Associations between out of home food sector outlet menu healthiness scores, menu characteristics and energy consumed by customers in 2021-2022

Greater consumption of food prepared outside of the home (OOH) is associated with higher energy intake. Strategies are needed to make eating OOH food less harmful to health. Identifying menu characteristics that contribute to higher energy consumption OOH could aid characterisation of OOH outlets by their relative healthiness and inform future policy intervention in the OOH food sector. Customers (N=3718) were asked to recall their food orders upon exiting a range of OOH outlets across four local authorities in England during 2021 and 2022. For each outlet, universal health rating scores were calculated based on select menu characteristics and deep learning healthiness scores were calculated based on outlet name. Random forest models and robust linear regression models clustered by outlet were used to identify whether outlet healthiness scores and individual menu characteristics were associated with kcal consumed. Universal health rating scores, but not deep learning scores, were predictive of energy consumed during OOH outlet visits (-28.27; 95% CI -44.76 to -11.77; p=.003). Menu characteristics with the greatest importance for predicting energy consumed were the percent of savoury main menu items over 600kcal and 1345kcal, the number of desserts, the number of unique vegetables, and the percent of drinks over 100kcal. Menu characteristics accounted for 29% of variance in energy consumed by customers. Universal health rating scores may be a useful tool to characterise the healthiness of OOH outlets in England. Investigating the potential impact of OOH outlet health ratings on consumer and business behaviour is now warranted.