Can front-of-pack food labelling change our diets for the better?
Food label, or encyclopedia?
Have you checked out the labels on processed and packaged foods lately?
There are no fewer than 12 pieces of information mandated by law to appear on food labels, printed at a font size above a specified minimum. The intention is to inform consumers, ensure they are not misled, and help them make informed food choices to meet their health and dietary needs.
First, there is the name of the food. Then the ingredients, listed in descending order of volume/weight used in the preparation of the product, including the quantity of certain ingredients. Some, potential allergens, appear in bold type. Then, the weight or volume of the product, depending on whether it is solid or liquid. This is followed by the indication of minimum durability of the product: ‘use by’ date for perishables, or ‘best before’ date for less fragile products, and the storage instructions (cool, dry place, refrigerator, freezer), and/or conditions of use – for example reheating or cooking instructions. How to store the product once it is open, and how soon to consume it after that. The address of the manufacturer, or the retailer within the EU to enable any complaints or return. The place of provenance must be specified if it is implied in the description of the food. In the case of alcoholic drinks with 1.2% or more alcohol, the alcohol strength must be specified.
Finally, the especially intimidating nutritional information. Values are given per 100 g/100 ml or per “serving” of product, with the weight or volume of the serving specified, and an indication of the percentage this represents of the reference intake per day for each item in the list. These include energy in kilojoules and kilocalories; fat, of which saturates; carbohydrates, of which sugars; fibres; protein and salt.
Not mandated, but often indicated are whether the product is suitable for vegetarians or vegans, whether it is organic (with the relevant logo), or whether the packaging is recyclable. If there is still room on the busy label, manufacturers might add more information.
Still with me?
While the intention is to inform, even consumers with good literacy skills can be overwhelmed. Despite the minimum font provisions, those of us with challenged vision can struggle to read the details. And just how well equipped are we to understand what we are reading well enough to make genuinely informed choices?
With obesity affecting 60% of Irish adults and one in five children, improving our diets and lifestyles is crucial to our quality of life and life expectancy. To ward off cardiovascular diseases, diabetes, certain cancers and more we need to “watch what we eat”. Cooking fresh food from scratch is always good, but all of us use packaged processed foods every day, so we need to understand what we buy before we eat it.
In an effort to make our task easier, public health authorities in the UK, France and some other European countries have adopted interesting labelling initiatives for Front of Pack (FoP) labelling – these are voluntary, the mandated information appears on the back or sides of the pack. The UK provisions have also been widely adopted in Ireland. Those are not currently legally mandatory, though many retailers insist on it for their private labels, as do many food manufacturers – so they are ubiquitous on the shelves. Also, they result in additional information on the already busy label. So, the challenge is to ensure that the way in which the information is conveyed makes it genuinely – pardon the pun – more digestible.
Reference Intake, Traffic Lights, Nutri-Score – simpler, or simplistic?
The initiatives I refer to are the Traffic Light (UK and Ireland) and the Nutri-Score (France first, and in a few other EU countries now) schemes. They rely on a simplification of the message around nutrients, and visualisation through colour coding from good (green) to very bad (red). In the case of the Nutri-Score, the colour code is complemented by a five-letter grading, from A (dark green and very good) to E (red, and terrible).
I remember being involved in industry/policy discussions around front-of-pack food labelling some years ago. There was a lot of scepticism – including on my part – on the Reference Intake approach, which gave rise in the British Isles to the “Traffic Light” labelling system. The main issue was that the system appeared so overly simplified as to give consumers misleading advice and encouraging exclusion of individual foods with valuable nutrients. Put simply, the message appeared to be “Avoid nutrient rich cheese (scored red for salt and saturated fat) or olive oil, but drink all the nutrient-free, artificially sweetened fizzy drinks you want (green lighted across the board)”.
How credible is a system which gives zero calorie and nutrient diet Coke a better score than whole milk, and penalises cheese? And how sound is an approach which does not always identify the positives of certain foods, in smaller portions than 100grs or 100ml, and makes no reference to lifestyle?
How are the scores calculated?
The Nutri-Score and the Traffic Light systems are both based on the same algorithm, developed for the UK Food Standards Agency in the early noughties and regularly updated.
Each product is scored based on nutrients which are considered negative or positive. Negatives include high sugar, high caloric/energetic density per 100g or per 100ml, high saturated fats, high salt content. Positively scored nutrients include fruit, vegetable, nuts or legumes contents, fibre, protein, content of rapeseed, walnut or olive oil.
