Download Consumers* Reactions to Converting Percentage Daily Energy into

Consumers’ Reactions to Converting
Percentage Daily Energy into
Equivalent Walking Time: Results
from Qualitative and Quantitative
Measures
Brennen Mills, Owen Carter, Steve Pratt
Obesity

Worldwide obesity has more than doubled since 1980. (1)

In 2008, more than 1.4 billion adults (20 and older) were
overweight. Of these over 200 million men and nearly 300 million
women were obese. (1)

In 2009–2010, 35.7% of U.S. adults were obese. (2)

In UK, 26% obese, 37% overweight. (3)

In Australia, 21% obese but 62% Australian adults overweight or
obese. (4)

Obesity prevalence in Australia has doubled in the period between
1990 and 2005. (5)
Food intake


Most of the worldwide increase in obesity is attributable
to a corresponding increase in caloric intake.
(6-8)
Mandatory nutrition labels

Consumers are unsure of recommended intake levels against which to compare nutrient content. (9)
Quote from Australian Medical Association

“A simple and uniform 'front of pack' system
of nutritional labelling for packaged food
should be mandated, and supported by an
ongoing public education campaign. Clear
information about nutrient content should
also be provided.” (10)
Daily Intake Guide (Australia)
TOTAL
SUGARS
SATURATED
FAT
CARBOHYDRATE
25.5 g
9.7 g
34.7 g
6.1 g
960 mg
36%
40%
11%
7%
42%
ENERGY
PROTEIN
FAT
2000 kJ
25.2 g
23%
50%
Percentage Daily Intakes are based on an average adult diet of 8700 kJ.
Your daily intakes may be higher or lower depending on your energy needs.
SODIUM
Guideline Daily Amount (EU)
Facts Up Front (USA)
Quote from the Australian Food and
Grocery Council

“DIG thumbnails now feature on more than 4000
supermarket products across Australia including on an
increasing number of private label products.”
(11)

(12)
Approximately 2/3 of energy dense/nutrition poor food
and beverages used the DIGkJ (Energy alone).
Energy only (USA)
Study conducted by International Food
Information Council Foundation (USA)


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Non-peer reviewed
N=7,363
“Increasing the amount of nutrition information on the
front of package served to strengthen consumers’
comprehension and comfort level with such material.”
15g
PROTEI
N

(13)
VIT A
IRON
Previous research

Qualitative

Participants described the label as being “confronting
because it makes them realise how much work it takes to
burn off a small amount of calories by walking” (p. 209). [14]

“Some participants said that it evoked a feeling of guilt... flags
(FOP labels) should focus on the pleasure of choosing and
eating foods.” (p. 209). [14]
Equivalent Walking time
Equivalent walking time examples
1 burger
2h 01 min
45g packet
57 min
53g
1h 01 min
375 mL
27 min
*based upon a 70kg male with average BMR walking at 5 km/h (Naismith’s Rule) (3.5 MET)
Food label examples
3
Pilot data





8 focus groups
1.5 hours duration (approx.)
Stratified by sex, age (18–34 and 35–54 years) and socioeconomic status (upper and lower).
Questions proceeded in a naturalistic and semistructured manner to assess participants’ immediate
reactions and overall opinion of each labelling system.
To test for facilitator bias, groups were asked at the end
of the sessions which labelling system they thought the
facilitator favoured. By consensus, three groups suggested
the DIGkJ, two the full DIG and three were undecided.
Results - Qualitative (DIGkJ)
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% daily intake confusion
“I wasn’t sure what the DI was, that just didn’t hit me.”
“I looked at it and thought ‘5% of what?’”
“I don’t think it has relevance for me, without that prior
knowledge and without me being able to work out my daily
intake of kilojoules it’s just not something that I’d bother with.”
Results - Qualitative (DIGkJ)



After understanding, there were issues with
interpretation of the % daily intake information:
“It means you can have 20 [chocolates] in a day and you
don’t need anything else.”
“If it’s only 7% out of my whole day than I can have plenty.”
Results - Qualitative (Energy Alone)
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Label too small to be noticed:
I wouldn’t even notice that, it’s so small.”
“You can’t even see that.”
“There’s eight people in this room and nobody here has even
noticed that.”
“You can barely even see it…it’s so tiny no one would even
notice that.”
Results – Qualitative (Energy Alone)


