Research reportWhat types of nutrition menu labelling lead consumers to select less energy-dense fast food? An experimental study
Introduction
The increasing prevalence of overweight and obesity represents a significant threat to population health and policies that support the provision of appropriate nutrition information form part of an integrated approach to global health promotion (World Health Organization, 2003). The application of nutrition information has consistently been linked with healthier diets using cross-sectional, longitudinal and experimental designs, though much of the available evidence is based on self-report data (Campos, Doxey, & Hammond, 2011). Nutrition information panels are mandatory on packaged foods in most high-income countries (e.g., Food and Drug Administration, 1994, Food Standards Australia and New Zealand, 2000) and several summary forms of this information have been developed for the front of packaging to assist consumers in making healthier choices. Percentages of nutrient amounts based on recommended daily values is the front-of-pack labelling scheme favoured by the food industry (Magnusson, 2010) but shows some deficits in its use and interpretation by consumers, particularly those from disadvantaged groups (Feunekes et al., 2008, Kelly et al., 2009, van Kleef et al., 2008). A Traffic Light Labelling system which provides ‘at a glance’ information using universally recognised symbols to indicate the amounts of important nutrients assists consumers in distinguishing the healthiest product from less healthy ones in experimental conditions (Borgmeier and Westenhoefer, 2009, Jones and Richardson, 2007, Kelly et al., 2009).
While the provision of nutrition information on packaged foods is well established, greater consumption of foods prepared away from home has been identified as an important contributing factor to rising rates of obesity (Swinburn, Caterson, Seidell, & James, 2004). Food consumed outside the home now accounts for almost half of overall yearly food expenditure in the United States (Economic Research Service/United States Department of Agriculture, 2010). The largest proportion of average Australian household weekly food expenditure (27%) is also spent on meals consumed outside the home, including from fast food restaurants (Australian Institute of Health and Welfare, 2012). Consumers are largely unaware of the high energy density of these foods (Berman and Lavizzo-Mourey, 2008, Burton et al., 2006, Lachat et al., 2012) and their frequent consumption has consistently been associated with increased body weight (Bezerra et al., 2012, Bowman and Vinyard, 2004, Niemeier et al., 2006, Prentice and Jebb, 2003).
Where nutrition information is made available by fast food chains, it is most commonly on food packaging and company Web sites and not provided on the premises prior to purchase (Roberto et al., 2009, Wellard et al., 2011, Wootan et al., 2006). The placement of this information on menu boards at the point-of-sale improves accessibility and acts as a prompt to inform purchase decisions (Berman and Wootan, 2003, Seiders and Petty, 2004). Such policies may also encourage reformulation to improve the nutrition content of available foods thereby having wider benefit (Berman and Lavizzo-Mourey, 2008, Bruemmer et al., 2012, Young and Swinburn, 2002). Given the level of consumption of food from fast food restaurants, even small reductions in kilojoule intake could have a significant impact at the population level.
Legislation was enacted in the United States in 2010 requiring restaurant chains with 20 or more outlets nationwide to provide calorie information on menus (Food and Drug Administration, 2010), and trialled on a voluntary basis in the UK commencing in 2009 (UK Food Standards Agency, 2009). A small number of restaurant chains in Australia also voluntarily display nutrition information on menus, and three states and territories have recently introduced the mandatory provision of kilojoule counts on menus, though the thresholds for number of outlets per chain vary (ACT Government, 2011, NSW Food Authority, 2010, SA Government, 2012). A nationwide approach to mandatory kilojoule counts on menus and vending machines, and a provision to encourage the inclusion of traffic light labels, has been recommended (Blewett, Goddard, Pettigrew, Reynolds, & Yeatman, 2011).
The few evaluations of the effectiveness of menu labelling in reducing the energy content of food purchases have shown mixed findings (Harnack and French, 2008, Swartz et al., 2011) and are limited to the United States where implementation is more advanced and calorie information (and a statement regarding daily caloric intake) is mandated (Food and Drug Administration, 2010). In recent experimental studies (Chu et al., 2009, Liu et al., 2012, Roberto et al., 2010, Tandon et al., 2010) and an evaluation that did not include a comparison group (Pulos & Leng, 2010), calorie menu labelling was associated with significant reductions in the energy content of foods purchased. The addition of information on the recommended daily caloric intake was also shown to enhance this effect (Roberto et al., 2010). However, other studies have found no difference (Harnack, French, Oakes, Story, Jeffery, & Rydell, 2008), a slight increase (Finkelstein, Strombotne, Chan, & Krieger, 2011) and variable findings by restaurant chain (Dumanovsky, Huang, Nonas, Matte, Bassett, & Silver, 2011).
The mixed findings to date on the efficacy of energy content labelling suggest that there may be more effective ways of displaying this information on menus and that supplementing energy content with additional nutrition information may enhance the existing policy initiative. Furthermore, in contrast to Europe and North America where a preference for calorie information is evident (Borra, 2006, Cowburn and Stockley, 2005, van Kleef et al., 2008), Australian consumers who make use of nutrition information do not use the energy content of foods as their primary influence in making purchase decisions (Kelly et al., 2009, Morley et al., 2012). Therefore, while the limited studies available show some promising evidence in support of energy content labelling on menus, there is a need for further experimental evaluations to determine whether the presence of this information is associated with choosing products with lower energy content in other jurisdictions where this obesity prevention policy has been proposed. The aim of this study is to examine the influence of potential models of point-of-sale nutrition menu labelling on the energy content of Australian adults’ fast food meal selections.
Section snippets
Design
The present study used a between-subjects experimental design to test five menu labelling conditions. A web-based methodology was used to expose adults to one of the five randomly selected menu boards, from which respondents made their evening meal selection. The study was approved by Cancer Council Victoria’s Human Research Ethics Committee.
Sample
A sample frame of Victorian adults aged 18–49 years who had purchased food from a fast food restaurant chain in the last month were sourced from an existing
Sample characteristics and group assignment
Overall, 1294 eligible adults completed the online survey (response rate = 14%). As shown in Table 1, they were most commonly female (74%) and aged 30–49 years (76%). Approximately one-third (34%) resided in a low SES area, while 21% lived in a high SES area. Forty-five percent of respondents had completed tertiary education. Approximately 40% of respondents reported eating at fast food restaurant chains four or more times in the last month.
Respondents did not differ significantly across menu
Discussion
This study collected data on adults’ propensity to make healthier food choices when fast food menus listed energy (kJ) alone or accompanied by further nutrition information. The results indicate that the provision of kilojoule information, with and without traffic light labels, is associated with lower energy content of selected meals compared with no nutrition information. This reduction also did not differ by demographic factors, nutrition information knowledge or usage, suggesting this is an
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