Navigating Nutrition in the Aisles

Navigating Nutrition in the Aisles

June 23, 2021
Business SkillsRetail Industry Insights

By Elizabeth Hall, PhD, RDN, LDN, K-VA-T Food Stores, Inc.

Food packaging and promotional signage include a myriad of nutrition information sometimes contributing to confusion among shoppers. With nearly half of consumers focusing on health and nutrition as top priorities for meal inspiration [1] now, more than ever, retail dietitians can serve as a key resource for navigating nutrition messaging in the grocery aisles. 

As a retail dietitian and PhD candidate in Public Health Nutrition at the University of Tennessee, Knoxville, I wanted to explore an intervention often used in grocery retail settings to do exactly that: to help guide customers to healthier purchases – shelf-label programs. My retailer had dabbled with various shelf-labeling programs in the past, but nothing really stuck. After a conversation with a colleague, Monica Amburn (we were at an RDBA conference!), we launched a 2-year research initiative to assess the effectiveness of shelf-label programs in increasing healthier purchases in grocery retail. 

From previous literature, I knew that consumers report interest in nutrition-focused labeling of foods, [2-4] especially for products that are “nutritionally ambiguous”4 or for comparison purposes, [5] but effectiveness of these programs in influencing purchase behavior varies and often depends on the product itself [6] or the consumer’s previous knowledge of the label system. [7,8]

As retail dietitians, we know that product labeling comes in many forms and includes package messaging such as regulated health claims, [9] Front-of Package (FOP) labeling [10] and of course, the Nutrition Facts Panel (NFP) and ingredient lists. However, researchers suggest that the NFP’s complexity may deter use among some consumers,[11-13] potentially limiting its influence on purchase decision-making. [14]

I was well aware that many retailers highlight better-for-you options on the shelf edge through shelf-label programs [15,16] and that shelf aesthetics have been shown to capture shopper attention and influence purchase decisions.[17-21] Shelf-label programs, specifically, are the promotional program most noticed by consumers [22] and consumers report a strong affinity for nutrition information on shelf-labels [23] which influences their evaluation of products and ultimate product choice. [24-28] Also, shelf-labels are considered the last point of communication with a shopper at the point-of-purchase, which makes the shelf-edge an important location for nutrition education and potential influencer of better-for-you purchases.

As I began to explore the effectiveness of various shelf-label programs, I found that branding and messaging of these programs vary from use of validated nutrition claims and lifestyle attributes such as “heart healthy” or “whole grain” [29] to summary systems like nutrient quality scoring (e.g., Nuval) or graded ranking systems (e.g., Guiding Stars Program [GSP]). Although both Nuval and the GSP have displayed positive outcomes in the literature, [30-32] these programs were sometimes misinterpreted unless the consumer had prior nutrition-related knowledge of the product or label. [30,33] 

From my engagement with other retail dietitians, I also knew that an emerging trend in retail is to brand shelf-label programs as being “dietitian-approved,” [34-41] especially as the scope of dietitians in retail continues to expand and grow. While there was not extensive literature on the effectiveness of these dietitian-branded programs specifically, I did find studies in consumer behavior literature showing that branding with a spokesperson or expert can increase product purchases, especially when the expert’s expertise is perceived by the consumer as congruent with what they are promoting. [42-45] I wondered if this consumer behavior theory, called the “match-up” hypothesis, [42-45] would extend to retail shelf-label programs branded with a dietitian as the expert.

For my dissertation project and in partnership with my retailer, K-VA-T Food Stores, Inc., parent company to Food City supermarkets, and Vestcom’s healthyAisles, we embarked on a 6-month cluster-randomized controlled trial in which all 125 Food City stores were randomized to receive the “Dietitian’s Pick” shelf-label program, a general “healthy”-branded program, or no shelf-label program (the control group). I first worked with healthyAisles to develop the Dietitian’s Pick nutrient criteria, which was the same criteria that was also used for the “healthy” branded program. Throughout the study we conducted fidelity assessments and collected qualitative feedback from associates and customers, but our primary outcome measure was sales lift of products that received each version of the shelf-label program compared to control stores. Our results showed that both versions of the shelf-label program performed well throughout the study, with a statistically significant incremental lift in product sales and units sold observed in the 4th month of the evaluation period. The “Dietitian’s Pick” program came out on top when it came to raw sales data. 

