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This work aims to provide a comprehensive overview of the use of front‐of‐package nutritional labeling (FOPL), identify and characterize the major existing FOPL systems, examine the impact of FOPL systems on consumer behavior, and discuss future perspectives. The searched databases were PubMed, Scopus, and Web of Science, and papers in English, Portuguese, Spanish, and French were considered. The integrative review method was used, comprising 68 papers. The FOPL system from more than 47 countries from North America, South America, Africa, Europe, Australia, and Asia was included in this study. The two main ways to characterize FOPL are the level of interpretation and the type of information provided. Interpretive schemes (such as warning labels, multiple traffic lights, and Nutri‐Score) appear to lead to better consumer understanding and support healthier food purchases. However, due to the differences among the results and the specificity of the contexts in which they are used, it is impossible to define one FOPL interpretation scheme superior to the others. Some potential factors that influence the effectiveness of FOPL on consumer attitudes have been identified, such as food taste, as a major intrinsic factor. Extrinsic factors, such as price, food category, cultural diversity, politics, and economics, were also relevant. The lack of availability of similar alternatives, lack of understanding of the importance of FOPL, and lower levels of income and education were also some cognitive and social aspects impairing FOPL effectiveness. Prospects for the United States, Europe, Brazil, Colombia, and Argentina were discussed.
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Received: 30 April 2022 Revised: 13 October 2022 Accepted: 15 November 2022
DOI: 10.1111/1541-4337.13085
COMPREENSIVE REVIEWS IN FOOD SCIENCE AND FOOD SAFETY
Front-of-package nutrition labeling as a driver for healthier
food choices: Lessons learned and future perspectives
Mariana Frazão Batista1,2Joana Pereira de Carvalho-Ferreira3,4
Diogo Thimoteo da Cunha4Veridiana Vera De Rosso2
1Graduate Program in Nutrition, Federal
University of São Paulo (UNIFESP), São
Paulo, Brazil
2Nutrition and Food Service Research
Center, Federal University of São Paulo
(UNIFESP), Santos, Brazil
3Department of Biosciences, Federal
University of São Paulo (UNIFESP),
Santos, Brazil
4School of Applied Sciences, State
University of Campinas (UNICAMP),
Limeira, Brazil
Correspondence
Veridiana Vera de Rosso, Nutrition and
Food Service Research Center,
Universidade Federal de São Paulo
(UNIFESP), Rua Silva Jardim 136, Santos,
Postal Code 11015–020, Santos, Brazil.
Email: veridiana.rosso@unifesp.br
Funding information
Conselho Nacional de Desenvolvimento
Científico e Tecnológico, Grant/Award
Numbers: 310450/2021-7, 315378/2021-2,
130474/2020-7
Abstract
This work aims to provide a comprehensive overview of the use of front-of-
package nutritional labeling (FOPL), identify and characterize the major existing
FOPL systems, examine the impact of FOPL systems on consumer behavior, and
discuss future perspectives. The searched databases were PubMed, Scopus, and
Web of Science, and papers in English, Portuguese, Spanish, and French were
considered. The integrative review method was used, comprising 68 papers. The
FOPL system from more than 47 countries from North America, South Amer-
ica, Africa, Europe, Australia, and Asia was included in this study. The two main
ways to characterize FOPL are the level of interpretation and the type of infor-
mation provided. Interpretive schemes (such as warning labels, multiple traffic
lights, and Nutri-Score) appear to lead to better consumer understanding and
support healthier food purchases. However, due to the differences among the
results and the specificity of the contexts in which they are used, it is impossible
to define one FOPL interpretation scheme superior to the others. Some poten-
tial factors that influence the effectiveness of FOPL on consumer attitudes have
been identified, such as food taste, as a major intrinsic factor. Extrinsic factors,
such as price, food category, cultural diversity, politics, and economics, were also
relevant. The lack of availability of similar alternatives, lack of understanding
of the importance of FOPL, and lower levels of income and education were also
some cognitive and social aspects impairing FOPL effectiveness. Prospects for
the United States, Europe, Brazil, Colombia, and Argentina were discussed.
