Paradoxical effect of a nutrition labelling scheme in a student cafeteria

U.S. adults noticing and using menu calorie information: Analysis of the National Cancer Institute's Health Information National Trends Survey Data

FDA's Menu Labeling Final Rule requires covered establishments provide calorie information on menus or menu boards, among other requirements. This study describes correlates of noticing and using menu calorie information in a nationally representative sample of U.S. adults before implementation of the Final Rule in May 2018. Data from the 2018 National Cancer Institute Health Information National Trends Survey was used to assess noticing menu calorie information, using menu calorie information to change menu ordering behavior, and knowledge of daily calorie needs. Regression analysis of weighted data tested associations between individual characteristics and noticing and using menu calorie information. Nearly half of adults (44%) reported noticing menu calorie information. Women, younger individuals, those who seek health information, individuals with a BMI ≥ 30, and those with higher education or higher income were more likely to report noticing menu calorie information. Among adults who reported noticing menu calorie information, three-quarters responded by ordering less (e.g., fewer calories), which equates to about one-third of the population. About 36% of women and 42% of men lacked calorie knowledge. Men with, versus without, calorie knowledge were twice as likely to report noticing menu calorie information (adjusted OR 2.23 95% CI 1.51, 3.29). Findings suggest behavioral response to menu calorie information varies and most individuals who notice the information respond by ordering less in ways that could reduce caloric intake. Future analyses could compare noticing and using menu calorie information before and after menu labeling implementation to assess the effect of policy on population behaviors.

"I'll try the veggie burger": Increasing purchases of sustainable foods with information about sustainability and taste

Food production--especially raising animals for meat--has a massive negative impact on the environment and contributes to global warming. To address this, we investigated whether information about food sustainability would increase purchases of sustainable foods by patrons of university cafés. In Study 1, patrons were randomly assigned either to see a menu that had sustainability labels indicating the degree of environmental impact of each item, or to see a menu without labels. Women who saw the labels were significantly more likely to purchase sustainable foods, whereas men were not influenced by the labels. In Study 2 we targeted one sustainable menu item (a veggie burger) and, in a 2 (sustainability) x 2 (taste) design, varied whether patrons learned that the veggie burger was especially sustainable or especially tasty. Women were significantly more likely to purchase the veggie burger if they learned it was sustainable or tasty, but again, the manipulations had no effect on men. We discuss why women are more likely to change their food choices to eat more sustainably than are men.

The effects of nudges on purchases, food choice, and energy intake or content of purchases in real-life food purchasing environments: a systematic review and evidence synthesis

Background

Adults with a low socioeconomic position (SEP) are more likely to engage in unhealthy diets as compared to adults with high SEP. However, individual-level educational interventions aiming to improve food choices have shown limited effectiveness in adults with low SEP. Environmental-level interventions such as nudging strategies however, may be more likely to benefit low SEP groups. We aimed to review the evidence for the effectiveness of nudges as classified according to interventions in proximal physical micro-environments typology (TIPPME) to promote healthy purchases, food choice, or affecting energy intake or content of purchases, within real-life food purchasing environments. Second, we aimed to investigate the potentially moderating role of SEP.

Methods

We systematically searched PubMed, EMBASE, and PsycINFO until 31 January 2018. Studies were considered eligible for inclusion when they i) complied with TIPPME intervention definitions; ii) studied actual purchases, food choice, or energy intake or content of purchases, iii) and were situated in real-life food purchasing environments. Risk of bias was assessed using a quality assessment tool and evidence was synthesized using harvest plots.

Results

From the 9210 references identified, 75 studies were included. Studies were generally of weak to moderate quality. The most frequently studied nudges were information (56%), mixed (24%), and position nudges (13%). Harvest plots showed modest tendencies towards beneficial effects on outcomes for information and position nudges. Less evidence was available for other TIPPME nudging interventions for which the harvest plots did not show compelling patterns. Only six studies evaluated the effects of nudges across levels of SEP (e.g., educational level, food security status, job type). Although there were some indications that nudges were more effective in low SEP groups, the limited amount of evidence and different proxies of SEP used warrant caution in the interpretation of findings.

Conclusions

Information and position nudges may contribute to improving population dietary behaviours. Evidence investigating the moderating role of SEP was limited, although some studies reported greater effects in low SEP subgroups. We conclude that more high-quality studies obtaining detailed data on participant’s SEP are needed.

Registration

This systematic review is registered in the PROSPERO database (CRD42018086983).

Nutrient Profiling Systems, Front of Pack Labeling, and Consumer Behavior

PURPOSE OF REVIEW

Guiding consumers toward more healthful food choices may help address the high prevalence of poor dietary quality and diet-related diseases. The use of front-of-package labels (FOPL) on food items is expanding to provide focused nutritional information or representations, often based upon nutrient profiling systems.

