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Weijers RJ, Claessens IWH, Gillebaart M, de Ridder DTD. Nudging towards sustainable dining: Exploring menu nudges to promote vegetarian meal choices in restaurants. Appetite 2024; 198:107376. [PMID: 38670347 DOI: 10.1016/j.appet.2024.107376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Accepted: 04/24/2024] [Indexed: 04/28/2024]
Abstract
Food choice behavior plays a large role in achieving sustainability goals. Meat in particular has a negative environmental impact as compared with plant-based food - and is more frequently chosen in restaurant contexts. To increase plant-based meal choices in restaurants, we tested three nudges for menus that are likely to be implemented by restaurant owners: a hedonic label (e.g., artisanal vegetable burger), a chef's recommendation (specifying the vegetarian option as the chef's favorite), and a salience nudge (a box around the vegetarian option). In an online experiment, we showed participants (n = 513) in four conditions (no nudge, hedonic label, chef's recommendation, and salience nudge) five menus with four meal options each, one of which was vegetarian. We asked participants to choose a meal and subsequently to rate these meals on how tasty and indulgent they were (taste and indulgence attributions). We then revealed which nudge was used to the participants and asked how participants received it. Results show that the hedonic label and chef's recommendation nudge (but not the salience nudge) both increase vegetarian meal choices. The hedonic label increased participants' attributions of indulgence of the meal, but not of tastiness. This finding fits with restaurants' gastronomic, pleasure-seeking context and shapes future directions of labeling interventions, namely that indulgence attributions can be increased in vegetarian foods. Furthermore, the nudges were generally well accepted and participants' intention to return to the (virtual) restaurant was high. Finally, customers expected the hedonic label nudge to be more effective in promoting vegetarian food choices than the other two nudges, partially corresponding with our findings of actual effectiveness.
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Affiliation(s)
- Robert J Weijers
- Department of Social, Health, and Organizational Psychology, Utrecht University, the Netherlands.
| | - Iris W H Claessens
- Department of Social, Health, and Organizational Psychology, Utrecht University, the Netherlands
| | - Marleen Gillebaart
- Department of Social, Health, and Organizational Psychology, Utrecht University, the Netherlands
| | - Denise T D de Ridder
- Department of Social, Health, and Organizational Psychology, Utrecht University, the Netherlands
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Robinson E, Boyland E, Christiansen P, Haynos AF, Jones A, Masic U, Robertson D, Tapper K, Marty L. Is the effect of menu energy labelling on consumer behaviour equitable? A pooled analysis of twelve randomized control experiments. Appetite 2023; 182:106451. [PMID: 36610541 PMCID: PMC10082393 DOI: 10.1016/j.appet.2023.106451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/18/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023]
Abstract
Menu energy labelling has been implemented as a public health policy to promote healthier dietary choices and reduce obesity. However, it is unclear whether the influence energy labelling has on consumer behaviour differs based on individuals' demographics or characteristics and may therefore produce inequalities in diet. Data were analysed from 12 randomized control trials (N = 8508) evaluating the effect of food and drink energy labelling (vs. labelling absent) on total energy content of food and drink selections (predominantly hypothetical) in European and US adults. Analyses examined the moderating effects of participant age, sex, ethnicity/race, education, household income, body mass index, dieting status, food choice motives and current hunger on total energy content of selections. Energy labelling was associated with a small reduction (f2 = 0.004, -50 kcal, p < 0.001) in total energy selected compared to the absence of energy labelling. Participants who were female, younger, white, university educated, of a higher income status, dieting, motivated by health and weight control when making food choices, and less hungry, tended to select menu items of lower energy content. However, there was no evidence that the effect of energy labelling on the amount of energy selected was moderated by any of the participants' demographics or characteristics. Energy labelling was associated with a small reduction in energy content of food selections and this effect was similar across a range of participants' demographics and characteristics. These preliminary findings suggest that energy labelling policies may not widen existing inequalities in diet.
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Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | | | - Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Una Masic
- Gender Identity Development Service, Tavistock and Portman NHS Trust, London, UK
| | - Deirdre Robertson
- Behavioural Research Unit, Economic and Social Research Institute, Ireland & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Katy Tapper
- Department of Psychology, City, University of London, UK
| | - Lucile Marty
- Centre des Sciences Du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000, Dijon, France
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Robinson E, Polden M, Langfield T, Clarke K, Calvert L, Colombet Z, O'Flaherty M, Marty L, Tapper K, Jones A. Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2023; 20:10. [PMID: 36747247 PMCID: PMC9903416 DOI: 10.1186/s12966-023-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP). METHODS Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups. RESULTS Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041]. CONCLUSIONS Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required. REVIEW REGISTRATION Registered on PROSPERO (CRD42022312532) and OSF ( https://doi.org/10.17605/OSF.IO/W7RDB ).
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Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Megan Polden
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Tess Langfield
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Katie Clarke
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Lara Calvert
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Zoé Colombet
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lucile Marty
- Centre Des Sciences Du Goût Et de L'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - Katy Tapper
- Department of Psychology, City, University of London, London, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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Mazzù MF, Baccelloni A, Finistauri P. Uncovering the Effect of European Policy-Making Initiatives in Addressing Nutrition-Related Issues: A Systematic Literature Review and Bibliometric Analysis on Front-of-Pack Labels. Nutrients 2022; 14:3423. [PMID: 36014929 PMCID: PMC9414449 DOI: 10.3390/nu14163423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/19/2022] Open
Abstract
The last decades have been marked by the introduction of front-of-pack labels (FoPL) as an institutional corrective action against obesity and nutrition-related illnesses. However, FoPL-related policy-making initiatives issued by the European Union evolved over time and led to a diversity of labels with different effects on consumers' decisions. As a result, the extant literature adapted to the regulative scenario over the years and investigated the effects of the labels, creating consensus on some topics while being fragmented on others. Similarly, policy-makers adapted some regulations to the evidence supported by the research. With the aim to systematize the overall structure and evolution of the literature on FoPL, investigate the presence of a consensus on specific topics through a co-citation analysis, and examine the evolution of the consensus and co-citation networks over the years and potential research gaps, we report the results of bibliometric and co-citation analyses and a systematic literature review involving 170 papers and a selection of 49 articles published in the last months, for a total of 219 articles, analysed according to three timespans (Period 1 (1989-2011); Period 2 (2012-2016) and Period 3 (2017-2022)). Our findings highlight the interplay of policy development and FoPL research, the presence of few self-reinforcing and well-established co-citation networks based on validated evidence in the literature and the presence of alternative emerging theories that offer different and valid perspectives overlooked by mainstream co-citation research networks.
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Affiliation(s)
| | - Angelo Baccelloni
- Department of Communication and Social Research, Sapienza University, Via Salaria 113, 00198 Rome, Italy
| | - Piera Finistauri
- Department of Business and Management, Luiss University, Viale Romania 32, 00197 Rome, Italy
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Giazitzi K, Chrysanthakopoulou V, Boskou G. A Hypothetical Tavern Menu for the Evaluation of Calorie Selection through Menu Labelling. Foods 2022; 11:foods11111624. [PMID: 35681374 PMCID: PMC9180666 DOI: 10.3390/foods11111624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
The purpose of the present study is to evaluate calories selection according to the type of menu labelling applied on a hypothetical Greek tavern menu. Three questionnaires were designed and each one included a hypothetical menu of Greek tavern food. Menu A did not include any nutritional information, Menu B included calorie posting and Menu C had the “NB” mark next to dishes that were Nutritionally Balanced choices. A total of 437 participants were recruited in the study. The mean calories selection was significantly lower on Menu B (1874 Kcal) and C (1787.7 Kcal) compared to Menu A (2157.3 Kcal). The overweight and obese participants ordered significantly fewer calories on Menu B (−504 Kcal and −404 Kcal) and C (−451.3 Kcal and −393 Kcal) than on the Menu A. Menu labelling should be assessed in real-life settings in Greece. It could be a policy for the prevention and control of obesity in European countries.
