As new rules are introduced in England requiring large businesses to display calorie information on food and drink, Sarah Chapman revisits Cochrane evidenceCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. on nutritional labelling, and reflects on the potential for harm as well as benefit.
Page originally published: 27 February 2018. Revised and republished: 4 April 2022 to reflect the introduction of mandatory calorie labelling in the restaurants, cafes and take-aways of large businesses in England from April 2022, and some of the impacts of the pandemic.
Page updated 13 April 2022.
Eating out has changed since 2018 when a Cochrane Review was published looking at the evidence on labelling menus with the calories for each item. Since then, the pandemic has altered perceptions and experiences of eating out, from apprehensiveness about food sharing and a new appeal of eating outdoors to encouragements to ‘eat out to help out’ sandwiched between lockdown closures and now a perhaps cautious return to cafes and restaurants.
Just as many of us are eating out again, something else has changed. From April 2022, in England, cafes, restaurants and takeaways in England with more than 250 employees have to display the calorie information of all the food and drink on offer. The Department of Health and Social Care says “[the] Rules will help the public to make healthier choices when eating out” – but will they? Let’s dig a bit deeper.
Cochrane evidence on nutritional labelling
The Cochrane Review Nutritional labelling for healthier food or non‐alcoholic drink purchasing and consumption (February 2018) draws on 28 studies, mostly done in laboratories, exploring the impact of nutritional labelling on buying or consuming food or non-alcoholic drinks. The authors said that “findings from a small body of low‐quality evidence suggest that nutritional labelling comprising energy information on menus may reduce energy purchased in restaurants.” They are even more uncertain about any effect on calories consumed (rather than just bought): the evidence, from studies done in laboratories, “suggests a similar effect to that observed for purchasing, although the evidence is less definite and also of low quality.”
They conclude that “Accordingly, and in the absence of observed harms, we tentatively suggest that nutritional labelling on menus in restaurants could be used as part of a wider set of measures to tackle obesity. Additional high‐quality research in real‐world settings is needed to enable more certain conclusions.”
And here we are, with this being implemented. The point about real-world research is important. People taking part in studies in laboratories may well behave rather differently than they would with their mates in Wetherspoons or at home enjoying a take-away and box set. Then there is the issue of harms…
What about possible harms of nutritional labelling?
With any interventionA treatment, procedure or programme of health care that has the potential to change the course of events of a healthcare condition. Examples include a drug, surgery, exercise or counselling. , it’s important to consider the potential for harm as well as benefit and Cochrane ReviewsCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. do this. However, the only potential harm assessed in this review was “high‐energy snack foods consumed with misleading low fat/energy labels”. No consideration is given to the potential harms for those living with eating disorders. When I read and wrote about this review in 2018, I knew nothing about this, but personal experience means this too has changed. Now in recovery from anorexia, my loved one has told me of the dread she feels about the prospect of seeing calories displayed against food and drink. The difficulties are eloquently explained by Clare Finney in her article Putting calories on menus won’t solve obesity, but it will harm those of us with eating disorders. Finney also mentions that mandating calorie information on menus in the US appears not to be working as an obesity-tackling measure.
The pandemic has had particularly detrimental effects on people with or at riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of eating disorders according to The Lancet. In particular there has been a sharp increase in anorexia among adolescent girls. The new labelling policy may add to the difficulties.
The charity BEAT has advice on eating out with calorie labelling for those affected by eating disorders and those supporting them.
Policy in Scotland, Wales and Northern Ireland
This Cochrane Review has informed a rapid evidence review in Scotland, where people are now being invited to have their say on plans to add calories to menus, in a 12 week consultation period. In Northern Island, in The Obesity Policy and Action Plan, the Irish Government committed to the development and implementation of legislation on calorie posting on menus by food businesses. Public consultation took place in February 2020 and in the latest progress report on implementation of the Plan, one of the measures listed as now taken is posting calorie information in restaurants. In Wales, the first of seven national priority areas in their Healthy Weight: Healthy Wales Strategy is to “Shape the food and drink environment towards sustainable and healthier options” and includes a plan to introduce legislation by 2024 on calorie labelling in out-of-home settings.
As for the future of research to inform policy, let’s hope that there will be new, high-quality studies to fill the existing evidence gaps, studies conducted in the real world and considering harms beyond ‘eating too many calories’.
Join in the conversation on Twitter with @SarahChapman30 @CochraneUK or leave a comment on the blog.
Please note, we cannot give medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.
Sarah Chapman has nothing to disclose.
As a calorie counter since the age of 11, showing calories would help me. But whilst it is comparatively easy for manufacturers of shop-sold items, or even massive chains, to calculate the calories for everything they sell, requiring such information from independent outlets, restaurants would be prohibitively difficult and expensive.