1932

Abstract

Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of () real-world evaluations of front-of-package nutrition labels that analyze objective sales data and () 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 improvepopulation 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.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-nutr-111120-094932
2021-10-11
2024-03-29
Loading full text...

Full text loading...

/deliver/fulltext/nutr/41/1/annurev-nutr-111120-094932.html?itemId=/content/journals/10.1146/annurev-nutr-111120-094932&mimeType=html&fmt=ahah

Literature Cited

  1. 1. 
    Acton RB, Vanderlee L, Roberto CA, Hammond D. 2018. Consumer perceptions of specific design characteristics for front-of-package nutrition labels. Health Educ. Res. 33:2167–74
    [Google Scholar]
  2. 2. 
    Ananthapavan J, Sacks G, Brown V, Moodie M, Nguyen P et al. 2020. Priority-setting for obesity prevention—The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study. PLOS ONE 15:6e0234804
    [Google Scholar]
  3. 3. 
    Bhawra J, Reid JL, White CM, Vanderlee L, Raine K, Hammond D 2018. Are young Canadians supportive of proposed nutrition policies and regulations? An overview of policy support and the impact of socio-demographic factors on public opinion. Can. J. Public Health 109:498–505
    [Google Scholar]
  4. 4. 
    Bialkova S, Grunert KG, Juhl HJ, Wasowicz-Kirylo G, Stysko-Kunkowska M, van Trijp HCM. 2014. Attention mediates the effect of nutrition label information on consumers’ choice. Evidence from a choice experiment involving eye-tracking. Appetite 76:66–75
    [Google Scholar]
  5. 5. 
    Bleich SN, Economos CD, Spiker ML, Vercammen KA, VanEpps EM et al. 2017. A systematic review of calorie labeling and modified calorie labeling interventions: impact on consumer and restaurant behavior. Obesity 25:122018–44
    [Google Scholar]
  6. 6. 
    Bollinger B, Leslie P, Sorensen A. 2011. Calorie posting in chain restaurants. Am. Econ. J. Econ. Policy 3:191–128
    [Google Scholar]
  7. 7. 
    Boztuğ Y, Juhl HJ, Elshiewy O, Jensen MB. 2015. Consumer response to monochrome Guideline Daily Amount nutrition labels. Food Policy 53:1–8
    [Google Scholar]
  8. 8. 
    Burton S, Creyer EH, Kees J, Huggins K. 2006. Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants. Am. J. Public Health 96:91669–75
    [Google Scholar]
  9. 9. 
    Cabrera M, Machín L, Arrúa A, Antúnez L, Curutchet MR et al. 2017. Nutrition warnings as front-of-pack labels: influence of design features on healthfulness perception and attentional capture. Public Health Nutr 20:183360–71
    [Google Scholar]
  10. 10. 
    Campos S, Doxey J, Hammond D. 2011. Nutrition labels on pre-packaged foods: a systematic review. Public Health Nutr 14:81496–506
    [Google Scholar]
  11. 11. 
    Cawley J, Sweeney MJ, Sobal J, Just DR, Kaiser HM et al. 2015. The impact of a supermarket nutrition rating system on purchases of nutritious and less nutritious foods. Public Health Nutr 18:18–14
    [Google Scholar]
  12. 12. 
    Christoforou A, Dachner N, Mendelson R, Tarasuk V. 2018. Front-of-package nutrition references are positively associated with food processing. Public Health Nutr 21:158–67
    [Google Scholar]
  13. 13. 
    Comans T, Moretto N, Byrnes J. 2017. Public preferences for the use of taxation and labelling policy measures to combat obesity in young children in Australia. Int. J. Environ. Res. Public Health 14:3324
    [Google Scholar]
  14. 14. 
    Correa T, Fierro C, Reyes M, Carpentier FRD, Taillie LS, Corvalan C. 2019. Responses to the Chilean law of food labeling and advertising: exploring knowledge, perceptions and behaviors of mothers of young children. Int. J. Behav. Nutr. Phys. Act. 16:121
    [Google Scholar]
  15. 15. 
