BackgroundIn addition to helping consumers make healthier food choices, front-of-pack nutrition labels could encourage companies to reformulate existing products and develop new ones with a healthier product composition. This is the largest study to date to investigate the effect of a nutrition logo on the development of healthier products by food manufacturers.MethodsA total of 47 food manufacturers joining the Choices Foundation in the Netherlands (response: 39.5%) indicated whether their Choices products were newly developed, reformulated or already complied with the Choices criteria and provided nutrient composition data for their products (n = 821; 23.5% of the available Choices products in August 2009).ResultsMost products carrying the logo as a result of reformulation and new product development were soups and snacks. Sodium reduction was the most common change found in processed meats, sandwiches, soups and sandwich fillings. Dietary fiber was significantly increased in most newly developed Choices product groups; for example, in fruit juices, processed meats, dairy products, sandwiches and soups. Saturated fatty acids (SAFA) and added sugar were significantly decreased both in reformulated and newly developed dairy products. Caloric content was significantly decreased only in reformulated dairy products, sandwich fillings and in some newly developed snacks.ConclusionsThe results indicate that the Choices logo has motivated food manufacturers to reformulate existing products and develop new products with a healthier product composition, especially where sodium and dietary fiber are concerned.

Objective: A front-of-pack nutrition logo on products with relatively favourable product compositions might help consumers to make more healthful choices. Studies investigating actual nutrition label use in point-of-purchase settings are scarce. The present study investigates the use of the 'Choices' nutrition logo in Dutch supermarkets. Design: Adults were asked to complete a validated questionnaire about motivation for food choice and their purchased products were scored for the Choices logo after they had done their shopping. Setting: Nine supermarkets in The Netherlands. Subjects: A total of 404 respondents participated. Results: Of the respondents, 62 % reported familiarity with the logo. The motivations for food choice that were positively associated with actually purchasing products with the logo were attention to 'weight control' and 'product information'. The food choice motive 'hedonism' was negatively associated with purchasing products with the logo. Conclusions: This is the first study to investigate actual use of the Choices logo. In order to stimulate consumers to purchase more products with a favourable product composition, extra attention should be paid to hedonistic aspects such as the tastefulness and the image of healthy products.

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This study aimed to perform a quantitative and qualitative process evaluation of the introduction of the Choices logo, a front-of-pack nutrition logo on products with a favorable product composition, adopted by many food producers, retail and food service organizations, conditionally endorsed by the Dutch government, validated by scientists, and in the process of international dissemination. An online questionnaire was sent to adult consumers 4 months after the introduction of the logo (n = 1,032) and 1 year later (n = 1,127). Additionally, seven consumer focus groups (n = 41) were conducted to provide more insight into the questionnaire responses. Quantitative analyses showed that exposure to the logo had significantly increased. Elderly and obese respondents reported to be more in need of a logo than younger and normal-weight individuals. Women perceived the logo more attractive and credible than men did. Further qualitative analyses indicated that the logo's credibility would improve if it became known that governmental and scientific authorities support it. Elderly respondents indicated that they needed a logo due to health concerns. Consumers interested in health reported that they used the logo. Further research focusing on specific target groups, forming healthful diets, and health outcomes is needed to investigate the effectiveness of the Choices logo.

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This study shows that the way worksite cafeterias offer products affects purchase behavior. Situated nudging and social marketing-based strategies are effective in promoting healthier choices and aim to remain effective over time. Some product groups only indicated an upward trend in purchases. Such an intervention could ultimately help prevent and reduce obesity in the Dutch working population. This trial was registered at the Dutch Trial Register (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5372) as NTR5372.

This review evaluates the methodological quality of current front-of-pack labeling research and discusses future research challenges. Peer-reviewed articles were identified using a computerized search of the databases PubMed and Web of Science (ISI) from 1990 to February 2011; reference lists from key published articles were used as well. The quality of the 31 included studies was assessed. The results showed that the methodological quality of published front-of-pack labeling research is generally low to mediocre; objective observational data-based consumer studies were of higher quality than consumer studies relying on self-reports. Experimental studies that included a control group were lacking. The review further revealed a lack of a validated methodology to measure the use of front-of-pack labels and the effects of these labels in real-life settings. In conclusion, few methodologically sound front-of-pack labeling studies are presently available. The highest methodological quality and the greatest public health relevance are achieved by measuring the health effects of front-of-pack labels using biomarkers in a longitudinal, randomized, controlled design in a real-life setting.

The Netherlands Nutrition Centre has developed ‘Guidelines for Healthier Canteens’. To facilitate their implementation, implementation tools were developed: stakeholders’ questionnaires, the ‘Canteen Scan’ (an online tool to assess product availability/accessibility), a tailored advisory meeting/report, communication materials, establishment of an online community, newsletters, and a fact sheet with students’ wishes/needs. In this quasi-experimental study, we investigated the effect of these tools in secondary schools on (a) factors perceived by stakeholders as affecting implementation; (b) the quality of implementation. For six months, ten intervention schools implemented the guidelines, supported by the developed implementation tools. Ten control schools received the guidelines without support. School managers, caterers, and canteen employees (n = 33) reported on individual and environmental factors affecting implementation. Implementation quality was determined by dose delivered, dose received, and satisfaction. Stakeholders (n = 24) in intervention schools scored higher on the determinants’ knowledge and motivation and lower on need for support (p < 0.05). Dose received (received and read) and satisfaction was highest for the advisory meeting/report (67.9%, 64.3%, 4.17), communication materials (60.7%, 50.0%, 3.98), and fact sheet (80%, 60%, 4.31). Qualitative analyses confirmed these quantitative results. In conclusion, a combination of implementation tools that includes students’ wishes, tailored information/feedback, reminders and examples of healthier products/accessibility supports stakeholders in creating a healthier school canteen.