The prime minister is proposing mandatory labelling in restaurants – but where’s the evidence for it, and how will it work? By David Burrows.
Dear Prime Minister,
I write in response to your consultation, launched last week, on the introduction of calorie labelling across the out-of-home sector. This is part of your wider strategy to halve childhood obesity by 2030, but I wonder if it is a waste of time and money.
Polls show that the wind of public opinion is blowing in your favour on this one. In April Diabetes UK said 71% of diners told them they did not have enough information about what was in their food. Almost three-quarters (73%) wanted all cafés, restaurants and takeaways to use traffic-light labelling on their products and menus, the survey found; Public Health England research puts the figure at 79%.
So it’s a good news story, but let’s not get carried away just yet.
First, there is the evidence – or rather the lack of it. “There is no evidence that putting calories on labels actually changes consumption,” said one nutritionist in a post on Linkedin when news of this broke. Well, there is, but it is pretty sparse. Research by the University of Cambridge behaviour and health research unit, published this month, showed that labelling calories in canteens was pretty straightforward but only one of the six sites (all workplace cafeterias) that displayed the information for 17 weeks showed a reduction in energy purchased by workers. Another of the most recent studies, conducted by Cornell University in the US, showed more potential. Data from 5,500 diners in two full-service restaurants showed that those who were given menus with calorie information ordered meals with 3% less calories (about 45 calories less).
But as I said, there isn’t a lot of information out there. Serendipitously, however, an analysis of current evidence has just been published, for which the conclusion was: “Findings from a small body of low-quality evidence suggest that nutritional labelling comprising energy information on menus may reduce energy purchased in restaurants. The evidence assessing the impact on consumption of energy information on menus or on a range of food options in laboratory settings suggests a similar effect to that observed for purchasing, although the evidence is less definite and also of low quality.”
The authors of that paper “tentatively suggest” the approach is worth a try, but as part of a wider strategy to tackle obesity. Indeed, to refer back to McKinsey’s seminal report on the subject four years ago, labelling is in the bottom half of interventions – portion control, reformulation and availability top the list. That doesn’t mean it’s pointless, of course. Last year, Richard Dobbs, the lead author of that report and a senior partner at the consultancy firm, told me that governments have been distracted by policies such as taxes on sugar-sweetened drinks (way below labelling in McKinsey’s report), which has meant they’ve lost sight of the bigger picture. “You can’t just pull one or two policy levers – you need to pull 50,” he said, “but that’s much harder than saying: ‘I’m going to introduce a sugar tax’.”
However, it seems that you are keen to introduce these labels. So let’s look at how it could work.
The second issue I’d like you to consider is consistency. The idea of using calorie labels in a foodservice setting has been on and off the menu for years. It was one of the highest-profile pledges in the Public Health Responsibility Deal, but by 2014 (three years into the deal) only one in three high-street outlets were providing the information. More and more brands have started to display the information voluntarily (one in four products reportedly have information beside them now), but this has brought a pick-and-mix approach – for example, by labelling food but not drinks. Consider an analysis by Action on Sugar in 2016 that found some “hot fruit drinks” contained 25 teaspoons of sugar per cup and this selective approach quickly unravels and people lose interest.
It is therefore reassuring to see your intention is “to make sure that labelling is applied consistently so that families know how much they and their children are eating when out”. This is critical – and has also been a failure of the approach to nutritional labelling on packaged foods where a voluntary approach has resulted in a hotchpotch of approaches that serve only to confuse people. Even industry is not always quite sure what it’s doing – a study published by Which? in June found that some cereal manufacturers were using outdated dietary guidance, while others were simply changing their portion sizes to make the sugar content appear lower. Charlatans? Or just confused and in need of mandatory guidance?
Of course, some European member states have never been keen on the traffic-light system that food companies here have been encouraged to use (and which consumers seem to understand, the tricks listed above aside). Therefore, Brexit presents an opportunity to introduce a mandatory scheme that runs across both grocery and out-of-home. You have in the past shown interest in Jamie Oliver’s idea of teaspoons of sugar, which is certainly worth a look. But be prepared for this to get ugly. There are those in the industry already arming themselves to fight against increasing support for tobacco-style labels on unhealthy foods. You might want to look at some of the stats surrounding tobacco and the tactics you and other ministers and parties have used over the past decade or so to effectively reduce smoking (your manifesto noted that smoking rates are now lower than in Germany and France).
I’m not saying you shouldn’t eat a Big Mac or chicken chow mein in public – though look at how that worked out for poor Ed Miliband – but this is serious stuff. It is time for you to stick to your promise of “exploring what additional opportunities leaving the European Union presents for food labelling in England that displays world-leading, simple nutritional information as well as information on origin and welfare standards”. Consistency and ubiquity across food sectors throughout the UK are key if labelling is going to work (alongside those other 49 policy levers).