RECENT FINDINGS

FOPL provide a source of nutrition and health information that is readily understood by consumers, including those with limited literacy. There is evidence that FOPL can shift consumer behavior toward more nutritious and healthful choices. However, assessments of the effectiveness of FOPL have been restricted in scope and rely largely on simulation models rather than real-world environments. FOPL are a direct source of nutritional guidance at the point-of-purchase and provide an opportunity to convey critical information on ingredients that are associated with health promotion and/or increased risk of non-communicable diseases. However, limited evidence regarding the most effective forms of FOPL to achieve behavior change and challenges from the food industry impedes the establishment of standardized nutrient profiles and algorithms. Future opportunities for FOPL include the potential for integrating nutritional profiles with non-nutrient factors affecting health such as food processing and environmental sustainability.

Influence of the nutrition and health information presented on food labels on portion size consumed: a systematic review

Context

In recent decades, portion sizes have increased significantly. Although previous research indicates that food labels impact on product choice and healthiness perception, their impact on portion sizes consumed is less clear.

Objective

This systematic review examined whether food label information influenced portion size consumption.

Data sources

A search of 7 major electronic databases for studies published from 1980 to April 2016 was conducted.

Data extraction

Two reviewers independently screened 11 128 abstracts. Data were extracted from 32 articles (comprising 36 studies).

Results

Based on the test food used, the overall effects were found to be: no effect, a positive effect, or a negative effect. Labels displaying energy content (n = 15 studies, 17 effects) and fat content information (n = 13 studies, 14 effects) were evaluated most commonly, with exercise equivalent labels evaluated least (n = 2 studies, 2 effects).

Conclusions

Nutrition and health information presented on food labels has varying impacts on portion sizes consumed, from increased to decreased intake. Recommendations for future research include evaluating more recent food label types and achieving more consistent reporting standards.

A Meta-Analysis of Food Labeling Effects on Consumer Diet Behaviors and Industry Practices

CONTEXT

The influence of food and beverage labeling (food labeling) on consumer behaviors, industry responses, and health outcomes is not well established.

EVIDENCE ACQUISITION

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Ten databases were searched in 2014 for studies published after 1990 evaluating food labeling and consumer purchases/orders, intakes, metabolic risk factors, and industry responses. Data extractions were performed independently and in duplicate. Studies were pooled using inverse-variance random effects meta-analysis. Heterogeneity was explored with I2, stratified analyses, and meta-regression; and publication bias was assessed with funnel plots, Begg's tests, and Egger's tests. Analyses were completed in 2017.

EVIDENCE SYNTHESIS

From 6,232 articles, a total of 60 studies were identified, including 2 million observations across 111 intervention arms in 11 countries. Food labeling decreased consumer intakes of energy by 6.6% (95% CI= -8.8%, -4.4%, n=31), total fat by 10.6% (95% CI= -17.7%, -3.5%, n=13), and other unhealthy dietary options by 13.0% (95% CI= -25.7%, -0.2%, n=16), while increasing vegetable consumption by 13.5% (95% CI=2.4%, 24.6%, n=5). Evaluating industry responses, labeling decreased product contents of sodium by 8.9% (95% CI= -17.3%, -0.6%, n=4) and artificial trans fat by 64.3% (95% CI= -91.1%, -37.5%, n=3). No significant heterogeneity was identified by label placement or type, duration, labeled product, region, population, voluntary or legislative approaches, combined intervention components, study design, or quality. Evidence for publication bias was not identified.

CONCLUSIONS

From reviewing 60 intervention studies, food labeling reduces consumer dietary intake of selected nutrients and influences industry practices to reduce product contents of sodium and artificial trans fat.

Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption

BACKGROUND

Nutritional labelling is advocated as a means to promote healthier food purchasing and consumption, including lower energy intake. Internationally, many different nutritional labelling schemes have been introduced. There is no consensus on whether such labelling is effective in promoting healthier behaviour.

OBJECTIVES

To assess the impact of nutritional labelling for food and non-alcoholic drinks on purchasing and consumption of healthier items. Our secondary objective was to explore possible effect moderators of nutritional labelling on purchasing and consumption.

SEARCH METHODS

We searched 13 electronic databases including CENTRAL, MEDLINE and Embase to 26 April 2017. We also handsearched references and citations and sought unpublished studies through websites and trials registries.

SELECTION CRITERIA

Eligible studies: were randomised or quasi-randomised controlled trials (RCTs/Q-RCTs), controlled before-and-after studies, or interrupted time series (ITS) studies; compared a labelled product (with information on nutrients or energy) with the same product without a nutritional label; assessed objectively measured purchasing or consumption of foods or non-alcoholic drinks in real-world or laboratory settings.

