By Katharine Jenner, Registered Public Health Nutritionist and Campaign Director for Action on Salt and Sugar
Despite years of heavy lobbying from the hospitality industry, the government has shown it is serious about addressing obesity and improving dietary health by introducing a number of evidence-based structural policies that are targeting food and drink businesses, rather than placing responsibility solely on the individual. One key policy is calorie (kcal) labelling on all food and drink for larger businesses in the out of home (OOH) sector in England. Although we all have a right to know what’s in our food, this policy is about much more than just providing information, so let’s look behind the label.
Once the regulation comes into force from April 2022, calorie information will need to be displayed as ‘the energy content of a portion of food, followed by kcal, the portion size, and the statement that adults need around 2000 kcal a day’[1]. This will be required for larger (>250 employees) restaurants, cafes, takeaways and home delivery at the point of choice, ie on printed & online menus, food delivery platforms and pre-packaged food labels – with penalties for those who don’t comply.
The reason for focusing on calories is that regularly eating calorific foods lead to higher calorie intakes which can in turn contribute to obesity. Eating out is no longer an occasional treat, research shows that eating out accounts for 20-25% of an adult’s energy intake. When someone dines out or eats a takeaway meal, they consume on average 200 more calories per day than if they eat food prepared at home. That’s the equivalent of a whole bottle of cola, and no wonder when you look at the variation between similar products sold in retail and in out of home*:
| Dish | Retail | Calories per portion (kcal) | Out of Home | Calories per portion (kcal) |
| Pizza | Pizza Express Margherita Pizza | 608 | Pizza Express Margherita Pizza | 834 |
| Sausage Roll | Sainsbury’s Taste the Difference Sausage Roll | 160 | Greggs Sausage Roll | 318 |
| Lasagne | Tesco Finest Lasagne | 671 | Zizzi Lasagne | 947 |
| Chicken | Birds Eye Chick Shop Buttermilk Chicken Strips | 168 | Harvester Buttermilk Fried Chicken Tenders | 395 |
*Selected products for illustrative purpose only
Calorie information has to be displayed on food bought in retailers by law, so there is an information gap that this policy will address, meaning we can find out the calorie content of our meals, wherever we buy them. The lack of information in the Out of Home sector, for all but a few responsible companies, has allowed them an unofficial ‘exempt status’ from the salt, sugar and calorie reduction policies, serving up ever larger portion sizes, simply because Public Health England have not been able to hold them to account and then work with them to improve their menus.
Why has the hospitality sector been allowed to hide what’s in their food for so long? Front of pack labelling on packaged foods is so well-understood and accepted that the debate has moved on from ‘should we have it?’, to ‘what is the absolute optimum way of providing this information?’, as evidenced in the recent consultation[2]. Whilst calorie labelling on menus has been openly recommended for over 10 years, by us, the Food Standards Agency, the Department of Health (DHSC), Public Health England, and now the government.
Better menu labelling is popular with the general public. 79%[3] agree that menus should display the number of calories in food and drinks and 60%[4] would be more likely to eat at an establishment that had calorie labelling on its menus. Findings from a recent Cochrane Review in 2018, which offers high quality public health evidence, showed for a typical lunch with an intake of 600 calories, labelling calories at the point of choice may reduce the energy content of food purchased by about 8% (48 calories) with no differences between socio economic groups[5].
However, there are concerns that calories on menus will exacerbate problems faced by those already living with disordered eating, who find eating out very stressful. This is a valid concern, based on feedback from people with eating disorders and it must be taken seriously in the context of rising eating disorder prevalence. DHSC has recognised these concerns and stated that businesses will be able to have menus without calories available on request for those who don’t wish to see them. Because research is lacking, when calorie labelling is evaluated five years after implementation, it is essential we look at all aspects of the policy, including eating behaviours on different population groups.
It’s important that we don’t just think of this as a policy that puts the onus on individuals to make ‘good choices.’ Clear labelling encourages chefs to make healthier recipes and allows for transparency and monitoring. It is possible that with more complete nutritional information displayed, outlets will be held to account and change what they serve for the better. According to research by Theis and Adams[6], UK restaurants with voluntary menu labelling had 45% less fat and 60% less salt than those without menu labelling. Most fast food and restaurant owners don’t knowingly mean to make their guests or their employees unhealthy, after all.
But the healthfulness of food is about way more than the number of calories it contains. Calorie labelling is an important first step. Next, we want to be able to see fat, sugar and salt information. It would make the information available to us uniform across the food and drink sector, it would help customers make better-informed choices about the dishes they select, and it would allow restaurants to present healthier options based on the meals’ actual nutritional value rather than by how healthy they sound. Without it, excessive portion sizes, salt or sugar content can go unnoticed. For example, in 2020 we found nearly half (45%) of healthy-sounding plant-based meals eaten Out of Home contain 3g or more salt in just one meal – Papa John’s Vegan American Hot Medium Pizza, contained 9.28g salt – equal to more than 7 McDonald’s Hamburgers. In 2018, we found more than a third (36%) of salads Out of Home contained 2g of salt or more per salad – Nandos Mediterranean Salad with Chicken Breast and extra hot sauce had 6.2g salt – more than the total daily recommendation.
Our own research has also shown that once companies are presented with exactly how much salt, sugar and fat is in each portion of their foods, they are often shocked into action. In 2016, we highlighted that Pret a Manger’s Lemon Drizzle slice contained 18 tsp of sugar per slice. Following our survey, this product was removed from the menu and later re-introduced with just 6.5 teaspoons – a third of the original – showing public health professionals, food businesses and the public that with better labelling, they can have their cake and eat it.
Finally, we acknowledge that this is just a first step to creating a healthier food environment. Having better labelling is a bit like putting flood warning signs up and hoping people swim to safety. We need stronger reformulation programmes, ambitious fiscal measures, and restrictions on marketing and promotions to truly stop the flood of unhealthy food and drink.
[1] Draft legislation: https://www.legislation.gov.uk/ukdsi/2021/9780348223538/contents
[2] https://www.gov.uk/government/consultations/front-of-pack-nutrition-labelling-in-the-uk-building-on-success
[3] Public Health England. (2018). Calorie reduction: The scope and ambition for action https://www.gov.uk/government/publications/calorie-reduction-the-scope-and-ambition-for-action
[4] Diabetes UK. (2018). Public Views on food labelling survey. ComRes interviewed 2,121 UK adults online, aged 18+, between 12th -14th Jan 2018. Data were weighted to be demographically representative of all UK adults by age, gender, region and social grade. ComRes is a member of the British Polling Council and abides by its rule
[5] Crockett RA, King SE, Marteau TM, Prevost AT, Bignardi G, Roberts NW, et al. Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption. Cochrane Database of Systematic Reviews. 2018(2).
[6] Dolly R. Z. Theis and Jean Adams ‘Differences in energy and nutritional content of menu items with versus without voluntary menu labelling: A cross-sectional study’ [year]