We can’t go anywhere or do anything without some reminder or temptation for us to eat unhealthy foods, or foods of low nutritional value. We see it on commercials, in magazines, on billboards and even at the checkout counter in stores where candies are wrapped up in shiny packaging to attract our eye.

There’s a principle in marketing that goes along the lines of: the more marketing a product has, the less we truly need it. This seems to fit with foods in that we rarely see promotions for eating healthy foods like fruits and vegetables. We may see the odd public health message but nothing on the scale of unhealthy foods.

As we continue to learn the role our environment plays in our food choices, certain public health initiatives have begun to develop to offset the promotion of unhealthy foods. One area in particular that has received a lot of attention is menu labelling. This makes sense since most people eat in restaurants at least once per week.

New York 2

Menu labelling began in 2006 when New York City passed a law requiring chain restaurants to include calorie counts on their menus. Even hot dog vendors in New York’s Central Park have to adhere to menu labelling. Laws have since been passed across the entire US and in Canada with other countries considering similar regulations. For example, in the UK, 75% of people surveyed think menu labelling in restaurants is a good idea.

These laws are predominantly limited to providing the number of calories a specific item has on the menu and commonly apply only to restaurant chains containing more than 15 to 20 restaurants. In doing so, this leaves out many restaurants from having to adhere to the labelling.

The idea behind menu labelling is that if you know how many calories are in an item, you may alter your choice at the restaurant to a lower calorie item. These laws have been created in response to the high, and increasing, levels of obesity worldwide. Again, based on the premise that if people ate less, there would be less obesity.

This sounds good in practice, and I would like to think it works but I’m skeptical that a person will go to McDonald’s, see how many calories a burger has and then order the salad instead. If you’re going to a place like McDonald’s, you’ve pretty much decided on the type of food you’re going to have. That doesn’t mean to say menu labelling doesn’t change people’s behaviours at all.

menu

Early studies looked at whether people noticed menu labels after eating at a restaurant and encouragingly nearly two-thirds of restaurant customers remembered seeing calorie counts on menus and this can result in increased awareness of how many calories a menu item has.

Trying to find out if menu labelling changes purchasing behaviour is a different challenge altogether. One study that looked at purchase receipts at a fast food chain before and after menu labelling found no difference in calories sold per purchase. This was similar to a larger study in which customers were interviewed before and after labelling went into effect, and also found no change. However, this study reported that for certain restaurant chains, there was a reduction in total calories per purchase. In addition, 15% of people reported using the calorie labelling and consumed less calories at their meal compared to the rest of the people surveyed. And a recent review of studies did find a small, but significant reduction in calories per purchase.

The problem with the studies to date are the limitations in how they are designed. Many of the studies do not include comparison groups not exposed to menu labelling. Therefore, the above studies use before and after surveys of different people assuming purchasing habits would be similar between different people. Some studies looked at fast food restaurants only, while others sit-down restaurants or a mix. As a result, we’re left with studies that aren’t very robust with different designs, making it hard to compare between them.

What we can surmise to date, is that menu labelling may alter purchase habits of some people in certain restaurants, but not in all. It may be more effective in sit-down restaurants compared to fast food, and it may be helpful for people who are conscious of their weight or trying to lose weight.

counting calories

But even if people choose lower calorie items, does this mean it is the healthier choice? If a salad is 500 calories while a cookie is only 200 calories, does that mean the cookie is better for you because it has fewer calories? Only having the total calories of an item provides little indication of its nutritional value.

Most people also don’t know how many calories is good enough for our needs and how much is too much. To do that, we need to know how many calories we should eat in a day. I can estimate it’s somewhere between 1500 and 2000 calories per day for most people but that is still a big range. Add to that, the fact that we’ve likely eaten other meals during that same day for which we have no idea what the calorie content is. If that is the case, then how are we to know how many calories to eat at that restaurant meal?

Whether or not menu labelling helps prevent, or reduce, obesity in an individual or a population will be difficult to determine. Long-term studies will be needed but even then, these studies may occur on the background of other public health initiatives such as a tax on sugary drinks or more informative labelling on foods in grocery stores, that may also act on reducing total calories of foods. That being said, menu labelling is unlikely to be of harm and it helps to build awareness of the challenges in trying to eat healthy in a world which promotes the unhealthy.