Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment

The impact of the English calorie labelling policy on the energy content of food offered and purchased in worksite cafeterias: a natural experiment

BACKGROUND

On 6 April 2022, legislation came into effect in England requiring calorie labels to be applied to food items on menus of larger food businesses. This study aimed to assess the impact of calorie labelling on (a) food purchased and (b) energy content of menu options in worksite cafeterias.

METHODS

Product-level sales data and energy content of available items was obtained from 142 worksite cafeterias from January 2022-October 2022. Interrupted-time-series (ITS) analysis with level and slope change evaluated daily energy (kcal) purchased per item, and ITS with level change assessed mean energy per option available on menus before and after calorie labelling. Each analysis was conducted 6 weeks and 6 months from implementation. A post-hoc ITS examined weekly energy purchased per item over a longer period (March 2021-October 2022; 135 sites).

RESULTS

There was no evidence calorie labelling changed the energy content of foods purchased (6-week: + 0.60 cal/product, 95%CI:-2.54, + 3.75; 6-month: + 1.59 cal/product, 95%CI:-0.96, + 4.16). Post-hoc analyses suggested calorie labels were associated with a reduction in mean energy of items purchased over time (-0.65 kcal/week, 95%CI:-0.81,-0.49), but a significant increase (+ 3 kcal, 95%CI: + 0.43, + 5.60) at the point of implementation. There was a reduction in the mean energy content of menu options at each seasonal menu change (April 2022:-1.79 kcal, 95%CI:-3.42,-0.15; July 2022:-4.18 kcal, 95% CI:-7.65,-0.73).

CONCLUSION

This large observational study in worksite cafeterias found no evidence to indicate the introduction of calorie labelling led to any immediate reduction in energy purchased by customers. There was some evidence of increasing impact over time, possibly associated with changes in menu offerings, but this effect was small and cannot be directly attributed to calorie labelling.

Point-of-choice kilocalorie labelling practices in large, out-of-home food businesses: a preobservational versus post observational study of labelling practices following implementation of The Calorie Labelling (Out of Home Sector) (England) Regulations 2021

BACKGROUND AND OBJECTIVES

On 6 April 2022, the UK government implemented mandatory kilocalorie (kcal) labelling regulations for food and drink products sold in the out-of-home food sector (OHFS) in England. Previous assessments of kcal labelling practices in the UK OHFS found a low prevalence of voluntary implementation and poor compliance with labelling recommendations. This study aimed to examine changes in labelling practices preimplementation versus post implementation of mandatory labelling regulations in 2022.

METHODS

In August-December 2021 (preimplementation) and August-November 2022 (post implementation), large OHFS businesses (250 or more employees) subject to labelling regulations were visited. At two time points, a researcher visited the same 117 food outlets (belonging to 90 unique businesses) across four local authorities in England. Outlets were rated for compliance with government regulations for whether kcal labelling was provided at any or all point of choice, provided for all eligible food and drink items, provided per portion for sharing items, if labelling was clear and legible and if kcal reference information was displayed.

RESULTS

There was a significant increase (21% preimplementation vs 80% post implementation, OR=40.98 (95% CI 8.08 to 207.74), p<0.001) in the proportion of outlets providing any kcal labelling at point-of-choice post implementation. Only 15% of outlets met all labelling compliance criteria post implementation, with a minority of outlets not presenting labelling in a clear (33%) or legible (29%) way.

CONCLUSION

The number of large businesses in the OHFS providing kcal labelling increased following the implementation of mandatory labelling regulations. However, around one-fifth of eligible outlets sampled were not providing kcal labelling 4-8 months after the regulations came into force, and the majority of businesses only partially complied with government guidance. More effective enforcement may be required to further improve kcal labelling practices in the OHFS in England.

PREREGISTRATION

Study protocol and analysis strategy preregistered on Open Science Framework (https://osf.io/pfnm6/).

A Narrative Review of Public Health Interventions for Childhood Obesity

PURPOSE OF REVIEW

Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB).

RECENT FINDINGS

Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.

Effect of calorie labelling in the out-of-home food sector on adult obesity prevalence, cardiovascular mortality, and social inequalities in England: a modelling study

BACKGROUND

England implemented a menu calorie labelling policy in large, out-of-home food businesses in 2022. We aimed to model the likely policy impact on population-level obesity and cardiovascular disease mortality, as well as the socioeconomic equity of estimated effects, in the adult population in England.

