October 17, 2018
Now on the Menu: Calorie Labels

Now on the Menu: Calorie Labels

by Wellness Letter

In May 2018, long-awaited, long-overdue menu labeling regulations, developed under the Obama administration as part of the Affordable Care Act, finally went into effect nationally. They were passed in 2010 and finalized in 2014, but the original compliance date of December 2015 was extended to December 2016 and then to May 2017—and then to May 2018—in large part due to heavy lobbying by the food industry from the start and then a last-minute delay under the Trump administration.

Some groups still oppose it, saying the government should not be involved in what people eat, but even the restaurant industry’s trade association is now on board.

The new FDA regulations require that calories be posted on menus, menu boards, or other signage, and they apply to restaurants (both fast-food and sit-down) and other food outlets offering prepared foods (including beverages) that have 20 or more locations. That includes supermarkets, convenience stores, movie theaters, ballparks, amusement parks, donut stores, take-out restaurants, and even ice creamtrucks.

You’ll know how many calories are in that large movie popcorn, that giant smoothie from the juice shop, and that pizza delivered to your door. The regulations also apply to many vending machines. Exempt are schools, trains, and airplanes.

Restaurants Weigh In on Mandatory Menu Calorie Labeling

Even if all diners don’t respond as hoped, the new mandatory calorie labeling regulations seem to be motivating restaurants to reformulate their products and shift their menus toward lower-calorie fare.

At restaurants, only standard menu items must be labeled—not things like condiments and daily specials. But the calories of certain alcoholic beverages fall under the rule, since alcohol contributes “a substantial portion of average total calories consumed by American adults,” according to the FDA.

If you want more than calorie information, you just have to ask: The regulations also require that establishments provide the fat, cholesterol, sodium, carbohydrate, sugar, fiber, and protein content of standard menu items upon request.

As you may have noticed, many large restaurant chains—including Starbucks, McDonald’s, Chipotle, Panera, and Subway—had already been providing this information, in various forms, either to be compliant with city, county, or state laws or in anticipation of the federal regulations. In fact, menu labeling has been mandatory in places like New York City (where it all started back in 2008), Philadelphia, King County in Washington State, and California for years now.

A helping hand

The idea behind menu labeling is to help combat America’s growing weight problem. As the FDA notes, more than two-thirds of adults and about one-third of children in the U.S. are overweight or obese—and more than one-third of the calories in the American diet come from foods prepared outside the home (typically in meals that are higher in fat and sodium and lower in fiber, fruits, and vegetables than meals prepared at home).

Yet many people don’t know how many calories are in prepared foods—or they underestimate the numbers. Of course, many people also don’t know how many calories a day they should be eating, which is why, along with calorie counts, menus must include a statement such as: “2,000 calories a day is used for general nutrition advice, but calorie needs vary.”

The goal, as the FDA final rule stated, is to provide “accurate, clear, and consistent nutrition information…in a direct and accessible manner to enable consumers to make informed and healthful dietary choices.”

But do diners really make better choices when calorie information is in plain view? Do they opt for the lower-calorie grilled chicken sandwich over the fatty cheeseburger, or the fruit plate over the chocolate cake? If so, might they make up for the calories saved by ordering larger portions, indulging in something they wouldn’t normally get, or overconsuming later on (the so-called health halo effect)?

The evidence to date, unfortunately, is not clear cut. Some of the research, for example, suggests that people with lower income and less education are less likely to use menu labeling and that those who respond most to the information are already health-conscious. The huge diversity in study design and the limitations of much of the research also make it difficult to come to definitive conclusions about who may benefit most from menu labeling.

Still, health experts believe that menu labeling is a step in the right direction.

Research à la carte

  • A large study in Health Affairs in 2009 looked at purchases at fast-food chains in New York City before and after menu labeling requirements went into effect, and also compared them to purchases in Newark, New Jersey, where there was no menu labeling. To gather the data, researchers surveyed 1,156 adult diners and collected their receipts. Of the 54 percent of diners in New York City who noticed the new menu information in the post-labeling sample, about one-quarter said it influenced what they ordered, with nearly 90 percent of that group reporting that they purchased foods with fewer calories. However, in reality, the total calories ordered before and after menu labeling did not change—and was not significantly different from that of the New Jersey diners.
  • A 2015 study in the American Journal of Public Health, which included more than 3,000 adults in King County, Washington, found significant increases in calorie awareness and use of the information after amenu labeling policy was implemented there in 2009 for chain restaurants with 15 or more locations, though there were differences across racial and other groups. Non-whites, men, and those with lower income, for instance, were less likely overall to see or use the information.
  • A 2017 systematic review and meta-analysis of 14 studies, published in the journal Nutrients, found no overall reduction in calories as a result of menu labeling. There was, however, a significant reduction incalories per meal (115) in the five studies done in lab settings—though the researchers noted that food and beverage choices made under such artificial scenarios may be different from those in real-world settings.
  • A Cochrane review, published in February 2018, analyzed 28 studies that looked at the impact of menu and nutrition labeling on people’s food selections and consumption in both real-world settings (restaurants, grocery stores, vending machines) and in lab settings, though the studies varied tremendously in design and populations. The results “suggest that nutritional labeling comprising energy [calorie] information on menus may reduce energy [calories] purchased in restaurants,” and “tentatively suggest that nutrition labeling on menus in restaurants could be used as part of a wider set of measures to tackle obesity.” But the authors also emphasized that the quality of the evidence is low and that “more high-quality studies are needed to make this finding more certain.”

Bottom line

It’s wishful thinking that simply posting calorie information will lead to significant and lasting dietary changes and reduce obesity rates, since it doesn’t address the many causes of obesity or the complexities of behavior change. But it may at least nudge diners—and the food industry—in the right direction.

More research is needed to determine the optimal way to present calorie labels (such as the best placement, font size, and color) and the best strategies to reduce disparities in responsiveness among different demographic groups. The information will likely have more effect if it is accompanied by educational campaigns and other policy initiatives that help put the calorie numbers into better perspective. For instance, including activity icons with the number of minutes needed to walk off that Big Mac may have more impact than just listing its 540 calories. (For the record, a 150-pound person would have to walk briskly for about two hours.)

This article first appeared in the UC Berkeley Wellness Letter.

Also see Alcohol: Where's the Calorie Label?