Food Compass Score vs FDA Healthy Labeling and Consumer Purchases: A Randomized Clinical Trial.

Importance: The US Food and Drug Administration (FDA) has finalized a new front-of-package binary healthy label for packaged foods. Effects of this governmental label compared with a more holistic food rating score on consumer purchases are unknown. Objective: To evaluate the effects of the continuous Food Compass Score (FCS) and FDA healthy label in a real-choice randomized trial. Design, Setting, and Participants: This randomized clinical trial used real-choice experiments among adults recruited on-site at 6 locations of 3 supermarket chains in diverse neighborhoods across Massachusetts from July to November 2023. Intervention: Participants were randomized into 2 treatments: FCS (1-100) and FDA healthy (binary) labels. Real-choice experiments tested purchasing decisions comparing different snack foods with and without both label treatments, with these decisions leading to an actual final purchase. Each treatment group had 12 choice scenarios (6 labeled and 6 unlabeled) in which they could choose either 1 of 3 products or no product. Main Outcomes and Measures: Purchase choices (healthy product [defined as FCS≥70], unhealthy product, or no purchase) in multiple choice scenarios, recorded in-person by investigators, and willingness to pay for different features. Results: This study included 275 adults, with a median (IQR) age of 55 (38-66) years, and 175 (63.6%) were female. Compared with no label, both labels increased the purchase of healthier products (FCS: 11.2 [95% CI, 8.2 to 14.2] per 100 choices; P < .001; FDA healthy: 6.4 [95% CI, 3.4 to 9.4] per 100 choices; P < .001). Both labels also reduced the purchase of unhealthy products (FCS: -7.2 [95% CI, -9.9 to -4.6] per 100 choices; P < .001; FDA healthy: -6.3 [95% CI, -9.0 to -3.6] per 100 choices; P < .001). The FCS, but not FDA, label also reduced the occurrence of no purchases by 4.0 (95% CI, 1.8 to 6.1) per 100 choices (P < .001). Compared with the FDA healthy label, the FCS label increased healthy purchases by 1.75-fold (93 of 828 purchases [11.2%] vs 53 of 822 purchases [6.4%]). Conclusions and Relevance: In this randomized clinical trial, both labels increased healthy and decreased unhealthy product purchases, with larger effects as well as decreases in no-purchase decisions with the FCS label. These results can inform labeling decisions by policymakers, retailers, and manufacturers.