Will required menu calorie counts curb eating?

Starting in December 2016, you may notice a change in the menus of your favorite chain restaurants. Thanks to the Affordable Care Act (ACA), many restaurants will have to list the calorie count of the food they serve.

The measure was originally to go into effect in December of this year, but restaurants just got a one-year reprieve, which critics worry will give food lobbyists extra time to kill the measure during the delay.

The rule covers chain restaurants with at least 20 stores. The requirements have three main components: First, each menu item must have a clearly visible calorie count. Second, the restaurant must point out that the average daily intake is 2,000 calories. Third, they must let customers know that detailed nutritional information about each menu item is available on request. The National Restaurant Association estimates about 1 out of 3 U.S eating establishments will be affected. The law also applies to vending machines that are part of an operating or ownership group of 20 vending machines or more.

Many hail this as an important step in the battle against obesity, but a review of 19 menu calorie labeling studies in May showed that the practice yielded virtually no statistically significant change in calorie consumption.

The Food and Drug Administration (FDA) remains undaunted. It estimated adding nutritional information to the menus will produce a “stream of benefits” of anywhere from $3.7 billion to $10.4 billion over the next 20 years. The FDA said the benefit was mostly attributable to a lower probability of death from eating healthier food.

Laura Bartee, clinical registered dietitian at Baylor All Saints Carter Rehabilitation & Fitness Center, said her research shows people are at least looking at calorie counts even though a smaller number act on the information.

“We can’t give people this (calorie) information and not educate them on what they should be doing with it. Calories are king, and are what research proves impacts weight loss the most,” Bertee said.

The percentage of total food calories consumed in restaurants has almost doubled, from about 18 percent in the 1970s to about 33 percent now. The rate of obese and overweight adults has since more than doubled. Restaurant food typically has larger portions, more fat, more calories, and less fiber than home-cooked meals, according to a Food and Drug Administration (FDA) 2014 analysis.

A study at the Johns Hopkins School of Public Health found that restaurant customers in Baltimore made little attempt to eat healthily when shown calorie listings. But when food calories were matched with an equivalent amount of exercise, they made more of an attempt to eat less.

The results were equally promising involving parents. A study earlier this year in the journal Pediatrics found that parents shown menus with any type of caloric content label may order fast food meals totaling fewer calories for their children. Moreover, menu labels showing physical activity equivalents may be more likely to influence parents to encourage their children to exercise.

Could menus listing exercise, not calories, be more effective?

The ACA allows restaurants to provide a range of calories, allowing for customization of dishes. Vox’s Sarah Kliff found a Chipotle menu listed a burrito at between 350-970 calories. That’s not very helpful. Bartee said a client once ate what he thought was a healthy Chipotle meal of chicken, brown rice, avocado, beans and salsa. He punched the ingredients into his calorie tracker and discovered he had consumed 750 calories.

“He was very upset,” Bartee said. “Those are very healthy foods, but the portions are too big.”

People are not very good at estimating calories on their own. Harvard Medical School researchers found that people significantly underestimated the calories in their meals. More than 1 out of 4 underestimated calorie content by at least 500 calories, according to the research in the British Medical Journal in 2013. Bartee points out that even registered dietitians have difficulty estimating calories because it is difficult to know how the food was prepared.

Perhaps the strongest public policy justification for menu-nutrition labeling is the widely held assumption that more information is better than less information. According to a literature review of studies on menu labeling, the idea is clearly popular. In the United States, for instance, nearly three-quarters of Americans support menu labeling.

About the author

Steve Jacob
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Steve is a senior marketing and public relations consultant for Baylor Scott & White Health. He spent nearly four decades in newspaper and magazine editorial and business management and is the author of two books on healthcare reform. He was also the founding editor of D Magazine's D Healthcare Daily.

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Will required menu calorie counts curb eating?