Abstract
Calorie labeling on menus is required in US chain food establishments with 20 or more locations. This policy may encourage retailers to offer lower-calorie items, which could lead to a public health benefit by reducing customers' calorie intake from prepared foods. However, potential reformulation of restaurant menu items has not been examined since nationwide enforcement of this policy in 2018. To examine the calorie content of menu items at large chain restaurants before and after implementation of federally mandated menu calorie labels. This pre-post cohort study used restaurant menu data from MenuStat, a database of nutrition information for menu items offered in the largest chain restaurants in the US, collected annually from 2012 to 2019. The study comprised 35 354 menu items sold at 59 large chain restaurants in the US. Statistical analysis was conducted from February 4 to October 8, 2021. Nationwide implementation of menu calorie labeling. Changes in menu items' calorie content after restaurant chains implemented calorie labels were estimated, adjusting for prelabeling trends. All menu items, continuously available items, items newly introduced to menus, and items removed from menus were examined separately. Among the 59 restaurant chains included in the study, after labeling, there were no changes in mean calorie content for all menu items (change = -2.0 calories; 95% CI, -8.5 to 4.4 calories) or continuously available items (change = -2.3 calories; 95% CI, -11.5 to 6.3 calories). Items that were newly introduced after labeling, however, had a lower mean calorie content than items introduced before labeling (change = -112.9 calories; 95% CI, -208.6 to -25.2 calories), although there was heterogeneity by restaurant type. Items removed from menus after labeling had similar calorie content as items removed before labeling (change = 0.5 calories; 95% CI, -79.4 to 84.0 calories). In this cohort study of large chain restaurants, implementing calorie labels on menus was associated with the introduction of lower-calorie items but no changes in continuously available or removed items.
Highlights
The calorie menu labeling provision of the 2010 Patient Protection and Affordable Care Act (P.L. 111-148) requires food establishments with 20 or more US locations to post the calorie content of prepared foods on menus alongside the item’s price.[1]
Among the 59 restaurant chains included in the study, after labeling, there were no changes in mean calorie content for all menu items or continuously available items
Items that were newly introduced after labeling, had a lower mean calorie content than items introduced before labeling, there was heterogeneity by restaurant type
Summary
The calorie menu labeling provision of the 2010 Patient Protection and Affordable Care Act (P.L. 111-148) requires food establishments with 20 or more US locations to post the calorie content of prepared foods on menus alongside the item’s price.[1] The goals of the policy, enforced as of May 2018, are to encourage customers to purchase lower-calorie foods (change what consumers demand) and to prompt retailers to offer lower-calorie options (change what restaurants supply) Most evaluations of this policy have examined changes in consumer behavior,[2,3,4,5,6,7,8] with the studies with the largest samples finding 4% to 6% reductions in calories purchased after labeling.[7,8]. Several studies conducted before nationwide implementation of calorie labeling identified small declines in calorie content of restaurant offerings since 2012, for newly introduced items.[10,11,12,13,14] some restaurants in those studies were subject to local calorie labeling regulations, national chains may have waited until the nationwide rollout of calorie labels to consider reformulation rather than respond to local policies that affected only some restaurants
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