Testing Front-of-Package Labels on Packaged Food for Adult and Adolescent Population in Bangladesh

Abstract

Background. Front-of-pack labeling (FOPL) is a promising tool to improve consumer understanding of unhealthy foods and reduce diet-related non-communicable diseases (NCDs). However, evidence on the effectiveness of different formats in Bangladesh is limited.

Objectives. This study evaluated the impact of 4 FOPL formats-warning label (WL), health star rating (HSR), multiple traffic light (MTL), and guideline daily allowance (GDA)-on consumers' ability to identify products high in nutrients of concern and their intention to purchase these products.

Methods. A nationally representative randomized controlled trial was conducted across all 8 divisions of Bangladesh among adolescents (10-18 y) and adults (19-60 y). Participants were randomly assigned to 5 arms (control, WL, HSR, MTL, or GDA) and evaluated using mock packaged foods. Primary outcomes included correct identification of foods high in sugar, sodium, saturated fat, or calories and purchase intention. Secondary outcomes included perceived unhealthiness, perceived message effectiveness (PME), and cognitive elaboration. Tertiary outcomes assessed reactions to FOPL formats.

Results. < 0.001). Although MTL outperformed GDA, it was generally less effective than WLs. WLs were most effective at reducing adults' intention to purchase harmful products. All FOPL formats improved psychological responses compared with control. WLs, followed by MTL, had the strongest effects on perceived unhealthiness, health concern, PME, cognitive elaboration, credibility, and support for labeling, with WLs most strongly discouraging consumption and increasing health concern.

Conclusions. Interpretive FOPL systems outperform noninterpretive labels in improving consumer understanding, with WLs showing the strongest effects. These findings support the use of mandatory WLs as an effective policy to promote healthier food choices and address diet-related NCDs in Bangladesh.This study was preregistered at the Open Science Framework on February 5, 2025. Registration DOI: https://doi.org/10.17605/OSF.IO/8ZDK6.