Using FoodFlip© to Improve Food Choices Among Post-secondary Students

NCT ID: NCT06033911

Last Updated: 2025-03-30

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 133 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-01-29
• Study Completion Date: 2024-05-01

Brief Summary

Canada passed mandatory front-of-package labelling (FOPL) regulations where pre-packaged food and beverage products that are high in sugar, saturated fat, and/or sodium are required to display a 'high-in' front-of-pack nutrition symbol (NS). FOPL is an effective tool to inform consumers about products that can harm health and help guide their purchasing decisions. However, as the regulations are limited to the pre-packaged food supply and do not apply to restaurants and other food services, little is known about the potential impact of the NS in such settings. Therefore, the objective of the present study is to investigate the impact of the Canadian FOPL (i.e. the 'high-in' NS) as delivered through a mobile health (mHealth) app in a setting currently not subject to regulations. The study will take place on a post-secondary campus (University of Toronto) hosting students, a population vulnerable to poor dietary choices, nutritional knowledge, and associated weight gain. A 2-week long, randomized controlled trial with a 3-parallel arm study design will be conducted to explore the effect of the 'high-in' NS on students' purchasing behaviours and nutritional knowledge. Eligible participants will be randomly allocated into one of 3 intervention groups: no App control; App control with no NS; App with NS. Questionnaires will be used to assess nutritional knowledge, and receipts will be used to analyze purchasing behaviour.

Detailed Description

Poor diets increase the risk of non-communicable diseases (NCDs), one of the major causes of disability and premature mortality in Canada. To help improve the diets of Canadians, Health Canada recently promulgated front-of-pack labelling (FOPL) regulations, which mandate pre-packaged foods and beverages meeting and/or exceeding the thresholds for nutrients of public health concern (i.e., sugars, saturated fat, and/or sodium) to display a 'high-in' front-of-pack nutrition symbol (NS). Moreover, previous studies have shown that FOPL can improve purchasing behaviours of consumers by decreasing purchases of nutrients of public health concern and/or foods carrying 'less healthy' FOPL and increase the nutritional knowledge of consumers. However, the FOPL regulations do not address restaurant foods, which are significant caloric contributors to the Canadian diet and are often high in nutrients of public health concern. Further, FOPL regulations do not address foods sold in other institutional settings, including schools, long-term care homes, and daycares. This policy gap may adversely affect the young adult population - a group notably vulnerable to poor diets and associated weight gain and poor nutritional knowledge. Emerging evidence suggests that FOPL can be an effective tool to communicate nutrition information to promote healthier food choices in food service settings; however, limited data exist on the effectiveness of FOPL on menu items available on post-secondary campuses to influence students' food purchasing behaviours on campus and to improve their nutritional knowledge. Furthermore, nutrition mobile health (mHealth) apps have been shown to have the potential to support behavioural change, improve nutrition knowledge, and develop skills to promote healthy eating behaviours through quick information-sharing capacity, customizable tracking abilities, and interactive components. The L'Abbe Lab has developed a mobile application, FoodFlip©, that provides nutrition information at the point of purchase to influence the decision-making process with high usability and functionality in grocery shopping settings. However, the application of FoodFlip© on purchasing behaviours in post-secondary campus settings is unknown. Therefore, the primary objective of the study is to investigate the effect of the Canadian FOPL (i.e., the 'high-in' nutrition symbol) on purchasing behaviours and nutritional knowledge of post-secondary students on campus, using the FoodFlip© App.

Conditions

Healthy Diet

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: SINGLE

Study Groups

No App

No intervention. Participants will be given access to a web-based submission portal.

Group Type: NO_INTERVENTION

No interventions assigned to this group

FoodFlip© App with no nutrition symbol

Intervention control: participants will have access to food information in the shape of a Nutrition Facts table through FoodFlip©. Participants will have access to a submission portal linked to their study ID through the app.

Group Type: PLACEBO_COMPARATOR

FoodFlip© App with no nutrition symbol

Intervention Type: DEVICE

Intervention control: participants will have access to food information such as calories or the Nutrition Facts table through FoodFlip©

FoodFlip© App with 'high-in' nutrition symbol

Intervention: Participants will have access to food information through FoodFlip© with Health Canada's 'high-in' nutrition symbol. ©. Participants will have access to a submission portal linked to their study ID through the app.

