Assessing the impact of a mandatory calorie labelling policy in out-of-home food outlets in England on consumer behaviour: a natural experimental study.

Background: Out-of-home (OOH) food tends to be energy-dense and nutrient-poor. In response, England implemented a mandatory calorie labelling policy in the OOH sector. We evaluated changes in consumer behaviours after the policy was implemented in April 2022.

Methods: We employed a natural experimental design to assess pre-post changes in noticing and using nutrition information, and behaviours associated with menu labelling. We compared changes in England to comparator jurisdictions without similar policies. Data included four consecutive years (2019-2022) from the International Food Policy Study; participants were adults aged 18 years or older. Mixed effects logistic regression models assessed pre-post changes in binary outcomes, and mixed effects negative binomial regression assessed changes in frequency of OOH eating.

Results: In England, noticing nutrition information increased from 16.0% (95% CI 15.6 to 16.4) in 2020 to 19.7% (95% CI 19.1 to 20.2) in 2021 and to 25.8% (95% CI 25.5 to 26.1) in 2022. This increase was 4.8% points (95% CI 2.5 to 7.1) higher in England versus the comparator group. Using nutrition information increased in England from 8.0% (95% CI 7.5 to 8.4) in 2020 to 11.8% (95% CI 10.9 to 12.6) in 2021 and to 13.5% (95% CI 13.1 to 13.9) in 2022. There was a 2.7% points (95% CI 2.0 to 3.4) greater increase in England versus the comparator group from 2020 to 2021. Ordering something different was the only behaviour associated with nutrition information that increased after implementation of the policy in England: from 12.6% (95% CI 12.4 to 12.7) in 2020 to 15.2% (95% CI 14.7 to 15.6) in 2021 and to 17.7% (95% CI 17.6 to 17.8) in 2022. There was a 2.8% points (95% CI 1.8 to 3.9) greater increase in England versus the comparator group from 2021 to 2022. Frequency of OOH eating did not change after policy implementation.

Conclusions: The introduction of mandatory calorie labelling in England led to increases in self-reported noticing and using, with the key behavioural impact on ordering something different. Additional strategies may be required to maximise the public health benefits of calorie labelling.