Josephine Wills

A Review of European Research on Consumer Response to Nutrition Information on Food Labels

The aim of this study was to review research conducted in 2003–2006 in the EU-15 countries on how consumers perceive, understand, like and use nutrition information on food labels. Based on a search of databases on academic publications, Google-based search, and enquiries directed to a range of food retailers, food companies, consumer associations and government agencies, a total of 58 studies were identified. These studies were summarised using a standard format guided by a model of consumer information processing, and these summaries were subsequently processed using the MAXqda software in order to identify key findings and common themes across the studies. The studies show widespread consumer interest in nutrition information on food packages, though this interest varies across situations and products. Consumers like the idea of simplified front of pack information but differ in their liking for the various formats. Differences can be related to conflicting preferences for ease of use, being fully informed and not being pressurised into behaving in a particular way. Most consumers understand the most common signposting formats in the sense that they themselves believe that they understand them and they can replay key information presented to them in an experimental situation. There is, however, virtually no insight into how labelling information is, or will be, used in a real-world shopping situation, and how it will affect consumers’ dietary patterns. Results are largely in line with an earlier review by Cowburn and Stockley (Public Health Nutr 8:21–28, 2005), covering research up to 2002, but provide new insights into consumer liking and understanding of simplified front of pack signposting formats. There is an urgent need for more research studying consumer use of nutritional information on food labels in a real-world setting.

Use and understanding of nutrition information on food labels in six European countries.

AimThe goal of the study was to investigate the use of nutrition information on food labels and understanding of guideline daily amount (GDA) front-of-pack nutrition labels in six European countries.Subjects and methodsIn-store observations and in-store interviews were conducted in major retailers in the UK (n = 2019), Sweden (n = 1858), France (n = 2337), Germany (n = 1963), Poland (n = 1800) and Hungary (n = 1804), supplemented by questionnaires filled out at home and returned (overall response rate 50.3%). Use of labels was measured by combining in-store observations and in-store interviews on concrete purchases in six product categories. Understanding of GDA front-of-pack nutrition labels was measured by a variety of tasks dealing with conceptual understanding, substantial understanding and health inferences. Demographics, nutrition knowledge and interest in healthy eating were measured as potential determinants.ResultsAcross six product categories, 16.8% of shoppers were found to have looked for nutrition information on the label, with the nutrition grid (table or list), GDA labels and the ingredients list as the main sources consulted and calories, fat and sugar the information most often looked for. Understanding of GDA labels was high in the UK, Sweden and Germany, and more limited in the other countries. Regression analysis showed that, in addition to country-specific differences, use and understanding are also affected by differences in interest in healthy eating and in nutrition knowledge and by social grade.ConclusionUnderstanding of nutrition information seems to be more widespread than use, suggesting that lack of use is a question of not only understanding, but also motivation. Considerable national differences exist in both understanding and use, some of which may be attributed to different histories of the role of nutrition in the public debate.

Policies to promote healthy eating in Europe: a structured review of policies and their effectiveness

This review provides a classification of public policies to promote healthier eating as well as a structured mapping of existing measures in Europe. Complete coverage of alternative policy types was ensured by complementing the review with a selection of major interventions from outside Europe. Under the auspices of the Seventh Framework Programmes Eatwell Project, funded by the European Commission, researchers from five countries reviewed a representative selection of policy actions based on scientific papers, policy documents, grey literature, government websites, other policy reviews, and interviews with policy-makers. This work resulted in a list of 129 policy interventions, 121 of which were in Europe. For each type of policy, a critical review of its effectiveness was conducted, based on the evidence currently available. The results of this review indicate a need exists for a more systematic and accurate evaluation of government-level interventions as well as for a stronger focus on actual behavioral change rather than changes in attitude or intentions alone. The currently available evidence is very heterogeneous across policy types and is often incomplete.

