Implementation and enforcement of mandatory calorie labelling regulations for the out-of-home sector in England: Qualitative study of the experiences of business implementers and regulatory enforcers

Background: Mandatory calorie labelling on menus of large out-of-home food outlets was implemented in England on 6 April 2022. Barriers and facilitators that were unforeseen before implementation may modify policy impacts. As part of a process evaluation, we aimed to examine the implementation of calorie labeling in England, focusing on business experiences and local authority enforcement to identify barriers and facilitators to achieving policy goals. Methods: Using purposive sampling, we recruited 11 employees of large food businesses (implementers) and 9 employees of LA environmental health or trading standards departments (enforcers). Post-implementation semi-structured interviews were conducted by video conference. Interviews were audio recorded, transcribed verbatim and analysed using the Framework Method. Results: Both groups of participants described a decentralised approach to delivery and enforcement, and resource constraints meant LAs were unable to assist with all business inquiries. Enforcement activity was limited because complaints about labelling from the public were rare, and enforcers prioritized acute food safety issues. Pre-implementation discussions created the presumption among enforcers that most businesses were compliant. Implementers claimed that businesses wanted to comply to safeguard their reputation and maintain customer trust. While participants supported calorie labelling, potential barriers to policy impact included a presumed lack of customer interest. Financial pressure during implementation strained business resources, and businesses suggested that customers may prioritise financial over health concerns in their decision-making. Conclusions: These findings underscore the need for central guidance, verification of adherence, and sufficient enforcement resources. To optimize policy success, future developments should consider economic contexts, customer expectations, and policy refinement, while recognizing common industry arguments against policy implementation.