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Luick M, Bandy L, Jebb SA, Pechey R. The impact of the English calorie labelling policy on the energy content of food offered and purchased in worksite cafeterias: a natural experiment. BMC Nutr 2024; 10:110. [PMID: 39138549 PMCID: PMC11321062 DOI: 10.1186/s40795-024-00914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024] Open
Abstract
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.
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Affiliation(s)
- Madison Luick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Lauren Bandy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Rachel Pechey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK.
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2
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Polden M, Jones A, Essman M, Adams J, Bishop T, Burgoine T, Donohue A, Sharp S, White M, Smith R, Robinson E. 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. BMJ Open 2024; 14:e080405. [PMID: 38604637 PMCID: PMC11015320 DOI: 10.1136/bmjopen-2023-080405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
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/).
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Affiliation(s)
- Megan Polden
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Lancaster University, Lancaster, UK
| | | | - Michael Essman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tom Bishop
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Stephen Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Richard Smith
- Institute of Health Research, University of Exeter Medical School, Exeter, Devon, UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK
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Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A Narrative Review of Public Health Interventions for Childhood Obesity. Curr Obes Rep 2024; 13:87-97. [PMID: 38172483 DOI: 10.1007/s13679-023-00550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
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.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
| | - Erica Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, USA
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, Mass General for Children, The Greater Boston Food Bank, Boston, USA
| | - Ellen McMahon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Lauren Kruse
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, USA
| | - Emma K Edmondson
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
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4
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Colombet Z, Robinson E, Kypridemos C, Jones A, O'Flaherty M. 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. Lancet Public Health 2024; 9:e178-e185. [PMID: 38429017 DOI: 10.1016/s2468-2667(23)00326-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 03/03/2024]
Abstract
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.
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Affiliation(s)
- Zoé Colombet
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Andrew Jones
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Salvia MG, Mattie H, Tran A. Noticing and Responding to Calorie Labels on Restaurant Menus: Patterns in Sexual-Minority Men. Am J Prev Med 2024; 66:269-278. [PMID: 37813173 DOI: 10.1016/j.amepre.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
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.
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Affiliation(s)
- Meg G Salvia
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
| | - Heather Mattie
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Alvin Tran
- Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, Connecticut
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Dupuis R, Block JP, Barrett JL, Long MW, Petimar J, Ward ZJ, Kenney EL, Musicus AA, Cannuscio CC, Williams DR, Bleich SN, Gortmaker SL. Cost Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S. Am J Prev Med 2024; 66:128-137. [PMID: 37586572 PMCID: PMC10840662 DOI: 10.1016/j.amepre.2023.08.012] [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: 03/29/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
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.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Jason P Block
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Jessica L Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Joshua Petimar
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erica L Kenney
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aviva A Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Hswen Y, Moran AJ, von Ash T, Prasad S, Martheswaran T, Simon D, Cleveland LP, Brownstein JS, Block JP. The impact of the federal menu labeling law on the sentiment of Twitter discussions about restaurants and food retailers: An interrupted time series analysis. Prev Med Rep 2023; 36:102478. [PMID: 37927975 PMCID: PMC10622709 DOI: 10.1016/j.pmedr.2023.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/22/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023] Open
Abstract
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.
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Affiliation(s)
- Yulin Hswen
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, CA, USA
| | - Alyssa J. Moran
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tayla von Ash
- Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | | | | | - Denise Simon
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, USA
| | | | - John S. Brownstein
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jason P. Block
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, 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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Rummo PE, Mijanovich T, Wu E, Heng L, Hafeez E, Bragg MA, Jones SA, Weitzman BC, Elbel B. Menu Labeling and Calories Purchased in Restaurants in a US National Fast Food Chain. JAMA Netw Open 2023; 6:e2346851. [PMID: 38100109 PMCID: PMC10724762 DOI: 10.1001/jamanetworkopen.2023.46851] [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: 07/17/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
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.
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Affiliation(s)
- Pasquale E. Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Tod Mijanovich
- Steinhardt School of Culture, Education, and Human Development, New York University, New York
| | - Erilia Wu
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Lloyd Heng
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Emil Hafeez
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Marie A. Bragg
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Simon A. Jones
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Beth C. Weitzman
- Wagner Graduate School of Public Service, New York University, New York
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York
- Steinhardt School of Culture, Education, and Human Development, New York University, New York
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10
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Roberto CA, Petimar J. Restaurant Calorie Labeling and Changes in Consumer Behavior. JAMA Netw Open 2023; 6:e2346813. [PMID: 38100113 DOI: 10.1001/jamanetworkopen.2023.46813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Essman M, Burgoine T, Cameron A, Jones A, Potvin Kent M, Polden M, Robinson E, Sacks G, Smith RD, Vanderlee L, White C, White M, Hammond D, Adams J. 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. Public Health Nutr 2023; 26:2595-2606. [PMID: 37661595 PMCID: PMC10641604 DOI: 10.1017/s1368980023001775] [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: 10/21/2022] [Revised: 07/06/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
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.