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Wang C, Li Y, Luo X, Fu H, Ye Z, Deng G. How Are Consumers Affected by Taste and Hygiene Ratings When Ordering Food Online? A Behavioral and Event-Related Potential Study. Front Neurosci 2022; 16:844027. [PMID: 35386593 PMCID: PMC8978544 DOI: 10.3389/fnins.2022.844027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
With the rapid development of the take-out industry, taste and hygiene ratings as social-based information have been frequently used by online food-ordering platforms to facilitate consumer purchases. The present study aims to uncover the effects of taste and hygiene ratings on online food-ordering decision by incorporating behavioral and neural approaches. The behavioral results showed that a high taste rating induced a higher ordering intention than a low taste rating, and that a high hygiene rating induced a higher ordering intention than a low hygiene rating. The effect of hygiene rating on ordering intention was moderated by taste rating. Hygiene rating had a greater impact on ordering intention when the taste rating was high (vs. low). In addition, inconsistency between taste and hygiene ratings increased the cognitive load and took more time for decision-making. The event-related potential (ERP) data revealed that consumers paid more attention to a high (vs. low) taste rating in the early cognitive process, which was reflected by a larger P2. Subsequently, a more negative N2 was elicited by conflicting ratings than consistent ratings when the taste rating was low. In the relatively late decision-making process, a larger P3 was evoked by consistent than conflicting ratings, suggesting that consumers had more confidence in their decisions for consistent ratings. These findings could help restaurants understand the roles of taste and hygiene rating cues in affecting consumer behavior and prompt those restaurants to adopt effective measures to increase online sales.
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Menu labeling influence on purchase behaviors: Applying the theory of planned behavior and health consciousness. Appetite 2022; 172:105967. [DOI: 10.1016/j.appet.2022.105967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/06/2022] [Accepted: 02/04/2022] [Indexed: 11/18/2022]
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Wong CA, Hakimi S, Santanam TS, Madanay F, Fridman I, Ford C, Patel M, Ubel PA. Applying Behavioral Economics to Improve Adolescent and Young Adult Health: A Developmentally-Sensitive Approach. J Adolesc Health 2021; 69:17-25. [PMID: 33288458 PMCID: PMC8175460 DOI: 10.1016/j.jadohealth.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 12/28/2022]
Abstract
Each day, adolescents and young adults (AYAs) choose to engage in behaviors that impact their current and future health. Behavioral economics represents an innovative lens through which to explore decision-making among AYAs. Behavioral economics outlines a diverse set of phenomena that influence decision-making and can be leveraged to develop interventions that may support behavior change. Up to this point, behavioral economic interventions have predominantly been studied in adults. This article provides an integrative review of how behavioral economic phenomena can be leveraged to motivate health-related behavior change among AYAs. We contextualize these phenomena in the physical and social environments unique to AYAs and the neurodevelopmental changes they undergo, highlighting opportunities to intervene in AYA-specific contexts. Our review of the literature suggests behavioral economic phenomena leveraging social choice are particularly promising for AYA health. Behavioral economic interventions that take advantage of AYA learning and development have the potential to positively impact youth health and well-being over the lifespan.
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Affiliation(s)
- Charlene A Wong
- Division of Primary Care, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; Duke-Robert J. Margolis, MD, Center for Health Policy, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; Duke Sanford School of Public Policy, Durham, North Carolina
| | - Shabnam Hakimi
- Center for Cognitive Neuroscience, Duke University, Levine Science Research Center, Durham, North Carolina.
| | - Taruni S Santanam
- Duke-Robert J. Margolis, MD, Center for Health Policy, Durham, North Carolina
| | - Farrah Madanay
- Duke Sanford School of Public Policy, Durham, North Carolina
| | - Ilona Fridman
- Duke-Robert J. Margolis, MD, Center for Health Policy, Durham, North Carolina
| | - Carol Ford
- Division of Adolescent Medicine, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mitesh Patel
- Perelman Center for Advanced Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter A Ubel
- Duke Sanford School of Public Policy, Durham, North Carolina; Fuqua School of Business, Durham North Carolina
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Roy R, Alassadi D. Does labelling of healthy foods on menus using symbols promote better choices at the point-of-purchase? Public Health Nutr 2020; 24:1-9. [PMID: 32854800 DOI: 10.1017/s1368980020002840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Take-away foods account for a significant proportion of dietary intake among young adults (18-35 years). Young adults want nutrition information at the point-of-purchase (POP); however, it is either unavailable, perceived as ineffective or difficult to use. The present study examined whether symbols on university food outlet menus identifying healthier options would increase their sales and consumer's awareness of these symbols, purchasing factors and barriers to eating healthy foods. DESIGN Repeated-measures, comparison group, quasi-experimental study. SETTING Two carefully matched university food outlets were analysed to determine the targeted items. Tick symbols ✓ were placed next to the targeted items in the experimental outlet. No changes were made at the comparison outlet. Customers were surveyed at the experimental outlet. Food sales were collected for 4 weeks from both outlets at baseline and during the intervention. Food sales were also collected from the experimental outlet 10 weeks later. PARTICIPANTS Food outlet patrons. RESULTS Significant increases in food sales were observed during observation 3 compared with observation 1 (P = 0·0004) and observation 2 (P = 0·0002). Sixty-eight per cent of respondents noticed the symbols, and of that, 30 % reported being influenced. Taste was the most common purchasing factor, and people were less likely to select taste as a factor if they were influenced by the symbols (P = 0·04). CONCLUSIONS Identifying healthier options with a symbol at the POP increased sales over time. Several purchasing factors (price, taste and healthy food availability) need to be addressed to improve the food selection of young adults.
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Affiliation(s)
- Rajshri Roy
- Discipline of Nutrition and Dietetics, University of Auckland, Auckland1011, New Zealand
| | - Deema Alassadi
- Discipline of Nutrition and Dietetics, University of Auckland, Auckland1011, New Zealand
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Bosselman R, Choi HM, Lee KS, Kim E, Cha J, Jeong JY, Jo M, Ham S. Customers' perception of the attributes of different formats of menu labeling: a comparison between Korea and the U.S. Nutr Res Pract 2020; 14:286-297. [PMID: 32528635 PMCID: PMC7263896 DOI: 10.4162/nrp.2020.14.3.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study compared the perception of customers from Korea and the U.S. on the attributes of different formats of menu labeling The specific objectives were 1) to compare the customers' perceived usefulness, ease-of-understanding, clarity, and attractiveness of different formats of menu labeling between Korea and the U.S.; and 2) to compare the customers' use intention to different formats of menu labeling between Korea and the U.S. SUBJECTS/METHODS A survey was conducted in Korea and the U.S. The participants were allocated randomly to view 1 of the 7 restaurant menus that varied according to the following types of menu labeling formats: (type 1) kcal format, (type 2) traffic-light format, (type 3) percent daily intake (%DI) format, (type 4) kcal + traffic-light format, (type 5) kcal + %DI format, (type 6) traffic-light + %DI format, and (type 7) kcal + traffic-light + %DI format. A total of 279 Koreans and 347 Americans were entered in the analysis. An independent t-test and 1-way analysis of variance were performed. RESULTS Koreans rated type 4 format (kcal + traffic light) the highest for usefulness and attractiveness. In contrast, Americans rated type 7 (kcal + traffic light + %DI) the highest for usefulness, ease-of-understanding, attractiveness, and clarity. Significant differences were found in the customers' perceived attributes to menu labeling between Korea and the U.S. Americans perceived higher for all the 4 attributes of menu labeling than Koreans. CONCLUSIONS The study is unique in identifying the differences in the attributes of different formats of menu labeling between Korea and the U.S. Americans rated the most complicated type of menu labeling as the highest perception for the attributes, and showed a higher use intention of menu labeling than Koreans. This study contributes to academia and industry for practicing menu labeling in different countries using different formats.
