NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
Extraction table used during the literature review conducted for the following document:
Morestin, F., Hogue, M.-C., Jacques, M. & Benoit, F. (2011). Public policies on nutrition labelling: Effects and implementation issues — A knowledge
synthesis. Montreal: National Collaborating Centre for Healthy Public Policy.
The documents are presented in reverse chronological order and alphabetically by first author.
Reference
Characteristics of Status
Document
Canadian
Food
Inspection
Agency,
2009
Grey literature;
source = CFIA
website;
description of
CFIA activities;
authors =
government
“Health Canada and
the Canadian Food
Inspection Agency
(CFIA) carry joint
responsibility for
federal food labelling
policies.” “Health
Canada is responsible
for setting food
labelling policies with
respect to health and
safety matters. CFIA is
responsible for the
development of nonhealth and safety food
labelling regulations
and policies.”
Center for
Science in
the Public
Interest,
2009
Grey literature;
source = CSPI
website; fact
sheet (primary
study, crosssectional survey,
755 persons
surveyed);
authors =
lobbyists
In 2008, New York City
was the first American
city to require posting
calories on the menus
and menu boards of
fast-food restaurants
and other chain
restaurants.
Centre for
Science in
the Public
Grey literature;
source = CSPI
website; press
- April 2009, Bill 156
tabled by NDP member
(for posting calorie
Effectiveness
89% of respondents were
surprised by the number of
calories posted (higher than
they thought).
Of those who frequented
restaurants, 82% said that
the postings had an impact
on their selections. Among
those who took the nutrition
information into account,
71% looked for lower-calorie
options and 51% no longer
ordered some items.
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
89% of the residents
surveyed felt that the
labelling was a positive
change. 76% felt that
governments at all
levels should play a
more active role
regulating nutritional
issues in restaurants.
- Earlier in the week, the
Ontario Medical
Association asked the
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
Reference
Characteristics of Status
Document
Interest –
Canada,
2009a
release; authors = counts on the menus
lobbyists
and menu boards of
large chain
restaurants) was
adopted in its second
reading in the Ontario
Legislature.
- Similar measures
exist in the UK, New
York, California and
other American
jurisdictions.
Centre for
Science in
the Public
Interest –
Canada,
2009b
Grey literature;
source = CSPI
website; press
release; authors =
lobbyists
- In 2000, Health
Canada decided to
exempt restaurants
from the requirement to
provide nutrition
information.
- In 2006, the federal
parliament also
dropped the issue in
exchange for promises
that the large chain
restaurants would
voluntarily present this
information.
- Bill 156 (proposing
mandatory posting of
calories on menus by
the large chain
restaurants) was tabled
in the Ontario
legislature in 2009 by
the NDP member from
Sudbury
- In the U.S., in
October 2008, Yum!
Brands (which owns
KFC, Pizza Hut and
Taco Bell) promised to
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
Ontario government for
calorie counts to be
posted in chain
restaurants and school
cafeterias.
- In 2006, the
federal
parliament
also dropped
the issue in
exchange for
promises
that the large
chain
restaurants
would
voluntarily
present this
information.
- In the Fall
of 2007, two
thirds of
chain
restaurants
had not
applied the
(already
weak)
standards of
the nutrition
information
program of
the Canadian
The Ontario Medical
Association asked the
Government of Ontario
to require the posting of
calorie counts in chain
restaurants and school
cafeterias.
2
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Characteristics of Status
Document
(cont’d)
Effectiveness
Unintended
Effects
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Feasibility
provide calorie counts
on its menus.
- In April 2009, the
Minister of Health of
the UK and the Food
Standards Agency
announced the names
of 18 large chain
restaurants that were
ready to post calorie
counts in the following
few months.
Restaurant
and Food
Service
Association.
Acceptability
Coalition
québécoise
sur la
problématique du
poids, 2009a
Grey literature;
source =
environmental
scan; press
release; authors =
lobbyists
- Logos appearing on
the front of packages
are unregulated.
- The criteria set by
industry.
Presence of
logos on
certain
products is
highly
questionable,
given their
low
nutritional
value
- The Coalition and
Options
Consommateurs (a
consumer protection
organization) have
asked Health Canada to
regulate logos so that
consumers will be able
to trust them.
Coalition
québécoise
sur la
problématique du
poids, 2009b
Grey literature;
source =
environmental
scan;
presentation at a
press conference
(nutrition analyses
on products with
health logos);
authors =
lobbyists
- In Canada, there are
no regulations
governing front-ofpackage logos.
- The industry sets the
criteria for logos.
Study of
several
products with
“health”
logos (Smart
Selections by
PepsiCo,
Snack Wise
by Old
Dutch,
Sensible
Solution by
Kraft): shows
that they are
only healthy
with respect
to some
ingredients,
- The Coalition has
asked for regulatory
control of front-ofpackage logos.
3
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Characteristics of Status
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Effectiveness
(cont’d)
Engelhard,
Garson, &
Dorn, 2009
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
or do not
merit the
logo when
compared
with even
less healthy
products
Grey literature;
source =
politiquessociales.
net website;
comment; authors
= an independent,
non-profit
research centre
(study funded by
a health
insurance
company)
- The NLEA (the
Nutrition Labelling and
Education Act) was
proclaimed in 1990:
labelling of packaged
foods
- Most developed
countries are planning
front-of-package
labelling to complete
nutrition facts table;
already widespread on
a voluntary basis in
Europe and the UK.
- System of stars in
Hannaford
supermarkets,
implemented in Sept.
2006. 28% of their
25,500 products
receive 1 or more
stars. After testing,
program extended to
over 1,300 stores.
- Laws on posting of
nutrition info on menus
in chain restaurants
adopted in
Philadelphia, NYC,
California, Maine,
Massachusetts, and
Oregon, and are
proposed in two bills
- Half of the food budget and
a third of calories are
consumed in the U.S. = in
food services.
- NLEA appears to have
shifted consumption toward
more healthy products.
- Consumers say that they
often use these labels as
guidance on purchases, but
studies show that actual use
is much lower than reported
use, and fewer consumers
use labels now than in the
past.
- Studies show that the
nutrition facts table often
creates confusion (too much
information).
- Many studies show that
front-of-package labels
significantly improve
consumers’ ability to
understand and use nutrition
information.
- More effective format
(studies in the UK and
Australia in 2009): multiple
traffic lights with % of daily
intake.
- Sales figures showed shift
to healthier prepared foods
after logos introduced at
Restaurants:
In June
2009, one of
the bills
before
Congress
received the
support of
the National
Restaurant
Association
(see efforts
made to
have a single
national
standard for
nutrition
labels).
- Consumers have
shown interest in
Hannaford’s star
system.
Food:
- The
industry
needs some
time to
implement
the standard;
more time
may be given
to small
companies.
4
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Characteristics of Status
Document
(cont’d)
Health
Canada,
2009a
before Congress.
Grey literature;
source = Health
Canada website;
description of
Health Canada’s
actions; authors =
the government
- Before adoption of
regulations, nutrition
regulations were
optional. Not uniformly
applied.
- “Through the Food
and Drug Act, Health
Canada regulates the
labelling of food
products in Canada.
Regulations published
on January 1, 2003
make nutrition labelling
mandatory on most
food lables.” Since
December 2005,
mandatory labelling for
most pre-packaged
foods. Small
businesses had to
comply with the new
regulation starting
December 12, 2007.
- Content of the
nutrition facts table:
caloric value and
content in 13 core
nutrients: fats,
saturated fats, trans
Effectiveness
Unintended
Effects
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Cost
Feasibility
Acceptability
Tesco.
- After stars introduced at
Hannaford: packaged foods
and frozen meals with stars
were chosen 2.5 to 4.5 times
more often than those
without the stars.
- The many types of labels on
packages creates confusion
among consumers in the UK
and the U.S.
