Introduction

The purchasing and consumption of foods high in energy, saturated fat, free sugars, and salt, is associated with an increased risk of obesity and diet-related non-communicable diseases (NCDs) [1]. Globally, diet-related NCD prevalence is high, with approximately 40% of cardiovascular disease mortality between 1990 and 2019 attributable to dietary risk factors [2]. The same is true for the UK specifically, with poor diet being a leading cause of death and ill health [3].

Food reformulation initiatives are a common approach to NCD prevention across the globe; 68 countries have a salt reduction policy in place [4], with countries such as the UK, Brazil, New Zealand, and USA, having further initiatives for sugar reduction [5], with the majority of such schemes being voluntary [4,5]. Modelling studies highlight the potential for such policies to significantly reduce the incidence of diet-related diseases, such as obesity and cardiovascular disease [6,7]. The UK Government first introduced their salt reduction programme in 2004, following advice from the Scientific Advisory Committee on Nutrition to reduce the population average salt intake by approximately 10%, to 6 g a day. The first reduction and reformulation targets for industry were published in 2006 and have since been revised on several occasions, with the most recent revision in 2020 (for targets to be met by 2024) covering 84 category-specific salt targets for grocery foods (e.g., Ready Meals), and 24 for the out-of-home (OOH) sector (e.g., Seasoned Fries) [8]. Evidence suggests that the salt reduction programme has been successful, with average urinary sodium reducing by approximately 2% each year from 2004 to 2011, and significant reductions being observed in the salt content of food products sold by UK retailers [9].

Complementary to the salt reduction programme, the UK Government published targets for sugar and calories in 2017 and 2020, respectively [10,11]. The sugar reduction programme aimed to achieve a 20% reduction in the sugar content of 14 food categories that contribute most to sugar intake in children, across all sectors of the food industry, by 2020 [10]. The calorie reduction programme aimed to achieve a 10% reduction by retailers and manufacturers across nine food categories, and a 20% reduction by the OOH sector across seven food categories (with four common categories), in the calorie content of products sold, by 2025 (extended from 2024 due to the Covid-19 pandemic) [11]. Governmental progress reports indicate that within the retailer and manufacturer sector, there has been a 3.5% reduction in the sugar content of products sold between 2015 and 2020 [12], and category-level decreases of up to 2.4% in the calorie content of products sold between 2017 and 2021 [13]. Their findings suggest comparatively less progress has been made in the OOH sector, with only a 0.2% reduction in the sugar content of products sold between 2017 and 2020, and category-level increases of up to 2.3% in the calorie content of products sold between 2017 and 2021 [12,13]. However, since the most recent data included in the sugar, salt, and calorie reduction progress reports was from 2020, 2018, and 2021 respectively, these conclusions may have since changed.

A considerable proportion of UK individuals’ weekly food intake comes from takeaway or restaurant meals [14]. The UK Diet and Nutrition Survey finds 72% of respondents reported purchasing food or drink from an OOH establishment in the past week, with the largest proportion of these consumers being children aged 11–18 years old [15]. Eating OOH is becoming more popular, with a 159% increase in per-person expenditure on eating out from 2021 to 2022 in the UK [16], and an additional 3.5% increase to 2023 [17], potentially due to its perceived lower cost and higher convenience than preparing food at home [18]. The OOH sector is dominated by a small number of multinational companies who operate chained food outlets (hereafter ‘restaurants’; see Table 1). In 2023, sales from chained food service outlets reached £35.1 billion in the UK, increasing by nearly £8 billion over the previous two years [19], showcasing the significant influence these companies have over diet and health.

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Table 1. A summary of characteristics for each restaurant, including their affiliated company, type, 2022 sales value, number of menu items included, and number of subcategories included. Restaurants presented in descending order by 2022 Sales Value.

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The UK Government’s sugar, salt, and calorie reduction targets are voluntary, leaving the responsibility for meeting the targets to individual companies, yet there is limited evidence for how food companies have responded to the reduction programmes. One study looking at company-level adherence to the sugar reduction targets among UK manufacturers found that of the top 10 companies across 5 target food categories, just under half met the interim 5% sugar reduction targets for 2018 [20]. Similar work conducted in the OOH sector found that only four out of 48 brands reduced the sugar content of their desserts by at least 20% from 2018 to 2020, and only half of which significantly reduced their calorie content as well [21].

