The following are comments from Richard Besser, MD, president and CEO of the Robert Wood Johnson Foundation (RWJF), on nutrition labeling of standard menu items in restaurants and similar retail food establishments.
The Robert Wood Johnson Foundation strongly supports implementation of the U.S. Food and Drug Administration’s (FDA) final rule on menu labeling for restaurants, supermarkets, convenience stores, and other food retailers. We encourage FDA to implement the rule on May 8, 2018, as scheduled, with no intervening actions to weaken or reverse the requirements.
RWJF’s vision to build a Culture of Health includes helping everyone in America be proactive in making food choices that lead to the healthiest lifestyle possible. Providing families with nutrition information when they eat out will make it easier to instill healthy habits in their children from a young age, which in turn will help them become healthier adults. Increased transparency will give consumers the tools they need to make informed decisions and empower them to choose healthy options for themselves and their families.
The menu labeling requirements will provide consumers with important nutrition information that will help them make healthy choices when eating outside their homes. More than two-thirds of adults1 and one-third of children and teens2 in the United States are overweight or obese, increasing their risk for cardiovascular disease, several types of cancer, and type II diabetes, which results in more than $147 billion in annual health care costs.3 Significant racial and ethnic inequities persist, with higher rates among Latino and Black children and adults compared to their White and Asian counterparts.4 Ensuring that populations with higher obesity rates and greater risk of chronic disease receive important nutrition information is paramount to reversing the nation’s obesity epidemic and closing health disparities.
With Americans consuming about one-third of their daily calories on food prepared away from home,5 menu labeling is an important tool that empowers people to make informed decisions. According to What Works for Health—a component of the RWJF-funded County Health Rankings and Roadmaps program that provides information to help communities make evidence-based policy decisions—expected beneficial outcomes of restaurant menu labeling include increased awareness of, and a reduction in, calories purchased. Other potential beneficial outcomes include reduced caloric intake and reduced portion sizes.6
U.S. Consumers Want Menu Labeling
Several surveys have found that a large number of consumers want and use menu labeling when it is available,7, 8, 9,10 and a variety of restaurant, movie theater, convenience store, and supermarket chains already are successfully providing calorie information.11
Consumers Choose Fewer Calories
Although results of impact are mixed, some studies on menu labeling show positive results. A study funded by RWJF’s Healthy Eating Research program examined the impact of Seattle/King County’s menu labeling policy on calories purchased from a select group of chain restaurants. Researchers found that adults and teens who used the menu labeling information purchased up to 143 fewer calories than customers who did not see or use the calorie information.12 A 2015 follow-up study found that the percentage of adults in the Seattle area who saw and used calorie information tripled after a menu labeling policy went into effect for chain restaurants, and the results were sustained up to 24 months.
Research indicates that menu labeling is particularly effective in full service restaurants, and that product reformulation following its implementation is another potential benefit alongside positive behavioral changes.13 Menu labeling can be most effective as part of a comprehensive strategy to change food offerings and food choices.14
Convenience Stores Trending to Healthier Options
Americans increasingly purchase ready-to-eat food from grocery and convenience stores. Consequently, we urge FDA to not change course and exclude certain currently covered establishments like grocery and convenience stores. The Partnership for a Healthier America currently has nine partnerships with convenience store chain companies located in 23 states where the companies have committed to stock healthier, more affordable snacks and meals; support healthier choices through in-store marketing and promotions; and support community and employee wellness.15 These voluntary efforts indicate that consumers are increasingly looking to purchase healthier products and convenience stores are responding in kind. Menu labeling requirements are a natural next step towards building on this momentum and ensuring that consumers have the information they need to make healthy decisions.
