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Restaurant nutrition labeling

Evidence Rating
Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Disparity Rating
Strategies with this rating have the potential to increase or exacerbate disparities between subgroups. Rating is suggested by evidence, expert opinion or strategy design.
Community Conditions
Diet and exercise
Authors
Lead: Naiya Patel
Contributor(s): Ben Case, Bomi Kim Hirsch
Acknowledgements: Alison Bergum, Lael Grigg
Date Last Updated
December 11, 2023

Restaurant nutrition labeling involves voluntary or government mandated provision of nutrition and portion size information by restaurants and other food outlets. Nutrition information is typically included on restaurant menus, as well as on menu boards, signs, and posters, and is sometimes accompanied by contextual information such as recommended daily calories for adults or interpretive information such as exercise equivalent labels or traffic light labels (Sinclair 2014); these types of labeling are sometimes referred to as qualitative menu labeling (Fogolari 2023). State and federal laws preempt local governments from enacting such measures (CSPI-Nutrition and menu labeling).

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased awareness of calories purchased
  • Reduced calories purchased

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Reduced caloric intake
  • Reduced food portion sizes

What does the research say about effectiveness? -+

There is some evidence that providing nutrition information on restaurant menus and signboards increases awareness of calories purchased and reduces calories purchased (Long 2015), especially when labels include contextual or interpretive information for consumers (Sinclair 2014) and are easily visible (Nikolaou 2015). Restaurant nutrition labeling may be effective in university settings (Fogolari 2023) and some restaurants (Littlewood 2015), including fast-food restaurants (Bleich 2017). Additional evidence is needed to confirm effects.

Nutrition labeling on menu items in restaurants may help decrease the number of calories purchased per meal (Cochrane-Crockett 2018) including fast-food restaurants (Bleich 2017). In New York City, labeling is associated with reduced calories purchased at McDonalds, Au Bon Pain, and KFC, although not in the city as a whole (Dumanovsky 2011). A study looking at voluntary calorie labeling at McDonalds in New England cities finds a small positive change in the nutritional quality of meals consumed by adults, but not amongst adolescents or children compared to other fast-food restaurants that did not label calories (Petimar 2020). Studies from Seattle King County and on early New York City data show reductions in calorie intake among some customers (Pulos 2010, Vadiveloo 2011,Dumanovsky 2011), but no overall reduction in consumption (Elbel 2009, Elbel 2011, Dumanovsky 2011, Finkelstein 2011, Tandon 2011).

Young adults may be particularly receptive to calorie labels, especially on alcoholic drinks and catered food items (Nikolaou 2015). Larger effects are also common among individuals who previously made higher calorie purchases (Bollinger 2011). Some studies suggest that calorie labels only lead to behavior change when they include contextual or interpretive language for consumers (Sinclair 2014). Promotional messages used in conjunction with calorie labels may increase their effectiveness (Harnack 2008a). Calorie labels that include a symbol (e.g., a traffic light image) can further reduce calories ordered (Ellison 2013) and may increase healthy food choices (Fernandes 2016) in university settings (Fogolari 2023).

Menu labeling laws can affect businesses’ behavior. Several chains reformulated specific menu items or default ingredients following implementation of the New York City law (Dumanovsky 2011). Nutrient analysis performed in a voluntary pilot labeling program at non-chain restaurants in Pierce County, WA led owners to modify, drop, or add menu items (Pulos 2010).

Challenges to implementing nutrition labeling include lack of standardized recipes for nutrition information, frequent menu changes, cost of labeling, lack of consumer demand, and lack of training and guidelines for food service businesses (Kerins 2020).

How could this strategy advance health equity? This strategy is rated potential to increase disparities: supported by some evidence. -+

There is some evidence that restaurant nutrition labeling has the potential to increase disparities in calories purchased and healthy food choices: Women (Littlewood 2015), individuals with higher education, and individuals with higher incomes are more influenced by nutrition labels than men or individuals with less education or lower incomes (Bollinger 2011, Roberto 2009, Breck 2014).

In higher education settings, women are affected more by the calorie information displayed on menus than men leading to an increase in purchase of lower-calorie items (Roseman 2017). Subjective nutrition knowledge is associated with behaviors that result in healthier and lower calorie purchase of food items (Roseman 2017).

