Will Menu Calorie Counts Help Whittle America’s Waistline?

Nov 7, 2014, 2:00 PM

By Sheree Crute

Maricelle Ramirez is a foot soldier in America’s battle against obesity. For three years, Ramirez has politely offered Boston area patrons of McDonald’s, Kentucky Fried Chicken, Burger King, Dunkin’ Donuts, Wendy’s and Subway a $2 gift card in exchange for their estimates of the amount of calories in their fast-food feasts.

“I’ve met all types of people,” Ramirez says, recalling the surprise of encountering a nutritionist who was on her way out of McDonald’s after chowing down on a burger and fries. “She explained that she was just enjoying a meal because she had a craving for something indulgent, but she provided a very careful nutritional analysis of what she was eating.”

At the other end of the spectrum was an older woman leaving Kentucky Fried Chicken with a drumsticks-to-mashed potatoes spread for her family who confessed, “I don’t know much about the calorie content of the food, but it would really make a difference for me and my family if I had more information.”

Fast Food: The American Way

As summer fades and people ramp up their schedules for work and school, they are also likely to increase their consumption of foods they can pick up on the fly. A 2014 poll by the company 72 Point reported that Americans spend $1,200 a year on fast food primarily because “they are too busy to make a meal at home.”

Gallup reports that eight in 10 Americans eat fast food at least once a month, so Robert Wood Johnson Foundation (RWJF) grantees Jason Block, PhD, and Peter Ubel, MD, decided to investigate just how much fast-food fans know about what they are eating.

“We wanted to learn how well people did when it to came estimating the calories in their meals and whether placing calorie counts on menus would encourage them to eat healthier,” explains Block, an RWJF Health & Society  Scholar (2007-2009) who led the research team guiding Ramirez’s on-the-street interviews.

Ubel, a 2007 recipient of an RWJF Investigator Award in Health Policy Research, took the calorie question one step further by trying to determine if people were able to accurately interpret menu calorie counts.

“The whole point of publishing the calorie count is to inform consumers, but it’s tricky when you are dealing with customizable foods,” Ubel says, referring to menu items such as pizza and burritos where the calorie count depends on how many ingredients customers request.

Block and Ubel ultimately hope to assess the value of Section 4205 of the Patient Protection and Affordable Care Act. It mandates menu labeling (the regulations are still under review) at eateries offering standardized meals. In its explanation of Section 4205, the Food and Drug Administration reports that “some studies show that people consume fewer calories when menus have calorie counts displayed.”

However, there are several studies, including a 2010 analysis conducted at Duke Medicine, that find menu labeling to have “no impact on [food] purchasing behavior” at fast food chains.

Mixed Results

To advance the debate, Block analyzed the data collected by Ramirez and others on his team and discovered that “adolescents underestimated their meals by about 250 calories. Adults were off by about 175 calories on average, but one quarter thought their meals had nearly 500 calories less than they actually contained,” he says.

“People also underestimated more at Subway than any other chain, we suspect because they think the food is healthier and therefore lower calorie. But ultimately, Block concludes that menu labeling could encourage some consumers to eat healthier and give more thought to what they consume. More importantly, he suggests that as a result of menu labeling, restaurant chains might offer more low-calorie options.

Block and his co-researcher Christina A. Roberto, PhD, a 2012-2014 RWJF Health & Society Scholar, discuss their perceptions in a September 3, 2014, commentary in JAMA, “Potential Benefits of Calorie Labeling in Restaurants.”

The Great Burrito Boondoggle

Ubel’s approach was to look at whether restaurants were presenting calorie information in a way that was clear to consumers. “Our findings suggest that labeling may change consumer behavior as well as the restaurant’s practices,” he says.

His findings were reported in “How Many Calories are in My Burrito? Improving Consumers’ Understanding of Calorie Range Information” in the April 2014 issue of Public Health Nutrition.

Ubel’s team asked patrons of the Chipotle chain if they knew what was included in the restaurant’s lowest calorie burrito—the option marked “vegetarian” and 410 calories.

Of course the chain’s customer’s had no idea that the 410 only referred to a burrito that contained pinto beans, not the guacamole, sour cream and other goodies that most people added before getting to the cash register. The actual burrito was somewhere around 650 calories.  

Does Public Calorie Counting Matter?

Block, Ubel and other public health researchers may never be able to calculate the exact impact of menu labeling, but they are confident that there is some value in encouraging healthier behavior on the part of fast food consumers and restaurateurs.

“The new policy is likely an important step toward improving the public’s eating habits,” Block says. Ubel adds: “Restaurants will also have to change. They will either have to make healthier versions of their entrees or accurately explain what’s in a meal.”

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.