KEYWORDS
consumer, eating behavior, health, nutrition labeling, packaged foods
1 INTRODUCTION
Nutrition labeling is a strategy developed to inform con-
sumers about the nutritional properties of packaged foods
(Codex Alimentarius, 2017). Since the beginning of the
21st century, in parallel with the global increase in non-
communicable diseases (NCDs), the Food and Agricul-
ture Organization of the United Nations, governments,
and nongovernmental organizations have shown a grow-
ing interest in nutrition labeling, which is recognized
as a far-reaching measure to easily inform consumers
and promote healthier food choices (FAO, 2014;Kanter
et al., 2018;WHO,2004, 2013,2014, 2017,2019;WHO-
EU, 2016). In this sense, one can observe innovative and
Compr Rev Food Sci Food Saf. 2023;22:535–586. © 2022 Institute of Food Technologists R
.535wileyonlinelibrary.com/journal/crf3
... Some studies suggest that education, geographic location, and health status may in uence engagement, with urban residents, individuals with higher education levels, and those managing health conditions reportedly using the label more frequently (30,31,33,34). These ndings align with some reviews on FoPL more broadly, which suggest higher engagement with such systems among individuals with higher socio-economic status and greater access to information (12,35). ...
... It was rather those unaware of the TNL who reported the lowest UPF consumption frequency, with fewer participants consuming UPFs more than three days per week. These results align with existing evidence suggesting that TNL use may better support healthier dietary behaviours in urban environments, where awareness of labels is higher and access to diverse food options is more common (12,35). ...
... Efforts to address these disparities have included government-led communication campaigns, but these have been criticized for their lack of sustained reach and engagement, limiting their effectiveness in raising awareness among vulnerable populations (22,33). Strengthening these campaigns to target groups with lower education and limited nutrition knowledge could help bridge this gap and enhance the label's public health impact (12,30). Additionally, improving the visibility of the TNL is essential to increase its accessibility. ...
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Background Ecuador introduced the traffic-light nutrition label (TNL) to address the rising burden of diet-related non-communicable diseases linked to increasing ultra-processed food (UPF) consumption. The TNL aims to provide simplified nutritional information to consumers, yet its effectiveness across diverse population groups remains unclear. Previous research suggests that TNL awareness and use may vary based on factors such as education, income, and geographic location, highlighting the need to explore how these factors are associated with dietary choices and health outcomes in different regions of Ecuador. Methods A cross-sectional survey was conducted in three Ecuadorian cantons—Quito, Ibarra, and Riobamba—targeting adults to assess TNL use, dietary habits, and health conditions. Data collection involved structured interviews, food frequency questionnaires, and anthropometric measurements. Associations between TNL use and dietary and health variables were analyzed using descriptive statistics and chi-square tests with survey and post-stratification weights to enhance representativeness. Results In Quito, TNL use was correlated with lower UPF intake and higher fruit and vegetable consumption. Regional differences were evident, with Riobamba showing lower UPF intake primarily among those unaware of the TNL, and Ibarra exhibiting no significant association between TNL use and UPF consumption. TNL awareness was lower among elderly and less-educated groups across all cantons, and among rural and low-income groups in Ibarra and Riobamba, who nevertheless reported concerning UPF consumption and limited fruit and vegetable intake. Conclusions TNL use in Ecuador varies by sociodemographic factors and is associated with healthier dietary patterns in some populations. However, disparities in awareness and usage highlight the need for improved label visibility and targeted public health strategies to enhance engagement among vulnerable groups. Addressing structural barriers to nutritious food access is crucial to maximizing the label's public health impact. These findings provide valuable insights for policy adjustments and nutrition education efforts in Ecuador and similar contexts.
