Nutrition and health claims on healthy and less-healthy packaged food products in New Zealand

The Impact of Time on Nutrition and Health Claims on the Irish Marketplace

Since the implementation of Regulation (EC) No 1924/2006 on nutrition and health claims (NHCR) made on food, only 261 health claims have been authorised, suggesting that the regulation creates challenges for the food industry. This study looks at the prevalence of nutrition and health claims labelled on food on the Irish market. Specifically, we compared their prevalence in 2009 with those present on the marketplace in 2022. Food labels of defined food categories were examined in three nationwide supermarkets in Ireland, and data of claims made on these labels were collected. A series of statistical analyses was conducted to compare the results from 2021 with those of 2009. In 2021, around half of the examined products (52.8%) displayed at least one nutrition claim, showing no significant difference with the data collected in 2009 (53.5%). Individual categories, however, did exhibit changes between the two time points. The prevalence of health claims on food has decreased from 21.6% in 2009 to 10.5% in 2021. There will always be a time lag between when a regulation is enacted and what its true impact can be measured. This study provides these data for the impact of time on EU Regulation 1924/2006 on the Irish market.

The influence of the Nutri-Score on the perceived healthiness of foods labelled with a nutrition claim of sugar

High sugar intake in humans is associated with the development of overweight and other diet-related diseases. The World Health Organization and other health organizations recommend limiting the sugar intake to 10% of the total energy intake. There have been different approaches of front-of-pack labelling to reduce the amount of sugar in food products. Companies use nutrition claims to advertise the sugar content (e.g., without added sugar, 30% less sugar). Such nutrition claims can lead to false assumptions about the healthiness of foods and can lead to health-halo effects. Nutrition claims make products appear healthier than they really are, the aspect advertised in the nutrition claim is transferred to the entire food product. As a result, food products can be perceived as healthy even though they are not. Recently, the Nutri-Score was introduced in an increasing number of countries throughout Europe to provide consumers with an overview of the overall nutritional quality of a product. This study analyzes if the Nutri-Score can help to prevent health-halo effects caused by nutrition claims on sugar. Therefore, an online survey consisting of a split-sample design with more than 1,000 respondents was assessed. The results show that, depending on the initial perceived healthiness of a product, the Nutri-Score is able to prevent health-halo effects caused by claims on sugar. Making the Nutri-Score mandatory when using nutrition claims would be one possible way to reduce misperceptions about unhealthy food and reduce health-halo effects caused by claims on sugar.

The Source of Protein or Its Value? Consumer Perception Regarding the Importance of Meat(-like) Product Attributes

Food product attributes may significantly influence the general perception of the product itself, as well as the willingness for its consumption. Assessment of the product is based on customers’ beliefs and individual preferences. Because meat-like products are presented as meat substitutes providing sufficient protein values, the present study aimed to determine the effect of protein source and labelling pointing at high protein content on the evaluation of the product. The experimental online study was conducted with a group of 552 respondents. Four versions of product packaging were designed and tested. These packages differed in the presence or absence of the Nutrition Claim and the presence of the text indicating the vegetable or meat origin of the product. Data collected in the experiment were analyzed using a 2 × 2 ANOVA. The study revealed that the source of protein (plant vs. animal) appears to shape consumers’ perception of the product as more eco-friendly (F (1.518) = 38.681, p < 0.001, η2 = 0.069), natural (F (1.518) = 15.518, p < 0.001, η2 = 0.029), and healthy (F (1.518) = 25.761, p < 0.001, η2 = 0.047). Moreover, labelling including a “high-protein” Nutrition Claim increases the willingness to consume the product (F (1.518) = 4.531, p = 0.034, η2 = 0.009), and provides the impression of it being more eco-friendly (F (1.518) = 6.658, p = 0.01, η2 = 0.012) and of a higher quality (F (1.518) = 7.227, p = 0.007, η2 = 0.014). The obtained results may have theoretical significance by improving the understanding of factors determining the perception of food products and the use of meat substitutes.

The compliance of nutrition claims on pita bread in Lebanon and risk on public health: a cross-sectional study

Background

Mislabeling is a type of fraud, that can lead to major health concerns, especially when used on staple foods like bread. This study aimed to assess the compliance of nutrition claims on pre-packaged Pita bread in Mount Lebanon with national (LIBNOR; NL 661:2017) and international (CODEX; CAC/GL -2–1985) standards.

Methods

A cross-sectional study was conducted and Lebanese bread samples (n = 75) were collected from all the registered bakeries in Mount Lebanon directorate (n = 25). The claim compliance assessment was based on values of the nutrition facts panel and standard nutrient analyses, following official methods.

Results

Of all assessed breads, 84% carried nutrition claims, and 25.3% carried health claims. Among nutrition claims, 70.7% had non-addition claims, 56.0% had nutrient content claims, and 1.3% had comparative claims. The results showed a high prevalence of nutrition claims with majority non-compliant. Based on the nutrition facts panel, only 32.4% of the sugar related claims, 45.5% of the fiber claims, and 54.4% of salt claims were eligible to make those statements. Based on the chemical nutrient analyses, only 47.0% of sugar claims, 16.1% of fiber claims, and 37.5% of salt claims were compliant. All the claims related to protein (n = 7) were compliant.

