Health Star Rating food labelling – experts respond

A new voluntary food labelling system aims to give Australian and New Zealand consumers greater insight in the nutritional value of their food at a glance. Will it lead to healthier choices?  

Ministry for Primary Industries

Minister for Food Safety Nikki Kaye announced that the government will be adopting a new Health Star Rating food labelling system, at the Australian and New Zealand Ministers food forum in Sydney on Friday.

The front-of-pack labels use a five star scale to reflect the nutritional value of the food product.

According to the Ministry for Primary Industries the system takes into account four aspects of a food associated with increasing the risk factors for chronic diseases (energy, saturated fat, sodium and total sugars) along with certain ‘positive’ aspects of a food such as fruit and vegetable content, and in some instances dietary fibre and protein content.

The Ministry expects it will be six to 12 months before the label starts appearing on shelves.

The SMC collected the following expert commentary. Feel free to use these quotes in your reporting. If you would like to contact a New Zealand expert, please contact the SMC (04 499 5476;

NEW: Dr Helen Eyles, Research Fellow, National Institute for Health Innovation, The University of Auckland, comments:

“Packaged foods, especially those which have undergone a lot of processing, tend to be high in adverse nutrients such as saturated fat, salt, and sugar.  Therefore, in an ideal world we would all be eating predominantly whole, fresh, unprocessed foods.   However, cost, convenience and other factors mean that packaged foods are often included in our diets.

“The new Health Star Rating food labelling system will provide New Zealand consumers with a much-needed consistent front-of-pack nutrition label to enable them to compare packaged foods and make healthier choices more easily.

“The new Health Star Rating food label is based on a robust system used in the UK to determine foods eligible to be marketed to children.  It has also been developed with input from a range of stakeholders, including nutrition experts.  A nice feature of the new label is that the number of stars given to a product is based on the balance of positive nutrients such as fibre and protein, with adverse nutrients including salt and sugar.

“Extensive testing of the new label has been undertaken with foods available for sale in the New Zealand and Australian food supplies. However, it isn’t perfect because the set of rules sitting behind it mean that some foods will receive a star rating that gives the wrong message to consumers.  For example, fruit juice is very high in sugar and receives 4 ½ (out of a possible five) stars. The public information campaign accompanying the roll-out of the new label should help consumers to realise there will be anomalies and how best to use it to make healthier choices across the food supply.

“Although there is no evidence of the effectiveness of the new label, the format is interpretive, summarising nutrient and ingredient information to give an overall health score for individual products.  This is positive because current research points to interpretive labels as being best understood by all types of consumers. The National Institute for Health Innovation is also working to provide some of the evidence needed. We are currently recruiting participants for a new study to find out what effect different types of front-of-pack nutrition labels, including the new Star Rating system, have on consumer food purchases. In addition, monitoring of how many and which type of products display the new voluntary label, and an evaluation of its cost effectiveness in the ‘real world’ will be important.

“The new front-of-pack Health Star Rating food label on its own is not going to solve our alarming rates of obesity and diet-related disease in New Zealand.  However, it is a positive step in the right direction, and one component of a much-needed multi-factorial approach to improving New Zealanders health. ”

Dr Rachael McLean PhD, Senior Lecturer Public Health & Nutrition, University of Otago, comments:

“The recently announced decision to adopt a front of pack Health Star Rating food labelling system will be welcomed by many nutrition and public health practitioners as long overdue.  A simple front of pack label that consumers can understand allows consumers to choose products that are healthier, and encourage food manufacturers to reformulate and produce food items in order to achieve a better grade under the system.  Food items will qualify for a star rating (between half a star and 5 stars) based on Nutrient Profiling Scoring Criteria outlined in the Australia New Zealand Food Standards Code- Standard 1.2.7 – Nutrition, Health and Related Claims. Nutrient Profiling involves an examination of a range of nutrients, awarding an overall score.  The star rating is accompanied by the Daily Intake Label already in use in New Zealand.

