Assessing public perception and awareness of UK mandatory calorie labelling in the out‐of‐home sector: Using Twitter and Google trends data

Objectives: In 2021 the UK government announced a new obesity policy requiring large out-of-home food outlets to provide mandatory in-store calorie labelling on food and drink items. Public acceptability and engagement with obesity policies could influence the level of impact on wider public health particularly with population-level policies such as calorie labelling. This study aimed to examine public responses and awareness of the policy using social media (Twitter) comments and Google trends data. Methods: This study examined responses to social media posts on Twitter (tweets) from the UK Department of Health and Social Care detailing the policy, implementation date and post-implementation information about the policy’s enforcement. The sentiments of the tweets were coded and the number of likes and replies extracted. This study utilised google trends to examine public awareness of the policy by extracting weekly relative search volume for relevant phrases such as ‘calorie labelling’. Results: From the 276 replies/quote-tweet extracted, the majority expressed a negative sentiment towards the policy (N=197/ 71.4%). There were fewer tweets expressing a positive sentiment (N=25 / 8.7%) and a neutral/no sentiment (N=54 / 19.6%). There was no difference in the number of ‘likes’ or retweets between tweets expressing positive or negative sentiments. Five themes were identified expressing negative sentiments (most common being negative impacts on eating disorders). Google trends data revealed increased searches for 'calorie labels/labelling' during the week of the policy enforcement compared to previous weeks in the last 5 years but no significant differences in searches for specific menu calorie labelling. Conclusions: This analysis revealed negative sentiment towards and increased searching of calorie labelling information during the announcement and implementation of the 2021 mandatory calorie labelling policy in England. A greater understanding of public responses to calorie labelling policies may help tailor future policies and public communication strategies

Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis

BACKGROUND: There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP). METHODS: Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups. RESULTS: Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041]. CONCLUSIONS: Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required

Kilocalorie labelling in the out-of-home sector: an observational study of business practices and consumer behaviour prior to implementation of the mandatory calorie labelling policy in England, 2022

Background: Regulations mandating kilocalorie (kcal) labelling for large businesses in the out-of-home food sector (OHFS) came into force on 6th April 2022 as a policy to reduce obesity in England. To provide indicators of potential reach and impact, kcal labelling practices were studied in the OHFS, and customer purchasing and consumption behaviours prior to implementation of the mandatory kcal labelling policy in England. Methods: From August-December 2021, large OHFS businesses subject to the kcal labelling regulations were visited prior to regulations coming into force on 6th April 2022. 3308 customers were recruited from 330 outlets and collected survey information on the number of kcal purchased and consumed by customers, customers’ knowledge of the kcal content of their purchases, and customers noticing and use of kcal labelling. In a subset of 117 outlets, data was collected on nine recommended kcal labelling practices. Results: The average number of kcals purchased (1013 kcal, SD = 632 kcal) was high with 69% of purchases exceeding the recommendation of a maximum of 600 kcal per meal. Participants underestimated the energy content of their purchased meals by on average 253 kcal (SD = 644 kcals). In outlets providing kcal labelling in which customer survey data was collected, a minority of customers reported noticing (21%) or using (20%) kcal labelling. Out of the 117 outlets assessed for kcal labelling practices, 24 (21%) provided any in-store kcal labelling. None of the outlets met all nine aspects of recommended labelling practices. Conclusions: Prior to implementation of 2022 kcal labelling policy, the majority of sampled OHFS large business outlets in England did not provide kcal labelling. Few customers noticed or used the labels and on average customers purchased and consumed substantially more energy than recommended in public health guidelines. The findings suggest that reliance on voluntary action for kcal labelling implementation failed to produce widespread, consistent, and adequate kcal labelling practices

Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis

Background: There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP). Methods: Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups. Results: Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041]. Conclusions: Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required

Point-of-choice kilocalorie labelling practices in large, out-of-home food businesses: a preobservational versus post observational study of labelling practices following implementation of The Calorie Labelling (Out of Home Sector) (England) Regulations 2021.

