Menu Calorie Labeling Research Articles

A Survey on the Knowledge, Attitude, and Practice of Students at Jazan University Regarding Calorie Menu Labeling in Restaurants and a Literature Review.

The global rise in obesity and related health complications has cast a spotlight on the urgent need for initiatives that promote informed dietary decisions. This cross-sectional study investigates the knowledge, attitudes, and practices of university students at Jazan University, Saudi Arabia, regarding menu calorie labeling. The study examines how these variables may affect dietary decisions, body mass index (BMI), and support for proposed legislative measures requiring calorie disclosure on restaurant menus. The study included 581 Saudi university students who were 18 years of age or older as a convenience sample. A three-part questionnaire that asked about demographics, anthropometric measurements, and attitudes and behaviors related to calorie counting was completed by the participants. Using the Statistical Product and Service Solutions (SPSS, version 25.0; IBM SPSS Statistics for Windows, Armonk, NY) program, chi-square, t-tests, and ANOVA tests were used to evaluate the data. Both informed consent and ethical approval were obtained. The study finds that, even while more than half of the participants knew their recommended daily calorie intake and exhibited curiosity about calorie information on menus, this knowledge did not always result in healthy eating habits. Participants' opinions and behaviors regarding calorie labeling were significantly correlated with their BMI levels, indicating the importance of education in promoting nutritional awareness and healthy eating habits. New calorie labeling regulations received higher approval from people who regularly ate out. This study emphasizes the necessity of comprehensive nutritional education initiatives to raise calorie knowledge and encourage Saudi Arabian university students to make healthier eating choices. It also emphasizes the possible effects of legislative measures requiring calorie information on menus, particularly among regular diners. However, while evaluating the results, it is important to take into account the study's limitations, including self-reported data and convenience sample. To support menu calorie labeling legislation and inform targeted public health interventions for university students' eating behaviors, more research that takes cultural quirks and regional settings into account is necessary.

Response of the consumers to the menu calorie-labeling on online food ordering applications in Saudi Arabia

BackgroundThe use of online food ordering applications is widespread; however, to date, there have been no studies on the effect of the menu calorie labeling in online food ordering applications on the consumers’ dietary habits and food choices in Saudi Arabia. Therefore, this study aimed to evaluate the response of the consumers to the menu energy-labeling on online food ordering applications in Saudi Arabia by exploring: (a) the consumers’ preference and frequency of ordering from online food applications; (b) the consumers' self-reported knowledge, awareness, and interest towards menu calorie information on online food ordering applications; (c) the impact of menu calorie information on online food ordering applications on consumers’ food choices.MethodsThis is a cross-sectional study conducted between October and November of 2022. A total of 419 participants were recruited using an online questionnaire.ResultsThe findings showed that most participants (59%) preferred to order using online food ordering applications. Saving time and effort are the main reasons for using online food ordering applications (61%). Nearly half of the participants (45%) were interested in viewing calorie information on online food ordering applications menus and (47%) did notice calorie information displayed on the menu when ordering from an online food ordering application. Calorie information in online food ordering applications menus is primarily utilized to monitor intake for weight maintenance (19%). The ability to calculate energy requirements and interest in viewing calorie information on online food ordering applications menus were linked to younger age and a higher level of education (p < 0.05).ConclusionsOverall, consumers showed limited awareness and interest towards the menu calorie information displayed in the online food ordering applications. These findings highlight the importance of developing public health programs to increase public awareness about calorie labeling on menus to aid in the success and effectiveness of the calorie labeling in online food ordering applications as a tool to promote balanced energy intake. Further research is needed to understand the most effective way to deliver calorie information to consumers on an online food ordering application.

