The ICMR National Institute of Nutrition’s detailed study on the acceptability and potential use of different formats of front-of-pack nutrition labels in promoting informed food choices strongly claims that ‘warning labels’ can discourage choice and consumption of even moderately unhealthy foods.
The study also depicted that ‘summary ratings’ like the health star or Nutri-Score can help identify healthier variants among the available foods. Summary labels provide a brief and concise overview of a product’s key features and benefits, often including information about positive as well as negative nutrients.
Warning labels, on the other hand, provide information about potential hazards associated with a product as they take into consideration nutrients of concern like sugars, fats, and salt. Front-of-package labelling (FOPL) is usually seen as an important tool of public health communication about health. And every country has different formats of FOPNL, either voluntarily or through mandatory implementation.
For now, the Food Safety and Standards Authority of India (FSSAI) is making an allowance to implement a symbol-based FOPNL. Yet, context-specific evidence on the effectiveness of FOPNL is needed to inform ongoing advocacy and regulatory processes in India.
The most important thing is that the type of FOPNL used in a country should be chosen based on local research, along with regional and global evidence, and in consideration of each country’s specific objectives for developing a FOPNL policy. Given this background, the current study tested the consumer acceptability, reliability, and understandability as well as the cognitive workload, informativeness, and purchase intention of five FOPNL formats, namely Nutri-Score (NS), Health Star Rating (HSR), Warning Labels (WL), Multiple Traffic Lights (MTL), and NutriStar Rating (NSR). The NS and HSR are the FOPNL formats currently in vogue in Europe and Australia, respectively, and the FOPNL rating (colour coding from ‘green’ for healthy, ‘orange’ for moderately healthy, and ‘red’ for unhealthy in the case of NS, and number of stars in the case of HSR) is based on both positive and negative nutrients.
The cross-sectional study, with a quasi-experimental design, was conducted among 3,231 participants from five regions of India: north (Delhi), east (Kolkata), west (Pune), south (Hyderabad), and northeast (Jorhat, Assam). In the present study, it was observed that even though the percentage of participants reading nutrition information is low, those checking vegetarian or non-vegetarian symbols and quality symbols were higher.
Consequently, FOPNL on pre-packaged processed foods is likely to have good acceptance among the Indian population as they are symbol-based.
The study is also notable for using FOPNL formats on different variants of mock packs of the same food. Unlike in other studies, different foods were not used to depict different labels.
“Therefore, the responses could be solely based on the understanding of the FOPNL without any preconceived perception about the healthiness of the product,” said Dr. Hemalatha R., Director, ICMR-NIN.
The study showed that warning labels (WL and NSR) deterred more people from choosing moderately healthy or unhealthy variants, whereas the summary labels made them look healthier.
“Participants randomized to any of the FOPNL formats were able to identify the healthiest and least healthy variants of foods; however, warning labels had a greater impact in altering the health perception of the food products as the presence of even one warning sign prompted more cautious behaviours in choosing the foods,” said Dr. SubbaRao M. Gavaravarapu, the lead investigator of the study.