Front-of-pack symbols are not a reliable indicator of products with healthier nutrient profiles.

BACKGROUND: Front-of-pack (FOP) nutrition rating systems and symbols are a form of nutrition marketing used on food labels worldwide. In the absence of standardized criteria for their use, it is unclear if FOP symbols are being used to promote products more nutritious than products without symbols. OBJECTIVES: To compare the amount of calories, saturated fat, sodium, and sugar in products with FOP symbols, and different FOP symbol types, to products without symbols. METHODS: The median calorie, saturated fat, sodium, and sugar content per reference amount of products with FOP symbols were compared to products without FOP symbols using data from the Food Label Information Program, a database of 10,487 Canadian packaged food labels. Ten food categories and 60 subcategories were analyzed. Nutrient content differences were compared using Wilcoxon rank-sum test; differences greater than 25% were deemed nutritionally relevant. RESULTS: Products with FOP symbols were not uniformly lower in calories, saturated fat, sodium, and sugar per reference amount than products without these symbols in any food category and the majority of subcategories (59/60). None of the different FOP types examined were used to market products with overall better nutritional profiles than products without this type of marketing. CONCLUSION: FOP symbols are being used to market foods that are no more nutritious than foods without this type of marketing. Because FOP symbols may influence consumer perceptions of products and their purchases, it may be a useful public health strategy to set minimum nutritional standards for products using FOP symbol marketing.

Food products qualifying for and carrying front-of-pack symbols: a cross-sectional study examining a manufacturer led and a non-profit organization led program.

BACKGROUND: Concern has been raised that the coexistence of multiple front-of-pack (FOP) nutrition rating systems in a marketplace may mislead consumers into believing that a specific food with a FOP is 'healthier' than foods without the symbol. Eleven summary indicator FOP systems are in use in Canada, including one non-profit developed system, the Heart and Stroke Foundation's Health Check™, and ten manufacturer-developed systems, like Kraft's Sensible Solutions™. This study evaluated FOP's potential to mislead consumers by comparing the number of products qualifying to carry a given FOP symbol to the number of products that actually carry the symbol. METHODS: The nutritional criteria for the Health Check™ and the Sensible Solutions™ systems were applied to a 2010-2011 Canadian national database of packaged food products. The proportion of foods qualifying for a given FOP system was compared to the proportion carrying the symbol using McNemar's test. RESULTS: Criteria were available to categorize 7503 and 3009 of the 10,487 foods in the database under Health Check™ and Sensible Solutions™, respectively. Overall 45% of the foods belonging to a Health Check™ category qualified for Health Check's™ symbol, while only 7.5% of the foods carried the symbol. Up to 79.1% of the foods belonging to a Sensible Solutions™, category qualified for Sensible Solutions's™ symbol while only 4.1% of the foods carried the symbol. The level of agreement between products qualifying for and carrying FOP systems was poor to moderate in the majority of food categories for both systems. More than 75% of the products in 24 of the 85 Health Check™ subcategories and 9 of 11 Sensible Solution™ categories/subcategories qualified for their respective symbols based on their nutritional composition. CONCLUSIONS: FOP systems as they are currently applied are not, in most instances, a useful guide to identifying healthier food products in the supermarket as many more products qualify for these systems than the number of products actually displaying these symbols on FOP, and the level of agreement between qualifying and carrying products is poor to moderate. The adoption of a single, standardized FOP system would assure consumers that all products meeting certain nutritional standards are designated by the symbol.

Effectiveness of front-of-pack nutrition symbols: a pilot study with consumers.

PURPOSE: The effectiveness of different front-of-pack nutrition rating systems and symbols (FOPS) has not been studied among Canadians. We pilot tested an online FOPS survey with consumers. METHODS: Members of the Guelph Food Panel were randomly exposed to traffic light, Percent Daily Value, Health Check, and Smart Pick logos on mock food packages and were asked to rate the FOPS on a Likert-type scale. The FOPS were rated on consumers' ability to understand them, credibility, and influence on purchase decisions. Participants also provided feedback on the survey. RESULTS: Participants (n=337) deemed the survey appropriate in length and language, and provided suggestions for improving survey clarity. More than 50% of the respondents believed that FOPS should be present on all food packages (65.1%) and should be government regulated (53.0%). The Percent Daily Value symbol was rated highest with respect to liking, credibility, helpfulness, and influence, but was the least understood. When they used direct comparison, consumers preferred the traffic light symbol (53.1%) over the Percent Daily Value (40.0%), Health Check (6.7%), and Smart Pick (0.3%) symbols. CONCLUSIONS: The survey was revised as a result of the pilot study feedback. Preliminary findings from this pilot study suggest that consumers prefer a single, government-regulated symbol, and value more complex FOPS, like the Percent Daily Value symbol, despite finding them harder to understand.

