Intended for healthcare professionals

Editorials

New calorie labelling regulations in England

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1079 (Published 04 May 2022) Cite this as: BMJ 2022;377:o1079
  1. Asha Kaur, intermediate research fellow1,
  2. Adam Briggs, honorary associate professor2,
  3. Jean Adams, associate professor3,
  4. Mike Rayner, professor1
  1. 1Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Warwick Medical School, University of Warwick, Warwick, UK
  3. 3MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
  1. Correspondence to: A Briggs adam.briggs{at}warwick.ac.uk

One small step in the right direction

Regulations came into effect on 6 April1 requiring restaurants, cafes, and takeaways in England to provide calorie information on menus and food displays, including those online. The legislation applies only to businesses with over 250 employees, with exemptions for charities, hospitals, care homes, and temporary menu items. But this is still an important milestone in government obesity policy—an area where promised interventions are not always delivered.2

The global burden of diet-related ill health is growing.34 In England, 68% of men and 60% of women are overweight or obese.5 Recent estimates suggest a huge jump in rates of childhood obesity. Over 40% of 10-11 year olds were overweight or obese in 2020-21 compared with 35.2% the year before, and obesity rates are twice as high among the most deprived children as in the least deprived.6

The introduction of calorie labelling regulations should be applauded. Up to a quarter of adults’ calories are consumed outside the home.7 The policy should have some, albeit limited, effect through changes to consumer behaviour and reformulation. One systematic review found that calorie labelling on menus led to a 7.8% (95% confidence interval 2.5% to 13.1%) reduction in calories purchased.8 Other systematic reviews found limited evidence of a reduction in calories purchased9 or menu reformulation, although this may be because of a lack of larger studies.10 In the US, where calorie labelling has been mandatory for large chains since 2018,11 reductions have been reported in both calories purchased and the number of calories in food items.12 In New South Wales, Australia calorie labelling has also had a positive influence on consumer behaviour.13

Policies that aim to benefit everyone by working at the population level and require limited personal resources to benefit, such as a sugar tax, are more likely to reduce the overall disease burden and be equitable than individual level policies aimed at high risk individuals, such as referring people to exercise classes.14

Compulsory calorie labelling is a population level policy with both high agency (individuals making choices) and low agency (menu reformulation) mechanisms of action. Evidence suggests that benefits may vary across socioeconomic groups,15 including data from the US suggesting calorie labelling may have a greater influence on calorie intake among people from higher socioeconomic groups.16

Other concerns include the possibility of adverse effects on people with eating disorders,17 although businesses covered by the regulations must provide menus without calorie labelling on request. While there is limited evidence of harm from countries that already mandate calorie labelling, this should be monitored closely as the policy is rolled out.

Missed opportunity

Diet-related ill health needs a multifaceted, cross-government response18 that combines individual level approaches for those at high risk with an increased emphasis on population level, low agency policies19 that are implemented and evaluated appropriately.2 England’s current obesity strategy includes some population level policies such as banning advertisements for unhealthy food before 9 pm on television and at all times online, and ending multibuy offers in large retail outlets.20

The introduction of calorie labelling may be seen as a missed opportunity to provide more comprehensive nutritional information on menus. Labelling policies for packaged foods in Brazil, Chile, and Mexico, for example, mandate clear black and white warning labels on foods high in salt, sugar, or saturated fat. Other schemes include traffic light labelling21 (red, amber, green) to indicate whether a food contains high, medium, or low levels of fat, saturated fat, sugar, and salt. The Nutri-Score system,22 which assigns foods one of five colours (red to green) and a letter (A-E) based on multiple nutrients and components, has been used on packaged foods since 2017—on a voluntary basis—in France, Belgium, Switzerland, Germany, Luxembourg, Spain, and the Netherlands. Both colour coded labels and warning labels have been associated with healthier consumer choices.23 Labelling foods according to their effect on the environment could have added benefits for planetary health.242526

The policies outlined in England’s obesity strategy are unlikely to lead to the profound changes in our food environment required to reverse current obesity trends. England’s National Food Strategy argues that consumers and businesses are stuck in a “junk food cycle” that “We cannot escape ... without rebalancing the financial incentives within the food system.”27 Calorie labelling on food eaten outside the home could encourage food outlets to reduce the calorie content of their foods,28 but it’s not the radical change called for. The food strategy’s recommendations include a sugar and salt reformulation tax with some of the revenue raised funding subsidies for fresh fruit and vegetables.

The impact of the calorie labelling policy will be monitored though regular reports by food authorities and the secretary of state for health and social care, and by an independent scientific evaluation.29 It must be considered as just one part of a much broader approach to reshape the food system.

Footnotes

  • Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

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