Ref. Ares(2021)6170379 - 11/10/2021
Research Article
ISSN 2641-4295
Food Science & Nutrition Research
Comparison of the Efficacy of Five Front-of-Pack Nutrition Labels in
Helping the Brazilian Consumer Make a Healthier Choice
Wendy A.M. Blom1*, Nathalie C. Goenee2, Lucia Juliano3, Els M. de Groene1 and
Fernanda de Oliveira Martins4
1Unilever Foods Innovation Centre Wageningen, Netherlands.
*Correspondence:
2Unilever R&D Vlaardingen, Netherlands.
Wendy A.M. Blom, Unilever Foods Innovation Centre Wageningen,
Netherlands, E-mail: xxxxx.xxxx@xxxxxxxx.xxx.
3Harris Interactive UK Ltd, Netherlands.
Received: 02 August 2021;
Accepted: 28 August 2021
4Unilever Brazil.
Citation: Blom WAM, Goenee NC, Juliano L, et al. Comparison of the Efficacy of Five Front-of-Pack Nutrition Labels in Helping the
Brazilian Consumer Make a Healthier Choice. Food Sci Nutr Res. 2021; 4(2): 1-14.
ABSTRACT
We tested, in an online survey, how well five different front-of-pack (FOP) labels helped Brazilian consumers make
a healthier choice between two food products as compared to a no FOP label control. All 1072 respondents were
randomly allocated to one of six groups 1) no FOP label (control), 2) ABIA label, 3) GGALIii Nutrient Profile
label, 4) IdeC label, 5) Hybrid label or 6) Nutri-Score label and were all shown 9 food stimuli consisting of two
products. The nutrient profiles of ABIA and Hybrid labels consider serving size of the food whereas the other three
labels score per 100g. Respondents were asked which of the two products they perceived to be the healthier choice.
Overall, the Hybrid and ABIA labels performed best, resulting in a statistically significantly higher percentage of
correct answers as compared to the control for 9/9 and 8/9 of the food stimuli, respectively. Nutri-Score performed
reasonably well and outperformed the control in 6/9 cases. The IdeC and GGALIii NP warning labels were least
helpful, outperforming the control group only once and twice, respectively. In conclusion, the Hybrid and the ABIA
FOP labels, two interpretative traffic light labels that use colours and provide nutritional information per serving,
were best suited to help Brazilian consumers choose the healthier product. They especially outperformed the other
FOP labels when serving sizes differed significantly or when deeper consideration of nutritional information was
needed to make an informed decision.
Keywords
healthfulness of a food or beverage.
Online consumer research, Front-of-pack label, Nutri-Score,
Warning label, Traffic light label, Brazil.
There is no international standardization of FOP labels and therefore
many different FOP labels have been developed and implemented
Introduction
across the world [3-5]. These FOP labels differ not only in graphic
Although many countries and health organizations have issued dietary presentation, but also in the type and level of information they
guidelines with clear recommendations as to which food groups fit provide, the nutritional profiles used, the food products covered
into a healthy diet and which foods and nutrients should be consumed and the implementation (i.e. voluntary or mandatory). This is at
in moderation, adherence to dietary recommendations is low.
least partly explained by the fact that the model must meet the
needs for each country, taking into consideration cultural and
Nutrient declarations on the back of the pack provide important dietary patterns, education level and alignment with national
information about the nutritional composition of food products, dietary guidance.
but consumers find this information complex and difficult to
understand [1,2]. That’s why, Front-of-Pack (FOP) nutrition FOP labels can be roughly divided into two type’s namely
labelling systems are designed to help the consumer make a interpretative and non-interpretative labels. Non-interpretative
quick, informed decision about the nutritional content or relative FOP labels provide information on the amount of key nutrients
Food Sci Nutr Res, 2021
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(e.g. fat, sugar and sodium) and percent recommended intakes, sugar, saturated fat and sodium content per 100g or 100 ml of
with little interpretation of this information (e.g. Guideline Daily product [23,24].
Amounts [GDA] or Reference Intake [RI]logos [6]). Interpretative
FOP labels contain an interpretation of the nutritional quality of This study was performed in 2019 and designed to determine
the products, with or without information about the amount of key which of five different types of nutritional front-of-pack labels best
nutrients. Some FOP labels use colours (e.g. Multi Traffic Light helps Brazilian respondents identify the healthiest choice between
[MTL] [7]) to indicate whether the level of a nutrient is high (red), two food products, compared to a non-label control. Four of the
medium (amber) or low (green). Other interpretive FOP labels tested FOP labels were also reviewed by Anvisa. We wanted to
provide a simple summary score of a product’s overall nutritional test the robustness of the efficacy of different FOP labels by also
profile (e.g. Keyhole logo [8], Choices Programme Logo [9]), a comparing products from different product categories, consumed
ranking (e.g. Health Star Rating [10], Nutri-Score [11]) or warn for in different serving sizes or with closer nutritional profiles. As a
high levels of certain critical nutrients in products (e.g. Warning result, wide range of products were tested.
labels [12]).
