research paper on food labeling

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Food Labeling: Analysis, Understanding, and Perception

Daniela martini.

1 Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy

Davide Menozzi

2 Department of Food and Drug, University of Parma, 43124 Parma, Italy

Associated Data

Not applicable.

Food labels are the first informative tool found by the customers during shopping, and are informative in terms of ingredients, nutrient content, and the presence of allergens of the selected product. However, food labeling also represents a marketing tool and may influence perception of the food quality and, in turn, the dietary choice of consumers. For this reason, there is growing research in the food labeling field and in the evaluation of its effects on consumers, food operators, and the whole market [ 1 , 2 ]. This is supported by a wide range of manuscripts published in recent years, for instance, with the specific purpose to better investigate how specific information on the food packaging may influence food purchases and consumption and, in general, dietary behavior [ 3 , 4 , 5 , 6 , 7 , 8 ]

The Special Issue “ Food Labeling: Analysis, Understanding, and Perception ” was conceived with the intention to further explore current efforts in food labeling research and welcomed original studies, as well as reviews of the literature, focusing on: (i) the analysis of the nutrient profile of products with different characteristics reported on the food labels, i.e., nutrition and health claims (NHCs), organic, gluten-free (GF); (ii) the nutrient profile underlying front-of-pack (FOP) nutrition labels and their graphical design in different countries; (iii) the consumers’ perception, knowledge, and understanding of the information provided on food labeling; (iv) the impact of information on food labeling (e.g., FOP information, serving size) on consumers’ willingness to pay and food choice; (v) the attitudes, beliefs, and perceptions and behavioral and socioeconomic determinants regarding the use of food labels.

This Special Issue provides a series of 25 contributions, with 20 original papers, four narrative reviews, and one commentary. This last article is a consensus by eminent exponents of the International Carbohydrate Quality Consortium (ICQC) [ 9 ], which underlines the importance of dietary fiber, which is not always mandatory on food labeling (e.g., Reg. (EU) No 1169/2011) [ 10 ]. The authors supported the need for including fiber values in food labeling by distinguishing between intrinsic and added fiber, which may also help to achieve the recommended intake by consumers. The need to consider other information on food labels has also been discussed by Marinangeli and colleagues [ 11 ], who reviewed the regulatory frameworks and examples of associated non-mandatory food labeling claims currently employed to highlight healthy carbohydrate foods to consumers. Among the information, the authors considered NHCs related to dietary fiber, glycemic index, and glycemic response, and the presence of whole carbohydrate foods and ingredients that are intact or reconstituted (e.g., whole grains).

Some studies focused on the analysis of the nutritional quality of specific food groups and/or specific nutrients. Three studies were performed within the Food Labeling of Italian Products (FLIP) [ 12 , 13 , 14 ], a project aiming to evaluate the nutritional quality of packaged products currently sold in the online shops of several retailers in Italy [ 15 , 16 , 17 ]. Specifically, two studies focused on the analysis of the food labeling of breakfast cereals [ 12 ] and pasta [ 14 ]. The first study reported an elevated inter-product variability among breakfast cereals currently sold in Italy, with only limited differences when products with NHCs and GF declarations were compared with products not carrying this information [ 12 ]. Similarly, the study performed on pasta revealed that pasta types currently on the Italian market largely vary in terms of nutrition profile, with stuffed pasta characterized by a high salt content [ 14 ]. This last aspect supports the importance of providing nutrition facts of product to consumers to help them in making informed food choices. The last study performed within the FLIP project compared the nutritional quality of organic and conventional food products, highlighting that, with just a few exceptions, prepacked organic products are not of a superior nutritional quality than conventional ones, based on the mandatory information present on their packaging [ 13 ].

Yusta-Bojo et al. [ 18 ] focused on the sugar content in the most-consumed processed foods in Spain and compared the sugar values declared on the label (LVs) with laboratory analysis values (AVs). The study findings evidenced a high adequacy of LVs with the EU labeling tolerance requirements, with only cured ham presenting significant differences between the median AVs and LVs. Lastly, Azzopardi et al. investigated the energy density (ED) of food products targeted at children sold in Australia, finding a high proportion of products with a high ED (i.e., >950 kJ/100 g) among the 548 food items considered [ 19 ]. The same study observed that the health star rating (HSR) system, one of the FOP systems introduced in Australia in 2014, did not consistently discriminate between ED levels, particularly for high-ED foods.

The HSR was also studied in another study focused on consumers’ perception [ 20 ] and performed with fifteen Australian grocery shoppers. Intriguingly, the findings from this study showed that the HSR was perceived as a simple, easy-to-understand, and useful tool, despite a certain grade of skepticism concerning its conception. The consumers’ perception and responses to FOP labels was also considered in another two papers published by Egnell et al. [ 21 ] and Talati et al. [ 22 ], showing results from the Netherlands and across another 12 countries, respectively, supporting that this represents a widely explored field of research. In detail, the first study [ 21 ] compared the perception and understanding of five FOP labels (HSR, Nutri-Score, multiple traffic lights (MTLs), reference intake, and warning symbols) among 1032 Dutch participants, finding a favorable perception, with Nutri-Score showing the highest performance in helping consumers to rank the products according to their nutritional quality. Conversely, in a similar study performed with over 12,000 participants across 12 countries, MTLs obtained the most favorable ratings, with mixed or neutral perceptions of the other FOP labels [ 22 ]. A third study by Breen et al. [ 23 ] compared NHCs, the HSR, and the price of snack foods sold in health food (HF) stores and aisles with the ones sold in regular areas (RAs) of supermarkets. The results showed that snack foods of HF stores displayed a significantly higher number of product claims compared to RA foods, together with a higher HSR and cost.

Botelho et al. [ 24 ] analyzed the FOP of food items shown in specific sections of the circulars of two Brazilian supermarket chains during a 10-week period, classifying them by their “unprocessed/minimally processed” versus “ultraprocessed” (UP) items and the presence and type of claims on the FOP. The NOVA systems represent another way of classifying foods that has receiving growing interest and which is based on the degree of food processing [ 25 ]. In this Special Issue, authors found that more than 50% of the items sold in the health and wellness section were UP and reported a high presence of reduced and increased nutrient content claims, suggesting that supermarkets’ circulars often promote the sale of UP foods.

Besides the study of consumers’ perception of FOP, it is worth investigating the predictors of consumer interest in FOP and back-of-pack labels. This was the object of a Polish study [ 26 ] which found that self-rated knowledge about nutrition healthiness is the only significant predictor in over 1000 Polish consumers, while neither demographic nor socioeconomic variables were significant predictors of interest towards food labels. Plasek and coworkers [ 27 ] focused on six categories of actors that seem to influence the perceived healthiness of foods: (i) the communication information (such as FOPs and NHCs), (ii) the product category, (iii) the shape and color of the product packaging, (iv) the ingredients of the product, (v) the organic origin of the product, and (vi) the sensory characteristics of food. Bryla [ 28 ] also found that FOP label reading is one of the predictors of the importance linked to salt content in over 1000 Polish consumers, in addition to other predictors such as the importance and attention to NHCs and the respondent’s age.

Two studies applied hypothetical discrete choice experiments to analyzing consumers’ choices and willingness to pay (WTP) for, respectively, fish products [ 29 ] and pork sausages [ 30 ]. Menozzi and colleagues interviewed 2500 fish consumers in five European countries to assess the relative importance and WTP for different fish species and labeled attributes (i.e., sustainability label, NHCs, product presentation, production system, and price). The findings showed positive premiums for sustainability label, NHCs, and wild-caught alternatives, with high heterogeneity across countries and species [ 29 ]. Czine et al. [ 30 ] investigated whether product characteristics indicated on food labels of sausage made from traditional Hungarian mangalica pork might influence consumers’ choices. The authors found respondents’ preference for the label of origin indicating meat from registered animals, and purchasing from the farmers’ market is preferred over the butcher and hyper-/supermarket.

Country-of-origin (COO) labeling effects were analyzed by Bimbo et al. [ 31 ]. The authors tested the price differential associated with the COO information for extra-virgin olive oil (EVOO) in Italy, employing a hedonic price model on the purchase of EVOO products collected from 982 consumers at the supermarket checkouts. Although the mandatory COO labeling regulation for EVOO can be an effective tool for consumers to identify the origin of the product and for producers to differentiate products, the results evidenced a significant share of consumers unable to correctly identify the origin of the EVOO purchased, mostly among consumers who reported having purchased Italian EVOO.

Two experiments were conducted to analyze the effects of visual aids and color nutrition information (CNI) on sugar-sweetened beverages [ 32 ] and sweet food consumption [ 33 ]. Merillat et al. [ 32 ] assessed the effects of visual aids on judgments of sugar quantity in popular drinks and the choices of 261 individuals recruited in the USA. In the experimental condition, participants viewed beverages along with test tubes filled with the total amount of sugar in each drink and this led to a lower intention to consume any of the beverages, suggesting that this simple visual aid intervention affected judgments and choices towards curtailing sugar intake. Using an eye-tracking technique, Potthoff et al. [ 33 ] evaluated the effect of CNI based on a traffic light system adopted in Austria; participants in this study viewed images depicting sweets preceded by a colored circle informing about the sugar content of the food, with and without nutrition information. The results showed that the intervention had the opposite of the intended effect and the authors questioned whether CNI is helpful to influence initial cue reactivity toward sweet foods.

A quasi-experimental online trial on the choice of sugar foods was performed by Chen et al. [ 34 ] in Taiwan. The authors analyzed how mothers’ choices of low-sugar food were affected by theory-driven nutrition interventions, finding that, after the intervention, they exhibited enhanced sugar and nutrition label knowledge, perceived behavioral control, behavioral intentions, and behavior.

Another experiment was conducted by Modlinska et al. [ 35 ] with 99 Polish individuals to assess the influence of food labeling (insect content) and appearance (traces of insect-like ingredients) on the participants’ perception. The results showed that products labeled as containing insects are consumed with reluctance and in lower quantities despite their appearance, regardless of the form in which the insects are served. The authors provided recommendations for labeling strategies to help to reduce the effect of disgust.

As already mentioned, food labeling does not include only nutritional information, and this is why a series of papers focused on other aspects is included. For instance, Ontiveros and colleagues [ 36 ] focused on allergens, by evaluating the characteristics of food allergen labeling and precautionary allergen labeling (PAL) in over 10,000 products sold in six Latin American countries. The authors found a high (>87.4%) compliance with local regulations, but countries without specific regulations for allergen labeling had two-fold more products containing allergens in their ingredients lists but no food allergen labeling, compared to countries with regulations. These results suggest that the lack of regulations for the characteristics of allergen labeling increases the risk of accidental exposure to allergens of interest.

Another interesting topic was reviewed by Van der Horst and coworkers [ 37 ], who investigated how healthy adults perceive and interpret serving size information on food packages and its influence on product perception and consumption. In their systematic review, the authors observed an overall poor conception of serving size, while the few included studies showed that labeled serving size affects portion size selection and consumption.

Finally, Rincón-Gallardo Patiño et al. [ 38 ] investigated restaurant menu labeling policies and their effects on menu reformulation. The authors found three voluntary and eight mandatory menu labeling policies primarily for energy disclosures, developed in upper-middle- and high-income countries, whereas none was found in low- or middle-income countries. The subsequent analysis conducted by the authors showed reductions in energy for newly introduced menu items only in the US. Implications for policy, practice, and research are also provided.

Overall, the studies included in the Special Issue provide new insights in this field of research, with relevant recommendations for policy makers, business operators, and researchers for developing more effective labeling strategies, allowing consumers to make informed dietary choices. At the same time, many authors reported the need for performing further investigations to confirm and expand current findings.

This research received no external funding.

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Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest.

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Food Labeling: Analysis, Understanding, and Perception

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section " Nutritional Policies and Education for Health Promotion ".

