Effects of physical activity calorie expenditure (PACE) labeling: study design and baseline sample characteristics

Anthony J Viera,Derek Hales,Laura Linnan,Seth M Noar,Laura Tuttle,Ziya Gizlice,Feng-Chang Lin,Julie Gras-Najjar,Alice Ammerman,Emily Olsson

doi:10.1186/s12889-017-4710-0

Abstract

BackgroundObesity and physical inactivity are responsible for more than 365,000 deaths per year and contribute substantially to rising healthcare costs in the US, making clear the need for effective public health interventions. Calorie labeling on menus has been implemented to guide consumer ordering behaviors, but effects on calories purchased has been minimal.MethodsIn this project, we tested the effect of physical activity calorie expenditure (PACE) food labels on actual point-of-decision food purchasing behavior as well as physical activity. Using a two-group interrupted time series cohort study design in three worksite cafeterias, one cafeteria was assigned to the intervention condition, and the other two served as controls. Calories from food purchased in the cafeteria were assessed by photographs of meals (accompanied by notes made on-site) using a standardized calorie database and portion size-estimation protocol. Primary outcomes will be average calories purchased and minutes of moderate to vigorous physical activity (MVPA) by individuals in the cohorts. We will compare pre-post changes in study outcomes between study groups using piecewise generalized linear mixed model regressions (segmented regressions) with a single change point in our interrupted time-series study. The results of this project will provide evidence of the effectiveness of worksite cafeteria menu labeling, which could potentially inform policy intervention approaches.DiscussionLabels that convey information in a more readily understandable manner may be more effective at motivating behavior change. Strengths of this study include its cohort design and its robust data capture methods using food photographs and accelerometry.

Highlights

Obesity and physical inactivity are responsible for more than 365,000 deaths per year and contribute substantially to rising healthcare costs in the US, making clear the need for effective public health interventions
We developed the Physical Activity Calorie Expenditure label based on mixed-methods preliminary research [10, 11]
To minimize participant awareness of the intervention differences between cafeterias, coordinators referred to the study by its working title, “Capturing Health Options at Work (CHOW)”, and participants were informed that the purpose of the study was to learn more about decisions made when choosing food away from home in a setting like a workplace cafeteria

Summary

Introduction

Obesity and physical inactivity are responsible for more than 365,000 deaths per year and contribute substantially to rising healthcare costs in the US, making clear the need for effective public health interventions. One policy intervention is the requirement included in the 2010 Patient Protection and Affordable Healthcare Act (ACA) that restaurants post nutrition information on their menus. This requirement expanded upon the 1994 Nutrition Label and Education Act that required standardized nutrition labels on packaged foods. Viera et al BMC Public Health (2017) 17:702 studies have examined the potential effect of physical activity energy equivalent food labeling schemes [9, 10]. Respondents shown the calories plus miles ordered an average of 194 fewer calories compared to no label and 101 fewer compared to those shown the calories-only label [10]

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