Changes in Calorie Content of Menu Items at Large Chain Restaurants After Implementation of Calorie Labels

Abstract

IMPORTANCE Calorie labeling on menus is required in US chain food establishments with 20 or more locations. This policy may encourage retailers to offer lower-calorie items, which could lead to a public health benefit by reducing customers' calorie intake from prepared foods. However, potential reformulation of restaurant menu items has not been examined since nationwide enforcement of this policy in 2018.OBJECTIVE To examine the calorie content of menu items at large chain restaurants before and after implementation of federally mandated menu calorie labels. DESIGN, SETTING, AND PARTICIPANTSThis pre-post cohort study used restaurant menu data from MenuStat, a database of nutrition information for menu items offered in the largest chain restaurants in the US, collected annually from 2012 to 2019. The study comprised 35 354 menu items sold at 59 large chain restaurants in the US. Statistical analysis was conducted from February 4 to October 8, 2021. INTERVENTION Nationwide implementation of menu calorie labeling. MAIN OUTCOMES AND MEASURESChanges in menu items' calorie content after restaurant chains implemented calorie labels were estimated, adjusting for prelabeling trends. All menu items, continuously available items, items newly introduced to menus, and items removed from menus were examined separately. RESULTS Among the 59 restaurant chains included in the study, after labeling, there were no changes in mean calorie content for all menu items (change = −2.0 calories; 95% CI, −8.5 to 4.4 calories) or continuously available items (change = −2.3 calories; 95% CI, −11.5 to 6.3 calories). Items that were newly introduced after labeling, however, had a lower mean calorie content than items introduced before labeling (change = −112.9 calories; 95% CI, −208.6 to −25.2 calories), although there was heterogeneity by restaurant type. Items removed from menus after labeling had similar calorie content as items removed before labeling (change = 0.5 calories; 95% CI, −79.4 to 84.0 calories). CONCLUSIONS AND RELEVANCEIn this cohort study of large chain restaurants, implementing calorie labels on menus was associated with the introduction of lower-calorie items but no changes in continuously available or removed items.

Sodium content of menu items in New York City chain restaurants following enforcement of the sodium warning icon rule, 2015-2017

“…Our analysis includes 10 Odds ratios (OR) comparing the likelihood of an item meeting or exceeding the 2,300 mg sodium threshold are shown in Table 4. Compared to baseline, there was a non-significant increase in the overall likelihood of menu items at follow-up requiring a warning icon (OR=1.32, 95% CI=0.97, 1.79).…”

“…In addition to informing purchasing decisions, menu labeling at chain restaurants may lead to improvements in the nutritional composition of offered menu items. In an analysis of 59 national chain restaurants between 2012-2019, Grummon et al reported that menu items newly introduced following implementation of calorie labeling, in accordance with the federal requirement, were lower in calories than items newly introduced prior to calorie labeling [10].…”

“…In an analysis of 59 national chain restaurants between 2012-2019, Grummon et al . reported that menu items newly introduced following implementation of calorie labeling, in accordance with the federal requirement, were lower in calories than items newly introduced prior to calorie labeling [10]. We investigated whether the sodium content of menu items offered in NYC chain restaurants changed following enforcement of the sodium warning rule in 2016.…”

Impact of health warning labels and calorie labels on selection and purchasing of alcoholic and non-alcoholic drinks: a randomised controlled trial

“…Regardless of whether labelling can elicit meaningful effects on behaviour, information on calories can enable people to accurately estimate calorie intake from drinks 45 and appears to be highly acceptable to the public. It may also lead to indirect impacts, for example by encouraging industry and supermarkets to increase the availability or promotion of lower calorie alternatives 33,46,47 .…”

Changes in consumer purchasing patterns at New York City chain restaurants following adoption of the sodium warning icon rule, 2015–2017

“…Considering this context, in 2016, NYC began enforcing a sodium warning regulation. A body of research shows that warning labels on foods can increase consumer knowledge and facilitate healthier choices [ 13 ] and that improvements in the nutritional composition of chain restaurant menu items may follow menu labeling mandates [ 14 ]. This novel policy requires chain restaurants (those with 15 or more locations nationally) to display warning icons next to high-sodium menu items (containing ≥2,300 mg sodium) and post a statement explaining the icon and associated health risks [ 15 ] (S1 Fig in S1 File ) [ 16 ].…”