Impact of front-of-pack nutrition labels on consumer purchasing intentions: a randomized experiment in low- and middle-income Mexican adults

Jáuregui, Alejandra; Vargas-Meza, Jorge; Nieto, Claudia; Contreras‐Manzano, Alejandra; Alejandro, Nelson Zacarías; Tolentino‐Mayo, Lizbeth; Hall, Marissa G.; Barquera, Sı́món

doi:10.1186/s12889-020-08549-0

Cited by 66 publications

(78 citation statements)

References 48 publications

(57 reference statements)

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“…However, previous studies of individuals have found that those with higher incomes are more likely to see and use calorie menu labels than those with lower incomes [34][35][36]. Based on prior studies, other labeling systems (e.g., traffic light labels and warning labels) may be more effective than nutrient disclosures [37,38], particularly among low-and middle-income populations [39,40].…”

Section: Discussionmentioning

confidence: 99%

Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment

et al. 2021

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Background Calorie menu labeling is a policy that requires food establishments to post the calories on menu offerings to encourage healthy food choice. Calorie labeling has been implemented in the United States since May 2018 per the Affordable Care Act, but to the best of our knowledge, no studies have evaluated the relationship between calorie labeling and meal purchases since nationwide implementation of this policy. Our objective was to investigate the relationship between calorie labeling and the calorie and nutrient content of purchased meals after a fast food franchise began labeling in April 2017, prior to the required nationwide implementation, and after nationwide implementation of labeling in May 2018, when all large US chain restaurants were required to label their menus. Methods and findings We obtained weekly aggregated sales data from 104 restaurants that are part of a fast food franchise for 3 national chains in 3 US states: Louisiana, Mississippi, and Texas. The franchise provided all sales data from April 2015 until April 2019. The franchise labeled menus in April 2017, 1 year prior to the required nationwide implementation date of May 2018 set by the US Food and Drug Administration. We obtained nutrition information for items sold (calories, fat, carbohydrates, protein, saturated fat, sugar, dietary fiber, and sodium) from Menustat, a publicly available database with nutrition information for items offered at the top revenue-generating US restaurant chains. We used an interrupted time series to find level and trend changes in mean weekly calorie and nutrient content per transaction after franchise and nationwide labeling. The analytic sample represented 331,776,445 items purchased across 67,112,342 transactions. Franchise labeling was associated with a level change of −54 calories/transaction (95% confidence interval [CI]: −67, −42, p < 0.0001) and a subsequent 3.3 calories/transaction increase per 4-week period (95% CI: 2.5, 4.1, p < 0.0001). Nationwide implementation was associated with a level decrease of −82 calories/transaction (95% CI: −88, −76, p < 0.0001) and a subsequent −2.1 calories/transaction decrease per 4-week period (95% CI: −2.9, −1.3, p < 0.0001). At the end of the study, the model-based predicted mean calories/transaction was 4.7% lower (change = −73 calories/transaction, 95% CI: −81, −65), and nutrients/transaction ranged from 1.8% lower (saturated fat) to 7.0% lower (sugar) than what we would expect had labeling not been implemented. The main limitations were potential residual time-varying confounding and lack of individual-level transaction data. Conclusions In this study, we observed that calorie labeling was associated with small decreases in mean calorie and nutrient content of fast food meals 2 years after franchise labeling and nearly 1 year after implementation of labeling nationwide. These changes imply that calorie labeling was associated with small improvements in purchased meal quality in US chain restaurants.

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Section: Discussionmentioning

confidence: 99%

Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment

et al. 2021

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“…In addition, food retailers may be reluctant to test interventions they view as potentially harmful to sales, such as taxes or warning labels. Another viable option is to conduct experiments in virtual 3D stores [38][39][40], which may facilitate faster and more affordable recruitment, although the simulated shopping environment is not as realistic as a physical store. Finally, some studies have used experimental online stores intended to replicate online grocery shopping or food ordering websites [41,42].…”

Section: Discussionmentioning

confidence: 99%

Using a Naturalistic Store Laboratory for Clinical Trials of Point-of-Sale Nutrition Policies and Interventions: A Feasibility and Validation Study

