How healthy are new food products targeted to children?

November 5, 2020

This blog post has been contribute by Danielle Azzopardi. After 15 years of private practice as a naturopath, Danielle embarked on a project of improving the diet of children by becoming the manager of a primary school canteen where she delights in promoting good food for growing bodies. Danielle is completing her final unit of the Master of Health Nutrition at Deakin University and plans to enrol in a PhD in 2021. 

In Australia, one in four children aged 5-17 years are overweight or obese. Additionally, just under 40% of the total energy consumed by 4-13 year-olds comes from ‘discretionary’ foods, which are those that energy dense, nutrient poor foods that are not necessary for a healthy diet.

What is Energy Density and why is it important?

In children, decreasing dietary ED could potentially prevent energy over consumption without reducing energy intake below the child’s needs. This could contribute to a reduction in rates of childhood obesity. Diets that are lower in ED tend to be of higher quality and more in line with dietary guidelines.

The Health Star Rating (HSR) system was introduced in Australia in June 2014 to assist consumers in making healthy food choices in a discretionary food-flooded environment. The number of stars a product receives is based on an nutrient profiling algorithm, and should theoretically increase as its ED decreases, helping consumers to choose lower-ED options.

In our cross-sectional study, we examined the relationship between ED and HSR, of all new products targeted to children (5-12 years) and launched in Australia from June 2014 to June 2018. A total of 548 products were categorised as low (<630 kJ/100g), medium (630-950 kJ/100g), or high (>950 kJ/100g) ED according to cut-offs defined by the World Cancer Research Fund. We then classified each product that displayed a HSR as discretionary or core according to the Discretionary Food List produced by the Australian Bureau of Statistics (ABS) in the Australian Health Survey User Guide.

Almost three quarters of the products were categorised as high ED. Less than 20% of products displayed a HSR (n=100) and the HSR system did not consistently distinguish between low-ED and high-ED products. About three quarters of products with a HSR were categorised as having a high HSR (≥2.5 stars) and the majority of products with a HSR (70%) were categorised as discretionary foods.

Is the Health Star Rating a consistent measure of healthiness?

Among the foods displaying a HSR, all low and medium ED foods displayed a high HSR, as would be expected. However, our study found that only 31% of high ED foods displayed a low HSR, with the remaining 69% displaying a high HSR. Some high ED products may have been deserving a high HSR. For example, the Happy Snack Company’s ‘Roasted Fav-va Beans’, which has an ED of 1867 kJ/100g, scored highly on the HSR algorithm for it’s high protein, legume and fibre content. However, there are also products that are clearly discretionary, such as ‘Messy Monkey Strawberry and Apple Snack Bars’ by Freedom Foods. This snack item displays 4.5 stars, yet has an ED of 1410 kJ/100g, is one third sugar, and contains mostly dried fruit, which is recommended as an ‘occasional’ food by the Australian Dietary Guidelines. If the HSR was classifying foods on the basis of ED, we would expect a much lower percentage of high ED foods displaying a high HSR.

By not accurately discriminating among discretionary and high ED foods, the HSR is effectively allowing these foods to be perceived as healthier than they actually are.

It is important to encourage children to meet dietary recommendations and energy needs through healthful food intake and limited intake of high-ED, nutrient-poor foods. Strategies that target the retail food market have the potential to assist in moderating children’s dietary energy density and energy intake. As the HSR system is currently voluntary, it is likely that manufacturers selectively apply the HSR to products receiving higher ratings.

In light of the continuing support for the expansion of HSRs, it is imperative that the system provides appropriate guidance for shoppers to make food choices in line with the Australian Dietary Guidelines. When choosing between two products with HSRs, selecting the food with the greater number of health stars will not always be the “healthier” or lowest ED choice. With most new foods marketed to children categorised as high ED, and the majority of those with a HSR considered discretionary, consumers need a more consistent measure of healthiness.