These findings are exciting and show the potential for shelf-label programs, especially those branded with a dietitian’s expertise, to serve as a positive promotional strategy to assist consumers in navigating nutrition information, potentially increasing sales, [31,34,46-52] improving the healthfulness of purchases, [30,33,48,53-58] and influencing growth in consumer loyalty initiatives. 

To learn more details about this research, please join Vestcom’s Monica Amburn and I for the RDBA webinar Measuring the ROI and Shopper Impact of a Custom Dietitian’s Pick Attribute at the Shelf Edge scheduled for Tuesday, August 3rd at 12 CST. Check here to register.


  1. Food Industry Association. The power of health and well-being in the food industry. Published June 15, 2021. Accessed June 15, 2021.
  2. Food Industry Association. 2014 report on retailer contributions to health and wellness. 2015. Available at: Published 2015. Accessed January 16, 2021.
  3. Food Industry Association. The power of health and well-being in food retail. Published 2020. Accessed March 4, 2021. 
  4. Acton RB, Vanderlee L, Hammond D. Influence of front-of-package nutrition labels on beverage healthiness perceptions: Results from a randomized experiment. Prev Med. 2018;115: 83-89.
  5. Newman CL, Howlett E, Burton S. Shopper response to front-of-package nutrition labeling programs: potential consumer and retail store benefits. J Retail. 2014;90:13–26.
  6. Julia C, Blanchet O, Mejean C, et al. Impact of the front-of-pack 5-colour nutrition label (5-CNL) on the nutritional quality of purchases: an experimental study. Int J Behav Nutr Phys Act. 2016;13(101):1-9.
  7. Hodgkins C, Barnett J, Wasowicz-Kirylo G, et al. Understanding how consumers categorise nutritional labels; a consumer derived typology for front-of-pack nutrition labelling. Appetite. 2012;59(3):806-817. 
  8. Derby BM, Levy AS. Do food labels work? Gauging the effectiveness of food labels pre- and post-NLEA. In: Bloom PN, Gundlach GT, eds. Handbook of Marketing and Society. Sage; 2001:372–398.
  9. Glanz K, Bader MD, Iyer S. Retail grocery marketing strategies and obesity: an integrative review. Am J Prev Med. 2012;42(5):503-512.
  10. Institute of Medicine (IOM). Examination of front-of-package nutrition rating systems and symbols: phase I report. Bookshelf_NBK209847.pdf. Published 2010. Accessed March 4, 2021.
  11. Gonzalez-Vallejo C, Lavins BD, Carter KA. Analysis of nutrition judgments using the
    Nutrition Facts Panel. Appetite. 2016;105:71-84.
  12. Nelson D, Graham D, Harnack L. An objective measure of nutrition facts panel usage
    and nutrient quality of food choice. J Nutr Educ Behav. 2014;46:589-594.
  13. Todd JE., Variyam JN. The Decline in Consumer Use of Food Labels, 1995-2006. Economic Research Report 63. August 2008. Accessed February 13, 2020.
  14. Stranieri S, Baldi L, Banterle A. Do nutrition claims matter to consumers? An empirical analysis considering European requirements. J Agric Econ. 2010;61(1):15–33.
  15. Milliron BJ, Woolf K, Appelhans BM. A point-of-purchase intervention featuring in person supermarket education affects healthful food purchases. J Nutr Educ Behav. 2012;44:225–232. 
  16. Mayer JA, Dubbert PM, Elder JP. Promoting nutrition at the point of choice: a review. Health Educ Q. 1989;16:31–43. 
  17. Gabrielli V, Cavazza N. The influence of in-store product holders on orientation towards the product and on purchase intention. Int Rev Retail Distrib Consum Res. 2014;24(3):311–327. 
  18. Clement J, Aastrup J, Forsberg SC. Decisive visual saliency and consumers’ in-store decisions. J Retail Consum Serv. 2015;22:187–194.