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Confusion when using kilojoules as a measurement of
daily intake:
“I don’t know what a high number for energy is...anything over
1000 is pretty high isn’t it? Or is that for calories?”
“To me 169kJ is just gibberish. Even if I knew the average I
wouldn’t be thinking if I’ve done 500kJ I’ve still got 750 left…I
wouldn’t even think like that.This is pointless to me.”
Results – Qualitative (Energy Alone)
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The concept of high ‘energy’ being associated with poor
nutrition was lost on a number of participants:
“Well I know that it’s good for kids when it’s got a high energy
content.”
“Energy is a good thing, you give them [kids] energy that they
can use for sport.”
“Energy means power. I guess it is kind of like a burst of
power or energy.”
“If I drink a carton of beer that will give me good energy.”
Results – Qualitative (EWT)
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The majority of participants described the EWT as instantly
understandable, difficult to ignore, and helps people truly
appreciate the implications of consuming EDNP foods:
“It’s an easy concept to understand straight away.”
“It puts everything into perspective.”
“People can easily relate to exercise time rather than working with
statistics and percentages.”
“It’s more meaningful because it shows the direct impact on what
we need to do.”
“It would help control portion sizes.”
“I’d second guess whether I bought it or not.”
Results – Qualitative (EWT)

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Participants also mentioned that it would most likely be
easy for children to understand:
“He [my son] would definitely prefer that [EWT label]
because he would see walking time and understand it.”
Results – Qualitative (EWT)
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However, some people that expressed fat or sugar, not
energy, was their primary focus when selecting foods
Therefore neither the DIGkJ (Energy alone) or EWT
appealed to them.
“I would usually go try and find the three main ones, the sugar,
the fat and the salt, I don’t really look at the energy.”
Methods - Quantitative

Commercial survey company

N=1000 participants from all states
and territories throughout Australia

Sampling quotas set to ensure equal numbers of males and
females, equal numbers from lower and higher socio-economic
strata, and equal numbers from lower and upper age-groups
(18–34 and 35–65 years).

Online questionnaire
Methods – Quantitative (Materials)
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Thirty packaged foods and beverages were selected for
the study.
They were classified into three categories of ‘green’,
‘amber’ or ‘red’ based on the nutrient cut-offs from the
Food Standards Authority (Australia and New Zealand) (24)
Biscuits and crackers, snack bars, crisps and snack foods,
milk drinks, and soft drinks made five food/beverage
categories.
Methods – Quantitative (Materials)

In order to minimise confounding from participants’ preexisting familiarity with the foods and beverages, products
that are not marketed or available in Australia were
sourced from other countries.
Methods – Quantitative (Procedure)
Methods – Quantitative (Procedure)
Methods – Quantitative (Procedure)
Methods – Quantitative (Procedure)
Methods – Quantitative (Procedure)
Methods – Quantitative (Procedure)
Methods – Quantitative (Procedure)
Methods – Quantitative (Procedure)
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Interpretability of label
Understandability of label
Likelihood consumer would pay attention to label
Act as a deterrent to purchasing unhealthy ‘snack foods’
Methods – Quantitative (Procedure)
Results - Quantitative
Mean difference in overall ratings from ‘no label’ condition
.8
.6
.4
.650
.2
0
.355
-.094
-.2
DIGkJ
DIG
EWT
Results - Quantitative
Subjective results
10
DIGkJ
EWT
9
Mean rating (1= lowest, 10 = highest)
8
7.34
6.90
7
7.14
6.95
6
5.55
5.52
5
5.24
5.05
4
3
2
1
Useful
Understand
Attention
Properties
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* All differences were statistically significant (p<0.05)
Deterrent
Discussion (Main findings)

Participants found the DIGkJ
or apply in any practical sense.
difficult to understand

The EWT
was found to be more useful in
identifying energy dense/nutrition poor (EDNP) foods

The EWT label may be a viable alternative to the DIGkJ,
while depicting the exact same energy information in a
different way, that satisfies the ‘at a glance’ criterion of a
FOP food label and also allows consumers to correctly
identify EDNP foods.
Discussion (Study Limitations)

Additional images on packages were removed (e.g. “diet,
99% fat free).

