175

13
Consumer Reactions to Health
Claims on Food Products
Klaus G. Grunert and Lisa Lhteenmki
13.1 HEALTH CLAIMS FROM A CONSUMER PERSPECTIVE
Healthiness is one of the major quality attributes that consumers look for in food products, second
only to taste (Grunert 2005). However, in contrast with taste, healthiness cannot be perceived
directly by the human senses; it is what is called a credence attribute. Health needs to be commu-
nicated, and this communication may be more or less credible and convincing. It may be understood
correctly, or lead to different kinds of inferences in the mind of the consumer.
Communication promising that a food product has positive health effects is called a health claim.
Health claims have become a major issue in the development and marketing of healthy food prod-
ucts, and especially functional foods. There has been widespread concern that consumers could be
misled by health claims to believe that food products have health properties that they in fact do not
possess. As a result, the use of health claims has been regulated. In the EU (EU Regulation
1924/2006) health claims are allowed on food products if they are based on scientifc evidence. The
strength of this evidence is assessed by the European Food Safety Authority (EFSA) with its expert
groups, and based on their advice the European Commission makes decisions on which claims are
allowed. EFSA has been following a strict practice with regard to the evaluation of health claims,
and as a result, few products with health claims are found on the European market at present. But
even if health claims are based on suffcient scientifc evidence so that they can pass the legal hur-
dles and in fact be used on food products, the questions remains how consumers will perceive them,
and how they will affect their purchasing and eating behavior.
Health claims have been the subject of a good deal of consumer research (for overviews see
Pothoulaki and Chryssochoidis 2009; Williams 2005). Issues addressed have been the effects of
health claims on overall product evaluations and purchase intentions (e.g., Garretson and Burton
2000; Lyly et al. 2007), on product sales (e.g., Ippolito and Mathios 1991, 1994), and on infer-
ences about other product attributes (e.g., Andrews etal. 1998; Mitra etal. 1999; Roe etal. 1999).
Also, the possible reciprocal impact of health claims and nutrition information has been analyzed
(e.g., Ford et al. 1996; Mazis and Raymond 1997; Kozup et al. 2003). Despite this stream of
research, we still have a rather fragmented view of the factors that infuence how consumers react
to health claims. In the following, we will frst present a theoretical framework that is useful for
Q1
CONTENTS
13.1 Health Claims from a Consumer Perspective ..................................................................... 175
13.2 The Role of Health Claims in the Process of Quality Perception ...................................... 176
13.3 Which Type of Health Claim is Most Convincing? ............................................................ 178
13.4 Consumer Understanding of Health Claims ....................................................................... 179
13.5 What Are the Inferences from Health Claims? .................................................................. 182
13.6 The Future of Health Claims from a Consumer Perspective .............................................. 183
References ...................................................................................................................................... 184
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176 Innovation in Healthy and Functional Foods
distinguishing different questions that can be posed on how consumers react to health claims on
food products. We will then go into more depth with regard to three of these questions:
1. What determines whether a health claim is regarded as convincing by consumers?
2. Are consumers able to understand health claims correctly, and are some consumers more
apt to misunderstand health claims than others?
3. How does the presence of the health claim affect the overall perception of the product?
In answering these questions, we will draw on research undertaken to shed light on these issues,
drawing especially on a consumer study carried out in the Nordic countries (Grunert et al. 2009;
Lhteenmki etal. 2010) and a study carried out together with Danone in Germany (Grunert etal. 2011).
13.2 THE ROLE OF HEALTH CLAIMS IN THE PROCESS
OFQUALITYPERCEPTION
We argue that the effect of health claims on consumers can be understood best by regarding health
claims as quality cues. To illustrate this, we draw on the work on consumer food quality perception
done within the framework of the Total Food Quality Model (Grunert 2005). A simplifed version of
this model is shown in Figure 13.1. Consumers evaluate food quality on some key dimensionstypi-
cally taste, healthiness, convenience, and production process. All of these are uncertain before the
purchase, and consumers therefore need to use quality cues to make (uncertain) inferences about the
expected quality. Two types of cues are distinguished in the quality perception literature: intrinsic cues