    De la Cruz-Góngora V, Torres P, Contreras-Manzano A, de la Mota AJ, Mundo-Rosas V et al. 2017. Understanding and acceptability by Hispanic consumers of four front-of-pack food labels. Int. J. Behav. Nutr. Phys. Act. 14:28
    [Google Scholar]
  16. 16. 
    Dummer J. 2012. Sodium reduction in Canadian food products with the health check program. Can. J. Diet. Pract. Res. 73:1e227–227
    [Google Scholar]
  17. 17. 
    Minist. Salud Pblica 2014. Reglamento sanitario sustiutivo de etiquetado de alimentos procesados para el consumo humano. 318-Segundo Supl. 318. Minist. Salud Pblica. Quito, Ecuador
    [Google Scholar]
  18. 18. 
    Egnell M, Ducrot P, Touvier M, Allès B, Hercberg S et al. 2018. Objective understanding of Nutri-Score Front-Of-Package nutrition label according to individual characteristics of subjects: comparisons with other format labels. PLOS ONE 13:8e0202095
    [Google Scholar]
  19. 19. 
    Egnell M, Talati Z, Hercberg S, Pettigrew S, Julia C 2018. Objective understanding of front-of-package nutrition labels: an international comparative experimental study across 12 countries. Nutrients 10:101542
    [Google Scholar]
  20. 20. 
    Feunekes GIJ, Gortemaker IA, Willems AA, Lion R, van den Kommer M 2008. Front-of-pack nutrition labelling: testing effectiveness of different nutrition labelling formats front-of-pack in four European countries. Appetite 50:157–70
    [Google Scholar]
  21. 21. 
    Fichera E, von Hinke S. 2020. The response to nutritional labels: evidence from a quasi-experiment. J. Health Econ. 72:102326
    [Google Scholar]
  22. 22. 
    Freire WB, Waters WF, Rivas-Mariño G, Nguyen T, Rivas P. 2017. A qualitative study of consumer perceptions and use of traffic light food labelling in Ecuador. Public Health Nutr 20:5805–13
    [Google Scholar]
  23. 23. 
    Gibson L, Brennan E, Momjian A, Shapiro-Luft D, Seitz H et al. 2015. Assessing the consequences of implementing graphic warning labels on cigarette packs for tobacco-related health disparities. Nicotine Tob. Res. 17:8898–907
    [Google Scholar]
  24. 24. 
    Gillon-Keren M, Kaufman-Shriqui V, Goldsmith R, Safra C, Shai I et al. 2020. Development of criteria for a positive front-of-package food labeling: the Israeli case. Nutrients 12:61875
    [Google Scholar]
  25. 25. 
    Gorski Findling MT, Werth PM, Musicus AA, Bragg MA, Graham DJ et al. 2018. Comparing five front-of-pack nutrition labels’ influence on consumers’ perceptions and purchase intentions. Prev. Med. 106:114–21
    [Google Scholar]
  26. 26. 
    Graham DJ, Mohr GS. 2014. When zero is greater than one: consumer misinterpretations of nutrition labels. Health Psychol 33:121579–87
    [Google Scholar]
  27. 27. 
    Griffith R, O'Connell M, Smith K 2017. The importance of product reformulation versus consumer choice in improving diet quality. Economica 84:33334–53
    [Google Scholar]
  28. 28. 
    Grummon AH, Hall MG. 2020. Sugary drink warnings: a meta-analysis of experimental studies. PLOS Med 17:5e1003120
    [Google Scholar]
  29. 29. 
    Grummon AH, Hall MG, Taillie LS, Brewer NT. 2019. How should sugar-sweetened beverage health warnings be designed? A randomized experiment. Prev. Med. 121:158–66
    [Google Scholar]
  30. 30. 