There is a need for a more comprehensive assessment of company-level adherence to the targets. Furthermore, fewer studies in the broader literature have assessed the nutritional quality of foods in the OOH sector compared to the retailer and manufacturer sector, due to OOH nutrition data being less easily accessible. Evaluating industry’s response to the reduction programmes will improve transparency around companies’ commitment to population health, help with enforcement of comparable schemes in the future, and underpin other approaches to incentivising healthier food provision (e.g., investment decision-making based on food healthiness). The introduction of mandatory reporting of healthy sales from large companies, as pledged in the NHS 10 Year Plan [22], will contribute to improving transparency and potentially incite greater commitment from companies to meet nutritional guidelines. This study aimed to assess the nutritional content and adherence to the UK Government’s sugar, salt, and calorie reduction targets, for food items offered by the highest-grossing restaurant chains in the UK, in 2024.

Methods

We assessed the nutritional content of food items offered in 2024 by the 21 highest-grossing restaurant chains in the UK. We collected nutrition information for restaurants’ menu items directly from their websites. Each menu item was categorised by the sugar, salt and calorie reduction target groups and their nutrient values compared to the relevant targets. The average kcal, salt, sugar per 100 g and per serving, was also calculated for each restaurant and food subcategory. The study protocol was published on Open Science Framework prior to data analysis [23] (S1 File). This study is reported as per the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline (S1 Table—STROBE checklist). Ethical approval was not required for this study as it does not involve human participants.

Analysis

Data analyses were conducted in R (version 4.4.2) [27], using the following packages: readxl [28], dplyr [29], tidyr [30], stringr [31], tidyverse [32], zoo [33], writexl [34], reshape [35], ggplot2 [36].

Missing data

We excluded menu items where all three of the nutrients of interest (kcal, salt, and sugar), were missing. For menu items that were missing two or fewer of the nutrients of interest, where possible, we calculated the missing values using the following formulas:

In order to assess an item’s adherence to the Government’s reduction targets, nutrition information was needed per 100 g for the sugar targets, per serving for the calorie targets, and in both formats for the salt targets. If per 100 g, per serving, or serving size information was missing, the missing value was calculated from the provided information using the following formulas:

Here, ‘Serving Size’ refers to the weight of the menu item in grams, and ‘Per 100 g’ and ‘Per Serving’ refer to nutrient content (e.g., salt content in 100 g or in a single serving of a menu item).

Where it was not possible to calculate serving size (only per 100 g or only per serving nutrient information was provided), the mean serving size for the menu item’s subcategory was used instead. For example, if the serving size for a burger was not provided, the mean serving size of menu items within the ‘Burger’ subcategory was used instead.

Results

A total of 3,099 menu items across 21 restaurants were included in this study. Originally, 5,435 menu items were collected. Of the 2,336 items excluded, 453 were duplicates, 103 did not have the required nutritional information, 825 were pizzas with non-default crust options, and 955 were drinks. One menu item was missing a sugar value, so this item was excluded from analyses where sugar content is the outcome. For 1,630 out of 3,099 menu items, no serving size was provided and only one format of nutrient content was provided (either per 100 g or per serving), and therefore the subcategory average serving size was used in calculating the missing nutrient content. S5 and S6 Tables provide the number of affected products, and the mean, median, and lower and upper quartiles for serving size (g) (from the 1,469 where it was provided/calculated), for each restaurant and subcategory.

The mean number of menu items per restaurant was 148, although this varied widely from 40 items for Burger King to 330 items for Pizza Hut (Table 1). The number of subcategories offered by each restaurant ranged from 5 for Starbucks and Burger King, to 11 for Leon. Some restaurants had large menus that focussed on a smaller number of subcategories, such as Pizza Hut and Domino’s, while others had smaller menus with more diverse types of items, such as Leon (Fig 1).

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Fig 1. The number and proportion of menu items by restaurant and subcategory.

The values in boxes show the number of menu items belonging to that restaurant-subcategory. Main meals are coloured in blue, sides/extras are coloured in red, and desserts are coloured in purple. The darkness of each colour indicates the proportion of menu items from each restaurant that belong to that subcategory (calculated separately for mains, sides/extras, and desserts, with the ‘total’ rows calculated across mains, sides/extras, and desserts), where a darker colour indicates a higher proportion. KFC and Nando’s were characterised as ‘Chicken’ restaurant type despite majority of main meal menu items belonging to ‘Sandwich’ or ‘Burger’ subcategories, as these menu items were majority chicken burgers and chicken wraps. The same principle was applied to restaurants with the majority of their main menu items being ‘Breakfast Items’.

