New Study Reveals Perils of Communicating the Energy Content of Alcohol Products

“There’s just a lot of numbers and I just want to have a drink”: The challenge of communicating the energy content of alcohol products

Research article

Highlights

• Countries are increasingly considering mandatory energy labels on alcohol products.
• Consumers generally support mandating the provision of energy information.
• Consumers can experience difficulty understanding energy terminology.
• Energy information in terms of standard alcoholic drinks and servings is problematic.
• Community education will be needed to optimise the benefits of energy labelling.

Background

A lack of evidence on how consumers respond to energy labelling information presents a key challenge to integrating such information into government labelling policy.

Increasing obesity prevalence rates are prompting governments to consider various policy interventions designed to improve individuals’ diet quality in an effort to stem rapidly escalating health system costs. While comprehensive approaches combining multiple policies are more likely to be effective in combatting obesity and its associated negative health outcomes, proposed interventions often focus on specific nutrients , specific product categories (e.g., sugar-sweetened beverages), or information provision (e.g., nutrition labelling) to capitalise on ‘low hanging’ options that can make a substantial difference to diet quality through single initiatives. These policy initiatives are consistent with World Health Organization recommendations for interventions that have substantial cost-effectiveness data to support their implementation, such as sugar-sweetened beverage taxes and front-of-pack nutrition labelling on packaged foods.

Alcohol is different from other macronutrients in that the energy it provides is not associated with essential nutrients. In addition, the relationship between alcohol consumption, energy intake, and weight status is complex due to different quantities and patterns of alcohol consumption having different effects on intake of other nutrients (e.g., fat, carbohydrate, and protein) and the metabolism of alcohol involving some heat loss rather than solely supplying metabolic energy. Alcohol affects energy metabolism, and weight gain resulting from alcohol use tends to contribute to central adiposity, which in turn is associated with increased risk of heart disease and liver damage.

Despite evidence of a lack of consumer awareness of the energy content of alcohol and clear consumer support for energy labelling, there are some concerns about the provision of this information on alcohol products.

1. There is the potential for the presence of energy information to assist in the promotion of low-energy alcohol products and distract consumers from the most harmful aspect of these products – the alcohol content.
2. There is the possibility that making energy content salient could result in consumers ‘trading off’ energy sourced from foods for energy sourced from alcohol in an attempt to avoid weight gain. As consumers tend to over-estimate the energy content of alcohol, the provision of accurate energy information has the potential to result in increased alcohol consumption.
3. Understanding about the risks linked to alcohol (e.g., that it is a group one carcinogen) among the general public is low. There is thus the potential for the provision of nutrition information that is typically seen on food products to further confuse consumers about the status of alcohol as a drug rather than a food.
4. The energy content of foods is often presented in the context of a nutrition information panel that also lists quantities of various nutrients, particularly carbohydrates/sugars, sodium, and fats. Given the nature of many alcoholic beverages, there can be negligible or nil quantities of these nutrients, resulting in the potential for nutrition information panels to convey the impression that the products are healthy. Such an interpretation is highly problematic given that alcohol is a major cause of death and disability and there is no safe level of intake. It is therefore important that energy labelling does not inadvertently provide alcohol with a ‘health halo’.

These complexities have contributed to a lack of government policy on alcohol energy labelling in most countries.

Growing international interest in developing further policy guidance in this area can be seen in discussions on alcohol labelling since 2017 at the international food standards agency, the Codex Alimentarius Commission (Codex) (Food and Agriculture Organization of the United Nations, 2017). During the most recent meeting of the Codex Committee on Food Labelling in 2023, the Secretariat noted that existing Codex texts already apply to alcoholic beverages (Food and Agriculture Organization of the United Nations, 1991), including the Codex Guidelines on Nutrition Labelling that mandate nutrient declarations that incorporate energy value on all prepackaged foods. However, the Secretariat also noted that these Guidelines do not appear to have been widely applied by Codex Member States to alcoholic beverages (Food and Agriculture Organization of the United Nations, 2017). Codex is currently considering whether it should take further action in this area.

Key results

Three primary themes were derived from the data:

1. overall acceptance of an energy label on alcoholic beverages,
2. substantial confusion about terms used to communicate energy information, and
3. the potential for both energy labels and nutrition information panels to create a health halo for alcohol products.

Theme 1: General support for the provision of energy information

While not overtly enthusiastic about the mandatory display of energy values on alcohol products, many focus group participants felt that provision of this information could be of benefit to at least some consumers due to a current lack of understanding of the energy contained in alcohol products. It was noted that there is increasing health consciousness among the general public, including in relation to alcohol choices. Communicating energy content through product labelling was generally considered an appropriate method of drawing attention to information that is likely to be relevant to this growing segment of the population.

