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Joshi R. Prevalence of menu label use and its association with calorie intake among US adults. Appetite 2024; 200:107577. [PMID: 38909695 DOI: 10.1016/j.appet.2024.107577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 06/12/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024]
Abstract
The 2018 Federal Menu Labeling regulations require restaurants and similar retail food establishments that are part of a chain with 20 or more locations to provide calorie and other nutrition information for standard menu items. In this study, we describe the sociodemographic correlates of prevalence of menu label use at Food-Away-From-Home (FAFH) establishments and estimate the association between menu label use and calorie intake. We use nationally representative data spanning the years 2007-2018 and multivariable logit regression and ordinary least squares regression models. For FAFH establishments, we find that female respondents have about 26% (95% CI = [1.14, 1.39]) higher odds of using menu labels. Respondents with high school degree have 51 percent higher odds (95% CI = [1.24, 1.85]), respondents with some college education have 107 percent higher odds (95% CI = [1.74, 2.47]) of seeing menu labels. Higher income is associated with 12% (95% CI = [1.08, 1.15]) greater odds of seeing menu labels. Hispanic respondents have 29% (95% CI = [0.62, 0.81]) lower odds of seeing and 79% (95% CI = [1.41, 2.29]) higher odds of using menu labels. Black respondents have 54% (95% CI = [1.35,1.75] higher odds of seeing menu labels at sit-down restaurants. Menu label users at fast-food restaurants reported consuming 202 kcal (95% CI = [-252,-153]) fewer total calories than nonusers and menu label users at sit-down restaurants reported using 181 kcal (95% CI = [-256,-106]) fewer total calories than nonusers. Our findings highlight the sociodemographic disparities in menu label use and provide baseline estimates for future studies evaluating the federal menu labeling regulation.
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Affiliation(s)
- Riju Joshi
- Department of Economics, Portland State University, College of Urban and Public Affairs, 450-K Urban Center Building, 506 SW Mill Street, Portland, OR, 97201-5412, USA.
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Jia J, Van Horn L, Linder JA, Ackermann RT, Kandula NR, O'Brien MJ. Menu Calorie Label Use and Diet Quality: a Cross-Sectional Study. Am J Prev Med 2023; 65:1069-1077. [PMID: 37433378 PMCID: PMC11192142 DOI: 10.1016/j.amepre.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Menu calorie labeling has been implemented in food service businesses to promote healthy food choices; however, evidence is limited on whether label use is associated with healthier dietary intake. This study examined the association between menu calorie label use and diet quality and whether it varied by weight status. METHODS Adults in the National Health and Nutrition Examination Survey 2017-2018 who visited restaurants were included. Menu calorie label use was categorized as did not notice labels, noticed labels, and used labels. Diet quality was measured using the Healthy Eating Index 2015 (maximum score 100) by two 24-hour diet recalls. The association between menu calorie label use and diet quality was examined using multiple linear regression and tested for effect modification by weight status. Data were collected during 2017-2018 and analyzed during 2022-2023. RESULTS Of 3,312 participants (representing 195,167,928 U.S. adults), 43% did not notice labels, 30% noticed labels, and 27% used labels. Using labels was associated with 4.0 points (95% CI 2.2, 5.8) higher Healthy Eating Index 2015 scores than not noticing labels. Healthy Eating Index 2015 scores in those using labels were higher for adults with normal BMI (3.4 points; 95% CI=0.2, 6.7), overweight (6.5 points; 95% CI=3.6, 9.5), and obesity (3.0 points; 95% CI=1.0, 5.1) (p-interaction=0.0004) than those who did not notice labels. CONCLUSIONS Using menu calorie labels was associated with modestly healthier diet quality than not noticing labels, regardless of weight status. This suggests that providing caloric information may help some adults with food decisions.
