Socioeconomic position and the impact of increasing availability of lower energy meals vs. menu energy labelling on food choice: two randomized controlled trials in a virtual fast-food restaurant

Lucile Marty,Eric Robinson,Andrew Jones

doi:10.1186/s12966-020-0922-2

Abstract

BackgroundFood consumed outside of the home is often high in energy and population level interventions that reduce energy intake of people from both lower and higher socioeconomic position (SEP) are needed. There is a lack of evidence on the effectiveness and SEP equity of structural-based (e.g. increasing availability of lower energy options) and information provision (e.g. menu energy labelling) interventions on food choice.MethodsAcross two online experiments, participants of lower and higher SEP made meal choices in a novel virtual fast-food restaurant. To be eligible to take part, participants were required to be UK residents, aged 18 or above, fluent in English, have access to a computer with an internet connection and have no dietary restrictions. Participants were randomized to one of four conditions in a 2 × 2 between-subjects design: menu energy labelling present vs. absent and increased availability of lower energy options (75% of menu options lower energy) vs. baseline availability (25% of menu options lower energy). Participants also completed measures of executive function and food choice motives.ResultsThe analysis of pooled data from both studies (n = 1743) showed that increasing the availability of lower energy options resulted in participants ordering meals with significantly less energy on average (− 71 kcal, p < 0.001, partial η2 = 0.024) and this effect was observed irrespective of participant SEP. Menu labelling had no significant effect on energy ordered (− 18 kcal, p = 0.116, partial η2 = 0.001) in participants from both higher and lower SEP. Furthermore, we found no evidence that executive function or food choice motives moderated the effect of increasing lower energy menu options or energy labelling on total energy ordered.ConclusionsIn a virtual fast-food environment, energy labelling was ineffective in reducing total energy ordered for both higher and lower SEP participants. Increasing the availability of lower energy options had an equitable effect, reducing total energy ordered in participants from higher and lower SEP.Trial registrationStudy protocols and analysis plans were pre-registered on the Open Science Framework (https://osf.io/ajcr6/).

Highlights

Food consumed outside of the home is often high in energy and population level interventions that reduce energy intake of people from both lower and higher socioeconomic position (SEP) are needed
We found no evidence that participant SEP moderated the effect of availability or energy labelling on total energy ordered, irrespective of whether SEP was based on education level, household income or subjective SEP
Given that there is need to consider whether policies can ameliorate SEP inequalities in obesity [62], the present findings suggest that neither increasing availability of lower energy options nor energy labelling in fast food restaurants are likely to directly achieve this aim by altering the food choices of lower vs. higher SEP populations

Summary

Introduction

Food consumed outside of the home is often high in energy and population level interventions that reduce energy intake of people from both lower and higher socioeconomic position (SEP) are needed. The frequency by which people eat out of the home is associated with greater daily energy intake and overweight/obesity [5,6,7] This relationship may be explained by the excessive energy content of the meals in both full service and fast- food restaurants [8]. In the context of the overweight and obesity crisis and social inequalities in diet and health, these findings underline the need to identify effective interventions that can reduce the amount of energy (kcal) ordered and consumed in the OOH food sector and in fast-food settings [12,13,14]

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