Calorie Labeling Did Not Change the Total Number of Calories Purchased

October 06, 2009

Last year, New York became the first city in the nation to enforce mandatory calorie labeling in fast-food restaurants throughout the five boroughs. This important public policy is the first of its kind in its attempt to alter the "food environment", the area in which individuals are actually making their food choices, in an attempt to influence the obesity epidemic. Currently, dozens of cities and states have implemented or are working to implement calorie labeling. A new study led by an NYU Langone Medical Center investigator is the first to evaluate the effectiveness of this policy that is sweeping across the country. 

The goal of the policy was to encourage consumers to think twice before purchasing high calorie foods from restaurants, and to increase awareness of the calorie contents of the food they were purchasing.  The new study, which focused on low-income areas in New York City, found that posting calories increased the percentage of consumers who saw calorie information to 54 percent and approximately 25 percent of these consumers indicated that this information was influential for them in their food choice. However, the introduction of calorie labels did not translate into an increase in the number of calories purchased by consumers in the areas studied. 

"It's encouraging to see that menu labeling increased awareness of calories," said Brian Elbel, PhD, MPH. "Though the introduction of calorie labels did not change the number of calories purchased, a combination of public policy efforts are likely necessary to produce a meaningful change in obesity."

The study is published as a web exclusive in the October 6, 2009, issue of the leading health policy journal Health Affairs.  Dr. Elbel and his co-workers gathered receipts and surveys from 1,156 adults at fast-food restaurants both before and after mandatory labeling began in July 2008. They focused on lower income communities in New York City and utilized Newark, New Jersey (which does not have mandatory labeling) as a comparison city. Data were collected before labeling began, and one month after labels were present in restaurants.  As adults were leaving fast food restaurants, their receipts were collected and the foods they purchased were confirmed, along with a brief survey. 

Dr. Elbel said that the study is an important first step in evaluating the effectiveness of calorie labeling, and more work must be done in this area. "Further studies will address how to make labeling more effective in altering food choice.  While low-income groups were an important first population to study given their increased health problems, we must also expand our research to understand how labeling influences other groups as well." 

Nearly two-thirds of adults in the United States are overweight. Almost one-third are obese, according to data from the National Health and Nutrition Examination Survey (NHANES) 2001 to 2004. Health care professionals and policy makers have noted this rising epidemic with alarm.  Most studies show an increase in mortality rates associated with obesity. Individuals who are obese have a 10- to 50-percent increased risk of death from all causes, compared with healthy weight individuals (BMI 18.5 to 24.9). Most of the increased risk is due to cardiovascular causes. Obesity is associated with about 112,000 excess deaths per year.

Many researchers and policy makers are looking to change the food environment as a way to combat obesity.  "Food choice is a complicated and multifaceted.  Altering such choices is difficult, and understanding the role of calorie labeling is an important first step.  Perhaps a combination of approaches—such as increasing the availability of healthy foods and making these foods more affordable—is needed to combat the obesity epidemic."  

Last year, the New York City Department of Health and Mental Hygiene required restaurants with more than 15 locations nationally to visibly post the calorie content of regular menu items. NYC was the first locality to implement calorie labeling.  Generally, fast-food establishments must post calories on their menu boards and sit-down restaurants must list their calories on their printed menus in a readable font and type size.

The study was lead by Brian Elbel, PhD, MPH, assistant professor of medicine and health policy at the NYU School of Medicine and the NYU Wagner School of Public Service. Additional investigators are Rogan Kersh, PhD, NYU Wagner School of Public Service; Victoria L. Brescoll, PhD, Yale School of Management; and L. Beth Dixon, PhD, MPH, NYU Steinhardt.

This study was supported with grants from the Robert Wood Johnson Foundation Healthy Eating Research program, the Yale Rudd Center for Food Policy and Obesity and the NYU Wagner Dean's Fund.

Media Inquiries:

Lorinda Klein
212-404-3533 | 917-693-4846 (cell) | lorindaann.klein@nyumc.org