Restaurant nutrition labeling
Restaurant nutrition labeling involves voluntary or government mandated provision of nutrition and portion size information by restaurants and other food outlets. Nutrition information is typically included on restaurant menus, as well as on menu boards, signs, and posters, and is sometimes accompanied by contextual information such as recommended daily calories for adults or interpretive information such as exercise equivalent labels or traffic light labels1. Some local governments cannot enact such measures due to state and federal preemption legislation2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased awareness of calories purchased
Reduced calories purchased
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced caloric intake
Reduced food portion sizes
What does the research say about effectiveness? This strategy is rated some evidence.
There is some evidence that providing nutrition information on restaurant menus and signboards increases awareness of calories purchased and reduces calories purchased3, especially when labels include contextual or interpretive information for consumers1 and are easily visible4. Additional evidence is needed to confirm effects.
Starbucks locations realized a sustained overall decrease in calories purchased after adding nutrition labels5. In New York City, labeling was associated with reduced calories purchased at McDonalds, Au Bon Pain, and KFC, although not in the city as a whole6. Studies from Seattle King County and on early New York City data showed reductions in calorie intake among some customers6, 7, 8, but no overall reduction in consumption6, 9, 10, 11, 12.
Some studies suggest that calorie labels only lead to behavior change when they include contextual or interpretive language for consumers1. Promotional messages used in conjunction with calorie labels may increase their effectiveness13. Calorie labels that include a symbol (e.g., a traffic light image) can further reduce calories ordered14.
Women, individuals with higher education, and individuals with higher incomes are more influenced by nutrition labels than men or individuals with less education or lower incomes5, 15, 16. Young adults may be particularly receptive to calorie labels, especially on alcoholic drinks and catered food items4. Larger effects are also common among individuals who previously made higher calorie purchases5.
Menu labeling laws can affect businesses’ behavior. Several chains reformulated specific menu items or default ingredients following implementation of the New York City law6. Nutrient analysis performed in a voluntary pilot labeling program at non-chain restaurants in Pierce County, WA (near Seattle) led owners to modify, drop, or add menu items7.
How could this strategy impact health disparities? This strategy is rated likely to increase disparities.
Implementation Examples
Section 4205 of the Patient Protection and Affordable Care Act of 2010 (ACA) requires restaurants and similar retail food establishments with 20 or more locations to list calorie content information for standard menu items on restaurant menus and menu boards, including drive-through menu boards17. This federal legislation preempts state and local authority over menu labeling for affected restaurants2.
Some cities and states have also adopted local requirements for restaurant nutrition labeling: New York City, King County (WA), and San Francisco require chain restaurants to post calorie counts on menu boards. As of April 2011, California, Maine, Massachusetts, New Jersey, Oregon, Tennessee, and Vermont have passed state labeling policies18, 19.
Eight states (Alabama, Arizona, Florida, Georgia, Mississippi, Ohio, Utah, and Wisconsin) have preemption legislation that prevents local communities from adopting regulations for restaurants that are more restrictive than state laws for posting calorie information, offering toys in children’s meals, and regulating nutritional value or content of restaurant food2.
Implementation Resources
CSPI-Menu labeling - Center for Science in the Public Interest (CSPI). State and local menu labeling policies.
ChangeLab-Restaurant regulations 2012 - ChangeLab Solutions. Creating successful healthy restaurant policies: Understanding the laws regulating restaurants. 2012.
ChangeLab-Healthy restaurants - ChangeLab Solutions. Putting health on the menu: A toolkit for creating healthy restaurant programs and a model healthy restaurant program agreement.
LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural childhood obesity prevention toolkit. Leadership for Healthy Communities (LHC), Center for Global Policy Solutions, Robert Wood Johnson Foundation; 2014.
LHC-Toolkit 2009 - Leadership for Healthy Communities (LHC). Action strategies toolkit: A guide for local and state leaders working to create healthy communities and prevent childhood obesity. Princeton: Robert Wood Johnson Foundation (RWJF); 2009.
