Prepared for EvidenceNetwork.ca by Melanie Meloche-Holubowski
Data indicate several problems related to the dietary habits of Canadians; Canadians are over-consuming snacks, fats and foods not belonging to the basic food groups. According to Health Canada and the Canadian Community Health Survey (2004):
- Half of women and seven in 10 men consume more calories than needed;
- Nearly 25% have fat intakes above the recommended value;
- 78% of Canadians consume too much sodium.
The World Health Organization and Health Canada recommend that individuals reduce their consumption of calories, saturated and trans-fats, sugar and salt in order to reduce food-induced health diseases.
Many health policy experts believe that having comprehensive nutritional information readily available on labels can help consumers make better choices, reduce food intake and have an impact on obesity, and other diet-related diseases (hypertension, diabetes, cardio-vascular diseases).
According to studies, nutrition labels on pre-packaged foods:
- Are a cost-effective population-level health intervention;
- Are relatively inexpensive to implement;
- Give consumers the autonomy to choose what they will eat, while being informed;
- Have considerable reach;
- Are generally perceived as a highly credible source of information.
But many consumers fail to comprehend the nutritional information available, have difficulty comparing similar products and are confused by industry logos and claims.
Modifying current labelling regulations to simplify nutritional information, imposing standardized labelling and nutrition labelling at restaurants are some of the ways public health experts believe will increase consumer understanding and positively affect their nutritional behaviour.
Overview of current regulation in Canada
Since December 2007, pre-packaged foods in Canada are required to display a Nutrition Facts table. The federal governmental website states that “Health Canada establishes the policies, regulations and standards for nutrition labelling on foods, and the Canadian Food Inspection Agency ensures industry compliance.” But Health Canada also indicates that industry bears the responsibility of complying with the regulations and for ensuring the accuracy of label values.
Caloric value and content of 13 nutrients (fat, saturated fat, trans fat, cholesterol, sodium, carbohydrate, fibre, sugars, protein, vitamin A, vitamin C, calcium and iron) must be indicated on all pre-packaged products. Existing regulations are limited to prepackaged food products and do not apply to foods served in restaurants or fast-food outlets. Serving sizes are also not standardized.
Front of packages (FOPs) are not regulated in Canada. Therefore, many companies have created their own health logos or symbols. Even though they are unregulated and not necessarily based on nutritional evidence, health logos or symbols are nevertheless used by 23% of Canadians when making their food choices, according to the Canadian Council of Food and Nutrition.
Canadians who read labels are looking for:
- ingredient information (80%);
- the Nutrition Facts table (71%);
- the serving size (29%).
In 2012, the federal government announced that it would change how the Canadian Food Inspection Agency “monitors and enforces non-health and non-safety labelling regulations.” Many critics have noted, because of budgetary constraints, the CFIA no longer polices nutrition claims on food, rather choosing to use “a web-based label verification tool.”
In 2014, the Canadian government surveyed the population to know how well food labelling was understood and used and asked for suggestions for improvements. Canadian consumers asked for labels that are easier to read (larger and more legible fonts and a consistent appearance), simpler terms, explanations of terms and nutrients and the use of colours. In response to this survey, the federal government is considering making some minor adjustments to the nutrition labels (such as regrouping all sugars to make them more noticeable and changing font sizes).
According to the Tracking Nutrition Trends report from the Canadian Council of Food and Nutrtion, food product labels in Canada were the most common source of nutrition information (67% of respondents), followed by the Internet (51%) and magazines and newspapers (43%). According to the Dietitians of Canada, more than two thirds of Canadians read food labels to help them decide which foods to buy and eat. Food selection based on labels increased significantly in 2006 after mandatory labelling of trans-fat on packaged foods in Canada. Another study pegs label use at 75% in the United States, 82% in New Zealand and 47 % in the European Union.
Source: Canadian Council of Food and Nutrition. Tracking Nutrition Trends: A 20-Year History – August 2009.
Labelling standards around the world
How does Canada compare to other countries around the world?
USA: The government adopted the Nutrition Labelling and Education Act, which took effect in 1994, implementing nutritional labelling on pre-packaged foods. Before this law, 60% of pre-packaged foods carried nutrition labels; 96% did after the law was passed.
European Union: In 2012, the EU adopted new food labelling regulations. Industry has until December 2016 to apply them. Labels (back of package) must provide:
- energy value and the value of six nutrients (fat, saturates, carbohydrate, sugars, protein and salt – in this order);
- all values must be expressed per portion or per 100 g or per 100 ml of product;
- labels must abide by specific presentation guidelines (e.g., font size);
- FOPs labelling remain only partially regulated.
