What foods are healthy and how can you tell from a menu?

To see the summary abstract of the study I refer to in this blog post, please click here.
The lead author is Lillian Sonnenberg.

   The purpose of this particular post is to share the results of another menu labeling study that used the Multiple Traffic Light (MTL) system to help customers identify "healthier" items.  I have a concern and a point to make regarding overall menu labeling, the federal legislation and why my point probably won't make a difference, but first.. a digression.
   Notice that in the above paragraph I put the word healthier in quotation marks.  I did this because in the research publication the authors assessed purchasing of items deemed healthier if they met criteria to be labeled as green. Two of the 5 criteria for a green label were low calorie (e.g., 500 or less for an entree) and low in saturated fat (i.e., < 2 grams).  The researchers also surveyed the customers before and after they introduced the labels.  The foods sold before and after the introduction of the labels were the same and the researchers knew if a person bought a green labeled food even during the time when no labels were posted.  When the researchers asked customers to answer a few questions after their purchase, the researchers also took their receipts.  Therefore, the researchers could match the survey answers with the items purchased.  A funny thing.. even customers who said that they always or almost always choose 'healthy' items were buying foods that were most often red (or unhealthy).  After the labels were placed, the 'healthy' eaters did only slightly better at purchasing green labeled foods.
   The researchers point out that customers do not seem to know what determines a foods healthiness.  I am not at all surprised and to be fair, isn't 'healthy' subjective and likely to change with every news headline?  Instead, I think that the researchers could have defined healthy in their question. They might have asked how often the customer chose foods low in calories or low in saturated fat (but even here a person must possess some nutrition knowledge to know what constitutes low, which is why MTL labels are effective - green = low).  The researchers failed to mention another likelihood for why people who said they chose healthy items did not in fact buy them. It is possible that they said it because it was the socially correct answer, not because it was what they actually do.
   Ok, now my main point.  Since the Affordable Care Act was passed with a National Restaurant Association supported nutrition menu labeling law included, new research has indicated that calorie disclosure alone (as per the law) is not sufficient to change selections.  Instead, menus using the MTL as the Sonnenberg et al study and many others have found, are more effective.  The law should be amended to incorporate these new findings, but it won't be  - nor will it be overturned - even if the ACA is.  I make both assertions for the same reason.  The National Restaurant Association is in large part responsible for the passing of the law - which in many ways is great.  It probably would not have happened without their endorsing it.  They will make sure that the law stays in place because it prevents states and cities from requiring restaurants to do anything different - it mandates a nationally standardized format that a restaurant chain can implement across its regions.  One law - one format.  And the format won't change (even if it isn't effective, or maybe for that very reason)  because if the MTL was used, the menus would be covered in RED and that would be bad for business.  (I think it would force restaurants to revise their recipes - in a good way-, but I just don't see this getting any industry support)
 

See how the type of nutrition label impacts your understanding.

I have spoken of front of pack nutrition labels many times and provided examples of different systems.  A system can be one that appoints stars for meeting a certain criteria, or one that uses a symbol to denote healthiness, or my favorite, one that uses a multiple traffic light.  The multiple traffic light system shows whether the product is low, medium or high in amount of each nutrient most people should limit (i.e., sugar, salt, sat fat and calories).
The most important thing about a front of pack label is that it be standardized across all products, manufacturers and restaurants (if it goes to menu labeling).  Imagine how confusing it would be (and is now in the US) if each company decided what information, if any, to put on the front of a package.  
When it comes to making health and weight related dietary choices the most important disclosures are these: calories, sodium, sugar, and probably saturated fat. We need to be able to see the amount of these nutrients at a glance across items as we shop.  The traffic light system goes one better.  If the traffic light is used, a consumer does not have to do math or know the number of grams or milligrams that are recommended for any one nutrient in a daily diet.  The consumer just has to know that green is better (GO) and red should be limited or avoided (STOP).  In essence, a consumer can aim for mostly green and yellow.
The UK has begun its voluntary traffic light labeling program in grocery stores and it seems to be doing well.
When researchers and public health professionals were making the case for front of pack labels, they put together an on line quiz to test consumers understanding of nutrition labels.  It is still available, here.  I took it and suggest you do as well.