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Context Providing a nutrition rating system on the front of food packages or on retail shelf tags has been proposed as a policy strategy for supporting healthier food choices. Guiding Stars is an on-shelf nutrition labelling system that scores foods in a supermarket based on nutritional quality; scores are then translated into ratings of 0 to 3 stars. It is consistent with evidence-informed recommendations for well-designed labels, except for not labelling 0-star products. The largest supermarket retailer in Canada rolled out the Guiding Stars system in supermarkets across Ontario, Canada. The aim of our study was to examine the extent to which consumers respond to an on-shelf nutrition labelling system in supermarkets to inform current and future nutrition labelling policies and practices. Methods Capitalizing on a natural experiment, we conducted a quasi-experimental study across 3 supermarket banners (or 'chains') in Ontario, one of which implemented the Guiding Stars system in 2012. We used aggregated supermarket transaction data to test the effect of Guiding Stars on the nutritional quality of food purchases in intervention supermarkets relative to control supermarkets. We also conducted exit surveys among 783 randomly selected shoppers from intervention and control supermarkets to assess consumer awareness, understanding, trust, and self-reported use of the labelling system. Findings Relative to control supermarkets, shoppers in intervention supermarkets made small but significant shifts toward purchasing foods with higher nutritional ratings; however, shifts varied in direction and magnitude across food categories. These shifts translated into foods being purchased with slightly less trans fat and sugar and more fiber and omega-3 fatty acids. We also found increases in the number of products per transaction, price per product purchased, and total revenues. Results of the exit surveys indicate a modest proportion of consumers were aware of, understood, and trusted Guiding Stars in intervention supermarkets, and a small proportion of consumers reported using this system when making purchasing decisions. However, 47% of shoppers exposed to Guiding Stars were confused when asked to interpret the meaning of a 0-star product that does not display a rating on the shelf tag. Conclusions This study demonstrates support for policies promoting on-shelf nutrition labels designed according to evidence-informed principles, but policymakers should move forward with caution when investing in such systems until research has confirmed optimal label design, clarified the mechanisms through which dietary intake is improved, and assessed associations with nutrition-related health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To examine the impact of a calorie label intervention on cafeteria menus. Methods: Exit surveys were conducted in a university cafeteria. Participants were surveyed at baseline and one week after calorie labels were displayed. We assessed changes in noticing and use of nutrition information, the calorie content of food purchased, and estimated calorie consumption. Results: The intervention was associated with significant increases in noticing nutrition information (92.5% vs 39.6%; p < .001), and the use of nutrition information to guide food purchases (28.9% vs 8.8%; p < .001). The calorie content of foods purchased decreased after calorie labels were posted (B = -88.69, p = .013), as did the estimated amount of calories consumed (B = -95.20, p = .006). Conclusions: Findings suggest that displaying calorie amounts on menus can help reduce excess energy intake. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Sugar-sweetened beverages ( SSBs) may play a role in increased rates of obesity. This study examined patterns and frequencies of beverage consumption among youth in 3 distinct regions in Canada, and examined associations between beverage consumption and age, sex, body mass index ( BMI), physical activity and dieting behavior, as well as beverage displacement. METHODS The study included data from 10,188 youth (ages 13-18) from Hamilton and Thunder Bay, Ontario, and Prince Edward Island ( PEI) in 2009 to 2010. The study used in-school self-reported surveys with 12 questions regarding beverage consumption during the previous day, along with self-reported height, weight, physical activity levels, and demographic information. Logistic regression analyses were conducted to examine variables associated with SSB intake. RESULTS Overall, 80% of youth consumed at least 1 SSB in the previous day, with 44% consuming 3 or more SSBs. Youth in Thunder Bay consumed significantly more SSBs than Hamilton and PEI, and youth in Hamilton consumed more SSBs than PEI. Boys consumed significantly more SSBs than girls. Older and more physically active youth consumed significantly fewer SSBs. No significant association between BMI and SSB consumption was observed in any model. A modest positive correlation was identified between SSB consumption and milk (r = .06, p < .001) and 100% fruit juice (r = .10, p < .001). CONCLUSIONS A large proportion of youth consumed SSBs, many at high levels. Research evaluating SSB policy and interventions should be considered a priority. [ABSTRACT FROM AUTHOR]