Deadline for manuscript submissions: closed (31 July 2020) | Viewed by 180727

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Dear Colleagues,

Food labels are a tool to promote public health by providing information which allows consumers to make informed dietary choices. At the same time, food labels may represent a marketing tool and may influence consumers’ perception of food quality. This Special Issue welcomes original research and reviews of literature focusing on:

• The analysis of the nutrient profile of products with different characteristics reported on the food labels (including but not limited to nutrition and health claims, organic, gluten-free);
• The nutrient profile underlying FOP nutrition labels and their graphical design in different countries;
• The consumers’ perception, knowledge and understanding of the information made on food;
• The impact of information on food labeling (e.g., front-of-pack information, serving size) on consumers’ willingness to pay and food choice;
• The attitudes, beliefs, perceptions, behavioral, and socioeconomic determinants regarding the use of food labels.

Dr. Daniela Martini Prof. Davide Menozzi Guest Editors

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• nutrition and health claims
• gluten free
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• Published: 17 October 2019

Understanding and use of food labeling systems among Whites and Latinos in the United States and among Mexicans: Results from the International Food Policy Study, 2017

• Claudia Nieto   ORCID: orcid.org/0000-0003-0091-8703 1 ,
• Alejandra Jáuregui   ORCID: orcid.org/0000-0001-9158-2007 1 ,
• Alejandra Contreras-Manzano 1 ,
• Edna Arillo-Santillan 2 , 5 ,
• Simón Barquera   ORCID: orcid.org/0000-0003-1854-4615 1 ,
• Christine M. White   ORCID: orcid.org/0000-0003-3319-7391 3 ,
• David Hammond   ORCID: orcid.org/0000-0001-8197-6010 3 &
• James F. Thrasher 2 , 4  

International Journal of Behavioral Nutrition and Physical Activity volume  16 , Article number:  87 ( 2019 ) Cite this article

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Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world.

Adults from online consumer panels in the US (Whites n  = 2959; Latinos n  = 667) and in Mexico ( n  = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline Daily Amounts (GDA) that shows levels of nutrients of concern; 3. Multiple Traffic-Light (MTL) that color codes each GDA nutrient (green = healthy; yellow = moderately unhealthy; red = unhealthy); 4. Health Star Rating System (HSR) that rates foods on a single dimension of healthiness; 5. Warning Label (WL) with a stop sign for nutrients present in unhealthy levels. Participants rated each label on understanding (“easy”/“very easy to understand” vs “difficult”/“very difficult to understand”), and, for NFTs and GDAs, frequency of use (“sometimes”/“often” vs “never”). Mixed logistic models regressed understanding and frequency of use on indicators of labeling systems (NFT = ref), testing for interactions by ethnicity (US Latinos, US Whites, Mexicans), while controlling for sociodemographic and obesity-related factors.

Compared to the NFT, participants reported greater understanding of the WL (OR = 4.8; 95% CI = 4.4–5.3) and lower understanding of the HSR (OR = 0.34, 95% CI = 0.31–0.37) and the MTL (OR = 0.56, 95% CI = 0.52–0.61), with similar patterns across ethnic subgroups. Participants used GDAs less often than NFTs (OR = 0.48; 95%CI = 0.41–0.55), with the greatest difference among US Whites (OR = 0.10; 95%CI = 0.07–0.14).

Conclusions

Understanding and use of the GDA was similar to that of the NFT. Whites, Latinos, and Mexicans consistently reported the best understanding for WLs, a FOPL that highlights unhealthfulness of a product. Therefore, a FOPL summary indicator, such as WLs, may be more effective in both the US and Mexico for guiding consumers towards informed food choices.

Introduction

The highest rates of obesity in the world are in Mexico and the United States (US) [ 1 , 2 ], where 72.5% [ 3 ] and 71.6% [ 4 ] of adults >  20 years old, respectively, are overweight or obese. Diabetes is also high in both countries at 9.4% [ 3 , 5 ], along with other chronic diseases that could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating.

The National Health and Nutrition Examination Survey (NHANES) data has shown that 61.6% of Americans reported using a Nutrition Facts Table (NFT) [ 6 ], with a slightly lower percentage of use among US Latinos (60%) [ 7 ]. In contrast, only 41.5% of Mexicans reported reading the NFT [ 8 ]. In minority groups, like Latinos in the US, NFT comprehension is reported to be difficult compared to their white counterparts [ 9 , 10 ].

The NFT is the oldest labeling system implemented on pre-packaged foods to inform consumers about nutrition content. The display of NFTs on packaged foods is mandatory in the US and Mexico, and is required by the National Labeling Act of 1990 and the Official Mexican Norm 051 (NOM-051), respectively. NFTs are displayed on the back or side of the package and provide information about the nutrition content per portion [ 8 , 11 , 12 ]. One limitation of NFTs is that serving sizes often differ across brands and products; studies suggest that consistent serving sizes would facilitate compare nutrient content of similar products [ 13 ]. Consumers also have difficulty using NFTs to understand if a food is ‘high’ or ‘low’ in a nutrient [ 14 ]. Perhaps most importantly, there are persistent disparities in the use and understanding of NFTs among consumers with lower education and income [ 15 , 16 ].

To overcome limitations of NFTs, a number of Front-of-Package Labeling (FOPL) systems have been proposed and, in some countries, adopted to better communicate nutrition information to consumers [ 15 , 17 ]. FOPLs provide summary information on energy and key nutrients, such as sugar, sodium, and saturated fat [ 18 , 19 ], to facilitate healthy food choices [ 15 , 17 ]. Many food-labeling systems have been proposed, including the FOPLs discussed below, yet there is no agreement on which is most effective.

Warning Labels (WL) are displayed on the front of packages for energy and nutrients considered to be present in unhealthy levels (see Fig.  1 ). Products with WLs are perceived as less healthful than those with numerical FOPL systems [ 20 , 21 ]. The World Health Organization has recognized that interpretive FOPL, like WLs, can help create healthier food environments because they are more easily understood by consumers at all levels of literacy and also indirectly motivate companies to put healthier products on the market [ 22 ]. Furthermore, the Pan American Health Organization indicated that WLs should be used as a tool in the design and implementation of various regulatory strategies related to the prevention and control of overweight and obesity [ 23 ]. Chile, Israel, Peru, and Uruguay recently adopted WLs as a nutrition policy tool; WLs are also under consideration in Brazil, Canada, and Mexico.

Food labelling systems evaluated. 1) Nutrition Facts Table, 2) Warning Labels, 3) Health Star Rating, 4) Guideline Daily Amounts, and 5) Multiple Traffic Light

One FOPL approach favored by industry is the Guideline Daily Amounts (GDA), which shows energy and the percentage of key nutrients of concern (saturated fat, other fat, sugar and sodium) on the front of the package (see Fig. 1 ). GDAs have been mandatory on the front of packaged foods in Mexico since 2014. In the US, industry voluntarily uses a similar system called Facts Up Front [ 24 ], for many products. US consumers report better understanding of nutrition information presented in the GDA format than in NFTs [ 25 ]. However, US consumers show evidence of greater nutrition knowledge when using other systems (e.g., traffic light) compared to the GDA [ 26 ]. Furthermore, Mexicans show evidence of low understanding of GDA formatted information [ 8 , 27 ].

The Health Star Rating (HSR) synthesizes all nutrient information into a single dimension of healthiness. The HSR was voluntarily implemented by the food industry in 2014 in Australia and New Zealand. Products receive ratings from half a star up to 5 stars, depending on the overall healthiness of the product [ 28 ]. Studies suggest that the HSR can be more effective at directing consumers towards healthier choices compared to the GDA [ 29 ].

Finally, the Multiple Traffic Light (MTL) color codes each nutrient in order to quickly communicate whether the product contains relatively low (green), average (yellow) or high (red) levels of potentially harmful nutrients [ 20 ]. Consumers using the MTL have been shown to have more accurate reports of calories per serving compared to the GDA, HSR and the single traffic light [ 30 ]. Additionally, MTLs have high acceptability among Europeans [ 31 , 32 ].

This study assessed labeling systems currently used by the food industry in the US and Mexico, as well as other systems adopted by other countries. The objective was to compare adult consumers’ understanding and use of five food labeling systems (NFT, WL, GDA, HSR, and MTL; see Fig. 1 ). Our approach is oriented by the framework of consumer decision-making proposed by Grunert, in which awareness is a necessary precursor to understanding food labels. Once labeling is understood, it may influence food choices [ 33 ]. We compared US Whites, US Latinos, and Mexicans, partly because Latinos are the largest minority group in the US [ 34 ] and the majority are of Mexican heritage [ 35 ]. Furthermore, US Latinos have disproportionately high rates of obesity and lower health literacy than Whites [ 36 , 37 , 38 ]. Furthermore, comparisons with Mexican consumers allowed assessment of mandated GDAs in Mexico relative to the voluntary use of FOPLs in the US.

We analyzed cross-sectional survey data from the US and Mexico administrations of the 2017 International Food Policy Study. The sample included 7159 participants aged 18 to 64 who completed an online survey in December 2017. Participants were recruited through the Nielsen Consumer Insights Global Panel and their partners. In US, participants self-reported their ethnicity. We used data from participants in the US who considered themselves ‘White’ or ‘Hispanic or Latino’; and all participants in Mexico. The Nielsen panels were originally recruited using both probability and non-probability sampling methods in each country. For the current project, Nielsen targeted recruitment, so that the percentage of participants in each age group would be similar to the general population for each country. Latino respondents were over-sampled in the US ( n  = 667), to facilitate comparisons between US Whites ( n  = 2959) and Mexicans ( n  = 3533). Respondents provided consent prior to completing the survey. Participants received remuneration in accordance with their panel’s usual incentive structure (e.g., points-based or monetary rewards, chances to win prizes). Post-stratification weights were constructed separately for each country to weight the sample so that it was similar to known sex, age, and region distributions in the general population. Surveys were conducted in Spanish in Mexico, and US participants could choose to answer either an English- or Spanish-language survey. Native and bilingual Spanish speakers on the research team reviewed the Spanish translations independently. The average time to complete the survey in US and Mexico was 35.7 min. The study was reviewed by and received ethics clearance through a University of Waterloo Research Ethics Committee (ORE# 21460). A full description of the study methods can be found in the International Food Policy Study: Technical Report – Wave 1 (2017) at www.foodpolicystudy.com/methods .

Food labeling systems evaluated

Participants were asked to evaluate five different food labeling systems: 1) NFT, 2) WL, 3) GDA, 4) HSR, and 5) MTL (Fig. 1 ). Participants were shown an image of each labelling system, one at a time, and asked to answer two questions about each label before proceeding to the next label: 1) how easy or difficult the information was to understand (responses re-coded to ‘easy/very easy to understand’ vs ‘neither easy nor difficult’ or ‘difficult/very difficult to understand’), and 2) how often they used that type of label when choosing food to purchase (responses recoded to ‘often/sometimes’ vs ‘never’). The label images were shown on screen with the question (one question and image per screen). Label images were presented isolated from other images rather than being part of a food package. The researchers did not give any explanation to interpret or assess the labeling systems shown.

Covariates included socio-demographic characteristics and other variables relevant to food choices, including sex (male or female), age group (18 to 33, 34 to 49, or 50 to 64 years old), education (high school or lower, technical studies, or bachelor’s degree or higher) and survey language (English or Spanish). Income adequacy was assessed with the question ‘Thinking about your total monthly income, how difficult or easy is it for you to make ends meet?,’ with responses collapsed into difficult, neither easy nor difficult, or easy. Occupation was classified as ‘full-time worker or full-time student’, ‘part-time worker and/or part-time student’ or ‘unemployed’.

