In a recent study published within the journal JAMA Network Open, researchers used long-term (nine years) data from fast food restaurants (Taco Bell) across the USA to analyze if dietary composition labels in menus would alter consumers’ dietary selections. The study comprised 2,329 unique restaurants and case-control comparison cohorts of 474 menu labeling and 474 non-labeling outlets. Their findings reveal that dietary menu labeling resulted in a 22-25% reduced calories-per-transaction across restaurants. These results validate the advantages of the USA Patient Protection and Reasonably priced Care Act of 2010, which mandated dietary labels in restaurant chains and highlights that buyers alter their dietary intakes/make informed, healthy selections when presented with menu labels.

Study: Menu Labeling and Calories Purchased in Restaurants in a US National Fast Food Chain. Image Credit: Chubykin Arkady / Shutterstock

Calorie labeling

Calorie labeling is a method wherein the dietary information of products, especially their calorific values, is included on the packaging of foods and beverages. This strategy is designed to tell and support consumers’ ability to judge the healthfulness of labeled products, thereby allowing consumers to make informed decisions about which items to buy and which to avoid. Primarily utilized in the retail food and beverage environment, labels have increasingly turn into legally mandated in countries worldwide.

Research has supported product labeling as a possible technique of population-level reductions in calorific intakes, thereby leading to positive health outcomes comparable to lowered risk of cardiovascular diseases (CVDs) and weight abnormalities. Constructing upon the successes of labels on retail food packaging, the USA (US) Patient Protection and Reasonably priced Care Act of 2010 made it mandatory for food chains and restaurants with greater than 20 outlets to list the dietary value of their menu items by 2018. Encouragingly, quite a few States within the US implemented the clauses of the Act prior to its national rollout.

Despite scientific efforts to judge the outcomes of this early restaurant label adoption, lack of normal methodology and small sample sizes have presented confounding outcomes – some studies have found small reductions in calories-per-transaction, while others have found no association between menu labels and consumer calorific intakes.

Moreover, prior research’s location-specificity and short study duration have resulted in difficulties in end result generalization. A big and long-term study would help set these confounds to rest and supply policymakers and consumers, each for the US and other nations, the data needed when taking their next steps in the continuing fight against poor weight loss program selections.

Concerning the study

In the current study, researchers used long-term (nine years) transactional sales data from 1,280 restaurants belonging to the Taco Bell chain. Using a quasi-experimental methodological design, they compared calorie-per-transaction values from restaurants mandated to disclose (label) their menu’s dietary values to those who never implemented menu labeling. Study methodology and results reporting were carried out in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

Researchers began by identifying and collecting data from all 10,575 Taco Bell branches across the US (each open and closed) between 2007 and 2014. This data represented 5.33 billion transactions, which were subsequently trimmed based on study requirements, namely, a 1:1 comparison between outlets that listed the dietary values of their menus and outlets with the identical menu but didn’t publicize their dietary values. The previous (case) cohort comprised outlets within the States of California, Vermont, and Maine, together with seven counties and two cities, and included a complete of 474 outlets. The latter (control) cohort was synthetically matched to mirror the case group as closely as possible across each menu- and community-level characteristics.

“In the ultimate analytic sample, comparison restaurants were positioned in 878 counties in 35 states. Our primary end result was mean calories per transaction and secondary outcomes included grams of total fat, carbohydrates, protein, saturated fat, sugar, and dietary fiber, and milligrams of sodium.”

The MenuStat dietary database was used to discover 3,517 unique menu items based on their dietary values. Statistical analyses consisted of 2-ways fixed effects regression models used to check outcomes between case and control restaurants. Since most (94%) of sampled restaurants were positioned within the State of California, heterogeneity analyses were conducted in Californian versus non-Californian restaurants.

Study findings

“The ultimate sample size was 2329 unique restaurants and 31 468 restaurant-month observations, with 474 restaurants within the menu labeling group and 474 synthetic control units.”

This study revealed that at baseline, the mean calories-per-transaction of case restaurants was 1035 while that of controls was 1056. During follow-up assessments, progressive reductions in calories-per-transaction were noted for case restaurants, starting from 21.9% (3-month follow-up) to 25.0% (at 24 months).

Differences in customer responses were observed by region, with Californian restaurants depicting much larger case versus control differences than non-Californian outlets. Interestingly, the degree of calorific difference was found to differ by the point of day, with the morning hours presenting the very best calories-per-transaction differences between cases and controls and no statistically significant differences within the late evening and night hours.

Difference-in-Differences (DID) Estimates of Calories Purchased per Transaction After Implementation of Menu Labeling, by Location

Conclusions

The current study represents the longest-term and most extensive scale comparison of consumer responses to menu labeling in the USA and potentially the world. A direct comparison between 474 menu-labeling restaurants and 474 non-menu-labeling restaurants revealed that, on average, consumers reduced their calories-per-transaction by 25% when supplied with the dietary value of their potential food purchases. These findings support the legislature’s call for the mandatory labeling of menus in restaurants and have the potential to guide policy which may contribute to reductions in global diet-associated comorbidities, including CVD and obesity.