Menu Labeling Can Impact Weight
A study conducted by FDA that analyzed the impact of mandatory calorie labeling laws in local New York jurisdictions found that the point-of-purchase provision of calorie information on chain restaurant menus causes economically important and statistically significant reductions in body mass index (BMI) and the risk of obesity. Results indicated that in the New York jurisdictions studied, calorie labeling had similar impacts across the BMI distribution, with a larger impact on the body weight of lower-income individuals, especially minorities.16
Restaurants Adjust their Menus and Maintain Sales In addition to helping consumers choose fewer calories, menu labeling also has led to restaurants lowering the number of calories in their menu items. For example, researchers found that large chain restaurants lowered the number of calories of new menu items by about 60 calories (a 12 percent decline) from 2012 to 2014,17,18 and large chain restaurants that voluntarily post calorie information have lower-calorie items compared to chains that do not post.19 Another study examining Starbucks offerings found that average calories per transaction fell by six percent following mandatory calorie postings, driven primarily from changes in food purchases. Researchers also found that, on average, there was no negative impact on Starbucks profits following the change. In some cases, when a store was located near a competitor (i.e., Dunkin Donuts) revenues even increased.20
Potential Savings to Health Care Seen With Menu Labeling
The benefit to consumers and potential savings in health care costs of implementing menu labeling as planned, are considerable. According to the FDA’s regulatory impact analysis issued with the final rule, the menu labeling policy will impact approximately 300,000 establishments, with an estimated benefit of $9.2 billion over 20 years. The total cost of implementation is estimated at $1.2 billion, providing a total net savings of $8 billion.21 In addition, a Harvard study found restaurant menu labeling could prevent up to 41,000 cases of childhood obesity and could save over $4.6 billion in health care costs over ten years.22
Consumer Awareness Campaign Could Optimize Menu Labeling
RWJF strongly urges FDA to continue efforts to develop and disseminate resources for professionals and consumers to accompany the roll out of menu labeling. According to recent research (funded in part by RWJF) that assessed parental awareness of calorie recommendations for children’s meals, about two-thirds of parents either underestimate (33.3 percent) or overestimate (31.8 percent) the appropriate number of calories for children 5 to 12 years old. Researchers concluded that parent education about calorie recommendations for children could improve understanding and use of menu labeling information in restaurants, with targeted efforts needed to address health disparities.23 As a result, we urge FDA to ensure that nationwide implementation of menu labeling be accompanied by a consumer awareness and promotion campaign that can strengthen its impact.
As required by the FDA final rule, RWJF supports the following standards:
- Menu labeling should apply to ready-to-eat foods and beverages purchased at all chain retailers, including restaurants, supermarkets, convenience stores, movie theaters, and stadiums.
- Calorie information should be presented in a consistent format across menu items and food service establishments and for the entire menu item as listed on the menu. Consumers should be able to easily compare across menu items and not have to guess whether the listed calorie information applies to the entire meal, or just a portion of it.
- Calorie information should be located on, or adjacent to, the name of the food on the menu, menu board, or food label and not in a separate part of the establishment.
- Calorie labeling should be required on all menus that customers use to make food selection decisions, including in-store, drive through, printed takeout and delivery, and online.
Millions of Americans walk into restaurants, grocery stores, and other food retail established covered by the menu labeling rule every day. When these requirements are implemented, they will walk out more informed and more confident consumers—and as FDA’s own regulatory impact analysis of the final rule shows, healthier customers are good for businesses, have reduced health care costs, and boost local economies. RWJF urges FDA to move forward with implementation of the final rule on May 8, 2018.
About the Robert Wood Johnson Foundation
For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working with others to build a national Culture of Health enabling everyone in America to live longer, healthier lives. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.
1 Fryar CD, Carroll MD, and Ogden CL. Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults Aged 20 and Over: United States, 1960-1962 Through 2013-2014. Centers for Disease Control and Prevention, National Center for Health Statistics. July 18, 2016. Available at www.cdc.gov/nchs/data/hestat/obesity_adult_13_14/obesity_adult_13_14.htm. Accessed May 10, 2017.
2 Fryar CD, Carroll MD, and Ogden CL. Prevalence of Overweight and Obesity Among Children and Adolescents Aged 2-19 Years: United States, 1963-1965 Through 2013-2014. Centers for Disease Control and Prevention, National Center for Health Statistics. July 18, 2016. Available at www.cdc.gov/nchs/data/hestat/obesity_child_13_14/obesity_child_13_14.htm. Accessed May 10, 2017.