The Impact of Restaurant Menu Calorie Labels on Restaurant Revenue and Profit: Evidence From a Randomized Controlled Trial

In 2018, the United States implemented a nationwide law requiring chain restaurants with more than 20 units to post calorie counts next to each of their menu items. Previously, individual cities, counties, and states had passed such laws, and certain chains had voluntarily posted calorie counts. Despite the widespread nature of this practice, the effect of calorie counts on restaurant outcomes is still not well understood. This paper estimates the impact of restaurant menu calorie labels on four important outcomes: 1) restaurant revenue; 2) restaurant profit; 3) the labor time of kitchen staff; and 4) patrons’ support for calorie labels. We estimate these impacts by conducting a randomized controlled experiment in two full-service restaurants. The results indicate that posting calorie counts on menus has no detectable negative impact on restaurants – the impacts on revenue, profit, and labor time are indistinguishable from zero. Moreover, exposure to the labels increases patrons’ support of restaurant menu calorie labels by 14.3% and reduces their opposition to them by 27.1%. Altogether, these results suggest that posting calorie counts does not harm restaurants, and are appealing to consumers.

Public's calorie literacy and perceived effectiveness of restaurant menu calorie labeling in the United Arab Emirates.

Restaurant menu calorie labeling is regarded as a promising, cost-effective, and innovative method that will have an impact on the food environment, raise awareness among consumers, and aid in global efforts to prevent obesity. This study aimed to assess the public's calorie literacy, dining practices, and perceived effectiveness of restaurant menu labeling implementation in the United Arab Emirates (UAE). A descriptive, web-based cross-sectional study was conducted among 1279 adults in the UAE. Socio-demographic characteristics, calorie literacy, and perceived effectiveness of restaurant menu labeling among participants were investigated. Chi-square analysis was used to compare indicators across demographic characteristics. More females than males completed the online survey, (56.1% and 43.9%). Most of the participants aged < 30 years old (54.8%), The majority of participants reported eating away from home at least once per week (89.6%). 66.0% of participants were knowledgeable about calorie definition, but only 37.1% knew about average daily energy requirements. Younger participants, with a normal BMI, and higher education levels reported a significantly higher likelihood of eating at a chain restaurant with caloric information on the menu (p <0.05). The majority of participants (76.0%) preferred to see calorie information and other nutrition information on menus. To conclude, menu labeling is a welcomed policy to be implemented in food outlets. Further investigation is necessary to ascertain the most efficacious method of presenting nutrition information to consumers to facilitate informed purchasing decisions considering the potential benefits of mandating calorie declaration in obesity prevention efforts.

The impact of the federal menu labeling law on the sentiment of Twitter discussions about restaurants and food retailers: An interrupted time series analysis

The US federal menu labeling law, implemented on May 7 th 2018, required that restaurant chains post calorie counts on menu items. The purpose of this study was to analyze the change in public sentiment, using Twitter data, regarding eight restaurant chains before and after the calorie labeling law’s implementation.Twitter data was mined from Twitter’s application programming interface (API) for this study from the calendar year 2018; 2016 and was collected as a control. We selected restaurant chains that had a range of compliance dates with the law. Tweets about each chain were filtered by brand-specific keywords, and Valence Aware Dictionary and sEntiment Reasoner (VADER) sentiment analysis was applied to receive a continuous compound score (−1–1) of how positive (1) or negative (−1) each tweet was. Controlled Interrupted Time Series (CITS) was performed with Ordinary Least Squares (OLS) Regression on 2018 and 2016 series of compound scores for each brand, and level and trend changes were calculated.Most restaurant chains that implemented the federal menu calorie labeling law experienced no change or a small change in level or trend in sentiment after they implemented labeling. Chains experienced mildly more negative sentiment right after the law was implemented, with attenuation of this effect over time.Calorie labeling did not have a strong effect on the public’s perception of food brands over the long-term on Twitter and may imply the need for greater efforts to change the sentiment towards unhealthy restaurant chains.

