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by Jason P. Block, MD, MPH

A colleague and I recently wrote a JAMA commentary that revisited the arguments in favor of menu labeling.  People eat large calorie meals when dining at restaurants, and they often don’t know how many calories they are consuming.  Calorie labeling provides immediately accessible calorie information at the moment when customers are making decisions.  Also, calorie labeling might prompt restaurants to reduce the calories in items, especially those with the most egregious calorie counts (check out Dave’s Hot and Juicy ¾ pounder at Wendy’s or the 12 inch Big Hot Pastrami at Subway, both coming in at over 1000 calories, even before the sides are added on).
The passage of a federal law requiring calorie menu labeling in chain restaurants was a momentous public health policy development.  The law was included as part of the 2010 Affordable Care Act and will require that all chain restaurants with 20 or more sites across the country post calories on their menus.  The law passed only 4 years after chain restaurants fought tooth and nail to prevent New York City from implementing a similar law.  After New York City prevailed in court and implemented the law, many cities and states followed, leading to a patchwork of laws that varied in their scope and requirements.  Restaurants desired more uniformity, hence they supported a federal law that supersedes state and local laws.

We’ve now been waiting 4 long years for its implementation.  The US Food and Drug Administration (FDA) released preliminary regulations on schedule in April 2011.  But, since then, silence.  No final regulations.  Delays have resulted from myriad factors:  controversies regarding whether movie theatres and supermarkets must comply; a presidential election that led to a halt in many regulations; and competing priorities that intervened, including FDA’s proposed revisions to the nutrition facts panel on packaged foods.  But, the time for the final regulations is near . . . maybe.  After 3+ years of delay in the final regulations, one cannot be very confident.

Will calorie labeling work?  The jury is still out.  A recent systematic review concluded that menu labeling appears to work in some circumstances.  Labeling seems to work best for women and diners who are presented with information putting meal calorie counts into context, such as when information about total daily calorie requirements also is presented.  The best evidence may have to wait until we have long term data.  Some of these studies are in process, including a study that we are doing in New England, which will evaluate the effect of menu labeling at McDonald’s.  Starting in 2013, McDonald’s voluntary posted calorie labels on menus.  We have data from 6 restaurant chains, collected annually from 2010 through 2014.  Of those chains, only McDonald’s posted calories on menus, giving us the opportunity to explore the effect of McDonald’s labeling program. 


More definitive results might have to wait until the federal law is finally implemented.  The wait may soon be over. 
 


Comments

Stephen B. Soumerai, ScD
09/09/2014 4:42pm

Hi Jason: What's the totality of evidence these days that calorie labeling meaningfully affects food choices? Written information is notoriously weak. I saw and wrote a letter a few years ago about the New York experiment published in BMJ that reported positive findings, but the design was so weak it couldn't possibly inform policy. What do reviews of the best studies conclude? Best, Steve

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Jason
09/10/2014 11:02am

You're right. The evidence is mixed thus far and not yet convincing either way. Some of the studies only have pre-post measures, like the BMJ study, and others may be underpowered to detect very small differences in purchases (which is what we might expect with labeling). Using sales receipts from Starbucks and more sophisticated methods, Bollinger et al (Am Econ J Econ Policy. 3, 91-128) found small (14 calorie) reductions in calories after labeling began in NYC. Some of the other smaller studies would not be3 able to detected such a small difference. What's really needed is some longer term data, using some of the methods that you advocate, such as time series. Our study in New England will incorporate these methods and will hopefully provide some important information.

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Katherine Yih
09/09/2014 4:42pm

Thanks, Jason, and congratulations to OPP for launching this blog site. I've been wondering what the OPP folks think of the film Fed Up, specifically their thesis that calories from sugar are more fattening than an equivalent number of calories from other sources (fats, proteins, complex carb's). What's the science on this?

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Jason Block
09/10/2014 11:33am

Thanks Katherine! In my opinion, the science on the harmful effects of sugar is still relatively new. I think the best evidence is for sugary drinks. Biologically, the body absorbs liquids more efficiently than solids, thus calories from liquids are less satiating than calories from solids (Barbara Roll has published quite a bit on this). There is some evidence that low glycemic index diets help with weight maintanenance (JAMA 2012; 307:2627-34) and that low carb diets are better than low fat diets for short term weight loss (JAMA 2014; 312: 923-933). However, there's more convincing evidence that over the long term, the exact breakdown of macronutrients isn't all that important (N Engl J Med 2009; 360:859-873; JAMA 2014; 312: 923-933). Limiting calories, in whatever way that is sustainable for people, is the key. That's where I see sugar as most important - adding sugar to foods increases calories; it may do other other harmful things too, but it's effect on calories is most clear.

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Marc Ledet
09/10/2014 12:15am

Are there any studies as to the negation of the consequences of selecting the Dave's Big & Juicy when coupled with a diet soda? I'll hang up and listen.

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Jason Block
09/10/2014 11:36am

Thanks Marc! While the Dave's Big and Juicy is a calorie load, adding a sugary drink to it is even worse. While there are some concerns about the metabolic effects of diet drinks, these drinks are better, from a weight perspective, than the sugary version. But, staying away from the Dave's Big and Juicy is likely the best choice.

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Marc Ledet
09/11/2014 7:16pm

Was also wondering why only Wendy's was singled out? Is there a pro-McDonald's agenda here?

Smells like someone is in bed with the clown.


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