DATA COLLECTION AND ANALYSIS

Two authors independently selected studies for inclusion and extracted study data. We applied the Cochrane 'Risk of bias' tool and GRADE to assess the quality of evidence. We pooled studies that evaluated similar interventions and outcomes using a random-effects meta-analysis, and we synthesised data from other studies in a narrative summary.

MAIN RESULTS

We included 28 studies, comprising 17 RCTs, 5 Q-RCTs and 6 ITS studies. Most (21/28) took place in the USA, and 19 took place in university settings, 14 of which mainly involved university students or staff. Most (20/28) studies assessed the impact of labelling on menus or menu boards, or nutritional labelling placed on, or adjacent to, a range of foods or drinks from which participants could choose. Eight studies provided participants with only one labelled food or drink option (in which labelling was present on a container or packaging, adjacent to the food or on a display board) and measured the amount consumed. The most frequently assessed labelling type was energy (i.e. calorie) information (12/28).Eleven studies assessed the impact of nutritional labelling on purchasing food or drink options in real-world settings, including purchases from vending machines (one cluster-RCT), grocery stores (one ITS), or restaurants, cafeterias or coffee shops (three RCTs, one Q-RCT and five ITS). Findings on vending machines and grocery stores were not interpretable, and were rated as very low quality. A meta-analysis of the three RCTs, all of which assessed energy labelling on menus in restaurants, demonstrated a statistically significant reduction of 47 kcal in energy purchased (MD -46.72 kcal, 95% CI -78.35, -15.10, N = 1877). Assuming an average meal of 600 kcal, energy labelling on menus would reduce energy purchased per meal by 7.8% (95% CI 2.5% to 13.1%). The quality of the evidence for these three studies was rated as low, so our confidence in the effect estimate is limited and may change with further studies. Of the remaining six studies, only two (both ITS studies involving energy labels on menus or menus boards in a coffee shop or cafeteria) were at low risk of bias, and their results support the meta-analysis. The results of the other four studies which were conducted in a restaurant, cafeterias (2 studies) or a coffee shop, were not clearly reported and were at high risk of bias.Seventeen studies assessed the impact of nutritional labels on consumption in artificial settings or scenarios (henceforth referred to as laboratory studies or settings). Of these, eight (all RCTs) assessed the effect of labels on menus or placed on a range of food options. A meta-analysis of these studies did not conclusively demonstrate a reduction in energy consumed during a meal (MD -50 kcal, 95% CI -104.41, 3.88, N = 1705). We rated the quality of the evidence as low, so our confidence in the effect estimate is limited and may change with further studies.Six laboratory studies (four RCTs and two Q-RCTs) assessed the impact of labelling a single food or drink option (such as chocolate, pasta or soft drinks) on energy consumed during a snack or meal. A meta-analysis of these studies did not demonstrate a statistically significant difference in energy (kcal) consumed (SMD 0.05, 95% CI -0.17 to 0.27, N = 732). However, the confidence intervals were wide, suggesting uncertainty in the true effect size. We rated the quality of the evidence as low, so our confidence in the effect estimate is limited and may change with further studies.There was no evidence that nutritional labelling had the unintended harm of increasing energy purchased or consumed. Indirect evidence came from five laboratory studies that involved mislabelling single nutrient content (i.e. placing low energy or low fat labels on high-energy foods) during a snack or meal. A meta-analysis of these studies did not demonstrate a statistically significant increase in energy (kcal) consumed (SMD 0.19, 95% CI -0.14to 0.51, N = 718). The effect was small and the confidence intervals wide, suggesting uncertainty in the true effect size. We rated the quality of the evidence from these studies as very low, providing very little confidence in the effect estimate.

AUTHORS' CONCLUSIONS

Findings from a small body of low-quality evidence suggest that nutritional labelling comprising energy information on menus may reduce energy purchased in restaurants. The evidence assessing the impact on consumption of energy information on menus or on a range of food options in laboratory settings suggests a similar effect to that observed for purchasing, although the evidence is less definite and also of low quality.Accordingly, and in the absence of observed harms, we tentatively suggest that nutritional labelling on menus in restaurants could be used as part of a wider set of measures to tackle obesity. Additional high-quality research in real-world settings is needed to enable more certain conclusions.Further high-quality research is also needed to address the dearth of evidence from grocery stores and vending machines and to assess potential moderators of the intervention effect, including socioeconomic status.

