September 2014

Obesity has been on the rise in the US and leads to other chronic diseases.  This rise has been correlated with the increase consumption of food, especially outside of the home. Nutrition information labeling at restaurants has been an initiative taken to help consumers make better food choices while dining out. Places such as chain restaurants, retail food restaurants, and vending machines with 20 or more locations are required to post the calorie content and contextual information for each menu item. While this is a great start, there are many other factors that can prevent the consumer from making healthy food choices while dining out. These factors include health and literacy competencies, price, SES, time constraints, hunger cues, food habits, and understanding the nutrition labels.

The purpose of this study was to review and analyze previous studies that looked into nutrition labeling of menu items to determine the effectiveness of informative, contextual, and interpretive nutrition information on menus on consumer's calorie selection and consumption. Informative nutrition labeling only provides the fact to the consumer, such as calories in a particular meal. Contextual nutrition labeling provides the calories, and also puts it into context, such as with the recommended dietary intake (RDI). Interpretative nutrition labeling will provide more information than just calories in a meal and RDI but possibly adding exercise equivalents to burning those calories or using "traffic light" symbols to suggest a high, medium, or low calorie food.

There were 5 fast food studies, 2 studies in worksite cafeterias, and several experimental studies that were examined in this meta-analysis. Of the 5 fast food studies, only one reported a significant change in calories purchased after incorporating informative nutrition labeling. This particular study also found that calorie reduced purchasing occurred more in areas that were had higher education and income. Two of the other fast food studies had a small sample size and the remaining 2 studies had a large sample size, however, neither found a significant difference in food items purchased after incorporating informative nutrition labeling. In one of the cafeteria studies, the researcher used informative nutrition labeling in one cafeteria to increase sales of healthier items, and no nutrition labeling in a controlled cafeteria. This study found that nutrition labeling was effective in increasing sales for targeted snacks and sides but not for entrees sold in the test cafeteria, while sales remained the same in the control cafeteria. In the second cafeteria study, the researcher used an interpretive nutrition labeling method by placing a heart symbol next to low-fat items in the test cafeteria and no labeling in the control cafeteria. The study found that the number of targeted heart-labeled entrees had significantly increased compared to the control cafeteria entrees. The experimental studies used contextual nutrition labeling and/or interpretive nutrition labeling alongside informative calorie content labeling. These studies found that, compared to the control group, participants selected and consumed fewer calories when given contextual and/or interpretive information on their nutrition labels as opposed to when given just informative calorie content alone.

In conclusion, this meta-analysis found that labeling of menus with just informative calorie content alone did not have a significant impact on calories selected and consumed by participants. However, menu labeling with contextual and/or interpretive nutrition information resulted in fewer calories selected and consumed by participants. This could be due to consumers health and literary competencies. Consumers may not connect the dots between stand alone calorie information on a menu and how it impacts their health. Also, without interpretive information, consumers may not understand the relevance of the informative nutrition labels presented on a menu. This meta-analysis suggests that a more uniform and easy to understand icon or symbol should be investigated for nutrition labels on a menu to promote better food choices in consumers dining out. Promoting better food choices for all levels of health and literary competencies may be improved by using contextual and interpretive nutrition labeling.

Sinclair, S., Cooper, M., & Masfield, E. (2014). The Influence of Menu Labeling on Calories Selected or Consumed: A Systematic Review and Meta-Analysis. Journal of the Academy of Nutrition and Dietetics, 114(9), 1375-1388. Retrieved September 3, 2014, from http://www.andjrnl.org/article/S2212-2672(14)00599-1/abstract

Supplemental Article:

Elbel, B., Kersh, R., Brescoll, V.L., and Dixon, L.B. Calorie labeling and food choices: A first look at the effects on low-income people in New York City. Health Aff. 2009; 28: w1110–w1121