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Affiliation(s)
- Michael Essman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Adrian Cameron
- Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Andrew Jones
- School of Psychology, Liverpool John Moore’s University, Liverpool, UK
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Megan Polden
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Eric Robinson
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Gary Sacks
- Institute for Health Transformation, Deakin University, Burwood, Australia
| | | | - Lana Vanderlee
- School of Nutrition, Centre Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
| | - Christine White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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12
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Cheikh Ismail L, Kassem H, Osaili TM, Hashim M, Obaid R, Radwan H, Mohamad MN, Saleh ST, Al Zomut Z, Abu Qiyas S, Al Rajaby R, Al Daour R, Ali HI, Stojanovska L, Al Dhaheri AS. Public's calorie literacy and perceived effectiveness of restaurant menu calorie labeling in the United Arab Emirates. PLoS One 2023; 18:e0293387. [PMID: 37874847 PMCID: PMC10597515 DOI: 10.1371/journal.pone.0293387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
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.
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Affiliation(s)
- Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Hanin Kassem
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Tareq M. Osaili
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Mona Hashim
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Reyad Obaid
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Maysm N. Mohamad
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Sheima T. Saleh
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Zein Al Zomut
- Jordanian Society for Food and Nutrition, Amman, Jordan
| | - Salma Abu Qiyas
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Radhiya Al Rajaby
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Rameez Al Daour
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Habiba I. Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Lily Stojanovska
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
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13
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Polden M, Robinson E, Jones A. Assessing public perception and awareness of UK mandatory calorie labeling in the out-of-home sector: Using Twitter and Google trends data. Obes Sci Pract 2023; 9:459-467. [PMID: 37810520 PMCID: PMC10551121 DOI: 10.1002/osp4.674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/01/2023] [Accepted: 04/10/2023] [Indexed: 10/10/2023] Open
Abstract
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.
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Affiliation(s)
- Megan Polden
- Department of Primary Care and Mental HealthUniversity of LiverpoolLiverpoolUK
| | - Eric Robinson
- Department of PsychologyUniversity of LiverpoolLiverpoolUK
| | - Andrew Jones
- School of PsychologyLiverpool John Moores UniversityLiverpoolUK
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14
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Lemke MK, Houghtaling B, Winkler MR, Hege A. Rethinking Efforts to Improve Dietary Patterns Among Long-Haul Truck Drivers: Transforming Truck Stop Retail Food Environments Through Upstream Change. Am J Health Promot 2023; 37:755-759. [PMID: 36719742 PMCID: PMC10330639 DOI: 10.1177/08901171231155050] [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] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
| | - Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Megan R. Winkler
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Adam Hege
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
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15
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Hua SV, Collis CE, Block JP. Developing Effective Strategies for Obesity Prevention. Gastroenterol Clin North Am 2023; 52:469-482. [PMID: 37197887 DOI: 10.1016/j.gtc.2023.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
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.
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Affiliation(s)
- Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
| | - Caroline E Collis
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA, USA
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16
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AlTamimi JZ, AlFaris NA, Alshwaiyat NM, Alkhalidy H, AlKehayez NM, Alsemari MA, Alagal RI. Prevalence of fast-food intake among a multi-ethnic population of middle-aged men and connection with sociodemographic factors and obesity. Medicine (Baltimore) 2023; 102:e33555. [PMID: 37058044 PMCID: PMC10101309 DOI: 10.1097/md.0000000000033555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
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.
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Affiliation(s)
- Jozaa Z. AlTamimi
- Department of Physical Sports Sciences, College of Education, Princess Nourah Bint Abdulrahman University Riyadh, Riyadh, Saudi Arabia
| | - Nora A. AlFaris
- Department of Physical Sports Sciences, College of Education, Princess Nourah Bint Abdulrahman University Riyadh, Riyadh, Saudi Arabia
| | - Naseem M. Alshwaiyat
- School of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Hana Alkhalidy
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Nora M. AlKehayez
- Department of Physical Sports Sciences, College of Education, Princess Nourah Bint Abdulrahman University Riyadh, Riyadh, Saudi Arabia
| | - Malak A. Alsemari
- Department of Medical Imaging – MRI, King Abdullah Bin Abdulaziz University Hospital (KAAUH), Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reham I. Alagal
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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17
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Robinson E, Polden M, Langfield T, Clarke K, Calvert L, Colombet Z, O'Flaherty M, Marty L, Tapper K, Jones A. Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2023; 20:10. [PMID: 36747247 PMCID: PMC9903416 DOI: 10.1186/s12966-023-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP). METHODS Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups. RESULTS Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041]. CONCLUSIONS Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required. REVIEW REGISTRATION Registered on PROSPERO (CRD42022312532) and OSF ( https://doi.org/10.17605/OSF.IO/W7RDB ).
