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Does Mandatory Menu Labeling Change Behaviour?



One of the proposed strategies to nudge consumers to eat fewer calories is the mandatory labeling of menus. While this makes intuitive sense, the actual impact of this strategy is not clear.

This issue was now addressed by Eric Finkelstein and colleagues from Duke-National University of Singapore, in a study just published in the American Journal of Preventive Medicine.

The investigators took advantage of a “natural experiment” made possible by a mandatory menu-labeling policy in King County, Washington. Beginning in January 2009, this policy requires all restaurant chains with 15 or more locations to disclose calorie information at the point of purchase.

To examine the effect of this new regulation, the investigators compared the transactions and purchasing behavior at one Mexican fast-food chain with locations within and adjacent to King County.

Seven King County restaurants and seven control locations were studied immediately following the law until the posting of drive-through menu boards (January 2009 to July 2009) and a second period following the drive-through postings (August 2009 through January 2010).

The researchers found no impact of the regulation on purchasing behavior. In fact, there was absolutely no change in transactions and calories per transaction between control and intervention locations after the law was enacted.

Thus, the authors conclude that (at least in this setting), mandatory menu labeling does not promote healthier food-purchasing behavior.

In the discussion of their findings, the authors point out a couple of important caveats:

because [the study] was at the store level, it was not possible to identify whether certain subgroups (e.g., more health conscious, parents ordering for children, or those with chronic illnesses who are more motivated to choose healthier options) differentially benefited from the legislation.

[in addition] this analysis focused solely on demand responses to menu-labeling legislation. Future studies should examine the extent to which mandatory menu labeling encourages supply-side changes and their subsequent impact on fast-food purchases. Supply-side effects may involve changes in in-store promotions, product mix, or reformulation of existing products.

Despite these caveats, I would certainly remain rather skeptical that simply putting calories on menus, without also promoting caloric literacy and specifically urging consumers to lower their caloric consumption, will have any major effect on eating behaviours.

Indeed, doing one without the other – or in other words – simply putting calories on food items or menus, when most people have no clue as to what those numbers actually mean or how they can use those numbers to manage their daily “calorie account” is likely to remain little more than a well-intended gesture.

Of course, this should not mean that the whole notion of putting calories on menus should be abandoned – I for one, would certainly wish I could look at the caloric content of meals that I am ordering in any restaurant.

What do my readers think – would calories on menus help you (or your clients) with weight management efforts?

What would consumers need to know in order to actually use those numbers to better manage their weights?

AMS
Toronto, Ontario

Finkelstein EA, Strombotne KL, Chan NL, & Krieger J (2011). Mandatory menu labeling in one fast-food chain in king county, washington. American journal of preventive medicine, 40 (2), 122-7 PMID: 21238859

21 Comments

  1. I was in a highway fast-food place on the weekend with a Wendy’s, Tim Horton’s, and a couple of other places in there … saw that the Wendy’s had a big poster w/ nutritional information posted beside the checkout – I sat & watched who looked at it, and it looked like the people who were “in shape” looked it but others ignored it. I love having it posted right there – but even when I talk to people about calories, so many really have no idea how many calories is a lot or a little anyway…
    D

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  2. Great blog Dr. Sharma. I find this a very interesing topic area and one that I’ve been following since the bill related to Healthy Decisions for Healthy Eating has been sitting in legislation (in Ontario).

    Although I agree there are unanswered questions and limited research in this area, I still think that the posting of calories on menu boards would be one small step in the right direction towards creating supportive environments. We know that education and increased knowledge don’t necessarily lead to behaviour change, however at least the posting of calories would provide consumers with the opportunity to make an informed decision. As noted in the quoted research, there is also the potential to impact industry and lead to product reformulation, etc.

    Having said that, there are still many unanswered questions and potential setbacks to this type of policy. One being that the amount of calories consumed at a meal isn’t the ‘picture’ of healthy eating – a good example being that a diet coke has less calories than a carton of milk. Also, we know little of the potential unintended negative consequences of this approach on various sub-groups.

    I think if this type of legislation came into effect it would be very important, as you’ve mentioned, to create further support for consumers. Some research in this area has identified that it may be beneficial to provide consumers with the approximate total amount of calories that should be consumed in a day, so that they can take their caloric consumption from a restaurant or fast-food meal into account for the remainder of their day.