    Grummon AH, Smith NR, Golden SD, Frerichs L, Taillie LS, Brewer NT. 2019. Health warnings on sugar-sweetened beverages: simulation of impacts on diet and obesity among U.S. adults. Am. J. Prev. Med. 57:6765–74
    [Google Scholar]
  31. 31. 
    Hagmann D, Siegrist M. 2020. Nutri-Score, multiple traffic light and incomplete nutrition labelling on food packages: effects on consumers’ accuracy in identifying healthier snack options. Food Qual. Prefer. 83:103894
    [Google Scholar]
  32. 32. 
    Hammond D. 2011. Health warning messages on tobacco products: a review. Tob. Control 20:5327–37
    [Google Scholar]
  33. 33. 
    Hammond D, Thrasher J, Reid JL, Driezen P, Boudreau C, Santillán EA. 2012. Perceived effectiveness of pictorial health warnings among Mexican youth and adults: a population-level intervention with potential to reduce tobacco-related inequities. Cancer Causes Control 23:57–67
    [Google Scholar]
  34. 34. 
    Hayward LE, Vartanian LR. 2019. Potential unintended consequences of graphic warning labels on sugary drinks: Do they promote obesity stigma?. Obes. Sci. Pract. 5:4333–41
    [Google Scholar]
  35. 35. 
    Herrera AM, Crino M, Erskine H, Sacks G, Ananthapavan J et al. 2018. Cost-effectiveness of product reformulation in response to the Health Star Rating food labelling system in Australia. Nutrients 10:5614
    [Google Scholar]
  36. 36. 
    Hobin E, Bollinger B, Sacco J, Liebman E, Vanderlee L et al. 2017. Consumers’ response to an on-shelf nutrition labelling system in supermarkets: evidence to inform policy and practice. Milbank Q. 95:3494–534
    [Google Scholar]
  37. 37. 
    Kahneman D. 2003. Maps of bounded rationality: psychology for behavioral economics. Am. Econ. Rev. 93:51449–75
    [Google Scholar]
  38. 38. 
    Kahneman D. 2013. Thinking, Fast and Slow New York: Farrar, Straus and Giroux. , 1st ed..
  39. 39. 
    Kim WK, Kim J. 2009. A study on the consumer's perception of front-of-pack nutrition labeling. Nutr. Res. Pract. 3:4300–6
    [Google Scholar]
  40. 40. 
    Levy AS, Mathews O, Stephenson M, Tenney JE, Schucker RE. 1985. The impact of a nutrition information program on food purchases. J. Public Policy Mark. 4:11–13
    [Google Scholar]
  41. 41. 
    Li Y, Yang B, Owusu D, Popova L. 2020. Higher negative emotions in response to cigarette pictorial warning labels predict higher quit intentions among smokers. Tob. Control 29:5496–501
    [Google Scholar]
  42. 42. 
    Lima M, Ares G, Deliza R. 2018. How do front of pack nutrition labels affect healthfulness perception of foods targeted at children? Insights from Brazilian children and parents. Food Qual. Prefer. 64:111–19
    [Google Scholar]
  43. 43. 
    Mhurchu CN, Eyles H, Choi Y-H. 2017. Effects of a voluntary front-of-pack nutrition labelling system on packaged food reformulation: the Health Star Rating system in New Zealand. Nutrients 9:8918
    [Google Scholar]
  44. 44. 
    Moorman C, Ferraro R, Huber J. 2012. Unintended nutrition consequences: firm responses to the Nutrition Labeling and Education Act. Mark. Sci. 31:5717–37
    [Google Scholar]
  45. 45. 
    Morley B, Martin J, Niven P, Wakefield M 2012. Public opinion on food-related obesity prevention policy initiatives. Health Promot. J. Austr. 23:286–91
    [Google Scholar]
  46. 46. 
