Calorie labeling in England linked to only small reductions in out-of-home food

Calorie labeling, which became law in April 2022 in England, is associated with only a small (2%) average reduction in the energy content of food that is available away from home, finds research published in the open access journal BMJ Public Health.

And these changes are primarily due to swapping in slightly lower calorie items, rather than reformulating existing ones, with no changes observed in continuously available items. The impact on population health is likely to be "moderate to limited," conclude the researchers.

Eating at restaurants, fast food outlets, and ordering takeaways, collectively known as out-of-home food outlets, is common and associated with poorer dietary quality, weight gain, and obesity, explain the researchers. 

Calorie labeling aims to try and counter this and improve public health by providing consumers with calorie information at the point of sale, they add.

In England calorie labeling regulations require large (at least 250 employees) food and non-alcoholic drink outlets to display kilocalories on their offerings.

The international evidence on how these policies affect what is offered is somewhat mixed, note the researchers. To strengthen the evidence base, they compared changes in the energy content of menu items before and after the introduction of calorie labeling, stratified by food group and food business (chain) type.

They used the MenuTracker database to find out what changes had been made to the average energy content (Kcal values) of new, removed, and continuously available food items, and to assess the proportions of menu items exceeding recommended energy intake (above 600 kcal) per meal.

MenuTracker collects the food item name and description, serving size, energy, macronutrients, fibre, salt, allergens, special dietary information and menu section (children's or sharing items, for example).

The researchers focused on data collected in September 2021 for 79 chains (before the introduction of the regulations) and September 2022 for 90 chains (after the regulations had come into force). The final analysis included 31,045 menu items from 78 chains in both time periods.

The chains were classified as: cafes and bakeries; Western fast food and takeaways; pubs, bars, and inns; restaurants; sports and entertainment venues; and Asian fast food.

And menu items were classified as appetisers and sides; baked goods; beverages; burgers; desserts; fried potatoes; mains; pizza; salads; sandwiches; soup; and toppings and ingredients.

A significant average reduction per item was observed for non-alcoholic and soft drinks of 36 kcal, equivalent to a drop of nearly 16.5% in energy content.

And the average energy content of burgers fell by 103 kcal (11% reduction), and by 30 kcal for mains (4% reduction). 

But, overall, only a small reduction of 9 kcal (2% reduction) in average energy content per item was observed after the regulations had come on stream. 

Analysis of chain type revealed significant average reductions per item in pubs, bars, and inns (a reduction of 52 kcal; 9%); restaurants (a reduction of 23 kcal; 5%); and sports and entertainment venues (a reduction of 49 kcal;13.5%).

But changes were driven primarily by the removal of higher (average 458) kcal items and the addition of lower (average 434) kcal new items. 

And there was no significant change in energy content for continuously available items, indicating limited evidence of reformulation, say the researchers.

Before the introduction of the regulations continuously available items had an average energy content of 437 kcal; afterwards they had an average energy content of 439 kcal. 

Removed items contained an average of 21 kcal more than continuously available items and 25 kcal more than new items.

As to the recommended 600 kcal limit per meal, 22% of items remained over this limit. The food groups with the most items over 600 kcal were burgers, mains, and pizzas, and the

chain types with the most items exceeding this limit were restaurants and pubs, bars and inns.

The researchers acknowledge various limitations to their findings, including that MenuTracker only includes menu information from chains that posted kcal information online before and after the policy. 

The calorie labeling regulations also allow kcal information to be within plus or minus 20% and permit several different methods for estimating energy content, they add.

"We found more evidence of menu change rather than reformulation, with items removed from menus being higher energy than continuous items. Thus, the impact of a calorie labeling policy on food may differ from other policies like the Soft Drinks Industry Levy, which created an economic incentive for, and was associated with, substantial reformulation," point out the researchers.

Reformulating drinks may be easier for manufacturers to do than reformulating foods, and previous research indicates that large outlets are reluctant to reduce portion sizes because of how customers might perceive this, they acknowledge. 

But they suggest: "The small reduction in average kcal of items available on menus we found is likely to have modest to limited impact on population health."

And for these "to lead to meaningful population health improvements, consumers would need to shift purchases towards the lower calorie items," they add.