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Affiliation(s)
- Jenny Jia
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Linda Van Horn
- Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald T Ackermann
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Namratha R Kandula
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J O'Brien
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Finlay A, Boyland E, Jones A, Witkam R, Robinson E. The impact of calorie labelling and proportional pricing on out of home food orders: a randomised controlled trial study using a virtual food and drink delivery app. Int J Behav Nutr Phys Act 2023; 20:112. [PMID: 37726788 PMCID: PMC10508026 DOI: 10.1186/s12966-023-01513-2] [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: 04/24/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Mandatory calorie labelling in the out-of-home food sector was introduced in England in 2022, and menu pricing strategies that ensure cost is equivalent to portion size (proportional pricing) have been proposed as a policy to reduce obesity. Food delivery app-based platforms now contribute significantly to diet, and evidence suggests that those at a socioeconomic disadvantage may have greater exposure to unhealthy options on these platforms. However, public health policies to improve nutritional quality of food ordered from food delivery apps has received limited examination. OBJECTIVE This experimental study assessed the impact of calorie labelling and proportional pricing on item and meal size selection, calories ordered, and money spent when selecting food and drinks from three outlet types on a virtual delivery app. METHODS UK adult participants (N = 1126, 49% female), stratified by gender and education level completed an online study where they ordered items from three branded food and beverage outlets (coffee shop, sandwich outlet, fast food outlet) using a virtual delivery app. Participants were presented food and beverage options with vs. without calorie labels and with value (larger portions are proportionally cheaper) vs. proportional pricing. RESULTS Calorie labelling did not influence portion size selection for any outlets, but significantly reduced calories ordered from the coffee shop (-18.95kcals, 95% CI -33.07 to -4.84) and fast food outlet (-54.19kcals, 95% CI -86.04 to -22.33). Proportional pricing reduced the likelihood of choosing a larger beverage from the coffee shop (OR = 0.58, 95% CI 0.45 to 0.75), but was associated with increased calories ordered from the fast food outlet (51.25kcals, 95% CI 19.59 to 82.90). No consistent interactions were observed with participant characteristics, suggesting that effects of calorie labelling and pricing on outcomes were similar across sociodemographic groups. CONCLUSIONS Calorie labelling on food delivery platforms may effectively reduce calories ordered. Proportional pricing may be useful in prompting consumers to select smaller portion sizes, although further research in real-world settings will now be valuable.
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Affiliation(s)
- Amy Finlay
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK.
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Andrew Jones
- Department of Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Rozemarijn Witkam
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
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Fogolari N, Souza AD, Bernardo GL, Uggioni PL, Oliveira RC, Rodrigues VM, Proença RPC, Fernandes AC. Qualitative menu labelling in university restaurants and its influence on food choices: A systematic review and synthesis without meta-analysis. NUTR BULL 2023; 48:160-178. [PMID: 37161615 DOI: 10.1111/nbu.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 05/11/2023]
Abstract
Qualitative menu labelling can be defined as descriptive or non-numerical interpretive labels (e.g. traffic light labelling, healthy food symbols, messages or ingredient lists). Qualitative information seems to have a positive influence on consumers' food choices, particularly in institutional food service establishments, such as in universities. The aim of this systematic review was to assess the influence of different formats of qualitative menu labelling on food choices in university restaurants. This systematic review was guided by the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis Without Meta-Analysis (SWiM) and conducted vote counting of studies based on the direction of effect. Studies were retrieved from Cochrane Library, Scopus, MEDLINE, LILACS, SciELO and Web of Science databases and reference lists of selected articles. Experimental and quasi-experimental studies were included. Two independent researchers searched and extracted the data and assessed the methodological quality using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. From the initial search (460 records), four papers were selected, plus one paper identified in a previous study and a further six from an update search, totalling 11 included studies, reporting 14 different interventions (n = 499 174). Types of interventions included the use of symbols and the inclusion of traffic light labelling. Outcomes of interest were food choice, expressed as mean, median or percent healthy food choices or purchases. Qualitative menu labels increased healthy food choices and/or purchase behaviour, with 10 of 12 interventions favouring the intervention (83%; 95%CI 55-95%; p = 0.0386). Most of the studies favouring the intervention used healthy food symbols for healthier foods or food components, alone or in association with another intervention and were of moderate and weak quality. These findings may serve as a basis for the implementation of nutrition information policies in university restaurants.