Materials and Methods
Many studies have examined the different attributes of effectiveness
Study population
of FOP labels, but there are numerous inconsistencies in the Study participants were recruited from an existing research panel of
results. This can be explained by the fact that the definition of Brazilian consumers that represent general members of the public.
effectiveness differs from study to study. Some studies focus on The aim was to have a representative sample of respondents and
consumer liking, understanding or preference for FOP labels, an even gender split. Participants were eligible for participation if
others on food choice or actual or intended food purchase and some they were aged between 18 and 65 years.
on food intake. There are also major differences in methodologies
used. However, research into the effectiveness of FOP labels on
Front-of-pack labels
consumer behavior in practice is lacking [13].
Five FOP labels were tested in this study, i.e. GGALIii Nutrient
Profile, IDEC, ABIA, Nutri-Score and a hybrid label which was
Studies focusing on consumers’ understanding of FOP labels and developed for this study. The first four FOP labels were selected
product choice generally show that FOP labels appear to help because they were proposed by different stakeholders to Anvisa, the
consumers determine which foods are healthier and which are less National Health Surveillance Agency of Brazil [22]. The selected
healthy [14,15]. Simple FOP labels such as MTL, warning labels labels cover three different visual expressions of nutritional
and Nutri-Score appear to be most effective [15].
labelling. GGALIii Nutrient Profile and IDEC labels are warning
style labels, Nutri-Score is an interpretative color coded label.
The MTL label has been implemented in the United Kingdom The ABIA label is a traffic light system that provides nutritional
[7]. It provides information on energy, fat, saturated fat, sugar information. The hybrid label is an adaptation of the Evolved
and salt content per 100 gram and as percentage of reference Nutrition Label [25] and contains both nutritional information and
intake, combined with traffic lights colours (green, amber and a red color code, as warning sign, if levels of an ingredient are
red) to highlight low, medium or high levels of the nutrients. It high. The Control Group received visual expressions of products
also provides serving size information that is expressed in easily without a FOP label. This group was used as a reference.
recognizable and meaningful ways to the consumer (e.g. ¼ of
a pie). Nutri-Score is an interpretive FOP label that uses letters This study focused on the three nutrients of concern that were
and colours to rank healthiness of products [11]. The French initially proposed by Anvisa, i.e. saturated fat, sugar and sodium
government adopted the Nutri-Score in 2017 and since then [22]. Hence other nutrients were not taken into account.
governments of other countries such as Belgium, Switzerland and
Germany have also chosen to adopt the Nutri-Score [16,17]. In
GGALIii NP label
Latin America, the implementation of warning labels is spreading. GGALI (Gerência-Geral de Alimentos) is Anvisa’s General Food
Ecuador was the first to implement a mandatory FOP label system, Management who prepared the "regulatory impact analysis"
i.e. a traffic light system [18]. They were followed by Chile which published by Anvisa in 2018 [22]. GGALI proposed two nutrient
implemented mandatory warning labels in 2016 [19]. Since then, profiles. We selected the stricter one – GGALIii –. The GGALIii NP
Peru [20], Paraguay and Uruguay also decided to implement label is a warning style label highlighting high levels of nutrients
warning labels and Mexico has recently followed suit [21]. of concern. It is based on the nutrient content per 100 g or 100 ml
Brazil recently reviewed mandatory nutrition labelling. Anvisa, for food and beverages, having as reference the guidelines of the
the National Health Surveillance Agency of Brazil established a World Health Organization (WHO) and Codex Alimentarius [22].
working group on Nutrition Labelling to identify problems in the Criteria were defined for low, medium and high content of free
transmission of nutritional information and alternatives that could sugars, saturated fat, total fat and sodium [22]. For the GGALIii
help improve the effectiveness of nutrition labelling [22]. Several NP label in this study criteria for high levels were applied. When
FOP labels were proposed to Anvisa and reviewed. In October this study was designed and conducted, Anvisa had not chosen
2020, ANVISA approved a FOP label for food and beverages, the nutrient profile or visual model. The nutrient profile that was
which is a warning label that uses a nutrient profile based on added approved by ANVISA in 2020, is more lenient than the nutrient
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profile that we used in this study. The magnifying glass visual that an adaptation of the Evolved Nutrition Label (ENL) [25]. Criteria
we used is similar to the visual approved by Anvisa [23,24]. This for sugar, saturated fat and sodium were defined for small serving
visual is also under discussion in Canada.
sizes (<60 g), medium serving sizes (60-120 g) and large serving
sizes (>120 g). In line with ENL, calculations were done per
IDEC label
serving size, except for serving sizes between 60 and 120 g, in
IDEC (Instituto Brasileiro de Defesa do Consumidor) is a civil which case calculations were done per 100 g. The label provides
society in Brazil. They proposed a FOP label that is a warning style quantitative nutritional information per serving and uses the red
label and uses black triangles to inform the high content of sugars, color to indicate high amounts of the nutrient in a serving of the
total fat, saturated fat and sodium, and the presence of trans fats product.
and sweeteners. The nutritional profile model was adapted from
the Pan American Health Organization (PAHO) profile model and An example of the five labels is provided in Figure 1. The specific
is based on percentage of energy [22].
criteria used for the ABIA, GGALIii, IdeC and Hybrid labels are
presented in Table S1. For the Nutri-Score label, the Nutri-Score
ABIA label
algorithm was used to calculate the score for each product [11].