METHODS

For this modelling analysis, we built a comparative assessment model using two scenarios: the current implementation scenario refers to actual deployment only in large (≥250 employees), out-of-home food businesses, whereas the full implementation scenario refers to deployment in every out-of-home food business. We compared each scenario with a counterfactual: the scenario in which no intervention is implemented (ie, baseline). For both scenarios, we modelled the impact of the policy through assumed changes in energy intake due to either consumer response or product reformulation by retailers. We used data from the Office for National Statistics and the National Diet and Nutrition Survey 2009-19, and modelled the effect over 20 years (ie, 2022-41) to capture the long-term impact of the policy and provided mid-period results after 10 years. We used the Monte Carlo approach (2500 iterations) to estimate the uncertainty of model parameters. For each scenario, the model generated the change in obesity prevalence and the total number of deaths prevented or postponed.

FINDINGS

The current implementation scenario was estimated to reduce obesity prevalence by 0·31 percentage points (absolute; 95% uncertainty interval [UI] 0·10-0·35), which would prevent or postpone 730 cardiovascular disease deaths (UI 430-1300) of the 830 000 deaths (UI 600 000-1 200 000) expected over 20 years. However, the health benefits would be increased if calorie labelling was implemented in all out-of-home food businesses (2·65 percentage points reduction in obesity prevalence [UI 1·97-3·24] and 9200 cardiovascular disease deaths prevented or postponed [UI 5500-16 000]). Results were similar in the most and the least deprived socioeconomic groups.

INTERPRETATION

This study offers the first modelled estimation of the impact of the menu calorie labelling regulation on the adult population in England, although we did not include a cost-effectiveness analysis. Calorie labelling might result in a reduction in obesity prevalence and cardiovascular disease mortality without widening health inequalities. However, our results emphasise the need for the government to be more ambitious by applying this policy to all out-of-home food businesses to maximise impact.

FUNDING

European Research Council.

Noticing and Responding to Calorie Labels on Restaurant Menus: Patterns in Sexual-Minority Men

INTRODUCTION

A calorie-labeling policy for restaurant menus was implemented in 2018. Whether and how sexual-minority men use this information has not been evaluated.

METHODS

The Men's Body Project, a 2020 cross-sectional survey study of 504 cisgender sexual-minority men (mean age=35.8±10.4 years, 71.0% White, 5.6% Asian, 14.3% Black, 9.1% another/multiple race identities) assessed respondents' awareness of calorie labels on restaurant menus and subsequent responses. Additional questions were asked about weight-change goals, body image, disordered eating behaviors, and muscle-enhancing supplement use. Analyses in 2022-2023 used multivariate logistic regression to assess the associations between noticing calories and weight- and muscularity-oriented behaviors and, among those who noticed calorie labels, whether participants reported using this information to order more or fewer calories.

RESULTS

Approximately half of the participants reported noticing calorie labels. Those who did were more likely to report engaging in disordered eating behaviors (OR=2.03). Among participants who noticed menu labels, ordering fewer calories was the most frequent response, whereas 25% reported not changing the caloric content of their order. Many participants (21%) reported ordering both more and fewer calories, and this heterogeneous ordering pattern was associated with both disordered eating (OR=4.70) and muscle-enhancing behaviors (OR=9.42) compared with that among participants who did not report behaviors. Reporting weight-control efforts was associated with ordering fewer calories than participants not doing anything to change their weight (OR=2.53).

CONCLUSIONS

Most participants noticed calorie labels on menus, and many reported subsequently ordering fewer calories. Disordered eating and muscle-enhancing behaviors were associated with behavior changes in response to calorie information.

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.

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

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

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

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.

Menu Labeling and Calories Purchased in Restaurants in a US National Fast Food Chain

Importance

Menu labeling has been implemented in restaurants in some US jurisdictions as early as 2008, but the extent to which menu labeling is associated with calories purchased is unclear.

Objective

To estimate the association of menu labeling with calories and nutrients purchased and assess geographic variation in results.

Design, Setting, and Participants

A cohort study was conducted with a quasi-experimental design using actual transaction data from Taco Bell restaurants from calendar years 2007 to 2014 US restaurants with menu labeling matched to comparison restaurants using synthetic control methods. Data were analyzed from May to October 2023.

Exposure

Menu labeling policies in 6 US jurisdictions.

Main Outcomes and Measures

The primary outcome was calories per transaction. Secondary outcomes included total and saturated fat, carbohydrates, protein, sugar, fiber, and sodium.

