What is the impact of increasing the prominence of calorie labelling? A stepped wedge randomised controlled pilot trial in worksite cafeterias

Milica Vasiljevic,Georgia Fuller,Mark Pilling,Gareth J Hollands,Rachel Pechey,Susan A Jebb,Theresa M Marteau

doi:10.1016/j.appet.2019.05.035

Milica Vasiljevic, Georgia Fuller + Show 5 more

Open Access

https://doi.org/10.1016/j.appet.2019.05.035

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Abstract

BackgroundCalorie labelling may help to reduce energy consumption, but few well-controlled experimental studies have been conducted in real world settings. In a previous randomised controlled pilot trial we did not observe an effect of calorie labelling on energy purchased in worksite cafeterias. In the present study we sought to enhance the effect by making the labels more prominent, and to address the operational challenges reported previously by worksites. MethodsThree worksite cafeterias were randomised in a stepped wedge design to start the intervention at one of three fortnightly periods between March and July 2018. The intervention comprised introducing prominent calorie labelling for all cafeteria products for which calorie information was available (on average 87% of products offered across the three sites were labelled). Calorie content was displayed in bold capitalised Verdana typeface with a minimum font size of 14 e.g.120 CALORIES. Feasibility and acceptability were assessed using post-intervention surveys with cafeteria patrons and semi-structured interviews with managers. Effectiveness was assessed using total daily energy (kcal) purchased from intervention items across the three sites, analysed using semi-parametric GAMLSS models. ResultsRecruitment and retention of worksite cafeterias proved feasible: all three randomised sites successfully completed the study. Post-intervention feedback suggested high levels of intervention acceptability: 87% of responding patrons wanted calorie labelling to remain in place. No effect of the intervention on daily energy purchased was observed: −0.6% (95%CI -2.5 to 1.2, p = .487). By-site analyses showed similar null effects at each of the three sites, all ps > .110. ConclusionsThere was no evidence that prominent calorie labelling changed daily energy purchased across three English-based worksite cafeterias. The intervention was feasible to implement and acceptable to patrons and managers.

Highlights

Calorie labelling may help to reduce energy consumption, but few well-controlled experimental studies have been conducted in real world settings
Highly acceptable to cafeteria patrons and managers, the calorie labelling intervention had no effect upon energy purchased across the six sites
A large proportion of respondents (83%) were either happy or very happy about the introduction of calorie labelling, 12% were neither happy nor unhappy, 1% were unhappy or very unhappy, whilst 2% reported not noticing any changes in labelling

Summary

Introduction

Calorie labelling may help to reduce energy consumption, but few well-controlled experimental studies have been conducted in real world settings. In a previous randomised controlled pilot trial we did not observe an effect of calorie labelling on energy purchased in worksite cafeterias. Feasibility and acceptability were assessed using post-intervention surveys with cafeteria patrons and semi-structured interviews with managers. Effectiveness was assessed using total daily energy (kcal) purchased from intervention items across the three sites, analysed using semi-parametric GAMLSS models. Conclusions: There was no evidence that prominent calorie labelling changed daily energy purchased across three English-based worksite cafeterias. Recent evidence suggests that interventions that change aspects of the physical environment or ‘choice architecture’ may be more effective at changing dietary behaviour including reducing energy intake than more traditional interventions requiring conscious engagement, such as educational campaigns (Hollands, Marteau & Fletcher, 2016; Hollands et al, 2017; Marteau, Hollands, & Fletcher, 2012; Thaler & Sunstein, 2008). In England the government is considering implementing similar legislation to make calorie labelling mandatory for the out-of-home sector (Department of Health and Social Care, 2018)

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