Too much sugar focus: ‘More measures’ needed for Singapore’s Nutri-Grade system to improve consumer diets – study

12-Apr-2023 - Last updated on 12-Apr-2023 at 04:34 GMT

Singaporean research on the government’s Nutri-Grade front-of-package (FOP) beverage labelling scheme has concluded that more work needs to be done for it to make a positive impact on consumer dietary and purchasing choices. ©MOH

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A recent study conducted by Singaporean researchers on the government’s Nutri-Grade front-of-package (FOP) beverage labelling scheme has concluded that more work needs to be done for it to make a positive impact on consumer dietary and purchasing choices.

Singapore first announced the Nutri-Grade labelling scheme for sugar-sweetened pre-packaged beverages back in 2020, and this was finally officially enforced in the country in December 2022 after various delays attributed to COVID-19.

The scheme grades beverages from A (healthiest) to D (least healthy) in terms of sugar and saturated fat levels.

Researchers at the Duke-NUS Medical School conducted a randomised trial involving 138 participants to examine the impacts of Nutri-Grade implementation on consumer purchasing choices, via an experimental online grocery store platform NUSMart in collaboration with local grocery retailer FairPrice.

The platform made 2,500 of FairPrice’s most popular food and beverage products available on NUSMart, classified into 23 categories with listings containing product pictures, brands, descriptions, prices and Nutritional Facts Panel information. Participants were given a minimum spend of SGD50 (US$37.61) per grocery shopping experience, and asked to make two shops one week apart.

They found that although the FOP labelling system did help to encourage consumers to choose beverages with higher ratings, this was not quite so clear in terms of helping them to improve health and dietary choices.

“The label encouraged consumers to choose beverages with higher ratings [and this] led to a reduction in sugar from beverages purchased by 1.51g per serving overall – but we also saw that this was not effective at reducing the amount of saturated fat purchased per serving,” the study authors highlighted.

“[As such], this increase appears to be driven entirely due to sugar reduction. One of the reasons could be that the underlying Nutri-Grade algorithm itself does largely focus on sugar as beverages with high sugar content receive C or D grades even if they are low in saturated fat – which means that consumers switching out of these beverages toward healthier products could actually increase saturated fat intake.”

The study also found that the labels did not result in any improvement towards overall diet quality, which the researchers attributed to the challenges of Nutri-Grade having a sole focus on pre-packaged beverages only.

“This is likely because beverages account for a small part of the total shopping basket only,” Duke-NUS Professor of Health Services and Systems Research Professor Eric Finkelstein told us.

“This reveals the limits of a labelling system focussing on only pre-packaged beverages - The government has recognised this and will be expanding Nutri-Grade to freshly prepared beverages by the end of 2023.”

Too many systems, too little clarity

Questions were also raised as to the efficacy of enforcing one system targeted at beverages that has several levels, in addition to the Healthier Choice Symbol (HCS) logo, another system in the country that is applied for all packaged food and beverage products but is limited to the logo being ‘present’ (healthy) or ‘absent’ (not healthy).

“The effectiveness of this and other positive FOP labels have been questioned, largely because they do not help to identify the least healthy products, which are highest in sugar and calories,” said the study authors.

“HCS also includes multiple claims for different nutrients, which could confuse consumers; and This confusion may only get worse with the addition of Nutri-Grade.”

The best solution according to these experts may be to look at the implementation of a unifying system for all foods and beverages in the scored style of Nutri-Grade, especially as consumers do already appear to be open to this concept.

“This statement is bolstered by the fact that 89% of the participants in this study stated that they would use a Nutri-Grade type label if it were displayed on food products,” they added.

“Prior experimental research has already shown [systems such as France’s Nutri-Score, also a coloured grading system which is applied to both foods and beverages] to be effective at improving diet quality of the shopping basket among shoppers in Singapore.

“[So] although Nutri-Grade is likely to reduce consumers’ sugar purchased from beverages, to improve overall diet quality in Singapore [there is no doubt that more] additional measures will be needed.”