The impact of voluntary front-of-pack nutrition labelling on packaged food reformulation: A difference-in-differences analysis of the Australasian Health Star Rating scheme
Front-of-pack nutrition labelling (FoPL) of packaged foods can promote healthier diets. Australia and New Zealand (NZ) adopted the voluntary Health Star Rating (HSR) scheme in 2014. We studied the impact of voluntary adoption of HSR on food reformulation relative to unlabelled foods and examined dif...
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| creator | Bablani, Laxman Ni Mhurchu, Cliona Neal, Bruce Skeels, Christopher L Staub, Kevin E Blakely, Tony |
| description | Front-of-pack nutrition labelling (FoPL) of packaged foods can promote healthier diets. Australia and New Zealand (NZ) adopted the voluntary Health Star Rating (HSR) scheme in 2014. We studied the impact of voluntary adoption of HSR on food reformulation relative to unlabelled foods and examined differential impacts for more-versus-less healthy foods.
Annual nutrition information panel data were collected for nonseasonal packaged foods sold in major supermarkets in Auckland from 2013 to 2019 and in Sydney from 2014 to 2018. The analysis sample covered 58,905 unique products over 14 major food groups. We used a difference-in-differences design to estimate reformulation associated with HSR adoption. Healthier products adopted HSR more than unhealthy products: >35% of products that achieved 4 or more stars displayed the label compared to |
| doi_str_mv | 10.1371/journal.pmed.1003427 |
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Annual nutrition information panel data were collected for nonseasonal packaged foods sold in major supermarkets in Auckland from 2013 to 2019 and in Sydney from 2014 to 2018. The analysis sample covered 58,905 unique products over 14 major food groups. We used a difference-in-differences design to estimate reformulation associated with HSR adoption. Healthier products adopted HSR more than unhealthy products: >35% of products that achieved 4 or more stars displayed the label compared to <15% of products that achieved 2 stars or less. Products that adopted HSR were 6.5% and 10.7% more likely to increase their rating by ≥0.5 stars in Australia and NZ, respectively. Labelled products showed a -4.0% [95% confidence interval (CI): -6.4% to -1.7%, p = 0.001] relative decline in sodium content in NZ, and there was a -1.4% [95% CI: -2.7% to -0.0%, p = 0.045] sodium change in Australia. HSR adoption was associated with a -2.3% [-3.7% to -0.9%, p = 0.001] change in sugar content in NZ and a statistically insignificant -1.1% [-2.3% to 0.1%, p = 0.061] difference in Australia. Initially unhealthy products showed larger reformulation effects when adopting HSR than healthier products. No evidence of a change in protein or saturated fat content was observed. A limitation of our study is that results are not sales weighted. Thus, it is not able to assess changes in overall nutrient consumption that occur because of HSR-caused reformulation. Also, participation into labelling and reformulation is jointly determined by producers in this observational study, impacting its generalisability to settings with mandatory labelling.
