Impact of Front-of-package Warning Labels on Perceived Weight Stigmatization

Examining the Impact of Different Types of Front-of-package Warning Labels for Sugar-sweetened Beverages on Perceived Weight Stigmatization Among a Sample of US Adults

The goal of this experiment is to examine the effects of three different types of front-of-package warning labels for sugar-sweetened beverages on perceived weight stigmatization, as well as the effect of making such labels more weight-neutral. The main questions this experiment aims to answer are:

• Are certain types of front-of-package warning labels perceived as more stigmatizing than others?
• Are more weight-neutral versions of front-of-package warning labels perceived as less stigmatizing than their regular versions?
• Is there a trade-off between label effectiveness in discouraging product consumption and perceived weight stigmatization?

Additionally, this experiment also aims to answer the following questions:

• Does exposure to certain types of front-of-package warning labels lead to changes in participants' weight bias?
• Are changes in participants' weight bias as a result of label exposure mediated by attribution of personal responsibility for body weight, pathogen disgust, or perceived social consensus?

Study Overview

• Status: Completed
• Conditions: Weight Stigma
• Intervention / Treatment: Behavioral: Control labels; Behavioral: Nutrient warning labels; Behavioral: Text-only health warning labels; Behavioral: Graphic health warning labels

Detailed Description

Participants will be randomly assigned to see one of four types of labels: control labels, nutrient warning labels, text-only health warning labels, or graphic health warning labels. Participants will then see an image depicting different types of fictional sugar-sweetened beverages carrying the label type that they were assigned to. Participants will see this image twice, in random order, each time differing in whether the label is weight-neutral or not (i.e., whether the label references calories/obesity or not). Each time, participants will answer survey questions about the label. Last, participants will answer survey questions measuring their weight bias and potential mediating variables.

• Study Type: Interventional
• Enrollment (Actual): 2522
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27516
      • University of North Carolina at Chapel Hill

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion criteria:

• At least 21 years of age.
• Residing in the US.

Exclusion Criteria:

-Involved in any pre-testing.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Sham Comparator: Control labels; Individuals in this trial arm will see neutral control labels on sugar-sweetened beverages.	Behavioral: Control labels; In random order, participants in this arm will see an image of fictional sugar-sweetened beverages carrying: A neutral bar code label; A neutral quick response (QR) code label (not scannable)
Experimental: Nutrient warning labels; Individuals in this trial arm will see nutrient warning labels on sugar-sweetened beverages.	Behavioral: Nutrient warning labels; In random order, participants in this arm will see an image of fictional sugar-sweetened beverages carrying: Labels that read "high in sugars" and "high in calories"; A label that reads "high in sugars"
Experimental: Text-only health warning labels; Individuals in this trial arm will see text-only health warning labels on sugar-sweetened beverages.	Behavioral: Text-only health warning labels; In random order, participants in this arm will see an image of fictional sugar-sweetened beverages carrying: A label that reads "Drinking beverages with added sugars contributes to obesity, type 2 diabetes and tooth decay"; A label that reads "Drinking beverages with added sugars contributes type 2 diabetes and tooth decay"
Experimental: Graphic warning labels; Individuals in this trial arm will see graphic health warning labels on sugar-sweetened beverages.	Behavioral: Graphic health warning labels; In random order, participants in this arm will see an image of fictional sugar-sweetened beverages carrying: A label that reads "Drinking beverages with added sugars contributes to obesity, type 2 diabetes and tooth decay" and contains graphics illustrating obesity, type 2 diabetes, and tooth decay; A label that reads "Drinking beverages with added sugars contributes type 2 diabetes and tooth decay" and contains graphics illustrating type 2 diabetes and tooth decay

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived weight stigmatization, mean score	Stigmatization of people with obesity will be measured by survey through a three-item scale. Items will inquire about how much participants perceive the label to (1) stigmatize people with obesity, (2) promote negative stereotypes about people with obesity, and (3) portray people with obesity in a disrespectful manner. Response options will be on a 1 to 5 scale, with higher scores representing a higher perceived weight stigmatization by the study labels. Each participant's responses to each item will be combined to obtain their final score on the outcome.	Immediately after exposure to intervention (i.e., study stimuli), assessed during one-time online study survey.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived message effectiveness, mean score	How much the labels discourage participants from wanting to consume the products will be measured by survey. Response options will be on a 1 to 5 scale, with higher scores representing a higher perceived message effectiveness.	Immediately after exposure to intervention (i.e., study stimuli), assessed during one-time online study survey.
Weight bias, mean score	Weight bias will be measured by survey through a seven-item scale. Items will present participants with adjective pairs and ask that they select the box closest to the adjective that they feel best describe their feelings and beliefs about people with obesity: (1) lazy-industrious, (2) no will power - has will power, (3) good self-control - poor self-control, (4) active - inactive, (5) self-indulgent - self-sacrificing, (6) dislikes food - likes food, (7) undereats - overeats. Response options will be 5 boxes between adjectives, which will be coded on a 1 to 5 scale so that higher scores represent higher weight bias. Each participant's responses to each item will be combined to obtain their final score on the outcome.	Immediately after exposure to intervention (i.e., study stimuli), assessed during one-time online study survey.

Collaborators and Investigators

• Sponsor: University of North Carolina, Chapel Hill
• Collaborators: Stanford University
• Investigators: Principal Investigator: Aline D'Angelo Campos, MPP, University of North Carolina, Chapel Hill

Publications and helpful links

General Publications

• Grummon AH, Gibson LA, Musicus AA, Stephens-Shields AJ, Hua SV, Roberto CA. Effects of 4 Interpretive Front-of-Package Labeling Systems on Hypothetical Beverage and Snack Selections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Sep 5;6(9):e2333515. doi: 10.1001/jamanetworkopen.2023.33515.
• Hayward LE, Vartanian LR. Potential unintended consequences of graphic warning labels on sugary drinks: do they promote obesity stigma? Obes Sci Pract. 2019 Aug 2;5(4):333-341. doi: 10.1002/osp4.353. eCollection 2019 Aug.

Study record dates

Study Major Dates

• Study Start (Actual): January 18, 2024
• Primary Completion (Actual): January 26, 2024
• Study Completion (Actual): January 26, 2024

Study Registration Dates

• First Submitted: December 11, 2023
• First Submitted That Met QC Criteria: December 11, 2023
• First Posted (Actual): December 21, 2023

Study Record Updates

• Last Update Posted (Estimated): February 13, 2024
• Last Update Submitted That Met QC Criteria: February 9, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Body Weight
• Other Study ID Numbers: 23-3069

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: A deidentified dataset and analytic code will be uploaded to a public repository upon publication of the study.
• IPD Sharing Time Frame: Upon publication of the study.
• IPD Sharing Access Criteria: No access criteria. The dataset and analytic code will be made publicly available at Open Science Framework.
• IPD Sharing Supporting Information Type: ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No