March 29, 2017

Health Canada is currently proposing mandatory front-of-package (FOP) labelling on prepackaged foods, aiming to provide quick and easy guidance to encourage consumers to make informed choices and encourage food industry to reformulate and innovate.

There are currently different formats of FOP labelling adopted in Canada as well as around the world. Some use informative schemes highlighting specific nutrients (e.g. Facts Up Front), while others use interpretive schemes based on established rating criteria or algorithms (e.g. Traffic Light Labelling in the UK, Health Star Rating in Australia and New Zealand). Global consensus has not been reached on the most effective FOP system, and research continues to be conducted in this field.

To further the discussion, these are  three recent publications from Canada, the United States and Australia that explored the effectiveness of several FOP schemes in achieving their intended purpose.  


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

Emrich TE, Qi Y, Lou WY, L'Abbe MR. PLoS One. 2017 Feb 9;12(2):e0171188.

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.

Impact of explained v. unexplained front-of-package nutrition labels on parent and child food choices: a randomized trial.

Graham DJ, Lucas-Thompson RG, Mueller MP, Jaeb M, Harnack L. Public Health Nutr. 2016 Oct 17:1-12.

OBJECTIVE: The present study investigated whether parent/child pairs would select more healthful foods when: (i) products were labelled with front-of-package (FOP) nutrition labels relative to packages without labels; (ii) products were labelled with colour-coded Multiple Traffic Light (MTL) FOP labels relative to monochromatic Facts up Front (FuF) FOP labels; and (iii) FOP labels were explained via in-aisle signage v. unexplained.

DESIGN: Participants were randomly assigned to one of five conditions: (i) FuF labels with in-aisle signs explaining the labels; (ii) FuF labels, no signage; (iii) MTL labels with in-aisle signage; (iv) MTL labels, no signage; (v) control group, no labels/signage. Saturated fat, sodium, sugar and energy (calorie) content were compared across conditions.

SETTING: The study took place in a laboratory grocery aisle.

SUBJECTS: Parent/child pairs (n 153) completed the study.

RESULTS: Results did not support the hypothesis that MTL labels would lead to more healthful choices than FuF labels. The presence of FOP labels did little to improve the healthfulness of selected foods, with few exceptions (participants with v. without access to FOP labels selected lower-calorie cereals, participants with access to both FOP labels and in-aisle explanatory signage selected products with less saturated fat v. participants without explanatory signage).

CONCLUSIONS: Neither MTL nor FuF FOP labels led to food choices with significantly lower saturated fat, sodium or sugar. In-aisle signs explaining the FOP labels were somewhat helpful to consumers in making more healthful dietary decisions. New FOP labelling programmes could benefit from campaigns to increase consumer awareness and understanding of the labels.

Effects of interpretive nutrition labels on consumer food purchases: the Starlight randomized controlled trial

Mhurchu CN, Volkova E, Jiang Y, Eyles H, Michie J, Neal B, Blakely T, Swinburn B, Rayner M. Am J Clin Nutr. 2017 Feb 1.

OBJECTIVE: We aimed to evaluate the effects of 2 interpretive nutrition labels compared with a noninterpretive label on consumer food purchases.

DESIGN: In this parallel-group randomized controlled trial, we enrolled household shoppers across New Zealand who owned smartphones and were aged ≥18 y. Eligible participants were randomly assigned (1:1:1) to receive either traffic light labels (TLLs), Health Star Rating labels (HSRs), or a control [nutrition information panel (NIP)]. Smartphone technology allowed participants to scan barcodes of packaged foods and to receive allocated labels on their smartphone screens. The primary outcome was the mean healthiness of all packaged food purchases over the 4-wk intervention period, which was measured by using the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC).

RESULTS: Between October 2014 and November 2015, 1357 eligible shoppers were randomly assigned to TLL (n = 459), HSR (n = 443), or NIP (n = 455) labels. Overall difference in the mean transformed NPSC score for the TLL group compared with the NIP group was −0.20 (95% CI: −0.94, 0.54; P = 0.60). The corresponding difference for HSR compared with NIP was −0.60 (95% CI: −1.35, 0.15; P = 0.12). In an exploratory per-protocol analysis of participants who used the labeling intervention more often than average (n = 423, 31%), those who were assigned to TLL and HSR had significantly better NPSC scores [TLL compared with NIP: −1.33 (95% CI: −2.63, −0.04; P = 0.04); HSR compared with NIP: −1.70 (95% CI: −2.97, −0.43; P = 0.01)]. Shoppers who were randomly assigned to HSR and TLL also found the labels significantly more useful and easy to understand than the NIP (all P values <0.001).

CONCLUSIONS: At the relatively low level of use observed in this trial, interpretive nutrition labels had no significant effect on food purchases. However, shoppers who used interpretive labels found them to be significantly more useful and easy to understand, and compared with frequent Nutrition Information Panel users, frequent Traffic Light Labels and Health Star Rating label users had significantly healthier food purchases. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12614000644662.