This post is from HKS student Rui Zhang, who is working as a research assistant for the Ash Center’s Transparency Policy Project. At a time when “families are regularly eating out more,” Zhang notes, “even trained dietitians underestimate the calorie and fat content of restaurant meals.” But is it safe to assume that more information is better in the search for answers to diet-related health problems? Learn more about transparency policy and information disclosure at transparencypolicy.net and @SunshinePolicy.
By Rui Zhang
America is suffering from an obesity epidemic. The latest reports show that 35% of U.S. adults and 17% of teenagers are obese. People’s changing eating habits may be a contributing factor. Americans are increasingly eating foods that are not prepared at home. From the 1970s to 2012, Americans’ restaurant spending rose from 26% to 43% of their total spending on food.
The first problem with this is that often restaurant foods are packed with fat, sodium, sugar, not to mention calories, so they are not the most nutritious options to begin with. The second problem is that restaurant goers widely underestimate the calories they are eating when they order a burger and a shake.
For example, at a chain like the Cheesecake Factory, entrees such as beef ribs and some pasta dishes measure well above 2,000 calories. That is the recommended amount of calories an adult should eat in the entire day, not in a single meal. Consumers are not the only ones having a hard time estimating the calories in their meals. A survey showed that even trained dietitians consistently underestimate the calorie and fat content of restaurant meals by 220 to 680 calories and by 18 to 57 grams of fat.
Is Menu Labeling the Solution?
Some local regulators in cities like New York and Philadelphia as well as states like California tried to improve the way we eat by enlisting transparency. They asked restaurant chains to post calorie information on their menus and menu boards, a policy known as “menu labeling” or “calorie labeling,” hoping that after reading calorie counts consumers would switch to foods with fewer calories. Organizations like the Center for Science in the Public Interest were instrumental in raising awareness around over-consumption of prepared food, and worked with legislators to craft several local menu labeling initiatives.
In 2010, the Affordable Care Act made menu labeling a national policy for chains operating 20 or more locations. Many restaurant chains favored a national standard over a patchwork of state and local mandates. However, certain businesses, like the pizza industry, campaigned hard against the rule by arguing that it was too onerous and served no purpose because most Americans order pizzas online or over the phone, not in a restaurant. As a result, the US Food and Drug Administration (FDA) delayed the implementation of menu labeling by a year in 2015 to give companies more time to comply. It was not until May 2016 that the FDA finally released its menu labeling guidance for restaurants and retail establishments selling away-from-home food. The guidance requires restaurant chains with 20 or more locations to provide calorie information on their menus starting in 2017.
Will menu labeling be an effective tool to curb obesity? The answer is quite uncertain at this point. The assumption behind menu labeling is that, if provided with calorie information, people will order healthier foods. However, research conducted so far shows that it is unclear whether customers actually change their purchases in response to calorie information.
Several studies indicate that consumers care about menu labeling and notice the information. Support for government mandated calorie posting in chain restaurants is high (68%). In New York City, after implementation of local menu labeling rules, 64% of customers said they saw the calorie information. In Philadelphia, 80% consumers had seen calorie information in the restaurants and 34% reported using it.
Consumers seem to notice calorie labels, but are they buying fewer calories in response to the new information? Research findings are mixed. There are studies showing some effectiveness. For example, New York City adults who reported noticing calorie labels consumed fast food less frequently than adults who did not see the labels (4.9 vs. 6.6 meals per week). Another study conducted in King County, WA revealed that consumers’ calorie intake decreased from 908.5 to 870.4 in food chains and from 154.3 to 132.1 in coffee chains after the implementation of mandatory menu labeling. A prominent study found that, after menu labeling, Starbucks average calories per transaction fell by 6%, an effect driven by changes in consumers’ food choices, while beverage choices remained unchanged.
It is even more questionable whether menu labeling is reaching people who are at high risk of obesity—certain minority groups, low income and less educated people. A sample of mostly Black (71%) and high school educated (62%) Philadelphia consumers did not change calories purchased and number of fast food visit after the implementation of the menu labeling rule. Among low-income, minority New York communities, 27.7% people saw the calorie labeling, but no significant change in calories purchased occurred.
While menu labeling might not have had a large impact on consumers, research points to effectiveness on the supply side. Large restaurant chains in the US have recently had overall declines in calories in newly introduced menu items (-56 calories, 12% decline) due to menu labeling. These declines were concentrated mainly in new main course items (-67 calories, 10% decline), new beverage (-26 calories, 8% decline) and children’s items (-46 calories, 20% decline). Some restaurants chains, which introduced voluntary menu labeling before 2014, had lower mean per item calorie content than restaurants without voluntary calorie labeling (the difference were 139 calories in 2012, 136 calories in 2013, and 139 calories in 2014). Restaurants in King County, WA, saw some long-term improvements in the nutrient content of restaurant foods. There are several reasons behind this decline: first, restaurants may anticipate negative media coverage and public backlash after releasing the information so they introduce options with fewer calories; second, restaurants may expect a shift in consumers’ demand towards healthier choices. Overall, menu labeling appears to have triggered some improvements in restaurant food options.
Using Caloric Information More Effectively
But can calorie information be delivered in ways that also improve the eating habits of the American public? Research points to different strategies to make calorie information more meaningful and actionable for consumers.
Organizing calorie information using rankings or categories can help. For example rank-ordered calories (organizing foods on a menu by the amount of calories they contain) and colored calories (calorie labels ordered from low to high calories that also have green or red circles indicating low and high calorie choices) might be good ways to convey calorie information. Rather than going through the entire menu, these interventions allow consumers to easily spot foods with the desired calorie amount.
Providing calorie information in more understandable formats can more readily translate into action and lead to healthier eating choices. Labels telling consumers how long they need to exercise to work off the calories they eat are a good example. One study shows that black teenagers in Baltimore were less likely to opt for soda after learning that they would need to exercise for 50 minutes to burn a bottle of soda. Research indicates that conveying the information using familiar measurement units, such as sugar packs or teaspoons of sugar, rather than grams, can help. Well-designed menu labeling should enable customers to translate calorie information into something they can easily understand and act on, such as hours of exercise, miles of running to burn the calories, or number of teaspoons of sugar. Research in other areas shows that translating information into dollar values helps consumers’ choices. A similar approach could be adopted to let Americans know the costs associated with obesity-related ailments.
Also enabling consumers to put calorie information into context can help. For example, few people know that the recommended calorie allowance for an adult is 2,000 calories per day. Without this information, we are unable to understand whether a 500-calorie muffin is a high or low calorie food. Showing prominently a recommended daily caloric requirement label may be a good idea. It has been shown that when consumers saw calorie labels and a prominently displayed notice reminding them of the 2,000 calories per day allowance, their calorie consumption declined significantly (from 1625 calories in normal calorie labels, to 1380 calories in calorie labels plus calorie allowance).
Whether the national menu labeling rule will work well in the future highly depends on how it is implemented. So far some local rules have not fully reached their goals, largely because the presentations of calorie information do not match customers’ knowledge, habits, and awareness. Providing the information in simplified formats as well as public health campaigns informing consumers of menu labeling and how to put calorie information into practice could help. Similarly, press coverage of menu labeling, especially around the time national calorie posting goes into effect, may also raise awareness and prepare consumers to use the information. Most importantly, menu labeling is a reminder that providing information does not easily translate into improved choices. Public policies based on transparency deserve close scrutiny and empirical testing to improve their design and reach.
Rui Zhang is a research assistant for the Transparency Policy Project and MPP student at Harvard Kennedy School.