PURPOSE: To investigate how a pilot environmental intervention changed food sales patterns in carryout restaurants.
DESIGN: Quasi-experimental.
SETTING: Low-income neighborhoods of Baltimore, Maryland.
SUBJECTS: Seven carryouts (three intervention, four comparison).
INTERVENTION: Phase 1, menu board revision and healthy menu labeling; phase 2, increase of healthy sides and beverages; and phase 3, promotion of cheaper and healthier combination meals.
MEASURES: Weekly handwritten menu orders collected to assess changes in the proportion of units sold and revenue of healthy items (entrée, sides and beverages, and combined).
ANALYSIS: Logistic and Poisson regression models with generalized estimating equations.
RESULTS: In the intervention group, odds for healthy entrée units and odds for healthy side and beverage units sold significantly increased in phases 2 and 3; odds for healthy entrée revenue significantly increased in phase 1 (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.26), phase 2 (OR 1.32, 95% CI 1.25-1.41), and phase 3 (OR 1.39, 95% CI 1.14-1.70); and odds for healthy side and beverage revenues increased significantly in phase 2 (OR 1.62, 95% CI 1.33-1.97) and phase 3 (OR 2.73, 95% CI 2.15-3.47) compared to baseline. Total revenue in the intervention group was significantly higher in all phases than in the comparison group (p < .05).
CONCLUSION: Environmental intervention changes such as menu revision, menu labeling, improved healthy food selection, and competitive pricing can increase availability and sales of healthy items in carryouts.
Many recreation and sports facilities have unhealthy food environments, however managers are reluctant to offer healthier foods because they perceive patrons will not purchase them. Preliminary evidence indicates that traffic light labeling (TLL) can increase purchase of healthy foods in away-from-home food retail settings. We examined the effectiveness of TLL of menus in promoting healthier food purchases by patrons of a recreation and sport facility concession, and among various sub-groups. TLL of all menu items was implemented for a 1-week period and sales were assessed for 1-week pre- and 1-week post-implementation of TLL (n = 2101 transactions). A subset of consumers completed a survey during the baseline (n = 322) and intervention (n = 313) periods. We assessed change in the proportion of patrons' purchases that were labeled with green, yellow and red lights from baseline to the TLL intervention, and association with demographic characteristics and other survey responses. Change in overall revenues was also assessed. There was an overall increase in sales of green (52.2% to 55.5%; p < 0.05) and a reduction in sales of red (30.4% to 27.2%; p < 0.05) light items from baseline to the TLL period. The effectiveness of TLL did not differ according to any of the demographic or other factors examined in the survey. Average daily revenues did not differ between the baseline and TLL periods. TLL of menus increased purchase of healthy, and reduced purchase of unhealthy foods in a publicly funded recreation and sport facility, with no loss of revenue. Policymakers should consider extending menu labeling laws to public buildings such as recreation and sports facilities to promote selection of healthier items.
PURPOSE: Determine the effect of menu labels displaying the energy content of food items or the exercise equivalent on energy ordered and consumed at lunch and energy intake for the remainder of the day in young adults.
DESIGN: Subjects were randomized to a menu with no labels (no-labels), menu with kilocalorie labels displaying the energy content of the food items (kcal-labels), or menu with exercise labels displaying the minutes of brisk walking needed to burn the food energy (exercise-labels).
SETTING: The study was conducted in one dining area located in a metabolic kitchen at the Texas Christian University and another located in a residence occupied by graduate students.
SUBJECTS: Of the 300 subjects, 55.7% were female, 77.3% were college students, 88% were white, and 88% were non-Hispanic. Mean body mass index and age were 24.2 ± 4.5 kg/m(2) and 21.9 ± 2.3 years, respectively.
INTERVENTION: All menus contained the same food/beverage choices. Subjects ordered and consumed foods/beverages for lunch from the menu to which they were assigned. Subjects were blinded to study purpose.
MEASURES: Energy ordered and consumed at lunch were assessed from the weight of the food ordered and consumed, respectively, and the energy content of the same foods available on the restaurant Web site. Postlunch energy intake was assessed by food recall.
ANALYSIS: Analysis of covariance, adjusted for premeal hunger levels and gender, determined the effect of menu type on energy ordered and consumed and postlunch energy intake.
