An assessment of nutrition information on front of pack labels and healthiness of foods in the United Kingdom retail market

Research has shown an increase in the level of diet-related non-communicable diseases (NCDs) such as obesity, overweight, type 2 diabetes and cardiovascular disease. Although these diseases have been common in high-income countries since the end of the twentieth century, recently developing countries are beginning to face similar threats owing to increased consumption of highly processed and energy-dense foods [1‐6]. In a document published by the World Health Organization (WHO), total global deaths attributed to NCDs was 78% [7]; this high incidence of NCDs has initiated efforts by the WHO and Food Standards Agency (FSA) to reduce the global health effects of NCDs by 2030 [8, 9].

Nutritional labelling is used as a tool to inform the general public about the healthiness of foods, protect consumers against unsafe foods and prevent manufacturers from making false, deceptive and misleading claims [10, 11]. Nutrition labels can either be on the back of pack (BOP) or front of a pack (FOP). In BOP labels, energy (in kJ or kcal) and the amounts of fat, saturated fat, carbohydrates, sugars, protein and salt (in g) are indicated. BOP was the most prevalent and mandatory label format worldwide in 2014 [11, 12].

The FOP traffic-light (TL) system that was recommended by the UK government for healthier food choices identifies four nutrients in addition to energy values. It categorises foods key nutrient contents as ‘low’, ‘medium’ and ‘high’, represented with green, amber or red, respectively. Moreover, the Guideline Daily Amounts (GDA), which is also referred to as Reference Intake (RI),¹ presents the recommended number of calories, fat, saturated fat, sugar or salt per day that an average individual should consume, beyond which the consumption may have an adverse effect on health. In the TL system, the United Kingdom’s FSA postulated standards for categorising foods according to nutrient levels per 100 g or 100 ml as shown in Table 1a and b [13, 14]. The criteria² were proposed as a standard in agreement with government agencies in England, Scotland, Wales and Northern Ireland. This was implemented owing to an increase in the reported incidence of diet related NCDs [14]. Grunert et al. [15], Stones [16] and Hodgkins [17] highlighted that the UK’s use of FOP was the highest in Europe.

This study assesses the frequency of usage of colour coded TL, GDA, a hybrid of colour coded TL and GDA (HYD), and HL food rating systems on food products in the UK grocery market. The study also measures the healthiness of some foods in the online UK market by categorising them into ‘low’, ‘medium’ and ‘high’ according to their nutrient profiles based on the FSA’s recommendation on their salt, sugar and fat thresholds. These categories reflect the level of healthiness of the assessed food products.

The nutrient profiles of 500 foods comprising five categories, (1) cereals and cereal products, (2) dairy products, (3) beverages, (4) packaged meats and meat products, and (5) pre-packaged fruits and vegetables were obtained from three of the ‘Big Four’ supermarkets with the highest grocery market share in the UK between August 2012 and August 2019 [18]. These categories were selected according to the classifications based on food industry ingredients [19], retailers` categories [20] and household usage [21]. Non-packaged or ‘loose’ meat, fruits and vegetables were not included because preference was given to products with either FOP and or BOP label. The selection of the products was not based on brand or manufacturer’s name, price, name of product nor perceived healthiness of the product by the researcher.

The retail market was chosen because of the recommendations of Rayner et al. [22] that not many studies have been done by exploring food retailers’ websites. The authors emphasised that it is important for researchers to monitor the components of different labelling formats in the retail market and their likelihood in affecting health-related food choices. Similar to Rayner et al. [22] recommendation, Stones [16] also reiterated the significance of studying the use of nutrition labels in an online food environment, due to the increase in online shopping and the prevalence of diet-related illnesses across the globe.

Assessments were carried out on fat, saturated fat, sugar and salt, which are the four most declared nutrients on FOP nutrition labels. The following information for each product was included in an excel spreadsheet: country of origin, serving/preparation instructions, declaration of allergens, type of labelling tool used, BOP nutrient amounts, health and nutrition claims, product weight, expiry dates (use by date and/or best before date), storage information, description of the product or the statement of identity and dietary information provided by the manufacturer. The data obtained were sorted by the excel spreadsheet ‘sort and filter’ tool and organised for easy categorisation when necessary.

Of the 500 products that were assessed, 346 (69.2%) were produced in the UK. As shown in Table 2, the country of origin of 14 (2.8%) food products were not specified, nine (1.8%) were said to be made in the EU and no specific country was declared on five (1.0%) products. The country with the highest number of imported foods from outside Europe is the United States, with 21 (4.2%) food products. Products from the UK were represented by 26.0% meat and meat products, 19.6% of the beverages, 19.4% of the dairy products, 18.5% of the breakfast cereals and 16.5% of the fruits and vegetables.

