Sophie Hieke

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.

Prevalence of Nutrition and Health-Related Claims on Pre-Packaged Foods: A Five-Country Study in Europe

This study is part of the research undertaken in the EU funded project CLYMBOL (“Role of health-related CLaims and sYMBOLs in consumer behaviour”). The first phase of this project consisted of mapping the prevalence of symbolic and non-symbolic nutrition and health-related claims (NHC) on foods and non-alcoholic beverages in five European countries. Pre-packaged foods and drinks were sampled based on a standardized sampling protocol, using store lists or a store floor plan. Data collection took place across five countries, in three types of stores. A total of 2034 foods and drinks were sampled and packaging information was analyzed. At least one claim was identified for 26% (95% CI (24.0%–27.9%)) of all foods and drinks sampled. Six percent of these claims were symbolic. The majority of the claims were nutrition claims (64%), followed by health claims (29%) and health-related ingredient claims (6%). The most common health claims were nutrient and other function claims (47% of all claims), followed by disease risk reduction claims (5%). Eight percent of the health claims were children’s development and health claims but these were only observed on less than 1% (0.4%–1.1%) of the foods. The category of foods for specific dietary use had the highest proportion of NHC (70% of foods carried a claim). The prevalence of symbolic and non-symbolic NHC varies across European countries and between different food categories. This study provides baseline data for policy makers and the food industry to monitor and evaluate the use of claims on food packaging.

The nutritional quality of foods carrying health-related claims in Germany, the Netherlands, Spain, Slovenia, and the United Kingdom

Backgroung/Objectives:Compares the nutritional quality of pre-packaged foods carrying health-related claims with foods that do not carry health-related claims.Subject/Methods:Cross-sectional survey of pre-packaged foods available in Germany, The Netherlands, Spain, Slovenia and the United Kingdom in 2013. A total of 2034 foods were randomly sampled from three food store types (a supermarket, a neighbourhood store and a discounter). Nutritional information was taken from nutrient declarations present on food labels and assessed through a comparison of mean levels, regression analyses and the application of a nutrient profile model currently used to regulate health claims in Australia and New Zealand (Food Standards Australia New Zealand’s Nutrient Profiling Scoring Criterion, FSANZ NPSC).Results:Foods carrying health claims had, on average, lower levels, per 100 g, of the following nutrients, energy—29.3 kcal (P<0.05), protein—1.2 g (P<0.01), total sugars—3.1 g (P<0.05), saturated fat—2.4 g (P<0.001), and sodium—842 mg (P<0.001), and higher levels of fibre—0.8 g (P<0.001). A similar pattern was observed for foods carrying nutrition claims. Forty-three percent (confidence interval (CI) 41%, 45%) of foods passed the FSANZ NPSC, with foods carrying health claims more likely to pass (70%, CI 64%, 76%) than foods carrying nutrition claims (61%, CI 57%, 66%) or foods that did not carry either type of claim (36%, CI 34%, 38%).Conclusions:Foods carrying health-related claims have marginally better nutrition profiles than those that do not carry claims; these differences would be increased if the FSANZ NPSC was used to regulate health-related claims. It is unclear whether these relatively small differences have significant impacts on health.

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.

Consumers and health claims

In 2006, the pan-European Regulation on nutrition and health claims (EC) No. 1924/2006 (NHCR) was published and came into effect in 2007. Considerable research has been undertaken since to better understand the potential effect of such claims on consumer behaviour. Findings from the EU-funded pan-European research project CLYMBOL (‘Role of health-related CLaims and sYMBOLs in consumer behaviour’, No. 311369) are presented and discussed in light of additional empirical findings, to provide an introduction to the topic for the reader of this book.

Country Differences in the History of Use of Health Claims and Symbols

Health-related claims and symbols are intended as aids to help consumers make informed and healthier food choices but they can also stimulate the food industry to develop food that goes hand in hand with a healthier lifestyle. In order to better understand the role that health claims and symbols currently have and in the future potentially can have, the objective of the CLYMBOL project (“Role of health-related claims and symbols in consumer behaviour”, Grant no 311963) is to investigate consumers’ understanding of health claims and symbols, and how they affect purchasing and consumption [1]. As part of this endeavour, it is important to understand the history of use of claims and symbols in Europe. What have consumers been exposed to and how were these health-related messages used and discussed among the public? In this study, we interviewed key stakeholders across Europe about how health claims have been regulated in their country, how health symbols have been and currently are being treated, what form of monitoring there is or should be and how both health claims and symbols have been debated in the public opinion. In 26 European Union (EU) Member States, opinions from 53 key informants from up to three different stakeholder groups were gathered: national food authorities, representatives of the food industry, and consumer organisations. While 14 Member States reported (at least partial) regulation of the use of health claims and/or symbols before the introduction of the EU Regulation (EC 1924/2006) on nutrition and health claims made on foods [2], mandatory reporting of use had only been in place in three EU Member States. A number of voluntary codes of practice for health claims and/or symbols (i.e. pre-approval or justification when challenged) was said to be in use in 15 Member States. There are only a few national databases on health claims and symbols available, the data for which is often incomplete. Only eight Member States reported having some form of database from which information about health claims and symbols could be extracted. The stakeholders interviewed expressed a strong interest in measuring the impact of health claims and symbols, particularly research into the effects on consumer behaviour (e.g. awareness and understanding, attitudes towards products carrying claims and symbols and purchase/consumption effects), public health (health outcomes and changes in national health status due to the introduction of claims and symbols on food products) and economic aspects including sales, return on investment and reputation measurements. Public debates were said to have evolved around the topics of consumer understanding of claims, acceptance as well as trust in the information presented but also the effects on vulnerable groups such as children and elderly consumers. Another field of debate was said to have been the question of the effectiveness of health claims and symbols. Lastly, stakeholders reported that public debates focussed mainly on the legislative aspects, i.e. how to apply the EU Regulation (No 1924/2006) with regards to wording issues, the evaluation process at the European Food Safety Authority (EFSA), the status of various claims and the nutrient profile modelling to be introduced in Europe.

