Calorie labelling in the out of home sector: consultation analysis

10. Impact Assessments

Q18. Impact of policy on protected characteristics

Q18 - What impacts, if any, do you think the proposed policy would have on people on the basis of their: age, sex, race, religion, sexual orientation, pregnancy and maternity, disability, gender reassignment and marriage/civil partnership?

In total, 359 individuals and 54 organisations provided a response to question 18.

Age

The main view expressed in relation to age was that many young people would be vulnerable due to being perceived as highly impressionable, with views that the policy may lead to a rise in extreme calorie counting behaviours linked to disordered eating among young people (especially women) in particular. Other age related concerns included that:

• the number of calories individuals need varies by age and the policy may encourage people of different ages to eat too few (especially children for whom failure to consume enough food can impact on the developing body) or too many (which may lead to inappropriate weight at different life stages); and
• children in particular may be likely to misinterpret calorie information as providing a full picture of nutritional content.

Sex

The main theme in relation to sex was that the policy may disproportionately negatively impact on women, who were considered to be more likely to experience body shame and disordered eating behaviours. That being said, others perceived that mandatory calorie labelling would be bad for both men and women equally, as both can suffer from eating disorders.

The other main themes related to sex included that:

• females (especially younger females) may be more likely to feel social pressure to eat the least calorific items on menus (due to social pressures to be 'slim' to be attractive);
• men and women having different requirements depending on size, metabolism and activity levels can mean that people using the '2000 calorie' reference statement (alongside mandatory calorie labelling) may consume inappropriate numbers of calories;
• inappropriate calorie consumption possibly affecting menstrual cycles of females, with altered eating as a result of the policy potentially making this more prevalent; and
• middle aged and menopausal women who have a lack of oestrogen, menstruation and overall 'body balance' could be negatively impacted. Negative impacts included anxiety, body dysmorphia, and fad dieting.

Race

There were fewer comments overall in relation to race (compared to age and sex), the main comments being that:

• historically, calorie recommendations/BMI calculators have catered to white adults and may be inappropriate for people from other racial backgrounds to use as a guide;
• Black, Caribbean and African people, especially women, may experience weight stigma in higher proportions and may be disproportionately affected by the policy;
• some ethnic dishes may have higher calorie content and become stigmatized as a result of the policy (affecting businesses that sell an ethnic groups' cuisine); and
• additional information on menus may be confusing to people who do not speak English as their first language or who already struggle to read and understand information available in the OOH sector.

Religion

Again, there were relatively few comments made specifically in relation to religion, the main comments being that:

• some religions already have dietary restrictions and associated labelling which may be made more complex by the addition of further information; and
• while it is important to know what is in food to respect dietary and religious sensibilities, calorific value does not feature in this.

Sexual orientation

A common theme to emerge across responses was that there may be a predisposition to eating disorders among the LGBT+ community and that this would need to be considered if the policy was taken forward. One respondent suggested that the policy may affect gay men disproportionately, noting that they have higher percentages of eating disorders and disordered eating behaviours (although no link to specific evidence to support this claim was provided).

Pregnancy and maternity

There were few comments made in relation to pregnancy and maternity, the main concerns being that:

• Mandatory calorie labelling may inadvertently lead some pregnant and nursing women to eat less which may be harmful to the developing baby;
• the policy may exacerbate existing negative social judgements about what women should/should not consume during pregnancy, to their detriment; and
• post-partum mothers may potentially make poorer food choices based on calorie information alone (without wider nutritional data), due to wanting to lose weight/regain their pre-pregnancy shape/weight.

Disability

The main views in relation to disability were that the policy had the potential to be particularly negatively impactful on those with mental ill health, especially those with eating disorders (which many described as a disability in its own right). Other disability specific concerns included that:

• access to information for visually impaired/those with numeracy and literacy issues may be problematic and would need separate consideration during any implementation phase;
• people with disabilities tend to experience lower incomes and poorer health and so the policy may have more negative impacts on this group;
• individuals with specific learning difficulties are more likely to find the information confusing;
• obsessive calorie counting can particularly affect people on the autistic spectrum;
• many disabled people are already heavier compared to non-disabled and may be stigmatised or made to feel responsible for their disabilities alongside their weight;
• some people living with disabilities require additional calories to healthy adults and this policy may deter some from consuming enough; and
• eating disorders have a lifelong impact both mentally and physically, causing individuals to be disabled in either or both areas (and if the number of eating disorders increases, more individuals would be classed as disabled under the 2010 Equality Act).

Gender reassignment

The main concern raised in relation to gender reassignment was that transgender individuals may be more susceptible to eating disorders and therefore be more likely to be affected by mandatory calorie labelling.

Marriage/civil partnership

There were few comments made in relation to marriage and civil partnership, the main comments being that:

• eating disorders can put stress on intimate relationships and the policy may worsen this and cause more separations/relationship distress; and
• those in controlling marriages/partnerships may be scared to order certain food items for fear of being reprimanded.

Others who may be impacted by the policy

Others who it was may be more negatively affected by the policy included:

• people who are larger in size/already overweight and who may experience additional discrimination if the policy perpetuates social stigmas linked to body size; and
• those on low/no incomes and those experiencing poverty

The following quote provides an example of these views:

"Many people in the above categories are forced to live in less well off areas due to poverty/ discrimination. In these areas, there is often much less access to healthy alternatives and so putting calorie counts on meals would only serve as a reminder that they live in places where there only options are to eat unhealthy food, further reminded them of their social exclusion." [Individual]

Several respondents who did not agree with mandatory calorie labelling overall again commented that the policy would impact negatively on 'all' people.

