Fact check: Do higher food star ratings always mean a healthier choice?

The Federal Government’s health star rating system for food products has attracted much controversy since its unofficial unveiling in February 2014.

Ten months later the Assistant Health Minister Fiona Nash formally launched a website and an education campaign.

A second phase of the education campaign began in June 2015.

The marketing slogan is: “The more stars, the healthier.”

But some health experts say it’s not so straightforward and the system can cause confusion for consumers.

So what is going on behind the star ratings? ABC Fact Check investigates.

How are the ratings calculated?

The Federal Government’s website for the rating system says the star labels provide an “at-a-glance overall rating of the healthiness of the food product”.

Stars are awarded to packaged foods depending on the balance between good and bad nutrients they contain.

The process is complex and a comprehensive overview is given in the Government’s guide for the food industry.

Essentially, foods are broken up into categories – food, beverages, oils, spreads, and dairy products.

Dairy products are classified further, depending on calcium content.

The system has a calculator that then awards foods and drinks “baseline” (or negative) points depending on how much energy, saturated fat, sodium and total sugars they contain per 100 grams or 100 millilitres.

The guide says these aspects were chosen because they are the risk factors for obesity and diet-related chronic disease.

The calculator produces a final score which is converted to one of 10 star ratings, ranging from half a star to five stars.

Todor Vasiljevic, a Professor of Food Science at Victoria University, told Fact Check the star system provides a way for consumers to “visualise a nutritional label” in a way similar to the established star ratings for energy efficiency on appliances.

So far there are said to be over 1000 products on supermarket shelves bearing the star labels.

Are all nutrients rated equally?

The Government guide says the stars are calculated so foods lower in saturated fat, sugar, salt and energy are assigned higher ratings than similar foods with “an appreciably higher content of these nutrients”.

Likewise, foods with a high fibre content are assigned a higher rating than similar foods with “an appreciably lower” fibre content.

However, the ratings do not score all nutrients the same way and the points awarded will vary depending on the type of food and the type of nutrient.

Megan Cobcroft is a food policy analyst with the NSW Department of Health and a member of the Dietitians Association of Australia, the national body for the dietetics profession.

She supports the way the calculator awards star ratings within particular categories.

“Dairy, for example, is treated as a different category to other type of drinks, recognising that milk is a core food and provides important nutrients in the diet,” she said.

This is why many brands of plain dairy milk score five stars, despite the naturally occurring levels of fat and sugar (in the form of lactose).

The ratings calculator pays more attention to saturated fat than sugars.

A spokeswoman from the Federal Department of Health explained the reasoning behind this to Fact Check: “One gram of saturated fat does not provide an equivalent amount of energy or nutrition as one gram of sugar and it would therefore be inappropriate to allocate equivalent baseline points for both.”

“Similarly, in most cases 10g of sugar would contribute far less to ill health than 10g of sodium and it would therefore not be appropriate to allocate equivalent baseline points for ‘risk’ when the risk posed is vastly different,” she said.

Some unusual results

Because of the way it assigns weightings to nutrients, the ratings system has produced some peculiarities.

Full-cream unsweetened natural yoghurts can score lower than sugary fruit yoghurts, while fruit juices score four or five stars despite being high in sugar because they receive positive points for fruit content.

Rosemary Stanton, a nutritionist and visiting fellow at the University of New South Wales, told Fact Check the algorithm used by the ratings calculator needs a bit of tweaking to fix these kinds of anomalies.

“I think it needs to be changed to have a lot more penalty on sugar and probably more penalty on sodium as well as the sodium quota is really low,” Dr Stanton said.

She suggested discretionary foods should automatically get extra “negative” points from the ratings calculator.

In an article published by The Conversation, Professor in Public Health Nutrition at Deakin University, Mark Lawrence, and Christina Pollard from the school of public health at Curtin University pointed out that Coles home brand Greek-style yoghurt received one and

half stars “even though it is clearly healthy” while the supermarket chain’s home brand strawberry flavoured soft licorice received two and a half stars.

Foods in different categories

The guide for industry says the health star rating system “is designed to assist consumers to discriminate between foods in the same food category and to compare foods across different food categories”.