    Either way, more research is needed and it will be very important for any future legislation in this area to incorporate an evaluation component.

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  3. I, for one, will welcome the addition of mandatory calorie information on menus. Certainly some people won’t care, but I still know far too many people who think, for example, that ordering a “salad” is OBVIOUSLY a healthy option, even when that salad is slathered in creamy dressing, bacon, cheese, meat, etc.

    One problem I see with this study is that it was conducted at a taco joint! Somebody who cares about the calorie content of their food is, in my opinion and experience, rather unlikely to be picking a taco fast food restaurant as their eating establishment of choice!

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  4. Yes I agree that people have no idea as to how many calories they need but i think people can still distinguish between high and low. They can choose the dishes that are low in calories relative to others. So i think caloric info on labels would definitely help.

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  5. I do agree that posting caloric content is likely to have little effect without increased nutritional literacy by the public. I review caloric and nutritional content in chains that post the information. ie Extreme Pita, however I notice very few other consumers take notice.

    I agree it needs to be accomopanied with increased knowledge that would be acheived with people whom are receiving nutritional education for health issues or weight management.

    However, maybe similar to posting the sub of the week (featured food item), an addendum to that ad could be a caloric or nutritional tip related. Increasing knowledge or awareness to the public whom do not or can not access health professionals, but in small tidbits. But this would require hug buy-in by the corporate world.

    Just a thought!

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  6. There is one restaurant that I go to frequently that has the calories listed, and it has both low-calorie and high-calorie options. It hasn’t stopped me from ordering certain things, but it has made me feel guilty about ordering them.

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  7. I think the emphasis should be on total calories per 100 grams or so and indicated how much food that is. Without going into the specifics of fats, carbs or pro. The other thing should be sodium. There should be some way to put that too.

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  8. I use restaurant nutrition info, and it determines what I eat.

    At McDonalds, taking a break during an afternoon of shopping and errands:
    My friend orders a carrot muffin. I order a hamburger.

    She asks why I don’t order just a muffin, instead of a hamburger, if I’m trying to loose weight.
    I flip over paper placemat to the nutrition info and point out:
    Carrot muffin: 430 calories, 6 g protein, 16g fat, 36g sugar, 320mg sodium
    Hamburger: 250 calories, 12 g protein, 8g fat, 7 g sugar, 510 mg sodium
    The nutrition info at McD’s means I can get a protein providing snack at a reasonable calorie cost and and money cost. (But – I should use less salt at supper.)
    Note: I spread calories out over the day, so 250 cals is not too much to spend on a snack, because I have small meals.

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  9. Research has shown that information on food labels primarily benefits pepole who are already making careful food choices. Most people do know the ball park number of 2000 daily calories for the average adult. Perhaps more information about gender specific calorie needs and about how that number breaks down for meals and snacks (ie. 400-600 at meals, 100-200 for one to two snacks) would be helpful.

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  10. I personally would prefer to have calories and other nutrition facts like protein, fibre, carbs, sodium etc. listed on menus at all Restaurants not just fast food joints.
    Like one commenter mentioned a lot of people who eat at fast food joints don’t bother too much about calories but a lot of people still do; they just go to different type of Restaurants.

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  11. I believe the study is somewhat flawed in that the test population is somewhat self-selecting. Those who regularly frequent fast-food outlets may, as a group, be more interested in making their food selection based on taste rather than on health. One does not order french fries believing they are a healthy choice, yet millions of orders of fries are still consumed daily. The study also looked at calories per transaction, but it was not clear (from what I could see) if the posting of the caloric information discouraged the transaction altogether – driving the consumer to leave the restaurant without making a purchase.

    As CS put it, the labeling benefits those who are already making careful choices. I, as an obese adult trying to make better choices, would appreciate more complete information, but my teenage children of healthy weight and high activity levels are less likely to be influenced.

    Ultimately, exposure to the information on a widespread, continuous basis could, and likely would, have an effect on “caloric literacy”, and perhaps better choices would be made.