A Meta-Analysis to Determine the Impact of Restaurant Menu Labeling on Calories and Nutrients (Ordered or Consumed) in U.S. Adults

A systematic review and meta-analysis determined the effect of restaurant menu labeling on calories and nutrients chosen in laboratory and away-from-home settings in U.S. adults. Cochrane-based criteria adherent, peer-reviewed study designs conducted and published in the English language from 1950 to 2014 were collected in 2015, analyzed in 2016, and used to evaluate the effect of nutrition labeling on calories and nutrients ordered or consumed. Before and after menu labeling outcomes were used to determine weighted mean differences in calories, saturated fat, total fat, carbohydrate, and sodium ordered/consumed which were pooled across studies using random effects modeling. Stratified analysis for laboratory and away-from-home settings were also completed. Menu labeling resulted in no significant change in reported calories ordered/consumed in studies with full criteria adherence, nor the 14 studies analyzed with ≤1 unmet criteria, nor for change in total ordered carbohydrate, fat, and saturated fat (three studies) or ordered or consumed sodium (four studies). A significant reduction of 115.2 calories ordered/consumed in laboratory settings was determined when analyses were stratified by study setting. Menu labeling away-from-home did not result in change in quantity or quality, specifically for carbohydrates, total fat, saturated fat, or sodium, of calories consumed among U.S. adults.

A Cross-Sectional Study of the Relationship between Nutrition Label Use and Food Selection, Servings, and Consumption in a University Dining Setting

BACKGROUND

Nutrition labels at the point of purchase are recommended to improve food choice, yet food choice does not always translate into food consumption. It is important to understand the relationship between label use, food selection, servings, and consumption. Previous research, which has relied on self-reported intake or inferred label use or intake based on sales data, has not adequately answered this question.

OBJECTIVE

To combine survey and meal photographic data to compare food selection, servings, and consumption between label users and nonusers.

DESIGN

Diners were surveyed in two cross-sectional waves during the fall 2014 semester. Food selections were recorded, and pre- and postmeal photographs were taken of diners' plate. Photographs were coded to identify the selection, servings, and consumption of MyPlate food categories.

PARTICIPANTS/SETTING

Convenience sample of 1,069 diners (39% women, 53% freshman) in two university dining halls. Students had to be older than age 18 years and just beginning their meal to participate.

MAIN OUTCOME MEASURES

Selection, servings, and consumption of MyPlate food categories for label users and nonusers.

STATISTICAL ANALYSES PERFORMED

Differences in food selection were tested via χ² tests, and differences in adjusted least squares means for servings and consumption were tested via t tests.

RESULTS

A greater proportion of nutrition label users selected fruits, vegetables, and beans and fewer selected potatoes compared with nonusers. In addition, fewer label users selected fried foods and foods with added sugars (all P values <0.05). Label users served themselves and consumed more vegetables and fewer potatoes and refined grains compared with nonusers (all P values <0.05).

CONCLUSIONS

Our results suggest label users behave differently compared with nonusers. Based on the meals observed, these differences appear more qualitative in nature (selecting different foods) than quantitative (selecting more or less food).

Impact of nutritional labelling on 10-d energy intake, appetite perceptions and attitudes towards food

The purpose of this study was to investigate the impact of nutritional labelling on energy intake, appetite perceptions and attitudes towards food. During a 10-d period, seventy normal-weight (BMI<25 kg/m2) and seventy-one obese women (BMI≥30 kg/m2) were given three meals per d under ad libitum conditions. Participants were randomly assigned to one of three experimental labelling groups in which the only difference was the label posted on lunch meal entrée: (1) low-fat label, (2) energy label (energy content of the entrée and average daily needs) and (3) no label (control). Average energy intake was calculated by weighing all foods before v. after daily consumption. Hunger and fullness perceptions were rated on visual analogue scales immediately before and after each meal. Satiety efficiency was assessed through the calculation of the satiety quotient (SQ). The appreciation and perceived healthiness of the lunch entrées were rated on eight-point Likert scales. There was no difference in energy intake, SQ and attitudes towards food between the three labelling groups. Fasting hunger perception was higher in the low-fat label group compared with the two others groups (P=0·0037). No interactions between labelling groups and BMI categories were observed. In conclusion, although labelling does not seem to influence energy intake, a low-fat label may increase women’s fasting hunger perceptions compared with an energy label or no label.

Systematic review and meta-analysis of the impact of restaurant menu calorie labeling

We conducted a systematic review and meta-analysis evaluating the relationship between menu calorie labeling and calories ordered or purchased in the PubMed, Web of Science, PolicyFile, and PAIS International databases through October 2013. Among 19 studies, menu calorie labeling was associated with a -18.13 kilocalorie reduction ordered per meal with significant heterogeneity across studies (95% confidence interval = -33.56, -2.70; P = .021; I(2) = 61.0%). However, among 6 controlled studies in restaurant settings, labeling was associated with a nonsignificant -7.63 kilocalorie reduction (95% confidence interval = -21.02, 5.76; P = .264; I(2) = 9.8%). Although current evidence does not support a significant impact on calories ordered, menu calorie labeling is a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories. These findings are limited by significant heterogeneity among nonrestaurant studies and few studies conducted in restaurant settings.