  19. Atalay AS, Bodur HO, Rasolofoarison D. Shining in the center: central gaze cascade effect on product choice. J Consum Res. 2012;39(4):848–866. 
  20. Janiszewski C, Kuo A, Tavassoli NT. The influence of selective attention and inattention to products on subsequent choice. J Consum Res. 2013;39(6):1258–1274. 
  21. Vilnai-Yavetz I, Koren R. Cutting through the clutter: purchase intentions as a function of packaging instrumentality, aesthetics, and symbolism. Int Review Retail Distrib Consum Res. 2013;23(4):394–417.
  22. Glanz K, Bader MD, Iyer S. Retail grocery marketing strategies and obesity: an integrative review. Am J Prev Med. 2012;42(5):503-512.
  23. Berning JP, Chouinard HH, Manning KC, et al. Identifying consumer preferences for nutrition information on grocery store shelf labels. Food Policy. 2010;35(5):429-436.
  24. Bialkova S, Sasse L, Fenko A. The role of nutrition labels and advertising claims in altering consumers’ evaluation and choice. Appetite. 2016;96:38-46. 
  25. Arslan K, Gustafson CR, Rose DJ. Point-of-decision prompts increase dietary fiber content of consumers’ food choices in an online grocery shopping simulation. Nutrients. 2020;12(3487):1-16.
  26. Gustafson CR, Kent R, Prate MR. Retail-based healthy food point-of-decision prompts (PDPs) increase healthy food choices in a rural, low-income, minority community. PLoS ONE. 2018;13:e0207792.
  27. Beckelman T, Sinclair-White BM, McGurk MD, et al. Encouraging adults to Choose Healthy Now: a Hawai‘i convenience store intervention. J Nutr Educ Behav. 2020;52:330–334.
  28. Papies EK, Potjes I, Keesman M, Schwinghammer S, Van Koningsbruggen GM. Using health primes to reduce unhealthy snack purchases among overweight consumers in a grocery store. Int J Obes. 2013;38:597–602.
  29. Hersey JC, Wohlgenant KC, Aresenault JE, Kosa KM, Muth MK. Effects of front-of-package and shelf nutrition labeling systems on consumers. Nutr Rev. 2013;71(1):1–14.
  30. Hobin E, Bollinger B, Sacco J, et al. Consumers’ response to an on-shelf nutrition labelling system in supermarkets: Evidence to inform policy and practice. Milbank Q. 2017;95(3):494-534.
  31. Finkelstein EA, Li W, Melo G, Strombotne K, Zhen C. Identifying the effect of shelf nutrition labels on consumer purchases: results of a natural experiment and consumer survey. Am J Clin Nutr. 2018;107(4):647-651.
  32. Rahkovsky I, Lin B-H, Lin C-TJ, Lee J-Y. Effects of the Guiding Stars Program on purchases of ready-to-eat cereals with different nutritional attributes. Food Policy. 2013;43:100-107.
  33. Melo G, Zhen C, Colson G. Does point-of-sale nutrition information improve the nutritional quality of food choices? Econ Hum Biol. 2019;35:133-143.
  34. Hall EL, Colby S, Anderson-Steeves E, Raynor H, Ehrlich S. Food retail shelf-label program increases healthful purchases: a cluster randomized control trial utilizing the RE-AIM framework. 2021. Manuscript in preparation.
  35. Amburn M. COVID-19 impact on retail health & wellness communications. Lecture presented at Retail Dietitian’s Business Alliance Virtual Experience. September 24, 2019. Accessed April 4, 2021. 
  36. Ruhs B. The market RD: powering health & wellness everywhere food is sold. Retail dietitian programs: an introduction. Published August 2019. Accessed April 4, 2021. 
  37. Angrisani C. Many packaged foods are dietitian-approved. Published July 22, 2013. Accessed April 4, 2021. 
  38. Intermountain Healthcare. ‘Dietitian Preferred’ program helps shoppers find healthy foods at a glance. Accessed April 4, 2021. 
