Does Menu Labeling Lead to Healthier Food Choices?

Leather menu with the word 'menu' embossed

Americans consume about a third of their calories outside the home,1 but estimating the calorie count of a restaurant’s meal can be extremely difficult. In a cross-sectional study of 1,877 adults and 330 school age children, two thirds of participants underestimated the calories of fast food meals.2 

The larger the ingested meal, the larger the discrepancy between the estimated and the actual calorie content of that meal. In another study, participants consistently underestimated both the fat and calorie content of a range of menu items, where the actual content was up to 2 times greater than expected by consumers.3

With this in mind, policymakers have pushed towards requiring restaurants to display calorie counts on their menus. In 2010, Congress passed the Nutrition Labeling of Standard Menu Items at Chain Restaurants law.4 After an 8-year delay and several pushbacks from the restaurant and grocery trade organizations,5 the national law finally went into effect on May 7, 2018.Restaurant chains with 20 or more locations now have to list calories for menu items, and, if prompted, be able to provide more detailed nutrition information (such as macronutrient composition).6

However, the question remains – Does menu labeling lead to healthier food choices?

The studies examining the effects of menu labeling on the amount of calories ordered have shown inconsistent results.7 A systematic review from 2016 which analyzed the results of 38 studies, showed little overall effect of menu labeling. Of the studies conducted in restaurants, 9% showed a positive influence on food choices (i.e., participants picked healthier meals with lower calories), 50% showed a partial effect and 41% showed no effect.7 In this analysis, a greater effect of menu labeling on ordering behaviors was seen in studies of cafeterias. However, the studies analyzed were generally of small size, variable quality, and used different methodological approaches, making it difficult to draw any robust conclusions. Furthermore, while studies conducted in artificial settings point towards a positive effect on parents, adolescents, and children, real-world studies of menu labeling did not demonstrate changes in food-purchasing behaviors.8

The mixed results of these initial studies have been disappointing for the public health community. Cultural change and greater population education may be required for menu labeling to be more effective. However, change also needs to come from within the food industry itself. Transparency may prove a useful tool in this regard—by  having to disclose calories and nutrition information, restaurant chains may choose to modify meals and decrease their calorie content. Indeed, in an analysis of 66 out of 100 of the largest US restaurant chains obtained from the MenuStat project (a nutritional database of foods offered at restaurant chains), newly introduced meals and beverages had 12-20% fewer calories.9

In conclusion, adding calorie information to menu items highlights the calorie-dense nature of many restaurant meals and increases transparency for consumers. However, additional steps are needed to help individuals make healthier choices. The traffic-light system, where green corresponds to lower calories or an overall healthier, nutrient-rich meal might be such an example. Indeed, when the traffic-light system supplemented menu labeling, purchased calories were found to be lower.10 Finally, more research is needed to understand and overcome the barriers to healthier food choices and maximize the potential benefit of menu labeling.