictorial warnings arm (sugary drinks displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (sugary drinks displayed a barcode label). Parents selected 1 beverage and 1 snack for their child, as well as 1 household good; one of these items was selected for them to purchase and take home. The primary outcome was whether parents purchased a sugary drink for their child. Secondary outcomes included reactions to the trial labels, attitudes toward sugary drinks, and intentions to serve their child sugary drinks. Pictorial warnings led to a 17-percentage point reduction in purchases of sugary drinks (95% CI for reduction: 7% to 27%), with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm (p = 0.002). The impact of pictorial warnings on purchases did not differ by any of the 13 participant characteristics examined (e.g., race/ethnicity, income, education, and age of child). Pictorial warnings also led to lower calories (kcal), purchased from sugary drinks (82 kcal in the control arm versus 52 kcal in the pictorial warnings arm, p = 0.003). Moreover, pictorial warnings led to lower intentions to serve sugary drinks to their child, feeling more in control of healthy eating decisions, greater thinking about the harms of sugary drinks, stronger negative emotional reactions, greater anticipated social interactions, lower perceived healthfulness of sugary drinks for their child, and greater injunctive norms to limit sugary drinks for their child (all p < 0.05). There was no evidence of difference between trial arms on noticing of the labels, appeal of sugary drinks, perceived amount of added sugar in sugary drinks, risk perceptions, or perceived tastiness of sugary drinks (all p > 0.05). CONCLUSIONS Pictorial warnings reduced parents' purchases of sugary drinks for their children in this naturalistic trial. Warnings on sugary drinks are a promising policy approach to reduce sugary drink purchasing in the US. TRIAL REGISTRATION The trial design, measures, power calculation, and analytic plan were registered before data collection at www.clinicaltrials.gov NCT04223687.
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Affiliation(s)
- Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Isabella C. A. Higgins
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Allison J. Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carmen E. Prestemon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mirian I. Avendaño-Galdamez
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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6
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Ogundijo DA, Tas AA, Onarinde BA. Factors influencing the perception and decision‐making process of consumers on the choice of healthier foods in the United Kingdom: a systematic review using narrative synthesis. Int J Food Sci Technol 2022. [DOI: 10.1111/ijfs.15478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Daniel A. Ogundijo
- National Centre for Food Manufacturing University of Lincoln Holbeach PE12 7LD UK
| | - Ayten A. Tas
- National Centre for Food Manufacturing University of Lincoln Holbeach PE12 7LD UK
| | - Bukola A. Onarinde
- National Centre for Food Manufacturing University of Lincoln Holbeach PE12 7LD UK
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Miller C, Ettridge K, Pettigrew S, Wittert G, Wakefield M, Coveney J, Roder D, Martin J, Brownbill A, Dono J. Warning labels and interpretive nutrition labels: Impact on substitution between sugar and artificially sweetened beverages, juice and water in a real-world selection task. Appetite 2021; 169:105818. [PMID: 34838869 DOI: 10.1016/j.appet.2021.105818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
Effective strategies to reduce free sugar intake are needed. This study examined exposure to a warning label, independently and in conjunction with a Health Star Rating (HSR) label, on the selection of commercially available cold beverages with real decision-making stakes. Participants (N = 511, 47.9% female, mean = 21.7 (SD = 6.1) years) accessed an online convenience store app via an on-campus laptop to select one of 10 beverages (5 sugar-sweetened beverages [SSBs], 1100% fruit juice, 2 artificially sweetened beverages [ASBs] and 2 waters). The task was repeated with the addition of a warning label on high-sugar drinks in Round 2, and the addition of an HSR label on all drinks in Round 3. Participants were informed that they would receive a complementary drink (valued at <$5AUD) based on their selections following the completion of a brief questionnaire. Baseline results indicated that SSBs and waters were the most and least popular choices, respectively. For both males and females, there was a significant decrease in SSB selection (p < 0.001) and significant increase in ASB and water selection (p < 0.001) following the addition of warning labels to high-sugar drinks. The decreased selection of SSBs and increased selection of waters was maintained in Round 3 when HSR labels were added to all drinks. 100% fruit juice selection decreased with the addition of a warning label for females only (p < 0.01), but increased following the addition of a 4-star HSR label, for both males (p < 0.05) and females (p < 0.001). Warning labels reduced young adults' selection of SSBs and promoted substitution to water. The HSR reinforced this effect for the least healthy drinks. Increased water selection may be further enhanced by ensuring that warning label thresholds and HSR algorithms align to present consistent messaging.