... Nutrition labeling is a key tool for encouraging mindful eating and fostering a healthy lifestyle. Numerous studies have reported a significant relationship between FOP food labeling standards and consumer satisfaction (Batista, de Carvalho-Ferreira, Thimoteo da Cunha, & De Rosso, 2023;Clarke et al., 2021;Moreira, García-Díez, De Almeida, & Saraiva, 2019;Oswald, Adhikari, & Mohan, 2022;Sicilia, López, & Palazón, 2023;Smed, Edenbrandt, & Jansen, 2019;Yaseen, Mehdi, Somogyi, & Ahmad, 2016). However, there is a dearth of literature which examines the mediating role of perceived food quality (PFQ) (Andik & fitri Rachma, 2022;Shriedeh, Hanaysha, & Gulseven, 2024) and brand loyalty (Chuenban, Sornsaruht, & Pimdee, 2021;Liu, Tse, & He, 2022) and the moderating role of consumer consciousness of nutritional value (CCNV) (Aguenaou et al., 2021;Andik & fitri Rachma, 2022;Liu et al., 2022). ...
... However, the importance of accurate information clearly describing product properties without misleading the user cannot be overstated (Bandara, De Silva, Maduwanthi, & Warunasinghe, 2016). FOP nutrition labeling programs, endorsed by the World Health Organization, aim to combat obesity (Gassler, Faesel, & Moeser, 2023) and focus on providing information about critical nutrients like sodium, trans and saturated fats, and total sugars (Batista et al., 2023;Smed et al., 2019). Equally important, consumer attitudes emphasize balanced lifestyles, food safety, and nutritional content with labels influencing purchasing decisions. ...
... A continuous debate revolves around the efficacy of food labels, specifically FOP nutrition labels, in addressing health risks. Previous studies emphasize that consumers' perception of a product's excellence is influenced by subjective impressions, encompassing both intrinsic and extrinsic attributes (Batista et al., 2023;Loebnitz & Grunert, 2022). There are two aspects of perceived food quality based on FOP food labels. ...
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Food labeling standards play a vital role in shaping our food choices. Many food-borne diseases can be effectively curtailed by adopting customer centered Front-of-Package (FOP) food labeling and nutritional standards. Past studies primarily cover consumer behavior towards food labels, yet there is a noticeable lack of literature underscoring factors affecting the consumer satisfaction towards FOP food labeling standards. To address this research gap, this study proposes an analytical framework to, first, analyze the impact of FOP food labeling standards on consumer satisfaction, second, examine the mediating role of perceived food quality and brand loyalty and third, test the moderating effect of consumer consciousness of nutritional value. A cross-section of 775 Pakistani consumers between the age of 18-65 years was drawn through purposive sampling technique and accessed through online survey to collect data. Data was analyzed using SmartPLS for structural equation modeling and confirmatory factor analysis to assess the effect size between variables. A significant positive association was found between FOP food labeling standards and consumer satisfaction, and perceived food quality and brand loyalty mediated this relationship. It was further established that consumer consciousness of nutritional value acts as a moderator in the association between FOP food labeling standards and perceived food quality and brand loyalty, respectively. In the light of these findings this study offers policy measures to enhance informed consumer choices and promote healthier eating habits. This paper fulfills an identified need to highlight inherent factors affecting consumer behavior towards FOP food labeling standards.
... En este sentido, investigaciones como las de Liu et al. (2022) y McClements (2020), subrayan la relevancia de integrar el concepto de nutrición funcional en el desarrollo de productos alimenticios saludables y sostenibles. El objetivo principal es crear alimentos que no solo sean agradables al paladar, sino también comercialmente viables y con un perfil nutricional equilibrado, aspectos esenciales para promover el bienestar general de la población (Batista et al., 2022;Trejo-Osti et al., 2021). Además, resulta fundamental identificar las prácticas alimentarias cotidianas de la población objetivo para diseñar tecnologías que respalden dichas prácticas, incrementando así las probabilidades de éxito del producto en el mercado (Comber et al., 2012). ...
