Five years of evolving dual red/green front of package food labeling: Criteria evolution and governance lessons from Israel's scientific committee

In 2020, the Israeli Ministry of Health introduced a front-of-package labeling (FOPL) policy featuring both mandatory red warning labels for excessive sugar, sodium, or saturated fat, as well as a voluntary green positive label for foods that align with national dietary guidelines. This study aims to systematically document and analyze the activities of the Scientific Committee, which is responsible for defining and updating the positive FOPL criteria from 2020 to 2024. The committee operated independently, without involvement from the food industry. A retrospective analysis was conducted using official protocols, stakeholder submissions, and regulatory updates. Over the course of five years, the committee held ten meetings and implemented three formal updates. Of the 88 inquiries received, 77 (87.5%) were submitted by industry stakeholders, with 56 requiring a full review; 41% of these were approved, with no significant difference between industry and non-industry submissions. The updated criteria adopted five core principles that expanded eligible food categories and clarified standards for processing and additives, particularly for bread, legumes, and dairy. Eligible products must: (1) not carry any warning FOPL, (2) meet a uniform maximum sodium threshold, (3) be unprocessed, minimally processed, or processed foods (as classified by NOVA) without preservatives, containing only permitted enrichment or allowed additions (such as salt or spices); ultra-processed foods are excluded except for specific exceptions, (4) align with Israeli nutritional guidelines, including preparation and consumption patterns, and (5) provide a significant nutritional contribution to the overall diet. The number of inquiries declined over time. Notably, approximately 36% of inquiries concerned products whose eligibility was clearly defined in published criteria, indicating a need for improved communication and outreach to stakeholders. This study underscores the importance of transparent, expert-led, and adaptive processes in nutrition policy. The Israeli FOPL model may serve as a valuable reference for other countries looking to implement dynamic, health-promoting labeling systems.