Alignment of Supermarket Own Brand Foods' Front-of-Pack Nutrition Labelling with Measures of Nutritional Quality: An Australian Perspective

Front-of-Package Nutrition Labeling and Its Impact on Food Industry Practices: A Systematic Review of the Evidence

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.

Australian Consumers Are Willing to Pay for the Health Star Rating Front-of-Pack Nutrition Label

The Australia and New Zealand Ministerial Forum on Food Regulation has supported the recommendations set out in the 2019 Health Star Rating System Five Year Review Report. Specifically, the forum supported, in principle, Recommendation 9, to mandate the Health Star Rating if clear uptake targets were not achieved while the system is voluntary. Given that mandatory labelling is being considered, it is important to investigate how much consumers value the Health Star Rating in order to understand potential consumer uptake and inform industry. The aim of this study was to assess consumers' valuation of the Health Star Rating system by analysing their willingness to pay for a packaged food product with the Health Star Rating label, utilising a double-bounded dichotomous choice contingent valuation approach. The results indicate that almost two-thirds of Australian household grocery shoppers were willing to pay more for a product with the Health Star Rating, on average up to an additional 3.7% of the price of the product. However, public health nutrition benefits associated with consumers' willingness to pay more for products with the Health Star Rating is currently limited by the lack of guarantee of the systems' accuracy. Given consumer support, a well validated and comprehensive Health Star Rating labelling system can potentially improve health outcomes, cost effectiveness and reduce environmental impacts.

Energy Density of New Food Products Targeted to Children

High dietary energy density (ED) is linked to childhood obesity and poor diet quality. The Australian Health Star Rating (HSR) system aims to assist consumers in making healthful food choices. This cross-sectional study used 2014-2018 data from the Mintel Global New Products Database to describe the ED of new food products targeted to children (5-12 years) released after the introduction of HSR and examine relationships between ED and HSR. Products were categorised by ED (low < 630 kJ/100 g, medium 630-950 kJ/100 g, high > 950 kJ/100 g) and HSR (no, HSR < 2.5 low, HSR ≥ 2.5 high). Non-parametric statistics were used to examine ED and HSR. A total of 548 products targeted children: 21% low, 5% medium, 74% high ED. One hundred products displayed an HSR: 24% low, 76% high; 53 products with both high HSR and ED. The EDs of products differed by HSR (p < 0.05), but both group's medians (HSR < 2.5: 1850 kJ/100 g, HSR ≥ 2.5: 1507 kJ/100 g) were high. A high proportion of new products had a high ED, and the HSR of these foods did not consistently discriminate between ED levels, particularly for high ED foods. Policies to promote lower ED foods and better alignment between ED and HSR may improve childhood obesity and diet quality.

The nutritional quality of supermarket own brand chilled convenience foods: an Australian cross-sectional study reveals limitations of the Health Star Rating

OBJECTIVE

To assess the nutritional quality of Australian supermarket own brand chilled convenience foods (SOBCCF), for example, ready meals, pizza, pies and desserts.

DESIGN

Cross-sectional.

SETTING

Two large supermarkets (Coles and Woolworths) in Perth, Western Australia were audited in February 2017.

PARTICIPANTS

Data were extracted from photographic images of 291 SOBCCF, including front-of-pack information (i.e. product name, description and nutrition labels including Health Star Rating (HSR)) and back-of-pack information (i.e. nutrition information panel and ingredients list). SOBCCF were classified as healthy or unhealthy consistent with principles of the Australian Guide to Healthy Eating (AGTHE), NOVA classification of level of food processing and HSR score.

RESULTS

Fifty-four percentage of SOBCCF were classified as unhealthy according to AGTHE principles, 94 % were ultra-processed foods using NOVA and 81 % scored a HSR of ≥2·5, implying that they were a healthy choice. Some convenience food groups comprised more healthy choices overall including prepared vegetables, salad kits and bowls, soups and vegetarian food. A significantly larger proportion of SOBCCF from Coles were classified as unhealthy compared with Woolworths (70 v. 44 %, P < 0·05) using the AGTHE.

CONCLUSIONS

The findings suggest there is potential for Australian supermarkets to improve the nutritional quality of their SOBCCF and highlights the differences between supermarkets in applying their corporate social responsibility policies. Policies to assist consumers to select healthier foods should address difficulties in identifying healthy convenience foods. The findings reveal misclassification of unhealthy SOBCCF as healthy by the HSR suggesting that its algorithm should be reformed to align with recommendations of the AGTHE.

