Research and Professional Briefs
The Accuracy of Stated Energy Contents of
Reduced-Energy, Commercially Prepared Foods
LORIEN E. URBAN, MS; GERARD E. DALLAL, PhD; LISA M. ROBINSON, RD; LYNNE M. AUSMAN, DSc, RD; EDWARD SALTZMAN, MD;
SUSAN B. ROBERTS, PhD
The accuracy of stated energy contents of reduced-energy
restaurant foods and frozen meals purchased from super-
markets was evaluated. Measured energy values of 29
quick-serve and sit-down restaurant foods averaged 18%
more than stated values, and measured energy values of
10 frozen meals purchased from supermarkets averaged
8% more than originally stated. These differences sub-
stantially exceeded laboratory measurement error but
did not achieve statistical significance due to considerable
variability in the degree of underreporting. Some individ-
ual restaurant items contained up to 200% of stated val-
ues and, in addition, free side dishes increased provided
energy to an average of 245% of stated values for the
entrees they accompanied. These findings suggest that
stated energy contents of reduced-energy meals obtained
from restaurants and supermarkets are not consistently
accurate, and in this study averaged more than measured
values, especially when free side dishes were taken into
account. If widespread, this phenomenon could hamper
efforts to self-monitor energy intake to control weight,
and could also reduce the potential benefit of recent policy
initiatives to disseminate information on food energy con-
tent at the point of purchase.
J Am Diet Assoc. 2010;110:116-123.
ergy intake is therefore a cornerstone of weight manage-
ment (4,5), and self-monitoring of food intake is widely
recommended to facilitate success (6,7). However, achiev-
ing energy intake goals through self-monitoring depends
on the accuracy of energy information available for con-
All foods, including those prepared at home, may po-
tentially introduce error in self-monitoring of energy in-
take, but ready-prepared foods purchased from restau-
rants and supermarkets may be an area of particular
concern. Consumption of these foods has increased in
recent years (8,9), and meals purchased away from home
are reported to contain more energy than home-prepared
foods (10-14). Furthermore, information on the energy
content of restaurant foods is provided without any re-
quired verification or oversight (15,16). Two recent media
reports (17,18) suggested that the true energy contents of
restaurant meals may be considerably more than the
amounts of energy stated by the vendors, a suggestion
that has important implications but is at odds with the
results of a previous study (19). Inaccuracies in reported
food energy content, if replicated, could contribute to
inadvertent overeating, hamper efforts to use self-moni-
toring for weight control, and reduce the usefulness of
recent government initiatives to make information on the
energy content of restaurant foods available at the point
of purchase (20-22).
A pilot study was therefore conducted to assess the
accuracy of reported energy contents of restaurant and
supermarket foods with reduced energy suitable for
he prevalence of obesity has risen markedly in the
past 30 years (1), and energy intake has also risen
substantially during this period (2,3). Reducing en-
This study involved measurement of the energy content
of 39 commercially prepared restaurant foods and super-
market frozen convenience meals obtained in the Boston,
MA, area, and comparison of measured values with nu-
trition information stated by the vendor or manufacturer.
The restaurant chains included in the study were se-
lected as a convenience sample of quick-serve and sit-
down restaurant chains with broad distribution through-
out the United States who provided information on
nutrient contents (or reliable information was available
from other Web sites). Because the goal of the study was
to examine the accuracy of stated energy contents of foods
apparently favorable for weight control, specific restau-
rant menu items were chosen based on three criteria:
having ?500 kcal, being typical American foods, and hav-
L. E. Urban is a doctoral degree student, E. Saltzman is
chair, Department of Nutritional Sciences, and L. M.
Ausman is Saqr bin Mohammed Al Qasimi Professor in
International Nutrition, Gerald J. and Dorothy R.
Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA. G. E. Dallal is director, Biosta-
tistics Unit, L. M. Robinson is a research dietitian, and
S. B. Roberts is director, Energy Metabolism Labora-
tory, Jean Mayer US Department of Agriculture Human
Nutrition Research Center on Aging, Tufts University,
Address correspondence to Susan B. Roberts, PhD,
Energy Metabolism Laboratory, Room 1312, Jean Mayer
US Department of Agriculture Human Nutrition Re-
search Center on Aging, Tufts University, 711 Washing-
ton St, Boston, MA 02111. E-mail: susan.roberts@
Manuscript accepted: November 24, 2008.