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Affiliation(s)
- Natalia Fogolari
- Department of Nutrition and the Nutrition in Foodservice Research Centre (NUPPRE) of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Aretusa D Souza
- Department of Nutrition and the Nutrition in Foodservice Research Centre (NUPPRE) of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Greyce L Bernardo
- Department of Nutrition, NUPPRE, and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Paula L Uggioni
- Department of Nutrition, NUPPRE, and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Renata C Oliveira
- NUPPRE and the Catholic University Centre of Santa Catarina, Joinville, Santa Catarina, Brazil
| | - Vanessa M Rodrigues
- NUPPRE and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Rossana P C Proença
- Department of Nutrition, NUPPRE, and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ana C Fernandes
- Department of Nutrition, NUPPRE, and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Du M, Griecci CF, Cudhea F, Eom H, Wong JB, Wilde P, Kim DD, Michaud DS, Wang YC, Mozaffarian D, Zhang FF. What is the cost-effectiveness of menu calorie labelling on reducing obesity-associated cancer burdens? An economic evaluation of a federal policy intervention among 235 million adults in the USA. BMJ Open 2023; 13:e063614. [PMID: 37072239 DOI: 10.1136/bmjopen-2022-063614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE To assess the impact of menu calorie labelling on reducing obesity-associated cancer burdens in the USA. DESIGN Cost-effectiveness analysis using a Markov cohort state-transition model. SETTING Policy intervention. PARTICIPANTS A modelled population of 235 million adults aged ≥20 years in 2015-2016. INTERVENTIONS The impact of menu calorie labelling on reducing 13 obesity-associated cancers among US adults over a lifetime was evaluated for: (1) effects on consumer behaviours; and (2) additional effects on industry reformulation. The model integrated nationally representative demographics, calorie intake from restaurants, cancer statistics and estimates on associations of policy with calorie intake, dietary change with body mass index (BMI) change, BMI with cancer rates, and policy and healthcare costs from published literature. MAIN OUTCOME MEASURES Averted new cancer cases and cancer deaths and net costs (in 2015 US$) among the total population and demographic subgroups were determined. Incremental cost-effectiveness ratios from societal and healthcare perspectives were assessed and compared with the threshold of US$150 000 per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analyses incorporated uncertainty in input parameters and generated 95% uncertainty intervals (UIs). RESULTS Considering consumer behaviour alone, this policy was associated with 28 000 (95% UI 16 300 to 39 100) new cancer cases and 16 700 (9610 to 23 600) cancer deaths averted, 111 000 (64 800 to 158 000) QALYs gained, and US$1480 (884 to 2080) million saved in cancer-related medical costs among US adults. The policy was associated with net cost savings of US$1460 (864 to 2060) million and US$1350 (486 to 2260) million from healthcare and societal perspectives, respectively. Additional industry reformulation would substantially increase policy impact. Greater health gains and cost savings were predicted among young adults, Hispanic and non-Hispanic Black individuals. CONCLUSIONS Study findings suggest that menu calorie labelling is associated with lower obesity-related cancer burdens and reduced healthcare costs. Policymakers may prioritise nutrition policies for cancer prevention in the USA.
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Affiliation(s)
- Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Christina F Griecci
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Heesun Eom
- New York Academy of Medicine, New York, New York, USA
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts, USA
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, School of Medicine, Tuft University, Boston, Massachusetts, USA
| | - Y Claire Wang
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Oh GEG, Huh YE, Mukhopadhyay A. Inducing consumers to use calorie information: a multinational investigation. Psychol Health 2023; 38:459-477. [PMID: 34473007 DOI: 10.1080/08870446.2021.1972111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We identify individuals who set daily intake budgets and examine if an intervention making people estimate their calorie intake up to a certain point in the day helps those setting daily budgets to regulate their calorie intake for the remainder of the day, after high prior consumption. DESIGN We conducted an online experiment in five countries: Australia, China, Germany, India, and the UK (n = 3,032) using a 2 (setting calorie budget: yes vs. no, measured) x 2 (intervention: intake reminder vs. control, manipulated) between-subjects design, with the amount of prior consumption measured. Participants were contacted in the afternoon. Those in the intervention condition were asked to estimate their prior calorie intake on that day. MAIN OUTCOME MEASURES We measured the individual characteristics of those who set daily calorie budgets and the intended calorie intake for the remainder of the day. RESULTS Among people who set daily calorie budgets, the intervention reduced intended calorie intake for the remainder of the day by 176 calories if they had already consumed a high amount of calories that day. CONCLUSION A timely intervention to estimate one's calorie intake can lower additional intended calorie intake among those who set daily calorie budget.