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Average nutrient content

By subcategory.

Per 100 g, mean nutrient content across all menu items was 277 kcal, 1.1 g salt, and 9.5 g sugar. Per serving, mean nutrient content across all menu items was 450 kcal, 2.0 g salt, and 10.9 g sugar.

Desserts had the highest mean calorie (409 kcal) and sugar (34.2 g) content per 100 g across all subcategories, while Sauces had the highest salt content per 100 g (2.2 g) (Fig 2). Per serving, Other Mains had the highest calorie content (756 kcal) and joint highest salt content with Pizzas (3.4 g), and Desserts had the highest sugar content (26.2 g) (Fig 3). Means, Medians, and Standard Deviations for nutrient content per 100 g, per reported serving, and per subcategory average serving, for each subcategory, are found in S7–S10 Tables.

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Fig 2. The distribution of kcal, salt, and sugar content per 100 g for menu items by subcategory.

Subcategories are ordered ascendingly by median kcal per 100 g. Mid-lines represent the median, the box represents the inter-quartile range, and whiskers represent the range. Main meal subcategories are coloured in blue, Side categories are coloured in red, and Desserts are coloured in purple.

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Fig 3. The distribution of kcal, salt, and sugar content per serving for menu items by subcategory.

Subcategories are ordered ascendingly by median kcal per serving. Mid-lines represent the median, the box represents the inter-quartile range, and whiskers represent the range. Main meal subcategories are coloured in blue, Side categories are coloured in red, and Desserts are coloured in purple.

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By restaurant.

Menu items from Caffé Nero had the highest mean calorie content per 100 g (368 kcal) across all restaurants, while menu items from Prezzo had the highest salt content (1.8 g), and menu items from Costa had the highest sugar content (22.0 g) (Fig 4). Per serving, menu items from Prezzo had the highest calorie (644 kcal) and salt content (3.7 g) and menu items from Harvester had the highest sugar content (17.2 g) (Fig 5). Means, Medians, and Standard Deviations for nutrient content per 100 g, per reported serving, and per subcategory average serving, for each restaurant, are found in S11–S14 Tables.

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Fig 4. The distribution of kcal, salt, and sugar content per 100 g for menu items by restaurant.

Restaurants are ordered ascendingly by median kcal per 100 g. Mid-lines represent the median, the box represents the inter-quartile range, and whiskers represent the range. Burger restaurants are coloured in purple, Chicken restaurants in yellow, Pizza restaurants in Blue, Other Main restaurants in green, and Sandwich restaurants in pink.

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Fig 5. The distribution of kcal, salt, and sugar content per serving for menu items by restaurant.

Restaurants are ordered ascendingly by median kcal per serving. Mid-lines represent the median, the box represents the inter-quartile range, and whiskers represent the range. Burger restaurants are coloured in purple, Chicken restaurants in yellow, Pizza restaurants in Blue, Other Main restaurants in green, and Sandwich restaurants in pink.

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Averaging across menu items within restaurant groups, menu items from the Sandwich group had the highest mean calorie (293 kcal) and sugar content per 100 g (13.4 g), and menu items from the Pizza group had the highest mean salt content (1.4 g). Menu items from the Pizza group had the highest mean calorie (515 kcal) and salt content per serving (2.6 g), and menu items from the Other Mains group had the highest mean sugar content (12.6 g). Means, Medians, and Standard Deviations for nutrient content per 100 g, per reported serving, and per subcategory average serving, for each restaurant group, are found in S15–S18 Tables.

Target adherence

Across all restaurants and subcategories, 61% of menu items met their calorie targets (n = 1300/2148), 58% met their salt targets (n = 1348/2344), 36% met their sugar targets (n = 207/578), and 43% met all of their applicable targets (n = 1271/2951).

By subcategory.

Six out of the 12 subcategories had over 50% of their menu items meeting all applicable targets. Salads had the highest adherence to all applicable targets at 96% (n = 44/46) but were only eligible for the calorie targets (therefore having 96% adherence for calorie targets as well). Breakfast Items had the second highest adherence to all applicable targets at 66% (n = 125/190), while being eligible for all three target types. Excluding Other Sides and Children’s Meals (which had 100% adherence to the sugar targets but each had only one eligible item), the highest sugar target adherence was seen for Breakfast Items at 74% (n = 56/76), which also had the highest salt target adherence at 82% (n = 126/154) (Fig 6).