Penetration of nutrition information on food labels across the EU-27 plus Turkey

Objectives:The European Union (EU)-funded project Food Labelling to Advance Better Education for Life (FLABEL) aims to understand how nutrition information on food labels affects consumers’ dietary choices and shopping behaviour. The first phase of this study consisted of assessing the penetration of nutrition labelling and related information on various food products in all 27 EU Member States and Turkey.Methods:In each country, food products were audited in three different types of retailers to cover as many different products as possible within five food and beverage categories: sweet biscuits, breakfast cereals, pre-packed chilled ready meals, carbonated soft drinks and yoghurts.Results:More than 37 000 products were audited in a total of 84 retail stores. On average, 85% of the products contained back-of-pack (BOP) nutrition labelling or related information (from 70% in Slovenia to 97% in Ireland), versus 48% for front-of-pack (FOP) information (from 24% in Turkey to 82% in the UK). The most widespread format was the BOP tabular or linear listing of nutrition content. Guideline daily amounts labelling was the most prevalent form of FOP information, showing an average penetration of 25% across all products audited. Among categories, breakfast cereals showed the highest penetration of nutrition-related information, with 94% BOP penetration and 70% FOP penetration.Conclusions:Nutrition labelling and related information was found on a large majority of products audited. These findings provide the basis for subsequent phases of FLABEL involving attention, reading, liking, understanding and use by consumers of different nutrition labelling formats.

Exploring global consumer attitudes toward nutrition information on food labels

In many parts of the world, food companies, consumers, and governments are re-examining the provision of nutrition information on food labels. It is important that the nutrition information provided be appropriate and understandable to the consumer and that it impact food-choice behaviors. Potentially, food labeling represents a valuable tool to help consumers make informed decisions about their diet and lifestyle. Food information organizations worldwide have been following consumer trends in the use of this information as well as consumer attitudes about food, nutrition, and health. This paper summarizes a workshop that examined consumer attitudes gathered regionally with the aim of establishing commonalities and differences.

Assessment of evaluations made to healthy eating policies in Europe: A review within the EATWELL Project

OBJECTIVE To identify and assess healthy eating policies at national level which have been evaluated in terms of their impact on awareness of healthy eating, food consumption, health outcome or cost/benefit. DESIGN Review of policy documents and their evaluations when available. SETTING European Member States. SUBJECTS One hundred and twenty-one policy documents revised, 107 retained. RESULTS Of the 107 selected interventions, twenty-two had been evaluated for their impact on awareness or knowledge and twenty-seven for their impact on consumption. Furthermore sixteen interventions provided an evaluation of health impact, while three actions specifically measured any cost/benefit ratio. The indicators used in these evaluations were in most cases not comparable. Evaluation was more often found for public information campaigns, regulation of meals at schools/canteens and nutrition education programmes. CONCLUSIONS The study highlights the need not only to develop harmonized and verifiable procedures but also indicators for measuring effectiveness and success and for comparing between interventions and countries. EU policies are recommended to provide a set of indicators that may be measured consistently and regularly in all countries. Furthermore, public information campaigns should be accompanied by other interventions, as evaluations may show an impact on awareness and intention, but rarely on consumption patterns and health outcome.

Nutrition Labeling to Prevent Obesity: Reviewing the Evidence from Europe.

Overweight and obesity are major public health problems in the European Union (EU). Providing nutrition information on foods and menus is considered a relevant means to guide consumers toward more healthful food choices, in part characterized by adequate energy intakes to achieve and maintain a healthy body weight. Various formats of back-of-pack and front-of-pack nutrition labeling can currently be found across the EU, with varying levels of penetration. Experimental studies show that consumers are reasonably able to understand and use the different systems to identify more healthful food products from given choice sets. However, European studies assessing the impact of nutrition labeling on actual dietary intake are scarce, and no real-life evidence exists linking nutrition label use with measured changes in body weight. This review summarizes how European consumers respond to nutrition labels when shopping for food or eating out of home, considering evidence published between 2007 and mid-March 2012.