ABIA (Associação Brasileira das Indústrias da Alimentação),
representing the Brazilian food industry sector, proposed a Multiple
Food stimuli
Traffic Light (MTL) FOP label, based on the United Kingdom This study included 18 food items, which were presented to the
traffic lights, which reports the absolute quantities of sugars, respondents in sets of two. The respondents were asked to indicate
saturated fats and sodium per serving. It uses the red, amber and which of the two products they thought was healthier. The correct
green colours to indicate the high, medium and low levels of each answer was defined considering the contents of the three nutrients
nutrient according to criteria per serving [22].
highlighted on the front of pack label. That is, the product with
the lowest sugar, saturated fat and sodium content per serving was
considered the healthiest choice. When a product was higher in one
Nutri-Score
nutrient and lower in another, the larger difference was considered
Nutri-Score is an interpretative, graded, color-coded FOP label most important. In a few cases, one nutrient was slightly lower
that has been developed by French researchers [11]. It is based and one much higher. Subsequently the much higher nutrient was
on the nutrient profiling system of the United Kingdom Food considered more important for the classification.
Standards Agency which uses the nutrient content per 100 g
for food and beverages. Positive points (0-10) are allocated for The food sets (food stimuli) were carefully selected to test the
energy, total sugar, saturated fat and sodium content and negative robustness of the labels to help the consumer identify the healthier
points (0-5) are allocated for fruit, vegetables and nuts, fibre and option. The food stimuli differed with regard to the following
protein content. Products scores range from -15 (most healthy) to variables: similar products consumed in small serving size, similar
+40 (least healthy) [11] and are translated into five categories of products consumed in large serving size, similar product but
nutritional quality ranging from A (green) to E (red).
consumed in different serving sizes, and products from different
food categories but consumed in same eating occasion. The food
Hybrid label
categories included in the study were soft cheeses, fat spreads, ice
The hybrid FOP label is a model developed for this study and is creams, lasagne, frozen meals, fermented milks & chocolate oat
Control
ABIA Label
GGALIii NP Label
Portion of 40g
HIGH IN
MEDIUM
HIGH
LOW
SUGAR
SAT. FAT
SODIUM
SUGAR
11.8%
16.8%
3,4%
SATURATED FAT
IdeC Label
Hybrid Label
Nutri-Score Label
Portion of 40g
HIGH
HIGH
IN
SUGAR SAT. FAT SODIUM
IN
SUGAR
11.8%
16.8%
3,4%
SAT. FAT
Figure 1: Example of front-of-pack labels used in this study (translated from Portuguese to English).
Food Sci Nutr Res, 2021
Volume 4 | Issue 2 | 3 of 14
1
drinks, sweet snacks, cereal bars & yoghurt and chocolate bars. scale from 0 to 10, how useful the label was in helping them make
The products corresponded to different consumption occasions a healthy food choice and what they liked and disliked about the
(e.g. breakfast, lunch or main meal and in-between meal snack). specific type of label that they had evaluated.
Figure 2 shows an example of one of the stimuli as presented to
the respondents. In Brazil it is not mandatory to declare sugar
Statistical analyses
content of food products on the packaging. For some of the Descriptive statistics were calculated for the sociodemographic
products used in this study, i.e. ice creams, frozen meals, the dairy data of the participants. The percentage of participants selecting
alternative drink and sweet snacks, we had to estimate the sugar the answers “Product 1”, “Product 2”, “No difference” or “Don’t
content. Estimations were based on similar products marketed in know” were calculated for each set of food stimuli, for each FOP
countries where sugar content is declared in the nutrition table
. label group as well as for the control group. Significance testing
Table 1 summarizes the nutritional profiles of the food stimuli. (Z-test) was performed to test if the proportion of participants
Other, detailed information about the food stimuli can be found
in Figure S1
.
correctly identifying the healthier product differed between the
FOP label groups. Significance tests were performed within these
Data collection
subgroups to test whether participants who correctly chose the
A 5-minute online survey was conducted in July 2019, using healthier option differed according to education level or income.
Toluna Quick Surveys. All respondents were randomly allocated to The mean scores for usefulness of the labels were calculated.
one of six groups 1) no label (control), 2) ABIA label, 3) GGALIii T-tests were used to test for statistical differences between mean
NP label, 4) IDEC label, 5) Hybrid label or 6) Nutri-Score label.
scores.