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Affiliation(s)
- Caroline Miller
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Kerry Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Simone Pettigrew
- Food Policy, The George Institute for Global Health, Sydney, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia; Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute Adelaide, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - Jane Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Australia
| | - Aimee Brownbill
- Foundation for Alcohol Research and Education, Canberra, Australia
| | - Joanne Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
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8
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Projecting the Influence of Sugar-Sweetened Beverage Warning Labels and Restaurant Menu Labeling Regulations on Energy Intake, Weight Status, and Health Care Expenditures in US Adults: A Microsimulation. J Acad Nutr Diet 2021; 122:334-344. [PMID: 34689957 DOI: 10.1016/j.jand.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 04/01/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accurate, readily accessible, and easy-to-understand nutrition labeling is a promising policy strategy to address poor diet quality and prevent obesity. OBJECTIVE This study projected the influence of nationwide implementation of sugar-sweetened beverage (SSB) warning labels and restaurant menu labeling regulations. DESIGN A stochastic microsimulation model was built to estimate the influences of SSB warning labels and menu labeling regulations on daily energy intake, body weight, body mass index, and health care expenditures among US adults. PARTICIPANTS/SETTING The model used individual-level data from the National Health and Nutrition Examination Survey, Medical Expenditure Panel Survey, and other validated sources. STATISTICAL ANALYSES PERFORMED The model was simulated using the bootstrapped samples, and the means and associated 95% CIs of the policy effects were estimated. RESULTS SSB warning labels and restaurant menu labeling regulations were estimated to reduce daily energy intake by 19.13 kcal (95% CI 18.83 to 19.43 kcal) and 33.09 kcal (95% CI 32.39 to 33.80 kcal), body weight by 0.92 kg (95% CI 0.90 to 0.93 kg) and 1.57 kg (95% CI 1.54 to 1.60 kg), body mass index by 0.32 (95% CI 0.31 to 0.33) and 0.55 (95% CI =0.54 to 0.56), and per-capita health care expenditures by $26.97 (95% CI $26.56 to $27.38) and $45.47 (95% CI $44.54 to $46.40) over 10 years, respectively. The reduced per-capita health care expenditures translated into an annual total medical cost saving of $0.69 billion for SSB warning labels and $1.16 billion for menu labeling regulations. No discernable policy effect on all-cause mortality was identified. The policy effects could be heterogeneous across population subgroups, with larger effects in men, non-Hispanic Black adults, and younger adults. CONCLUSIONS SSB warning labels and menu labeling regulations could be effective policy leverage to prevent weight gains and reduce medical expenses attributable to adiposity.
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Clarke N, Pechey E, Kosīte D, König LM, Mantzari E, Blackwell AK, Marteau TM, Hollands GJ. Impact of health warning labels on selection and consumption of food and alcohol products: systematic review with meta-analysis. Health Psychol Rev 2021; 15:430-453. [PMID: 32515697 PMCID: PMC8635708 DOI: 10.1080/17437199.2020.1780147] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/03/2020] [Indexed: 01/31/2023]
Abstract
Health warning labels (HWLs) could reduce harmful consumption of food (including non-alcoholic drinks) and alcoholic drinks. A systematic review with meta-analysis using Cochrane methods was conducted to assess the impact on selection (including hypothetical selection) or consumption of food or alcoholic drink products displaying image-and-text (sometimes termed 'pictorial') and text-only HWLs. Fourteen randomised controlled trials were included, three for alcohol, eleven for food. For the primary outcomes, eleven studies measured selection and one measured consumption (two measured only other secondary outcomes). Meta-analysis of twelve comparisons from nine studies (n=12,635) found HWLs reduced selection of the targeted product compared with no HWL (RR=0.74 (95%CI 0.68-0.80)), with participants 26% less likely to choose a product displaying a HWL. A planned subgroup analysis suggested a larger (although not statistically significant) effect on selection of image-and-text HWLs (RR=0.65 (95%CI 0.54-0.80)) than text-only HWLs (RR=0.79 (95%CI 0.74-0.85)). These findings suggest significant potential for HWLs to reduce selection of food and alcoholic drinks, but all experimental studies to date were conducted in laboratory or online settings with outcomes assessed immediately after a single exposure. Studies in field and naturalistic laboratory settings are needed to estimate the potential effects of food and alcohol HWLs.Study registration: PROSPERO 2018 (registration number: CRD42018106522).
