1. Calorie-labelling as an anti-obesity measure George Thom Aviemore 6 th Nov 2014

2. Background Catering outlets: increasing Meals/snacks outside home: increasing Portion sizes: increasing ……. Obesity prevalence: increasing Calorie-labelling of meals suggested as an anti-obesity measure, and now mandatory in some US states. But evidence of impact is scarce How many calories?

4. Calorie-Labelling : a review of the literature Nikolaou et al 14 studies published since 1990 on calorie labelling of meals and entrees 7 among adults in real-life (restaurant) settings 6 studies with data for meta-analysis – Overall, no effect – -124 kcal among customers who noticed the calorie labels Customers who noticed the calorie-labels

5. Nutritional compositions of meals offered to young adults Nikolaou et al 2,056 meal-combinations offered at 7outlets analysed Current food provision may favour unwanted weight gain Means : 773-1189 kcal max 1,774 kcal How many calories

6. Prominent calorie-labelling presented every day prevents weight gain in residential students Nikolaou et al Weight change over 9 months No calorie-labels Mean weight change +3.5kg 120 residential students, catered ITT Weight changes over 9 months

7. Prominent calorie-labelling presented every day prevents weight gain in residential students Nikolaou et al Consumers could not fail to notice the labels Weight gain over 9 months abolished by calorie-labelling Catering food costs reduced by 33%, so potentially sustainable What about non-residential settings? Weight change over 9 months No calorie-labels Mean weight change +3.5kg With calorie-labels No weight change Weight change over 9 months

8. Calorie-Labelling as an anti-obesity measure Study Setting Sales compared: –Intervention sites (calorie-labels) –Control site

10. Calorie range of items: 236-544kcal Prominent calorie-labels in front of sandwiches for 2 weeks Questionnaire administered to students and staff, on-site and on-line Sales data one month without labels, then one month with labels 5.4 cms x 9.9 cms Calorie-Labelling as an anti-obesity measure Methods

12. Calorie-Labelling as an anti-obesity measure Results: sales data --p<0.0001-- ----NS--- During the labelling period Total Sales: Intervention sites: -17% Control site: -2% High-calorie items -30% Low-calorie items -18% Sales of unlabelled foods unchanged

13. Calorie-Labelling as an anti-obesity measure Survey ResponsesStaff = 646 (68% female) Students = 1166 (75% female) Ages Staff = 42.4 (SD 10.7) Students = 24.2 (SD 6.9) BMI Staff = 25.1 (SD 5.7) Students = 23.2 (SD 5.1) Calorie-labelling used more by healthy weight students and staff rather than those overweight or obese.

14. Calorie-labelling for obesity prevention 1.Existing evidence very limited: may reduce calorie purchases 2.Current food provision for young adults, without calorie-labelling, would favour weight gain 3.Calorie labelling prevented weight gain for residential students, and reduces costs 4.Wider use of calorie-labelling in catering outlets 1.Is welcomed by consumers 2.Is acceptable to caterers 3.Nudges sales towards lower-calorie items 4.Abolishes weight gain Acknowledgements State Scholarships Foundation of Greece

15. Thank you for listening c.nikolaou.1@research.gla.ac.uk