Are Calorie Counts on Menus Really Helpful?

According to recent estimates, nearly 40% of adults are obese in America. By December 1, 2016, all menus at fast food restaurants, restaurants with more than 20 locations, and in vending machines must contain calorie contents of each item. This is a provision of the Affordable Care Act. Research done in 2010 at Stanford University showed that calorie counts on menus cause significant changes in consumer behavior based on the results of detailed data over 14 months at Starbucks stores in New York City. In fact, seeing the calorie content resulted in a 6% reduction in calories per transaction, on average. Customers both bought fewer items overall and made lower-calorie choices. This study paved the way for legislation requiring the disclosure of calorie content.

Some research has found that people do eat less when they are informed of how many calories are in their choices. For example, one study of 66 large chain restaurants, some of which posted calorie counts and some that did not, found that people ate 139 fewer calories if the caloric content was noted on the menu.

However, more research has shown that knowing the calorie count helps very little, if at all, in the battle of the bulge. In New York City, calories have been posted since 2008. At first, it seemed to help and people reported that they were paying attention. Since then, there has been a steady decline in the percentage of people who say they notice these counts. In 2008, 51% of people reported seeing the calorie counts, and by 2013 and 2014, only 40% said the same. Knowing how many calories are in your food does not seem to spur behavior change. Moreover, people did not decrease the number of calories consumed in response to the information even when they were paying attention. In 2008, only 12% of individuals admitted to using the information to choose foods with lower calorie content. Only 9% have said the same in recent years.

A systematic review in 2015 looked at all existing studies related to menu labeling in the medical literature between 2010 and 2013. Six controlled studies that took place in the real-world, as opposed to in a lab, were found. Overall, no significant impact was found related to what people ordered. The Department of Agriculture’s Nutrition Evidence Library concluded that, “limited and inconsistent evidence exists to support an association between menu calorie labels and food selection on consumption.”

It has been hypothesized that accompanying calorie information with some public health education might be more beneficial than listing calorie content alone. However, researchers at Carnegie Mellon University found that calorie counts still do not matter to people even when presented along with information about how many calories are appropriate to consume at one meal or over the course of a day.

In 2012, a study published in The American Journal of Public Health noted that menu labeling seemed to increase caloric intake because people purposefully chose higher calorie foods. There are mixed results, especially in low-income communities. Some people have speculated that this population may be looking to get more for their money, and so are purposefully choosing higher calorie items. Some people are concerned that calorie counts will normalize unhealthy foods; ie, “a cheeseburger should contain 1,000 calories.”

Restaurants whose foods are more nutritionally sound are possibly more likely to willingly post the calorie counts, skewering our interpretation of studies showing benefit from putting caloric values on menus. Additionally, the kind of people most likely to pay attention to calorie information on menus already have a decent understanding of how many calories are in common foods and how many calories they should be consuming.

It is nearly impossible to control for every variable in a restaurant kitchen. About 20% of food items tested in one study contained at least 100 calories more than it was stated on the menu.

What might work, though, is some encouragement from restaurant servers. In a study published in Health Affairs, servers were trained to ask customers if they would like to downsize three starchy side dishes. One-third of customers ordered the smaller portions and consumed 200 fewer calories during their meal.

Studies are mostly done on fast food restaurants in low-income areas. Few studies provide insight into sit-down restaurants, among people of higher income, or in a range of cities.

The benefit of calorie counts might ultimately not come from the effect that they have on the consumer, but on the effect they have on food producers, who want to make their foods appear better. It is not uncommon for restaurants to add excessively high calorie items to their menus to make slightly less heavy items appear healthier.

In general, although it does not look promising right now, we do not know what the long-term effects from posting calorie counts may be. All that we can do is keep our fingers crossed.

References and recommended readings

Berman J. Putting calorie counts on fast-food menus won’t make people eat less, experts say. Huffington Post website. www.huffingtonpost.com/2014/12/02/calorie- counts-fast-food_n_6220628.html. Updated December 2, 2014. Accessed February 29, 2016.

Carroll AE. The failure of calorie counts on menus. New York Times website. http://www.nytimes.com/2015/12/01/upshot/more-menus-have-calorie-labeling-but- obesity-rate-remains-high.html?_r=2. Published November 30, 2015. Accessed February 29, 2016. Dahl M. Who cares about calories? Restaurant menu labels don’t work, study shows. Today website. http://www.today.com/health/who-cares-about-calories-restaurant- menu-labels-dont-work-study-6C10677922. Published July 18, 2013. Accessed February 29, 2016.

Nestle M. FDA caves in to lobbying pressures, delays menu labeling. Food Politics website. http://www.foodpolitics.com/2015/07/fda-caves-in-to-lobbying-pressures- delays-menu-labeling/. Accessed February 29, 2016.

Sunstein CR. Don’t give up on fast-food calorie labels. Bloomberg View website. http://www.bloombergview.com/articles/2015-11-03/don-t-give-up-on-fast-food- calorie-labels. Published November 3, 2015. Accessed February 29, 2016.

Contributed by Elaine Hinzey, RDN, LD/N Review date: 2/24/16