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Daina Kosīte
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Laura M. König
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Eleni Mantzari
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Anna K.M. Blackwell
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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10
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Pechey R, Sexton O, Codling S, Marteau TM. Impact of increasing the availability of healthier vs. less-healthy food on food selection: a randomised laboratory experiment. BMC Public Health 2021; 21:132. [PMID: 33517908 PMCID: PMC7849186 DOI: 10.1186/s12889-020-10046-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background Environmental cues shape behaviour, but few studies compare the impact of targeting healthier vs. less-healthy cues. One online study suggested greater impact on selection from increasing the number of less-healthy (vs. healthier) snacks. The current study aimed to: (1) extend the previous study by using physically-present snacks for immediate consumption; (2) explore responsiveness by socio-economic position; (3) investigate possible mediators (response inhibition, food appeal) of any socio-economic differences in selection. Methods In a between-subjects laboratory experiment UK adults (n = 417) were randomised according to their ID number (without blinding) to one of three ranges of options: Two healthier, two less-healthy [“Equal”] (n = 136); Six healthier, two less-healthy [“Increased Healthier”] (n = 143); Two healthier, six less-healthy [“Increased Less-Healthy”] (n = 138). Participants completed measures of response inhibition and food appeal, and selected a snack for immediate consumption from their allocated range. The primary outcome was selection of a healthier (over less-healthy) snack. Results The odds of selecting a less-healthy snack were 2.9 times higher (95%CIs:1.7,5.1) in the Increased Less-Healthy condition compared to the Equal condition. The odds of selecting a healthier snack were 2.5 times higher (95%CIs:1.5,4.1) in the Increased Healthier (vs. Equal) condition. There was no significant difference in the size of these effects (− 0.2; 95%CIs:-1.1,0.7). Findings were inconclusive with regard to interactions by education, but the direction of effects was consistent with potentially larger impact of the Increased Healthier condition on selection for higher-educated participants, and potentially larger impact of the Increased Less-Healthy condition for less-educated participants. Conclusions A greater impact from increasing the number of less-healthy (over healthier) foods was not replicated when selecting snacks for immediate consumption: both increased selections of the targeted foods with no evidence of a difference in effectiveness. The observed pattern of results suggested possible differential impact by education, albeit not statistically significant. If replicated in larger studies, this could suggest that removing less-healthy options has the potential to reduce health inequalities due to unhealthier diets. Conversely, adding healthier options could have the potential to increase these inequalities. Trial registration ISRCTN: ISRCTN34626166; 11/06/2018; Retrospectively registered.
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Affiliation(s)
- Rachel Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK. .,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Olivia Sexton
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Saphsa Codling
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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11
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Schubert E, Smith E, Brydevall M, Lynch C, Ringin E, Dixon H, Kashima Y, Wakefield M, Bode S. General and specific graphic health warning labels reduce willingness to consume sugar-sweetened beverages. Appetite 2021; 161:105141. [PMID: 33524439 DOI: 10.1016/j.appet.2021.105141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/05/2020] [Accepted: 01/22/2021] [Indexed: 11/25/2022]
Abstract
Sugar-sweetened beverage (SSB) consumption is associated with obesity and other severe negative health consequences. The present study examined the effectiveness of two types of health warning labels (HWLs) in modulating dietary choices for SSBs: specific HWLs, presenting health consequences associated with consuming SSBs, and general HWLs, presenting health consequences of an unhealthy diet and obesity. While electroencephalography (EEG) was recorded, 63 participants completed a computer-based task in which they were first randomly allocated to view either SBB-specific, general, or non-warning control HWLs. They then viewed images of a range of SSB products, varying on perceived healthiness and tastiness, and rated their willingness to consume (WTC) each one. Linear mixed-effect model analyses revealed that general and specific HWLs both decreased WTC SSBs perceived as tasty, compared to the control condition. For general HWLs, this effect was reduced for SSBs perceived to be healthy, suggesting that specific HWLs may be more effective at reducing SSB consumption. The EEG data showed that SSBs considered unhealthy elicited greater N1 amplitudes, and tasty SSBs elicited greater late positive potential (LPP) amplitudes, possibly reflecting attentional allocation and craving responses, respectively. However, no strong differences between HWL types were found. Taken together, the results suggest that graphic HWLs, both general and specific, have the potential to reduce SSB consumption, but they do not strongly modulate craving-related neural responses to SSBs.
