Estimating the effect of calorie menu labeling on calories purchased in a large restaurant franchise in the southern United States: quasi-experimental study (original) (raw)
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JAMA Network Open
IMPORTANCE Calorie labeling on menus is required in US chain food establishments with 20 or more locations. This policy may encourage retailers to offer lower-calorie items, which could lead to a public health benefit by reducing customers' calorie intake from prepared foods. However, potential reformulation of restaurant menu items has not been examined since nationwide enforcement of this policy in 2018. OBJECTIVE To examine the calorie content of menu items at large chain restaurants before and after implementation of federally mandated menu calorie labels. DESIGN, SETTING, AND PARTICIPANTS This pre-post cohort study used restaurant menu data from MenuStat, a database of nutrition information for menu items offered in the largest chain restaurants in the US, collected annually from 2012 to 2019. The study comprised 35 354 menu items sold at 59 large chain restaurants in the US. Statistical analysis was conducted from February 4 to October 8, 2021. INTERVENTION Nationwide implementation of menu calorie labeling. MAIN OUTCOMES AND MEASURES Changes in menu items' calorie content after restaurant chains implemented calorie labels were estimated, adjusting for prelabeling trends. All menu items, continuously available items, items newly introduced to menus, and items removed from menus were examined separately. RESULTS Among the 59 restaurant chains included in the study, after labeling, there were no changes in mean calorie content for all menu items (change = −2.0 calories; 95% CI, −8.5 to 4.4 calories) or continuously available items (change = −2.3 calories; 95% CI, −11.5 to 6.3 calories). Items that were newly introduced after labeling, however, had a lower mean calorie content than items introduced before labeling (change = −112.9 calories; 95% CI, −208.6 to −25.2 calories), although there was heterogeneity by restaurant type. Items removed from menus after labeling had similar calorie content as items removed before labeling (change = 0.5 calories; 95% CI, −79.4 to 84.0 calories). CONCLUSIONS AND RELEVANCE In this cohort study of large chain restaurants, implementing calorie labels on menus was associated with the introduction of lower-calorie items but no changes in continuously available or removed items.
PLOS Medicine, 2021
Background Calorie menu labeling is a policy that requires food establishments to post the calories on menu offerings to encourage healthy food choice. Calorie labeling has been implemented in the United States since May 2018 per the Affordable Care Act, but to the best of our knowledge, no studies have evaluated the relationship between calorie labeling and meal purchases since nationwide implementation of this policy. Our objective was to investigate the relationship between calorie labeling and the calorie and nutrient content of purchased meals after a fast food franchise began labeling in April 2017, prior to the required nationwide implementation, and after nationwide implementation of labeling in May 2018, when all large US chain restaurants were required to label their menus. Methods and findings We obtained weekly aggregated sales data from 104 restaurants that are part of a fast food franchise for 3 national chains in 3 US states: Louisiana, Mississippi, and Texas. The fra...
Calorie labeling, Fast food purchasing and restaurant visits
Obesity, 2013
Objective-Obesity is a pressing public health problem without proven population-wide solutions. Researchers sought to determine whether a city-mandated policy requiring calorie labeling at fast food restaurants was associated with consumer awareness of labels, calories purchased and fast food restaurant visits.
Assessing the Early Impact of Menu-Labeling on Calories in Chain Restaurants in Ontario, Canada
American Journal of Preventive Medicine, 2019
The objective of this study is to investigate the early impact of Canada's first provincewide mandatory menu-labeling legislation on calorie levels in foods offered on chain restaurant menus before, leading up to, and at the point-of-implementation. Methods: Data were obtained from Menu-FLIP, a database of publicly available nutrition data from chain restaurants in Canada. Data were collected in 2010, 2013, 2016, and 2017. Core food products, newly introduced products, discontinued products, and full menus were compared before (2010, 2013, 2016) and at the point-of-implementation (2017) of the policy. Calories and serving sizes of 2,988 unique foods (excluding beverages) from 28 chains were analyzed using mixed models comparing time points while controlling for covariates. Sub-analyses were stratified by restaurant type. Results: Full menu mean calories and serving sizes increased between 2010 and 2017 (>40 calories and 17 grams, respectively). There were no significant changes in mean calories or serving sizes among core menu items (p=0.47). New products in 2013 and 2017 were significantly higher in calories and serving size versus discontinued foods and foods already on the menu. Discontinued foods did not differ in calories or serving size compared with foods already on the menu; however, in 2017, the calories of discontinued foods in sit-down restaurants were higher than foods discontinued in 2013 (p=0.02). Conclusions: The results of this investigation show that at the point-of-implementation of the Ontario Healthy Menu Choices Act supply-side calories in core food products, new products, or full menus evaluated in this study did not significantly change.