    Morrison H, Meloncelli N, Pelly FE. 2019. Nutritional quality and reformulation of a selection of children's packaged foods available in Australian supermarkets: Has the Health Star Rating had an impact?. Nutr. Diet. 76:3296–304
    [Google Scholar]
  47. 47. 
    Ng M, Fleming T, Robinson M, Thomson B, Graetz N et al. 2014. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:9945766–81
    [Google Scholar]
  48. 48. 
    Noar SM, Hall MG, Francis DB, Ribisl KM, Pepper JK, Brewer NT. 2016. Pictorial cigarette pack warnings: a meta-analysis of experimental studies. Tob. Control 25:3341–54
    [Google Scholar]
  49. 49. 
    Oliver RL. 1980. A cognitive model of the antecedents and consequences of satisfaction decisions. J. Mark. Res. 17:4460–69
    [Google Scholar]
  50. 50. 
    Otite FO, Jacobson MF, Dahmubed A, Mozaffarian D. 2013. Trends in trans fatty acids reformulations of US supermarket and brand-name foods from 2007 through 2011. Prev. Chronic Dis. 10:120198
    [Google Scholar]
  51. 51. 
    Paulos JA. 1988. Innumeracy: Mathematical Illiteracy and Its Consequences New York: Macmillan
  52. 52. 
    Peebles K, Hall MG, Pepper JK, Byron MJ, Noar SM, Brewer NT. 2016. Adolescents’ responses to pictorial warnings on their parents’ cigarette packs. J. Adolesc. Health 59:6635–41
    [Google Scholar]
  53. 53. 
    Pelletier AL, Chang WW, Delzell JE Jr., McCall JW. 2004. Patients’ understanding and use of snack food package nutrition labels. J. Am. Board Fam. Pract. 17:5319–23
    [Google Scholar]
  54. 54. 
    Peters E, Hibbard J, Slovic P, Dieckmann N. 2007. Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Aff 26:3741–48
    [Google Scholar]
  55. 55. 
    Petty RE, Cacioppo JT. 1986. The Elaboration Likelihood Model of Persuasion New York: Springer
  56. 56. 
    Quitral V, Arteaga J, Rivera M, Galleguillos J, Valdés I. 2019. Comparison of sugar and non- caloric sweetener content in beverages before and after implementing Chilean law 20. 606: Rev. Chil. Nutr. 46:3245–53
    [Google Scholar]
  57. 57. 
    Repub. Fr 2017.. Arrêté du 31 octobre 2017 fixant la forme de présentation complémentaire à la déclaration nutritionnelle recommandée par l'Etat en application des articles L. 3232-8 et R. 3232-7 du code de la santé publique J. Off. Repub. Fr. 0257:16
    [Google Scholar]
  58. 58. 
    Restrepo BJ. 2017. Calorie labeling in chain restaurants and body weight: evidence from New York. Health Econ. 26:101191–209
    [Google Scholar]
  59. 59. 
    Reyes M, Smith Taillie L, Popkin B, Kanter R, Vandevijvere S, Corvalán C. 2020. Changes in the amount of nutrient of packaged foods and beverages after the initial implementation of the Chilean Law of Food Labelling and Advertising: a nonexperimental prospective study. PLOS Med 17:7e1003220
    [Google Scholar]
  60. 60. 
    Roberto CA, Wong D, Musicus A, Hammond D. 2016. The influence of sugar-sweetened beverage health warning labels on parents’ choices. Pediatrics 137:2e20153185
    [Google Scholar]
  61. 61. 
    Roodenburg AJC, Popkin BM, Seidell JC. 2011. Development of international criteria for a front of package food labelling system: the International Choices Programme. Eur. J. Clin. Nutr. 65:111190–200
    [Google Scholar]
  62. 62. 
    Rothman RL, Housam R, Weiss H, Davis D, Gregory R et al. 2006. Patient understanding of food labels: the role of literacy and numeracy. Am. J. Prev. Med. 31:5391–98
    [Google Scholar]
  63. 63. 