Evaluating Nutrient-Based Indices against Food- and Diet-Based Indices to Assess the Health Potential of Foods: How Does the Australian Health Star Rating System Perform after Five Years?

Nutrient-based indices are commonly used to assess the health potential of individual foods for nutrition policy actions. This study aimed to evaluate the nutrient profile-informed Australian Health Star Rating (HSR), against NOVA and an index informed by the Australian Dietary Guidelines (ADGs), to determine the extent of alignment. All products displaying an HSR label in the Australian marketplace between June 2014 and June 2019 were extracted from the Mintel Global New Product Database, and classified into one of four NOVA categories, and either as an ADG five food group (FFG) food or discretionary food. Of 4451 products analysed, 76.5% were ultra-processed (UP) and 43% were discretionary. The median HSR of non-UP foods (4) was significantly higher than UP foods (3.5) (p < 0.01), and the median HSR of FFG foods (4) was significantly higher than discretionary foods (2.5) (p < 0.01). However, 73% of UP foods, and 52.8% of discretionary foods displayed an HSR ≥ 2.5. Results indicate the currently implemented HSR system is inadvertently providing a ‘health halo’ for almost ¾ of UP foods and ½ of discretionary foods displaying an HSR. Future research should investigate whether the HSR scheme can be reformed to avoid misalignment with food-and diet-based indices.

A Comparison of the Nutritional Qualities of Supermarket's Own and Regular Brands of Bread in Sweden

Processed food is associated with unhealthy qualities such as higher content of harmful fats, sugars and salt. The aim of our study was to compare the nutritional qualities of supermarket's own brands and regular brands of bread sold in Sweden. Additionally, we compared the nutritional qualities of gluten-free and gluten-containing bread. We collected information from the labels of 332 bread products available in the largest grocery store chains. The Australian Health Star Rating (HSR) system was used to quantify the nutritional quality of each bread product. We compared all supermarket's own brand products to regular brand products, and gluten-free to gluten-containing bread. The mean HSR for the supermarket's own brands was lower than the regular brands (3.6 vs. 3.7; p = 0.046). For the regular brand products, the fibre, sugar and total fat content were greater (p < 0.001, p = 0.002 and p = 0.021, respectively), while less protein (p = 0.009) compared to regular bread products. Gluten-free bread had a lower HSR than gluten-containing bread (mean 3.5 vs. 3.8, respectively; p < 0.001). The regular brand products were slightly healthier than the supermarket's own brands, primarily as a result of a higher fibre content. Gluten-free bread products were slightly unhealthier due to a lower protein content.

Growing the Business of Whole Grain in the Australian Market: A 6-Year Impact Assessment

The Australia New Zealand Food Standards Code does not regulate on-pack claims describing the amount of whole grain in foods. In July 2013, The Grains & Legumes Nutrition Council^™ (GLNC) established a voluntary Code of Practice for Whole Grain Ingredient Content Claims (the Code) providing guidance for whole grain claims, with cut-off values and suggested wording ≥8 g, ≥16 g, and ≥24 g per manufacturer serve (contains; high and very high in whole grain), based on a 48 g whole grain daily target intake. The aim of this impact assessment was to report the uptake of the Code by manufacturers, changes in numbers of whole grain products, and claims on-pack since 2013, including compliance. The impact assessment was undertaken in August 2019, comparing current registered manufacturers (“users”) and their products to the total number of products in the market deemed eligible for registration through GLNC product audits since 2013. Reporting included breakfast cereals, bread products, crispbreads, crackers, rice/corn cakes, rice, pasta, noodles, couscous, other grains (e.g., quinoa, buckwheat, freekeh), and grain-based muesli bars. As of 30 June 2019, there were 33 registered users and 531 registered products in Australia and New Zealand representing 43% of the eligible manufacturers and 65% of the eligible whole grain foods. Three-quarters (78% and 74%) of the eligible breakfast cereals and bread products were registered with the Code in 2019, followed by 62% of grain-based muesli bars. Only 39% of crispbread, crackers, rice/corn cakes, and rice, pasta, noodles, couscous, and other grains were registered. From 2013 there has been a 71% increase in the number of whole grain foods making claims, demonstrating strong uptake by industry, with clearer, more consistent, and compliant on-pack communication regarding whole grain content.

