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Do Calories on Quick Serve Restaurant Menus Change Behaviour?



I like seeing calories on things I eat. This is because I roughly know how many calories I can afford to eat each day (about 1800) – any more and my weight goes up.

So I am all for putting calories on menues, packages, beverages, everywhere.

After all, calories and calories are the sole ‘currency’ of weight management.

But do calories on menus actually change behaviours of the general consumer?

The available data on this was now analysed by Jonas Swartz and colleagues from the University of North Carolina at Chapel Hill, published in the International Journal of Nutrition and Physical Activity.

Their systematic review is an update on a previous review in 2008 (which did not show much of an effect) and includes seven studies published since then.

They included seven studies that used an experimental or quasi-experimental design comparing a calorie-labeled menu with a no-calorie menu (conducted in laboratories, college cafeterias, and fast food restaurants). Two were judged to be of good quality, and five of were judged to be of fair quality. Only two of the seven studies reported a statistically significant reduction in calories purchased among consumers using calorie-labeled menus.

But as the authors note, these type of studies (even if they showed an effect) are difficult to generalize to real world behaviour.

In addition, to these ‘experimental’ studies, the authors also discuss observational studies conducted in cities after implementation of calorie labelling but point out that all of these studies are far too imprecise in their measure of the isolated effects of calorie labels to allow any meaningful conclusions.

Thus, the authors (again) conclude that,

“The current evidence suggests that calorie labeling does not have the intended effect of decreasing calorie purchasing or consumption.”

My guess is that for calorie labelling to have any effect, these numbers have to be meaningful – i.e. individuals must be able to put them into context of their over all daily needs.

The little evidence we have on this, suggests that most people have no real idea what Calories really are or how they work – much less their daily needs.

For those, who treat their daily caloric intake as a daily ‘budget’ having these numbers readily available is helpful. I certainly tend to consider the caloric ‘cost’ of my eating decisions.

For those, for whom these numbers are meaningless, are probably just looking at the price tag rather than the caloric ‘cost’ – why would anyone expect their behaviour to change?

So, while I fully support more disclosure of calories on menus and elsewhere, the authors are fair to leave us with their words of caution:

In the meantime, we must proceed with caution in widespread implementation of an unproven policy with social and monetary costs, especially since the effort may detract attention from other effective strategies to combat overweight and obesity or have inadvertent effects. Given that a majority of US consumers indicate that they want calorie menu labeling, and the policy now seems imminent, knowledge of successful strategies as well as potential negative ramifications should be carefully considered when deciding how the policy will be operationalized and implemented.”

Let me know if you find calories helpful and want to see more of them on menus.

AMS
Edmonton, Alberta

ResearchBlogging.orgSwartz JJ, Braxton D, & Viera AJ (2011). Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature. The international journal of behavioral nutrition and physical activity, 8 PMID: 22152038

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13 Comments

  1. Couple quick thoughts:

    Calorie/nutritional info on menus makes sense as part of an overall public health strategy to increase consumer attention to calories and portion control and lead to behavior change/action in this area over time.

    But that’s long-term; the sheer presence of calorie data is unlikely to specifically trigger immediate behavior change in weeks, months, or even a couple of years in most people. Nothing else works that way – why would this?

    Consider the process that resulted in significantly lower cigarette smoking in the U.S.. Behavior change resulted from numerous factors over many years: the combined effects of public health ads, voluntary removal of smoking images from movies and TV shows, cigarette taxes, limits on where people were allowed to smoke, new understanding by consumers of cause/effect (smoking=lung cancer, etc.) and so on.

    [Related and worth noting, since it’s rarely mentioned as a benefit of mandatory disclosure: many people with either Type 1 or Type 2 diabetes monitor carb grams closely as part of their diabetes management plan and/or in order to determine appropriate insulin dosage. Restaurant nutritional info has historically been virtually impossible to get, so mandating this data disclosure is hugely helpful for them.]

    Leslie Nolen
    The Radial Group

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  2. Hi Arya, I was pleased and surprised to see calories indicated on the board menu in a fast food restaurant at the Toronto Airport in June on my way to the Canadian Obesity Student Meeting in Edmonton. It certainly helped me to make a better decision for choosing the best meal which would not reach over maximum calories I needed. I was even more pleased by the lemon flavored cold water available for free on the counter right after the cashier. I have photos If you need them. Paul

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  3. Personally I find it helpful, but then again I am fully educated on the topic and have a deep understanding of energy balance. Unfortunately I suspect I am in the smallest minority of the population. So I am not really surprised at these findings, yet I welcome them since it is important we are trying to measure the effects of these approaches.

    I agree with Leslie’s points above, namely that getting people to reduce energy consumption requires a multifaceted approach that moves the needle very slowly over a number of years—maybe even as long as a generation.

    I have to believe that some kind of legislation around the marketing of foods that have been shown clearly to promote poor health is also required. Otherwise the marketing forces that public health has to face up against are massive, and if you will pardon the comparison is a bit like farting against thunder!

