A randomized trial in Massachusetts supermarkets shows that Food Compass, a numeric food rating system created by researchers at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University can guide shoppers to healthier purchases—and more purchases overall.
The findings arrive at a pivotal moment as the public, state governments, and federal agencies are increasingly concerned about the impacts of unhealthy food.
A team led by the Food is Medicine Institute at the Friedman School tested the effects on supermarket shopping choices of a front-of-package label showing the Food Compass Score (FCS), which rates foods on a 100-point scale based on nutrients, ingredients, processing, and more, compared to no label.
As a second comparison, the team also evaluated a potential U.S. Food and Drug Administration’s (FDA) “healthy” label, a binary stamp proposed in 2024 that may soon be rolled out, which indicates whether a food meets federal nutrition criteria.
Published in JAMA Network Open on Dec. 5, the study’s authors included the institute’s Bingbing Fan and Dariush Mozaffarian, and economist Sean Cash of the Friedman School.
It showed that the FCS led to an additional 11.2 healthy purchases per 100 purchasing decisions, compared to no label. The FDA healthy label also increased healthy purchases, but to a lesser extent at 6.4 per 100 purchasing decisions.
"While both the proposed FDA healthy label and the use of the Food Compass Score increased the purchase of healthier snacks, the Food Compass system had a bigger impact—suggesting that consumers benefit from the increased information in a more holistic scoring system compared to a simpler yes/no label around healthfulness,” said Cash, whose research includes how food labeling affects consumer demand and public health.
Fan, lead author of the paper, said the Food Compass score appears to give consumers a clearer sense of how healthy a product is relative to others, and may give them more confidence in their choices. "Our study supports both public health and business cases for creating and marketing healthier Food Compass Score-labeled products for consumers. It informs labeling strategies for policymakers, supermarkets, and food manufacturers,” Fan said.
Conducted in 2023, the study involved 275 adult shoppers recruited at six locations of three supermarket chains in diverse neighborhoods across Massachusetts.
Participants were randomly assigned to see either the FCS or the FDA healthy label, compared to no label, during a series of 12 real-choice experiments. In each scenario, they selected one of three snack products—or none at all—knowing they would have to purchase one of their chosen items with a provided $5 stipend.
“Most studies of consumer response to new food labels rely on hypothetical choices, where no money is changing hand or products are being purchased. This can often result in studies that may overpredict the impact of health-based labeling,” Cash said. “We put a lot of effort into designing a study where people actually went home with some of the products that they chose in the experiment, while still being able to get out more information about who these consumers were and what might be motivating their use of the labels.”
Both labels were found to improve purchasing behavior:
- The FCS increased healthy purchases by 11.2 per 100 choices.
- The FDA label increased healthy purchases by 6.4 per 100 choices.
- Both labels reduced unhealthy purchases by more than 6 per 100 choices.
But the FCS had a unique edge. The study found that shoppers were willing to pay nearly $3 more for a healthy product labeled with the FCS—above and beyond what they’d pay for a healthy product without the label. That price premium wasn’t observed with the FDA label.
The FCS also reduced the number of “no purchase” decisions by 4 per 100 choices, suggesting the score encouraged shoppers to buy something rather than walk away. In contrast, the FDA label had no effect on indecision.
The study was conducted in Massachusetts and focused on snack foods, so results may differ in other regions or food categories. Also, neither label was familiar to participants, raising questions about how long-term exposure might affect behavior.
Overall, the researchers say the real-choice design and diverse participant pool strengthen the study’s relevance. As food manufacturers and retailers continue to weigh how best to present nutrition information, future research could explore how these labels perform in online shopping or among different demographics.
“Our study shows that consumers, when presented with credible, straightforward nutrition information, make better choices—and increase their overall purchases,” said Mozaffarian, director of the Food is Medicine Institute, who led the team that developed Food Compass. “This is positive for both the public and the food sector: more healthy food for all.”
Citation and Disclaimer
This research was supported by the National Institutes of Health (2R01HL115189-06A1). Complete information on authors, funders, methodology and conflicts of interest is available in the published paper. Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.