by Maricelle Ramirez

If you are hungry and running low on time, money, and/or palatable options, eating nutritious food may take the backseat, even if you do care about your food.

Over the past few summers, as part of a nutrition study, I went out to over 40 fast-food restaurants across New England and surveyed people who had just purchased food. It seemed that even participants who answered that calories were important in choosing their food also tended to respond that they either did not see calorie information or saw it but did not use it.

These are anecdotal observations only, and our data from 2012–2014 are still being analyzed.  However, our results from 2010 and 2011 show that only 22% of adults and 14% of adolescents noticed calorie information posted in the restaurants. Furthermore, only 5% and 4%, respectively, reported using it. Another study found that only 0.1% of consumers accessed nutrition information available in a restaurant before buying fast-food.

Many of us think that we are careful about food, yet we find ourselves biting into unhealthy meals. We may do this without even considering nutritional values. Why?

Out of sight?

Some studies in 2008, 2010, and 2012 have found that consumers may miss posted nutritional information because the information is not very visible. If you have ever visited fast-food restaurants during rush hour, you might understand why many do not wade through the crowd to examine the small print nutrition facts, tucked somewhere in small font, before making a purchase. We also may not ask the hurried staff to find the calorie count and salt content of items, especially when that means stalling the line or losing our place in it.

But what if it was more visible? Findings like this one have shown that menu labeling increases the likelihood that consumers will notice calorie information.  But the results are mixed, either showing that labeling leads to better dietary quality or has no effect.  We still do not know whether effective menu labeling will improve meal quality.

Out of mind?

If it is inconvenient to look for nutrition information, we might use guesses. But, are we any good at guessing?  Our study showed that nearly 25% underestimated meal calories by over 500 calories, and another study showed that people tend to be unaware of, or misestimate, calories in restaurant foods by very large amounts.

Indeed, when I asked study participants to estimate meal calorie content, they very often responded, “I don’t really know”, “What’s a high number?”, or “this is probably a bad guess.” After the survey, a few of the teenage participants, looked it up on their smartphones, or asked their friends.

Out of pocket?

While nutrition is important to some of us, other factors like price, taste, or convenience take precedence. A 2008 and a 2010 study, for example, pointed to price as a major factor leading to choosing nutritionally poorer food at supermarkets. Can some of us only afford the time, price, or psychological convenience of certain fast food restaurants?

Even for those of us who have inadvertently memorized nutrition menus, calories might not be at the forefront of a hunger-clouded mind. The reality of our fast-food consumers seems more complex than just knowledge and self-efficacy. Labeling our menus is a step in the right direction, but it answers only the “out of sight” problem.  We need to consider other angles of our population’s poor nutrition, including the accessibility to appealing, affordable, healthy food. Only with a broad and sustained approach can we tackle the very complex and important issue of our population’s nutrition and health.

About the author:

Maricelle Ramirez is a research assistant at the OPP at Harvard Pilgrim Healthcare Institute with whom she has worked since 2011 on a study examining the effects of examining the effect of posting calories on menus. She is also a research coordinator at the Beth Israel Deaconess Medical Center where she coordinates recruitment and regulatory requirements for clinical studies.



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