United Kingdom: The UK uses a colour-coded system. Like traffic lights, green, yellow or red colour coding indicate if a product contains a little, some or a lot of a certain nutrient.
World Health Organisation: The Codex Alimentarius offers standards for nutrition labelling, including what nutrients should be listed and specific features regarding presentation.
Simplify and standardizing labelling
According to public health experts, it is important to balance the complexity of information on labels with consumers’ ability to process this information. Labels that are too detailed discourage consumers from seeking out nutritional information, but oversimplified information can lead to consumers being sceptical of this nutritional information.
Studies have reported greater effectiveness with labels that use graphics, color codes and symbols, adjective labels and labels with minimal numerical content. The Institute of Medicine suggests that labels should not require specific or sophisticated nutritional knowledge to understand the meaning; should offer guidance using a scaled or ranked approach; and use readily-remembered names or identifiable symbols. This can help bridge the literacy and numeracy barriers.
For example, in the UK, after colour coding was implemented, supermarkets saw an increase in sales of healthier foods. Participants in a study who read FOPs that had high or low sodium content descriptors were significantly more likely to choose the lower-sodium product.
Also a label that displays the number of minutes a person would need to walk in order to burn off the consumption of that food product, reduced caloric consumption and influenced consumer purchase, shows another study. (The Ontario Medical Association has proposed adding similar advisories on cigarette packages.)
A study from McGill University compared the traditional Nutrition Facts table to light labels and to the NuVal label (a scoring system devised by a team of independant nutrition experts which converts an algorithm of complex nutritional information into a single, easy-to-use score).
Source: Labeling schemes : % Daily Value, Traffic Light, NuVal, and Heart. The effects of nutrition labeling on consumer food choice : a psychological experiment and computational model.
They found that the Nutrition Facts table is ineffective in guiding participants toward nutritious choices. They also found that light labels are more effective than the Nutrition Facts table, but take more time to use and yield only moderate increases in nutrition. Light labels sometimes create decisional conflit (i.e., a product may have less sugar and salt, but may be high in fat).
Fix portion distortion
Nutrition labels that require calculations with respect to nutrient amounts and serving sizes are confusing to many, particularly those with lower education and literacy skills.
One third of Americans do not know what is the recommended daily caloric intake. Another Canadian study shows that less than half of participants could properly identify the number of calories in a beverage after consulting the nutritional labels on a soft-drink bottle. More than 40% of participants who saw a “110 calories per serving” logo or symbol thought this was the number of calories for the entire bottle, when, in fact, it contained several servings).
According to the National Institutes of Health, portion sizes on labels that better reflect what people eat in one sitting can help curb the confusion. These are some suggestions to fix portion distortion:
- Serving sizes should be standardized for different product categories;
- Provide calorie amounts for an entire container or for more realistic portion sizes (no one eats just one cookie);
- Adding total daily caloric intake helps people compare;
- Adjusting the % daily values to better reflect up-to-date recommended values (i.e., for sodium content and sugar content) is recommended by the WHO.
Update nutrition tables with current studies about nutrition
The FDA has recently proposed to update its label regulation (Canadian labels are modeled on the American ones) to better reflect current nutritional data. They proposed:
- Replacing the listing of “Total Carbohydrate” with “Total Carbs” and adding an “Added Sugars” line;
- New labels would include serving sizes that are more realistic of how much people typically eat at one time;
- Reducing the guidelines for daily value for sodium consumption;
- Making font size bigger for calories, total fat, cholesterol, sodium and carbs.
Original vs. Proposed modifications:
Source: U.S. Food and Drug Administration. Proposed Changes to the Nutrition Facts Label.
Better regulate health claims for front of package labels
Certain industry logos or symbols on front-of-packages can lead to confusion and increase caloric intake. In Canada, the multiplication of logos and symbols and point-of-purchase nutrition programs from food companies or organizations (e.g., the Health Check, Blue Menu or Smart Spot) on front-of-packages has made it difficult for consumers to know what criteria is being used in order to obtain that logo or symbol.
In its Engagement Summary Report on Key Issues, the Canadian government admits that it “it is challenging for industry to develop claims, for consumers to understand these claims, and for the CFIA to enforce the rules with consistency and predictability.” Instead of having multiple logos based on different nutrition programs that are created by the food or non-profit industries, having shared nutrition programs and logos or symbols that use the same criteria could facilitate consistent food product comparisons.
