Knowledge, attitude, and practice of consumers towards “Front of Package Label” (FOPL) on food packages regarding nutrition in India

Arpit Chelabhai Prajapati; Dr Himadri Patel; Dr Mansi Patel; Dr. Sahilkumari Chaudhary; Rajvee Soni; Saloni Soni; Vidhi Wadhwani

doi:10.31101/jhes.3175

Authors

Arpit Chelabhai Prajapati GCS Medical College, Hospital and Research Centre, Ahmedabad, India https://orcid.org/0000-0002-4944-2876
Dr Himadri Patel GCS Medical College, Hospital and Research Centre, India
Dr Mansi Patel Ananya College of Medicine & Research, India
Dr. Sahilkumari Chaudhary GCS Medical College, Hospital and Research Centre, India
Rajvee Soni GCS Medical College, Hospital and Research Centre, India
Saloni Soni GCS Medical College, Hospital and Research Centre, India
Vidhi Wadhwani GCS Medical College, Hospital and Research Centre, India

DOI:

https://doi.org/10.31101/jhes.3175

Keywords:

front of package labeling; food package; knowledge; nutrition

Abstract

Food labels give information about the elements of the food and can help people make healthy diet choices. Food labels are potential tools for improving the dietary patterns of populations and could change dietary behavior. The aims of this study were to assess the knowledge and attitude of consumers related to FOPL, evaluate the practices of consumers regarding FOPL, and identify consumers' purchasing preferences for packaged food. A cross-sectional study was conducted at selected supermarkets in Gandhinagar city using a convenient sampling method. A total of 500 participants were selected from 4 supermarkets (125 participants were selected from each supermarket). Exit interviews were done through pretested, semi-structured questionnaires. Out of 500 participants, 79% read food labels, but only 15% knew about FOPL. 88.2% of people noticed manufacturing and expiration dates on packaged food. Only 50% of the participants thought that FOPL contained nutritional information. 49.4% knew that FOPL was present on the front side of package food. 90% of people consume Namkeen food as packaged food. 59.4% thought that FOPL helped them choose healthier food, and 73% thought it should be mandatory on all food packages. Education level is significantly related to knowledge and information on the FOPL (P = 0.0001). Education programmes about nutrition labeling and how to read nutrition labels properly must be done to increase consumers' awareness, knowledge, and understanding of the importance of nutrition labeling information. It can be an effective means of helping consumers make healthier food choices and prevent NCDs.

Author Biographies

Arpit Chelabhai Prajapati, GCS Medical College, Hospital and Research Centre, Ahmedabad

Professor, Community Medicine Department

Dr Himadri Patel, GCS Medical College, Hospital and Research Centre

1st Year Resident, Community Medicine Department

Dr Mansi Patel, Ananya College of Medicine & Research

Associate Professor

Dr. Sahilkumari Chaudhary, GCS Medical College, Hospital and Research Centre

1st Year Resident, Community Medicine Department

Rajvee Soni, GCS Medical College, Hospital and Research Centre

2ndÂ year MBBS student

Saloni Soni, GCS Medical College, Hospital and Research Centre

2ndÂ year MBBS student

Vidhi Wadhwani, GCS Medical College, Hospital and Research Centre

2ndÂ year MBBS student

References

Arrúa, A., Curutchet, M. R., Rey, N., Barreto, P., Golovchenko, N., Sellanes, A., Velazco, G., Winokur, M., Giménez, A., & Ares, G. (2017). Impact of front-of-pack nutrition information and label design on children’s choice of two snack foods: Comparison of warnings and the traffic-light system. Appetite, 116, 139–146. https://doi.org/10.1016/j.appet.2017.04.012

Bablani, L., Mhurchu, C. N., Neal, B., Skeels, C. L., Staub, K. E., & Blakely, T. (2020). The impact of voluntary front-of-pack nutrition labeling on packaged food reformulation: A difference-in-differences analysis of the Australasian Health Star Rating scheme. PLOS Medicine, 17(11), e1003427. https://doi.org/10.1371/journal.pmed.1003427

Becker, M. W., Bello, N. M., Sundar, R. P., Peltier, C., & Bix, L. (2015). Front-of-pack labels enhance attention to nutrition information in novel and commercial brands. Food Policy, 56, 76–86. https://doi.org/10.1016/j.foodpol.2015.08.001