Copyright © 2010 by the American Dietetic
Journal of the AMERICAN DIETETIC ASSOCIATION
© 2010 by the American Dietetic Association
ing among the lowest stated energy contents on the
menu. Supermarket purchases were focused on frozen
complete meals that would be alternative choices to eat-
ing out. All items were purchased between December
2007 and June 2008. This study was deemed exempt
under federal regulation 45 CFR §46.101(b).
Food Collection and Analysis
One unit of each food item was purchased and trans-
ported upright in the original container to the research
center. Whole food items were weighed to determine por-
tion size, homogenized, freeze dried (Virtis Benchmark
1000 Lyophilizer, Virtis Co, Gardiner, NY), ground to a
fine powder, and then analyzed in duplicate for gross
energy using an Isoperibol Bomb Calorimeter (Parr
model 1261, Parr Instrument Co, Moline, IL). Weights
obtained throughout the sample preparation were used to
adjust for small food losses at different stages of process-
ing. Benzoic acid standards (Benzoic Acid 1g pellets, Parr
Instrument Co, Moline, IL) were analyzed and values
were within 1% of the known heat of combustion for
benzoic acid. The gross energy content of each food was
calculated by multiplying the average kilocalories per
gram of dry solids by the total weight of dry solids.
Two test “meals” were created out of basic food items with
consistent composition (white wheat flour, granulated
white sugar, corn oil, and nonfat dry instant milk) at
three energy levels and with macronutrient balances
spanning the range of test foods. The test meals were
processed for energy content as described above and an-
alyzed for energy content. Mean measured energy values
were ?1.9%?0.3% of values calculated from stated com-
positions of the individual ingredients, demonstrating the
accuracy and precision of the methodology used for direct
measurements of food energy content.
Bomb calorimetry directly measures the heat of combus-
tion of a food and thus gives values for gross energy (23),
whereas stated food values are metabolizable energy es-
timations (ie, gross energy corrected for assumed obliga-
tory energy losses before energy is available to the body).
Therefore, it was first confirmed that stated metaboliz-
able energy contents in study foods could be reliably
calculated from stated macronutrients, and then gross
energy was calculated for each food item from stated
macronutrients using the US Department of Agriculture
multiplicative factors appropriate for mixed foods (24).
This conversion introduced no error to the comparison
and allowed measured values to be compared directly
with values calculated from stated macronutrients
(henceforth called stated values). One restaurant re-
ported energy and all macronutrients except protein,
which was calculated by subtraction. Two other restau-
rants reported only energy, fat, and fiber. For these two
restaurants the carbohydrate content from www.
calorieking.com was adopted and protein content was
calculated by subtraction. This Web site employs regis-
tered dietitians who perform independent calculations,
including using the US Department of Agriculture data-
base (25), and thus the information was deemed accept-
able. Gross energy values are henceforth called energy in
the text for simplicity.
For foods that provided a portion weight on the restau-
rant Web sites or food package, stated values were com-
pared to actual served portion weight as measured in the
laboratory. For some analyses, measured energy values
were adjusted for portion size discrepancies by multiply-
ing the measured gross energy value by the percent dif-
ference in portion size.
Exploratory quantitative variables (eg, cost of food item,
cost per kilocalorie, and restaurant size) and categorical
variables (eg, whether the item was a free side dish or
entrée, restaurant type was quick-serve or sit-down, or
whether the meal would typically be eaten for breakfast
or lunch/dinner) were assigned to food items. Cost of food
was the menu price at the time and place of purchase, and
restaurant size was the total number of locations as in-
dicated in the annual report for each company. Free side
dishes were defined as food items accompanying the en-
trée that were not specifically ordered. Menus typically
listed these items as accompaniments with the entrée,
but the Web site energy information for side dishes was
listed separately from the entrée, or in one case, not at all.
Sit-down restaurants were defined as those where table
service from wait staff was available. Restaurants not
meeting this criterion were considered quick-serve.
Although formal statistical methods do not apply to con-
venience samples, standard statistical tests were em-
ployed to summarize the data for exploratory purposes
and to suggest directions for future study. Differences in
energy content (measured vs stated) were therefore com-
pared by using two-sided t tests of whether the observed
mean was within sampling variability of zero. Multifactor
analysis of variance was used to examine potential pre-
dictors of the percent difference between stated and mea-
sured energy for restaurant foods. Statistical significance
was set at P?0.05 (two sided). Statistical analyses were
performed by using SAS version 9.1 (2002, SAS Institute
Inc, Cary, NC).
