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. 2020 Nov 20;17(11):e1003427.
doi: 10.1371/journal.pmed.1003427. eCollection 2020 Nov.

The impact of voluntary front-of-pack nutrition labelling on packaged food reformulation: A difference-in-differences analysis of the Australasian Health Star Rating scheme

Laxman Bablani  1 , Cliona Ni Mhurchu  2   3   4 , Bruce Neal  3   4 , Christopher L Skeels  5 , Kevin E Staub  5 , Tony Blakely  1
Affiliations

The impact of voluntary front-of-pack nutrition labelling on packaged food reformulation: A difference-in-differences analysis of the Australasian Health Star Rating scheme

Laxman Bablani et al. PLoS Med. .

Abstract

Background: Front-of-pack nutrition labelling (FoPL) of packaged foods can promote healthier diets. Australia and New Zealand (NZ) adopted the voluntary Health Star Rating (HSR) scheme in 2014. We studied the impact of voluntary adoption of HSR on food reformulation relative to unlabelled foods and examined differential impacts for more-versus-less healthy foods.

Methods and findings: Annual nutrition information panel data were collected for nonseasonal packaged foods sold in major supermarkets in Auckland from 2013 to 2019 and in Sydney from 2014 to 2018. The analysis sample covered 58,905 unique products over 14 major food groups. We used a difference-in-differences design to estimate reformulation associated with HSR adoption. Healthier products adopted HSR more than unhealthy products: >35% of products that achieved 4 or more stars displayed the label compared to <15% of products that achieved 2 stars or less. Products that adopted HSR were 6.5% and 10.7% more likely to increase their rating by ≥0.5 stars in Australia and NZ, respectively. Labelled products showed a -4.0% [95% confidence interval (CI): -6.4% to -1.7%, p = 0.001] relative decline in sodium content in NZ, and there was a -1.4% [95% CI: -2.7% to -0.0%, p = 0.045] sodium change in Australia. HSR adoption was associated with a -2.3% [-3.7% to -0.9%, p = 0.001] change in sugar content in NZ and a statistically insignificant -1.1% [-2.3% to 0.1%, p = 0.061] difference in Australia. Initially unhealthy products showed larger reformulation effects when adopting HSR than healthier products. No evidence of a change in protein or saturated fat content was observed. A limitation of our study is that results are not sales weighted. Thus, it is not able to assess changes in overall nutrient consumption that occur because of HSR-caused reformulation. Also, participation into labelling and reformulation is jointly determined by producers in this observational study, impacting its generalisability to settings with mandatory labelling.

Conclusions: In this study, we observed that reformulation changes following voluntary HSR labelling are small, but greater for initially unhealthy products. Initially unhealthy foods were, however, less likely to adopt HSR. Our results, therefore, suggest that mandatory labelling has the greatest potential for improving the healthiness of packaged foods.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: C.NM is a member of the New Zealand Health Star Rating Advisory Group. The Advisory Group had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Figures

Fig 1
Fig 1. Percent products displaying HSR labels by imputed HSR rating for Australia in 2018 and NZ products in 2019.
HSR, Health Star Rating; NZ, New Zealand.
Fig 2
Fig 2. Percent of products by change in imputed HSR rating before HSR implementation (2013–2014) versus the last year observed after adoption (2018 for Australia and 2019 for NZ).
HSR, Health Star Rating; NZ, New Zealand.
Fig 3
Fig 3. Stratified analyses on the change in imputed HSR rating by pretreatment HSR—4.0 to 5.0 (most nutritious), 2.0 to 3.5, and 0.5 to 1.5 (least nutritious).
Regression estimates and 95% CIs displayed. Data used to construct this figure are in S3 Text. CI, confidence interval; HSR, Health Star Rating.
Fig 4
Fig 4. Stratified analyses on the 6 nutrient density outcomes by pretreatment HSR—4.0 to 5.0 (most nutritious), 2.0 to 3.5, and 0.5 to 1.5 (least nutritious).
Regression estimates and 95% CIs displayed. Data used to construct this figure are in S3 Text. CI, confidence interval; HSR, Health Star Rating.
See this image and copyright information in PMC

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