(physical characteristics of the product) and extrinsic cues (everything else, including all communicational
Before purchase: formation
of quality expectations
Cost
cues
Extrinsic
quality
cues
Intrinsic
quality
cues
After purchase: quality
experience
Perceived
costs
Expected
quality:
Experienced
quality:
Taste
Health
Convenience
Process
Taste
Health
Convenience
Meal
preparation
Intention
to buy
Health
FIGURE 13.1 Function of health claims in process of quality perception and formation of purchase intentions.
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177 Consumer Reactions to Health Claims on Food Products
cues). After the purchase, some dimensions of qualitytaste, conveniencebecome amenable to
experience, so that expectations can become confrmed or disconfrmed, whereas othershealthiness,
production processremain a question of communication also after the purchase.
A health claim is an extrinsic quality cue. Looking at the possible role of health claims as extrin-
sic quality cues in the quality perception process, the following questions can be asked:
1. Are health claims used as extrinsic cues when buying food?
This refers to the question whether health claims on food products are indeed noticed,
read, and further processed, with a possible impact on purchase decisions made.
2. Which types of health claims are regarded as more convincing?
Health claims come in several variations, combining information about active ingredients,
their physiological function and the resulting health beneft. They can also be formulated
in different ways, for example by positive/negative framing of the message or the use or
non-use of qualifers. We will address this question in more detail below.
3. Does presence of health claims affect use of other cues?
Some cues have a summary function in the quality perception process and make, when
present, the processing of other cues redundant. The major example of such a summary cue
is the brand name, which consumers may view as summarizing information on various
aspects of the product. Health claims may likewise be used as summary cues, and may for
example lead consumers to believe that the processing of information about the nutritional
content of the product is not necessary.
4. Do consumers understand the health claim correctly?
Understanding means assigning meaning to the message. Understanding is always a con-
structive process and there is no one-to-one correspondence between message and per-
ceived meaning; but in the case of health claims there is a concern about whether what the
consumer understands is within the realms of the scientifc dossier on the health claim. We
will deal more with this question below.
5. What are the inferences from the health claim?
It is common in the quality perception process that consumers make inferences beyondthe
manifest meaning of a message. This also goes for health claims, even when they are
correctly understood. Two types of inferences have been discussed in the literature: the
magic bullet effect and the halo effect. The magic bullet effect implies that con-
sumers may believe that if a product has a certain specifc health beneft,as indicated by
the health claim, then the product as a whole is also healthier than comparable products
without a health claim. The halo effect implies that the positive evaluation that a
consumer attaches to a health claim may spread to the overallevaluation of the product,
so that the product is regarded as generally superior to other products without this health
claim. These questions will be dealt with in more detail below.
6. How will health claims affect purchase intention?
This refers to the question whether health claims indeed move purchases. Healthiness is
almost never the only criterion when buying food, and any healthiness inferred from the
health claim will be traded off against other criteria, notably taste, convenience, and pro-
duction process.
7. Will the effect of health claims build up or wear off over repeated purchases?
Since health qualities are not reinforced by immediate gratifcation like taste and conve-
nience qualities are, there is the possibility that over time health-related qualities diminish
in importance compared with the experience qualities (especially) taste and convenience.
Continuous communication would then be necessary to remind the consumers about the
health-related qualities. On the other hand, purchase of the product bearing the health
claim may become habitualized and no wear-off will occur. Little is known about these
longitudinal effects of health information on food products.
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178 Innovation in Healthy and Functional Foods
In the following, we will present some examples of studies shedding light on which health claims
are regarded as convincing, on whether health claims are understood, and on the inferences made
form health claims.
13.3 WHICH TYPE OF HEALTH CLAIM IS MOST CONVINCING?
What makes health claims convincing? Three issues have dominated the discussion on this issue.
The frst refers to the architecture of the health claim. Health claims usually contain one, two, or
all three of the following components: information about a functional ingredient, information