Hall

Higgins

Grummon

et al. 2021

IJERPH

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Point-of-sale policies such as warnings and taxes are promising tools for improving the nutritional quality of food purchases. Research studies conducted in naturalistic store laboratories could improve the quality of evidence about point-of-sale interventions by allowing for realistic exposure in a controlled setting. This study aimed to assess whether purchasing behavior in a naturalistic store laboratory setting was similar to real-life purchasing behavior and to evaluate participants’ perceptions of store realism and the acceptability of research study protocols in this setting. In a longitudinal observational study in 2019, Latinx parents in North Carolina (n = 61) attended five weekly visits at the UNC Mini Mart, a naturalistic store laboratory that resembled a small convenience store. At each visit, participants purchased a week’s supply of beverages. Purchases of beverages in the Mini Mart were compared to participants’ purchases from receipts submitted the week prior to the study. Analyses compared the percentage of participants buying sugary drinks and non-sugary drinks in the Mini Mart vs. in real stores using Chi-Square tests with Fisher’s p. The percentage of parents who purchased sugary drinks in the Mini Mart (93%) was not significantly different from the percentage who purchased sugary drinks during the week before the study (74%, p = 0.28). The percentage purchasing non-sugary drinks was similar in the two settings (85% in the Mini Mart vs. 85% from receipts, p = 0.33). Nearly all participants reported that their Mini Mart purchases were similar to real-life purchases (96%); the Mini Mart felt like a real store (94%); they could find all the beverages they were looking for (92%); and they could imagine doing their real-life beverage shopping in the Mini Mart (92%). Moreover, retention was high, with 97% of participants attending the final study visit. These results indicate that naturalistic store laboratories are a promising method for increasing the ecological validity of trials to evaluate point-of-sale interventions.

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“…While the healthier fruit drink contained 18% of the daily value of sugar, the less healthy fruit drink contained 44% of the daily value of sugar; a difference of 26 percentage points. In a real life shopping situation, the ability to closely compare GDA labels on different products might be more limited as people have less time to examine the labels in detail [31]. In addition, the nutrient warning label performed better than the GDA on the majority of other outcomes, including: helping consumers to correctly identify products as having excess of sugar, saturated fat, or sodium; discouraging purchasing the product in the next week if it were available; and increasing perceived message effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Impact of nutrient warning labels on choice of ultra-processed food and drinks high in sugar, sodium, and saturated fat in Colombia: A randomized controlled trial

Mora‐Plazas

Higgins

Gómez

et al. 2021

Preprint

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BackgroundFront-of-package nutrient warning labels are one promising policy to inform healthier food choices and purchasing decisions. This study aimed to identify the impact of nutrient warning labels on product selection and the ability to correctly identify products with an excess of critical nutrients, among other outcomes in Colombia.MethodsWe conducted an online randomized experiment among 8,061 Colombian adults in October 2020. Participants were randomly assigned to a front-of-package label condition: nutrient warning, guideline daily amounts (GDA), Nutri-Score, or a no-label condition. First, they viewed a fruit drink with added sugar that was labeled per their assigned condition and one without added sugar, which was only labeled in the GDA and Nutri-Score conditions, and completed selection tasks. The primary outcomes were 1) selection of the fruit drink with added sugar as the fruit drink they would rather buy and 2) correctly identifying which fruit drink was higher in sugar. Next, they viewed four food products (cookies, yogurt, sliced bread, and breakfast cereal) with their assigned condition and answered a series of questions. Finally, they selected which of the three label types would most discourage them from consuming a specified ultra-processed food.ResultsFewer participants in the nutrient warning condition (20%) selected the added sugar fruit drink as the product they would rather buy compared to 24% in the GDA condition (p<.01), 29% in the no-label condition, and 33% in the Nutri-Score condition (both, p<.001). More participants in the nutrient warning condition (88%) correctly identified the fruit drink higher in sugar compared to the no-label condition (68%) and the Nutri-Score condition (65%) (both, p<.001). More participants in the GDA condition (91%) correctly identified the fruit drink higher in sugar compared to the nutrient warning condition (p<.01). Most participants (72%) selected the nutrient warning label as most discouraging, while only 20% selected the GDA label and 9% selected the Nutri-Score label.ConclusionsNutrient warning labels are a promising policy strategy to prevent obesity and diet-related non-communicable diseases in Colombia. Future research is needed to understand the impact of nutrient warning labels on actual ultra-processed food purchases in Colombia. Trial Registration: NCT04567004

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Impact of front-of-pack nutrition labels on consumer purchasing intentions: a randomized experiment in low- and middle-income Mexican adults

Cited by 66 publications

References 48 publications

Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment

Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment

Using a Naturalistic Store Laboratory for Clinical Trials of Point-of-Sale Nutrition Policies and Interventions: A Feasibility and Validation Study

Impact of nutrient warning labels on choice of ultra-processed food and drinks high in sugar, sodium, and saturated fat in Colombia: A randomized controlled trial

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