Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment.
<h4>Background</h4>Calorie menu labeling is a policy that requires food establishments to post the calories on menu offerings to encourage healthy food choice. Calorie labeling has been implemented in the United States since May 2018 per the Affordable Care Act, but to the best of our kn...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-07-01
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| Series: | PLoS Medicine |
| Online Access: | https://doi.org/10.1371/journal.pmed.1003714 |
| _version_ | 1819241072778280960 |
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| author | Joshua Petimar Fang Zhang Eric B Rimm Denise Simon Lauren P Cleveland Steven L Gortmaker Sara N Bleich Michele Polacsek Christina A Roberto Jason P Block |
| author_facet | Joshua Petimar Fang Zhang Eric B Rimm Denise Simon Lauren P Cleveland Steven L Gortmaker Sara N Bleich Michele Polacsek Christina A Roberto Jason P Block |
| author_sort | Joshua Petimar |
| collection | DOAJ |
| description | <h4>Background</h4>Calorie menu labeling is a policy that requires food establishments to post the calories on menu offerings to encourage healthy food choice. Calorie labeling has been implemented in the United States since May 2018 per the Affordable Care Act, but to the best of our knowledge, no studies have evaluated the relationship between calorie labeling and meal purchases since nationwide implementation of this policy. Our objective was to investigate the relationship between calorie labeling and the calorie and nutrient content of purchased meals after a fast food franchise began labeling in April 2017, prior to the required nationwide implementation, and after nationwide implementation of labeling in May 2018, when all large US chain restaurants were required to label their menus.<h4>Methods and findings</h4>We obtained weekly aggregated sales data from 104 restaurants that are part of a fast food franchise for 3 national chains in 3 US states: Louisiana, Mississippi, and Texas. The franchise provided all sales data from April 2015 until April 2019. The franchise labeled menus in April 2017, 1 year prior to the required nationwide implementation date of May 2018 set by the US Food and Drug Administration. We obtained nutrition information for items sold (calories, fat, carbohydrates, protein, saturated fat, sugar, dietary fiber, and sodium) from Menustat, a publicly available database with nutrition information for items offered at the top revenue-generating US restaurant chains. We used an interrupted time series to find level and trend changes in mean weekly calorie and nutrient content per transaction after franchise and nationwide labeling. The analytic sample represented 331,776,445 items purchased across 67,112,342 transactions. Franchise labeling was associated with a level change of -54 calories/transaction (95% confidence interval [CI]: -67, -42, p < 0.0001) and a subsequent 3.3 calories/transaction increase per 4-week period (95% CI: 2.5, 4.1, p < 0.0001). Nationwide implementation was associated with a level decrease of -82 calories/transaction (95% CI: -88, -76, p < 0.0001) and a subsequent -2.1 calories/transaction decrease per 4-week period (95% CI: -2.9, -1.3, p < 0.0001). At the end of the study, the model-based predicted mean calories/transaction was 4.7% lower (change = -73 calories/transaction, 95% CI: -81, -65), and nutrients/transaction ranged from 1.8% lower (saturated fat) to 7.0% lower (sugar) than what we would expect had labeling not been implemented. The main limitations were potential residual time-varying confounding and lack of individual-level transaction data.<h4>Conclusions</h4>In this study, we observed that calorie labeling was associated with small decreases in mean calorie and nutrient content of fast food meals 2 years after franchise labeling and nearly 1 year after implementation of labeling nationwide. These changes imply that calorie labeling was associated with small improvements in purchased meal quality in US chain restaurants. |
| first_indexed | 2024-12-23T14:18:06Z |
| format | Article |
| id | doaj.art-750832770fbe4bab971b56f035991e1f |
| institution | Directory Open Access Journal |
| issn | 1549-1277 1549-1676 |
| language | English |
| last_indexed | 2024-12-23T14:18:06Z |
| publishDate | 2021-07-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Medicine |
| spelling | doaj.art-750832770fbe4bab971b56f035991e1f2022-12-21T17:43:52ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762021-07-01187e100371410.1371/journal.pmed.1003714Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment.Joshua PetimarFang ZhangEric B RimmDenise SimonLauren P ClevelandSteven L GortmakerSara N BleichMichele PolacsekChristina A RobertoJason P Block<h4>Background</h4>Calorie menu labeling is a policy that requires food establishments to post the calories on menu offerings to encourage healthy food choice. Calorie labeling has been implemented in the United States since May 2018 per the Affordable Care Act, but to the best of our knowledge, no studies have evaluated the relationship between calorie labeling and meal purchases since nationwide implementation of this policy. Our objective was to investigate the relationship between calorie labeling and the calorie and nutrient content of purchased meals after a fast food franchise began labeling in April 2017, prior to the required nationwide implementation, and after nationwide implementation of labeling in May 2018, when all large US chain restaurants were required to label their menus.<h4>Methods and findings</h4>We obtained weekly aggregated sales data from 104 restaurants that are part of a fast food franchise for 3 national chains in 3 US states: Louisiana, Mississippi, and Texas. The franchise provided all sales data from April 2015 until April 2019. The franchise labeled menus in April 2017, 1 year prior to the required nationwide implementation date of May 2018 set by the US Food and Drug Administration. We obtained nutrition information for items sold (calories, fat, carbohydrates, protein, saturated fat, sugar, dietary fiber, and sodium) from Menustat, a publicly available database with nutrition information for items offered at the top revenue-generating US restaurant chains. We used an interrupted time series to find level and trend changes in mean weekly calorie and nutrient content per transaction after franchise and nationwide labeling. The analytic sample represented 331,776,445 items purchased across 67,112,342 transactions. Franchise labeling was associated with a level change of -54 calories/transaction (95% confidence interval [CI]: -67, -42, p < 0.0001) and a subsequent 3.3 calories/transaction increase per 4-week period (95% CI: 2.5, 4.1, p < 0.0001). Nationwide implementation was associated with a level decrease of -82 calories/transaction (95% CI: -88, -76, p < 0.0001) and a subsequent -2.1 calories/transaction decrease per 4-week period (95% CI: -2.9, -1.3, p < 0.0001). At the end of the study, the model-based predicted mean calories/transaction was 4.7% lower (change = -73 calories/transaction, 95% CI: -81, -65), and nutrients/transaction ranged from 1.8% lower (saturated fat) to 7.0% lower (sugar) than what we would expect had labeling not been implemented. The main limitations were potential residual time-varying confounding and lack of individual-level transaction data.<h4>Conclusions</h4>In this study, we observed that calorie labeling was associated with small decreases in mean calorie and nutrient content of fast food meals 2 years after franchise labeling and nearly 1 year after implementation of labeling nationwide. These changes imply that calorie labeling was associated with small improvements in purchased meal quality in US chain restaurants.https://doi.org/10.1371/journal.pmed.1003714 |
| spellingShingle | Joshua Petimar Fang Zhang Eric B Rimm Denise Simon Lauren P Cleveland Steven L Gortmaker Sara N Bleich Michele Polacsek Christina A Roberto Jason P Block Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment. PLoS Medicine |
| title | Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment. |
| title_full | Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment. |
| title_fullStr | Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment. |
| title_full_unstemmed | Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment. |
| title_short | Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment. |
| title_sort | changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling a natural experiment |
| url | https://doi.org/10.1371/journal.pmed.1003714 |
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