The costs of the scheme have to be considered, of course. John Cawley, a professor of policy analysis and management in the Cornell college of human ecology and lead author of the recent US study I mentioned above, said calorie labelling on menus was “a cheap policy to put in place, and the fact that there is a reduction in calories ordered makes it appealing”. However, your colleagues next door at No 11 have already suggested it will cost small businesses £13m. The Telegraph reported that the chief secretary to the Treasury, Liz Truss, reckons small businesses will have to pay £500 each to have their menus analysed. It’s not clear where that figure came from, though, so I asked around.
UKHospitality told me it was not aware how she came up with it, either. It is not keen on the idea regardless: mandatory requirements will place “considerable burdens” on small businesses and could increase food waste – chefs may be unable to reuse leftovers in improvised dishes, for example. The second is a fair point but I am not sure the whole process will be quite as economically horrific as some are making out. I opened this up for discussion on Linkedin last week and there were a few suggestions worth considering, such as: only label products that are already categorised as unhealthy; use “brackets” for calories (eg 0-100, 101-200 etc) to allow for some innovation from chefs and fewer analyses. The policing of the policy will be critical, so there are costs to be added on there too – cutting corners, as we’ve seen with food fraud, is probably best avoided.
It also seems a little unfair, as per your consultation, to make takeaways bear the brunt of the costs (by doing the analyses) while the likes of Just Eat and Deliveroo only have to put the numbers on their websites. I thought you were trying to fix the gig economy and bring companies like this under the same regulatory umbrella as everyone else?
The impact these tech platforms have had on the high street is a story for another day, but some will use the woes of Prezzo, Jamie’s Italian and Byron to suggest this is the wrong time for more red tape. But look at the bigger picture: IGD forecasts that the UK’s food-to-go sector will be worth £23.5 billion by 2022, up from £17.4 billion in 2017. Shoppers’ preference for eating on the move shows “no signs of slowing down” thanks to plenty of menu innovation, much of it inspired by trends towards health and wellness, as well as global flavours and tastes, IGD said. And Coca-Cola has just spent almost £4 billion on Costa.
But you are not Coca-Cola, of course, and don’t have £4 billion burning a hole in your back pocket (despite what Boris Johnson may have tried to tell us on that bus). But the price of the calorie labelling scheme is minute compared to the economic cost (the NHS spent £6.1 billion on overweight and obesity-related ill-health in 2014 to 2015) and social cost (the worrying statistics released by the NHS in April) of obesity.
But you know all that. And I sense that you are warming to the idea of what critics generically label nanny statism. How very un-Conservative of you. The sugar levy you can’t take the credit for – but could you extend it to foods?. Energy drinks – well done. Junk food advertising restrictions – let’s see (but you might want to consider the EU’s epic fail so far on that particular score). Reformulation – what some see as the key to all this – is proving to be a struggle (especially in foodservice), but you’ve promised to regulate if the voluntary targets aren’t working (next year’s result should give us a better idea).
And calorie labelling on menus? Well, please don’t use it for a few nice headlines and to get the campaigners off your back. There isn’t much evidence to suggest this can work, but that doesn’t mean it can’t – especially if it’s consistent, ubiquitous, well-policed and, critically, part of a number of other interventions. Tackling obesity is a means to protect people and the state. Sure, the public have a right to choose what they eat but is there any harm in helping them with those choices?
Take Scotland, where I live – home to the chippy that, in the words of the Daily Mail, “is selling what may be Britain’s unhealthiest takeaway: a giant box of deep-fried foods that contains an artery-clogging 7,000 calories”. This £10 Family Crunch Box isn’t (quite) the norm but still, 65% of the population here are overweight or obese already. People should be free to buy their box of battered things. I am not talking “Brave New World” but a few brave policies. Labelling menus with calorie information is one of them, but you need to think it through, otherwise it will be a waste of money. That will hurt businesses and energise critics of government intervention. As Daniel Kleinberg, the Scottish government’s deputy director for health improvement, suggested at the Scottish Grocers Federation conference last year: with almost two-thirds of the population overweight or obese, leaving it up to us to make choices clearly isn’t working. And neither are the efforts to educate, reformulate or nudge. “Whatever we have done voluntarily isn’t getting us there,” he said. “I don’t want to paint a picture of this spiralling out of control but [obesity] is the single greatest public health challenge left.”
On that note I wish you good luck.
Yours in anticipation,
David Burrows
