Overall, nutrition and other claims were frequently used on food labels in the Canadian food supply. Nutrition claims were used almost as often in 2013 as in 2010 [24]. Although, we expected the overall prevalence of nutrition claims (nutrient content claims, health claims, and general health claims within in the Canadian context), would be significantly higher in 2013 compared to 2010 due to changes in regulations and guidance documents mentioned earlier, this was not the case and in fact, it was lower. When specific types of nutrition claims were analyzed, the use of nutrient content claims significantly decreased, which could have driven the overall proportion of nutrition claims to decrease, as nutrient content claims were the most prevalent type of nutrition claims. The frequency of use of disease risk reduction claims not only remained low compared to nutrient content claims and front-of-pack claims, but also was unchanged and slightly lower compared to FLIP 2010 [24], despite the number of approved disease risk reduction claims being doubled in 2013 compared to 2010. Front-of-pack claims (a subtype of a general health claim) were used more often in 2013 and we found that other claims (specifically gluten-free claims) were used on foods labels in 2013.
In Canada, nutrient content claims can be used voluntarily by food manufacturers if products met the criteria established for each individual claim [13, 24]. The present study showed regulated nutrient content claims continued to be the type of nutrition claim most often used on food products (42.9%). Similar results were reported in the preceding study in Canada (45%) [24]. Trends among some individual types of nutrient content claims were identified. For instance, fat claims (total fat, trans fat and saturated fat) were less likely to be used in 2013 compared to 2010, consistent with a recent study that showed less emphasis is being made on fat in health messaging [36]. In that study, the authors noted that fat claims may be misleading consumers as they are not associated with lower calorie content in most foods, as most consumers expect [36]. Higher energy intake, rather than high fat per se, is probably one of the causes for obesity escalation [37]. Sodium claims were not significantly higher in 2013 compared to 2010 [24], despite huge efforts directed towards sodium reduction in Canada during this time [19]. For example, other research has shown that little sodium reduction progress overall has been achieved in the food supply during this period, although significant improvement has been achieved in some food categories [38]. One reason for the lack of low/reduced sodium claims could be that food manufacturers are using a step wise approach to reduce sodium in foods, as suggested by Health Canada’s sodium guidance document [19]; therefore, reductions are maybe not sufficient to reach the threshold of at least 25%, for a food to be allowed to carry a lower sodium nutrient content claim [13].
Only two types of nutrient content claims showed a significant increase between 2010 and 2013: sugar and protein claims. Although sugar claims were increasing in frequency, they are still only used approximately one third as often as nutrient content claims for fat or trans fat. Interest in sugar has risen in recent years and it is expected to continue to grow due the World Health Organization sugar guidelines which recommend keeping sugars, and particularly free sugars (defined as “all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices”), to less than 10% of total energy intake [39]. Free sugars are associated with increased risk of dental caries, obesity, and type 2 diabetes. [39,40,41]. In 2016, the Government of Canada issued nutrition labelling regulatory changes, which included providing consumers with more information regarding sugar on food labels (e.g., a new daily value for total sugar and grouping sugars in the Ingredient List) [14]. However, as opposed to the United States [42], the change in labelling did not include adding free or added sugars on the Nutrition Facts table. Our research group has shown that free sugars account for approximately 20% of the calories in prepackaged foods and beverages in the Canadian food supply [25]. Thus, one could expect to find more products with sugar claims in the food supply in the upcoming years. With regards to protein claims, our study is consistent with a food trends report published in 2014, that showed 3% worldwide and 6% in the Unites States launches of food and beverage new products displaying either a “high-protein” or “source of protein” claim [43]. Also, the growth in the development of alternative and novel sources of protein [44], may provide new ingredients for new products with this nutrient.
Interestingly, disease risk reduction claims (a subtype of health claim) decreased slightly in frequency despite 5 new disease risk reduction claims being approved by Health Canada after 2010 [45,46,47,48,49]. However, this research is in line with results from studies in other countries that showed disease risk reduction claims were only present on 1-3% of food labels [3, 5, 50]. Nevertheless, another 6 disease risk reduction claims were approved between 2014 and 2016 (after data collection for this study) [51,52,53,54,55,56], which may result in an increase in their use by food manufacturers, although research has shown that disease risk reduction claims are not often used on food labels [5].
