Show Me the Calories? Calorie Counts on Menu Boards May Not Impact Consumer Choice in Restaurants

More than one third of adults in the United States are obese, resulting in annual medical costs of nearly $150 billion. Evidence suggests that the effects of obesity might be strong enough to halt an upward trend in life expectancy that has been occurring for over two centuries. As a result, policymakers across the globe consider curbing obesity to be a top priority in the near future.

Many policies have been implemented in the United States that attempt to limit consumption of unhealthy foods. These include taxes on sugar-sweetened beverages, bans on the use of trans fats in restaurants, and subsidies for buying fresh fruits and vegetables. However, outside of listing nutrition facts on food labels, few policies have sought to change consumer behavior through better information. Moreover, as Americans eat more meals outside of the home, where labeling mandates do not apply, nutrition information is likely to be less impactful.

In 2008, New York City implemented a policy mandating that chain restaurants post calorie counts on their menu boards, whereas, typically, these restaurants had provided calorie counts and ranges through company websites or brochures. New York City’s policy intended to increase the visibility of calorie counts by requiring that they be posted next to each menu item, in the same style as the menu item’s name and price. Policymakers thought that, by making calorie counts more prominent, consumers might be inclined to choose healthier options.

In a recent study in Health Affairs, Jonathan Cantor, Alejandro Torres, Courtney Adams, and Brian Elbel examine the effects of New York City’s menu board mandate on consumer behavior in fast food restaurants. The researchers were interested in the extent to which the mandate made consumers more likely to see calorie information in the restaurant, as well as whether or not consumers used the information to purchase healthier foods.

Cantor et al. surveyed customers at fast food restaurants across New York City for a one-week period before, and a one-week period after, the implementation of the menu board mandate in July 2008. Upon leaving the restaurant, customers were asked whether they saw any calorie information in the restaurant. If they did, customers were asked if they used the information when deciding what to buy, and whether it drove them to buy higher-calorie or lower-calorie food. The researchers then collected register receipts to verify what the participants actually purchased and to determine the saturated fat, sugar, and sodium content of meals purchased using company nutrition information.

Cantor et al. then compared changes in survey responses before and after the mandate in New York City to changes in survey responses over the same period in Newark, New Jersey, where a calorie count mandate was not in place. To look at longer-term effects of the mandate, they also conducted follow-up studies in both locations in 2013 and 2014.

Their findings suggest that the mandate helped people notice calorie information before purchasing meals, but the effects were strongest immediately after the policy change in 2008 and dissipated over time. In 2008, even after controlling for age, sex, race/ethnicity, and specific restaurant chain, customers in New York City were 37 percentage points more likely to notice calorie information after the mandate was in place. Further, customers seeing calorie information were 10 percentage points more likely to use it to order healthier food.

These effects became less apparent over time but did not disappear entirely. In the 2013-14 follow-up studies, customers in New York City were 30 percentage points more likely to notice the calorie information but only seven percentage points more likely to use the information to order healthier food, relative to before the calorie count mandate.

By looking at customers’ actual purchases, the researchers find no significant change in the nutritional content of food purchased, even if customers reported using the information. There were no population-level differences at either location in the calories, saturated fat, sodium, or sugar content of meals purchased. In fact, the average number of calories purchased increased for the New York and New Jersey groups between the 2008 and 2013-14 observation periods. These findings suggest that, while posting calorie counts may help individuals make healthier decisions in the short run, the information may not be as effective when applied to the entire population over a longer period of time.

Calorie count mandates will be expanding nationwide under the Affordable Care Act, with all large restaurant chains being required to post calorie information on menus by the end of 2016. This study suggests that, while consumers are more aware of calorie information once it is put on the menu, the information alone likely does not impact the choices they make when purchasing food. It is possible that the information could have an effect on certain subsets of the population, but, for now, the strategy will remain unproven for the population as a whole. Without a better understanding of how information can be translated into action, calorie count mandates will likely fall short of their intended effect.

Article Source: Cantor, Jonathan, Alejandro Torres, Courtney Adams, and Brian Elbel, “Five Years Later: Awareness of New York City’s Calorie Labels Declined, With No Changes in Calories Purchased,” Health Affairs. November 2015.

Featured Photo: cc/(Vilseskogen)