Stars plus warnings for healthier food choices

Professor Cliona Ni Mhurchu and her team compared the voluntary Health Star Rating (HSR) system used in Aotearoa New Zealand and Australia with the mandatory health warning system used in Chile.
The Chilean system involves one or more black ‘stop signs’ on the front of packages and bottles warning the product is high in energy (calories), added sugar, salt or saturated fat. It was put in place 2016 to help curb rising obesity, with 75 percent of Chileans over 15 years overweight or obese according to latest figures. In New Zealand, that figure is 65 percent. More broadly, dietary factors are the leading cause of avoidable health loss here.

The Health Star Rating system rates food from half a star (least healthy) to five stars (healthiest).

For the comparison, the Auckland researchers classified almost 14,000 packaged food and beverages according to both systems. They found that two-thirds (67 percent) of New Zealand products would have at least one health warning under the Chilean system. Around one-third would require a warning for high energy (37 percent), high sodium (34 percent), high sugar (33 percent) or high saturated fat (29 percent).

For almost nine out of ten products, the two systems largely agreed with each other. But around eight percent received conflicting ratings/warnings, mostly due to the Chilean system restricting warnings to food containing added (rather than naturally occurring) ingredients and the HSR awarding points for healthy components.

“A lot of public health experts here view the Chilean system as better than the HSR because it is mandatory, and because it provides unambiguous warnings on all foods that are high in nutrients that we know are harming people, usually due to over-consumption,” says Professor Ni Mhurchu, from the School of Population Health in the University of Auckland’s Faculty of Medical and Health Sciences.

“Often, these nutrients are ‘hidden’ in processed food – for example, when sodium is used as a preservative in food – and people don’t realise what they’re eating; or they’ve gotten used to highly salty or sweet flavours over years of eating ultra-processed food.”

She says if warning labels were introduced in New Zealand, they could co-exist with the Health Star Ratings, potentially off-setting each other’s limitations.

“The main thing is, whichever labelling system we use, it’s clear that it should be mandatory to work effectively. Currently, less than one quarter of New Zealand products display a HSR, and the rating is applied selectively on healthier products by most manufacturers.”

A separate, in-depth snapshot of packaged food published by Professor Ni Mhurchu with other University of Auckland researchers earlier this year revealed that nearly 70 percent of packaged food and drink in our supermarkets is ultra-processed, and nearly three-fifths (59 percent) qualify for a low star rating (less than 3½ stars).

“Most shoppers want to eat well for their own and their family’s health. A compulsory health warning, or health star rating, or both, on the front of every packaged item would allow them to make a quick, informed choice,” says Professor Ni Mhurchu.

A five-year review of the HSR system published earlier this year concluded it should continue with some changes to better reflect dietary guidelines, including automatically giving fruit and vegetables five stars, penalising total sugars more strongly and rating unsweetened flavoured waters closer to water to distinguish from juice and sugar-sweetened drinks.

The Australian and New Zealand Ministerial Forum on Food Regulation is expected to respond to the recommendations by the end of the year.

The study’s other authors were Senior Lecturer Dr Helen Eyles and Masters student Fredrik Söderlund. It was published in the Australian and New Zealand Journal of Public Health this week.

Professor Ni Mhurchu is a member of the New Zealand Health Star Rating Advisory Group which provides advice to the Government on implementation of the HSR system. The Advisory Group was not involved in this latest study.

Read the article:

Australian and New Zealand Journal of Public Health: Stars versus warnings: comparison of the Australasian Health Star Rating nutrition labelling system with Chilean Warning Labels