- Regulation
on nutrition
labelling for
foods was
developed
following
extensive
consultations
with
consumers,
healthrelated
interest
groups and
the food
industry.
- The
Canadian
Food
Inspection
Agency was
charged with
enforcing the
regulation.
- Nov. 2007
to March
2008, Health
Canada
carried out
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NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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(cont’d)
Characteristics of Status
Document
fats, cholesterol,
sodium, carbohydrates,
fibre, sugars, protein,
vitamin A, vitamin C,
calcium and iron.
- Inspired by the model
used in the U.S.,
particularly its graphic
design, which earned
prizes.
- The nutrition facts
table is not mandatory
for other foods,
including those served
or sold in restaurants.
However, consumers
need to be encouraged
to look for and demand
nutrition information.
For example,
pamphlets are
sometimes available
upon requests in
restaurants.
- “Front of package
(FOP) labelling is the
term sometimes used
for simplified nutrition
or health-related
claims, symbols and
logos that are
highlighted and
positioned on the front
of a food package.”
- Manufacturers
sometimes use
symbols or logos on
the front of packages to
communicate these
messages, implicitly
and simply.
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
consultations
on health
claims with
researchers,
consumer
groups, the
federal gov’t,
provincial
and
municipal
gov’ts, the
industry,
institutions
and health
professionals
in order to
develop a
new frame of
reference.
Mailings,
workshops
held in
Vancouver,
Winnipeg,
StHyacinthe,
Halifax,
Edmonton
and Toronto.
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NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Characteristics of Status
Document
(cont’d)
Health
Canada,
2009b
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
- Nov. 2007 to March
2008, Health Canada
carried out
consultations on health
claims with
researchers, consumer
groups, the federal
gov’t, provincial and
municipal gov’ts, the
industry, institutions
and health
professionals in order
to develop a new frame
of reference. Mailings,
workshops held in
Vancouver, Winnipeg,
St-Hyacinthe, Halifax,
Edmonton and
Toronto.
Grey literature;
source =
environmental
scan; action plan;
authors =
government
- Consultations on
managing health
claims for food: online
publication of a
discussion paper;
meetings with 286
stakeholders in 6 cities;
written feedback using
a questionnaire.
- Following the
consultations, Health
Canada developed a
five-year plan.
- Regarding front-ofpackage labelling and
implicit health claims:
“Health Canada
[proposes] to
undertake consumer
research on the
interpretation of FOP
- “Health Canada [proposes]
to undertake consumer
research on the interpretation
of FOP labelling in concert
with the Nutrition Facts
table.”
Consultation
s on
managing
health claims
for foods:
online
publication of
a discussion
paper;
meetings
with 286
stakeholders
in 6 cities;
written
feedback
using a
questionnair
e.
- Following
the
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NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Characteristics of Status
Document
(cont’d)
Heart and
Stroke
Foundation,
2009a
Grey literature;
source = Heart
and Stroke
Foundation
website;
presentation of
activities; authors
= Foundation
Effectiveness
Unintended
Effects
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Cost
Feasibility
labelling in concert with
the Nutrition Facts
table and to examine
the standardization of
the nutritional criteria
underlying FOP
symbols and claims.”
- Current measure:
analysis at the national
and international scale
of the nutritional criteria
used, the definitions of
“healthy” foods, the
potential obstacles to
implementing this type
of measure and its
potential impacts on
public health.
- Next step: targeted
consultations
consultations
, Health
Canada
developed a
five-year
plan.
- Next step:
targeted
consultations
- To receive the Health
Check logo, a food or
meal must satisfy the
nutritional criteria of
Canada’s Health
Guide. Different criteria
for each product
category. Neither the
food industry nor
restaurants participate
in developing these
criteria.
- Once accepted in the
Health Check program,
companies pay a
modest annual fee to
cover program
operating costs.
- Participating
restaurants must make
[Recap]
- Companies
submit
products on
a voluntary
basis.
- Over 1,700
products,
including
fresh
products,
carry the
Health
Check logo.
It also
appears on
the menus of
several chain
restaurants.
Acceptability
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NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
Reference
Characteristics of Status
Document
(cont’d)
Heart and
Stroke
Foundation,
2009b
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
nutrition info available
for each meal carrying
the logo.
- Companies submit
products on a voluntary
basis.
- Over 1,700 products,
including fresh
products, carry the
Health Check logo. It
also appears on the
menus of several chain
restaurants.
- But there are also
healthy products that
do not carry the logo:
the nutrition facts table
remains the best way
to compare products.
- H&S dieticians
provide companies with
suggestions on how to
modify recipes to meet
program criteria.
- Participating
restaurants must
create food preparation
standards and
procedures.
- Informative material
provided by H&S to
help train staff.
Grey literature;
source = Health
Check website
(Canada); fact
sheet (presenting
opinion surveys);
authors = NGO
- 90% of consumers had
seen the Health Check logo
on products.
- 74% said that the logo
helps them to make good
choices.
- 74% are more likely to buy
a product with the logo.
80% trust Health Check
because it’s a Heart and
Stroke Foundation
program. Consumers
also believe that the
program is based on
science/research/input
from dieticians
9
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Characteristics of Status
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Effectiveness
Kiesel &
Villas-Boas,
2009
Grey literature
(thesis –
University of
California,
Berkeley); source
= PsycINFO;
primary study
(controlled
randomized trial,
5 supermarkets in
the test, 27
control subjects);
authors =
academics
- Other studies: Consumer
interest in the labels; 50%
use them in their purchase
decision making; use
associated with weight loss
and probability of obesity;
decline in sales of high-fat
vinaigrettes after NLEA is
passed. But declining use
from 1995-2006, inability to
interpret the labels, increased
sales of only certain types of
healthy products.
- This study: labels placed on
shelves rather than on
products; experiment with
popcorn; sales data
measures.
- The “No trans fat” label
significantly increases sales
(even if info was already
available on the NLEA label
and sometimes in the
company’s written notices;
the effect could therefore be
attributable to the
standardized info format,
which allows consumers
faster product comparisons).
- “Low fat” label reduces
sales (consumers may
perceive that low-fat products
are less tasty, and popcorn is
a treat: taste issue may be
more important than health
issue).
- “Low calorie” label
increases sales.
- No apparent evidence that
consumers infer that
unlabelled products are of
In response to the
declining use of labels,
the FDA is considering
changing their format
and content.
Unintended
Effects
Equity
- Less use of
NLEA labels,
particularly
among young
adults and
less educated
consumers.
Cost
Feasibility
Acceptability
- Consumers prefer
having logos on the
front of the package (vs.
labels).
10
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Characteristics of Status
Document
(cont’d)
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
inferior quality (since in this
case only healthier products,
in terms of calories, fat and
trans fat, are labelled).
- Labels showing information
on several nutrients have no
effect on sales (consumers
may be less likely to interpret
info when there is too much
of it).
- Strongest impact seen right
after implementation (4-week
experiment, data collected 5
weeks before and after);
impact dissipates after the
study period for calories and
fat, but not for trans fat
(probably because it is easier
to verify products for this
nutriment).
Kohn, 2009
Grey literature;
source =
environmental
scan; reporting;
authors = health
professionals
A law on menu
- Calorie labelling in
labelling in the State of restaurants led 25% of clients
California comes into
to make healthier choices.
force in 2011.
Restaurants
changed their
menus to
include lowercalorie
options.
Robert Wood
Johnson
Foundation,
2009
Grey literature;
source = CSPI
website;
comments (non-
NLEA 1990 applies to
packaged foods.
Restaurants are not
subject to federal laws
- From 1991
to 1995, the
number of
low-fat
- Cites Wootan studies:
number of American
restaurants providing
nutrition info has increased
Big Cities Health
Coalition (group of 18
municipal or county
health departments
representing 14% of the
U.S. population) asked
the federal government
to support their efforts to
prevent chronic
illnesses. Proposed
interventions include
requiring chain
restaurants to post
easy-to-understand
nutrition info on their
menus.
