Slight Shift Seen After Calories Added to Fast-food Menus

The introduction of total calories to menu labeling may be helping to make a small dent in the number of calories that people consume at fast-food restaurants, a new study suggests.

Compared with restaurants where the calories of menu items weren’t specified, people eating at establishments where those details were visible ordered an average of 25 fewer calories, and fewer items overall.

“This strategy may yield a reduction in daily caloric intake and create a positive influence on population-level health outcomes, including obesity and cardiovascular disease,” the authors write.

Pasquale E. Rummo, PhD, MPH (New York University Grossman School of Medicine, NY), led the study, which focused on Taco Bell restaurants in the United States. He told TCTMD that while the effect size is small, the hope is that it can lead to meaningful changes over time.

“I think it's valuable to know the calorie information and frankly, other types of information, which is what we're pushing for now—like added sugars—but calorie information in itself can only do so much in terms of moving the needle,” he said.

Posting calories for menu items became a requirement in the United States in 2018 for chain restaurants with 20 or more locations as part of the Patient Protection and Affordable Care Act. Prior studies that have examined the association between this legislation and the number of calories and nutrients that consumers ultimately choose have shown mixed results, with some indicating a small decrease in calories ordered and others showing no clear impact, say Rummo and colleagues in a paper published today in JAMA Network Open.

“When you look at blood pressure trials, for example, many times the mean blood pressure reduction is a couple of points and yet they still have these massive benefits. What you're seeing in this study is a population average,” noted Andrew Freeman, MD (National Jewish Health, Denver, CO), who commented on the study for TCTMD. “I bet if you were to look at the delta rather than the mean calorie reduction, the change in calories at an individual level [might show] a bigger effect.”

He believes the key to this type of legislation and its ability to impact individual health is consistency of exposure—essentially the normalization—of posted caloric information.

“Sure, there are going to be some people who don’t care . . . but if you follow people long enough and kept showing them calories, you'd likely see a bigger and bigger impact over time,” Freeman added.

Cutting Back on Tacos

The study addresses some of the limitations of previous research by focusing on transaction-level sales data collected over 9 years from 2,329 restaurants in California, New York, Vermont, Maryland, and Washington.

Rummo and colleagues reviewed data on 5.33 billion transactions from Taco Bell restaurants, all of which had the same menu items. The transactions included detailed information on the items purchased, including the date, time, location, and how they were ordered (drive-through, eat in, or takeout). During the study period, 474 restaurants had already introduced menu labeling ahead of the 2018 mandate.

While all restaurants had similar baseline calories purchased, the addition of menu labeling resulted in approximately 25 fewer calories per transaction compared with restaurants without menu labeling in the first 3 to 24 months after implementation.

Some geographic variations were seen, as were differences in total calories purchased at different times of the day. However, sensitivity analyses confirmed the validity of the main findings.

Overall, tacos were the food category most frequently purchased, and the authors hypothesize that some consumers may be changing how they customize their tacos to reduce calories based on greater awareness.

Full Disclosure Is Important

Rummo said his group is still trying to unpack some of the information to understand more about geographic variation and generalizability, since the majority of restaurants analyzed were in California. They’re also thinking beyond calories to other information that, if available, could factor into healthy food choices, but in a way that isn’t overwhelming.

“What we need is a suite of healthy-eating policies,” he said. “Something that might be splashier is way of distinguishing the type of calories you’re taking in, because people need calories, but knowing if those are coming from added sugars is important and could catch the consumers’ eye.”

Freeman agreed, adding that consumer education about calories is sorely lacking, with many people programmed to choose comfort foods without considering how they factor into their daily calorie intake.

“Education level, motivation, socioeconomic status, social disparities, disparities in health: . . . there are so many things that play a role in these choices and how they are made,” he said. “It's important to have full disclosure on the foods that we're eating, where they come from, what they're made out of, and what harms they may have, including caloric content.”