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Affiliation(s)
- Elektra Schubert
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Emma Smith
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Maja Brydevall
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Carmen Lynch
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Elysha Ringin
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Australia
| | - Yoshihisa Kashima
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Australia
| | - Stefan Bode
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
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12
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Scapin T, Fernandes AC, Curioni CC, Pettigrew S, Neal B, Coyle DH, Rodrigues VM, Bernardo GL, Uggioni PL, Proença RPC. Influence of sugar label formats on consumer understanding and amount of sugar in food choices: a systematic review and meta-analyses. Nutr Rev 2020; 79:788-801. [PMID: 33313917 DOI: 10.1093/nutrit/nuaa108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Reducing population intakes of sugar has become a focus of many national and international public health policies. Packaged foods and beverages are key contributors to sugar intakes, and food labels can be an effective tool to reduce sugar consumption. OBJECTIVE The aim of this systematic review was to examine the influence of sugar label formats on 2 outcomes: consumers' understanding of sugar information, and the amount of sugar in consumers' food choices. DATA SOURCES Scopus, Web of Science, PubMed, CAB Abstracts, SciELO, and the Cochrane Library databases were searched up until February 4, 2020. STUDY SELECTION Randomized experiments or quasi-experiments were included if they investigated the influence of sugar label formats on consumers' understanding of sugar information or on the amount of sugar in consumers' food choices. DATA EXTRACTION Data were extracted independently by 2 authors. Mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs) plus 95%CIs were used to describe between-group differences for intervention label formats using random-effects models. RESULTS Twenty-three studies, which examined 39 comparisons, were included. Label formats using "high in sugar" interpretative texts (traffic light labels [MD 41.6; 95%CI 37.9-45.4] and warning signs [OR 1.33; 95%CI 1.0-1.78]) were most effective in increasing consumers' understanding of the sugar content in packaged foods. Health warning messages (SMD -0.32; 95%CI -0.43 to -0.22), graphical depictions of sugar content in teaspoons (SMD -0.32; 95%CI -0.48 to -0.17), and warning signs (SMD -0.24; 95%CI -0.35 to -0.13) were most effective for influencing consumers to choose products with lower sugar content. CONCLUSIONS Formats that provide an interpretation of sugar information, particularly those indicating if a product is high in sugar, were more helpful than only numerical information for improving consumer understanding and promoting food choices with less sugar. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42018081222.
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Affiliation(s)
- Tailane Scapin
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ana C Fernandes
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Cintia C Curioni
- Department of Social and Applied Nutrition, Institute of Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Simone Pettigrew
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Daisy H Coyle
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Vanessa M Rodrigues
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Greyce L Bernardo
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Paula L Uggioni
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Rossana P C Proença
- Nutrition Postgraduate Program, Nutrition in Foodservice Research Centre (NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
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13
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Leung CW, Wolfson JA, Hsu R, Soster K, Mangan S, Falbe J. Warning Labels Reduce Sugar-Sweetened Beverage Intake among College Students. J Nutr 2020; 151:179-185. [PMID: 33245125 PMCID: PMC7779215 DOI: 10.1093/jn/nxaa305] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/24/2020] [Accepted: 09/15/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Health-related warning labels may reduce the intake of sugar-sweetened beverages (SSBs), but the effectiveness of such labels in real-world settings is not well established. OBJECTIVES We investigated the influence of warning labels on SSB intake among college students at a large public Midwestern university. METHODS We conducted a quasi-experimental intervention study among 840 undergraduate students recruited from 3 dining halls on 1 university campus. One dining hall was selected as the intervention (I) site, whereas the other dining halls served as control (C) sites. In January 2019, warning labels were posted on SSB dispensers at the I site. All students reported their beverage intake using a modified beverage frequency questionnaire 2 mo before and 2 mo after the warning label implementation. Generalized linear models examined the influence of the warning labels on SSB consumption at the I site compared with the C sites, adjusting for students' sociodemographic characteristics. RESULTS In the sample, 68% were aged 17-18 y old at baseline, and 51% identified as female. From baseline to follow-up, there was a 19% decrease in SSB intake at the I site, compared with a 5% decrease at the C sites (P = 0.049 comparing I with C). This difference was driven by significant decreases in the intakes of fruit-flavored drinks, sweetened teas, and flavored milk at the I site compared with the C sites. Although not an SSB, 100% fruit juce consumption decreased 21% at the I site, compared with a 1% increase at the C sites (P = 0.01 comparing I with C). No significant differences were observed in the intakes of soda, energy drinks, sweetened coffees, and nonsugary drinks at the I site compared with the C sites. CONCLUSIONS Warning labels were effective in reducing SSB intake among college students, particularly for fruit-flavored drinks, sweetened teas, and flavored milk.This trial was registered at clinicaltrials.gov as NCT04435145.
