Member Matters
The Role of Health Star Ratings (HSR) in Guiding Consumer Food Choices: A Systematic Review
16 September 2024
The Health Star Rating (HSR) system is gaining attention from policymakers, academics, and the media as a potential tool to improve public health by guiding consumers toward healthier food choices. Introduced in Australia and New Zealand in 2014, the HSR uses a front-of-pack labelling system to help consumers compare the healthiness of packaged foods. Despite voluntary adoption, there is increasing interest in making the system mandatory to maximise its public health benefits.
A recent systematic literature review (1) examined the effectiveness of the HSR in helping consumers make healthier food choices and identified areas for future research. The review analysed over 100 peer-reviewed studies and identified five major themes: marketing strategies for HSR, consumer food choices, nutrient profiling focus, stakeholder perspectives on HSR, and regulations, implementation, and evaluation of the system. Below, the key findings under each theme are explored.
1. Marketing Strategies and HSR
One of the primary themes emerging from the literature is the interaction between HSR scores and marketing strategies. Studies reveal an inverse correlation between HSR scores and product promotions. Products with lower HSR scores (e.g., 0.5 stars) tend to be more heavily promoted through discounts and special offers than products with higher HSR scores (e.g., 5 stars). This marketing strategy could undermine the effectiveness of the HSR system by encouraging consumers to purchase less healthy products simply because they are more affordable.
This finding raises concerns about how the HSR is used in the marketplace. While it is intended to guide healthier consumer choices, marketing of less healthy products with low HSR scores may counteract the system’s health-promoting goals. It also highlights the potential need for regulations around how HSR-labelled products are marketed to ensure the system supports healthier eating habits.
2. Consumer Food Choices and HSR
The core purpose of the HSR system is to assist consumers in making healthier food choices. However, research suggests that brand familiarity and trust often outweigh a product’s healthiness in consumer decision-making. Even when the HSR label is visible, consumers are more likely to buy products from brands they know and trust, regardless of the product’s nutritional quality.
Moreover, the ease of understanding the HSR label is crucial for consumer engagement. Studies show that consumer education and health literacy play a vital role in the effectiveness of the HSR system. Consumers with higher levels of health literacy are better equipped to understand and use the HSR to guide their food choices. This finding underscores the importance of public health campaigns that not only promote the HSR but also educate consumers on how to interpret and apply the information it provides.
3. Nutrient Profiling Focus
The HSR system’s design is based on nutrient profiling, which means that a product’s star rating reflects its overall nutritional composition. This allows consumers to compare products within the same category and choose healthier options. The system also encourages food manufacturers to reformulate their products to achieve higher HSR scores, which can improve the nutritional quality of food available on the market.
International health organisations, such as the World Health Organization, have recognized the value of nutrient profiling systems like the HSR. These systems help reduce the risk of non-communicable diseases, including obesity and cardiovascular diseases, by encouraging consumers to choose healthier products and motivating manufacturers to improve the nutrient profile of their offerings. In countries where unhealthy diets are prevalent, implementing nutrient profiling systems can be a powerful tool for improving population health.
4. Manufacturer Perspectives on HSR
From the perspective of food manufacturers, the voluntary nature of the HSR system poses certain challenges. Studies show that manufacturers are often reluctant to display the HSR label on products with low ratings, fearing that it will deter consumers from purchasing these products. Instead, they tend to display the stars only on products with high HSR scores, creating a skewed representation of the nutritional quality of their product ranges.
Manufacturers also face logistical and financial challenges in adopting the HSR system. Calculating accurate star ratings for products requires additional resources, including specialised knowledge and data. For smaller companies, these requirements can be particularly burdensome. Some manufacturers argue that without mandatory implementation, the system will remain inconsistently applied, limiting its effectiveness.
5. Regulations, Implementation, and Evaluation of HSR
One of the most significant findings from the literature is the importance of mandatory regulation to ensure the effectiveness of the HSR system. Currently, HSR labelling is voluntary, meaning that manufacturers can choose whether to display the rating on their products. This voluntary approach has led to selective labelling, where healthier products are more likely to display the stars, while less healthy products often omit the rating altogether.
Researchers argue that making HSR labelling mandatory would help standardise the system and ensure that consumers have access to consistent information across all product categories. Without mandatory regulations, the system’s potential to guide healthier choices may be undermined, as consumers may not trust a system where only certain products display their health rating.
Furthermore, there is ongoing debate about the appropriate cut-off points for determining what constitutes a “healthy” product within the HSR framework. Some studies suggest that the current criteria may not align with consumer perceptions of healthiness, leading to confusion and mistrust of the system. More research is needed to evaluate how consumers interpret the star ratings and whether adjustments to the system are necessary to improve its clarity and effectiveness.
Conclusion
According to the authors, the HSR system holds significant promise as a tool to improve public health by guiding consumers toward healthier food choices. However, the current voluntary nature of the system, combined with inconsistent application and challenges in consumer understanding, limits its impact. To fully realize the potential of the HSR, policymakers may need to consider mandating its use and enhancing public education around its meaning and application.
Further research is needed to address gaps in understanding, particularly around consumer behaviour, manufacturer adoption, broadening the use of HSR beyond packaged food such as food service, and the effectiveness of nutrient profiling in driving product reformulation. By continuing to refine and strengthen the HSR system, governments, health organisations, and food manufacturers can work together to create a healthier food environment for all consumers.
A limitation of the study is the use of only two databases to source the peer-reviewed papers.
Reference
(1). Junaid, Muhammad & Rehman, Mohsin & Pontes, Nicolas & Yaqub, Muhammad. (2024). Health Star Rating Labels: A systematic review and future research agenda. Food Quality and Preference. 122. 105310. 10.1016/j.foodqual.2024.105310.