Questions in quantitative survey were posed in terms of
consumption of the product on a daily basis.
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Study was based on five food/beverage categories.
Conclusions
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“There is no scientific or government research to
demonstrate that any food labelling system is substantially
better than others.” (2009) (15)
Conclusions
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Evidence from Australia alone:

Carter, O., B. Mills, and T. Phan, An Independent Assessment of the
Australian Food Industry's Daily Intake Guide 'Energy Alone' Label.
Health Promotion Journal of Australia, 2011. 22(1): p. 63-67.
Blewett, N., et al., Labelling logic: review of food labelling law and
policy. Canberra: Commonwealth of Australia; 2011
Kelly. B, et al., Consumer testing of the acceptability and
effectiveness of front-of-pack food labelling systems for the
Australian grocery market. Health Promot Int, 2009. 24(2): p.
120-9.
Kelly, B., et al., On behalf of a Collaboration of Public Health and
Consumer Research Groups. Front-of-Pack Food Labelling:Traffic
Light Labelling Gets the Green Light. Cancer Council: Sydney. 2008.
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Conclusions
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“Industry is always looking at ways to better inform
consumers and assist them to select healthy diets” (p.17). (16)
Funding and resources
Contact Details
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Brennen Mills - Edith Cowan University, Western
Australia.
[email protected]
Owen Carter - Edith Cowan University, Western
Australia.
[email protected]
Steve Pratt – Cancer Council Western Australia
[email protected]
References

1. World Health Organisation Obesity Fact sheet no. 311.

http://www.who.int/mediacentre/factsheets/fs311/en/

2. Prevalence of Obesity in the United States: Data from the National Health and Nutrition Examination Survey, 2009–2010. NCHS Data Brief ■ No. 82 ■ January
2012

http://www.cdc.gov/nchs/data/databriefs/db82.pdf

3. The NHS Information Centre, Lifestyles Statistics. Statistics on obesity, physical activity and diet: England, 2012

4. Australian Bureau of Statistics. 4364.0 - 2007-08 National Health Survey: Summary of Results [report on the Internet]. Canberra (AUST): ABS; 2009 [cited 2011 Mar 8].
Available from: http://www.ausstats.abs.gov.au/Ausst\ats/subscriber.nsf/0/9FD6625F3294CA36CA25761C0019DDC5/$File/43640_2007-2008%20(reissue).pdf.

5. Australian Bureau of Statistics 2008, Overweight and Obesity in Adults, Australia, 2004-05, ABS Cat No. 4719.0.

6. Swinburn, B. Sacks, G. Ravussin, E. Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr. 2009 90(6) 1453-56

7. Swinburn BA, Sacks G, Lo SK, et al. Estimating the changes in energy flux that characterize the rise in obesity prevalence. Am J Clin Nutr 2009;89:1723–8.

8. Hall KD, Chow CC. Estimating the quantitative relation between food energy intake and changes in body weight. Am J Clin Nutr March 2010 vol. 91 no. 3 816

9. Cowburn, G. and L. Stockley, Consumer understanding and use of nutrition labelling: a systematic review. Public Health Nutr, 2005. 8(1): p. 21-8.

10. Australian Medical Association 2008. AMA Position Statement on Obesity. Canberra: Australian Medial Association.
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11. Daily Intake Guide gets thumbs up from Woolworths.

http://docs.noodls.com/viewDoc.asp?filename=104517/EXT/89C01E4DCE6159AE3F143603F42B5BA15AEDB78E_A55E34169B0555695D20B402B22D777B1DB77AC
A.PDF

12. Carter, O, Mills B, Llyod E, Phan T. An independent audit of the Australian food industry's voluntary front-of-pack nutrition labelling scheme for energy-dense
nutrition-poor foods. Accepted for Publication17/10/2012. European Journal of Clinical Nutrition.

13. . International Food Information Council Foundation. Front of Pack Lbaeling: Consumer Research Project.

14. van Kleef, E., et al., Consumer preferences for front-of-pack calories labelling. Public Health Nutr, 2007. 11(2): p. 203-213.

15. 25. Palmer, D., Food Labelling Debate Flares Up [news page on the Internet]. Melbourne (AUST): Australian Food News; 2009 [cited 2010 Nov 4]. Available from:
http://www.ausfoodnews.com.au/2009/04/06/food-labelling-debate-flares-up.html.
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16. 26. Australian Food and Grocery Council. Australian Food and Grocery Council Submission to the Department of Health and Ageing Food Regulation Secretariat in Response to
the Review of Food Labelling Law and Policy [submission on the Internet]. Canberra(AUST): AFGC; 2009 [cited 2010 Nov 4]. Available from: http://www.afgc.org.au/doclibrary/category/11-general-documents.html?download=140%3Aafgcsubmission-to-the-review-of-food-labellign-law-and-policy.