Menu Labeling Utilization and Socioeconomic Status in West Virginia and Mississippi

Prevalence of menu label use and its association with calorie intake among US adults

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.

Cost Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S

INTRODUCTION

Calorie labeling of standard menu items has been implemented at large restaurant chains across the U.S. since 2018. The objective of this study was to evaluate the cost effectiveness of calorie labeling at large U.S. fast-food chains.

METHODS

This study evaluated the national implementation of calorie labeling at large fast-food chains from a modified societal perspective and projected its cost effectiveness over a 10-year period (2018-2027) using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model. Using evidence from over 67 million fast-food restaurant transactions between 2015 and 2019, the impact of calorie labeling on calorie consumption and obesity incidence was projected. Benefits were estimated across all racial, ethnic, and income groups. Analyses were performed in 2022.

RESULTS

Calorie labeling is estimated to be cost saving; prevent 550,000 cases of obesity in 2027 alone (95% uncertainty interval=518,000; 586,000), including 41,500 (95% uncertainty interval=33,700; 50,800) cases of childhood obesity; and save $22.60 in healthcare costs for every $1 spent by society in implementation costs. Calorie labeling is also projected to prevent cases of obesity across all racial and ethnic groups (range between 126 and 185 cases per 100,000 people) and all income groups (range between 152 and 186 cases per 100,000 people).

CONCLUSIONS

Calorie labeling at large fast-food chains is estimated to be a cost-saving intervention to improve long-term population health. Calorie labeling is a low-cost intervention that is already implemented across the U.S. in large chain restaurants.

Qualitative menu labelling in university restaurants and its influence on food choices: A systematic review and synthesis without meta-analysis

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.