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Affiliation(s)
- Robert Bosselman
- Department of Apparel, Events & Hospitality Management, College of Human Sciences, Iowa State University, Ames, IA 50011, USA
| | - Hyung-Min Choi
- International Center for Hospitality Research & Development, Dedman School of Hospitality, Florida State University, Tallahassee, FL 32306, USA
| | - Keum Sil Lee
- Department of Tourism Management, Jangan University, Hwaseong 18331, Korea
| | - Eojina Kim
- Department of Hospitality & Tourism Management, Pamplin College of Business, Virginia Tech, Blacksburg, VA 24061, USA
| | - Jaebin Cha
- Department of Health & Medical Administration, Kyungmin University, Uijeongbu 11618, Korea
| | - Jin-Yi Jeong
- Department of Food & Nutrition, Institute of Symbiotic Life-TECH, College of Human Ecology, Yonsei University, Seoul 03722, Korea
| | - Mina Jo
- Division of Hotel & Tourism, College of Economics & Business Administration, The University of Suwon, Hwaseong 18323, Korea
| | - Sunny Ham
- Department of Food & Nutrition, Institute of Symbiotic Life-TECH, College of Human Ecology, Yonsei University, Seoul 03722, Korea
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Gustafson CR, Zeballos E. The effect of presenting relative calorie information on calories ordered. Appetite 2020; 153:104727. [PMID: 32387531 DOI: 10.1016/j.appet.2020.104727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/19/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
In this research, we tested the effect of a novel method of presenting calorie information-highlighting relative differences in calories among ingredients. We conducted an online hypothetical food choice experiment where 633 participants selected the ingredients for a sandwich from five categories: meat/protein, cheese, spread/dressing, bread, and vegetables. Each participant was randomly assigned to one of four calorie information conditions: 1) a condition in which no information about calories was provided, 2) a condition in which calorie information was provided for each ingredient, 3) a condition in which calorie information was presented relative to the highest calorie item, and 4) a condition in which calorie information was presented relative to the lowest calorie item. Participants in the high- and low-calorie reference conditions ordered between 32 and 36 fewer calories per sandwich than participants in the no-calorie information control condition (p ≤ 0.04). Calories ordered by participants in the per-item calorie condition were not significantly different than the control. Presenting relative calorie or other nutritional information to make health-related trade-offs more salient may guide consumers to make healthier choices.
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Affiliation(s)
- Christopher R Gustafson
- Department of Agricultural Economics, University of Nebraska-Lincoln, 314A Filley Hall, Lincoln, NE, 68583, USA.
| | - Eliana Zeballos
- USDA Economic Research Service, Food Economic Division, Washington, D.C, USA.
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Testing the efficacy of and parents' preferences for nutrition labels on children's menus from a full-service chain restaurant: results of an online experiment. Public Health Nutr 2020; 23:1820-1831. [PMID: 32308190 DOI: 10.1017/s1368980019004488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Test the efficacy and perceived effectiveness of nutrition labels on children's menus from a full-service chain restaurant in an online study. DESIGN Using a between-groups experiment, parents were randomised to view children's menus displaying one of five children's nutrition labelling conditions: (i) No Nutrition Information (control); (ii) Calories Only; (iii) Calories + Contextual Statement (CS); (iv) Calories, Sodium + CS; or (v) Calories and Sodium in Traffic Lights + CS. Parents hypothetically ordered up to one entrée, side, beverage and dessert for their child, then rated and ranked all five labelling conditions on the level of perceived effectiveness. SETTING Online survey. PARTICIPANTS 998 parents with a 3-12 year old child. RESULTS Parents exposed to menus displaying 'Calories, Sodium + CS' selected significantly fewer calories 'overall' (entrées + side + dessert + beverage) compared to parents exposed to the control condition (-53·1 calories, P < 0·05). Parents selected 'entrees' with significantly fewer calories and lower sodium when exposed to menus with 'Calories + CS' (-24·3 calories, P < 0·05); 'Calories, Sodium + CS' (-25·4 calories, -56·1 mg sodium, P < 0·05 for both); and 'Calories and Sodium in Traffic Lights + CS' (-29·1 calories, -58·6 mg sodium, P < 0·05 for both). Parents exposed to menus with 'Calories, Sodium + CS' and 'Calories and Sodium in Traffic Lights + CS' were more likely to notice and understand nutrition information compared to other nuntrition labelling conditions. Parents perceived the menu with 'Calories and Sodium in Traffic Lights + CS' as most effective (P < 0·05). CONCLUSIONS Menus disclosing calories, sodium and a contextual statement increased the proportion of parents who noticed and understood nutrition information, and resulted in parents selecting lower calorie and sodium entrées for their children in the hypothetical purchase task.
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Factors Influencing Purchase Intention for Low-Sodium and Low-Sugar Products. Foods 2020; 9:foods9030351. [PMID: 32197361 PMCID: PMC7143532 DOI: 10.3390/foods9030351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 11/18/2022] Open
Abstract
As sodium and sugar intake in South Korea exceed recommended levels, the government and food industry have been attempting to reduce the amount of sodium and sugar in the food products. In line with these efforts, this study sought to examine how the purchase intention for low-sodium/low-sugar products vary based on consumers’ previous choices of low-sodium/low-sugar products and other consumer-related factors. For this study, two online survey-based experiments were conducted: one using soy sauce to represent a sodium-based product and the other using yogurt to represent a sugar-based product. The significant variables that influenced the purchase intention for both were the consumers’ previous low-sodium/low-sugar product choices and their propensity for food neophobia. Consumers who had previously selected regular products showed a lower intention to purchase low-sodium soy sauce or low-sugar yogurt. In addition, those who had a strong tendency toward food neophobia also had a significantly lower purchase intention for these products. Moreover, the lower the consumer′s unhealthy = tasty intuition (UTI), the higher the purchase intention for the low-sodium soy sauce, but UTI did not act as a significant variable for the low-sugar yogurt. These results demonstrate that government interventions for low-sodium products and low-sugar products should be differentiated.
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Seyedhamzeh S, Nedjat S, Hosseini H, Shakibazedeh E, Viera AJ, Dorosty Motlagh A. Potential effect of different nutritional labels on food choices among mothers: a study protocol. BMC Public Health 2020; 20:294. [PMID: 32138775 PMCID: PMC7059293 DOI: 10.1186/s12889-020-8411-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/26/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prevalence of non-communicable diseases (NCDs) is increasing in the world. Healthy food choice and adequate physical activity are key factors in preventing NCDs. Food labeling is a strategy that can inform consumers to choose healthier foods at the point of purchase. In this study, we intend to examine the status of existing labels and to clarify their strengths and weaknesses. Then, for the first time in Iran, we will design a type of physical activity equivalent calorie label and will test it on some food groups of packaged products including dairy products, sweetened beverages, cakes, and biscuits. METHODS This study will be conducted in two phases. In phase 1, nutrition fact labels and traffic light labels will be assessed through focus group discussions and interviews among different groups of mothers, industrialists and nutrition and food industry specialists as to determine strengths and weaknesses of the current labels on packaged products. Then, the initial layout of the physical activity calorie equivalent label will be drawn with respect to the viewpoints received from mothers. Thereafter, we will include the scientific opinions to it for creating the first draft of our new label. In phase 2, a total of 500 mothers of students 6-12 years old randomly assigned to five groups. The study groups will be as follows: (1) without nutrition label group, (2) current traffic light label group, (3) current traffic light label group in which, a brochure will be used to inform mothers, (4) physical activity calorie equivalent label group, and (5) physical activity calorie equivalent label group in which a brochure will be used to inform mothers. Some samples of dairy products, beverages, cakes, and biscuits will be presented. ANOVA and multiple linear regressions will be used to examine the association between the label type and the main consequence (energy of the selected products) and secondary outcome (time). DISCUSSION The effect of the new food labels will be evaluated based on the differences between the calories of selected food groups. TRIAL REGISTERATION Iranian Registery of Clinical Trials [IRCT]20,181,002,041,201 N1.
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Affiliation(s)
- Shirin Seyedhamzeh
- Department of Community Nutrition [DCN], School of Nutritional Sciences and Dietetics [SNSD], Tehran University of Medical Sciences [TUMS], Tehran, Iran.,Students' Scientific Research Center, TUMS, Tehran, Iran
| | | | - Hedayat Hosseini
- Department of Food Sciences & Technology, National Nutrition &Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Anthony J Viera
- Department of Community and Family Medicine, Duke University, Durham, NC, USA
| | - Ahmadreza Dorosty Motlagh
- DCN, SNSD, TUMS, No 44, Hojjat-dost Alley, Naderi Street, Keshavarz Boulevard, Tehran, 1416-643931, Iran.