- Labelling
could lead to
men
(particularly
- Chefs are
not
accustomed
to following
- Most consumers (over
60% in 4 different
surveys) would like a
law passed on info in
11
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Characteristics of Status
Document
Effectiveness
Unintended
Effects
Equity
(cont’d)
systematic review
of the literature);
authors =
Johnson &
Johnson
Foundation
over the last 10 years, but
most still do not present info
at point of sale.
- Nutrition info is less
available in restaurants not
belonging to chains and not
providing fast food.
- If nutrition info is not
apparent enough, it is not
frequently used.
- 63% of adults use nutrition
labels when choosing
packaged foods.
- Consumers who read labels
on packaged foods tend to
have healthier diets.
- From 1991 to 1995, sales of
low-fat products increased.
- Cites LA County study:
annual weight gain will be
reduced 39% if restaurant
labelling made 10% of clients
make choices that reduce
consumption by 100 calories.
- Posting reduces intentions
to buy high-calorie and highfat meals (many studies of
teenagers 11-18 years old:
29% changed their choice
when they saw nutrition info,
and 46% of them made
choices with fewer calories),
above all if there is a large
difference between perceived
and actual content. But
intentions are subject to
social desirability bias, as
much as respondents were
not interested in paying the
difference.
- Reality of purchases:
products
increased.
This suggests
that a similar
change may
occur in
restaurants
(no research
on this
subject).
- Possible
impacts of
labelling:
theoretically,
restaurant
revenues
could fall,
particularly
those with
high-calorie
menus, but no
evidence
currently
available on
this subject.
Desire to
spend in
restaurants is
mainly
determined by
disposable
income,
convenience
and taste. On
the other
hand,
purchases
could be
transferred to
other
restaurants.
young men)
consuming
more calories.
Other studies
suggest that
men use
nutrition info
less than
women.
According to a
study of
college
students, men
use nutrition
info mainly to
gain weight
(as compared
to women).
unless they make
nutritional claims. Few
other regulations have
been adopted at this
time. Examples: NYC,
first state law
(California) requiring
posting of calories in
chain restaurants
starting January 2011.
- In 2005, the National
Restaurant Association
(U.S.) launched the
Ask us! program to
help restaurants
provide nutrition info.
Cost
Feasibility
Acceptability
standardized
menus.
Custom
orders would
change
nutrition
values from
those
posted.
- Labelling
would reduce
menu
planning
flexibility.
- Labelling is
difficult when
menu has
many
variations.
- Little space
on menus for
nutrition
labelling.
- May be
difficult to
train staff to
answer
questions on
the nutrition
info
provided.
restaurants (even if they
do not use the info each
time). Cites
O’Dougherty: Those in
favour believe it would
help them make
informed decisions and
would make restaurants
accountable; opponents
believe that the law
would place too great a
burden on restaurants
and not be effective in
changing consumers’
decisions.
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NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
Reference
Characteristics of Status
Document
(cont’d)
Center for
Science in
the Public
Interest,
2008a
Grey literature;
source = CSPI
website; fact
sheet; authors =
lobbyists
Effectiveness
Unintended
Effects
modest improvement in
selections (according to 14
studies); 6 studies found no
evidence of a positive impact.
- Restaurants’ health claims
made consumers
underestimate the number of
calories in main courses and
order higher-calorie side
dishes, drinks and desserts.
- Other important factors in
selections (price, taste,
convenience) often run
counter to a healthy diet. In a
randomized trial that tested 4
different labelling (or nonlabelling) conditions and
value pricing (or lack thereof)
(lower per-unit prices on
larger portions), no
differences found in the food
ordered by different groups.
- Many consumers have
problems interpreting calorie
info in terms of the
recommended daily amounts
(implies that labelling needs
to be accompanied by
nutrition education).
- Lack of studies on repeated
exposure to labels.
Few studies
have
measured the
impact of
labelling on
consumer
spending.
- Labelling
could reduce
demand for
menu items
that generate
higher profits.
- Half of the chain restaurants
already post nutrition info on
their websites.
- Labels on packaged foods:
¾ of adults say that they use
them. Use associated with
healthier choices.
- Info provided in restaurants
helps consumers choose
Labels on
packaged
foods led to
the
reformulation
of some
products.
Equity
Cost
Feasibility
- Half of chain
restaurants
already post
nutrition info
on their
websites and
will not incur
additional
costs to
- Concerns
regarding
feasibility of
special
orders and
combinations
of items, but
labelling only
applies to
Acceptability
13
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
Reference
Characteristics of Status
Document
(cont’d)
Center for
Science in
the Public
Interest,
2008b
Effectiveness
Unintended
Effects
Equity
low-calorie products.
Grey literature;
source = CSPI
website; literature
review (nonsystematic? Not
specified);
authors =
PACKAGED FOODS
Nutrition info has an effect on
attitudes toward products.
Use of labels has a positive
impact on food quality.
Lower sales of high-fat
vinaigrettes after enactment
Cost
Feasibility
Acceptability
analyze
standard
products.
items on the
Others:
menu.
analysis
software costs
$500; the cost
of a dietician
or laboratory
analysis is
similar to the
cost of a new
commercial
dishwashing
machine.
- In most chain
restaurants,
analysis and
printing costs
are assumed
by head office.
- Printed and
illuminated
menus are
already often
changed for
marketing
reasons.
- Labelling
requirements
apply to
chains only,
not to small
restaurants.
Between the
intro. of NLEA
and 1996,
more new
products were
introduced
with fewer
A study by
Variyam
(2006) found
that the NLEA
had a greater
impact on
body weight
- The FDA has
estimated that
listing trans
fats on labels
would save
$3 billion to
$8 billion per
- 78% of Americans
support restaurant
labelling policies.
- 84% of respondents in
NY found the new
labelling regulation
useful.
14
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Effectiveness
Unintended
Effects
Equity
Cost
(cont’d)
lobbyists
of NLEA.
One study (Variyam 2006)
associated NLEA with lower
body weight and lower
probability of obesity in the
general public.
The FDA believes that listing
trans fats on labels will save
2,100 to 5,600 lives per year.
RESTAURANTS
Labelling changes the
attitudes of customers and
their purchase intentions
toward more healthy
alternatives.
Nutrition info is associated
with healthier, lower-calorie
purchases, particularly when
the levels listed exceed
consumers’ estimates.
It has been estimated that in
California, if 80% of
customers see the info on
labels in fast food
restaurants, the weight loss
would be one pound per
person per year (vs. the onepound gain currently
observed).
Los Angeles County Public
Health estimates that in LA
County, labelling could
prevent 39% of current
weight gains.
NYC Department of Health
estimates that, over 5 years,
150,000 fewer people would
be obese, resulting in at least
30,000 fewer cases of
diabetes.
negative
nutrients.
More positive
nutrients were
also added to
existing
products
(without more
negative
nutrients
being
removed).
reduction and
the probability
of obesity
among white
non-Hispanic
women.
- Labels in
restaurants
used more by
women
(students);
students used
labels to
identify food
with higher
levels of
proteins.
- One study
found that
nutrition info
had a positive
impact on
persons who
were not
dieting, but no
change
among people
who were
dieting.
year.
- The
economic
benefit of the
NLEA over 20
years due to
reduced
weight and
risk of obesity
is $63 billion
to $166 billion
(Variyam
2006).
Feasibility
Acceptability
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Center for
Science in
the Public
Interest,
2008c
Grey literature;
source = CSPI
website; fact
sheet; authors =
lobbyists
Since 1994, the NLEA
deals with labels on
packaged foods but
explicitly excludes
restaurants.