Apart from the control group, the respondents were shown the Statistics were performed with the Toluna Analytics tool. A
FOP label. The FOP label was briefly explained. The respondents significance testing at a 95% confidence level was used.
were then shown 9 food stimuli consisting of two products and,
based on the information they received, they were asked which
Results
product they thought was the healthier choice. The respondents
Respondents
in the control group were also shown the same 9 choice sets of A total of 1072 Brazilian men and women participated in the
products, but without a label. Respondents were provided with online survey. Sociodemographic data are presented in Table S2.
four potential answers: 1) Product 1; 2) Product 2; 3) No difference A total of 176 respondents were included in the control group, 181
and 4) I don’t know. Respondents were also asked to rate, on a respondents were allocated to the ABIA group, 177 respondents
Control
ABIA Label
GGALIii NP Label
Porção de 30g
Porção de 30g
IdeC Label
Hybrid Label
Nutri-Score Label
Porção de 30g
Porção de 30g
Figure 2: Example of stimulus used for each randomized group.
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Table 1: Nutritional profile of food stimuli.
Per serving
Per 100 g
Food category
Product
Serving size (g)
Sugar (g)
Saturated fat (g) Sodium (mg)
Sugar (g)
Saturated fat (g) Sodium (mg)
Soft Cheese
Product 1*
30
NA
1,9
118
NA
6,3
393
Soft Cheese
Product 2
30
NA
5,2
239
NA
17,3
796
Fat spreads
Product 1*
10
NA
0,9
70
NA
9
700
Fat spreads
Product 2
10
NA
4,8
90
NA
48
900
Ice cream
Product 1
86
21,5
7,7
40
25
8,9
46,5
Ice cream
Product 2*
60
13
1,8
12
21,7
3
20
Lasagne
Product 1
400
12
10
1280
3
2,5
320
Lasagne
Product 2*
400
11,2
5,2
1440
2,8
1,3
360
Frozen meals
Product 1*
300
NA
2,9
250
NA
0,9
83,3
Frozen meals
Product 2
275
NA
9,3
1242
NA
3,4
451,6
Fermented milk drink
Product 1
200
32,5
0
75
16,25
0
37,5
Chocolate oat drink
Product 2*
260
12
0,6
60
4,6
0,2
23
Sweet snacks
Product 1
40
10,6
3,4
68
26,6
8,4
170
Sweet snacks
Product 2*
20
6,6
2,1
26
33
10,5
130
Cereal Bar
Product 1*
21
6,9
0,8
0
32,8
3,8
0
Yoghurt
Product 2
170
20,4
4,6
160
12
2,7
94
Chocolate bars
Product 1*
16,7
8
2,6
16
47,9
15,5
100
Chocolate bars
Product 2
40
19,9
6,6
40
49,8
16,5
100
* Healthier option
Table 2: Percentage of participants correctly choosing the healthiest option within each food stimulus, by randomization assignment to FOP label or control.
Soft cheese
Fat spreads
Ice cream
Lasagne
Frozen meals Milk drinks
Sweet snacks Cereal bar &
yoghurt
Chocolate bars
Control
76d
37c
31d
48d,f
13
40
26c
44 c,f
39 c,f
ABIA
88a,c,d
82a,c,d,f
85 a,c,d,f
46 d,f
81 a,c,d,f
73 a,c,d
77 a,c,d,f
85 a,c,d,f
76 a,c,d,f
GGALIii
77d
24
65a,d
41f
59a,d
32
15
31
29
IdeC
51
32
13
33f
12
34
23
70 a,c,f
33
Hybrid
88 a,c,d
75 a,c,d,f
88 a,c,d,f
64a,b,c,d,f
85 a,c,d,f
78 a,c,d
79 a,c,d,f
86 a,c,d,f
72 a,c,d,f
Nutri-Score
87 a,c,d
58 a,c,d
60 a,d
20
67a,d
74 a,c,d
66 a,c,d
22
26
Performing significantly (p<0.05) better than a: Control; b: ABIA; c: GGALIii NP; d: IdeC; e: Hybrid; f: Nutri-Score within the same category.
were allocated to the GGALIii NP warning label, 181 respondents two (41% and 44%, respectively) or indicated that there was no
to the IDEC – triangle warning label, 178 respondents to the hybrid difference between the two products (32% and 24%, respectively).
color code label and 179 respondents were allocated to the Nutri- The GGALIii label scored worse than the control group. Also 55%
Score label.
of the respondents in the control group chose the less healthy
product.
There were no consistent significant differences in terms of
education and income levels between the different groups.
For the ice cream stimuli, the group of respondents who were
shown the IDEC labels had most difficulty choosing the healthier
Accuracy of choosing the healthier product
option; only 13% of the respondents chose the healthier product.