Body Mass Index (BMI) measurement followed World Health Organization criteria [ 39 ], wherein self-reported height and weight were used to classify participants as underweight (18.5 kg/m 2 ), normal weight (18.5 to 24.9 kg/m 2 ), overweight (25.0 to 29.9 kg/m 2 ), or obese (> 30 kg/m 2 ). Self-reported nutrition knowledge was assessed with the question ‘How would you rate your nutrition knowledge?’ with responses collapsed into not knowledgeable, or somewhat knowledgeable / knowledgeable. Daily calorie count was queried by asking ‘Do you count calories you consume each day?’ with responses including ‘never’, ‘sometimes’, and ‘most of the time’. Household responsibility for food shopping was assessed by asking whether the participant did most of the food shopping in their household (‘yes’, ‘no’, or ‘share equally with others’).

Statistical analysis

Pearson chi square tests were used to evaluate sample differences by ethnicity (US Whites, US Latinos, and Mexicans). Prevalence and 95% confidence intervals were estimated for understanding and use of each food labeling system, both overall and by ethnicity.

Crude and adjusted mixed-effects logistic models were estimated by regressing understanding of food labels (0 = difficult/very difficult/neither easy nor difficult, 1 = easy/very easy) on each type of labeling system (NFT = Reference group). This approach was also used in models where label use (0 = never, 1 = often/sometimes) was the outcome and labeling systems currently in use in both countries were the independent variable (i.e., GDA and NFT) (NFT = Reference group). Adjusted models included all covariates described in methods. Since our initial models indicated that significant differences in label understanding existed across ethnicities, models were estimated both for the entire sample and stratified by ethnicity. We used the F-test to test for significance ( p  < 0.05). Model fit was tested with goodness of fit of the model. All analysis were performed in STATA, version 14 (StataCorp, L.P., College Station, TX).

A total of 7159 adults were included in the present study. US participants who were neither White nor Latino were excluded from the analysis ( n  = 118). Participants with missing data for the covariates and dependent variables were also excluded from the analysis ( n  = 1345). In the total sample ( n  = 7159), 39% [95% CI: 38.36–41.09] were US whites, 10% [95% CI: 9.46–11.22] were US Latinos, and 50% [95% CI: 48.57–51.35] were Mexicans (Table  1 ). Across ethnicities, US white participants had the highest proportion of older adults (41.8%, [95%CI: 39.64–43.94]), self-reported obesity (26.4%, [95% CI: 24.54–28.42]), participants reporting it was easy to make the ends meet (53.3%, [95% CI: 51.02–55.46]) and being a full-time worker or student (61.1%, [95% CI: 58.92–63.22]) ( p  < 0.001 for all). Mexican participants had higher education level (bachelor’s degree or higher) (71.8%, [95% CI: 70.08–73.50]), reported that they were somewhat knowledgeable about nutrition (55.1%, [95% CI: 53.21–57.05]) and reported that they never counted calories (70.8%, [95% CI: 69.06–72.58]) ( p  < 0.05 for all). A higher proportion of US Latino participants reported doing most of the food shopping for their household (75.3%, [95% CI: 71.17–79.07]) ( p  < 0.05). The majority of US Latinos (67.4%, [95% CI: 63.14–71.46]) answered the survey in Spanish.

Figure  2 presents the prevalence of reported understanding of food labeling systems among Whites, Latinos, and Mexicans. Across ethnicities, Whites reported the highest level of understanding (87, 95% CI: 85.91–88) for WL, and reported lowest understanding of the HSR (34, 95% CI: 32.30–36.63) and the MTL (47, 95% CI: 45.10–49.57) labels. Latinos and Mexicans also reported high understanding for WL (82 and 84%, respectively).

Understanding (easy/very easy) of food labelling systems

Figure  3 shows the use of the GDA and the NFT. US Latinos reported the highest levels of use for the GDA and NFT labeling systems (GDA: 91, 95% CI: 88–94; NFT: 94, 95% CI: 92–96%). While 31% reported using GDAs “sometimes” and 60% reported using them “often”. Almost all Whites reported using the NFT (98, 95% CI: 97–98%): 28% reported using the NFT “sometimes”, while 70% reported using the NTF “often”. A lower percentage of Mexicans reported using GDAs (84, 95% CI: 82–85) and NFTs (84, 95% CI: 83–86%).

Use (sometimes/often) of the Guideline Daily Amounts and Nutrition Facts Table

Across the total sample, the adjusted model for label understanding (Table  2 ) indicated that participants were 4.82 (95%CI: 4.39–5.30) times more likely to report understanding the WL compared to the NFT. In contrast, reported understanding of the HSR (OR = 0.34, 95% CI: 0.31–0.37) and the MTL (OR = 0.56, 95% CI: 0.52–0.61) were lower compared to the NFT.

The understanding of FOPL systems relative to NFT differed by ethnicity ( p  < 0.05 for the interaction term Ethnicity x labelling system, data not shown). Compared to Latinos, Mexicans were more likely to report understanding the WL (OR = 2.15, 95% CI 1.54–3.01), HSR (OR = 2.44, 95% CI: 1.80–3.32) and MTL (OR = 2.39, 95% CI = 1.79–3.17) than the NFT. Compared to Latinos, Whites had lower odds for understanding the HSR and MTL (HSR OR = 0.23, 95% CI = 0.17–0.32.; MTL OR = 0.34, 95% CI = 0.25–0.46).

When stratified by ethnicity (Table 2 ), participants were more likely to report understanding the WL compared to the NFT ( p  < 0.05) across all ethnicities (Whites OR = 2.90, 95% CI = 2.49–3.38; Latinos OR = 4.07, 95% CI = 2.92–5.68; Mexican OR = 7.95, 95% CI = 6.89–9.16), and all ethnicities were less likely to report understanding the GDAs compared to the NFT ( p  < 0.05). The MTL and HSR had a lower rating of understanding among Whites (MTL = 0.19, 95% CI: 0.17–0.22; HSR = 0.09, 95% CI: 0.08–0.11) and Latinos (MTL = 0.52, 95% CI: 0.39–0.69; HSR = 0.35, 95% CI: 0.25–0.47), whereas the MTL had a better rating of understanding among Mexicans (MTL = 1.31, 95% CI: 1.17–1. 45), compared to the NFT.

Adjusted models of label use for the full sample indicated that participants were less likely (OR = 0.48, 95% CI = 0.41–0.55) to report using GDAs compared to the NFT (Table  3 ). In the full sample, women, participants with a higher level of education, more nutrition knowledge, reporting to find it easy to make ends meet, and those who reported to count calories had a higher odds of using food labels. The use of labels differed by ethnicity ( p  < 0.05 for the interaction term Ethnicity x labelling system).

When stratified by ethnicity, the use of the GDA remained significant for Whites (OR = 0.10, 95% CI = 0.07, 0.14) and Latinos (OR = 0.53, 95% CI = 0.32–0.88) only. Both ethnicities were less likely to report using the GDAs compared to the NFT. In all stratified models, women, participants with a higher level of education, more nutrition knowledge, reporting to find it easy to make ends meet, and those who reported to count calories had a higher odds of using food labels.

Our study indicated that understanding and use of the GDA is similar to that of the NFT, suggesting that GDAs may not provide additional guidance to consumers to make informed food choices. Even in Mexico, where implementation of the GDA on the front of the packages was accompanied with a massive media campaign sponsored by the food industry, this labeling scheme was not more understood or used than the NFT. This is not surprising given that GDAs communicate the same nutrient numbers displayed in NFTs, with relatively little interpretative information compared to other FOPL systems. Our results also suggest differences in the understanding and use of food labeling schemes across ethnicities.

The GDA is currently displayed on the packages of processed foods in both Mexico and US [ 24 , 40 ]. This non-interpretative labeling format was introduced by the food industry as their response to the need to provide simplified nutrition information for consumers [ 41 ]. However, studies in Mexico and other countries indicated that the GDA may not help consumers to make informed food purchases and does not promote healthy food choices due to difficulties understanding quantitative nutrient amounts, even among highly educated populations [ 8 , 27 , 42 ]. In line with these findings, in our study the self-reported understanding and use of the GDA was similar to NFTs across the three populations. Like NFTs, the GDA requires consumers to do mathematical calculations which may be a determining factor for a poor understanding [ 43 ]. Indeed, consumers demonstrate even greater deficits in understanding when consumers are asked to apply nutrient numbers featured in GDAs in functional tests, rather than simply self-report their level of understanding [ 20 , 44 ]. Additionally, the nutritional criteria used for estimating GDA are not based on international benchmarks [ 43 ]. Taken together, these findings support the growing evidence suggesting that GDA is an inadequate FOPL to promote healthy food choices among consumers.

In our study we also tested the understanding of other semi-directive (HSR and MTL) labeling formats, which in theory have better potential to guide consumers towards healthy food choices [ 45 , 46 ]. Interestingly, the reported understanding for the HSR was lower than that of the NFT among Whites and Latinos, whereas among Mexicans, the understanding of this labeling format was similar to the NFT. However, a qualitative study among Hispanic adults showed that front of package labels with star formats were not easily understood or liked [ 12 ]. Additionally, since consumers in the US and Mexico are not familiar with the HSR, this may contribute to their reported difficulty understanding the HSR.

Ecuador successfully implemented the MTL which helped consumers reduce the consumption of products with high levels of fat, sugar and salt [ 47 ]. In the present study, the MTL was also associated with lower reported understanding compared to the NFT among Latinos and Whites, but not Mexicans. This is in line with a study showing good subjective understanding for the MTL among Mexican consumers [ 12 ]. Differences in the understanding of labels by ethnicities also support the hypothesis that labels should be targeted towards specific populations [ 48 ], as cultural factors may determine the effectiveness of a label [ 7 , 9 ]. Additionally, different acculturation levels between Whites and Latinos may influence the use of nutrition information [ 10 , 49 ].

WLs appeared to be the most effective FOPL format for Mexicans, Latinos and Whites. Despite some differences in understanding across ethnicities, this label format consistently had the highest rating for reported understanding. The high ratings for WLs might be explained by the finding that interpretive labels that include information on product unhealthfulness tend to better support consumers to choose nutritionally favorable products [ 22 ]. Our findings are consistent with previous studies in Latin American adults showing that WLs improve consumer’s ability to correctly identify products containing excessive amounts of critical nutrients, compared with the GDA system [ 20 , 50 ]. Studies conducted in Brazil and Uruguay demonstrated the ease and rapidity of WL understanding at the point of sale [ 20 , 50 ]. For example, in a randomized experiment in Brazil, WLs improved understanding of excess nutrient content (27.0% versus 8.2%, p  < 0.001); and helped participants to correctly identify healthier products (14.0% versus 6.9%, p  < 0.001) [ 50 ]. A study in Uruguay found that introducing WLs reduced response time when shopping compared to the GDA [ 20 ].

Overall, women had higher odds of understanding the labels than men. In prior studies, females tend to better understand and use food labels [ 48 , 51 ] compared to men. Other research among Latino women in the US indicates that they are less acculturated than Latino men [ 37 , 52 ], nevertheless in our Latino sample we did not find statistically significant differences by sex. We integrated a proxy measure of acculturation into our analyses by adjusting for language of survey administration; however, acculturation is a complex process and enriched measures may be needed to better understand whether lower acculturation among Latina women helps explain our counterintuitive findings [ 53 , 54 ]. Our results show that Latinos with higher education levels have higher odds of understanding food labels; other international studies have also found similar results [ 55 , 56 , 57 , 58 , 59 ]. Whites reported a higher labeling understanding compared to Latinos. On the other hand, Latinos reported a higher use of labels. This might be explained by the Latino participant’s desire to please the interviewer; some studies have documented that Latinos have a higher probability of acquiescence response bias [ 60 ].