What is the relevant historical background? -+

The Nutrition Labeling and Education Act of 1990 mandated the Nutrition Facts Label (NFL) be included on most packaged food to provide consumers with accurate nutrition information (Dumoitier 2019). In 2016, revisions were made to the NFL to ensure that consumers had access to the most up to date scientific information and information was clearly communicated (Dumoitier 2019).

In 2014, a federal menu labeling rule required all chain restaurants or similar establishments with 20 or more locations to display calorie information on their menus (VanEpps 2016). Displaying calorie information for nonstandard items or items not listed on menus is not required (VanEpps 2016). This rule was in response to the obesity epidemic in the U.S., as larger amounts of food was being consumed and prepared outside of the home. Policymakers believed that restaurant nutrition labeling would help individuals make healthier choices while providing accurate nutrition information (VanEpps 2016, ChangeLab-Menu Labeling).

Equity Considerations -+

  • What type of restaurant labeling is used in your community? Is contextual information (e.g., recommended daily calories) and/or interpretive information (e.g., traffic light labeling, symbols, etc.) included?
  • What challenges do businesses in your community face when implementing restaurant nutrition labeling? What state and local policies and support can expand implementation?
  • How can restaurants in your community make interpreting nutrition labeling easier for consumers?

Implementation Examples -+

Section 4205 of the Patient Protection and Affordable Care Act of 2010 (ACA) requires restaurants and similar retail food establishments with 20 or more locations to list calorie content information for standard menu items on restaurant menus and menu boards, including drive-through menu boards (Federal Register-Food labeling). This federal legislation preempts state and local authority over menu labeling for affected restaurants (CSPI-Nutrition and menu labeling).

Some cities and states have also adopted local requirements for restaurant nutrition labeling: New York City, King County (WA), and San Francisco require chain restaurants to post calorie counts on menu boards. As of April 2011, California, Maine, Massachusetts, New Jersey, Oregon, Tennessee, and Vermont have passed state labeling policies (CSPI-Labeling policies map).

Implementation Resources -+

CDC-Nutrition fact label - Centers for Disease Control and Prevention (CDC). Learn how the nutrition facts label can help you improve your health.

ChangeLab-Healthy restaurants - ChangeLab Solutions. Putting health on the menu: A toolkit for creating healthy restaurant programs and a model healthy restaurant program agreement.

ChangeLab-Restaurant regulations 2012 - ChangeLab Solutions. Creating successful healthy restaurant policies: Understanding the laws regulating restaurants. 2012.

CSPI-Menu labeling - Center for Science in the Public Interest (CSPI). State and local menu labeling policies.

LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural childhood obesity prevention toolkit. Leadership for Healthy Communities (LHC), Center for Global Policy Solutions, Robert Wood Johnson Foundation; 2014.

Citations -+

* Journal subscription may be required for access.

Bleich 2017 - Bleich SN, Economos CD, Spiker ML, et al. A systematic review of calorie labeling and modified calorie labeling interventions: Impact on consumer and restaurant behavior. Obesity (Silver Spring). 2017;25(2):2018-2044.

Bollinger 2011* - Bollinger BB, Leslie P, Sorensen A. Calorie posting in chain restaurants. American Economic Journal: Economic Policy. 2011;3:91-128.

Breck 2014* - Breck A, Cantor J, Martinez O, Elbel B. Who reports noticing and using calorie information posted on fast food restaurant menus? Appetite. 2014;81:30-36.

ChangeLab-Menu Labeling - ChangeLab Solutions. What can states and local government do about menu labeling?

Cochrane-Crockett 2018* - Crockett RA, King SE, Marteau TM, et al. Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption. Cochrane Database of Systematic Reviews. 2018;(2):CD009315.

CSPI-Labeling policies map - Center for Science in the Public Interest (CSPI). State and local menu labeling policies.

CSPI-Nutrition and menu labeling - Center for Science in the Public Interest (CSPI). FDA urged to let cities, states innovate on nutrition and menu labeling.

