Will the United Kingdom’s idea of changing food labels catch on?

The United Kingdom (UK) is considering a controversial move to use a symbol on food labels to indicate how much exercise (walking, running) is required to burn off one serving of that food.1 Both food and drinks are targeted. The idea is to keep the food part of the label (calories and nutrients) the same and add this exercise symbol, called physical activity calorie equivalent (PACE) labeling .1-4

Will more information on the food packaging, in the form of exercise advice, be better? What effect might PACE labeling have? The Royal Society of Public Health in the UK is in favor of the PACE labels. The hope is that PACE labeling will impact the selection, purchase, and consumption of food.

Dr. Amanda Daley2 reported that the current UK food labels have had little impact on the persistent problem of obesity in the UK. Her team conducted a meta-analysis recently,2 reviewing 15 research studies on the effect of PACE labeling versus comparator labeling. They found that significantly fewer calories were selected and fewer calories consumed in PACE labeling group versus comparator food labeling or no labeling. Calorie reductions as low as 100 calories per day accompanied by sustained physical activity may reduce obesity.

Experts favoring PACE labeling see it as a simple strategy for labeling of food products, restaurant menus, and even on price lists under each item at supermarkets and warehouse food stores. However, several limitations of the research on PACE labeling exist, including the use of small samples and the use of experimental settings instead of real-life settings like supermarkets.

Concerns with PACE Labeling

Several experts have also spoken out about the possible detrimental influences of PACE labeling. For example, eating disorder experts point out that, for those suffering from or vulnerable to eating disorders and exercise addiction, encouraging exercise to match the calorie value of foods eaten might exacerbate these conditions.3,4  Advocates for patients with eating disorders see the labels as a simplistic approach5 to a much bigger, more complex problem, one including obesity-shaming and major psychosocial influences. Their premise is that there needs to be a more focus on confidence and support for healthy eating and less focus on weight and calories.4

The proposed exercise advice emphasizes burning calories, and in no way provides messages as to whether the actual food product is healthy or not healthy.3 Also, exercise scientists note that accurate estimation of calorie expenditure, in the form of numbers on a package, is more different than it seems on the surface. For example, calorie expenditure varies between children and adults and among individuals based on how much energy it takes for the body to produce heat.5 Finally, some experts are not convinced by the findings of the meta-analysis and are very concerned with the absence of follow-up data on PACE labeling’s influence on physical activity habits over time.5

Cardiovascular nurses might consider whether PACE labeling would work in their own country. Cardiovascular nurses would also need to determine whether PACE labeling would work best in their practice as part of individualized, tailored teaching sessions or at the population level.


  1. Loughborough University. (December 2019). Press release: Labeling foods with the amount of physical activity needed to burn off calories linked to healthier choices.
  2. Daley AJ, McGee E, Bayliss S, et al. Effects of physical activity calorie equivalent food labelling to reduce food selection and consumption: systematic review and meta-analysis of randomised controlled studies. J Epidemiol Community Health: 2020. doi: 10.1136/jech-2019-213216
  3. 62CBSDetroit. (2019). Press release: Researchers: Exercise advice on food labels could help reduce obesity.
  4. Beat Eating Disorders. (2019) Beat’s response to ‘exercise calorie’ labelling. http://www.beateatingdisorders.org.uk/news
  5. Mathews, J., Sale, C. (2019). Feel the (Calorie) burn: Can advice on food labels halt UK obesity? https://www.acsm.org/blog-detail/acsm-blog/2019/12/18/calorie-burn-food-labels-uk-obesity

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