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Restaurant nutrition labeling

Health Factors: Diet & Exercise
Decision Makers: Employers & Businesses Local Government State Government Federal Government Public Health Professionals & Advocates
Evidence Rating: Some Evidence
Population Reach: 50-99% of WI's population
Impact on Disparities: Likely to increase disparities

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Description

Restaurant nutrition labeling involves voluntary or government mandated provision of nutrition and portion size information by restaurants and other food outlets. Nutrition information is typically included on restaurant menus, as well as on menu boards, signs, and posters, and is sometimes accompanied by contextual information such as recommended daily calories for adults or interpretive information such as exercise equivalent labels or traffic light labels (Sinclair 2014). Some local governments cannot enact such measures due to state and federal preemption legislation (Grassroots Change).

Expected Beneficial Outcomes

Increased awareness of calories purchased
Reduced calories purchased
Reduced caloric intake
Reduced food portion sizes

Evidence of Effectiveness

There is some evidence that providing nutrition information on restaurant menus and signboards increases awareness of calories purchased and reduces calories purchased (Long 2015), especially when labels include contextual or interpretive information for consumers (Sinclair 2014) and are easily visible (Nikolaou 2015). Additional evidence is needed to confirm effects.

Starbucks locations realized a sustained overall decrease in calories purchased after adding nutrition labels (Bollinger 2011). In New York City, labeling was associated with reduced calories purchased at McDonalds, Au Bon Pain, and KFC, although not in the city as a whole (Dumanovsky 2011). Studies from Seattle King County and on early New York City data showed reductions in calorie intake among some customers (Pulos 2010, Vadiveloo 2011, Dumanovsky 2011), but no overall reduction in consumption (Elbel 2009, Elbel 2011, Dumanovsky 2011, Finkelstein 2011, Tandon 2011).

Some studies suggest that calorie labels only lead to behavior change when they include contextual or interpretive language for consumers (Sinclair 2014). Promotional messages used in conjunction with calorie labels may increase their effectiveness (Harnack 2008a). Calorie labels that include a symbol (e.g., a traffic light image) can further reduce calories ordered (Ellison 2013).

Women, individuals with higher education, and individuals with higher incomes are more influenced by nutrition labels than men or individuals with less education or lower incomes (Roberto 2009, Bollinger 2011, Breck 2014). Young adults may be particularly receptive to calorie labels, especially on alcoholic drinks and catered food items (Nikolaou 2015). Larger effects are also common among individuals who previously made higher calorie purchases (Bollinger 2011).

Menu labeling laws can affect businesses’ behavior. Several chains reformulated specific menu items or default ingredients following implementation of the New York City law (Dumanovsky 2011). Nutrient analysis performed in a voluntary pilot labeling program at non-chain restaurants in Pierce County, WA (near Seattle) led owners to modify, drop, or add menu items (Pulos 2010). 

Implementation

United States

Section 4205 of the Patient Protection and Affordable Care Act of 2010 (ACA) requires restaurants and similar retail food establishments with 20 or more locations to list calorie content information for standard menu items on restaurant menus and menu boards, including drive-through menu boards (Federal register-Food labeling). This federal legislation preempts state and local authority over menu labeling for affected restaurants (Grassroots Change).

Some cities and states have also adopted local requirements for restaurant nutrition labeling: New York City, King County (WA), and San Francisco require chain restaurants to post calorie counts on menu boards. As of April 2011, California, Maine, Massachusetts, New Jersey, Oregon, Tennessee, and Vermont have passed state labeling policies (CSPI-Labeling policies map, NCSL-Menu labeling).

Eight states (Alabama, Arizona, Florida, Georgia, Mississippi, Ohio, Utah, and Wisconsin) have preemption legislation that prevents local communities from adopting regulations for restaurants that are more restrictive than state laws for posting calorie information, offering toys in children’s meals, and regulating nutritional value or content of restaurant food (Grassroots Change). 

Wisconsin

Wisconsin has no law that requires reporting of nutritional content (NCSL-Menu labeling). A 2013 Wisconsin statute preempts local governments from restricting the sale of food and non-alcoholic beverages based on portion sizes, calories, or nutritional value (Grassroots Change). 

