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).

Introduction: Eating 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. The aim of this evaluation study was to examine pre-post changes in the energy content of menu items from large OHFO in England after the labelling policy. Methods: Energy content of menu items from large OHFO in England was obtained using MenuTracker, a longitudinal database of online menus. Data were collected in two waves: September 2021 (prepolicy) and September 2022 (postpolicy). Linear mixed regression models were used to estimate pre-post changes in mean energy content (kcal) for all items by food group and by chain type. We also examined reformulation by estimating energy content for removed, continuous and new items. Results: Overall, a small reduction of 9 (-2.0%) (95% CI: -16 to -1) kcal in mean energy content per item was observed postpolicy. Significant mean reductions per item were found in beverages (-36 (-16.4%); 95% CI: -52 to -21 kcal), burgers (-103 (-11.1%); 95% CI: -150 to -56 kcal) and mains (-30 (-4.2%); 95% CI: -48 to -12 kcal). By chain type, significant mean reductions per item were seen in pubs, bars and inns (-52 (-8.8%); 95% CI: -68 to -36 kcal), restaurants (-23 (-4.9%); 95% CI: -42 to -5 kcal) and sports and entertainment venues (-49 (-13.4%); 95% CI: -79 to -19 kcal). Changes were driven by the removal of higher kcal items (458 kcal, 95% CI: 394 to 523) and addition of lower kcal new items (434 kcal, 95% CI: 370 to 499). There was no significant change in energy content for continuously available items, indicating limited evidence of reformulation. Conclusions: The 2022 mandatory calorie labelling policy in England led to a small reduction in the mean energy content of menu items, primarily driven by the removal of higher calorie items and the addition of lower calorie items. Further research is needed to assess long-term effects and strategies to enhance policy impact.