Results

The final sample included 2329 restaurants, with menu labeling in 474 (31 468 restaurant-month observations). Most restaurants (94.3%) were located in California. Difference-in-differences model results indicated that customers purchased 24.7 (95% CI, 23.6-25.7) fewer calories per transaction from restaurants in the menu labeling group in the 3- to 24-month follow-up period vs the comparison group, including 21.9 (95% CI, 20.9-22.9) fewer calories in the 3- to 12-month follow-up period and 25.0 (95% CI, 24.0-26.1) fewer calories in the 13- to 24-month follow-up period. Changes in the nutrient content of transactions were consistent with calorie estimates. Findings in California were similar to overall estimates in magnitude and direction; yet, among restaurants outside of California, no association was observed in the 3- to 24-month period. The outcome of menu labeling also differed by item category and time of day, with a larger decrease in the number of tacos vs other items purchased and a larger decrease in calories purchased during breakfast vs other times of the day in the 3- to 24-month period.

Conclusions and Relevance

In this quasi-experimental cohort study, fewer calories were purchased in restaurants with calorie labels compared with those with no labels, suggesting that consumers are sensitive to calorie information on menu boards, although associations differed by location.

A multi-country comparison of jurisdictions with and without mandatory nutrition labelling policies in restaurants: analysis of behaviours associated with menu labelling in the 2019 International Food Policy Study

OBJECTIVE

To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups.

DESIGN

Cross-sectional data from the International Food Policy Study (IFPS) online survey.

SETTING

IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019.

PARTICIPANTS

Adults aged 18-99; n 19 393.

RESULTS

Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy.

CONCLUSIONS

Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.

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

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

Assessing public perception and awareness of UK mandatory calorie labeling in the out-of-home sector: Using Twitter and Google trends data

Objectives

In 2021 the UK government announced a new obesity policy requiring large out-of-home food outlets to provide mandatory in-store calorie labeling on food and drink items. Public acceptability and engagement with obesity policies could influence the level of impact on wider public health particularly with population-level policies such as calorie labeling. This study aimed to examine public responses and awareness of the policy using social media (Twitter) comments and Google trends data.

Methods

This study examined responses to social media posts on Twitter (tweets) from the UK Department of Health and Social Care detailing the policy, implementation date and post-implementation information about the policy's enforcement. The sentiments of the tweets were coded and the number of likes and replies extracted. This study utilized google trends to examine public awareness of the policy by extracting weekly relative search volume for relevant phrases such as "calorie labeling."

Results

From the 276 replies/quote-tweet extracted, the majority expressed a negative sentiment toward the policy (N = 197/71.4%). There were fewer tweets expressing a positive sentiment (N = 25/8.7%) and a neutral/no sentiment (N = 54/19.6%). There was no difference in the number of "likes" or retweets between tweets expressing positive or negative sentiments. Five themes were identified expressing negative sentiments (most common being negative impacts on eating disorders). Google trends data revealed increased searches for "calorie labels/labeling" during the week of the policy enforcement compared to previous weeks in the last 5 years but no significant differences in searches for specific menu calorie labeling.

Conclusions

This analysis revealed negative sentiment toward and increased searching of calorie labeling information during the announcement and implementation of the 2021 mandatory calorie labeling policy in England. A greater understanding of public responses to calorie labeling policies may help tailor future policies and public communication strategies.

Rethinking Efforts to Improve Dietary Patterns Among Long-Haul Truck Drivers: Transforming Truck Stop Retail Food Environments Through Upstream Change

A multitude of upstream occupational exposures influence poor dietary patterns that contribute to cardiometabolic health disparities among long-haul truck drivers in the United States. Herein, we delineate the unique characteristics of the truck driving profession that shape dietary patterns. Next, we discuss current health promotion efforts and why they are unlikely to be sufficient for improving population-level dietary patterns. We then advocate for prioritizing health promotion efforts that target upstream factors that influence population dietary patterns and have the potential to holistically and sustainably support drivers' nutrition. Finally, we propose novel research directions to catalyze upstream-oriented health promotion efforts.

Developing Effective Strategies for Obesity Prevention

Nutrition policies can work with clinical treatments to address the obesity epidemic. The United States has passed beverage taxes at the local level and calorie labeling mandates at the federal level to encourage healthier consumption. Nutritional changes to federal nutrition programs have been either implemented or suggested; evidence shows that the changes that have been implemented have resulted in improvements in diet quality and are cost-effective in decreasing the increase in obesity prevalence. A comprehensive policy agenda that addresses risk of obesity on multiple levels of the food supply will have meaningful long-term effects on obesity prevalence.

