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Chen J, Fan Y, Zhang M, Wu S, Li H. The neural model of front-of-package label processing. Nutr Rev 2024; 82:374-388. [PMID: 37604108 DOI: 10.1093/nutrit/nuad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Front-of-package (FOP) labels have been adopted in many countries to battle the obesity pandemic and its serious health consequences by providing clearer and easier-to-understand nutrition and health information. The effectiveness of FOP labels has been generally confirmed, with some contextual and individual factors modifying their effectiveness. Existing theories (eg, the dual-process theory) and shifting priorities for self-control, provide some explanations for the FOP label effect. However, the cognitive and neural mechanisms underlying the processing of FOP labels remain unknown. Here, a new model, namely, the neural model of FOP label processing, has been proposed to fill this gap by providing an integrated account of FOP label processing while simultaneously considering multiple important situational and individual factors in the same framework. This neural model is built on the core eating network (ie, the ventral reward pathway and the dorsal control pathway) for food cue processing and actual food consumption. The new model explains how FOP labels may facilitate attention, influence the core eating network, and thus alter food choices. It also demonstrates how motivation may modify FOP label processing in 2 ways: affecting attention (the indirect way) and changing the process of evaluating the food (the direct way). It further explains how some contextual and individual factors (eg, ego depletion, time pressure, and health knowledge) influence the process. Thus, the neural model integrates evidence from behavioral, eye-tracking, and neuroimaging studies into a single, integrated account, deepening understanding of the cognitive and neural mechanisms of FOP label processing. This model might facilitate consensus on the most successful FOP label. Moreover, it could provide insights for consumers, food industries, and policy makers and encourage healthy eating behaviors.
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Affiliation(s)
- Jing Chen
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Yixuan Fan
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Manlu Zhang
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Shuhuan Wu
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Huiyan Li
- School of Psychology, Beijing Sport University, Beijing 100084, China
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Ganderats-Fuentes M, Morgan S. Front-of-Package Nutrition Labeling and Its Impact on Food Industry Practices: A Systematic Review of the Evidence. Nutrients 2023; 15:nu15112630. [PMID: 37299593 DOI: 10.3390/nu15112630] [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: 05/16/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
The obesity epidemic has become a major public health concern globally, and the food supply is a significant driver of this trend. Front-of-package (FOP) labels have been implemented in many countries to encourage healthier food choices. This systematic review aimed to examine the effect of FOP label implementation on food manufacturers' practices. A comprehensive search of multiple databases was conducted following PRISMA guidelines, identifying 39 relevant articles from 1990 to 2021. The studies indicated that FOP labels conveying intuitive information influenced product reformulation, whereas those with numerical information without specific guidance had no impact on reducing unhealthy nutrients. The most common outcomes were sodium, sugar, and calorie reduction. Mandatory policies reported higher and more consistent effects on product reformulation compared to voluntary approaches. Voluntary FOP labeling resulted in low uptake and tended to be applied to healthier products. Food manufacturers responded to FOP labeling heterogeneously, depending on the label design and type of enforcement. FOP label implementation can reduce nutrients of concern but food manufacturers behave strategically by labeling healthier choices. This review provides recommendations for maximizing the benefits of using FOP labels to prevent obesity, and findings can inform future public health research and policymaking.
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Affiliation(s)
| | - Sherry Morgan
- Holman Biotech Commons, University of Pennsylvania, Philadelphia, PA 19104, USA
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Hammond D, Acton RB, Rynard VL, White CM, Vanderlee L, Bhawra J, Reyes M, Jáuregui A, Adams J, Roberto CA, Sacks G, Thrasher JF. Awareness, use and understanding of nutrition labels among children and youth from six countries: findings from the 2019 - 2020 International Food Policy Study. Int J Behav Nutr Phys Act 2023; 20:55. [PMID: 37143053 PMCID: PMC10157591 DOI: 10.1186/s12966-023-01455-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/21/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Nutrition facts tables (NFTs) on pre-packaged foods are widely used but poorly understood by consumers. Several countries have implemented front-of-package labels (FOPLs) that provide simpler, easier to use nutrition information. In October 2020, Mexico revised its FOPL regulations to replace industry-based Guideline Daily Amount (GDA) FOPLs with 'Warning' FOPLs, which display stop signs on foods high in nutrients of concern, such as sugar and sodium. This study examined self-reported awareness, use, and understanding of NFTs and FOPLs among young people in six countries with different FOPLs, with an additional focus on changes before and after implementation of Mexico's FOPL warning policy. METHODS A 'natural experiment' was conducted using 'pre-post' national surveys in Mexico and five separate comparison countries: countries with no FOPL policy (Canada and the US), countries with voluntary FOPL policies (Traffic Lights in the UK and Health Star Ratings in Australia), and one country (Chile) with mandatory FOPL 'warnings' (like Mexico). Population-based surveys were conducted with 10 to 17-year-olds in 2019 (n = 10,823) and in 2020 (n = 11,713). Logistic regressions examined within- and between-countries changes in self-reported awareness, use, and understanding of NFTs and FOPLs. RESULTS Across countries, half to three quarters of respondents reported seeing NFTs 'often' or 'all the time', approximately one quarter reported using NFTs when deciding what to eat or buy, and one third reported NFTs were 'easy to understand', with few changes between 2019 and 2020. In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were higher than for NFTs in all countries, and compared with GDA FOPLs in Mexico (p < .001). Mandated Warning FOPLs in Mexico and Chile had substantially higher levels of awareness, use, and understanding than the voluntary Traffic Lights in the UK and Health Star Ratings in Australia (p < .001 for all). CONCLUSIONS Mandated easy-to-understand FOPLs are associated with substantially greater levels of self-reported awareness, use and understanding at the population-level compared to NFT and GDA-based labeling systems.