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Affiliation(s)
- Ga-Eun Grace Oh
- Department of Marketing and International Business, Lingnan University, Tuen Mun, Hong Kong
| | - Young Eun Huh
- School of Business and Technology Management, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Anirban Mukhopadhyay
- School of Business and Management, Hong Kong University of Science and Technology, Kowloon, Hong Kong
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Bhawra J, Kirkpatrick SI, Hall MG, Vanderlee L, Thrasher JF, Jáuregui de la Mota A, Hammond D. A five-country study of front- and back-of-package nutrition label awareness and use: patterns and correlates from the 2018 International Food Policy Study. Public Health Nutr 2023; 26:275-286. [PMID: 36284083 PMCID: PMC11077451 DOI: 10.1017/s1368980022002257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to identify correlates of nutrition label awareness and use, particularly subgroup differences among consumers. Two label types were assessed: (1) nutrition facts tables (NFt) in Australia, Canada, Mexico, UK, and USA and (2) front-of-package (FOP) labels, including mandatory Guideline Daily Amounts (Mexico), voluntary Health Star Ratings (Australia) and voluntary Traffic Lights (UK). DESIGN Respondents were recruited using Nielsen Consumer Insights Global Panel (n 21 586) and completed online surveys in November-December 2018. Linear regression and generalised linear mixed models examined differences in label use and awareness between countries and label type based on sociodemographic, knowledge-related and dietary characteristics. SETTING Australia, Canada, Mexico, UK and USA. PARTICIPANTS Adults (≥18 years). RESULTS Respondents from the USA, Canada and Australia reported significantly higher NFt use and awareness than those in Mexico and the UK. Mexican respondents reported the highest level of FOP label awareness, whereas UK respondents reported the highest FOP label use. NFt use was higher among females, 'minority' ethnic groups, those with higher nutrition knowledge and respondents with 'adequate literacy' compared with those with 'high likelihood of limited literacy'. FOP label use was higher among those with a 'high likelihood of limited literacy' compared with 'adequate literacy' across countries. CONCLUSIONS Lower use of mandatory Guideline Daily Amount labels compared with voluntary FOP labelling systems provides support for Mexico's decision to switch to mandatory 'high-in' warning symbols. The patterns of consumer label use and awareness across sociodemographic and knowledge-related characteristics suggest that simple FOP labels may encourage broader use across countries.
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Affiliation(s)
- Jasmin Bhawra
- School of Occupational and Public Health, Faculty of Community
Services, Toronto Metropolitan University, Toronto,
ON, Canada
| | - Sharon I Kirkpatrick
- School of Public Health Sciences, Faculty of Health,
University of Waterloo, Waterloo,
ONN2L 3G1, Canada
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public
Health, and Lineberger Comprehensive Cancer Center, University of North
Carolina, Chapel Hill, NC,
USA
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, Santé et Société (Centre
NUTRISS) and Institut Sur la Nutrition et les Aliments Fonctionnels (INAF),
Université Laval, Québec,
Canada
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold
School of Public Health, University of South Carolina,
Columbia, SC, USA
| | | | - David Hammond
- School of Public Health Sciences, Faculty of Health,
University of Waterloo, Waterloo,
ONN2L 3G1, Canada
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Petimar J, Grummon AH, Zhang F, Gortmaker SL, Moran AJ, Polacsek M, Rimm EB, Roberto CA, Rao A, Cleveland LP, Simon D, Franckle RL, Till S, Greene J, Block JP. Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain. JAMA Intern Med 2022; 182:965-973. [PMID: 35913728 PMCID: PMC9344388 DOI: 10.1001/jamainternmed.2022.3065] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Calorie labels for prepared (ie, ready-to-eat) foods are required in large chain food establishments in the US. Large evaluations in restaurants suggest small declines in purchases of prepared foods after labeling, but to the authors' knowledge, no studies have examined how this policy influences supermarket purchases. OBJECTIVE To estimate changes in calories purchased from prepared foods and potential packaged substitutes compared with control foods after calorie labeling of prepared foods in supermarkets. DESIGN, SETTING, AND PARTICIPANTS This controlled interrupted time series compared sales 2 years before labeling implementation (April 2015-April 2017) with sales 7 months after labeling implementation (May 2017-December 2017). Data from 173 supermarkets from a supermarket chain with locations in Maine, Massachusetts, New Hampshire, New York, and Vermont were analyzed from March 2020 to May 2022. INTERVENTION Implementation of calorie labeling of prepared foods in April 2017. MAIN OUTCOMES AND MEASURES Purchased items were classified as prepared foods, potential packaged substitutes for prepared foods, or all other (ie, control) foods. The primary outcome was mean weekly calories per transaction purchased from prepared foods, and the secondary outcome was mean weekly calories per transaction purchased from similar packaged items (for substitution analyses). Analyses of prepared and packaged foods were stratified by food category (bakery, entrées and sides, or deli meats and cheeses). RESULTS Among the included 173 supermarkets, calorie labeling was associated with a mean 5.1% decrease (95% CI, -5.8% to -4.4%) in calories per transaction purchased from prepared bakery items and an 11.0% decrease (95% CI, -11.9% to -10.1%) from prepared deli items, adjusted for changes in control foods; no changes were observed for prepared entrées and sides (change = 0.3%; 95% CI, -2.5% to 3.0%). Labeling was also associated with decreased calories per transaction purchased from packaged bakery items (change = -3.9%; 95% CI, -4.3% to -3.6%), packaged entrées and sides (change = -1.2%; 95% CI, -1.4% to -0.9%), and packaged deli items (change = -2.1%; 95% CI, -2.4% to -1.7%). CONCLUSIONS AND RELEVANCE In this longitudinal study of supermarkets, calorie labeling of prepared foods was associated with small to moderate decreases in calories purchased from prepared bakery and deli items without evidence of substitution to similar packaged foods.
