Clinical trial NCT04172337: Testing the Effects of Singapore's Front-of-Pack Healthier Choice Symbol Label With or Without a Physical Activity Equivalent Label
Official title: A Randomized Controlled Trial Testing the Effects of Singapore's Front-of-Pack Healthier Choice Symbol Label With or Without a Physical Activity Equivalent Label on Food Purchases and Measures of Diet Quality
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Obesity
Diabetes
Diet, Healthy
Keywords: nutrition
front-of-pack label
calories
online grocery store
Singapore
physical activity equivalent
Lead sponsor: Duke-NUS Graduate Medical School
Sponsor class: OTHER
Collaborators: name: National Medical Research Council (NMRC), Singapore
First posted: 2019-11-21
Enrollment: 117
Sex: ALL
Minimum age (years): 21
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: This will be a crossover study design with all participants exposed once to 3 shopping conditions (1xControl, 1x Arm 2 and 1x Arm 3) in random order. The total study duration for each participant is 3 weeks, with each participant spending 1 week in each shopping condition.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Poor diets are known risk factors for chronic diseases, and in recent years, food labelling has been increasingly sought-after as a cost-effective intervention to help stem the rising trend in chronic diseases.

In efforts to promote a healthy diet, the Singapore Health Promotion Board (HPB) supplements traditional nutrition labelling with the Healthier Choice Symbol (HCS), which identifies food items within a specific category of foods as healthier choices. The original logos were enhanced to include additional information focusing on particular macronutrients, taking one of two themes; it either indicates that a product contains more of a healthier ingredient, or less of a less healthy ingredient.

However, to date, no published studies have assessed the role of the original and enhanced HCS logos in influencing food choices. There is a lack of scientific evidence on the role of the existing symbols in assisting consumers make healthier food purchasing decisions. There are also concerns over the unintended consequences of health claims made based on a single aspect of nutrient content, without considering other aspects. That is the goal of this effort. Specifically, the investigators

propose to conduct the following:

Use a three arm randomized controlled trial (RCT) and an experimental fully functional web-based grocery store to assess the causal effect of the new HCS logos on measures of diet quality either alone, or in combination with a complementary front-of-package (FOP) label: Physical Activity Equivalents (PAEs), which provides information on how long one would need to engage in a certain activity (e.g., jogging) to burn off one serving of the product.

The investigators hypothesize that the greatest reduction in calories per serving (primary outcome) will occur in the HCS plus PAEs arm, followed by HCS only, and no logo control arm.


Eligibility criteria: Inclusion Criteria:

* Singapore residents
* 21 years of age and above
* Primary grocery shopper for the household

Exclusion Criteria:

* Not residing in Singapore
* Under 21 years of age
* Not the primary grocery shopper for the household

Primary outcomes:
measure: Change in average calories per serving purchased per shopping trip
timeFrame: Once a week for three weeks
Secondary outcomes:
measure: Proportion of HCS labelled products purchased (or would have been if not in control arm) per shopping trip
timeFrame: Once a week for three weeks
measure: Total Calories per shopping trip
timeFrame: Once a week for three weeks
measure: Diet quality per shopping trip as measured by the Grocery Purchase Quality Index-2016
timeFrame: Once a week for three weeks
measure: Diet quality per shopping trip as measured by weighted average Nutri-Score
timeFrame: Once a week for three weeks
measure: Sugar per serving per shopping trip
timeFrame: Once a week for three weeks
measure: Sodium per serving per shopping trip
timeFrame: Once a week for three weeks
measure: Saturated fat per serving per shopping trip
timeFrame: Once a week for three weeks
measure: Calories per dollar spent per shopping trip
timeFrame: Once a week for three weeks
Other outcomes:
Locations:
city: Singapore
country: Singapore
facility: Duke-NUS Medical School
Study officials:
References:
citation: Finkelstein EA, Doble B, Ang FJL, Wong WHM, van Dam RM. A randomized controlled trial testing the effects of a positive front-of-pack label with or without a physical activity equivalent label on food purchases. Appetite. 2021 Mar 1;158:104997. doi: 10.1016/j.appet.2020.104997. Epub 2020 Oct 13.