Calorie labels on menus can reduce obesity and save lives without widening health disparities

Calorie labels on menus can reduce obesity and save lives without widening health disparities

In a recent study published in The Lancet Public Healthresearchers modeled the impact of calorie labeling in out-of-home food businesses on adult obesity prevalence and cardiovascular mortality in England.

Population-level dietary policies reduce the burden of non-communicable diseases and obesity. The United Kingdom (UK) introduced a mandatory energy labeling policy for out-of-home food businesses in England in April 2022. This required businesses to label energy or calorie information for items on menus online or in stores, third-party apps, platforms for food delivery and at any point where customers choose their food and drinks.

This policy may alleviate the prevalence of obesity and cardiovascular mortality, given that out-of-home establishments are likely to serve high-energy meals associated with increased body mass index (BMI). Energy labeling can enable consumers to make better and healthier food choices. However, there is limited evidence on the long-term effect of the menu energy labeling policy on obesity and other related outcomes.

Calorie labels on menus can reduce obesity and save lives without widening health disparitiesStudy: Effect of calorie labeling in the non-home food sector on adult obesity prevalence, cardiovascular mortality and social inequalities in England: a modeling study. Image credit: ELUTAS / Shutterstock

About the research

In the current study, researchers modeled the impact of a menu calorie labeling policy in out-of-home businesses on adult obesity and cardiovascular mortality in England. A comparative risk assessment model was created to quantify the (long-term) effects of the policy over two decades (2022-41). The team modeled current and full deployment scenarios that reflect the deployment of policies across large and all out-of-home businesses, respectively.

Each scenario was compared to the baseline, i.e. lack of intervention. The researchers assumed that implementing the policy would reduce energy intake by 47 kcal for each meal and that the effect of labeling on consumer behavior would remain constant over time. In addition, they assume that other meals will compensate for some of the reduction in energy intake. Specifically, they accept an average of 26.5% energy compensation.

The team conservatively estimated that retailers reduced 15 kcal per meal after the policy was implemented. Model uncertainty was estimated using the Monte Carlo approach. Labeling is hypothesized to reduce body weight by reducing energy intake, which in turn is hypothesized to influence the risk of cardiovascular mortality. The team assessed the change in energy intake and converted it into changes in body weight and thus changes in BMI.

Thus, changes in BMI modify the risk of cardiovascular mortality. These data were then used to quantify new mortality rates and the number of predicted deaths. The model gives changes in the prevalence of obesity and the number of deaths delayed or prevented. Finally, the team assessed the equity impact of the policy intervention as the ratio between the most and least needy groups.

Findings

Implementation of the existing policy in England is estimated to reduce the prevalence of obesity by 0.27 percentage points over the next two decades, considering consumer response alone. The prevalence of obesity was further reduced by 0.07 percentage points when food reformulation was additionally taken into account. Cumulatively, the current scenario would result in 0.31 percentage points lower obesity prevalence.

In contrast, the full implementation scenario would reduce obesity prevalence by 2.65 percentage points, taking into account consumer response and reformulation. Without any policy, there would have been about 830,000 deaths from cardiovascular disease by 2041. The current scenario would delay or prevent 730 deaths from cardiovascular disease over two decades, given consumer response and reformulation .

It should be noted that the full implementation scenario would prevent or delay 9,200 deaths from cardiovascular disease. The ratios of obesity prevalence or cardiovascular mortality between the most and least deprived quintile groups were constant. This meant that the policy did not widen health inequalities in terms of obesity or cardiovascular mortality, assuming that the effect of the policy would be the same across the socioeconomic spectrum.

Conclusions

The study models the likely effects of a calorie labeling policy in England. It revealed that the current implementation scenario would reduce the prevalence of obesity by 0.31 percentage points and prevent or delay 730 deaths over two decades. There is no evidence that existing implementation would widen existing health inequalities, assuming that the effect of the policy is the same across ages, genders and socioeconomic positions. However, the benefits would be greatly increased if the policy were implemented in all food-out-of-home establishments, emphasizing that the full implementation scenario would maximize the effect.

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