Group Type: ACTIVE_COMPARATOR

FoodFlip© App with 'high-in' nutrition symbol

Intervention Type: DEVICE

Intervention: Participants will have access to food information through FoodFlip© with Canada's 'high-in' NS

Interventions

FoodFlip© App with no nutrition symbol

Intervention control: participants will have access to food information such as calories or the Nutrition Facts table through FoodFlip©

Intervention Type: DEVICE

FoodFlip© App with 'high-in' nutrition symbol

Intervention: Participants will have access to food information through FoodFlip© with Canada's 'high-in' NS

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• ≥18 years of age
• enrolled at UofT
• have regular access to either iPhone or Android
• purchases at least one meal a day on campus
• able to speak and read English
• not currently pregnant or in lactation

Exclusion Criteria

• <18 years of age
• not enrolled at UofT
• does not have access to a smartphone
• does not purchase at least one meal a day on campus
• unable to speak and read English
• currently pregnant or in lactation

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of Toronto

OTHER

Sponsor Role: lead

Responsible Party

Mary L'Abbe

Professor Emeritus, CM, PhD

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Mary R L'Abbe, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Toronto

Hayun Jeong, HBSc

Role: STUDY_DIRECTOR

University of Toronto

Locations

Department of Nutritional Sciences, University of Toronto

Toronto, Ontario, Canada

Countries

Canada

References

World Health Organization, Chronic diseases and their common risk factors. 2005 [cited 2021 Sept 1]; Available from: https://www.who.int/chp/ chronic_disease_report/media/Factsheet1.pdf.

Reference Type: BACKGROUND

World Health Organization, Noncommunicable diseases country profiles 2018. 2018 [cited 2021 Sept 1]; Available from: https://www.who.int/nmh/ publications/ncd-profiles-2018/en/.

Reference Type: BACKGROUND

Health Canada. Regulations Amending the Food and Drug Regulations (Nutrition Symbols, Other Labelling Provisions, Vitamin D and Hydrogenated Fats or Oils) [Internet]. Canada Gazette, Part II. 2022. Available from: https://canadagazette.gc.ca/rp-pr/p2/2022/2022-07-20/html/sor-dors168-eng.htmlHealth.

Reference Type: BACKGROUND

Vergeer L, Vanderlee L, Ahmed M, Franco-Arellano B, Mulligan C, Dickinson K, L'Abbe MR. A comparison of the nutritional quality of products offered by the top packaged food and beverage companies in Canada. BMC Public Health. 2020 May 11;20(1):650. doi: 10.1186/s12889-020-08828-w.

Reference Type: BACKGROUND

PMID: 32393206 (View on PubMed)

Ang FJL, Agrawal S, Finkelstein EA. Pilot randomized controlled trial testing the influence of front-of-pack sugar warning labels on food demand. BMC Public Health. 2019 Feb 7;19(1):164. doi: 10.1186/s12889-019-6496-8.

Reference Type: BACKGROUND

PMID: 30732609 (View on PubMed)

Neal B, Crino M, Dunford E, Gao A, Greenland R, Li N, Ngai J, Ni Mhurchu C, Pettigrew S, Sacks G, Webster J, Wu JH. Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases-A Randomised Controlled Trial. Nutrients. 2017 Nov 24;9(12):1284. doi: 10.3390/nu9121284.

Reference Type: BACKGROUND

PMID: 29186803 (View on PubMed)

Taillie LS, Reyes M, Colchero MA, Popkin B, Corvalan C. An evaluation of Chile's Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study. PLoS Med. 2020 Feb 11;17(2):e1003015. doi: 10.1371/journal.pmed.1003015. eCollection 2020 Feb.

Reference Type: BACKGROUND

PMID: 32045424 (View on PubMed)

Vanderlee L, Franco-Arellano B, Ahmed M, Oh A, Lou W, L'Abbe MR. The efficacy of 'high in' warning labels, health star and traffic light front-of-package labelling: an online randomised control trial. Public Health Nutr. 2021 Jan;24(1):62-74. doi: 10.1017/S1368980020003213. Epub 2020 Oct 6.

