An interventional study of Control condition and Calorie labelling in Food Labelling, Eating Behaviour and Mental Health, sponsored by University of Liverpool. Not yet recruiting at 1 site in United Kingdom. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-09-09.
Sponsored by University of Liverpool · Not applicable, Interventional, and Prevention
Calorie labelling in out-of-home (OOH) settings was introduced by the government in England as part of a wider strategy to 'tackle obesity' (DHSC, 2020). The OOH sector encompasses outlets where food and drinks are prepared for immediate consumption, on or off the premises (DHSC, 2021). Increased consumption of OOH food is associated with greater intake of energy and nutrients of concern; therefore, is implicated in poorer dietary quality and ill-health (Gesteiro et al., 2022). The key ambition for the calorie labelling policy was to inform consumers of the calorie content of their food choices, making it easier to select healthier food choices (DHSC, 2020). An additional potential benefit of the policy was to prompt reformulation by the food industry to either reduce the calorie content of foods on offer or provide new lower calorie options (DHSC, 2021).
The calorie labelling policy in England was criticised at the time of implementation in the media for its potential to cause harm in individuals with eating disorders (Polden et al., 2023). However, limited research had explored effects on individuals with eating disorders (Robinson et al., 2023). It is estimated that over a million individuals in the UK are living with an eating disorder (Beat Eating disorders, 2026). Therefore, it is important for research to understand the impact of food labelling interventions on mental health outcomes in individuals with eating disorders and other mental health conditions, and whether alternative nutritional labelling practices that are not focused on calories alone could have positive health impacts without unintended negative consequences.
One alternative form of nutritional labelling that could be considered in OOH settings is Nutri-score. Nutri-score provides food items with a label from A (dark green, healthiest) to E (Red, least healthy) according to the content of both positive (e.g. fibre, protein) and negative (e.g. saturated fat, salt, sugar) nutrients. Nutri-score has been implemented as a front-of-pack label in several countries across Europe, with positive impacts on the healthiness of food purchasing in supermarkets (Andreani et al., 2025). Two studies have assessed Nutri-score in OOH settings, also finding associations between Nutri-score and healthier food choices (Chandon \& Indaburu, 2026; Julia et al., 2021). However, Nutri-score on food menus has not previously been examined in terms of the potential impact on individuals with eating disorders and other mental health outcomes.
Nutri-score encompasses the nutritional quality of a food product, by accounting for both positive and negative components. This may be less harmful to individuals with eating disorders as it would remove the focus on calorie content. Previous qualitative research has shown that individuals with eating disorders may support labelling strategies that provide more holistic approaches to nutrition (Trompeter et al., 2026). It could also be of benefit to general population health to focus on helping individuals to consume a well-rounded diet higher in positive nutrients (fibre, protein), with high fruit, vegetable and nut content, and lower in negative nutrients that contribute to ill health (salt, sugar, fats). To date, limited research has compared Calorie labelling to Nutri-score in the general population or among those living with mental health conditions, like eating disorders.
OBJECTIVES This new study will explore the impact of Nutri-score labelling vs Calorie labelling vs no labelling (Control) in a simulated OOH food delivery ordering platform (common setting for food purchasing and calorie labelling is required by law in England) on participants' perceived effectiveness of nutritional labelling, healthiness of food choices, positive and negative affect, and perceived impacts on mental health.
We will examine effects in a general population sample (no eating disorder diagnosis), a sample of participants with a past or current diagnosis of an eating disorder by a medical practitioner and a sample of participants with a common mental health condition diagnosed by a medical practitioner without eating disorder (e.g., anxiety), in order to understand potential effects across groups of participants who may differ in their risk of poorer mental health in response to nutritional labelling.
(references in attached protocol)
See attached study protocol for detailed information
985 studies on the registry are indexed under Feeding Behavior; 178 are open to participants now.
This study's planned enrollment of 900 is above the median of 77 across 700 interventional studies indexed under Feeding Behavior.