Impact of nutrition education on university students' fat consumption.

PURPOSE: University science students who have taken a nutrition course possess greater knowledge of fats than do those who have not; whether students apply this knowledge to their diet is unknown. We measured and compared science students' total and saturated fat intake in the first and fourth years, and evaluated whether taking a nutrition course influenced fat consumption. METHODS: A sample of 269 first- and fourth-year science students at a small undergraduate university completed a survey with both demographic questions and a semi-quantitative food frequency questionnaire about fats in the diet. Data were analyzed using chi-square tests and independent-sample t-tests. RESULTS: Fourth-year science students consumed fewer grams of total and saturated fat than did first-year science students (p<0.001). Science students who had taken a nutrition course consumed fewer grams of total and saturated fat than did those who had not (p<0.001). CONCLUSIONS: Taking a nutrition course may decrease first-year students' fat consumption, which may improve diet quality and decrease the risk of chronic disease related to fat consumption.

Traffic light labelling could prevent mortality from noncommunicable diseases in Canada: A scenario modelling study.

BACKGROUND: Traffic-light labelling (TLL) is a promising front-of-pack system to help consumers make informed dietary choices. It has been shown that adopting TLL in Canada, through an optimistic scenario of avoiding, if possible, foods with red traffic lights, could effectively reduce Canadians' intakes of energy, total fat, saturated fat, and sodium by 5%, 13%, 14% and 6%, respectively. However, the potential health impact of adopting TLL has not been determined in the North American context. OBJECTIVE: This study modelled the potential impact of adopting TLL on mortality from noncommunicable diseases (NCDs) in Canada, due to the previously predicted improved nutrient intakes. METHODS: Investigators used data from adults (n = 19,915) in the 2004 nationally representative Canadian Community Health Survey (CCHS)-Cycle 2.2. Nutrient amounts in foods consumed by CCHS respondents were profiled using the 2013 United Kingdom's TLL criteria. Whenever possible, foods assigned at least one red light (non-compliant foods) were replaced with similar, but compliant, foods identified from a Canadian brand-specific food database. Respondents' nutrient intakes were calculated under the original CCHS scenario and the counterfactual TLL scenario, and entered in the Preventable Risk Integrated ModEl (PRIME) to estimate the health impact of adopting TLL. The primary outcome was the number of deaths attributable to diet-related NCDs that could be averted or delayed based on the TLL scenario compared with the baseline scenario. RESULTS: PRIME estimated that 11,715 deaths (95% CI 10,500-12,865) per year due to diet-related NCDs, among which 72% are specifically related to cardiovascular diseases, could be prevented if Canadians avoided foods labelled with red traffic lights. The reduction in energy intakes would by itself save 10,490 deaths (9,312-11,592; 90%). CONCLUSIONS: This study, although depicting an idealistic scenario, suggests that TLL (if used to avoid red lights when possible) could be an effective population-wide intervention to improve NCD outcomes in Canada.

Traffic-light labels could reduce population intakes of calories, total fat, saturated fat, and sodium.

Traffic-light labelling has been proposed as a public health intervention to improve the dietary intakes of consumers. OBJECTIVES: to model the potential impact of avoiding foods with red traffic lights on the label on the energy, total fat, saturated fat, sodium, and sugars intakes of Canadian adults. METHODS: Canadian adults aged 19 and older (n = 19,915) who responded to the Canadian Community Health Survey (CCHS), Cycle 2.2. The nutrient levels in foods consumed by Canadians in CCHS were profiled using the United Kingdom's criteria for traffic light labelling. Whenever possible, foods assigned a red traffic light for one or more of the profiled nutrients were replaced with a similar food currently sold in Canada, with nutrient levels not assigned any red traffic lights. Average intakes of calories, total fat, saturated fat, sodium, and sugars under the traffic light scenario were compared with actual intakes of calories and these nutrients (baseline) reported in CCHS. RESULTS: Under the traffic light scenario, Canadian's intake of energy, total fat, saturated fat, and sodium were significantly reduced compared to baseline; sugars intakes were not significantly reduced. Calorie intake was reduced by 5%, total fat 13%, saturated fat 14%, and sodium 6%. CONCLUSION: Governments and policy makers should consider the adoption of traffic light labelling as a population level intervention to improve dietary intakes and chronic disease risk.

Canadians' perceptions of food, diet, and health--a national survey.

