Recent global initiatives to control or decrease obesity have led to the implementation of public health policies aimed at lowering calorie intake. These initiatives promote food labeling regulations and raise awareness of the obesity epidemic. These health policies introduced mandatory nutrition labels for out-of-home beverages and food in Ontario (January 2017) and England (April 2022). These calorie values raise concerns regarding their effects on people with eating disorders and psychiatric conditions such as anxiety.
Bulimia, anorexia, and obesity share common risk factors and increase susceptibility to psychiatric disorders, which contribute to a lower quality of life and higher mortality rates. This underscores the need for integrated public health strategies. Additionally, broader public and mental health implications require further investigation.
The systematic literature review and meta-analysis published in BMJ Public Health focused on a comprehensive understanding of the effect of out-of-home nutrition label policies on individuals with disordered eating or eating disorders.
This approach was carried out according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and PROSPERO study protocol (CRD42023389596). The relevant studies were selected using various databases such as Embase, APA PsycINFO, Medline, CINAHL, Web of Science, Scopus, ProQuest Dissertations, and Theses Global for published studies. Google Scholar and PsyArXiv data sources were utilized for reviewing unpublished studies. This study was conducted on 11 October 2023. Articles examining the impact of nutritional value information on prepacked beverages and food were excluded.
A total of 16 studies were included in this review which consisted of 5 experimental or quasi-experimental studies along with 5 cross-sectional studies and 6 qualitative or mixed-method studies. Data related to demographic characteristics and eating disorder measures like eating disorder questionnaire – 7 item version (EDE-Q7), eating pathology symptoms inventory (ESPI), and body-esteem scale for adolescents and adults (BESAA) score were extracted from included studies. The quality of the included studies was determined using the analysis technique like mixed-methods appraisal tool (MMAT).
Experimental studies found that there was no significant difference in eating pathology observed between individuals who were exposed to nutrition labels and those who were not. The cross-sectional studies revealed that eating pathology was linked with noticing and using the nutrition label. These studies have noticed greater awareness of calorie intake and more frequent behavioral changes based on caloric values.
The meta-analysis of this study identified five key themes including attention calorie information, reassurance, influence on social eating, reinforcement of the eating disorder, and feelings of frustration. Â
The study’s limitations include a regional focus, which require consideration of the social and cultural factors for accurate interpretation of results. These studies primarily focused on undergraduate students rather than the broader population. The comparison between the labelling types was not possible. This limitation led to general rather than label-specific conclusions.
This review concluded that calorie labels had a negative impact on people with restrictive eating disorders. Policymakers should consider obesity and eating disorders when designing nutrition labeling policies. Future studies should include the children and adolescent population with eating disorders to investigate the effect of nutritional information policies.
Reference: Trompeter N, Duffy F, Peebles I, et al. Impact of out-of-home nutrition labeling on people with eating disorders: a systematic review and meta-synthesis. BMJ Public Health. 2025;3:e000862. doi:10.1136/bmjph-2023-000862
