The Minister for Health here in Ireland wants
to introduce calorie counts on menus and has given the industry 6 months to
implement the proposal or, if they fail to do so, legislation will be introduced. All packaged food
requires full nutrition labeling, so it would seem quite reasonable to require
the food service sector to follow suit. Calorie counts on menus were first
introduced into New York in 2008 and, in 2010, the US Congress passed an act
which required menu labeling for all restaurants with 20 or more locations.
Researchers at the University of North Carolina conducted a systematic review
of the impact of this legislation on actual average caloric intake in the US
food service sector. A systematic review sets out very clearly, the criteria
that a published paper must meet in order to be considered by the reviewers. In
this case the studies had to have an experimental or quasi-experimental design
comparing a calorie labeled menu with a menu without any caloric data. The
review only considered studies with data on either consumption or purchase and,
of course, only English language publications.[1]
They identified 164 titles, of which only 32
appeared from the title to meet the entry criteria. Having read the abstracts
of these 32, a total of 18 papers were read in full and of these, 7 were
included in the review. Two reported reductions in calorie intake with calorie
labeling, 3 reported no change, 1 reported an increase and 1 found that of the
11 largest fast food chains, 3 reported a decrease (McDonald’s -44, Au Bon Pain
-80 and KFC -59), 1 reported an increase (Subway +133) while 7 reported no
change (Burger King, Wendy’s, Popeye’s, Domino’s, Pizza Hut, Papa John’s and
Taco Bel)[2].
This might sound like music to the ears of the
food service sector but before the rapture begins lets just ask ourselves if
the data should surprise us. Research shows that consumers do not rate obesity
and overweight as an important risk for them personally but they do see it as a
risk to society as a whole. That is explained by the fact that although a
consumer may be fat, they are themselves in control of the situation and if and
when they decide to lose weight, they can manage that without any doubt.
However, they are not convinced that the rest of society has such marvelous
self control and hence, weight is a societal issue but not a personal issue. So
if they are asked for their opinion on the listing of calories on menus, they
will see the value. Now when consumers go out to dine in a cafeteria, fast food
outlet or a restaurant, those that are in the mode of counting calories will be
able to benefit from menu labeling. Since this is a minority, we should not be
surprised that on average, there was no impact of caloric labeling. If the
research was to include those who wanted to lose weight, then almost certainly,
the outcome would be positive.
One useful and informative paper comes from
Tacoma-Pierce County in Washington and was written by those members of the
County Health department that set out to promote menu labeling in a program
called SmartMenu[3]... This programme targeted locally owned restaurants, not the food chain restaurants and this
was done specifically to see how such local restaurants with less resources
than the chains, could cope with the challenge. Of the 600 restaurants
contacted, only 24 agreed to participate and of these, only 18 finally posted
the data on their menus. By far the biggest barrier was the preparation of the
menu items into a standardized format that could be entered into a nutritional
analysis software programme. In the words of the authors: “The challenge for
locally owned restaurant owners who are not using standardized recipes to
participate in this programme cannot be overstated”. The average time from
a signed agreement to participate to the posting of the menus was 8 months. The
costs for the restaurants ranged from $1,500 to $8,400. Besides the time,
complexity and costs issues, other barriers included the perceived business
risk of labeling (the “I got fat eating in your restaurant which mislabeled the
caloric value of my favourite dish” law suit) and the low perceived demand for
such calorie labeling.
As ever, things are not as straight forward as
first imagined. That does not mean that we shouldn’t try to label menus if
indeed we believe that it will help those who are dieting and who are generally
weight conscious. A few further observations can be made. We must also be aware
that there are consumers who rate monetary value higher than health aspects
when purchasing foods and who in fact might opt for the best value in terms of
calories per euro. Based on the experience of Tacoma-Pierce County, someone is
going to have to invest in this if it is going to work. If it is the restaurant
owners, then guess who’s ultimately going to pay for the service. Then again,
when you go out for dinner, cost is not really an issue. Finally, last night we ate in a
delightful Thai restaurant and nobody ate everything served. How many calories
were left on the plate?
[1] 1 English is the language of
scientific publication and papers published in other languages are always
excluded from systematic reviews. To use them would require a full translation
with the help of the author to retain accuracy and that is not feasible.
Moreover, journals in non-english language have a local focus and are always
of a very low impact factor.
[2] 2 JJ Swartz et al (2011)
International Journal of Behavioral Nutrition and Physical Activity 8, 135
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