For the average person, if you look at me, I don’t count calories enough. If I have to, and that’s on the back, geez, it wakes you up to it and gives you a bit of extra knowledge.”

male, 51+ years

The two forms of assessed labels – full nutrition information panels (Figure 2) and the FSANZ energy-only information panel (Figure 1) – received quite different reactions. The full nutrition information panels were typically seen as largely irrelevant due to the inclusion of nutrients not usually found in alcohol products, especially protein and fat. However, sugar content information was often considered to be useful because of perceptions of sugar as being a particularly harmful nutrient.

Correspondingly, while there was general support for the energy-only label, a common criticism was that information specific to sugar was not provided. In some cases, this concern appeared to be linked to expectations formed due to exposure to the nutrition information panels usually found on packaged food products.

I think it’s a bit limited in the information it provides. Normally, when I see these labels, I’m used to seeing not just energy in terms of kilojoules, but also amount of sugar, which is more influential for me personally.”

male, 18-30 years

For the minority who expressed no interest in the availability of energy labelling on alcohol products, it appeared that alcohol represented a non-negotiable source of kilojoules in their diets because the desire to consume alcohol outweighed other considerations. In almost all cases, these participants were female, with representation across all age groups.

There’s just a lot of numbers and I just want to have a drink.”

female, 31-50 years

Theme 2: Copious confusion

Multiple areas of confusion relating to the energy-only label were evident across all the focus groups. These included an inadequate understanding of energy as an abstract construct, difficulty differentiating between terms used on the label, and an inability to effectively apply the information provided within the label at the point of purchase.

Confusion about energy-related concepts was less commonly mentioned when participants were discussing the full nutrition information panel (compared to the energy-only label), which seemed to be due to the lack of attention paid to energy information in this context and the focus instead on sugar and carbohydrate content.

The concept of energy

In almost all instances the focus group participants discussed energy in terms of calories, not kilojoules (the latter being the official Australian metric). However, regardless of which term they preferred, some participants were not able to adequately contextualise the energy information provided in the energy-only label for it to be useful.

Without immediate access to additional information about how much energy the alcoholic beverage would contribute to recommended daily energy intakes, they did not know how to process the information.

Some participants negated the importance of energy as a concept altogether, perceiving it to be of much lesser relevance than other nutrition-related product attributes such as sugar and additives.

Competing terminology

The term standard alcoholic drinks was familiar to participants due to its presence on alcohol containers in Australia since 1995 and its long-standing use in alcohol impaired driving guidance.

Serving sizes were only familiar to participants in terms of being listed on food products, and some of the focus group participants raised concerns about how this information would be interpreted if displayed on alcohol labels. While some could readily grasp the intended meaning of the displayed energy information across both the standard alcoholic drinks and serving size measures, for others the combined use of these terms in the context of alcohol consumption was clearly problematic.

Too much information. It’s too confusing. It needs to be more plain.”

female, 51+ years

The 100ml alternative was considered useful by some because of the consistency in metric across products of different sizes. However, it was seen by others to be less helpful for high-alcohol products that are typically served in small quantities.

Others, typically males, were able to explain the difference between standard alcoholic drinks and serving sizes, but noted that the latter may or may not be helpful depending on the alcohol consumption situation. In particular, some were uncomfortable with serving sizes because they can vary between products, which complicates comparisons.

Some participants raised the issue of the energy label needing to be fit for purpose in alcohol purchasing contexts where shoppers do not typically come prepared for a maths exercise.

I think you have to compare like for like. So I think when you compare labels on different bottles you have to go with the 100mls … You can’t do the math in your head while you’re standing in the bottle shop, so it has to be like for like.”

female, 51+ years

Theme 3: Signalling healthiness

The full nutrition information panel examples shown to participants during the focus groups frequently resulted in comments about the perceived healthiness of the products. The low or zero values for most of the listed nutrients drew attention and sparked interest.

It’s practically good for you.”

female, 51+ years

It appeared that the provision of detailed nutrient information distracted participants from considering the alcohol in the product as a potentially harmful component. Instead, they were left with the impression that there was nothing present to worry about at all.

