Objective Understanding of Front-of-Package Nutrition Labels: An International Comparative Experimental Study across 12 Countries

Abstract

Front-of-Package labels (FoPLs) are efficient tools for increasing consumers’ awareness of foods’ nutritional quality and encouraging healthier choices. A label’s design is likely to influence its effectiveness; however, few studies have compared the ability of different FoPLs to facilitate a consumer understanding of foods’ nutritional quality, especially across sociocultural contexts. This study aimed to assess consumers’ ability to understand five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbol] in 12 different countries. In 2018, approximately 1000 participants per country were recruited and asked to rank three sets of label-free products (one set of three pizzas, one set of three cakes, and one set of three breakfast cereals) according to their nutritional quality, via an online survey. Participants were subsequently randomised to one of five FoPL conditions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Changes in a participants’ ability to correctly rank products across the two tasks were assessed by FoPL using ordinal logistic regression. In all 12 countries and for all three food categories, the Nutri-Score performed best, followed by the MTL, HSR, Warning symbol, and RIs.

Enhancing the effectiveness of the Health Star Rating via presentation modifications

“…The nutrient icons remained B&W across all conditions and only the HSR graphic was coloured in the colour versions to replicate the high-performing Nutri-Score that provides a colour representation of overall healthiness. 2 The star rating was the same size regardless of condition, meaning that the footprint of the full HSR versions was considerably larger. As per previous research, 3 other than the test variables, the images were identical to enable determination of FoPL effects with all else being equal.…”

“…2,3 Hybrid FoPLs, such as the HSR and the Multiple Traffic Lights (MTL), have both interpretive and reductive elements in recognition of the superior ability of interpretive nutrition information to facilitate rapid comparisons across products 4 and consumers' stated desire for nutrientspecific information on the front of pack. 2,3 Hybrid FoPLs, such as the HSR and the Multiple Traffic Lights (MTL), have both interpretive and reductive elements in recognition of the superior ability of interpretive nutrition information to facilitate rapid comparisons across products 4 and consumers' stated desire for nutrientspecific information on the front of pack.…”

“…2,3 Hybrid FoPLs, such as the HSR and the Multiple Traffic Lights (MTL), have both interpretive and reductive elements in recognition of the superior ability of interpretive nutrition information to facilitate rapid comparisons across products 4 and consumers' stated desire for nutrientspecific information on the front of pack. 2 The dominance of the Nutri-Score held across the total sample and within the Australian subsample, despite Australians' greater familiarity with the HSR. 2 The dominance of the Nutri-Score held across the total sample and within the Australian subsample, despite Australians' greater familiarity with the HSR.…”

“…Interpretive FoPLs that provide an assessment of a product's healthiness have been found to be more effective in increasing consumers' understanding and influencing their product choices than reductive FoPLs that replicate nutrient and energy information provided in the Nutrition Information Panel on the back/side of the pack. 2,3 Hybrid FoPLs, such as the HSR and the Multiple Traffic Lights (MTL), have both interpretive and reductive elements in recognition of the superior ability of interpretive nutrition information to facilitate rapid comparisons across products 4 and consumers' stated desire for nutrientspecific information on the front of pack. 5 A recent study of FoPL effectiveness across 12 countries found that of five FoPLS the highly interpretive Nutri-Score (that features only the letters A to E shown in colours ranging from green to red) produced the largest increase in understanding of product healthiness, followed by the MTL.…”

“…5 A recent study of FoPL effectiveness across 12 countries found that of five FoPLS the highly interpretive Nutri-Score (that features only the letters A to E shown in colours ranging from green to red) produced the largest increase in understanding of product healthiness, followed by the MTL. 2 The dominance of the Nutri-Score held across the total sample and within the Australian subsample, despite Australians' greater familiarity with the HSR. The HSR ranked second among Australians, followed by the MTL, then the warning labels, and lastly the Daily Intake Guide (DIG).…”