Types of front-of-package labels
A poor diet predicts increased risk of cardiovascular disease and other chronic diseases. We Americans are constantly tempted by foods that have little or no nutritional value. Small labels on the front of food packages that present some aspect of food quality might help purchasers shift their buying to healthier items.
Front-of-package (FOP) labels come in several flavors: 1) health or nutrition warnings, 2) nutritional evaluations, 3) color-coded or black, 4) text and/or graphic. The artful combination of text and graphics can affect purchasers emotionally thereby encouraging or discouraging shopper behavior. The devil seems to be in the details.
As of 2020, 31 countries implemented some form of FOP labeling of foods and beverages. A recent systematic review and meta-analysis included 134 studies that evaluated the effectiveness of color-coded labels and warning labels. The traffic-light, nutrient warning, and health warning labels all significantly increased the probability of study participants selecting more healthful products. The nutrient warning label was the most effective. The effectiveness of the traffic light, Nutri-Score, and nutrient warnings on purchasing behaviors arose from improved understanding of nutrition information that elicited negative perceptions of less healthful products and positive perceptions of more healthful products. Color-coded labels (such as Nutri-Score) worked best to encourage purchase of more healthful food products, while warning levels worked best to discourage purchase of less healthful food products. All but 8 of the included studies were conducted in laboratory settings, thereby limiting the applicability of the findings to the real world.
Health warning labels
Researchers in the UK conducted a systematic review and meta-analysis of studies that evaluated the effects of health warning labels of food and drink packages on product selection or consumption. The review included 14 randomized controlled trials, 3 for alcohol and 11 for food. Health warning labels contained text or text and images that highlighted a potential adverse health outcome of consuming the target food or beverage product. Twelve comparisons from 9 studies showed that health warning labels significantly reduced selection of the target product by 24 percent compared to no health warning label. Health warning labels for food and drinks that combined images and text appeared to reduce product selection more than labels with only text. Four of the studies showed health warnings created significant negative arousal compared to no health warning. All of the included studies were conducted in laboratory or online settings, with only one study conducted in a naturalistic lab setting and none included studies conducted in the field. Nevertheless, health warnings can potentially discourage consumption of less healthy foods and drinks.
Features of effective FOP labels
A recent narrative review found that sufficient evidence exists to warrant mandatory front-of-package labels to improve public health. The optimally designed label would be highly visible and salient, simple and easy to understand, elicit automatic associations, and combine informational and emotional / social messaging. Nutrient warnings, such as, ‘High in Sugar’, seem to be especially effective. Front-of-package labels have been adopted in dozens of countries of varying socio-economic status throughout the world. Within the labeling framework, many approaches are now in use. Incorporating multiple aspects of healthy and unhealthy foods and drinks, while maintaining simplicity and clarity, presents major challenges. One caveat: Food labels are primarily useful in distinguishing the health value of various types of ultra-processed foods, which should probably be avoided in the first place.
Researchers designed four different food labels and tested them with an online sample of 7,945 adults with an average age of 48 years. The four small labels included 1) green color (‘Choose Often’), 2) single traffic-light (either ‘Choose Often’ in green or ‘Choose Sometimes’ in yellow or ‘Choose Rarely’ in red, 3) physical activity (number of minutes of physical activity needed to expend the number of calories in the food package in orange), and 4) nutrient warning in black (either High in Calories, or High in Saturated Fat, or High in Sugar, or High in Sodium). On a computer screen, participants viewed images of two vending machines, one with images of 16 beverages and the other with images of 16 snack foods. Each participant was randomly assigned to images that had one of the four small labels or (as a control) a label that showed the number of calories (but not one of the four labels). All of the images of the beverages and snack foods showed the number of calories. All of the four test labels led participants to choose beverages or snack foods that had significantly fewer calories than beverages or snack foods selected by participants assigned to the control with only the number of calories shown. The nutrient warning and physical activity green labels received the most favorable ratings. Thus, cleverly designed beverage and food labels might help us make better food choices.
Sugar-sweetened beverages
Higher consumption of sugar-sweetened beverages predicts higher risk of chronic diseases. Population-wide declines in sugar-sweetened beverage consumption might reduce that risk. Warning labels might be one way to reach a broad swath of potential sugary drink purchasers. Labels with carefully designed messages might reduce sugary drink consumption. Researchers at Harvard conducted a meta-analysis of 23 experiments that compared the effects of various labels to control conditions. Compared to the control conditions, sugary drink warnings caused stronger negative emotional reactions and led to more thinking about the health effects of and lower healthfulness perceptions of these drinks and stronger disease likelihood disease perceptions. Sugary drink warnings also reduced hypothetical and actual purchasing and consumption behaviors. Health warnings (such as, Drinking Sugar-sweetened Beverages May Increase Risk of Obesity) were more effective than nutrient warning labels (such as, High in Sugar). Warning labels may be an effective means to alter purchasers’ perceptions, emotions, and behaviors related to consuming sugary drinks.
Front-of-package labels vs. food influencers
Front-of-package labels provide credible information about the relative healthiness of food products. These days, influencers also exert substantial impact on food choices. Researchers in Spain compared the relative strengths of front-of-package food labels and a well-known Spanish food influencer, Carlos Rios, in a laboratory study. Participants (N=454) with an average age of 31 years viewed either a positive or negative Nutri-Score label (used across EU countries) for a food package and rated their initial purchase intention. Then participant learned of the influencer’s recommendation (either positive or negative) for that particular food and again rated their intention to purchase the food product. Participants rated the credibility of both the Nutri-Score label and the influencer. Results showed that the influencer had greater effect on intention to purchase than did the Nutri-Score label. When the label and the influencer recommendations were aligned (either positive or negative), the influencer reinforced the effect of the label. When the label and the influencer were not aligned, the influencer recommendation prevailed. The credibility of the food label increased when aligned with the influences recommendation and decreased when not aligned. Thus, food influencers can exert substantial clout over shoppers’ food buying decisions.
What’s happening in the US
In 1990, Congress, passed the Nutrition Labeling and Education Act (NLEA). NLEA gave Food and Drug Administration (FDA) the authority to set uniform nutrition labeling standards. Certain information such as serving size, the number of calories, and the types and amounts of fats, carbohydrates, and fiber, is required on food labels.
The Biden administration developed a National Strategy to end hunger and increase healthy eating and physical activity by 2030. The desired outcomes include lower incidence of diet-related diseases such as type 2 diabetes, obesity and hypertension. Part of the National Strategy is a standardized FOP system for food packages to help Americans, especially those with lower nutrition knowledge, quickly and easily identify foods that can comprise a healthy eating pattern. The FOP label would complement the existing Nutrition Facts label that’s required on food packages.
What to do
Front-of-package labels have gained wide-spread acceptance globally but not yet in the US. The fate of the Biden administration's FOP initiative remains uncertain. Evidence from the EU suggests that the Nutri-Score FOP positively alters food shoppers’ purchasing behaviors, which in turn, predict improved metabolic health. In the meantime, you can glance at the list of ingredients on the back of a food package. A long list with unpronounceable names that you don’t understand or a hefty amount of sugar might prompt you to leave that package on the shelf.
