Calorie Labeling Research Articles

Characteristics of successful government-led interventions to support healthier populations: a starting portfolio of positive outlier examples

Despite progress on the Millennium and Sustainable Development Goals, significant public health challenges remain to address communicable and non-communicable diseases and health inequities. The Healthier Societies for Healthy Populations initiative...

Assessing public perception and awareness of UK mandatory calorie labeling in the out-of-home sector: Using Twitter and Google trends data.

In 2021 the UK government announced a new obesity policy requiring large out-of-home food outlets to provide mandatory in-store calorie labeling on food and drink items. Public acceptability and engagement with obesity policies could influence the level of impact on wider public health particularly with population-level policies such as calorie labeling. This study aimed to examine public responses and awareness of the policy using social media (Twitter) comments and Google trends data. This study examined responses to social media posts on Twitter (tweets) from the UK Department of Health and Social Care detailing the policy, implementation date and post-implementation information about the policy's enforcement. The sentiments of the tweets were coded and the number of likes and replies extracted. This study utilized google trends to examine public awareness of the policy by extracting weekly relative search volume for relevant phrases such as "calorie labeling." From the 276 replies/quote-tweet extracted, the majority expressed a negative sentiment toward the policy (N=197/71.4%). There were fewer tweets expressing a positive sentiment (N=25/8.7%) and a neutral/no sentiment (N=54/19.6%). There was no difference in the number of "likes" or retweets between tweets expressing positive or negative sentiments. Five themes were identified expressing negative sentiments (most common being negative impacts on eating disorders). Google trends data revealed increased searches for "calorie labels/labeling" during the week of the policy enforcement compared to previous weeks in the last 5years but no significant differences in searches for specific menu calorie labeling. This analysis revealed negative sentiment toward and increased searching of calorie labeling information during the announcement and implementation of the 2021 mandatory calorie labeling policy in England. A greater understanding of public responses to calorie labeling policies may help tailor future policies and public communication strategies.

What is the cost-effectiveness of menu calorie labelling on reducing obesity-associated cancer burdens? An economic evaluation of a federal policy intervention among 235 million adults in the USA

ObjectiveTo assess the impact of menu calorie labelling on reducing obesity-associated cancer burdens in the USA.DesignCost-effectiveness analysis using a Markov cohort state-transition model.SettingPolicy intervention.ParticipantsA modelled population of 235 million adults...

Identifying and Addressing the “Health Halo” Surrounding Plant-Based Meat Alternatives in Limited-Information Environments

In limited-information environments like restaurants, consumers are forced to make health inferences by drawing from the menu or promotional materials or by using their intuition. Understanding such health inferences related to plant-based meat alternatives (PBMAs), which are available at a rapidly growing number of restaurants, is increasingly important. In addition to their clear environmental benefits, PBMAs are widely promoted as being healthier than traditional meat. Across five experiments, results illustrate that although some perceptions of PBMAs are aligned with reality (e.g., environmental friendliness), consumers greatly underestimate calories and nutrition (e.g., fat, sodium) relative to objective values. Additionally, consumers believe PBMAs are substantially healthier than, and decrease disease risk relative to, traditional meat, which is not always true. The currently accepted interventions of calorie labeling and nutrition information disclosure are not enough to attenuate this “health halo.” However, ensuring that consumers actively compare menu items realigns perceptions with reality. The health halo resulting from inferences formed with the limited information available at the point of purchase has numerous implications for public health, sustainable consumerism, and public policy decisions.

A Cross-Sectional Study of Gender Differences in Calorie Labeling Policy among Students: Dietary Habits, Nutritional Knowledge and Awareness.

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.

The Negative Effects of Physical Activity Calorie Equivalent Labels on Consumers' Food Brand Evaluation.

