Front-of-pack symbols are not a reliable indicator of products with healthier nutrient profiles

Background: Front-of-pack (FOP) nutrition rating systems and symbols are a form of nutrition marketing used on food labels worldwide. In the absence of standardized criteria for their use, it is unclear if FOP symbols are being used to promote products more nutritious than products without symbols. Objectives: To compare the amount of calories, saturated fat, sodium, and sugar in products with FOP symbols, and different FOP symbol types, to products without symbols. Methods: The median calorie, saturated fat, sodium, and sugar content per reference amount of products with FOP symbols were compared to products without FOP symbols using data from the Food Label Information Program, a database of 10,487 Canadian packaged food labels. Ten food categories and 60 subcategories were analyzed. Nutrient content differences were compared using Wilcoxon rank-sum test; differences greater than 25% were deemed nutritionally relevant. Results: Products with FOP symbols were not uniformly lower in calories, saturated fat, sodium, and sugar per reference amount than products without these symbols in any food category and the majority of subcategories (59/60). None of the different FOP types examined were used to market products with overall better nutritional profiles than products without this type of marketing. Conclusion: FOP symbols are being used to market foods that are no more nutritious than foods without this type of marketing. Because FOP symbols may influence consumer perceptions of products and their purchases, it may be a useful public health strategy to set minimum nutritional standards for products using FOP symbol marketing.