In this study, we observed that reformulation changes following voluntary HSR labelling are small, but greater for initially unhealthy products. Initially unhealthy foods were, however, less likely to adopt HSR. Our results, therefore, suggest that mandatory labelling has the greatest potential for improving the healthiness of packaged foods.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1003427</identifier><identifier>PMID: 33216747</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Australia ; Biology and Life Sciences ; Consumer behavior ; Consumers ; Descriptive labeling ; Diet, Healthy ; Energy ; Food ; Food labeling ; Food Labeling - legislation & jurisprudence ; Food Packaging - legislation & jurisprudence ; Food products ; Health aspects ; Health Behavior - physiology ; Humans ; Labeling ; Labelling ; Medicine and Health Sciences ; New Zealand ; Nutrients ; Nutrition ; Nutrition Policy - legislation & jurisprudence ; Nutritional aspects ; Nutritive Value - physiology ; Packaged food ; Packaged goods ; People and Places ; Product development ; Proteins ; Sodium ; Sugar ; Supermarkets ; Trends</subject><ispartof>PLoS medicine, 2020-11, Vol.17 (11), p.e1003427</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Bablani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Bablani et al 2020 Bablani et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c764t-3541083dcd9eab6d88f698e642a375786a60fa344058cc56aed50da1affca79b3</citedby><cites>FETCH-LOGICAL-c764t-3541083dcd9eab6d88f698e642a375786a60fa344058cc56aed50da1affca79b3</cites><orcidid>0000-0002-6995-4369 ; 0000-0001-5601-7387 ; 0000-0002-0490-7465 ; 0000-0003-3632-1933 ; 0000-0002-1144-9167</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7679009/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7679009/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33216747$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bablani, Laxman</creatorcontrib><creatorcontrib>Ni Mhurchu, Cliona</creatorcontrib><creatorcontrib>Neal, Bruce</creatorcontrib><creatorcontrib>Skeels, Christopher L</creatorcontrib><creatorcontrib>Staub, Kevin E</creatorcontrib><creatorcontrib>Blakely, Tony</creatorcontrib><title>The impact of voluntary front-of-pack nutrition labelling on packaged food reformulation: A difference-in-differences analysis of the Australasian Health Star Rating scheme</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Front-of-pack nutrition labelling (FoPL) of packaged foods can promote healthier diets. Australia and New Zealand (NZ) adopted the voluntary Health Star Rating (HSR) scheme in 2014. We studied the impact of voluntary adoption of HSR on food reformulation relative to unlabelled foods and examined differential impacts for more-versus-less healthy foods.
Annual nutrition information panel data were collected for nonseasonal packaged foods sold in major supermarkets in Auckland from 2013 to 2019 and in Sydney from 2014 to 2018. The analysis sample covered 58,905 unique products over 14 major food groups. We used a difference-in-differences design to estimate reformulation associated with HSR adoption. Healthier products adopted HSR more than unhealthy products: >35% of products that achieved 4 or more stars displayed the label compared to <15% of products that achieved 2 stars or less. Products that adopted HSR were 6.5% and 10.7% more likely to increase their rating by ≥0.5 stars in Australia and NZ, respectively. Labelled products showed a -4.0% [95% confidence interval (CI): -6.4% to -1.7%, p = 0.001] relative decline in sodium content in NZ, and there was a -1.4% [95% CI: -2.7% to -0.0%, p = 0.045] sodium change in Australia. HSR adoption was associated with a -2.3% [-3.7% to -0.9%, p = 0.001] change in sugar content in NZ and a statistically insignificant -1.1% [-2.3% to 0.1%, p = 0.061] difference in Australia. Initially unhealthy products showed larger reformulation effects when adopting HSR than healthier products. No evidence of a change in protein or saturated fat content was observed. A limitation of our study is that results are not sales weighted. Thus, it is not able to assess changes in overall nutrient consumption that occur because of HSR-caused reformulation. Also, participation into labelling and reformulation is jointly determined by producers in this observational study, impacting its generalisability to settings with mandatory labelling.
