Nudging towards healthier choices when eating out - Calories on labels
Findings from a Cochrane review published on Tuesday (27th February) suggest that adding calories to menus and next to food available in restaurants, coffee shops and cafeterias could reduce the calories that people consume.
What did the review involve?
The review included 28 studies, of which 11 assessed the impact of nutrition labelling on purchasing and 17 studies assessed the impact of labelling on consumption. Of the 28 studies included, some assessed buying food and drinks from vending machines, grocery stores, restaurants, cafeterias or coffee shops. Others looked at the amount consumed during an eating occasion in an artificial (laboratory) setting. Most of the studies (21 or the 28) were conducted in the USA and most (20 of the 28) assessed the impact of labelling on menus or menu boards, or nutritional labelling placed on, or next to, a range of foods and drinks from which participants could choose.
What were the findings of the review?
The authors identified three studies where calories labels were added to menus or put next to food in restaurants, coffee shops and cafeterias. For a typical lunch with an intake of 600 calories, having calories on the menu or on display may reduce the energy content of the food purchased by about 8% (48 calories). However, the authors of the review describe the evidence as low quality and low in quantity. They are therefore tentative in their conclusion that calorie labelling may help with a modest decrease in calories purchased when eating out of the home.
Of note, is that the authors found no evidence of unintended consequences such as increased energy purchased or consumed. Of course, further research, for example, to explore the effects of calorie labelling on food choices made throughout the day, or whether specific population groups are more influenced by such labels, would add to our understanding of this intervention.
This review should provide enough evidence for encouraging more out of home establishments to display calorie information.
Are we likely to start seeing more calorie information when eating out of the home?
Having calories on menus is likely to be useful alongside Public Health England’s calorie reduction campaign starting this Spring. It may also encourage food business operators to revise portion sizes and reformulate recipes to offer meals and snacks with calorie amounts more in line with what is suggested by Public Health England (e.g. 400 calories for breakfast, 600 for lunch and dinner, and 400 for all drinks and snacks throughout the day).
However, the focus should not only be on calories, as calorie information does not tell us about the overall quality of the food or drinks, for example in terms of salt, saturated fat or nutrient density.
Some countries have already introduced labelling on menus. Calorie labelling in restaurants was first introduced in the state of New York in 2008, and by May 2018 energy information is required for all states on menus and menu boards in chain restaurants with 20 or more locations, as well as in all vending machines (FDA, 2017). In the UK, some restaurants and cafés have already started to display calories on menus or next to the food choices.
Having calorie information on alcoholic drinks may help reduce consumption. Many people are not aware that a pint of 4% beer is over 180 calories and a large glass (250ml) of 14% wine is 230 calories (Drinkaware Unit & Calorie Calculator). A recent report by the Royal Society of Public Health found that 8 out of ten people are unable to correctly estimate the calories in a glass of wine. The report also suggests that displaying calories on alcohol products could result in a 10% swing in consumer purchasing decisions from the highest alcohol drinks to the lowest, within all main drink categories and across all socio-economic groups (RSPH, 2018).
Currently there is no legal requirement in the UK for nutrition information to be displayed on alcoholic products, although with the increasing pressure from health professionals in favour of this labelling, this may change.
Calories on the menu in Scotland?
Two thirds (66%) of Scottish consumers agree that cafés and restaurants should display calorie information (Food Standards Scotland, 2018). We know that food eaten outside the home is generally skewed towards less healthy products such as chips, burgers, cakes and pastries and it is estimated that food and drink consumed in the out of home environment can provide as much as 25% of an adult’s energy intake in the UK (Food Standards Scotland, 2016).
Food Standards Scotland will be taking forward a new strategy for eating outside the home in Scotland. A public consultation on this strategy, which will include measures on calorie labelling, is due later this year.
Currently, providing energy information for non-prepacked foods is voluntary. However, if calorie information is provided then it must be displayed in the correct way and not be misleading to consumers (Regulation (EU) No 1169/2011, 2014). Calculating the calorie information of menu items, including home baking, toasties and tray bakes is likely to be quite time consuming for many small and medium sized food business operators.
As an independent Registered Nutritionist, I am happy to assist businesses with calorie calculations as well as providing advice on ensuring healthy menu options that are appealing to customers. Do get in touch if you would like to discuss this further.
Crockett RA, King SE, Marteau TM, Prevost AT, Bignardi G, Roberts NW, Stubbs B, Hollands GJ, Jebb SA. Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD009315. https://doi.org/10.1002/14651858.CD009315.pub2