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Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Megan Polden
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Tess Langfield
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Katie Clarke
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Lara Calvert
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Zoé Colombet
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lucile Marty
- Centre Des Sciences Du Goût Et de L'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - Katy Tapper
- Department of Psychology, City, University of London, London, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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18
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Petimar J, Grummon AH, Simon D, Block JP. Nutritional Composition and Purchasing Patterns of Supermarket Prepared Foods Over Time. Am J Prev Med 2023; 64:213-220. [PMID: 36280402 PMCID: PMC9976399 DOI: 10.1016/j.amepre.2022.08.021] [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: 05/20/2022] [Revised: 08/10/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023]
Abstract
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.
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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
| | - Denise Simon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jason P Block
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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19
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Kraak VI, Davy BM. 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. Curr Dev Nutr 2023; 7:100012. [PMID: 37180081 PMCID: PMC10111594 DOI: 10.1016/j.cdnut.2022.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Vivica I. Kraak
- Department of Human Nutrition, Foods, and Exercise, West Campus Drive, Virginia Tech, Blacksburg, VA, USA
| | - Brenda M. Davy
- Department of Human Nutrition, Foods, and Exercise, West Campus Drive, Virginia Tech, Blacksburg, VA, USA
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20
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Besora-Moreno M, Queral J, Torres S, Llauradó E, Tarro L, Solà R. 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. Front Public Health 2023; 11:1137512. [PMID: 37113187 PMCID: PMC10126299 DOI: 10.3389/fpubh.2023.1137512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/06/2023] [Indexed: 04/29/2023] Open
Abstract
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.
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Affiliation(s)
- Maria Besora-Moreno
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
| | - Judit Queral
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari San Joan de Reus, Reus, Spain
| | | | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari San Joan de Reus, Reus, Spain
- *Correspondence: Elisabet Llauradó,
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
- Lucia Tarro
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari San Joan de Reus, Reus, Spain
- Hospital Universitari Sant Joan de Reus, Reus, Spain
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21
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Plamondon G, Labonté MÈ, Pomerleau S, Vézina S, Mikhaylin S, Laberee L, Provencher V. The influence of information about nutritional quality, environmental impact and eco-efficiency of menu items on consumer perceptions and behaviors. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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AlTamimi JZ, Alshwaiyat NM, Alkhalidy H, AlFaris NA, AlKehayez NM, Alsemari MA, Alagal RI. Prevalence of Fast Food Intake among a Multi-Ethnic Population of Young Men and Its Connection with Sociodemographic Determinants and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214933. [PMID: 36429650 PMCID: PMC9690178 DOI: 10.3390/ijerph192214933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 05/06/2023]
Abstract
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.
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Affiliation(s)
- Jozaa Z. AlTamimi
- Department of Physical Sports Sciences, College of Education, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Naseem M. Alshwaiyat
- School of Nutrition and Dietetics, Faculty of Health Sciences, Gong Badak Campus, Universiti Sultan Zainal Abidin, Kuala Nerus 21300, Terengganu, Malaysia
| | - Hana Alkhalidy
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Nora A. AlFaris
- Department of Physical Sports Sciences, College of Education, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Nora M. AlKehayez
- Department of Physical Sports Sciences, College of Education, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Malak A. Alsemari
- Department of Medical Imaging—MRI, King Abdullah bin Abdulaziz University Hospital (KAAUH), Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Reham I. Alagal
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
- Correspondence:
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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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/28/2022] [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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24
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Yeo GSH. Is calorie labelling on menus the solution to obesity? Nat Rev Endocrinol 2022; 18:453-454. [PMID: 35680986 PMCID: PMC9179223 DOI: 10.1038/s41574-022-00705-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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?
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Affiliation(s)
- Giles S H Yeo
- MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
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25
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Grummon AH, Petimar J, Soto MJ, Bleich SN, Simon D, Cleveland LP, Rao A, Block JP. Changes in Calorie Content of Menu Items at Large Chain Restaurants After Implementation of Calorie Labels. JAMA Netw Open 2021; 4:e2141353. [PMID: 34967879 PMCID: PMC8719240 DOI: 10.1001/jamanetworkopen.2021.41353] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Anna H. Grummon
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Mark J. Soto
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Denise Simon
- 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
| | - Anjali Rao
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jason P. Block
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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