Menu Calorie Label Use and Diet Quality: a Cross-Sectional Study

Menu calorie labeling has been implemented in food service businesses to promote healthy food choices; however, evidence is limited on whether label use is associated with healthier dietary intake. This study examined the association between menu calorie label use and diet quality and whether it varied by weight status. Adults in the National Health and Nutrition Examination Survey 2017-2018 who visited restaurants were included. Menu calorie label use was categorized as did not notice labels, noticed labels, and used labels. Diet quality was measured using the Healthy Eating Index 2015 (maximum score 100) by two 24-hour diet recalls. The association between menu calorie label use and diet quality was examined using multiple linear regression and tested for effect modification by weight status. Data were collected during 2017-2018 and analyzed during 2022-2023. Of 3,312 participants (representing 195,167,928 U.S. adults), 43% did not notice labels, 30% noticed labels, and 27% used labels. Using labels was associated with 4.0 points (95% CI 2.2, 5.8) higher Healthy Eating Index 2015 scores than not noticing labels. Healthy Eating Index 2015 scores in those using labels were higher for adults with normal BMI (3.4 points; 95% CI=0.2, 6.7), overweight (6.5 points; 95% CI=3.6, 9.5), and obesity (3.0 points; 95% CI=1.0, 5.1) (p-interaction=0.0004) than those who did not notice labels. Using menu calorie labels was associated with modestly healthier diet quality than not noticing labels, regardless of weight status. This suggests that providing caloric information may help some adults with food decisions.

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.

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.

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.

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.

Attention mediates restrained eaters’ food consumption intentions

Restrained eaters are chronic dieters who pay attention to their food choices, intend to eat healthier foods, but commonly suffer from obesity. With obesity rates continuing to rise, public policy makers are attempting to help consumers battle this disease. Accordingly, the Affordable Care Act menu labeling provision was passed in the United States, and requires restaurants to include calorie labeling on their menus. The literature on the effectiveness of menu calorie labeling has yielded mixed results thus far. We propose that is because the initiative helps certain individuals, but not others. Since individuals do not often accurately self-report their attention to menu calorie labeling due to social desirability bias, we utilize an eye-tracking methodology that focuses on the time consumers spent looking at menu calorie information. This (attention) measure is seen as a mediating process by which restrained eating reduces caloric intake intentions. Our results point to menu calorie labeling being effective for restrained eaters, a group in need of assistance.

Factors Influencing Customers' Behavior toward Eating Healthy Food in Restaurants at Minia Governorate in Egypt

The research aimed to examine the factors influencing customers' behavior towards eating healthy food at Minia district restaurants in Minia governorate in Egypt. The research used a quantitative approach and conducted descriptive-analytical methodology by using a questionnaire. The inhabitants of Minia district were the population of the research who visit 52 main restaurants in Minia. Five hundred questionnaires were distributed to restaurants' customers as a sample of the research, 385 returned questionnaires were valid to analyze with a response rate of 77 % of distributed questionnaires. The data were analyzed using descriptive statistics, regression, T-Test, and Anova by using SPSS 22. The results showed that the averages of restaurant customers' affective attitude; injunctive and descriptive norms; perceived behavioral control; behavioral intentions; behavior were moderate, which might cause obesity and its diseases to customers. Moreover, perceived health problems of eating high-calorie foods; positive outcomes of eating healthy food; affective and cognitive attitudes; injunctive and descriptive norms; perceived behavior control had a significant influence on customers' behavioral intentions towards eating healthful food in restaurants. Customers' behavioral intention also had a significant influence on their eating healthy food behavior. There were only significant differences between customers' educational levels, where customers who got secondary school were better than those who got bachelor degree towards eating healthy behavior. Menu calorie labeling; Healthy food; Theory of planned behavior, Behavioral intentions, Customer behavior.

Health and Economic Impacts of the National Menu Calorie Labeling Law in the United States: A Microsimulation Study.