(1) Background: To prevent excessive caloric intake, a food labeling strategy is widely adopted by governments. Physical activity calorie equivalent (PACE) labels prove to be effective in reducing calorie intake. However, previous literature has mainly discussed the effect of PACE labels on consumers’ purchase intention for high-calorie foods but has not analyzed whether consumers evaluate food brands negatively after inhibiting the consumers’ purchase intention for high-calorie foods. Therefore, the aims of this study are to explore the negative effects of PACE labels on consumers’ food brand evaluation and the underlying psychological mechanism. (2) Methods: This study manipulated the two calorie-information labeling (standard calorie label and PACE labels) in two studies, involving potato chips and chocolate products. It also adopted a prevention focus and anticipated enjoyment of food consumption variables to detect the moderation effects between consumers’ promotion focus and PACE labels. (3) Results: Results show that compared with calorie labels, PACE labels have a more negative influence on consumers’ food brand evaluation. Furthermore, consumers stimulated by PACE labels develop a stronger prevention focus, thereby reducing their anticipated enjoyment of food brands, and ultimately leading to lower brand evaluations. In addition, when consumers have a promotion focus before choosing food, PACE labels cannot reduce their anticipated enjoyment and food brand evaluation for food brands. (4) Conclusions: While focusing on the negative effect of PACE labels on consumers’ purchase intention for high-calorie foods, it should also be noted that PACE labels have a negative effect on food brand evaluation. Therefore, food enterprises should try their best to activate consumers’ promotion focus through various environmental cues, so as to avoid a double negative effect on consumers’ food purchases and brand evaluations.

Monitoring the Nutrient Composition of Food Prepared Out-of-Home in the United Kingdom: Database Development and Case Study.

BackgroundHand transcribing nutrient composition data from websites requires extensive human resources and is prone to error. As a result, there are limited nutrient composition data on food prepared out of the home in the United Kingdom. Such data are crucial for understanding and monitoring the out-of-home food environment, which aids policy making. Automated data collection from publicly available sources offers a potential low-resource solution to address this gap.ObjectiveIn this paper, we describe the first UK longitudinal nutritional database of food prepared out of the home, MenuTracker. As large chains will be required to display calorie information on their UK menus from April 2022, we also aimed to identify which chains reported their nutritional information online in November 2021. In a case study to demonstrate the utility of MenuTracker, we estimated the proportions of menu items exceeding recommended energy and nutrient intake (eg, >600 kcal per meal).MethodsWe have collated nutrient composition data of menu items sold by large chain restaurants quarterly since March 2021. Large chains were defined as those with 250 employees or more (those covered by the new calorie labeling policy) or belonging to the top 100 restaurants based on sales volume. We developed scripts in Python to automate the data collection process from business websites. Various techniques were used to harvest web data and extract data from nutritional tables in PDF format.ResultsAutomated Python programs reduced approximately 85% of manual work, totaling 500 hours saved for each wave of data collection. As of January 2022, MenuTracker has 76,405 records from 88 large out-of-home food chains at 4 different time points (ie, March, June, September, and December) in 2021. In constructing the database, we found that one-quarter (24.5%, 256/1043) of large chains, which are likely to be subject to the United Kingdom’s calorie menu labeling regulations, provided their nutritional information online in November 2021. Across these chains, 24.7% (16,391/66,295) of menu items exceeded the UK government’s recommendation of a maximum of 600 kcal for a single meal. Comparable figures were 46.4% (29,411/63,416) for saturated fat, 34.7% (21,964/63,388) for total fat, 17.6% (11,260/64,051) for carbohydrates, 17.8% (11,434/64,059) for sugar, and 35.2% (22,588/64,086) for salt. Furthermore, 0.7% to 7.1% of the menu items exceeded the maximum daily recommended intake for these nutrients.ConclusionsMenuTracker is a valuable resource that harnesses the power of data science techniques to use publicly available data online. Researchers, policy makers, and consumers can use MenuTracker to understand and assess foods available from out-of-home food outlets. The methods used in development are available online and can be used to establish similar databases elsewhere.

Association Between Menus’ Calorie Labels and Students’ Food Choices: A Cross-Sectional Study

A policy that mandates posting calorie information on monitors and printed menus in restaurants was implemented in Saudi Arabia in 2018. This may help consumers make healthier decisions. This study assessed the level of awareness regarding calorie labeling on menus and its association with restaurant food choices among Saudi university students. A cross-sectional study was conducted using 400 female Saudi students at Princess Nourah Bint Abdulrahman University (PNU), Riyadh. Pregnant or lactating students or those who had any dietary restrictions were excluded. An online self-administered questionnaire regarding demographic characteristics, awareness of calorie labeling, and restaurant food choices were used. Pearson’s and MaNemar’s chi-square tests, the odds ratio, and multivariate binary logistic regression were used in the analysis. While 73.5% of the students noticed the calorie labeling on the restaurant’s menus, only 24% of students read it carefully. No statistically significant association was observed between the awareness of calorie labeling and food selection. Comparing good versus poor awareness about labels, 67.7% versus 49% of participants change their food selections based on the calorie information on the menus (p < 0.0007), and 77.8% versus 22.2% select items with fewer calories (p < 0.001). Calorie labeling may be an effective method for improving food choices among those who have an awareness of such and use calorie information. Nevertheless, public health education campaigns are needed to increase awareness of calorie requirements and the value of calorie labeling on restaurant menus.

Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain

Calorie labels for prepared (ie, ready-to-eat) foods are required in large chain food establishments in the US. Large evaluations in restaurants suggest small declines in purchases of prepared foods after labeling, but to the authors' knowledge, no studies have examined how this policy influences supermarket purchases. To estimate changes in calories purchased from prepared foods and potential packaged substitutes compared with control foods after calorie labeling of prepared foods in supermarkets. This controlled interrupted time series compared sales 2 years before labeling implementation (April 2015-April 2017) with sales 7 months after labeling implementation (May 2017-December 2017). Data from 173 supermarkets from a supermarket chain with locations in Maine, Massachusetts, New Hampshire, New York, and Vermont were analyzed from March 2020 to May 2022. Implementation of calorie labeling of prepared foods in April 2017. Purchased items were classified as prepared foods, potential packaged substitutes for prepared foods, or all other (ie, control) foods. The primary outcome was mean weekly calories per transaction purchased from prepared foods, and the secondary outcome was mean weekly calories per transaction purchased from similar packaged items (for substitution analyses). Analyses of prepared and packaged foods were stratified by food category (bakery, entrées and sides, or deli meats and cheeses). Among the included 173 supermarkets, calorie labeling was associated with a mean 5.1% decrease (95% CI, -5.8% to -4.4%) in calories per transaction purchased from prepared bakery items and an 11.0% decrease (95% CI, -11.9% to -10.1%) from prepared deli items, adjusted for changes in control foods; no changes were observed for prepared entrées and sides (change = 0.3%; 95% CI, -2.5% to 3.0%). Labeling was also associated with decreased calories per transaction purchased from packaged bakery items (change = -3.9%; 95% CI, -4.3% to -3.6%), packaged entrées and sides (change = -1.2%; 95% CI, -1.4% to -0.9%), and packaged deli items (change = -2.1%; 95% CI, -2.4% to -1.7%). In this longitudinal study of supermarkets, calorie labeling of prepared foods was associated with small to moderate decreases in calories purchased from prepared bakery and deli items without evidence of substitution to similar packaged foods.

Consumers' Knowledge, Attitudes, and Practices Toward Calorie Labeling in Riyadh City, Saudi Arabia: A Cross-Sectional Assessment.

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.

Is calorie labelling on menus the solution to obesity?

Is calorie labelling on menus the solution to obesity?

“Maybe a little bit of guilt isn’t so bad for the overall health of an individual”: a mixed-methods exploration of young adults’ experiences with calorie labelling

BackgroundMenu labelling, and more specifically calorie labelling, has been posited as an intervention to improve nutrition literacy and the healthfulness of consumers’ food purchases. However, there is some concern calorie labelling may unintentionally trigger or exacerbate disordered eating among vulnerable persons. The purpose of this research was to explore young adults’ experiences with labelling, with a focus on its implications for their relationships with food.MethodsIndividual semi-structured interviews were conducted with participants from a campus-based menu labelling study. Interview data were inductively coded using thematic analysis and supported by survey data assessing disordered eating, body esteem, and related constructs.ResultsThe sample consisted of 13 participants (10 women, 3 men), most of whom perceived themselves as “about the right weight” (62%). Four key themes included: (1) participants’ support of and skepticism about labelling interventions, (2) the identification of knowledge and autonomy as mechanisms of labelling interventions, (3) the role of the individual’s and others’ relationships with food in experiences with labelling, and (4) disordered eating and dieting as lenses that shape experiences with interventions. Participants’ perceptions of and experiences with calorie labels were shaped by gender, body esteem, and disordered eating risk.ConclusionsThe results provide insight into the complexity of young adults’ interactions with labelling interventions and context for future research exploring the unintended consequences of public health nutrition interventions.