Journal of Public Policy & Marketing, 2019
Menu calorie labeling is now required nationwide for chain restaurants in the United States; however, a number of studies have found that calorie labeling does not reduce average calories ordered. This research examines how different food-value orientations are associated with divergent consumer responses to the provision of calorie information on restaurant menus and menu boards. Results from two pilot studies and two experiments, including a restaurant field experiment, indicate that calorie labeling is effective in decreasing the number of calories ordered by health-value oriented consumers. However, for quantity-and taste-value oriented consumers, menu calorie labeling may result in an increase in calories ordered. These influences counterbalance one another, leading to an overall nonsignificant effect of calorie labeling on calories ordered in restaurant settings. These findings offer a compelling explanation for the many studies showing nonsignificant effects of menu calorie labeling and inform ongoing policy debates regarding the national implementation of menu calorie labeling for chain restaurants. The conceptual contributions and implications of these findings for public policy and consumer wellbeing are discussed.
American Journal of Public Health, 2015
Objectives. We examined population-level impact on customer awareness and use and explored potential disparities in outcomes regarding the King County, Washington, regulation requiring chain restaurants to provide calorie information.Methods. We analyzed 2008 to 2010 Behavioral Risk Factor Surveillance System data from 3132 English-speaking King County residents aged 18 years and older who reported eating at a regulated chain. We used regression models to assess changes in calorie information awareness and use from prepolicy to postpolicy implementation by customer demographics, health status, and restaurant type.Results. Calorie information awareness and use increased significantly from 2008 to 2010. Unadjusted analyses indicated that the proportion who saw and used calorie information tripled, from 8.1% to 24.8%. Fully adjusted analyses confirmed significant increases. After policy implementation, White, higher income, and obese respondents had greater odds of seeing calorie information. Women, higher income groups, and those eating at a fast-food versus a sit-down chain restaurant were more likely to use this information.Conclusions. Significant increases in calorie information awareness and use following regulation support the population-wide value of this policy. However, improvements varied across race, income, and gender.
Menu Labeling as a Potential Strategy for Combating the Obesity Epidemic: A Health Impact Assessment
American Journal of Public Health, 2009
Objectives. We conducted a health impact assessment to quantify the potential impact of a state menu-labeling law on population weight gain in Los Angeles County, California. Methods. We utilized published and unpublished data to model consumer response to point-of-purchase calorie postings at large chain restaurants in Los Angeles County. We conducted sensitivity analyses to account for uncertainty in consumer response and in the total annual revenue, market share, and average meal price of large chain restaurants in the county. Results. Assuming that 10% of the restaurant patrons would order reduced-calorie meals in response to calorie postings, resulting in an average reduction of 100 calories per meal, we estimated that menu labeling would avert 40.6% of the 6.75 million pound average annual weight gain in the county population aged 5 years and older. Substantially larger impacts would be realized if higher percentages of patrons ordered reduced-calorie meals or if average per-m...
Mandatory Menu Labeling in One Fast-Food Chain in King County, Washington
American Journal of Preventive Medicine, 2011
Background: As part of a comprehensive effort to stem the rise in obesity, King County, Washington, enforced a mandatory menu-labeling regulation requiring all restaurant chains with 15 or more locations to disclose calorie information at the point of purchase beginning in January 2009.