The battle over the design of front-of-package (FOP) food labelling continues. Last October, the US Institute of Medicine (IOM) issued a report recommending a simple plan(Reference Neuman1): FOP labels would show zero to three stars depending on the presence of added sugars, sodium and saturated or trans fats in the product. Foods with excessive amounts of any one of those nutrients would receive no stars. The food industry intends to continue following its own plan, in which FOP labels show amounts per serving of energy, saturated fat, sodium and sugars, but potentially also up to two ‘nutrients to encourage’(Reference Neuman2). In a previous report, the IOM had recommended that FOP labelling exclude ‘good’ nutrients and emphasize only the negative ones, for an unambiguous message(Reference Neuman3). The message, essentially, should be this: either ‘This is bad for you’ or ‘This is not bad for you’. It has been over 2 years since the US Food and Drug Administration announced that it would propose standards for FOP labelling. But if or when it will take any action on food labelling is unclear.
In this issue of Public Health Nutrition, Barker and colleagues offer a cautionary voice in the food labelling battle(Reference Barker, Lawrence and Robinson4). We may argue over what information to put on the front of the package, but whether labelling even makes a measurable difference in dietary behaviour is still up in the air. Their invited editorial makes the point that food labels are not enough to produce behaviour change, particularly in the people who most need it. In an article by Chen et al. also in this issue, we see clearly who is not reading food labels – men, black men in particular, women of low socio-economic standing, rural residents and overweight Americans who perceived their weight as being ‘about right’(Reference Chen, Jahns and Gittelsohn5). These are people who should be reading labels. Is it because they don't know how to use them, or because they know they won't use the information on them anyway?
Seen from this perspective, the IOM's recommendation of an unambiguous emphasis on negative nutrients makes perfect sense. For the consumer who doesn't know how to use the more confusing labels, a visually clear label should help. For the consumer who doesn't plan to use the information, FOP labels might work in a more subtle way – by giving the consumer pause; by planting the seed of knowledge, warning or guilt; by acting as the angel on the shoulder. The fact is that we don't need more encouragement to buy things that most of us know are good for us (hence the recommendation to exclude positive nutrients from labels). We need the little voice in our ear to remind us that something we're about to drop in our shopping cart is bad for us.
The study by Hieke and Wilczynski provides some evidence for this(Reference Hieke and Wilczynski6). In their evaluation of consumers’ responses to a traffic light scheme of labelling, participants paid greater attention to a change from ‘amber’ to ‘red’ compared with a change from ‘green’ to ‘amber’. A red light delivers the unambiguous message of danger to consumers motivated enough to look for the information. It may also deliver the necessary reminder – the knowledge, warning or guilt – for people not looking for it.
In another article in this issue, McLean et al. describe a more specific application of food labelling for discriminating between high- and low-sodium products, and they confirm the utility of a traffic light system in delivering the necessary information clearly and simply(Reference McLean, Hoek and Hedderley7). Turconi et al. address a separate but related topic of providing nutrition information in a cafeteria setting(Reference Turconi, Bazzano and Roggi8). In their study, customers perceived information on meals’ nutritional content as very helpful and most claimed to have changed their decision after knowing the foods’ nutritional content.
It is notable that several of the articles we highlight here raise the issue of empowerment: consumers should be empowered to use food labels, to make informed decisions, to take control over their health behaviours and, hence, their health status. But whether food labels work in such a noble fashion or whether they are just a subtle way of delivering a subliminal message does not ultimately matter – all we really want is for them to work.
