Calorie labelling and other drivers of takeaway food choices

Potential benefits of calorie labeling in restaurants.

We assessed the impact of restaurant menu calorie labels on food choices and intake. Participants in a study dinner (n=303) were randomly assigned to either (1) a menu without calorie labels (no calorie labels), (2) a menu with calorie labels (calorie labels), or (3) a menu with calorie labels and a label stating the recommended daily caloric intake for an average adult (calorie labels plus information). Food choices and intake during and after the study dinner were measured. Participants in both calorie label conditions ordered fewer calories than those in the no calorie labels condition. When calorie label conditions were combined, that group consumed 14% fewer calories than the no calorie labels group. Individuals in the calorie labels condition consumed more calories after the study dinner than those in both other conditions. When calories consumed during and after the study dinner were combined, participants in the calorie labels plus information group consumed an average of 250 fewer calories than those in the other groups. Calorie labels on restaurant menus impacted food choices and intake; adding a recommended daily caloric requirement label increased this effect, suggesting menu label legislation should require such a label. Future research should evaluate menu labeling's impact on children's food choices and consumption.

BackgroundMenu calorie labeling is a useful means to encourage consumers to be informed about healthy eating and food choices. It is projected as an innovative method that will change the food environment and increases consumers' awareness of calories.ObjectiveThis study aims to determine the consumer's knowledge, attitudes, and practices toward menu calorie labeling in Saudi Arabia.MethodsThis is a descriptive cross-sectional study involving 435 consumers in Saudi Arabia. The participants filled out an online electronic survey questionnaire that assesses the demographic factors, knowledge, attitudes, practices, and barriers toward menu calorie labeling. Logistic regression was performed to determine the predictor of attitudes of consumers toward menu calorie labeling.ResultsOf those 435 consumers, 50.1% were men, 33% were in the age group of 30–39, and 49.4% had a bachelor's degree. The majority of the participants reported that they can understand the calorie labels that were presented on the menus of the restaurants (N = 365, 83.9%). A high percentage of participants reported that calorie labeling encourages them to choose foods with a smaller number of calories (N = 387, 89%) and supported the posting of calorie content next to the price of the food items on the menus (N = 405, 93.1%). Barriers to using calorie labels were time-consuming and low-calorie food items are usually costly. Gender and educational attainment were found significantly associated with consumers' knowledge while marital status and BMI level were found significantly associated with attitudes and practices to using calorie labels (p < 0.05).ConclusionOverall, the participants had adequate knowledge and positive attitudes about menu calorie labeling in Saudi Arabia. Menu calorie labeling may be a useful policy tool for promoting healthy eating habits and appropriate caloric consumption.

Calorie labeling is a recent initiative from the Saudi Food and Drug Authority (SFDA) aimed to reduce the prevalence of noncommunicable diseases (NCDs) by influencing people to make healthier food choices when they eat out and can also help people with weight disturbances to be more aware of their calorie intake. The present study aimed to investigate the association between the use of calorie labeling on restaurant menus, calorie intake, weight concern, body weight perception, and weight-control behaviors among young women. A quasi-experimental study was conducted among female students at a university restaurant. Participants were assigned to two groups: food menus with (experimental group) and without (control group) calorie labeling. The logistic regression model assessed the predictors of using calorie information separately for the experimental and control groups. Calorie labeling had a significant effect on reducing calorie consumption in the experimental group by 59 calories compared to the control group. The higher weight concern in the control group (OR = 0.410; 95% CI 0.230–0.730; P ≤ 0.002) was a predictor for using calorie information. The experimental group had higher weight concern (OR = 1.530; 95% CI 1.107–2.115; P ≤ 0.01) and body weight perception (OR = 4.230; 95% CI 1.084–6.517; P ≤ 0.038) and lower calorie intake (OR = 1.005; 95% CI 1.001–6.517; P ≤ 0.008) predictors for using calorie information. Weight-control behaviors did not significantly predict the use of calorie information in the groups. Calorie labeling might increase the weight disturbances among young females. More investigation is needed across various populations to gain a better understanding of calorie labeling as an effective food choice among people who are vulnerable to weight disturbances or already have weight disorders.

