Food Consumption Habits and Public Attitudes Toward the Front-of-Package Nutritional Labeling Program

Background

The government of Israel has for several years now been implementing the EfshariBari (Health is Possible) program, a national effort to encourage active and healthy living. As part of the program, highly visible labels have been placed on the front of food packaging since January 2020: food sold in Israel that is suitable for the recommended Mediterranean diet is marked in green while food with high levels of sugar, salt, or saturated fat is marked in red. The purpose of the labels is to provide nutritional information to consumers with the goal of making it easier for them to make informed choices with respect to healthy food products.

The Ministry of Health asked the Myers-JDC-Brookdale Institute to examine the purchasing and consumption habits for healthy and unhealthy food among the general population before and after the introduction of the front of package nutrition labeling. The study included two surveys of the general population – the first conducted prior to the introduction of the labeling, and the second, described in this report, conducted three years after the introduction of the labeling.

Objectives

• To examine the purchasing habits of the general population in Israel and the frequency of consuming healthy and unhealthy food products in Israel, three years after the introduction of front-of-package nutrition labeling.
• To examine the attitudes of the Israeli public towards front-of-package nutrition labeling and steps taken by the Ministry of Health to promote healthy nutrition.
• To compare the survey results at two points in time.

Method

Two cross-sectional studies were conducted by means of a telephone survey among a representative sample of households in Israel. Data collection for the first survey took place from September 2019 to January 2020 among 944 households, and the second survey was conducted from March to August 2023 among 500 households. In order to achieve the required number of respondents for the second survey, 2,156 individuals were approached, with a response rate of 23%. To ensure that the sample is representative, the data were weighted by household size and population group (ultra-Orthodox Jews, non-ultra-Orthodox Jews and Arabs). The questionnaire was administered in both Hebrew and Arabic and included questions regarding food purchasing habits, frequency of consuming red-labelled and green-labelled foods, attitudes towards the nutrition front-of-package labeling program, attitudes towards government policies aimed at promoting healthy nutrition, and also demographic questions.

Main Findings

Awareness of nutritional labeling on front of food packaging, understanding its significance, and taking it into consideration when purchasing

The survey findings indicate that red labeling on packaged foods is highly noticeable: 92% of respondents are aware of the red labeling, compared to 57% who are aware of the green labeling. 89% of the respondents understood the significance of the labeling, namely that consumption of foods marked in red should be limited and 60% indicated that when there are alternatives without red labeling, they will always or often prefer them.

The respondents are somewhat more likely to check the labeling on the front of food packaging than the nutritional information on the back: 52% check the list of ingredients, and 48% check the nutritional values on the back of the packaging, as compared to 69% who always or often check for the red labeling. The proportion who regularly check for the red labeling is lower among Arab households (60%) than among Jewish households (71%) and lower among households with children under the age of 18 (64%) than among other households (73%). 50% of the respondents reported that they buy fewer products marked in red than before the front of package nutrition labeling was introduced and 22% reported that they buy more products with green labeling.

Food purchasing habits and frequency of consuming red-labelled products

In the case of most of the red-labelled products checked in the survey, there was no change between the two surveys in the proportion of households who report purchasing them, except for a decline in the proportion of households who bought sweetened drinks (48% in 2023 as compared to 57% in 2019) and salty snacks (64% in 2023 as compared to 70% in 2019). The distribution of the consumption of salty snacks and sweetened drinks revealed that although the purchase of salty snacks decreased, the distribution of consumption frequency remained similar. In contrast, the proportion of households who reported daily consumption of sweetened drinks remained similar, but there was a significant decline in the proportion of households consuming sweetened drinks up to four times a week (23% in 2023 as compared to 31% in 2019) and an increase in the proportion of households who do not consume sweetened drinks at all (58% in 2023 as compared to 51% in 2019).

Two indices were constructed to summarize a household’s overall score in the consumption of red-labelled products (range of 0 to 55) and green-labeled products (range of 0 to 70). In a multivariate linear regression for predicting the score for consumption of red-labelled products, it was found that the variables “household with children under the age of 18” (4.9 points on the consumption index, hereafter referred to simply as “points”), “household size” (0.8 points), and “lack of an academic education” (2.5 points) predict a higher consumption score. In contrast, the variables “belonging to the lowest quintile” (1.6 points less), “checking the nutritional information on the back of the packaging” (2.8 points less), and “checking for red labeling” (1.7 points less) predict a lower score on the index.

In a multivariate linear regression for predicting the score for consumption of green-labelled products, it was found that the variables “checking the nutritional information on the back of the packaging” (4.3 points), “household size” (0.6 points), and “a food constraining health situation in the household” (1.9 points) predict a higher consumption score. In contrast, the variables “belonging to the lowest quintile” (2.7 points less) and “lack of an academic education” (2.2 points less) predict a lower score on the index.

Assessing the impact of the increase in market prices on purchasing habits

The findings show that the prevailing perception is that healthy food is more expensive than unhealthy food (87% of respondents). Also, a higher proportion of those belonging to the lowest quintile reported that due to an increase in market prices during the two years prior to the second survey, they have reduced their consumption of healthy food: 73% reported consuming a more limited variety of fruits, 64% reported consuming less fruit, and 54% reported consuming smaller quantities of meat, poultry, or fish.

Attitudes toward policy measures that could potentially be implemented by the Ministry of Health

87% of the respondents claimed that one of the government’s roles should be to help people eat healthier. A high proportion expressed support for measures that could be implemented by the Ministry of Health in order to promote healthy nutrition: 87% believe that food manufacturers should be incentivized to use healthier ingredients in their products, 80% believed that stores should be encouraged to clearly identify the sections where healthy food products are available, 80% believe that stores should mark healthy food products bought in bulk with green labels, and 72% believe that advertisements of unhealthy food and drinks which target children should be prohibited.

Conclusions and Main Recommendations

The findings showed a decline between the two surveys in the rates of purchase of two food categories: sweetened drinks and salty snacks. A significant difference in the distribution of consumption frequency was found only in sweetened drinks, perhaps due to the combined effect of front-of-package labeling and the taxation of sweetened drinks.

A high proportion of respondents reported being aware of red labeling, understanding its meaning, checking whether it appeared on a product, and even having a greater tendency to prefer products without red labeling, and indeed, checking for red labelling was associated with a lower score on the overall consumption index.

A high proportion of respondents felt that the government’s role is to encourage healthy nutrition and expressed support for various measures the government could adopt, including taxation and encouraging food manufacturers to reformulate food composition. It is recommended that the public be encouraged to make decisions while shopping according to the red labeling, and combined strategies should be considered in order to achieve the maximal impact in reducing the purchase of those products.

The survey findings indicate that households with children under 18 purchase and consume unhealthy products at higher rates than other households. Respondents from this group also reported that they take the red labeling into consideration less often, even though their awareness of the labeling and understanding of its meaning were not significantly different from that of other households. It is recommended that an intervention be undertaken among this population group with the goal of minimizing the impact of unhealthy nutrition on children’s health both today and in the future.