Background

Food and menu labels can provide information that improves an individual’s food selection and potentially improves body weight outcomes. Research focusing upon the impact of food labeling on body weight and other health outcomes is beginning to emerge. A recent systematic review included 17 studies with experimental or quasi-experimental designs that determined whether menu-based nutrition information affects the selection and consumption of calories in restaurants and other foodservice establishments. The review concluded that menu labeling of calories alone did not decrease calories selected or consumed but that the addition of contextual or interpretive information on menus, such as daily caloric recommendations or physical activity equivalents, assisted consumers to select and consume fewer calories. The intent of this NEL systematic review was to focus on controlled trials that isolate the impact of menu labeling on food selection and consumption at the individual level.

Conclusion statement

Limited and inconsistent evidence exists to support an association between menu calorie labels and food selection or consumption.

2015 DGAC Grade: Limited

Methods

Literature searches were conducted using PubMed, Embase, Cochrane, EconLit, Social Sciences and SocINDEX databases to identify studies published in English in peer-reviewed journals from January 2004 to November 2014. Included studies met the following inclusion and exclusion criteria established a priori to the review: randomized and non-randomized controlled trials; human subjects; adults and adolescents who were healthy or at elevated chronic disease risk; studies conducted in the United States; at least 30 subjects per study arm; the dependent variable included menu labeling or Nutrition Fact Panel labeling for packaged foods; and outcome measures included food selection or dietary intake.

Data from each included article were extracted and risk of bias was assessed by two abstractors. The evidence was qualitatively synthesized, a conclusion statement was developed and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the quality and risk of bias, quantity, consistency, magnitude of effect and generalizability of available evidence.

Findings

• Ten randomized controlled trials (RCTs) were included in this body of evidence that compared menu calorie labeling on food selection. Three of the studies also measured calorie intake of a test meal.
• Results were mixed regarding the influence of menu calorie labeling on food selection:
  • Five studies found no effect of calorie information alone on food selection
  • Three studies found calorie labeling led to selection of fewer calories
  • Two studies showed mixed results. One found an impact of calorie labeling with women but not men, and another found that parents ordered fewer calories for their children, but not for themselves when calorie information was included on a test menu.
• Two studies found that providing calorie labels with either recommended daily caloric intake information or physical activity equivalents resulted in the consumption of fewer calories at a test meal. One study did not find an effect of calorie labeling on calorie consumption.
• Two studies examining physical activity equivalents as a component of the calorie labeling found a decrease in the calorie content of selected food items
• One study that examined the effect of calorie labeling and value pricing (structuring product prices such that the per-unit cost decreases as portion size increases) also showed no association between calorie labeling and food selection or consumption.

Limitations

The ability to draw stronger conclusions was limited by the following issues:

• Short study duration: Most studies only measured food selection or consumption at one time point, although two studies measured subsequent intake via dietary recall
• Studies did not measure physical activity
• External validity: Laboratory-based settings or surveys were used to collect data, yet consumer behavior may be markedly different in a restaurant setting
• Many studies relied on a convenience sample
• Design and analysis did not control for hunger and physical activity
• Results are not generalizable to broader US population.