Canadian Consumer Perspectives on Food Fortification

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Executive Summary

Twenty-three focus groups were conducted between July 19 and July 22, 2004 in seven cities across Canada . The goals of the research were: to understand how discretionary fortification may affect consumer behaviors; whether there was general support or opposition to discretionary fortification; and the perception of the role that Health Canada should play in discretionary fortification.

The specific research objectives were as follows :

• To examine participant's current food choice criteria, exploring whether participants have enough choice, how they weight various nutrition factors when purchasing food, how they incorporate vitamins and minerals in their diets and if they purchase fortified food.
• To determine basic awareness and opinion towards fortified food. Participants were asked what foods in the market are fortified, how important fortification is to them in choosing a product, what information they need to know to purchase a fortified product, what – if anything – participants trade-off when purchasing a fortified food and if their food choices would change if there is a greater array of fortified food available to them.
• To explore opinions about discretionary fortification. Participants were read a policy concept statement and asked to discuss what it means, how it would influence their decisions, what other information they need to know, whether discretionary fortification would make food healthier, what foods they want to see fortified, if they want food of low nutritional value fortified and what type of labelling should be available on packaging of food fortified at the discretion of manufacturers.
• To discuss Health Canada's role in discretionary fortification. Participants were asked about where they get their nutrition information, what Health Canada's role is in general regarding foods and healthy eating, whether opinion/credibility of Health Canada would be affected and where participants would go to get more information on discretionary fortification.

The locations of the tests and participant characteristics were as follows:

*Low SES: Low Socioeconomic Status-those with a household income of $30, 000 or less and have at most a secondary school education.

** High SES: High Socioeconomic Status-those with a household income of over $50,000 in Montreal, and over $75,000 in Toronto, and at least a university education.

Participants were led through a guided discussion about food choices, food fortification in general, and discretionary fortification. The moderator followed a guide and also pursued themes and questioning based on responses in the group that helped shed light on the objectives of the research.

Each group was conducted by one of three moderators: one moderated groups in Trois-Rivières and Montréal in French, one in Winnipeg and the west, and one in St John's and Toronto.

Consumers Somewhat Accepted The Proposed Discretionary Fortification Policy. There Are, However, Qualifications To The Acceptance, And Consumers Said That Discretionary Fortification Will Not Change The Way They Evaluate Their Food Choices.

For the most part, the fortification of foods at the discretion of manufacturers, with limits on nutrients and amounts set by Health Canada was accepted among participants in the focus groups. This support though can be characterized as qualified acceptance. That is, in order to accept the policy, participants needed to know:

• The effect fortification would have on price and taste of the food. If either significantly change, participants will have more difficulty accepting the policy and choosing fortified food at the discretion of the manufacturer.
• That labelling would be mandatory and they would be provided with enough information and reassurance about the fortification process, including providing information about excessive intake and the health benefits of the added nutrients. Participants saw labelling as a fundamental aspect of this policy. Many said they would reject it if labels are not mandatory and do not contain enough information. Participants felt that honest labelling will be what gives the consumer the opportunity to make an informed choice, and this is fundamental to them.
• The nutritional information necessary to make proper food choices under discretionary fortification. Those who said they would consider foods fortified at the discretion of the manufacturer needed to know information like the benefits of the fortified nutrients to them and whether or not they run the risk of excessive intake. They expected Health Canada to do this through education in general, and mandating labelling that would inform them of this.
• That manufacturers will be monitored on two fronts: on the one front, participants want Health Canada to monitor the amount of nutrients added and check it against the amounts manufacturers claim on labels. On the second front, the monitoring concerns the actual quality or source of the nutrient. Participants want Health Canada to ensure that the source of nutrients comes from safe, natural and non-chemical sources.

Even if these questions are answered, participants indicated that it is quite likely that discretionary fortification would not really change the way they currently purchase food. That is, they indicated their intention to continue to consider their regular choice factors like salt, fat, sugar, calories, taste and price before they consider added nutrients, even if they happen to be specifically looking for that vitamin or mineral as part of their diet. Moreover, if they needed to get vitamins and minerals, they would first look to their existing sources, which include fruits, vegetables and vitamin/mineral pills. The fact that participants expressed an intention to continue to employ their existing choice standards also underscores the fact that for the most part, participants do not currently make specific attempts to purchase fortified food in the marketplace.

There Are, However, Strong Ideological Concerns About Discretionary Fortification. These Concerns Definitely Impact Support For The Policy.

It is important to note that there were definitely those who either do not support the policy or at the very least think that an extremely cautious approach needs to be taken towards it. These people cited ideological concerns about the policy. Some of those concerns included the fact that Health Canada should be spending money on encouraging a more healthy diet, rather than on discretionary fortification, or at the very least providing strong educational messages that focus on placing fortified foods in context of the food in its entirety (i.e. even though a packaged food is fortified, it is not the healthiest choice).