The Traffic Light system looks at the individual, potentially negative nutrients, and score them individually green (low) amber (neither low nor high) or red (high), depending on how much of each is present per 100g (or 100ml) of product, or per serving size. The picture below, which is helpful in understanding how to use the system as a consumer, is not available on the product label.
What the consumer sees on the product label is this:
In some respects, it is useful to have those indicators adjusted for a serving size rather than 100g or 100ml, especially when the normal serving is less than 100g or 100ml. On the other hand, this is very focused on the negative nutrients, and one might avoid the product on which the above appeared, on account of its high sugar contents, while no information is conveyed on any potential positive nutrients.
The information at the bottom of the graphic about the percentage of an adult’s reference intake which a portion of the product represents makes the graphic more complex, and risks being lost on many consumers.
The Nutri-Score, on the other hand, attributes positive and negative points for all nutrients in the products, so that the positives are netted off the negatives. Hence, a product which has high fruit, veg, nuts, legume, rapeseed oil, walnut oil or olive oil, and/or has high fibre and protein, will score relatively well even if it has a high saturated fat contents, for example. Since 2021, there has been significant research to review, refine and improve the calculations.
This is what the Nutri-Score looks like on a food packet today:
As it provides a single, highly visual score, based on five colours and the letters A to E, it is also much easier for a rushed consumer to use in decision-making – for example in comparing breakfast cereal choices.
It speaks well of the Nutri-Score that, while Diet Coke shows green across all macronutrients in the Traffic Light system, it scores a more nuanced C in the Nutri-Score, while the Open Food Facts database also gives it the Nova4 score indicating that it is an ultra processed food (see below).
How do food manufacturers get their products scored?
Both the Traffic Light and Nutri-Score schemes are voluntary. However, many retailers insist on it for their private label products, while many branded manufacturers also demand it.
The Traffic Light system is subject to compliance with specific legal requirements, set out by the UK Food Standards Agency and the Department of Health. The information panel can include energy (calories) only, or all the macronutrients – sugar, salt, fat, carbohydrates – as well as energy, but not, for example, just the energy and sugar. The energy information must be given per 100g or 100ml, and per portion of the product – and the portion has to be realistic.
As previously stated, the size of the font on the label is also regulated, as are the colours to be used, depending on the amount of each macronutrient in the product. For products served in portions that exceed 100g or 150ml, the contents cut-off which requires a change of colour is different.
The Nutri-Score system requires companies to register with Santé Publique France. Beyond France, other territories where the Nutri-Score is in common use include Belgium, Switzerland, Luxembourg, the Netherlands, Spain and Germany. Certain imported products may feature it on our shelves, but it is not in common use by Irish or British food brands.
To register, the food company must provide the details by brand of the categories of products it wishes to use the logo on and make commitments to use the logo for all the products they have on the market under the registered brand. They must also commit to adhere to the conditions of use of the Nutri-Score logo. Once its application has been acknowledged by the French public health authority, the company can start using the logo.
What impact on processed food recipes?
Public health interventions like the sugar tax on soft drinks and certain foods in the UK, have led to widespread recipe reformulations and a notable reduction in sugar in products. A 2020 study from Public Health England shows that the introduction of a sugar tax led to a reduction in the sugar contents of yoghurt of 12.9%, and 13.3% in breakfast cereals between 2015 and 2019.
The expectation would be that, as FoP labelling enables consumers to readily identify products with high contents of potentially unhealthy macronutrients, it too would influence the formulation of food recipes to improve scores.
A 2021 study from the Dutch Institute of Public Health and the Environment found that a substantial percentage of food products shifted to a more favourable Nutri-Score after manufacturers reduced the sodium, saturated fat, and sugar contents, and/or boosted fibres.
What impact on buying habits, diets or health?
The purpose of the mandatory nutritional information on food labels is to influence consumer choices towards healthier foods. The purpose of the colour coded FoP Traffic Light and Nutri-Score systems is to make that easier, by increasing visibility, and ease of understanding at a glance.
While the efficacy and utility of those systems is still under some debate, there have been studies to show that it is having the type of positive impact desired by the public health authorities promoting them.
This study from the University of Burgos in Spain found that “the Nutri-Score is an effective system for guiding consumer purchase decisions on packaged foods” and that “the usefulness of the label generates positive attitudes toward intention of use among consumers”.