“The announcement follows an independent Review of Food Labelling Law and Policy in 2011, which recommended the adoption of a single interpretive label as a means of encouraging more healthy eating to reduce chronic disease in the population.  The review recommended the adoption of the colour coded Multiple Traffic Light label as the option that has been shown in multiple studies to be most effective in communicating messages about nutrition to a wide range of consumers.  By contrast, the food industry has promoted the Daily Intake Labelling Scheme, which is incorporated into the Health Star Rating label.  The Daily Intake Label has recently been adopted for use in the European Union, whereas a traffic light style colour coded Daily Intake Label is in currently use in the United Kingdom.

“A recent study commissioned by the Ministry for Primary Industries used an online experiment to test the ability of the Health Star Rating system to enable consumers to correctly identify a healthier food product compared to a control label with no front of pack label.  This was tested in general population sample as well as samples of M?ori and Pacific consumers. The study showed that the presence of the Health Star Rating label significantly improved consumers’ ability to identify healthier food products compared to the control.  However, the study did not test the Health Star Rating label against other interpretive front of pack labels such as the Multiple Traffic Light label favoured by the Review of Food Labelling Law and Policy (2011).

“While it has been shown that under experimental conditions consumers are able to use the health star rating system to identify healthier food products, it is not clear how the system will operate in real world settings.  It is essential that the label is evaluated following its introduction to determine whether the presence of the label has an impact on consumer purchasing behaviour, as previous research suggests that consumers over-estimate their use of nutritional information and read information less than expected.  Improved nutrition has the potential to decrease obesity, and prevent chronic diseases such as cardiovascular disease, diabetes and cancer. The introduction of a front of pack label such as the Health Star Rating has the potential to increase healthy eating, but should be part of wider initiatives to improve the nutritional quality of foods available in a variety of settings.”

Prof Cliona Ni Mhurchu, Programme Leader for Nutrition Research at the National Institute for Health Innovation, University of Auckland, comments:

“Introduction of interpretive, front-of-pack nutrition labels is a positive step for New Zealand. We have high rates of obesity and diet-related disease in this country and simple, interpretive, front-of-pack nutrition labels have been identified as potentially one of the most cost-effective ways to counteract these problems. Good nutrition labels work in two ways: they help people identify healthier foods and make better food choices, and they provide an incentive to the food industry to reformulate their products so they can gain better ratings on the labels. Both of these should have positive effects on health.

“Evidence shows that people struggle to use and understand our current back-of-pack Nutrition Information Panels (NIP). Research has also shown that people can work out what foods are healthy or unhealthy more easily when using interpretive nutrition labels (e.g. the UK traffic light labels). Our New Zealand research found that all of our key population groups find interpretive nutrition labels easier to use and understand than numerical labels like NIP and the Daily Intake Guide.

“However, any nutrition label will only have positive effects on diets and health if they are available widely across the food supply (i.e. not just in niche categories or on a small number of brands) and if consumers use them effectively to make healthy choices. As yet we don’t know if either condition will be met. The new system is voluntary so it is essential that there be an independent review of progress of implementation after a reasonable period e.g. two years. If there is not widespread uptake at that point, New Zealand should consider following the example of Australia who has said they will make the system mandatory unless voluntary uptake is extensive. The effects of the Health Star Rating labels on consumer food choices is another big unknown. To answer this question our research team will shortly begin a large randomised trial to determine the effects of different nutrition labels (including the new Health Star Rating system) on the food choices of 1500 New Zealanders.

“Reducing obesity is a huge challenge and should not be underestimated. While the adoption by New Zealand of an interpretive, front-of-pack labelling system is a step in the right direction it is no panacea. We need to do much more to improve our food environment, support healthy choices, and prioritise the health of all New Zealanders.”

Prof Elaine Rush, Professor of Nutrition, AUT, comments:

“The announcement that the governments of New Zealand and Australia will be adopting a new Health Star Rating food labelling system”  is welcome.  It is a small step towards providing  a ranking for the  nutrient composition on the front of pack will make it much easier to make decisions about the food. The ranking of the foods with a number of stars is based on the total energy and the amounts of the positive “components”: fruit and vegetable content, protein and fibre and the negative components saturated fats, sugars and sodium (salt). ”

“The amount of the more negative nutrients energy, saturated fat, sugars and sodium are presented as four :”tombstones”  and state the quantity of these per pack or per 100 gram. Another nutrient can be included in this detail which may be, in a very small font given the size of some packets, too hard to read unless taken off the shelf and looked at closely? Most shoppers do not have the time for this

“There are a number of issues that need to be evaluated as this voluntary system is rolled out.