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Improving the quality of foods available in a rural kibbutz cafeteria in Israel to align with a freshly prepared Mediterranean-style diet through a community culinary coaching programme. Public Health Nutr 2019; 22:3229-3237. [PMID: 31327325 DOI: 10.1017/s1368980019001721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the impact of a community culinary coaching programme (CCCP) on cafeteria food alignment with a freshly prepared Mediterranean-style diet, and diners' consumption habits and satisfaction. DESIGN A non-randomized, controlled, community-based participatory research programme. CCCP included eight 90 min coaching sessions with a community steering committee, 22 h of kitchen staff training, 12 h of pre-school staff training and 30 h of education for diners; control communities received no intervention. Outcomes, measured before and 12 months after programme initiation, included cafeteria food alignment with a freshly prepared Mediterranean-style diet through a food items list derived from the cafeteria food purchasing software, and adult diners' consumption habits and satisfaction through questionnaires. SETTING Communal cafeterias of rural kibbutzim. PARTICIPANTS Intervention: kibbutz with 493 adults and 214 children. Control: Two kibbutzim with a total of 487 adults and 206 children. RESULTS Intervention cafeteria food improved significantly in all Mediterranean index categories except nuts (legumes, wholegrain products, fish, MUFA/SFA P < 0·0001; fruits, vegetables P < 0·001; processed meats P = 0·004), and in the proportion of ultra-processed and unprocessed or minimally processed foods categories of the NOVA classification (-22 %, P < 0·001 and +7 %, P < 0·001, respectively), compared with the control community. The intervention group's satisfaction was significantly improved in twenty-five (83 %) out of the thirty satisfaction items, compared with twelve (40 %) in the control group. No changes were identified in diners' consumption habits in either intervention or control communities. CONCLUSIONS CCCP might be useful in improving alignment of cafeteria food with a freshly prepared Mediterranean-style diet.
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Thorndike AN, Gelsomin ED, McCurley JL, Levy DE. Calories Purchased by Hospital Employees After Implementation of a Cafeteria Traffic Light-Labeling and Choice Architecture Program. JAMA Netw Open 2019; 2:e196789. [PMID: 31290988 PMCID: PMC6624805 DOI: 10.1001/jamanetworkopen.2019.6789] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Nearly one-third of the 150 million US adults who are employed are obese. A workplace program that reduces employees' caloric intake could help prevent obesity. OBJECTIVE To determine if implementation of a hospital workplace cafeteria healthy eating program was associated with reduction in calories purchased by employees over 2 years. DESIGN, SETTING, AND PARTICIPANTS A longitudinal cohort study of 5695 employees who purchased food with their employee identification card before and after implementation of a workplace cafeteria healthy eating program was conducted from December 1, 2009, to February 29, 2012, in a hospital in Boston, Massachusetts. Statistical analysis was conducted from April 6, 2018, to May 14, 2019. EXPOSURE After a 3-month baseline period, "traffic light" food labels (in which green indicates healthy, yellow indicates less healthy, and red indicates least healthy) and choice architecture (product placement) changes were implemented permanently. MAIN OUTCOME AND MEASURES Main outcomes were changes in calories of employees' purchases from baseline (December 1, 2009, to February 28, 2010) to the same quarter 1 year (December 1, 2010, to February 28, 2011) and 2 years (December 1, 2011, to February 29, 2012) later. Purchases were obtained from sales data linked to employee identification cards. The hypothesized association of estimated changes in daily calories consumed with employees' weight was calculated using a dynamic model of weight change. Analyses were adjusted for age, sex, race/ethnicity, and job type. RESULTS Among the 5695 employees in the study, 4057 were women and 1638 were men, and the mean (SD) age was 40 (12) years. Baseline purchases had a mean of 565 kcal per transaction (95% CI, 558-572 kcal) and decreased 19 kcal per transaction (95% CI, -23 to -15 kcal) at 1 year and 35 kcal per transaction (95% CI, -39 to -31 kcal) at 2 years (-6.2%; P < .001) relative to baseline. The largest reduction was from red-labeled items, decreasing 42 kcal per transaction at 2 years (95% CI, -45 to -39 kcal) from a mean of 183 kcal per transaction (95% CI, 177-188 kcal) at baseline (-23.0%; P < .001). Calories from green-labeled items increased 6 kcal per transaction (95% CI, 3-9 kcal) from a mean of 152 kcal per transaction (95% CI, 149-155 kcal) (4.0%; P < .001), and calories from yellow-labeled items did not change. Among frequent purchasers (≥36 transactions per quarter; n = 453), total kilocalories per quarter at baseline was 41 784, which, averaged over the entire follow-up, decreased a mean of 4275 kcal/quarter (95% CI, -5325 to -3224 kcal) over 2 years. Assuming no compensatory changes in diet or activity, this equated to a reduction of 47 kcal per day and estimated a 2.0-kg weight loss over 3 years. CONCLUSIONS AND RELEVANCE A workplace cafeteria traffic light-labeling and choice architecture program was associated with a sustained decrease in calories purchased, particularly from unhealthy foods. Point-of-purchase programs could help improve dietary intake and prevent obesity in employees.
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Affiliation(s)
- Anne N. Thorndike
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Emily D. Gelsomin
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston
| | - Jessica L. McCurley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Douglas E. Levy
- Harvard Medical School, Boston, Massachusetts
- Health Policy Research Center at the Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
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Niven P, Morley B, Dixon H, Martin J, Jones A, Petersen K, Wakefield M. Effects of health star labelling on the healthiness of adults' fast food meal selections: An experimental study. Appetite 2019; 136:146-153. [PMID: 30684644 DOI: 10.1016/j.appet.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/09/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
The addition of Health Star Rating (HSR) labelling to menus at fast food outlets is feasible, however how this would impact consumer menu selection remains unclear. The aim of this study was to test whether the addition of HSR labelling to kilojoule (kJ) labelling on menus at fast food outlets would prompt consumers to select healthier meals. Using a between-subjects experimental design, 1007 adults aged 18-49 were allocated to one of four menu labelling conditions: (i) no labelling; (ii) kilojoule labelling; (iii) HSR labelling; and (iv) kilojoule + HSR labelling. Respondents were presented with their assigned menu online and instructed to select an evening meal as they would at a fast food restaurant. The main analyses tested differences by menu labelling condition in the total mean kilojoule content and Nutrient Profiling Score (NPS) of respondents' evening meal selections using one-way ANOVA. The mean kilojoule content of meals did not differ significantly by menu labelling condition. However, respondents in the kilojoule + HSR labelling condition selected healthier meals (lower mean NPS) than those who viewed menu boards with kilojoule labelling only (M = 2.88 cf. M = 3.78, p = 0.046). In addition, in a post hoc per-protocol analysis of respondents who reported using menu labelling to assist their meal selection, respondents shown kilojoule + HSR menu labelling selected meals with a significantly lower kilojoule content compared to those shown HSR labelling only (4751 kJ cf. 5745 kJ, p = 0.038). Findings provide evidence that adding HSRs to kilojoule labelling on menu boards at fast food outlets has the potential to assist adults to make healthier evening meal selections.
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Affiliation(s)
- Philippa Niven
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.
| | - Jane Martin
- Obesity Policy Coalition, Melbourne, Victoria, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Kristina Petersen
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia; The Pennsylvania State University, Department of Nutritional Sciences, University Park, PA, USA
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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Using insights from behavioral economics to nudge individuals towards healthier choices when eating out: A restaurant experiment. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2018.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nolan LJ. Food selection, food craving, and body mass index in persons in treatment for substance use disorder. Appetite 2019; 138:80-86. [PMID: 30880085 DOI: 10.1016/j.appet.2019.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/25/2019] [Accepted: 03/10/2019] [Indexed: 02/02/2023]
Abstract
Studies of persons in treatment for substance use disorder (SUD) frequently report significant body weight gain and higher food consumption. It is unclear what psychological variables might mediate a relationship between SUD treatment status and food selection. To examine the association between SUD treatment status and food selection, 212 men and women (104 in treatment for SUD) were asked, in an online survey, to choose from among 16 food images in an imagined all-you-can-eat buffet scenario. Food craving, emotional eating (EE), impulsivity, and drugs used were examined as potential mediators while reward responsiveness (RR) was examined as a potential moderator. The amount of energy from foods selected was the predicted variable. Results indicated that those in treatment for SUD had significantly higher food cravings, positive EE, and attentional and motor impulsivity (but not RR or negative EE) which were (with the exception of RR) not correlated with energy selected from food images. Those in SUD treatment selected more energy (M = 2655.10 kcal, SEM = 156.97) from food images than those in the control group (M = 2221.52 kcal, SEM = 112.29), t(188) = -2.25, p = 0.026. In a multiple regression moderation analysis, SUD treatment status (β = 419.58, p = 0.029) and RR (β = 39.23, p = 0.016) were significant predictors of energy from foods selected. The amount of energy selected from food images predicted by SUD treatment status was dependent on values of RR. Mean BMI was not significantly higher for the SUD group but there were more participants with BMI values over 29 and fewer with BMI between 25 and 29 in the SUD treatment group. While the cause remains unclear, the results show that persons in treatment for SUD and with higher RR do select more energy from food images in a meal scenario.
