Testing the Effects of Singapore's Front-of-Pack Healthier Choice Symbol Label With or Without a Physical Activity Equivalent Label
- Conditions
- ObesityDiabetesDiet, Healthy
- Interventions
- Behavioral: Healthier Choice SymbolBehavioral: Physical Activity Equivalent label
- Registration Number
- NCT04172337
- Lead Sponsor
- Duke-NUS Graduate Medical School
- Brief Summary
Poor diets are known risk factors for chronic diseases, and in recent years, food labelling has been increasingly sought-after as a cost-effective intervention to help stem the rising trend in chronic diseases.
In efforts to promote a healthy diet, the Singapore Health Promotion Board (HPB) supplements traditional nutrition labelling with the Healthier Choice Symbol (HCS), which identifies food items within a specific category of foods as healthier choices. The original logos were enhanced to include additional information focusing on particular macronutrients, taking one of two themes; it either indicates that a product contains more of a healthier ingredient, or less of a less healthy ingredient.
However, to date, no published studies have assessed the role of the original and enhanced HCS logos in influencing food choices. There is a lack of scientific evidence on the role of the existing symbols in assisting consumers make healthier food purchasing decisions. There are also concerns over the unintended consequences of health claims made based on a single aspect of nutrient content, without considering other aspects. That is the goal of this effort. Specifically, the investigators
propose to conduct the following:
Use a three arm randomized controlled trial (RCT) and an experimental fully functional web-based grocery store to assess the causal effect of the new HCS logos on measures of diet quality either alone, or in combination with a complementary front-of-package (FOP) label: Physical Activity Equivalents (PAEs), which provides information on how long one would need to engage in a certain activity (e.g., jogging) to burn off one serving of the product.
The investigators hypothesize that the greatest reduction in calories per serving (primary outcome) will occur in the HCS plus PAEs arm, followed by HCS only, and no logo control arm.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 117
- Singapore residents
- 21 years of age and above
- Primary grocery shopper for the household
- Not residing in Singapore
- Under 21 years of age
- Not the primary grocery shopper for the household
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description HCS-only Healthier Choice Symbol Arm 2 (termed HCS-only) displayed the HCS on eligible products, crossed referenced via the Health Promotion Board's HCS database (https://www.hpb.gov.sg/food-beverage/healthier-choice-symbol). Out of the 4,177 products available on NUSMart, 311 (7·45%) carried the HCS. This was comprised of 150 foods and 161 beverages. HCS+PAE Healthier Choice Symbol Arm 3 displayed the HCS on eligible products as in Arm 2 and the PAE label on all products (termed HCS+PAE). PAE was calculated as the minutes required to burn off the calories of a single serving for a 73 kg person jogging at 8 km per hour. HCS+PAE Physical Activity Equivalent label Arm 3 displayed the HCS on eligible products as in Arm 2 and the PAE label on all products (termed HCS+PAE). PAE was calculated as the minutes required to burn off the calories of a single serving for a 73 kg person jogging at 8 km per hour.
- Primary Outcome Measures
Name Time Method Change in average calories per serving purchased per shopping trip Once a week for three weeks Calories per serving (kCal per serving) is calculated by dividing the total number of calories purchased in the shopping trip by the total number of servings purchased. The average calories per serving purchased (kcal per serving) is based on mean standardized serving sizes within each subcategory.
- Secondary Outcome Measures
Name Time Method Sugar per serving per shopping trip Once a week for three weeks Amount of sugar (g) per serving purchased based on mean standardized serving sizes within each subcategory.
Calories per dollar spent per shopping trip Once a week for three weeks Number of calories per dollar (kcal per dollar) spent
Proportion of HCS labelled products purchased (or would have been if not in control arm) per shopping trip Once a week for three weeks Calories per Shopping Trip will be calculated as the sum of all purchased products' total calories.
Diet quality per shopping trip as measured by the Grocery Purchase Quality Index-2016 Once a week for three weeks Diet quality per shopping trip as measured by the Grocery Purchase Quality Index-2016 (GPQI-2016). The Grocery Purchase Quality Index-2016 (GPQI-2016) contains 11 different food components with eight components scored based on adequacy and three moderation components. We followed the standard GPQI-2016 scoring methods by mapping NUSMart's subcategories to USDA food plan categories and then to the GPQI components. Each component was scored based on the deviation of the observed expenditure share of each component and the expected expenditure share, and the scores were totaled up to generate the final GPQI-2016 score (minimum possible score = 0, maximum possible score = 75) for each participant's weekly grocery order. A higher score indicates better diet quality of the grocery basket.
Diet quality per shopping trip as measured by weighted average Nutri-Score Once a week for three weeks We applied the standard Nutri-Score algorithm to assign a grade to each product. This algorithm assigns a score of A to E based on nutritional quality, which we recoded to 5 to 1 and then calculated an average score for each participant's weekly grocery order (minimum possible score = 0, maximum possible score = 5), weighted by the number of servings of each product. A higher score indicates better diet quality of the grocery basket.
Total Calories per shopping trip Once a week for three weeks Total calories purchased in kcal.
Sodium per serving per shopping trip Once a week for three weeks Amount of sodium (mg) per serving purchased based on mean standardized serving sizes within each subcategory.
Saturated fat per serving per shopping trip Once a week for three weeks Amount of saturated fat (g) per serving purchased based on mean standardized serving sizes within each subcategory.
Trial Locations
- Locations (1)
Duke-NUS Medical School
🇸🇬Singapore, Singapore