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El etiquetado nutricional ha cobrado importancia en los últimos años debido a la creciente preocupación por la alimentación equilibrada y la salud pública. La normativa sobre el etiquetado busca garantizar que los consumidores reciban información precisa y útil para tomar decisiones informadas sobre su alimentación. Sin embargo, estudios realizados en diversos países han revelado discrepancias frecuentes entre los valores nutricionales reales y los declarados en las etiquetas de los productos. Estas inconsistencias se atribuyen, en parte, a la falta de supervisión adecuada por profesionales en nutrición. En este artículo se presenta una revisión de la literatura científica relacionada con el etiquetado nutricional, con el objetivo de proponer un enfoque estandarizado para su correcta aplicación. Se realizó una búsqueda bibliográfica en bases de datos científicas utilizando palabras clave relacionadas con el tema. De los 596 artículos identificados inicialmente, se seleccionaron 101 estudios relevantes acorde a los criterios de inclusión y exclusión establecidos. Los resultados indican que el etiquetado nutricional puede influir positivamente en las decisiones de compra de los consumidores, siempre y cuando esté acompañado de educación en salud y nutrición. Sin embargo, persisten desafíos en cuanto a la interpretación de la información por parte de la población general. Se concluye que la estandarización del etiquetado y la mejora en su aplicación contribuirán a reducir errores y promover hábitos alimenticios más saludables, impactando de manera positiva en la salud pública.
... To date, warning label schemes have largely involved communicating risks associated with the consumption of labelled products, with the most common approach involving denoting products as "high in" a particular nutrient such as sugar [6]. Chile implemented this approach in 2016, and several countries have followed suit with similar mandatory labelling schemes, including Peru, Mexico, Uruguay, Argentina, Venezuela, Brazil, and Canada [10]. In addition to "high in" labels, other label types, such as health warnings and labels denoting teaspoons of sugar, have also shown potential. ...
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Background Front-of-pack (FOP) warning labels have demonstrated effectiveness for reducing sugar-sweetened beverage (SSB) consumption and switching to water. However, an unintended consequence is that they may also increase switching to non-sugar-sweetened beverages (NSSBs). A non-hypothetical experimental study examined the effectiveness of combining sugar and sweetener FOP warning labels to reduce sugary drink consumption and prevent NSSB substitution. The study also examined potential integration with Australia and New Zealand’s existing Health Star Rating (HSR) system to determine suitability for local context and other jurisdictions with interpretive labelling schemes already in place. Methods Participants (N = 414) accessed an online convenience store app via an on-campus laptop to select one drink from an array of 10 beverages, on three occasions. Drink options included a variety of SSBs, 100% fruit juice, NSSBs, and water. Following an escalating exposure procedure, drinks were presented (1) without any additional labelling, (2) with warning labels added to sugary drinks or to both sugary drinks and NSSBs (according to allocated condition), then (3) with HSR icons added to all drinks. Participants were informed they would receive a complementary drink, based on their selections, following the completion of a brief questionnaire. Results Baseline results indicated that SSBs and water were the most and least popular drink choices, respectively. Placing FOP warning labels on sugary drinks decreased selection of SSBs and increased NSSB and water choices. Water became the most popular individual drink choice in response to warnings on sugary drinks. Placing FOP warning labels on both sugary drinks and NSSBs successfully avoided an increase in NSSB choices, whilst also increasing water selections, but did not significantly decrease selection of SSBs until HSR ratings were added. The incorporation of HSR icons consolidated warning label effects on NSSB and water selection across both conditions. Conclusions Results demonstrate the potential of FOP sugar warning labels for addressing beverage consumption behaviours. The incorporation of sweetener warning labels may successfully avoid substitution towards NSSBs, whilst still promoting water choices, but may also dilute the impact of the sugary drinks warning labels. Warning labels were complementary to existing interpretive FOP labels.
... 6,9 More than 32 governments have implemented some form of front-of-pack nutrition labelling. 10,11 Policy developments include a shift away from so-called softer positive signposts that highlight healthier options, such as Sweden's Keyhole, 12 towards innovation in two directions. Led by the World Health Organization (WHO) Region of the Americas, 10 countries have followed Chile's lead in adopting so-called stop-sign warnings 13 that signal products high in risk nutrients and discourage consumption. ...
