Calorie labeling has no effect on teenagers' or parents' food purchases, study finds

Obesity in the United States is an enormous public health problem and children and teenagers are increasingly becoming overweight or obese. Calorie labeling is the first significant policy effort to address obesity that has been implemented. Calorie menu labeling is now mandated to begin soon across the nation by the new health reform law called the "Patient Protection and Affordable Care Act of 2010" (ACA). Among the claims supporting this policy is that menu labeling will help people make better informed and healthier food choices.

In 2008, New York became the first city in the nation to enforce mandatory calorie labeling in fast-food restaurants throughout the five boroughs. It is the first attempt of its kind to influence the obesity epidemic by altering the environment in which individuals are actually making their food choices. The goal is to encourage consumers to think twice before purchasing high calorie foods from restaurants, and to increase awareness of the calorie contents of the food they were purchasing.

In the new study, Dr. Elbel and his colleagues gathered receipts and surveys from 427 parents and teenagers at fast-food restaurants both before and after mandatory labeling began in July 2008. They focused on lower income communities in New York City and used Newark, New Jersey (which did not have mandatory labeling) as a comparison city. Data were collected before labeling began, and one month after labels were present in restaurants. As parents and teens were leaving fast-food restaurants, their receipts were collected and the foods they purchased were confirmed, along with a brief survey.

Before labeling began, none of the teens in the study said they noticed calorie information in the restaurant. After labeling began 57% in New York and 18% in Newark said they noticed the calorie information. A total of 9% said that the information influenced their choices, and all of these teens said they used the information to purchase fewer calories. This number is considerably smaller than the percentage of adults who said the information influenced their choice (28%). "While the same percentage of adolescents and adults noticed calorie information, fewer adolescents report actually using the information in their food choice," Dr. Elbel said.

However, the study did not find a change in the number of calories purchased at fast-food restaurants after labeling went into effect. Teens purchased about 725 calories and parents purchased about 600 calories for their children.

The way food tastes was considered the most important reason that teens bought it, while price was a consideration for slightly over 50%. Just over a quarter of the group said that they often or always limited the amount of food they ate in an effort to control their weight. The study also reported that most teenagers underestimated the amount of calories they had purchased, some by up to 466 calories.

Parental influence in food choice and childhood obesity is not well understood. Almost 60% of parents said they decided what food their child ate. However, even with greater involvement from parents there was no evidence of less consumption of fast-food calories.

In much the same way that adults responded in the few studies that have been conducted regarding this issue to date, the eating habits of children and teens in this study, a group of racial and ethnic minorities from low income areas, were barely influenced by the presence of calorie labeling. Easy access and the convenience of restaurant locations were the greatest drivers for teens and then taste influenced where they chose to eat. "It is important to further examine the influence of labeling, as it rolls out across the country as a result of the new federal law," said Dr. Elbel. "At the same time, it is important to understand that labeling is not likely to be enough to influence obesity in a large scale way. Other public policy approaches, as well as the efforts of food companies as other actors, will be needed."

The study was led by Brian Elbel, Ph.D., MPH, Assistant Professor of Medicine and Health Policy at the NYU School of Medicine and the NYU Wagner School of Public Service. Additional investigators are Rogan Kersh, Ph.D., NYU Wagner School of Public Service and Joyce Gyamfi, MA, Program Manager at the NYU School of Medicine.

This study was supported with grants from the Robert Wood Johnson Foundation Healthy Eating Research Program, the Yale Rudd Center for Food Policy and Obesity, the NYU Wagner Dean's Fund and the National Heart, Lung, Blood Institute, part of the National Institutes of Health (RO1HLO95935).