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By Debbie Fetter

“Wow! I had no idea there was so many calories in that,” a family friend exclaimed at a baseball game. The menu labeling regulations would be pleased. “I was going to get the peanuts, but now I’m getting the hot dog because it has less calories.” Now we have a problem–if only he knew that a portion size of peanuts would be more nutritious than the hot dog.

The U.S. Food and Drug Administration recently released the highly anticipated menu and vending machine calorie labeling requirements. These rules, as part of the 2010 Patient Protection and Affordable Care Act, require calorie information to be labeled on menus, including menu boards, in chain restaurants, similar retail food establishments, and vending machines, that have 20 or more locations. The hope is the nutritional information displays will help consumers make more healthful choices. The question is, do consumers actually modify their food choices when presented with the calorie information? Or, are these menu-labeling laws just an unsuccessful battle on the fight against obesity? The LEAN Act, introduced in 2008 by Congress, has already spearheaded posting calorie content information on menus in several major US cities (1). Since there already has been exposure to menu labeling, let’s take a look at some of the evidence so far.

Ideally, customers will order less caloric meals once they know the true calorie contents. Realizing some customers may be alarmed at the high calorie content, restaurants may even choose to reduce the calorie content of their items by using healthier ingredients (2). Almost half of American’s food expenditures and calories come from quick and table service restaurants. Consumers also tend to underestimate the calorie content, and this underestimation increases as the meal calorie levels increase. Burton and colleagues conducted a consumer diary study to examine how accurately consumers estimate the calorie content of their food. Nutrition information estimates for calorie, fat, and sodium were all underestimated (p<0.001). After exposure to the nutrition information, meals lower in calories (less than 720 cal) had a significant increase in attractiveness (p<0.01), whereas meals higher in calories (greater than 1,030 cal) had a significant decrease in attractiveness (p<0.001). These findings suggest that providing the nutrition information on the menus may cause customers to purchase less caloric meals, and could even cause restaurants to reformulate higher calorie foods because of the decline in sales. There are barriers to consumers' understanding and use of this nutrition information, such as price, time constraints, confusion or lack of understanding about nutrition information, personal preference, hunger, and purchasing habits. Among five fast-food restaurant studies that have been conducted, only one study found a significant association between menu labeling and choosing a purchase with fewer calories. This calorie reduction was equal to only 14.4 (5.8%) fewer calories. Further, calorie reductions have been shown to be greater in areas where the people had more education and higher incomes (4). Harnack and colleagues conducted a randomized 2x2 factorial experiment to test the effects of calorie labeling and value size pricing on fast food meal choices. Participants were adolescents and adults who regularly ate fast food (n=594) and were randomly placed in one of four groups. The “control menu” had value pricing, but didn't list the calorie content. The “calorie menu” had both the listed calorie content and value pricing. The “price menu” didn't list the calorie content or have value pricing. The “calorie plus price menu” listed the calorie content, but didn't have value pricing. Participants were instructed to order individually from their assigned menu with a staff member. When participants finished eating, the remaining food was covertly measured using a digital food scale. A final interview was conducted upon leaving where the staff member asked questions about nutrition knowledge and beliefs, and recorded self-reported height and weight. The average energy and nutrient composition of the meals were similar (p=0.25), regardless of the experimental condition. This suggests that providing calorie information may have little effect on food choices on people who already regularly consume fast food. Also, when asked to rate the importance of price, taste, nutrition, and convenience when buying food from either a fast food restaurant or a grocery store, taste was the highest rated answer for each scenario (97.6% and 98.5%, respectively). Nutrition was the least likely to be ranked as number 1 out of these factors. These findings indicate that provision of calorie information may not have much effect on regular fast food customers. Results from a systematic review and meta-analysis found that menu labeling, with calories alone, did not have the desired effect of consumers choosing and consuming fewer calories (4). Additional contextual or interpretive nutrition information on menus seemed to help consumers in the selection and consumption of fewer calories. Further research needs to be done to find the most successful approach for providing menu-based nutrition information, especially for consumers who may be limited in their food and health literacy skills. References 1. Burton S, Howlett E, Heintz Tangari A. Food for thought: How will the nutrition labeling of quick service restaurant menu items influence consumers' product evaluations, purchase intentions, and choices? J of Retailing. 2009;85(3):258-273. doi:10.1016/j.jretai.2009.04.007 2. Farley TA, Caffarelli A, Bassett MT, Silver L, Frieden TR. New York City's fight over calorie labeling. Health Aff. 2009;28(6):w1098-1109. doi:10.1377/hlthaff.28.6.w1098 3. Harnack LJ, French SA, Oakes JM, Story MT, Jeffery RW, Rydell SA. Effects of calorie labeling and value size pricing on fast food meal choices: results from an experimental trial. Int J Behav Nutr Phys Act. 2008;5:63. doi:10.1186/1479-5868-5-63 4. Sinclair SE, Cooper M, Mansfield ED. The influence of menu labeling on calories selected or consumed: A systematic review and meta-analysis. J Acad Nutr Diet. 2014;114(9):1375-1388. doi:10.1016/j.jand.2014.05.014