BackgroundA significant proportion of the Canadian diet comes from foods purchased in restaurant settings. In an effort to promote healthy eating, the province of British Columbia (BC) implemented the Informed Dining Program (IDP), a voluntary, industry supported information program in 2012, while the province of Ontario implemented mandatory calorie labelling on menus in 2017. The study examined differences in awareness and the self-reported influence of nutrition information on food choices in restaurants with voluntary nutrition information, calorie labelling on menus, and no nutrition information program.MethodsExit surveys were conducted outside of nine chain restaurants in Toronto, Ontario and Vancouver, British Columbia (Canada) in 2012, 2015, and 2017 with varying nutrition information programs implemented. Logistic regression analyses compared self-reported noticing and influence of nutrition information in restaurants with: 1) the IDP which provided nutrition information upon request, 2) calorie labelling on menus, and 3) control restaurants with no specific nutrition information program in place, adjusted for year, city and socio-demographic characteristics. Awareness and knowledge of the IDP were also examined.ResultsThere were no significant differences in noticing and self-reported influence of nutrition information on food choices between restaurants with the IDP and restaurants with no program. Participants were more likely to notice nutrition information in restaurants when calorie information was provided on menus (57%) compared to in restaurants with the IDP (22%, AOR = 6.20, 95%CI 3.51–10.94, p < 0.001) or restaurants with no nutrition information program (20%, AOR = 7.44, 95%CI 4.21–13.13, p < 0.001). Participants in restaurants with menu labelling were also more likely to report that nutrition information influenced their food purchase (38%) compared to restaurants with the IDP (12%, AOR = 4.43, 95%CI 2.36–8.30, p < 0.001) and restaurants with no nutrition information program (12%, AOR = 5.29, 95%CI 2.81–9.95, p < 0.001). Fewer than 1 in 5 participants who visited an IDP restaurant had heard of the IDP across all data collection years in both cities.ConclusionsThere was no evidence that voluntary programs which provide nutrition information upon request were effective. Providing calorie information on menus increased the likelihood that consumers noticed and that their food choices were influenced by nutrition information in restaurant settings.

Background: Unhealthy diet quality is a risk factor for cardiometabolic diseases. The Affordable Care Act mandated menu calorie labeling in many food service businesses to promote healthy food choices, but evidence is limited on whether label use affects dietary intake. Hypothesis: We studied the hypothesis that menu calorie label use is associated with healthier diet quality in a nationally representative dataset. Methods: We included individuals age≥16 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 who reported buying food from a fast food, sit-down, or buffet restaurant or coffee shop in the past year (n=3,823). The exposure, menu calorie label use, was dichotomized to participants who used labels vs. those who did not use labels at any of the mentioned food service sites using the Consumer Behavior Phone Follow-up Module survey data. The primary outcome was diet quality measured by the Healthy Eating Index 2015 (HEI-2015; range 0-100) using two days of 24-hour diet recall data (n=3,809). Secondary outcomes included certain HEI components (added sugars, saturated fats, fruits, vegetables) and total daily calories. We used multiple linear regression to measure the association between label use and outcomes, accounting for the complex survey design of NHANES and adjusting for demographic, socioeconomic, and comorbidity factors. Results: Of 3,806 participants (representing 224,305,985 Americans), 903 (26.9 weighted %) used menu calorie labels. Those who used menu calorie labels were more likely to be younger (μ=43.3 years, SE 0.58), female (60.8%), and with higher educational attainment (college degree or higher 44.6%), and less likely to be low-income (≤200% of federal poverty level 19.5%) compared to those who did not use them (age μ=47.1 years, SE 0.79; female 49.7%; college degree or higher 26.9%; ≤200% FPL 33.6%). Compared to participants who did not use calorie labels, those who used menu calorie labels had HEI-2015 scores that were 3.95 points (95% CI 2.28, 5.63) higher and consumed less calories (β=-240.4 kcal, 95% CI -384.3, -96.5). Of the HEI-2015 components, participants who used menu calorie labels ate more vegetables (β=0.41 points, 95% CI 0.20, 0.62) and less added sugars (β=0.74 points, 95% CI 0.24, 1.24). No differences were seen in saturated fat or fruit intake. Conclusions: Individuals who used menu calorie labels had significantly healthier dietary intake and consumed less calories compared to those who did not use labels, suggesting that providing caloric information may influence healthy food decisions. Those who did not use labels had lower education level and family income. Further research is needed to explore how people use label information to make food choices and why individuals may not use calorie labels to improve utility and effectiveness of point-of-purchase nutrition information without amplifying health disparities.

Need for and Effectiveness of Menu Labeling

BackgroundObesity is a major public health threat and policies aimed at curbing this epidemic are emerging. National calorie labeling legislation is forthcoming and requires rigorous evaluation to examine its impact on consumers. The purpose of this study was to examine whether point-of-purchase calorie labels in New York City (NYC) chain restaurants affected food purchasing patterns in a sample of lower income adults in NYC and Newark, NJ.MethodsThis study utilized a difference-in-difference design to survey 1,170 adult patrons of four popular chain restaurants in NYC and Newark, NJ (which did not introduce labeling) before and after calorie labeling was implemented in NYC. Receipt data were collected and analyzed to examine food and beverage purchases and frequency of fast food consumption. Descriptive statistics were generated, and linear and logistic regression, difference-in-difference analysis, and predicted probabilities were used to analyze the data.ResultsA difference-in-difference analysis revealed no significant favorable differences and some unfavorable differences in food purchasing patterns and frequency of fast food consumption between adult patrons of fast food restaurants in NYC and Newark, NJ. Adults in NYC who reported noticing and using the calorie labels consumed fast food less frequently compared to adults who did not notice the labels (4.9 vs. 6.6 meals per week, p <0.05).ConclusionWhile no favorable differences in purchasing as a result of labeling were noted, self-reported use of calorie labels was associated with some favorable behavioral patterns in a subset of adults in NYC. However, overall impact of the legislation may be limited. More research is needed to understand the most effective way to deliver calorie information to consumers.

