People Order Healthier Meals When Menu Has Nutritional Info, At Least In Philadelphia

A new study led by Drexel University demonstrated that customers of full-service, dine-in restaurants do use nutritional labeling to help them 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.

The team found that overall, patrons of restaurants with labels purchased food with 151 fewer calories (155 fewer calories when counting beverages), 224 milligrams less sodium and 3.7 less grams of saturated fat compared to customers at restaurants without menu labels.

The study, published online in the American Journal of Preventative Medicine, reported that 80 percent of customers at labeled restaurants reported seeing labels, and 26 percent of all customers reported using them when deciding what to order. Those who reported that they used labels bought meals with 400 fewer calories (representing a relative difference of 20 percent), 370 milligrams less sodium and 10 grams less saturated fat than the overall average.

Even so, consumers who used the labels still purchased oversized meals. On average, these meals far exceeded what could be considered “healthy” – highlighting the difficulty for consumers when dining out. There is a need to do more to help consumers to eat sensibly and to encourage portion control, according to the study findings.

Currently, Americans get at least one-third of the calories they consume on a daily basis on food prepared away from home. Providing detailed nutritional information on menus and packaged foods is a commonly touted a tactic way to educate consumers and encourage them to make healthier food 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.

In Philadelphia, restaurants with more than 15 locations nationwide are required by law to list values for calories, sodium, fat and carbohydrates for each item on all printed menus. Menu boards in fast food restaurants must display calories and make other nutritional information available upon request. Philadelphia’s law, enacted in 2010, is unique in requiring more than just calories on menus. The law 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, inside and outside of city limits.

When the Patient Protection and Affordable Care Act is fully implemented, menu labeling will expand nationwide. All fast food and full-service restaurant chains with more than 20 locations will be required to provide nutritional information at the point of purchase.

The team, which included members from the Philadelphia Department of Public Health and the University of Pennsylvania, assessed whether food purchases at full-service restaurants varied depending on the presence of labeling. To conduct the study, they collected 648 customer surveys and transaction receipts at seven restaurant outlets of one large full-service restaurant chain. Two of the outlets had menu labeling, while the other five did not. Differences in calories and nutrients purchased between those who dined at outlets with menu labeling and those who did not were examined, as well as 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 only need around 2,000 calories for an entire day, so a single meal approximated a full day’s worth of calories. The purchased meals had an average sodium content of 3,200 milligrams, with an average of 35 grams of saturated fat – numbers which far exceed the recommended daily limits for an entire day. Recommended daily limits for most people 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.

“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.”

According to the authors, the current efforts don’t go far enough to help consumers to eat sensibly and to encourage portion control. They believe that 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. “This might include product reformulation, promoting healthier options on menus, and offering smaller portion sizes.”

In contrast, earlier this week, redOrbit reported that researchers from NYU’s Langone Medical Center had released a similar study of menu labeling effects in Philadelphia, finding that food labels do not change purchasing habits or decrease the number of calories that those customers consume.

“What we’re seeing is that many consumers, particularly vulnerable groups, do not report noticing calorie labeling information and even fewer report using labeling to purchase fewer calories,” says lead study author Dr. Brian Elbel, assistant professor of Population Health and Health Policy at NYU School of Medicine.

“After labeling began in Philadelphia, about 10 percent of the respondents in our study said that calorie labels at fast-food chains resulted in them choosing fewer calories.”