Implementation Resources

ChangeLab-Healthy restaurants - ChangeLab Solutions. Putting health on the menu: A toolkit for creating healthy restaurant programs and a model healthy restaurant program agreement. Accessed on May 4, 2016
ChangeLab-Restaurant regulations 2012 - ChangeLab Solutions. Creating successful healthy restaurant policies: Understanding the laws regulating restaurants. 2012. Accessed on May 4, 2016
CSPI-Menu labeling - Center for Science in the Public Interest (CSPI). State and local menu labeling policies. Accessed on December 10, 2015
LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural Childhood Obesity Prevention Toolkit. Leadership for Healthy Communities (LHC). 2014. Accessed on June 16, 2017
LHC-Toolkit 2009 - Leadership for Healthy Communities (LHC). Action strategies toolkit: A guide for local and state leaders working to create healthy communities and prevent childhood obesity. Princeton: Robert Wood Johnson Foundation (RWJF); 2009. Accessed on June 16, 2017

Citations - Description

Grassroots Change - Grassroots Change. Connecting for better health. Accessed on February 13, 2017
Sinclair 2014* - Sinclair SE, Cooper M, Mansfield ED. The influence of menu labeling on calories selected or consumed: A systematic review and meta-analysis. Journal of the Academy of Nutrition and Dietetics. 2014;114(9):1375-1388. Accessed on May 4, 2016

Citations - Evidence

Bollinger 2011* - Bollinger BB, Leslie P, Sorensen A. Calorie posting in chain restaurants †. American Economic Journal: Economic Policy. 2011;3(February):91–128. Accessed on March 14, 2016
Breck 2014* - Breck A, Cantor J, Martinez O, Elbel B. Who reports noticing and using calorie information posted on fast food restaurant menus? Appetite. 2014;81:30-36. Accessed on May 4, 2016
Dumanovsky 2011 - Dumanovsky T, Huang CY, Nonas CA, et al. Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: Cross sectional customer surveys. BMJ. 2011;343:d4464. Accessed on January 11, 2016
Elbel 2009* - Elbel B, Kersh R, Brescoll VL, Dixon LB. Calorie labeling and food choices: A first look at the effects on low-income people in New York City. Health Affairs. 2009;28(6):w1110-21. Accessed on January 14, 2016
Elbel 2011 - Elbel B, Gyamfi J, Kersh R. Child and adolescent fast-food choice and the influence of calorie labeling: A natural experiment. International Journal of Obesity. 2011;35(4):493-500. Accessed on December 15, 2015
Ellison 2013 - Ellison B, Lusk JL, Davis D. Looking at the label and beyond: The effects of calorie labels, health consciousness, and demographics on caloric intake in restaurants. International Journal of Behavioral Nutrition and Physical Activity. 2013;10:21. Accessed on December 30, 2015
Finkelstein 2011* - Finkelstein E, Strombotne KL, Chan NL, Krieger J. Mandatory menu labeling in one fast-food chain in King County, Washington. American Journal of Preventive Medicine. 2011;40(2):122-7. Accessed on February 5, 2016
Harnack 2008a - Harnack LJ, French SA. Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: A review of the literature. International Journal of Behavioral Nutrition and Physical Activity. 2008;5(51). Accessed on February 5, 2016
Long 2015* - Long MW, Tobias DK, Cradock AL, Batchelder H, Gortmaker SL. Systematic review and meta-analysis of the impact of restaurant menu calorie labeling. American Journal of Public Health. 2015;105(5):e11-e24. Accessed on May 4, 2016
Nikolaou 2015* - Nikolaou CK, Hankey CR, Lean MEH. Calorie-labelling: Does it impact on calorie purchase in catering outlets and the views of young adults? International Journal of Obesity. 2015;39:542-545. Accessed on May 4, 2016
Pulos 2010* - Pulos E, Leng K. Evaluation of a voluntary menu-labeling program in full-service restaurants. American Journal of Public Health. 2010;100(6):1035-9. Accessed on May 20, 2016
Roberto 2009* - Roberto CA, Schwartz MB, Brownell KD. Rationale and evidence for menu-labeling legislation. American Journal of Preventive Medicine. 2009;37(6):546-51. Accessed on May 20, 2016
Sinclair 2014* - Sinclair SE, Cooper M, Mansfield ED. The influence of menu labeling on calories selected or consumed: A systematic review and meta-analysis. Journal of the Academy of Nutrition and Dietetics. 2014;114(9):1375-1388. Accessed on May 4, 2016
Tandon 2011* - Tandon PS, Zhou C, Chan NL, et al. The impact of menu labeling on fast-food purchases for children and parents. American Journal of Preventive Medicine. 2011;41(4):434-38. Accessed on November 9, 2015
Vadiveloo 2011 - Vadiveloo MK, Dixon LB, Elbel B. Consumer purchasing patterns in response to calorie labeling legislation in New York City. International Journal of Behavioral Nutrition and Physical Activity. 2011;8:51. Accessed on November 20, 2015

Citations - Implementation

CSPI-Labeling policies map - Center for Science in the Public Interest (CSPI). State and local menu labeling policies. Accessed on December 14, 2015
Federal register-Food labeling - Federal Register. Food labeling: Nutrition labeling of standard menu items in restaurants and similar retail food establishments. Accessed on February 4, 2016
Grassroots Change - Grassroots Change. Connecting for better health. Accessed on February 13, 2017
NCSL-Menu labeling -

National Conference of State Legislatures (NCSL). Trans fat and menu labeling legislation.

Accessed on November 24, 2015

Page Last Updated

May 5, 2016

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