Bennett, J. E., Stevens, G. A., Mathers, C. D., Bonita, R., Rehm, J., Kruk, M. E., Riley, L. M., Dain, K., Kengne, A. P., Chalkidou, K., Beagley, J., Kishore, S. P., Chen, W., Saxena, S., Bettcher, D. W., Grove, J. T., Beaglehole, R., & Ezzati, M. (2018). NCD Countdown 2030: Worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. The Lancet, 392(10152), 1072–1088. https://doi.org/10.1016/S0140-6736(18)31992-5

Bhattacharya, S., Bera, O. P., & Shah, V. (2022). Consumers’ Perception About Front of Package Food Labels (FOPL) in India: A Survey of 14 States. Frontiers in Public Health, 10. https://www.frontiersin.org/articles/10.3389/fpubh.2022.936802

Campos-Nonato, I., Cervantes-Armenta, M. A., Pacheco-Miranda, S., Quezada-Sánchez, A. D., Contreras-Manzano, A., Barquera, S., & Vargas-Meza, J. (2022). Perception and Understanding of Guideline Daily Amount and Warning Labeling among Mexican Adults during the Law Modification Period. Nutrients, 14(16), 3403. https://doi.org/10.3390/nu14163403

Carlson, D. L., Miller, A. J., & Sassler, S. (2018). Stalled for Whom? Change in the Division of Particular Housework Tasks and Their Consequences for Middle- to Low-Income Couples. Socius, 4, 2378023118765867. https://doi.org/10.1177/2378023118765867

CDC. (2022, September 20). Food Labels. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/eat-well/food-labels.html

Champagne, B., Arora, M., ElSayed, A., Løgstrup, S., Naidoo, P., Shilton, T., Vaca McGhie, D., Armstrong-Walenczak, K., Berteletti, F., Ganesan, S., & Popkin, B. (2020). World Heart Federation Policy Brief: Front-Of-Pack Labeling: Unhealthy Changes in the Global Food System. Global Heart, 15(1), 70. https://doi.org/10.5334/gh.935

Chopera, P., Chagwena, D., & Mushonga, N. (2014). Food label reading and understanding in parts of rural and urban Zimbabwe. African Health Sciences, 14(3), 576–584. https://doi.org/10.4314/ahs.v14i3.12

Cui, J., Yan, R., Astell-Burt, T., Gong, E., Zheng, L., Li, X., Zhang, J., Xiang, L., Ye, L., Hu, Y., Tang, Y., Gao, C., Xiao, L., Jiang, Y., Shao, R., Feng, X., Zhang, J., & Yang, Y. (2022). Types and Aspects of Front-of-Package Labeling Preferred by Parents: Insights for Policy Making in China. Nutrients, 14(4), Article 4. https://doi.org/10.3390/nu14040800

De la Cruz-Góngora, V., Torres, P., Contreras-Manzano, A., Jáuregui de la Mota, A., Mundo-Rosas, V., Villalpando, S., & Rodríguez-Oliveros, G. (2017). Understanding and acceptability by Hispanic consumers of four front-of-pack food labels. The International Journal of Behavioral Nutrition and Physical Activity, 14(1), 28. https://doi.org/10.1186/s12966-017-0482-2

Ducrot, P., Méjean, C., Julia, C., Kesse-Guyot, E., Touvier, M., Fezeu, L., Hercberg, S., & Péneau, S. (2015). Effectiveness of Front-Of-Pack Nutrition Labels in French Adults: Results from the NutriNet-Santé Cohort Study. PloS One, 10(10), e0140898. https://doi.org/10.1371/journal.pone.0140898

Egnell, M., Ducrot, P., Touvier, M., Allès, B., Hercberg, S., Kesse-Guyot, E., & Julia, C. (2018). Objective understanding of Nutri-Score Front-Of-Package nutrition label according to individual characteristics of subjects: Comparisons with other format labels. PLOS ONE, 13(8), e0202095. https://doi.org/10.1371/journal.pone.0202095

Elizabeth, L., Machado, P., Zinöcker, M., Baker, P., & Lawrence, M. (2020). Ultra-Processed Foods and Health Outcomes: A Narrative Review. Nutrients, 12(7), 1955. https://doi.org/10.3390/nu12071955

Fiolet, T., Srour, B., Sellem, L., Kesse-Guyot, E., Allès, B., Méjean, C., Deschasaux, M., Fassier, P., Latino-Martel, P., Beslay, M., Hercberg, S., Lavalette, C., Monteiro, C. A., Julia, C., & Touvier, M. (2018). Consumption of ultra-processed foods and cancer risk: Results from NutriNet-Santé prospective cohort. BMJ, 360, k322. https://doi.org/10.1136/bmj.k322