Excess caloric intake is linked to weight gain, obesity, and related diseases, including type 2 diabetes mellitus and cardiovascular disease (CVD). Obesity incidence is rising, with nearly 3 in 4 US adults being overweight or obese. In 2018, the US federal government finalized the implementation of mandatory labeling of calorie content on all menu items across major chain restaurants nationally as a strategy to support informed consumer choice, reduce caloric intake, and potentially encourage restaurant reformulations. Yet, the potential health and economic impacts of this policy remain unclear. We used a validated microsimulation model (CVD-PREDICT) to estimate reductions in CVD events, diabetes mellitus cases, gains in quality-adjusted life years, costs, and cost-effectiveness of the menu calorie labeling intervention, based on consumer responses alone, and further accounting for potential industry reformulation. The model incorporated nationally representative demographic and dietary data from National Health and Nutrition Examination Surveys 2009 to 2016; policy effects on consumer diets and body mass index-disease effects from published meta-analyses; and policy effects on industry reformulation, policy costs (policy administration, industry compliance, and reformulation), and health-related costs (formal and informal healthcare costs, productivity costs) from established sources or reasonable assumptions. We modeled change in calories to change in weight using an established dynamic weight-change model, assuming 50% of expected calorie reductions would translate to long-term reductions. Findings were evaluated over 5 years and a lifetime from healthcare and societal perspectives, with uncertainty incorporated in both 1-way and probabilistic sensitivity analyses. Between 2018 and 2023, implementation of the restaurant menu calorie labeling law was estimated, based on consumer response alone, to prevent 14 698 new CVD cases (including 1575 CVD deaths) and 21 522 new type 2 diabetes mellitus cases, gaining 8749 quality-adjusted life years. Over a lifetime, corresponding values were 135 781 new CVD cases (including 27 646 CVD deaths), 99 736 type 2 diabetes mellitus cases, and 367 450 quality-adjusted life years. Assuming modest restaurant item reformulation, both health and economic benefits were estimated to be about 2-fold larger than based on consumer response alone. The consumer response alone was estimated to be cost-saving by 2023, with net lifetime savings of $10.42B from a healthcare perspective and $12.71B from a societal perspective. Findings were robust in a range of sensitivity analyses. Our national model suggests that the full implementation of the US calorie menu labeling law will generate significant health gains and healthcare and societal cost-savings. Industry responses to modestly reformulate menu items would provide even larger additional benefits.

Cost-Effectiveness of the FDA Menu Labeling to Reduce Obesity-Associated Cancer Burden in the United States

Abstract Objectives The FDA menu labeling policy requires chain restaurants with ≥20 outlets to list total calories on menus or menu boards. While obesity is a known risk factor for 13 cancers, the potential impact of this policy on cancer burdens and healthcare costs in the US is unknown. Methods Using a probabilistic cohort state-transition model, we estimated the health impacts, costs, and cost-effectiveness of the FDA menu labeling policy on reducing calorie intake, subsequent weight change, and obesity-related cancer cases among US adults over a lifetime. Baseline demographics and calorie intake from restaurants were estimated using NHANES 2013–2016. Based on published meta-analyses, we assumed that labeling would reduce calorie intake per meal by 7.3%, evaluated with and without an additional 5% reduction through industry reformulations; and assumed only half of these calorie reductions would be sustained by individuals throughout their day (i.e., to account for potential calorie compensation outside restaurants). Changes in BMI were derived from published energy models (0.45 kg lower long-term weight per 55 kcal/d calorie reduction). National cancer rates and healthcare costs were obtained from published sources. Uncertainties of inputs were incorporated in probabilistic sensitivity analyses using 1000 simulations. Results The FDA menu labeling policy was estimated to prevent 31,300 (95% UI: 27,600–35,500) new cancer cases and 18,700 (16,400–21,300) cancer deaths, gaining 134,000 (117,000–153,000) quality-adjusted life years (QALYs) among US adults over a lifetime. Top three cancers prevented were endometrial, post-menopausal breast, and kidney. Accounting for policy implementation and healthcare costs, the policy was net cost saving at $1.74B ($1.55–$1.95B) and $1.76B ($1.46–$2.09B) from healthcare and societal perspectives, respectively. A modest industry response (5% calorie reduction) would prevent a total of 51,800 new cancer cases (47,900–56,400) and 30,900 cancer deaths (28,600–34,000) and increase net savings to $2.87B ($2.68–$3.12B) and $3.19B ($2.86–$3.54B), respectively. Conclusions Our model suggests implementation of the FDA menu calorie labeling policy would substantially reduce incident cancers and deaths and be cost-saving, with even larger effects if accompanied by modest industry reformulation. Funding Sources NIH/NIMHD.