Conclusions

These results suggest the urgent need to develop clear guidelines for the effective implementation of the current standard; in order to prevent mislead consumers from making poor decisions at the point-of-sale, which might affect their overall health and efforts towards proper nutrition.

"It's All Just Marketing", a Qualitative Analysis of Consumer Perceptions and Understandings of Nutrition Content and Health Claims in New Zealand

Nutrition content and health claims are widely used globally on both food labels and in food advertising. This study explored how New Zealand consumers understand, perceive, and use nutrition content and health claims on food labels. A qualitative approach was used with semi-structured in-depth online interviews and in-person focus groups including 49 participants, aged ≥25 years responsible for household food shopping. Transcripts were analysed using reflexive thematic analysis using inductive coding, with development of five themes—(1) aware of claims but did not use, (2) mistrust and scepticism, (3) confusion and misinterpretation, (4) using claims to guide food choice, and (5) not all claims are equal. For theme 1, price and habit were found to be the most influential in driving food choice. Underlying theme 2 was the perception by most of nutrition and health claims as marketing. Scepticism was exacerbated when nutrient claims were displayed on inherently unhealthy products. However participants with specific dietary requirements did find claims helpful. Restricting nutrient claims to foods meeting a healthy nutrient profile aligned to the existing Health Star Rating system, education about regulation and supporting claims with more contextual information may increase trust, the perceived value of claims and therefore their utility.

The Relationship of Health and Nutrition Claims towards Purchasing Choices among Consumers in Shah Alam, Selangor

Consumers nowadays have more awareness for healthy foods and demanded healthier food choices to avoid health-related problems; therefore, industries had included health and nutrition claims on their products. Health and nutrition claims usually influence consumers' food choice decision. Products with health claim resulted in higher perception of healthiness and nutritional value of the product, even if the product was not considered as a healthy choice. The aim of this study was to assess whether the health and nutrition claims had led to a healthier perception or better evaluation of the product among consumers.

METHODS

A cross-sectional survey was conducted using an online questionnaire on 385 respondents collected through convenience sampling. The survey consisted of four parts: socio-demographic background, health awareness, understanding and usage of health and nutrition claims, and purchase intention measured through the use of a mock packaging. Data collected were analyzed using SPSS version 22.

RESULTS

Most of the respondents aged 18-30 (81.0%) and almost half of them were Malay (45.7%) with bachelor/master or PhD qualification (60.0%). The distribution of household income for all categories was almost similar (18.2-20.8%). There was a significant statistical relationship between health awareness and purchase intention among respondents (r=0.391, p<0.01).

CONCLUSIONS

Health and nutrition claims influenced consumer's perceptions and purchase intention, especially for those who were more concerned about their health, thus, more focus on policy regarding claims is needed.

Nutrition and Health Claims Spectra of Pre-Packaged Foods on Serbian Supermarket Shelves: A Repeated Cross-Sectional Study

Nutrition and health claims (NHCs) are a powerful tool that influence consumers’ final decision on the choice of food products. The purposes of this repeated cross-sectional study were to (i) assess the prevalence of pre-packaged food products containing nutrition and health claims among different food categories, (ii) to determine the type of NHCs labelled on the examined food products, and (iii) to evaluate the trend in the use of NHCs in comparison to the 2012 survey. The survey was conducted immediately before the full enforcement of the new national legislation on NHCs in 2020. It comprised 3141 pre-packaged food products from 10 product categories. In total, 21.2% of food products contained any claim (19.4% contained any nutrition claim; 8.2% contained any health claim). In comparison to the 2012 survey, we observed a rising trend in the presence of NHCs; the use of nutrition claims on food products increased three times and the use of health claims increased 1.3 times in the 2020 survey. Bearing in mind that NHCs are a powerful tool guiding consumers’ food purchase decisions, NHCs should be supported by precise legislation and strict surveillance by the public health authorities.

Estimated effects of the implementation of the Mexican warning labels regulation on the use of health and nutrition claims on packaged foods

BACKGROUND

The use of health and nutrition claims on front-of-pack labels may impact consumers' food choices; therefore, many countries have established regulations to avoid misinformation. This study describes the prevalence of health and nutrition claims on the front-of-pack of food products in retail stores in Mexico and estimate the potential effects of the Official Mexican Standards 051 (new regulation that includes specifications for implementing warning labels and other packaging elements such as health and nutrition claims on less healthy foods) on the prevalence of these claims.

METHODS

This is a cross-sectional study in which health and nutrition claims, nutrition information panels, and the list of ingredients of all foods and beverages available in the main retail stores in Mexico City were collected. The products were grouped by level of processing according to the NOVA food system classification. Claims were classified using the internationally harmonized INFORMAS taxonomy. According to the criteria of the new Mexican front-of-pack labelling regulation, the effect on the reduction on the prevalence of health and nutrition claims was estimated by type of food and by energy and nutrients of concern thresholds.

RESULTS

Of 17,264 products, 33.8% displayed nutrition claims and 3.4% health claims. In total, 80.8% of all products in the Mexican market were classified as "less healthy"; 48.2% of products had excess calories, 44.6% had excess sodium, and 40.7% excess free sugars. The new regulation would prevent 39.4% of products with claims from displaying health and nutrition claims (P < 0.001); the largest reduction is observed for ultra-processed foods (51.1%, P < 0.001). The regulation thresholds that resulted in the largest reduction of claims were calories (OR 0.62, P < 0.001) and non-sugar sweeteners (OR 0.54, P < 0.001).