Strengths and limitations of the study

This is the first food labeling study that compares White, Latino and Mexican populations, and as such may be of international interest to several countries who are looking to modify their current food labelling policies. This study is subject to a variety of limitations. First, the use of an online survey might have biased the findings in Mexico as 40% of the Mexican population does not have internet access and internet is often restricted to certain residential areas [ 61 ]. Also, the Mexico sample had higher levels of education [ 3 ], likely resulting in higher levels of understanding and use of labeling than would be found in the general population. A similar pattern was observed for education among US Whites and Latinos [ 62 ], but the education level was particularly high in the Mexico sample. However, the analysis was adjusted by education in statistical models when examining differences across the ethnic sub-groups. BMI was somewhat lower in our sample than for national estimates. This may be partially explained by the known under-reporting for weight and over-reporting for height [ 63 , 64 ]; however, it may also mean that our sample had healthier food patterns and therefore may have been more likely to use labels than the general population.

Additionally, the present study assessed self-reported use of labels, which is likely to over-estimate actual use [ 31 , 65 ]. Label understanding was also self-reported, although subjective understanding provides a reasonable approximation on the extent to which consumers believe they have “understood” what is being communicated, and this likely reflects the effectiveness of the label [ 31 ]. Future research should use protocols that involve a more objective assessment of understanding with real food products and behavioral outcomes, such as purchasing. Finally, US Latino participants did not provide information about their specific heritage and there may be important differences in our outcomes across specific ethnic subgroups of Latinos. Still, it is likely that most of our Latino sample was of Mexican heritage, given that almost two-thirds of US Latinos are from this ethnic subgroup [ 34 ].

Our study found that understanding and use of the GDA was similar to that of the NFT, suggesting that this labeling format may not provide much additional guidance to consumers to make healthier food choices. Whites, Latinos, and Mexican participants consistently reported the best understanding when using WLs that highlight the unhealthfulness of a product. A FOP summary indicator, such as WLs, may be effective in both the US and Mexico for guiding consumers towards informed food choices.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Body Mass Index

Front-of-Pack Labeling

Guideline Daily Amounts

Health Star Rating

Multiple Traffic Light

Nutrition Facts Table

United States

Warning Label

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Acknowledgements

The authors would like to acknowledge Luis Zavala for his assistance running the statistical models.

Funding for this project was provided by a Population Health Intervention Research operating grant from the Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada. Additional funding for this project has been provided by a PHAC – CIHR Chair in Applied Public Health (DH). The funding agency did not play any role in the design of the study, analysis and interpretation of data and in writing the manuscript.

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Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico

Edna Arillo-Santillan & James F. Thrasher

School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

Christine M. White & David Hammond

Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA

James F. Thrasher

School of Demography, ANU College of Arts and Social Sciences, The Australian National University, 9 Fellows Road Acton ACT 260, Canberra, Australia

Edna Arillo-Santillan

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CN performed the statistical analysis and wrote the first draft of the manuscript. ACM helped analyze and interpret data, and prepared the graphs. DH conceived, designed and executed the International Food Policy Study. AJ, SB and JT contributed to the preparation of the survey and designed the analysis of this study. AJ and JT supervised the statistical analysis. EAS, AJ, JT, CW, and DH revised the manuscript critically for intellectual content. All authors read and approved the final manuscript.

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Correspondence to Alejandra Jáuregui .

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The study was reviewed by and received ethics clearance through a University of Waterloo Research Ethics Committee (ORE# 21460). A full description of the study methods can be found in the International Food Policy Study: Technical Report – Wave 1 (2017) at www.foodpolicystudy.com/methods .

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Nieto, C., Jáuregui, A., Contreras-Manzano, A. et al. Understanding and use of food labeling systems among Whites and Latinos in the United States and among Mexicans: Results from the International Food Policy Study, 2017. Int J Behav Nutr Phys Act 16 , 87 (2019). https://doi.org/10.1186/s12966-019-0842-1

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The science on front-of-package food labels

Published online by Cambridge University Press:  22 March 2012

The US Food and Drug Administration and Institute of Medicine are currently investigating front-of-package (FOP) food labelling systems to provide science-based guidance to the food industry. The present paper reviews the literature on FOP labelling and supermarket shelf-labelling systems published or under review by February 2011 to inform current investigations and identify areas of future research.

A structured search was undertaken of research studies on consumer use, understanding of, preference for, perception of and behaviours relating to FOP/shelf labelling published between January 2004 and February 2011.

Twenty-eight studies from a structured search met inclusion criteria. Reviewed studies examined consumer preferences, understanding and use of different labelling systems as well as label impact on purchasing patterns and industry product reformulation.

The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems’ abilities to influence consumer behaviour is needed.

In May 2010 the White House Childhood Obesity Task Force highlighted the need to ‘empower parents and caregivers to make healthy choices’ with simple, practical information, including improved front-of-package (FOP) food labels ( 1 ) . Currently the US Food and Drug Administration (FDA) has undertaken a Front-of-Package Labeling Initiative ( 2 ) with the goal of reviewing available evidence on FOP labelling systems to determine whether one approach can be recommended over others. Congress also requested that the Institute of Medicine (IOM) examine this issue and in October 2010 the Committee on Examination of Front-of-Package Nutrition Ratings Systems and Symbols released its first of two consensus reports which reviewed the current FOP systems and examined the strengths and limitations of the nutrition criteria that underlie them ( Reference Wartella, Lichtenstein and Boon 3 ) .

A variety of FOP systems exist, including industry-initiated systems in the USA ( 4 ) , a Traffic Light (TL) approach in the UK developed by the Food Standards Agency (UK FSA) ( 5 ) and the ‘Choices’ programme check mark system being used by food manufacturers around the world ( Reference Vyth, Steenhuis and Mallant 6 ) . A number of major food manufacturers in the USA and the UK have also voluntarily agreed to post the number of calories per serving and the per cent daily calorie value on the front of their food products ( Reference Switt 7 ) . More recently, prior to the FDA and IOM's recommendations, the Food Marketing Institute and the Grocery Manufacturers Association, two of the industry's largest trade groups, announced the introduction of a new ‘Nutrition Keys’ labelling system ( 8 ) . The four basic icons on the symbol will provide information about calories, saturated fat, sodium and sugars per serving as well as per cent daily value (%DV) ( 9 ) . The label will also highlight up to two nutrients to encourage which include potassium, fibre, vitamin A, vitamin C, vitamin D, calcium, iron and/or protein ( 9 ) .

Much is at stake regarding an FOP labelling system. An FDA survey found that 67 % of respondents reported using FOP symbols often or sometimes when making purchasing decisions ( Reference Choinière and Lando 10 ) , but the array of non-standardized labelling systems makes it difficult for consumers to evaluate and compare the nutritional profiles of foods. In addition, each labelling system is based on a different set of nutrition criteria, which are susceptible to industry manipulation. Furthermore, because people tend to use heuristic-based decision making when pressed for time, consumers are vulnerable to food manufacturers highlighting healthy aspects of an overall unhealthy product ( Reference Schofield and Mullainathan 11 ) . Therefore, it is critical that an informative, easily understood, science-based FOP labelling system be implemented.

The current paper aims to: (i) evaluate existing research to identify FOP/shelf labelling systems which hold the most promise; and (ii) identify key FOP/shelf labelling research needs.

A structured search of research studies published or under review by February 2011 on consumer use, understanding of, preference for, perception of and behaviours relating to FOP labelling and supermarket shelf-labelling systems was performed.

Inclusion and exclusion criteria

To be considered, a published, in press or under review research paper had to meet the following criteria: (i) must relate to FOP nutrition labelling and/or shelf-labelling systems and consumer use, understanding, preference, perception or behaviour related to that label; (ii) the labels examined must include symbols or nutrition information flags located on the front of the package or on the supermarket shelf; and (iii) must relate to original research or a review of research.

Studies were excluded if they: (i) discussed policy and legal strategies for obesity prevention and the FOP/shelf label was only mentioned; (ii) included general information on FOP/shelf labelling, but did not describe relevant research; (iii) described nutrition criteria for FOP/shelf labelling, but not consumer use; (iv) described research related to nutrition labels, but not FOP/shelf labels specifically; (v) described research on health claims; (vi) were not peer-reviewed research, except for government reports; or (vii) related to nutrition labelling on menus or trans fat labelling.

Search strategy

A search strategy using (‘FOP’ OR ‘front-of-pack’ OR ‘shelf label’) AND nutrition was run in Medline and adapted for other databases including Google Scholar, CINHAL, PsychINFO, CDSR and AGRICOLA. Titles and abstracts were screened for relevance; when in doubt, full papers were reviewed and/or authors were contacted for clarification. In addition, nutrition label researchers were contacted for any in press or under review publications. Twenty-eight studies were included in the current review (see Table 1 ).

Table 1 Studies included in the present review

Consumer preferences for label elements and systems

Front-of-package label simplicity.

Consumer preferences for labelling systems were assessed via focus groups in Germany, France, the UK and the Netherlands. The study included young adults, families and individuals over 55 years old ( Reference van Kleef, van Trijp and Paeps 12 ) . The participants reported that an FOP label with information about calories, exercise, %DV and daily caloric amounts provided too much information ( Reference van Kleef, van Trijp and Paeps 12 ) . Overall, participants in these groups ( Reference van Kleef, van Trijp and Paeps 12 ) , as well as those participating in a large FOP study undertaken by the UK FSA ( Reference Malam, Clegg and Kirwin 13 ) , expressed a desire for a simple FOP label. The FDA also evaluated consumer preference for various FOP labelling systems by conducting eight focus groups across four US cities ( Reference Lando and Labiner-Wolfe 14 ) . Sixty-eight adults from varying educational backgrounds responded most positively to a simple keyhole summary symbol that included the statement ‘meets FDA Healthy Meal Guidelines’. In addition, a study conducted by Unilever found that individuals with low perceived nutritional knowledge reported difficulty understanding complex FOP labels, although no difference between education and comprehension level was observed ( Reference Feunekes, Gortemaker and Willems 15 ) .

How should front-of-package labels present calorie information?

Calorie information is one of the most frequently accessed pieces of information on nutrition labels ( Reference van Kleef, van Trijp and Paeps 12 , Reference Malam, Clegg and Kirwin 13 , 16 ) . In the UK FSA study, calorie information was the most understood element of FOP labels ( Reference Malam, Clegg and Kirwin 13 ) , and those trying to lose weight reported using calorie information most frequently ( Reference Malam, Clegg and Kirwin 13 ) .

One study recommended that calorie information be presented in a neutral, white box because when it was displayed inside a starburst shape consumers interpreted the attention-grabbing nature of the symbol as an indication that the calorie information was for the whole package ( Reference Lando and Labiner-Wolfe 14 ) . Consumers also felt that calorie information alone was not enough for them to make an informed choice; however, that study did not identify what additional information consumers would want ( Reference Lando and Labiner-Wolfe 14 ) .

In addition, FOP labels that include information about daily caloric needs were viewed positively and could be an important educational tool, as few people in the USA can accurately identify such needs ( Reference Lando and Labiner-Wolfe 14 , 16 ) . European focus group participants also favoured FOP labels that included daily caloric reference values for men and women ( Reference van Kleef, van Trijp and Paeps 12 ) . Furthermore, research on restaurant menu labelling has shown that the statement ‘The recommended daily caloric intake for an average adult is 2000 calories’ enhanced the effect of menu labelling by staving off overeating at a subsequent meal ( Reference Roberto, Larsen and Agnew 17 ) . One concern with a daily caloric requirement and per cent dietary intake (%DI) labels is that they are based on a recommended number of calories that is not suitable for everyone.

It is also important to consider how calorie information should be presented in relation to serving size. Individuals in the USA, Korea and the UK were confused by labels showing calories per serving for products often consumed in one sitting (i.e. a muffin, 20 ounce soda bottle) ( Reference Malam, Clegg and Kirwin 13 , Reference Lando and Labiner-Wolfe 14 , Reference Kim and Kim 18 ) . This suggests that calorie information should be listed per package for these types of foods. In addition, participants in Europe felt that information about calories per 100 g should be avoided because it makes it difficult to compare across products and does not provide serving size information ( Reference van Kleef, van Trijp and Paeps 12 ) . More research on how the presentation of calorie information per serving or per package impacts purchasing behaviour and perception of product healthfulness is greatly needed.

