Has Menu Labeling Had an Impact on TV Ads?

   There is a lot of opinion and a little bit of science for and against the (conspicuously absent) national menu labeling law.  In case you have forgotten - it has been 4 years - the law requires restaurant chains with 20 or more outlets to post calorie information for all standard items at the point of decision making/purchase (i.e., the menu board or menu).  If you have not been following the issue with me, let me state up front that I am a proponent of nutrition disclosures, especially calorie amounts, at all places where food and beverages are sold.  I believe that the information helps certain consumers and harms none.

   What I take away from the many research studies (Krieger & Saelens, 2013; Liu, 2013; Sinclair, Cooper, & Mansfield, 2014; Wei & Miao, 2013) that have tested local laws (and field/lab experiments) is: 1) for some people, the information is helpful and leads them to choose lower calorie options, while others either don’t see the information, don’t know what to do with it (when calorie disclosures come within a context, the information is more meaningful), or see it and actually choose higher calorie meals, and 2) some researchers are assessing whether menu labeling has an impact on weight or BMI, which is a long term goal and not necessarily the primary goal of calorie disclosures.

   What is of greater and more immediate interest to me is 1) whether or not consumer attitudes about and understanding of calories change after the introduction of calorie information and 2) whether or not the items available to purchase become lower in calories.  If you are interested in a good over view of calorie content in major restaurant items circa 2010, see this article by Wu (Wu & Sturm, 2013).

    On that last note - do restaurant owners change their behavior - I have something promising to report.  I have seen at least 3 TV commercials from different restaurants that post the calorie content, out loud, in a caption or both.  For example, McDonald’s states that its egg McMuffin has 300 calories in this TV ad, and Dunkin Donuts promotes a less than 300 calorie breakfast flat bread here.  I am pretty sure that I have seen a Taco Bell ad showing calorie content as well.  This is something new and though I don’t have evidence to back my assertion, it is possible that the state and local laws, along with the national labeling expectations and all this talk about calories, is leading consumers to expect the information and companies to provide it - and in so doing, the restaurant owners realize that they might need to offer lower calorie options.  YES, there are still plenty of ridiculous offerings, see the CSPI Xtreme Eating 2014, but that doesn’t negate the positive.

    Block and Roberto (Block & Roberto, 2014) encourage us to look for myriad positive outcomes of menu labeling as we continue to study the impact of such laws, I think they are right, and I add these commercials to the examples they provided in their recent publication (free on line).

Block, J. P., & Roberto, C. A. (2014). Potential Benefits of Calorie Labeling in Restaurants. JAMA.

Krieger, J. W., & Saelens, B. E. (2013). Impact of menu labeling on consumer behavior: A 2008-2012 update. Minneapolis, MN.

Liu, J. (2013). Menu labeling and food choice: A systematic review of the literature concerning the effects of menu labeling on consumer food choices.

Sinclair, S. E., Cooper, M., & Mansfield, E. D. (2014). The Influence of Menu Labeling on Calories Selected or Consumed: A Systematic Review and Meta-Analysis. Journal of the Academy of Nutrition and Dietetics.

Wei, W., & Miao, L. (2013). Effects of calorie information disclosure on consumers’ food choices at restaurants. International Journal of Hospitality Management, 33(0), 106-117. doi: 10.1016/j.ijhm.2012.06.008

Wu, H. W., & Sturm, R. (2013). What's on the menu? A review of the energy and nutritional content of US chain restaurant menus. Public health nutrition, 16(01), 87-96.