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Affiliation(s)
- David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Rachel B Acton
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Vicki L Rynard
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec City, QC, G1V 0A6, Canada
| | - Jasmin Bhawra
- School of Occupational and Public Health, Toronto Metropolitan University, 288 Church Street, Suite 300, ON, M5B 1Z5, Toronto, Canada
| | - Marcela Reyes
- Instituto de Nutrición Y Tecnología de los Alimentos (INTA), Universidad de Chile, Avda. El Líbano, 5524, Macul, Santiago, Chile
| | - Alejandra Jáuregui
- Center for Health and Nutrition Research, Instituto Nacional de Salud Pública, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | - Jean Adams
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge, CB2 0QA, UK
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 1121 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
- Center for Population Health Research, Instituto Nacional de Salud Pública, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
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Improving the understanding of key nutritional elements to support healthier and more informed food choices: The effect of front-of-pack label bundles. Nutrition 2023; 105:111849. [PMID: 36279716 DOI: 10.1016/j.nut.2022.111849] [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: 04/19/2022] [Revised: 08/24/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In the current open debate at the European level on what would be the best Front-of-Pack Label (FOPL) to support customers' healthier and more informed food choices, little effort has been dedicated to analyzing the potential effects of bundling existing FOPLs. This study aims to compare the effects of consumers' subjective understanding and liking of different types of FOPL bundles. METHODS We performed an experimental design by manipulating the FOPLs' scheme, where different types of FOPL bundles were designed according to the "directiveness" of the FOPLs' scheme. A "mixed" bundle was composed of a non-directive label (i.e., NutrInform Battery) and a directive label (i.e., Keyhole), and a "double-directive" bundle was composed of two directive labels (i.e., Nutri-Score and Keyhole). This study was conducted among a sample of 327 Swedish individuals responsible for purchases recruited through international web panel providers. RESULTS The results showed that a mixed bundle has been more effective than the double-directive bundle and the single-directive label (i.e., the existing FOPL in the investigated market) in allowing consumers to improve their subjective understanding (in terms of comprehensibility, help-to-shop, and complexity reduction) and liking towards the labels. CONCLUSIONS This study extends the current research on bundling in general and on FOPL bundles in particular by providing evidence regarding consumers' subjective understanding and liking of the labels. Additionally, the research provided findings that might be relevant for policymakers by suggesting to investigate bundle of FOPLs to help the consumers' understanding in their process toward healthier and more informed food choices.
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Scheidmeir M, Kubiak T, Luszczynska A, Wendt J, Scheller DA, Meshkovska B, Müller-Stierlin AS, Forberger S, Łobczowska K, Neumann-Podczaska A, Wieczorowska-Tobis K, Zeeb H, Steinacker JM, Woods CB, Lakerveld J. Acceptability of policies targeting dietary behaviours and physical activity: a systematic review of tools and outcomes. Eur J Public Health 2022; 32:iv32-iv49. [PMID: 36444105 PMCID: PMC9897019 DOI: 10.1093/eurpub/ckac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents. METHODS A systematic review (PROSPERO: CRD42021232326) was conducted using three databases (Science Direct, PubMed and Web of Science). RESULTS Of the initial 7780 hits, we included 48 eligible studies (n = 32 on dietary behaviour, n = 11 on physical activity and n = 5 on both), using qualitative and quantitative designs (n = 25 cross-sectional, quantitative; n = 15 qualitative; n = 5 randomized controlled trials; n = 3 mixed-methods design). Acceptability was analysed through online surveys (n = 24), interviews (n = 10), focus groups (n = 10), retrospective textual analysis (n = 3) and a taste-test experiment (n = 1). Notably, only 3 (out of 48) studies applied a theoretical foundation for their assessment. Less intrusive policies such as food labels and policies in a later stage of the implementation process received higher levels of acceptability. Women, older participants and respondents who rated policies as appropriate and effective showed the highest levels of acceptability. CONCLUSION Highly intrusive policies such as taxations or restrictions are the least accepted when first implemented, but respondents' confidence in the relevance and effectiveness of the policy may boost acceptability over the course of implementation. Studies using validated tools and a theoretical foundation are needed to further examine opportunities to increase acceptability.