Should front-of-package labels include percentages?

The purpose of including percentages on labels is to put the numbers in context of the overall diet. Research strongly suggests, however, that percentages on FOP labels are confusing and few people find them helpful. In FDA focus groups, some consumers did not understand %DV labels ( Reference Lando and Labiner-Wolfe 14 ) and in European focus groups, symbols including a graphic expression of %DV were viewed by consumers as difficult to understand ( Reference van Kleef, van Trijp and Paeps 12 ) . In an Australian study, individuals in socially disadvantaged areas were six times less likely to identify the healthier of two foods when using a monochrome %DI symbol in contrast to the TL symbol which resulted in equitable performance across socio-economic groups ( Reference Kelly, Hughes and Chapman 19 ) . In that study two versions of the TL label also yielded more correct answers for the identification of nutrients in food products compared with two variants of the %DI system ( Reference Kelly, Hughes and Chapman 19 ) .

In a study of 1525 supermarket shoppers in New Zealand, the least preferred among four FOP labelling systems was the %DI label ( Reference Gorton, Ni Mhurchu and Chen 20 ) . The UK FSA study also found that many people had a poor understanding of what information per cent guideline daily amount (%GDA) conveys and those over 65 years old found labels with %GDA information particularly difficult to comprehend ( Reference Malam, Clegg and Kirwin 13 ) . These findings suggest avoiding percentages as a method of providing dietary context on labels.

Should front-of-package labels include text to indicate nutrient levels?

The UK FSA study found that the best predictor of successful label comprehension was the appearance of text indicating whether a product had ‘high’, ‘medium’ or ‘low’ levels of a specific nutrient ( Reference Malam, Clegg and Kirwin 13 ) . The study used a factorial design for the presence and absence of %GDA, TL and interpretive text to examine consumers’ evaluation of the level of individual nutrients and the overall healthfulness of a product. The inclusion of text increased the proportion of correct answers for both product types (main meal sized portion and snack) for both the evaluation of a single nutrient and overall healthfulness of the product. In addition, interviews with customers revealed that shoppers who did not understand that the TL colours were meaningful or had trouble comprehending percentages were assisted by the text. These findings suggest that such interpretive text can greatly improve label comprehension.

The UK FSA recommends the use of a label combining TL colours, text which specifies whether the product is high, medium or low in a specific nutrient, and %GDA because it was liked the best and had good comprehension ( Reference Malam, Clegg and Kirwin 13 ) . When used alone %GDA was not found to be effective, but when combined with both text and TL colours, the percentage helped some shoppers to determine the level of individual nutrients ( Reference Malam, Clegg and Kirwin 13 ) . These findings suggest that if percentages are to be used on a label, they should be accompanied by text to help with interpretation.

Should front-of-package labels include information statements about exercise or energy balance?

There is very little research on how exercise labels or statements about energy balance appearing on packaged foods may influence consumer perception and behaviour. In European focus groups ( Reference van Kleef, van Trijp and Paeps 12 ) , most participants disliked exercise labels which gave the calories per serving of the product plus the amount of exercise needed to burn these calories. While younger consumers liked the label because they found it easy to understand and motivating, most others argued that the exercise labels would be ‘demotivating and patronizing’ and induce guilt. The participants also indicated that FOP labels should avoid phrases about energy balance on labels. For example, a symbol including calories per serving and the phrase ‘balance your energy’ was least preferred and viewed with scepticism as a marketing tool, which was ‘gimmicky and coercive’. Some respondents saw the label as meaningless because they did not understand what it was trying to convey. Larger studies using quantitative methods, rather than focus groups, are needed to draw more definitive conclusions about the impact of exercise and energy balance phrases on FOP labels.

What is the appropriate size for a front-of-package label?

Participants in the UK FSA study expressed concern that the labels were too small and difficult to read, especially for those requiring reading glasses ( Reference Malam, Clegg and Kirwin 13 ) . Given that consumer ability to see the label is important, studies should report information on the text size of the labels tested and further research should seek to determine adequate label size.

Which front-of-package label do consumers prefer?

Only a handful of studies have asked consumers about their preferences regarding different FOP labels. In addition, there is a dearth of research comparing preferences for different industry and non-industry developed labels. However, existing research comparing the Multiple Traffic Light (MTL) label to other FOP labels suggests that consumers prefer a TL system.

A New Zealand study of 1525 supermarket shoppers found the MTL symbol was preferred most often ( Reference Gorton, Ni Mhurchu and Chen 20 ) . An interview-based study of 1019 consumers in Korea ( Reference Kim and Kim 18 ) found that 58 % of respondents believed colour differences based on nutrient content (as seen on the MTL label) convey important information, but 33 % of respondents had difficulty understanding what the information was conveying.

Two surveys, one conducted in Germany and one in Belgium, investigated perceptions of their widely used GDA label compared with the MTL ( Reference Möser, Hoefkens and Van Camp 21 ) . The GDA label provides average energy and macronutrient intake levels per serving that people should consume daily. This label has been criticized because the nutrient reference levels are not grounded in science, the nutrition requirements are based on those for an average adult and therefore not applicable to groups with different needs, and the portion sizes used are unrealistically small. Participants in Germany preferred the MTL label because it was easier to understand and seen as more appealing and trustworthy than the widely used GDA label. However, a similar study in Belgium found that Belgians preferred the GDA label to the MTL, although this was partly explained by Belgians’ familiarity with the GDA symbol. However, older individuals and those with a higher BMI had less of a preference for the GDA label.

More studies on perceptions and use of the MTL label and other existing FOP symbols in US samples are needed. However, several studies have found that consumer preference for a label format is not indicative of label comprehension ( Reference Malam, Clegg and Kirwin 13 , Reference Kelly, Hughes and Chapman 19 , Reference Levy, Mathews and Stephenson 22 ) or ability to use a label to choose a healthy product ( Reference Levy, Mathews and Stephenson 22 ) . This suggests that less emphasis should be placed on studies examining preference alone.

Consumer understanding and use of labels

Which front-of-package label best helps consumers assess product healthfulness.

Existing literature suggests that consumers are better able to evaluate food products when using the MTL label compared with other approaches. A study of 790 respondents conducted in Australia ( Reference Kelly, Hughes and Chapman 19 ) tested consumer perceptions and performance using four different FOP labels: (i) a TL system ranking levels of total fat, saturated fat, sugar and sodium; (ii) TL rankings plus an overall rating (TL+) for the product; (iii) a monochrome %DI label indicating the per cent dietary contribution of energy, protein, total fat, saturated fat, total carbohydrate, sugar, fibre and sodium; (iv) a colour-coded %DI system with the same nutrients ranked plus a colour code for total fat, saturated fat, sugar and sodium. Each respondent was exposed to one labelling format on two sets (a healthy product and less healthy product) of two different food products. A product was defined as healthy if it was eligible to carry a health claim based on the Australia and New Zealand 2007 Food Standards Agency Nutrient Profiling guidelines. The authors found that while people initially thought they would have the easiest time using a colour-coded %DI label, the TL label was most successful in assisting customers select the healthier food product.

In a two-part experimental study, 420 participants were randomized to one of five label formats: (i) a simple tick; (ii) an MTL format; (iii) a monochrome GDA; (iv) a colour-coded GDA; or (v) a no label control. Exposure to the MTL symbol yielded the highest percentage of correct choices when trying to decide which of two foods was healthier ( Reference Borgmeier and Westenhoefer 23 ) . However, when participants completed a virtual supermarket task during which they were asked to select all the foods they would eat the next day, no differences in the energy content of the foods was found across the label conditions.

A study of 1525 ethnically diverse shoppers in New Zealand found that the Simple Traffic Light (STL) format led to increased ability to correctly determine if a food was healthy, followed very closely by the MTL label ( Reference Gorton, Ni Mhurchu and Chen 20 ) . ‘Not healthy’ was defined as high in fat, saturated fat and sodium, and low in fibre, as assessed by a registered dietitian. The nutrition information panel and %DI label yielded fewer correct distinctions regarding food healthfulness.

In contrast, an Internet survey of 1630 participants from four European countries found that survey respondents viewed the MTL as the easiest to comprehend and most credible. However, when making selections between healthy and less healthy products in the food spreads category, the MTL label differentiated significantly less between products compared with a label with Smileys or with Stars ( Reference Feunekes, Gortemaker and Willems 15 ) . This significant difference was not found between the other products studied (dairy drink and ice cream), which highlights the need for future research to examine more product categories when testing label formats.

In addition to helping consumers identify the healthier of two products, the TL system impacts perceptions of healthfulness. When 294 parents and caregivers in New Zealand evaluated pictures of cereals, those who saw the MTL label reported significantly lower health scores for cereals of poor nutritional quality compared with a control condition, while those who viewed a %DI label gave lower, but not significantly different ratings from a control condition ( Reference Maubach and Hoek 24 ) . In contrast, a web-based study examining perceptions of healthfulness for a frozen chicken dinner with a ‘Smart Choices’ logo, a TL plus %GDA or no logo revealed that participants viewed an unhealthy product as being healthier and having lower levels of negative nutrients when it had a Smart Choices symbol on it relative to a no logo control. This was also true, although less strong, for the TL plus %GDA symbol compared with the no logo control. Furthermore, the Smart Choices icon, relative to the control, led to more favourable product attitudes and purchase intentions as well as reduced assumptions that regularly eating the food would lead to heart disease and weight gain. The TL plus %GDA also led to an increase in favourable product attitudes and purchase intentions, but did not impact perceptions of eating the food and developing heart disease or gaining weight ( Reference Andrews, Burton and Kees 25 ) .

An eye-movement study of ninety-two participants comparing a label with eight nutrients to a label with the same nutrients plus TL symbols for specific nutrients found that nutrients on the TL were examined most ( Reference Jones and Richardson 26 ) . Unlike the colourless label format where testing found that the nutrients people examined had a limited impact on the nutrients they used when making a judgement, the TL guided people to important nutrients which they used when making healthfulness judgement. More research testing different FOP labels using eye-movement technology would be useful.

Which front-of-package labels impact food purchases?

Little research exists on the impact FOP labelling systems have on purchasing patterns. One study examined sales of products with the Choices logo ( Reference Vyth, Steenhuis and Vlot 27 ) . Four hundred and four customers exiting nine different grocery stores in the Netherlands completed questionnaires while research staff counted the number of their purchased products that contained the Choices logo. The study found that most products purchased with the logo were in the dairy category, followed by oils and fats, vegetables and fruits, and finally soups. Out of the 246 participants who were familiar with the Choices label, seventy-two participants reported purchasing products with the logo and did indeed buy more products with the logo relative to those who did not report buying Choices products.

There are few studies examining the impact FOP labels have on actual sales of food products. One study conducted in the UK examined supermarket sales data for two types of food products (chilled pre-packaged meals and fresh pre-packaged sandwiches) sold by a major retailer four weeks before and after the implementation of the TL label ( Reference Sacks, Rayner and Swinburn 28 ) . The study investigators found that the TL labels did not substantially influence the sale of healthier products. However, only two categories of food were examined over a short period of time. Additionally, such before-and-after studies should be accompanied by informational campaigns to ensure consumers are educated about the change in label format and the meaning of the label.

Which front-of-package labels impact food consumption?