It was found that 97.1% of the foods that were made in the UK had either one of colour coded TL label, GDA or RIs, Health Logo (HL), declared nutrition information (BOP) or a combination of these, and 48.8% of the assessed UK foods had hybrid (HYD) labels. Only 2.3% of the total foods manufactured in the UK had health logos. Most of the imported foods from the US (3.8%), Italy (2.2%), France (2%), Spain (1.8%), Netherlands (1.6%) and New Zealand (1.4%) had either colour coded TL, GDA or a combination of both. The TL colour coded labelling format was specific to UK manufactured foods, for example, only one of the twenty-one foods from the US had a colour coded TL label.

All breakfast cereals and dairy products stated fat, saturated fat, sugar and salt, 1.0% of the meat products did not state the fat content, and 2.0% of the meat products did not have saturated fat, sugar and salt content declared (Table 3). The declarations of the key four nutrients are presented in Tables 3 and 4. Fat, saturated fat, sugar and salt were not stated on 36.0% of the labels of the beverages (hot drinks, fizzy drinks, wines, gins and confectionery such as cocoa drinks). In addition, 33.2% of the foods did not have TL, GDAs nor nutrition table or grid, which were either absent or not visible to online shoppers.

Moreover, 36.0% of the beverages did not have these four nutrients, this may be as a result of voluntary declaration of these nutrients on beverages according to Articles 16(4) and 44(1)(b) Annex (V) of the (EU) 1169/2011 regulation [29] on food labelling. In this regulation, exemptions for declaration of these nutrients are given to beverages such as whole or milled coffee beans, single ingredient products, fruit infusions, tea, fermented vinegars and beverages with more than 1.2% v/v alcohol.

The categorisation of food products based on the amount of their nutrients are presented in Table 5. As it can be observed in Table 5, out of the total foods assessed, 15.6% were high in fat, 21.4% were ‘high’ in saturated fat, 14.2% were high in sugar and 5.8% were high in salt, which renders them least healthy. Only 16% of the meat and meat products randomly sampled were high in fat and 38% were high in saturated fat.

Some of the dairy products sampled had the greatest proportion of products with high fat and saturated fat. The dairy products assessed include milk of various types such as whole milk, skimmed milk and buttermilk, yoghurt, cheese and ice-cream. These had the highest amounts of nutrients, 36.0% high in fat, 40.0% high in saturated fat, 10.0% high in sugar and 12.0% high in salt. Of the assessed breakfast cereals, 16.0% was high in fat, 18.0% high in saturated fat, 35.0% high in sugar and 5.0% high in salt.

Also, in the breakfast cereals category, 61.0% of the products had the amount of fat that fall into the medium category (Table 6), 24.0% had medium saturated fat, 48.0% had medium sugar and 46.0% had medium salt content. The meats assessed had the highest number of products with medium nutrients. Among these, 73.0% of meats had medium fat, 45.0% had medium saturated fat, 5.0% medium sugar and 44.0% of the products had medium salt. In contrast, beverages had the lowest number of products with ‘medium’ nutrients. Only 3.0% had medium fat, 1.0% medium saturated fat, 32.0% medium sugar and 6.0% medium salt. When all the products were considered, 37.2% had a medium amount of fat, 22.0% medium saturated fat, 33.8% medium sugar and 25.2% medium salt content.

Among the 500 foods assessed, 41.4% had low fat, 48.6% had low saturated fats, 44.4% had low sugar and 52.0% had low salt levels (Table 7). The breakfast cereals have the least number of the overall products with low amount of sugar (7.7%), 9.5% were beverages, 19.8% were dairy products and 41.8% were meats. Higher number of dairy products (15.0%) were found to contain low fat when the numbers with low nutrients was compared. Only 11.1% of the products in the cereal category had low fat, however 23.9% of the cereal products had low saturated fat as compared to 11.1% of the dairy products. Higher number of products in the cereal category (18.6%) were found to have low salt content than the 16.2% in meats and 9.6% of the dairy products.

TL and GDA were the most used FOP labelling formats on the assessed food products in the UK retail market. The use of colour in TL and table or grid in GDA are easy to understand and could provide consumers with at-a-glance information of the products which they intend to buy during shopping. In the times of outbreak of diseases where physical contact is restricted, such as the recent Covid-19 pandemic when people are encouraged to shop online; or even when shopping in store, these FOP formats could help consumers to reduce the time they spend to read the labels before making decisions on the foods they buy. Incorporating these formats on all food products may be a good initiative to improve public health nutrition. The risks of many diet-related illnesses may be reduced if consumers use of the FOP labelling to make informed decisions to purchase healthier foods. Adopting the use of FOP nutrition labelling formats such as the UK government’s TL and HL systems, may particularly be helpful to tackle the reported increase of diet-related illnesses in low- and medium-income countries.

Our study found out that a higher number of assessed products belonged to the “moderately healthy” and “healthier” categories than the “least healthy”. This could suggest that food manufacturers are now responding to the trends that are driven by the public’s demand for the wider availability of healthier foods.

The imported foods that were found in the UK retail market also showed that food choices could be made from the diverse food types in the grocery markets. If more widespread use of a front of pack label that is going to be valid across the countries is planned for the future, more attention should be given to how information is disseminated on the label, and the use of easy-to-understand unilateral labelling format that uses colour should be encouraged.