CONCLUSIONS

The new Mexican front-of-pack labelling regulation will prevent most processed and ultra-processed foods from displaying health and nutrition claims and will potentially improve information on packaging for consumers.

A Cross-Sectional Audit of Nutrition and Health Claims on Dairy Yoghurts in Supermarkets of the Illawarra Region of New South Wales, Australia

Health and nutrition claims are used by consumers to guide purchasing decisions. In consequence, monitoring and evaluation of such claims to ensure they are accurate and transparent is required. The aim of this study was to investigate the use of nutrition and health claims on dairy-yoghurt products within select Australian supermarkets and assess their compliance with the revised Food Standards Code (FSC). Nutrition, health, and related claims on yoghurt products were assessed in a cross-sectional audit of five supermarkets in the Illawarra region of New South Wales. Claim prevalence, type, and compliance were assessed and products were compared against current rating measures. A total of n = 340 dairy yoghurt products were identified. Most products (97.9%) carried at least one nutrition and/or health claim, with nutrition-content claims (93.9%) the most prevalent. Most products (n = 277) met the nutrient profiling scoring criterion; while 87.9% of products did not carry the health star rating. Almost all claims surveyed (97.4%) were compliant with the FSC. Health and nutrition claims are highly prevalent across yoghurt categories, with the majority of these compliant with regulations. The ambiguity surrounding the wording and context of claims challenges researchers to investigate consumers’ interpretations of health messaging within the food environment.

Comparison of requirements for using health claims on foods in the European Union, the USA, Canada, and Australia/New Zealand

Nutrition is recognized as one of the leading factors influencing the growing incidence of noncommunicable diseases. Despite society experiencing a global rise in obesity, specific populations remain at risk of nutrient deficiencies. The food industry can use health claims to inform consumers about the health benefits of foods through labeling and the broader promotion of specific food products. As health claims are carefully regulated in many countries, their use is limited due to considerable investments required to fulfill the regulatory requirement. Although health claims represent a driving force for innovation in the food industry, the risk of misleading of consumers need to be avoided. The health claim scientific substantiation process must be efficient and transparent in order to meet the needs of companies in the global market, but should be based on strong scientific evidence and plausible mechanisms of actions, to ensure highest level of consumer protection. The objective of this review is to compare the possibilities for using health claims on foods in the European Union, the USA, Canada, and Australia and New Zealand. In particular, we focused on differences in the classification of claims, on the scientific substantiation processes and requirements for health claims use on foods in the selected regions. Reduction of disease risk (RDR) claims are associated with relatively similar procedures and conditions for use, whereas several notable differences were identified for other types of claims. In all cases, RDR claims must be approved prior their introduction to the market, and only a few such claims have been authorized. Much greater differences were observed concerning other types of claims.

Voluntary food fortification policy in Australia: did 'formal' stakeholder consultation influence the outcome?

This research aimed to understand how the policy was represented as a 'problem' in food regulatory decision-making in Australia, and the implications for public health nutrition engagement with policy development processes. Bacchi's 'what's the problem represented to be?' discourse analysis method was applied to a case study of voluntary food fortification policy (VFP) developed by the then Australia and New Zealand Food Regulation Ministerial Council (ANZFRMC) between 2002 and 2012. As a consultative process is a legislated aspect of food regulatory policy development in Australia, written stakeholder submissions contributed most of the key documents ascertained as relevant to the case. Four major categories of stakeholder were identified in the data; citizen, public health, government and industry. Predictably, citizen, government and public health stakeholders primarily represented voluntary food fortification (VF) as a problem of public health, while industry stakeholders represented it as a problem of commercial benefit. This reflected expected differences regarding decision-making control and power over regulatory activity. However, at both the outset and conclusion of the policy process, the ANZFRMC represented the problem of VF as commercial benefit, suggesting that in this case, a period of 'formal' stakeholder consultation did not alter the outcome. This research indicates that in VFP, the policy debate was fought and won at the initial framing of the problem in the earliest stages of the policy process. Consequently, if public health nutritionists leave their participation in the process until formal consultation stages, the opportunity to influence policy may already be lost.

Consumers' Implicit and Explicit Recall, Understanding and Perceptions of Products with Nutrition-Related Messages: An Online Survey

This study aimed to assess consumers' implicit and explicit recall, understanding and perceptions of products with a nutrition claim and a symbol depicting 'health,' and to determine whether these perceptions differed among Nutrition Facts table (NFt) users vs. nonusers. In an online survey, participants (n = 1997) were randomized to one of eight conditions in a 2 × 2 × 2 factorial design, consisting of a label with a claim (present/absent) a heart-shaped symbol depicting 'health' (present/absent) for a healthier or less healthy soup. Participants were shown a label for 10 s and asked whether they recalled seeing a claim. If participants answered yes, they were then asked to describe their response using open-ended questions. Participants also rated the product's perceived nutritional quality and purchase intentions using seven-point Likert scales. In the claim condition, most participants (75%) were able to recall the presence of a claim, while 12% incorrectly mentioned the presence of a claim when there was none. Claims likely attracted consumers' attention and increased perceived nutritional quality, although with limited influence among NFt users (23%). The symbol depicting 'health' did not enhance perceived nutritional quality or purchase intentions. Although most participants (77%) made their decisions implicitly using the front of labels, those who used the NFt had a better understanding of the nutritional quality of products.

