Changes in energy content of menu items at out-of-home food outlets in England after calorie labelling policy implementation: a pre-post analysis (2021-2022)

ImportanceEating from out-of-home food outlets (OHFO) is common and linked to poor dietary quality, weight gain, and obesity. In response, England implemented mandatory calorie labelling regulations in April 2022 to encourage reformulation and reduce calorie consumption. Few studies have examined the impact of a national calorie labelling policy on OHFO menus. ObjectiveExamine pre-post changes in energy content of menu items from large OHFO in England after mandatory calorie labelling. Design, Setting, and ParticipantsObservational study using data from MenuTracker, a longitudinal database of online menus. Data were collected in September 2021 (pre-policy) and September 2022 (post-policy) from large OHFO in England. 15,057 pre-policy and 15,988 post-policy menu items were included from 78 large OHFO chains present in both periods. InterventionImplementation of mandatory calorie labelling on menus of large OHFOs in England. Main Outcomes and MeasuresMean energy content (kcal) of menu items, examined overall and by food group and chain type. Changes in energy content for removed, continuous, and new items to assess reformulation. ResultsOverall, a reduction of 9 kcal (95% CI: -16 to -1) in mean energy content was observed post-policy. Significant reductions per item in beverages (-36 kcal), burgers (-103 kcal), and mains (-30 kcal). By chain type, significant reductions per item in pubs, bars, and inns (-52 kcal), restaurants (-23 kcal), and entertainment venues (-49 kcal). Changes driven by removal of higher kcal items (458 kcal, 95% CI: 394 to 523) and addition of lower kcal items (434 kcal, 95% CI: 370 to 499). No significant change in energy content for continuously available items, indicating limited evidence of reformulation. Conclusions and RelevanceThe 2022 mandatory calorie labelling policy in England led to a small reduction in mean energy content of menu items, driven by removal of higher calorie items and addition of lower calorie items. Elsewhere, we did not find evidence of changes in kcal purchased or consumed, suggesting these menu changes did not focus on the most commonly consumed items. Further research is needed to evaluate longer-term menu changes and additional strategies to enhance policy impact on consumer behavior and public health.