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Affiliation(s)
- Marie Scheidmeir
- Correspondence: Marie Scheidmeir, Department of Health Psychology, Johannes Gutenberg University, Binger Str. 14-16, 55122 Mainz, Germany, Tel: +49 6131 39 39 132, e-mail:
| | - Thomas Kubiak
- Department of Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Janine Wendt
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Biljana Meshkovska
- Department of Nutrition, Institute of Basic Medical Sciences (UiO-PHN), University of Oslo, Oslo, Norway
| | | | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Karolina Łobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland
| | | | | | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jürgen M Steinacker
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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6
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Bopape M, De Man J, Taillie LS, Ng SW, Murukutla N, Swart R. Effect of different front-of-package food labels on healthfulness perception of ultraprocessed food and intention to purchase the products- A randomised controlled trial. Appetite 2022; 179:106283. [PMID: 36027994 DOI: 10.1016/j.appet.2022.106283] [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: 03/18/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022]
Abstract
This study aimed to evaluate the effect of different labels on participants: identifying products high in nutrients of concern; identifying unhealthy products, and intention to purchase unhealthy products. This blinded randomised controlled trial included a representative sample of South African households (n = 1951). Per household we selected a member primarily responsible for food purchases. Participants were randomised into the Warning Label (WL), Guideline Dietary Amounts (GDA) or Multiple Traffic Light (MTL) arms. Each participant answered questions in a no label condition (control) followed by same questions in the label condition (experiment). Complete data were collected and analysed for 1948 participants (WL = 33.7%, GDA = 32.1% and MTL = 34.2%). The probability of correctly identifying products high in nutrients of concern and identifying products as being unhealthy was higher with the WL compared to the GDA or MTL for most items. There was no difference in performance between the GDA and the MTL when considering all items together. A higher percentage of participants reported a lower intention to purchase an unhealthy product after exposure to the WL compared to MTL for 5 out of 6 products; 2 out of 6 products for the WL compared to GDA and 2 out of 6 products for GDA compared to MTL. Compared to the control condition, exposure to each of the labels resulted in better identification of nutrients of concerns, unhealthy products and a lower intention to purchase when considering all specific outcome items together. The WL showed a higher potential to enable South African consumers to identify products high in nutrients of concern, identify unhealthy products and discourage purchasing of unhealthy products.
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Affiliation(s)
- Makoma Bopape
- Department of Human Nutrition and Dietetics, Faculty of Health Sciences, University of Limpopo, South Africa; Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, South Africa.
| | - Jeroen De Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
| | - Lindsey Smith Taillie
- Carolina Population Center and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | - Shu Wen Ng
- Carolina Population Center and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | | | - Rina Swart
- Department of Dietetics and Nutrition, Faculty of Community and Health Sciences, University of the Western Cape, South Africa.
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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. Nutrients 2022; 14:nu14163423. [PMID: 36014929 PMCID: PMC9414449 DOI: 10.3390/nu14163423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/19/2022] Open
Abstract
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.
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8
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Campos-Nonato I, Cervantes-Armenta MA, Pacheco-Miranda S, Quezada-Sánchez AD, Contreras-Manzano A, Barquera S, Vargas-Meza J. Perception and Understanding of Guideline Daily Amount and Warning Labeling among Mexican Adults during the Law Modification Period. Nutrients 2022; 14:nu14163403. [PMID: 36014909 PMCID: PMC9415154 DOI: 10.3390/nu14163403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 12/05/2022] Open
Abstract
Front-of-pack labeling (FOPL) is a tool that enables consumers to compare foods and select healthier options. Due to low understanding of the Guideline Daily Amount (GDA) labeling among Mexicans, a law was implemented in October 2020 that modified the FOPL to a warning labeling (WL) system. The purpose of this study was to compare the perception and understanding of GDA and WL during the law modification period. We conducted a panel design with two measurements: (1) using GDA label (September 2020) and (2) using WL (October–November). We estimated differences in GDA vs. WL through multinomial logistic regression models and changes were measured through predictive margin contrasts and Wald tests. When comparing the same products with different labels, the participants reported that it would be unlikely/very unlikely that they would consume products packaged with the WL (81.5%; 95%CI: 79.2, 83.8) compared to those with GDA (24.2%; 95%CI: 21.7, 26.7). Consumers’ perception was that the quantities of packaged products they should consume was small or very small when they used the WL (93.8%; 95%CI: 92.4, 95.5) compared to GDA (41.6%; 95%CI: 39.7, 44.6). When comparing food groups, participants were more confident about choosing healthy products when using the WL compared to the GDA. During the implementation of WL in Mexico, the studied population had a better perception and understanding of less healthy packaged foods when using WL, compared to the GDA label.
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Affiliation(s)
- Ismael Campos-Nonato
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca C.P. 62100, Morelos, Mexico
| | - Manuel A. Cervantes-Armenta
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca C.P. 62100, Morelos, Mexico
| | - Selene Pacheco-Miranda
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca C.P. 62100, Morelos, Mexico
| | - Amado D. Quezada-Sánchez
- Center for Research in Evaluation and Surveys, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca C.P. 62100, Morelos, Mexico
| | - Alejandra Contreras-Manzano
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca C.P. 62100, Morelos, Mexico
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca C.P. 62100, Morelos, Mexico
| | - Jorge Vargas-Meza
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca C.P. 62100, Morelos, Mexico
- Correspondence:
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9
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Sagaceta-Mejía J, Tolentino-Mayo L, Cruz-Casarrubias C, Nieto C, Barquera S. Understanding of front of package nutrition labels: Guideline daily amount and warning labels in Mexicans with non-communicable diseases. PLoS One 2022; 17:e0269892. [PMID: 35749373 PMCID: PMC9231753 DOI: 10.1371/journal.pone.0269892] [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] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile’s labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants’ number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA.