Nutrition Claims Frequency and Compliance in a Food Sample of the Spanish Market: The BADALI Study

Nutrition claims (NCs) have been shown to affect customers’ perceptions and behaviour. In Europe, they are regulated by Regulation (EC) No 1924/2006. The aim of this work was to analyse the prevalence and compliance of NCs according to this regulation in Spain. For this purpose, we used the BADALI database, which included 3197 foods present in the Spanish market. Our results show that 36.1% of all foods carried NCs, at a rate of 3.3 NCs/food. The prevalence was very heterogeneous among food groups. Nuts and seeds, legumes and non-alcoholic beverages were the groups with the highest prevalence. Micronutrients, fat, fibre and sugars were the nutrients most referred to in NCs. Overall, the compliance was low, with 49.2% NCs correct. Fibre and proteins were the nutrients with most correct NCs. Vegetables and non-alcoholic beverages were the food groups with the highest proportion of correct NCs. The main reason for incorrect NCs was because the amount of the nutrient was not stated in the label. The results of our study reveal that the aim of the European Commission to ensure a high level of protection for consumers regarding NCs has not been fulfilled. Therefore, we consider it crucial that European institutions invest in guaranteeing regulation compliance.

Changes in nutrition content and health claims post-implementation of regulation in Australia

OBJECTIVE

To determine whether there were changes in the prevalence or healthiness of products carrying claims post-implementation of Standard 1.2.7: Nutrition, Health and Related Claims in the Australia New Zealand Food Standards Code.

DESIGN

Observational survey of claims on food packages in three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products to determine their eligibility to carry health claims under Standard 1.2.7. The Standard came into effect in 2013. The proportion of products carrying claims and the proportion of those not meeting the nutrient profiling criteria were calculated. A comparative analysis was conducted to determine changes between 2011 and 2016.

SETTING

Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in 2011 and 2016.

PARTICIPANTS

All claims on all available products in 2016 (n 1737). Nutrition composition and ingredients were collected from the packaging.

RESULTS

Overall in 2016, 76 % of products carried claims and there were 7367 claims identified in the three food categories. Of products in 2016 with health claims, 34 % did not meet nutrient profiling criteria. These may breach Standard 1.2.7. Comparison of 2011-2016 showed a significant increase in the number of products carrying claims (66 v. 76 %, P < 0·001).

CONCLUSIONS

The proportion of products carrying claims that do not meet nutrient profiling and consumers' tendency to infer health benefits from nutrition content claims warrants the regulation of all claims using the nutrient profiling. This will ensure consumers are not misled by claims on unhealthy food products.

Nutritional Content, Labelling and Marketing of Breakfast Cereals on the Belgian Market and Their Reformulation in Anticipation of the Implementation of the Nutri-Score Front-Of-Pack Labelling System

Objective: Breakfast cereals are frequently consumed in Belgium, especially among children. We investigated the nutritional content, labelling and marketing of breakfast cereals and the changes in nutrient content and reformulation in anticipation of the implementation of the Nutri-Score front-of-pack label. Design: Pictures were taken of cereal packages. The WHO-Europe nutrient profiling tool was used to classify cereals into ‘permitted’/‘not-permitted’ to be marketed to children, while the nutritional quality was assessed using Nutri-Score. The proportion of cereals with nutrition and health claims and/or promotional characters on the front-of-pack was compared between permitted and not-permitted cereals and between different Nutriscore categories using Chi-squared tests. The average nutrient contents per 100g were compared between 2017 and 2018 using paired t-tests. Setting: Belgium. Participants: All breakfast cereals in the major supermarkets (n = 7) in 2017 and 2018. Results: Overall, 330 cereals were included. About 77.2% of cereals were not permitted to be marketed to children but, of those, 22.0% displayed promotional characters. More claims (68.9% of all claims) were found on ‘not-permitted’ compared with ‘permitted’ cereals, particularly nutrition claims. Most claims were displayed on cereals with the allocated Nutri-Score A (42.0%) and C (37.0%). A significant reformulation of cereals was found between 2017 and 2018, with reductions in total sugar (−5%) (p < 0.001) and sodium (−20%) (p = 0.002) and increases in fibre (+3%) (p = 0.012) and proteins (+2%) (p = 0.002). Conclusion: Breakfast cereals on the Belgian market are predominantly unhealthy and frequently carry claims and promotional characters. Minimal reformulation occurred over one year. Policy recommendations include restrictions on claims and marketing for not-permitted cereals.

Conflicting Messages on Food and Beverage Packages: Front-of-Package Nutritional Labeling, Health and Nutrition Claims in Brazil

We assessed the prevalence of front-of-package (FoP) claims in the Brazilian packaged food supply and examined whether foods with claims were more likely to be high in critical nutrients. Using data from a random 30% subsample of 11,434 foods and beverages collected in the five largest food retailers in Brazil in 2017 (n = 3491), we classified claims into nutrition, health, and environment. We examined whether foods with claims were more likely to be high in critical nutrients using 95% confidence intervals. Claims were found in 41.2% of the products. Nutrition claims were the most prevalent (28.5%), followed by health (22.1%), and environment-related claims (5.2%). More than 85% of the breakfast cereals, granola bars, and nectars contained claims, which were found in 51% of the dairy beverages. Foods with nutrition claims were more likely to be high in critical nutrients (65.3%; 95% CI 62.3, 68.2% vs. 54.1% 95% CI 52.1, 56.0). Products with health (52.9%; 95% CI 49.3, 56.4% vs. 58.5%; 95% CI 56.6, 60.3) and environment-related claims (33.5%; 95% CI 27.0, 40.8% vs. 58.6%; 95% CI 56.9, 60.2%) were less likely to be high in critical nutrients. FoP claims are prevalent in Brazil, and nutrition claims are more likely to have a poorer nutritional profile. Policymakers should consider restricting the presence of claims on unhealthy products.