RESULTS AND DISCUSSION
The energy contents of individual foods are given in the
Table, and Figure 1 illustrates percent differences be-
tween measured and stated values. On average, restau-
rant foods contained 18% more energy than stated; how-
ever, there was substantial variability in the difference
between measured and stated values, and some foods
contained twice as much energy as stated. The measured
energy content of supermarket-purchased meals was also
greater than stated values, by 8%. There was no statisti-
cally significant difference between measured and stated
values in either restaurant foods (P?0.12) or supermar-
ket meals (P?0.12), and no significant difference between
the mean accuracy of restaurant vs supermarket foods
(P?0.64). However, the difference between the standard
January 2010 ● Journal of the AMERICAN DIETETIC ASSOCIATION
Table. Nutrients and energy in reduced-energy meals ordered from restaurants and convenience meals purchased in supermarkets
Food item description
Vendor-Stated Values Measured Values
Restaurants (meals and side dishes)d
1. Denny’seveggie-cheese omelette (with egg beaters)
2. Denny’s hashed browns
3. Denny’s dry english muffin
4. Denny’s center cut sirloin and eggs
5. Denny’s dry toast (white)
6. Denny’s grits (served with butter)
7. Ruby Tuesdayfpetite sirloin steak
8. Ruby Tuesday baked potato (with butter and sour cream)
9. Ruby Tuesday broccoli
10. Ruby Tuesday Asian glazed salmon
11. Ruby Tuesday toast
12. Ruby Tuesday brown rice pilaf
13. Ruby Tuesday broccoli
14. Taco Bellhexpress taco salad (chicken)
15. Taco Bell nachos
Restaurants (individual items)
16. Ruby Tuesday fries
17. P.F. Chang’siCantonese shrimp
18. P.F. Chang’s Sichuan-style asparagus (large)
19. Olive Gardenjshrimp primavera
20. Applebee’skSteak and portobellos
21. Taco Bell crunchy beef taco
22. McDonald’slCaesar salad with grilled chicken
23. McDonald’s McChicken sandwich
24. Domino’smthin crust veggie feast pizza (large)
25. Domino’s thin crust cheese pizza (large)
26. Dunkin’ Donutsnplain bagel
27. Dunkin’ Donuts egg cheese english muffin sandwich
28. Wendy’soultimate chicken grill
29. Wendy’s grilled chicken go wrap
January 2010 Volume 110 Number 1
Table. Nutrients and energy in reduced-energy meals ordered from restaurants and convenience meals purchased in supermarkets (continued)
Food item description
Vendor-Stated ValuesMeasured Values
Supermarket convenience meals
30. Lean Cuisineproasted garlic chicken
31. Lean Cuisine shrimp and angel hair pasta
32. Weight WatchersqSmart Ones Roast Beef Bistro Selections
33. Weight Watchers lemon herb chicken piccata
34. Healthy Choicerslow roasted turkey breast with gravy
35. Healthy Choice chicken parmigiana
36. South Beach Livingskung pao chicken
37. South Beach Living roasted turkey
38. Bell & Evanstgrilled chicken breast
39. Bell & Evans chicken breast tenders
aCHO?carbohydrate. Net CHO is total carbohydrate content minus fiber content.
bME?metabolizable energy (stated by vendor).
cGE?gross energy. GE calculated from macronutrients stated by vendor using general heats of combustion.
dFree side dishes are listed in italics directly under the entree they accompanied.
eDenny’s Corp, Spartanburg, SC.
fRuby Tuesday, Maryville, TN.
gThese restaurants reported serving size as entire served portion.
hTaco Bell Corp, Irvine, CA.
iP.F. Chang’s China Bistro, Inc, Scottsdale, AZ.
jDarden Restauarants, Inc, Orlando, FL.
kApplebees Services, Inc, Lenexa, KS.
lMcDonald’s Corp, Oak Brook, IL.
mDomino’s Pizza, Ann Arbor, MI.
nDunkin’ Brands, Canton, MA.
oWendy’s Old Fashioned Hamburgers, Dublin, OH.
pNestle SA, Salon, OH.
qWeight Watchers Foods, LLC, New York, NY.
rConAgra Foods, Omaha, NE.
sKraft Foods, Northfield, IL.
tBell & Evans, Fredricksburg, PA.