Reference Type: BACKGROUND

PMID: 33019950 (View on PubMed)

Statistics Canada Eating out - How often and why [Stats in brief: 11-627-M2019003], Statistics Canada: Ottawa, Ontario. 2019.

Reference Type: BACKGROUND

Moubarac, J.C., Ultra-processed foods in Canada: consumption, impact on diet quality and policy implications. University of Montreal: Montreal. 2017.

Reference Type: BACKGROUND

Yang Y, Weippert M, Ahmed M, L'Abbe MR. Cross-Sectional Nutritional Information and Quality of Canadian Chain Restaurant Menu Items in 2020. Am J Prev Med. 2023 Jan;64(1):42-50. doi: 10.1016/j.amepre.2022.07.015. Epub 2022 Sep 22.

Reference Type: BACKGROUND

PMID: 36155709 (View on PubMed)

Murphy SA, Weippert MV, Dickinson KM, Scourboutakos MJ, L'Abbe MR. Cross-Sectional Analysis of Calories and Nutrients of Concern in Canadian Chain Restaurant Menu Items in 2016. Am J Prev Med. 2020 Oct;59(4):e149-e159. doi: 10.1016/j.amepre.2020.05.005. Epub 2020 Aug 20.

Reference Type: BACKGROUND

PMID: 32828587 (View on PubMed)

Vella-Zarb RA, Elgar FJ. The 'freshman 5': a meta-analysis of weight gain in the freshman year of college. J Am Coll Health. 2009 Sep-Oct;58(2):161-6. doi: 10.1080/07448480903221392.

Reference Type: BACKGROUND

PMID: 19892653 (View on PubMed)

Levitsky DA, Halbmaier CA, Mrdjenovic G. The freshman weight gain: a model for the study of the epidemic of obesity. Int J Obes Relat Metab Disord. 2004 Nov;28(11):1435-42. doi: 10.1038/sj.ijo.0802776.

Reference Type: BACKGROUND

PMID: 15365585 (View on PubMed)

Matthews JI, Doerr L, Dworatzek PDN. University Students Intend to Eat Better but Lack Coping Self-Efficacy and Knowledge of Dietary Recommendations. J Nutr Educ Behav. 2016 Jan;48(1):12-19.e1. doi: 10.1016/j.jneb.2015.08.005. Epub 2015 Sep 28.

Reference Type: BACKGROUND

PMID: 26424531 (View on PubMed)

Block JP, Roberto CA. Potential benefits of calorie labeling in restaurants. JAMA. 2014 Sep 3;312(9):887-8. doi: 10.1001/jama.2014.9239. No abstract available.

Reference Type: BACKGROUND

PMID: 25077460 (View on PubMed)

West JH, Belvedere LM, Andreasen R, Frandsen C, Hall PC, Crookston BT. Controlling Your "App"etite: How Diet and Nutrition-Related Mobile Apps Lead to Behavior Change. JMIR Mhealth Uhealth. 2017 Jul 10;5(7):e95. doi: 10.2196/mhealth.7410.

Reference Type: BACKGROUND

PMID: 28694241 (View on PubMed)

McCarroll R, Eyles H, Ni Mhurchu C. Effectiveness of mobile health (mHealth) interventions for promoting healthy eating in adults: A systematic review. Prev Med. 2017 Dec;105:156-168. doi: 10.1016/j.ypmed.2017.08.022. Epub 2017 Sep 4.

Reference Type: BACKGROUND

PMID: 28882743 (View on PubMed)

Ahmed M, Oh A, Vanderlee L, Franco-Arellano B, Schermel A, Lou W, L'Abbe MR. A randomized controlled trial examining consumers' perceptions and opinions on using different versions of a FoodFlip(c) smartphone application for delivery of nutrition information. Int J Behav Nutr Phys Act. 2020 Feb 12;17(1):22. doi: 10.1186/s12966-020-0923-1.

Reference Type: BACKGROUND

PMID: 32050996 (View on PubMed)

Pan American Health Organization. Front-of-package labeling [Internet]. Available from: https://www.paho.org/en/topics/front-package-labeling

Reference Type: BACKGROUND

Other Identifiers

CIHR UD1-170157

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

508519

Identifier Type: -

Identifier Source: org_study_id