A study carried out in Korea and published in October 2022 sought to establish the impact of labelling foods with a five-letter Nutri-Score-type system in a sports facility store v a non-sports facility store. It concluded that its “results implied Nutri-Score labelling positively affected sales of healthy foods only in the sports facilities because few people in non-sports facilities sought to purchase healthy foods.”
In June 2022, an OECD report titled Healthy Eating and Active Lifestyles: Best Practices in Public Health published a case study of the Nutri-Score, concluding that “Nutri-Score is a best practice and transferable intervention with the potential to significantly improve diet, reduce obesity and disease incidence when scaled-up across France and transferred to other OECD and non-OECD European countries”.
Particularly interesting because it originates from the ESRI, the Irish Economic and Social Research Institute, this study concluded that, while the Nutri-Score increases the attention consumers pay to nutritional information, the likelihood of their purchasing healthier foods also requires increasing the availability of such products on the shelf.
There is good evidence that the public understands the Nutri-Score and Traffic Light systems, that the Nutri-Score in particular is considered by public health authorities as a strong tool to improve consumer choices and that they impact shoppers’ declared purchase intentions.
Proving that they actually help increase sales of foods scored healthiest while reducing sales of unhealthier foods may take a little more time: the Nutri-Score was introduced in France in 2017, and is not widespread in all countries. It is however likely that over time, a combination of consumers learning to use the “at a glance” system more fluently and food processors reformulating recipes will result in healthier products on shelves ending up in our shopping baskets.
Showing what impact it may have on actual diets, never mind health, of consumers is some way off yet. However, I have come to revisit my scepticism on the real scope those FoP labelling initiatives have to facilitate consumers in eating more healthily.
Next public health battle on labelling: ultra processed foods?
The Nova classification developed by the School of Public Health in the University of Sao Paolo, Brazil, identifies four food groupings:
- Unprocessed or minimally processed foods – including vegetables, fruit, nuts, cereal grains, flours, dried or fresh pasta, fresh milk and yoghurts and fresh meat;
- Processed culinary ingredients – oils, fats, salt and sugar;
- Processed foods – including canned vegetables, tomato paste, fruit in sugar syrup; bacon, beef jerky, freshly made cheese, unpackaged freshly made bread;
- Ultra processed food – Such fatty sweet, savoury or salty packaged snacks, biscuits, ice cream, chocolates, carbonated soft drinks, breakfast cereals and bars, packaged breads and buns, distilled alcoholic beverages, margarines and spreads and many, many more foods.
While ultra processed foods (UPF) are often characterised by high levels of fat, sugar or salt, they are difficult to define beyond the non-exhaustive list of the Nova classification. Also, some foods that are not classified as ultra processed also have problematic nutritional profiles. Yet, UPFs have been found to have lower nutritional quality on average. A study of 220,522 UPFs identified in the Open Food Facts database showed 79% of them were scored C, D and E, 13% B and only 8% as A. UPF consumption has also been linked in numerous studies to weight gain and negative health outcomes, regardless of nutrient profiles.
Already, the Université de la Sorbonne, Paris scientists have developed proposals to amend the Nutri-Score FoP graphic to flag those foods (see below), and encourage consumers, now familiar with the concept of healthy food scoring, to avoid them.
I think it is fair to say that FoP nutritional guidance, especially when simple and highly visual, allows us consumers to make better-informed judgements to shop and eat better. The potential to improve population health and quality of life, reduce the cost of health care and more is worth the investment.
For consumer diets to improve generally, and unhealthy eating-related morbidity to fall, however, the ubiquitous presence of addictive UPFs will have to be curbed. Whether this can be achieved through FoP graphics and visuals remains to be seen. The removal of branding and introduction of shocking graphic imagery of diseases caused by smoking have contributed to reduce smoking and its associated health impacts, and some scientists argue UPFs packs should feature the same warnings.
The very occasional consumption of UPFs as part of an otherwise healthy, varied diet and active lifestyle should not be a concern. However, these are foods formulated to play with our brains to optimise more-ishness and repeat sales, they are addictive, often significantly cheaper than healthier choices and they contribute in a major way to the current epidemic of obesity.
Will we see photos of clogged arteries on our chocolate bar wrappers soon?
Post scriptum: While finishing this piece, I came across this recent New Scientist article on UPFs. Not all UPFs have worse nutrient profiles than foods that are not categorised as ultra processed, and menus which feature them can work out significantly cheaper for hard pressed consumers. Who knew: food is complicated.
© Catherine Lascurettes, Cúl Dara Consultancy
