Rapid Evidence Review: Comparing the Implementation of International Mandatory Calorie Labelling in the Out of Home Sector

5.1 Overview of included studies

Database searches identified 203 records from Web of Science and 79 records from PubMed. Following duplicate removal and screening, 22 peer reviewed studies and 5 grey literature reports met the inclusion criteria and were included (total n = 27; Table 4.1).

Table 4.1: Screening procedure

The peer reviewed studies (n=22) were conducted across a range of countries, with the largest number from England (n=6) and the United States (n=6), together accounting for 55% of peer reviewed studies (12/22). This was followed by Canada (n=4) and Australia (n=3), with a smaller number conducted in Saudi Arabia (n=2) and Ireland (n=1). Mandatory calorie labelling policies were in place in all of these countries except Ireland, where menu calorie labelling was a long-standing voluntary scheme with no statutory requirement. The five grey literature reports (n=5) are described separately and are used to provide contextual insight into business perspectives, implementation challenges, and stakeholder commentary, rather than as equivalent evidence on effectiveness. A summary of countries and the number of studies contributing to each thematic area is provided in Table 4.2.

Study designs included observational audits, cross-sectional analyses, and pre/post comparisons. Evidence was synthesised across three recurring themes: business compliance with labelling requirements, business responses and operational impacts, and changes in the calorie content of menu items following implementation.

Table 4.2: Geographic distribution of included peer reviewed studies (n=22)

Note: This table summarises peer reviewed studies only (n=22); grey literature reports (n=5) are not included.

5.2 Business compliance with labelling requirements

Nine studies assessed business compliance with mandatory menu calorie labelling requirements across different countries and settings. Assessment was conducted in terms of the presence, completeness, and in some cases accuracy, of calorie information on menus. Compliance varied across business settings and menu formats, with several studies reporting incomplete or inconsistent provision of calorie information, including missing values, unclear presentation, or inconsistencies between physical menus and online ordering platforms. The policies examined in this review differed not only in whether labelling was mandatory or voluntary, but also in which businesses were covered, whether online ordering was included, what had to be displayed at the point of choice, and how implementation and enforcement were arranged. Direct evidence on enforcement mechanisms was limited; in most studies, enforcement was not measured directly, but its likely influence could be inferred from reported compliance patterns, stakeholder interviews, and descriptions of implementation processes. A summary of key compliance findings by policy context is provided in Table 4.3, and a summary of key legislative features across jurisdictions, including scope, display requirements, and online coverage, is provided in Appendix A. However, while statutory enforcement arrangements could usually be identified from legislation or guidance, very few reviewed studies measured how enforcement operated in practice.

Evidence from the US illustrates how compliance changed during the transition from voluntary to mandatory calorie labelling. Cleveland et al. (2018) reported that prior to federal enforcement, approximately 66% of restaurant chains subject to federal calorie labelling requirements were fully compliant. In addition, a further 13% displayed calorie information on some, but not all, menus or ordering platforms. This partial compliance indicates that calorie information was present in certain formats (for example in-store menu boards) but absent in others (such as drive-through menus or online ordering pages). As a result, compliance was inconsistent across required menu types and ordering formats (for example, present on in-store menu boards but missing from drive-through menus or online ordering pages). In contrast, an observational study by the same authors (Cleveland et al., 2020) conducted within seven months of mandatory implementation found that 94% of the largest restaurant chains displayed calorie information in line with federal requirements. Among the minority of chains that were not fully compliant with federal requirements (6%), pizza and seafood restaurants were most frequently represented. The authors suggested that these sectors faced particular challenges in calculating and presenting calories for items with multiple customisation options or frequently changing menus.

Similarly high levels of compliance were observed in Australia. Lyndal et al. (2015) audited large chain restaurants across states with and without mandatory menu energy labelling requirements and found that 95% of outlets provided energy information. Importantly, there was no substantial difference in provision between states with mandatory requirements and those without. This suggests that large national chains may have implemented menu energy labelling across all outlets for operational consistency, rather than limiting compliance to jurisdictions where it was legally required. There was substantial variation between chain brands, but not between outlets within the same chain across geographic locations. However, the authors noted variation in visibility and accessibility, with some calorie information displayed in less prominent locations or formats that may reduce consumer noticeability. 

