FLICC (Front of pack food Labelling: Impact on Consumer Choice)

Lead Research Organisation: University of Oxford
Department Name: Population Health


Since 2006, retailers and manufacturers in the UK have begun using front of pack (FOP) nutrition labelling on foods. Presently, around four fifths of foods in UK supermarkets carry FOP labelling. There have been many studies of consumer understanding of FOP labelling, and of use of FOP labelling in experimental settings. However, little is known about how consumers use FOP labelling in real-life shopping situations. This project will investigate the use of FOP labelling during real-life shopping situations, and explore the feasibility of a trial of two interventions aimed at amplifying the impact of FOP labelling - tailored feedback to consumers on food purchases, and interactive education about FOP labelling.
Two recent studies involved participants being tailed by researchers during real-life shopping situations, in order to investigate facilitators and barriers to buying healthy foods. Transcripts of the interviews from these studies will be re-analysed with a focus on the role of FOP labelling in food purchasing decisions. A new qualitative study will then be conducted with innovative data collection techniques. Participants will be asked to wear SenseCam - a wearable camera that takes time-stamped first-person photos at regular intervals. After the shop, the participants will be interviewed, and images collected by SenseCam will be used to aid recall of the food purchase decisions at each stage in the shop. These interviews will be used to gauge the influence of FOP labelling in food purchase decisions, in relation to other competing influences. Participants will also be asked to consider how the influence of FOP labelling might be amplified in future shopping experiences, and their responses will feed into the development of two interventions. The tailored feedback intervention will consist of automatic delivery of information about the FOP labels of recently purchased products with alternatives from within the same product range with a more healthy FOP label profile. The interactive education intervention will consist of a web-based programme that educates individuals about how FOP labelling systems are designed and work, what consumers should look for in different food product ranges, and the range of FOP labels that are likely to appear in different food product ranges.
A pilot RCT will then be conducted, which will assess the feasibility of conducting a full RCT of these two interventions. Stores from the Co-operative supermarket chain will be the setting. Approximately 400 participants will be recruited from all Co-operative store card holders. They will be randomised into four arms: control; tailored feedback only; interactive education only; tailored feedback and interactive education. Data collection will take place over 12 weeks. During this time, all food purchases made by participants using their Co-operative store cards will automatically be relayed to the researchers. For the first four weeks of data collection, no intervention will take place. Both tailored feedback and the interactive education intervention will take place during weeks 5-8. No intervention will take place during weeks 9-12. The primary outcome variables for the full RCT will be average healthiness of ready meals, pizzas, sandwiches and breakfast cereals purchased in weeks 5-8 minus average healthiness of similar foods purchased in weeks 1-4, and similar comparison between weeks 9-12 and weeks 1-4. Telephone interviews with participants and Co-operative staff will be conducted after data collection. The results of the pilot RCT and the telephone interviews will be used to assess feasibility of recruitment method, recruitment rates by demographic subgroups, effective delivery of intervention, feasibility of data collection, and estimates of drop-out rates. Because of the automated nature of the interventions, both could be rolled out to a wider population of supermarket shoppers if a full RCT demonstrates effectiveness.

Technical Summary

Front of pack (FOP) nutrition labels are displayed on most foods available in UK supermarkets but little is known about how they are used in real-life shopping situations, or whether their influence can be amplified to encourage healthier food purchases.
This project involves three phases. Phase 1 is secondary analyses of two studies where researchers accompanied shoppers and observed behaviour. The analyses will focus on the influence of FOP labels. Phase 2 is a qualitative study of use of FOP labels in shopping situations using innovative data collection techniques. 30 participants will conduct a routine shop wearing SenseCam (a wearable camera which automatically takes photos from a first-person viewpoint at a standard interval), and 30 participants will conduct both a routine shop and a 'healthy shopping' task whilst wearing SenseCam. The images will be used to prompt recall in a semi-structured interview conducted immediately after the shop. Participants will be asked about two interventions to amplify the impact of FOP labels (I1) tailored feedback promoting foods with healthier FOP labels than previous purchases, (I2) a web-based education programme about FOP labels. Phase 3 is a pilot RCT of the effectiveness of I1 and I2. The pilot RCT will be conducted in Co-op supermarkets nationwide. 400 participants will be randomised to four arms: control; I1; I2; I1 and I2. Data collection will take place over 12 weeks, during which time electronic sales data from the participants will be automatically delivered to researchers. I1 and I2 will be delivered during weeks 5-8. Final outcome measure will be average healthiness of foods purchased during weeks 5-8 compared to weeks 1-4, and between weeks 9-12 compared to weeks 1-4. Data on these final outcome measures will be used to inform power calculations for a full RCT. A process evaluation involving telephone interviews with Co-op staff and study participants will be conducted to assess the feasibility of a full RCT.

