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      Exploratory Analysis of Fast-Food Chain Restaurant Menus Before and After Implementation of Local Calorie-Labeling Policies, 2005–2011

      research-article
      , MPH, , PhD, MPH , , MS, RD, CSP, FADA, LDN, , DSc
      Preventing Chronic Disease
      Centers for Disease Control and Prevention

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          Abstract

          Introduction

          Since 2008, several states and municipalities have implemented regulations requiring provision of nutrition information at chain restaurants to address obesity. Although early research into the effect of such labels on consumer decisions has shown mixed results, little information exists on the restaurant industry’s response to labeling. The objective of this exploratory study was to evaluate the effect of menu labeling on fast-food menu offerings over 7 years, from 2005 through 2011.

          Methods

          Menus from 5 fast-food chains that had outlets in jurisdictions subject to menu-labeling laws (cases) were compared with menus from 4 fast-food chains operating in jurisdictions not requiring labeling (controls). A trend analysis assessed whether case restaurants improved the healthfulness of their menus relative to the control restaurants.

          Results

          Although the overall prevalence of “healthier” food options remained low, a noteworthy increase was seen after 2008 in locations with menu-labeling laws relative to those without such laws. Healthier food options increased from 13% to 20% at case locations while remaining static at 8% at control locations (test for difference in the trend, P = .02). Since 2005, the average calories for an à la carte entrée remained moderately high (approximately 450 kilocalories), with less than 25% of all entrées and sides qualifying as healthier and no clear systematic differences in the trend between chain restaurants in case versus control areas ( P ≥ .50).

          Conclusion

          These findings suggest that menu labeling has thus far not affected the average nutritional content of fast-food menu items, but it may motivate restaurants to increase the availability of healthier options.

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          Most cited references13

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          Calorie labeling and food choices: a first look at the effects on low-income people in New York City.

          We examined the influence of menu calorie labels on fast food choices in the wake of New York City's labeling mandate. Receipts and survey responses were collected from 1,156 adults at fast-food restaurants in low-income, minority New York communities. These were compared to a sample in Newark, New Jersey, a city that had not introduced menu labeling. We found that 27.7 percent who saw calorie labeling in New York said the information influenced their choices. However, we did not detect a change in calories purchased after the introduction of calorie labeling. We encourage more research on menu labeling and greater attention to evaluating and implementing other obesity-related policies.
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            Dietary energy density determined by eight calculation methods in a nationally representative United States population.

            Dietary energy density [kcal/g (kJ/g)] influences energy intake under controlled laboratory conditions. Little is known about the energy density of the diets of free-living persons. Because energy density investigations are a relatively new endeavor, there are neither standard calculation methods nor published nationally representative values. This paper examines the calculation of energy density based on systematic exclusion of beverage categories, presents data on variability, and compares values by sex, age, and race/ethnicity in a representative sample of U.S. adults. Mean daily dietary energy density values for adults (aged >19 y) were calculated using two 24-h recalls from the Continuing Survey of Food Intakes by Individuals 1994-1996 based on food, food and liquid meal replacements, food and alcohol, food and juice, food and milk, food and juice and milk, food and energy-containing beverages, and food and all beverages. Energy density varied by calculation method, ranging from 0.94 to 1.85 kcal/g (3.93-7.74 kJ/g). Intraindividual-to-interindividual CV ratios were highest for the food and energy-containing beverages calculation. Men reported diets with a higher energy density than women for all calculation methods (P < 0.0001). There were differences by race/ethnicity and an inverse linear trend for age. These data indicate that beverage inclusion schemes should be clearly defined when reporting energy density values. In epidemiologic studies, calculations based on food and all beverages and food and energy-containing beverages may diminish associations with outcome variables. These nationally representative data, which provide an important frame of reference for other studies, indicate that dietary energy density differs by sex, age, and race/ethnicity.
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              Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys

              Objective To assess the impact of fast food restaurants adding calorie labelling to menu items on the energy content of individual purchases. Design Cross sectional surveys in spring 2007 and spring 2009 (one year before and nine months after full implementation of regulation requiring chain restaurants’ menus to contain details of the energy content of all menu items). Setting 168 randomly selected locations of the top 11 fast food chains in New York City during lunchtime hours. Participants 7309 adult customers interviewed in 2007 and 8489 in 2009. Main outcome measures Energy content of individual purchases, based on customers’ register receipts and on calorie information provided for all items in menus. Results For the full sample, mean calories purchased did not change from before to after regulation (828 v 846 kcal, P=0.22), though a modest decrease was shown in a regression model adjusted for restaurant chain, poverty level for the store location, sex of customers, type of purchase, and inflation adjusted cost (847 v 827 kcal, P=0.01). Three major chains, which accounted for 42% of customers surveyed, showed significant reductions in mean energy per purchase (McDonald’s 829 v 785 kcal, P=0.02; Au Bon Pain 555 v 475 kcal, P<0.001; KFC 927 v 868 kcal, P<0.01), while mean energy content increased for one chain (Subway 749 v 882 kcal, P<0.001). In the 2009 survey, 15% (1288/8489) of customers reported using the calorie information, and these customers purchased 106 fewer kilocalories than customers who did not see or use the calorie information (757 v 863 kcal, P<0.001). Conclusion Although no overall decline in calories purchased was observed for the full sample, several major chains saw significant reductions. After regulation, one in six lunchtime customers used the calorie information provided, and these customers made lower calorie choices.
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                Author and article information

                Journal
                Prev Chronic Dis
                Prev Chronic Dis
                PCD
                Preventing Chronic Disease
                Centers for Disease Control and Prevention
                1545-1151
                2013
                20 June 2013
                : 10
                : E101
                Affiliations
                [1]Author Affiliations: Alexa Namba, School of Public Health, Drexel University, Philadelphia, Pennsylvania; Beth L. Leonberg, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania; Margo G. Wootan, Center for Science in the Public Interest, Washington, DC
                Author notes
                Corresponding Author: Amy H. Auchincloss, PhD, MPH, Drexel University School of Public Health, 1505 Race Street, Mail Stop 1033, Philadelphia, PA 19102. Telephone: 215-762-2056. E-mail: aha27@ 123456drexel.edu .
                Article
                12_0224
                10.5888/pcd10.120224
                3690828
                23786908
                7b6d6e8a-1adc-43e6-81e4-784c1441a4b1
                History
                Categories
                Original Research
                Peer Reviewed

                Health & Social care
                Health & Social care

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