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Objective: To compare uptake of the voluntary Health Star Rating front-of-pack nutrition labelling system with uptake of a mostly mandatorycountry-of-origin label in Australia over a similar period. Methods: We used data on numbers and proportions of products carrying health stars and country-of-origin labelling recorded annuallybetween 2015 and 2023 through surveys of four large Australian food retailers.We determined the proportion of products with health stars andcountry-of-origin labels for each year by dividing the number of products carrying each label by the total number eligible to carry that label. Findings: The uptake of the voluntary Health Star Rating increased steadily between 2014 and 2018, reaching a maximum of 42% (8587/20286)of products in 2021 before decreasing to 39% (8572/22 147) in 2023. Mandatory country-of-origin labelling uptake rose rapidly and wasfound on 93% (17567/18 923) of products in 2023. In categories where country-of-origin labelling was voluntary, uptake by 2023 was 48%(3313/6925). In our 2023 sample of 22147 products, 11 055 (50%) carried country-of-origin labelling only, 7466 (35%) carried both healthstar and country-of-origin labelling, 1106 (5%) carried health star labels only and 2520 (11%) carried neither label. Conclusion: The experience with country-of-origin labelling shows that widespread and rapid food labelling change can be achieved whenrequired by law. The Australian government should mandate the Health Star Rating without delay. Australia’s experience supports otherjurisdictions in implementing mandatory front-of-pack nutrition labelling as well as updates to global guidance to recognize mandatorylabelling as best-practice in delivering benefits to consumers (PDF) Voluntary versus mandatory food labels, Australia. Available from: https://www.researchgate.net/publication/384325036_Voluntary_versus_mandatory_food_labels_Australia [accessed Oct 16 2024].
... The compliance of food products with nutritional regulations in the presence of BOP labeling varies depending on several factors. 39 There is a growing emphasis on compliance as food manufacturers recognize the importance of providing accurate and transparent information to consumers. With BOP labeling as a prominent means of conveying nutritional information, manufacturers have increasingly prioritized compliance with nutritional regulations. ...
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This systematic literature review aims to examine the impact of back-of-pack (BOP) labels on food manufacturers' practices in the field of consumer behaviour research. The review comprehensively analyses a wide range of articles spanning over two decades to provide an up-to-date and comprehensive analysis of the subject matter. It focuses specifically on how BOP labels affect consumers, food manufacturers' behaviors and practices. The findings highlight that BOP labels conveying intuitive information effectively prompt product reformulation, particularly in reducing unhealthy nutrients such as sodium, sugar, and calories. Voluntary BOP labeling has limited uptake and is often applied to already healthier products. Consumers and food producers' response varies based on label design and enforcement type, suggesting strategic labeling of healthier choices. The review provides valuable insights for future public health research and policymaking efforts, emphasizing the importance of mandatory policies and specific guidance in BOP labels. This research brings novelty by comprehensively examining the impact of back-of-pack (BOP) labeling on consumers and food manufacturers' practices. The findings contribute to the literature by highlighting the differential effects of mandatory and voluntary BOP labeling approaches and offering insights into label design and enforcement types. As per the researcher knowledge there is no available systematic literature review (SLR) specifically focusing on BOP labeling in recent years. Future research should explore the long-term impacts of mandatory versus voluntary BOP labeling on consumer dietary habits and food manufacturers' product reformulation strategies.
... Although warning labelling is useful, other factors are more influential when buying foods. These include price, food category, lack of similar alternative foods, poor understanding, educational and economic levels, and preferences regarding flavour [45,46]. ...
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Background: Reading nutritional labelling helps consumers select healthier food, thereby benefitting their oral health. The purpose of this study was to describe the knowledge, attitudes, and practices (KAPs) of parents and carers of children and preteens, associated with reading nutritional labelling, selecting sweetened ultra-processed foods, and their impact on oral health. Materials and Methods: This was a descriptive cross-sectional study in which a validated questionnaire was administered to 298 parents and caregivers of children aged 1–12 years from different districts in Villavicencio, Colombia. Participants’ scores, based on the number of correct answers, were used to classify their level of KAP as low, medium, or high. In addition, the frequency of responses, the KAP levels, and the median scores were analysed. Finally, associations were determined using the chi-square test. Results: Most participants reached a medium level in terms of knowledge (41.6%) and attitudes (49.3%) and a low level in terms of practices (43.3%). An association was found between participants’ level of KAPs and their socioeconomic and educational level (p < 0.05). Conclusions: The study findings reveal inadequate KAPs associated with nutritional labelling, adequate food selection, and the importance of oral health.
