Assessing public perception and awareness of UK mandatory calorie labeling in the out-of-home sector: Using Twitter and Google trends data

Two online randomised controlled trials examining effects of alcohol calorie labelling on hypothetical ordering of calories from alcohol and food

BACKGROUND

Providing calorie information for alcoholic beverages is a potential public-health intervention which may serve to reduce alcohol use but also overweight / obesity. Equivocal evidence has been found for the effectiveness of alcohol calorie information at reducing drinking intentions as well as purchasing and consumption. However, the extent at which calorie information 'on-trade' will impact consumer behaviour for both alcohol and food consumption has not been investigated.

AIMS

(1) To examine the presence of alcohol calorie labelling for hypothetical purchasing of alcohol and food in typical UK restaurant scenarios. (2) To determine the characteristics of individuals who will be likely to choose to view alcohol calorie labels.

METHODS

Two online randomised control trials using a hypothetical menu selection. In experiment one (N = 325) participants were randomised to the presence or absence of alcohol calorie labels. In experiment two (N = 1,081) individuals were randomised to alcohol calorie labels absent or the choice to view alcohol calorie labels. The primary outcome for each study was calories ordered from alcoholic beverages.

RESULTS

There was no evidence that the presence of alcohol calorie information on restaurant menus impacted the number of calories ordered from alcoholic beverages or from food and soft drinks. Younger individuals and individuals who exhibit greater motives for good health were more likely to choose to view alcohol calorie labels.

CONCLUSIONS

In two online, hypothetical experiments there is no evidence for alcohol calorie labelling impacting consumer decisions to order alcohol or food. Given the choice, a self-selecting group of individuals who are more motivated by health concerns will view alcohol calorie labels, and in turn may be less likely to order alcohol.

Point-of-choice kilocalorie labelling practices in large, out-of-home food businesses: a preobservational versus post observational study of labelling practices following implementation of The Calorie Labelling (Out of Home Sector) (England) Regulations 2021

BACKGROUND AND OBJECTIVES

On 6 April 2022, the UK government implemented mandatory kilocalorie (kcal) labelling regulations for food and drink products sold in the out-of-home food sector (OHFS) in England. Previous assessments of kcal labelling practices in the UK OHFS found a low prevalence of voluntary implementation and poor compliance with labelling recommendations. This study aimed to examine changes in labelling practices preimplementation versus post implementation of mandatory labelling regulations in 2022.

METHODS

In August-December 2021 (preimplementation) and August-November 2022 (post implementation), large OHFS businesses (250 or more employees) subject to labelling regulations were visited. At two time points, a researcher visited the same 117 food outlets (belonging to 90 unique businesses) across four local authorities in England. Outlets were rated for compliance with government regulations for whether kcal labelling was provided at any or all point of choice, provided for all eligible food and drink items, provided per portion for sharing items, if labelling was clear and legible and if kcal reference information was displayed.

RESULTS

There was a significant increase (21% preimplementation vs 80% post implementation, OR=40.98 (95% CI 8.08 to 207.74), p<0.001) in the proportion of outlets providing any kcal labelling at point-of-choice post implementation. Only 15% of outlets met all labelling compliance criteria post implementation, with a minority of outlets not presenting labelling in a clear (33%) or legible (29%) way.

CONCLUSION

The number of large businesses in the OHFS providing kcal labelling increased following the implementation of mandatory labelling regulations. However, around one-fifth of eligible outlets sampled were not providing kcal labelling 4-8 months after the regulations came into force, and the majority of businesses only partially complied with government guidance. More effective enforcement may be required to further improve kcal labelling practices in the OHFS in England.

PREREGISTRATION

Study protocol and analysis strategy preregistered on Open Science Framework (https://osf.io/pfnm6/).

Effect of calorie labelling in the out-of-home food sector on adult obesity prevalence, cardiovascular mortality, and social inequalities in England: a modelling study

BACKGROUND

England implemented a menu calorie labelling policy in large, out-of-home food businesses in 2022. We aimed to model the likely policy impact on population-level obesity and cardiovascular disease mortality, as well as the socioeconomic equity of estimated effects, in the adult population in England.

METHODS

For this modelling analysis, we built a comparative assessment model using two scenarios: the current implementation scenario refers to actual deployment only in large (≥250 employees), out-of-home food businesses, whereas the full implementation scenario refers to deployment in every out-of-home food business. We compared each scenario with a counterfactual: the scenario in which no intervention is implemented (ie, baseline). For both scenarios, we modelled the impact of the policy through assumed changes in energy intake due to either consumer response or product reformulation by retailers. We used data from the Office for National Statistics and the National Diet and Nutrition Survey 2009-19, and modelled the effect over 20 years (ie, 2022-41) to capture the long-term impact of the policy and provided mid-period results after 10 years. We used the Monte Carlo approach (2500 iterations) to estimate the uncertainty of model parameters. For each scenario, the model generated the change in obesity prevalence and the total number of deaths prevented or postponed.