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Affiliation(s)
- Janine Sagaceta-Mejía
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Lizbeth Tolentino-Mayo
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
- * E-mail:
| | - Carlos Cruz-Casarrubias
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Claudia Nieto
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Simón Barquera
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
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10
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Krieger J, Bleich SN, Scarmo S, Ng SW. Sugar-Sweetened Beverage Reduction Policies: Progress and Promise. Annu Rev Public Health 2021; 42:439-461. [PMID: 33256536 DOI: 10.1146/annurev-publhealth-090419-103005] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, political, and public health needs; and emerging science is critical.
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Affiliation(s)
- James Krieger
- Healthy Food America, Seattle, Washington 98122, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98195, USA;
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Stephanie Scarmo
- American Heart Association, National Center, Dallas, Texas 75231, USA;
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA;
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11
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Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, Vorkoper S. [Implementación de políticas de prevención y control de la obesidad infantil en Estados Unidos y Latinoamérica: lecciones para la investigación y la práctica transfronterizas]. Obes Rev 2021; 22 Suppl 5:e13347. [PMID: 34708536 DOI: 10.1111/obr.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, EE. UU
| | - Mireya Vilar-Compte
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Ciudad de México, México
| | - Elizabeth Rhodes
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, EE. UU.,Yale School of Medicine, New Haven, Connecticut, EE. UU
| | - Olga L Sarmiento
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Camila Corvalan
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, EE. UU
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, EE. UU
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Roberto CA, Ng SW, Ganderats-Fuentes M, Hammond D, Barquera S, Jauregui A, Taillie LS. The Influence of Front-of-Package Nutrition Labeling on Consumer Behavior and Product Reformulation. Annu Rev Nutr 2021; 41:529-550. [PMID: 34339293 DOI: 10.1146/annurev-nutr-111120-094932] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of (a) real-world evaluations of front-of-package nutrition labels that analyze objective sales data and (b) studies that objectively assess product reformulation in response to a front-of-package nutrition label implementation. We argue that there is sufficient scientific evidence to recommend that governments implement mandatory front-of-package nutrition labeling systems to improve population health. We also present a conceptual framework to describe front-of-package label influence and provide recommendations for the optimal label design, emphasizing that labeling systems should be highly visible and salient, be simple and easy to understand, leverage automatic associations, and integrate informational and emotional messaging. The existing research suggests that Guideline Daily Amount labels should be avoided and that the Health Star Rating and Nutri-Score systems are promising but that systems with warning labels like the one in Chile are likely to produce the largest public health benefits. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27516, USA; ,
| | - Montserrat Ganderats-Fuentes
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada;
| | - Simon Barquera
- Department of Nutrition Policy Research, National Institute of Public Health, 62100 Cuernavaca, Mexico;
| | - Alejandra Jauregui
- Department of Physical Activity and Healthy Lifestyles, National Institute of Public Health, 62100 Cuernavaca, Mexico;
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27516, USA; ,
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Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, Vorkoper S. Implementation of childhood obesity prevention and control policies in the United States and Latin America: Lessons for cross-border research and practice. Obes Rev 2021; 22 Suppl 3:e13247. [PMID: 33951275 PMCID: PMC8365637 DOI: 10.1111/obr.13247] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front-of-food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby-Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, and progress of PAPs across RE-AIM framework dimensions. Evidence-based advocacy along with political will and evidence of scalability and impact were key for successful launch and implementation of all PAPs. Diverse adaptations of PAP design and implementation had to be done across contexts. Stronger process and impact monitoring and evaluation systems that track equity indicators are needed to maximize the population benefits of these PAPs. Implementation science offers an important contribution toward addressing knowledge gaps, enhancing obesity policy dialogue, and producing transferable lessons across the Americas and, therefore, should be used for research and evaluation during PAP development and throughout the implementation and maintenance phases.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth Rhodes
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Camila Corvalan
- Institute of Nutrition, Universidad de Chile, Santiago, Chile
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
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Mazzù MF, Romani S, Baccelloni A, Gambicorti A. A cross-country experimental study on consumers' subjective understanding and liking on front-of-pack nutrition labels. Int J Food Sci Nutr 2021; 72:833-847. [PMID: 33657942 DOI: 10.1080/09637486.2021.1873918] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Different Front-of-Pack (FOP) nutritional labels have been implemented in order to increase consumers' awareness of food nutritional quality and encourage healthier choices. However, few studies have analysed the effects of FOPLs on consumers' subjective understanding and liking across different socio-cultural contexts. This study tests the effect that the new enriched informative label NutrInform Battery and the summary label Nutri-Score have on subjective comprehension and liking across 2776 respondents of seven European countries (France, Germany, Greece, Italy, Portugal, Romania and Spain). Main effects regarding socio-demographic differences are also explored according to extant literature and highlighting significant effects of education and income. This study therefore extends the current research on subjective understanding and liking with a cross-country analysis. Findings suggest that NutrInform Battery can help consumers in understanding information in a relevant way, obtaining the highest performance across countries and showing limited impact of socio-cultural differences.