January 2010 ● Journal of the AMERICAN DIETETIC ASSOCIATION
deviation of the energy discrepancies in restaurant vs
supermarket foods approached significance (P?0.06) and
became significant once the energy discrepancies were
adjusted for discrepancies of portion size (P?0.05). Thus,
there is more uncertainty regarding stated energy values
in restaurant foods than in supermarket packaged foods.
Five restaurants provided side dishes at no extra cost.
The mean additional energy provided by these items was
471?167 kcal, which was greater than the 443 kcal mean
value for the entrées they accompanied. Portion size dis-
crepancies (measured minus stated values) were a signif-
icant predictor of percent energy difference between mea-
sured and stated energy contents values when added to
the model predicting provided food energy (P?0.0001),
indicating that greater portions than stated did contrib-
ute to the energy discrepancy.
There was no statistically significant association be-
tween differences in measured vs stated energy based on
whether the item was a side dish or an entrée, type of
restaurant (quick-serve or sit-down), meal at which the
food is usually consumed (breakfast or lunch/dinner), res-
taurant size (number of franchises), cost per unit calcu-
lated energy content, or where the meal was purchased
(restaurant or supermarket). It should also be noted that,
since single samples of each food were obtained, the vari-
ability in results pertains to the general sample of foods
studied, and individual results cannot be attributed to
specific restaurants and brands of foods.
These results indicate that, in contrast to two recent
reports in the media (17,18), restaurant meals and pre-
pared meals purchased in US supermarkets do not typi-
cally contain substantially more energy than stated.
However, measured energy values did average 18%
higher in restaurant foods and 8% higher in supermarket
meals than stated. The underreporting of energy by res-
taurants and food manufacturers notwithstanding, the
majority of foods tested were not out of compliance with
US Food and Drug Administration regulations because
most fell within the 20% overage the Administration al-
lows for packaged food (no ceiling of overage is specified
for restaurant foods). In relation to this observation, it
should be noted that, as outlined in Figure 2, the US Food
and Drug Administration considers noncompliance in
packaged foods to include food energy (average of 12
samples) in excess of 120% of stated energy or ?99% of
stated weight (average of 48 samples) (26,27), which be-
cause of greater leniency in standards on the side of
overprovision compared to underprovision, may contrib-
ute to provided energy values being greater than mea-
sured. It should also be noted that three individual su-
permarket-purchased meals and seven restaurant foods
did contain up to twice the stated energy, so some indi-
vidual discrepancies were substantial.
The extra mean measured energy in this study com-
pared to stated information may cause substantial weight
gain over time. For example, positive energy balance of
only 5% per day for an individual requiring 2,000 kcal/
day could lead to a 10-lb weight gain in a single year. It is
also notable that free side dishes on average contained
more energy than the entrées alone. It is unclear whether
consumers are aware of how much energy free side dishes
contain, and providing more accessible information on
meal energy contents both with and without side dishes
could help increase attention to the potential of these
casual food items to more than double meal energy in-
Mean measured energy contents of reduced-energy res-
taurant and supermarket meals in this pilot study ex-
ceeded vendor-stated amounts by substantially more
than could be accounted for by laboratory measurement
error. Although the discrepancies were within acceptable
limits based on federal regulations for most packaged and
restaurant foods (which are not subject to these federal
regulations) some restaurant foods did have measured
energy contents that were double those stated by the
restaurant, and free side dishes contained more energy
on average than the entrées they accompanied. On an
individual level, discrepancies of this magnitude, if wide-
spread, are likely to substantially hamper efforts to con-
Figure 1. Measured energy amounts in selected reduced-energy restaurant foods (panel A) and supermarket convenience meals (panel B).
GE?gross energy. Numbers correspond to restaurant or supermarket food items shown in the Table.
January 2010 Volume 110 Number 1
Food macronutrients and portion size Manufacturers of packaged food must provide a Nutrition Facts label, including information on macronutrients and dietary
fiber (per serving and number of servings) for each commercial food they sell (28). The macronutrient determinations may be conducted chemically by the
manufacturer according to the most recent Official Methods of Analysis of the AOAC International (29,30), or can involve calculation from recipe ingredients using US
Food and Drug Administration (FDA)-approved nutrient composition databases (31).
