Introduction
Overweight and obesity are widespread in the European Union (EU). In its 2010 Implementation progress report about the “Strategy for Europe on Nutrition, Overweight and Obesity related health issues (2007–2013)”, the European Commission reports 30–70 % of EU adults to be overweight and 10–30 % obese [
1]. As obesity is a condition of multifactorial origin, preventative measures need to consider various dimensions including individual, societal, economic, and environmental aspects. In this context, the “Strategy” identified consumer information as one of four priority areas for which it aims to provide guidance for action to EU Member States [
1]. The 2004 Global Strategy on Diet, Physical Activity and Health by the World Health Organization listed nutrition labeling as an important means to meet the consumers’ requirement for “accurate, standardized and comprehensible information on the content of food items in order to make healthy choices” [
2]. Likewise, the Organization for Economic Co-operation and Development (OECD) views nutrition labeling as “a main tool for preventing increasing rates of obesity and unhealthy diets in OECD countries” [
3]. European public health professionals and other stakeholders appear to agree that (mandatory) nutrition labeling is one of the more important policy options for obesity prevention, but food and health education were also considered relevant [
4]. This is supported by research showing that consumers report that they value the on-pack provision of nutrition information [
5].
Although a new mandatory nutrition labeling legislation was adopted in December 2011 [
6], any existing European studies into the role nutrition labeling could play in helping people choose healthful, balanced diets, were carried out on the backdrop of voluntary nutrition labeling. Only in the presence of a nutrition claim did nutrition labeling become mandatory in the EU, as laid down in Directive 90/496/EC of 1990 [
7] and Directive 2000/13/EC of 2000 [
8]. Depending on the claim, either the “big 4” (energy, protein, carbohydrate, and fat) or the “big 8” (“big 4” plus sugar, saturated fat, fiber, and sodium) had to be stated. An audit of the penetration of nutrition information on food and drink labels in the EU plus Turkey, carried out in 2008/2009, showed that the basic nutrition table was present (back-of-pack) on 84 % of over 37,000 products from five predefined food and drink categories (sweet biscuits, breakfast cereals, carbonated soft drinks, chilled fresh ready meals, yogurts) [
9]. Penetration was lowest in Slovenia at 68 % and highest in the United Kingdom (UK) and Ireland at 97 %. There was an uneven split between “big 8” and “big 4” across countries, with the UK most often providing the “big 8” (94 % of all products audited), and Turkey least often (19 %). The average split was 49 % “big 8” and 34 % “big 4” (not summing up to 84 % due to rounding errors).
Dietary energy intake and physical activity are the most immediate contributors to energy balance. In case of sustained positive energy balance (ie, when more calories are being consumed than expended), overweight and obesity ensue. As energy (usually given in kJ and kcal per 100 g [mL]) is commonly one of the core information items in nutrition labeling, the above figures give an idea of the availability of dietary energy labeling on prepackaged food and drink products in Europe. Much less effort has gone into nutrition labeling outside the supermarket setting. In early 2006, McDonald’s introduced Guideline Daily Amount (GDA) labeling (energy, protein, fat, carbohydrates, and salt) on product packages in Italy in conjunction with the Olympic Winter Games held in Turin, followed by a rollout across Europe and the rest of the world in the months thereafter [
10]. As concerns governmental action, the most prominent example appears to be the UK, where the national Department of Health in early 2011 initiated a Public Health Responsibility Deal [
11]. Amongst others, the deal includes a pledge for out-of-home calorie labeling, “asking catering businesses, who sell food in out of home settings, to provide calorie information for customers on menus or menu boards, to help people make healthier choices” [
11]. By early March 2012, 45 business partners had signed the pledge, 38 of them having submitted concrete delivery plans. First monitoring results were announced for April 2012, to be followed by annual reports every April thereafter.
Regardless of these efforts to make energy (calorie) information ubiquitous, the main question is whether people use this information when shopping for food or eating out, and with what outcome. Moreover, it is fair to assume that consumers need to know their energy requirements to make appropriate dietary choices based on the energy information provided. Two pan-European surveys [
12,
13] indicated that while a majority of consumers know experts recommend to consume less calories, they were less certain about daily energy requirements for the average female (2000 kcal) and male (2,500 kcal). Knowledge about differences in calorie needs for men versus women and younger versus older adults was reasonably good, but over a third of respondents (over half in Poland) thought incorrectly children needed more calories than an adult man [
13].
In their systematic review, Campos et al. [
14] highlight that a number of studies have shown consumers to be struggling with quantitative nutrition label information. This was especially true for certain patient groups (diabetics, chronic kidney disease), older adults, adolescents, infrequent label users, and those with lower education levels, but appeared to be amenable to change through educational efforts targeted at label knowledge and understanding.
The need for simplicity was demonstrated by van Kleef et al. [
15] who tested different front-of-pack energy signposts with consumer focus groups in the UK, Germany, The Netherlands, and France. Among the formats–from basic calorie labels to complex schemes including daily reference values and information about how much physical activity would balance out the stated calories–the simplest format was liked best. The more complex the scheme became, the less it was liked, and this effect was substantially more pronounced in German respondents compared to the other three countries.
To the best of our knowledge, research causally linking nutrition labeling with total energy intake over time, and corresponding changes in body weight, is lacking. A large part of the research into nutrition labeling stems from North America (the United States in particular), with comparatively little evidence from Europe [
14]. The studies discussed below have looked at the potential of nutrition labeling to guide Europeans toward more healthful diets, mainly characterized by products lower in fat, saturated fat, sugar, or salt. As most of these key nutrients also provide calories, reduced dietary intakes thereof may be considered a proxy for lower energy intakes.
