Food should be labelled with the exercise needed to expend its caloriesBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1856 (Published 06 April 2016) Cite this as: BMJ 2016;353:i1856
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While agreeing with the other three comments provided so far, I would like to add that the study by van Kleef et al. (2008; doi:10.1017/S1368980007000304) should be considered in the discussion. In a 4-country qualitative study, it clearly showed that there are substantial cultural differences in how calorie labelling linked with physical activity information is perceived by consumers. As the authors state, complex labels "including references to daily needs or exercise and the flag including a phrase referring to balanced lifestyle were least preferred" (van Kleef et al. 2008, p. 203).
Competing interests: No competing interests
The commentary entitled “Food should be labelled with the exercise needed to expend its calories,”1 by Shirley Cramer CBE, is based on an antiquated understanding of the etiology and treatment of obesity. My theoretical and empirical work have demonstrated that the “energy balance” and “move more and eat less” conceptualizations of obesity are seriously flawed and that simplistic notions of altering “gluttony or sloth” (e.g., food labeling or excise taxes) will have absolutely no long-term effects on those currently struggling with obesity.2-4
My work demonstrates that obesity is the result of nongenetic evolutionary processes in which a mother’s metabolic and behavioral prenatal phenotypes determine the fat, muscle and pancreatic β-cell development of her fetus.2-4 As such, infants born with an excessive number of fat cells, altered insulin production and decreased skeletal muscle function are permanently and irreversibly predisposed to “eating more and moving less.”2-4
As such, it should be obvious that because willpower, volition, and/or taxes cannot compete with evolution, altering food labels and taxing foods and beverages are not only paternalistic and regressive, such policies will be wholly ineffective and contribute to the stigma individuals struggling with obesity must face.
1. Cramer S. Food should be labelled with the exercise needed to expend its calories. BMJ 2016;353.
2. Archer E. The Childhood Obesity Epidemic as a Result of Nongenetic Evolution: The Maternal Resources Hypothesis. Mayo Clinic Proceedings 2015;90(1):77-92.
3. Archer E. In reply—Maternal, Paternal, and Societal Efforts Are Needed to “Cure” Childhood Obesity. Mayo Clinic Proceedings 2015;90(4):555-57.
4. Archer E. The Mother of All Problems. New Scientist. London,, 2015:32-33.
Competing interests: Dr. Archer has received speaking fees from industry and non-profit organizations.
Re: Food should be labelled with the exercise needed to expend its calories. Not taking the biscuit.
This personal view suggests that ‘food should be labelled with the exercise needed to expend its calories’. While we all agree that the nation’s weight is a major concern, I am more sceptical than the author that the proposed solution would be effective.
As the author will be aware, reviews consistently conclude that effects of calorie labelling on actual behaviour are mixed (1,2). Part of this uncertainty may reflect the fact that we are uncertain which information and formats would be effective (3). While providing information about a physical activity equivalent is an interesting idea, I am unconvinced that these labels would be any more effective than previous versions. On empirical grounds, the cited recent paper by Viera and colleagues (4) , and an earlier one by the same group (5), are not encouraging. Both papers report hypothetical meal choices using online surveys. In both cases, calorie labelling outperformed the absence of any information. Nonetheless, neither study provided any evidence that labels with physical activity information were better than a simple calorie label, despite sample sizes adequate to detect differences (n > 800).
While parents reported that they were more likely to encourage their children to be more physically active with exercise labelling, there is a logical problem here. Parents were hypothetically choosing food not physical activity. Point-of-purchase labels, as with point-of-choice prompts for physical activity, aim to change behaviour at the time and place where choice is made (6). The sequential behavioural chain from eating a meal to subsequently engaging in physical activity could be a major barrier to any effects on physical activity. In essence, the label would be encouraging future activity and translation of any motivation to do so into actual behaviour fraught with the same issues as current exhortations to be more active from public health.
Finally, it is not clear that physical activity labelling would be encouraging. For example, one digestive biscuit made by the original manufacturer contains 71 kcals. To match the energetic contents of this biscuit with the simple, achievable lifestyle physical activity of climbing stairs would require ascent of 25 floors. Informal discussions suggest that the typical conclusion is that climbing the stairs is not worth effort. The problem here is the contents of the biscuit, not the physical activity.
1. Harnack LJ, French SA. Effect of point-of purchase calorie labeling on restaurant and cafeteria food choices: a review of the literature. Int J Behav Nutr Phys Act. 2008;5(51):51
2. Swartz JJ, Braxton D, Viera AJ. Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature. Int J Behav Nutr Phys Act. 2011;8:135
3. Thomas EL, Puig-Ribera A, Senye-Mir A, Greenfield S, Eves FF. Promoting healthy choices in workplace cafeterias: A qualitative study. J Nutr Educ Behav. 2016; 48 138-145. doi: 10.1016/j.jneb.2015.11.001.
4. Viera AJ, Antonelli R. Potential effect of physical activity calorie equivalent labeling on parent fast food decisions. Pediatrics 2015;135:e376-82. doi:10.1542/peds.2014-2902 pmid:25624379.
5. Dowray S, Swartz JJ, Braxton D, Viera AJ. Potential effect of physical activity based menu labels on the calorie content of selected fast food meals. Appetite 2013; 62:173–181. .doi:10.1016/j.appet.2012.11.013.
6. Eves FF, Webb OJ, Griffin C, Chambers J. A Multi-component intervention targeting calorific expenditure with stair climbing; Effects on behaviour, attitudes and intentions. BMC Public Health 2012, 12: 423. http://www.biomedcentral.com/1471-2458/12/423
Competing interests: No competing interests
In relation to overweight and obesity, Cramer suggests that "innovative schemes to change behaviour at the population level." I agree. However, it is plausible that "activity equivalent" labelling may have a perverse effect on individual's behaviour as a result of a failure to consider the basal metabolic energy used.
If all foodstuffs are labelled with an "activity equivalent", then the sum total activity recommended by all items consumed by an individual in a typical day will appear absurd. Assuming that walking burns around 5 calories per minute, as implied by Cramer's suggestion that "the calories in a can of fizzy drink take a person of average age and weight about 26 minutes to walk off", then the total activity recommended by the packaging of a typical 2000kcal daily diet would be more than 400 minutes of walking per day. Given that 41% of the adult population enjoys fewer than 150 minutes of physical activity per week,  consumers may disregard the labelling as unrealistic. This dismissal might plausibly extend to other parts of the nutritional labelling, including the energy content itself.
It is notable that the two research papers Cramer cites in support of activity equivalent labelling both involved only single meals being labelled in this fashion, [2,3] thus side-stepping the potential problem of perceived lack of information integrity introduced by labelling all food products across the diet.
As Cramer suggests, more detailed research is warranted before any action is taken.
 Davies, S. C . “ Annual Report of the Chief Medical Officer, Surveillance Volume, 2012: On the State of the Public’s Health” London: Department of Health (2014)
 Bleich SN, Herring BJ, Flagg DD, Gary-Webb TL. Reduction in purchases of sugar-sweetened beverages among low-income Black adolescents after exposure to caloric information. Am J Public Health2012;102:329-35.
 Viera AJ, Antonelli R. Potential effect of physical activity calorie equivalent labeling on parent fast food decisions. Pediatrics2015;135:e376-82.
Competing interests: I am a fellow of the Royal Society of Public Health. The author of the article on which this comment is made is the Chief Executive of the Royal Society of Public Health.