title: Consumer understanding of calorie amounts and serving size: implications for nutritional labelling.
abstract: OBJECTIVE
  Increased consumption of sugar-sweetened beverages has contributed to rising obesity levels. Under Canadian law, calories for pre-packaged foods and beverages are presented by serving size; however, serving sizes differ across products and even for the same product in different containers. This study examined consumer understanding of calorie amounts for government nutrition labels and industry labelling schemes.
  
  
  METHODS
  A national sample of 687 Canadian adults completed an online survey. Participants were randomized to view images of Coke® bottles that displayed different serving sizes and calorie amounts. Participants viewed either the regulated nutrition information on the "back" of containers, or the voluntary calorie symbols displayed on the "front" of Coke® products. Participants were asked to determine how many calories the bottle contained.
  
  
  RESULTS
  Across all conditions, 54.2% of participants correctly identified the number of calories in the beverage. Participants who viewed government-mandated nutrition information were more likely to answer correctly (59.0%) than those who saw industry labelling (49.1%) (OR=5.3, 95% CI: 2.6-10.6). Only 11.8% who viewed the Coke® bottle with calorie amounts per serving correctly identified the calorie amount, compared to 91.8% who saw calorie amounts per container, regardless of whether information was presented in the Nutrition Facts Table or the front-of-pack symbol (OR=242.9, 95% CI: 112.1-526.2).
  
  
  CONCLUSIONS
  Few individuals can use nutrition labels to correctly identify calorie content when presented per serving or using industry labelling schemes. The findings highlight the importance of revising labelling standards and indicate that industry labelling initiatives warrant greater scrutiny.
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.
authors.forename: Lana
authors.initials: L
authors.lastname: Vanderlee
authors.forename: Samantha
authors.initials: S
authors.lastname: Goodman
authors.forename: Wiworn
authors.initials: W
authors.lastname: Sae Yang
authors.forename: David
authors.initials: D
authors.lastname: Hammond
mesh_terms: D000293:Adolescent; D000328:Adult; D001628:Beverages; D002170:Canada; D002149:Energy Intake; D005260:Female; D019649:Food Industry; D005515:Food Labeling / Q000331:legislation & jurisprudence* / Q000379:methods*; D033161:Government Regulation; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D055815:Young Adult
keywords: Nutrition labelling; comprehension; food labelling; front-of-package labelling; nutrition policy