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Affiliation(s)
- Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anna H Grummon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alyssa J Moran
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, Portland, Maine
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Anjali Rao
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Lauren P Cleveland
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Denise Simon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Sue Till
- Hannaford Supermarkets, Scarborough, Maine
| | - Julie Greene
- Guiding Stars Licensing Company LLC, Ahold Delhaize USA, Scarborough, Maine
| | - Jason P Block
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Tapper K, Yarrow K, Farrar S, Mandeville K. Effects of calorie labelling and contextual factors on hypothetical coffee shop menu choices. Appetite 2022; 172:105963. [DOI: 10.1016/j.appet.2022.105963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 12/28/2022]
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Neff Warner LR, Ruderman SA, Zinsli KA, Jones-Smith JC, Littman AJ. Menu Labeling Utilization and Socioeconomic Status in West Virginia and Mississippi. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:172-180. [PMID: 35148871 DOI: 10.1016/j.jneb.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Determine the association between socioeconomic status and self-reported noticing and using calorie menu labels in 2 states with high poverty and obesity. DESIGN Cross-sectional study of responses to the 2016 Behavioral Risk Factor Surveillance System Menu Labeling Module. PARTICIPANTS Representative sample of noninstitutionalized adults aged ≥ 18 years in West Virginia and Mississippi (n = 9,469). MAIN OUTCOME MEASURES The outcomes were reported noticing and using menu labels to make decisions at fast-food restaurants. Independent variables were highest attained education and federal poverty level (% FPL). ANALYSIS Generalized linear models estimated prevalence ratios for noticing and using menu labels. Models mutually adjusted for education, % FPL, age, sex, race/ethnicity, and body mass index. RESULTS Eighty-six percent of respondents reported noticing, and 56% reported using menu labels. Compared with individuals with less than high school education, college graduates were 11% more likely to report noticing (95% confidence interval, 1.06-1.18; P < 0.001) and 18% more likely to report using (95% confidence interval, 1.06-1.30; P < 0.01) menu labels. Patterns were similar for % FPL. CONCLUSIONS AND IMPLICATIONS These data support further investigation of menu labels among subgroups and a larger geographic scope. Limitations of the menu labeling module question and the cross-sectional nature of the existing literature warrant additional research.