Assessment of Fast and Junk Food Consumption and Addiction Among Saudi Population. National Descriptive Study 2020.

Kingdome of Saudi Arabia (KSA) has undergone lifestyle changes that have resulted in unhealthy dietary patterns So this study aims to investigate the frequency, determinants, and the context of Fast Food (FF), and Junk Food (JF) consumption,, to study the effect of the Saudi Food and Drug Authority (SFDA) food related policy, and to study the use of Ministry of Health (MOH) calorie guide among Saudi population all over KSA. Through a cross-sectional study recruited 355 randomly selected Saudis stratified to represent the 20 health regions in KSA through a self-administered and validated questionnaire. Ethical approval was obtained for this work. Results; The majority had age distribution between 20-&lt; 40 y, and 218 (61.4%) were single. The prevalence of FF, and JF consumption was 308 (86.7 %).The most frequently consumed FF in descending order were (French fries, Shawarma, Burger, then Pizza) , while the most frequently consumed JF in descending order were (all kinds of cocoa, and cakes, then Ice cream), and more than half of participants did not drink carbonated soft drinks. Dinner was the main time of consuming FF (79.2%), and soft drinks (55.6%), while sweets were consumed mainly as snack (68.8%). The consumption of FF, and JF were significantly higher among young participants. The most common causes for consuming the above mentioned foods were entertainment 173 (48.5%), eating with friends 100 (28.1%) and due to better taste 92 (25.8%). The majority 48.7% of Saudi were unaware about the SFDA food related policy. Although the use of calorie labeling policy significantly (p&lt;0.05) affected the food choices, reduced the average weekly spending on Saudi Riyal, but not on weight loss. We concluded that FF, and JF consumption among Saudis is a prevalent, and complex problem, indicating a critical need for community-based interventions to change the attitudes and behaviors toward healthy eating.

Fast food menu calorie labeling contexts as complex contributing factors to overeating

The effectiveness of menu calorie labeling in limiting the amount of calories selected has been called into question since it was mandated within the Affordable Care Act. This study examined how contexts that are known to influence motivational and information processing might limit the effectiveness of calorie labeling in order to shed some light on the mixed findings in this area. An online experiment was conducted in which calorie labels were paired or not paired with visual cues in different motivational contexts: greater and lesser variety and energy density choices available. Results contribute to the general conclusion that calorie labels are not particularly effective. Specifically, the only context in which a calorie label succeeded in reducing calories selected was a high variety mix of low and high energy density foods with visual food cues present; however, this type of context elicited the greatest number of calories selected on average, even more than when only highly energy density items were present. The findings from this study add to the body of knowledge about the effectiveness of calorie labeling by defining some boundary conditions on whether and when the presence of calorie labels are likely to reduce caloric intake. This knowledge is helpful in furthering food selection and choice research, but also may help health practitioners design effective intervention strategies.

The Negative Effects of Long Time Physical Activity Calorie Equivalent Labeling on Purchase Intention for Unhealthy Food.

(1) Background: Obesity has become a global epidemic that arouse much attention from governments, companies and scholar. Physical activity calorie equivalent (PACE) labels are introduced as a more effective nudge invention on less-calorie ordering. However, the effects of PACE labels are controversial in previous literature, thus, the research objective is to explore the effects of different PACE labels and furtherly to explore the underlying psychological mechanism; (2) Methods: Across four scenario-based experiments, involving potato chips, chocolate and cookies, this study manipulated the three calorie-information labeling (standard calorie label, long time PACE and short time PACE labels). Meanwhile, the mediating mechanism of the effects involving anticipatory guilt and the moderation effects between consumers’ future self-continuity and PACE labels are also measured; (3) Results: Results show that compared with the short time PACE and calorie labels, the longtime PACE labels have more negative influence on consumers’ purchase intention for unhealthy food. What’s more, the anticipatory guilt has negative effect of PACE labels as consumers are often prone to feeling guilty in the process of unhealthy food consumption. In addition, individuals with high future self-continuity have higher self-control and take more consideration of future outcomes, they are reluctant to choose unhealthy food than others; (4) Conclusions: Unhealthy food with a long time PACE label has more negative effect on consumers’ purchase intention rather than a short time PACE label. At the same time, companies that produce healthy foods should actively participate in the movement to label calories through the PACE labels.