Bruce Neal, the senior director of the food policy division for the George Institute for Global Health and a Professor of Medicine at the University of Sydney, says the calculator does not fulfil the second of these goals.

The George Institute has been following the stars and cataloguing the ratings of thousand of products through its website and app called FoodSwitch.

Dr Neal told Fact Check the “key thing most people don’t understand about the system” is that it allows like-with-like comparisons only.

If looking at potato chips, for example, it will help consumers choose which are the healthiest.

“But what it won’t do is enable you to choose between chips and yoghurt,” Dr Neal said.

“This is clearly a problem with the system – most people, when they use the system assume the number of stars basically tell you how healthy this product is compared to everything else.”

Despite this concern, Dr Neal said the easy-to-read star system is still an improvement on previous nutrition panels on the back of foods.

Dr Cobcroft said that since shoppers tend to look for one type of product at a time (for example, in the cereal aisle), the stars work to help people make healthier choices.

“It would only be in situations when someone is looking for a snack across a range of products when it could have the potential to mislead,” Dr Cobcroft said.

The health star ratings website also states the types of comparisons that can be made when using the system.

In a list of frequently asked questions, it says “as the calculations used to determine each product’s rating are specific to each of the six food categories, the system is not designed, for example, to compare yoghurt with frozen lasagna or frozen chips with cereal.”

Peer pressure

Experts told Fact Check a benefit of the rating system is the potential for product reformulation.

Dr Neal said in a competitive market, manufacturers will try to change their nutrient composition to get higher stars.

“If you have the rice bubbles with 2.5 stars and your competitors all have 3.5 stars, your days are probably numbered,” he said.

“So probably at least as big health impacts will be derived from manufacturers reformulating their foods so there is a bit less salt, a bit less sugar, etc, to get a better star rating as will be achieved with consumers actually making better choices.”

Jane Martin, the executive manager for the Obesity Policy Coalition (OPC), a group of public health agencies aiming to support obesity prevention in Australia, described this potential for product reformulation as “stealth public health action”.

“It is a way of reducing across the population levels of salt, or fat, or sugar … and even small changes across the population can have a big impact on disease,” she said.

However, Dr Stanton told Fact Check not all reformulations were necessarily healthy.

She said some manufacturers were already substituting sugar in their products for pear juice or fruit puree – which have the vitamins and fibre stripped out – so they can receive positive “modifying points”, instead of being penalised for containing sugar.

Products with no stars

In their article, Professor Lawrence and Dr Pollard said a weakness of the system is that because it’s voluntary, food manufacturers can decide whether a product will display health stars or not.

“Understandably, although manufacturers might be happy to display stars on foods that attract between two and five stars, they are less likely to put one or half a star on their products,” they said.

Unless every manufacturer adopts the star labels, consumers will never be able to make proper comparisons.

Dr Cobcroft was more optimistic that manufacturers would apply the labels correctly.

“The companies that have publicly announced are putting it on all products, even ones that aren’t rating healthy,” she said.

Cereal producer Kellogg’s Australia received attention in April when the company announced it would apply the rating to all its products, including for example its Crispix cereal that scores only 1.5 stars.

Comparing packaged foods with fresh foods

Another concern among experts is that stars are only applied to processed, packaged foods.

Professor Lawrence told Fact Check since there are no stars on fresh products, it may mislead a consumer to think a packaged product is a healthier option.

The Federal Government’s dietary guidelines recommend eating from five food groups every day: vegetables and legumes; fruit; grains and cereals; lean meats and poultry, fish, eggs, tofu, nuts and seeds; and milk, yoghurt and cheese.

Some of these items may be pre-packaged and could carry the stars – such as frozen fish or vegetables – but most fresh produce will not bear the ratings.

“So you have processed, discretionary foods appearing in supermarkets, many of which have more stars than five-food-group foods, which is just the antithesis of what the guidelines are trying to recommend,” Professor Lawrence said.

Kellie Bilinski, a spokeswoman from the Dietitians Association of Australia (DAA), said she was concerned the stars could become a “marketing ploy” for processed foods – and lead people to choose them over fruit and vegetables just because they had stars.

The decision to exclude fruit and vegetables from the star rating calculations was an intentional one.

Although some pre-packaged varieties may choose to adopt the stars, the calculator was not designed to accommodate these foods.