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Affiliation(s)
- Laurence J Nolan
- Department of Psychology, Wagner College, Staten Island, NY, 10301, USA.
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Bacon L, Krpan D. (Not) Eating for the environment: The impact of restaurant menu design on vegetarian food choice. Appetite 2018; 125:190-200. [DOI: 10.1016/j.appet.2018.02.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/30/2018] [Accepted: 02/07/2018] [Indexed: 01/11/2023]
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Adding sodium information to casual dining restaurant menus: Beneficial or detrimental for consumers? Appetite 2018; 125:474-485. [DOI: 10.1016/j.appet.2018.02.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/27/2018] [Accepted: 02/23/2018] [Indexed: 11/18/2022]
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Lee K, Lee Y. Parents' meal choices for their children at fast food and family restaurants with different menu labeling presentations. Nutr Res Pract 2018; 12:243-250. [PMID: 29854330 PMCID: PMC5974070 DOI: 10.4162/nrp.2018.12.3.243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study examined the effect of nutrition labeling formats on parents' food choices for their children at different restaurant types. SUBJECTS/METHODS An online survey was conducted with 1,980 parents of children aged 3-12 years. Participants were randomly assigned to fast food or family restaurant scenarios, and one of four menu stimuli conditions: no labeling, low-calorie symbol (symbol), numeric value (numeric), and both low-calorie symbol and numeric value (symbol + numeric). Participants selected menu items for their children. Menu choices and total calories were compared by nutrition labeling formats in each type of the restaurant. RESULTS Low-calorie item selections were scored and a two-way analysis of variance (ANOVA) was conducted for an interaction effect between restaurant and labeling type. In the fast food restaurant group, parents presented with low-calorie symbols selected the lowest calorie items more often than those not presented with the format. Parents in the symbol + numeric condition selected significantly fewer calories (653 kcal) than those in the no labeling (677 kcal) or numeric conditions (674 kcal) (P = 0.006). In the family restaurant group, no significant difference were observed among different labeling conditions. A significant interaction between restaurant and labeling type on low-calorie selection score (F = 6.03, P < 0.01) suggests that the effect of nutrition labeling format interplays with restaurant type to jointly affect parents' food choices for their children. CONCLUSIONS The provision of easily interpretable nutritional information format at fast food restaurants may encourage healthier food choices of parents for their children; however, the effects were negligible at family restaurants.
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Affiliation(s)
- Kiwon Lee
- Hospitality Management, College of Education, Health and Human Services, Kent State University, Kent, OH 44242, USA
| | - Youngmi Lee
- Department of Food and Nutrition, Myongji University, 116, Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 17058, Korea
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Christoph MJ, An R. Effect of nutrition labels on dietary quality among college students: a systematic review and meta-analysis. Nutr Rev 2018; 76:187-203. [DOI: 10.1093/nutrit/nux069] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jeong JY, Ham S. Application of the Health Belief Model to customers' use of menu labels in restaurants. Appetite 2017; 123:208-215. [PMID: 29248690 DOI: 10.1016/j.appet.2017.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 11/14/2017] [Accepted: 12/10/2017] [Indexed: 11/17/2022]
Abstract
Some countries require the provision of menu labels on restaurant menus to fight the increasing prevalence of obesity and related chronic diseases. This study views customers' use of menu labels as a preventive health behavior and applies the Health Belief Model (HBM) with the aim of determining the health belief factors that influence customers' use of menu labels. A self-administered survey was distributed for data collection. Responses were collected from 335 restaurant customers who experienced menu labels in restaurants within three months prior to the survey. The results of a structural equation model showed that all the HBM variables (perceived threats, perceived benefits, and perceived barriers of using menu labels) positively affected the customers' use of menu labels. Perceived threats were influenced by cues to action and cues to action had an indirect influence on menu label use through perceived threats. In conclusion, health beliefs were good predictors of menu label use on restaurant menus. This study validated the application of the HBM to menu labeling in restaurants, and its findings could offer guidelines for the industry and government in developing strategies to expand the use of menu labels among the public.
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Affiliation(s)
- Jin-Yi Jeong
- Food Export Support Center, Korea Food Research Institute, Office: 245, Nongsaengmyeong-ro, Iseo-myeon, Wanju-Gun, Jeollabuk-do 55365, South Korea; Symbiotic Life Tech Research Institute, Department of Food and Nutrition, College of Human Ecology, Yonsei University, Office: 505 Samsung Hall, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Sunny Ham
- Symbiotic Life Tech Research Institute, Department of Food and Nutrition, College of Human Ecology, Yonsei University, Office: 505 Samsung Hall, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
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Bleich SN, Economos CD, Spiker ML, Vercammen K, VanEpps EM, Block JP, Elbel B, Story M, Roberto CA. A Systematic Review of Calorie Labeling and Modified Calorie Labeling Interventions: Impact on Consumer and Restaurant Behavior. Obesity (Silver Spring) 2017; 25:2018-2044. [PMID: 29045080 PMCID: PMC5752125 DOI: 10.1002/oby.21940] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Evidence on the effects of restaurant calorie labeling on consumer and restaurant behavior is mixed. This paper examined: (1) consumer responses to calorie information alone or compared to modified calorie information and (2) changes in restaurant offerings following or in advance of menu labeling implementation. METHODS Searches were conducted in PubMed, Web of Science, Policy File, and PAIS International to identify restaurant calorie labeling studies through October 1, 2016, that measured calories ordered, consumed, or available for purchase on restaurant menus. The reference lists of calorie labeling articles were also searched. RESULTS Fifty-three studies were included: 18 in real-world restaurants, 9 in cafeterias, and 21 in laboratory or simulation settings. Five examined restaurant offerings. CONCLUSIONS Because of a lack of well-powered studies with strong designs, the degree to which menu labeling encourages lower-calorie purchases and whether that translates to a healthier population are unclear. Although there is limited evidence that menu labeling affects calories purchased at fast-food restaurants, some evidence demonstrates that it lowers calories purchased at certain types of restaurants and in cafeteria settings. The limited data on modified calorie labels find that such labels can encourage lower-calorie purchases but may not differ in effects relative to calorie labels alone.
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Affiliation(s)
- Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health
| | | | - Marie L. Spiker
- Department of International Health, John Hopkins Bloomberg School of Public Health
| | - Kelsey Vercammen
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health
| | | | - Jason P. Block
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine and Wagner School of Public Service
| | - Mary Story
- Duke Global Health Institute, Duke University
| | - Christina A. Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania
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Cantu-Jungles TM, McCormack LA, Slaven JE, Slebodnik M, Eicher-Miller HA. A Meta-Analysis to Determine the Impact of Restaurant Menu Labeling on Calories and Nutrients (Ordered or Consumed) in U.S. Adults. Nutrients 2017; 9:E1088. [PMID: 28973989 PMCID: PMC5691705 DOI: 10.3390/nu9101088] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
| | - Lacey A McCormack
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD 57007, USA.
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Maribeth Slebodnik
- Arizona Health Sciences Library, University of Arizona, Tucson, AZ 85724, USA.
