Weight stigma in Mexico and front-of-package labeling. A systemic review

Cipatli Ayuzo del Valle, Fernando García, María Musi Gómez, Paola G. Parker, Brenda Ayuzo, Gina Salame Kanan

DOI: https://doi.org/10.17711/SM.0185-3325.2022.011


Background. Front-of-package food labeling is a public health strategy implemented to reduce the consumption of processed food to decrease the incidence of obesity in Mexico. Although there is an increasing focus among public health officials on implementing policies designed to address obesity, much less attention has been paid to how these policies could impact those with disordered eating, despite the fact that millions suffer from such illnesses.

Objective. The aim of this article is to present scientific literature related to front-of-package labeling and its impact on obesity and eating disorders.

Method. Papers related to nutrition labels and obesity and eating disorders were reviewed.

Results. The papers reviewed found no significant improvement regarding the consumption of processed food. Other measurements, including nutritional education, availability, physical education, and body-image acceptance, have a better impact on nutritional health.

Discussion and conclusion. Front-of-package labeling is regarded as an important measure in the attempt to reduce obesity levels. However, there is insufficient scientific evidence to suggest that this type of labeling reduces the consumption of processed foods in patients with obesity.


Labels; obesity; eating behavior disorders; anxiety

Full Text:



Acton, R. B., Jones, A. C., Kirkpatrick, S. I., Roberto, C. A., & Hammond, D. (2019). Taxes and front-of-package labels improve the healthiness of beverage and snack purchases: a randomized experimental marketplace. International Journal of Behavioral Nutrition and Physical Activity, 16(1), 46. doi: 10.1186/s12966-019-0799-0

Becker, C. B., Middlemass, K., Taylor, B., Johnson, C., & Gomez, F. (2017). Food insecurity and eating disorder pathology. International Journal of Eating Disorders, 50(9), 1031-1040. doi: 10.1002/eat.22735

Bener, A., Yousafzai, M. T., Darwish, S., Al-Hamaq, A. O. A. A., Nasralla, E. A., & Abdul-Ghani, M. (2013). Obesity Index That Better Predict Metabolic Syndrome: Body Mass Index, Waist Circumference, Waist Hip Ratio, or Waist Height Ratio. Journal of Obesity, 2013(269038), 1-9. doi: 10.1155/2013/269038

Draper, A. K., Adamson, A. J., Clegg, S., Malam, S., Rigg, M., & Duncan, S. (2013). Front-of-pack nutrition labelling: are multiple formats a problem for consumers? European Journal of Public Health, 23(3), 517-521. doi: 10.1093/eurpub/ckr144

Durso, L. E., & Latner, J. D. (2008). Understanding Self-directed Stigma: Development of the Weight Bias Internalization Scale. Obesity, 16(S2), S80-S86. doi: 10.1038/oby.2008.448

Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders, 16(4), 363-370.

Flegal, K. M., Kit, B. K., Orpana, H., & Graubard, B. I. (2013). Association of All-Cause Mortality with Overweight and Obesity Using Standard Body Mass Index Categories. JAMA, 309(1), 71-82. doi: 10.1001/jama.2012.113905

Hartmann-Boyce, J., Bianchi, F., Piernas, C., Riches, S. P., Frie, K., Nourse, R., & Jebb, S. A. (2018). Grocery store interventions to change food purchasing behaviors: a systematic review of randomized controlled trials. The American Journal of Clinical Nutrition, 107(6), 1004-1016. doi: 10.1093/ajcn/nqy045

Hastie, C. E., Padmanabhan, S., Slack, R., Pell, A. C. H., Oldroyd, K. G., Flapan, A. D., … Pell, J. P. (2009). Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention. European Heart Journal, 31(2), 222-226. doi: 10.1093/eurheartj/ehp317

Haynos, A. F., & Roberto, C. A. (2017). The effects of restaurant menu calorie labeling on hypothetical meal choices of females with disordered eating. International Journal of Eating Disorders, 50(3), 275-283. doi: 10.1002/eat.22675

Hughes, V. (2013). The big fat truth. Nature, 497(7450), 428-430. doi: 10.1038/497428a

Hunger, J. M., Smith, J. P., & Tomiyama, A. J. (2020). An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy. Social Issues and Policy Review, 14(1), 73-107. doi: 10.1111/sipr.12062

Hunger, J. M., Tomiyama, A. J., Nguyen-Cuu, J., & Wells, C. (2016). Moving to a personalized medicine approach to promote health across the weight spectrum. International Journal of Obesity, 40(8), 1334. doi: 10.1038/ijo.2016.100

Islam, M. S., & Hossain, M. A. (2017). Obesity and Cardiovascular Disase Risk Factors, Paradox and Impact of Weight Loss. KYAMC Journal, 5(1), 476-479. doi: 10.3329/kyamcj.v5i1.32320

Jeffery, R. W., Pirie, P. L., Rosenthal, B. S., Gerber, W. M., & Murray, D. M. (1982). Nutrition education in supermarkets: An unsuccessful attempt to influence knowledge and product sales. Journal of Behavioral Medicine, 5(2), 189-200. doi: 10.1007/bf00844808

Jenkins, D. J. A., Willett, W. C., Astrup, A., Augustin, L. S. A., Baer-Sinnott, S., Barclay, A. W., … Wolever, T. M. S. (2013). Glycaemic index: did Health Canada get it wrong? Position from the International Carbohydrate Quality Consortium (ICQC). British Journal of Nutrition, 111(2), 380-382. doi: 10.1017/s0007114513003905