In addition to a lack of research on purchasing patterns, few studies have examined how FOP labels influence food consumption. One concern with placing an FOP label on food products is that people may eat even more of the product because they perceive it to be healthy. For example, this ‘health halo’ effect has been documented for products labelled as ‘low fat’ ( Reference Chandon and Wansink 29 ) . To test this possibility with the Choices logo, participants in a laboratory-based study using a cross-over design ( Reference Steenhuis, Kroeze and Vyth 30 ) were given a piece of chocolate mousse cake. In one condition, they were told the cake qualified for a Choices logo, which was further explained on an information card. In the other condition, they were not told the cake qualified for the Choices symbol. When the Choices logo appeared on the cake, it was perceived as ‘less unhealthy’, but there was no difference in taste perception or cake consumption relative to when the cake did not have the logo on it. This suggests that the logo does not promote overconsumption of unhealthy foods or cause people to think a food will taste worse because it is viewed as healthier. It is possible, however, that this would not be the case with other food products that are not as obviously unhealthy. More research on the impact FOP labelling systems have on purchasing and consumption of foods is greatly needed.

For which front-of-package labels are people willing to pay more?

A study in Greece found that students participating in a laboratory experiment were willing to pay more for products with nutrition labels v . without. However among the products with nutritional information, the students’ willingness to pay differed across label formats ( Reference Drichoutis, Lazaridis and Nayga 31 ) . The study participants were presented with different labelling schemes and were asked what they would pay for each product with a nutritional label via a second price Vickrey auction. Products with a European Union-endorsed label or a TL label were valued more than a US government-endorsed label and an unlabelled product. The authors noted that the US label provided much more information which might have overwhelmed participants and led to label indifference.

What are the potential problems of the Multiple Traffic Light symbol?

While the MTL symbol has a growing body of research support, several issues regarding this system arose during the UK FSA study. One concern is that some people did not realize that the red/amber/green colours had meaning ( Reference Malam, Clegg and Kirwin 13 ) . Some assumed the colours were simply being used to make the labels stand out. In addition, some individuals thought the colours were related to specific nutrients (i.e. fats were always in red). However, this problem was overcome when text was included on the FOP label to indicate high/medium/low levels of nutrients in food products. An additional problem uncovered by the UK FSA study was that some consumers did not know that different nutrients have different maximum daily amounts, which explained why 0·5 g of salt had an orange label, but 1·4 g of sugars had a green label.

What label characteristics increase attention to a front-of-package label?

A study using a visual search paradigm found that attentional performance was faster when a logo was: (i) present (instead of absent); (ii) doubled in size; and (iii) displayed on the top-right of the package ( Reference Bialkova and van Trijp 32 ) . Participants also responded faster when viewing a monochromatic v . polychromatic logo. Given the research described thus far indicating the utility of a polychromatic TL, more research is needed to understand the relationship between response time and label comprehension. Finally, attentional performance was improved when the logo location did not change in consecutive tasks, suggesting that a single location for the logo on each product may be most beneficial.

How often do consumers report using supermarket shelf-label systems?

In contrast to FOP food labels, another possible labelling scheme is supermarket shelf-label systems. These systems place nutrition information on the shelf underneath or above the product, rather than on the actual product packaging. A number of studies have evaluated consumers’ preference for, awareness of and use of nutrition labels placed on grocery store shelves. One study conducted in eighteen Detroit supermarkets examined consumer awareness and use of colour-coded shelf labels that indicated varying levels of product healthfulness ( Reference Lang, Mercer and Tran 33 ) . Exit surveys of 361 participants revealed that 28 % of the sample was aware of the shelf labels, and ethnic and racial minority groups were significantly more likely to report awareness than Caucasians. However, 37 % of participants reported they did not use the shelf-label system, with only 17 % of participants reporting use of the system ‘often’ or ‘always’.

Another study of 400 participants involving eight supermarkets in Minnesota examined the effect of shelf labels using pre- and post-test surveys that assessed consumer nutrition knowledge ( Reference Jeffery, Pirie and Rosenthal 34 ) . Results indicated that there were no differences in consumer knowledge between the control and intervention supermarkets, although data were only collected over the course of 9 months and there were no intensive marketing efforts to promote the programme. In one study, a quasi-experimental repeated-measures design was used in twenty matched supermarkets in Washington, DC and Baltimore, MD to evaluate consumer use of shelf labels ( Reference Levy, Mathews and Stephenson 22 ) . Two years after the shelf labels were implemented, 31 % of customers in the shelf label condition reported using the labels.

More recently, an interdisciplinary group of nutrition and public health researchers developed the Overall Nutritional Quality Index (ONQI), which served as the basis for NuVal, a shelf-labelling system that considers nutrient properties as well as associations between nutrients and health outcomes ( Reference Katz, Njike and Rhee 35 ) . Katz et al . found that approximately 80 % of participants in one study ( n 804) reported the ONQI would influence their purchase intentions. While there is a strong correlation between various food products’ ONQI scores and the products’ nutritional rankings according to expert panellists ( Reference Katz, Njike and Faridi 36 ) , the actual algorithm used as the basis for the labelling system has not been released to the public for evaluation.

Overall, consumers view shelf-labelling systems positively and health-conscious consumers are strongly in favour of them ( Reference Katz, Njike and Rhee 35 , Reference Berning, Chouinard and Manning 37 ) . However, none of these studies directly compared whether consumers would prefer shelf-labelling systems more than FOP labels.

Which shelf labels have impacted food sales?

A few studies have evaluated consumer use of shelf labels through sales data, and have generally found a positive impact of shelf labels on the purchase of healthy options. A quasi-experimental repeated-measures design involving twenty grocery stores in the USA was used to examine the effect of the ‘Special Diet Alert’ (SDA) programme ( Reference Levy, Mathews and Stephenson 22 ) . This shelf-labelling programme was implemented in ten of the twenty grocery stores, and sales data were compared across various food categories for a 2-year period. In each store 1600 food items were grouped into twenty-three food categories (e.g. butter/margarine) and then assigned to a product sector that described the amount of a given nutrient (e.g. low/reduced sodium sector). Valid comparisons between the intervention and control stores were made in sixteen instances (fourteen food categories): seven sodium sector comparisons and nine calorie/fat/cholesterol comparisons.

Eight of these sixteen instances showed a significant positive effect of the SDA programme. More specifically, five low calorie/low fat/low cholesterol sectors (canned fish, mayonnaise, butter, cottage cheese, fruit juice) and three low sodium sectors (soft drinks, frozen vegetables, tomato sauce) showed growth trends in market share between the intervention and control stores consistent with a positive programme effect. Significant market share differences between the intervention and control stores were not found in the following low fat/low calorie/low cholesterol sectors: canned fruit, fresh milk, soft drinks and cheese. A significant market share difference between intervention and control stores was not found in the following low sodium sectors: nuts and snacks, dry cereals, crackers and butter/margarine. Results also demonstrated that sales increased by 4 to 8 % in the SDA condition, indicating a positive effect of the programme. A study comparing four supermarkets with shelf labels and four control supermarkets failed to observe sales differences based on the shelf-labelling system ( Reference Jeffery, Pirie and Rosenthal 34 ) .

More recently, researchers investigating the impact of the ‘Guiding Stars’ shelf-labelling system found changes in sales of ready-to-eat cereals that translated into 2·9 million more items with stars being purchased monthly and an equivalent decrease in the products that did not receive stars ( Reference Sutherland, Kaley and Fischer 38 ) . Strengths of the study include the participation of 168 supermarkets and analyses of sales data eight months before the start of the programme as well as at 1- and 2-year follow-up periods. More sales data of this nature are clearly needed and future research should include comparisons across multiple food categories. In addition, the few studies which have examined the influence of demographic factors on shelf-label system use ( Reference Levy, Mathews and Stephenson 22 , Reference Sutherland, Kaley and Fischer 38 ) have reported mixed results on the effect of income and education on preference for shelf-labelling systems ( Reference Berning, Chouinard and Manning 37 ) and/or used samples of primarily middle-aged women ( Reference Jeffery, Pirie and Rosenthal 34 , Reference Berning, Chouinard and Manning 37 ) .

What nutrients should appear on front-of-package or shelf labels?

The decision regarding which nutrients to highlight on an FOP labelling system is complex and consumer preference is only a small piece. Respondents in the UK reported that they most frequently look for fat, then sugar, calories, salt, saturates and additives ( Reference Grunert, Wills and Fernandez-Celemin 39 ) . In the UK FSA study participants usually started with calorie information when determining product healthfulness because it was the most easily understood ( Reference Malam, Clegg and Kirwin 13 ) . Participants felt the next most understood element was salt, and saturated fats were the least well understood and used. Individuals with medical conditions reported most frequently checking sugar content if diabetic and salt and fat content for those with heart disease. Those shopping for children most frequently checked salt and sugar. In a Korean survey, most people felt four or five nutrients should be displayed on the FOP label, including calories, trans fat, total fat, cholesterol and sodium ( Reference Kim and Kim 18 ) . In its first report, the IOM noted that ‘Americans consume too many calories, saturated fats, trans fats, and added sugars; too much sodium; and too little vitamin D, calcium, potassium, and fiber’ ( Reference Wartella, Lichtenstein and Boon 3 ) , suggesting that these nutrients should be the focus of FOP labels. However, in an online consumer study of 320 mostly female participants located in the USA, consumer perception of food healthfulness was most primarily driven by the presence of protein, fibre, calcium and vitamin C, and the absence of saturated fat and sodium ( Reference Drewnowski, Moskowitz and Reisner 40 ) . The finding that the presence of positive nutrients can greatly influence health perceptions cautions against the inclusion of such nutrients on FOP labels appearing on nutritionally poor foods. One option is to highlight problem nutrients associated with the most prevalent health problems in the USA. In addition, it should be considered that those nutrients that appear on an FOP label will likely be the greatest focus of potential industry reformulation.

Industry product reformulation

Which labels will promote food product reformulation.

Few studies have examined industry reformulation of food products following the implementation of FOP labelling systems. It is possible to argue that even a system that produces little impact on consumer behaviour could have considerable public health benefit if companies feel compelled to reformulate their foods.

When a new logo system was introduced in New Zealand, food companies excluded 33 tonnes of salt over the course of a year by reformulating products ( Reference Young and Swinburn 41 ) . In addition, following the FDA mandate to list trans fat content on packaged food labels ( 42 ) , the amount of trans fats was reduced in many products ( Reference Eckel, Borra and Lichtenstein 43 ) , suggesting that similar effects would be seen based on the nutrients highlighted on FOP labels. In a larger study examining the impact of the Choices programme on product reformulation in the Netherlands, Vyth et al . ( Reference Vyth, Steenhuis and Roodenburg 44 ) retrieved nutritional information for 821 products from food manufacturers participating in the programme. The authors found that 168 products were reformulated after the Choices logo was introduced and 236 newly developed products meeting the Choices criteria were introduced into the market. After reformulation, there was a significant increase in fibre for fruit juices and sandwiches. Sodium and SFA levels were reduced in processed meats as was sodium in sandwiches, sandwich fillings and soups. Dairy products saw a decrease in SFA, added sugar and energy, and added sugars were reduced in sauces. Finally, sandwich fillings also decreased in SFA, trans fat and energy. Products that were newly developed had increased fibre levels for fruit juice; less sodium and increased fibre for processed meats; lower SFA and added sugar and more fibre for dairy products; more fibre for sandwiches, although added sugar levels increased; and lower sodium and more fibre for soups. However, for newly developed products, energy was unchanged across all product groups. The Choices stamp used in the Netherlands at this time did not include calorie information on the logo. Displaying the calorie information with the logo may have encouraged manufacturers to decrease the energy in products.

Improving label awareness and trust

How do demographics impact label awareness and use.

In a study commissioned by the Choices Foundation ( Reference Vyth, Steenhuis and Mallant 6 ) , the elderly, obese and those with diet-related health problems expressed the need for an FOP logo, although respondents over 50 years old were less familiar with the Choices logo after it was launched. Interestingly, respondents with a lower education reported paying more attention to the logo. In the Netherlands, women liked the Choices logo more than men overall.

