Childhood obesity is a public health challenge in many countries. Food labelling may help children make healthier food choices. Food is typically labelled using the traffic light label system but this is complex to understand. Physical activity calorie equivalent (PACE) labelling may be easier for children to understand and more appealing because it contextualises the energy content of food/drinks.
A cross-sectional online questionnaire was completed by 808 adolescents aged 12–18 years in England. The questionnaire investigated participants’ views and understanding of traffic light and PACE labels. Participants were also asked about their understanding of the meaning of calories. The questionnaire explored participants’ views about the potential frequency of use of PACE labels and their perceived usefulness in influencing purchasing and consumption decisions. Questions that explored participants’ views about the possible implementation of PACE labelling, preferences for food settings and types of food/drinks they may like such labelling implemented, and whether PACE labels would encourage physical activity were included. Descriptive statistics were explored. Analyses assessed associations between variables and tested differences in the proportions of views about the labels.
Evidence suggests that the average adolescent is consuming an excess of energy, typically, from sugary drinks, confectionary and cakes. Eating out of the home has been linked with unhealthy food choices. One strategy to help promote healthier eating and drinking is nutrition labelling. A common food label on packaged food and drinks in the UK and other countries is the traffic light food label (TLL). In the UK, the TLL uses colour coding to display whether a food or drink is high, medium or low in fat, saturated fat, sugar and salt. The TLL also shows energy information.
Eating Out of Home Issues
Recognising that eating out of the home can drive the overconsumption of calories, governments in several countries, including the UK, have made it mandatory for large businesses in the out of home sector (such as restaurants, cafés and takeaways) to have calorie labelling. Though nutrition labelling is considered a way to promote healthy eating, it is unclear whether it influences food purchasing or consumption. Nutrition labelling may not be effective, or not effective as it could be, because it displays information that is hard to understand and interpret (e.g. number of calories). This may be particularly true for children as current food labelling approaches require complex thought processes.
Until early adolescence, children are unable to think hypothetically. Therefore, children may struggle to understand the context of eating/drinking unhealthily such as how it relates to energy balance. Given this concern, an alternative approach to food labelling that may be more appealing to young people is physical activity calorie equivalent (PACE) food labelling. This labelling aims to contextualise the energy content of food/drinks by showing the number of minutes or miles/kilometres of physical activity equivalent to the calories contained in the item. As well as being a potential means of reducing calorie intake, unlike other types of food labelling, PACE labelling may also promote participation in physical activity. Unlike TLLs, PACE labelling does not require complex mental mathematical calculations to understand the full calorie content.
Evidence suggests that PACE labelling may influence food/drink choice, including among adolescents. Most research in this area however has tested the effects of PACE food labels in laboratory settings/hypothetical food choice scenarios in adults and more real-world studies are needed to test the effectiveness of PACE food labels in reducing calorie intake and increase physical activity in both adults and children. Qualitative research has indicated that young people may prefer PACE labelling over other types of labelling.
As young people start to make independent decisions about what and where they eat, it is crucial that they are given understandable information to help them in their decision making. This study aimed to compare young people’s views (perceptions) and understanding of TLLs and PACE labels. Additionally, the study aimed to gather views about the possible implementation of PACE labelling such as preferences for locations and the types of food and drinks PACE labelling could be displayed on. Answers to these questions may help guide future health policy about the role of PACE labelling as a public health strategy.
When asked to select the label that was easier for them to understand, a significantly higher proportion of participants selected the PACE label as easier to understand (n = 509), compared to the TLL (n = 233) (69% vs 31% respectively). The free-text responses highlighted the main reasons why the PACE label was easier to understand is because they are considered simple (56%) and show physical activity information (38%). Participants who selected the TLL as easier to understand reported in their free-text responses this was because the TLL shows nutrient information (53%) and is simple (19%).
Sixteen percent of participants reported TLLs were very easy to understand, compared to 43% for PACE labels. Of the total participants, 49% reported both labels easy to understand. There was a significant association between understanding of TLLs and PACE labels, with 81% of those who found TLLs easy to understand, also finding PACE labels easy to understand. Conversely, 59% of those who found TLLs hard to understand, found PACE labels easy to understand. Only 2% of all participants reported both labels were hard to understand. Older participants found TLLs easier to understand than younger participants.
Of participants who had seen TLLs on food and drinks before, 19% looked at TLLs often/always. Out of the total participants, 42% said they would look at PACE labels often/always if they were implemented. There was a significant association between how often young people looked/would look at the labels. Participants who looked at TLLs were more likely to say they would look at PACE labels. Specifically, 67% of participants who looked at TLLs often/always also reported that they would look at PACE labels often/always.
Furthermore, 43% of participants who looked at TLLs rarely/sometimes said that they would look at PACE labels more often; and 68% who never looked at TLLs said they would look at PACE labels more often. Females and participants of non-white ethnicity were more likely to report that they would look at PACE labels often/always. The most common reason why participants never/would never look at food labels is because they are not interested in making healthy choices.
A significantly higher proportion of participants selected the PACE label (n = 623) as the label that would take less time for them to read, compared to the TLL (n = 132). Reasons why the PACE label would take less time to read is because it shows less information (45%) and is simple (32%). Reasons given why the TLL takes less time to read is that it has colours (27%) and is easier to understand (22%).
Compared to the TLL (n = 255), a significantly higher proportion of participants selected the PACE label (n = 463) as the type of label that catches their attention the most (36% vs 64% respectively). The PACE label would catch attention the most because it is simple/easier to read (36%) and is bigger (29%). The main reasons why the TLL would catch attention the most is because of the colours (40%) and that it shows more information (23%).
Consistent with previous research suggesting that nutrition labels may not be effective in altering food purchasing or consumption, this study found that the use of TLLs among adolescents was low. Participants reported that they would look at PACE labels more often than TLLs and overall, perceived PACE labels as more useful. This suggests a preference for PACE labels in young people, supporting findings by Evans et al. (2016) who found that young people may prefer PACE labelling over other types of labelling. Our findings indicate that PACE labels may make it easier for some young people to choose healthy food and drinks on their own. PACE labels may prevent young people buying unhealthy food and drinks e.g. discretionary foods, which could contribute to reducing overconsumption behaviour and thus leading to a reduction in overweight and obesity, if such behaviour changes are sustained.
It is interesting that views were divided about the type of labelling that would make it easier for participants to choose healthier food and drinks. This result may add to the case that placing both the TLL and PACE label on packaged food and drinks, or a ‘hybrid’ incorporating the most important elements of both types of labelling, may be of benefit. This could serve the needs of most young people by displaying nutrient information to those who need/want it, as well as providing contextual information on energy content in food/drinks. On unpackaged food and drinks, PACE labelling could complement absolute calorie labelling to provide young people with more information about energy.
Results
More participants reported PACE labels as easier to understand than traffic light labels (69% vs 31%). Of participants who had seen traffic light labels, 19% looked at them often/always. Forty-two percent of participants would look at PACE labels often/always. The most common reason why participants never/would never look at food labels is because they are not interested in making healthy choices. Fifty-two percent of participants said PACE labels would make it easier for them to choose healthy food and drinks. Fifty percent of participants reported PACE labels would encourage them to be physically active. It was perceived that PACE labels could be useful in a range of food settings and on a range of food/drinks.
PACE labelling may be easier for young people to understand and more appealing/useful to them than traffic light labelling. PACE labelling may help young people choose healthier food/drinks and reduce excess energy consumption. Research is now needed to understand the impact of PACE labelling on food choice among adolescents in real eating settings.