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Affiliation(s)
| | | | - Kaitlin A Zinsli
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Jessica C Jones-Smith
- Department of Epidemiology, University of Washington, Seattle, WA; Department of Health Services, University of Washington, Seattle, WA
| | - Alyson J Littman
- Department of Epidemiology, University of Washington, Seattle, WA; Department of Veterans Affairs, Seattle Epidemiologic Research and Information Center, Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Health Services, Seattle, WA
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Petimar J, Zhang F, Rimm EB, Simon D, Cleveland LP, Gortmaker SL, Bleich SN, Polacsek M, Roberto CA, Block JP. Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment. PLoS Med 2021; 18:e1003714. [PMID: 34252088 PMCID: PMC8312920 DOI: 10.1371/journal.pmed.1003714] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/26/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Calorie menu labeling is a policy that requires food establishments to post the calories on menu offerings to encourage healthy food choice. Calorie labeling has been implemented in the United States since May 2018 per the Affordable Care Act, but to the best of our knowledge, no studies have evaluated the relationship between calorie labeling and meal purchases since nationwide implementation of this policy. Our objective was to investigate the relationship between calorie labeling and the calorie and nutrient content of purchased meals after a fast food franchise began labeling in April 2017, prior to the required nationwide implementation, and after nationwide implementation of labeling in May 2018, when all large US chain restaurants were required to label their menus. METHODS AND FINDINGS We obtained weekly aggregated sales data from 104 restaurants that are part of a fast food franchise for 3 national chains in 3 US states: Louisiana, Mississippi, and Texas. The franchise provided all sales data from April 2015 until April 2019. The franchise labeled menus in April 2017, 1 year prior to the required nationwide implementation date of May 2018 set by the US Food and Drug Administration. We obtained nutrition information for items sold (calories, fat, carbohydrates, protein, saturated fat, sugar, dietary fiber, and sodium) from Menustat, a publicly available database with nutrition information for items offered at the top revenue-generating US restaurant chains. We used an interrupted time series to find level and trend changes in mean weekly calorie and nutrient content per transaction after franchise and nationwide labeling. The analytic sample represented 331,776,445 items purchased across 67,112,342 transactions. Franchise labeling was associated with a level change of -54 calories/transaction (95% confidence interval [CI]: -67, -42, p < 0.0001) and a subsequent 3.3 calories/transaction increase per 4-week period (95% CI: 2.5, 4.1, p < 0.0001). Nationwide implementation was associated with a level decrease of -82 calories/transaction (95% CI: -88, -76, p < 0.0001) and a subsequent -2.1 calories/transaction decrease per 4-week period (95% CI: -2.9, -1.3, p < 0.0001). At the end of the study, the model-based predicted mean calories/transaction was 4.7% lower (change = -73 calories/transaction, 95% CI: -81, -65), and nutrients/transaction ranged from 1.8% lower (saturated fat) to 7.0% lower (sugar) than what we would expect had labeling not been implemented. The main limitations were potential residual time-varying confounding and lack of individual-level transaction data. CONCLUSIONS In this study, we observed that calorie labeling was associated with small decreases in mean calorie and nutrient content of fast food meals 2 years after franchise labeling and nearly 1 year after implementation of labeling nationwide. These changes imply that calorie labeling was associated with small improvements in purchased meal quality in US chain restaurants.
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Affiliation(s)
- Joshua Petimar
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Denise Simon
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lauren P Cleveland
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Michele Polacsek
- Westbrook College of Health Professions, University of New England, Portland, Maine, United States of America
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America
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Fichera E, von Hinke S. The response to nutritional labels: Evidence from a quasi-experiment. JOURNAL OF HEALTH ECONOMICS 2020; 72:102326. [PMID: 32526549 DOI: 10.1016/j.jhealeco.2020.102326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 05/09/2023]
Abstract
This paper evaluates a UK policy that aimed to improve dietary information provision by introducing nutrition labelling on retailers' store-brand products. Exploiting the differential timing of the introduction of Front-of-Pack nutrition labels as a quasi-experiment, our findings suggest that labelling led to a reduction in the quantity purchased of labelled store-brand foods, and an improvement in their nutritional composition. More specifically, we find that households reduced the total monthly calories from labelled store-brand foods by 588 kcal, saturated fats by 14 g, sugars by 7 g, and sodium by 0.8 mg.
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Affiliation(s)
- Eleonora Fichera
- Department of Economics, University of Bath and Institute for Fiscal Studies, United Kingdom; Institute for Fiscal Studies, United Kingdom.
| | - Stephanie von Hinke
- School of Economics, University of Bristol, United Kingdom; Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands; Institute for Fiscal Studies, United Kingdom.