The Nature and Quality of Australian Supermarkets' Policies that can Impact Public Health Nutrition, and Evidence of their Practical Application: A Cross-Sectional Study

Improving population diets is a public health priority, and calls have been made for corporations such as supermarkets to contribute. Supermarkets hold a powerful position within the food system, and one source of power is supermarket own brand foods (SOBFs). Many of the world’s largest supermarkets have corporate social responsibility (CSR) policies that can impact public health, but little is known about their quality or practical application. This study examines the nature and quality of Australian supermarkets’ CSR policies that can impact public health nutrition, and provides evidence of practical applications for SOBFs. A content analysis of CSR policies was conducted. Evidence of supermarkets putting CSR policies into practice was derived from observational audits of 3940 SOBFs in three large exemplar supermarkets (Coles, Woolworths, IGA) in Perth, Western Australia (WA). All supermarkets had some CSR policies that could impact public health nutrition; however, over half related to sustainability, and many lacked specificity. All supermarkets sold some nutritious SOBFs, using marketing techniques that made them visible. Findings suggest Australian supermarket CSR policies are not likely to adequately contribute to improving population diets or sustainability of food systems. Setting robust and meaningful targets, and improving transparency and specificity of CSR policies, would improve the nature and quality of supermarket CSR policies and increase the likelihood of a public health benefit.

Health Star Rating in Grain Foods-Does It Adequately Differentiate Refined and Whole Grain Foods?

The Australian front-of-pack labelling system, Health Star Rating (HSR), does not include whole grain (WG) in its algorithm, but uses dietary fibre (DF), despite Dietary Guidelines recommending WG over refined grain (RG) foods. This study aimed to determine how effectively HSR differentiates WG and RG foods. Product label data were collected 2017–18 from bread, rice, pasta, noodles, flour and breakfast cereals (n = 1127). Products not displaying HSR, DF per 100 g, and %WG ingredients were excluded, leaving a sample of 441 products; 68% were WG (≥8 g/manufacturer serving). There was a significant difference (p < 0.001) in HSR between WG bread and breakfast cereal over RG varieties, yet the mean difference in stars depicted on the pack was only 0.4 for bread and 0.7 for breakfast cereal. There was no difference for rice (p = 0.131) or flour (p = 0.376). Median HSR also poorly differentiated WG. More WG foods scored 4–5 stars compared to RG, yet there was notable overlap between 3.5–5 stars. DF content between RG and WG subcategories was significantly different, however wide variation and overlap in DF highlights that this may not be a sufficient proxy measure, raising concerns that the HSR algorithm may not adequately communicate the benefits for consumers of swapping to WG foods.

Free Sugars Intake, Sources and Determinants of High Consumption among Australian 2-Year-Olds in the SMILE Cohort

In the first 2 years of life, it is important to limit exposure to foods high in free sugars, in order to lay foundations for lifelong eating patterns associated with a reduced risk of chronic disease. Intake data at this age is limited, so compliance with recommendations is not known. This analysis describes free sugars intakes, food sources and determinants of high consumption among Australian children at 2 years of age. Free sugars intakes were estimated using a customized Food Frequency Questionnaire, and median usual free sugars intake at 2 years was 22.5 (Interquartile Range (IQR) 12.8⁻37.7) g/day, contributing a median 8% of the estimated energy requirement (EER). Based on the EER, most children (71.1%) exceeded the World Health Organization recommendation that <5% of energy should come from free sugars, with 38% of participants exceeding the <10% recommendation. Children from households with the greatest socioeconomic disadvantage were more likely to exceed the 10% recommendation (Prevalence Ratio (PR) 1.44, 95% Confidence Interval (95% CI) 1.13⁻1.84), and be in the top tertile for free sugars intake (PR 1.58, 95% CI 1.19⁻2.10) than the least disadvantaged. Main sources of free sugars were non-core foods, such as fruit juice, biscuits, cakes, desserts and confectionery; with yogurt and non-dairy milk alternatives the two notable exceptions. Improved efforts to reduce free sugars are needed from the introduction of solid food, with a particular focus on fruit juice and non-core foods.