Does Information Disclosure Improve Consumer Knowledge? Evidence from a Randomized Experiment of Restaurant Menu Calorie Labels

The United States, in 2018, implemented a nationwide requirement that chain restaurants disclose calorie information on their menus and menu boards. This law was motivated by concern that consumers underestimate the number of calories in restaurant food, but it remains unclear the extent to which this information disclosure affects consumer knowledge. This paper fills that gap by estimating the impact of information disclosure on consumer knowledge through a randomized controlled field experiment of calorie labels on the menus of a full-service restaurant. The results indicate that information disclosure significantly reduces the extent to which consumers underestimate the number of calories in restaurant food; the labels improve the accuracy of consumers’ post-meal estimates of the number of calories they ordered by 4.0 percent and reduces by 28.9% the probability of underestimating the calories in one’s meal by 50% or more, both of which are statistically significant. However, even after information disclosure, there remains considerable error in consumer beliefs about the calorie content of the restaurant food they ordered. Even among the treatment group who received calorie labels, the average absolute value of percent error in their report is 34.2%.

Use of research evidence in state health policymaking: Menu labeling policy in California.

Addressing the translational gap between research evidence and state health policy requires an understanding of the current use of research evidence in the state policymaking process. In this study, we explore the use of research evidence to inform the legislative debate about restaurant nutrition labeling policy in California. In 2008, California was the first state to enact a mandatory menu calorie labeling policy in the U.S. Using a qualitative approach, we examine data sources and types of evidence used in legislative documents (n = 87) related to six menu labeling bills introduced in California’s state legislature between 2003 and 2008. Federal- and state-level government agency reports were the most frequently cited sources of technical knowledge. Advocacy coalition members who were active participants involved in the policy debate were also cited as experts. Five of the six bills included evidence in related legislative documents. While documents included considerable evidence on the magnitude and severity of the obesity problem to justify policy enactment, there were a limited number of statements referring to policy effectiveness and only one statement identified attesting to implementation context and acceptability. Reference to evidence on related policy suggests policy precedence may also play an important role in policy decision making. There is a need to improve the dissemination of obesity policy effectiveness and implementation studies in a politically time sensitive manner to influence state health policy debates. Strategies are discussed to effectively integrate the use of research evidence in the state health policymaking process.

Cost-Effectiveness of the U.S. Federal Restaurant Menu Calorie Labeling Law for Improving Diet and Health: A Microsimulation Modeling Study (P22-014-19)

ObjectivesExcess caloric intake is linked to weight gain, obesity and related diseases including type 2 diabetes and cardiovascular disease (CVD). Obesity incidence has been on the rise, with almost 2 of 3 people being overweight or obese in the US. In 2018, the US federal government passed a law mandating the labeling of calories on all menu items across chain restaurants, as a strategy to support informed consumer choice and reduce caloric intake. Yet, potential health and economic impacts of this policy remain unclear. MethodsWe used a validated microsimulation model (CVD-PREDICT) to estimate reductions in CVD events, diabetes cases, gains in quality-adjusted life-years (QALYs), costs, and cost-effectiveness of two policy scenarios: (1) implementation of the federal menu calorie labelling (menu calorie label), and (2) further accounting for corresponding industry reformulation (menu calorie label + reformulation). The model utilized nationally representative demographic and dietary data from NHANES 2009–2016; policy effects on consumer intake and BMI-disease effects from published meta-analyses; and policy effects on industry reformulation, policy costs (policy administration, industry compliance and reformulation) and health-related costs (formal and informal healthcare costs, productivity costs) from established sources. We conservatively modeled change in calories to change in weight using an established dynamic weight-change model. Findings were evaluated over 10 years and lifetime from a healthcare and societal perspective. Costs were inflated to constant 2018 USD, and costs and QALYs were discounted at 3% annually. We performed probabilistic analyses and a range of one-way sensitivity and subgroup analyses to assess the robustness of our findings. ResultsSample statistics were shown (Table). American adults (35+) consume ∼21% calorie from restaurants (Figure) that would be reduced by 2% due to this law at the population level. Government administration costs were estimated at 11.6$M, industry compliance costs at 652$M, and industry reformulation costs at 9.2$B. Findings for all other analyses will be presented at the meeting. ConclusionsThese findings will provide much needed evidence on the health and economic impacts of the US menu calorie labeling law. Funding SourcesNIH, AHA. Supporting Tables, Images and/or Graphs▪▪