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Background Front-of-pack (FOP) warning labels have demonstrated effectiveness for reducing sugar-sweetened beverage (SSB) consumption and switching to water. However, an unintended consequence is that they may also increase switching to non-sugar sweetened beverages (NSSBs). A real-stakes experimental study examined the effectiveness of combining sugar and sweetener FOP warning labels to reduce sugary drink consumption and prevent NSSB substitution. The study also examined potential integration with Australia and New Zealand’s existing Health Star Rating (HSR) system to determine suitability for local context and other jurisdictions with interpretive labelling schemes already in place. Methods Participants (N = 414) accessed an online convenience store app via an on-campus laptop to select one drink from an array of 10 beverages, on three occasions. Drink options included a variety of SSBs, 100% fruit juice, NSSBs, and water. Following an escalating exposure procedure, drinks were presented (1) without any additional labelling, (2) with warning labels added to sugary drinks or to both sugary drinks and NSSBs (according to allocated condition), then (3) with HSR icons added to all drinks. Participants were informed they would receive a complementary drink, based on their selections, following the completion of a brief questionnaire. Results Baseline results indicated that SSBs and water were the most and least popular drink choices, respectively. Placing FOP warning labels on sugary drinks decreased selection of SSBs and increased NSSB and water choices. Water became the most popular individual drink choice in response to warnings on sugary drinks. Placing FOP warning labels on both sugary drinks and NSSBs successfully avoided an increase in NSSB choices, whilst also increasing water selections, but did not significantly decrease selection of SSBs until HSR ratings were added. The incorporation of HSR icons consolidated warning label effects on NSSB and water selection across both conditions. Conclusions Results demonstrate the potential of FOP sugar warning labels for addressing beverage consumption behaviours. The incorporation of sweetener warning labels may successfully avoid substitution towards NSSBs, whilst still promoting water choices, but may also dilute the impact of the sugary drinks warning labels. Warning labels were complementary to existing interpretive FOP labels.
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Background: Warning Labels (WL) highlight excessive amounts of critical nutrients in order to discourage consumption of unhealthful packaged food products. This study aimed to evaluate among Mexican school children, the objective understanding of traditional and numeric WL (aimed at small products) considered by the Mexican regulation, and whether cartoon characters influenced the understanding of WL. We also tested some communication strategies to facilitate the correct use of the WL. Methods: We carried out a randomized experiment in July 2019 in public elementary schools from Morelos, Mexico. Participants aged 6-13 years, were randomly assigned to one of four groups: 1) Nutrient Facts Panel (NF) (n = 120), 2) Nutrient Facts Panel with cartoon characters (NF + C) (n = 83), considered the control groups, 3) Warning Labels (WL) (n = 109), and 4) Warning Labels with cartoon characters (WL + C) (n = 96). After allocation, children assigned to both WL groups (WL or WL + C), were randomly required to watch two posters simultaneously or a video explaining how to correctly interpret WLs. Logistic regression models adjusted by sex, age and cluster (school) were fitted. Results: The percentage of children correctly choosing the healthiest or the unhealthiest option was higher for WL groups (56.8, 95%CI; 40.8-72.8) compared to NF groups (24.3, 95%CI; 20.4-28.3, p < 0.05). The understanding of traditional WL was higher (28.7, 95%CI: 22.8-35.4) than the numeric WL (19, 95%CI: 14.2-25.0, p < 0.05). But, correct answers for identifying healthy and unhealthy products were higher for numeric WL than for NF groups. Cartoon characters reduced the percentage of correct answers for choosing unhealthiest products (WL + C: 48.9, 95%CI: 25.6-72.4 vs WL: 58.7, 95%CI: 36.4-81.1, p < 0.05). The video was 2.23 times more helpful than the posters to the correct interpretation of the WL (p < 0.05). Conclusions: In scholar Mexican children, traditional and numeric WL were useful to identify healthier and unhealthier packaged products in comparison to NF, suggesting that both WL formats may effectively communicate the excessive content of nutrients of concern among children. Cartoon characters may reduce the objective understanding of the WL, underscoring the need to regulate advertising directed to children along with the implementation of front-of-pack labeling.
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