Are Front-of-Pack Nutrition Labels Influencing Food Choices and Purchases, Diet Quality, and Modeled Health Outcomes? A Narrative Review of Four Systems

Abstract

Front-of-Pack Nutrition labels (FOPNLs) aim to improve consumers’ food purchases and prompt product reformulation by the food and beverage industry. Despite their widespread use, the effectiveness of FOPNL in achieving these goals is still a matter of debate. This review has gathered 65 original studies exploring the performances of four widely used FOPNLs (Multiple Traffic Light, Warning signs, Nutri-Score and Health Star Rating). Although FOPNLs have been associated with healthier food purchases, the magnitude of improvements was small and dependent on study settings. Any associated health effects were modeled rather than observed. None of the four FOPNLs clearly outperformed the other ones on any outcome. Few studies dealt with the impact of FOPNL on product reformulation. Some of those studies, but not all, found small reductions in energy, sodium, sugar and saturated fat content of foods in some food categories. Although global trends point to a small favorable effect of FOPNL, this conclusion is subject to caution since the evidence is inconsistent and comes from a wide variety of contexts and study designs. There remain numerous research gaps, notably with regard to the optimal characteristics of FOPNLs, the durability of FOPNL effects on consumer behaviors, and any possible unexpected consequences.

Food Front-of-Pack Labelling and the Nutri-Score Nutrition Label—Poland-wide Cross-sectional Expert Opinion Study

“…There are not enough studies to simulate real-world conditions and assess how the system will realistically affect consumer behaviours. As highlighted in Braesco and Drewnowski (2023), the research to date provides some, but insufficient, evidence that FOPNLs can lead to meaningful improvements in consumer behaviours and nutritional quality of the packaged food [5]. Caution on the introduction of this system in the country therefore seems highly advisable.…”

Food Front-of-Pack Labelling and the Nutri-Score Nutrition Label—Poland-Wide Cross-Sectional Expert Opinion Study

“…Often, however, the mandatory information on the packaging is insufficient for the selection of a valuable product, and its interpretation by people without adequate knowledge may take a long time, often leading to the choice of a product with less beneficial properties [ 2 , 3 , 4 ]. Appropriate information and labelling on packaging therefore plays a huge role in making more informed dietary choices, and thus in improving the quality of the public’s diet and preventing related diseases [ 5 , 6 ].…”

“…Individual countries, based on the opinions of their experts and scientific societies, are therefore introducing FOPLs based on internal regulations in an effort to improve the health of their citizens. For example, Warning Signs have been introduced as mandatory in Chile, Peru, Uruguay, Mexico, Colombia and Argentina, while by 2023, the Nutri-Score was introduced, as recommended, in seven European countries, including France, Spain, Switzerland and Germany, among others [ 5 ]. Several countries also officially did not support the introduction of the Nutri-Score system, including Italy, Czech Republic, Cyprus, Greece, Hungary, Latvia and Romania.…”

Front-of-Pack Nutrition Labels

“…A review of "front-of-pack nutrition labeling schemes" by the Joint Research Centre (JRC) of the European Commission 5 was recently updated with studies testing the impact of Multiple Traffic Light (MTL), warning sign, Nutri-Score, and Health Star rating logos. 6 Based on the JRC report, the overall impact of FOP nutrition labels on the quality of food purchases was small, even if it was statistically significant at times. 5 Basically, there was no convincing evidence that consumers were modifying their behaviors based on FOP food labels alone.…”

“…What is the evidence the FOP directly influences food choices and food purchases, diet quality, and health outcomes? A review of “front-of-pack nutrition labeling schemes” by the Joint Research Centre (JRC) of the European Commission 5 was recently updated with studies testing the impact of Multiple Traffic Light (MTL), warning sign, Nutri-Score, and Health Star rating logos 6 . Based on the JRC report, the overall impact of FOP nutrition labels on the quality of food purchases was small, even if it was statistically significant at times 5 .…”