Views of people with disordered eating on current and alternative out-of-home calorie labelling policies in England:A mixed-methods survey

Introduction: Out-of-home calorie labelling was introduced in England as part of public health policy to address obesity. We examined the acceptability and perceived impacts of the policy on individuals with eating disorders. Additionally, potential alternative nutritional label policies were explored. We hypothesised that individuals with binge eating would view the policy more favourably compared to individuals without binge eating. <br/>Methods: A cross-sectional mixed methods study was conducted from February 2024 – March 2025. Inclusion criteria were age ≥16 years, living in England, and having experienced disordered eating. In total, 1,001 people participated.<br/>Results: Latent profile analyses revealed five distinct groups of people based on policy acceptability, perceived impacts, and avoidance of calorie labels: (a) Highly negative with avoidance (n = 202, 20.2%); (b) Highly negative without avoidance (n = 112, 11.2%); (c) Moderately negative (n = 183, 18.3%); (d) Neutral (n = 241, 24.1%); (e) Positive (n = 263, 26.3%). Current binge eating was associated with lower likelihood of belonging in the highly negative with avoidance (OR = 0.45 [0.30; 0.69] or highly negative without avoidance groups (OR = 0.45 [0.26; 0.78]) and higher likelihood of belonging in the neutral (OR = 1.84 [1.26; 2.69]) or positive groups (OR = 2.04 [1.42; 2.93]). Thematic analysis generated four superordinate themes: Reassurance; emotional distress; criticisms; impacts on recovery. When ranking different nutritional label policies, optional calorie labels were the most popular policy, with 63.6% ranking the policy in their top three options. <br/>Conclusions: People with eating disorders hold diverse opinions on out-of-home calorie labels. Our findings shed new light on which demographic groups are negatively or positively impacted by such labels and suggest that optional calories on menus would be the preferred policy choice of people with eating disorders.<br/>