Energy content Nutrition Facts labels on packaged foods must also report energy (ie, predicted metabolizable energy [ME] available to the body) using one of five
methods prescribed in the Code of Federal Regulations (CFR) (32). Manufacturers may choose any one of the five methods and are not required to justify their choice
of one method over another.
● Using specific Atwater factors (24, Table 13) to calculate ME from macronutrient weights. The specific Atwater factors give estimated metabolizability of energy in
different classes of foods. The values were determined in human digestibility studies by Atwater and others in which subjects consumed specific foods and food
groups or specific foods within a mixed diet, then fecal and urinary energy losses were determined (24).
● Using general Atwater factors (9, 4, and 4 kcal/g for fat, protein, and carbohydrate, respectively) to calculate ME from macronutrient weights. The general Atwater
factors predict ME contents of all macronutrients irrespective of food type they are contained in, and were determined by compositing the specific Atwater factors
● Using general Atwater factors adjusted for insoluble fiber (by subtracting the amount of insoluble dietary fiber from total carbohydrate content) to calculate ME
from macronutrient weights. These adjusted Atwater factors allow manufacturers to take into account the lower estimated ME content of insoluble fiber compared
to other types of carbohydrate, including soluble fiber, and result in a lower estimated ME content of the food when insoluble fiber content is higher.
● Using specific factors for macronutrient energy content as approved by FDA to calculate ME. This option is designed for food additives such as preservatives,
gums, anticaking agents, and coatings (see 21 CFR §172 for complete list) (33), and substances added to food that are generally recognized as safe, such as
tannic acid and selected algaes (see 21 CFR §184 for complete list) (34).
● Using bomb calorimetry values for gross energy corrected to estimated ME by subtracting 1.25 kcal/g protein (to take into account the low ME of protein). This
method assumes 100% metabolizability of carbohydrate and fat and allows manufacturers to develop their own data based on bombed food samples.
In addition, manufacturers may develop databases of nutrient content information from their own laboratory testing or from software used to calculated nutrient
content from recipe ingredients (31). FDA provides guidance on developing these databases, and encourages manufacturers to submit the databases for FDA
approval. Submission is voluntary; however, it is the manufacturer’s responsibility to ensure that any nutrition information attained by use of database is compliant if
subsequently chemically tested by FDA (35).
Rounding The FDA promotes rounding of nutrient values to encourage realistic expectations of accuracy in stated nutrition information. Total carbohydrates and
protein are rounded to 1 g and fat is rounded to 0.5 g, and foods containing less than 1 g or 0.5 g, respectively, are labeled as 0 g. Energy values are rounded to
the nearest 5 kcal for foods ?50 kcal and to the nearest 10 kcal for foods ?50 kcal. Foods containing ?5 kcal are labeled as 0 kcal (36).
Compliance Assessment and Enforcement
There is no required oversight of Nutrition Fact information for packaged food before distribution for sale; however, FDA performs inspections of Nutrition Fact labels
on packaged food at least every 2 years as an add-on program to inspections mandated under other programs (eg, food safety) (37). Within this add-on program,
emphasis is placed on specific labeling issues to be inspected, which recently have included absence of a Nutrition Facts label, unauthorized health or nutrient
claims, allergen declaration, approved health or nutrient content claims where the nutrient content fails to meet the level of the claim, missing components of the
Nutrition Facts label, and other deficiencies such as missing percent juice (37).
FDA may collect food samples to verify questionable composition information uncovered during inspections (called compliance samples) by obtaining samples either
overtly at the point of manufacture (37) or covertly through commercial outlets (38). In one documented case, an inspection of a bread manufacturer prompted
officials to purchase bread at a supermarket and send it for analysis. Nutrient content was analyzed, the product was found to be misbranded, and a warning letter
was issued to the manufacturer (39). In addition to samples collected on the basis of suspicion, random surveillance samples of food types specified quarterly may
be collected. Analysis of these samples focuses first on those nutrients about which a nutrient content claim is made (eg, “low calorie”). If no claim is made, random
nutrients listed on the label with a content greater than a certain percentage of the daily value may be analyzed (37). Widespread testing of nutrients may not be
common due to the risk-based prioritization of the FDA described above and consideration of available resources at the district level. District offices are required to
collect a certain number of samples annually; however, information on the number of times samples are randomly collected for nutrient analysis is not publically
Compliance is assessed in chemical analysis of 12 random samples, and in the case of energy must average no more than 120% of the value stated on the label
(no specifications are given on lower acceptable limits for energy content) (26). In addition, there are strict requirements that packaged food meet defined weight
limits relative to stated; specifically, that the average weight of 48 units cannot be ?99% of the weight stated on the package after shrinkage and other losses due
to shipping and storage are considered (27). Thus, current regulations may predispose toward larger portions than reported because compliance limits for low portion
weight are stricter than compliance limits for high energy content.