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Gruner J, Ohri-Vachaspati P. Food and Beverage Selection Patterns among Menu Label Users and Nonusers: Results from a Cross-Sectional Study. J Acad Nutr Diet 2017; 117:929-936. [DOI: 10.1016/j.jand.2016.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
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Weight stigma predicts inhibitory control and food selection in response to the salience of weight discrimination. Appetite 2017; 114:382-390. [PMID: 28416329 DOI: 10.1016/j.appet.2017.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Fear and stigmatization are often used to motivate individuals with higher body weight to engage in healthy behaviors, but these strategies are sometimes counterproductive, leading to undesirable outcomes. In the present study, the impact of weight-based stigma on cognition (i.e., inhibitory control) and food selection (i.e., calories selected) was examined among individuals who consider themselves to be overweight. It was predicted that participants higher in perceived weight stigma would perform more poorly on an inhibitory control task and order more calories on a food selection task when they read about discrimination against individuals with higher weight versus discrimination against an out-group. METHODS Participants completed online prescreen measures assessing whether they considered themselves to be overweight and their perceptions of weight stigma. Individuals who considered themselves to be overweight were invited into the laboratory to complete tasks that manipulated weight-based discrimination, then inhibitory control and food selection were measured. RESULTS The higher participants were in perceived weight stigma, the more poorly they performed on the inhibitory control task and the more calories they ordered when they read about discrimination against individuals with higher body weight. These relationships were not observed when participants read about discrimination against an out-group. CONCLUSIONS The present findings provide evidence that perceptions of weight stigma are critical in understanding the impact of weight-based discrimination. Additionally, these results have theoretical and practical implications for both understanding and addressing the psychological and physical consequences of weight-based stigma.
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Haynos AF, Roberto CA. The effects of restaurant menu calorie labeling on hypothetical meal choices of females with disordered eating. Int J Eat Disord 2017; 50:275-283. [PMID: 28130796 PMCID: PMC5378635 DOI: 10.1002/eat.22675] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/15/2016] [Accepted: 12/29/2016] [Indexed: 11/09/2022]
Abstract
Concerns have been raised that obesity public policy measures may have harmful effects on individuals with eating disorders. However, little research has investigated this topic. We examined the impact of a popular obesity public policy, menu calorie labeling, on hypothetical food choices of women with disordered eating. Seven hundred sixteen adult females completed an online survey in which they were randomly assigned to receive a restaurant menu with or without calorie information listed. Participants selected foods representative of a meal they would choose to consume and answered questions on restaurant ordering and menu labeling. Participants completed the Eating Disorder Examination Questionnaire (Fairburn & Beglin, ) to assess global eating pathology. Diagnoses of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) were also derived from this measure. Generalized linear modeling examined the impact of menu label condition, disordered eating, and the menu label by disordered eating interaction on hypothetical food selection and related variables. When disordered eating was examined continuously, menu labeling did not differentially affect food selections of those with elevated disordered eating (p = .45). However, when examined by eating disorder diagnosis, participants with AN or BN ordered significantly fewer (p < .001) and participants with BED ordered significantly more (p = .001) calories in the menu label versus no label condition. Menu labeling may decrease the calories ordered among individuals with AN or BN and increase calories ordered among individuals with BED.
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Affiliation(s)
- Ann F. Haynos
- University of Minnesota Medical Center, Minneapolis, MN
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Proximity of snacks to beverages increases food consumption in the workplace: A field study. Appetite 2016; 103:244-248. [DOI: 10.1016/j.appet.2016.04.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 11/23/2022]
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Kerins C, Cunningham K, Finucane FM, Gibson I, Jones J, Kelly C. Effects of an icon-based menu labelling initiative on consumer food choice. Perspect Public Health 2016; 137:45-52. [DOI: 10.1177/1757913916640826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: The purpose of this study was to examine the impact of an icon-based menu labelling initiative on consumer buying behaviour. Methods: This quasi-experimental study recruited a convenience sample of eight food service establishments, all with at least one menu item meeting the heart healthy criteria. Data from sales of all menu items sold over an 8-week period were collated 4 weeks prior to and 4 weeks during the display of information icons related to healthy food choices on menus. Results: The absolute change in menu item sales showed a non-significant trend towards an increase in healthier menu item selections. Furthermore, there was no association between the type of food service establishment and the percentage change in labelled menu item sales. Conclusion: The study did not find a statistically significant influence of the icon-based menu labels on consumer food choice. Given the limited amount of research that examines alternative menu labelling formats in real-world settings, more studies are necessary to confirm these results. Further research is needed to identify the optimal format, content and impact of menu labels on consumer behaviour.
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Affiliation(s)
- Claire Kerins
- National Institute for Preventive Cardiology, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Katie Cunningham
- National Institute for Preventive Cardiology, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Francis M Finucane
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway, Ireland
| | - Irene Gibson
- National Institute for Preventive Cardiology, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Jenni Jones
- National Institute for Preventive Cardiology, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland; Health Promotion Research Centre, National University of Ireland, Galway, Ireland
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland, Galway, Ireland
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Shah M, Bouza B, Adams-Huet B, Jaffery M, Esposito P, Dart L. Effect of calorie or exercise labels on menus on calories and macronutrients ordered and calories from specific foods in Hispanic participants: a randomized study. J Investig Med 2016; 64:1261-1268. [PMID: 27402619 DOI: 10.1136/jim-2016-000227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 11/04/2022]
Abstract
The effect of menu labels on food choices is unknown in Hispanics. This study evaluated the impact of menu labels on calories and macronutrients ordered in Hispanics. 372 Hispanics (18-65 years) were randomly assigned to menus with no labels (NL) (n=127), rank-ordered calorie labels plus a statement on energy needs per meal (CL) (n=123), or rank-ordered exercise labels showing minutes of brisk walking necessary to burn the food calories (EL) (n=122). The menus had identical food choices. Participants were instructed to select foods from the assigned menu as if having lunch in a fast food restaurant. One-way analysis of variance found no difference in calories ordered (median (25th and 75th centiles)) by menu condition (NL: 785.0 (465.0, 1010.0) kcal; CL: 790.0 (510.0, 1020.0) kcal; EL: 752.5 (520.0, 1033.8) kcal; p=0.75). Calories from specific foods and macronutrient intake were not different by menu condition. Menu label use was 26.8% in the CL and 25.4% in the EL condition. Calories ordered were not different between those who used and those who did not use the labels. Regression analysis showed that perception of being overweight (p=0.02), selecting foods based on health value (p<0.0001), and meeting exercise guidelines (p<0.0001) were associated with fewer calories ordered. Logistic regression showed that selecting foods based on health value (p=0.01) was associated with higher food label use. Menu labels did not affect food choices in Hispanic participants. Future studies should determine if nutrition, exercise, and weight perception counseling prior to menu labels intervention would result in better food choices. TRIAL REGISTRATION NUMBER NCT02804503; post-results.
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Affiliation(s)
- Meena Shah
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
| | - Brooke Bouza
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
| | - Beverley Adams-Huet
- Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Manall Jaffery
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
| | - Phil Esposito
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
| | - Lyn Dart
- Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas, USA
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Reale S, Flint SW. The Impact of Menu Label Design on Visual Attention, Food Choice and Recognition: An Eye Tracking Study. J SENS STUD 2016. [DOI: 10.1111/joss.12216] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sophie Reale
- School of Health and Related Research; University of Sheffield; Regent Court, Sheffield, S1 4DA United Kingdom
| | - Stuart William Flint
- Academy of Sport and Physical Activity; Sheffield Hallam University; United Kingdom
- Centre for Sport and Exercise Science; Sheffield Hallam University; United Kingdom
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CVD Prevention Through Policy: a Review of Mass Media, Food/Menu Labeling, Taxation/Subsidies, Built Environment, School Procurement, Worksite Wellness, and Marketing Standards to Improve Diet. Curr Cardiol Rep 2016; 17:98. [PMID: 26370554 PMCID: PMC4569662 DOI: 10.1007/s11886-015-0658-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Poor diet is the leading cause of cardiovascular disease in the USA and globally. Evidence-based policies are crucial to improve diet and population health. We reviewed the effectiveness for a range of policy levers to alter diet and diet-related risk factors. We identified evidence to support benefits of focused mass media campaigns (especially for fruits, vegetables, salt), food pricing strategies (both subsidies and taxation, with stronger effects at lower income levels), school procurement policies (for increasing healthful or reducing unhealthful choices), and worksite wellness programs (especially when comprehensive and multicomponent). Evidence was inconclusive for food and menu labeling (for consumer or industry behavior) and changes in local built environment (e.g., availability or accessibility of supermarkets, fast food outlets). We found little empiric evidence evaluating marketing restrictions, although broad principles and large resources spent on marketing suggest utility. Widespread implementation and evaluation of evidence-based policy strategies, with further research on other strategies with mixed/limited evidence, are essential “population medicine” to reduce health and economic burdens and inequities of diet-related illness worldwide.
