Nutrition Menu Labeling May Lead to Lower-Calorie Restaurant Meal Choices for Children

Tandon, Pooja; Wright, Jeffrey A.; Zhou, Chuan; Rogers, Cara Beth; Christakis, Dimitri A.

doi:10.1542/peds.2009-1117

Cited by 132 publications

(119 citation statements)

References 18 publications

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“…In support of our study, other investigators have reported similar findings backing menu labeling [22][23][24]27,[33][34][35]; one of those studies reported findings similar to those in this study with 90% of the respondents reporting they would use nutrition information if it was available on restaurant menus [33].…”

Section: Discussionsupporting

confidence: 91%

Impact of Menu Labeling on Food Choices of Southern Undergraduate Students

Gonzales¹

2014

J Obes Weight Loss Ther

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IntroductionThe rate of overweight and obesity has drastically increased over the past two decades. Recent obesity statistics from the National Health and Nutrition Examination Survey (NHANES) captured by the Centers for Disease Control and Prevention (CDC) in [2009][2010] indicate that approximately 68.8% of American adults are either overweight or obese, with 35.7% of them being obese [1]. As the rate of overweight and obesity continues to rise steadily with no end in sight, the government is charged with the task of devising strategies to hamper the epidemic. With the passage of the Nutrition Labeling and Education Act (NLEA) in 1990, all foods purchased in stores were required to list nutrition information on the packages in a standard format-a law implemented for the purpose of creating informed consumers who make healthier choices based on their knowledge of the nutritional content of the foods on store shelves [2]. This law, however, did not have the anticipated impact on overweight and obesity rates-partially because Americans are consuming more and more meals away from home at fast-food and dine-in restaurants [3].The term "menu labeling" refers to the listing of nutrition information next to each food item on restaurant menus, menu boards, and drive-through menu boards so it can be viewed and considered by customers when making their food selections [4]. According to the Patient Protection and Affordable Care Act of 2010, Section 4205, restaurant chains with 20 or more establishments of the same name will be required to disclose nutrition information for their menu items on the menu or menu board [5]. This nutrition information, at minimum, must include calories [5] but can list further information including, but not limited to, total fat, saturated fat, carbohydrates, sodium, protein, and fiber. If not disclosed on the menu, the additional nutrition information beyond calories must be made available to customers in written form upon request [6]. In addition to the calorie labels, menus must also contain a statement specifying the recommended daily caloric intake for one day for the average American-2000 caloriesenabling customers to put the calorie labels of individual food items into context of a total daily caloric intake [5].Restaurant foods are notorious for their energy density and large portion sizes-undoubtedly contributing to the undesirable weight status of a majority of Americans. Studies show that on average, foods prepared and eaten outside the home consist of large portion sizes and have high energy density with little nutritional value and low satiating power [7,8].Some chain restaurants currently offer nutrition information in the form of tray liners, pamphlets, posters, charts, on-site computers [9,10] or on food containers or napkins, depending on the restaurant. Most restaurants offer the information online, but not necessarily at the point-of-service [11].Research has shown the difficulty of estimating the number of calories and other determinants of nutritional quality in restauran...

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Section: Discussionsupporting

confidence: 91%

Impact of Menu Labeling on Food Choices of Southern Undergraduate Students

Gonzales¹

2014

J Obes Weight Loss Ther

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“…In the USA, although many consumers expressed an interest in having access to calorie information on restaurant menus, only 40 % linked calorie imbalance to weight gain (23) . Recent studies in the USA on the effect of menu labelling on the amount of calories purchased have reported mixed results (24)(25)(26) . The present study contributes to the evidence that Australian consumers have insufficient knowledge to interpret energy information on food labels.…”

Section: Discussionmentioning

confidence: 99%

How well do Australian shoppers understand energy terms on food labels?

Watson

Chapman

King

et al. 2012

Public Health Nutr.