Liberato, S. C., Bailie, R., & Brimblecombe, J. (2014). Nutrition interventions at point-of-sale to encourage healthier food purchasing: a systematic review. BMC Public Health, 14(1), 919. doi: 10.1186/1471-2458-14-919

Mah, C. L., Luongo, G., Hasdell, R., Taylor, N. G. A., & Lo, B. K. (2019). A Systematic Review of the Effect of Retail Food Environment Interventions on Diet and Health with a Focus on the Enabling Role of Public Policies. Current Nutrition Reports, 8(4), 411-428. doi: 10.1007/s13668-019-00295-z

Miller, A. L., & Lumeng, J. C. (2018). Pathways of Association from Stress to Obesity in Early Childhood. Obesity, 26(7), 1117-1124. doi: 10.1002/oby.22155

Möser, A., Hoefkens, C., Van Camp, J., & Verbeke, W. (2009). Simplified nutrient labelling: consumers’ perceptions in Germany and Belgium. Journal Für Verbraucherschutz Und Lebensmittelsicherheit, 5(2), 169-180. doi: 10.1007/s00003-009-0531-0

Nicholls, W., Devonport, T. J., & Blake, M. (2016). The association between emotions and eating behaviour in an obese population with binge eating disorder. Obesity Reviews, 17(1), 30-42. doi: 10.1111/obr.12329

Nieto, C., Jáuregui, A., Contreras-Manzano, A., Arillo-Santillan, E., Barquera, S., White, C. M., … Thrasher, J. F. (2019). Understanding and use of food labeling systems among Whites and Latinos in the United States and among Mexicans: Results from the International Food Policy Study, 2017. International Journal of Behavioral Nutrition and Physical Activity, 16(1), 87-97. doi: 10.1186/s12966-019-0842-1

Roberto, C. A., Bragg, M. A., Seamans, M. J., Mechulan, R. L., Novak, N., & Brownell, K. D. (2012). Evaluation of Consumer Understanding of Different Front-of-Package Nutrition Labels, 2010–2011. Preventing Chronic Disease, 9, 120015. doi: 10.5888/pcd9.120015

Sacks, G., Veerman, J. L., Moodie, M., & Swinburn, B. (2011). ‘Traffic-light’ nutrition labelling and ‘junk-food’ tax: a modelled comparison of cost-effectiveness for obesity prevention. International Journal of Obesity, 35(7), 1001-1009. doi: 10.1038/ijo.2010.228

Secretaría de Salud [SSA], Instituto Nacional de Salud Pública [INSP], & Instituto Nacional de Estadística y Geografía [INEGI]. (2018). Encuesta Nacional de Salud y Nutrición ENSANUT - August 1. Retrieved from https://ensanut.insp.mx/encuestas/ensanut2018/doctos/informes/ensanut_2018_presentacion_resultados.pdf

Secretaría de Salud [SSA]. (1998). Norma Oficial Mexicana. NOM-174-SSA1-1998, Para el manejo integral de la obesidad. Retrieved from http://www.salud.gob.mx/unidades/cdi/nom/174ssa18.html

Secretaría de Salud [SSA]. (2020). Norma Oficial Mexicana NOM-051-SCFI/SSA1-2010, Especificaciones generales de etiquetado para alimentos y bebidas no alcohólicas preenvasados-Información comercial y sanitaria. Retrieved from https://www.dof.gob.mx/2020/SEECO/NOM_051.pdf

Sharma, A. M., & Kushner, R. F. (2009). A proposed clinical staging system for obesity. International Journal of Obesity, 33(3), 289-295. doi: 10.1038/ijo.2009.2

Storcksdieck Genannt Bonsmann, S., & Wills, J. M. (2012). Nutrition Labeling to Prevent Obesity: Reviewing the Evidence from Europe. Current Obesity Reports, 1(3), 134-140. doi: 10.1007/s13679-012-0020-0

Taillie, L. S., Ng, S. W., & Popkin, B. M. (2016). Global growth of “big box” stores and the potential impact on human health and nutrition. Nutrition Reviews, 74(2), 83-97. doi: 10.1093/nutrit/nuv062

The Lancet Psychiatry. (2020). A good enough measure. Lancet Psychiatry, 7(10), 825. doi: 10.1016/s2215-0366(20)30395-3

Tomiyama, A. J., Hunger, J. M., Nguyen-Cuu, J., & Wells, C. (2016). Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012. International Journal of Obesity, 40(5), 883-886. doi: 10.1038/ijo.2016.17

van Herpen, E., & van Trijp, H. C. M. (2011). Front-of-pack nutrition labels. Their effect on attention and choices when consumers have varying goals and time constraints. Appetite, 57(1), 148-160. doi: 10.1016/j.appet.2011.04.011

Vargas-Meza, J., Jáuregui, A., Pacheco-Miranda, S., Contreras-Manzano, A., & Barquera, S. (2019). Front-of-pack nutritional labels: Understanding by low- and middle-income Mexican consumers. PLoS One, 14(11), e0225268. doi: 10.1371/journal.pone.0225268

Visschers, V. H. M., Hess, R., & Siegrist, M. (2010). Health motivation and product design determine consumers’ visual attention to nutrition information on food products. Public Health Nutrition, 13(7), 1099-1106. doi: 10.1017/s1368980009993235