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Affiliation(s)
| | - Julia A Wolfson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Robert Hsu
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Keith Soster
- Michigan Dining, University of Michigan, Ann Arbor, MI, USA
| | - Steve Mangan
- Michigan Dining, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, Davis, CA, USA
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14
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Gupta A, Billich N, George NA, Blake MR, Huse O, Backholer K, Boelsen-Robinson T, Peeters A. The effect of front-of-package labels or point-of-sale signage on consumer knowledge, attitudes and behavior regarding sugar-sweetened beverages: a systematic review. Nutr Rev 2020; 79:1165-1181. [DOI: 10.1093/nutrit/nuaa107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Context
Globally, the use of labels or signage targeting SSBs remains in its infancy and there is limited evidence available regarding its ability to decrease purchase and consumption of SSBs.
Objective
This systematic review aimed to synthesize the evidence on the effect of sugar- or health-related sugar-sweetened beverage (SSB) warning labels or signage on knowledge, attitudes, and beliefs, and SSB purchase and consumption.
Data sources
Nine databases – Ovid Medline, Emerald Insight, Scopus, Informit, Business Source Complete, CINAHL, Global Health, PsychINFO, and SocIndex – were searched along with grey literature from inception to December 2019. The PRISMA guidelines were applied for reporting this systematic review.
Study Selection
Studies examining the impact of front of pack (FOP) labels and/or point of sale (POS) signage highlighting added sugar content or its health risks were included.
Data extraction
Two authors independently extracted data on items, including study details, study design, population characteristics, intervention label details (type, duration, and settings), and outcomes measures. The Effective Public Health Practice Project tool was used to assess the study quality.
Data analysis
Findings were synthesized narratively.
Results
Twenty-one studies published between 1992 and 2019 were included. Of these, 16 studies examined the impact of FOP labels and 5 studies examined the impact of POS signage. Both FOP labels and POS signage were associated with improved health knowledge, attitudes, and beliefs regarding SSBs and reduced SSB purchases. Warning labels with diet-related health consequences were found to be particularly effective. Overall quality of studies was assessed as mixed.
Conclusion
Health- or sugar-related FOP labels and POS signage for SSBs are promising public health measures and may improve consumers’ health behaviors toward reduced SSB purchase and consumption.
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Affiliation(s)
- Adyya Gupta
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Melbourne, Burwood, Victoria, Australia
- N. Billich is with the Department of Nutrition Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Natassja Billich
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Melbourne, Burwood, Victoria, Australia
- N. Billich is with the Department of Nutrition Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
- The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Neetu Abey George
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Melbourne, Burwood, Victoria, Australia
- N. Billich is with the Department of Nutrition Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Miranda R Blake
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Melbourne, Burwood, Victoria, Australia
- N. Billich is with the Department of Nutrition Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Oliver Huse
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Melbourne, Burwood, Victoria, Australia
- N. Billich is with the Department of Nutrition Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Kathryn Backholer
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Melbourne, Burwood, Victoria, Australia
- N. Billich is with the Department of Nutrition Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Tara Boelsen-Robinson
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Melbourne, Burwood, Victoria, Australia
- N. Billich is with the Department of Nutrition Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
- The University of Sydney, The Boden Collaboration, Charles, Perkins Centre, New South Wales, Australia
| | - Anna Peeters
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Melbourne, Burwood, Victoria, Australia
- N. Billich is with the Department of Nutrition Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
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Abstract
