Nutritional Pearls: Do Nutrition Scores Improve Food Choices?
Thomas is a 20-year-old overweight college student struggling to lose weight. When asked about his eating habits, he tells you that many of his daily meals consist of prepackaged food, and he rarely looks at the nutritional information on the back of the boxes.
How would you advise your patient?
(Answer and discussion on next page)
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Answer: Prominent nutritional labels and scores encourage individuals to purchase healthier foods.
In 2010, a study examined at whether college students would make healthier food choices when the foods were labeled with shelf tags that indicated their relative healthfulness. The sales of 4 categories of foods carrying the labels were analyzed for a 5-week period and compared with a 6-week period in which the labels were not on the products. The authors found that in 3 of the 4 categories the students were only slightly more likely to choose the healthier items.
You've probably seen some form of this shelf labeling at your own grocery store. The 3 most popular types include a traffic light-style label, a label with stars (more being better), and a single number called NuVal. This scoring system assigns a number from 1 to 100 (higher being better) to each of over 120,000 different food items based on not just their overall nutrient content but also how that nutrient affects or is linked to health conditions such as high blood pressure, heart disease, or diabetes.
The Research
The authors of a recent article essentially repeated the previous study, but on a much, much larger scale. Instead of 4 categories, the authors assessed 8: frozen pizza, tomato products, soup, salad dressing, yogurt, spaghetti sauce, granola bars, and ice cream. Instead of about 3,500 potential purchasers, Dr. Nikolova and her team were provided access to the weekly purchase data of over 535,000 American shoppers through their use of a store chain's frequent shopper program card (with all identifying information removed). Finally, instead of 5 or 6 weeks of data, the authors were able to analyze a period of 6 months before the NuVal numbers were introduced in the 1,500 stores and 6 months afterward.
The Results
It shouldn't surprise you that the average scores of the NuVal-labeled foods that people purchased went up about 20%, with the largest improvements seen in canned soup (up by almost 70%), ice cream (almost 30%), and granola bars (almost 25%). Even frozen pizzas that were purchased tended to be healthier by a little over 10%, while spaghetti sauce and tomato products improved by around 6% each.
What's particularly interesting about this research is that the authors also took into account the price of each food item purchased. The researchers in the study of college students chose their food categories partially because all the items in each category were priced the same—taking the issue of cost out of the equation. In today's article, the authors found that people seemed to be willing to spend more on foods with higher NuVal scores—and were also likely to purchase more of those items at a time when they were on sale.
What’s The “Take Home”?
The authors rightly describe this as a "win-win" for both the grocery store and the consumer: the consumer finds it easier to make healthier choices, while the grocery store will see this as justification for what might be a higher price for healthier items within the same broad food category. I wouldn't mind seeing that happen in the case of processed foods. That said, the good news is that when you're purchasing basic ingredients like produce, whole grains (brown rice), lean meats, and vegetables, you already know they're good for you and the NuVal number on the label (and likely the price) won't vary too much between options. It's unlikely that food out of a box will ever be cheaper and healthier than making your own from scratch.
References:
- Freedman MR, Connors R. Point-of-Purchase Nutrition Information Influences Food-Purchasing Behaviors of College Students: A Pilot Study. Journal of the American Dietetic Association. 2010;111(5):S42-S46.
- Ni kolova HD, Inman JJ. Healthy choice: the effect of simplified point-of-sale nutritional information on consumer food choice behavior J Marketing Res 2015;52(6):817-835)