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  4. One more thought to add:

    Another potential benefit from menu labelling would be a reformulation of products by industry, in order to display more ‘reasonable’ amounts of calories (and perhaps other nutrients as well).

    A recently published study by Bruemmer and colleagues in the Journal of the Academy of Nutrition and Dietetics* suggests that there was an improvement of nutritional profiles of food after implementation of mandatory restaurant menu labelling in King County, Washington. There are some limitations to this study, and it will be interesting to see if there is a noticeable impact on nutrient profiles of foods at the national level when the US implements menu labelling.

    There is also some anecdotal evidence of this occurring in the US in anticipation of the new menu labelling legislation.
    (http://articles.latimes.com/2011/jun/22/business/la-fi-calorie-count-20110622).

    Perhaps this will add one more piece to the obesity prevention puzzle?

    *Bruemmer B, Krieger J, Saelens BE, Chan N. Energy, saturated fat, and sodium were lower in entrees at chain restaurants at 18 months compared with 6 months following the implementatino of mandatory menu labelling regulation in King County, Washington. Journal of the Academy of Nutrition and Dietetics, doi: 10.1016/j.jand.2012.04.019

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  5. Calorie labeling stopped me dead in my tracks when ordering off a menu from a family restaurant in Washington. I know a fair amount about nutrition and cooking, so I like to think that I have a fairly good grasp of the caloric content of a lot of foods out there. When I saw the # attached to the meal I was planning to order, I was absolutely shocked at how high it was. This really makes me aware of the problem that people are likely ordering foods off on menus thinking that they are making a good and semi-healthy choice, when the reality is is that they have no idea just how high the calorie content actually is. We never truly know what’s going into our foods when it comes to restaurants so there are hidden calories everywhere.

    As someone who tries to eat healthy and is very conscious of my diet, calorie labeling on menu items is really helpful and I wish all restaurants had them implemented into their menus. For someone who is going out for a meal and thinks of dining out as a treat in which calories don’t count, then the labeling is useless. A lot of people will see the calories and just think, “Oh, I don’t do this that often. I’ll go all out this time!” Unfortunately more and more meals are being eaten away from the home so this state of mind will likely work against restaurant diners in the long run.

    I say that calorie labeling will only change behaviour for those who watch what they eat, know about daily caloric needs and their own personal needs to maintain/lose/raise their weight.

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  6. Before I started to go to Weight Wise if this information had been on a menu I would have said ‘oh interseting’ and ordered what ever I wanted to eat. Now the calories/budget thinking is what I do. However there are so few restaraurants that have this feature that eating out becomes toxic very easily. The activity in Module 2 of the Weight Wise lessons had an exersize that put only calories beside the menu item (and this was standard restaurant fair) for us to chose from.

    Maybe having 2 local media personalities go through this with you to put the ressults on the news “might”, help the average person see that they are indeed over eating

    Then there are the liquid calories–if you can get the average person to limit them you are going to be doing real well. Thanks for the info

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  7. Perhaps it depends on the restaurant? Presumably if you’re heading to a fast-food joint you’ve checked your health concerns at the door. However, at a restaurant with a variety of options, I think it would have an influence. Furthermore, the best way to educate the public on calories is to start providing that information more readily.

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  8. Yes, I really want to see calories on restaurant menus. It may not change the choices of those not understanding or counting calories, but for those of us trying to be mindful of our choices, it makes a world of difference!

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  9. I think it’s a great idea for chain restaurants with static menus. However, there’s no way that good restaurants or small local cafes and diners could do this. They have different foods every day, based on what’s in season and what high quality ingredients are available at a good price from the wholesaler. Many good cooks don’t measure ingredients. The best restaurants – both in the gourmet sense and in the “home cooking” sense – don’t use the same recipes over and over again and wouldn’t be able to easily calculate the calories in all their menu items every day.

    I wouldn’t like to see that change, because frankly I consider the kinds of places where there’s room for creativity in the cooking to be the best places to eat out.

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  10. I like having calorie counts on things—but even more helpful is knowing things like grams of protein, fat, and carbs. I don’t really count calories, just grams of protein.

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  11. Thank you for the research-based, rational post Arya. I definitely think the Menu Labeling component of the Affordable Care Act is a step in the right direction. You did, however, hit the nail on the head with this statement: “individuals must be able to put them into context of their overall daily needs.” Menu labeling is the first step to make nutrition information accessible across all aspects of the food industry, packaged products & restaurant meals. But the next step is implementing education to scale that makes this information relevant to the individual, for their specific dietary needs. Thanks for sharing.

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  12. Yeah, I would love to see sugar/carb content displayed. And calories! but consider that by law calories reported only have to be within 20% of what it actually is. And portion sizes being slightly different every time confound things as well. I think this kind of labeling will help those that are already trying to make better choices be able to make even better choices but those who don’t care still won’t. But seriously, sugar content would help a lot more. I got my kids fat free choc milk at a fast food place the other day but it had so much sugar they might as well had soda. I would rather give them full fat milk with much less sugar. What’s with all this focus on calories as the only factor that matters?

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