The influence of menu labeling on calories selected or consumed: a systematic review and meta-analysis

Recent menu labeling initiatives in North America involve posting the calorie content of standard menu items, sometimes with other nutrients of public health concern, with or without contextual information (such as the recommended daily caloric intake for an average adult) or interpretive information (such as traffic light symbols). It is not clear whether this is an effective method to convey nutrition information to consumers wanting to make more-informed food choices. Of particular concern are those consumers who may be limited in their food and health literacy skills to make informed food choices to meet their dietary needs or goals. The purpose of this systematic review was to determine whether the provision of menu-based nutrition information affects the selection and consumption of calories in restaurants and other foodservice establishments. A secondary objective was to determine whether the format of the nutrition information (informative vs contextual or interpretive) influences calorie selection or consumption. Several bibliographic databases were searched for experimental or quasiexperimental studies that tested the effect of providing nutrition information in a restaurant or other foodservice setting on calories selected or consumed. Studies that recruited generally healthy, noninstitutionalized adolescents or adults were included. When two or more studies reported similar outcomes and sufficient data were available, meta-analysis was performed. Menu labeling with calories alone did not have the intended effect of decreasing calories selected or consumed (-31 kcal [P=0.35] and -13 kcal [P=0.61], respectively). The addition of contextual or interpretive nutrition information on menus appeared to assist consumers in the selection and consumption of fewer calories (-67 kcal [P=0.008] and -81 kcal [P=0.007], respectively). Sex influenced the effect of menu labeling on selection and consumption of calories, with women using the information to select and consume fewer calories. The findings of this review support the inclusion of contextual or interpretive nutrition information with calories on restaurant menus to help consumers select and consume fewer calories when eating outside the home. Further exploration is needed to determine the optimal approach for providing this menu-based nutrition information, particularly for those consumers who may be limited in their food and health literacy skills.

Does nutrition information on menus impact food choice? Comparisons across two hospital cafeterias

OBJECTIVE

Food prepared and consumed away from home accounts for a significant proportion of dietary intake among Canadians. Currently, Canadians receive little or no nutrition information when eating in restaurant and fast-food outlets. The present study examined the impact of nutrition information on menus in hospital cafeterias on noticing and perceived influence of nutrition information and on food consumption.

DESIGN

Cross-sectional surveys.

SETTING

Exit surveys (n 1003) were conducted in two hospital cafeterias. The 'intervention' site featured energy (calorie), sodium and fat content on digital menu boards, as well as a health logo for 'healthier' items. The intervention site had also revised its menu items to improve the nutrient profiles. The 'control' site provided limited nutrition information at the point of sale.

SUBJECTS

Cafeteria patrons recruited using the intercept technique.

RESULTS

Significantly more respondents at the intervention site reported noticing nutrition information (OR = 7·6, P < 0·001) and using nutrition information to select their food items (OR = 3·3, P < 0·001) compared with patrons at the control site, after adjusting for sociodemographic factors. Patrons at the intervention site consumed significantly less energy (-21 %, P < 0·001), sodium (-23 %, P < 0·001), saturated fat (-33 %, P < 0·001) and total fat (-37 %, P < 0·001) than patrons at the control site.

CONCLUSIONS

A nutritional programme, including nutrition information on menus and improved nutrition profile of food offerings, was associated with substantial reductions in energy, sodium and fat consumption. The results are consistent with a positive impact of menu labelling.

The impact of nutritional labels and socioeconomic status on energy intake. An experimental field study

There is some evidence for paradoxical effects of nutritional labelling on energy intake particularly amongst restrained eaters and those with a higher body mass index (BMI) resulting in greater consumption of energy from foods with a positive health message (e.g. "low-fat") compared with the same foods, unlabelled. This study aimed to investigate, in a UK general population sample, the likelihood of paradoxical effects of nutritional labelling on energy intake. Participants (n = 287) attended a London cinema and were offered a large tub of salted or toffee popcorn. Participants were randomised to receive their selected flavour with one of three labels: a green low-fat label, a red high-fat label or no label. Participants watched two film clips while completing measures of demographic characteristics, emotional state and taste of the popcorn. Following the experiment, popcorn consumption was measured. There were no main effects of nutritional labelling on consumption. Contrary to predictions neither BMI nor weight concern moderated the effect of label on consumption. There was a three-way interaction between low-fat label, weight concern and socioeconomic status (SES) such that weight-concerned participants of higher SES who saw a low-fat label consumed more than weight unconcerned participants of similar SES (t = -2.7, P = .04). By contrast, weight-concerned participants of lower SES seeing either type of label, consumed less than those seeing no label (t = -2.04, P = .04). Nutritional labelling may have different effects in different socioeconomic groups. Further studies are required to understand fully the possible contribution of food labelling to health inequalities.

A randomized trial of calorie labeling on menus

BACKGROUND

Food consumed outside the home accounts for a growing proportion of the North American diet and has been associated with increased obesity.