Other ideological concerns included unease about tampering with food too much, what increased fortification really says about the nutritional state of the food supply, the exact source of the added nutrients, marketing low nutrient food as healthy and who exactly is driving this policy – the manufacturers or Health Canada. Generally participants that held these views did so quite strongly, and in a few instances were able to sway others away from supporting the policy. While focus groups are not quantitative research, by basic observation, it appears as if ideological rejection or concern is vocal, but it is not as prevalent among participants as is qualified acceptance of the policy.

Finally, in terms of ideology, some of those who expressed support for the policy, feel that discretionary fortification is a pro-active stance. They say that Health Canada is both controlling discretionary fortification, setting limits and conditions for nutrient addition by manufacturers, and is also protecting our welfare, and reducing health-care costs by helping Canadians prevent disease in the future.

Participants Indicated They Would Choose A Fortified Food If That Food Met Their Current Food Choice Criteria. However, Even Though They Would Choose A Fortified Food, They Stated The Policy Is Not About Choice.

As mentioned, discretionary fortification will not necessarily change food choices. However, participants indicated that for the most part they would purchase a fortified food if all their other decision factors were equal. That is, if they saw a fortified food and it meets their current requirements, they would purchase it and feel that they have received a "bonus".

The reason for this, again, comes from the way participants stated they presently choose their packaged food. Specifically, participants indicated that they do not look at packaged food as a source of vitamins and minerals, and for the most part they would not start to do so, even if they had a wider selection of fortified food available to them.

It is also important to note that participants were probed on whether they feel the policy would give them more choices in where they get their vitamins and minerals. Since participants currently do not look for vitamins and minerals in packaged food, they do not feel this is a policy about choice. What did come through in the groups though is that participants want the choice not to choose a fortified food if they do not want it. This is driven by concerns about excessive intake, as well as changes to the taste and price of food. Also, those with ideological concerns about discretionary fortification vehemently demand that there be a choice to choose equivalent non-fortified foods.

Fortifying Food Of Low Nutritional Value Has Some Support, Though It Raises A Lot Of Issues, Especially For Parents

Much like general attitudes towards fortification, if a food of low nutritional value is fortified, participants felt that it would be a bonus to them, as long as it did not affect the taste. Participants were quick to point out that they would not be swayed into buying a low nutritional value food just because it is fortified. Rather, they say that if they were going to make the choice to begin with, fortification would not be such a bad thing.

There are two concerns though. The first is a general one about marketing and labelling. If anything, the issue around fortifying food of low nutritional value is seen as one of marketing. Participants do not want manufacturers to abuse fortification as a marketing tool, and they were very concerned about this.

The other issue comes from parents who have concern for their children. For the most part, parents felt that at present, they are in good control of how their children eat, and felt this will remain the same under discretionary fortification. They were more concerned about the fact that discretionary fortification will mean that their children need more education about food, either from them or the school system. That is, parents said that they will have to explain that just because a food is fortified does not make it any more or less healthy on other attributes such as fat, sugar and salt. Also, parents felt that they will have to explain why it is better to get vitamins and minerals from fruits and vegetables, as opposed to packaged snack food. Some parents were alright with having to explain this, while others were quite concerned that they did not want the possibility of the issue to even arise.

The Role Of Health Canada Is Education And Regulation

Participants strongly requested that Health Canada provide a significant amount of information to the public in the face of discretionary fortification. They wanted to know:

• The exact reasons for the policy
• How the added nutrients improve health
• The risk of excessive intake, and what acceptable intake levels are
  
  
• That Health Canada will monitor manufacturers in terms of verifying the amount of added nutrients, and ensuring that manufacturers will not abuse fortification as a marketing tool.
• That Health Canada will set strict labelling guidelines that provide Canadians with all the information they need to know

There Is A General Belief That Health Canada's Credibility Will Not Be Affected

Health Canada wanted to gauge whether perceptions of its credibility would change as a result of discretionary fortification. Overall, Health Canada does not have a credibility issue in regards to discretionary fortification, even when participants were directly questioned about Health Canada permitting fortification of low nutritional value foods. In the context of discretionary fortification, Health Canada is viewed positively, with the general sentiment that it is looking out for the health of Canadians with this policy, and is doing its best to be pro-active in setting controls which would put safe limits on what manufacturers can do .

However, the research did identify an underlying trust issue with food manufacturers. When Health Canada communicates about discretionary fortification, it must be open and honest about if, and how, food manufacturers influenced the decision. Participants in most groups indicated that it is alright that food manufacturers have input and influence into discretionary fortification. What they needed to hear, and what they wanted to believe, is that Health Canada is looking after the best interests of consumers and not the manufacturers. Anything less than this will call Health Canada's credibility into question.

It is important to note that individuals will give more weight towards what Health Canada does, as opposed to what it says about discretionary fortification. Specifically, if Health Canada is perceived in any way to be endorsing (as opposed to controlling /setting limits) the marketing of foods of low nutritional value, an assumption will likely be made that Health Canada is looking out more for manufacturers than Canadians in general, regardless of what Health Canada may say to the contrary. This will raise questions about Health Canada's credibility in the future.