A document on the health star rating website catalogues complaints about any potential quirks in the ratings calculator.

It says that during the development stage, it was decided that “giving all vegetables a five-star rating would impact on ratings for other food products and create a lack of differentiation for many processed foods”.

The OPC’s Ms Martin, who worked in the initial working group involved in creating the star system, said a decision was made based on extensive qualitative and quantitative research to exclude fruit and vegetables, as people overwhelmingly knew they should be having these as part of a balanced diet.

But Dr Neal said he would support the stars being applied to fresh fruit and vegetables “because then it would give people additional information and bring home the message a bit harder”.

Dr Stanton suggested a different approach to remedy these concerns.

She told Fact Check the ratings calculator could be changed so discretionary junk foods could automatically be awarded extra negative baseline points.

“[Discretionary foods] don’t really have nutrients that are important at all so giving them stars is putting them into an area that they shouldn’t be, making them look like they have some sort of health halo.“

Room for improvement?

The majority of experts contacted by Fact Check agreed the health star ratings are a useful tool that could lead to change provided consumers know how to use them correctly.

Stars only allow for comparisons between similar products, and they are meant to be considered along with the dietary guidelines.

A spokeswoman from the Federal Department of Health told Fact Check the use of the star rating on a product doesn’t mean a food is healthy.

“Just because a food has a high star rating doesn’t mean it contains all of the nutrients necessary for a healthy diet,” she said.

DAA spokeswoman Dr Bilinski said “there are going to be criticisms of it…and I still think people need to be educated and read labels for themselves, but it certainly is a step in the right direction to make people aware of what foods they consume”.

The OPC’s Ms Martin told Fact Check that “although not 100 per cent perfect”, the star system is “a really important tool for consumers to cut through the marketing spin”.

“I think it surprises people to find Coco Pops have the same number of stars as Nutri Grain and that is what it is designed to do,” she said.

Experts also agreed there could be changes to improve the ratings – for example, by making it apply to more products and by reviewing the ratings algorithm to make sure it is in line with public health messages.

Professor Lawrence and Dr Pollard, who are more critical of the star system, have advocated for stars to apply to five food group foods only, and for health warnings to be displayed on discretionary foods.

“This change would provide food manufacturers with stronger incentive to reformulate discretionary foods to avoid attracting health warning symbols on their product labels,” they wrote.

The star system is due for review in 2016.

In the meantime, potential anomalies can be reported to the Health Star Rating Advisory Committee, with a register of complaints showing the system has already been altered in some ways.

The verdict

The Federal Government’s marketing material says its health star rating system for food and drink products is simple and “the more stars, the healthier”.

Experts contacted by Fact Check say that this is not always so.

The system produces some anomalies when foods of different types are being compared.

For example, a “clearly healthy” full-cream yoghurt receives fewer stars than licorice confectionery.

It can also lead to consumers believing that fresh fruit and vegetables, which are not rated, are less healthy than processed and packaged foods.

A product labelled with a half-star rating can appear to have some health benefits.

And it can encourage manufacturers to substitute ingredients, such as fruit juice for sugar, in order to obtain a higher rating without the same level of health benefit.

More stars does not always mean a healthier product.

Sources

• Federal Department of Health, Health Star Rating System website
• Federal Department of Health, Health star rating system formative research, December 6 2014.
• Federal Department of Health, Guide for industry to the Health Star Rating Calculator, March 3 2015.
• Federal Department of Health, Process for dealing with anomalies.
• Federal Department of Health, Register of potential anomalies submitted to the Health Star Rating Advisory Committee for consideration, 2015.
• Australian Government, National Health and Medical Research Council, Australian Dietary Guidelines, 2013.
• The George Institute for Global Health, Foodswitch website
• Chamber of Commerce and Industry of Western Australia, Front of pack labelling – background
• Rita Panahi, Dietitians criticise health star rating system which ranks potato chips above fruit, Herald Sun, April 22, 2015.
• The Obesity Policy Coalition, Policy brief: The health star rating food labelling system, October 2014.
• Mark Lawrence and Christina Pollard, A year on, Australia’s health star food-rating system is showing cracks, July 13, 2015.
• Food Magazine, Health star rating awareness campaign enters second stage, July 8 2015.