- Half of chain restaurants
provide no nutrition info.
- Of those that do: often by
means that are not very
visible to consumers when
they place their orders
(website, which requires
access to a computer and the
Internet; on tray liners or food
packaging, which are only
visible after the order;
brochures and posters – but
less than 5% of consumers
see this info).
- Americans consume one
third of their calories outside
the home.
- Labels on packaged foods:
¾ of adults say that they use
them. Use associated with
healthier choices.
- Info in restaurants helps
consumers make lowercalorie choices.
Labels on
packaged
foods have
led to the
reformulation
of some
products
(particularly in
the case of
trans fats).
Center for
Science in
the Public
Interest,
2008d
Grey literature;
source = CSPI
website; fact
sheet; authors =
lobbyists
Trans fat labelling
requirements came into
effect in January 2006.
Policies on menu
labelling have been
adopted in California,
Philadelphia and
Multnomah County
(Portland, Oregon) and
applied in NYC.
Immediately following
enactment of the NLEA, the
demand for low-fat products
and products low in sugar
grew by 65%.
Equity
Cost
Feasibility
Acceptability
- [Vs. coercion]: The
authors argue that
having labels on menus
addresses the
consumer’s right to be
informed and allows
consumers to exercise
personal responsibility.
- 78% of Americans
support labels on
menus.
- Nutrition info in
restaurants is
recommended by the
Institute of Medicine, the
Food and Drug
Administration, the
Surgeon General, the
U.S. Department of
Health and Human
Services, the National
Cancer Institute and the
American Medical
Association.
- Faced with
the postNLEA change
in demand,
79% of firms
surveyed said
that they had
introduced
new products.
- Since trans
fat labelling
was
introduced,
the use of
partially
hydrogenated
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Feasibility
Acceptability
oils in North
America has
fallen 50%.
- Following
the intro of
labelling in
NYC
restaurants,
calories were
significantly
reduced in
many dishes.
Center for
Science in
the Public
Interest,
2008e
Grey literature;
source = CSPI
website; fact
sheet (summary
of 4 national
surveys, 1 in
Connecticut and 1
in California);
authors =
lobbyists
Centre for
Science in
the Public
Interest –
Canada,
2008a
Grey literature;
source = CSPI
Canada website;
press release (on
a cross-sectional
observation
survey of 136
Canadian chain
restaurants);
authors =
lobbyists
Surveys found that 67%
to 84% of respondents
favoured nutrition
labelling in restaurants.
- The Canadian
.
Restaurant and
Foodservice
Association created a
program in 2006
(commitment to make
nutrition info available
in brochures in
restaurants and on
websites).
- In December 2007,
Health Canada began
consultations on more
detailed labelling
provisions for
packaged foods, but
did not discuss
labelling in restaurants.
- The
Canadian
Restaurant
and
Foodservice
Association’s
program was
created to
convince
members of
Parliament to
defeat Bill C283 on
nutrition
labels for
chain
restaurant
menus.
Among the opponents to
Bill C283: 4 MPs with
personal or family
interests in large fast
food chains and 7 MPs
who raise livestock.
- The CSPI called on
provincial and municipal
governments to adopt
menu labelling laws as
long as they were not
adopted at the federal
level.
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(cont’d)
Centre for
Science in
the Public
Interest –
Canada,
2008b
Effectiveness
Unintended
Effects
Equity
Cost
- In the U.S.: NYC and
Seattle have adopted
restaurant labelling
laws. Governor
Schwarzenegger
vetoed a bill adopted
by the California
Assembly and Senate.
Grey literature;
source = CSPI
Canada website;
letter of
notification sent to
Health Canada;
authors =
lobbyists
- Companies have
developed their own
logos: Smart Spot by
Pepsico, Sensible
Solutions by Kraft, Blue
Menu by President’s
Choice and Goodness
Corner by General
Mills.
- The companies’ logos
are based on criteria
developed in-house.
- Hannaford’s star
program: stars are
placed on the shelf
label next to the price.
Feasibility
Acceptability
- Among the
27 chain
restaurants
participating
in the
program, 18
have not met
their
commitment,
and none
post the info
on menus.
- In 2006 the
Conservative
Party voted
unanimously
against Bill
C-283, and it
was not
supported by
a sufficient
number of
opposition
members.
- Many American consumers
use the nutrition labels. Its
use is associated with
healthier eating.
Front-ofpackage
logos would
be a strong
incentive to
reformulate
products.
- Mandatory
nutrition
labelling on
packaged
foods (2003
regulation)
should save
$5 billion CAN
over 20 years
through
healthier food
choices that
reduce the risk
of premature
death or
disability due
- In 9 years,
Canada’s
Health
Check
program has
included
1,500
products,
which is
impressive
for an NGO,
but this
represents
only 3% of
the products
available in
- CSPI Canada
recommends that Health
Canada: establish
nutrition criteria for a
symbol that would be
mandatory on packaged
foods and in chain
restaurants; to conduct
research and ask for
comments from
scientists, health and
communications
experts, the industry
and consumers on the
best possible system;
determine whether the
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Hannaford applies its
program to all of its
25,500 products; 28%
of them are awarded
stars (criteria are
stricter than Health
Check).
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
to
cardiovascular
disease,
cancers and
diabetes
(source = The
Canada
Gazette).
- Cost (non
recurring) of
label changes:
$263 million
CAN over 3
years (source
= The Canada
Gazette).
- By
comparison,
revenues on
food sales
over 3 years =
$120 billion
CAN.
the market.
- 130
participants
in Health
Canada’s
consultation
on nutritional
claims in
Toronto,
including
health and
food industry
experts.
- The criteria
for the
companies’
logos vary
and are
sometimes
weak.
- The Health
Check
criteria
(Heart and
Stroke
Foundation
of Canada)
are stricter
than those of
the industry,
but some
products
carrying the
logo are only
healthy in
comparison
to other
products in
the same
category.
- The use of
current logos promoted
by industry and third
parties do not
correspond with the
proposed official system
and should be
eliminated. Believes that
the federal government
is responsible for
labelling (even if an
NGO can provide
nutrition education).
- The Standing
Committee on Health of
the House of Commons
recommends mandatory
and standardized frontof-package logos.
- Health Canada’s
Advisory on Healthy
Children and Youth
makes the same
recommendation. Also
recommends posting
nutrition info on food
packaging and menu
boards in chain
restaurants.
- In November 2006, the
B.C. Select Standing
Committee on Health
recommended that the
B.C. government
develop a front-ofpackage logo system (of
the traffic light and/or
caloric value type).
- In its opposition to Bill
C-283, the restaurant
industry argued that
there isn’t enough space
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(cont’d)
Friedman,
2008
Grey literature;
source = Yale
Rudd Center
website; nonsystematic review
of the literature;
authors =
academics
Policies on labelling in
restaurants have been
adopted in several
large American cities
and have been
proposed at the federal
level and in many
states.
- 75% of American adults
read the labels on packaged
foods.
- 48% of American adults say
that reading labels has
changed their purchasing
habits.
- Americans spend half of
their food budget on food
prepared outside the home
and consume a third of their
calories in restaurants.
- Many chain restaurants
already publish nutrition info,
but on their websites or other
supports not directly
accessible when ordering
(posters, brochures, tray
liners, etc.). Only a small
minority of clients consult this
information, since they
usually don’t notice it.
- There is an association
between the fact that
- Following
mandatory
listing of trans
fat on the
labels of
packaged
foods, many
products were
reformulated.
- [Theory]
restaurants
risk losing
clients.
- Fast food is
consumed
disproportiona
tely by lowincome
people, a
group at a
higher risk for
obesity.
- Analysis of
nutrition
content is a
one-time cost;
the current
policies
proposed do
not apply to
small
restaurants,
which are
unable to
assume these
costs.