about the physiological function of the ingredient, and information about the health beneft. These
components can occur by themselvesfor example the claim This product contains omega-3
contains only information about the active ingredient, whereas the claim This product promotes
cardiovascular health contains only information about the health beneft. Or they can occur
togetherthe claim This product contains omega-3 which reduces blocking of arteries con-
tains information about the ingredient and about the physiological function. The claim This
product contains omega-3 which may help to keep arteries clean and therefore promote cardiovas-
cular health contains both ingredients, physiological function and health beneft. Research on
which combination of elements is most convincing to consumers (Bech-Larsen and Grunert 2003;
van Trijp and van der Lans 2007; Verbeke et al. 2009) has not led to conclusive evidence, but
failed to take into account that consumers may differ in their ability to interpret health claims,
which may be related to the diverging effects. The second issue refers to whether a health claim
is framed positively or negatively. The claim This product contains omega-3 which reduces
blocking of arteries is negatively framed, whereas the claim This product contains omega-3
which may help to keep arteries clean is positively framed. Also research fndings are not con-
clusive here, suggesting that whether positive or negative framing works best may depend on the
type of health beneft (Svederberg 2002; van Kleef etal. 2005). Finally, the third issue refers to
the use of qualifers, like this product may reduce . . ., which may make a claim less convincing
because of the weaker formulation, but at the same time may increase credibility of the claim
(Kapsak etal. 2008).
A recent study conducted in the fve Nordic countries (Grunert etal. 2009) investigated all the
above three issues by constructing claims that included all logically possible combinations of the
three elements ingredient/physiological function/health beneft, which were then tested both with
positive and negative framing, and with and without the use of qualifers. Two active ingredients
were usedomega-3 and bioactive peptidesand three benefts were used as examples: cardiovas-
cular health, memory functions, and weight management, as these represent the three kinds of func-
tions allowed in the new EU legislation (Regulation (1924/2006).
A total of 4612 respondents flled out a survey on the web in the fve Nordic countries. Claims
were presented in pairs, and respondents had to decide which of the two claims in a pair was more
convincing. The active ingredient and structure of the claim had the most impact on whether the
claim was found convincing, whereas framing and qualifer had only a minor role. Claims contain-
ing omega-3 were found much more convincing than claims about bioactive peptides, which can be
interpreted as a familiarity effect. When the active ingredient was familiar omega-3 the claim on
cardiovascular health and dementia was perceived to be more convincing than claims with no ingre-
dient or with bioactive peptides. For weight management the ingredient did not add convincingness:
not mentioning the ingredient was as convincing as having omega-3 as a functional component, the
unfamiliar bioactive peptides were less convincing than not mentioning the ingredient at all.
Consumers use their existing knowledge when assessing the claims and familiarity seems to be
crucial for fnding the claim convincing.
As regards claim architecturethe combination of information on ingredient, physiological
function, and health beneftthe respondents could be divided into two groups according to the
way they perceived the convincingness of the claims (Figure 13.2). The beneft only group (46%)
K12908_C013.indd 178 5/9/2012 9:00:38 AM
179 Consumer Reactions to Health Claims on Food Products
thought that short claims describing the function or the health outcome only were most convincing,
whereas longer claims were less convincing. The other half of respondents, the know all group
(54%), found the longest claim having the whole chain of information from ingredient via function
to health outcome as most convincing. Previous exposure to health claims seems to facilitate the
ability to process the information in long claims. When the shares of individuals belonging to the
beneft only and know all groups were compared among the fve Nordic countries, the size of
know all people was clearly higher in Finland and Sweden, where health claims have been allowed
even before EU-legislation. There were also a higher proportion of know all respondents among
women than among men.
These results suggest that consumers previous knowledge and experience plays a major role in
the perception of health claims, and that their effects therefore need to be seen in a dynamic per-
spective. Certain ingredients, like omega-3, can achieve brand-like status and just mentioning them,
even without any information on their function and associated benefts, can be a convincing selling
argument to consumers. And while consumers unfamiliar with health claims may easily be over-
whelmed by excessive information and technical language, repeated exposure and processing of
