Part D. Chapter 3: Individual Diet and Physical Activity Behavior Change
Food and Menu Labeling
Food and menu labels can provide information that improves an individuals food selection and potentially improves body weight outcomes. Research focusing upon the impact of food labeling on body weight and other health outcomes is beginning to emerge. The U.S. Food and Drug Administration (FDA) recently finalized regulations requiring calorie information to be listed on menus and menu boards in chain restaurants, similar retail establishments, and vending machines with 20 or more locations. Studying the effects of this regulation on dietary choices, weight and chronic disease outcomes will provide an opportunity to understand how policy works in real-world conditions.
Some studies, including existing reviews, have examined the impact of restaurant calorie labeling on free-living consumer food selection and have had mixed results. Few studies have actually measured calories consumed as a result of menu labeling. A recent systematic review including 17 studies with experimental or quasi-experimental designs evaluated whether menu-based nutrition information affects the selection and consumption of calories in restaurants and other foodservice establishments.102 Five of these studies measured the association between the introduction of menu labeling and average calories purchased per transaction in fast-food restaurants before and after implementation of policies that required restaurants to add calorie values to menus. Data collection varied in terms of duration (2 weeks to 6 months) and time from menu changes (from 4 weeks to one year after menu calorie labeling took place). Only one of the five reported a statistically significant association between the introduction of menu labeling and the selection of fewer calories.
Overall, however, the review concluded that menu labeling of calories alone did not decrease calories selected or consumed but that the addition of contextual or interpretive information on menus, such as daily caloric recommendations or physical activity equivalents, assisted consumers to select and consume fewer calories. 102 Additionally, there appeared to be a difference in sex response such that women tended to use the information to select and consumer fewer calories than men.
The intent of this NEL systematic review was to focus on controlled trials that isolated the impact of menu labeling on food selection and consumption at the individual level. The Committee was also interested in the effects of menu labeling on body weight outcomes; however there was insufficient evidence from RCTs examining the association between food and menu labels and body weight to complete a systematic review with body weight as the outcome.
Question 7: What is the effect of use of food and menu labels on measures of food selection and dietary intake in U.S. population groups?
Source of evidence: NEL systematic review
Limited and inconsistent evidence exists to support an association between menu calorie labels and food selection or consumption. DGAC Grade: Limited
The impact of food and menu labeling on food selection and health outcomes is limited by the heterogeneous approaches and the modest number of high quality studies, particularly RCTs. Thus, no implication could be drawn from the RCTs although policy level studies suggest that menu labeling of calories alone will not decrease calories selected or consumed but that addition of contextual or interpretive information on menus, such as daily caloric recommendations or physical activity equivalents, can assist consumers to select and consume fewer calories.102 The new menu labeling regulations recently finalized by the FDA will provide an opportunity for further food and nutrition policy research in real-world settings.
Review of the Evidence
Ten RCTs103-112 were included in this body of evidence that compared menu calorie labeling on food selection. Three of the ten studies also measured calorie intake of a test meal.107-109 Results were mixed regarding the influence of menu calorie labeling on food selection. Five studies found no effect of calorie information alone on food selection.104, 105, 107, 108, 110 Three studies found calorie labeling led to selection of fewer calories.103, 109, 112 Two studies showed mixed results. One106 found an impact of calorie labeling with women, but not men, and another111 found that parents ordered fewer calories for their children, but not for themselves when calorie information was included on a test menu.
Two studies found that providing calorie labels with either recommended daily caloric intake information109 or physical activity equivalents108 resulted in the consumption of fewer calories at a test meal. One study did not find an effect of calorie labeling on calorie consumption.107 Two studies examining physical activity equivalents as a component of the calorie labeling found a decrease in the calorie content of selected food items.104, 108 One study that examined the effect of calorie labeling and value pricing (structuring product prices such that the per unit cost decreases as portion size increases) also showed no association between calorie labeling and food selection or consumption.
This body of evidence has many limitations: two of the ten studies were conducted in actual restaurant settings, limiting the external validity of the findings; three studies measured food intake; some studies included pricing as a confounder, while others did not; and all studies were conducted in one session. The methodological complexities of laboratory studies limit generalizability to free living populations.
For additional details on this body of evidence, visit: http://NEL.gov/topic.cfm?cat=3379