Odds and Ends

F as in Fat The 2012 report from RWJF and the Trust for America's Health will be released soon.  This week a press update offered news on disappointing and compelling trends.  The majority of states have an adult obesity rate of 25% or higher.  Twelve states have rates of 30% or higher and when rank ordered, the 30 heaviest states include 7 from the South.  This speaks to regional food norms.  In the South one can expect foods to be deep fried, rich, sweet and salty (maybe not all at once!).  It is also custom in the South to eat what you are offered and for those offerings to be generous.  The pending report form TFAH and RWJF will offer suggestions on curbing the obesity epidemic and the benefits that we can expect from certain strategies.  
We're # 1 I passed a billboard that proclaimed hospital X to be number one in heart surgery. I considered this to be evidence that hospitals are competing for customers.  There must be a significant number of them (or why advertise on a billboard).  A great many Americans have or will have heart disease - in fact, the odds of dieing from it are pretty high.  It is the number one cause of death here.  The hospitals know this and can profit from it.  They must - billboards are not cheap.  Incidentally, the current HSPH newsletter has a link to a blog post by one of their esteemed staff on the topic of hospital ratings.  The blogger discusses how a hospital can be scored differently by 3 credible sources. It is a great, MUST read.  Click HERE.
MCR (medicare)  Not to be political but to acknowledge a topic that has become political.  I have been listening to the public discourse and in the interest of full disclosure, I support the Affordable Care Act.  The ACA has benefited Medicare recipients that I know personally.  Still, there may be a future where persons over the age of 67 are seeking health care coverage as primary payers of that coverage.  Perhaps they will have vouchers.  In order for such a person to find the best coverage for the least amount of money (premium, copay, deductible) they will need to be healthy and not smoke.  The insurance companies will probably SEEK out healthy active seniors in order to reduce losses related to costs of covering non healthy older adults.  The majority of older adults are currently and will continue to be unhealthy.  Half of all adults now suffer from at least one chronic disease associated with being inactive and or overweight.  (increasingly adults have more than one disease, i.e arthritis and diabetes)
     You won't be able to change your past, but you have some control over your future. Get some amount of exercise every single day, always be aware of the foods you are consuming - aim for quality in the proper quantity, avoid all cigarette smoke.

Labels Everywhere

The Affordable Care Act of 2010 did mandate nationwide menu and vending machine labeling for certain retailers.  Namely those with more than 20 restaurants or 20 vending machines under operation.  This is exactly the type of informed eating policy that I have supported as it rolled out in some 18 states, cities and counties of the US in the last few years.  It was led by NYC and San Francisco.  Menu labeling is supported by numerous health organizations including the ADA and the AHA.  You can view the substantial list here.
The FDA is still accepting comments on the final rule - but the basic gist is that the information that is mandatory is calorie content, but other nutrient information (fat, sodium, sugar) is welcome and often already available.  [because other states and cities have already passed rules like this, big fast food enterprises have been making this information available.  You know this because I often use the info in my posts] The additional nutrient information must be provided in writing if a patron requests it.  This nutrient disclosure is to be displayed on menu boards and food tags, near to the food and in the same format(size) as the name and price of the food.  It must also be made available on line.  The label or tag must include wording on the fact that the "average adult" should consume 2000 calories a day.  This is, in my opinion, a big mistake and I am going to make my comment on the FDA website tomorrow. 
A separate initiative by the FDA and IOM which is backed by many public health experts is Front of Pack or FOP labeling.  The issue is not whether to do it, but how.  This is a worldwide endeavor.  I have read a good deal of research and it appears that the most understood and useful concept is the multiple traffic light.  This system offers the green, yellow, red coding much like go slow whoa to which I often refer, but per nutrient.  So the label has four or five panels and fat, sugar, sodium, calorie, etc gets a color code.  Standards for use have been developed by a government entity in the UK.
In one of the research studies I reread today, focus group participants made comments about some additional information on the labels, as they were making comparisons across many versions.  They did not like the 2000 calories a day for an average adult as they did not KNOW what an average adult was - Amen to that.  Also, one of the label formats, and this has been put forth as an option in the USA, denotes how much exercise (say walking) is necessary to burn the amount of calories in a serving of the product.  Here the focus group participants noted that they did not like seeing how much exercise it took to burn so few calories!  Also in that article, the researcher noted the inherent problems with any such suggestion of how many calories a person would burn without knowing anything about THAT person. 
What I want to say tomorrow, and this is supported by research reported just moments ago - whatever science was used to determine that average adults burn 2000 calories a day is clearly outdated because we have ceased to be an active society.  More often, a sedentary adult, which most are, needs 1500 calories a day.  See this story.

For up to date information on labeling initiatives and current status - see the Rudd Center for Food Policy website.

We eat most of our meals away from home and there is no reason why we should do so without knowledge of nutrient content.  When we are advised to watch our intake, it makes sense that the information we need to do so be on ALL the products we consume, not just the ones at the grocery store.  Here, we are not telling people what TO eat, just letting them know what they ARE eating.  Lastly, if you know what the healthy option is, i.e. sometimes it is NOT the salad, and you choose that option, the retailer is likely to respond by providing more healthful and low calorie meals.  Research indicates that this is so.