    Rozin P, Royzman EB. 2001. Negativity bias, negativity dominance, and contagion. Pers. Soc. Psychol. Rev. 5:4296–320
    [Google Scholar]
  64. 64. 
    Sacks G, Rayner M, Swinburn B. 2009. Impact of front-of-pack ‘traffic-light’ nutrition labelling on consumer food purchases in the UK. Health Promot. Int. 24:4344–52
    [Google Scholar]
  65. 65. 
    Sacks G, Tikellis K, Millar L, Swinburn B. 2011. Impact of ‘traffic-light’ nutrition information on online food purchases in Australia. Aust. N. Z. J. Public Health 35:2122–26
    [Google Scholar]
  66. 66. 
    Sacks G, Veerman JL, Moodie M, Swinburn B. 2011.. ‘ Traffic-light’ nutrition labelling and ‘junk-food’ tax: a modelled comparison of cost-effectiveness for obesity prevention. Int. J. Obes. 35:1001–9
    [Google Scholar]
  67. 67. 
    Sambra V, López-Arana S, Cáceres P, Abrigo K, Collinao J et al. 2020. Overuse of non-caloric sweeteners in foods and beverages in Chile: a threat to consumers’ free choice?. Front Nutr 7:68
    [Google Scholar]
  68. 68. 
    Santos JA, Sparks E, Thout SR, McKenzie B, Trieu K et al. 2019. The science of salt: a global review on changes in sodium levels in foods. J. Clin. Hypertens. 21:81043–56
    [Google Scholar]
  69. 69. 
    Schuldt JP. 2013. Does green mean healthy? Nutrition label color affects perceptions of healthfulness. Health Commun 28:8814–21
    [Google Scholar]
  70. 70. 
    Shahid M, Neal B, Jones A. 2020. Uptake of Australia's Health Star Rating system 2014–2019. Nutrients 12:6 1791.
    [Google Scholar]
  71. 71. 
    Shang C, Huang J, Cheng K-W, He Y, Chaloupka FJ. 2017. The association between warning label requirements and cigarette smoking prevalence by education—findings from the Global Adult Tobacco Survey (GATS). Int. J. Environ. Res. Public Health 14:198
    [Google Scholar]
  72. 72. 
    Shangguan S, Afshin A, Shulkin M, Ma W, Marsden D et al. 2019. A meta-analysis of food labeling effects on consumer diet behaviors and industry practices. Am. J. Prev. Med. 56:2300–14
    [Google Scholar]
  73. 73. 
    Shankar P, Ahuja S, Sriram K. 2013. Non-nutritive sweeteners: review and update. Nutrition 29:11–121293–99
    [Google Scholar]
  74. 74. 
    Shi Y, Grech AL, Allman-Farinelli M. 2018. Changes in the nutritional quality of products sold in university vending machines since implementation of the health star rating in 2014; an environmental audit. BMC Public Health 18:11255
    [Google Scholar]
  75. 75. 
    Sinclair S, Hammond D, Goodman S. 2013. Sociodemographic differences in the comprehension of nutritional labels on food products. J. Nutr. Educ. Behav. 45:6767–72
    [Google Scholar]
  76. 76. 
    Smith L, Reyes M, Colchero A, Popkin B, Corval C. 2019. Changes in sugar-sweetened beverage purchases one year after Chile's front-of-package warning labels and marketing restrictions: a pre-post analysis. protocols.io https://dx.doi.org/10.17504/protocols.io.8tchwiw
    [Crossref] [Google Scholar]
  77. 77. 
    Soederberg Miller LM, Cassady DL, Beckett LA, Applegate EA, Wilson MD et al. 2015. Misunderstanding of front-of-package nutrition information on US food products. PLOS ONE 10:4e0125306 Correction. 2015. PLOS ONE 10:7e0134772
    [Google Scholar]
  78. 78. 