There’s nothing really bad in there – there’s less than a gram of sugar, there’s less than a gram of total saturated fats. You’re not having anything that’s really bad for you.”

male, 51+ years

They’ve got clearly very little ingredients on there so people can be comfortable in knowing that they’re not putting anything in their bodies that’s going to affect them in a negative way.”

female, 51+ years

The results of this exploratory study suggest that in Australia the task of integrating energy labelling information is likely to be complicated by considerable consumer uncertainty about the key terms used to communicate energy-related information on alcohol products. Areas of confusion were found to range from the fundamental concept of dietary energy through to the co-use of measurement units such as serving sizes and standard alcoholic drinks. An additional identified issue was apparent low interest in using energy content as a decision criterion when selecting alcohol products, which is likely to reduce consumers’ motivation to engage with energy information, especially where substantial cognitive effort is required.

In terms of understanding the concept of dietary energy, similar issues have been identified in the food sector, with the limited available research finding that consumers have a poor grasp of the abstract concept of energy and can struggle to apply this concept to specific products.

Consumer education on the relative energy contributions of different nutrients seems warranted given the focus group participants appeared to consider sugar to be of greater concern, despite alcohol containing substantially more energy than sugar. This reflects growing consumer concern about sugar that has been identified in the literature relating to consumers’ perceptions of healthy and unhealthy food products.

A tendency to judge product healthiness according to sugar content is problematic in the alcohol context given recent evidence showing that low sugar claims can provide an overall health halo to alcoholic beverages.

In terms of the proposed per serving terminology, findings of the present study are aligned with research in the food domain showing that consumers have difficulty understanding and applying per serving information, especially where companies are permitted to set their own serving sizes on a product-by-product basis.

Similarly, studies have shown suboptimal public understanding of standard alcoholic drinks measures. The focus group participants often struggled to reconcile the standard alcoholic drinks information provided with the serving size and per 100mls information. The uncertainty experienced when attempting to apply each of these pieces of information individually appeared to be compounded when they were presented together.

The focus group results suggest that neither the FSANZ draft energy label nor the full nutrition information panels examined in this study are likely to achieve the policy goal of adequately informing consumers about the energy content of alcoholic beverages due to substantial consumer confusion.

In particular, the co-location of mandatory energy information in close proximity to information about the number of standard alcoholic drinks and servings in the container may compound confusion. This finding has implications for how energy labelling regulations could be most effectively introduced. In the first instance, whichever unit(s) of measurement is chosen, appropriate levels of public education will be needed to ensure consumers can use the provided information to effectively manage their alcohol energy intake. Second, this education would need to include explanation of alcohol as a substantial source of energy for many people who consume alcohol, including in comparison to other nutrients such as sugar, to motivate energy information processing.

Third, any use of serving size terminology would ideally be accompanied by the specification of standardised units to facilitate like-with-like comparisons between different types of alcoholic beverages and to avoid the misleading use of different serving sizes as has been found in the food sector. In the absence of any apparent determination on alcohol serving sizes to date by FSANZ, equating a serving size to a standard alcoholic drink and using only the latter term may ultimately be more feasible given familiarity with standard alcoholic drinks measures in the context of alcohol impaired driving.

Finally, the apparent health halo produced by the full nutrition panels due to the large number of small values highlights the need to reconsider requirements for products displaying nutrition content claims (e.g., ‘low carb’ and ‘low sugar’) to provide a full nutrition information panel. Options could include restricting nutrition information to only nutrients of relevance to the claim or prohibiting the use of nutrition claims on alcohol products altogether due to their potential to mislead consumers about product healthiness..

Abstract

Various governments are considering the implementation of energy labelling on alcohol products as one element of obesity prevention policies. However, little is known about the most effective ways to communicate energy information to consumers.

The aim of the present study was to explore consumers’ reactions to different energy information provision formats to assist the development of effective energy labels. Nine focus groups (n=83 participants) were conducted with Australian adults who reported drinking alcohol at least twice per month.

Participants were exposed to an energy-only information label and labels displaying full nutrition information panels. A thematic analysis approach was used to identify key issues.

While few participants were overtly enthusiastic about the mandatory display of energy values on alcohol products, there was general support for the provision of this information to assist those alcohol consumers who could benefit from it.

Substantial confusion was apparent as participants attempted to distil meaning from the provided information, particularly where it was expressed in terms of serving sizes and standard alcoholic drinks.

Full nutrition panels were especially problematic in terms of creating a health halo due to the nil or low values for multiple nutrients listed. This was especially notable for information relating to sugar content.

Overall, there appears to be inadequate public understanding of the concept of dietary energy in alcoholic beverages and the various terms used to quantify its presence, which is likely to limit the utility of mandatory energy information provision requirements unless they are accompanied by effective community education.

Source Website: Science Direct