Categorizing Foods by Relative Healthfulness: A Scoping Review of Front of Pack Labelling
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Limitations and Future Directions of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Form of Expression | FOP Labelling Scheme | Logo/Symbol with Graphic Example | Brief Description | Nutrients/Ingredients Included | Country Where the System Is Used or Proposed |
---|---|---|---|---|---|
Summary Labels | |||||
Simple | Endorsement Logo | Choices Logo | Green logo with a “healthy choice” text that displays healthy options (including bread, milk, fruit, and vegetables) within specific categories essential to a healthy diet. Blue logo with “conscious choice” text to help customers make better decisions for non-basic items. | Saturated and trans-fat, sodium, added sugar across all foods. Energy criteria for non-basic food groups. | Poland, Belgium, Czechia, Netherlands (until 2016) |
Endorsement Logo | Green Endorsement Logo | Squiggle within a green circle. | Sugar, sodium, saturated fat, and fiber (criteria not yet available). | Israel | |
Endorsement Logo | Healthy Living Guarantee Mark | Green cloud with text “Live Well”. | Total fat, saturated fat, sugar, sodium, and fiber. | Croatia | |
Endorsement Logo | Heart Symbol | Heart symbol with encircling text “Better choice”. | Total fat, saturated and unsaturated fat, sodium, sugar, and fiber. | Finland | |
Endorsement Logo | Keyhole Logo | Green with a white keyhole, followed by the registered trademark symbol. | Total fat, saturated and trans-fat, added sugar, salt, dietary fiber, and whole grains. | Iceland, Lithuania, Denmark, Norway, Sweden | |
Endorsement Logo | Protective Food Logo (Little heart Logo) | List below heart symbol gives the product’s specific nutritional properties that make it a healthier option compared with other food products in the same category. | Fat, ratio of fatty acids, salt, added sugar, energy, and fiber. | Slovenia | |
Nutrient-Specific Labels | |||||
Color-Coded | Nutrient-specific interpretive system | Color-coded %RI (Recommended intake) | Traffic light color coding: Interpretive (color) and non-interpretive (%RI). Color coding indicates high (red), medium (amber), and low (green) levels of negative nutrients. Energy is depicted in greyscale. | Energy, total fat, saturated fat, sugars, and salt. | United Kingdom, Portugal, Ireland |
Warning Labels | Nutrient-specific warning label | Red warning label | Single symbols used for sugar (spoon), sodium (saltshaker) and saturated fat (solid fat and knife), with text “high in nutrient”. Back of pack displays the amount of calories, sugar, sodium, and saturated fat in bold font. | Sugar, sodium, and saturated fat. | Israel |
Nutrient-specific warning label | The Chilean System | The words “alto en…” (“high in…”) calories, sugars, saturated fats, or sodium are written in a black octagon with white borders on the front of the food or beverage package. | Saturated fats, sodium, calories, and sugar. | Chile, Uruguay, Peru, Israel, Brazil, Canada, India. |
FOP Labelling Scheme | Author, Year, Location | Population | Results of Study | Limitations |
---|---|---|---|---|
Endorsement Logo | Jewell and Kelly (2019) [19] Europe | 13 countries: Croatia, Czechia, Denmark, Finland, France, Iceland, Israel, Lithuania, Norway, Poland, Slovenia, Sweden and the United Kingdom, Belgium, and Netherlands. Study population not reported. | The aim of the logo is to suggest options that are better for you but provide no clear details to suggest whether a product is unhealthy. Front of packaging labelling (FOLP) policies were supported by government in three countries that provided directive details on product healthiness. This included nutrient-specific warning labels, a summary indicator system providing information on the overall nutrition quality of a product, and an interpretive system providing both numerical and color-coding information on the contribution a food makes to a nutrient ‘s prescribed daily intake. | Lack of information on formal provisions for the assessment of FOPL policies as part of label implementation, while scholarly reviews have provided proof in encouraging the consumer and reformulation objectives. |
Summary indicator system: Nutri-Score information system | Hurtado et al. (2020) [31] France | Study population not reported. | The nutritional profiles developed by the United Kingdom British Food Standards Agency Nutrient Profile System (FSA-NPS) were used as the for the scoring criteria for the nutritional profiles of Food Standards the Australian and New Zealand, the model of nutritional profiles in South Africa and the model of nutritional profiles in Ireland. The FSA algorithm consists of a basic scoring system in which points are assigned on the basis of per 100 g of product nutrient material. | FOPL development: it may not be considered acceptable to use a dichotomous scoring system (with binary scoring suggesting the definition of good and bad food products). Taking this into account, Santé Publique (Public Health) France, in collaboration with the University of Paris, created five nutritional quality categories based on the British FSA-NPS, in order to ensure a high degree of discrimination within each food and beverage division, while retaining a core category in order to avoid classifying food items as good or bad. |
Nutrient-specific interpretive system: Traffic Light Labelling | Al-Jawaldeh et al. (2020) [32] Eastern Mediterranean Region | Study population not reported | Three countries in the area have been reported as introducing front-of-pack nutrition labelling schemes, and three more schemes are under progress. In the area, the regimes listed fell into three categories:
| In real world environments, there is not enough testing. No conclusive proof exists as to which particular scheme is most successful. The most suitable FOP labelling scheme can differ from country to country, so policy makers need to select the scheme that is most appropriate for their unique national background. |
Endorsement Logo—Keyhole logo | Mork et al. (2017) [33] Denmark | Males older than 35 years old with poor educational standards | In two out of three supermarket outlets investigated, the initiative had a positive impact on sales of keyhole labelled items. Sales of keyhole branded goods increased by approximately 20% in these two retail chains. There was a slight decline in sales of keyhole branded goods in the third chain. The impact varied considerably between categories of goods. Interview data analysis found that shoppers with poor education had a greater likelihood of mentioning health as a purchase motive by the end of the campaign, and there was a higher general propensity to search for nutrition information. | The findings are based on a few selected stores examined. As the frozen ready to eat meal counter was not very well visited, the observation/interview portion of the analysis is restricted by the range of product categories and may be one of the categories where a nutrition label may have a reverse effect. The experiments were also carried out within a short time frame, and it was therefore not possible to calculate the long-term impact of the initiative. |
Nutrient-specific interpretive system: Australian Health Star Rating System | O’Connor and Anderson (2019) [34] Australia | Males and females aged 17–83 years old from the community and psychology students from the Queensland University of Technology. | The purpose of this study was to see how the Australian HSR effects consumer decision-making in various comparative processing scenarios. Individuals were asked to complete six binary forced-choice comparisons wherein the appearance of the HSR and the nutritional status (high or low) of the cereal products were both changed. Participants were also asked to rate their willingness to buy the products. As opposed to prior research, consumers did not interpret the existence of the HSR as a sign of a healthier alternative. This indicates that the level of cognitive processes required to assess the HSR system is suitable for successful decision-making. When evaluating a product excluding a HSR label to a product including a HSR label, individuals who did not review the back-of-pack (BOP) nutritional information were more likely to make less informed choices. Irrespective of BOP viewing, consumers’ capacity to choose healthier items was enhanced when both products exhibited a HSR (namely a mandated labeling). This shows that consumer decision-making is influenced by the sort of comparison environment. Consumers’ propensity to purchase products with low and high nutritional content was also found to be affected differently by nutrition knowledge. | The participants in this study were predominantly women, aged 17–24, with secondary school education. One of the limitations in the study is that the results may not be reflective of the average working-class Australian household. Future studies should include a more diverse group as results that are used to inform public policies must be generalizable. Another limitation is that when respondents had no apparent product preference, the forced-choice method may have inadvertently altered consumer decision. |
Endorsement Logo | Reyez et al. (2019) [35] Chile | Study population not reported. | Information on general text, for example, short wording and design characteristics (such as use of the logo, use of red or black colors), was presented in the literature review and qualitative stage; 15 prototypes were produced and quantitatively evaluated on the basis of the selected characteristics. A black and white stop sign and a black-and white hand were preselected in the first survey. In the second survey, in terms of visualization, intention to buy and willingness to change the planned purchase, the stop sign saying ‘Excess of <nutrient>‘ had a considerably higher score than the hand. | The FOP warning label suggested in this article was introduced by the Chilean Minister of Health by replacing the words’ Excess of ‘with’ High in ‘because the language of the legislation did not permit the use of’ Excess.’ A communication campaign to present the latest alert message was launched to ensure that individuals correctly interpreted the significance of ‘High in’. The use of the term ‘High in’ as a beneficial food attribute (that is, high in vitamins) was forbidden. |
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Singh, S.; Naicker, A.; Memela, S.N. Categorizing Foods by Relative Healthfulness: A Scoping Review of Front of Pack Labelling. Int. J. Environ. Res. Public Health 2021, 18, 11980. https://doi.org/10.3390/ijerph182211980
Singh S, Naicker A, Memela SN. Categorizing Foods by Relative Healthfulness: A Scoping Review of Front of Pack Labelling. International Journal of Environmental Research and Public Health. 2021; 18(22):11980. https://doi.org/10.3390/ijerph182211980
Chicago/Turabian StyleSingh, Shivneta, Ashika Naicker, and Sinenhlanhla Ntokozo Memela. 2021. "Categorizing Foods by Relative Healthfulness: A Scoping Review of Front of Pack Labelling" International Journal of Environmental Research and Public Health 18, no. 22: 11980. https://doi.org/10.3390/ijerph182211980