3 Finkelstein EA, Trogdon JG, Cohen JW, and Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Affairs 2009;28(5):w822-31.
4 Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA, 315(21): 2292-2299, 2016.
5 Lin B-H and Guthrie J. Nutritional Quality of Food Prepared at Home and Away from Home, 1977-2008. U.S. Department of Agriculture Economic Research Service. December 2012. Available at www.ers.usda.gov/webdocs/publications/43698/34514_summaryeib105.pdf?v=41270. Accessed May 10, 2017.
6 University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. What Works for Health Policies: Restaurant Menu Labeling. www.countyhealthrankings.org/policies/restaurant-nutrition-labeling. Accessed June 12, 2017.
7 AP-GfK Poll: Americans support menu labeling in restaurants, grocery stores. December 31, 2014. Available at ap-gfkpoll.com/featured/findings-from-our-latest-poll-11. Accessed May 10, 2017.
8 Lee-Kwan, SH, Pan L, Maynard, L, et al. Restaurant Menu Labeling Use Among Adults – 17 States, 2012. MMWR 2014;63:581-584.
9 Healthy Eating Research. Impact of Menu Labeling on Consumer Behavior: A 2008-2012 Update. Research Review. June 2013. Available at healthyeatingresearch.org/wp-content/uploads/2013/12/HER-RR-Menu-Labeling-FINAL-6-2013.pdf. Accessed May 10, 2017.
10 Caravan ORC International. Restaurant Calorie Content: ORC Study 721210, May 2012. Conducted for the Center for Science in the Public Interest. Accessed at: cspinet.org/new/pdf/restaurant-calorie-content.pdf.
11 Bottemiller Evich, Helena. “Trump’s Delay of Calorie-Posting Rules Jolts Restaurants.” Politico. May 27, 2017. www.politico.com/story/2017/05/27/trump-restaurant-calorie-posting-rule-238873
12 Krieger JW et al. Menu labeling regulations and calories purchased at chain restaurants. American Journal of Preventive Medicine 2013;44:595-604.
13 Auchincloss AH, Mallya GG, Leonberg BL, Ricchezza A, Glanz K, Schwarz DF. Customer Responses to mandatory menu labeling at full-service restaurants. American Journal of Preventive Medicine 2013;45:710-9
14 Sinclair SE, Cooper M, Mansfield ED. The influence of menu labeling on calories selected or consumed: a systematic review and meta-analysis. Journal of the Academy of Nutrition and Dietetics 2014;114:1375-1388
15 Partnership for a Healthier America: Our Partners. Accessed at: www.ahealthieramerica.org/our-partners
16 Calorie Labeling in Chain Restaurants and Body Weight: Evidence from New York
Brandon J. Restrepo U.S. Food and Drug Administration February 11, 2016
17 Bleich SN, Wolfson JA, Jarlenski MP. Calorie changes in chain restaurant menu items: implications for obesity and evaluations of menu labeling. American Journal of Preventive Medicine 2015;48:70-5.
18 Bleich SN, Wolfson JA, Jarlenski MP. Calorie changes in large chain restaurants: declines in new menu items but room for improvement. American Journal of Preventive Medicine 2016;50:e1-e8.
19 Bleich SN, Wolfson JA, Jarlenski MP, Block JP. Restaurants with calories displayed on menus had lower calorie counts compared to restaurants without such labels. Health Affairs 2015;34:1877-84.
20 Bollinger B, Leslie P, Sorensen A. Calorie Posting in Chain Restaurants. American Economic Journal: Economic Policy 2011; Economic Policy 3:91-128.
21 U.S. Food and Drug Administration. Final Regulatory Impact Analysis: Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishment, November 2014. Accessed at: www.fda.gov/downloads/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/UCM423985.pdf.
22 Gortmaker, SL, et al. "Three Interventions that Reduce Childhood Obesity Are Projected to Save More than They Cost to Implement." Health Affairs 34.11 (2015): 1932-1939.
23 Lynskey VM et al. Low parental awareness about energy (calorie) recommendations for children’s restaurant meals: findings from a national survey in the USA. Public Health Nutrition. June 2017.