Table 2 summarizes for each of the labels and the control group the Forty percent of the respondents in the control group and 60% of
percentages of respondents that correctly identified the healthier the respondents from the IdeC group indicated that there was no
product for each of 9 stimuli.
difference between the two ice cream products. The ABIA and
hybrid labels helped the respondents best to make the healthier
When the soft cheese food stimuli were presented, most respondents choice, with 85% and 88%, respectively selecting the healthier
accurately identified the healthier product. Respondents who were product.
shown the IDEC warning label performed significantly worse than
the control group; a third of the respondents in this group indicated Many respondents had difficulty identifying the healthier lasagne.
that there was no difference between the two products and only Only the respondents who were shown the hybrid label performed
51% of the respondents correctly identified the healthier product.
significantly better (64% correct) than the control group (48%
correct). The Nutri-Score label helped only 20% of respondents
Respondents who were shown the ABIA or hybrid labels were make the right choice, compared to 48% of the respondents in
most likely to identify the healthier choice from the fat spreads the control group. Seventy percent of the respondents who were
category. Most respondents who were shown the GGALIii or shown the Nutri-Score label indicated that there was no difference
IDEC warning style labels selected the least healthy product of the between the products.
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Respondents in the control group and those shown the IDEC label the control in all cases. The ABIA label outperformed the control
found it particularly difficult to choose the healthier option from group eight times out of nine.
the frozen meals. A total of 56% of the respondents in the control
group and 62% of respondents in the IDEC label group indicated If we look at the participants who correctly identified the healthier
that there was no difference between the two frozen meals. The options, there appears to be no effect of education level or income.
ABIA and hybrid label performed best.
Statistical tests showed a statistically significant effect for only
3 of the 36 subgroups tested (9 food stimuli x 6 FOP label
In the category fermented milk and chocolate oat drinks, the groups). Low-income participants from the control group scored
ABIA, Hybrid and Nutri-Score labels performed best and the significantly higher than high-income participants in selecting the
GGALIii and IDEC labels performed worse with about one-third healthier ice cream. Participants with a higher income who were
of respondents choosing the less healthy option and about one-
shown the ABIA label scored significantly higher than participants
third indicating that there was no difference between products.
with a lower income in selecting the healthier milk drink. Finally,
the less educated in the control group scored higher than the higher
There was a marked difference between labels in their ability educated when selecting the healthier chocolate bar.
to help choose the healthier sweet snack. The majority of the
respondents in the control group (56%) and those who were shown
Usefulness ratings
the GGALIii (73%) or Idec (57%) label considered that there was no Respondents were asked to indicate on a scale of 0-10 how useful
difference between the two products with regard to health. The labels the label was in helping to choose the healthier product. Between
ABIA, Hybrid and Nutri-Score performed significantly better.
89% and 92% of respondents rated their label as either very useful
(7-8) or extremely useful (9-10). Mean usefulness scores were 9.7,
When respondents were shown a cereal bar and a yoghurt 9.6, 9.4, 9.6 and 9.8 for the ABIA, GGALIii NP, IDEC, Hybrid
product, i.e. two very different products, the ABIA, IDEC and Nutri-Score labels, respectively, and did not differ statistically
and hybrid labels were most successful in helping them make significant. The IDEC and GGALIii NP warning labels had the
a healthier choice. Forty-five percent of respondents who highest proportion (7% and 5%, respectively) of respondents
were shown the GGALIii label believed that there was no indicating that the label was not at all useful (0-4). The proportion
difference between products and 72% of respondents who were of respondents that rated the IDEC labels as not at all useful
shown the Nutri-Score label selected the less healthy product. (7%) was significantly higher than the 2% of respondents rating
the Nutri-Score and Hybrid label as not useful. See Figure 3 for
There was confusion amongst the majority of the respondents for usefulness ratings of FOP labels.
the chocolate bar category (showing two different sizes of the same
brand chocolate bar). Most respondents seeing the GGALIii (59%),
Idec (56%) or Nutri-score (63%) labels, which do not consider
Feedback on labels
serving size, thought that there was no difference between the two To better understand how the FOP labels were perceived by the
products. The ABIA and Hybrid labels, which do consider serving respondents, they were all asked what they liked or disliked about
size, resulted in the highest numbers of respondents choosing the the FOP label they were shown.
healthier option.