Feasibility
Acceptability
simple
symbols
would solve
the problem
of the lack of
space on the
menus.
on menus.
- The U.S. Institute of
Medicine believes that
the industry’s different
logos may create
confusion, particularly
among young
consumers, so a
classification and
symbol system needs to
be developed (by the
FDA) and regulated,
one that would apply to
the entire industry and
could be understood by
children.
- Many
chains
already
analyze the
nutrition
content of
their menus.
- Feasibility
problems
and counterarguments:
- Special
offers are
constantly
changing,
and
customers
often make
special
orders
(answer:
labelling only
applies to
dishes
- According to 5 national
surveys and 4 local
surveys, from 62% to
84% of consumers
support a policy for
labelling in restaurants.
- One argument against
labelling laws
(opponents not
identified): they are an
infringement on our
freedom to eat what we
want (answer: it is only
info, it creates no
obligation).
- According to
opponents, labelling will
not result in fewer
calories consumed.
- Many associations and
public institutions
recommend caloric
labelling in restaurants
(see list in the
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Effects
restaurant customers receive
info and the probability that
they will select lower-calorie
dishes.
- Impact study conducted in
Los Angeles County: if 10%
of chain restaurant
customers reduced the
content of their meals by 100
calories, this would prevent
40% of the 6.75 million
pounds gained each year in
the county.
Grey literature;
source = CSA;
audit report;
authors =
Government
Accountability
Office
(independent
agency that works
for Congress and
- The UK: traffic lights
on the front of
packages (voluntary)
- The Netherlands:
voluntary “healthy
choice” logo developed
by industry and
supported by the
Department of Health
- Sweden: voluntary
- Other studies: consumers
find the daily intake values
useful, but find the labels
difficult to understand. Some
studies suggest that many
read the labels when they
buy something the first time,
but other studies suggest that
they don’t interpret the info
- The UK: sales data
Equity
Cost
Feasibility
Acceptability
offered on a document).
permanent
basis).
- The reading
of this info
slows down
service in
fast food
restaurants
(answer: If
the info is
provided in
large letters,
clients can
read it while
they wait in
line).
- The menus
should be
changed too
often
because of
special offers
(answer: this
is already the
case for
marketing
reasons and
for price
changes).
- The UK: the
industry
develops new
products or
reformulates
products to be
able to have
green or
amber lights.
- Sweden:
[Implication
for implementation]
- The FDA
inspects
industry
compliance
with labelling
obligations
and may sign
- According to the
Institute of Medicine,
there is little evidence
that labelling has a
significant impact on
food and purchases.
- The Institute of
Medicine has
recommended more
research on labelling
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(cont’d)
audits federal
government
activities)
“keyhole” logo
- U.S.: consumer
health associations and
the industry have
developed many logos
(American Heart
Association, Whole
Grains Council, Kraft,
Hannaford)
Effectiveness
Unintended
Effects
suggests that the traffic lights idem.
influence purchases.
- The U.S.: many brands and
supermarkets report that
logos increase sales
(Sensible Solutions,
Hannaford’s stars program)
Equity
Cost
Feasibility
Acceptability
contracts
with the
states to
have them
make
inspections.
The FDA
may take
samples and
have them
analyzed.
- Over the
last few
years the
number of
food
companies
has grown
but the
number of
inspections
and
corrective
actions has
declined or
not changed.
- The FDA
deplores its
lack of
resources
(financial and
human) and
power (for
example, the
power to
have
offending
firms pay the
cost of reinspection
and to certify
(and, in particular,
logos), by the FDA and
others.
- The Institute of
Medicine has
recommended that
industry, government,
researchers, public
health authorities and
consumer associations
work together to
develop and implement
a front-of-package
labelling system across
the industry.
- The Institute of
Medicine has
recommended that food
consumed in one sitting
have a label indicating
the number of calories
for the entire package.
- According to research
financed by the industry:
consumers prefer
nutrition labelling for the
whole package (rather
than by portion).
- The American Medical
Association and the
American Heart
Association recommend
a mandatory front-ofpackage labelling
system.
- In 2006 the Center for
Science in the Public
Interest asked the FDA
to develop such a
system.
- The U.S.: The Grocery
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third parties
for some
inspections)
to apply the
labelling
regulations
and conduct
research on
consumer
perceptions.
- The U.S.:
Grocery
Manufacturer
s / Food
Products
Association
opposes
mandatory
front-ofpackage
labelling
(wants a
voluntary
system) as
well as
having
nutrition
labelling for
the entire
content of
packages
(vs. smaller
portions)
- In April
2008, Health
Canada
indicated that
it would
consult with
stakeholders
and propose
Manufacturers / Food
Products Association is
opposed to a mandatory
front-of-package
labelling system (wants
a voluntary system); it
believes that many
companies use logos
and have reformulated
their products. The
Association is also
opposed to labels with
nutrition info for the
entire package contents
(vs. smaller portions),
arguing that this will
encourage consumers
to consume the entire
product.
- Canada: in 2007, the
Health Committee of the
House of Commons
recommended that
Health Canada
introduce a mandatory,
standardized and simple
front-of-package
labelling system.
Recommendation
supported by the
Chronic Disease
Prevention Alliance of
Canada.
- The European
Commission has
proposed a law that
would ask for front-ofpackage labelling.
- The European Heart
Network (an alliance of
health organizations)
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(cont’d)
Rudd Center
for Food
Policy and
Obesity,
2008
Grey literature;
source = Yale
Rudd website;
fact sheet (case
study); authors =
academics
- Subway already uses
labelling as a sign of
the attention it pays to
customers.
- In January 2007, a
California senator
introduced a bill for
labelling in the state’s
chain restaurants
(calories on menu
boards, calories +
saturated fats, trans
fats, sugar and sodium
on menus). Approved
by the Assembly and
Senate but vetoed by
the Governor in
October 2007. The bill
was re-introduced in
2008.
2nd objective
of the bill
(after
informing
consumers):
to encourage
product
reformulations
- Study of tax
impact:
According to
the California
Senate, the
restaurant
labelling act
would cost the
state nothing;
according to
the Senate, it
would cost
$100,000.
Feasibility
Acceptability
research on
front-ofpackage
labels.
and the European
Consumers’
Organization support
mandatory front-ofpackage labelling.
- The UK: the National
Heart Forum supports
the use of traffic lights.
- The bill
(California)
was drafted
based on the
model
provided by
the CSPI and
reviewed by
lawyers to
prevent
lawsuits.
- The bill was
approved by
the
Assembly
and Senate
but vetoed
by the
Governor in
October
2007.
- Bill proposed to a
senator by the California
Center for Public Health
Advocacy, the American
Heart Association, the
American Cancer
Society and the
California Optometric
Association.
- Bill moved quickly
through the two houses
due to a positive political
climate: obesity was on
the agenda, senators
were increasingly
informed on the subject,
and the senator behind
the bill was truly
committed.
- Survey of the public in
March 2007: 84% in
favour of labelling; 78%
of Republicans and 89%
of Democrats;
percentages were
similar across different
education levels and
income groups and
different ethnicities.
- The media gave
labelling considerable
coverage, except some
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(cont’d)
Centre for
Science in
the Public
Interest –
Canada,
2007
Acceptability
very conservative local
papers.
- Greatest opponents:
the California
Restaurant Association,
the Grocery
Manufacturers
Association, the State
Chamber of Commerce,
the California
Independent Grocers
Association.
- According to the NRA,
the public doesn’t need
labelling because
people already know
how to make healthier
choices (false,
according to testing of
the subject).
- Governor’s arguments
for using his veto: some
restaurants incur costs
and charges, but not
others; some
restaurants already
provide info, particularly
on the Internet (and
called on them to
continue this work);
labelling is not an
effective way to educate
the public.