    Stern D, Tolentino L, Barquera S. 2011. Revisión del etiquetado frontal: análisis de las Guías Diarias de Alimentación (GDA) y su comprensión por estudiantes de nutrición en México Inst. Nac. Salud Pública Cuernavaca, Mex:.
  79. 79. 
    Strahan EJ, White K, Fong GT, Fabrigar LR, Zanna MP, Cameron R 2002. Enhancing the effectiveness of tobacco package warning labels: a social psychological perspective. Tob. Control 11:3183–90
    [Google Scholar]
  80. 80. 
    Sutherland LA, Kaley LA, Fischer L. 2010. Guiding Stars: the effect of a nutrition navigation program on consumer purchases at the supermarket. Am. J. Clin. Nutr. 91:41090S–94S
    [Google Scholar]
  81. 81. 
    Taillie LS, Busey E, Mediano Stoltze F, Dillman Carpentier FR. 2019. Governmental policies to reduce unhealthy food marketing to children. Nutr. Rev. 77:11787–816
    [Google Scholar]
  82. 82. 
    Taillie LS, Hall MG, Popkin BM, Ng SW, Murukutla N. 2020. Experimental studies of front-of-package nutrient warning labels on sugar-sweetened beverages and ultra-processed foods: a scoping review. Nutrients 12:2569
    [Google Scholar]
  83. 83. 
    Talati Z, Egnell M, Hercberg S, Julia C, Pettigrew S 2019. Consumers’ perceptions of five front-of-package nutrition labels: an experimental study across 12 countries. Nutrients 11:81934
    [Google Scholar]
  84. 84. 
    Thomson RK, McLean RM, Ning SX, Mainvil LA. 2016. Tick front-of-pack label has a positive nutritional impact on foods sold in New Zealand. Public Health Nutr 19:162949–58
    [Google Scholar]
  85. 85. 
    Thorndike AN, Sonnenberg L, Riis J, Barraclough S, Levy DE. 2012. A 2-phase labeling and choice architecture intervention to improve healthy food and beverage choices. Am. J. Public Health 102:3527–33
    [Google Scholar]
  86. 86. 
    Venegas Hargous C, Reyes M, Smith Taillie L, González CG, Corvalán C 2020. Consumption of non-nutritive sweeteners by pre-schoolers of the food and environment Chilean cohort (FECHIC) before the implementation of the Chilean food labelling and advertising law. Nutr. J. 19:69 Correction 2020. Nutr. J 19:135
    [Google Scholar]
  87. 87. 
    Vyth EL, Steenhuis IHM, Roodenburg AJC, Brug J, Seidell JC. 2010. Front-of-pack nutrition label stimulates healthier product development: a quantitative analysis. Int. J. Behav. Nutr. Phys. Act. 7:165
    [Google Scholar]
  88. 88. 
    Wogalter MS, Conzola VC, Smith-Jackson TL. 2002. Research-based guidelines for warning design and evaluation. Appl. Ergon. 33:3219–30
    [Google Scholar]
  89. 89. 
    World Cancer Res. Fund Int 2020. NOURISHING database. World Cancer Res. Fund Int. London, accessed on Nov. 1, 2020. https://policydatabase.wcrf.org
    [Google Scholar]
  90. 90. 
    World Health Organ 2019. Guiding principles and framework manual for front-of-pack labelling for promoting healthy diet Manual World Health Organ. Geneva:
  91. 91. 
    Young L, Swinburn B. 2002. Impact of the Pick the Tick food information programme on the salt content of food in New Zealand. Health Promot. Int. 17:113–19
    [Google Scholar]
  92. 92. 
    Zhen C, Zheng X. 2017. The impact of NuVal shelf nutrition labels on food purchase. Appl. Econ. Perspect. Policy 42:870–87
    [Google Scholar]
/content/journals/10.1146/annurev-nutr-111120-094932
Loading
/content/journals/10.1146/annurev-nutr-111120-094932
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error