Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases—A Randomised Controlled Trial
by
Bruce Neal 1,2,3,4,*, Michelle Crino 1
, Elizabeth Dunford 1,5, Annie Gao 1, Rohan Greenland 6, Nicole Li 1, Judith Ngai 7, Cliona Ni Mhurchu 8, Simone Pettigrew 9, Gary Sacks 10, Jacqui Webster 1 and Jason H. Y. Wu 1
Bruce Neal 1,2,3,4,*, Michelle Crino 1, Elizabeth Dunford 1,5, Annie Gao 1, Rohan Greenland 6, Nicole Li 1, Judith Ngai 7, Cliona Ni Mhurchu 8, Simone Pettigrew 9, Gary Sacks 10, Jacqui Webster 1 and Jason H. Y. Wu 1
1
The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia
2
The Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
3
Royal Prince Alfred Hospital, University of New South Wales, Sydney, NSW 2050, Australia
4
Department of Epidemiology and Biostatistics, Imperial College London, London SW7 2AZ, UK
5
Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
6
National Heart Foundation of Australia, Melbourne, VIC 3000, Australia
7
Bupa, Brisbane, QLD 4001, Australia
8
National Institute for Health Innovation, University of Auckland, Auckland 1010, New Zealand
9
School of Psychology and Speech Pathology, Curtin University, Bentley, WA 6102, Australia
10
School of Health and Social Development, Deakin University, Melbourne, VIC 3008, Australia
*
Author to whom correspondence should be addressed.
Nutrients 2017, 9(12), 1284; https://doi.org/10.3390/nu9121284
Received: 11 October 2017 / Revised: 10 November 2017 / Accepted: 19 November 2017 / Published: 24 November 2017
Background: Front-of-pack nutrition labelling may support healthier packaged food purchases. Australia has adopted a novel Health Star Rating (HSR) system, but the legitimacy of this choice is unknown. Objective: To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions. Design: Individuals were assigned at random to access one of four different formats of nutrition labelling—HSR, multiple traffic light labels (MTL), daily intake guides (DIG), recommendations/warnings (WARN)—or control (the nutrition information panel, NIP). Participants accessed nutrition information by using a smartphone application to scan the bar-codes of packaged foods, while shopping. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks. Results: The 1578 participants, mean age 38 years, 84% female recorded purchases of 148,727 evaluable food items. The mean healthiness of the purchases in the HSR group was non-inferior to MTL, DIG, or WARN (all p < 0.001 at 2% non-inferiority margin). When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all p > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; p = 0.04). HSR was perceived by participants as more useful than DIG, and easier to understand than MTL or DIG (all p < 0.05). Participants also reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all p < 0.03). Conclusions: These real-world data align with experimental findings and provide support for the policy choice of HSR. Recommendation/warning labels warrant further exploration, as they may be a stronger driver of healthy food purchases.
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Keywords:
food labelling; food industry; food purchases; policy; randomised trial
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MDPI and ACS Style
Neal, B.; Crino, M.; Dunford, E.; Gao, A.; Greenland, R.; Li, N.; Ngai, J.; Ni Mhurchu, C.; Pettigrew, S.; Sacks, G.; Webster, J.; Wu, J.H.Y. Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases—A Randomised Controlled Trial. Nutrients 2017, 9, 1284.
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