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Affiliation(s)
| | - Simona Romani
- Department of Business and Management, Luiss University, Rome, Italy
| | - Angelo Baccelloni
- Department of Business and Management, Luiss University, Rome, Italy
| | - Antea Gambicorti
- Department of Business and Management, Luiss University, Rome, Italy
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Mazzù MF, Romani S, Gambicorti A. Effects on consumers' subjective understanding of a new front-of-pack nutritional label: a study on Italian consumers. Int J Food Sci Nutr 2020; 72:357-366. [PMID: 32746654 DOI: 10.1080/09637486.2020.1796932] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Front-of-pack nutritional label (FOPL) systems have been developed worldwide to amplify and simplify nutritional information and induce healthier choices. This study explores consumers' internal reactions - in terms of subjective understanding and liking - to a new FOPL: the NutrInform Battery. The investigation aims to assess the clear comprehension by consumers of the information provided by the NutrInform Battery FOPL scheme, based on a sample of 200 Italian respondents, in a real-life setting, with products representative of the most widely consumed food categories, using a between-subject design. Participants were randomly assigned to one of the two conditions: products marked with NutrInform Battery or Nutri-Score labels. The results provided evidence of the effectiveness of NutrInform Battery in being perceived by consumers as an informative FOPL scheme. Specifically, consumers found NutrInform Battery more informative and helpful than Nutri-Score in terms of their understanding of the product composition.
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Affiliation(s)
| | - Simona Romani
- Department of Business and Management, LUISS University, Rome, Italy
| | - Antea Gambicorti
- Department of Business and Management, LUISS University, Rome, Italy
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Nutri-Score, multiple traffic light and incomplete nutrition labelling on food packages: Effects on consumers’ accuracy in identifying healthier snack options. Food Qual Prefer 2020. [DOI: 10.1016/j.foodqual.2020.103894] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
PURPOSE OF REVIEW Guiding consumers toward more healthful food choices may help address the high prevalence of poor dietary quality and diet-related diseases. The use of front-of-package labels (FOPL) on food items is expanding to provide focused nutritional information or representations, often based upon nutrient profiling systems. RECENT FINDINGS FOPL provide a source of nutrition and health information that is readily understood by consumers, including those with limited literacy. There is evidence that FOPL can shift consumer behavior toward more nutritious and healthful choices. However, assessments of the effectiveness of FOPL have been restricted in scope and rely largely on simulation models rather than real-world environments. FOPL are a direct source of nutritional guidance at the point-of-purchase and provide an opportunity to convey critical information on ingredients that are associated with health promotion and/or increased risk of non-communicable diseases. However, limited evidence regarding the most effective forms of FOPL to achieve behavior change and challenges from the food industry impedes the establishment of standardized nutrient profiles and algorithms. Future opportunities for FOPL include the potential for integrating nutritional profiles with non-nutrient factors affecting health such as food processing and environmental sustainability.
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Franco-Arellano B, Vanderlee L, Ahmed M, Oh A, L'Abbé M. Influence of front-of-pack labelling and regulated nutrition claims on consumers’ perceptions of product healthfulness and purchase intentions: A randomized controlled trial. Appetite 2020; 149:104629. [DOI: 10.1016/j.appet.2020.104629] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 01/17/2023]
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Jáuregui A, Vargas-Meza J, Nieto C, Contreras-Manzano A, Alejandro NZ, Tolentino-Mayo L, Hall MG, Barquera S. Impact of front-of-pack nutrition labels on consumer purchasing intentions: a randomized experiment in low- and middle-income Mexican adults. BMC Public Health 2020; 20:463. [PMID: 32252716 PMCID: PMC7137298 DOI: 10.1186/s12889-020-08549-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/18/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Front-of-pack (FOP) nutrition labeling is a cost-effective strategy to help consumers make informed and healthier food choices. We aimed to investigate the effect of the FOP labels used in the Latin American region on consumers' shopping intentions when prompted to make their choices with specific nutrients-to-limit in mind among low- and middle-income Mexican adults (> 18 y). METHODS In this experimental study of an online simulated shopping situation participants (n = 2194) were randomly assigned to one of three labeling conditions: Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), or red Warning Labels (WL). Participants were required to view a video explaining how to correctly interpret the assigned label. Primary outcomes were the overall nutritional quality (estimated using the Nutrient Profiling Scoring Criterion [NPSC] and NPSC baseline score) and mean energy and nutrient content of purchases. Secondary outcomes included shopping time variables. We also evaluated the impact of the labels across food categories (ready-made foods, dairy beverages, non-dairy beverages, salty snacks, and breakfast cereals) and sociodemographic subgroups. RESULTS The MTL and the WL led to a better overall nutritional quality of the shopping cart compared to the GDA (p < 0.05). According to the NPSC score, the WL led to a better nutritional quality across breakfast cereals and salty snacks compared to the GDA (p < 0.05); a similar effect was observed for the MTL among non-dairy beverages (p < 0.05). The MTL and the WL required shorter shopping times compared to GDA (p < 0.05). Across all labeling conditions, the nutritional quality of the shopping cart tended to be lower among those with low income, education and nutrition knowledge levels. CONCLUSION WL and MTL may foster healthier food choices in a faster way among low- and middle-income groups in Mexico. To produce an equitable impact among consumers of all socioeconomic strata, efforts beyond simply the inclusion of a communication campaign on how to use and interpret FOP labels will be required. TRIAL REGISTRATION clinicaltrials.gov. NCT04308408 Retrospectively registered March 16, 2020.