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Objective: To investigate nutrition literacy among adult grocery buyers regarding energy-related labelling terms on food packaging. Design: Qualitative interviews and quantitative surveys to determine shoppers' understanding of energy terms ('energy', 'calories' and 'kilojoules') and how energy terms affect perceptions of healthiness and intentions to purchase breakfast cereals, muesli bars and frozen meals. Setting: Individual in-depth interviews and surveys in two metropolitan supermarkets, Sydney, Australia. Subjects: Australian adults (interview n 40, survey n 405) aged 18-79 years. Results: The relationship between energy and perceived healthiness of food varied by product type: higher energy breakfast cereals were perceived to be healthier, while lower energy frozen meals were seen as healthier choices. Likewise, intentions to purchase the higher energy product varied according to product type. The primary reason stated for purchasing higher energy products was for sustained energy. Participants from households of lower socio-economic status were significantly more likely to perceive higher energy products as healthier. From the qualitative interviews, participants expressed uncertainty about their understanding of kilojoules, while only 40 % of participants in intercept surveys correctly answered that kilojoules and calories measured the same thing. Conclusions: Australian consumers have a poor understanding of energy and kilojoules and tend to perceive higher energy products as healthier and providing sustained energy. This has implications regarding the usefulness of industry front-ofpack labelling initiatives and quick service restaurant menu labelling that provides information on energy content only. Comprehensive and widely communicated education campaigns will be essential to guide consumers towards healthier choices.

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“…fast food) rather than a variety of discretionary choices (36)(37)(38) . One study reported a significant, negative relationship between the policy strategy and intake; that is, the introduction of the policy was associated with a significant reduction in children's fast-food intake (36) . One intervention focused on food reformulation (physical influence) and reported a negative, but non-significant, association with children's snack food intake (38) .…”

Section: Resultsmentioning

confidence: 99%

Reducing discretionary food and beverage intake in early childhood: a systematic review within an ecological framework

Johnson

Hendrie

Golley

2015

Public Health Nutr.

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Objective: To systematically review the literature and map published studies on 4-8-year-olds' intake of discretionary choices against an ecological framework (ANalysis Grid for Environments Linked to Obesity; ANGELO). Design: Articles were identified through database searches (PubMed, PyscINFO ® , Web of Science) in February and March 2014 and hand-searching reference lists. Studies were assessed for methodological quality and mapped against the ANGELO framework by environment size (macro and micro setting) and type (physical, economic, policy and socio-cultural influences). Setting: Studies were conducted in the USA (n 18), Australia (n 6), the UK (n 3), the Netherlands (n 3), Belgium (n 1), Germany (n 1) and Turkey (n 1). Subjects: Children aged 4-8 years, or parents/other caregivers. Results: Thirty-three studies met the review criteria (observational n 23, interventions n 10). Home was the most frequently studied setting (67 % of exposures/strategies), with the majority of these studies targeting family policy-type influences (e.g. child feeding practices, television regulation). Few studies were undertaken in government (5·5 %) or community (11 %) settings, or examined economic-type influences (0 %). Of the intervention studies only four were categorised as effective. Conclusions: The present review is novel in its focus on mapping observational and intervention studies across a range of settings. It highlights the urgent need for high-quality research to inform interventions that directly tackle the factors influencing children's excess intake of discretionary choices. Interventions that assist in optimising a range of environmental influences will enhance the impact of future public health interventions to improve child diet quality.

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Nutrition Menu Labeling May Lead to Lower-Calorie Restaurant Meal Choices for Children

Abstract: This study is the first to suggest that labeled menus may lead to significantly lower calorie content in restaurant meals purchased for children.

Cited by 132 publications

References 18 publications

Impact of Menu Labeling on Food Choices of Southern Undergraduate Students

Impact of Menu Labeling on Food Choices of Southern Undergraduate Students

How well do Australian shoppers understand energy terms on food labels?

Reducing discretionary food and beverage intake in early childhood: a systematic review within an ecological framework

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