  39. Harmons Neighborhood Grocer. Dietitian’s Choice: healthy shopping made easy with registered dietitians. Accessed April 4, 2021. 
  40. Chain Store Age. ALDI hires dietitians to certify healthy foods. Accessed April 4, 2021. 
  41. Milley K. ‘DAT’ is nutritious: Commissaries unveil dietitian-approved program that tags foods limiting added sugar, sodium, unhealthy fat while offering whole grains, healthy fats, fiber or lean protein. Published January 21, 2021. Accessed April 4, 2021. 
  42. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71-82.
  43. Ma J, Flanders WD, Ward EM, Jemal A. Body mass index in young adulthood and premature death: analyses of the US National Health Interview Survey linked mortality files. Am J Epidemiol. 2011;174(8):934-944.
  44. Rappange DR, Brouwer WBF, Hoogenveen RT, Van Baal PHM. Healthcare costs and obesity prevention: drug costs and other sector-specific consequences. Pharmacoeconomics. 2009;27(12):1031-1044.
  45. Hussain SS, Bloom SR. The regulation of food intake by the gut-brain axis: Implications for obesity. Int J Obes (Lond). 2013;37(5):625-633.
  46. Sacks G, Rayner M, Swinburn B. Impact of front-of-pack “traffic-light” nutrition labelling on consumer food purchases in the UK. Health Promot Int. 2009;24(4):344-352.
  47. Ogawa Y, Tanabe N, Honda A, et al. Point-of-purchase health information encourages customers to purchase vegetables: objective analysis by using a point-of-sales system. Environ Health Prev Med. 2011;16(4):239-246.
  48. Freedman MR, Connors R. Point-of-purchase nutrition information influences             food-purchasing behaviors of college students: A pilot study. J Am Diet Assoc. 2011;110(8):1222-1226.
  49. Mork T, Grunert KG, Fenger M, Juhl HJ, Tsalis G. An analysis of the effects of a campaign supporting use of a health symbol on food sales and shopping behaviour of consumers. BMC Public Health. 2017;17(1):239.
  50. Smed S, Jansen L, Edenbrandt A. The impact on food purchases of the Dutch choices and the Danish keyhole FOP systems. Ann Nutr Metab. 2017;71:100.
  51. Chapman LE, Sadeghzadeh C, Koutlas M, Zimmer C, De Marco M. Evaluation of three behavioural economics “nudges” on grocery and convenience store sales of promoted nutritious foods. Public Health Nutr. 2019;22(17):3250-3260.
  52. Worsley A, McConnon S. Evaluation of the New Zealand Heart Food Festival 1988-9. Health Promot Int. 1990;5(2):127-135.
  53. Russo J, Staelin R, Nolan CA, Russell GJ, Metcalf BL. Nutrition information in the supermarket. J Consum Res. 1986;13(1):48-70.
  54. Hunt MK, Lefebvre RC, Hixson ML, Banspach SW, Assaf AR, Carleton RA. Pawtucket Heart Health Program point-of-purchase nutrition education program in supermarkets. Am J Public Health. 1990;80(6):730-732.      
  55. Sutherland LA, Kaley LA, Fischer L. Guiding stars: The effect of a nutrition navigation program on consumer purchases at the supermarket. Am J Clin Nutr. 2010;91(4):1090S-1094S.
  56. Nikolova HD, Inman J. Healthy choice: The effect of simplified point-of-sale nutritional information on consumer food choice behavior. J Mark Res. 2015; 52(6):817-835.
  57. Payne CR, Niculescu M, Just DR, Kelly MP. This way to produce: Strategic use of arrows on grocery floors facilitate produce spending without increasing shopper budgets. J Nutr Educ Behav. 2016; 48(7):512-513e1.
  58. Ni Mhurchu C, Eyles H, Jiang Y, Blakely T. Do nutrition labels influence healthier food choices? Analysis of label viewing behaviour and subsequent food purchases in a labelling intervention trial. Appetite. 2017;121:360-365.