  • What is the extent of adoption by the food industry and are the foods that have this labelling biased towards the more nutrient dense ones such as the whole grain products of Sanitarium
  • Is it the number of stars, the cost or the taste  that decides which food is actually purchased?
  • Does the overall nature of the food supply in supermarkets change? Is less shelf space given to sugary drinks and more to whole grain cereals with little added sugar?
  • Is the food industry reformulating foods so that they have a better nutrient profile? If so which foods and by how much? Will targets be set?

“Everyone is on a diet – the word means all the kinds of foods and drinks a person usually eats. The best diet is one that provides all the nutrients and food groups in adequate quantities for optimal function, growth and development on average every day. PEOPLE EAT FOODS NOT NUTRIENTS yet these labels do not say anything about the wholesomeness of the food or how much processing went into producing the food that has the highest ranking. The only “whole” component is the contribution to the score of the fruit and vegetable content. Theoretically one could have all the products in their shopping trolley with a relatively high star ranking but not have a balanced diet as important food groups could be omitted or under represented. The bottom line for the gatekeeper for the household’s food supply is to think about all the foods that are eaten and look at the overall foods that enter the house and mouths of the household.

“On the other hand the ability to make an informed choice is not just about looking at the stars.  The message that fruit and vegetables are good for health is known by most but are those choices available in the local shops in enough quantity at a price that can be afforded or are there other “fake foods” competing for the $ and the taste?

“This food labelling system is a step in the right direction, but government, industry, society and individuals all have a responsibility for pushing now  for more steps  that will allow truly healthful eating, with all its different food diversity, cultures and social implications, be the norm and a real choice for New Zealand.”

Dr Ninya Maubach, Heart Foundation White-Parsons Research Fellow, Department of Marketing, University of Otago, comments:

“There is no question that New Zealanders would benefit from more accessible nutrition information placed on the front of food labels. Moreover, this should be an interpretive label that removes the requirement for specialist nutrition knowledge or mathematical ability to understand.  Ostensibly, the new Health Star Rating is certainly much better than the Nutrition Information Panel, and the Minister’s desire to improve food labels is commendable.  However, we just don’t know whether this is actually the best format. Given the expert recommendation for Multiple Traffic Light labels contained in the Blewett (2011) report was apparently rejected due to a lack of evidence, this development is puzzling.   A similar government-industry partnership in the United Kingdom has resulted in 60% of producers agreeing to use a Traffic Light Label.  This format has been extensively studied, and indications are this may be more useful than the newly created Health Star Rating.

“Many researchers in several countries have examined the effectiveness of a variety of front-of-pack label formats. One recent literature review concluded “the Multiple Traffic Light system has most consistently helped consumers identify healthier products” (Hawley et al., 2013). The new Health Star Rating has not been compared to any traffic light formats. However, last year I led research to compare a Star Rating label developing according to the NZ working group guidelines, to the Multiple Traffic Light and Daily Intake Guide.  This will be discussed in a press release issued on Monday 30 June.

“The Health Star Rating label also includes icons for nutrient specific information, presented numerically in either absolute or percent daily intake amounts. Another recent literature review, by Hersey et al. (2013), concluded “consumers can more easily interpret and select healthier products with nutrient-specific FOP labels that incorporate text and symbolic color to indicate nutrient levels rather than nutrient-specific labels that only emphasize numeric information, such as Guideline Daily Amounts expressed as percentages or grams”.  At the very least, if the HSR is adopted, then descriptors ‘high’, ‘medium’, and ‘low’ should appear in the Fat, Sugar and Sodium icons, as originally proposed.

“As the scheme is voluntary, and many in the industry seem committed to retaining the Daily Intake Guide, it is unclear how widely this new label will be adopted. If only a small number of products include this label, then the potential for it to affect consumers’ shopping patterns will be reduced because comparisons will remain hard to make.  We need further experimental research to examine whether this new label will shift shopper behaviour towards healthier choices, rather than waiting to see what happens in the market-place.”