The role of health-related claims and health-related symbols in consumer behaviour: Design and conceptual framework of the CLYMBOL project and initial results

Health claims and symbols are potential aids to help consumers identify foods that are healthier options. However, little is known as to how health claims and symbols are used by consumers in real-world shopping situations, thus making the science-based formulation of new labelling policies and the evaluation of existing ones difficult. The objective of the European Union-funded project Role of health-related CLaims and sYMBOLs in consumer behaviour (CLYMBOL) is to determine how health-related information provided through claims and symbols, in their context, can affect consumer understanding, purchase and consumption. To do this, a wide range of qualitative and quantitative consumer research methods are being used, including product sampling, sorting studies (i.e. how consumers categorise claims and symbols according to concepts such as familiarity and relevance), cross-country surveys, eye-tracking (i.e. what consumers look at and for how long), laboratory and in-store experiments, structured interviews, as well as analysis of population panel data. EU Member States differ with regard to their history of use and regulation of health claims and symbols prior to the harmonisation of 2006. Findings to date indicate the need for more structured and harmonised research on the effects of health claims and symbols on consumer behaviour, particularly taking into account country-wide differences and individual characteristics such as motivation and ability to process health-related information. Based on the studies within CLYMBOL, implications and recommendations for stakeholders such as policymakers will be provided.

Interventions to promote healthy eating habits: evaluation and recommendations.

Although in several EU Member States many public interventions have been running for the prevention and/or management of obesity and other nutrition‐related health conditions, few have yet been formally evaluated. The multidisciplinary team of the EATWELL project will gather benchmark data on healthy eating interventions in EU Member States and review existing information on the effectiveness of interventions using a three‐stage procedure (i) Assessment of the interventions impact on consumer attitudes, consumer behaviour and diets; (ii) The impact of the change in diets on obesity and health and (iii) The value attached by society to these changes, measured in life years gained, cost savings and quality‐adjusted life years. Where evaluations have been inadequate, EATWELL will gather secondary data and analyse them with a multidisciplinary approach incorporating models from the psychology and economics disciplines. Particular attention will be paid to lessons that can be learned from private sector that are transferable to the healthy eating campaigns in the public sector. Through consumer surveys and workshops with other stakeholders, EATWELL will assess the acceptability of the range of potential interventions. Armed with scientific quantitative evaluations of policy interventions and their acceptability to stakeholders, EATWELL expects to recommend more appropriate interventions for Member States and the EU, providing a one‐stop guide to methods and measures in interventions evaluation, and outline data collection priorities for the future.

Reference amounts utilised in front of package nutrition labelling; impact on product healthfulness evaluations

Background/Objectives:The research question addressed in this paper is how different reference amounts utilised in front of package nutrition labelling influence evaluation of product healthfulness.Subjects/Methods:A total of 13 117 participants from six European countries (Germany, UK, Spain, France, Poland and Sweden) were recruited via online panels. A mixed between/within-subject factorial design was employed with food (biscuits, sandwiches, yogurts), healthfulness and presence of Guideline Daily Amounts as within-subjects factors and reference amount (‘per 100 g’, ‘typical portion’, ‘half portion’) and country as between-subjects factors.Results:Overall, people correctly ranked foods according to their objective healthfulness as defined by risk nutrients alone, and could distinguish between more and less healthful variants of foods. General healthfulness associations with the three product categories do not appear to have had a strong influence on product ratings. This study shows that where the reference amount of ‘per 100 g’ is very different from the ‘typical’ portion size, as was the case for biscuits, products with a ‘per 100 g’ label are rated significantly less healthful than the ‘typical’ or ‘half typical’ portions.Conclusion:The results indicate that across the three food categories, consumers do factor the reference amount, that is, the quantity of food for which the nutritional information is being presented, into their judgements of healthfulness. Therefore, appropriate reference amounts are also of importance for the effective presentation of nutritional information.