• I really wish policy would be more research based

    I’ve caught some flack here on the blog for my lukewarm support for menu-labeling. It’s not that I’m against policy to diminish obesity in America. It’s that I don’t think that the policies we are choosing are necessarily going to work. Menu-labeling is one such policy.

    There are a number of people who think that the reason people order unhealthy food is because they don’t know what they are eating. So, if we tell them, then they’ll stop ordering that food. This is an answerable question, though. Will they?


    Background: Nutrition labeling of menus has been promoted as a means for helping consumers make healthier food choices at restaurants. As part of national health reform, chain restaurants will be required to post nutrition information at point-of-purchase, but more evidence regarding the impact of these regulations, particularly in children, is needed.

    Purpose: To determine whether nutrition labeling on restaurant menus results in a lower number of calories purchased by children and their parents.

    Methods: A prospective cohort study compared restaurant receipts of those aged 6–11 years and their parents before and after a menu-labeling regulation in Seattle/King County (S/KC) (n=75), with those from a comparison sample in nonregulated San Diego County (SDC) (n=58). Data were collected in 2008 and 2009 and analyzed in 2010.

    So the researchers got a number of families in two counties and measured their ordering in restaurants. Then, in one of the counties, they implemented menu-labeling. Later, they remeasured the ordering in both the county that not labeled, and the one that didn’t.

    In the county where menu-labeling was implemented, calories ordered for children went from 823 on average to 822. In the county without labeling, calories ordered for children went from 984 on average to 949. Not impressive. The calories ordered by parents for themselves did drop in the labeling restaurants from 823 to 720, but they dropped in the non-labeling restaurants just as much, from 895 to 789.

    Parents did say that they did see the nutrition information in the labeling restaurants. Some may hold this up as a good thing, but to be honest, it makes it all much worse. They saw the calorie information, but didn’t care. Or, at least they didn’t change their behavior because of it.

    This doesn’t bode well for the future. If menu-labeling is the great hope for the obesity epidemic, then we may be very disappointed in how all this turns out.

    • One issue that I think these studies may miss out on is how people are eating outside of the restaurants. If restaurants are seen as a splurge because the rest of the week you’re eating salads and fruit, then the food being ordered isn’t going to change. There’s got to be a way to do a study that takes that into account.

      Let’s face it, the people that are trying to be healthy are going to order the healthier foods. The people that don’t care are going to order whatever they want. Menu labeling may help at the margin for people that are trying to be healthy but need help. I think those are the people this effort should target. By the same token, I think the overall bombardment of nutritional information is reinforcing the idea that we should all be concerned with our health. Maybe I’m wrong but I still think putting this information out there is a good thing.

    • Exactly why should we base nutrition labeling on research based evidence but not health care policy? If the latter can be based on what is politically possible and the alter of compromise versus what works best, why not the former?

      • Hey, if I had my way, it would all be based on evidence. But we can’t let the great be the enemy of the good. It’s much harder to do randomized, controlled trials of health insurance reform than of menu-labeling. Just because we can’t do one, shouldn’t mean we ignore the other.

        And, yes, we often compromise. But we shouldn’t compromise by going with something that is proven not to work. I don’t think you’ll find us advocating that on this blog.

    • Aaron,

      I was under the impression there are a few different studies on calorie labeling and they’ve gone different ways. While the one you link to and Elbrel et al. find that labelling didn’t have an effect on nutritional choices, Bollinger et al. did. Bollinger et al. looked at Starbucks customers and found that calorie labelling reduced average calories 6%, largely related to food choices (and not beverages). It also interestingly found no effect on average profit, but an increase in revenues when the Starbucks is close to a Dunkin’ Donuts. I haven’t reviewed it in depth so I can’t speak to whether there are any major identification problems.

      Bryan Bollinger, Phillip Leslie and Alan Sorensen, “Calorie Posting in Chain Restaurants,” NBER Working Paper No. 15648, January 2010, http://www.nber.org/papers/w15648.

      Brian Elbel, Rogan Kersh, Victoria L. Brescoll and L. Beth Dixon, “Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City,” Health Aff November/December 2009 vol. 28 no. 6. http://content.healthaffairs.org/content/28/6/w1110.abstract