ABIA label
Overall, the IDEC warning label was least helpful for consumers Most respondents said they liked the label, especially the use of
to make the healthier choice. Eight out of nine times, the IDEC colors and the clarity and objectivity of the information provided.
label for the healthier product was the same as for the less healthy When asked about what they did not like, some respondents
product, providing no guidance to the consumer. Only once, when indicated that they would also like information about other
comparing the cereal bar and yoghurt, the IDEC label outperformed nutrients and energy.
the control group. In that case, 70% of the respondents chose the
healthier option. The other warning label, GGALIii NP, performed
GGALIii NP label
a bit better than the IDEC label, but also failed to distinguish Respondents were pleased with the label’s simplicity, its decisive
products six out of nine times. It outperformed the control group in message and the fact that it attracts attention. Not all respondents
only two out of nine cases. Nutri-Score performed reasonably well were satisfied with the black color and some were missing
but also failed two times in guiding the consumer to the healthier nutritional information.
choice when products were given the same rating. This happened
for example when the serving sizes of the two products differed
Hybrid label
significantly. In case of the cereal bar (21g) versus yoghurt (170g) Respondents were particularly pleased with the use of the red
food stimulus, a better Nutri-Score was given for the least healthy color as it draws attention and also the clear and easy to understand
product (yoghurt).
information about the nutrients and serving size. However, the
language should be kept simpler (e.g. salt instead of sodium) and
The hybrid label performed best, resulting in statistically some respondents wanted more information about other nutrients
significantly higher percentage of correct answers as compared to and energy.
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7 – 10
91%
90%
89%
92%
92%
score
9 - 10 Extremely Useful
63%
63%
56%
61%
66%
7 - 8 Quite Useful
5 - 6 Somewhat Useful
0 - 4 Not at al useful
28%
28%
33%
31%
26%
5% 4%
5%
4%
5%
7%
6% 2%
6% 2%
ABIA
GGALIii
NP
IdeC
Hybrid
Nutri-
Score
Answer to question: To what extent is the label below useful when helping you make healthy food choices?
Figure 3: Usefulness ratings of the five FOP labels.
IDEC
products, compared products within the same food category and
Respondents were especially pleased with the simple information with the same serving size, but with marked differences in nutrient
that helps people make a quick decision. Not all respondents were profiles. These studies often found that simple interpretative labels
happy with the black color and said it wasn’t noticeable, and some such as Nutri-Score or warning labels were effective in helping
would like more specific information about the amount of the the consumer make a healthier choice [26-29]. This makes sense,
nutrients in the products.
because when a label clearly distinguishes between products
(e.g. different score, color or with or without a warning label),
Nutri-Score
the consumer can easily make a choice. However, this does not
When evaluating the Nutri-Score label, the respondents indicated reflect the complexity consumer’s face when shopping as this
that they liked the simple, clear message and the use of colors. clear distinction does not always exist. Our research showed that
Negative aspects of the Nutri-Score were the lack of information when labels do not clearly distinguish between two products, or
about nutrient levels and the underlying model. Some respondents when products from different product categories or with different
misinterpreted the label as they believed that the colors and letters serving sizes are compared, these simple labels do not help the
represented the presence of vitamins in the products.
consumers to make an informed choice.
In summary, respondents prefer simple FOP labels that use colors Many factors influence how consumer’s process information on
(not black) to convey the message. They would like to receive a FOP label and how deeply this information is processed [30].
information about the amount of nutrients in the products, but in Consumers may only glance at the FOP label, process partial
simple language.
information or process the FOP label in depth. For example, the
level of nutritional knowledge influences the type of information
Discussion
the consumer processes. Knowledgeable consumers are more
FOP labels are designed to help consumers choose healthier food likely to use the more complex nutrient information on complex
and drinks. This study compared how well five different FOP labels labels, while a less knowledgeable consumer may look for calorie
helped Brazilian consumers make a healthier choice between two and color-coded information. Average consumers are more likely
food or drink products. It showed that the Hybrid label and the to process the information on the FOP label in depth. Under time
ABIA label, performed best under the tested conditions. Both pressure consumers will only quickly inspect the information
labels provide both nutritional information per serving as well on the FOP label and not process all available information [30].
as concise interpretation using colors (i.e. traffic light or red light Health-motivated consumers may also look more actively for
only).
nutritional information, while hedonically-motivated consumers
may not look at nutritional information, but more at brand names
Most of the other studies that investigated how well different [30]. So, depending on the situation, different types of FOP labels
FOP labels helped consumers make a healthier choice between can be the most effective.
Food Sci Nutr Res, 2021
Volume 4 | Issue 2 | 7 of 14
Our study showed that simple summary labels are effective of >100g/ml it is underestimated. As a result, some products with
when there is a clear distinction between products, but if a quick small serving sizes will unfairly receive a warning label, while
decision cannot be made, consumers will consider the nutritional some products with large serving sizes that are high in nutrients of
information on the FOP label, when available. In those cases, concern receive no warning label. For example, in this study, two
interpretative labels that provide nutritional information to the lasagnas with a 400g serving size were compared. According to
consumer better assist the consumer in making an informed choice. the nutritional profile criteria defined by GGALIii, based on 100g,
This study showed that, even when the colors on the Hybrid and neither of the two products would receive a warning label, and
ABIA labels did not differ between products, participants could with Nutri-Score both lasagnas would receive a score of B. These
choose the healthier option based on the nutritional information two FOP labels would thus suggest that products are healthy,
presented on these labels. This suggests that the nutritional despite the relatively high saturated fat and sodium contents per
information facilitates the comparison of the nutritional content serving as % GDA.
of the products, allowing the consumer to make a healthier choice.