this type of information results in greater profciency and may also result in a preference for more
informative claims.
13.4 CONSUMER UNDERSTANDING OF HEALTH CLAIMS
If consumers do not understand the health claims that are attached on the product, the health
claimhas at best no effect on consumer behavior and in the worst cases misleads the consumer into
believing that the product has some characteristics which it in fact does not have. Formulating
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
Omega-3 Bioactive
peptides
Function Health
outcome
Group 1: know all Group 2: benefit only
Ingredient
+
Function
Ingredient
+
Health
outcome
Function
+
Health
outcome
Ingredient
+
Function
+
Health
outcome
FIGURE 13.2 Effect of active ingredient and claim architecture on likelihood of fnding a claim more
convincing (paired comparisons). (From Grunert, K.G. et al. 2009. Journal of Consumer Policy, 32,
269287.)
K12908_C013.indd 179 5/9/2012 9:00:39 AM
180 Innovation in Healthy and Functional Foods
health claims in a way that consumers will understand, and understand correctly, is required both
by legislation and by corporate social responsibility. Health claims should therefore be tested for
consumer understanding, and such testing should include a comparison of different types of poten-
tial customers, such that groups of consumers who may be especially vulnerable with regard to
misunderstanding a claim can be identifed. Such testing calls for a standardized methodology
(Leathwood etal. 2007a,b). However, studies on understanding of health claims have been rather
sparse. Qualitative studies showed considerable potential for consumer confusion and misunder-
standing (Food Standards Agency 2002; Svederberg 2002). A few studies have related understand-
ing to demographic criteria (low-educated consumers understand less, Fullmer et al. 1991) and
previous knowledge (knowledgeable consumers understand better, Andrews et al. 2000). No stan-
dardized methodology has become adopted in the consumer research community.
A promising methodology for measuring consumer understanding of health claims is the con-
sumer understanding test (CUT) developed by Danone (see Rogeaux 2010). CUT is a web-based
approach, where the health claim is presented to respondents in the context of the packaging and/or
the TV commercial in which it appears; for the packaging, respondents have the possibility to view
all faces of the product. After exposure, respondents are asked two questions:
After seeing this pack and commercial, if you had to tell a friend what XXX does, what would
you say?
And if you had to tell a friend how it works?
These are open questions, and respondents type their answers into a screen window. The use of
open questions does not preclude any type of answer. Answers are content analyzed into a hierarchi-
cal coding scheme, and each resulting code is then categorized as follows:
Safe: the statement is in line with the scientifc dossier
Risky: the statement is not in line with the scientifc dossier
Vague: the statement expresses a vague notion (e.g., a healthy product) or an expression that
is irrelevant with regard to the health claim (e.g., the product is easy to eat)
The CUT methodology was developed according to the principles recommended by ILSI
(Leathwood etal. 2007b; see also Leathwood etal., 2007a). It combines a qualitative and a quantita-
tive approach, and it investigates how the health claim is understood in the context in which it
appears in a real-life exposure situation.
As an example, a health claim for the Danone product Actimel was studied with a sample of 720
respondents in Germany (Grunert etal. 2011). The health claim was Actimel helps strengthens the
bodys natural defenses (in German: Actimel aktiviert Abwehrkrfte). Answers to the open ques-
tions on understanding of the health claim were coded and, according to the scientifc dossier on the
health claim, classifed as safe, risky, or vague (where vague answers could be beneft-related or
not). Depending on their coded answers, respondents were classifed into three categories: respon-
dents with answers categorized only as safe, and respondents with answers classifed partly as safe
and partly as vague, were categorized as safe. Respondents with at least one answer classifed as
risky, or with answers that were only vague but at least partly beneft-related, were classifed as
risky. Respondents giving no answer or respondents whose answers were all vague and not beneft-
related were classifed as other.
Of the potential determinants of understanding measured, only attitude to functional foods
emerged as a direct predictor of respondent membership in the three categories of claim understand-
ing. The other latent constructsinterest in healthy eating and subjective knowledge on food and
healthas well as the demographic characteristics of the respondent had no predictive power with
regard to respondent membership in the three categories of claim understanding. Figure 13.3 shows
how membership probability of the three categories of understanding is related to membership in the
Q2
Q3
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181 Consumer Reactions to Health Claims on Food Products
35
(a)
(b)
(c)
Base rate
Base rate
Base rate
%