In contrast, evidence from England prior to mandatory implementation found that only 17% of 104 large restaurant chains operating in the UK (each with 20 or more outlets) provided calorie information at the point of choice on in-store menus (Robinson et al., 2019). Cafés within the four largest supermarket chains were also included in that analysis. Similarly, Polden et al. (2024) conducted audits of 114 individual food outlets across four geographically and socioeconomically diverse areas in England. Unlike Robinson et al. (2019), which examined chain-level practices, this study assessed calorie labelling at the level of individual premises and focused on point-of-choice display on in-store menus. Prior to implementation, only 21% of outlets displayed calorie information at the point of choice, increasing to 80% after the regulations came into force, although only 15% of outlets met all compliance criteria. A single study from Ireland, where menu calorie labelling is encouraged on a voluntary basis, reported very low provision of calorie information at the point of choice. Fitzgerald et al. (2018)  assessed 604 food service businesses and found that only 7% displayed calorie information at the point of choice. Businesses raised concerns about accuracy, time and cost burdens, and questioned consumer demand for such information in the absence of a legal requirement.

Accuracy of calorie labelling in the English OOH sector was examined in detail by one study. Finlay et al. (2025) reported that 56% of assessed menu items had a lower measured calorie content than stated, while 23% had a higher measured energy content. Importantly, 35% of items fell outside the permitted ±20% legal tolerance for energy variability, indicating that even where calorie labelling is present, accuracy cannot be assumed, and that compliance assessments based solely on label presence may overestimate the quality of information provided.

Several studies reported lower or more inconsistent compliance in online ordering environments compared with on-premises menus. Unless otherwise stated, compliance findings described above refer to physical, in-store menus. In Ontario (Canada), Vanderlee et al. (2023) examined online menus and food delivery platforms following implementation of mandatory calorie labelling legislation, which applies to online menus where ordering is possible. Among the 13 largest restaurant chains assessed, 53.8% displayed calorie information for more than 90% of items on their online menus, despite being compliant in-store. Compliance varied across platforms, and only one chain achieved more than 90% item-level calorie labelling across all evaluated online food delivery platforms. The study evaluated multiple third-party delivery platforms used by the same chains, although compliance was not uniform across them. In-store compliance in this study was substantially higher, highlighting a gap between physical and digital environments. Similarly in Sydney (Australia, New South Wales), Cassano et al. (2024) assessed online food delivery platforms and company-owned websites/apps separately. Of 92 mid-sized food outlets (5 to 19 locations within New South Wales), only 2 outlets displayed any calorie information across online delivery platforms. Among large chain outlets, 35% displayed complete calorie labelling on their own company apps. However, on third-party delivery platforms, 23% of large outlets displayed no required calorie information and a further 23% displayed incomplete or inconsistent labelling. In New South Wales, kilojoule labelling is legally required on online menus where food is offered for sale, so these gaps occurred despite a clear statutory requirement. In Saudi Arabia, where mandatory calorie labelling applies to all food establishments and includes digital ordering platforms, Abdulaziz et al. (2023) compared compliance across delivery applications and restaurant-owned websites. On a widely used third-party delivery application, 24.2% of restaurants were fully compliant with menu calorie labelling requirements, while 56.5% were compliant on their own websites. Conversely, 43.3% of restaurants were non-compliant on the delivery application and 32.6% were non-compliant on restaurant websites. Here, “compliant” refers to meeting the national calorie display requirements as specified in Saudi regulation. No significant association was found between compliance and restaurant rating or existing website labelling practices. These findings indicate that even where legislation explicitly requires online menu labelling, compliance is often lower on third-party delivery platforms than on company-owned websites or in-store menus, suggesting that digital ordering environments pose distinct implementation and enforcement challenges.

Six studies examined business responses to menu calorie labelling requirements, including implementation experiences, operational burden, perceived impacts, and, in some cases, reformulation. These studies used qualitative interviews and surveys.

Essman et al. (2025) interviewed employees in the OOH food sector in England who were involved in delivering calorie labelling requirements. Participants described challenges related to perceived gaps or lack of clarity in government guidance, as well as ongoing menu updates and recipe standardisation required to ensure accuracy of calorie information. Although businesses supported the principle of calorie labelling to protect reputation and maintain customer trust, they believed it would have little impact on customer behaviour as “healthy is more planned, indulgence is spontaneous” or that customers prioritised price over health information when making food choices. Additionally, local enforcement authorities in London reported that responsibility for implementation support and enforcement was distributed across local authorities rather than centrally coordinated, and that limited resources meant calorie labelling enforcement was often deprioritised in favour of more urgent food safety issues. As a result, they were often unable to support all businesses or undertake proactive enforcement beyond responding to complaints.

A study from Saudi Arabia surveyed 41 owners from local and international restaurants after mandatory calorie labelling was introduced. Alkhaldy et al. (2020) reported that 56% supported the policy. Only 46% of restaurant owners knew the reason for implementing calorie labelling. Regarding calculation and display of calorie information, 73% of restaurant owners in the Saudi study reported no major technical problems. However, there was substantial variation in how businesses interpreted and implemented the regulations. For example, some businesses displayed calories alongside all menu items as required, while others omitted calorie information for combination meals, failed to include all accompanying statements required by the regulation, or displayed calorie information less prominently than required. Although 37% of restaurant owners reported noticing reduced sales of higher-energy meals following implementation, these perceived sales shifts did not translate into systematic reformulation or changes to preparation methods.