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Fig 6. The proportion of menu items that met sugar, salt, calorie, and all applicable targets, for each subcategory.

Values in brackets show the total number of menu items that were eligible for the given target, in that subcategory. Subcategories are ordered descending by the proportion of menu items meeting the respective target, with ‘All Subcategories’ as the top bar. The dark orange bars indicate the proportion of menu items meeting the target, and the light orange bars indicate the proportion of menu items not meeting the target.

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By restaurant.

Nine of the 21 restaurants had over 50% of their menu items meeting all applicable targets (Fig 7).

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Fig 7. The proportion of menu items that met sugar, salt, calorie, and all applicable targets, for each restaurant.

Values in brackets show the total number of menu items that were eligible for the given target, in that restaurant. Restaurants are ordered descending by the proportion of menu items meeting the respective target, with ‘All Restaurants’ as the top bar. The dark blue bars indicate the proportion of menu items meeting the target, and the light blue bars indicate the proportion of menu items not meeting the target.

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Menu items from the Pizza restaurant group had the lowest combined adherence to all applicable targets at 32% (n = 310/961), to the salt targets at 49% (n = 409/832), and to the calorie targets at 53% (n = 449/846). Adherence to sugar targets was based on lower product numbers, with menu items from the Chicken restaurant group having the lowest adherence at 0%, but with only 23 eligible items. Menu items from the Pizza restaurant group were the second lowest adhering to the sugar targets at 23%, with 65 eligible items.

Menu items from the Burger restaurant group had the highest combined adherence to all applicable targets at 59% (n = 88/149), and to the salt targets at 80% (n = 92/115), while menu items from the Chicken group had the highest combined adherence to the calorie targets at 78% (n = 97/124). Menu items from the Burger restaurant group had the highest adherence to the sugar targets at 53%, but with only 36 eligible items, of which 32 were from McDonald’s. Full results for adherence to each target type by restaurant group can be found in S19 Table.

Sensitivity analysis using lower and upper quartiles for serving size

Table 2 provides the average nutrient content across all menu items when the subcategory average, lower quartile, and upper quartile serving sizes were used to replace missing serving sizes. S22–S25 Tables provide the equivalent values for each subcategory and restaurant.

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Table 2. Average nutrient content across all menu items when the subcategory average, lower quartile, and upper quartile serving sizes were used to replace missing serving sizes.

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Table 3 provides the proportion of menu items meeting sugar, salt, calorie, and all applicable targets across all menu items, when the subcategory average, lower quartile, and upper quartile serving sizes were used to replace missing serving size. S26 and S27 Tables provide the equivalent values for each subcategory and restaurant.

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Table 3. Target adherence across all menu items when the subcategory average, lower quartile, and upper quartile serving sizes were used to replace missing serving sizes.

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Discussion

This study shows that only 43% of menu items from the highest-grossing UK restaurant chains had met all of their reduction targets at the start of 2024, indicating low adherence with the reduction programmes from the OOH sector. The majority of menu items met the calorie (61%) and salt (58%) reduction targets, however, only 36% of menu items met sugar targets. Heterogeneity in adherence was observed across food categories, with Desserts having the lowest proportion of menu items meeting all applicable targets at 22%, and Salads the highest at 96%. Heterogeneity in target adherence was also observed across restaurants, with Papa John’s having the lowest proportion of menu items that met all their applicable targets at 8%, and Subway the highest at 76%. A similar number of restaurants had over 50% of their menu items meeting the calorie and salt targets (17/21 and 18/21, respectively), but salt target adherence varied much more widely from 8%–89%, compared to 35%–89% for calories. Subcategories were not always consistent in their performance across the target types, for example, Children’s Meals had 95% of menu items meeting calorie targets, but 62% meeting salt targets.