Nutritional Content According to the Presence of Front of Package Marketing Strategies: The Case of Ultra-Processed Snack Food Products Purchased in Costa Rica

The industry uses nutrition and health claims, premium offers, and promotional characters as marketing strategies (MS). The inclusion of these MS on ultra-processed products may influence child and adolescent purchase behavior. This study determined the proportion of foods carrying claims and marketing strategies, also the proportion of products with critical nutrients declaration, and nutritional profile differences between products that carry or not claims and MS on the front-of-package (FoP) of ultra-processed food products sold in Costa Rica. Data were obtained from 2423 photographs of seven food groups consumed as snacks that were sold in one of the most widespread and popular hypermarket chains in Costa Rica in 2015. Ten percent of products lacked a nutrition facts panel. Sodium was the least reported critical nutrient. Energy and critical nutrients were significantly highest in products that did not include any nutrition or health claim and in products that included at least one MS. Forty-four percent and 10% of all products displayed at least one nutrition or at least one health claim, respectively, and 23% displayed at least one MS. In conclusion, regulations are needed to restrict claims and marketing on ultra-processed food packages to generate healthier food environments and contribute to the prevention of childhood and adolescent obesity in Costa Rica.

The first INFORMAS national food environments and policies survey in New Zealand: A blueprint country profile for measuring progress on creating healthy food environments

The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support aims to benchmark national food environments. This study proposes a blueprint country profile to measure progress on creating healthy food environments, based on the results of the first, comprehensive survey in New Zealand (NZ). We assessed the implementation of national food environment policies and food industry commitments to improve population nutrition and the strength and comprehensiveness of public sector settings' nutrition policies. The healthiness of the packaged food supply, including health-related labelling, was evaluated. Food environments were measured in 833 schools, 204 supermarkets, 1500 takeaway outlets, 28 hospitals, 70 sport centres, and around all NZ schools. Food swamps, defined as areas with high relative density of unhealthy food outlets, were identified, and food marketing to children on television, websites, social media and packages, in magazines, and in and around schools was measured. The cost differential between healthy and current household diets was calculated for different population groups. NZ's food environment profile is largely unhealthy, and there are inequalities in access to healthy food environments. It is anticipated that the proposed country profile can help other countries tackle unhealthy food environments through increasing accountability of governments and the industry.

Who Buys Products with Nutrition and Health Claims? A Purchase Simulation with Eye Tracking on the Influence of Consumers' Nutrition Knowledge and Health Motivation

Nutrition and health claims are seen as a way of promoting healthy aspects of food. However, the results of previous studies have been contradictory regarding the effect of these claims on purchase. This study aims to achieve a better understanding of how the consumer characteristics ‘nutrition knowledge’ and ‘health motivation’ influence the purchase of products with nutrition and health claims and what role gaze behavior plays. We included gaze behavior in our analysis, as visual attention on the claims is a precondition to its influence on the purchase decision. In a close-to-realistic shopping situation, consumers could choose from three-dimensional orange juice packages labeled with nutrition, health, and taste claims. In total, the sample consisted of 156 consumers. The data were analyzed with a structural equation model (SEM), linking the purchase decision for products with claims to gaze data recorded with a mobile eye tracker and consumer and product-related variables collected via the questionnaire. Results showed that the variables in the SEM explained 31% (8%) of the variance observed in the purchase of products with a nutrition (health) claim. The longer a consumer looked at a specific claim, the more likely the consumer would purchase the respective product. The lower the price and the higher the perceived healthiness and tastiness of the product further heightened its likelihood of being purchased. Interestingly, consumers with higher nutrition knowledge and/or higher health motivation looked longer at the nutrition and health claims; however, these consumer characteristics did not show an effect on the purchase decision. Implications for policy makers and marketers are given.

Tracking Kids' Food: Comparing the Nutritional Value and Marketing Appeals of Child-Targeted Supermarket Products Over Time

Marketing unhealthy foods negatively impacts children’s food preferences, dietary habits and health, prompting calls for regulations that will help to create an “enabling” food environment for children. One powerful food marketing technique is product packaging, but little is known about the nature or quality of child-targeted food products over time. This study assesses how child-targeted supermarket foods in Canada have transformed with respect to nutritional profile and types of marketing appeals (that is, the power of such marketing). Products from 2009 (n = 354) and from 2017 (n = 374) were first evaluated and compared in light of two established nutritional criteria, and then compared in terms of marketing techniques on packages. Overall, child-targeted supermarket foods did not improve nutritionally over time: 88% of child-targeted products (across both datasets) would not be permitted to be marketed to children, according to the World Health Organization (WHO) criteria, and sugar levels remained consistently high. Despite this poor nutritional quality, the use of nutrition claims increased significantly over time, as did the use of cartoon characters and appealing fonts to attract children’s attention. Character licensing—using characters from entertainment companies—remained consistent. The findings reveal the critical need to consider packaging as part of the strategy for protecting children from unhealthy food marketing. Given the poor nutritional quality and appealing nature of child-oriented supermarket foods, food product packaging needs to be included in the WHO’s call to improve the restrictions on unhealthy food marketing to children.

