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 disordered eating. Additionally, potential alternative nutritional label policies were explored. We hypothesised that individuals with binge eating would view the policy more favourably compared with individuals without binge eating. Methods A cross-sectional mixed-methods study was conducted from February 2024 to March 2025. Inclusion criteria were age ≥16 years, living in England and having experienced disordered eating. In total, 1001 people participated. Results Latent profile analyses revealed five distinct groups of people based on policy acceptability, perceived impacts and avoidance of calorie labels: (1) highly negative with avoidance (n=202, 20.2%); (2) highly negative without avoidance (n=112, 11.2%); (3) moderately negative (n=183, 18.3%); (4) neutral (n=241, 24.1%) and (5) 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 a 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 and 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. Conclusions People with disordered eating 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 disordered eating.