Impact of out-of-home nutrition labelling on people with eating disorders: A systematic review and meta-synthesis

Background: Mandatory nutrition labels for out-of-home food consumption have been introduced in several countries to curb rising obesity levels. However, concerns have been raised about the potential negative impacts of such policies could have on individuals with eating disorders. This review aimed to summarise the literature on the impact of out-of-home nutrition labels on individuals with eating disorders or disordered eating. Methods: A systematic search across eight databases was conducted up to 11th of October 2023. Studies were included if they assessed the impact of out-of-home nutrition labelling policies on individuals with eating disorders or disordered eating. 538 studies were screened, of which 16 studies met inclusion criteria and were included. Results: The reviewed studies included 5 experimental/quasi-experimental studies, 5 cross-sectional studies, and 6 qualitative/mixed methods studies. Most studies were conducted in Western countries and all study participants were adults. Across studies, eating disorder pathology was associated with noticing labels more frequently, paying more attention to caloric intake, and more frequent behaviour changes due to caloric values. The meta-synthesis identified 5 themes based on the qualitative findings, being drawn to calories, facilitating the eating disorder, reassurance, social eating, and frustration. Discussion: The current review summarised the existing literature on the impact of out-of-home nutrition label policies on individuals with eating disorders. The evidence suggests that there is cause for concern regarding negative impacts, particularly for those with restrictive eating disorders, which should be explored further by research and considered by policy makers when making decisions on public health policies.