A small number commented that an impact assessment of this kind did not seem appropriate (i.e. was an artificially 'woke' or 'politically correct' question) and/or felt that the consultation should have given more attention to specific sub-groups throughout.

Positive comments

Very few respondents indicated that they did not anticipate any issues with the policy on an equalities basis. Similarly, very few gave views that the policy may impact positively on any group with protected characteristics, the exceptions being that:

• Mandatory calorie labelling could help those with certain disabilities or other medical issues with controlled diets to better monitor their calorie consumption. Specifically, the policy could positively impact people with diabetes to support them with information to maintain their weight and calorie intake and the policy could help older people and people at risk of developing dementia who are in need of increasing their calories intake when recommended by a healthcare professional;
• Mandatory calorie labelling may positively affect younger people as they will grow up with more knowledge of what they are eating; and
• Mandatory calorie labelling could help women in managing weight before pregnancy to aid fertility and healthy pregnancies and information on calories could help pregnant women raise calorie intakes in their last trimester when recommended to do so by a healthcare professional.

A small number of respondents again perceived that mandatory calorie labelling would not influence people's food choices (which would remain personal), and so felt that there would be no negative consequences for any group directly:

"I only see positive impacts. People who want the information will have it, people who do not want it will simply ignore it. I see no negative impacts on people." [Individual]

Q19. Impact on people living with socio-economic disadvantage

Question 19 - What impacts, if any, do you think the proposed policy would have on people living with socio-economic disadvantage? Please consider both potentially positive and negative impacts and provide evidence where available

In total, 336 individuals and 54 organisations provided a response to question 19.

Among those who cited a positive impact for those living with socio-economic disadvantage the most common emerging theme was that the policy would allow people to make healthier and more informed choices about diet. While choices are more limited for those living with socio-economic disadvantage, it was suggested, giving calorie information would allow access to information to make healthier choices.

Others noted that any positive impacts were likely to be mitigated by the fact that people living with socio-economic disadvantage are often more constrained in their choices overall.

Again, some raised that those on low/no incomes and those experiencing poverty may feel guilt as a result of feeling that they have to shop in cheaper, lower nutrition supermarkets or live in areas where there is less access to healthy alternatives. This was raised as potentially serving as a reminder of their social exclusion.

Q20. Impact of policy on other communities or populations

Question 20 - Please use this space to identify other communities or population groups who you consider may be differentially impacted by this policy proposal. Please consider both potentially positive and negative impacts and provide evidence where available

In total, 268 individuals and 44 organisations provided a response to question 20.

Only two groups were identified by respondents as potentially benefiting from the policy: calorie counters and those who were not aware of the calories in their food.

Beyond the equality characteristics identified in questions 18 and 19, a myriad of other groups that would be negatively affected by the policy were identified.

By far, the greatest concern was for sufferers of eating disorders and their families and other mental illnesses. For example:

"People with existing mental health conditions such as anxiety, bipolar disorder, depression and of course those who already suffer with eating disorders will be immensely affected by this. The Scottish government cannot claim to take mental health seriously and also enact this policy, one which would excessively harm those suffering with an eating disorder, which is statistically the most deadly form of mental health condition." [Individual]

There was also concern for those providing food, such as businesses and community groups, for example:

"Small business - I am just about ready to give up with all the regulation, costs, stress, anxiety. Many more are already insolvent." [Organisation, Out of Home Food Provider]

"Community groups or organisation proving catering or meals may struggle to find the resources to meet mandatory requirements. This means that those people who rely on these groups for food, socialisation would be disadvantaged." [Individual]

Counter to the goals of the policy to reduce obesity, overweight people were argued to be losers in this policy by many as it was believed it would increase stigmatization of larger bodies. For example:

"Those with a high Body Mass Index (BMI) - calorie labelling reinforce sizes stigma and is therefore likely to have a negative impact. Making choices based on calories content may support self efficacy when they do this, but undermine it when they don't." [Organisation, Public Sector]

Additionally, those with other dietary requirements were perceived to be negatively affected if restaurants cannot alter orders on request as it would change the calorie content.

Finally, those who are visually impaired, faced literacy barriers, or were non-English speakers were again identified as groups that could struggle with the policy.

It should be noted that several respondents were dissatisfied with this question in the consultation as they argued that not giving people the choice on whether or not they would like to see calorie labelling would have a (negative) effect on everyone by design and felt the questionnaire asking them to pick out groups was designed to imply that the policy would be positive for the majority.

Q21. Potential unintended consequences to businesses, consumers and others

Question 21 - Please tell us about any other potential unintended consequences (positive or negative) to businesses, consumers or others you consider may arise from the proposals set out in this consultation, where available

In total, 263 individuals and 48 organisations provided a response to question 21.

Many of the responses to this question covered territory that was explored in previous questions such as negative impacts on those with disordered eating, additional costs to businesses and opinions given on whether the policy would be effective in meeting its aims.

Some themes that were identified as positives were that the policy could drive an increase in people approaching their GPs for more information on weight loss and drive the introduction of smaller portion sizes in OOH settings.