Browse Feeding Behavior studies →University of Liverpool is the lead sponsor of 99 studies on the registry; 10 are open to participants now.
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Inclusion Criteria:
Inclusion for specific participant groups:
Exclusion Criteria:
Participants with no diagnosis of a mental health or eating disorder
Behavioral: Control condition · Behavioral: Calorie labelling · Behavioral: Nutri-Score labelling
Participants with a diagnosis of a mental health condition but no diagnosis of an eating disorder
Behavioral: Control condition · Behavioral: Calorie labelling · Behavioral: Nutri-Score labelling
Participants with a diagnosis of an eating disorder
Behavioral: Control condition · Behavioral: Calorie labelling · Behavioral: Nutri-Score labelling
Participants will be asked to select a meal from a food menu with no nutritional labelling
Participants will be asked to select a meal from a food menu with calorie labelling
Participants will be asked to select a meal from a food menu with calorie labelling
Perceived Message Effectiveness
An adapted version of the University of North Carolina Perceived Message Effectiveness (PME) scale will be used as a measurement of how effective participants believe nutritional labelling is in promoting behaviour change. The scale measures health concern, product attitude, and discouragement of item consumption in response to public health messaging or in this context, the food menu presented during the study. Participants will be shown a screenshot of the menu they ordered. All participants will answer 3 questions using a Likert scale ranging from 1 - 5 anchored by "Strongly disagree" and "Strongly agree". The mean response to the three items will be calculated. PME is used as an early indicator of a health messages potential to change behaviour (e.g., reduce selection of less healthy items). The scale has been used previously to identify the potential impact of food labels and is predictive of long-term behaviour.
Time frame: Day 1 of 1: the PME measure will be completed immediately after participants have made their food selection
Perceived usefulness of menu in identifying healthier/less healthy food choices
Participants will be asked 'To what extent was the menu useful in helping you identify healthy vs. less healthy food choices'. Participants will select their answer on a Likert scale ranging from 1 - 5 anchored by "Strongly disagree" and "Strongly agree".
Time frame: Day 1 of 1: Participants will rate the perceived usefulness of the menu immediately after making their food selection.
Nutritional quality of food ordered
An overall measure of nutritional quality of participants food order will be calculated using mean UK NPM scores of individual items, weighted according to the energy content of the item. Nutritional content used to calculate NPM scores for each menu item was obtained from outlet websites and input into the online NPM calculation tool (2004/05). Weighted scores will be calculated using the weighted.mean function in R.
Time frame: Day 1 of 1: Food orders (item names, energy content, UK Nutrient Profiling Model scores) will be recorded immediately after the baseline questionnaire. The recorded information will be used to calculate weighted NPM scores.]
Positive/negative affect
Participants will complete an adapted version of PANAS after completing the food selection task. This is a 20-item measure, whereby participants will be asked to 'indicate the extent you feel this way right now' on a scale of 1 to 5 from 'very slightly or not at all' to 'extremely'. Participants receive a positive affect score and a negative affect score.
Time frame: Day 1 of 1: Participants will complete the PANAS measure immediately after making their food selection
Perceived impact of labelling on mental health
Questions were developed based on self-reported mental health-related outcomes in previous research. Participants will be asked to respond to each of the following points on a scale of 1 to 5 from 'very slightly or not at all' to 'extremely'. The information on the menus made me feel... * Anxious about my food choice * Guilty about my food choice * Reassured about my food choice * Ashamed about my food choice * Fixated on the nutritional content of my food choice
Time frame: Day 1 of 1: Participants will complete these measures immediately after making their food choices.