The two warning labels, i.e. IDEC and GGALIii NP were in most While the GGALIii NP and IDEC warning labels were the least
cases not sensitive enough to help the consumer distinguish successful in helping participants make the healthier food choice,
products based on healthiness. They did not outperform the control the labels were considered by the respondents to be as useful as
group. Both the Idec and GGALIii labels use very strict nutrient the other FOP labels. It is important to note that the respondents
profiles and therefore most products bear the logo [22], making did not receive any feedback on how well they did. So, they were
them less sensitive to distinguish products. The nutrient profile not aware of the correct answer and how often they correctly
that will be implemented in Brazil is more lenient and if we would identified the healthier option or mistakenly assumed there was
have used this more lenient profile, the number of warning labels no difference. One could speculate that if they got this feedback,
would have been different for two food stimuli; only one of two ratings of usefulness would be lower. In any case, the ratings show
frozen meals would have carried a warning logo for sodium and that any FOP label that could help make the consumer an informed
the yogurt would have carried no warning label for added sugar. choice is considered useful by consumers. For research purposes,
Besides the lack of discrimination between products, these labels asking this question without providing feedback to the participants
are also very simplistic and do not contain additional nutritional does not seem relevant. Feedback from the participants suggests
information to help the consumer make an informed decision, that simple FOP labels that use bright colors and contain nutritional
where the number of warning labels for sugars, saturated fats and information in simple language, are liked.
sodium does not differ between two foods.
Grunert et al hypothesized that consumers’ liking for FOP labels
When labels on two different products are the same, respondent is guided by three considerations: 1) consumers like simplicity,
interpret this as if products are equally healthy, or respondents 2) when provided with simplified information consumers still
base their decision on other information that they have about want to know what it stands for and how the simplified message
the product (e.g. packaging, type of product, claims on product, (e.g. warning- or health logo) has been derived, and 3) nutrition
presence of other ingredients, and knowledge of the brand). information can create a consumer resistance when they feel
For example, the vegetable-oil based spread used in this study pushed to make choices that they do not want to take [31].
contained less saturated fat and sodium than the presented butter,
so it is nutritionally, the healthier choice. However, Brazilian This is also confirmed by a recent study conducted by Talati et
Dietary guidelines promote butter consumption, not vegetable-
al. [32] who investigated consumer perception of five FOP labels,
oil based spreads. Butter can therefore be seen as more natural i.e Health Star Rating, MTL, Nutri-Score, RI and a warning
and healthier than vegetable-oil based spreads in Brazil and this label. The colored FOP labels MTL and Nutri-Score stood out
is also reflected in the results. When the FOP labels indicated and were most liked by consumers in all countries. Although the
that the vegetable-oil based spread was the healthier choice, most most simplified FOP labels, Nutri-Score and warning labels, were
respondents chose that product. However, if no label was shown, easy to understand, they were perceived as providing insufficient
or if labels on butter and vegetable-oil based spreads did not differ information and the least trusted. The RI label was perceived
(in case of IDEC and GGALIii NP), more than 40% of participants as the most confusing but scored high on trust. Overall, the
chose butter as the healthier option.
MTL label, which combines nutrient-specific information and a
summary interpretation using colour, was most liked and trusted
A recent review of FOP schemes performed by the European in this study.
Commission concluded that FOP schemes providing nutritional
information per 100g were better understood than portion-based A strength of the current study was that it really tested the
schemes [13]. However, more than 90% of the food categories in robustness of five FOP labels that differed not only in visual
Brazil have regulated serving sizes less than 100g / 100ml. When expression and the amount of information provided, but also in
a nutrient profile is standard applied in 100g or 100mL distorted the underlying nutrient profile. Unlike other studies that mostly
comparisons are generated. For products consumed in serving tested products within the same food category and with the same
sizes <100g or ml, the amount of nutrients to calculate the FOP serving size, this study was designed to compare how well these
label is overestimated, while for products consumed in portions five FOP labels enabled consumers to choose between products
Food Sci Nutr Res, 2021
Volume 4 | Issue 2 | 8 of 14
that differ in nutritional composition, serving size and/or food products. It does therefore not reflect a real-life situation in which
category as consumers face in real life. Another strength is that participants can examine packaging and other information, such
a control group has been included and that the effectiveness of as the nutrition table on the back, to make an informed choice.
the FOP labels in helping the consumer to choose the healthier Finkelstein et al [39] attempted to mimic a real-life situation by
product could therefore be compared with a reference group that asking the participants (n=147) to purchase their weekly groceries
was not given a FOP label. This provides insight into whether the in an online grocery store with 3343 foods and 832 beverages.
presence of a specific FOP label is of added value for a consumer Participants had only access to back-of-pack Nutrition Information
when making an informed choice.