PURPOSE

To examine the effect of nutrition labeling on menus on awareness, use, and food consumption, including the impact of "traffic light" labeling and adding other nutrients.

METHODS

Blinded, randomized trial with 635 Canadian adults conducted in 2010-2011. Participants ordered a free meal from one of four experimental menus: 1) no nutritional information shown, 2) calorie amounts only, 3) calorie amounts in "traffic lights", and 4) calorie, fat, sodium, and sugar shown in "traffic lights". Recall of nutrition information, knowledge of calorie content and nutrient consumption were assessed.

RESULTS

Participants in the calorie conditions were more likely to recall the calorie content of meals and to report using nutrition information when ordering. The calorie content of meals was not significantly different across conditions; however, calorie consumption was significantly lower among participants in the Calorie-only condition compared to the No information condition (mean=-96 kcal, p=.048).

CONCLUSIONS

Menu labeling increased awareness and use of nutrition information and reduced consumption. Adding "traffic lights", fat, sodium, and sugar amounts to menus had little impact compared to calorie-only labeling.

Efficacy and consumer preferences for different approaches to calorie labeling on menus

OBJECTIVE

To evaluate the efficacy and consumer preferences of calorie labeling on menus.

DESIGN

Between-group experiment. Participants were randomized to view menu items according to 1 of 4 experimental conditions: no calorie information, calorie-only information, calorie plus health statement (HS), and calorie plus the Physical Activity Scale. Participants selected a snack and then rated menus from all conditions on the level of understanding and perceived effectiveness.

SETTING

University of Waterloo, Canada.

PARTICIPANTS

A total of 213 undergraduate university students recruited from classrooms.

MAIN OUTCOME MEASURES

The calorie amount of menu selection and ratings of understandability and perceived effectiveness.

ANALYSIS

Linear regression models and chi-square tests.

RESULTS

Participants who selected items from menus without calorie information selected snacks with higher calorie amounts than participants in the calorie-only condition (P = .002) and the calorie plus HS condition (P = .001). The calorie plus HS menu was perceived as most understandable and the calorie plus calorie plus Physical Activity Scale menu was perceived as most effective in helping to promote healthy eating.

CONCLUSIONS AND IMPLICATIONS

Calorie labeling on menus may assist consumers in making healthier choices, with consumer preference for menus that include contextual health statements.

How, when and why do young women use nutrition information on food labels? A qualitative analysis

BACKGROUND

Nutrition information (NI) on food packaging offers a public health tool that could be used to promote informed consumer choice and aid consumption of a healthy diet. Research indicates that the use of NI can lead to reduced energy intake and lower BMI, but little evidence is available regarding how, when or why people use NI when making everyday food choices.

METHODS

This qualitative study explored motivations and contexts surrounding the use of NI among 25 UK-based female NI users aged 23-35 years, using semi-structured individual interviews. Verbatim transcripts were analysed using thematic analysis.

RESULTS

Six themes were identified: (1) understanding and (2) functions of NI, (3) health versus appearance motives, NI use in (4) affective and (5) symbolic food episodes, and (6) competing point-of-purchase influences. Notable observations included a difficulty in understanding and converting NI into personally meaningful terms, and eschewal of NI in settings where food plays an affective or symbolic role (e.g. food consumption after a stressful day, buying food for a dinner party).

CONCLUSIONS

We suggest evidence-based directions for future research and offer policy and practice recommendations, including the adoption of clear and consistent NI formats.

Availability and accessibility of healthier options and nutrition information at New Zealand fast food restaurants

The aim of this study was to assess the availability of healthier options and nutrition information at major New Zealand fast food chains. A cross-sectional survey was undertaken at 24 fast food stores (two from each of 12 major chains) using on-site visits, telephone calls, and website searches. Of available products, only 234/1126 (21%) were healthier options. Healthier options were generally cheaper and lower in energy, total fat, saturated fat, sugar, and sodium per serve than their regular counterparts. Regular options were commonly high in sugar or sodium per serve (mean sugar content of beverages=56 g (11 teaspoons) and sodium content of burgers and pasta=1095 mg and 1172 mg, respectively). Nutrition information was available at 11/12 (92%) restaurant chains (range=0% at Tank Juice to 99% at Domino's Pizza). However, <1% of this information was available at the point-of-purchase. Therefore, there is huge potential for improving nutrition in the New Zealand fast food restaurant setting. Implications of these findings for policy and food industry include: consideration of mandatory menu labelling, increasing the percentage of healthier options available, and improving the nutrient content of regular options at New Zealand fast food restaurants.