According to the WHO, only health claims that are consistent with a country’s nutrition policy should be allowed. The U.S. Institute of Medicine, as well as the WHO, call for a single, standardized and universal FOPS: Information on FOPs should be consistent with the nutrition table at the back of the package. Imposing stricter guidelines for labelling would also increase consumer awareness and in turn, encourage the food industry to improve the quality and content of their products.
Labelling on menus in restaurants
More people are eating out, and in most places, nutrition labelling on menus is not required. According to the 2004 Canadian Community Survey, a quarter of Canadians had, during the previous day, consumed food prepared in a fast-food restaurant. In the U.S., 34 % of calories are consumed outside the home.
A 2008 survey found that only 22% of people report looking for nutrition information when eating out. Less than 1% of consumers seek out nutritional value of restaurant food if it is not readily available and people consistently underestimate the calories in restaurant meals, sometimes by up to 900 calories. Even registered dietitians underestimated calories by 200 to 600 calories.
According to some public health and medical groups, mandatory display of nutrition information on menus and menu boards of food outlets can:
- increase nutrition awareness;
- lead to fewer calories consumed;
- change consumer purchasing decisions and encourage restaurants to change the content of their food, thereby reducing the amount of calories consumed.
In one study, when labels are available on menus in restaurants, 10% of clients reduce their caloric intake by 100 calories per meal ordered. In another study in the U.S., participants who viewed calorie labels on restaurant foods consumed 14% fewer calories (between 124 and 203 calories) per meal than the participants who did not have access to calorie labels.
In the U.S., restaurants with 20 or more locations are required to post calories and a daily calorie intake statement on menus and menu boards, including boards at drive through service. Vending machine operators with more than 20 machines must also post calories on or next to the machines. In November 2014, Ontario introduced menu labelling legislation. If passed, all restaurants, convenience stores and grocery outlets with more than 20 locations would be required to post calories on menus and menu boards.
Criticism of imposing standardized labelling
Critics of proposed labelling changes suggest it would cost the food industry excessive amounts of money to implement. However, according to a study by Agriculture and AgriFood Canada, when the Nutrition Facts table was added to all prepackaged foods in Canada, the cost was approximately C$263 million over three years compared to food sales revenues that were estimated at C$120 billion for the same period. Analyzing the food content would represent less than 0.1% of sales revenues (and most already have the information).
For restaurants, it would cost 220$US per menu item to add nutrition information. However, the cost would be higher for smaller restaurants.
Some critics believe mandatory labelling will possibly help motivated consumers in making healthier choices, but does have its limits. Some people might continue to ignore the information, for various reasons: lack of time, purchasing habit or the price of food. Also, nutrition labels do not necessarily prevent the excessive consumption of calories.
Concerned about the impact on food sales, several organizations from the American food industry, (the American Bakers Association, American Beverage Association, American Frozen Foods Institute, Corn Refiners Association, International Dairy Foods Association and National Confectioners Association) wrote to the FDA in 2014 demanding more research before updating nutritional labels. They claim that nutrition label regulations that are too rigid may have a negative impact on the sale of certain products.
The Dairy Farmers of Canada are equally concerned; they believe that stricter FOP labelling that rates foods based on certain nutrients rather than the food as a whole, can decrease the perceived healthiness of foods. For example, consumers might avoid certain foods, like cheese, milk or eggs if the label indicates a higher amount of fat.
Experts available for interview
Denis Daneman, MBBCh FRCPC DSc(Med)(Wits)
University of Toronto
Chronic Disease and Social Determinants of Child Health
416 813-6122 | email@example.com
Yoni Freedhoff, MD
University of Ottawa
Nutrition, Obesity, Weight Management
613-730-0264 | firstname.lastname@example.org | @YoniFreedhoff
Michael Hayes, PhD
University of Victoria
Health inequities, disability and child obesity
250 853 3108 or (c) 250 818 2410 | email@example.com
Jennifer Kuk, PhD
School of Kinesiology and Health Science
Weight Management, Health Promotion, Lifestyle Interventions
416-736-2100 ext 20080 | firstname.lastname@example.org
John Millar, MD, FRCP(C), MHSc
University of British Columbia
Public Health, Health Policy, International Health
604-922-0995 or (c) 604-785-9058 | email@example.com | @JohnMillar10
Kim Raine, PhD, RD, FCAHS
University of Alberta
Social Factors and Interventions in Obesity and Food
780-492-9415 | firstname.lastname@example.org
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