Grey literature;
source = CSPI
Canada website;
testimony to the
House of
Commons’
Standing
- Some companies
have developed their
own logos: Smart Spot
by PepsiCo, Sensible
Solutions by Kraft, Blue
Menu by President’s
Choice, Goodness
- Many American consumers
use the nutrition label. Its use
is associated with a healthier
diet.
- The nutrition label could be
more effective through simple
presentation of the info on
Front-ofpackage
labelling is a
stronger
incentive to
reformulate
products.
- According to
Health
Canada,
mandatory
nutrition
labelling on
packaged
- Companies’
logos are
based on
their own
criteria,
which are
sometimes
- The restaurant
industry’s argument
against Bill C-283 was
that space was lacking
on menus.
- The U.S. Institute of
Medicine believes that
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(cont’d)
Committee on
Health; authors =
lobbyists
the front of the package,
which requires less
calculating and time to
interpret.
- Logos are even more
important in chain
restaurants, where the
information is often available
on the website or not at all.
- The companies’ logos are
based on their own criteria,
which vary (risk of confusing
consumers).
- In Sainsbury’s
supermarkets, use of traffic
lights had a positive impact
(in terms of healthy food) on
sales.
- In Sweden and Norway,
sales of products carrying the
logo rose 15% to 20%.
Corner by General
Mills.
- Companies’ logos are
based on their own
criteria.
- Voluntary traffic lights
system in the UK was
established in March
2006; some large
companies followed
suit while others have
their own systems.
- Lock symbol in
Sweden: identifies the
healthier choices in a
given category; use is
voluntary.
- The Hannaford Star
Program: stars placed
on shelf label next to
price. Hannaford
applies its program to
all its products; three
quarters of them do not
obtain stars.
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
foods (2003
regulation)
should result
in $5 billion in
savings over
20 years.
- The cost
(nonrecurring) of
label
changes (figur
es from
Agriculture
and Agri-Food
Canada):
$263 million
CAN over 3
years.
- By
comparison,
revenues from
food sales
over 3 years =
$120 billion
CAN.
weak.
- Even some
Health
Check
criteria
(Heart and
Stroke
Foundation)
are weak.
- The
restaurant
industry was
opposed to
Bill C-283.
- Use of
simple
symbols
would solve
the problem
of lack of
space on
menus.
the industry’s different
logos may create
confusion, particularly
among young
consumers, so a
classification and
symbol system needs to
be developed (by the
FDA) and regulated that
would apply to the entire
industry and could be
understood by children.
- In November 2006, the
B.C. Select Standing
Committee on Health
recommended that the
B.C. government
develop a front-ofpackage logo system (of
the traffic light and/or
caloric value type).
. CSPI Canada
recommended that
Health Canada conduct
research and ask for
comments from
scientists, health and
communications
experts, the industry
and consumers on the
traffic light system. It
should then determine
whether the selected
system (with a symbol
and nutrition criteria)
should be voluntary or
mandatory (CSPI
favours the mandatory
approach, since
otherwise companies
will not use the logos on
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(cont’d)
Health
Canada,
2007
Acceptability
marginally healthy
foods).
Grey literature;
source = Health
Canada website;
document for
discussion/
consultation;
authors = Health
Canada
- “With respect to
foods, Health Canada
is responsible for the
development of
policies, regulations
and standards that
relate to health and
safety”; “The Canadian
Food Inspection
Agency (CFIA) is
responsible for their
related compliance and
enforcement,” as well
as their application.
- Definition of “a health
claim for food”: “any
representation in
labelling and
advertising that states,
suggests or implies
that a relationship
exists between the
consumption of foods
or food constituents
and health.”
- These relationships
“may be stated
explicitly with words or
represented implicitly
(implied) through
slogans, graphics,
logos, symbols.”
- Health claims can be
specific or general.
- No rule specifies or
governs the use of
general health claims
(of the “healthy choice”
- Confusion due to the
proliferation of implicit health
claims.
- Problem of implicit
claims [particularly theory]:
difficult for consumers to
determine what criteria have
been used. When the
simplification is exaggerated,
the info may become
misleading. Too much
importance is given to
positive aspects, which may
divert attention from other,
less healthy characteristics.
Some studies [nonCanadian] have shown that
implicit claims may lead to
reduced use of the nutrition
facts table. Because of the
different criteria used,
products cannot be
compared. There is a risk
that consumers turn away
from products with no claims
that may nevertheless be
healthy and less expensive.
- Canadian consumer
surveys indicate significant
reported use of food labels
[sic: not only nutrition labels]
to select healthier foods, but
some (non-Canadian) studies
suggest less actual use.
- Health Canada believes
that policy development
should be backed by
research on consumers’
- Health
Canada’s
proposals
include
monitoring the
long-term
impact of
health claims
on the nature
of food supply
in Canada
and
investments in
research by
Canadian
companies for
food
innovation.
- Health
Canada wants
to collect info
on how health
claims are
understood
and used by
different
social groups
(including
purchase
behaviour).
Consultation
on claims:
- Health
Canada
seeks the
participation
of
consumers,
health
professionals
, the industry
and
organizations
interested in
specific
illnesses.
- The use of
symbols or
slogans (vs.
explicit
claims made
in longer
statements)
helps solve
the problem
of too little
space on
labels
(including the
challenge of
bilingual
labels on
small
packages).
- “With
respect to
foods, Health
- If the claims are not
regulated or
standardized,
consumers may become
sceptical about them.
- But consumers appear
to appreciate simplified
representations of
nutrition profiles.
- Health Canada
recommends research
on consumers’
assessments of claims
(including symbols), the
sources of scepticism.
- In March 2007, the
Standing Committee on
Health of the House of
Commons recognized
the usefulness of having
clear and simple frontof-package labels based
on standard criteria, and
recommended that the
federal government act
quickly.
- Health Canada
recommends research
on consumers’
expectations about the
roles, responsibilities
and accountability
obligations of
government, industry
and other stakeholders
concerning front-ofpackage claims.
- In this consultation
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Characteristics of Status
Document
type), except that
under the Food and
Drug Act, claims
should not be false,
misleading or
deceptive. There is no
standardized nutrition
criterion for making this
type of claim on a
package. But the CFIA
and Health Canada
have developed
guidelines (in 2003) to
foster proper use.
- The Food and Drug
Regulations do not
directly address implicit
claims.
- Various simplified
messages on the front
of packages are based
on different criteria
(some are based on a
nutrient, others on
several nutrients; still
others are more
complex, since they
take into account
dietary guidance).
Some criteria are set
by manufacturers,
others by third parties.
- “Health claims are
distinct from nutrient
content claims, which
are representations,
expressed or implied,
that characterize the
energy value of the
food or the amount of a
nutrient contained in
Effectiveness
interpretations of claims
(including symbols), their
relationship with use of the
nutrition facts table, the
interpretation when the food
also has negative
characteristics, and attitudes
toward products with no
claims.
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
Canada is
responsible
for the
development
of policies,
regulations
and
standards
that relate to
health and
safety”; the
Canadian
Food
Inspection
Agency is
“responsible
for their
related
compliance
and
enforcement,
” as well as
their
application.
document, Health
Canada recommends
(for discussion
purposes) several
options for reducing the
confusion around the
proliferation of front-ofpackage claims:
consumer education,
industry guidelines on
the conditions
formulations, and
improved nutrition
labelling regulations, if
required.
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NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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(cont’d)
Characteristics of Status
Document
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
the food. Provisions for
nutrient content claims
in Canada were
updated as part of the
regulations on nutrition
labelling and claims
introduced in the Food
and Drug Regulations
(FDR) in December
2002 and are outside
the scope of this
document and
initiative.”
- CONSULTATION
DOCUMENT: Several
options proposed to
reduce confusion
around the proliferation
of logos: consumer
education, industry
guidelines on the
conditions
formulations, and
improved nutrition
labelling regulations, if
required.
