It is now globally well established that front-of-pack-labels (FOPLs) on packaged, processed food items have the ability to direct consumer’s attention towards healthier options. The back of pack Nutrition Facts Table are rarely used and difficult to interpret, even by those literate.

Looking them up and comprehending takes time and cognitive effort. Especially in a country like India that has a plethora of regional languages and where a majority of consumers can read only one or two regional languages, text heavy nutritional labels are less effective in influencing behaviour.

Concomitantly, India’s food, health and nutrition security challenges are no less daunting. Non-communicable diseases (NCDs), including those arising from eating disorders contribute to around 5.87 million (60 per cent) of all our deaths. Easy availability of energy-dense foods high in saturated fats, sugars and salts is one of the leading factors contributing to this.

Since a large section of the consumers in India consists of the urban and rural poor who have very low literacy and income levels, their disposable incomes reduce further when medical expenses are incurred due to consumption of unhealthy or unsafe food.

Despite this, food regulators of many countries, including India, find it very difficult to introduce such systems. This is either due to paucity of reliable research or resistance from vested interests or lack of clarity about an FOPL format that would be easily understandable and also impact choices across different consumer types.

Global experience

A few countries such as Mexico, Chile and Israel have introduced mandatory front labelling in recent years. A majority of the Western European countries, Australia and New Zealand have allowed voluntary use of front labels, where uptake by food companies is on the rise, but quite slow.

The formats range from informative designs such as Multiple Traffic Lights (MTL) or Guideline Daily Amounts (GDA) to summary ratings such as Warning Labels or Health Stars. Research and empirical evidence is still evolving and opinion split on which format is better. However, what is clear is that front labels are impactful and that the most effective formats have to be context specific and suited to socio-demographic realities of the country.

Therefore, and as pointed out by an April, 2020 correspondence by researchers from ICMR-National Institute of Nutrition in The Lancet Public Health, any proposal for a labelling format has to be mindful of the fact that a quarter of the Indian population is illiterate.

In this context, the FSSAI asked the authors of this article to suggest a suitable, representative front labelling format that would be easy to understand and influence purchase intentions for an average Indian consumer. We conducted large scale national randomised controlled trials (RCT) to determine preference ranks among the popular formats of informative nutrient specific labels and summary ratings.

An RCT is, arguably, the most rigorous method of determining whether a cause-effect relation exists between the intervention and the outcome with minimum selection, observer, participant, response or attentional bias.

While it has been used for long in clinical research, Abhijit Banerjee, Esther Duflo and Michael Kremer were awarded the 2019 Nobel Prize in Economics for pioneering this technique in development studies and making it the gold standard toolkit for robust research based insights for policy decision making globally.

For our study, we randomly allocated 20,564 consumer subjects to treatment and control groups and asked their level of recognition, understanding of their purchase intention for packaged food products treating them to stimuli in the form of five different types of FOPLs. This is the largest, most robust study of its kind in India based on consumption patterns of the two largest consumed packaged foods in India — chips and biscuits.

We covered consumers from all the major States and across all major socio-economic, geographical and demographic categories. The experiments were conducted face-to-face over a period of three months with innovative app based spot checks to ensure accuracy and quality of the highest order. Relevant primes and manipulation checks were used to increase the robustness of the data.

Consumer preference

Upon analysing the results, we found that the summary format of Health Star Rating was the most preferred when the measure used is a combination of of ease of identification, understanding, reliability and purchase intention. Informative labels such as Multiple Traffic Lights, monochrome GDA or Nutri Score were ranked lower by the average consumer.

We also ran additional sub-sample tests based on age, literacy levels, health awareness levels, gender, frequency of grocery shopping, rural-urban habitat and levels of back-of-pack-label awareness. Results even from these tests were consistent with summary ratings being clearly favoured over the others. Among the summary ratings, the Health Star was the easiest to understand among those that influenced purchase decisions leaving behind Warning Labels.

This, we believe, is very likely because the latter still required some text reading abilities and awareness about the highlighted nutrient of concern. On the other hand, a simpler star rating made it easier to understand the relative position of healthiness across products in the minds of an average Indian consumer. However, global experience cautions that whichever format is implemented, its effectiveness will very much depend on how good and consistent is the communication strategy and awareness campaign attached to them.

Simple indicators for health quotient of packaged food has to be taken up with an urgency by all stakeholders that includes FSSAI, industry and the civil society, as a very crucial first step towards healthy dietary transitions in fast moving diseased society.

If India does this well, we hope that it will inspire consumer confidence and appropriate policy actions in other developing countries. And that decisions on FOPL are based on research and not spin and lobbying.

Sahay and Ghosh are faculty members at IIM Ahmedabad specialising in behavioral marketing and food policy, respectively. The authors are grateful to Rahul Sanghvi, PhD candidate at IIM-A, for research support