BACKGROUND AND OBJECTIVES: On 6 April 2022, the UK government implemented mandatory kilocalorie (kcal) labelling regulations for food and drink products sold in the out-of-home food sector (OHFS) in England. Previous assessments of kcal labelling practices in the UK OHFS found a low prevalence of voluntary implementation and poor compliance with labelling recommendations. This study aimed to examine changes in labelling practices preimplementation versus post implementation of mandatory labelling regulations in 2022. METHODS: In August-December 2021 (preimplementation) and August-November 2022 (post implementation), large OHFS businesses (250 or more employees) subject to labelling regulations were visited. At two time points, a researcher visited the same 117 food outlets (belonging to 90 unique businesses) across four local authorities in England. Outlets were rated for compliance with government regulations for whether kcal labelling was provided at any or all point of choice, provided for all eligible food and drink items, provided per portion for sharing items, if labelling was clear and legible and if kcal reference information was displayed. RESULTS: There was a significant increase (21% preimplementation vs 80% post implementation, OR=40.98 (95% CI 8.08 to 207.74), p<0.001) in the proportion of outlets providing any kcal labelling at point-of-choice post implementation. Only 15% of outlets met all labelling compliance criteria post implementation, with a minority of outlets not presenting labelling in a clear (33%) or legible (29%) way. CONCLUSION: The number of large businesses in the OHFS providing kcal labelling increased following the implementation of mandatory labelling regulations. However, around one-fifth of eligible outlets sampled were not providing kcal labelling 4-8 months after the regulations came into force, and the majority of businesses only partially complied with government guidance. More effective enforcement may be required to further improve kcal labelling practices in the OHFS in England. PREREGISTRATION: Study protocol and analysis strategy preregistered on Open Science Framework (https://osf.io/pfnm6/)

A multi-country comparison of jurisdictions with and without mandatory nutrition labelling policies in restaurants: analysis of behaviors associated with menu labelling in the 2019 International Food Policy Study

Objective: To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups. Design: Cross-sectional data from the International Food Policy Study (IFPS) online survey. Setting: IFPS participants from Australia, Canada, Mexico, United Kingdom and United States in 2019. Participants: Adults aged 18-99; n=19,393. Results: Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order, and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10.7%, 95% CI 8.9 to 12.6) to low education (difference of 4.1%, 95% CI 1.8 to 6.3). For used nutrition information, differences were greatest comparing high education (difference of 4.9%, 95% CI 3.5 to 6.4) to low education (difference of 1.8%, 95% CI 0.2 to 3.5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy. Conclusions: Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small

Leadership to Address Implicit Bias in the Legal Profession

This Article discusses the problem of implicit bias within the legal profession; why its persistence impedes the work that lawyers do; and the need for leaders to take steps to recognize, understand, and ameliorate it. Implicit biases, also referred to as unconscious biases, are prejudices that people have, but are unaware of their existence. These biases act as mental shortcuts based on known stereotypes and social norms that cause people to make decisions that favor one group to the detriment of another. Even though the United States has laws prohibiting discrimination on the basis of race, religion, gender, and disability, these laws are incapable of confronting the systemic racism perpetuated by implicit bias. A law will not prevent people from reacting to biases that they are unaware they hold. For this reason, leaders cannot lead equitably without first discovering what biases may be influencing their decisions at the sub-conscious level. This Article calls for leaders within the legal profession to educate themselves about implicit bias, discover what implicit biases they harbor on a personal level, take time to ensure that their decisions are not being influenced by such biases, take steps to de-bias, and lead their constituents to do the same

Leadership to Address Implicit Bias in the Legal Profession

This Article discusses the problem of implicit bias within the legal profession; why its persistence impedes the work that lawyers do; and the need for leaders to take steps to recognize, understand, and ameliorate it. Implicit biases, also referred to as unconscious biases, are prejudices that people have, but are unaware of their existence. These biases act as mental shortcuts based on known stereotypes and social norms that cause people to make decisions that favor one group to the detriment of another. Even though the United States has laws prohibiting discrimination on the basis of race, religion, gender, and disability, these laws are incapable of confronting the systemic racism perpetuated by implicit bias. A law will not prevent people from reacting to biases that they are unaware they hold. For this reason, leaders cannot lead equitably without first discovering what biases may be influencing their decisions at the sub-conscious level. This Article calls for leaders within the legal profession to educate themselves about implicit bias, discover what implicit biases they harbor on a personal level, take time to ensure that their decisions are not being influenced by such biases, take steps to de-bias, and lead their constituents to do the same