Manufacturers found to be noncompliant in the previous year may be inspected more frequently than every 2 years. Also, manufacturers of items such as infant
formula and products containing peanuts may be inspected more frequently because of greater potential risks associated with noncompliance (40).
Punitive measures for mislabeled packaged food typically begin with a Notice of Observations letter that details significant observations and deficiencies. If
reinspection reveals continuing problems, a Warning Letter will be issued. More severe actions (seizures and injunctions) are reserved for violations that have a major
influence on public health (41). Violations meeting this criterion are not likely to include energy content mislabeling.
(continued on following page)
Figure 2. Summary of US Food and Drug Administration regulations on nutrition labeling in relation to energy.
January 2010 ● Journal of the AMERICAN DIETETIC ASSOCIATION
trol weight by individuals self-monitoring their energy
intake. On a public scale, the emerging policy initiatives
on requiring energy information at the point of purchase
may not translate into improved dietary intake if foods
typically contain more energy than stated. Based on these
findings, registered dietitians can advise consumers
about the wide variability in accuracy of stated energy
contents for prepared reduced-energy foods. Approaches
to improving the accuracy of stated energy information
may include increased attention to quality control in food
preparation. Additional measures may also be needed
such as improved federal and state regulations and a
monitoring system to ensure compliance.
STATEMENT OF POTENTIAL CONFLICT OF INTEREST:
No potential conflict of interest was reported by the
FUNDING/SUPPORT: This work was supported by Na-
tional Institutes of Health grant no. HL069772-06, and the
US Department of Agriculture under agreement no. 58-
1950-4-401. Any opinions, findings, conclusions, or recom-
mendations expressed in this publication are those of the
authors and do not necessarily reflect the views of the US
Department of Agriculture.
ACKNOWLEDGEMENTS: The authors thank Paul
Fuss for providing training in bomb calorimetry techniques.
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22. Pomeranz JL, Brownell KD. Legal and public health considerations
The regulations described above for packaged food are not generally applied to food served in restaurants. Currently, restaurants are required to follow 21 CFR
§101.9 only if a nutrient or health claim is being made about the food (eg, “low calorie”). In these cases, only the constituent about which the claim is made must
be reported in accordance with 21 CFR §101.9, and the method of determining energy and macronutrient information to be reported includes not only the methods
described above for packaged food but also use of databases, recipes, or other “reasonable bases that provide assurance that the food or meal meets the nutrient
requirements for the claim” (42) as set forth in 21 CFR §101.10. Restaurants voluntarily posting nutrition information are also not required to follow 21 CFR §101.9
precisely, but instead may state nutrients and energy according to the reasonable basis method described in 21 CFR §101.10. The same rounding criteria for
reporting macronutrients and energy for packaged foods described above are applied to restaurant foods.
Compliance Assessment and Enforcement
Responsibility for restaurant nutrition labeling falls under state jurisdiction, rather than federal as for packaged food, and is subject to much less scrutiny currently
than packaged foods. States’ prerogative governs whether accuracy of reported nutrition information provided by restaurants is assessed and there is no federal
oversight. If a state decides to assess accuracy for any individual item at a restaurant it is not assessed by chemical analyses (as for packaged food) but rather by
whether the food reasonably fits the claim (16). Furthermore, the states are responsible for interpretation of what a “reasonable fit” may be.
Some local governments such as New York City have adopted labeling regulations for restaurant food, and now require energy contents to be posted prominently at
the point of purchase in restaurants with at least 15 locations (43). This affects approximately 10% of the 21,000 restaurants in New York City. Whereas the variable
nature of food preparation in restaurants naturally leads to a likelihood of some uncertainty regarding stated energy values, the true magnitude of the uncertainty is
not well characterized and, even in New York City, reviewing accuracy has only recently been considered.
Figure 2. Continued
January 2010 Volume 110 Number 1
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January 2010 ● Journal of the AMERICAN DIETETIC ASSOCIATION