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14
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Petimar J, Ramirez M, Rifas-Shiman SL, Linakis S, Mullen J, Roberto CA, Block JP. Evaluation of the impact of calorie labeling on McDonald's restaurant menus: a natural experiment. Int J Behav Nutr Phys Act 2019; 16:99. [PMID: 31684961 PMCID: PMC6829981 DOI: 10.1186/s12966-019-0865-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background The long-term effect of calorie labeling on fast-food purchases is unclear. McDonald’s voluntarily labeled its menus with calories in 2012, providing an opportunity to evaluate this initiative on purchases. Methods From 2010 to 2014, we collected receipts from and administered questionnaires to 2971 adults, 2164 adolescents, and 447 parents/guardians of school-age children during repeated visits to 82 restaurants, including McDonald’s and five control chains that did not label menus over the study period in four New England cities. In 2018, we analyzed the data by using difference-in-differences analyses to estimate associations of calorie labeling with calories purchased (actual and estimated) and predicted probability of noticing calorie information on menus. Results Calorie labeling at McDonald’s was not associated with changes in calories purchased in adults (change = − 19 cal pre- vs. post-labeling at McDonald’s compared to control chains, 95% CI: − 112, 75), adolescents (change = − 49 cal, 95% CI: − 136, 38), or children (change = 13 cal, 95% CI: − 108, 135). Calorie labeling generally increased the predicted probability of noticing calorie information, but did not improve estimation of calories purchased. Conclusions Calorie labeling at McDonald’s was not associated with changes in calories purchased in adults, adolescents, or children. Although participants were more likely to notice calories on menus post-labeling, there was no improvement in ability to accurately estimate calories purchased.
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Affiliation(s)
- Joshua Petimar
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Maricelle Ramirez
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Stephanie Linakis
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jewel Mullen
- Departments of Population Health and Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Leask CF, Colledge N, Laventure RME, McCann DA, Skelton DA. Co-Creating Recommendations to Redesign and Promote Strength and Balance Service Provision. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3169. [PMID: 31480290 PMCID: PMC6747106 DOI: 10.3390/ijerph16173169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 12/04/2022]
Abstract
Background: Awareness of physical activity guidelines are low, particularly the "forgotten guidelines" of strength and balance. Increasing awareness of guidelines, but also of appropriate local services that can be utilised, is an important step towards active ageing. Co-creation can inform tailored service provision to potentially increase uptake and adherence. The aim was to co-create recommendations to redesign and promote local leisure services, emphasising strength and balance activity provision. Method: Twenty-four ageing and older adults engaged in 10 co-creation workshops. Workshops consisted of interactive tasks, and fieldwork tasks were undertaken externally. Data were collected using field notes, worksheet tasks and facilitator reflections and were analysed using qualitative content analysis. Results: Retention and adherence rates were 92% and 85%. Co-creators cited group cohesion, scientific input from experts and perceived knowledge development as enjoyable elements of the process. Four key themes emerged from analysis: (1) localised strategies for awareness raising, (2) recruitment of volunteer champions to increase uptake and maintenance, (3) accessibility of activities, including what they are and when they are, and (4) evaluation of impact. Conclusion: This has been the first study, to our knowledge, to utilise co-creation for informed leisure service provision improvement. Future work should aim to implement these recommendations to ascertain what impact these themes might make.
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Affiliation(s)
- Calum F Leask
- Aberdeen City Health & Social Care Partnership, Marischal College, Broad Street, Aberdeen AB10 1AB, UK.
- Health Intelligence Department, NHS Grampian, Summerfield House, Eday Road, Aberdeen AB15 6RE, UK.
| | - Nick Colledge
- External Consultant, Robin Park Sports Centre, Loire Drive, Newtown, Wigan WN5 0UL, UK
| | | | - Deborah A McCann
- Inspiring Healthy Lifestyles, Robin Parks Sports Centre, Loire Drive, Newtown, Wigan WN5 0UL, UK
- Physical Activity Exchange, School of Sport and Exercise Sciences, Liverpool John Moores University, 70 Great Crosshall Street, Merseyside L3 2AB, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
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Abstract
Obesity affects more than 35% of women aged 20 to 39 years in the United States. This article summarizes recent research that reconceptualizes obesity as adipose disease associated with smoking; socio-economic disparities in employment, education, healthcare access, food quality, and availability; and environmental toxins, ultimately altering microbiomes and epigenetics. Individual prenatal care of women with obesity includes early testing for diabetes, counseling on epigenetic diets, advice supporting weight gain within national guidelines, and vigilance for signs of hypertensive disorders of pregnancy. Intrapartum care includes mechanical cervical ripening measures, patience with prolonged labor, and uterotonic medication readiness in the event of postpartum hemorrhage. Postpartum care includes thrombus risk amelioration through early ambulation, use of compression stockings, and anticoagulation. Delays in lactogenesis II can be offset by measures to support early breastfeeding. Sociopolitical action by nurses at national, state, and community levels to reduce population disparities in racism, education, and employment; reduce pollution from obesogenic chemicals; and improve food quality and distribution policies is likely to have the broadest impact in future obesity reductions and prevention.
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