Improving consumer understanding of dietary health risks using the lens of ultra-processing: an experimental study.

BACKGROUND: Over-consumption of ultra-processed foods is a major barrier to healthier eating, indicating the current food-based dietary guidelines utilised in many countries are not deterring consumption of these foods. A level-of-processing framework that discourages Ultra-processed Food (UPF) consumption represents a potential paradigm shift in communicating dietary risk to consumers and guiding dietary behaviour. This study experimentally compared two infographics: (1) a proof-of-concept visual representation of level-of-processing guidelines (UPF infographic); and (2) the Australian Guide to Healthy Eating (AGHE) infographic (consumer-facing food selection guide based on the 2013 Australian Dietary Guidelines) using subjective measures of communication effectiveness. METHODS: A nationally representative online survey of 1,505 Australian adults (18 + years) was conducted in September 2022. Following randomisation to one of the two infographics, participants responded to questions measuring consumer receptiveness and communication effectiveness of the infographic at guiding dietary behaviour. Participants’ general dietary pattern was also ascertained. Differences between conditions and dietary pattern groups were compared using chi-square tests and adjusted logistic regression analyses. RESULTS: The UPF infographic outperformed the AGHE infographic on a range of metrics, indicating participants perceived that it was easier to use the information to guide their choices around healthier eating (AOR = 2.22, p<0.001) and were more discouraged from consuming ultra-processed/discretionary products (AOR = 2.08, p<0.001). The results were most pronounced for those with an unhealthy dietary pattern, with higher agreement on numerous metrics for the UPF infographic compared to the AGHE infographic, including ease of understanding (80.3% vs. 62.9%, p < 0.001), discouraging ultra-processed/discretionary food consumption (54.2% vs. 28.5%, p < 0.001). making ultra-processed/discretionary food seem unpleasant (47.8% vs. 28.1%, p < 0.001), and guiding healthy dietary choices (51.7% vs. 37.6%, p = 0.005). CONCLUSIONS: It is imperative that consumer-facing visual aids accompanying official dietary guidelines are evaluated to ensure that they are effective at improving consumer understanding of unhealthy dietary patterns and health risk. The UPF infographic provided simplified messaging for the most at-risk consumers and was more likely than the AGHE infographic to discourage consumption of ultra-processed/discretionary foods. Consumer-facing communication tools that use level-of-processing visual aids may help guide policy action to improve consumer understanding of low-quality foods and drinks and, in turn, diet quality.