Understanding the Calorie Labeling Paradox in Chain Restaurants: Why Menu Calorie Labeling Alone May Not Affect Average Calories Ordered

Menu calorie labeling is now required nationwide for chain restaurants in the United States; however, a number of studies have found that calorie labeling does not reduce average calories ordered. This research examines how different food value orientations are associated with divergent consumer responses to restaurants providing calorie information on menus and menu boards. Results from two pilot studies and two experiments, including a restaurant field experiment, indicate that calorie labeling is effective in decreasing the number of calories ordered by health value–oriented consumers. However, for quantity value and taste value–oriented consumers, menu calorie labeling may result in an increase in calories ordered. These influences counterbalance one another, leading to an overall nonsignificant effect of calorie labeling on calories ordered in restaurant settings. These findings offer a compelling explanation for the many studies showing nonsignificant effects of menu calorie labeling and inform ongoing policy debates regarding chain restaurants nationally implementing menu calorie labeling. The conceptual contributions and implications of these findings for public policy and consumer well-being are discussed.

Menu labels, for better, and worse? Exploring socio-economic and race-ethnic differences in menu label use in a national sample

Menu calorie labeling aims to empower customers to make healthier food choices, but researchers have questioned whether labels will empower those with greater health literacy, literacy or numeracy more, possibly reinforcing race-ethnic or socioeconomic inequalities in obesity. The goal of this study was to investigate differences in seeing and using restaurant menu calorie labels and whether differences have compounded over time.Using data from three rounds of the National Health and Nutrition Examination Survey covering the period 2007–2014, we investigate race-ethnic and socio-economic differences in menu label usage over time adjusting for sex, age and body weight.While menu label usage increased over time, not all groups increased their use equally. While we find that Blacks and Hispanics use labels more than Whites in sit-down restaurants, more educated individuals, higher income groups and Whites each increased the degree to which they saw and/or used labels in certain settings compared with other groups.This study reinforces concerns that menu-calorie labeling may exacerbate socio-economic and certain race-ethnic obesity differences.As menu labeling policy moves forward to be implemented federally, more attention may need to be diverted to educational campaigns accompanying the implementation and improving the labels so the information is easier to use.

Adoption and Design of Emerging Dietary Policies to Improve Cardiometabolic Health in the US.

Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains-food prices, reformulation, marketing, labeling, and government food assistance programs-appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the US and key elements crucial to define in designing such policies are not well established. We created an inventory of recent US dietary policy cases aiming to improve cardiometabolic health and assessed the extent of their proposal and adoption at federal, state, local, and tribal levels; and categorized and characterized the key elements in their policy design. Recent federal dietary policies adopted to improve cardiometabolic health include reformulation (trans-fat elimination), marketing (mass-media campaigns to increase fruits and vegetables), labeling (Nutrition Facts Panel updates, menu calorie labeling), and food assistance programs (financial incentives for fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant and Children (WIC) program). Federal voluntary guidelines have been proposed for sodium reformulation and food marketing to children. Recent state proposals included sugar-sweetened beverage (SSB) taxes, marketing restrictions, and SNAP restrictions, but few were enacted. Local efforts varied significantly, with certain localities consistently leading in the proposal or adoption of relevant policies. Across all jurisdictions, most commonly selected dietary targets included fruits and vegetables, SSBs, trans-fat, added sugar, sodium, and calories; other healthy (e.g., nuts) or unhealthy (e.g., processed meats) factors were largely not addressed. Key policy elements to define in designing these policies included those common across domains (e.g., level of government, target population, dietary target, dietary definition, implementation mechanism), and domain-specific (e.g., media channels for food marketing domain) or policy-specific (e.g., earmarking for taxes) elements. Characteristics of certain elements were similarly defined (e.g., fruit and vegetable definition, warning language used in SSB warning labels), while others varied across cases within a policy (e.g., tax base for SSB taxes). Several key elements were not always sufficiently characterized in government documents, and dietary target selections and definitions did not consistently align with the evidence-base. These findings highlight recent action on dietary policies to improve cardiometabolic health in the US; and key elements necessary to design such policies.