o
f

r
e
s
p
o
n
d
e
n
t
s

i
n

o
t
h
e
r

c
a
t
e
g
o
r
y
%

o
f

r
e
s
p
o
n
d
e
n
t
s

i
n

r
i
s
k
y

c
a
t
e
g
o
r
y
%

o
f

r
e
s
p
o
n
d
e
n
t
s

i
n

s
a
f
e

c
a
t
e
g
o
r
y
30
25
20
15
10
5
0
Very negative Negative,
excessive
promises
Other
Risky
Safe
Neutral,
doesnt care
Neutral, sees
possibilities
Positive, not
quite
convinced
Very positive
Very negative Negative,
excessive
promises
Neutral,
doesnt care
Neutral, sees
possibilities
Positive, not
quite
convinced
Very positive
Very negative Negative,
excessive
promises
Neutral,
doesnt care
Neutral, sees
possibilities
Positive, not
quite
convinced
Very positive
35
30
25
20
15
10
5
0
80
70
60
50
40
30
20
10
0
FIGURE 13.3 Relationship of attitude to functional foods to categories of claim understanding. (From
Grunert, K.G., Scholderer, J., and Rogeaux, M. 2011. Appetite, 56, 269277.)
Q4
K12908_C013.indd 181 5/9/2012 9:00:39 AM
182 Innovation in Healthy and Functional Foods
six categories of attitude to functional foods. We can see that respondents in the other category either
have a very negative attitude to functional foods or do not care about functional foods. We can also
see that the probability of being in the risky group is higher for respondents with a positive attitude
to functional foods. The picture is not quite as clear with regard to membership in the safe category,
where differences between the six categories of attitude to functional foods are less pronounced.
The study illustrates the use of the CUT methodology to study consumer understanding of health
claims, and it gives an indication of which consumers may be most apt to misunderstand the health
claim: those that are most enthusiastic about functional foods. Since standard measures for measur-
ing attitude to functional foods exist (Urala and Lhteenmki 2007), conducting tests of under-
standing that focus on this group of consumers is easy to implement.
13.5 WHAT ARE THE INFERENCES FROM HEALTH CLAIMS?
One specifc concern about health claims has been that consumers may think that foods with health-
related claims offer a magic bullet against all health problems or that these products are perceived
as generally superior (a halo effect). A magic bullet effect occurs if a consumer associates the
product with inappropriate health benefts (Roe etal. 1999). For example, from a low cholesterol
claim it might be inferred that the product will automatically help against cardio-vascular disease.
A halo effect occurs if the consumer generalizes positive perceptions to other product attributes
(Roe etal. 1999). For example, a low cholesterol claim may lead to assume that the product is low
in fat even though this is not mentioned in the claim.
In previous studies health-related claims have resulted in higher ratings of perceived healthiness,
but the increase has been small or moderate (Urala and Lhteenmki 2003; Lyly etal. 2007; van
Trijp and van der Lans 2007). Inferences to other product-quality attributes have been studied less
in products with health claims, but there are suggestions that health and taste can sometime be
regarded as opposite attributes so that increasing healthiness results in decreased palatability
(Hamilton et al. 2000). Adding health claims to food products may on one hand increase health
value by adding new health benefts, but, may on the other result in inferences on less eating quality
and naturalness and thus decrease their appeal.
Effects of health claims on the perception of other product attributes (attractiveness, healthiness,
naturalness, and tastiness) were studied in the Nordic investigation referred to above (Lhteenmki
etal. 2010). Respondents had to rate product descriptions (yogurt, bread, or pork chops) with differ-
ent health claims according to expected tastiness, healthiness, naturalness, and overall attractive-
ness, and these ratings were compared with ratings of the same products without any claim. On
average, putting a health claim on the product resulted in lower ratings on all attributes compared
with the same product without a health claim (Figure 13.4), suggesting that negative inferences were
elicited by the health claim. Also here, the familiarity of the active ingredient (omega-3 or bioactive
peptides) made a big difference on how the health claims affected the perception of other attributes.
With the familiar omega-3 the perceived healthiness did not change compared with the base product
and decrease in perceived tastiness, attractiveness, and naturalness was clearly lower than for the
unfamiliar bioactive peptides. The ingredient also had a different effect depending on the carrier
