Effectiveness of front-of-pack nutrition labels in Saudi Arabia: a comparative study

Objectives To evaluate Saudi consumers’ understanding and food choices based on five FoPL systems using a validated methodology adapted from the international FOP-ICE (Front-Of-Pack International Comparative Experimental) study. Methods An online survey was administered to 1,500 Saudi adults (≥18 years) from all five regions. Eligible participants regularly purchased yoghurt, biscuits, or breakfast cereals. Participants were randomly assigned to view products with or without FoPLs and completed a structured questionnaire assessing their food choices and label understanding. Results Among respondents, 56.9% were female, and 47.4% were primarily responsible for grocery shopping. The greatest improvement in correct product choices was observed with the Multiple Traffic Light (MTL) label (31%), followed by Health Warnings (28%) and Nutri-Score (27%). The strongest associations with accurate nutritional ranking were observed for MTL (OR = 2.18, p < 0.001), followed by Health Warnings (OR = 1.83, p < 0.001) and Nutri-Score (OR = 1.56, p = 0.003). Nutri-Score and Health Star Rating (HSR) improved biscuit selection, whereas Health Warnings, HSR, and MTL influenced cereal choices ( p < 0.05). Significant associations with changes in nutritional quality were observed for gender, place of residence, responsibility for grocery shopping, and self-reported nutrition knowledge. Conclusion All FoPL systems improved food choices compared with no labelling. MTL, Health Warnings, and Nutri-Score were the most effective and well-received. MTL showed strong potential to guide healthier choices, whereas Nutri-Score may gain impact through broader public education and awareness.