Abstract
BackgroundThe long-term effect of calorie labeling on fast-food purchases is unclear. McDonald’s voluntarily labeled its menus with calories in 2012, providing an opportunity to evaluate this initiative on purchases.MethodsFrom 2010 to 2014, we collected receipts from and administered questionnaires to 2971 adults, 2164 adolescents, and 447 parents/guardians of school-age children during repeated visits to 82 restaurants, including McDonald’s and five control chains that did not label menus over the study period in four New England cities. In 2018, we analyzed the data by using difference-in-differences analyses to estimate associations of calorie labeling with calories purchased (actual and estimated) and predicted probability of noticing calorie information on menus.ResultsCalorie labeling at McDonald’s was not associated with changes in calories purchased in adults (change = − 19 cal pre- vs. post-labeling at McDonald’s compared to control chains, 95% CI: − 112, 75), adolescents (change = − 49 cal, 95% CI: − 136, 38), or children (change = 13 cal, 95% CI: − 108, 135). Calorie labeling generally increased the predicted probability of noticing calorie information, but did not improve estimation of calories purchased.ConclusionsCalorie labeling at McDonald’s was not associated with changes in calories purchased in adults, adolescents, or children. Although participants were more likely to notice calories on menus post-labeling, there was no improvement in ability to accurately estimate calories purchased.
Highlights
The long-term effect of calorie labeling on fast-food purchases is unclear
We did not observe associations of calorie labeling by these characteristics in adults. In this natural experiment of adults, adolescents, and children, we found that McDonald’s voluntary calorie labeling was not associated with large overall changes in calorie content of meals purchased compared to unlabeled fast-food restaurant meals
Our main results are consistent with most previous studies conducted in fast-food restaurants using a natural experiment design [12,13,14,15,16,17, 20], which have generally found that calorie labeling is associated with noticing calorie information but not with calories purchased
Summary
The long-term effect of calorie labeling on fast-food purchases is unclear. McDonald’s voluntarily labeled its menus with calories in 2012, providing an opportunity to evaluate this initiative on purchases. Care Act (ACA) [1] Policymakers adopted this requirement to increase awareness of the calorie content of prepared food purchased outside the home, especially restaurant food, where calories are underestimated by restaurant patrons [2,3,4]. The federal policy preempted city and state laws requiring calorie labeling, establishing uniform requirements for chain food establishments across the country [5]. Due to several delays in implementation of the law [5], many large restaurant chains began voluntarily posting calories on their menus before it was required, including
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