Several studies examined business-level responses to menu calorie labelling before mandatory implementation in the respective country. Brown et al. (2017) conducted a pilot programme with 22 independent restaurant owners in Toronto (Canada) to test the feasibility of voluntary menu calorie labelling. Participating businesses were asked to standardise recipes, conduct nutrient analysis of menu items, and display calorie information. While 15 restaurants completed some elements of the programme, only 4 completed all components, including recipe standardisation, nutritional analysis, and menu display. Owners recognised potential public health benefits but reported that implementation was resource-intensive, particularly due to time constraints, limited technical expertise, complexity of nutrient analysis, and variability in ingredient sourcing. Many indicated they would require external support or simplified tools to implement menu calorie labelling sustainably.

A second Canadian study from Vanderlee et al. (2016) examined stakeholder experiences two years after implementing a voluntary menu calorie labelling programme. Participants reported that implementation was feasible within highly standardised food-service environments, but emphasised the importance of organisational commitment, internal capacity, and access to nutritional expertise. However, businesses also reported increased staff workload and financial risk, including the cost of nutritional analysis, menu redesign, staff training, and the potential commercial risk of altering popular menu items.

In contrast, Susskind et al. (2024) assessed short-term business outcomes in two US university restaurants following introduction of menu calorie labelling. As calorie labelling might plausibly affect ordering patterns, sales mix, and operational workload, the study examined revenue, profit, and kitchen staff preparation time per order. The authors found no statistically significant changes in revenue or profit, and no detectable change in kitchen staff preparation time per order. However, the study assessed only direct food costs and did not quantify the time or resources required to calculate, verify, and display calorie information.

In Ireland, where calorie labelling remains voluntary, Fitzgerald et al. (2018) examined current display practices and business attitudes. Of 604 surveyed food-service businesses, only 7% reported currently displaying calorie information (38% of chains and 62% of single-outlet businesses among those displaying). Low uptake was attributed to concerns about time constraints (33%), perceived costs (26%), and lack of expertise (14%). A quarter of respondents questioned the usefulness of calorie information for customers. Among businesses that did display calories, 52% believed it promoted healthier eating and 47% believed it enabled informed decision-making. Small and independent businesses reported particular difficulty in conducting calorie analysis, covering the financial cost of nutritional assessment, and maintaining up-to-date information as menus changed. Across respondents, apprehension related primarily to resource requirements rather than opposition in principle.

Overall, businesses reported ongoing rather than one-off costs, primarily linked to menu updates, reformulation, recipe standardisation, and maintaining accurate calorie information as menus changed. Several studies highlighted the need for clearer operational guidance, access to simplified calculation tools, and ongoing technical support to enable compliance. Enforcement was also described as challenging, with local authorities reporting limited resources and competing priorities, particularly acute food safety issues. From the business perspective, implementation was perceived as resource-intensive due to time constraints, limited in-house expertise, the complexity of nutritional analysis, and the need for external support. These findings suggest that both implementation and enforcement require sustained capacity rather than short-term adjustment.

In addition to peer reviewed studies, grey literature from England provided contextual insight into how businesses and industry stakeholders perceived mandatory calorie labelling requirements. These sources suggested a mixed picture. Some stakeholders viewed calorie labelling as supportive of transparency and customer trust, while others emphasised implementation burden, increased costs, and concerns about impacts on menu flexibility, creativity, and businesses with less standardised or frequently changing offerings. As these sources were not peer reviewed and often reflected stakeholder or media perspectives, they are used here to illustrate implementation concerns rather than as evidence of effectiveness.

In line with some of the research findings, several sources highlighted that the impact of calorie labelling may vary by business type. Restaurant newsletters and industry commentary noted that “implementation will also be more challenging for less standardised businesses that cook from scratch”, and that businesses with “changing or daily menus, frequent specials, or those making use of seasonal or local produce” may face particular difficulties. Concerns were also raised that this could discourage innovation or the use of local products. Small businesses were reported to face additional challenges related to “lack of time, expertise and the cumulative burden of regulations”, with some suggesting that compliance could require additional staff. Further important concerns were raised about perceived inequities in scope, including restaurants operating under different legal entities despite being part of the same company, and restaurants located within large hotels exceeding employee thresholds despite operating small kitchens.

Seven studies examined whether the introduction of calorie labelling was associated with changes in the calorie content of menu offerings, using before vs. after, longitudinal, or comparative cross-sectional designs. 

