Help or hindrance: New calorie labeling rules in the UK

As of April 6, 2022, chain restaurants, cafés, and takeaway shops in the United Kingdom must display the caloric content of food, soft drinks, and some low-alcohol drinks. Although this regulation comes as an attempt to arm individuals with more information to engage in healthier out-of-home eating, not all experts believe the outcome will be positive.

The U.K. government is now requiring that large and chain restaurants, cafés, and takeaway establishments display the caloric content of menu items, including all non-repacked food, soft drinks, and low-alcohol drinks under 1.2% alcohol by volume.

Caloric information is typically available for foods purchased in a market. However, the governmental Department of Health and Social Care (DHSC) says that 25% of the calories U.K. residents consume come from businesses outside the home that serve prepared foods. Before the new regulations, nutritional information from such sources was not readily available to the public.

On average, says the DHSC, portions of food and drink acquired on the go contain twice as many calories as those prepared at home.

The regulations are a response to data showing that 63%—or nearly two-thirds—of the U.K.’s population is currently living with obesity, including 40% of primary-school-age children.

There were over one million hospital admissions between 2019 and 2020 in which obesity was the primary or secondary cause, according to the DHSC.

This represents a 17% increase from 2018–2019.

Dr. Joshua Petimar, a research scientist for the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School in the U.S., told Medical News Today:

“This represents a serious problem given the many chronic conditions that are associated with obesity, such as type 2 diabetes, heart disease, certain cancers, and others. This is why adopting healthy behaviors to prevent obesity is so important for a person’s long-term health.”

The DHSC explains that the intent of the new rules is to help U.K. residents “make more informed, healthier choices when it comes to eating food out or ordering takeaways”.

Members of the U.K.’s hospitality sector have expressed concern that the new requirements are being imposed at a delicate time since businesses are already engaged in a difficult recovery from the pandemic.

What are the new calorie labeling rules?

The regulations in force as of April 6, 2022, apply to a variety of eateries in the hospitality sector. They include:

• restaurants, including fast-food places, pubs, and cafés
• restaurants within supermarkets, department stores, and entertainment venues such as movie theaters
• home-delivery food services and some third-party food-purchasing apps
• specialized food stores, such as delicatessens, sweet shops, and bakeries
• contract catering, including for events and canteens
• food and drink service on domestic transport, including planes, trains, ferries, and other forms of water transport

The rules apply to any establishment with more than 250 employees. For the most part, these will be chain establishments. Businesses that violate these rules may be punished with a £2,500 fine.

The DHSC mandates that:

“Calorie information will need to be displayed on menus, online menus, third-party apps, food delivery platforms, and food labels at the point a customer is making their food and drink choices. As well as listing the calories for each food item, menus, and labels will also need to include daily recommended calorie needs.”

“People have more options for purchasing these ‘ready-to-eat’ meals than ever,” pointed out Dr. Petimar.

“[I]t can be difficult for people who want to make the healthiest choices to know what those options are. Calorie labeling is a step in the right direction in that it offers transparency on one measure of healthfulness that allows people to make the best choices for themselves,” he said.

Obesity in the U.K.

The U.K. National Health Service (NHS) recommends two methods for determining if one is at risk of obesity-related health problems: Body Mass Index (BMI) or waist size.

The NHS provides an online BMI calculator. They also present simple guidelines for waist size: if a male’s waist is 94 centimeters (about 37 inches) or larger, or a woman’s is 80 cm (about 31.5 inches) or greater, they are at risk of health issues related to obesity.

However, many experts argue that BMI is an outdated and flawed measure for obesity.

According to the NHS, being obese places an individual at a higher risk for:

• type 2 diabetes
• high blood pressure, or hypertension
• high cholesterol
• atherosclerosis
• asthma
• metabolic syndrome, which combines diabetes, high blood pressure, and obesity
• several types of cancer, including breast cancer, colorectal/bowel cancer, and endometrial/womb cancer
• gastroesophageal reflux disease
• gallstones
• fertility issues
• osteoarthritis
• sleep apnea
• liver disease
• kidney disease
• complications in pregnancy, such as gestational diabetes or preeclampsia.