RESULTS: Significant menu effect was observed for energy ordered (p = .008) and consumed (p = .04) at lunch. The exercise-labels group ordered significantly (p = .002) less energy (adjusted mean [confidence intervals]: 763 [703, 824] kcal) at lunch, compared to the no-labels group (902 [840, 963] kcal) but not compared to the kcal-labels group (827 [766, 888] kcal). The exercise-labels group also consumed significantly (p = .01) less energy (673 [620, 725] kcal) at lunch, compared to the no-labels group (770 (717, 823) kcal) but not compared to the kcal-labels group (722 [669, 776] kcal). Energy ordered and consumed were not different between kcal-labels and no-labels groups. There was no difference in postlunch energy intake by menu type.
CONCLUSION: The menu with exercise-labels resulted in less energy ordered and consumed and this did not lead to greater energy consumption post lunch, compared to the menu with no-labels in young adults largely made up of normal-weight, non-Hispanic white college students.
OBJECTIVE: Food prepared and consumed away from home accounts for a significant proportion of dietary intake among Canadians. Currently, Canadians receive little or no nutrition information when eating in restaurant and fast-food outlets. The present study examined the impact of nutrition information on menus in hospital cafeterias on noticing and perceived influence of nutrition information and on food consumption.
DESIGN: Cross-sectional surveys.
SETTING: Exit surveys (n 1003) were conducted in two hospital cafeterias. The 'intervention' site featured energy (calorie), sodium and fat content on digital menu boards, as well as a health logo for 'healthier' items. The intervention site had also revised its menu items to improve the nutrient profiles. The 'control' site provided limited nutrition information at the point of sale.
SUBJECTS: Cafeteria patrons recruited using the intercept technique.
RESULTS: Significantly more respondents at the intervention site reported noticing nutrition information (OR = 7·6, P < 0·001) and using nutrition information to select their food items (OR = 3·3, P < 0·001) compared with patrons at the control site, after adjusting for sociodemographic factors. Patrons at the intervention site consumed significantly less energy (-21 %, P < 0·001), sodium (-23 %, P < 0·001), saturated fat (-33 %, P < 0·001) and total fat (-37 %, P < 0·001) than patrons at the control site.
CONCLUSIONS: A nutritional programme, including nutrition information on menus and improved nutrition profile of food offerings, was associated with substantial reductions in energy, sodium and fat consumption. The results are consistent with a positive impact of menu labelling.
BACKGROUND: The food environment shapes individual diets, and as food options change, energy and sodium intake may also shift. Understanding whether and how restaurant menus evolve in response to labeling laws and public health pressures could inform future efforts to improve the food environment.
OBJECTIVES: To track changes in the energy and sodium content of US chain restaurant main entrées between spring 2010 (when the Affordable Care Act was passed, which included a federal menu labeling requirement) and spring 2011.
DESIGN: Nutrition information was collected from top US chain restaurants' websites, comprising 213 unique brands. Descriptive statistics and regression analysis evaluated change across main entrées overall and compared entrées that were added, removed, and unchanged. Tests of means and proportions were conducted for individual restaurant brands to see how many made significant changes. Separate analyses were conducted for children's menus.
RESULTS: Mean energy and sodium did not change significantly overall, although mean sodium was 70 mg lower across all restaurants in added vs removed menu items at the 75th percentile. Changes were specific to restaurant brands or service model: family-style restaurants reduced sodium among higher-sodium entrées at the 75th percentile, but not on average, and entrées still far exceeded recommended limits. Fast-food restaurants decreased mean energy in children's menu entrées by 40 kcal. A few individual restaurant brands made significant changes in energy or sodium, but the vast majority did not, and not all changes were in the healthier direction. Among those brands that did change, there were slightly more brands that reduced energy and sodium compared with those that increased it.
CONCLUSIONS: Industry marketing and pledges may create a misleading perception that restaurant menus are becoming substantially healthier, but both healthy and unhealthy menu changes can occur simultaneously. Our study found no meaningful changes overall across a 1-year time period. Longer-term studies are needed to track changes over time, particularly after the federal menu labeling law is implemented.
BACKGROUND: Vending machines and shops located within health care facilities are a source of food and drinks for staff, visitors and outpatients and they have the potential to promote healthy food and drink choices. This paper describes perceptions of parents and managers of health-service located food outlets towards the availability and labelling of healthier food options and the food and drinks offered for sale in health care facilities in Australia. It also describes the impact of an intervention to improve availability and labelling of healthier foods and drinks for sale.