To our knowledge, only two studies have looked at company-level performance against the reduction targets, both focussing on the sugar reduction programme only, with one looking at manufacturers of grocery foods and the other at OOH. Bandy and colleagues [20] found that in 2018, just under half (24/50) of the best-selling manufacturers across five food categories (biscuits and cereal bars, breakfast cereals, chocolate confectionery, sugar confectionery, and yoghurts) met the intermediary 2018 sugar targets, and four companies had already met the 2020 targets. Our study found no companies had 100% of menu items meeting their sugar targets, potentially indicating greater target adherence from the retailer grocery food sector compared to OOH. However, our study included a wider range of food categories, used nutritional data from 2024 (six years later), and Bandy and colleagues used sales-weighted averages for sugar content (by brand sales volume), which we did not have the relevant data to replicate. Pepper and colleagues [21] found that 4/48 OOH companies met the 20% reduction target for Desserts in 2020, which given that Bandy and colleagues found four manufacturers had already met the 20% reduction target by 2018, this could provide another indication that the grocery sector is more engaged with the programme than OOH. Pepper and colleagues observed large variation in sugar and calorie content between companies with different styles of food, but also between similar chains, which corroborates with findings from our study across all three target nutrients (sugar, salt, and calories) and beyond just Desserts. Together, these findings suggest that while adherence to the targets may be low overall, there are examples of OOH companies that are performing well, and performance is not constrained by the type of cuisine being offered.

The most recent sugar reduction progress report found no OOH companies met the 20% reduction target by 2020 [12], and while this is consistent with our findings, it was based on data from only five companies, and four of which were sandwich/café restaurants (Costa, Pret, Greggs, and Starbucks). The most recent salt reduction progress report had insufficient data to present company-level performance for the OOH sector, although it reported that overall, 74% of OOH products met their salt target [38]. Our study found only 58% of menu items met their salt target, potentially due to the progress report using the ‘maximum’ target values while we used the ‘average’ target values, which were less lenient (e.g., Dips had a ‘maximum’ target of 0.9g per 100 g but an ‘average’ target of 0.75 g). There is no relevant comparison between our findings and those in the calorie reduction progress report, as this report did not include any company-level analyses [13].

Reduction target programmes in other countries have been found to be effective in reducing the sugar, salt, calorie, and fat content of food products. One systematic review found that of 26 studies evaluating government-set reduction targets across 15 different countries, 22 found improvements in nutritional quality [39]. However, the vast majority of these studies only focussed on salt, and reported the percentage change in salt content over time rather than adherence to the targets specifically, so our findings may not be directly comparable. A study assessing OOH foods in the US found significantly fewer fast-food meals met the American Heart Association’s calorie guidelines in 2015, 2016, and 2017 compared to 2008, with no changes observed for saturated fat or sodium [40], suggesting that our findings are indicative of a wider global trend for poor nutritional quality in the OOH food sector. The restaurants included in our study are owned by multinational companies operating on a global scale, therefore our findings can provide insight into the nutritional quality of OOH foods beyond a UK context.

We evaluated all three reduction programmes within a single study, allowing us to compare adherence across the targets, both by individual company and overall. By providing an overview of restaurants’ whole menus, we were able to demonstrate that menu items offered by restaurants with similar menu portfolios displayed variable adherence to the reduction targets. Therefore, companies should not have to change the types of foods they offer in order to improve the nutritional quality of their menus, making the shift towards a healthier OOH sector a more achievable goal for industry.

We were not able to account for heterogeneity in item-level sales due to the lack of accessible sales data from the OOH sector. It is possible that healthier menu items (items that did meet their sugar, salt, and calorie targets) are responsible for a smaller proportion of sales, thus making little difference to diet-related health outcomes. The technical guidance for the reduction targets highlights that applying the targets based on sales-weighted averages is the gold standard approach, however, this is not always possible, particularly for the OOH sector (noted in the Government’s salt reduction progress report [38]). Greater transparency from companies in regards to the proportion of their sales that come from healthy and less healthy foods would permit a more holistic analysis, and could be encouraged by governments mandating the reporting of this information.

The time and resource constraints of manually collecting data from individual websites limited our sample size of menu items, and meant that the completeness and accuracy of the data was largely dependent on restaurants’ own reporting. For example, we found instances of Toby Carvery underreporting kcal (detailed further in S2 Table), which we left as reported as we did not have the capacity to laboratory test all menu items to verify the information. Only five restaurants reported serving size for all of their menu items, therefore we often had to use subcategory average serving sizes to calculate per serving or per 100 g information where missing, which may have differed to the true value given the variation we observed in nutritional content within subcategories. Not all menu items would have been included for each company, for example, we evaluated Burger King’s online menu rather than their more extensive ‘Nutrition Explorer’, due to the less complete nutritional information in the latter, and Subway now (as of 2025) have ‘Cookies and Sweet Treats’ on their online menu which was not published during our data collection. These limitations reflect the lack of standardisation in reporting nutritional information across the OOH sector, highlighting another gap that government regulation could address.

We only assessed adherence at one time point, therefore we cannot determine which restaurants or subcategories have shown the most or least improvement in nutritional quality over time, which could provide further insight into which areas of the sector need more stringent monitoring.