With obesity being the single most significant risk factor for type 2 diabetes, according to the DHSC, 13.6 million U.K. residents are at risk of developing the disease. Obesity is also the second most common cause of cancer in the UK.

There is more to good nutrition than calories

Ph.D. student Dolly R.Z. Theis of the University of Cambridge’s MRC Epidemiology Unit told MNT:

“I do consider obesity to be a serious health problem in the U.K., but it is important to understand obesity as being one of many health consequences of our food system and culture. One that makes enjoying a healthy life far too challenging, especially for people in the most deprived areas and on the lowest incomes.”

“If we focus on obesity alone, then it embeds weight-related stigma that people living with obesity are the problem, when in reality, our unhealthy food system, environment, and culture are the real problems.”
— Dolly R.Z. Theis, Ph.D. student

While many people successfully lose weight in the short term with diet plans based on calorie-counting, experts say that long-term success requires a deeper understanding of healthy eating.

Weight loss from commercial diets—many of which count calories either directly or as “points”—is difficult to sustain. According to a UCLA study that tracked individuals for more than two years, 83% eventually gained back more weight than they had lost.

Co-author of the UCLA study Janet Tomiyama says, “Several studies indicate that dieting is actually a consistent predictor of future weight gain.”

Quality over quantity

The quality of foods is more important than calorie counts, say experts.

Dr. Fatima Cody Stanford of Harvard’s Medical School says that not all calories are created equal in any event. She says that there are at least three factors that affect the manner in which one’s body processes calories: your microbiome, your metabolism, and the type of food you eat.

Some have suggested that the new calorie listings might even be counter-productive for people attempting to overcome eating disorders, since calorie listings may be triggering for such people. There is research supporting this.

Chief executive Alex Radford of eating-disorder charity Beat told woman&home that calorie counts on menus risk “great distress” among people who have or are vulnerable to eating disorders.

Recent research has reinforced the need of addressing other topics when considering a healthy diet, like healthier behaviors, “along with messaging about the vulnerability factors that might put some people at risk for the development of eating disorders.”

How caloric labeling has fared before

Theis was the lead author of a 2019 study of U.K. chain restaurants’ then-voluntary calorie labeling. She said the move could also have a more positive impact than feared.

“The new calorie labeling regulation may incentivize [positive] changes at the restaurant level and ensure that when customers eat out, they have more choice with more healthy options available — making choosing more nutritious food easier — and the nutritional state of unhealthy options may be improved through reformulation. This may in turn help reduce diet-related problems, such as increased consumption of unhealthier foods and consequential health problems,” she said.

In his study of similar calorie labeling in the U.S.— which has been required since 2018—Dr. Petimar recalled that the impact was limited on a retailer level.

“After calorie labeling was implemented in the U.S., we did not see strong evidence that food retailers reduced the calorie content of existing items, but we did see that restaurants and supermarkets were more likely to offer new, lower-calorie prepared foods.”
— Dr. Joshua Petimar

“So, we expect that food establishments may slowly decide to improve their offerings in response to the law, which could have long-term health benefits for a huge portion of the population that regularly purchases food from these establishments,” Dr. Petimar continued.

He said that based on previous evaluations, we could expect “modest declines” in the calorie content of meals purchased in the overall population.

“Findings from some of the most rigorous scientific studies show that labeling is associated with declines in the caloric content of purchases, so it likely is working for some segment of the population,” Dr. Petimar added.

However, his study also found that these declines had largely disappeared over the course of a year.

Obesity remains on the rise in the U.S. with 42.4% of adults living with the condition as of 2019.

Using information wisely

Calorie labeling could prove a useful tool for some but be detrimental to others’ mental and physical health.

The extent to which a person counts calories is largely a matter of personal nutritional strategy. The added information could help individuals make more informed choices.

As with all matters of health and nutrition, it may be best to speak to a healthcare professional before making drastic changes to one’s diet.

Most experts agree that for those living with obesity, developing a thorough understanding of the many factors involved⁠—not purely calories⁠⁠—will be the most promising path to wise choices.

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