Australia's Health Star Rating system – a voluntary front-of-pack labelling scheme that rates the nutritional value of packaged food – is doing the opposite of what was intended and is promoting food high in fat, salt and sugar, according to one of two contrasting papers in the latest issue of Public Health Research & Practice.
The paper, published today by the Sax Institute, claims the Health Star Rating (HSR) system is guided by an outdated view of nutrition science that contradicts some of the recommendations in the Australian Dietary Guidelines.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.
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.
The debate is highly topical given the recent publication of the report of the five-year review of the HSR scheme, commissioned by the Australian Government Department of Health. While finding the scheme was well used and should continue, the review report – which is open for consultation until 25 March 2019 – also identified a number of "opportunities for improvement", including changes that would reduce the number of stars given to unhealthy discretionary or 'treat' foods.
In the second article, the authors, who include the chair of the HSR Advisory Committee and the chair of the HSR Technical Advisory Group, say the most recent assessment of consumer awareness and use of the system found it was well recognised, with 84% of respondents aware of it, and 76% saying it was easy to use and understand. Two-thirds (67%) said the system had influenced their purchasing decisions.
The authors wrote that published evidence was now emerging to back reports of food companies reducing sugar, fat and/or salt in their products, and increasing fibre, as a means of earning ratings with more stars – and that product reformulation was more common among products participating in the HSR scheme.
"The available evidence suggests that people are using the system to influence product choice at point of purchase and are changing their long-term purchasing behaviour," the authors write.
"The experience of the HSR system… has demonstrated that when disparate stakeholders are included in the process and encouraged to engage 'in good faith', a workable and acceptable system that achieves tangible outcomes can be implemented."
In the paper taking a more critical view of the scheme, Dr Vidgen says by suggesting that some ultra-processed and discretionary foods (such as biscuits or confectionery) might be "healthier" than others, the HSR blinds Australians to the fact that they already consume far too much of them.
"The system is encouraging companies to change their recipes so their products can get more stars. 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 distraction from the far more important need to have a national nutrition policy.
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 industryand 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