Perceived impact of labelling on mental health
Two additional questions relating to compensation were adapted from an existing scale related to compensatory eating behaviour and alcohol (CEBRACS). Participants will be asked to respond to each of the following points on a scale of 1 to 5 from 'very slightly or not at all' to 'extremely'. * Like I should eat less than usual during one or more meals to make up for the amount of food I have selected * Like I should skip one or more meals to make up for the amount of food I have selected
Time frame: Day 1 of 1: Participants will complete this measure immediately after making their food choices
Nutri-Score labels of selected food items
We will record the Nutri-Score values (A-E) of all items selected by participants in the food choice task. Participants will be coded as having ordered any of the healthiest menu items labelled A or B (Y/N) and/or the least healthy menu items labelled D or E (Y/N).
Time frame: Day 1 of 1: UK Nutrient Profiling Model scores of food orders will be recorded immediately after the baseline questionnaire.
Energy content of meals
We will record the energy and nutrient content of all items selected by participants in the food choice task. The total energy content of the ordered meal will be calculated.
Time frame: Day 1 of 1: energy content of food orders will be recorded immediately after the baseline questionnaire.
Participant education
Participants will be asked to report their highest level of education achieved: * Less than high school * High school completion * College or foundation degree * Bachelor's degree * Master's degree
Time frame: Day 1 of 1: Participants will report demographic data in a baseline questionnaire prior to completing the food selection task Participants will be asked this question in the follow-up survey as an consistency check after the food selection task
Notice and impact of labels
Participants will be asked several questions to assess whether they noticed any nutritional labelling, and if the labelling impacted their food choices. Questions will be amended slightly according to labelling condition.
Time frame: Day 1 of 1: Participants will be asked these questions immediately after the food selection task
Participant age
Participants will report their age on a dropdown list
Time frame: Day 1 of 1: Participants will report demographic data in a baseline questionnaire prior to completing the food selection task
Participant gender
Participants will select their gender from the following options: * Man * Woman * Non-binary * Other * Prefer not to say
Time frame: Day 1 of 1: Participants will report demographic data in a baseline questionnaire prior to completing the food selection task
Participant ethnicity
Participants will select their ethnicity from a dropdown list: White English/Welsh/Scottish/Northern Irish/British White Irish Any other White background White and Black Caribbean White and Black African Any other mixed/multiple ethnic background please describe Indian Pakistani Bangladeshi Chinese Other Asian African Caribbean Arab Any other ethnic group
Time frame: Day 1 of 1: Participants will report demographic data in a baseline questionnaire prior to completing the food selection task
Participant height
Participants will report their height in either cm or ft and inches. This will be converted to metres in order to calculate BMI.
Time frame: Day 1 of 1: Participants will be asked these questions immediately after the food selection task
Participant weight
Participants will report their weight in either kg or stones and pounds. All will be converted if necessary to KG to calculate BMI.
Time frame: Day 1 of 1: Participants will be asked these questions immediately after the food selection task
Frequency of consumption of OOH food
Participants will be asked how often over the past year they have eaten food prepared out of the home (from restaurants, cafes, fast food etc.). The following options will be listed. * Not in the last year * Less than once per month * 1-3 times per month * 1-2 times per week * 3 times per week or more
Time frame: Day 1 of 1: Participants will report this in a baseline questionnaire prior to completing the food selection task
Plan to share: Yes — Anonymised participant data will be placed in an online data repository for other researchers to use in the future.
Supporting information: Study protocol, Statistical analysis plan, Informed consent form, Analytic code
Time frame: IPD and supporting information will be available once the study is completed and published, with no end date.
Access criteria: The IPD and supporting information will be uploaded to an online repository where it will be openly available.
No publications or documents are linked to this record.
Start is estimated for Sep 2026; primary completion for Sep 2026, 0 months later.
Of 503 non-industry interventional studies with no phase under Feeding Behavior, half reached primary completion within 14 months of starting (the median), counting those still running; a quarter within 5 and three quarters within 31. This study's planned 0 months is below that.
Counting every sponsor, half of 515 studies reached it within 14 months; a quarter within 5 and three quarters within 31.
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University of Liverpool