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  12. I think posting calories in a menu is an excellent idea that would help me to remember to stay on track (“Do I really need those extra calories today, in this meal?” maybe yes, maybe no).
    However, the couple of times a year I go to a fast food restaurant, I have already made the decision that I will be eating extra calories for this meal. Therefore seeing the calories at a fast food menu would probably not change my mind that day in what I eat. It would however make an impact on me in a regular restaurant, where I try to make healthy choices every time.
    But as I said, I probably eat fast food only a few times a year, solely in “I-have-run-out-of-time” situations.

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  13. I appreciate the nutritional information being available whenever and wherever I see it. I am morbidly obese. I could write a book on calorie counts and fiber and carb grams and on and on. I know it inside out and backwards it seems. When I’m on track with trying to live a healthy life, the information is hugely valuable. When I’ve given up on myself, I couldn’t care less. I have a pre-teen daughter who is very concerned about her weight and always asking me to rate her meal for how healthy it is. Although she understands there’s more to it than just the number of calories, she’s overwhelmed by all the information on the labels, the health check signs, the differences between low fat, fat free, reduced fat and so on. I’ve read a bit about the NuVal system and how a number is assigned to each food. It seems to make so much sense and be so user-friendly. I’m wondering what your opinion on this sort of system is Dr. Sharma.

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  14. Like the grotesque pictures and dire warnings on cigarette boxes, I don’t think that it will serve as a deterrent for all people all of the time. But an empowered consumer can make better choices when provided better information. I have learned in retrospect that some meals that I have had in restaurants – that I considered a middling indulgence at the time of eating – actually turned out to be a full day’s fat or caloric content when the info turned up in a study. Had I come face to face with that info when ordering, that would have been enough to dissuade me. It may not mean that I would have chosen the best option on any menu every time, but it would have stopped me from ordering the worst option on the menu the vast majority of times.

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  15. Note to those looking to see if people read nutrition info:
    Some people who don’t look at info may have read it before, and made a choice based on the info, but they don’t read it again every time.

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  16. I love calorie counts – they certainly have an impact on my behaviour. On a recent trip to London, I frequented a noodle chain that prominently boasted about its calorie counts. It just makes everything so simple.

    There have been some stories in the NY Times about what happened in New York when calorie counts were posted and it does seem that they’re generally used by the people who least need them e.g. the health conscious. But there must be people who are eating poorly at the moment who will be interested in change at some time, and in that case, the calorie counts are a tool to help with the transition.

    On top of that, many chain foods aren’t always what they seem to be. Something that appears to be a healthy sandwich might actually be highly processed food with an unexpectedly high calorie count. So even the health conscious population can be tricked into eating unhealthy food, in the absence of good information. Posting calories sorts the problem out.

    http://www.nytimes.com/2010/02/03/opinion/03wed4.html?scp=5&sq=calories%20menus%20starbucks&st=cse

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  17. I personally would welcome this type of information. As the mother of 2 young children I occaisonally find myself at McDonald’s and I’ve always used their posted nutrition information to make a choice for myself. Do I really want the mini cinamon buns? You betcha! But after reading what’s in them I chose a fruit and yogurt parfait instead.

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  18. When I first read the title of today’s blog I formulated an answer in my mind and then read on I was truly surprised by how my response mirrored the answer of the resaercher’s. I know for me the calorie info would make a difference but like you said “there needs to be wholesale calorie education” and mainstream media does not do that–the news media is even worse because they give high lights of the information not the information. I know before I took the weight wise modules I had no idea how much I was eating let alone how to deal with treats and treat meals, some may well feel unconfortalbe with this information publicly posted. Those who feel unconfortable may well not be ready to deal with any excess weight that he or she may be carrying around, or not ready to decrease there calorie intake. I personaly am looking forward to a specific weight so that I can go off one of my two cholesterol medcaitions. Those who aren’t ready to lose weight (if they need to may not have set a goal of reduced medication) Without goals even thinking of losing weight is meaningless

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  19. I’d welcome the nutritional information being easily and readily available.

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  20. I would also love to see calorie counts, it would make decision making a lot easier at restaurants. However, it’s clear that this won’t solve the underlying issues associated with our obeseogenic environment, but every little bit helps! Obesity is a complex issue that will require many different strategies to address it, so I think we should try as many as makes sense.

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