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Affiliation(s)
- Alejandra Jáuregui
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, CP. 62100 Cuernavaca, Morelos Mexico
| | - Jorge Vargas-Meza
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, CP. 62100 Cuernavaca, Morelos Mexico
| | - Claudia Nieto
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, CP. 62100 Cuernavaca, Morelos Mexico
| | - Alejandra Contreras-Manzano
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, CP. 62100 Cuernavaca, Morelos Mexico
| | - Nelson Zacarías Alejandro
- School of Public Health, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, CP. 62100 Cuernavaca, Mexico
| | - Lizbeth Tolentino-Mayo
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, CP. 62100 Cuernavaca, Morelos Mexico
| | - Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - Simón Barquera
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, CP. 62100 Cuernavaca, Morelos Mexico
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Vargas-Meza J, Jáuregui A, Contreras-Manzano A, Nieto C, Barquera S. Acceptability and understanding of front-of-pack nutritional labels: an experimental study in Mexican consumers. BMC Public Health 2019; 19:1751. [PMID: 31888575 PMCID: PMC6938009 DOI: 10.1186/s12889-019-8108-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Front-of-package labelling is a cost-effective strategy to help consumers make healthier choices and informed food purchases. The effect of labels is mediated by consumer understanding and acceptability of the label. We compared the acceptability and understanding of labels used in Latin-America among low- and middle-income Mexican adults. METHODS Participants (n = 2105) were randomly assigned to one of three labels: Mexican Guideline Daily Allowances (GDA), Ecuador's Multiple Traffic Lights (MTL), or Chile's Warning Labels (WL) in red. Label acceptability was evaluated through items regarding likeability, attractiveness and perceived cognitive workload. Objective understanding was evaluated by asking participants to select the product with the lowest nutritional quality among three products. We measured the time participants took to choose the product. Differences in label acceptability, understanding and time required to choose a product across labels were tested. RESULTS Compared to the GDA, a higher proportion of participants liked the MTL and WL, considered them attractive, and with a lower perceived cognitive workload (p < 0.05). Participants had 4.00 (2.86-5.59) times the odds of correctly identifying the product with the lowest nutritional quality when using the MTL label and 4.52 (3.24-6.29) times the odds when using the WL, in comparison to the GDA. Time required to choose the product was lower for the MTL (Median: 11.25 s; IQR = 8.00-16.09) and the WL (Median = 11.94 s, IQR = 8.56-16.52) compared to the GDA (Median: 15.31 s; IQR = 10.81-20.21; p < 0.05). No differences were observed between the MTL and the WL. CONCLUSIONS GDA had the lowest acceptability and understanding among the labels tested. The MTL and the WL were more accepted and understood, and allowed low- and middle-income consumers to make nutrition-quality related decisions more quickly. WL or MTL may foster healthier food choices in the most vulnerable groups in Mexico compared to the current labelling format.
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Affiliation(s)
- Jorge Vargas-Meza
- Center for Nutrition and Health Research, National Institute of Public Health, 62100 Cuernavaca, Mexico
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research, National Institute of Public Health, 62100 Cuernavaca, Mexico
| | | | - Claudia Nieto
- Center for Nutrition and Health Research, National Institute of Public Health, 62100 Cuernavaca, Mexico
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, 62100 Cuernavaca, Mexico
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Vargas-Meza J, Jáuregui A, Pacheco-Miranda S, Contreras-Manzano A, Barquera S. Front-of-pack nutritional labels: Understanding by low- and middle-income Mexican consumers. PLoS One 2019; 14:e0225268. [PMID: 31738782 PMCID: PMC6860442 DOI: 10.1371/journal.pone.0225268] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/31/2019] [Indexed: 12/01/2022] Open
Abstract
Front-of-pack labeling is a cost-effective strategy to decrease population consumption of sodium, sugar, saturated fat, total fat, and trans-fatty acids, considered critical nutrients for chronic disease. Our main objective was to explore the subjective understanding of labels that are currently used internationally among low- and middle-income Mexican consumers. We performed two phases of 10 focus groups with adolescents (13–15 y), young adults (21–23 y), mothers of children 3–12 y, fathers of children 3–12 y and older adults (55–70 y). Seven FOPL were evaluated: Guideline Daily Amounts, Multiple Traffic Light, Chilean Warning labels, Warning labels in Red, 5-Color Nutrition Label, Health Star Rating, and Healthy Choice label. Data was analyzed with a triangulation of researchers using a content analysis, based on three codes: 1) awareness and use of the Guideline Daily Amounts, 2) acceptability, and 3) subjective understanding of labels. Most participants were aware of the Guideline Daily Amounts, however they rarely used it because interpreting the information displayed on the label was too complicated. Health Star Rating, Warning labels, Multiple Traffic Light and the Healthy Choice logo labels were the most understandable, however the acceptability of the The Healthy Choice logo decreased as it did not provide information on specific ingredients. The Warning labels was the only label able to warn about critical nutrients that could represent a health risk. The Warning labels in red was more accepted compared to Warning labels in black. Results show that directive and semi-directive labels, such as Warning labels, Health Star Rating or Multiple Traffic Light, may be better at helping population of low- and middle income make healthier food choices, than non-directive FOPL such as the Guideline Daily Amounts implemented in México. The study results highlight the potential of Warning labels to support decreases in the consumption of critical ingredients in low- and middle-income Mexican consumers.