METHODS: Parents (n = 168) and food outlet managers (n = 17) were surveyed. Food and drinks for sale in health-service operated food outlets (n = 5) and vending machines (n = 90) in health care facilities in the Hunter New England region of NSW were audited pre (2007) and post (2010/11) the introduction of policy and associated support to increase the availability of healthier choices. A traffic light system was used to classify foods from least (red) to most healthy choices (green).
RESULTS: Almost all (95%) parents and most (65%) food outlet managers thought food outlets on health service sites should have signs clearly showing healthy choices. Parents (90%) also thought all food outlets on health service sites should provide mostly healthy items compared to 47% of managers. The proportion of healthier beverage slots in vending machines increased from 29% to 51% at follow-up and the proportion of machines that labelled healthier drinks increased from 0 to 26%. No outlets labelled healthier items at baseline compared to 4 out of 5 after the intervention. No changes were observed in the availability or labelling of healthier food in vending machines or the availability of healthier food or drinks in food outlets.
CONCLUSIONS: Baseline availability and labelling of healthier food and beverage choices for sale in health care facilities was poor in spite of the support of parents and outlet managers for such initiatives. The intervention encouraged improvements in the availability and labelling of healthier drinks but not foods in vending machines.
BACKGROUND: In 2010, Philadelphia enacted a menu-labeling law requiring full-service restaurant chains to list values for calories, sodium, fat, and carbohydrates for each item on all printed menus.
PURPOSE: The goal of the study was to determine whether purchase decisions at full-service restaurants varied depending on the presence of labeling.
METHODS: In August 2011, this cross-sectional study collected 648 customer surveys and transaction receipts at seven restaurant outlets of one large full-service restaurant chain. Two outlets had menu labeling (case sites); five outlets did not (control sites). Outcomes included differences in calories and nutrients purchased and customers' reported use of nutrition information when ordering. Data were analyzed in 2012.
RESULTS: Mean age was 37 years; 60% were female; 50% were black/African-American and reported incomes ≥$60,000. Customers purchased food with approximately 1600 kcal (food plus beverage, 1800 kcal); 3200 mg sodium; and 35 g saturated fat. After adjustment for confounders, customers at labeled restaurants purchased food with 151 fewer kilocalories (95% CI=-270, -33); 224 mg less sodium (95% CI=-457, +8); and 3.7 g less saturated fat (95% CI=-7.4, -0.1) compared to customers at unlabeled restaurants (or 155 less kilocalories from food plus beverage, 95% CI=-284, -27). Those reporting that nutrition information affected their order purchased 400 fewer food calories, 370 mg less sodium, and 10 g less saturated fat.
CONCLUSIONS: Mandatory menu labeling was associated with better food choices among a segment of the public dining at full-service restaurants. Consumer education on the availability and use of nutrition information may extend the impact of menu labeling.
To investigate how a pilot environmental intervention changed food sales patterns in carryout restaurants.
DESIGN:
Quasi-experimental.
SETTING:
Low-income neighborhoods of Baltimore, Maryland.
SUBJECTS:
Seven carryouts (three intervention, four comparison).
INTERVENTION:
Phase 1, menu board revision and healthy menu labeling; phase 2, increase of healthy sides and beverages; and phase 3, promotion of cheaper and healthier combination meals.
MEASURES:
Weekly handwritten menu orders collected to assess changes in the proportion of units sold and revenue of healthy items (entrée, sides and beverages, and combined).
ANALYSIS:
Logistic and Poisson regression models with generalized estimating equations.
RESULTS:
In the intervention group, odds for healthy entrée units and odds for healthy side and beverage units sold significantly increased in phases 2 and 3; odds for healthy entrée revenue significantly increased in phase 1 (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.26), phase 2 (OR 1.32, 95% CI 1.25-1.41), and phase 3 (OR 1.39, 95% CI 1.14-1.70); and odds for healthy side and beverage revenues increased significantly in phase 2 (OR 1.62, 95% CI 1.33-1.97) and phase 3 (OR 2.73, 95% CI 2.15-3.47) compared to baseline. Total revenue in the intervention group was significantly higher in all phases than in the comparison group (p < .05).
CONCLUSION:
Environmental intervention changes such as menu revision, menu labeling, improved healthy food selection, and competitive pricing can increase availability and sales of healthy items in carryouts.