product. Omega-3 was perceived positively when added to bread, but negatively when added to
pork. Bioactive peptides were perceived less negatively when added to bread and yogurt than to
pork. Regardless of the familiarity, both ingredients caused a major decrease in perceived natural-
ness. This was especially steep for pork chops and may be due to peoples beliefs that adding things
to raw meat requires more drastic methods than adding things to processed foods, such as yogurt
and bread, although enhancement can be achieved through animal feeding. Furthermore, yogurt
and bread products already are common carriers of health claims whereas meat is not.
The amount of information in the claim had an impact on how the product characteristics were
perceived. Claims that contained, in addition to ingredient, information about the function and the
outcome of the claim reduced the negative responses to the unfamiliar bioactive peptides, whereas
Q5
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183 Consumer Reactions to Health Claims on Food Products
for omega-3 the additional information had a mild negative impact. The former can be explained by
more information increasing the awareness of the component, but the responses to omega-3 are
more diffcult to explain. Perhaps omega-3 elicits a number of positive associations in peoples
minds and specifying them to specifc functions and outcomes limits these associations. However,
whether the promised outcome was improving ones health or avoiding a possible disease had no
impact on the perception of product characteristics. The country-wise differences among Denmark,
Finland, Norway, and Sweden refect the earlier exposure to health claims. The negative infuences
were the clearest in Denmark and smallest in Finland with Norway and Sweden somewhere in
between.
While the average inference effects of the health claims were thus predominantly negative, there
was a minority of respondents where the effects were in fact the opposite, that is, the claims did lead
to positive inferences. This underlines the role of food products bearing health claims as niche
products.
13.6 THE FUTURE OF HEALTH CLAIMS FROM A CONSUMER PERSPECTIVE
The discussion about legal restrictions of health claims, the requirements with regard to the docu-
mentation of scientifc evidence and, in Europe, the restrictive practice of the European Food Safety
Authority has to a large degree masked the discussion about how consumers will react to health
claims. But being allowed to put a health claim on a product is only the frst step. Whether it will
have any effect on the sales of a food product will depend on whether the health claim is perceived
as convincing and is understood. It will also depend on which other inferences are made from the
health claim, and the role it will play in the overall evaluation of a food product. Along that road,
numerous pitfalls exist, resulting in health claims that may be ignored, misunderstood, or result in
negative effects on overall product evaluation.
In addition, health claims are only one of many indicators that consumers use when forming
opinions about the healthiness of a food product. Other product-related information that can have an
impact on the evaluation of healthiness include nutrition information, ingredients, use of additives,
the degree of processing, whether the product is artisanal or industrial, origin, and whether the
product is organic. This is complemented by information that consumers obtain from the media and
from word-of-mouth.
For food manufacturers trying to develop and market products based on health benefts, this
implies that health claims have to be seen in the context of market communication. Consumers form
0.2
Attractive Healthy Natural Tasty
Bread
Yoghurt
Pork
0.2
0.4
0.6
0.8
1
1.2
p < 0.001
p < 0.001
p < 0.001
p < 0.001
1.4
0
FIGURE 13.4 Effect of adding a health claim to evaluation of products on several quality dimensions (means
and standard errors). (From Lhteenmki, L. etal. 2010. Food policy, 35(3), 230239.)
K12908_C013.indd 183 5/9/2012 9:00:40 AM
184 Innovation in Healthy and Functional Foods
opinions about food products, including their healthiness and health benefts, based on the totality
of information that is available on these products. Health claims will always only be a part of this,
albeit an important one. Health claims are not a panacea for modern food production, but just one
element in the process of developing and marketing healthy food products.
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