Designing a new physical activity calorie equivalent food label and comparing its effect on caloric choices to that of the traffic light label among mothers: a mixed-method study

Shirin Seyedhamzeh; Saharnaz Nedjat; Elham Shakibazadeh; Azam Doustmohammadian; Hedayat Hosseini; Asma Kazemi; Nafiseh Azizolahi; Maryam Chamary; Cain C T Clark; Ahmadreza Dorosty Motlagh

doi:10.3389/fpubh.2023.1280532

Designing a new physical activity calorie equivalent food label and comparing its effect on caloric choices to that of the traffic light label among mothers: a mixed-method study

Front Public Health. 2023 Nov 14:11:1280532. doi: 10.3389/fpubh.2023.1280532. eCollection 2023.

Authors

Affiliations

¹ Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
² Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.
⁶ Department of Food Sciences and Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁷ Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
⁸ Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom.

Abstract

Objective: We designed a new type of 'physical activity calorie equivalent' (PACE) food label in Iran to compare its effect with that of the traffic light food label (TLL) on caloric choices.

Design: Mixed-method study.

Participants: Mothers of school children between the ages of 6-12 years.

Setting: In the qualitative phase, 10 focus group discussions (FGDs) were conducted with various groups of mothers, and two FGDs were conducted with food science and nutrition experts to design a new PACE label. In the quantitative phase, 496 mothers were randomly assigned to five groups: (1) no nutrition label, (2) current TLL, (3) current TLL + educational brochure, (4) PACE label, and (5) PACE label + brochure. Samples of dairy products, beverages, cakes, and biscuits were presented. ANOVA and multiple linear regressions were applied to examine the association between label types and calories of the selected products as our main outcome.

Results: The mothers' perspectives were classified into two sub-themes, the PACE label's facilitators and barriers. The new PACE label's characteristics were divided into two subcategories: (a) appearance, and (b) nutritional information, including 14 codes. In the quantitative section, mean calories of the selected foods were lowest in the TLL + brochure group (831.77 kcal; 95% CI: 794.23-869.32), and highest in the PACE label group (971.61; 95% CI: 926.37-1016.84).

Conclusion: The new PACE label was a combination of PACE, TLL, and warning labels. It did not significantly affect lower caloric choice, however, the TLL + brochure option was effective in choosing foods with fewer calories.Clinical trial registration: The study was registered in the Iranian Registry of Clinical Trials 23 (IRCT20181002041201N1).

Keywords: PACE; TLL; nutrition label; obesity; physical activity.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Child
Energy Intake*
Exercise*
Female
Food Preferences
Humans
Iran
Mothers

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was approved by Tehran University of Medical Sciences under the registry code of 96-03-161-37037 and registered at the Iranian Registry of Clinical Trials [https://irct.ir/]. At the beginning of the study the consent form was signed by the participants.