In this study, we observed that reformulation changes following voluntary HSR labelling are small, but greater for initially unhealthy products. Initially unhealthy foods were, however, less likely to adopt HSR. Our results, therefore, suggest that mandatory labelling has the greatest potential for improving the healthiness of packaged foods.</description><subject>Australia</subject><subject>Biology and Life Sciences</subject><subject>Consumer behavior</subject><subject>Consumers</subject><subject>Descriptive labeling</subject><subject>Diet, Healthy</subject><subject>Energy</subject><subject>Food</subject><subject>Food labeling</subject><subject>Food Labeling - legislation & jurisprudence</subject><subject>Food Packaging - legislation & jurisprudence</subject><subject>Food products</subject><subject>Health aspects</subject><subject>Health Behavior - physiology</subject><subject>Humans</subject><subject>Labeling</subject><subject>Labelling</subject><subject>Medicine and Health Sciences</subject><subject>New Zealand</subject><subject>Nutrients</subject><subject>Nutrition</subject><subject>Nutrition Policy - legislation & jurisprudence</subject><subject>Nutritional aspects</subject><subject>Nutritive Value - physiology</subject><subject>Packaged food</subject><subject>Packaged goods</subject><subject>People and Places</subject><subject>Product development</subject><subject>Proteins</subject><subject>Sodium</subject><subject>Sugar</subject><subject>Supermarkets</subject><subject>Trends</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqVk1Fv0zAQxyMEYmPwDRBYQkLwkOLUjh3zgFRNwCpNTNoGr5brnFOXxC6xM7HvxIfE2brRoj6A8uD4_Lv_ne98Wfa8wJOC8OLdyg-9U-1k3UE9KTAmdMofZIdFSUVeMM4ebv0fZE9CWGE8FVjgx9kBIdNkpvww-3W5BGS7tdIReYOufDu4qPprZHrvYu5Nno6-IzfE3kbrHWrVAtrWugalzXimGqiR8b5GPRjfd0OrRvA9mqHaGgM9OA25dfmfXUAqZX4dbBhjxpTBbAixV60KVjl0AqqNS3SR8kDnSSzFCnoJHTzNHhnVBni2WY-yr58-Xh6f5Kdnn-fHs9Ncc0ZjTkpa4IrUuhagFqyuKsNEBYxOFeElr5hi2ChCKS4rrUumoC5xrQpljFZcLMhR9vJWd936IDeFDnLKBMMVJgwnYn5L1F6t5Lq3XaqZ9MrKG4PvG6n6aHULElMmgLEaV5rQgpuKcFYSTYsSAxcgktaHTbRhkXqpwY2l2BHdPXF2KRt_JTnjAuNR4M1GoPc_BghRdjbo1CXlwA8pb8oIFpXgZUJf_YXuv92GalS6gHXGp7h6FJUzVuKqKNPrSVS-h2rAQUrSOzA2mXf4yR4-fTV0Vu91eLvjkJgIP2OjhhDk_OL8P9gv_86efdtlX2-xy5uXGdKQjE887IL0FtS9DyGNwn0DCyzHgb2rtBwHVm4GNrm92G7-vdPdhJLfK4Y8MQ</recordid><startdate>20201120</startdate><enddate>20201120</enddate><creator>Bablani, Laxman</creator><creator>Ni Mhurchu, Cliona</creator><creator>Neal, Bruce</creator><creator>Skeels, Christopher L</creator><creator>Staub, Kevin E</creator><creator>Blakely, Tony</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-6995-4369</orcidid><orcidid>https://orcid.org/0000-0001-5601-7387</orcidid><orcidid>https://orcid.org/0000-0002-0490-7465</orcidid><orcidid>https://orcid.org/0000-0003-3632-1933</orcidid><orcidid>https://orcid.org/0000-0002-1144-9167</orcidid></search><sort><creationdate>20201120</creationdate><title>The impact of voluntary front-of-pack nutrition labelling on packaged food reformulation: A difference-in-differences analysis of the Australasian Health Star Rating scheme</title><author>Bablani, Laxman ; Ni Mhurchu, Cliona ; Neal, Bruce ; Skeels, Christopher L ; Staub, Kevin E ; Blakely, Tony</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c764t-3541083dcd9eab6d88f698e642a375786a60fa344058cc56aed50da1affca79b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Australia</topic><topic>Biology and Life Sciences</topic><topic>Consumer behavior</topic><topic>Consumers</topic><topic>Descriptive labeling</topic><topic>Diet, Healthy</topic><topic>Energy</topic><topic>Food</topic><topic>Food labeling</topic><topic>Food Labeling - legislation & jurisprudence</topic><topic>Food Packaging - legislation & jurisprudence</topic><topic>Food products</topic><topic>Health aspects</topic><topic>Health Behavior - physiology</topic><topic>Humans</topic><topic>Labeling</topic><topic>Labelling</topic><topic>Medicine and Health Sciences</topic><topic>New Zealand</topic><topic>Nutrients</topic><topic>Nutrition</topic><topic>Nutrition Policy - legislation & jurisprudence</topic><topic>Nutritional aspects</topic><topic>Nutritive Value - physiology</topic><topic>Packaged food</topic><topic>Packaged goods</topic><topic>People and Places</topic><topic>Product development</topic><topic>Proteins</topic><topic>Sodium</topic><topic>Sugar</topic><topic>Supermarkets</topic><topic>Trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bablani, Laxman</creatorcontrib><creatorcontrib>Ni Mhurchu, Cliona</creatorcontrib><creatorcontrib>Neal, Bruce</creatorcontrib><creatorcontrib>Skeels, Christopher L</creatorcontrib><creatorcontrib>Staub, Kevin E</creatorcontrib><creatorcontrib>Blakely, Tony</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bablani, Laxman</au><au>Ni Mhurchu, Cliona</au><au>Neal, Bruce</au><au>Skeels, Christopher L</au><au>Staub, Kevin E</au><au>Blakely, Tony</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of voluntary front-of-pack nutrition labelling on packaged food reformulation: A difference-in-differences analysis of the Australasian Health Star Rating scheme</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2020-11-20</date><risdate>2020</risdate><volume>17</volume><issue>11</issue><spage>e1003427</spage><pages>e1003427-</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Front-of-pack nutrition labelling (FoPL) of packaged foods can promote healthier diets. Australia and New Zealand (NZ) adopted the voluntary Health Star Rating (HSR) scheme in 2014. We studied the impact of voluntary adoption of HSR on food reformulation relative to unlabelled foods and examined differential impacts for more-versus-less healthy foods.