Body dissatisfaction and beyond: Investigating attitudes towards calorie labels on UK food menus

BackgroundEating away from home has increased in prevalence among US adults and now comprises about 50% of food expenditures. Calorie labeling on chain restaurant menus is one specific policy that has been proposed to help consumers make better food choices at restaurants. The present review evaluates the available empirical literature on the effects of calorie information on food choices in restaurant and cafeteria settings.MethodsComputer-assisted searches were conducted using the PUBMED database and the Google Scholar world wide web search engine to identify studies published in peer-review journals that evaluated calorie labeling of cafeteria or restaurant menu items. Studies that evaluated labeling only some menu items (e.g. low calorie foods only) were excluded from the review since the influence of selective labeling may be different from that which may be expected from comprehensive labeling.ResultsSix studies were identified that met the selection criteria for this review. Results from five of these studies provide some evidence consistent with the hypothesis that calorie information may influence food choices in a cafeteria or restaurant setting. However, results from most of these studies suggest the effect may be weak or inconsistent. One study found no evidence of an effect of calorie labeling on food choices. Each of the studies had at least one major methodological shortcoming, pointing toward the need for better designed studies to more rigorously evaluate the influence of point-of-purchase calorie labeling on food choices.ConclusionMore research is needed that meets minimum standards of methodological quality. Studies need to include behavioral outcomes such as food purchase and eating behaviors. Also, studies need to be implemented in realistic settings such as restaurants and cafeterias.

Effect of Menu Calorie Labels on Menu Sales and Consumer's Recognition at a Korean Restaurant in a Hotel The role of calorie information is to help consumers make healthier food choices. However, calorie information is generally unavailable in restaurants. Even in high-end hotel restaurants, which try to provide high quality foods and service, calorie labeling is not mandatory. Therefore, the purpose of this study was to evaluate the effect of calorie labeling on menu sales and consumer's recognition at a Korean restaurant in Kangwonland hotel. The calorie contents of 10 dishes sold in the restaurant were calculated using the food composition table. After making a new menu plate displaying calorie information, the new menu plate and old menu plate were provided every other week for 4 weeks. When we compared the sales between the periods of calorie labeled and calorie unlabeled, sales of 4 items among the 5 food items providing less than 1000 kcal, increased, however the 3 items among the menu providing more than 1000 kcal decreased. As the survey results of total 405 consumers (male n = 232, female n = 173) showed the new menu plate, 68.2% of subjects recognized calorie labeling on the menu plate. Among the subjects who recognized calorie labeling, 58.3% answered that calorie information affected their food choices. And most of them answered that they chose lower calorie foods based on the information provided. The results suggest that displaying calorie information on the menu plate at a Korean restaurant was effective in changing consumer's food choices. (Korean J Community Nutr 18(5) : 505~514, 2013)

Background: Mandatory menu calorie labeling in restaurants is gaining popularity around the world as a beneficial strategy for promoting balanced energy consumption and encouraging healthier meal choices to lower obesity rates. Until now, calorie labeling effects on food purchasing are unclear. Objective: This study aimed to evaluate the calorie label-based purchasing, awareness, and factors that affect school-age children and adolescents in Saudi Arabia. Materials and Methods: An online questionnaire with simulated restaurant menus was distributed to determine the costumer’s behavior toward food purchasing. We targeted 431 school-aged children and adolescents (ages ranging from 7 to 18 years old). Results: Approximately half of participants (51%) noted the calorie labeling on the menu, although only 17% made a purchase based on the calorie labeling, and those who exercise regularly were more calorie-based purchasers in this study (P &lt; 0.001). The association between knowledge and calorie label-based purchasing was significant. When the level of knowledge was compared to other demographic characteristics, it was determined that father’s education (P = 0.040) and physical activity (P = 0.015) showed a significant association even though nutrition education was provided to only 29% of participants in schools. Conclusions: The collected data clarifies children’s and adolescents’ attitudes toward calorie labeling, in addition to the other factors that influence restaurant ordering decisions.