Perspective: Public Health Nutrition Policies Should Focus on Healthy Eating, Not on Calorie Counting, Even to Decrease Obesity

Calorie-focused policies, such as calorie menu labeling, seem to result in minor shifts toward healthier choices and public health improvement. This paper discusses the (lack of) relations between energy intake and healthy eating and the rationale for shifting the focus of public health nutrition policies to healthier foods and meals. We argue that the benefits of reducing caloric intake from low-quality foods might not result from the calorie reduction but rather from the reduced consumption of low-quality foods. It is better to consume a given number of calories from high-quality foods than a smaller number of calories from low-quality foods. It is not possible to choose a healthy diet solely based on the caloric value of foods because calories are not equal; they differ in nutritional quality according to their source. Foods are more than just a collection of calories and nutrients, and nutrients interact differently when presented as foods. Different subtypes of a macronutrient, although they have the same caloric value, are metabolized and influence health in different ways. For instance, industrial trans fats increase lipogenesis and the risk of heart diseases, whereas monounsaturated fats have the opposite effect. Food processing and cooking methods also influence the nutritional value of foods. Thus, public health nutrition policies should stop encouraging people to focus mainly on calorie counting to fight noncommunicable diseases. Instead, policies should focus on ingredients, dietary sources, and food processing and cooking methods.

Consumers' purchase decisions for products with nutrition and health claims: What role do product category and gaze duration on claims play?

Labeling food packages with nutrition and health claims is a widely used practice. This study aims to contribute to the literature by examining the gaze and purchase behavior of consumers regarding food products with nutrition and health claims. A close-to-realistic purchase situation with three-dimensional food packages with nutrition, health, and taste claims was simulated while the participants' eye movements were measured using head-mounted eye tracking glasses. In the purchase situation, two food categories with differing perceived healthiness were offered, orange juice and milk chocolate. In total, 156 consumers participated in this study which was undertaken in Germany. The findings indicate that each claim was noticed by at least 85% of the participants and health claims were looked at longer than nutrition or taste claims. Furthermore, when compared to other participants, the longer a participant looked at a specific claim, the more likely the participant was to purchase the respective product. Even though the product category had no effect on the gaze duration on claims, it affected the purchase behavior. Nutrition claims were preferred for orange juice while taste claims were preferred for milk chocolate. Health claims were preferred for neither. Marketers can benefit from this study, as it shows the gaze duration on claims influenced the purchase likelihood. Another important finding is that there are great differences between product categories regarding the type of claim consumers prefer.

Positioning food standards programmes to protect public health: current performance, future opportunities and necessary reforms

OBJECTIVE

To assess current performance and identify opportunities and reforms necessary for positioning a food standards programme to help protect public health against dietary risk factors.

DESIGN

A case study design in which a food standards programme's public health protection performance was analysed against an adapted Donabedian model for assessing health-care quality. The criteria were the food standards programme's structure (governance arrangements and membership of its decision-making committees), process (decision-making tools, public engagement and transparency) and food standards outcomes, which provided the information base on which performance quality was inferred.

SETTING

The Australia and New Zealand food standards programme.ParticipantsThe structure, process and outcomes of the Programme.

RESULTS

The Programme's structure and processes produce food standards outcomes that perform well in protecting public health from risks associated with nutrient intake excess or inadequacy. The Programme performs less well in protecting public health from the proliferation and marketing of 'discretionary' foods that can exacerbate dietary risks. Opportunities to set food standards to help protect public health against dietary risks are identified.

CONCLUSIONS

The structures and decision-making processes used in food standards programmes need to be reformed so they are fit for purpose for helping combat dietary risks caused by dietary excess and imbalances. Priorities include reforming the risk analysis framework, including the nutrient profiling scoring criterion, by extending their nutrition science orientation from a nutrient (reductionist) paradigm to be more inclusive of a food/diet (holistic) paradigm.

Assessment of Packaged Foods and Beverages Carrying Nutrition Marketing against Canada's Food Guide Recommendations

Canadians' food purchases consist largely of packaged processed and ultra-processed products, which typically fall outside the "core" foods recommended by Canada's Food Guide (CFG). Almost half of packaged products in Canada carry nutrition marketing (i.e., nutrient content and health claims). This study assessed whether packaged foods carrying nutrition marketing align with recommendations outlined in the 2007 CFG. Label data (n = 9376) were extracted from the 2013 Food Label Information Program (FLIP). Label components (including nutrition marketing) were classified using the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) labelling taxonomy. The Health Canada Surveillance Tool (HCST) was used to assess the alignment of products to CFG. Each food or beverage was classified into one of five groups (i.e., Tier 1, Tier 2, Tier 3, Tier 4, "Others"). Products in Tier 1, 2 or water were considered "in line with CFG". Most products in the analyzed sample were classified as Tier 2 (35%) and Tier 3 (27%). Although foods with nutrition marketing were significantly more likely to align to CFG recommendations (p < 0.001), many products not "in line with CFG" still carried nutrition marketing. This study provides important baseline data that could be used upon the implementation of the new CFG.