Annual nutrition information panel data were collected for nonseasonal packaged foods sold in major supermarkets in Auckland from 2013 to 2019 and in Sydney from 2014 to 2018. The analysis sample covered 58,905 unique products over 14 major food groups. We used a difference-in-differences design to estimate reformulation associated with HSR adoption. Healthier products adopted HSR more than unhealthy products: >35% of products that achieved 4 or more stars displayed the label compared to <15% of products that achieved 2 stars or less. Products that adopted HSR were 6.5% and 10.7% more likely to increase their rating by ≥0.5 stars in Australia and NZ, respectively. Labelled products showed a -4.0% [95% confidence interval (CI): -6.4% to -1.7%, p = 0.001] relative decline in sodium content in NZ, and there was a -1.4% [95% CI: -2.7% to -0.0%, p = 0.045] sodium change in Australia. HSR adoption was associated with a -2.3% [-3.7% to -0.9%, p = 0.001] change in sugar content in NZ and a statistically insignificant -1.1% [-2.3% to 0.1%, p = 0.061] difference in Australia. Initially unhealthy products showed larger reformulation effects when adopting HSR than healthier products. No evidence of a change in protein or saturated fat content was observed. A limitation of our study is that results are not sales weighted. Thus, it is not able to assess changes in overall nutrient consumption that occur because of HSR-caused reformulation. Also, participation into labelling and reformulation is jointly determined by producers in this observational study, impacting its generalisability to settings with mandatory labelling.
In this study, we observed that reformulation changes following voluntary HSR labelling are small, but greater for initially unhealthy products. Initially unhealthy foods were, however, less likely to adopt HSR. Our results, therefore, suggest that mandatory labelling has the greatest potential for improving the healthiness of packaged foods.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33216747</pmid><doi>10.1371/journal.pmed.1003427</doi><orcidid>https://orcid.org/0000-0002-6995-4369</orcidid><orcidid>https://orcid.org/0000-0001-5601-7387</orcidid><orcidid>https://orcid.org/0000-0002-0490-7465</orcidid><orcidid>https://orcid.org/0000-0003-3632-1933</orcidid><orcidid>https://orcid.org/0000-0002-1144-9167</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Australia Biology and Life Sciences Consumer behavior Consumers Descriptive labeling Diet, Healthy Energy Food Food labeling Food Labeling - legislation & jurisprudence Food Packaging - legislation & jurisprudence Food products Health aspects Health Behavior - physiology Humans Labeling Labelling Medicine and Health Sciences New Zealand Nutrients Nutrition Nutrition Policy - legislation & jurisprudence Nutritional aspects Nutritive Value - physiology Packaged food Packaged goods People and Places Product development Proteins Sodium Sugar Supermarkets Trends |
| title | The impact of voluntary front-of-pack nutrition labelling on packaged food reformulation: A difference-in-differences analysis of the Australasian Health Star Rating scheme |
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