Flagg, L. A., Sen, B., Kilgore, M., & Locher, J. L. (2014). The influence of gender, age, education, and household size on meal preparation and food shopping responsibilities. Public Health Nutrition, 17(9), 2061–2070. https://doi.org/10.1017/S1368980013002267

GBD 2017 Diet Collaborators. (2019). Health effects of dietary risks in 195 countries, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England), 393(10184), 1958–1972. https://doi.org/10.1016/S0140-6736(19)30041-8

Goyal, R., & Deshmukh, N. (2018). Food label reading: Read before you eat. Journal of Education and Health Promotion, 7, 56. https://doi.org/10.4103/jehp.jehp_35_17

Hafner, E., & Pravst, I. (2023). Comparison of Nutri-Score and Health Star Rating Nutrient Profiling Models Using Large Branded Foods Composition Database and Sales Data. International Journal of Environmental Research and Public Health, 20(5), Article 5. https://doi.org/10.3390/ijerph20053980

Hamlin, R., & McNeill, L. (2018). The Impact of the Australasian ‘Health Star Rating’, Front-of-Pack Nutritional Label, on Consumer Choice: A Longitudinal Study. Nutrients, 10(7), 906. https://doi.org/10.3390/nu10070906

Jáuregui, A., Vargas-Meza, J., Nieto, C., Contreras-Manzano, A., Alejandro, N. Z., Tolentino-Mayo, L., Hall, M. G., & Barquera, S. (2020). Impact of front-of-pack nutrition labels on consumer purchasing intentions: A randomized experiment in low- and middle-income Mexican adults. BMC Public Health, 20(1), 463. https://doi.org/10.1186/s12889-020-08549-0

Jones, A., Neal, B., Reeve, B., Mhurchu, C. N., & Thow, A. M. (2019). Front-of-pack nutrition labeling to promote healthier diets: Current practice and opportunities to strengthen regulation worldwide. BMJ Global Health, 4(6), e001882. https://doi.org/10.1136/bmjgh-2019-001882

Juul, F., Martinez-Steele, E., Parekh, N., Monteiro, C. A., & Chang, V. W. (2018). Ultra-processed food consumption and excess weight among US adults. The British Journal of Nutrition, 120(1), 90–100. https://doi.org/10.1017/S0007114518001046

Kaur, S., & Singh, D. A. (2020). Assessment Of Knowledge, Attitude And Practice (Kap) Vis-A-Vis Food Labels. PUSA Journal of Hospitality and Applied Sciences, 6, 58–71.

Khandpur, N., Mais, L. A., de Morais Sato, P., Martins, A. P. B., Spinillo, C. G., Rojas, C. F. U., Garcia, M. T., & Jaime, P. C. (2019). Choosing a front-of-package warning label for Brazil: A randomized, controlled comparison of three different label designs. Food Research International (Ottawa, Ont.), 121, 854–861. https://doi.org/10.1016/j.foodres.2019.01.008

Khandpur, N., Sato, P. de M., Mais, L. A., Martins, A. P. B., Spinillo, C. G., Garcia, M. T., Rojas, C. F. U., & Jaime, P. C. (2018). Are Front-of-Package Warning Labels More Effective at Communicating Nutrition Information than Traffic-Light Labels? A Randomized Controlled Experiment in a Brazilian Sample. Nutrients, 10(6), 688. https://doi.org/10.3390/nu10060688

Lane, M. M., Davis, J. A., Beattie, S., Gómez-Donoso, C., Loughman, A., O’Neil, A., Jacka, F., Berk, M., Page, R., Marx, W., & Rocks, T. (2021). Ultraprocessed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies. Obesity Reviews, 22(3), e13146. https://doi.org/10.1111/obr.13146

Law, C., Green, R., Kadiyala, S., Shankar, B., Knai, C., Brown, K. A., Dangour, A. D., & Cornelsen, L. (2019). Purchase trends of processed foods and beverages in urban India. Global Food Security, 23, 191–204. https://doi.org/10.1016/j.gfs.2019.05.007

Menon, G. R., Singh, L., Sharma, P., Yadav, P., Sharma, S., Kalaskar, S., Singh, H., Adinarayanan, S., Joshua, V., Kulothungan, V., Yadav, J., Watson, L. K., Fadel, S. A., Suraweera, W., Rao, M. V. V., Dhaliwal, R. S., Begum, R., Sati, P., Jamison, D. T., & Jha, P. (2019). National Burden Estimates of healthy life lost in India, 2017: An analysis using direct mortality data and indirect disability data. The Lancet Global Health, 7(12), e1675–e1684. https://doi.org/10.1016/S2214-109X(19)30451-6