Regulating health and nutrition claims in the UK using a nutrient profile model: an explorative modelled health impact assessment

Background

Health-related claims (HRCs) are statements found on food packets that convey the nutritional quality of a food (nutrition claims) and/or its impact on a health outcome (health claims).

The EU stated that HRCs should be regulated such that they can only appear on foods that meet a specified nutrient profile (NP). A NP model has been proposed, but not agreed by the European Commission.

Methods

To model the impact of HRCs on health impacts in the UK, we built a front-end model to a pre-established non-communicable-disease (NCD) scenario model, the Preventable Risk Integrated ModEl (PRIME) by combining data from a meta-analysis examining the impact of HRCs on dietary choices and a survey of pre-packaged foods examining the prevalence of HRCs and the nutritional quality of foods that carry them. These data are used to model the impact of regulating HRCs on the nutritional quality of the diet and PRIME is used to model the health outcomes associated with these changes. Two scenarios are modelled: regulating HRCs with a NP model (the FSANZ NPSC and a draft EU model) so that only foods that pass the model are eligible to carry HRCs, and reformulating HRC-carrying foods that fail the model.

Results

Regulating the use of HRCs with a NP model (the FSANZ NPSC) would have unclear impacts on population health and could potentially lead to less healthy diets. This is because HRCs are currently more likely to be found on products with a better nutritional profile and restricting their use could shift consumers to less healthy diets. Two hundred fifty-eight additional deaths (95% Uncertainty Intervals [UI] -6509, 8706) were predicted if foods did not change in their nutrient composition. If all foods that currently carry HRCs were reformulated to meet the NP model criteria then there would be a positive impact of using the model: (4374 deaths averted (95%UI -2569, 14,009)). The largest contributor to the uncertainty is the underpowered estimates of nutritional quality of foods with and without claims.

Conclusions

Regulating HRCs could result in negative health impacts, however the wide uncertainty intervals from this analysis demonstrate that a larger health impact assessment is necessary.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0778-5) contains supplementary material, which is available to authorized users.

Examining the Nutritional Quality of Canadian Packaged Foods and Beverages with and without Nutrition Claims

Nutrient content claims, health claims, and front-of-pack symbols (henceforth referred to as “nutrition claims” in the present study) are often found on food labels in Canada. However, it is currently unknown whether foods and beverages (F&Bs) carrying nutrition claims have a more favourable nutritional profile than those without such claims. This study examined differences in the global nutritional quality, as determined by the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (FSANZ-NPSC), of Canadian F&B bearing nutrition claims as compared to those without, as well as in their nutritional composition. Data (n = 15,184) was obtained from the University of Toronto 2013 Food Label Information Program. Forty-two percent of F&Bs carrying nutrition claims (n = 2930/6990) were found to be ineligible to carry claims based on the FSANZ-NPSC, in comparison to 66% of F&Bs without (n = 5401/8194, p < 0.001). Sugars and sweets, and miscellaneous products were the food categories with larger proportions of foods carrying nutrition claims not meeting the FSANZ-NPSC eligibility criteria. F&Bs with nutrition claims had fewer calories, less saturated fat, sodium, and sugar, and higher content of protein and fibre than comparable products without nutrition claims (p < 0.05 in all cases). In conclusion, nearly half of F&Bs carrying nutrition claims in Canada did not meet the FSANZ-NPSC threshold, although Canadian products carrying nutrition claims have an overall “healthier” profile than their counterparts without such claims.

Consumer and product-specific characteristics influencing the effect of nutrition, health and risk reduction claims on preferences and purchase behavior - A systematic review

The research on nutrition, health, and risk reduction claims (NHR claims) shows a lack of consensus as to whether these claims have a positive or negative effect on consumer's preferences and purchase behavior. This issue has been highlighted by many authors. Therefore, a comprehensive literature review was performed to find reasons for contradictory results. First, a theoretical framework was developed which divided the determinants of the effects of NHR claims on consumers' preferences and purchase behavior into consumer and product-specific characteristics. Additionally, a categorization for the different NHR claim types was constructed to make the studies comparable. Afterwards, the scientific literature from the 1980s until May 2017 was scanned and 66 articles were found to be relevant. Consumer-specific characteristics such as nutrition knowledge, health motivation, familiarity, and socio-demographic characteristics were found to influence the NHR claim effect. Important product-specific characteristics were the perceived healthiness of the food product, the interaction between the product and the nutrient in the NHR claim, and the interaction between the claimed benefit and the NHR claim type. The consumer's nutrition knowledge and the product's perceived healthiness were deemed to be the most promising determinants for further investigation.

Declaration of nutrition information on and nutritional quality of Thai ready-to-eat packaged food products

OBJECTIVE

The present study assessed the nutrition information displayed on ready-to-eat packaged foods and the nutritional quality of those food products in Thailand.

DESIGN

In March 2015, the nutrition information panels and nutrition and health claims on ready-to-eat packaged foods were collected from the biggest store of each of the twelve major retailers, using protocols developed by the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS). The Thai Nutrient Profile Model was used to classify food products according to their nutritional quality as 'healthier' or 'less healthy'.

