Front-of-pack nutrition labelling (FOPL) is a major public health tool for promoting healthier food choices at the population level. The Health Star Rating (HSR) system, introduced in Australia and New Zealand in 2014, assigns a summary rating of ½ to 5 stars to packaged foods to indicate overall nutritional quality. While the system has achieved relatively high consumer awareness, fundamental questions remain unanswered: do consumers interpret the HSR scale in a threshold-based manner — that is, do they set a minimum star count below which a food is deemed "unhealthy"? And if so, does this threshold vary according to food category?
This scoping review maps the current evidence on consumer perceptions of healthiness as communicated by the HSR, with a specific focus on whether consumers apply categorical thresholds when interpreting star ratings, and whether such thresholds are consistent across food categories.
A systematic literature search was conducted across eight electronic databases (Medline, ScienceDirect, Web of Science, CINAHL, PubMed, Scopus, Embase, and Global Health), covering publications from January 2000 to April 2025. Inclusion was restricted to peer-reviewed English-language studies examining consumer perceptions, behaviours, or attitudes toward the HSR in Australia or New Zealand. Thirteen studies meeting eligibility criteria were identified and narratively synthesised using the Joanna Briggs Institute (JBI) scoping review framework.
Thirteen studies published between 2016 and 2021 were included, comprising focus groups (n=5), discrete choice experiments and surveys (n=5), and randomised controlled trials (n=3). Evidence suggests that consumers do apply directional thresholds when interpreting the HSR: foods rated ≤2 stars are broadly perceived as nutritionally poor, while foods rated ≥3 stars are perceived as healthier. However, no study has directly elicited the consumer-defined cut-off point across multiple food categories. At least four distinct cutoff points (<2.0, ≥2.5, ≥3.0, and ≥3.5 stars) are in concurrent use in research and policy without empirical consumer validation. Ultra-processed foods (UPFs) frequently achieve star ratings consumers associate with healthiness, creating systematic "health halo" effects.
Consumer thresholds for HSR-based healthiness perceptions are understudied, inconsistently defined across research and policy, and not validated against consumer behaviour. This review identifies critical gaps to guide future primary research and informs the ongoing policy debate around HSR mandatory implementation and algorithmic reform.
Keywords: Health Star Rating; front-of-pack labelling; consumer perception; healthiness threshold; food labelling policy; nutrition labelling; Australia; New Zealand; ultra-processed foods; scoping review