BACKGROUND Policymakers worldwide are considering requiring warnings for sugary drinks. A growing number of experimental studies have examined sugary drink warnings' impacts, but no research to our knowledge has synthesized this literature. To inform ongoing policy debates, this study aimed to identify the effects of sugary drink warnings compared with control conditions. METHODS AND FINDINGS We systematically searched 7 databases on June 21, 2019, and October 25, 2019. We also searched reference lists of relevant articles. Two investigators independently screened titles, abstracts, and full texts to identify peer-reviewed articles that used an experimental protocol to examine the effects of sugary drink warnings compared to a control condition. Two investigators independently extracted study characteristics and effect sizes from all relevant full-text articles. We meta-analyzed any outcome assessed in at least 2 studies, combining effect sizes using random effects meta-analytic procedures. Twenty-three experiments with data on 16,241 individuals (mean proportion female, 58%) were included in the meta-analysis. Most studies took place in Latin America (35%) or the US or Canada (46%); 32% included children. Relative to control conditions, sugary drink warnings caused stronger negative emotional reactions (d = 0.69; 95% CI: 0.25, 1.13; p = 0.002) and elicited more thinking about the health effects of sugary drinks (d = 0.65; 95% CI: 0.29, 1.01; p < 0.001). Sugary drink warnings also led to lower healthfulness perceptions (d = -0.22; 95% CI: -0.27, -0.17; p < 0.001) and stronger disease likelihood perceptions (d = 0.15; 95% CI: 0.06, 0.24; p = 0.001). Moreover, sugary drink warnings reduced both hypothetical (d = -0.32; 95% CI: -0.44, -0.21; p < 0.001) and actual consumption and purchasing behavior (d = -0.17; 95% CI: -0.30, -0.04; p = 0.012). Statistically significant effects were not observed for perceptions of added sugar or positive sugary drink attitudes (p's > 0.10). Moderation analyses revealed that health warnings (e.g., "Beverages with added sugar contribute to obesity") led to greater reductions in hypothetical sugary drink purchases than did nutrient warnings (e.g., "High in sugar"; d = -0.35 versus -0.18; Qb = 4.04; p = 0.04). Limitations of this study include that we did not review grey literature and that we were unable to conduct moderation analyses for several prespecified moderators due to an insufficient number of studies. CONCLUSIONS This international body of experimental literature supports sugary drink warnings as a population-level strategy for changing behavior, as well as emotions, perceptions, and intentions. PROTOCOL REGISTRY PROSPERO ID 146405.
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16
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Hallez L, Qutteina Y, Raedschelders M, Boen F, Smits T. That's My Cue to Eat: A Systematic Review of the Persuasiveness of Front-of-Pack Cues on Food Packages for Children vs. Adults. Nutrients 2020; 12:E1062. [PMID: 32290522 PMCID: PMC7230775 DOI: 10.3390/nu12041062] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 02/01/2023] Open
Abstract
Packaging is increasingly recognized as an essential component of any marketing strategy. Visual and informational front-of-pack cues constitute salient elements of the environment that may influence what and how much someone eats. Considering their overwhelming presence on packaging of non-core foods, front-of-pack cues may contribute to the growing rates of overweight and obesity in children and adults. We conducted a systematic review to summarize the evidence concerning the impact of front-of-pack cues on choices and eating behaviors. Four electronic databases were searched for experimental studies (2009-present). This resulted in the inclusion of 57 studies (in 43 articles). We identified studies on children (3-12 years) and adults (≥ 18 years), but no studies on adolescents (12-18 years). The results suggest that children and adults are susceptible to packaging cues, with most evidence supporting the impact of visual cues. More specifically, children more often choose products with a licensed endorser and eat more from packages portraying the product with an exaggerated portion size. Adults' eating behaviors are influenced by a range of other visual cues, mainly, package size and shape, and less so by informational cues such as labels.
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Affiliation(s)
- Lotte Hallez
- Institute for Media Studies, KU Leuven, 3000 Leuven, Belgium; (L.H.); (Y.Q.); (M.R.)
| | - Yara Qutteina
- Institute for Media Studies, KU Leuven, 3000 Leuven, Belgium; (L.H.); (Y.Q.); (M.R.)
| | - Maxime Raedschelders
- Institute for Media Studies, KU Leuven, 3000 Leuven, Belgium; (L.H.); (Y.Q.); (M.R.)
| | - Filip Boen
- Physical Activity, Sports & Health Research Group, KU Leuven, 3001 Leuven, Belgium;
| | - Tim Smits
- Institute for Media Studies, KU Leuven, 3000 Leuven, Belgium; (L.H.); (Y.Q.); (M.R.)
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