Tables or were also shown an MTL label or Nutri-Score label.
Both the MTL and Nutri-Score FOP labels improved the dietary
Participants were also asked to select the healthier product. quality of the purchases as compared to the control group. The
This demonstrates how effective the FOP label is in helping the Nutri-Score label performed best in improving overall diet quality,
consumer make a choice and whether it fits its purpose. In other but unlike Nutri-Score, the MTL label reduced calories. Thus,
studies consumers were asked which product they would buy [33-
FOP labels had added value when purchasing products, even in
37], but this may be influenced by factors such as familiarity and the presence of a Nutrition Information Table.
liking of the product and cost of the product [31]. Other studies
only asked which FOP label is preferred [32,38]. As demonstrated
Conclusions
by our study, all FOP labels were rated as very useful, irrespective In conclusion, this study showed that the Hybrid and the ABIA
of their efficacy in helping the consumer choose the healthier FOP labels, two interpretative labels that use colors and provide
option. Only asking for preference is thus not very useful.
nutritional information per serving, were best suited to help
Brazilian consumers choose the healthier product. The other
This study also has some limitations. Participants were a three labels are based on per 100g and therefore will not always
representative sample of the Brazilian population. Therefore, we discriminate enough to help consumers. The ABIA and Hybrid
also included participants with a lower education level, who may labels outperformed the other FOP labels when serving sizes
have had difficulty understanding the information on the FOP differed significantly or when deeper consideration of nutritional
labels. However, socio-economic status and level of education was information was needed to make an informed decision.
similar between the six FOP label groups and therefore we did not
expect this to affect the outcomes of the study. This was confirmed
by statistical subgroup analyses showing that participants who
Acknowledgments
correctly identified the healthier options, did not differ with We thank the volunteers who participated in this online survey
respect to level of education or income. Another limitation is that and all other staff at Harris Interactive, Toluna and Unilever who
we did not ask the participants if they were color-blind. Thus, it helped with the study or provided input to this manuscript.
is possible that participants with color-blindness were included,
which may have adversely affected the ability to understand the
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Supplementary Materials
Table S1: Criteria used for the ABIA, GGALIii NP, IdeC and Hybrid labels.
Label
Product criteria
Category
Total sugar (g)
Free sugars (g)
Saturated fat (g)
Sodium (mg)
ABIA label
Solids<100g and
Liquids (ml)
Low
≤ 5,0
≤ 1,5
≤ 80
ABIA label
Solids<100g and
Liquids (ml)
Medium
> 5,0 ≤ 13,5
> 1,5 ≤ 3,0
> 80 ≤ 300
ABIA label
Solids<100g and
Liquids (ml)
High
> 13,5
> 3,0
> 300
ABIA label
Solids ≥ 100 g
Low
≤ 5,0
≤ 1,5
≤ 80
ABIA label
Solids ≥ 100 g
Medium
> 5,0 ≤ 27,0
> 1,5 ≤ 6,0
> 80 ≤ 600
ABIA label
Solids ≥ 100 g
High
> 27,0
> 6,0
> 600
GGALIii NP label
Solid (100 g)
Warning label
≥ 10
≥ 4
≥ 400
GGALIii NP label
Liquids (100 mL)
Warning label
≥ 5
≥ 2
≥ 200
IdeC label#
All products
Warning label
≥ 10%E
≥ 10%E
≥ 1 mg/kcal
Hybrid label
Solids < 60 g and
Liquids
High
> 13,5 per serving
> 3,0 per serving
> 300 per serving
Hybrid label
Solids ≥ 60g ≤ 120g
High
> 22,5 per 100 g
> 5,0 per 100 g
> 500 per 100 g
Hybrid label
Solids > 120 g
High
> 27 per serving
>6,0 per serving
> 600 per serving
# %energy of product
Table S2: Sociodemographic data
Characteristics
Sex
Number of participants (%)
Female
578 (54%)
Male
494 (46%)
Age
18-34
681 (64%)
35-54
338 (32%)
55+
53 (5%)
Education
Low
82 (8%)
Medium
481 (45%)
High
496 (46%
Undisclosed
13 (1%)
Social grade
A
209 (19%)
B1
194 (18%)
B2
329 (31%)
C1
179 (17%)
C2
103 (10%)
D-E
22 (2%)
Undisclosed
36 (3%)
Income
Low
596 (56%)
High
401 (37%)
Undisclosed
75 (7%)
Geographic location
Midwest
60 (6%)
Norteast
227 (21%)
North
41 (4%)
South
145 (14%)
Southeast
581 (54%)
Undisclosed
18 (2%)
Household shopping responsibility
Sole
54%
Joint
38%
None
8%
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Figure S1: Overview of all stimuli.
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© 2021 Blom WAM, et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
Food Sci Nutr Res, 2021
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