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Reale S, Flint SW. Menu labelling and food choice in obese adults: a feasibility study. BMC OBESITY 2016; 3:17. [PMID: 26977307 PMCID: PMC4788894 DOI: 10.1186/s40608-016-0095-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/29/2016] [Indexed: 01/01/2023]
Abstract
Background To date research examining the benefits of menu labelling in the UK is sparse. The aim of the present study was to examine the impact of menu labelling in a UK obese population. Methods Using a repeated measures design, 61 patients at a tier 3 weight management service completed four questionnaires to assess their food choice (control) and behaviour change when presented with 3 menu labelling formats (calorie content; nutrient content; and energy expenditure). Results All three forms of labelling increased participants weight control concerns compared to the control condition. There was a significant difference in content of food ordered in the three menu labelling formats compared to the control condition. The calorie condition had the largest percentage decrease in calories selected followed by energy expenditure and nutrient content. However, no difference was observed between the three conditions in the desire for menu labelling in restaurants to be introduced in the UK. Conclusions The findings suggest that menu labelling should be enforced in the UK as it is both beneficial to promoting healthy eating and in demand. This study is the first to examine menu labelling in a UK obese population using energy expenditure equivalents to provide nutritional information.
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Affiliation(s)
- Sophie Reale
- Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Stuart W Flint
- Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK ; Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
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Haws KL, Liu PJ. Half-size me? How calorie and price information influence ordering on restaurant menus with both half and full entrée portion sizes. Appetite 2016; 97:127-37. [DOI: 10.1016/j.appet.2015.11.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
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Menu labelling is effective in reducing energy ordered and consumed: a systematic review and meta-analysis of recent studies. Public Health Nutr 2015; 19:2106-21. [DOI: 10.1017/s1368980015003468] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveMenu labelling is a practical tool to inform consumers of the energy content of menu items and help consumers make informed decisions in the eating-out environment, and the volume of studies published recently regarding its effects is expanding, both quantitatively and geographically. The aim of the present review and meta-analysis is to consider the most recent evidence which assesses the effect of menu labelling regarding changes in energy consumed, ordered or selected in both real-world and experimental settings.DesignThe review included fifteen peer-reviewed, full-text articles published between 2012 and 2014. Pertinent methodological information was extracted from each of the included studies and a quality assessment scheme was applied to classify the studies, after which systematic across-study comparisons were conducted. A meta-analysis was conducted including twelve of the fifteen studies, and stratified according to type of research setting and outcome: energy consumed, ordered or selected.ResultsThe rating yielded studies categorized by study quality: good (n 3), fair (n 9) and weak (n 3). Overall nine studies showed statistically significant reductions in energy consumed, ordered or selected. Three articles reported no effect of menu labelling. The meta-analysis showed statistically significant effects of menu labelling: overall energy consumed was reduced by a mean of 419·5 kJ (100·2 kcal) and energy ordered in real-world settings decreased by a mean of 325·7 kJ (77·8 kcal).ConclusionsThe review supports that menu labelling can effectively reduce energy ordered and consumed in the away-from-home food environment.
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Haws KL, Liu PJ. Combining food type(s) and food quantity choice in a new food choice paradigm based on vice-virtue bundles. Appetite 2015; 103:441-449. [PMID: 26585634 DOI: 10.1016/j.appet.2015.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 11/26/2022]
Abstract
Given the prevalence and rising rates of obesity in many countries, including the United States, much food decision-making research ultimately aims at understanding how consumers can make healthier choices. The two predominant choice paradigms used in food decision-making research ask consumers to choose (a) between a "vice" (or unhealthy food) and a "virtue" (or healthy food) or (b) among varying portion sizes of "vice." We propose a new food choice paradigm that encourages consumers to jointly consider both food type(s) choice and food portion size at each decision point. The purpose of this paradigm is two-fold. First, it aims to allow examination of more comprehensive eating behavior (e.g., to examine the overall composition of a plate of food rather than choice of a single food). Second, it aims to shift consumers towards including large proportions of virtues and smaller proportions of vice in their overall consumption portfolios. For this paradigm, we draw upon a recently introduced food product innovation called "vice-virtue bundles" (Liu et al., 2015) that illustrates the basis of this new food choice paradigm, in which food type(s) and portion decisions are made simultaneously. Accordingly, we first discuss relevant findings on vice-virtue bundles as well as the differences between simultaneous and sequential choice of multiple products. Second, we examine the benefits for managing and controlling one's consumption that are provided by vice-virtue bundles and this joint food choice paradigm more generally. Third and finally, we point out opportunities for future research by discussing (a) multiple factors that influence food choices, (b) decision processes affected by food choice paradigms, and (c) issues of generalizability related to the presence of vice-virtue bundles.
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Affiliation(s)
- Kelly L Haws
- Owen Graduate School of Management, Vanderbilt University, 401 21st Avenue South, Nashville, TN 37203, USA.
| | - Peggy J Liu
- Fuqua School of Business, Duke University, 100 Fuqua Drive, Durham, NC 27708, USA.
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Ahn JY, Park HR, Lee K, Kwon S, Kim S, Yang J, Song KH, Lee Y. The effect of providing nutritional information about fast-food restaurant menus on parents' meal choices for their children. Nutr Res Pract 2015; 9:667-72. [PMID: 26634057 PMCID: PMC4667209 DOI: 10.4162/nrp.2015.9.6.667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/OBJECTIVES To encourage healthier food choices for children in fast-food restaurants, many initiatives have been proposed. This study aimed to examine the effect of disclosing nutritional information on parents' meal choices for their children at fast-food restaurants in South Korea. SUBJECTS/METHODS An online experimental survey using a menu board was conducted with 242 parents of children aged 2-12 years who dined with them at fast-food restaurants at least once a month. Participants were classified into two groups: the low-calorie group (n = 41) who chose at least one of the lowest calorie meals in each menu category, and the high-calorie group (n = 201) who did not. The attributes including perceived empowerment, use of provided nutritional information, and perceived difficulties were compared between the two groups. RESULTS The low-calorie group perceived significantly higher empowerment with the nutritional information provided than did the high-calorie group (P = 0.020). Additionally, the low-calorie group was more interested in nutrition labeling (P < 0.001) and considered the nutritional value of menus when selecting restaurants for their children more than did the high-calorie group (P = 0.017). The low-calorie group used the nutritional information provided when choosing meals for their children significantly more than did the high-calorie group (P < 0.001), but the high-calorie group had greater difficulty using the nutritional information provided (P = 0.012). CONCLUSIONS The results suggest that improving the empowerment of parents using nutritional information could be a strategy for promoting healthier parental food choices for their children at fast-food restaurants.
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Affiliation(s)
- Jae-Young Ahn
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
| | - Hae-Ryun Park
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
| | - Kiwon Lee
- Department of Retail, Hospitality and Tourism Management, University of Tennessee, Knoxville, United States
| | - Sooyoun Kwon
- Department of Food and Nutrition, Honam University, Gwangju 506-714, Korea
| | - Soyeong Kim
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
| | - Jihye Yang
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
| | - Kyung-Hee Song
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea. ; Nutritional Education, Graduate School of Education, Myongji University, Seoul 120-728, Korea
| | - Youngmi Lee
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
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Cantor J, Torres A, Abrams C, Elbel B. Five Years Later: Awareness Of New York City’s Calorie Labels Declined, With No Changes In Calories Purchased. Health Aff (Millwood) 2015; 34:1893-900. [DOI: 10.1377/hlthaff.2015.0623] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jonathan Cantor
- Jonathan Cantor is a doctoral student at New York University’s Robert F. Wagner Graduate School of Public Service and an analyst at the New York University School of Medicine, both in New York City
| | - Alejandro Torres
- Alejandro Torres is a medical student at the New York University School of Medicine
| | - Courtney Abrams
- Courtney Abrams is a program manager at the New York University School of Medicine
| | - Brian Elbel
- Brian Elbel (
) is an associate professor at the New York University School of Medicine and New York University’s Robert F. Wagner Graduate School of Public Service
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Cioffi CE, Levitsky DA, Pacanowski CR, Bertz F. A nudge in a healthy direction. The effect of nutrition labels on food purchasing behaviors in university dining facilities. Appetite 2015; 92:7-14. [DOI: 10.1016/j.appet.2015.04.053] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022]
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Menu label accuracy at a university's foodservices. An exploratory recipe nutrition analysis. Appetite 2015; 92:24-8. [PMID: 25958116 DOI: 10.1016/j.appet.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/15/2015] [Accepted: 05/03/2015] [Indexed: 01/17/2023]
Abstract
The increase in the weight of American adults and children has been positively associated with the prevalence of the consumption of food-away-from-home. The objective was to assess the accuracy of claimed nutritional information of foods purchased in contracted foodservices located on the campus of an institution of higher education. Fifty popular food items were randomly collected from five main dining outlets located on a selected campus in the northeastern United States. The sampling was repeated three times on separate occasions for an aggregate total of 150 food samples. The samples were then weighed and assessed for nutrient composition (protein, cholesterol, fiber, carbohydrates, total fat, calories, sugar, and sodium) using nutrient analysis software. Results were compared with foodservices' published nutrition information. Two group comparisons, claimed and measured, were performed using the paired-sample t-test. Descriptive statistics were used as well. Among the nine nutritional values, six nutrients (total fat, sodium, protein, fiber, cholesterol, and weight) had more than 10% positive average discrepancies between measured and claimed values. Statistical significance of the variance was obtained in four of the eight categories of nutrient content: total fat, sodium, protein, and cholesterol (P < .05). Significance was also reached in the variance of actual portion weight compared to the published claims (P < .001). Significant differences of portion size (weight), total fat, sodium, protein, and cholesterol were found among the sampled values and the foodservices' published claims. The findings from this study raise the concern that if the actual nutritional information does not accurately reflect the declared values on menus, conclusions, decisions and actions based on posted information may not be valid.