Prevalence of fast-food intake among a multi-ethnic population of middle-aged men and connection with sociodemographic factors and obesity

Adults are increasingly eating fast-food, which is connected to adverse health outcomes such as obesity and chronic diseases. This work was carried out to study the prevalence of fast-food intake among a multi-ethnic population of middle-aged men and its connection with sociodemographic factors and obesity. This cross-sectional study enrolled 1800 middle-aged men from Riyadh, Kingdom of Saudi Arabia. A valid and reliable questionnaire was used to assess participants fast-food intake frequency. Fast-food was consumed weekly by 87.8% of participants and daily by 45.6% of participants. The nationality of participants was determined as a predictor of fast-food intake. The highest and lowest prevalence of weekly fast-food intake was reported among Turkish (99.6%) and Sudanese (48.3%) participants. The highest and lowest daily intake rates were reported among participants from the Philippines (85.9%) and Bangladesh (10.0%). Another factor predicting fast-food intake was obesity. Obese participants had a significantly higher odds ratio (OR) of weekly (OR = 5.83, P <.001) and daily (OR = 1.93, P <.001) fast-food intake than non-overweight/nonobese participants. Fast-food intake was prevalent among middle-aged men who reside in Kingdom of Saudi Arabia. Results connect fast-food intake with nationality and obesity.

Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis

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 ).

Nutritional Composition and Purchasing Patterns of Supermarket Prepared Foods Over Time

INTRODUCTION

Prepared (ready-to-eat) foods are sold in >90% of U.S. supermarkets, but little is known about their nutritional quality. This study examined trends in purchases of supermarket prepared foods and compared their nutritional profile with that of supermarket packaged foods and restaurant foods.

METHODS

Nutrition data were obtained on prepared foods sold from 2015 to 2019 in 2 supermarket chains (∼1,200 stores). One chain (193 stores) provided transaction-level sales data from 2015 to 2017. Analyses (conducted in 2021-2022) examined trends in the number of different prepared foods offered by the chains and trends in purchases of calories, total sugar, saturated fat, and sodium from prepared foods. Calorie and nutrient densities (i.e., per 100 g of food) and prevalence of being high in calories or nutrients (on the basis of Chilean standards) were analyzed among supermarket prepared foods, supermarket packaged foods, and restaurant foods consumed in the National Health and Nutrition Examination Surveys 2015-2018.

RESULTS

The number of different prepared foods offered at supermarket chains increased from 1,930 in 2015 to 4,113 in 2019. Calories per transaction purchased from supermarket prepared foods increased by 1.0 calories/month (95% CI=0.8, 1.1), a ∼3% annual increase, with similar trends for other nutrients. At supermarkets, >90% of prepared bakery and deli items and 61% of prepared entrees/sides were high in calories or another nutrient of concern, similar to supermarket packaged foods and restaurant foods.

CONCLUSIONS

Supply of and demand for supermarket prepared foods have grown substantially over time. These trends are concerning given these foods' overall poor nutritional quality.

Multisectoral Strategies Needed to Establish Healthy Portion Size Norms That Disincentivize Hyperpalatable, Energy-Dense Foods and Sugary Beverages in Food Environments Linked to Obesity and Diet-Related Chronic Diseases in the United States

Over 40 y, Americans have consumed larger portions of hyperpalatable, energy-dense foods, sugary beverages, and meals prepared at home and away from home, which have contributed to obesity and diet-related chronic diseases in the United States (US). This perspective article explores synergies between the portion size and food matrix effects, and their associated biological, physiological, environmental, and cultural susceptibilities for populations. Thereafter, we describe evidence of US public- and private-sector initiatives to reduce, standardize, and incentivize portion size norms to align with recommended servings to promote a healthy weight for children, adolescents, and adults. Practitioners could use the Individual plus Policy, System, and Environment (I + PSE) Framework to implement multisectoral strategies for the US government, businesses, and civil society organizations to establish healthy portion size norms aligned with servings recommended by the Dietary Guidelines for Americans 2020-2025, and to disincentivize overconsumption of hyperpalatable products to reduce obesity and chronic disease risks.

Exploring restaurant and customer needs, barriers, interests, and food choices induced by the COVID-19 pandemic in Tarragona Province (Catalonia, Spain): A cross-sectional study

Background

COVID-19 has harmed restaurants, but customer preferences remain unknown. This study aims to determine the needs, barriers, interests, and food choice changes in restaurants and customers before and during the COVID-19 pandemic in Tarragona Province (Spain).

Methods

An observational cross-sectional study conducted in spring 2021 collected Mediterranean offerings, food safety, and hygiene information about the pandemic through online surveys and focus group interviews with restaurateurs and customers about the changes in their needs and new barriers.

