Fixing the flaws of food health star ratings

Research has revealed that Australia’s Health Star Rating (HSR) system is flawed, as products high in salt, sugar and fat score too highly due to loopholes in the algorithm, and the system fails to differentiate between whole grain and refined grain foods.

Introduced in Australia and New Zealand in 2014, the HSR is a front-of-pack labelling (FoPL) system that rates food between 0.5 to 5 stars, depending on the its nutritional profile.

Ahead of its official review at the end of June, public health researchers have looked into the HSR’s performance in Australia and New Zealand between June 2014 and October 2018, and the role the food industry played in its early development.

Researchers from The George Institute found the influence of the food industry has prevented the system from reaching its full potential as a tool to improve public health.

Published in the Australian and New Zealand Journal of Public Health, a review paper revealed that the since it is voluntary, HSR is only displayed on between 20 and 28% of eligible products, 75% of which scored 3 or more stars. Although more than 118 manufacturers in Australia were using HSR in 2018, Coles, Woolworths and Aldi were responsible for more than half of all uptake.

In terms of the graphic itself, consumers found the HSR ‘star’ logo easy to understand and use compared to the Nutrition Information Panel (NIP) and Daily Intake Guide, but there was little evidence to suggest it led to healthier purchases. A Five Year Review Draft Report published in February, however, noted a survey which revealed 23% of all consumers were influenced to purchase a product with more stars.

While the draft report recommended the HSR system should continue to be voluntary, The George Institute is among several public health groups calling for the scheme to become mandatory.

“Unhealthy diets are the leading cause of death and disability in the world and our obesity rates are being fuelled by the abundance of packaged foods high in sugar, salt and fat,” said Alexandra Jones, Public Health Lawyer from The George Institute and co-author of the research paper. “We categorically need labels that really do spell out whether a product is good or bad for us. Right now most unhealthy products simply don’t have the HSR being displayed on them. In fact, some products high in salt, sugar and fat are scoring too highly by gaming loopholes in the algorithm.”

Algorithm improvements

The paper suggested improving the algorithm by incorporating added sugars, increasing penalties on salt content and removing undue benefits from protein.

The Grains & Legumes Nutrition Council noted separate research which found the HSR algorithm currently relies on dietary fibre and does not consider whole grain within foods, which leads to foods like brown and white rice receiving a similar score.

Whole grain foods protect against cardiovascular disease, type 2 diabetes, colorectal cancer and weight gain, but many Australians still choose refined grain foods such as white bread, rice and pasta. These choices may be impacted by the system’s failure to promote whole grain foods as healthier.

A study published in the journal Nutrients compared the HSR scores of 441 grain foods and found an average difference of less than half a star between whole grain versus refined grain bread (0.4 stars), rice (0.3) and flour (0.4), and less than one star difference (0.7) in breakfast cereals. It found significant overlap in foods scoring between 3.5 and 5 stars.

“There are big differences in the amount of dietary fibre present in grain foods, between 3 and 18%, so it doesn’t make sense to rely solely on fibre as a surrogate measure for whole grain. Additionally, whole grains contain much more than just fibre — when all three natural layers of a grain are present, whole grains are rich in protein, B group vitamins, minerals and antioxidants too,” said Felicity Curtain, an Accredited Practising Dietitian and Nutrition Manager of the Grains & Legumes Nutrition Council.

As part of the HSR five-year review, whole grain is under consideration as an addition to the calculation.

As well as focusing on the algorithm, the paper suggested Australia could learn from Canada and France, which require labels to have a uniform position, size and colour to enhance visibility to consumers.

“As the formal five-year review draws to a close in 2019, reasonable refinements to HSR’s star graphic and algorithm, action to initiate mandatory implementation and strengthened governance — particularly through renewed, visible government leadership — present the clearest opportunities to enhance HSR’s public health impact,” the paper concluded.

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