A study conducted in New Zealand ( Reference Gorton, Ni Mhurchu and Chen 20 ) , which recruited ethnically diverse shoppers in supermarkets, found that those 18–24 years old were less likely to use labels. Individuals with special dietary requirements and from households with medium income compared to low income were more likely to use labels.

Should a uniform labelling system be used on all products?

Several studies have found that consumers desire uniform FOP systems across products ( Reference van Kleef, van Trijp and Paeps 12 , Reference Kelly, Hughes and Chapman 19 ) . However, participants in focus groups in the Netherlands expressed concern that a diversity of product categories such as vegetables and snacks carrying the same logo would be confusing ( Reference Vyth, Steenhuis and Mallant 6 ) .

Should front-of-package labels be government mandated or done voluntarily by industry?

A common theme throughout several studies was that FOP labels will be maximally effective if the label is perceived as credible. Focus group studies have found that individuals consistently desire a label where the definition of healthfulness is understood and comes from a trusted source ( Reference Vyth, Steenhuis and Mallant 6 , Reference van Kleef, van Trijp and Paeps 12 , Reference Jones and Richardson 26 ) . European focus groups also found that an official endorsement from a national or international organization strongly increased the consumer perception of credibility, while endorsements by the European Union and European food manufacturers were perceived as less credible compared with the WHO or a national nutrition organization ( Reference van Kleef, van Trijp and Paeps 12 ) . People were more sceptical if they thought the symbol was developed by the food industry ( Reference Vyth, Steenhuis and Mallant 6 ) . The UK FSA study also found that some consumers were sceptical about FOP labels because they thought the food companies were using them to push certain products and therefore could not be trusted ( Reference Malam, Clegg and Kirwin 13 ) . In contrast, others disliked the labels because they felt the government was trying to tell them what to eat.

The need for an information campaign

After the implementation of the Choices programme in the Netherlands, focus group participants generated a variety of explanations for the logo such as ‘product health, safety or natural or organic product’ and some people in the UK were confused about the meaning of the TL colours. Given concerns about the credibility of a system, misinterpretation of FOP label elements and overall label messages ( Reference Vyth, Steenhuis and Mallant 6 ) , it will be important to undertake a public health information campaign to inform consumers about what an FOP label means and how it should be interpreted. When the Nutrition Facts panel was first released, the Nutritional Labeling and Education Act funded a nationwide multi-lingual education campaign that attempted to reach every American household ( Reference Philipson 45 ) . However, little research exists evaluating the marketing campaign's influence. This will likely be an important component of any FOP initiative.

Research on FOP labelling systems in a variety of countries has produced mixed results. Existing studies have varied widely in the type of labelling systems tested, the methods used, the outcomes examined and the participants studied (see Table 2 ). A concerted research effort is necessary to discover which FOP or shelf labelling system is most beneficial to consumers. An ineffective labelling system could be misleading, deceptive, or at the very least represent a lost opportunity to improve public health.

Table 2 Summary of science on front-of-package (FOP)/shelf labelling systems

Based on current knowledge, the MTL label has the most consistent support. Research suggests that an effective MTL label should contain calorie information per serving, daily caloric requirement information and convey nutrient levels using high, medium or low text. The most prevalent health problems in the USA would indicate the need to highlight saturated fat, sodium and sugar. In addition, products consumed in one sitting should contain calorie information per package. A uniform labelling system that is prominent and consistently located in the top-right corner of the package should be implemented. It is also important that the labelling system be viewed as credible, which will most likely be achieved through endorsements from national and international agencies, rather than an industry-created system.

Such a label and its variants must be tested in diverse populations. In addition, different versions of the TL labels should be tested against possible alternatives that have not yet been compared with the TL symbol, including the Choices logo. Given that the Guiding Stars and the SDA shelf-label systems have had some impact on product sales, these should also be tested against the TL and Choices symbol as both a shelf-tag labelling system and a possible FOP graphic type. Furthermore, consumers’ preference for and use of FOP labels should be compared more generally with preference for and use of supermarket shelf-labelling systems. Real-world studies that evaluate sales data as well as consumer behaviour in response to FOP and shelf labelling systems are greatly needed. Finally, more research is needed to understand how best to inform and teach consumers to interpret a new labelling system (see Table 3 ).

Table 3 Research needs on front-of-package (FOP)/shelf labelling systems

Acknowledgements

This work was supported in part by funding from the Rudd Foundation and the Robert Wood Johnson Foundation. None of the authors reported any financial disclosures or conflicts of interest. K.L.H. and C.A.R. originated the idea for the review paper and led the writing. M.A.B. contributed significantly to the drafting of the original manuscript. K.D.B., P.J.L. and M.B.S. provided critical feedback on drafts of the manuscript.

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The Intersection of Food Laws and Legal Metrology Laws in India: A Framework for Analysis

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• G. R. Srikkanth   ORCID: orcid.org/0000-0001-5507-5817 1 ,
• Sanjay Yadav 2 , 4 &
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Life without legal metrology is inconceivable, as legal metrology encompasses every sphere of daily life, from eating to safeguarding health to ensuring public safety and the environment. On the other hand, food plays an important role in human life, and the entire civilisation survives on food. Food laws have been developed over the years with the primary objective of providing consumers with safe and nutritious food. Food laws primarily focus on ensuring the safety and quality of consumables, while legal metrology laws govern the accuracy of weights and measures in commercial transactions, including pre-packed food. The intersection of food laws and legal metrology laws in India presents a complex framework that requires careful analysis. This intersection becomes crucial as discrepancies in quantity, labelling, or packaging can impact consumer rights and public health and appropriate declarations on the packaging help the consumer make an informed choice. This comprehensive analysis involves examining how these regulations merge, identifying potential conflicts, and proposing harmonised measures to enhance regulatory efficiency and consumer protection. Balancing the intricacies of both frameworks is essential to creating a robust system that addresses the unique challenges posed by the intersection of food and metrology regulations in India.

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Srikkanth, G.R., Yadav, S. & Pavan Kumar, K.I. The Intersection of Food Laws and Legal Metrology Laws in India: A Framework for Analysis. MAPAN (2024). https://doi.org/10.1007/s12647-023-00731-0

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Impact of Food Labelling on Consumer Behaviour - A Green Marketing Initiative

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Green marketing is the buzzword nowadays which focuses on the organic concept of the product with minimum residue and wastages. It also focuses on the recycling and the reusability of the product for further usage. This research paper focuses on `The Impact of Food Labelling on Consumer's choice of Products - A Green Marketing Initiative'. It focuses on green marketing, how consumer perceives it and what are the real ingredients associated with it. This is the empirical research where the Likert scale is used to collect the primary data. A sample of 126 respondents was used to analyse the green marketing initiative. The various factors that used were nutrition information, green packaging, fitness labels like low fat, gluten free etc., allergen information and the product in which the product is made etc. also impact consumer choices. Correlation analysis is used as a statistical tool to analyse the data with the help of SPSS 28.0 software. The scope and application of the paper is that the suggestive framework for green marketing initiatives can be used by various marketing firms, and policymakers which will empower the consumers and the manufacturer both to make improved and better fitness, health and ecologically environmentally friendly choices.

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Table of Pharmacogenomic Biomarkers in Drug Labeling

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Pharmacogenomics can play an important role in identifying responders and non-responders to medications, avoiding adverse events, and optimizing drug dose. Drug labeling may contain information on genomic biomarkers and can describe:

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The table below lists therapeutic products from Drugs@FDA with pharmacogenomic information found in the drug labeling. The labeling for some, but not all, of the products includes specific actions to be taken based on the biomarker information. Pharmacogenomic information can appear in different sections of the labeling depending on the actions. For more information, please refer to the appropriate labeling guidance.

Biomarkers in the table include but are not limited to germline or somatic gene variants (polymorphisms, mutations), functional deficiencies with a genetic etiology, gene expression differences, and chromosomal abnormalities; selected protein biomarkers that are used to select treatments for patients are also included.

This table does not include non-human genetic biomarkers (e.g., microbial variants that influence sensitivity to antibiotics), biomarkers that are used solely for diagnostic purposes (e.g., for genetic diseases) unless they are linked to drug activity or used to identify a specific subset in whom prescribing information differs, or biomarkers that are related to a drug other than the referenced drug (e.g., influences the effect of the referenced drug as a perpetrator of an interaction with another drug). For drugs that are available in multiple dosage forms, salts, or combinations, a single representative product is listed. In the case of combination products, the single agent associated with the biomarker is listed unless the agent is only approved as a combination product, in which case all agents are listed.

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Pharmacogenomic Biomarkers in Drug Labeling

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Microplastics Are Everywhere. Here’s How to Avoid Eating Them.

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Katie Okamoto is an editor focused on the environment. She has covered the intersection of products and sustainability for more than a decade.

Microplastics and nanoplastics are everywhere.

The teeny tiny pieces of plastic have been found in everything from drinking water to chicken nuggets, apples, and broccoli.

Recent studies have linked these pollutants to heart disease , lung disorders , and more worrying health issues.

But unfortunately, microplastics are now so pervasive that they’re nearly impossible to avoid.

If you’re concerned about the health effects linked to microplastics, the experts I spoke with said that you can lower your risk by taking care of your general health: getting plenty of sleep and exercise, eating a balanced diet, lowering stress, and seeking preventative care.

Still, it’s probably a good idea to lower your exposure to microplastics even if you can’t avoid them completely. Although you can cut back your exposure in as many ways as there are sources of plastic, the experts I spoke with recommended focusing on exposures from water, food, and air.

I talked to three doctors and a research scientist for tips on how to reduce the amount of tiny plastics and their chemicals that you (or your kids ) might ingest. Here’s what they recommend.

1. Cut back on bottled water

Bottled water is a significant source of microplastics. In fact, it’s the most concentrated source , according to a study from 2019.

Researchers believe that bottled water contains many more microplastics than tap. The evidence is mounting: A study published in 2024 suggests that the typical plastic bottle of water contains two to three times the plastic than previously thought.

Drinking bottled water in a pinch isn’t the end of the world, but for a daily habit, try carrying a reusable steel or glass bottle or tumbler when out and about.

2. Get an NSF-certified water filter

Switching to tap water from plastic bottled water will likely significantly reduce your routine exposure to plastics. But while the average plastic water bottle contains more microplastics and nanoplastics than tap, research shows that tap water may also be a source of microplastics.

Several of our water filter picks are specifically NSF/American National Standards Institute–certified to reduce microplastics, which means they’ve been rigorously tested in an accredited lab. They’re certified only to reduce since the filters cannot guarantee total elimination. Our picks include under-sink filters , such as the Aquasana AQ-5200 , and the Brita Elite , a pitcher filter .

Aquasana AQ-5200

Exceptional, affordable under-sink filtration.

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$100 + FS w/code AQWC50

Brita Elite Filter

Ace filtration, long lifespan.

This 10-cup, user-friendly model is rated to last six months between replacements.

Yes, it’s ironic that most NSF/ANSI-certified water filters contain plastic. But any microplastic shedding from using the plastic filter is likely to be minimal, as long as you avoid running hot water through the filter and store your water in the fridge, since heat accelerates plastic degradation.

Research suggests that boiling tap water, cooling it, and then filtering it may be especially effective at reducing microplastics, although it’s less practical for most people than simply using a filter.

3. Don’t use plastic to store food

Plastic food storage and packaging is so common that it’s difficult to avoid entirely. But your safest bet is to avoid storing food or liquid in plastic when possible and to minimize exposing any plastic (even those that say they’re BPA-free or microwave-safe) to high heat. Sunlight, acids, and physical erosion can also degrade plastic.

4. Don’t reuse single-use plastics for food and drinks

It’s great to reuse single-use plastic —just not for food. Unless you’re using the plastic in the freezer, save it for something that isn’t food storage or reheating, said Dr. Gillian Goddard, an endocrinologist and author at ParentData , a science-based online resource for parents. That means don’t reuse plastic takeout containers, breastmilk bags, or drink bottles.

