Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Appetite. 2021 Mar 1;158:104997. doi: 10.1016/j.appet.2020.104997. Epub 2020 Oct 13.
Positive front-of-pack (FOP) labels, including Singapore's Healthier Choice Symbol (HCS), target a subset of healthier products whose consumption is to be encouraged. However, this may inadvertently lead to excess caloric intake, which could be addressed by including an additional label identifying calories per serving. We test this hypothesis by adding a Physical Activity Equivalent (PAE) label, an indicator of calorie content, to all products available in an on-line grocery store.
We conducted a randomized controlled trial using a 3 arm within-subject crossover design in adult Singapore residents recruited online. Participants shopped once in each condition in an experimental online grocery store in random order: 1) no FOP label (Control); 2) Select products displaying HCS labels (HCS-only); 3) Condition 2 with additional information displaying PAEs per serving on every product (HCS+PAE). 117 participants were recruited and data from 317 shops were analyzed. We used first-differenced regressions to assess the impact of the conditions on calories per serving (primary) and on other measures of diet quality.
The HCS-only condition led to a statistically significant five-percentage point increase in the proportion of HCS products purchased (95% CI, 1%: 9%). However, neither the HCS-only (3.45; 95% CI, -12.52: 19.43) nor HCS + PAE (8.14; 95% CI, -5.25: 21.54) condition led to a change in the number of calories per serving purchased or changes in other measures of diet quality.
Positive labels, like the HCS, are likely to increase purchases of labelled products. However, these changes may not lead to improvements in diet quality or calorie intake. Combining positive labels with additional PAE information does not appear to address this concern.
正面包装标签（FOP），包括新加坡健康选择标志（HCS），针对的是需要鼓励消费的一部分更健康产品。然而，这可能会无意中导致卡路里摄入过多，而通过添加额外的每份卡路里标签可以解决这个问题。我们通过在在线杂货店中的所有产品上添加身体活动等效（PAE）标签，即卡路里含量的指标，来验证这个假设。
我们在成年新加坡居民中进行了一项随机对照试验，采用 3 臂自身交叉设计，参与者在线招募。参与者在随机顺序的实验性在线杂货店中，每次购物都处于以下三种条件之一：1）无 FOP 标签（对照）；2）仅选择显示 HCS 标签的产品（仅 HCS）；3）条件 2 加上每款产品上显示每份 PAE 的额外信息（HCS+PAE）。共招募了 117 名参与者，分析了 317 次购物的数据。我们使用一阶差分回归来评估条件对每份卡路里（主要）和其他饮食质量指标的影响。
仅 HCS 条件导致购买 HCS 产品的比例显著增加了五个百分点（95%CI，1%：9%）。然而，仅 HCS（3.45；95%CI，-12.52：19.43）或 HCS+PAE（8.14；95%CI，-5.25：21.54）条件均未导致每份卡路里摄入量的变化或其他饮食质量指标的变化。
正面标签，如 HCS，可能会增加标签产品的购买量。然而，这些变化可能不会导致饮食质量或卡路里摄入的改善。将正面标签与额外的 PAE 信息结合使用似乎并不能解决这个问题。