Point-of-purchase nutrition information influences food-purchasing behaviors of college students: a pilot study

The goal of point-of-purchase (POP) nutrition information is to help consumers make informed, healthful choices. Despite limited evaluation, these population-based approaches are being advocated to replace traditional, more expensive, individual behavior-change strategies. Few studies have examined the effect of POP information on buying patterns of college students, a group with high obesity rates and poor eating habits. This quasi-experimental pilot project sought to determine whether the "Eat Smart" POP program affected food-purchasing habits of multiethnic college students shopping at an on-campus convenience store. Baseline sales data of foods in the cereal, soup, cracker, and bread categories were collected for 6 weeks during Fall 2008. After Winter break, a few food items within each of these food categories were labeled as healthful using a "Fuel Your Life" shelf tag, and sales data were then collected for 5 weeks. In each of the four food categories, nontagged foods were available at the identical price as tagged items. Following intervention, there were increased sales of tagged items (measured as a percentage of total sales) in the cereal, soup, and cracker categories, while sales of bread decreased. Although none of these changes were statistically significant, the intervention resulted in a 3.6%+/-1.6% (P=0.082) increase in the percentage of sales from tagged items. Thus, providing POP nutrition information in a college campus convenience store may promote healthful food choices. A longer study examining the effect of POP on sales of items in other food categories is warranted.

Evaluating the impact of menu labeling on food choices and intake

OBJECTIVES

We assessed the impact of restaurant menu calorie labels on food choices and intake.

METHODS

Participants in a study dinner (n=303) were randomly assigned to either (1) a menu without calorie labels (no calorie labels), (2) a menu with calorie labels (calorie labels), or (3) a menu with calorie labels and a label stating the recommended daily caloric intake for an average adult (calorie labels plus information). Food choices and intake during and after the study dinner were measured.

RESULTS

Participants in both calorie label conditions ordered fewer calories than those in the no calorie labels condition. When calorie label conditions were combined, that group consumed 14% fewer calories than the no calorie labels group. Individuals in the calorie labels condition consumed more calories after the study dinner than those in both other conditions. When calories consumed during and after the study dinner were combined, participants in the calorie labels plus information group consumed an average of 250 fewer calories than those in the other groups.

CONCLUSIONS

Calorie labels on restaurant menus impacted food choices and intake; adding a recommended daily caloric requirement label increased this effect, suggesting menu label legislation should require such a label. Future research should evaluate menu labeling's impact on children's food choices and consumption.

Rationale and evidence for menu-labeling legislation

Menu-labeling legislation is a proposed public health intervention for poor diet and obesity that requires chain restaurants to provide nutrition information on menus and menu boards. The restaurant industry has strongly opposed menu-labeling legislation. Using scientific evidence, this paper counters industry arguments against menu labeling by demonstrating that consumers want chain restaurant nutrition information to be disclosed; the current methods of providing nutrition information are inadequate; the expense of providing nutrition information is minimal; the government has the legal right to mandate disclosure of information; consumers have the right to know nutrition information; a lack of information reduces the efficiency of a market economy; and menu labeling has the potential to make a positive public health impact.

Helping consumers make more healthful food choices: consumer views on modifying food labels and providing point-of-purchase nutrition information at quick-service restaurants

OBJECTIVES

To understand consumer (1) interest in nutrition information on food labels and quick-service restaurant menu boards and (2) reactions to modifying this information to help highlight calories and more healthful choices.

DESIGN

Eight consumer focus groups, using a guide and stimuli.

SETTING

Focus group discussions in 4 US cities.

PARTICIPANTS

A total of 68 consumers, with 7 to 10 per focus group.

ANALYSIS

Authors prepared detailed summaries of discussions based on observation. Video recordings and transcripts were used to cross-check summaries. Data were systematically reviewed, synthesized, and analyzed.

PHENOMENON OF INTEREST

Consumer views on alternative presentations of nutrition information on packaged food items and quick-service restaurant menu boards.

RESULTS

Participants (1) were interested in having nutrition information available, but would not use it at every eating occasion; (2) thought that food products typically consumed at 1 eating occasion should be labeled as a single serving; and (3) indicated that an icon on labels and menu boards that signaled more healthful options could be helpful.

CONCLUSIONS AND IMPLICATIONS

Findings provide a basis for the development of more systematic studies to better understand whether alternative presentations of nutrition information would help consumers.

A reliable, valid questionnaire indicates that preference for dietary fat declines when following a reduced-fat diet

