Drexel study: Consumers order a less unhealthy meal when the menu has nutritional labeling

(Press-News.org) Contact information: Rachel Ewing
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Drexel University
Drexel study: Consumers order a less unhealthy meal when the menu has nutritional labeling

PHILADELPHIA (November 18, 2013)— An evaluation team led by the Drexel University School of Public Health has published a new study demonstrating that customers of full-service restaurants use nutritional labeling on menus to make healthier food choices.

"This is the first field-based study of mandatory menu labeling laws that found a large overall adjusted difference in calories between customers who dined at labeled restaurants when compared to unlabeled restaurants -- about 155 fewer calories purchased," said Amy Auchincloss, PhD, an assistant professor in the Drexel University School of Public Health and lead author of the study.

Overall, customers at restaurants with menu labels purchased food with 151 fewer calories (155 fewer calories when counting beverages), 224 milligrams less sodium and 3.7 grams less saturated fat compared to customers at restaurants without menu labels.

Almost 80 percent of customers at labeled restaurants reported seeing labels, and 26 percent of all customers reported using them when deciding what to order. The customers who reported they used labels purchased 400 fewer calories (representing a relative difference of 20 percent), 370 milligrams less sodium and 10 grams less saturated fat than the overall average.

Nevertheless, even consumers who used the labels purchased oversized meals that, on average, far exceeded what could be considered "healthy"– highlighting the difficulty for consumers when dining out. The authors argue for a need to do more to help consumers to eat sensibly and to encourage portion control, among other findings published online today ahead of print in the December issue of the American Journal of Preventive Medicine.

Americans currently purchase at least a third of the calories they consume on food prepared away from home– so providing detailed nutritional information on menus and on packaged foods is a commonly touted tactic to educate consumers and encourage them to make healthier choices.

"While previous studies have shown mixed impacts of menu labeling in fast food settings, this study suggests that nutrition information may be particularly useful in full-service restaurants," said Donald F. Schwarz, MD, health commissioner for the City of Philadelphia and a co-author of the study.

Philadelphia's menu labeling law requires full-service chain restaurants with more than 15 locations nationwide to list values for calories, sodium, fat and carbohydrates for each item on all printed menus. Fast food restaurants must list calories on their menus boards and make the other nutrition information available upon request. Philadelphia's law is unique in requiring more than just calories on menus. The enactment of this law in 2010 created the opportunity to observe whether menu labeling affects what consumers purchase – by comparing what happens at multiple locations of a single full-service chain restaurant, within and outside of city limits.

Menu labeling will expand nationwide when the Patient Protection and Affordable Care Act is fully implemented; at that time, all fast-food and full-service restaurant chains with more than 20 locations will be required to provide nutrition information at the point of purchase.

In this study, Auchincloss and colleagues from Drexel, the Philadelphia Department of Public Health and University of Pennsylvania, assessed whether food purchases at full-service restaurants varied depending on the presence of labeling. They collected 648 customer surveys and transaction receipts at seven restaurant outlets of one large full-service restaurant chain. Two outlets had menu labeling, while five outlets did not. The authors looked at differences in calories and nutrients purchased between those who dined at outlets with menu labeling and those who did not, and at customers' reported use of nutritional information when ordering.

On average, customers purchased food that had approximately 1,600 food calories (kcal) – a total that rose to 1,800 calories when also counting beverages. Most people need only 2,000 calories for an entire day, so a single meal approximated a full day's worth of calories. Purchased meals had an average sodium content of 3,200 milligrams, with an average of 35 grams of saturated fat. These numbers far exceed recommended limits for an entire day. For most people, recommended daily limits are 2,300 milligrams sodium and 20 grams of saturated fat.

"When you compare the average intake with the recommended daily intake, these consumers purchased almost all their calories, and more than the recommended sodium and saturated fat in just one meal," said Beth Leonberg, an assistant clinical professor and director of the didactic program in dietetics in Drexel's College of Nursing and Health Professions, who co-authored the study. "In order to not exceed recommended intakes for the day, most adults should consume fewer than 750 calories, 750 milligrams of sodium and 8 grams of saturated fat in a single meal."

The authors concluded that current efforts don't go far enough to help consumers to eat sensibly and to encourage portion control. Educating consumers about menu labeling may further increase the small observed impact on healthier consumer choices.

"We also need to pursue approaches that make the healthy choice the default," said Giridhar Mallya, MD, director of policy and planning for the Philadelphia Department of Public Health and a co-author of the study. "This might include product reformulation, promoting healthier options on menus, and offering smaller portion sizes."



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Other co-authors with Auchincloss, Schwarz, Leonberg and Mallya include Karen Glanz, PhD of the University of Pennsylvania and Andrew Ricchezza, who at the time of the study was a master's student at the Drexel School of Public Health.

Related studies by this evaluation team addressed the nutritional value of foods listed on menus at full-service restaurant chains with and without mandatory labeling laws (paper in press) and customer knowledge, attitudes and behaviors regarding menu labeling and their use (published in Public Health Nutrition in 2013: http://dx.doi.org/10.1017/S1368980013000104). Abstracts for all of these related studies are available at http://drexe.lu/16GLGRo.

The team and additional collaborators from Drexel and the Philadelphia Department of Public Health have prepared an executive summary of the set of studies with recommendations for the restaurant industry. This PDF document is available at http://drexe.lu/1dOexFa

Auchincloss and Leonberg address many common questions about this study on the Drexel News Blog, such as comparing these findings to past studies of fast-food restaurants, what can be done to make restaurant meals healthier and what consumers should know to eat well while dining out. These comments are available at http://drexe.lu/HZkoN4.

The paper in the American Journal of Preventive Medicine is available at http://dx.doi.org/10.1016/j.amepre.2013.07.014.

Funding for this research was provided in part by the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; and Get Healthy Philly, an initiative of the Philadelphia Department of Public Health (PDPH).