Naturalistic online grocery stores could provide a novel setting for evaluating nutrition interventions. In 2021–2022, we recruited US adults (n 144, 59% low-income) to complete two weekly study visits: one in a naturalistic (‘mock’) online grocery store developed for research and one in a real online grocery store. Participants selected groceries and responded to survey questions. Analyses examined survey responses and expenditures on fifteen food categories (e.g., bread, sugar-sweetened beverages). Nearly all enrolled participants completed both visits (98% retention). Moreover, nearly participants all reported that their selections in the naturalistic store were similar to their usual purchases (95%) and that the naturalistic store felt like a real store (92%). Participants’ spending on food categories in the naturalistic store were moderately-to-strongly correlated with their spending in the real store (range of correlation coefficients: 0⋅36–0⋅67, all P-values < 0⋅001). Naturalistic online grocery stores may offer a promising platform for conducting nutrition research.

Background/Objectives: Front-of-package labeling (FOPL) policies are a useful strategy to inform consumers about foods high in nutrients of concern, but little is known about what type of label works best in Bangladesh, a country with increasing levels of unhealthy food intake and diet-related diseases. Methods: We conducted 10 focus groups with men and women in rural and urban Bangladesh (n = 76). Using a semi-structured discussion guide, we asked consumers for their perceptions of the healthfulness of nutrients and foods, two common FOPLs (a color-coded guideline daily allowance [GDA] label and a warning label), and different visual elements of the warning label (e.g., shape, icon, text). Results: Participants understood the health harms of sugar and salt consumption but were less clear on saturated fat. Both FOPLs were perceived as helpful for identifying unhealthy foods, but the warning labels were perceived as easier to understand and more likely to influence behaviors than the GDA. Regarding the design of warning labels, participants perceived warning devices, holding straps, and octagonal shapes as effective but had mixed reactions to which icons or textual statements were most effective. Conclusions: FOPLs are likely to facilitate Bangladeshi consumers’ ability to identify unhealthy products. Further research is needed to understand the impact on food choices as well as the most effective design in this population.

Introduction: Ultra-processed foods (UPFs), defined as foods in group 4 of the NOVA classification system, are a key contributor to chronic disease in the United States. Front-of-package warning labels (“warnings”) offer a promising strategy to help Americans reduce consumption of UPFs. Requiring warning labels on UPFs could help reduce consumption of these foods. However, the effects of UPF warnings are largely unknown. The impact of warning labels on UPFs among Latino adults was examined. Study design: Online randomized trial. Setting/participants: 4,107 Latino adults (49% limited English proficiency) in the US. Intervention: Participants viewed one of three labels: control labels displaying barcodes; identity warnings stating “WARNING: Ultra-processed food”; or health warnings stating “WARNING: Consuming ultra-processed food and drinks can cause weight gain, which increases the risk of obesity and type 2 diabetes”. Main outcome measures: Participants viewed four UPF products displaying their randomly assigned labels. Participants indicated whether the product was UPF (primary outcome) and rated perceived healthfulness of the product, intentions to purchase the product, and perceived message effectiveness (secondary outcomes). Results: Identity warnings (70% correct) and health warnings (67% correct) both led to higher correct identification of UPF compared to control labels (54%, p<.001), with the identity warning having a larger impact than the health warning ( p =.007). Compared to the control label, the identity warning and health warning both elicited higher perceived message effectiveness and lower perceptions of healthfulness and purchase intentions ( p <.001 for all outcomes) with no significant differences between UPF labels. The impact of the health warning label (vs. the control label) on correct identification of UPF was greater for participants with high education ( p =0.012) compared to those with low education, and participants with limited English proficiency ( p =0.001). Conclusions: UPF warnings may help consumers identify UPFs and influence product perceptions and intentions. Trial registration: NCT06296355.