General health claims have a substantial presence in the Canadian food supply despite the fact they are not specifically regulated. As described in Fig. 1, front-of-pack claims are currently not regulated by Government, thus this may be one reason several systems were identified, which is far from the ideal single system recommended by nutrition experts [6]. Twenty percent of the products in FLIP 2013 carried front-of-pack claims, which is consistent with comparable research elsewhere [3]. Five different front-of-pack systems were identified on those food labels compared to 4 in 2010 [24], since an additional front-of-pack system related to calories was introduced after 2010, and used on 3.2% of food labels. The use of nutrient specific systems and food group/ingredient systems increased, while summary indicator systems and hybrid systems decreased. Nutrient specific systems were related primarily to single nutrients and very few products used a Guideline Daily Amounts (GDAs) or star rating system, and food group/ingredient systems were related mainly to whole grain. The decrease in use of summary indicators systems was largely due to the discontinuation of the Heart and Stroke Foundation’s Health Check™ program in 2013, which occurred during this collection [22]. Future collections of FLIP will likely reflect the complete termination of the Health Check program.
Besides the use of nutrition claims (nutrient content claims, health claims and other general health claims), this study also identified the frequency in use of other claims for the first time in our database, specifically gluten-free claims. This type of claim was present on 7.3% of the Canadian food supply, making it the fifth most popular claim, a proportion almost comparable to fibre claims (the fourth most common nutrient content claim), supporting reports that indicate “gluten-free claims” is a growing trend in food marketing in Canada [32, 57], perhaps largely driven because a number of non-celiac or non-gluten sensitive consumers are selecting gluten-free products because of their perceived “nutritional value” [32]. If this continues, one can expect products carrying gluten-free claims will be more prevalent in the upcoming years, although little research has been done to determine whether the nutritional value of these products is superior.
There are several strengths of this study. A major one is that this study provides a comprehensive assessment of the prevalence and trends in the use of nutrition marketing on foods in a structured way, using comparable methods as those established in the initial study conducted in 2010, which allowed us to objectively assess trends. This research also captured a large proportion of the products sold in the food supply in Canada (about 75% of the retail market); analyses did not restrict the selection to only certain food categories and certain types of claims. The use of electronic devices to photograph all foods in store allowed us to efficiently collect and process data. Although the categorization of some claims such as front-of-pack was not based on specific regulations, a standardized categorization framework was developed to minimize potential subjectivity, as it provided not only a path to decide whether claims fall into one or another category, but also provided graphic examples to guide those classifications.
Some limitations of this study were that it was cross-sectional in design. A second limitation is the approach used to classify nutrition claims. For example, this study classified both nutrient content claims and health claims as nutrition claims; however, other studies have used an international standardized nutrition labelling taxonomy to overcome the differences between regulations among countries [58,59,60,61], which can facilitate multi-country comparisons in the use of nutrition-related claims. FLIP 2013 did not capture products sold in value chain retailers, convenience stores and neighborhood stores, therefore some products available for purchase were probably missed, which might have included specialty products. Analyses were not weighted for sales data due cost restrictions, and the large sample size difference between 2010 and 2013 of products analyzed (n = 10,487 and n = 15,286 respectively), may have magnified variances in the claims assessed. However, to deal with this difference, analyses were carried out using weighted data (number of claims weighted to the number of products collected in each data set) rather than number of products collected.
In the end, different types of claims have been studied worldwide [3, 24, 58,59,60,61,62,63], although their impact on consumers’ health may be small [9]. Perhaps this is because claims are being used more as a marketing strategy by manufacturers [9]. However, monitoring and surveillance of the use of claims on food labels is important because it can help protect consumers from misleading information, evaluate regulatory compliance, provide information for public health research, or identify areas requiring improvement. Periodic evaluation of claims can also identify commonalities and differences among regions, which can be used for policy development and evaluation worldwide, support fair trade, among other uses.