The Impact of Menu Labeling on Fast-Food Purchases for Children and Parents

Center for Child Health, Behavior and Development, Seattle Children's Research Institute, University of Washington, USA.
American journal of preventive medicine (Impact Factor: 4.53). 10/2011; 41(4):434-8. DOI: 10.1016/j.amepre.2011.06.033
Source: PubMed


Nutrition labeling of menus has been promoted as a means for helping consumers make healthier food choices at restaurants. As part of national health reform, chain restaurants will be required to post nutrition information at point-of-purchase, but more evidence regarding the impact of these regulations, particularly in children, is needed.
To determine whether nutrition labeling on restaurant menus results in a lower number of calories purchased by children and their parents.
A prospective cohort study compared restaurant receipts of those aged 6-11 years and their parents before and after a menu-labeling regulation in Seattle/King County (S/KC) (n=75), with those from a comparison sample in nonregulated San Diego County (SDC) (n=58). Data were collected in 2008 and 2009 and analyzed in 2010.
In S/KC, there was a significant increase from pre- to post-regulation (44% vs 87%) in parents seeing nutrition information, with no change in SDC (40% vs 34%). Average calories purchased for children did not change in either county (823 vs 822 in S/KC, 984 vs 949 in SDC). There was an approximately 100-calorie decrease for the parents postregulation in both counties (823 vs 720 in S/KC, 895 vs 789 in SDC), but no difference between counties.
A restaurant menu-labeling regulation increased parents' nutrition information awareness but did not decrease calories purchased for either children or parents.

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    • "Studies from Philadelphia [[2]] and low-income areas in New York City [[3]] found that labeling was associated with consumers noticing calorie labels but no significant change in calories purchased. Most other controlled studies have found similar results [[4]-[7]], although one study found that consumers at Starbucks purchased 12 fewer calories following calorie labeling [[8]]. Experimental studies have found mixed results [[9],[10]]. "
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    ABSTRACT: Background Studies rarely find fewer calories purchased following calorie labeling implementation. However, few studies consider whether estimates of the number of calories purchased improved following calorie labeling legislation.FindingsResearchers surveyed customers and collected purchase receipts at fast food restaurants in the United States cities of Philadelphia (which implemented calorie labeling policies) and Baltimore (a matched comparison city) in December 2009 (pre-implementation) and June 2010 (post-implementation). A difference-in-difference design was used to examine the difference between estimated and actual calories purchased, and the odds of underestimating calories.Participants in both cities, both pre- and post-calorie labeling, tended to underestimate calories purchased, by an average 216¿409 calories. Adjusted difference-in-differences in estimated-actual calories were significant for individuals who ordered small meals and those with some college education (accuracy in Philadelphia improved by 78 and 231 calories, respectively, relative to Baltimore, p¿=¿0.03-0.04). However, categorical accuracy was similar; the adjusted odds ratio [AOR] for underestimation by >100 calories was 0.90 (p¿=¿0.48) in difference-in-difference models. Accuracy was most improved for subjects with a BA or higher education (AOR¿=¿0.25, p¿<¿0.001) and for individuals ordering small meals (AOR¿=¿0.54, p¿=¿0.001). Accuracy worsened for females (AOR¿=¿1.38, p¿<¿0.001) and for individuals ordering large meals (AOR¿=¿1.27, p¿=¿0.028).Conclusions We concluded that the odds of underestimating calories varied by subgroup, suggesting that at some level, consumers may incorporate labeling information.
    Full-text · Article · Jul 2014 · International Journal of Behavioral Nutrition and Physical Activity
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    • "Table 1b. Key Components of Interventions on Community-based Prepared- Food Sources: Interventions Conducted in Chain Restaurants Characteristic Coeur en Santé St-Henri (28,29) TrEAT Yourself Well (30) Tandon et al 2011 (31) Data sources Peer-reviewed article Peer-reviewed article; e-mail correspondence Peer-reviewed article; email correspondence Target population Montreal; restaurant customers; low- income San Diego area; restaurant customers; mostly white Seattle and San Diego; children aged 6–11 years and parents Model/Theory Social learning theory Theory of reasoned action; social marketing None specified Goal Awareness; consumption Awareness; consumption Awareness; consumption Types of preparedfood sources Fast-food restaurant and family-style restaurant 4 chain restaurants Chain restaurants Food targeted in intervention Low-fat, high-fiber items on menus Low-fat menu items containing fruits and vegetables Chain restaurant foods Intervention strategies Signage Menu labeling Point-of-purchase materials (table tents, posters) Menu labeling Increased availability of healthful foods Recipe modification to increase fiber or decrease fat None None Pricing None Discount cards None Community components Media (newspaper, telephone, leaflets) None Characteristic Coeur en Santé St-Henri (28,29) TrEAT Yourself Well (30) Tandon et al 2011 (31) "
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    ABSTRACT: Food purchased from prepared-food sources has become a major part of the American diet and is linked to increased rates of chronic disease. Many interventions targeting prepared-food sources have been initiated with the goal of promoting healthful options. The objective of this study was to provide a systematic review of interventions in prepared-food sources in community settings. We used PubMed and Google Scholar and identified 13 interventions that met these criteria: 1) focused on prepared-food sources in public community settings, 2) used an impact evaluation, 3) had written documentation, and 4) took place after 1990. We conducted interviews with intervention staff to obtain additional information. Reviewers extracted and reported data in table format to ensure comparability. Interventions mostly targeted an urban population, predominantly white, in a range of income levels. The most common framework used was social marketing theory. Most interventions used a nonexperimental design. All made use of signage and menu labeling to promote healthful food options. Several promoted more healthful cooking methods; only one introduced new healthful menu options. Levels of feasibility and sustainability were high; sales results showed increased purchasing of healthful options. Measures among consumers were limited but in many cases showed improved awareness and frequency of purchase of promoted foods. Interventions in prepared-food sources show initial promising results at the store level. Future studies should focus on improved study designs, expanding intervention strategies beyond signage and assessing impact among consumers.
    Full-text · Article · Oct 2013 · Preventing chronic disease
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    ABSTRACT: The majority of labeling studies at restaurants have focused on adults, not children, and utilized cross-sectional data with one menu labeling design, typically calorie information. The aim of this longitudinal study was to examine the effect of three different menu labeling designs for children's meals on total calories and fat selected by families. Each menu was implemented for 2months. Patrons' purchases were tracked from a control menu (with no nutrition information) through all three theoretically-based designs: calorie and fat information; followed by symbols denoting healthier choices; then nutrition bargain price. All menus were created specifically for the study. They featured six combination meals (pre-determined entrees and side items) and a la carte items (entrees and side items that could be ordered separately). Only combination meals contained labeling. Fixed effects models were estimated to detect changes in sales for each menu labeling design compared to the control. Overall, menu labeling did not result in a positive net effect on total calories or fat purchased by families, but resulted in significant shifts in purchases of combination and a la carte meals and healthy and unhealthy options. The most significant impact was seen for nutrition bargain price labeling, the last design.
    No preview · Article · Jun 2012 · Appetite
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