Evidence from New South Wales (Australia) and Ontario (Canada) showed no significant reduction in energy content of menu items following the introduction of mandatory labelling. In Australia, Wellard-Cole et al. (2017) analysed new menu items introduced by five major fast-food chains and reported an increase of 17 kJ per 100 g between 2009 and 2015 (approximately 4 kcal per 100 g). While this appears numerically small, many OOH portions exceed 100 g, meaning cumulative differences at the portion level may be larger. The study reported results per 100 g and did not identify systematic reductions in serving size to offset the increase in energy density. Similarly, Scourboutakos et al. (2019) examined 172 restaurant chains in Ontario and reported an average increase of 40 kcal per serving between 2010 and 2017. No significant change was observed for core menu items (those present at all time points). However, newly introduced items were significantly higher in calories per serving (+40 kcal), and limited-time items were significantly higher in energy per 100 g (+74 kJ, approximately 18 kcal per 100 g). Limited-time items showed no difference in calories per serving, suggesting that while energy density increased, serving sizes may have been smaller.

Three US studies examined calorie changes in large chain restaurants, focusing on reformulation trends over time. Bleich et al. (2017) analysed menu data from 44 of the 100 largest US chain restaurants and reported a decline in mean calories per menu item from 327 kcal to 310 kcal between 2008 and 2015 (per item, not per transaction). Among newly introduced items, there was a non-significant reduction of approximately 67 kcal per item, driven primarily by declines in main courses (−63 kcal) and desserts (−80 kcal). In an earlier analysis comparing chains with and without voluntary calorie labelling Bleich et al. (2015), restaurants displaying calorie information offered menu items with significantly lower mean calories per item (approximately 136 kcal lower) than restaurants without labelling. Although both groups reduced calories in newly introduced items over time, new items from restaurants with voluntary labelling had substantially fewer calories (approximately 182 kcal per item) compared with new items introduced by restaurants without labelling (approximately 110 kcal per item).

The third US study (Petimar et al., 2021) examined transaction-level purchasing data from 104 fast-food outlets across three national chains. The authors reported a reduction of 82 kcal per transaction nearly one year after nationwide implementation of calorie labelling, alongside reductions in total fat (−3.0%), carbohydrates (−5.0%), protein (−5.1%), saturated fat (−1.8%), sugar (−7.0%), fibre (−4.4%), and sodium (−5.0%). These findings reflect changes in calories purchased per transaction rather than reformulation of menu items. When linking restaurant locations to area-level median household income, the reduction in calories purchased per transaction was greater in higher-income areas (95 kcal) than in lower-income areas (49 kcal). This difference therefore reflects variation in purchasing behaviour by area, not differences in the underlying energy content of menu items offered by restaurants in those locations.

In England, two studies assessed the calorie content of menu items in relation to calorie labelling. Theis et al. (2019) compared menu offerings from 42 of the 100 most popular UK restaurant chains four years prior to mandatory implementation. Restaurants voluntarily displaying calorie information (13 restaurants, 31%) offered menu items with 32% lower average calorie content than those without labelling, although this difference was not statistically significant. Additionally, items from these outlets had significantly lower total fat (−45%) and salt (−60%) but higher sugar (+52%). Baked goods were a notable exception, with items from outlets displaying calories higher in energy (+18%), total fat (+74%), sugar (+300%) and salt (+43%). The authors suggested that reformulation may have begun prior to mandatory implementation among some businesses, but changes were inconsistent across menu categories. Essman et al. (2025) analysed menu data from 78 large OOH food chains in England and reported a small reduction of 9 kcal (2%) in mean calorie content six months post-implementation. The largest decreases were observed in burgers (−103 kcal; −11.1%), beverages (−36 kcal; −4.2%) and mains (−30 kcal; −4.2%). Pubs, bars and inns showed the greatest reductions (−52 kcal; −8.8%), followed by sports and entertainment outlets (−49 kcal; −13.4%) and restaurants (−23 kcal; −4.9%). In contrast, calories increased in sandwiches (+88 kcal; +15.8%) and western fast-food/takeaway outlets (+42 kcal; +11%). Changes were primarily driven by removal of higher-calorie items and introduction of slightly lower-calorie items. No significant change was observed for continuous menu items, nor in the proportion of items exceeding 600 kcal, indicating limited evidence of systematic reformulation.

Overall, evidence across jurisdictions suggests that business responses in terms of calorie content are heterogeneous. Some studies report small reductions, often in newly introduced items or at the transaction level, while others report no change or small increases. Where reductions were observed, they were typically in the order of a few kilocalories per menu item or tens of kilocalories per transaction, rather than evidence of large-scale reformulation across existing menus. In several cases, reductions were observed prior to formal enforcement, suggesting that businesses may respond to anticipated regulation. Effects vary by product type and business category, and where changes occur they are generally small and inconsistent. A summary of reported changes in calorie content and the metrics used is provided in Table 4.4.