Abstract EP24: Menu Calorie Label Use Is Associated With Healthier Diet Quality In Americans

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.

Effects of calorie labelling and contextual factors on hypothetical coffee shop menu choices

This study examined the effects of calorie labelling and two key contextual factors (reflective motivation and habits) on the calorie content of hypothetical coffee-shop menu choices. In one exploratory (n = 70) and one pre-registered (n = 300) laboratory study (Studies 1 and 2 respectively), participants viewed a hypothetical calorie-labelled or non calorie-labelled menuboard and selected their preferred item(s). Coffee shop drinking habits were measured using the Self-Report Habit Index, and reflective motivation (relating to calorie intake) was assessed with three items asking about watching weight, eating healthily, and reading calorie labels. In Study 2, participants also estimated calories contained in a subset of the menuboard drinks. Results of both studies showed that labelling did not significantly affect the total calorie content of items selected. However, in Study 2, as predicted, there was a trend toward moderation by reflective motivation (p = .056) with less motivated participants showing relatively greater calorie selection when exposed to labelling. Participants with weaker habits took longer to select items (p = .002) but, contrary to predictions, were not more influenced by labelling. Higher reflective motivation was associated with selecting fewer calories (p = .002), correctly recalling the presence/absence of labelling (p = .016) and better estimating calorie content (p < .001). Overall, participants significantly underestimated calories in higher calorie drinks but overestimated calories in lower calorie drinks. The results highlight the importance of contextual factors such as habits and reflective motivation for obesity interventions and are relevant for the UK's introduction of selective mandatory calorie labelling. In some instances, labelling may actually increase intake among those less motivated by health and weight concerns, but further research is needed to substantiate this concern.

Efficacy of calorie labelling for alcoholic and non-alcoholic beverages on restaurant menus on noticing information, calorie knowledge, and perceived and actual influence on hypothetical beverage orders: a randomized trial.

To test the efficacy of calorie labelling for alcoholic and non-alcoholic beverages on restaurant menus on noticing calorie information, calorie knowledge, and perceived and actual influence on hypothetical beverage orders. Participants included upper-level university students of legal drinking age residing in Ontario, Canada (n = 283). Using a between-groups experiment, participants were randomized to view one of two menus: (1) No Calorie Information (control), and (2) Calorie Information adjacent to each beverage. Participants completed a hypothetical ordering task, and measures related to noticing calorie information, calorie knowledge, and actual and perceived influence of calorieinformation on beverages ordered were assessed. Linear, logistic, and multinomial logistic regression models were used to examine the four outcomes. The odds of noticing calorie information were significantly higher in the Calorie Information (72.6%) versus No Calorie Information condition (8.0%) (OR = 43.7, 95%CI: 16.8, 113.8). Compared tothose in the No Calorie Information condition, participants in the Calorie Information condition had significantly lower odds of responding 'Don't know' (OR = 0.04, 95%CI: 0.02, 0.09), underestimating (OR = 0.06, 95%CI: 0.02, 0.2), and overestimating (OR = 0.05, 95%CI: 0.02, 0.2) versus accurately estimating calories in beverages ordered. No significant differences were observed between menu labelling conditions in the calories in beverages ordered or the perceived influence of calorie information on the number of beverages ordered. Exposure to menus with calorie information increased consumers noticing the calorie information, and accurately estimating calories in alcoholic and non-alcoholic beverages ordered. These results have implications for policy-makers considering mandatory menu labelling policy inclusive of alcoholic beverages.

Changes in Calorie Content of Menu Items at Large Chain Restaurants After Implementation of Calorie Labels

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.

What’s the Hold Up? The FDA’s Delayed Implementation of Menu-Labeling Policy

Calorie labeling on menus became a federal law in 2010 but was not implemented until 2018, 8 years after adoption. This study reconstructs the history of the federal menu-labeling mandate using a process-tracing approach and finds that the delays in implementation resulted not from direct agency capture by the regulated industry, but rather from a system of indirect influence whereby lawmakers continue to influence policy-making even after adoption. Excessive legislative control can contribute to substantial implementation delays that undermine legislative intent. However, administrative agencies can serve as trustees to hold elected officials accountable to their own policy commitments.