Nutri-Score labelling in the out-of-home food sector: evidence on effectiveness from a large, randomised control trial in UK restaurant settings
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Background
Over half of UK adults eat food prepared out-of-home (OOH) weekly and the poor nutritional profile of OOH food contributes to ill health. Nutri-Score is a form of interpretative labelling which assigns food products a value of A (healthiest) to E (least healthy) based on nutritional quality, and inclusion on menus could be a public health policy option to reduce obesity. This is the first real-world Randomised Control Trial to test the effectiveness of Nutri-Score alongside calorie labelling on food menus in UK OOH settings.
Methods
Adult participants (N=672), majority White (80%) female (63%), with a mean age of 47(±18) years, were recruited from the local community to visit OOH food businesses to order, consume, and pay for meals. Data collection days were randomised to be control (calorie labelling) or Nutri-Score (calorie labelling with Nutri-Score). Linear mixed models assessed impacts of labelling condition on perceived effectiveness of menu labelling and nutritional quality of food orders.
Findings
Scores for perceived effectiveness of labelling were significantly greater in the Nutri-Score condition compared to control (B = 0.21, p=0.010; 95% CI 0.05, 0.37) and food orders were significantly better nutritional quality, indicated by lower Nutrient Profiling Model scores in the Nutri-Score vs. control condition (B = -0.89, p=0.003; 95% CI -1.48, -0.31).
Interpretation
Compared to providing calorie labelling alone, inclusion of Nutri-Score could be an effective policy approach to improve nutritional quality of diet and reduce diet-related disease.
Funding
This research was funded by the Economic and Social Research Council (ESRC;Reference ES/W007932/1).
Research in context
Evidence before this study
PubMed was searched for all research into Nutri-Score food labelling, published between June 2016 (earliest available result), and February 24, 2026, using the search terms: (((((Nutri-Score)) OR (Nutriscore)) OR (Nutri-Score label*)) OR (Nutriscore label*)) with no language restrictions. The search returned n=354 articles deemed relevant according to title and abstract content. Nutri-Score labelling has been adopted as a front-of-pack food labelling policy in several European countries. Systematic reviews and meta-analyses have explored the impact of Nutri-Score labelling, primarily on food packaging, through both real world and experimental evidence. Findings suggest that Nutri-Score is effective in helping consumers to identify healthier foods, and rank foods in order of healthiness.
Additionally, Nutri-Score labelling is associated with improved nutritional quality of food selection, by facilitating the selection of healthier food choices and the avoidance of less-healthy food choices. However, most studies to date have been conducted in experimental settings, and only n=2 studies have tested Nutri-Score in out-of-home (OOH) settings. The two studies conducted in the OOH food sector were conducted in France and differed in design (e.g., non-randomized). Findings have suggested that Nutri-Score is associated with food choices of greater nutritional quality, although effects may not be consistent across socioeconomic status.
Added value of this study
No research has examined the effectiveness of Nutri-Score on food choices with a UK population or the impact of Nutri-Score on nutrient consumption (as opposed to purchase or selection). Inclusion of interpretive labelling (i.e., Nutri-Score) for OOH food menus is a potential avenue for national government policy, however research to assess effectiveness and guide implementation of such policy is limited. In the present real-world randomised controlled trial, participants visited an OOH food business in Liverpool city centre and selected a meal from a control menu (calorie labelling only) or a Nutri-Score intervention menu (calorie labelling with Nutri-Score). Primary outcomes of interest were perceived message effectiveness and nutritional quality of meal ordered.
Implications of all the available evidence
The evidence suggests that Nutri-Score labelling combined with calorie labelling on food menus is perceived to be effective by consumers and may prompt healthier food choices than calorie labelling alone. The inclusion of interpretative nutrition information, such as Nutri-Score, should be considered for OOH settings as a public health policy.