RESULTS

In total, information from 7205 food products was collected across five broad food categories. Out of those products, 5707 (79·2 %), 2536 (35·2 %) and 1487 (20·6 %) carried a nutrition facts panel, a Guideline Daily Amount (GDA) label and health-related claims, respectively. Only 4691 (65·1 %) and 2484 (34·5 %) of the products that displayed the nutrition facts or a GDA label, respectively, followed the guidelines of the Thai Food and Drug Administration. In total, 4689 products (65·1 %) could be classified according to the Thai Nutrient Profile Model, of which 432 products (9·2 %) were classified as healthier. Moreover, among the 1487 products carrying health-related claims, 1219 (82·0 %) were classified as less healthy. Allowing less healthy food products to carry claims could mislead consumers and result in overconsumption of ready-to-eat food products.

CONCLUSIONS

The findings suggest effective policies should be implemented to increase the relative availability of healthier ready-to-eat packaged foods, as well as to improve the provision of nutrition information on labels in Thailand.

Assessing nutrition and other claims on food labels: a repeated cross-sectional analysis of the Canadian food supply

Background

In 2010, nutrition claims were investigated in Canadian foods; however, many nutrition and other claims have been introduced since then. This study aimed to determine: i) the proportion of foods carrying claims in 2013, ii) the types and prevalence of nutrition claims (nutrient content claims, health claims, general health claims) and other claims displayed on labels in 2013, iii) and trends in use of nutrition claims between 2010 and 2013.

Methods

Repeated cross-sectional analysis of the University of Toronto Food Label Information Program (FLIP) of Canadian foods (2010/11 n = 10,487; 2013 n = 15,342). Regulated nutrition claims (nutrient content, health claims) were classified according to Canadian regulations. A decision tree was used to classify non-regulated general health claims (e.g., front-of-pack claims). Other claims (e.g., gluten-free) were also collected. Proportions of claims in 2013 were determined and χ² was used to test significant differences for different types of claims between 2010 and 2013.

Results

Overall, 49% of products in 2013 displayed any type of claim and 46% of foods in FLIP 2013 carried a nutrition claim (nutrient content claim, health claim, general health claim). Meal replacements and fruits/fruits juices were the categories with the largest proportion of foods with claims. At least one approved nutrient content claim was carried on 42.9% of products compared to 45.5% in 2010 (p < 0.001). Health claims, specifically disease risk reduction claims, were slightly lower in 2013 (1.5%) compared to 1.7% in 2010 (p = 0.225). General health claims, specifically front-of-pack claims, were carried on 20% of foods compared to 18.9% in 2010 (p = 0.020). Other claims, specifically gluten-free, were present on 7.3% of foods.

Conclusions

Nutrition and other claims were used on half of Canadian prepackaged foods in 2013. Many claims guidelines and regulations have been released since 2010; however, little impact has been seen in the prevalence of such claims in the food supply. Claims related to nutrients of public health priority, such as sugars and sodium, were not commonly used on food labels. Monitoring trends in the use of nutrition and other claims is essential to determine if their use on food labels reflects public health objectives, or instead are being used as marketing tools.

Characterization of Breakfast Cereals Available in the Mexican Market: Sodium and Sugar Content

Preschool Mexican children consume 7% of their total energy intake from processed breakfast cereals. This study characterized the nutritional quality and labelling (claims and Guideline Daily Amount (GDA)) of the packaged breakfast cereals available in the Mexican market. Photographs of all breakfast cereals available in the 9 main food retail chains in the country were taken. The nutrition quality of cereals was assessed using the United Kingdom Nutrient Profiling Model (UKNPM). Claims were classified using the International Network for Food and Obesity/non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) taxonomy and the GDA was defined according to the Mexican regulation, NOM-051. Overall, a total of 371 different breakfast cereals were analysed. The nutritional profile showed that 68.7% were classified as “less healthy”. GDAs and claims were displayed more frequently on the “less healthy” cereals. Breakfast cereals within the “less healthy” category had significantly higher content of energy, sugar and sodium (p < 0.001). Most of the claims were displayed in the “less healthy” cereals (n = 313). This study has shown that there is a lack of consistency between the labelling on the front of the pack and the nutritional quality of breakfast cereals.

Do Health Claims and Front-of-Pack Labels Lead to a Positivity Bias in Unhealthy Foods?

Health claims and front-of-pack labels (FoPLs) may lead consumers to hold more positive attitudes and show a greater willingness to buy food products, regardless of their actual healthiness. A potential negative consequence of this positivity bias is the increased consumption of unhealthy foods. This study investigated whether a positivity bias would occur in unhealthy variations of four products (cookies, corn flakes, pizzas and yoghurts) that featured different health claim conditions (no claim, nutrient claim, general level health claim, and higher level health claim) and FoPL conditions (no FoPL, the Daily Intake Guide (DIG), Multiple Traffic Lights (MTL), and the Health Star Rating (HSR)). Positivity bias was assessed via measures of perceived healthiness, global evaluations (incorporating taste, quality, convenience, etc.) and willingness to buy. On the whole, health claims did not produce a positivity bias, while FoPLs did, with the DIG being the most likely to elicit this bias. The HSR most frequently led to lower ratings of unhealthy foods than the DIG and MTL, suggesting that this FoPL has the lowest risk of creating an inaccurate positivity bias in unhealthy foods.