- In 2007, the FDA
announced initiatives
concerning consumer
reactions to claims and
symbols/logos. Public
hearings on the use of
symbols in September
2007.
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NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Document
Heart and
Stroke
Foundation,
2007
Grey literature;
source = Heart
and Stroke
Foundation of
Canada website;
position
statement; author
= NGO
Jauregui,
2007
Grey literature
(thesis –
University of
Florida); source =
PsycINFO;
secondary
analyses (data
from two
chronological
series, 19842003, 30,414 and
13,150
observations);
author =
academic
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
H&S Foundation
recommends that the
industry improve the
availability of nutrition
info in fast-food
restaurants, on menu
boards and on menus.
- In 1989: a committee
of the National
Academy of Sciences,
under contract with the
FDA and the USDA,
examines how to
improve labels.
- 1990: the NLEA
- 1991: the FDA makes
over 20 proposals on
how to apply the NLEA.
The FDA issues a rule
establishing a voluntary
labelling program for
fruits, vegetables and
fish. The USDA’s Food
Safety and Inspection
Services make
proposals on labels for
meat and poultry.
- 1992: Voluntary
labelling program for
fruits, vegetables and
fish in force.
- 1994: The NLEA is
enacted.
- [Logical model] in order for
the labels to be useful,
consumers must be aware
that the info exists, pay
attention to it and understand
it. The availability of
substitute products
influences changes after info
becomes available (if there
are no substitutes, the cost of
changing is too high).
- Other studies: new labels
(introduced in 1994)
improved understanding and
had a modest impact on
purchases, but (soon after
1994) only the most
motivated and sceptical
consumers used them, and
the percentage who never
used them did not change.
- [Note: The study dealt with
label use in general – not
only nutrition info, even if,
implicitly, it plays a large
role.]
- This study: 59% use labels
for purchase decisions; 55%
use them to identify harmful
ingredients. Label reading
peaked at the start of the
1990s (application of the
- [Theory]
Even if there
are few
informed
consumers,
competition
over this
minority may
lead
companies to
make
changes that
are beneficial
to all
consumers.
- [Theory]
Even the poor
and less
educated,
who are less
able to use
nutrition info,
must pay for
it.
- Other
studies: those
who make
more use of
labels =
women, better
educated,
older,
households
with children,
married
people, higher
income,
Caucasians,
people on
special diets,
non-smokers,
people
engaged in
regular
physical
activity,
people who
- [Theory]:
Direct costs of
labelling =
generating the
info, testing
whether
claims are
true, printing
labels,
applying/
enforcing the
labelling rules.
Indirect costs
due to loss of
flexibility in
production
(due to need
to comply with
what is
indicated on
the label, even
if there are
short-term
changes in
input
availability or
costs). Costs
are relatively
higher for
small
companies.
- [Theory]
70% want easy-tounderstand labels.
- Spanish study: the
groups that see
mandatory labels as
more beneficial are label
users, are older and are
more educated.
30
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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(cont’d)
Characteristics of Status
Document
Effectiveness
NLEA), then declined.
Unintended
Effects
Equity
Cost
consume less
fat, people
who believe
that they have
more
knowledge on
nutrition and
believe there
is a link
between food
and health.
- This study:
education has
no effect
(author notes
that this is
unusual).
Variables with
greatest
impact on the
probability of
reading labels
(in
descending
order): calorie
awareness,
nutrition
knowledge,
warning from
doctor on diet,
consumption
of fried
chicken,
attention to
additives,
attention to
cholesterol,
consumption
of hot dogs,
attention to
fat, trust in
Even the poor
and less
educated, who
are less able
to use nutrition
info, must pay
for it.
Feasibility
Acceptability
31
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
Reference
Characteristics of Status
Document
(cont’d)
Centre for
Science in
the Public
Interest –
Canada,
2006a
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
- The cost of
C-283 will be
minimal
because:
almost all
large chain
restaurants
already
calculate or
can easily
calculate
nutrition info
for their
standard
items; the
menus can be
changed
sometime
during the
next three
years when
menus are
updated.
- The cost of
C-283 will be
minimal
because the
nutritional
profiles of
meat, poultry
- The
voluntary
labelling
program of
the Canadian
Restaurant
and
Foodservice
Association
does not
encourage
placing info
on menus,
rather it
encourages
placing it
where it is
less visible
(websites,
brochures,
tray liners).
- Labelling in
restaurants and/or on
fresh products is
supported by health and
consumer defence
groups representing
over 2 million
Canadians [see list in
document].
- Labelling in
restaurants is
recommended in reports
by the CIHI’s Canadian
Population Health
Initiative, Ontario’s Chief
Medical Officer of
Health (in 2004), the
Heart and Stroke
Foundation of Canada,
and the Institute of
Medicine in the U.S.
- Labelling on products
other than packaged
products recommended
in reports by Ontario’s
Chief Medical Officer of
Health (in 2004) and the
B.C. Healthy Living
Alliance
- Associations in the
major brands
as a indication
of better
quality, age of
the woman
heading the
household,
women on
diets, avoiding
foreign food.
Grey literature;
source = CSPI
Canada website;
fact sheet;
authors =
lobbyists
Content of Bill C-283:
in the large chain
restaurants (others are
exempt), have calorie
counts of standard
items posted on menu
boards, as well as
sodium and saturated
and trans fats listed on
the menus of
restaurants with table
service. Also, nutrition
labelling on meat,
poultry and fresh
seafood products.
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NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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Document
Effectiveness
Unintended
Effects
Equity
Cost
and seafood
products are
already
provided on
certain
websites of
the meat
industry; the
labels can be
changed
sometime
during the
next three
years when
label
inventories are
replenished.
- According to
CSPI
estimates, the
cost of
nutrition
analysis is
1/10 of 1% of
retail sales.
- According to
estimates, the
nutrition facts
table would
save $5 billion
over the next
20 years (due
to reduced
health costs
and higher
productivity);
this is 20
times the cost
of changing
the labels.
Feasibility
Acceptability
food industry believe
that there is not enough
space on labels and
menus.
33
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
Reference
Characteristics of Status
Document
Centre for
Science in
the Public
Interest –
Canada,
2006b
Grey literature;
source = CSPI
Canada website;
press release;
author = lobbyist
Center for
Science in
the Public
Interest, n.d.
Grey literature;
source = CSPI
website; fact
sheet; authors =
lobbyists
Effectiveness
Bill C-283 was
defeated in a vote in
Parliament.
[Everything suggests the
theoretical effectiveness of
different ways of providing
info.]
- Available at the decision
point: menus and menu
boards, food labels (on
displays), posters and
brochures (occasionally),
alternative menus or
appendices including
nutrition info, printed
documents on tables
(occasionally), electronic
kiosks (occasionally).
- Accessible and easily
visible: menus and menu
boards, food labels (on
displays).
- Allows food comparisons:
menus and menu boards,
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
- The
restaurant
industry
mounted a
lobbying
campaign
against C283.
- All
Conservative
members
voted against
the Bill, and
it was not
supported by
enough
members of
the
opposition.
- [According to the
CSPI], federal
government scientists
and economists
recognize that
mandatory point-of-sale
info can efficiently
reduce the burden of
diet-related disease if it
is visible prior to
purchase.
- Some members of
Parliament opposing the
law had family links to
the food industry.
[Theoretical]
Ways of
providing info
that do not
impede the
ordering
process:
menus and
menu
boards,
websites,
tray liners,
food
packaging,
cashier
receipts
34
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
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(cont’d)
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Document
Effectiveness
Unintended
Effects
Equity
Cost
Feasibility
Acceptability
food labels (on displays),
posters and brochures,
alternative menus or
appendices including
nutrition info, printed
documents on tables,
electronic kiosks, websites,
tray liners.
