Income, education affect calorie menu use: Most notice it, few use it

A newly published research study conducted by graduate students Jessie Green and Alan Brown under the guidance of Punam Ohri-Vachaspati, a nutrition researcher at the School of Nutrition and Health Promotion at Arizona State University, examined whether noticing and using calorie menu labels was associated with demographic characteristics of customers at a national fast food chain currently posting calorie counts. They found that approximately 60% of participants noticed the calorie menu labels but only 16% reported using the labels to determine food and beverage choices.

Green and her co-authors found that customers with higher incomes were twice as likely to notice the calorie labels and three times more likely to use them.

The study, published today in the Journal of the Academy of Nutrition and Dietetics, is the first of its kind specifically designed to examine the likelihood of customers noticing and using calorie menu labels in fast-food restaurants in a mixed income and racially diverse sample of adults.

"Studies show consumers and nutritionists alike have trouble estimating the calorie and nutrient content of a restaurant meal," Ohri-Vachaspati said. "Because fast food is a popular choice among Americans, we wanted to see how effective menu labeling was and if it helped customers make healthier choices. What we found, however, was that while the majority of customers noticed the labels, a very small percentage reported using them to influence their purchasing decisions and customers with lower income and lower education levels reported using menu labels to a much lesser extent."

In the United States, fast food is the second-largest source of total energy in the diets of children and adolescents. Studies have found frequently eating out at fast-food restaurants is associated with greater weight gain and obesity, leading to a plethora of chronic health issues.

As part of the Patient Protection and Affordable Care Act, chain restaurants with 20 or more locations nationwide are required to post calorie information on menus with the aim of helping customers make healthier food choices. The Food and Drug Administration recently released final guidelines which go into effect December 1, 2015. In addition to listing the calorie content, the new rules require menus and menu boards to include the statement, "2,000 calories a day is used for general nutrition advice, but calorie needs vary." Such a statement was not posted on menu boards at the time the study was conducted.

"Including a statement with the daily calorie recommendations is key because it provides customers with the necessary context to make calorie labels meaningful," says Green.

To be effective, Ohri-Vachaspati says, this policy must affect all customers, especially those with lower incomes because they tend to be more at risk for poor health and diet outcomes.

"It's not just the calories that count, it's the context. People need to know how to interpret the information."

Green and her colleagues collected and analyzed customer receipts and survey data from 29 McDonald's restaurant locations in low and high income neighborhoods throughout the Phoenix metropolitan area. McDonald's restaurants were selected for the study because of the chain's decision to implement calorie menu labeling across all of its restaurants nearly three years ago.

The study's findings support menu labeling as an effective public policy that can potentially result in fewer calories purchased by those using the labeling. While only a small portion of people use them, a substantial number of people are noticing them and Ohri-Vachaspati says that while it is a step in the right direction, we need to do more.

"Once menu labeling is implemented, the fast-food industry and public health community must work together to make it easier for consumers from all income and education backgrounds to understand and use this information. We need effective ways to get those who only notice the information to start using it." Ohri-Vachaspati said. She also suggests educating school children on using menu labeling to help them become informed and health-focused consumers.