Introduction: Saudi Arabia has an obesity prevalence of 38.96%, ranking 15th globally. The increasing prevalence of obesity has motivated Saudi Arabian health policymakers to develop national strategies to prevent or reduce the anticipated increase in cases. Therefore, the Food and Drug Authority has recently enacted compulsory calorie labeling on the menus of all food industry providers who provide food and drinks to consumers outside their homes. This study aimed to determine whether calorie labeling on fast-food restaurant menus helps consumers make informed decisions about their food consumption. Methods: This cross-sectional study conducted in Saudi Arabia between April and October 2022 employed a self-reported online survey to investigate the influence of caloric labeling on residents’ food-ordering decisions and to determine the effects of the independent variables on calorie requirement knowledge. Participants included Arabic- and English-speaking adults residing in different regions of Saudi Arabia. Data collection utilized a river sampling technique, employing social media platforms for survey distribution. The inclusion criteria encompassed adult Saudi residents exposed to calorie labels, while those who did not encounter such labels were excluded. Results: This study aimed to examine the factors influencing individuals’ food choices and their knowledge of daily calorie requirements. A social media advertisement was used to recruit 935 participants, with 760 included in the final analysis. Descriptive statistics revealed that the mean age of participants was 37.5 years, with 61.1% being female. Moreover, 59.3% reported having a college degree, and the mean monthly income was SAR 7,725. Logistic regression analysis demonstrated that knowing the daily calorie requirements significantly influenced food choices, with individuals who knew their calorie needs being four times more likely to use calorie labels when selecting food. However, other independent variables were found to be statistically insignificant. Additionally, age and citizenship status were significantly associated with knowledge of calorie requirements, with the 18–29 age group and Saudi Arabian citizens showing higher knowledge levels. Discussion: The findings of this study may catalyze further research aimed at measuring and understanding other variables that may impact consumer choices, such as pictures and font sizes, and understanding consumer knowledge and awareness of daily calorie requirements.

Calorie labels may be the most important predictor of dietary choices among college students. The Saudi Food and Drug Authority (SFDA) has imposed calorie labels on the menus of restaurants and cafes. The current study looked at how the calorie labeling policy affects Saudi male and female students' dietary habits, nutritional knowledge, and awareness. The study included 802 students (360 males and 442 females) from Saudi Arabia's King Saud University, ranging between 18 and 35 years. Between December 2020 and October 2021, a cross-sectional, electronic, approved and validated survey was conducted to collect data on gender socio-demographic variables, food habits, and nutritional knowledge and awareness, in accordance with the food policy stated. The collected data were analyzed using descriptive statistical analysis. The Likert scale was used to determine the level of awareness and the food habit scores, and the Mann-Whitney U-test was used to determine the differences between the males and females. Spearman's correlation coefficient and simple regression analysis were performed to determine the association between the demographic factors and nutritional knowledge and the awareness of males and females. The results demonstrated that, with the exception of living situations, males and females differed significantly (p ≤ 0.01) in their socio-demographic characteristics. When asked about their food habits after the implementation of calorie labeling, the majority of respondents (>50%) gave negative responses, with a significant difference observed between maintaining body weight (p ≤ 0.05) and gaining weight (p ≤ 0.01). According to the Likert scale, there was a significant difference between males and females in terms of knowledge (p ≤ 0.01) and awareness (p ≤ 0.05). An average of 80.53% of males had very high knowledge (4.07) and 65.65% had medium level (3.24) awareness of calorie labeling, while 83.73% of females had very high knowledge (4.17) and 66.50% had medium level (3.32) awareness of calorie labeling. The socio-demographic and lifestyle variables were significantly and positively or negatively associated with calorie label utilization and varied between respondents, according to the Spearman correlation coefficients (r) and simple linear regression analysis. The number of factors that negatively impacted the males' knowledge and awareness was greater than that of the females. In conclusion, among college students, there were numerous gender differences in the demographic and social characteristics. The respondents' knowledge was insufficient, with females outperforming males.

Americans consume more meals away from home at fast-food and dine-in restaurants. The restaurant foods are notorious for their energy density and large portion sizes. The objective of our study was to determine whether or not the addition of calorie information to a restaurant menu affects the calorie content of meals ordered by college students. Study participants were selected from a random sample of 1,025 undergraduate students (≥ 18 years old). Data analyses included descriptive statistics and both paired-samples and independent-samples t-tests. Our data analysis found a significant difference between the number of calories chosen from the first menu (without calorie labels) versus the second menu (with calorie labels) (p=0.001, 2-tailed). Analysis also showed that there was no significant difference in calories ordered from the first menu versus the second menu for those who had taken a college-level nutrition class and those who had not (p=0.051, 2-tailed). Our findings suggest that menu calorie labels can positively affect college students’ meal selections making them lower in calories; however, no particular group of students was more likely than any other to change their menu selections after seeing the calorie labels. Further research is needed to determine if use of calorie labels will decrease the number of calories ordered at fast-food and dine-in restaurants among other populations.