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Affiliation(s)
- Jorge Vargas-Meza
- Center Health and Nutrition Research, National Institute of Public Health, Cuernavaca, México
| | - Alejandra Jáuregui
- Center Health and Nutrition Research, National Institute of Public Health, Cuernavaca, México
- * E-mail:
| | - Selene Pacheco-Miranda
- Center Health and Nutrition Research, National Institute of Public Health, Cuernavaca, México
| | | | - Simón Barquera
- Center Health and Nutrition Research, National Institute of Public Health, Cuernavaca, México
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The food environment in Latin America: a systematic review with a focus on environments relevant to obesity and related chronic diseases. Public Health Nutr 2019; 22:3447-3464. [PMID: 31666140 DOI: 10.1017/s1368980019002891] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Food environments may be contributing to the rapid increase in obesity occurring in most Latin American (LA) countries. The present study reviews literature from LA that (i) describes the food environment and policies targeting the food environment (FEP); and (ii) analytic studies that investigate associations between the FEP and dietary behaviours, overweight/obesity and obesity related chronic diseases. We focus on six dimensions of the FEP: food retail, provision, labelling, marketing, price and composition. DESIGN Systematic literature review. Three databases (Web of Science, SciELO, LILACS) were searched, from 1 January 1999 up to July 2017. Two authors independently selected the studies. A narrative synthesis was used to summarize, integrate and interpret findings. SETTING Studies conducted in LA countries. PARTICIPANTS The search yielded 2695 articles of which eighty-four met inclusion criteria. RESULTS Most studies were descriptive and came from Brazil (61 %), followed by Mexico (18 %) and Guatemala (6 %). Studies were focused primarily on retail/provision (n 27), marketing (n 16) and labelling (n 15). Consistent associations between availability of fruit and vegetable markets and higher consumption of fruits and vegetables were found in cross-sectional studies. Health claims in food packaging were prevalent and mostly misleading. There was widespread use of marketing strategies for unhealthy foods aimed at children. Food prices were lower for processed relative to fresh foods. Some studies documented high sodium in industrially processed foods. CONCLUSIONS Gaps in knowledge remain regarding policy evaluations, longitudinal food retail studies, impacts of food price on diet and effects of digital marketing on diet/health.
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Nieto C, Jáuregui A, Contreras-Manzano A, Arillo-Santillan E, Barquera S, White CM, Hammond D, Thrasher JF. Understanding and use of food labeling systems among Whites and Latinos in the United States and among Mexicans: Results from the International Food Policy Study, 2017. Int J Behav Nutr Phys Act 2019; 16:87. [PMID: 31623663 PMCID: PMC6798377 DOI: 10.1186/s12966-019-0842-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world. METHODS Adults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline Daily Amounts (GDA) that shows levels of nutrients of concern; 3. Multiple Traffic-Light (MTL) that color codes each GDA nutrient (green = healthy; yellow = moderately unhealthy; red = unhealthy); 4. Health Star Rating System (HSR) that rates foods on a single dimension of healthiness; 5. Warning Label (WL) with a stop sign for nutrients present in unhealthy levels. Participants rated each label on understanding ("easy"/"very easy to understand" vs "difficult"/"very difficult to understand"), and, for NFTs and GDAs, frequency of use ("sometimes"/"often" vs "never"). Mixed logistic models regressed understanding and frequency of use on indicators of labeling systems (NFT = ref), testing for interactions by ethnicity (US Latinos, US Whites, Mexicans), while controlling for sociodemographic and obesity-related factors. RESULTS Compared to the NFT, participants reported greater understanding of the WL (OR = 4.8; 95% CI = 4.4-5.3) and lower understanding of the HSR (OR = 0.34, 95% CI = 0.31-0.37) and the MTL (OR = 0.56, 95% CI = 0.52-0.61), with similar patterns across ethnic subgroups. Participants used GDAs less often than NFTs (OR = 0.48; 95%CI = 0.41-0.55), with the greatest difference among US Whites (OR = 0.10; 95%CI = 0.07-0.14). CONCLUSIONS Understanding and use of the GDA was similar to that of the NFT. Whites, Latinos, and Mexicans consistently reported the best understanding for WLs, a FOPL that highlights unhealthfulness of a product. Therefore, a FOPL summary indicator, such as WLs, may be more effective in both the US and Mexico for guiding consumers towards informed food choices.