Results

Fifty-one restaurateurs (44 survey, 7 focus group) and 138 customers (132 survey, 6 focus group) were included. In relation to the economic, emotional, and uncertainty restaurateurs' barriers detected, they implemented measures to tackle it: buy less and more often, reduce restaurant staff and reduce the restaurants offer, among others. Some customers reported changes in their restaurant orders, specifically increasing their takeaway orders. The Mediterranean diet offer (AMed criteria) remained without noticeable changes in any of the criteria. After lockdown, compared to before lockdown, restaurateurs increased their takeaway offerings by 34.1% (p < 0.001) and their use of digital menus by 27.3% (p < 0.001) because of customer demand. The use of local products in the menus remained high. The cleaning and disinfection tasks increased by 21.1% (p = 0.022), and the use of hydroalcoholic solutions increased by 13.7% (p = 0.031).

Conclusion

In restaurants, the first COVID-19 lockdown increased takeaway orders, sanitation, and digital communication. This study provides valuable information for adapting gastronomic offerings during challenging situations.

Prevalence of Fast Food Intake among a Multi-Ethnic Population of Young Men and Its Connection with Sociodemographic Determinants and Obesity

Fast food is commonly consumed by young adults. Eating fast food is connected with the risk of obesity and other related diseases. The present study examines the prevalence of fast food intake in a diverse sample of young men. This cross-sectional study included 3600 young men (20-35 years) who resided in Riyadh, KSA. The frequency of fast food intake was assessed using a valid and reliable questionnaire. Weekly and daily intake of fast food were the two outcome variables adopted to assess the intake frequency. Weight and height were measured. Fast food was eaten by 88.8% and 50.1% of participants weekly and daily, respectively. Fast food intake was predicted by the nationality of participants. The highest prevalence of weekly fast food intake (99.7%) was observed among Saudi, Egyptian, and Indian participants, while the lowest rate was observed among Sudanese participants (48.6%). The highest and lowest rates of daily intake were seen among Filipino (83.4%) and Bangladeshi (6.3%) participants. Obesity was another predictor of fast food intake. Obese participants had a significantly higher odds ratio of weekly (OR = 2.89, p = 0.006) and daily (OR = 1.39, p = 0.021) fast food intake than non-overweight/non-obese participants. In conclusion, fast food is frequently consumed by young men in KSA. Our findings link the likelihood of fast food intake to sociodemographic determinants and obesity.

Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain

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.

Is calorie labelling on menus the solution to obesity?

From April 2022, as part of the UK government’s new obesity strategy, it is now compulsory for all larger restaurant and cafes in the UK to include calorie labelling on their menus. Is this legislation, however, likely to be effective in reducing our caloric intake, thereby tackling obesity?

Changes in Calorie Content of Menu Items at Large Chain Restaurants After Implementation of Calorie Labels

IMPORTANCE

Calorie labeling on menus is required in US chain food establishments with 20 or more locations. This policy may encourage retailers to offer lower-calorie items, which could lead to a public health benefit by reducing customers' calorie intake from prepared foods. However, potential reformulation of restaurant menu items has not been examined since nationwide enforcement of this policy in 2018.

OBJECTIVE

To examine the calorie content of menu items at large chain restaurants before and after implementation of federally mandated menu calorie labels.

DESIGN, SETTING, AND PARTICIPANTS

This pre-post cohort study used restaurant menu data from MenuStat, a database of nutrition information for menu items offered in the largest chain restaurants in the US, collected annually from 2012 to 2019. The study comprised 35 354 menu items sold at 59 large chain restaurants in the US. Statistical analysis was conducted from February 4 to October 8, 2021.

INTERVENTION

Nationwide implementation of menu calorie labeling.

MAIN OUTCOMES AND MEASURES

Changes in menu items' calorie content after restaurant chains implemented calorie labels were estimated, adjusting for prelabeling trends. All menu items, continuously available items, items newly introduced to menus, and items removed from menus were examined separately.

RESULTS

Among the 59 restaurant chains included in the study, after labeling, there were no changes in mean calorie content for all menu items (change = -2.0 calories; 95% CI, -8.5 to 4.4 calories) or continuously available items (change = -2.3 calories; 95% CI, -11.5 to 6.3 calories). Items that were newly introduced after labeling, however, had a lower mean calorie content than items introduced before labeling (change = -112.9 calories; 95% CI, -208.6 to -25.2 calories), although there was heterogeneity by restaurant type. Items removed from menus after labeling had similar calorie content as items removed before labeling (change = 0.5 calories; 95% CI, -79.4 to 84.0 calories).

CONCLUSIONS AND RELEVANCE

In this cohort study of large chain restaurants, implementing calorie labels on menus was associated with the introduction of lower-calorie items but no changes in continuously available or removed items.