Health risk or benefit? How the supermarket Health Star Rating system stacks up

Nutrition experts are calling for an overhaul of Australia’s Health Star Rating system – a voluntary front-of-pack labelling scheme that rates the nutritional value of packaged food – claiming it is actually doing the opposite of what was intended and is promoting food high in fat, salt and sugar.

In their paper in the latest issue of Public Health Research & Practice, published by the Sax Institute, the authors say that the Health Star Rating (HSR) system is guided by an outdated view of nutrition science that contradicts some of the recommendations in the Australian Dietary Guidelines.

“Our work has shown that the Health Star Rating system is promoting both ultra-processed and discretionary foods. It’s not deliberately doing that and its intentions are good, but that’s the outcome, because it’s looking at nutrients in isolation rather than taking a holistic approach to diet,” says co-author Dr Helen Vidgen, Senior Lecturer at the School of Exercise and Nutrition Sciences at Queensland University of Technology.

The paper is one of two articles on the Health Star Rating system in the latest edition of the journal, published today, which examines a range of topics on tackling childhood obesity.

By contrast, the second article, whose authors include experts involved in designing the scheme, defends its approach and claims that the system provides readily understandable information that helps consumers make healthier choices.

This paper’s authors, led by Damian Maganja of the Australian Department of Health, say the most recent assessment of HSR labelling has shown error rates are low, with labels giving accurate information in 92% of cases.

In a recent survey, two-thirds of consumers reported that the system influenced purchasing decisions when shopping. Results also demonstrated the power of advertising: for consumers who recalled HSR marketing, three-quarters were influenced to buy a different product.

“The available evidence shows there is little doubt that people are using the system to influence product choice at point of purchase and are changing their long-term behaviour,” the authors write.

They note that the system is designed not to replace general dietary guidance, but to support it.

“Dietary guidance should help inform what goes on the shopping list, while the HSR system guides choices between similar products.”

However, Dr Vidgen says labelling that suggests some ultra-processed and discretionary foods (such as biscuits or confectionery) might be “healthier” than others blinds Australians to the fact that they already consume far too much of them. It is also too easy for food companies to game the system, she says.

“The system is encouraging companies to change their recipes so their products can get more stars. This is understandable but has questionable public health benefit. For example, companies can add fibre extracts or protein powders that have negligible or no public health benefit at all, but they get bonus points in the Health Star Rating system. In its present form, it’s a bit of a gift for the marketing of many ultra-processed and discretionary foods.”

Dr Vidgen says she and her colleagues want the system to work and they suggest reforms in their paper that could improve it. But she says the system has in itself become a massive distraction from the far more important need to have a national nutrition policy.

“We’re really concerned that there’s so much attention being placed on this and money being put into marketing campaigns. But we’re seeing nothing concrete in the area of a national nutrition policy, which would address much more important needs, focusing on improving health and wellbeing in a way that is equitable and takes into consideration the sustainability of the food supply.”

The two articles on the Health Star Rating system are among a number of papers dealing with childhood health and obesity in a special themed issue of Public Health Research & Practice, overseen by Co-Guest Editors Dr Jo Mitchell, Executive Director of the Centre for Population Health at the NSW Ministry of Health, and Professor Louise Baur AM, Head of Child and Adolescent Health at the Sydney Medical School, University of Sydney.

Other articles in this issue of Public Health Research & Practice find:

• Providing children with fixed outdoor play equipment is the best way to increase kids’ activity levels, with each additional piece of equipment adding five minutes to total daily playtimes outside.

• Health services should use growth assessments to routinely identify and manage children who are above healthy weight – just as they routinely identify and manage hypertension in older patients.

• The most cost-effective strategies to combat childhood overweight and obesity are the most vigorously opposed by the food industry and have not been fully implemented in any country.

Allowing a child an extra one or two sweet biscuits a day – equivalent to 200–300 kilojoules – is enough to put them on a path to being overweight, say the Guest Editors in their editorial where they argue for a society-wide response to improve what is so far a “fragmented, narrow and underpowered” approach to childhood obesity in Australia.
“We need to put into action what we already know and deliver successful interventions at scale, over time. We need to find new systemic solutions. And we need to be in this for the long haul,” they write.

Adam Cresswell, Communications Director, Sax Institute
M: 0402 297 674 E:

Nyssa Skilton, Editor, Public Health Research & Practice
M: 0408 331 262 E:

Public Health Research & Practice is an open-access, peer-reviewed quarterly online journal published by the Sax Institute. Click here to subscribe free of charge.

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