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Affiliation(s)
- Claudia Nieto
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Alejandra Jáuregui
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Alejandra Contreras-Manzano
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Edna Arillo-Santillan
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
- School of Demography, ANU College of Arts and Social Sciences, The Australian National University, 9 Fellows Road Acton ACT 260, Canberra, Australia
| | - Simón Barquera
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Christine M. White
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - James F. Thrasher
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC 29208 USA
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Nieto C, Tolentino-Mayo L, Monterrubio-Flores E, Medina C, Patiño SRG, Aguirre-Hernández R, Barquera S. Nutrition Label Use Is Related to Chronic Conditions among Mexicans: Data from the Mexican National Health and Nutrition Survey 2016. J Acad Nutr Diet 2019; 120:804-814. [PMID: 31585829 DOI: 10.1016/j.jand.2019.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-communicable diseases, such as obesity, diabetes, and hypertension, can be prevented and treated through a balanced nutrient-rich diet. Nutrition labels have been recognized as crucial to preventing obesity and non-communicable diseases through a healthier diet. OBJECTIVE Our aim was to examine the association between nutrition label use and chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension) among an adult Mexican population. DESIGN This was a cross-sectional study that used data from the Mexican National Health and Nutrition Survey of 2016 (ENSANUT MC 2016). PARTICIPANTS/SETTING The participants were 5,013 adults aged 20 to 70 years old. Older adults (>70 years), illiterate participants, pregnant women, and participants with implausible blood pressure data were excluded from the sample. The survey was conducted from May to August 2016 in the participants' households. MAIN OUTCOME MEASURES We measured chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension). STATISTICAL ANALYSES PERFORMED Pearson χ2 test was used to examine the associations among the use of nutrition labels and sociodemographic characteristics and chronic conditions. Multiple logistic regression was used to determine the association between nutrition label use and chronic conditions adjusting for the effect of confounding variables like sex, age, body mass index, education level, marital status, ethnicity, residence area, region, and socioeconomic status. RESULTS From the total sample, 40.9% (95% CI 38.4% to 43.8%) reported using nutrition labeling. Respondents with overweight or obesity were less likely to use nutrition labels (odds ratio 0.74; P<0.05). Participants who self-reported diabetes had significantly lower odds of nutrition label use than participants who did not report to have diabetes (odds ratio 0.66; P<0.05). Participants having 3 chronic conditions had lower odds of nutrition label use (odds ratio 0.34; P<0.01) relative to having zero chronic conditions. CONCLUSIONS This study suggests an association between nutrition label use and chronic conditions (obesity and diabetes). These findings demonstrate that people with obesity, diabetes, and a combination of chronic conditions were less likely to use nutrition labels than people without these conditions.
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Nutrition Labeling Schemes and the Time and Effort of Consumer Processing. SUSTAINABILITY 2019. [DOI: 10.3390/su11041079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Guideline Daily Amount (GDA) and nutrition tables are the most used front-of-pack (FOP) nutrition labeling schemes in the world; however, they are hard to process considering the nutritional knowledge, effort, and time needed for interpretation. Consumers spend little time and effort evaluating food products. Consumers are selective, and FOP nutrition labeling schemes should be too. Recent studies have shown that warning messages—a new FOP nutrition labeling scheme—improves consumers’ ability to correctly identify less-healthy products. This study proposes that warning messages are also easier to process. Using eye-tracking, this study demonstrates that warning messages require less processing effort and time than GDA and nutrition tables. This study also shows that females process warning messages easier than males. Additionally, this study found no significant differences between physically active and inactive consumers in their processing of warning messages. The results are robust across product categories and brands.
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Nieto-Orozco C, Chanin Sangochian A, Tamborrel Signoret N, Vidal González E, Tolentino-Mayo L, Vergara-Castañeda A. Percepción sobre el consumo de alimentos procesados y productos ultraprocesados en estudiantes de posgrado de la Ciudad de México. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jbhsi.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Krzepota J, Biernat E, Florkiewicz B. The Relationship between Levels of Physical Activity and Quality of Life among Students of the University of the Third Age. Cent Eur J Public Health 2016; 23:335-9. [PMID: 26841148 DOI: 10.21101/cejph.a4136] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/01/2015] [Indexed: 11/15/2022]
Abstract
AIM The assessment of quality of life (QoL) among elderly people is of great importance when preparing health care programmes for this social group. Many researchers indicate that poor health is less frequently observed in senior citizens who display levels of physical activity (PA) prescribed by WHO. The aim of the study was to investigate the relationship between the level of PA among students of the University of the Third Age (U3A) and their self-assessment concerning their QoL. METHODS The research sample consisted of 131 students from three U3A in West Pomeranian Voivodeship in Poland. PA was assessed with the aid of a short Polish version of the International Physical Activity Questionnaire (IPAQ). The assessment of QoL was conducted with the use of a Polish version of the WHO Quality of Life--BREF instrument (WHOQOL-BREF). RESULTS The present study has shown that highly active U3A students declare high QoL in the psychological and social domains more often than other respondents. CONCLUSION The level of PA recommended by WHO has a positive impact on the perceived QoL. Possible differences are visible mostly in the assessment of different domains of life in relation to the presented levels of PA.
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Affiliation(s)
- Justyna Krzepota
- Department of Physical Culture and Health Promotion, University of Szczecin, Szczecin, Poland
| | - Elżbieta Biernat
- Department of Tourism, Collegium of World Economy, Warsaw School of Economics, Warsaw, Poland
| | - Beata Florkiewicz
- Department of Physical Culture and Health Promotion, University of Szczecin, Szczecin, Poland
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