Micha, R., Shulkin, M. L., Peñalvo, J. L., Khatibzadeh, S., Singh, G. M., Rao, M., Fahimi, S., Powles, J., & Mozaffarian, D. (2017). Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: Systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE). PloS One, 12(4), e0175149. https://doi.org/10.1371/journal.pone.0175149

Ministry of Health and Family Welfare. (2022, February 8). Status of Non-Communicable Diseases (NCDs) in India. https://pib.gov.in/pib.gov.in/Pressreleaseshare.aspx?PRID=1796435

Neal, B., Crino, M., Dunford, E., Gao, A., Greenland, R., Li, N., Ngai, J., Ni Mhurchu, C., Pettigrew, S., Sacks, G., Webster, J., & Wu, J. H. (2017). Effects of Different Types of Front-of-Pack Labeling Information on the Healthiness of Food Purchases-A Randomised Controlled Trial. Nutrients, 9(12), 1284. https://doi.org/10.3390/nu9121284

Packer, J., Russell, S. J., Ridout, D., Hope, S., Conolly, A., Jessop, C., Robinson, O. J., Stoffel, S. T., Viner, R. M., & Croker, H. (2021). Assessing the Effectiveness of Front of Pack Labels: Findings from an Online Randomised-Controlled Experiment in a Representative British Sample. Nutrients, 13(3), 900. https://doi.org/10.3390/nu13030900

Pagliai, G., Dinu, M., Madarena, M. P., Bonaccio, M., Iacoviello, L., & Sofi, F. (2021). Consumption of ultra-processed foods and health status: A systematic review and meta-analysis. British Journal of Nutrition, 125(3), 308–318. https://doi.org/10.1017/S0007114520002688

Pettigrew, S., Jongenelis, M. I., Jones, A., Hercberg, S., & Julia, C. (2023). An 18-country analysis of the effectiveness of five front-of-pack nutrition labels. Food Quality and Preference, 104, 104691. https://doi.org/10.1016/j.foodqual.2022.104691

Poti, J. M., Braga, B., & Qin, B. (2017). Ultra-processed Food Intake and Obesity: What Really Matters for Health—Processing or Nutrient Content? Current Obesity Reports, 6(4), 420–431. https://doi.org/10.1007/s13679-017-0285-4

Roberto, C. A., Ng, S. W., Ganderats-Fuentes, M., Hammond, D., Barquera, S., Jauregui, A., & Taillie, L. S. (2021). The Influence of Front-of-Package Nutrition Labeling on Consumer Behavior and Product Reformulation. Annual Review of Nutrition, 41, 529–550. https://doi.org/10.1146/annurev-nutr-111120-094932

Rønnow, H. N. (2020). The Effect of Front-of-Pack Nutritional Labels and Back-of-Pack Tables on Dietary Quality. Nutrients, 12(6), 1704. https://doi.org/10.3390/nu12061704

Samant, S. S., & Seo, H.-S. (2016). Effects of label understanding level on consumers’ visual attention toward sustainability and process-related label claims found on chicken meat products. Food Quality and Preference, 50, 48–56. https://doi.org/10.1016/j.foodqual.2016.01.002

Singh, S. K., Taillie, L. S., Gupta, A., Bercholz, M., Popkin, B., & Murukutla, N. (2022). Front-of-Package Labels on Unhealthy Packaged Foods in India: Evidence from a Randomized Field Experiment. Nutrients, 14(15), 3128. https://doi.org/10.3390/nu14153128

Soederberg Miller, L. M., & Cassady, D. L. (2015). The Effects of Nutrition Knowledge on Food Label Use: A Review of the Literature. Appetite, 92, 207–216. https://doi.org/10.1016/j.appet.2015.05.029

Taillie, L. S., Hall, M. G., Popkin, B. M., Ng, S. W., & Murukutla, N. (2020). Experimental Studies of Front-of-Package Nutrient Warning Labels on Sugar-Sweetened Beverages and Ultra-Processed Foods: A Scoping Review. Nutrients, 12(2), 569. https://doi.org/10.3390/nu12020569

Vargas-Meza, J., Jáuregui, A., Contreras-Manzano, A., Nieto, C., & Barquera, S. (2019). Acceptability and understanding of front-of-pack nutritional labels: An experimental study in Mexican consumers. BMC Public Health, 19, 1751. https://doi.org/10.1186/s12889-019-8108-z

WHO. (2019, May 13). Guiding principles and framework manual for front-of-pack labeling for promoting healthy diets. https://www.who.int/publications/m/item/guidingprinciples-labeling-promoting-healthydiet

WHO. (2021, June 9). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight