An 18-country analysis of the effectiveness of five front-of-pack nutrition labels

The impact of nutri-score on consumers' preferences for geographical indications. Evidence from a non-hypothetical experiment

The EU Farm to Fork strategy (F2F) promotes the compulsory adoption of a nutritional front of pack label to improve the diets of the citizens, supporting healthier food choices. In the public debate, Nutri-Score (NS) is the most favored candidate. Although being widely supported, oppositions on the political and producer levels are raised against the NS, due to the economic impact it could have on specific food sector, and specifically on Geographical Indications (GIs). Recent literature has stressed the need to explore it in more detail. The current study contributes to fill this gap by analyzing consumers' monetary preferences for GI products labelled with different NS levels. An incentivized non-hypothetical experiment was conducted on 188 Italian consumers. Different products representing different levels of NS were used. Specifically, a conventional pasta and the Pasta di Gragnano PGI (NS = A), a conventional flatbread (piadina) and the Piadina Romagnola PGI (NSC), and a conventional hard cheese and the Parmigiano Reggiano PDO (NS = D) were considered in the survey. Results reveal that the NS elicits favorable responses and unfavorable reactions in consumers' preferences, aligning with expectations for A and D scores, respectively. The perceived healthiness of the product significantly affects consumers' WTP, increasing it. Results stress the need to have effective communication strategies within the EU to reach the F2F goals. NS diminishes the premium in prices associated with GIs independently from its level, when considering those consumers who value more the GIs. However, the most well-known GIs does not suffer from this negative effect of the NS, as the positive value associated to the GI offset the negative effect of the NS.

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

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

The Ability of Nutrition Warning Labels to Improve Understanding and Choice Outcomes Among Consumers Demonstrating Preferences for Unhealthy Foods

BACKGROUND

Given growing interest in warning labels as a form of front-of-pack nutrition label, it is important to better understand the mechanisms via which these labels may exert their effects, especially among those making suboptimal food choices.

OBJECTIVE

The study aim was to assess the extent to which consumers with the weakest outcomes for objective understanding and choice in no-label conditions were able to improve their understanding and choices after exposure to warning labels on food product options.

DESIGN

Post-hoc analyses of the cross-sectional FOP-ICE (Front-of-Pack International Comparative Experimental) study data generated from an online survey that included simulated food choice and nutritional quality ranking scenarios.

PARTICIPANTS/SETTING

Participants included 3,680 adults from the following 18 countries: Argentina, Australia, Belgium, Bulgaria, Canada, Denmark, France, Germany, Italy, Mexico, Netherlands, Poland, Portugal, Singapore, Spain, Switzerland, United Kingdom, and United States.

INTERVENTION

Survey respondents selected their preferred product options and ranked foods according to their healthiness before and after exposure to mock breakfast cereal, cake, and pizza products displaying warning labels.

MAIN OUTCOME MEASURES

Objective understanding and food choice were measured.

STATISTICAL ANALYSES PERFORMED

Within each product category, analyses were conducted on respondents who initially incorrectly identified the healthiest option and/or selected the unhealthiest option as their preferred choice. Significant differences between proportions selecting each understanding and choice response option were assessed using 2-sample z tests for proportions.

RESULTS

Salience of the warning labels was low; 46% reported noticing the labels while completing the survey. Just over one-third of those aware of the presence of warning labels were able to identify the least healthy option in the post-exposure condition. Approximately one-half reselected the least healthy option post exposure and just over one-fourth switched to the healthiest option.

CONCLUSIONS

The results indicated that warning labels can assist some consumers to improve their food quality assessments and choices. However, design improvements could enhance the salience and interpretability of this label format.

Do Brazilian consumers intend to use food labels to make healthy food choices? An assessment before the front-of-package labelling policy

Front-of-package labelling is a measure that can facilitate consumption of healthier foods. This study examined the predictors of consumers' intentions to use food labelling to make healthy food choices and prevent non-communicable diseases before the implementation of the front-of-package labelling policy in Brazil. An extended theory of planned behaviour incorporating knowledge and food literacy served as the theoretical foundation. First, experts (n = 6) and the target population (n = 30) validated the questionnaire, and the validation data were analysed using content validity coefficients (CVC). An online questionnaire was administered to 783 participants, and data were collected between May and October 2022. Partial least squares structural equation modelling (PLS-SEM) was used to test the prediction hypothesis. The questionnaire showed adequate content validity, with all indicators of CVC ≥ 0.75. In the PLS-SEM attitudes (p < 0.001), subjective norms (p < 0.001), knowledge (p < 0.001), and food literacy (p < 0.001) positively predicted the intention to use food labels to make healthy food choices, confirming the main hypothesis. Also, Food literacy and knowledge predicted all constructs of the theory of planned behaviour (p < 0.001). The results highlight the importance of providing nutritional knowledge and food literacy, developing nutritional skills and abilities to encourage consumers to make healthy food choices, and to strengthen other policies such as front-of-package labelling.

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

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

A 20-Country Comparative Assessment of the Effectiveness of Nutri-Score vs. NutrInform Battery Front-of-Pack Nutritional Labels on Consumer Subjective Understanding and Liking

The incidence of overweight and obesity has generated significant concerns among European consumers and institutions. As part of a set of measures undertaken, the European Union (EU) called for one harmonized mandatory front-of-pack nutritional label (FOPL) to improve consumer food nutritional knowledge and encourage healthier and more informed food choices. Different types of FOPLs, ranging from nutrient-specific labels-such as the NutrInform Battery-to summary labels-such as the Nutri-Score-have been developed and introduced in different markets, reporting different degrees of effectiveness in terms of understanding. The aim of this study is to provide actionable insights by analyzing a specific part of the complex consumers' decision-making process in food when aided by FOPLs. Adopting a between-subject experiment on a sample of 4560 respondents in 20 EU member countries, the study compares the consumer subjective understanding and liking of two labels currently under examination by the EU bodies, the NutrInform Battery and the Nutri-Score. At an aggregated level, the results show that NutrInform Battery is more effective than Nutri-Score in improving consumer subjective understanding and leads to a higher liking towards the label. A detailed by-country analysis highlights either a superiority or a parity of NutrInform Battery for subjective understanding and liking. Theoretically, this study, through a large panel of respondents, adds the fundamental perspective on subjective understanding, complementing the findings of extant research on objective understanding, and further clarifies the role of liking as a complementary element in the food decision-making process toward heathier and more informed food choices. This might be of significant relevance in providing additional evidence that can be used by policymakers in their attempt toward the selection of a uniform FOPL at EU level.

Front-of-Pack Nutrition Labels: Comparing the Nordic Keyhole and Nutri-Score in a Swedish Context

The extent to which different front-of-pack nutrition labels (FOPNLs) agree or contradict each other has been insufficiently investigated. Considering the 2020 proposal from the European Commission to create a harmonized FOPNL, the aim of this study was to assess agreements and disagreements between two FOPNL schemes-the Keyhole and the Nutri-Score-in a Swedish context. The current Keyhole criteria and the updated Nutri-Score 2022 algorithm were applied to 984 food items and their nutrient compositions, obtained from the food database of the Swedish Food Agency. Agreements (Keyhole-eligible and Nutri-Score A or B; or not Keyhole-eligible and Nutri-Score C, D, or E) and disagreements (Keyhole-eligible and Nutri-Score C, D, or E, or not Keyhole-eligible and Nutri-Score A or B) were calculated as percentages for all items and by food group. An agreement was found for 81% of included items. The lowest level of agreement was found for the groups of flour, grains, and rice (62% agreement) and for plant-based meat and fish analogues (33% agreement). There is generally a good level of agreement between the Keyhole and the Nutri-Score for food items on the Swedish market. Large disagreements found for plant-based meat and fish analogues, and products based on cereals/grains, highlight important considerations for the development of a harmonized FOPNL within Europe.

Front-of-pack nutrition labels: an equitable public health intervention

It is important for nutrition interventions to be equitable to ensure they do not widen socioeconomic health-based inequalities. The role of front-of-pack nutrition labels is to provide accessible and easily understood information on product packages, and it is essential that such labels assist those who are least able to access and interpret other forms of nutrition information. This secondary analysis of the FOP-ICE food labelling study involving 18 countries (N = 18,393) assessed whether five different front-of-pack labels varied in effectiveness according to income status. The two outcome variables were objective understanding of products' nutritional quality and product choice. While there were substantial differences in the ability of individual labels to improve understanding, for each label and across all labels combined there were no significant differences in changes in both outcome variables by income category. The results provide evidence that interpretive front-of-pack nutrition labels are an equitable and useful nutrition intervention.

Uncovering the Effect of European Policy-Making Initiatives in Addressing Nutrition-Related Issues: A Systematic Literature Review and Bibliometric Analysis on Front-of-Pack Labels

The last decades have been marked by the introduction of front-of-pack labels (FoPL) as an institutional corrective action against obesity and nutrition-related illnesses. However, FoPL-related policy-making initiatives issued by the European Union evolved over time and led to a diversity of labels with different effects on consumers’ decisions. As a result, the extant literature adapted to the regulative scenario over the years and investigated the effects of the labels, creating consensus on some topics while being fragmented on others. Similarly, policy-makers adapted some regulations to the evidence supported by the research. With the aim to systematize the overall structure and evolution of the literature on FoPL, investigate the presence of a consensus on specific topics through a co-citation analysis, and examine the evolution of the consensus and co-citation networks over the years and potential research gaps, we report the results of bibliometric and co-citation analyses and a systematic literature review involving 170 papers and a selection of 49 articles published in the last months, for a total of 219 articles, analysed according to three timespans (Period 1 (1989–2011); Period 2 (2012–2016) and Period 3 (2017–2022)). Our findings highlight the interplay of policy development and FoPL research, the presence of few self-reinforcing and well-established co-citation networks based on validated evidence in the literature and the presence of alternative emerging theories that offer different and valid perspectives overlooked by mainstream co-citation research networks.