Our data collection took place predominantly in February/March 2024, so it is possible that we would have seen better adherence to the salt targets if we had collected data later in 2024 (as the targets had to be met in 2024, with no specification of which day or month), and better adherence to the calorie targets if we had collected data later in 2025 (as the targets had to be met in 2025). However, with the lack of more recent governmental progress reports to monitor target adherence, our study provides a useful benchmark for how restaurants were performing against the targets in early 2024, which future monitoring of the targets could compare against.

The NHS 10 Year Health Plan for England [22] outlines plans for the introduction of mandatory reporting of healthy sales from large companies, with a further proposal to use this reporting to inform mandatory targets for healthy sales. Our study highlights that there is low adherence in the OOH sector with current voluntary regulation, and that monitoring of target adherence is largely limited by the lack of available sales data, which the two policies proposed in the NHS 10 Year Plan would directly address.

This study highlights the importance of mandatory reporting and targets, demonstrating overall low adherence to the targets in these voluntary programmes, with research from other countries also evidencing the increased effectiveness of mandatory (e.g., maximum limits or required declaration of salt content) versus voluntary (e.g., suggested limit on salt content) nutrition policies in inciting reformulation [39]. With no regular publication of progress reports to monitor companies’ adherence to the targets, there are minimal incentives for the companies to work towards them. More regular and granular reporting of adherence to the targets by individual restaurants in the OOH sector, alongside the introduction of mandatory reporting for healthy sales for example, might lead to greater public scrutiny and thus greater adherence with the targets. While the voluntary nature of the targets may be a contributor to the low target adherence, our study was able to demonstrate that restaurants with varying cuisines are able to meet the targets, highlighting their attainability across the OOH sector.

The overall lower adherence to the sugar targets compared to the calorie and salt targets could be a result of the deadline for the sugar targets being in 2020, versus 2024/5 for the calorie and salt targets. It is possible that adherence to the sugar targets has dropped since the deadline was reached, as there has been no subsequent revisions to the sugar targets to encourage food companies to maintain their adherence to the programme. Alternatively, the sugar reduction targets were set per 100 g, while the calorie and salt targets were primarily per serving (all calorie targets per serving, OOH-specific salt targets per serving), meaning progress towards the calorie and salt targets could be made through reducing menu items’ serving size, while the sugar targets could only be met through reformulation, which is potentially more time and resource intensive.

Unlike the retail sector, there is no mandatory reporting standard for nutritional information per 100 g or serving size for the OOH sector, resulting in inconsistent and limited data being used to monitor adherence to the targets. Mandating standardised nutrition reporting would improve transparency in the OOH sector and make tracking compliance to the targets easier and more accurate, potentially inciting greater compliance from companies. Modelling work by Shangguan and colleagues [7] found the drop from 100% to 50% industry compliance with US National Salt and Sugar Reduction targets approximately halved the averted cardiovascular disease events, QALYs gained, and net savings for healthcare observed over a lifetime, highlighting the importance of meeting the targets in full in order to bring about substantial benefits to public health.

Changes could be made to the targets themselves to encourage greater adherence. All menu items had to be manually categorised into the relevant target categories to compare their nutrient content to the target value, which was time and resource-intensive, and open to subjectivity and error. Using comparable categories across targets, or setting targets based on a single holistic measure of nutritional quality rather than individual nutrients (e.g., using the UK Nutrient Profiling Model), could remove some of the burden of self-monitoring placed onto companies, permitting greater progress.

The new policy proposals in the NHS 10 Year Plan suggest there is an appetite from the UK Government to impose stricter regulation on the food sector, highlighting the importance of research to inform careful and realistic target setting, particularly within under-regulated areas of the food sector such as OOH.

In conclusion, our findings suggest there has been low adherence against the UK Government’s reduction targets from the OOH sector, which could suggest that mandatory regulations may be a more effective approach to improving the nutritional quality of OOH food. While we found menu items from certain restaurant types to perform worse against the targets than others, menu items from restaurants with similar portfolios were also found to vary in target adherence, suggesting that companies should not have to change the focus of their menus in order to meet the targets, making them more attainable. This study highlights the need for standardised reporting of nutritional and serving size information from the OOH sector, alongside accessible sales data, to aid monitoring companies’ performance against the targets, and in turn incite greater adherence from industry with the reduction programmes.

Supporting information

Acknowledgments

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.