Our study found that only 50% of ready-to-eat packaged food labels were assessable, with most products (33%) imported from either New Zealand or Australia. Of these, only 14.4% had a front-of-pack HSR label. Healthier options, containing an HSR between 3.5 to 5, only formed 11.3% of products available. Overall, non-dairy beverages, confectionary, and salty snacks comprised the largest proportion of available food items containing high levels of sugar, fat, and sodium.
As one-third of processed food products originated from New Zealand and Australia, products from these countries follow the Food Standards Australia New Zealand best practice labelling code [23]. Other main contributors were Fiji and Indonesia, whose processed food products were largely deficient in nutrient information. This suggests a lack of regulation from key importers, highlighting the need for increased labelling policy and surveillance. Our study found a proportion (14%) of food items did not provide labelling in English or Tongan. This places Tongan consumers at risk of poor decision making if they are unable to decipher key information on front of pack labels. Label reading is a key strategy in the prevention and management of NCD’s. Given that 99% of Tongan adults are at moderate to high risk of developing an NCD this is a skill of utmost importance. The National Health and Nutrition Examination Survey investigated label reading amongst a group of American adults with chronic disease. When advised by their health professional to read food labels, those participants who complied consumed less energy, saturated fat, carbohydrates, and sugar in addition to increasing their intake of fibre compared to those who did not comply [22].
Considering most of the packaged foods are imported and that Tonga has little regulation regarding food labelling, international companies are required to adhere to their own countries food labelling standards[15, 18]. In places like Australia and New Zealand where strict regulations are in place, there is more adequate nutrition labelling required as well as voluntary HSRs providing a simple method of understanding the nutritional value of a UPF product [23]. However, it is common for other countries with less rigorous food labelling regulation to provide very little dietary information on such products. In turn nutrients and/or their quantities known to be linked to NCD’s, such as trans-fats, maybe inadvertently omitted from food product labels so as not to deter consumers purchases [15, 24]. Studies in Guatemala and the Pacific Islands have demonstrated imported UPFs are most likely to have limited nutritional information available [15, 25].
Less than one fifth of the food items in our study provided an HSR, with only 10% of those considered healthy options. As most of the processed food products had very poor nutritional value, it is unsurprising that so few included an HSR. Clearly, this is less incentive for food manufacturers to feature a low HSR displayed on the front of a package for marketing purposes. HSRs are beneficial to populations as they are easy to understand with the image of more stars equating to a healthier choice [19]. This can be a valuable figure to display for populations who do not speak English or potentially for companies that choose not to provide labelling in English. A review of HSRs in New Zealand showed this labelling scheme drove companies to provide healthier reformulation of products [26]. Likewise, an Australian study showed that since the introduction of the HSR program, most products using the scheme aim to have an HSR of 3.5 or higher [27]. Research supports that if more countries were to introduce HSRs as a voluntary or mandatory scheme, there would be an increased availability of healthier packaged food items as well as improved consumer understanding of products [26, 28].
Despite having a median total energy per serving of 496.5kJ, just over a third of processed food items available for analysis were considered high in total sugar, most of which were breakfast cereals and confectionary. This is a concerning finding as high sugar intake directly impacts obesity outcomes and breakfast cereals are a staple in the Tongan diet [29, 30]. A large proportion of food products were also high in total fat, saturated fat, and sodium. When consumed frequently, and in high quantities, these nutrients can contribute to the development of NCDs in addition to hindering management [31]. Tonga is in the middle of a significant nutrition transition where many of its citizens have abandoned regular intake of traditional foods such as fish, root vegetables and coconut in favour of cheaper, more convenient UPFs. The potential health consequences of this are significant especially as most UPFs available in Tongan supermarkets contain higher amounts of nutrients associated with developing NCDs. Trans-fats and dietary fibre were the most unreported nutrients across food labels. While FSANZ does not require all labels to report these two nutrients, both have a direct impact on NCD outcomes [23]. Consumption of trans-fats has been shown to contribute to NCD deaths whereas fibre has been shown to reduce NCD related all-cause mortality[32, 33]. This highlights the need for improved labelling policy to include trans-fats and dietary fibre in nutrition panels to inform populations on these nutrients that have a direct impact on their health.
Our pilot study highlights the need for more standardised food labelling in Tonga which has the potential to improve the nutritional quality of ready-to-eat UPF products available for consumption. Studies in the United States have shown that nutritional label use by Indigenous people led to decreased fat intake, particularly those associated with NCDs, and increased consumption of foods containing more beneficial nutrients such as fibre and iron [34–36]. Considering many of the manufacturing companies in our study provided very little nutrition information, and many products excluded undesirable nutrient information such as trans-fats, stricter standards and policies could encourage greater accountability for companies to provide improved labels. This in turn would provide consumers with a better understanding of the products they are buying and assist Tongans in choosing healthier packaged snack options.
A major limitation to research such as this is the difficulty with working in a middle-income country, particularly regarding access to supermarkets and age of products on the shelves. The sourcing of foodstuffs from abroad is also likely to be continuously evolving and changing, which lends further support for improved regulation around labelling and importation. Researchers were limited to assessing food products from three supermarkets on the main island of Tonga which may not reflect the smaller surrounding islands off the mainland. There were limitations in the HSR analysis as not all ingredient lists provided fruit, vegetable, nuts, and legume percentages which affected outcome of HSR ratings. The HSR system is not a perfect representation of the nutritional value of foods, but its simplicity allows for consumers and companies to have a basic understanding of the nutritional quality of food items. It should be acknowledged that this was a pilot study which aimed to examine the feasibility of the topic in question before undertaking a larger scale study. Our results demonstrated the need for future, larger scale research to assess the nutritional quality of packaged food products available in Tonga. Such data may help support the development of stricter, more standardised policies regarding food labelling and availability of packaged food product options.
Our study demonstrates that ready-to-eat packaged foodstuffs available in Tonga lack sufficient labelling and those that are legible, contain very little nutritional value and are high in sugar, fat, and/or sodium. High consumption of these nutrients leads to an increased population risk of NCDs. Future studies should collect a larger sample size of available products across all islands and include photographing nutritional panels for more accurate data collection. This will allow for a greater representation of ready-to-eat packaged food items sold and support a more substantial argument for the need to change policy and regulation regarding food labels, reformulation, and importation of healthier packaged food options sold in Tonga.