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Research Review: Menu Labeling Use

The research review continues! Today I’m reviewing another study from the Journal of the Academy of Nutrition and Dietetics. It’s a study on menu labels at fast food restaurants. Specifically, the researchers want to know whether noticing or using calorie menu labels was associated with any demographic information of customers.

Starbucks has calorie counts listed on their menus.

Starbucks has calorie counts listed on their menus.

What spurred this research?

Turns out that consumers and nutrition experts alike are not so great at estimating the calories of restaurant meals (1,2). You’d think all the years of schooling would make us better at this game, but alas. We’re just as aghast to find out our favorite sandwich has 800 calories, not the 400 we would have guessed.

You may have already been aware that restaurants that have 20 or more locations nationwide must make calorie information available to customers. Thanks to the Patient Protection and Affordable Care Act, that information will need to actually be on the menu soon, not just available upon request.

Since the information has been made available to people, various studies have been done to observe whether or not it has made a difference. There is somewhat conflicting evidence on whether people actually consume fewer calories, or whether it could help impact obesity rates.

That last part is the heart of the public health concern – how are we impacting obesity rates. Especially since low-income and minority populations carry a higher burden when it comes to obesity – an inherent health disparity. Enter the Patient Protection and Affordable Care Act.

The heart of the Act is to help those consumers who are at-risk for – or currently in – poor health to make better choices. But what if the policy doesn’t actually help everyone, and specifically doesn’t help the at-risk population? Should we spend the money to enforce this change? Where else should we then focus our efforts? Hence this research.

How’d they do it?

Simply put, they surveyed customers at McDonald’s across the Phoenix area. They made two lists of stores – those in lower-income zip codes (median income <$42,600) and those in higher-income zip codes (median income >$70,000). They randomly chose 29 locations to survey over an 8-week period.

The researchers recruited participants by standing outside the store’s entrance. Participants were told to purchase food and beverage items as they normally would, get a receipt, and then take a brief survey.

Data collectors took in demographic information, and asked, “Did you notice any calorie information listed for menu items at the restaurant today?” If they indicated they had, the follow-up question was, “Did the calorie information affect your food purchases today?” The data collectors calculated the calories purchased and the total cost from the receipts.

What did they find?

Overall, 57.4% of participants reported noticing calorie menu labels before they ordered, and about 16% actually used that information to inform their choices.

Income. Individuals with annual household income >$100,000 were twice as likely to notice the calorie levels than individuals with annual household incomes <$50,000. But individuals with annual household incomes between $50,000 and $99,999 were the most likely to use calorie information – 3.5 times more likely than individuals with household incomes <$50,000.

Age. Young participants were most likely to use the calorie information. Participants aged 36-49 years old were 82% less likely to use calorie information than participants aged 18-25 years old.

Education. Participants with a bachelor’s degree or higher were 3 times more likely to use calorie information than those with a high school diploma or less.

When participants used the calorie information, were there any benefits? Yes. Using menu labels was associated with the purchase of 146 fewer calories.

What does this mean?

First, there is a wide gap between people seeing calorie information and actually using it. What gives? Maybe if you’re eating at McDonald’s, you’re already in the “splurge” mindset, and you’re not looking to keep the calories down. Sure, you see it’s there, but it’s not of interest to you.

We also have no idea what else participants ate during that day. Maybe their meal at McDonald’s was a calorie bomb, but maybe it was their only meal. Or maybe they took their total calories into consideration and ate light the rest of the day.

[Sidenote: this is a good reminder that you never know someone’s whole story. Just like that coworker who only eats lettuce at lunch might be eating 3,000 calories at home, the fast food purchaser might be eating small meals throughout the rest of the day.]

What do we do with this information?

First of all, I think that dietitians need to do a better job of helping people notice the information, and know how to use it. If you don’t know how many calories you should eat in a day, how do you know what to do with the fact that a Big Mac and medium fries has 880 calories?

Second, as public health professionals, we need to be aware that higher-income and more-educated consumers are more likely to benefit from menu labeling efforts. This is creating a greater health disparity – the exact issue we’re trying to solve. Is not labeling the menu the answer? No, I don’t think so. But we need to understand why lower-income or less-educated consumers aren’t using the information, and help target solutions there.


Do you use the calorie information on menus? Why or why not?


References:

  1. Backstrand JR, Wootan MG, Young LR, Hurley J. Fat chance: A survey of dietitians’ knowledge of the calories and fat in restaurant meals. http://www.portionteller.com/pdf/cspistudy97.pdf. Accessed September 23, 2014.
  2. Black JP, Condon SK, Kleinman K, et al. Consumers’ estimation of calorie content at fast food restaurants: Cross section observational study. BMJ. 2012;346:f2907.