New research suggests mandatory calorie labeling alone is insufficient for healthier food choices

Mandatory calorie labeling in England’s out-of-home sector has not lowered calorie consumption, according to a new study by the University of Liverpool, UK. Although consumer awareness of calorie labeling doubled during the policy’s implementation in April 2022, only 22% of surveyed consumers reported using the information to make food choices.

The researchers surveyed 6,578 customers from 330 outlets, examining their purchased and consumed calories, knowledge of purchased calories and reported noticing and using labeling. Half the participants were surveyed before the policy was implemented, and the remainder in the first four to eight months after its implementation. 

Although the study notes that mandatory kcal labeling legislation alone is unlikely to impact out-of-home eating substantially, it may lead to wider and substantial public health impact and shift social norms when combined with other public health policies. For example, the authors point to the UK’s soft drinks industry levy and restrictions on unhealthy food advertising. 

“Future research would benefit from examining the impacts of multiple newly implemented policies and the combined impact of these policies on public health,” reads the report. 

“In my view, the study should not be taken as evidence that this policy has no efficacy. It highlights that by itself, calorie labeling will not be sufficient to address problems driven by a very complex food system,” comments Dr. Hilda Mulrooney, Nutrition & Health reader at  London Metropolitan University, UK. She was not involved in the study. 

“There was marked underestimation of the calorie content of foods purchased, although this was lower post- compared with pre-implementation. This highlights the need for ongoing education, and calorie labeling is part of this. Consumers cannot make informed choices without information. Linked to this, the format and presentation of nutritional information need to be clear, legible and understandable to consumers. Understanding what works best for consumers needs exploration.”

Growing consumer awareness

The study, published in Nature Human Behaviour, reveals that 31.8% of participants were more aware of calorie labels after implementation compared to 16.5% before. 

Tom Sanders, professor emeritus of Nutrition and Dietetics at King’s College London, adds that the difference in awareness of calorie labeling was most significant among people who were better off than the poorest participants. Sanders was not involved in the research. 

“It also seemed that labeling was more likely to be noticed in pubs rather than cafes, which the authors attribute to time spent perusing the menu,” he says. “Calories consumed in fast food outlets were greater compared with cafes, but far more calories were consumed in pubs and restaurants.”

People consumed most calories in pubs and restaurants, where labeling was also more likely to be noticed.“The takeaway from this study is that on its own, mandatory calorie labeling is an ineffective public health measure to prevent obesity. This would support the view that calorie labeling alone does not motivate people to change their dietary habits. However, calorie labeling is useful for motivated individuals.”  

In addition, Sanders says that mandatory nutrition labeling has helped computer programs and apps provide accurate and up-to-date estimates of nutrient intakes using product barcodes, which are helpful for nutritionists, dietitians and motivated individuals. “Consequently, it would be a backward step to abolish mandatory calorie labeling for the out-of-home food sector.”

Menu reformulation

The study authors point to menu reformulation as another pathway to reduce calorie consumption, suggesting that the UK’s policy may have impacted overall kcal consumption. 

They refer to earlier research finding a slight reduction in mean kcals in online menus between September 2021 and 2022, as out-of-home food outlets removed higher-calorie items and introduced lower-calorie options. There were no changes in calories for other continuously available items pre- and post-implementation. 

Dr. Mulrooney says the study does not clarify “whether and to what extent any such reformulation may have taken place,” but it was not evident for continuously available menu items.  

“Reformulation could result in marked changes to the overall calorie and nutrient content of dishes, thereby affecting consumer intake without a change in their conscious behaviors. Most of our daily food decisions are unconscious, so this is an important route to improving dietary intakes.” 

She adds that the study’s calorie content of out-of-home food sector meals was above the UK public health recommendations of 600 kcals per meal. 

“This again suggests that reformulation, including portion sizes, is an aspect that needs attention and could make a real difference, particularly to those groups who purchase and consume out-of-home food sector foods regularly.”

Another team from the University of Liverpool suggests making calorie-free menus available alongside menus with calorie information to accommodate people with eating disorders. Seeing calorie information on menus may increase their vulnerability, exacerbate symptoms or perpetuate weight stigma. 

Research also suggests that the food environment significantly impacts food choices. For example, digital ordering and sampling can lead to unhealthy food purchases, while spending time in nature or looking at green spaces outside the window helps nudge people to make healthier choices.