This study establishes the reliability and validity of the Fat Preference Questionnaire, a self-administered instrument to assess preference for dietary fat. Respondents select the food which tastes better and is eaten more frequently from 19 sets of food. Each set is comprised of related foods differing in fat content. The questionnaire was administered to women in laboratory-based (n=63), cross-sectional (n=150), and weight-loss (n=71) studies. The percentage of food sets in which high-fat foods were reported to "taste better" (TASTE score) and to be "eaten more often" (FREQ score) was determined. A measure of dietary fat restriction (DIFF) was created by subtracting TASTE from FREQ. Food intake was assessed by direct measure, 24-h recall, or food diary. Additionally, participants completed a standard survey assessing dietary restraint. Test-retest correlations were high (r=0.75-0.94). TASTE and FREQ scores were positively correlated with total fat intake (r=0.22-0.63). DIFF scores positively correlated with dietary restraint (r=0.39-0.52). Participants in the weight-loss trial experienced declines in fat consumption, TASTE and FREQ scores, and BMI values, and an increase in DIFF scores. Weight loss correlated with declines in FREQ (r=0.36) scores and increases in DIFF scores (r=-0.35). These data suggest that preference for dietary fat declines when following a reduced-fat diet and an increase in restraint for intake of dietary fat is important for weight loss. The Fat Preference Questionnaire is a stable, easily-administered instrument that can be used in research and clinical settings.

Does nutrition information about the energy density of meals affect food intake in normal-weight women?

This study investigated whether the energy density of foods affected energy intake when subjects were informed about the energy density of their meals. Forty normal-weight women ate breakfast, lunch, and dinner in the laboratory on three separate days. The entrée at each meal was varied in energy density to be either 1.25, 1.50, or 1.75 kcal/g (5.23, 6.28, or 7.32 kJ/g), but was held similar in macronutrient composition and palatability. On each day, the entrées at all three meals had the same energy density. All entrées were consumed ad libitum. Subjects were assigned to one of two groups. Subjects in the information group received a nutrition label with each meal, which showed the energy density of the entrée. Subjects in the no-information group did not receive any nutrition information. The results revealed that subjects in both groups had the same pattern of food intake across the three levels of energy density. Energy density significantly affected energy intake; subjects in both groups combined consumed 22% less energy in the condition of low energy density than in the condition of high energy density (p < 0.0001). These findings show that energy density can have a significant influence on energy intake, even when individuals are informed about the energy density of their meals.

The influence of recipe modification and nutritional information on restaurant food acceptance and macronutrient intakes

OBJECTIVE

To examine the influences of nutritional information and consumer characteristics on meal quality expectations, food selection and subsequent macronutrient intakes of consumers offered a reduced-fat option in a restaurant.

DESIGN

A target, full-fat (FF) main restaurant meal option was developed in a version substantially reduced in fat and energy (RF). Restaurant patrons were randomly placed into one of four treatment groups varying in provision of menu information about the target dish, and the actual version of that dish served (if ordered). A full-fat blind (FFB) control group was given no nutritional information in the menu and was served the FF version. The other three groups were all served the modified RF version: (i) reduced-fat blind (RFB), who were given no nutritional information; (ii) reduced-fat informed (RFI), who were given nutritional information; and (iii) reduced-fat informed with details (RFID), who were given the same nutritional information plus recipe modification details. Subjects rated their expected and actual liking, the pleasantness of taste, texture and appearance of the dish, how well the dish matched their expectations, and the likelihood of purchase again. Additional measures included the other dish selections, sociodemographic and attitudinal information.

SETTING

A silver service (training) restaurant.

SUBJECTS

Members of the public (n = 279) consuming meals in the restaurant.

RESULTS

The presence of nutritional information on the menu did not significantly increase subsequent intakes of energy and fat from the rest of the meal, and did not significantly influence sensory expectations or post-meal acceptance measures (which also did not differ between the FF and RF versions). Consumer characteristics relating to fat reduction attitudes and behaviours were significantly related to the selection of different dishes.

CONCLUSIONS

Provision of RF alternatives in a restaurant can have significant positive dietary benefits. Menu nutritional information did not affect measures of meal acceptance. Further studies should identify which types of information formats might be most effective in enhancing the selection of 'healthy' options.

Effect of reduced-fat information on expected and actual hedonic and sensory ratings of sausage

The effect of information about fat content on expected and actual sensory and hedonic ratings of regular- and reduced-fat Bologna sausages was studied using 115 young men. All the subjects rated the expected pleasantness, juiciness, saltiness and fattiness of "Bologna". Subsequently, a sub-group of subjects ("No information", N=54) rated the unlabelled samples after tasting. Another sub-group ("Information", N=61) rated the expected and actual pleasantness and attribute intensities of samples labelled as "Regular type of Bologna (20% fat)" and "Light Bologna (10% fat)". The samples were not rated significantly different by the "No information" group. In the "Information" group, "Light Bologna" was expected to be less fatty, less salty, less juicy and less pleasant than "Regular type of Bologna". After tasting, saltiness and fattiness of "Light Bologna" were rated lower while pleasantness and juiciness of the samples were not significantly different. Actual saltiness and fattiness of "Light Bologna" were assimilated to the low expected intensities. Even that the hedonic ratings of "Light" and "Regular type of Bologna" differed only slightly, low expected pleasantness, juiciness and other attribute intensities imply that young men would not choose the product. Other information strategies might result in better acceptance by this target group.