5. Don’t microwave in plastic

Avoid microwaving or heating food or water in plastic—even if it says it’s microwave-safe, said Tracey Woodruff, director of the Program on Reproductive Health and the Environment at University of California San Francisco. Instead, consider glass or ceramic. The Pyrex Simply Store 18-Piece Set is our pick for the best food storage containers , and they survived our drop tests, stack neatly, and come with user-friendly lids (although you may not want to microwave the plastic lids). Our runner-up, the leakproof Glasslock 18-Piece Container Set , is another great option.

Pyrex Simply Store 18-Piece Set

The best glass container set.

The Pyrex Simply Store containers stack neatly and are made from durable tempered glass. The colorful lids make it easier to match their shape to the corresponding container, though you may need to replace them over time.

Glasslock 18-Piece Container Set

The best leakproof glass container set.

The Glasslock containers have locking lids that will prevent leaks. But these lids also put stress on the lips of the containers, so the glass may be prone to chipping over time.

6. Wash plastic by hand

Dishwasher temperatures run very hot and can degrade plastic—even dishwasher-safe plastic—and lead to microplastic shedding. Try to wash your plastic food containers by hand.

7. Use wood or bamboo cutting boards

Some research suggests that plastic cutting boards can be a significant source of microplastics in your diet, since repeated cutting on their surface can dislodge particles that adhere to food. Wood cutting boards also have some other advantages: They’re better for your knife blades and last longer than plastic when properly maintained.

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This beautiful teak board requires more careful cleaning than a plastic board, but it feels better under a knife and is easier to maintain than the other wood boards we tested.

Our cutting board pick, the Teakhaus Medium Professional Carving Board with Juice Canal 109 , is made from sustainably harvested teak. If you still prefer plastic for certain uses, use it sparingly and replace it after heavy scarring.

8. Clean your air

The air we breathe is also a potential source of microplastics, in the form of dust. Reducing airborne dust in your home, then, may reduce your exposure to inhaled microplastics.

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That means doing boring stuff, like vacuuming regularly with a bagged, sealed-system vacuum that has a HEPA or S-class filter and mopping and wiping down surfaces with a damp sponge or cloth (since dusting kicks those tiny particles back up into the air).

Coway Airmega AP-1512HH Mighty

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Perfect for bedrooms, playrooms, and living rooms, this air purifier is one of the highest-performing, most-durable, and most-economical models we’ve tested.

You should also take care of seasonal chores like cleaning fans and AC unit filters and changing HVAC filters, and consider getting an air purifier if you live near a busy road.

Take special steps for infants and young children

Infants may be exposed to microplastics and nanoplastics in much higher concentrations than adults. Research shows that this exposure may be cause for concern, particularly at critical stages of early development. But much like health risks to adults, it’s important to think of microplastics exposure as just one piece of a child’s overall health.

“I emphasize that before putting much energy and resources into minimizing unknown risks, it is worth attending to reducing the risks we know about,” said Dr. Carlos Lerner, a pediatrician and professor of clinical pediatrics at UCLA Health. He cited following safe sleep recommendations for infants, avoiding secondhand smoke, and practicing good nutrition as examples.

If you want to take a more precautionary approach, avoid using plastic to warm formula or breastmilk. This is the main point of advice from the experts I spoke with, as well as the Cleveland Clinic .

1. Avoid microwaving or heating formula in plastic

Recent evidence shows that polypropylene-bottle-fed babies may swallow very high levels of tiny plastics due to the high temperatures used to sterilize bottles and prepare formula, as well as shaking the bottles to mix. If you want to feed your baby warmed formula and use plastic bottles, consider premixing the formula in a glass container, then cooling it down before transferring it to the feeding bottle.

2. Rinse heat-sterilized plastic bottles before adding formula or breastmilk

If you use heat to sterilize plastic bottles, leave them to cool then rinse them several times before filling them with formula or breastmilk, Lerner suggested.

3. Consider glass or silicone over plastic bottles

If you prefer to heat formula in a microwave, consider a glass or silicone bottle. The Philips Avent Glass Natural Response Baby Bottle  is our recommendation for the best glass baby bottle.

Philips Avent Glass Natural Response Baby Bottle

Our favorite glass bottles.

With only three pieces and a large, easy-to-screw-on collar, this glass bottle is simple to use and didn’t leak in our test. But the very wide nipple may not work well for all babies.

4. Wash hands before eating

For young kids who eat with their hands, try to establish a habit of handwashing before eating, said Woodruff. While handwashing is not always possible, it can help reduce exposure from touching microplastics in dust and soil (and maybe, just maybe, stem the tide of germs).

How worried should you be about microplastics?

Scientists are still studying the exact connections between these teeny tiny pieces of plastic and human health. But it’s clear that exposure to plastic—whether it’s those tiny particles, the chemicals they leach, or a combination—is being linked to a variety of worrying health issues.

Some of those connections still require more research, such as ties to colon cancer , respiratory disease , metabolic function , and disruption to endocrine systems , while others—like a recent study that found those with levels of plastics in their arteries were at a higher risk for heart attacks, strokes, and death—seem a little more clear.

It’s important to remember that these links point to concerns about the impact of microplastics on public health, but they are not specific, predictable outcomes. “What I’m thinking about is population risk, not a risk to a specific individual,” said Goddard.

The tricky thing is that microplastics and nanoplastics are impossible to avoid, no matter how diligent you are: They’re in the air we breathe , our drinking water , and our food. But scientists aren’t sure what levels of microplastics and nanoplastics we’re each taking in from those sources.

The oft-cited estimate that the average person eats a credit card’s worth of plastic every week has been called into question . But our bodies are certainly taking in plastic, and that’s more than nature intended.

Given the growing body of evidence, it’s possible that we’ll start to see more public health measures that address microplastic pollution. Until then, taking care of your overall health is the first line of defense, followed by taking reasonable steps to reduce microplastic exposure.

This article was edited by Christine Cyr Clisset and Ben Frumin.

Tracey Woodruff, director of the Program on Reproductive Health and the Environment at UCSF , phone interview , April 25, 2024

Gillian Goddard, MD, endocrinologist and adjunct assistant professor at NYU Langone Hospital and author of “Hot Flash” newsletter from ParentData , phone interview , April 26, 2024

Carlos Lerner, MD, pediatrician at the Children’s Health Center at UCLA and professor and Jack H. Skirball endowed chair in Pediatrics at UCLA , email interview , April 26, 2024

Hayley Goldbach, MD, board-certified physician and dermatologic surgeon at Brown University , email interview , April 29, 2024

Meet your guide

Katie Okamoto

Katie Okamoto is a writer and the editor of sustainability coverage at Wirecutter. She has been covering food and design products and their intersections with environment and health issues for more than a decade. Katie has also worked in design and sustainability, and she holds a bachelor’s in environmental studies, a master’s in architecture, and a professional certificate in life cycle assessment.

Mentioned above

• With eight different picks, we’ve found water bottles suited for everyone from gym rats to frequent travelers. The 8 Best Water Bottles  
• The affordable, leak-resistant Simple Modern Classic Tumbler keeps drinks cold (or warm) for hours, and it comes with both a straw lid and a flip-top lid. The Best Tumbler  
• After more than 30 hours researching hundreds of models, we’ve found the best under-sink water filtration systems for most people. Here’s what we recommend. The Best Under-Sink Water Filter  
• Water filters and pitchers are the simplest, most affordable way to get reliable filtered water at home. The Best Water Filter Pitcher and Dispenser  
• Most plastic isn’t actually recycled. These 12 tips can help you reduce your overall plastic use—and make a difference in the global plastic pollution problem. 12 Ways to Break Up With Single-Use Plastics  
• After years of using and abusing food-storage containers, we recommend the glass Pyrex Simply Store 18-Piece Set and the Snapware Total Solution 20-Piece Set. The Best Food Storage Containers  

Further reading

Silicone Kitchen Gear Isn’t As Sustainable As Many People Think. Try These Solutions Instead.

by Katie Okamoto

We share how to get the most out of silicone items you may already own, and we recommend swaps you should consider instead of buying new tools and gadgets.

The Best Reusable Produce Bags, Beeswax Wraps, and Other Ways to Reduce Plastic Waste

by Anna Perling

Our favorite alternatives to plastic or disposable food storage include silicone food-storage bags, beeswax wraps, and cloth produce bags.

Laundry Detergent Sheets Are Poor Cleaners. And Their Sustainability Claims Are Debatable.

by Andrea Barnes

Laundry detergent sheets claim to be a more-sustainable option than traditional liquid, powder, or pod detergents. Unfortunately, they don’t clean well.

Expert Tips for Freezing Food and Reducing Food Waste

by Anna Perling and Katie Okamoto

We have the best freezer containers, plus expert advice on saving money and reducing waste by getting the most from your freezer.

• News & Analysis on Food & Beverage Development & Technology

Why do consumers trust – and distrust – meat alternatives?

07-Jun-2024 - Last updated on 07-Jun-2024 at 10:54 GMT

• Email to a friend

Vegan and vegetarian meat alternatives are still a relatively new phenomenon in the West. Even the oldest companies producing them have been around for a significantly shorter period of time than animal agriculture, which stretches back 10,000 years. Thus, consumers still need time to get used to it.  

Research from ‘consumer awareness’ organisation ProVeg International revealed that, while consumer trust in plant-based protein is increasing steadily, and they appear to be aware of the benefits, there is still a long way to go before trust levels are high enough for full adoption.  

Why do some consumers not trust plant proteins? ​

Trust in plant proteins is higher than it once was, but there is still a long way to go. ProVeg’s research showed that while 46% of consumers assessed stated that their trust has improved or increased, 39% of consumers still do not trust them.

Trust, according to Elsa Guadarrama, consumer and market research manager at ProVeg International, regards consumers’ ‘knowledge and experience with plant-based alternatives.’ “Trust correlates quite well with increased consumption,” she suggested at the Smart Protein Closing Conference in Berlin last month.

Trust is often linked less to the actual safety of consuming plant proteins, Guadarrama suggested, but instead their supply chain.

Price parity and plant-based meat

Previous research ​ by ProVeg has shown that one of the main barriers for consumer adoption of plant-based meat is cost. Price parity has on occasion been achieved, but in the overall market still remains a long way off.

One of the reasons for this, according to ProVeg CEO Jasmijn de Boo, is because the meat industry receives more subsidies than plant-based foods, giving it an advantage when it comes to costing.

“When looking at the statements related to trust, we see that the bottom two are 'integrity' and 'traceability', with 47% of agreement (still high). In contrast, safety to consume and accuracy in labelling are the top two drivers of 'trust' with 57% and 56% of agreement respectively,” she told FoodNavigator.

This can, she suggested, be remedied. “Traceability and credible certifications will (already are) playing an important role in fostering higher trust in plant-based alternatives.”

Why do consumers trust cultivated meat more than algae proteins? ​

ProVeg’s research also showed that cultivated meat is considered by consumers the second most trustworthy meat alternative category, following plant-based. This puts it above algae protein, a far more established category, with companies such as Quorn being on the market for decades. Cultivated meat, by contrast, has only very recently become commercially available, and then only in Singapore.

Trust in cultivated meat, suggested Guadarrama, may have something to do with the positive media coverage around it.

Cultivated meat commercialisation

While cultivated meat has been submitted for market approval in a range of places, including the EU ​ and the UK ​, it has been approved in the US, Singapore and Israel. Of these, it is only Singapore where cultivated meat is commercially available.

There has even been some travel in the opposite direction. For example, Italy recently banned ​ the production of cultivated meat.

“I think this is a good example of the power of the media. There has been so much media coverage around cultured meat and it's also been seen as this next step of meat, so there might be some influence of this positive futuristic approach to it,” she told FoodNavigator.

There has been other research, she told us, showing that those who are most likely to consume cultivated meat are actually males and omnivores.

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