BACKGROUND: Poor nutrition is harmful to one's health as it can lead to overweight and obesity and a number of chronic diseases. Understanding consumer perceptions toward diet and nutrition is critical to advancing nutrition-related population health interventions to address such issues. The purpose of this paper was to examine Canadians' perceived health and diet status, compared to their actual health status, and general concern about their own diet and beliefs about health. Also analyzed were some of the perceived barriers to eating "healthy" foods, with a focus on the availability of "healthy" processed foods. METHODS: Two surveys were administered online to a group of Canadian panelists from all ten provinces during May 2010 to January 2011. Thirty thousand were invited; 6,665 completed the baseline survey and 5,494 completed the second survey. Panelists were selected to be nationally representative of the Canadian adult population by age, sex, province and education level, according to 2006 census data. RESULTS: Approximately one third of Canadians perceived their health or diet to be very good while very few Canadians perceived their health or diet to be very poor. While the majority of Canadians believed food and nutrition to be very important for improving one's health, fewer Canadians were concerned about their own diets. The majority of Canadians reported difficulty finding "healthy" processed foods (low in salt and sugar and with sufficient vitamins and minerals). Many also reported difficulty finding healthy foods that are affordable. CONCLUSION: Although consumers believe that nutrition is one of the most important factors for maintaining health, there are still a number of attitudinal and perceived environmental barriers to healthy eating.

Consumer perceptions of the Nutrition Facts table and front-of-pack nutrition rating systems.

Preferences for, and consumer friendliness of, front-of-pack (FOP) nutrition rating systems have not been studied in a Canadian population, and studies comparing systems that are accompanied by mandatory labelling, such as Canada's Nutrition Facts table (NFt), are lacking. The purpose of this study was to evaluate 4 FOP systems relative to the NFt with respect to consumer friendliness and their influence on perceptions of the healthiness and nutrient content of food. Canadian consumers (n = 3029) participating in an online survey were randomized to score the consumer friendliness of 1 of 5 FOP conditions with or without an NFt and to score the healthiness and nutrient content of 2 foods using the provided label(s). The mean differences in scores were evaluated with analysis of covariance (ANCOVA) controlling for age, gender, and education, with Tukey-Kramer adjustments for multiple comparisons. The NFt received the highest scores of consumer friendliness with respect to liking, helpfulness, credibility, and influence on purchase decisions (p < 0.05); however, consumers still supported the implementation of a single, standardized FOP system, with the nutrient-specific systems (a "Traffic Light" and a Nutrition Facts FOP system) being preferred and scored as more consumer friendly than the summary indicator systems. Without the NFt, consumer ratings of the healthiness and calorie and nutrient content differed by FOP system. With the NFt present, consumers rated the healthiness and calorie and nutrient content similarly, except for those who saw the Traffic Light; their ratings were influenced by the Traffic Light's colours. The introduction of a single, standard, nutrient-specific FOP system to supplement the mandatory NFt should be considered by Canadian policy makers.

Nutrition marketing on processed food packages in Canada: 2010 Food Label Information Program.

The current study describes the frequency of use of different forms of nutrition marketing in Canada and the nutrients and conditions that are the focus of nutrition marketing messages. Prepackaged foods with a Nutrition Facts table (N = 10,487) were collected between March 2010 and April 2011 from outlets of the 3 largest grocery chains in Canada and 1 major western Canadian grocery retailer. The nutrition marketing information collected included nutrient content claims, disease risk reduction claims, and front-of-pack nutrition rating systems (FOPS). We found that nutrition marketing was present on 48.1% of Canadian food packages, with nutrient content claims being the most common information (45.5%), followed by FOPS on 18.9% of packages. Disease risk reduction claims were made least frequently (1.7%). The marketing messages used most often related to total fat and trans fat (15.6% and 15.5% of nutrient content claims, respectively). Limiting total and trans fats is a current public health priority, as recommended by Health Canada and the World Health Organization. However, other nutrients that are also recommended to be limited, including saturated fats, sodium, and added sugars, were not nearly as prominent on food labels. Thus, greater emphasis should be placed by the food industry on these other important nutrients. Repeated data collection in the coming years will allow us to track longitudinal changes in nutrition marketing messages over time as food marketing, public health, and consumer priorities evolve.

Front-of-pack nutrition labelling systems: a missed opportunity?

Both the US Institute of Medicine and the Canadian Standing Committee on Health have called for simple, standardized front-of-package (FOP) nutrition labelling systems on packaged foods. However, despite scientific evidence and expert consensus on the topic, Canada's Minister of Health has dismissed these recommendations, stating that Canadian consumers already have "the tools they need to make healthy food choices when they shop for groceries". This is relevant since existing evidence suggests that the current regulated nutrition labelling tools may not meet their intended objectives. Furthermore, Canada's current FOP labelling environment--characterized by a variety of FOP labels with varying criteria--does not support the objectives of good nutrition labelling defined by Health Canada. Evidence suggests that well-designed FOP systems are capable of positively influencing consumer purchases as well as product reformulations by manufacturers. The US Institute of Medicine suggests a standardized, simple, interpretive, and ordinal FOP symbol as the ideal FOP labelling system. Although additional research is required, such a system should be considered in Canada, as it may be capable of addressing the shortcomings of existing nutrition labelling tools found in the Canadian marketplace.