What should be done to improve the Heath Star Rating (HSR) front-of-packet food labelling system?

Sep 14, 2020

When you pick up a food packet in the supermarket and look at the labelling trying to find the healthiest option, do you trust what it says? And do you really understand what you are reading?

Generally speaking, most of us have some understanding of basic healthy eating. Fruit and veges are healthy, and sugar is the devil. But when it comes to buying groceries and packaged foods, it’s not as clear cut which packaged foods are good choices, and manufacturers’ food marketing and packaging are not always upfront about the ingredients.

The Australian Government’s voluntary Health Star Rating (HSR) system launched in 2014, is a front-of-pack labelling system (FoPL) that rates the overall nutritional profile of packaged food and assigns it a rating from ½ a star to 5 stars. It provides a quick, easy, standard way to compare similar packaged foods. Basically, the more stars the product has, the healthier the choice. Or does it?

One of the key benefits of the HSR is to empower consumers to effectively compare the nutritional value of foods within a particular product range and increase awareness of foods that may contribute to positive or negative health outcomes. It aims to reduce the chance of consumers being confused or misled by claims, descriptions and images on product packaging, and to influence the food industry to reformulate and develop healthier food products.

Despite some superficial success, there is plenty more criticism to suggest the system is heavily flawed and in urgent need of major review. While the HSR has potential to improve public health and diet-related literacy and awareness, the current star-rating system’s design is based on a reductionist (nutrient) world view of nutrition science. As a result, the HSR system is often inadvertently contradicting Australian Dietary Guidelines (ADG) recommendations and promoting the marketing of discretionary and ultra-processed foods.

So, while the HSR has undergone ongoing criticism about its effectiveness and relationship to the ADG, interpretive FoPL are recommended by the World Health Organization (WHO) as an evidence‐based policy to promote healthier diets. These types of labels use nutrient profiling to assess the nutritional quality of individual foods and display this in a simplified, visual form.

What should be done to improve the current HSR

In 2019, the HSR underwent a 5-year review to consider its effectiveness and accuracy and looked at how the system is impacting consumer health and the effectiveness of healthy decision making. From this several recommendations were presented:

*The HSR is not mandatory– There have been recommendations made to make the HSR mandatory, or at least have incentives for manufactures to use the HSR. Another option is to have manufacturers state on their packets that they chose not to use the HSR as a mandatory rule. The capacity of consumers to successfully make comparisons between products is hampered by the voluntary nature and limited uptake of the HSR. This prevents the ultimate objective of the HSR to provide nutrition information on food packages to help consumers to make healthier choices and food manufacturers are selectively applying HSRs to their products that score more highly.

 * Foods high in sugar, sodium and saturated fat receiving high health star ratings- The association between added sugar and diet related disease is well documented. The current HSR system results in inappropriately high star ratings for some foods with relatively high levels of added sugar, sodium and saturated fat, all ingredients which are considered to increase the risk of chronic disease.

Stopping modifying points from being achieved if a product is high in any of saturated fat, sodium or added sugar have been recommended. Where a product exceeds the specified amount of any nutrient that attracts baseline points (ie saturated fat, sodium or sugar), the calculation of the HSR rating should not include positive points from other added nutrients, and processed foods don’t achieve additional modifying points through adding protein.

*Change the algorithm to score negative HSR points for ‘added sugar’ rather than total sugar so it is based on added sugars, not total sugars The current HSR system is based on total sugars in a product and makes no distinction between products with high levels of added sugar and those with intrinsic sugars – which aren’t considered dangerous to health, which makes it difficult to determine the relative healthiness of a product. There has also been discussions and recommendations that fruit juice concentrates and other highly processed fruit elements are classed as added sugar and as a result are treated in the same way as other added sugars.

*Apply a HSR cap to discretionary food items– Any foods classified as ‘discretionary’ according to the ADGs or through further nutrient profiling are unable to achieve a health star rating greater than 2.5. Research shows that consumers’ response to the HSR system found that products with a HSR of 2 or less were generally considered unhealthy, while products with a HSR of 3 or more stars were seen as healthier options.

*Effective communication and awareness of the HSR and any changes applied – The HSR system relies on correct consumer understanding and use to be effective in achieving public health outcomes. Communication with stakeholders to explain the rationale behind changes will help maintain consumer trust and understanding of the HSR system, particularly if heightened media scrutiny also exists.

*Position the HSR system in the context of broader healthy eating messages – The public profile of the HSR system has meant its role among the suite of tools that promote healthy eating can be overstated. The HSR system is one tool, designed to address one specific aspect of dietary advice and to support more comprehensive and broad healthy eating education efforts.

The HSR has the important potential to inform consumers and motivate their purchasing behaviour toward healthier choices if certain improvements are introduced. The HSR system does not and cannot provide complete dietary advice, therefore it’s important following Dietary Guidelines is emphasised as the best way to achieve a healthy and balanced diet. Promoting HSR in the context of Dietary Guidelines will help encourage consumers to eat a wide variety of nutritious foods every day.