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James A, Adams-Huet B, Shah M. Menu Labels Displaying the Kilocalorie Content or the Exercise Equivalent: Effects on Energy Ordered and Consumed in Young Adults. Am J Health Promot 2015; 29:294-302. [DOI: 10.4278/ajhp.130522-quan-267] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Determine the effect of menu labels displaying the energy content of food items or the exercise equivalent on energy ordered and consumed at lunch and energy intake for the remainder of the day in young adults. Design. Subjects were randomized to a menu with no labels (no-labels), menu with kilocalorie labels displaying the energy content of the food items (kcal-labels), or menu with exercise labels displaying the minutes of brisk walking needed to burn the food energy (exercise-labels). Setting. The study was conducted in one dining area located in a metabolic kitchen at the Texas Christian University and another located in a residence occupied by graduate students. Subjects. Of the 300 subjects, 55.7% were female, 77.3% were college students, 88% were white, and 88% were non-Hispanic. Mean body mass index and age were 24.2 ± 4.5 kg/m2 and 21.9 ± 2.3 years, respectively. Intervention. All menus contained the same food/beverage choices. Subjects ordered and consumed foods/beverages for lunch from the menu to which they were assigned. Subjects were blinded to study purpose. Measures. Energy ordered and consumed at lunch were assessed from the weight of the food ordered and consumed, respectively, and the energy content of the same foods available on the restaurant Web site. Postlunch energy intake was assessed by food recall. Analysis. Analysis of covariance, adjusted for premeal hunger levels and gender, determined the effect of menu type on energy ordered and consumed and postlunch energy intake. Results. Significant menu effect was observed for energy ordered (p = .008) and consumed (p = .04) at lunch. The exercise-labels group ordered significantly (p = .002) less energy (adjusted mean [confidence intervals]: 763 [703, 824] kcal) at lunch, compared to the no-labels group (902 [840, 963] kcal) but not compared to the kcal-labels group (827 [766, 888] kcal). The exercise-labels group also consumed significantly (p = .01) less energy (673 [620, 725] kcal) at lunch, compared to the no-labels group (770 (717, 823) kcal) but not compared to the kcal-labels group (722 [669, 776] kcal). Energy ordered and consumed were not different between kcal-labels and no-labels groups. There was no difference in postlunch energy intake by menu type. Conclusion. The menu with exercise-labels resulted in less energy ordered and consumed and this did not lead to greater energy consumption post lunch, compared to the menu with no-labels in young adults largely made up of normal-weight, non-Hispanic white college students.
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Long MW, Tobias DK, Cradock AL, Batchelder H, Gortmaker SL. Systematic review and meta-analysis of the impact of restaurant menu calorie labeling. Am J Public Health 2015; 105:e11-24. [PMID: 25790388 PMCID: PMC4386504 DOI: 10.2105/ajph.2015.302570] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Michael W Long
- Michael W. Long, Angie L. Cradock, and Steven L. Gortmaker are with Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Deirdre K. Tobias is with Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Holly Batchelder is with Tufts University Friedman School of Nutrition Science and Policy, Boston
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Adolescents' awareness and use of menu labels in eating establishments: results from a focus group study. Public Health Nutr 2015; 19:830-40. [PMID: 25895733 DOI: 10.1017/s1368980015001044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Menu labelling has been identified as a potential strategy to help individuals make healthier choices when eating out. Although adolescents eat out often, little research involving menu labelling has been conducted with this population. The objectives of the present study were to: (i) gather qualitative information from adolescents regarding use of menu labels when eating out; (ii) gather adolescents' suggestions for optimal ways to design menu labels; and (iii) examine differences between adolescents living in communities of different socio-economic status. DESIGN Qualitative. Five focus groups of five to ten participants. SETTING Austin, TX, USA, 2012. SUBJECTS Forty-one adolescents living in diverse communities recruited using a snowballing technique at public and private recreation centres (twenty-four females; twenty-two African American). RESULTS Participants reported that menu labelling, in general, does not influence food selections when eating out. Among participants living in low-income communities, food purchases were based on price, taste and familiarity. Among participants living in high-income areas, food purchases were based on quality and ability to satiate (among boys). According to participants, effective ways to present menu labels are by matching calorie levels with physical activity equivalents or through simple graphics. CONCLUSIONS For adolescents, providing menu labels in their current format may not be an effective strategy to increase healthy food selection. Given that the current menu label format has been set by federal policy in the USA cannot be easily changed, research to determine how this format can be best presented or enhanced so that it can have an impact on all US sub-populations is warranted.
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Raynor HA. What to do about portion sizes? Roundtable discussion at the Forefronts in Portion Size Conference. Int J Obes (Lond) 2015; 38 Suppl 1:S34-6. [PMID: 25033962 PMCID: PMC4105576 DOI: 10.1038/ijo.2014.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As portion size has increased in the United States, greater concern has arisen regarding the positive relationship between portion size and consumption, and how this relationship may negatively impact weight management. This article is a summary of a roundtable discussion from the Forefronts in Portion Size Conference held in Philadelphia, PA, USA in May 2013. The roundtable included four discussants, five speakers who had presented research on various components of portion size at the conference, two organizers and the moderator. Topics discussed included methods to reduce portion size that can assist with reducing energy intake, societal norms about portion size, values associated with portion size and methods to promote smaller portion sizes. Areas needing additional research were also identified.
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Affiliation(s)
- H A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, TN, USA
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50
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Roberto CA, Khandpur N. Improving the design of nutrition labels to promote healthier food choices and reasonable portion sizes. Int J Obes (Lond) 2015; 38 Suppl 1:S25-33. [PMID: 25033961 PMCID: PMC4105581 DOI: 10.1038/ijo.2014.86] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Accurate and easy-to-understand nutrition labeling is a worthy public health goal that should be considered an important strategy among many to address obesity and poor diet. Updating the Nutrition Facts Panel on packaged foods, developing a uniform front-of-package labeling system and providing consumers with nutrition information on restaurant menus offer important opportunities to educate people about food's nutritional content, increase awareness of reasonable portion sizes and motivate consumers to make healthier choices. The aims of this paper were to identify and discuss: (1) current concerns with nutrition label communication strategies; (2) opportunities to improve the communication of nutrition information via food labels, with a specific focus on serving size information; and (3) important future areas of research on nutrition labeling as a tool to improve diet. We suggest that research on nutrition labeling should focus on ways to improve food labels' ability to capture consumer attention, reduce label complexity and convey numeric nutrition information in simpler and more meaningful ways, such as through interpretive food labels, the addition of simple text, reduced use of percentages and easy-to-understand presentation of serving size information.
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Affiliation(s)
- C A Roberto
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA, USA
| | - N Khandpur
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
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