FINDINGS

The current implementation scenario was estimated to reduce obesity prevalence by 0·31 percentage points (absolute; 95% uncertainty interval [UI] 0·10-0·35), which would prevent or postpone 730 cardiovascular disease deaths (UI 430-1300) of the 830 000 deaths (UI 600 000-1 200 000) expected over 20 years. However, the health benefits would be increased if calorie labelling was implemented in all out-of-home food businesses (2·65 percentage points reduction in obesity prevalence [UI 1·97-3·24] and 9200 cardiovascular disease deaths prevented or postponed [UI 5500-16 000]). Results were similar in the most and the least deprived socioeconomic groups.

INTERPRETATION

This study offers the first modelled estimation of the impact of the menu calorie labelling regulation on the adult population in England, although we did not include a cost-effectiveness analysis. Calorie labelling might result in a reduction in obesity prevalence and cardiovascular disease mortality without widening health inequalities. However, our results emphasise the need for the government to be more ambitious by applying this policy to all out-of-home food businesses to maximise impact.

FUNDING

European Research Council.

Acceptability and perceived harm of calorie labeling and other obesity policies: A cross-sectional survey study of UK adults with eating disorders and other mental health conditions

OBJECTIVE

We assessed perceptions of recently proposed UK obesity policies (mandatory calorie labeling, banning of advertisements of unhealthy food and drinks online and before 9 pm on TV, and banning "buy one get one free" deals for unhealthy food and drinks) in people with an eating disorder (ED) and other mental health conditions.

METHOD

A total of 1273 participants with a self-reported lifetime mental health condition (N = 583 with an ED) completed an online survey in September-November 2022. Multinomial logistic regression was used to examine support for and potential adverse effects of policies in participants with and without an ED. A qualitative analysis of the potential effects of the policy on current ED symptoms was also conducted to better understand how and why policies may be damaging or beneficial.

RESULTS

Participants with an ED had a lower level of support for the implementation of the calorie labeling policy compared to those without an ED (43% vs. 58%). Half of the participants with an ED (55%) reported that labeling may worsen their ED symptoms. Qualitative data indicated perceived potential harm (e.g., a gateway to relapse, negative effects on mood) and perceived benefits (e.g., feeling informed and reassured) of calorie labeling in participants with an ED. No differences in support or perceived harms of the other two policies were observed between participants with versus without an ED.

DISCUSSION

Future studies are warranted to explore the potential effects of calorie labeling and how to mitigate negative impacts on people with an ED.

PUBLIC SIGNIFICANCE

This research is the first to assess the perceptions of UK obesity-related policies in people with an ED and other mental health conditions. Participants with an ED (vs. without) were more likely to disagree with the government implementing the calorie labeling policy. These findings highlight the potentially harmful effects of calorie labeling in people with an ED and the need for future research to understand how to mitigate negative impacts.

The impact of calorie labelling and proportional pricing on out of home food orders: a randomised controlled trial study using a virtual food and drink delivery app

BACKGROUND

Mandatory calorie labelling in the out-of-home food sector was introduced in England in 2022, and menu pricing strategies that ensure cost is equivalent to portion size (proportional pricing) have been proposed as a policy to reduce obesity. Food delivery app-based platforms now contribute significantly to diet, and evidence suggests that those at a socioeconomic disadvantage may have greater exposure to unhealthy options on these platforms. However, public health policies to improve nutritional quality of food ordered from food delivery apps has received limited examination.

OBJECTIVE

This experimental study assessed the impact of calorie labelling and proportional pricing on item and meal size selection, calories ordered, and money spent when selecting food and drinks from three outlet types on a virtual delivery app.

METHODS

UK adult participants (N = 1126, 49% female), stratified by gender and education level completed an online study where they ordered items from three branded food and beverage outlets (coffee shop, sandwich outlet, fast food outlet) using a virtual delivery app. Participants were presented food and beverage options with vs. without calorie labels and with value (larger portions are proportionally cheaper) vs. proportional pricing.

RESULTS

Calorie labelling did not influence portion size selection for any outlets, but significantly reduced calories ordered from the coffee shop (-18.95kcals, 95% CI -33.07 to -4.84) and fast food outlet (-54.19kcals, 95% CI -86.04 to -22.33). Proportional pricing reduced the likelihood of choosing a larger beverage from the coffee shop (OR = 0.58, 95% CI 0.45 to 0.75), but was associated with increased calories ordered from the fast food outlet (51.25kcals, 95% CI 19.59 to 82.90). No consistent interactions were observed with participant characteristics, suggesting that effects of calorie labelling and pricing on outcomes were similar across sociodemographic groups.

CONCLUSIONS

Calorie labelling on food delivery platforms may effectively reduce calories ordered. Proportional pricing may be useful in prompting consumers to select smaller portion sizes, although further research in real-world settings will now be valuable.