Planned Impact

Recent trends in adult obesity continue to rise, and the contribution of unhealthy diets to excess mortality is estimated to be 33,000 death per year. Food labelling is assumed to be a broad population approach to improving food purchases but the impact of labelling remains unknown. Our study will assess the impact of front of pack (FOP) labelling schemes commonly used in the UK on consumer purchasing decisions. FOP labelling is defined here as schemes that highlight the level of nutrients within a food in an 'at a glance' format on the front of the pack (e.g. traffic light labelling, % GDAs, 'healthy choices' logos). This research will not only assess the evidence of this impact but also develop new methods, provide a unique and rich dataset of food purchasing, and pilot test a key current UK government public health initiative. This dataset will be generated, for the first time, by an academic and food retail partnership using new method of automated delivery and analysis of electronic sales data. There is a real opportunity to capitalise on the 82% of packaged products available in UK supermarkets currently carry FOP labelling and this research will aid the development of interventions aimed at facilitating choice of healthy foods.

NPRI funding presents a unique opportunity to create a research, industry and third sector collaboration, optimising a diverse range of methodologies and skills to add value to a policy led public health area, where nothing was previously available. We feel that NPRI's focus on building an evidence base for population approaches to prevention will be a real contribution to British and international research which would be unlikely to emerge from other funding bodies.

Beneficiaries from this research are:
WHO? - Other Academic Researchers
HOW? - The development and utilisation of new and innovative methodologies, equipment, techniques, technologies, and cross-disciplinary approaches.
Use of digital images within qualitative methods to explore use of FOP labels.
Construction of automated delivery, analysis and feedback of electronic sales data.
Dataset of food purchasing.
Use of technology to feedback on food purchasing behaviour.
WHO? - The Public
HOW? - Enhancing health and well-being
Improve opportunity for healthier choices by better understanding of how FOP labels are used and deliver systems to public to nudge behaviour.
Optimise use of FOP labels within existing retail shopper feedback systems and delivery of messages via choice of digital or written media.
HOW? - Transforming evidence based policy in practice and influencing and informing practitioners and professional practice.
Use of FOP labels to raise the impact on chronic disease management and dietary management via National Obesity Observatory and NICE.
WHO? - Industry
HOW? - Changing organisational culture and practices.
Improve consumer choices by systematic feedback about food choices via store cards and delivered via choice of digital or written media.
WHO? - Government Departments
HOW? - Contributing towards evidence based policy-making and influencing public policies and legislation at a local, regional, national and international level.
FOP labels matches four main approaches supported by the new responsibility deal - the Food Network and DH.
Improve information to consumers on the content of food, improving awareness on the availability of healthy food, and direct promotion of healthier food choices.
WHO? - Third sector (Health NGOs)
HOW? - Contributing towards evidence based policy-making and influencing public policies.
British Heart Foundation, National Heart Forum, WHICH, Sustain all advocate for improvement to promotion of FOP labels.
Description Biomedical Research Centre at Oxford
Amount £4,156,781 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2017 
End 03/2022
Description Departmental pump priming award
Amount £57,494 (GBP)
Organisation University of Oxford 
Department Nuffield Department of Population Health
Sector Academic/University
Country United Kingdom
Start 06/2016 
End 06/2017
Description Public Health Intervention Development Scheme (PHIND)
Amount £186,261 (GBP)
Funding ID MR/R015465/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 01/2018 
End 02/2020