Labelling Sugary Drinks With Warnings Could Cut Consumption

Liam Davenport

May 29, 2018

VIENNA — Young adults are less likely to opt for sugar-sweetened beverages (SSBs) if they are presented with health labels on the packaging, especially if they are graphic warnings, the results of an Australian study suggest.

The findings in almost 1000 individuals aged 18–35 years also indicated, however, that young people may be more likely to choose a healthier option such as water if the label contains more positive information about the product’s health rating.

Anna Peeters, PhD, Deakin University, Melbourne, Australia, and Associate Director, Global Obesity Centre, World Health Organisation Collaborating Centre for Obesity Prevention, presented the study at the European Congress on Obesity.

In a release she said that the findings show that labels can "change consumer behaviour, reduce purchases of sugar-sweetened drinks, and help people to make healthier choices".

She added: "The question now is what kind of impact these labels could have on the obesity epidemic.

"While no single measure will reverse the obesity crisis, given that the largest source of added sugars in our diet comes from sugar-sweetened drinks, there is a compelling case for the introduction of front-of-pack labels on sugary drinks worldwide."

Sugar Reduction Programme

The study coincided with the first figures showing the progress of Public Health England's (PHE's) sugar reduction programme, which revealed that the first-year target for reducing sugar content and calories consumed at one go has not been met.

While a number of harmful products already carry health warnings, there is a great deal of debate over both whether SSBs should also carry warnings, and which warnings might have the greatest impact.

Peeters and colleagues were therefore commissioned by the health department of the New South Wales government to examine whether front-of-pack labels would affect individuals' drinks choices.

The team used an online platform to recruit people from four states in Australia who represented a diverse range of socioeconomic statuses and educational levels.

The participants were asked to imagine they were entering a shop or café or approaching a vending machine to purchase a drink. They were then asked to choose one of 15 drinks, including SSBs, or select 'no drink'.

For the test, the participants were randomised to one of five groups, in which SSBs were presented with:

  • No health warning

  • A text warning

  • A sugar information label

  • A graphic warning depicting rotten teeth

  • A health star rating (HSR), which is the food labelling system in Australia and New Zealand

A total of 994 adults aged 18–35 years took part in the study.

When they were presented SSBs with no warning, 64% chose an SSB. However, when they were presented with a text label, 47% chose an SSB. Similar figures were seen for the sugar information label and the HSR label, at 46% and 44%, respectively.

The lowest proportion of participants who chose an SSB was when they were presented with the graphic health warning, with only 28% opting for them.

Analysis confirmed that, compared with no label, the graphic warning label led to the greatest reduction in participants opting for an SSB, at a relative risk of 0.45.

However, an HSR label was, unlike the other labels, associated with an increased likelihood of participants opting for a healthy drink compared with no label, at a relative risk of 1.41.


During a press conference for the study, Peeters said that there are caveats to interpreting the findings, in particular that it was conducted online and not in the 'real world', "but they were much larger changes than I had expected".

She told Medscape News UK that, in terms of which of the four labels she would like to see on SSBs, she thinks that "if there was political palatability for the graphic warning, that clearly had the strongest effect, that's what would you'd go for.

"What was interesting, particularly in this Australian policy context is the Health Star Rating also tells you what you should choose and we did see that with that label; that group actually tended to switch their choices more to the healthier options.

"So I think it needs more work but what I would look at is both the trade-off between switching away from sugary drinks and switching to the healthiest choices, like water."

Peeters believes, however, that there has to be consistency in the use of labels and that, rather than schemes being voluntary, they should be mandatory to ensure that it is the same for everyone.

"At the moment, one of the reasons that companies don't implement if it's voluntary is because there's no level playing field, and until we get a level playing field, we really won't see the full effects of any system."

Different Approaches

Jason Halford, PhD, Chair in Biological Psychology and Health Behaviour, University of Liverpool, UK, who was not involved in the study, told Medscape News UK that the study was "very good".

He said: "What's interesting about this study is that they tried a variety of different approaches, and it's interesting that all labels worked but the graphic warning label seemed to have particular salience in this age group."

He agreed with Peeters that it "would be nice to see how it works in real shopping choices," pointing out that purchases are made "very quickly", with decisions involving both explicit and implicit processes.

"So I think we need to know a little bit more about the explicit and implicit mechanisms underpinning this and how it works out in a real-world scenario, but these data are very promising."

Sugar Reduction

The PHE sugar reduction programme challenges the food industry to reduce the sugar content of food products by 20% by 2020, with a first-year target of a 5% reduction.

The analysis looked at reductions in sugar content and likely calories consumed against the 2015 baseline, which does not include steps made by industry since the reporting cut-off of August/September 2017.

The report, published on 22nd May, reveals that retailers and manufacturers have achieved a 2% overall reduction in both sugar content and calories likely to be consumed.

However, the 5% target for sugar was exceeded for products such as yoghurts and fromage frais, and met for breakfast cereals and sweet spreads and sauces, while the calorie target was exceeded for ice creams, lollipops, sorbets, and yoghurts.

The report also states that the recently introduced levy on drinks that contain sugar levels of 5g per 100g or higher had led to an 11% reduction in sugar content and a 6% reduction in average calories.

While Public Health Minister, Steve Brine, described the findings as "encouraging", he said that "we do not underestimate the scale of the challenge we face".

"We are monitoring progress closely and have not ruled out taking further action."

The figures were not welcomed by the British Medical Association, however.

Dr Parveen Kumar, chair of its Board of Science committee, said in a statement: "These figures show a very disappointing lack of progress in tackling the massive problem of childhood obesity.

"Perhaps this is not surprising as the government rowed back on its promises in 2016 and produced a weak plan rather than the robust strategy promised."

She added: "What this proves is that relying on manufacturers to voluntarily reduce the amount of sugar in their products is a false economy, and change will only come through a mandatory approach backed up by regulation."

The study was funded by the New South Wales government. No conflicts of interest declared.

European Congress on Obesity 2018: Abstract O10.6. Presented 25 May.

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