Background: A significant proportion of the Canadian diet comes from foods purchased in restaurant settings. In an effort to promote healthy eating, the province of British Columbia (BC) implemented the Informed Dining Program (IDP), a voluntary, industry supported information program in 2012, while the province of Ontario implemented mandatory calorie labelling on menus in 2017. The study examined differences in awareness and the self-reported influence of nutrition information on food choices in restaurants with voluntary nutrition information, calorie labelling on menus, and no nutrition information program. Methods: Exit surveys were conducted outside of nine chain restaurants in Toronto, Ontario and Vancouver, British Columbia (Canada) in 2012, 2015, and 2017 with varying nutrition information programs implemented. Logistic regression analyses compared self-reported noticing and influence of nutrition information in restaurants with: 1) the IDP which provided nutrition information upon request, 2) calorie labelling on menus, and 3) control restaurants with no specific nutrition information program in place, adjusted for year, city and socio-demographic characteristics. Awareness and knowledge of the IDP were also examined. Results: There were no significant differences in noticing and self-reported influence of nutrition information on food choices between restaurants with the IDP and restaurants with no program. Participants were more likely to notice nutrition information in restaurants when calorie information was provided on menus (57%) compared to in restaurants with the IDP (22%, AOR = 6.20, 95%CI 3.51–10.94, p < 0.001) or restaurants with no nutrition information program (20%, AOR = 7.44, 95%CI 4.21–13.13, p < 0.001). Participants in restaurants with menu labelling were also more likely to report that nutrition information influenced their food purchase (38%) compared to restaurants with the IDP (12%, AOR = 4.43, 95%CI 2.36–8.30, p < 0.001) and restaurants with no nutrition information program (12%, AOR = 5.29, 95%CI 2.81–9.95, p < 0.001). Fewer than 1 in 5 participants who visited an IDP restaurant had heard of the IDP across all data collection years in both cities. Conclusions: There was no evidence that voluntary programs which provide nutrition information upon request were effective. Providing calorie information on menus increased the likelihood that consumers noticed and that their food choices were influenced by nutrition information in restaurant settings. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to characterize the availability of calorie labelling on major online food delivery (OFD) platforms for the largest restaurant brands in Canada to examine differences in provinces with and those without mandatory calorie labelling regulations., Methods: Data were collected for the 13 largest restaurant brands with locations in Ontario (with mandatory menu labelling) and Alberta and Quebec (with no mandatory menu labelling) from the web applications of the three largest OFD platforms in Canada. Data were sampled from three selected restaurant locations within each province (n = 117 locations across all provinces) on each platform. Univariate logistic regression models were used to test differences in the presence and amount of calorie labelling and other nutritional information across provinces and platforms., Results: The analytical sample included 48,857 food and beverage items (n = 16,011 in Alberta, n = 16,683 in Ontario, and n = 16,163 in Quebec). Items were more likely to have menu labelling in Ontario (68.7%) than in Alberta (44.4%, OR = 2.75, 95% CI 2.63-2.88) or Quebec (39.1%, OR = 3.42, 95% CI 3.27-3.58). In Ontario, 53.8% of restaurant brands had calorie labelling for  > 90% of items, compared to 23.0% in Quebec and 15.4% in Alberta. The presence of calorie labelling also differed across platforms., Conclusion: Nutrition information from OFD services differed across provinces with and those without mandatory calorie labelling. Chain restaurants on OFD service platforms were more likely to provide calorie information in Ontario, where calorie labelling is mandatory, compared to elsewhere where no such policy exists. In all provinces, calorie labelling was inconsistently implemented across OFD service platforms., (© 2023. The Author(s) under exclusive license to The Canadian Public Health Association.)

Objectives: To test the efficacy of calorie labelling for alcoholic and non-alcoholic beverages on restaurant menus on noticing calorie information, calorie knowledge, and perceived and actual influence on hypothetical beverage orders., Methods: Participants included upper-level university students of legal drinking age residing in Ontario, Canada (n = 283). Using a between-groups experiment, participants were randomized to view one of two menus: (1) No Calorie Information (control), and (2) Calorie Information adjacent to each beverage. Participants completed a hypothetical ordering task, and measures related to noticing calorie information, calorie knowledge, and actual and perceived influence of calorie information on beverages ordered were assessed. Linear, logistic, and multinomial logistic regression models were used to examine the four outcomes., Results: The odds of noticing calorie information were significantly higher in the Calorie Information (72.6%) versus No Calorie Information condition (8.0%) (OR = 43.7, 95% CI: 16.8, 113.8). Compared to those in the No Calorie Information condition, participants in the Calorie Information condition had significantly lower odds of responding 'Don't know' (OR = 0.04, 95% CI: 0.02, 0.09), underestimating (OR = 0.06, 95% CI: 0.02, 0.2), and overestimating (OR = 0.05, 95% CI: 0.02, 0.2) versus accurately estimating calories in beverages ordered. No significant differences were observed between menu labelling conditions in the calories in beverages ordered or the perceived influence of calorie information on the number of beverages ordered., Conclusion: Exposure to menus with calorie information increased consumers noticing the calorie information, and accurately estimating calories in alcoholic and non-alcoholic beverages ordered. These results have implications for policy-makers considering mandatory menu labelling policy inclusive of alcoholic beverages., (© 2021. Crown.)

The current study explored the influence of three summary indicator front-of-pack (FOP) nutrition labels on consumer perceptions of the healthiness of different beverage products. In 2016, a total of 675 respondents in southwestern Ontario aged 16 and over viewed images of soda, unflavoured milk and chocolate milk displaying one of four FOP label conditions (no FOP label, numeric rating, health star rating (HSR), or simplified traffic light (STL)), and rated the products' healthiness. Participants also indicated their preference for summary indicator versus nutrient-specific FOP labels. Logistic regression models comparing correct responses across label conditions found no differences across label conditions for unflavoured milk or soda. Consumers in the HSR and STL conditions were more likely to correctly perceive a chocolate milk beverage as 'moderately healthy' (p = 0.004, p = 0.016). No differences in responses were identified across sociodemographic groups. Most respondents (93%) indicated that they would like to see a health rating or nutrient-specific information on the front of food products. Results of this study suggest that the influence of FOP labels may vary based on the nutritional quality of food products, and may have the greatest influence on consumer perceptions of 'nutritionally ambiguous' foods. Consumers indicated almost unanimous support for implementing FOP nutrition labelling systems., (Copyright © 2018 Elsevier Inc. All rights reserved.)