Calorie menu labeling on quick-service restaurant menus. An updated systematic review of the literature

Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC 27599-7461, USA.
International Journal of Behavioral Nutrition and Physical Activity (Impact Factor: 4.11). 12/2011; 8(135):135. DOI: 10.1186/1479-5868-8-135
Source: PubMed


Nutrition labels are one strategy being used to combat the increasing prevalence of overweight and obesity in the United States. The Patient Protection and Affordable Care Act of 2010 mandates that calorie labels be added to menu boards of chain restaurants with 20 or more locations. This systematic review includes seven studies published since the last review on the topic in 2008. Authors searched for peer-reviewed studies using PUBMED and Google Scholar. Included studies used an experimental or quasi-experimental design comparing a calorie-labeled menu with a no-calorie menu and were conducted in laboratories, college cafeterias, and fast food restaurants. Two of the included studies were judged to be of good quality, and five of were judged to be of fair quality. Observational studies conducted in cities after implementation of calorie labeling were imprecise in their measure of the isolated effects of calorie labels. Experimental studies conducted in laboratory settings were difficult to generalize to real world behavior. Only two of the seven studies reported a statistically significant reduction in calories purchased among consumers using calorie-labeled menus. The current evidence suggests that calorie labeling does not have the intended effect of decreasing calorie purchasing or consumption.

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    • "Looking at the meta-analysis by Swart and colleagues, most studies involved a limited number of food categories, as typically found on QSR menus (Swartz, Braxton, and Viera 2011). Similarly, -several studies in quick service settings have indicated that not all consumers or participants were aware of calorie labels due to the speedy QSR ordering process (Finkelstein et al. 2011). "
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    ABSTRACT: Using mobile tablet technology, this study compared menu selections by millennial-age respondents to test the effects of five different menu nutrition labeling formats for attractiveness, perceived influence, and actual influence on the students’ food choices. Labeling formats presented on an iPad involved combinations of numeric caloric values, traffic-light color coding, and percentage of daily intake presented as a graphic summary. Each participant was asked to select four courses from a fine-dining restaurant menu, and each was shown one of the five nutrition labeling formats (or no information at all). Although there was no significant difference in the calorie count for the six groups, the labeling format with traffic-light color coding combined with a graphic summary of the meal’s calorie count (compared with the daily recommended intake) received the highest attractiveness ranking. This attractive graphic format also showed a significant positive correlation to its perceived influence on food choices. Overall, participants in all labeling groups indicated a strong support for inclusion of nutrition information on restaurant menus using mobile tablet technology.
    Cornell Hospitality Quarterly 12/2014; online:1-10. DOI:10.1177/1938965514546371 · 1.75 Impact Factor
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    • "Elbel el al.15) compared the difference in calories, saturated fat, sodium, and sugar content of foods ordered from fast food restaurants in selected areas of New York before and after the introduction of mandatory display of nutrition information on the menus. In a systematic review published in 2011, only 2 out of the 7 studies published between 2008 and 2011 showed an actual decrease in the intake of calories by displaying calories, and overall it was concluded that there was insufficient evidence that caloric intake was reduced.16) "
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    ABSTRACT: Background: Nutrition labels provide various information on the nutrient contents of food. However, despite the recent increase in the interest in dietary intake and expansion of related policies, studies on the association between nutrition label reading and dietary intake are lacking in Korea. Methods: This study analyzed the 2007–2009 KNHANES (Korean National Health and Nutrition Examination Survey) data. To examine macronutrients and micronutrients intake according to nutrition label reading, analysis of covariance was used. Multiple logistic regression analysis was also used to examine the association between adherence to dietary reference intake and nutrition label reading. Results: Nutrition label reading was significantly high among women, youth, and those with high education and high household income. Nutrition label reading was associated with higher intake of calcium and vitamin C in men and the lower intake of calorie, carbohydrates and higher energy ratio of protein in women. Additionally, male nutrition label readers were associated with adherence to dietary reference intake of fiber (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.23 to 3.26) and calcium (OR, 1.26; 95% CI, 1.03 to 1.54). In women, there were no significant differences in the adherence to the dietary reference intake in fat, fiber, sodium, potassium, and calcium according to the nutrition label reading. Conclusion: In men, nutrition label reading was associated with healthier intake of several micronutrients, although this was not observed in women. Consideration for clearly reporting vulnerable micronutrients in nutrition labels is necessary.
    Korean Journal of Family Medicine 07/2014; 35(4):190-198. DOI:10.4082/kjfm.2014.35.4.190
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    • "Two systematic reviews conducted in 2008 [5] and 2011 [6] identified six [7-10] and seven [11-16] studies, respectively, that evaluated the effects of calorie labels on consumer choice. Both reviews found only weak, inconsistent evidence that calorie menu labels lead consumers to make lower-calorie food choices [5,6]. "
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    ABSTRACT: Background This study used focus groups to pilot and evaluate a new nutrition label format and refine the label design. Physical activity equivalent labels present calorie information in terms of the amount of physical activity that would be required to expend the calories in a specified food item. Methods Three focus groups with a total of twenty participants discussed food choices and nutrition labeling. They provided information on comprehension, usability and acceptability of the label. A systematic coding process was used to apply descriptive codes to the data and to identify emerging themes and attitudes. Results Participants in all three groups were able to comprehend the label format. Discussion about label format focused on issues including gender of the depicted figure, physical fitness of the figure, preference for walking or running labels, and preference for information in miles or minutes. Feedback from earlier focus groups was used to refine the labels in an iterative process. Conclusions In contrast to calorie labels, participants shown physical activity labels asked and answered, “How does this label apply to me?” This shift toward personalized understanding may indicate that physical activity labels offer an advantage over currently available nutrition labels.
    Nutrition Journal 06/2013; 12(1):72. DOI:10.1186/1475-2891-12-72 · 2.60 Impact Factor
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