Nachhaltige Gütesiegel und ihre Rolle im Verbraucherverhalten

Die vorliegende Studie untersucht den Zusammenhang zwischen Motivation, Verstandnis und Anwendung von nachhaltigen Gutesiegeln in der Lebensmittelwahl. Insgesamt wurden 4408 Teilnehmer in sieben Europaischen Landern befragt. Die Befragten zeigten sich generell mittel bis sehr besorgt im Hinblick auf das Thema Nachhaltigkeit, je konkreter es allerdings um die Lebensmittelwahl ging, desto weniger Besorgnis konnte gemessen werden. Ein ubergreifendes Verstandnis der Thematik war ebenfalls gering, lediglich die vier fur diese Studie ausgesuchten nachhaltigen Gutesiegel wurden uberwiegend richtig erkannt. Weiterhin zeigt die Studie eine geringe Anwendung nachhaltiger Informationen in der Lebensmittelwahl – sowohl direkt als auch indirekt durch eine Conjoint Analyse gemessen. Die Ergebnisse lassen den Schluss zu, dass nachhaltige Gutesiegel noch keine grose Rolle im Verbraucherverhalten spielen. Dies kann sich erst andern wenn eine generelle Besorgnis um das Thema Nachhaltigkeit sich auch in entsprechendes Verhalten ubersetzt.

Are Nutrition-Related Knowledge and Attitudes Reflected in Lifestyle and Health Among Elderly People? A Study Across Five European Countries

Background: Nutrition-related knowledge (NRK) and nutrition-related attitudes (NRAs) are necessary for dietary changes toward healthier dietary patterns. In turn, healthier dietary patterns can be beneficial in maintaining health of older adults. Therefore, the aim of this cross-sectional study was to investigate whether NRK and NRAs were associated with lifestyle and health features among older adults (65+ years) from five European countries (France, Italy, Poland, the Netherlands and United Kingdom). Methods: Within the European project NU-AGE, 1,144 healthy elderly volunteers (65–79 years) were randomly assigned to two groups: intervention (NU-AGE diet) or control. After 1-year of follow-up, both NRK and NRAs were assessed during exit interviews, in combination with a number of lifestyle and health variables (e.g., physical activity, smoking, alcohol use, BMI, self-assessed health status). Multivariable linear regression models were used in data analysis. Results: In the NU-AGE study sample, good NRK was associated with lower BMI and higher physical activity. More positive NRAs were related to lower BMI and self-reported very good or good appetite. Moreover, both NRK and NRAs were associated with some socio-economic determinants, like financial situation, age, education, living area (for NRK), and country (for NRAs). Participants in the intervention group showed a better NRK (β = 0.367 [95% CI: 0.117; 0.617], p = 0.004) and more positive NRAs (β = 0.838 [95% CI: 0.318; 1.358], p = 0.002) than those in the control group. Higher self-evaluated knowledge was also significantly related to more positive NRAs (p < 0.001). The most popular sources of nutrition information were food labels, books and magazines on health, the dietitian and the doctors office, although their importance varied significantly among countries, and, to a lesser extent, between women and men and between intervention and control group. Conclusion: Higher NRK and NRA scores were associated with lower BMI and higher physical activity level. Therefore, a good nutrition-related knowledge and positive nutrition-related attitudes can strongly and positively influence the health status and quality of life among the older population. These results offer a great opportunity for policy makers to implement educational programs in order to counteract the epidemic of obesity and to improve the health span of European population.

Do health claims affect consumption, as measured in the laboratory or in the field?

K.A. Brown, K.H. Hart, G. Sommers-Jones, B. Egan, G.M.R. Fiates, M.M. Raats, S. Hieke and the CLYMBOL consortium Faculty of health and medical sciences, University of Surrey, Guildford, GU2 7XH, UK, Department of nutrition and dietetics, Faculty of medicine, nursing and health sciences, Monash University, Melbourne, Australia and Nutrition department, Federal University of Santa Catarina, Florianopolis, Brazil