What is Required to Make Nutrition Labeling More Helpful and Relevant to European Consumers?
In general, the influence of nutrition labeling on food purchasing decisions is weak, especially when compared to other factors such as taste, price, use by-date, brand, convenience, and family preferences [
22‐
24,
30,
41]. However, addressing a few barriers identified by FLABEL and other researchers could help optimize nutrition label use and thus its impact on dietary intakes.
While nutrition labels are already widely available [
9], complete penetration on food and drinks products is considered helpful [
30,
31•,
32,
33,
34•,
35‐
39]. Consistent label format and positioning emerged as important factors for easy and quick access [
39,
40•]. A previous representative survey involving six European countries showed that consumers can use different labeling systems similarly successfully to identify the most healthful option out of a choice of three ready meals/pizzas [
25••]. This and other research [
22,
23,
26] suggest it does not matter so much which system is used on product packages, as long as it is presented in the same format and place on all products. The provision of multiple systems should be avoided as it may cause consumer confusion and frustration [
23,
42]. Consistency, especially if supported by promotional and education campaigns, should aid familiarity with the nutrition labeling system, which in turn may enhance actual use [
43].
Consumers’ attention and motivation remain major barriers to using nutrition labels [
25••,
44•], thus limiting any potential impact on health. Eye-tracking research measuring how long consumers look at nutrition labels indicated a time span of 25–100 ms regardless of the system used [
30]. This period is far too short for any conscious processing of the information. However, the presence of a health logo can slightly improve attention to the nutrition label [
40•], which may be considered relevant within the (fairly) common condition of shopping under time pressure.
Actively seeking out nutrition information requires a certain level of motivation. Such motivation could derive from the presence of a diet-related disease (eg, type 2 diabetes, hypertension), which would make nutrition information more personally relevant. Research shows that consumers with a health goal in mind are more likely to pay attention to and use nutrition labels [
32,
44•,
45]. The opposite was observed when consumers followed their own preferences or were given a hedonic goal.
Beyond the Nutrition Label
Low income and lack of time may be major barriers to buying more basic and healthful foods; providing more information–in the form of nutrition labeling–will increase neither of these two [
14,
24,
46]. Furthermore, nutrition labels are more likely to be read by those who have an interest in healthy eating, show better nutrition knowledge, and thus may display healthier eating patterns already [
14,
25••]. In this context, findings from FLABEL [
30] and others [
32] indicate that expanding a given food/drink category by adding more healthful products can improve overall healthfulness of actual choice by the consumer. Nutrition labels, especially health logos, are seen as a potential driver for product reformulation in an attempt to meet eligibility criteria [
17,
26,
30,
47]. Furthermore, Barreiro-Hurlé et al. [
48] noted that clear and truthful nutrition and health claims may reach out to those who are less likely to read nutrition labels, such as people with lower nutrition knowledge or more hedonic lifestyles.
Conclusions
Nutrition labeling is considered a relevant component of public health policies attempting to stem the obesity epidemic in Europe. Scientific evidence to prove its actual use by consumers and the resulting impact on dietary energy intake, body weight, and health remains largely absent. Allison [
49••] rightfully stated that “[i]f we are to understand the value of any macro-environmental manipulation intended to reduce obesity levels, we must eventually measure body weight, fat, or obesity levels”.
While consumers like to see nutrition information on food and drink packages and appear able to use any labeling scheme to choose more healthful options out of a limited choice set under experimental conditions, they pay little attention to nutrition labels in real life. This lack of attention is partly driven by a lack of motivation, but the grander scheme suggests that price, taste, convenience, and shopping habits are simply far more important than nutrition information when making food purchasing decisions. Shopping under time pressure–a common phenomenon among today’s consumers–further impedes nutrition label use for healthy food shopping.
The new EU food information regulation, which makes nutrition labeling mandatory, provides an opportunity for monitoring the impact of this policy on public health. However, simply providing such information will not be enough to justify expectations for a (positive) change in people’s dietary habits. Instructive educational campaigns are required that raise awareness, understanding, and the motivation to use nutrition labels, taking into account the diverse needs of the European consumers.
Authors’ Note
After several years of negotiation, the European Commission in December 2011 made nutrition labeling mandatory on food and drink products. With a few exemptions, manufacturers must disclose information on the package about energy and six nutrients; total fat, saturated fat (saturates), carbohydrates, sugars, protein, and salt–in this order, and expressed per 100 g (mL) of product [
6]. This information should be presented in the same field of vision, usually on the back of the pack, and may in addition be expressed on a per portion basis. Manufacturers who already provided nutrition information in the past must comply with the new regulation by December 2014, whereas those who have yet to introduce nutrition labeling on their products are given until December 2016.
Front-of-pack labeling remains voluntary under the new regulation, yet if information is repeated on the front of the pack, specific rules apply. Front-of-pack information can be the content of energy alone or in combination with fat, saturates, sugar, and salt. Energy can be presented per 100 g (mL) alone or additionally expressed per portion. The new regulation maintains the requirement to display energy in both kilojoules (kJ) and kilocalories (kcal) (there are 4.2 kJ in each kcal). When this information is declared for a portion or unit (eg, amount per biscuit), the size of a portion/unit must also be indicated, in conjunction with the number of portions or units contained in the package.