Footnotes
* Journal subscription may be required for access.
1 Sinclair 2014 - Sinclair SE, Cooper M, Mansfield ED. The influence of menu labeling on calories selected or consumed: A systematic review and meta-analysis. Journal of the Academy of Nutrition and Dietetics. 2014;114(9):1375-1388.
2 Grassroots Change - Grassroots Change: Connecting for better health. Preemption Watch.
3 Long 2015 - Long MW, Tobias DK, Cradock AL, Batchelder H, Gortmaker SL. Systematic review and meta-analysis of the impact of restaurant menu calorie labeling. American Journal of Public Health. 2015;105(5):e11-e24.
4 Nikolaou 2015 - Nikolaou CK, Hankey CR, Lean MEH. Calorie-labelling: Does it impact on calorie purchase in catering outlets and the views of young adults? International Journal of Obesity. 2015;39:542-545.
5 Bollinger 2011 - Bollinger BB, Leslie P, Sorensen A. Calorie posting in chain restaurants †. American Economic Journal: Economic Policy. 2011;3(February):91–128.
6 Dumanovsky 2011 - Dumanovsky T, Huang CY, Nonas CA, et al. Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: Cross sectional customer surveys. BMJ. 2011;343:d4464.
7 Pulos 2010 - Pulos E, Leng K. Evaluation of a voluntary menu-labeling program in full-service restaurants. American Journal of Public Health. 2010;100(6):1035-9.
8 Vadiveloo 2011 - Vadiveloo MK, Dixon LB, Elbel B. Consumer purchasing patterns in response to calorie labeling legislation in New York City. International Journal of Behavioral Nutrition and Physical Activity. 2011;8:51.
9 Elbel 2009 - Elbel B, Kersh R, Brescoll VL, Dixon LB. Calorie labeling and food choices: A first look at the effects on low-income people in New York City. Health Affairs. 2009;28(6):w1110-21.
10 Elbel 2011 - Elbel B, Gyamfi J, Kersh R. Child and adolescent fast-food choice and the influence of calorie labeling: A natural experiment. International Journal of Obesity. 2011;35(4):493-500.
11 Finkelstein 2011 - Finkelstein E, Strombotne KL, Chan NL, Krieger J. Mandatory menu labeling in one fast-food chain in King County, Washington. American Journal of Preventive Medicine. 2011;40(2):122-7.
12 Tandon 2011 - Tandon PS, Zhou C, Chan NL, et al. The impact of menu labeling on fast-food purchases for children and parents. American Journal of Preventive Medicine. 2011;41(4):434-38.
13 Harnack 2008a - Harnack LJ, French SA. Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: A review of the literature. International Journal of Behavioral Nutrition and Physical Activity. 2008;5(51).
14 Ellison 2013 - Ellison B, Lusk JL, Davis D. Looking at the label and beyond: The effects of calorie labels, health consciousness, and demographics on caloric intake in restaurants. International Journal of Behavioral Nutrition and Physical Activity. 2013;10:21.
15 Roberto 2009 - Roberto CA, Schwartz MB, Brownell KD. Rationale and evidence for menu-labeling legislation. American Journal of Preventive Medicine. 2009;37(6):546-51.
16 Breck 2014 - Breck A, Cantor J, Martinez O, Elbel B. Who reports noticing and using calorie information posted on fast food restaurant menus? Appetite. 2014;81:30-36.
17 Federal Register-Food labeling - Federal Register. Food labeling: Nutrition labeling of standard menu items in restaurants and similar retail food establishments.
18 CSPI-Labeling policies map - Center for Science in the Public Interest (CSPI). State and local menu labeling policies.
19 NCSL-Menu labeling -
National Conference of State Legislatures (NCSL). Trans fat and menu labeling legislation.
Related What Works for Health Strategies
To see citations and implementation resources for this strategy, visit:
countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/restaurant-nutrition-labeling
To see all strategies:
countyhealthrankings.org/whatworks