Health Star Ratings get it right and should be mandatory, say authors of new report

A review of almost 50,000 Australian packaged foods has found the Health Star Rating (HSR) system provides sound dietary advice on more than 97% of products.

However, researchers at The George Institute for Global Health found Health Stars were displayed on only 3524 products – just 7.5% of the sample.¹

The review also found that food manufacturers were more likely to put Health Stars on foods that scored towards the higher end of the five star scale, rather than on more unhealthy products.

Lead author Alexandra Jones, public health lawyer with The George Institute, said: “What we have found demonstrates that the Health Star Rating system works very well in the vast majority of cases and is exactly the sort of tool people need to help them make better food choices.

“But, we have an obesity crisis in Australia and for Health Star Ratings to be truly useful they need to show us the good and the bad on our shelves. Most food manufacturers won’t voluntarily label products that score just one or two stars, but this is what most unhealthy foods rightly score.”

The HSR system has come under criticism for awarding high ratings to some foods high in fat, salt and sugar, including certain breakfast cereals and flavoured milks, and for products, such as Milo, which generate high scores based on how the manufacturer says they should be prepared. However, the report published in Nutrients found the HSR was only getting it wrong in just three per cent of products reviewed.

“There were some items that received high scores despite being high in sugar and salt, but these really were only a very small number. We need these high profile anomalies to be addressed and for Health Stars to be mandatory so they fully work for consumers, and don’t just act as a marketing tool for food companies,” added Ms Jones

The HSR is currently under a five-year review, with one key area focusing on how well the system is aligned with Australian Dietary Guidelines.

Researchers from The George Institute examined this alignment by calculating a HSR² for all 47,000 products surveyed, and also determined which of these foods were classified core (healthy) and discretionary (unhealthy) under Australian Dietary Guidelines.

It found 2,219 of the foods the Australian Dietary Guidelines would classify as core foods, actually received a low Health Star Rating of 2.0 or less. These included mostly cheeses and yoghurts, and some other items like smoked salmon and pate. However, these low scoring items were also high in saturated fat, salt or sugar.

It also found 4105 of the foods classified discretionary by the Australian Dietary Guidelines scored a Health Star Rating of 3.5 or above. About a quarter of these were chips, processed meats, muesli bars and breakfast cereals that were high in salt and sugar but 75 per cent were items such as hummus, passata and salsa.

Researchers say their results demonstrate the need for a review of the weighting given to salt in the HSR calculator given the large number of sauces, savoury snacks and processed meats that score highly despite being high in salt. They also suggest reviewing whether HSR deals adequately deals with sugar, given the large number of products like yoghurts, fruit bars and breakfast cereals that contain a mix of naturally occurring and added sugars.  

The findings also highlights the need for an examination of how core and discretionary products are assigned.  Currently breakfast cereals with up to 30 per cent sugar are considered core, as well as all milk, yoghurt and cheese regardless of how much sugar, salt or saturated fat they contain. All dips and all muesli bars are viewed as discretionary, even if they are low in harmful nutrients.

Professor Bruce Neal, Deputy Executive Director of The George Institute, Australia, said: “The results show the complexity of defining ‘healthy’ and ‘unhealthy’ across the thousands of products available on today’s supermarket shelves. But, flavoured yoghurts high in sugar and saturated fat are unhealthy desserts, not core foods.  They should be marked as such.  Likewise, writing off every dip or muesli bar as unhealthy is not helpful. 

“Consumers are going to eat these products and if they are all labelled with an HSR it will be possible for people to make the best possible choices when they choose them.”

The HSR is currently under review by the Federal Government, with leading health organisations calling for the inclusion of added sugars into the HSR calculator and for it to become mandatory once improvements have been agreed. The review is due to deliver its results in late 2019.

Professor Neal added: “Government should also use the review period to close loopholes and enhance the system. There are some easy fixes that could immediately rectify key issues. They won’t always be popular with industry, but salty, fatty and sugary foods need to be recognised for what they are.”

Read the full paper in Nutrients journal.

1. Data was collected over four years, from 2013 to 2017. It is estimated the average supermarket contains at least 15,000 products eligible for HSR. If all 3524 products displaying the label were present, this would still be less than a quarter of all products using the HSR system.
2. The HSR was calculated using nutrition information in The George Institute FoodSwitch database, according to instructions in the Guide for industry to the ‘Health Star Rating Calculator’.