- Presented with the
price (see arbitration in the
purchase decision): menus
and menu boards, food
labels (on displays).
- Specific notes: websites:
consumers must see them
before ordering. Kiosks: only
one person at a time can use
it. Represents a problem for
persons with little computer
experience.
List of documents referenced in this table
Canadian Food Inspection Agency (2009). Food labelling. Consulted on August 3, 2009: http://www.inspection.gc.ca/english/fssa/labeti/labetie.shtml
Center for Science in the Public Interest (2008a). Myth vs. reality: Nutrition labeling at fast-food and other chain restaurants. Retrieved from:
http://cspinet.org/new/pdf/myth_and_reality_2008.pdf
Center for Science in the Public Interest (2008b). Summary of findings: Influence of nutrition information provision. Retrieved from:
http://www.cspinet.org/new/pdf/lit_review-nutrition_info_studies.pdf
Center for Science in the Public Interest (2008c). Nutrition labeling at fast-food and other chain restaurants. Retrieved from:
http://cspinet.org/new/pdf/fact_sheet_2008.pdf
Center for Science in the Public Interest (2008d). Product reformulation: A beneficial outcome of menu labeling. Retrieved from:
http://cspinet.org/new/pdf/reformulation_fact_sheet.pdf
Center for Science in the Public Interest (2008e). Summary of polls on nutrition labeling in restaurants. Retrieved from:
http://www.cspinet.org/new/pdf/census_menu_board_question.pdf
35
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
Center for Science in the Public Interest (2009). New York City. Rave reviews for menu labeling. Retrieved from:
http://cspinet.org/new/pdf/nyc_review_fact_sheet.pdf
Center for Science in the Public Interest (n.d.). Approaches to providing nutrition information in restaurants. Retrieved from:
http://www.cspinet.org/new/pdf/display_methods_comparison_chart.pdf
Centre for Science in the Public Interest - Canada (2006a). 10 reasons to support Tom Wappel's Bill C-283 on September 18, 2006. Retrieved from:
http://www.cspinet.org/canada/pdf/C283_200609.pdf
Centre for Science in the Public Interest - Canada (2006b). Statement on Parliament's vote denying consumers of nutrition info. Retrieved from:
http://www.cspinet.org/canada/pdf/2006-11-09_statement_nutritioninfo.pdf
Centre for Science in the Public Interest - Canada (2007). Testimony of Bill Jeffery, national coordinator of the Centre for Science in the Public Interest, before
the House of Commons Standing Committee on Health on measures to reduce rates of childhood obesity. Ottawa: CSPI. Retrieved from:
http://www.cspinet.org/canada/pdf/2007-02-21_healthcomte.pdf
Centre for Science in the Public Interest - Canada (2008a). Most "volunteers" in restaurant industry's nutrition information program stepped back two paces.
Retrieved from: http://www.cspinet.org/canada/pdf/twopacesback.pdf
Centre for Science in the Public Interest - Canada (2008b). Simplifying nutrition labels and preventing deceptive claims (Response to Health Canada's
"Managing health claims for foods in Canada: Towards a modernized framework"). Retrieved from: http://www.cspinet.org/canada/pdf/2008-0414_deceptiveclaimscanada.pdf
Centre for Science in the Public Interest - Canada (2009a). "Healthy decisions for healthy eating Act" moves forward in Ontario legislature! Retrieved from:
http://cspinet.org/canada/pdf/ontariobill-156passes.second-reading.pdf
Centre for Science in the Public Interest - Canada (2009b). Ontario Medical Association's menu labelling advice. Just what the doctor ordered. Retrieved from:
http://cspinet.org/canada/pdf/oma-menulabel.comment.pdf
Coalition québécoise sur la problématique du poids (September 30, 2009a). Des logos "santé" qui sèment la confusion: Une réglementation s'impose. Press
release. Retrieved from: http://www.cqpp.qc.ca/documents/file/2009/Communique_Logos-sante_2009-09-30.pdf
Coalition québécoise sur la problématique du poids (2009b). Des logos "santé" qui sèment la confusion: Une réglementation s'impose. Presentation made
during a press conference held on September 30, 2009 [PowerPoint slides]. Retrieved from:
http://www.cqpp.qc.ca/documents/file/2009/PowerPoint_Logos-sante_2009-09-30.pdf.
Engelhard, C. L., Garson, A. & Dorn, S. (2009). Reducing obesity: Policy strategies from the tobacco wars. Washington DC: The Urban Institute. Retrieved
from: http://www.urban.org/UploadedPDF/411926_reducing_obesity.pdf
Friedman, R. (2008). Menu labeling in chain restaurants. Opportunities for public policy. New Haven: Rudd Center for Food Policy and Obesity, Yale
University. Retrieved from: http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf
Government Accountability Office (2008). Food labeling: FDA needs to better leverage resources, improve oversight, and effectively use available data to help
consumers select healthy foods. Washington DC: United States Government Accountability Office. Retrieved from:
http://www.gao.gov/new.items/d08597.pdf
36
NCCHPP – Nutrition Labelling - Grey Literature Extraction Table
Health Canada (2007). Managing health claims for foods in Canada: Towards a modernized framework. Ottawa. Retrieved from: http://www.hc-sc.gc.ca/fnan/alt_formats/hpfb-dgpsa/pdf/label-etiquet/man-gest_health_claims-allegations_sante-eng.pdf
Health Canada (2009a). Nutrition labelling. Consulted on August 2, 2009: http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/index-eng.php
Health Canada (2009b). Health Canada's action plan in response to stakeholder feedback from consultations on modernizing Canada's framework for health
claims on food. Ottawa. Retrieved from: http://www.hc-sc.gc.ca/fn-an/alt_formats/pdf/pubs/action-plan-consultation-eng.pdf
Heart and Stroke Foundation (2007). Position statement. Overweight, obesity, and heart disease and stroke. Retrieved from:
http://www.heartandstroke.com/atf/cf/%7B99452D8B-E7F1-4BD6-A57D-B136CE6C95BF%7D/Obesity_PS_Eng_June2007.pdf
Heart and Stroke Foundation (2009a). Heart&Stroke Health Check TM... Helping you eat well. Consulted on August 4, 2009:
http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483961/k.FBE9/Health_Check8482__Designed_to_help_you_make_healthy_food_choices.ht
m
Heart and Stroke Foundation (2009b). Health Check TM. What consumers say. Consulted on August 4, 2009: http://www.healthcheck.org/page/whatconsumers-say
Jauregui, C. E. (2007). Consumers' use of food labels: An application of ordered probit models (doctoral thesis). University of Florida, Gainesville.
Kiesel, K. & Villas-Boas, S.B. (2009). Can information costs confuse consumer choice? Nutritional labels in a supermarket experiment (doctoral thesis).
California State University, Sacramento. To be published as: Kiesel, K. & Villas-Boas, S.B. (in press). Can information costs affect consumer choice?
Nutritional labels in a supermarket experiment. International Journal of Industrial Organization.
Kohn, D. (2009). Better health, not just better health care: A prescription for progress from the Big Cities Health Coalition. New York: Milbank Memorial Fund.
Retrieved from: http://www.milbank.org/reports/BetterHealth2009/BetterHealth2009.pdf
Robert Wood Johnson Foundation (2009). Menu labeling: Does providing nutrition information at the point of purchase affect consumer behavior? Princeton:
Robert Wood Johnson Foundation. Retrieved from: http://www.rwjf.org/files/research/20090630hermenulabeling.pdf
Rudd Center for Food Policy and Obesity (2008). A case study of California's menu labeling legislation. New Haven: Rudd Center for Food Policy and Obesity,
Yale University. Retrieved from: http://www.yaleruddcenter.org/resources/upload/docs/what/policy/CaliforniaSB120MenuLabelCaseStudy.pdf
37