The ICMR-NIN study looked at the potential use of different formats of front-of-pack nutrition labels in promoting informed food choices.
This study has come back to the Food Safety and Standards Authority of India (FSSAI), which is considering implementing a symbol-based front-of-pack nutrition labeling (FONPL) system. (iStock)
India’s plan to add warning labels on food products based on their nutritional values may have just hit a snag.
A study involving 3,231 participants conducted across five cities to choose from a series of warning labels has thrown up a clear winner — at least in terms of readability.
However, experts say that while the “chosen one” is easy to read, it does not have enough details for the consumer to make an informed purchase decision.
They say it is one of the others that would help people — especially the health-conscious or those suffering from ailments like diabetes or hypertension — make an informed decision when choosing a snack.
The study by Hyderabad-based ICMR-National Institute of Nutrition is on the acceptability and potential use of different formats of what are known as “front-of-pack nutrition labelling” — the system of labelling food products with the nutritional information most relevant to the consumer prominently displayed on the front of the packaging.
Such labelling can help to promote healthier diets and reduce the incidence of diet-related health problems such as obesity and heart disease.
This study was done to help the Food Safety and Standards Authority of India (FSSAI), which is considering implementing a symbol-based front-of-pack nutrition labelling (FONPL) system.
The study by ICMR-NIN tested the consumer acceptability, reliability, and understandability, as well as the cognitive workload, informativeness and purchase intention of five FOPNL formats. These formats are:
Please refer to the image to understand how these formats work
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).
While FSSAI, in its notification, has preferred the health star rating (HSR), people who participated in the study have preferred the colour coding-based Nutri-Score (NS) on nutrition quality.
In the study, when the participants were shown mock food packages and were asked about their preference among all five front-of-pack labels, in almost all the categories their preference was Nutri-Score.
Nutri-Score indicates product healthfulness using five different colours and five letters ranging from Category A (dark green), indicating higher nutrition quality, to Category E (dark orange), with low nutrition quality.
According to the study, Nutri-Score was most preferred due to its colour-coding as it attracts attention and also because it is a summary indicator providing a quick evaluation of the product’s overall healthiness using both positive nutrients and nutrients of concern.
The lead investigator of the study, Dr SubbaRao M Gavaravarapu, told South First that in terms of likeability, the colour-coded labels are easily liked because people are familiar with red to green.
“They understand what red means and what green means. In terms of likeability, the health star rating is also understood by the people, because electrical gadgets are already in the market with such ratings,” said Dr Gavaravarapu.
“If the purpose of front-of-pack labels is to promote healthy food choices — based on the relative healthiness of the foods or the available variants of similar foods — then summary labels such as NS or HSR may be useful,” the study said.
“Alternatively, in the context of growing overweight, obesity, and non-communicable diseases, if the front-of-pack label has to serve as a preventive tool and deter the (buyer) from consumption of nutrients of concern, then warning indicator labels (like WL in NSR in the current study) could be helpful,” the study suggested.
The study stated that the decision on the type of front-of-pack label used in a country should be based on local research, along with regional and global evidence, and take into consideration each country’s specific objectives for developing a front-of-pack label policy.
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 for healthier options.
He said that the problem is not just telling people which food is healthiest or unhealthiest, but rating those that are somewhere in between.
“It is very easy using any label, five stars or green is healthiest, 0.5 star or red is unhealthy, but what about 2.5 or orange one, how do you categorise it as healthy or unhealthy?” asked Dr Gavaravarapu.
The researchers, however, realised that in the case of the middle range of the labels, such as 2.5 stars or orange colour, warning labels (WL) were guiding people’s choice.
”Even when there is one nutrient of concern like salt or sugar. It is making people think, ‘Should I take this or not, should I go for an alternative’?” said Dr Gavaravarapu.
He said that the purpose of the government in introducing labels is to deter people from consuming unhealthy foods. And, in this, warning labels were more effective.
In earlier studies, consumer purchase decisions were not very well studied, which has been done now, and adolescents have been included for the first time.
“The study says both — the NS and WL — are working in their own way, and both are good; but the purposes are different,” said a top official from the FSSAI.
“In my personal opinion, as, in India, the context is different, how about thinking of hybrid models? Go with a warning label, along with a star label or Nutri-Score label. We have to think out of the box,” he added.
Whatever the final choice, Dr Gavaravarapu said it is high time to decide on labelling.
“We should immediately introduce it as we have to tackle growing NCDs (non-communicable diseases), growing obesity. We cannot wait any further. Introduce something or other, and see what is working. If it is not working, change it in the future.
“We cannot satisfy all stakeholder groups. The industry won’t be happy with what FSSAI wants, FSSAI won’t be happy with what scientists want, and scientists won’t be happy with what industry wants; this will go on and on,” said Dr Gavaravarapu.
He added that for any label to be successful, people need to be educated thoroughly.
A majority of the participants in the study claimed to read food label information, but they often check only the manufacturing and expiry dates. Although there was a slight increase in the percentage of participants reading nutrition information from previous studies, further improvement is warranted, stated the study.
Even illiterate participants understood the front-of-pack formats as basic awareness about the formats and functions of front-of-pack labels was provided to the participants, the study noted.
The study also recommended that the choice of the front-of-pack label format for India should not be based only on wide acceptability and appeal, but on its ability to influence food choices.
The study also recommended that foods whose basic edible and nutrient portions are greatly altered and those that have artificial ingredients may be clearly indicated by a symbol or any such indicator right on the front of the pack to specify the food is “ultra-processed”.
This is very important to promote informed and healthy food choices, the study indicated.
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