Dumanovsky 2011 - Dumanovsky T, Huang CY, Nonas CA, et al. Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: Cross sectional customer surveys. BMJ. 2011;343:d4464.

Dumoitier 2019 - Dumoitier A, Abbo V, Neuhofer ZT, McFadden BR. A review of nutrition labeling and food choice in the United States. Obesity Science and Practice. 2019;5(6):581-591.

Elbel 2009* - Elbel B, Kersh R, Brescoll VL, Dixon LB. Calorie labeling and food choices: A first look at the effects on low-income people in New York City. Health Affairs. 2009;28(6):w1110-1121.

Elbel 2011 - Elbel B, Gyamfi J, Kersh R. Child and adolescent fast-food choice and the influence of calorie labeling: A natural experiment. International Journal of Obesity. 2011;35(4):493-500.

Ellison 2013 - Ellison B, Lusk JL, Davis D. Looking at the label and beyond: The effects of calorie labels, health consciousness, and demographics on caloric intake in restaurants. International Journal of Behavioral Nutrition and Physical Activity. 2013;10:21.

Federal Register-Food labeling - Federal Register. Food labeling: Nutrition labeling of standard menu items in restaurants and similar retail food establishments. 2015.

Fernandes 2016 - Fernandes AC, Oliveira RC, Proenca RPC, et al. Influence of menu labeling on food choices in real-life settings: A systematic review. Nutrition Reviews. 2016;74(8):534-548.

Finkelstein 2011* - Finkelstein E, Strombotne KL, Chan NL, Krieger J. Mandatory menu labeling in one fast-food chain in King County, Washington. American Journal of Preventive Medicine. 2011;40(2):122-127.

Fogolari 2023* - Fogolari N, Souza AD, Bernardo GL, et al. Qualitative menu labelling in university restaurants and its influence on food choices: A systematic review and synthesis without meta-analysis. Nutrition Bulletin. 2023;48:160-178.

Harnack 2008a - Harnack LJ, French SA. Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: A review of the literature. International Journal of Behavioral Nutrition and Physical Activity. 2008;5(51).

Kerins 2020 - Kerins C, McHugh S, McSharry J, et al. Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: A mixed methods systematic review. International Journal of Behavioral Nutrition and Physical Activity. 2020;17:48.

Littlewood 2015 - Littlewood JA, Lourenço S, Iversen CL, Hansen GL. Menu labelling is effective in reducing energy ordered and consumed: A systematic review and meta-analysis of recent studies. Public Health Nutrition. 2015;19(12):2106-2121.

Long 2015* - Long MW, Tobias DK, Cradock AL, Batchelder H, Gortmaker SL. Systematic review and meta-analysis of the impact of restaurant menu calorie labeling. American Journal of Public Health. 2015;105(5):e11-e24.

Nikolaou 2015* - Nikolaou CK, Hankey CR, Lean MEH. Calorie-labelling: Does it impact on calorie purchase in catering outlets and the views of young adults? International Journal of Obesity. 2015;39:542-545.

Petimar 2020* - Petimar J, Moran AJ, Ramirez M, Block JP. A natural experiment to evaluate the nutritional content of restaurant meal purchases after calorie labeling. Journal of the Academy of Nutrition and Dietetics. 2020;120(12):2039-2046.

Pulos 2010* - Pulos E, Leng K. Evaluation of a voluntary menu-labeling program in full-service restaurants. American Journal of Public Health. 2010;100(6):1035-1039.

Roberto 2009* - Roberto CA, Schwartz MB, Brownell KD. Rationale and evidence for menu-labeling legislation. American Journal of Preventive Medicine. 2009;37(6):546-551.

Roseman 2017 - Roseman MG, Joung HW, Choi EK, Kim HS. The effects of restaurant nutrition menu labelling on college students’ healthy eating behaviours. Public Health Nutrition. 2017;20(5):797-804.

Sinclair 2014* - 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(9):1375-1388.

Tandon 2011* - Tandon PS, Zhou C, Chan NL, et al. The impact of menu labeling on fast-food purchases for children and parents. American Journal of Preventive Medicine. 2011;41(4):434-438.

Vadiveloo 2011 - Vadiveloo MK, Dixon LB, Elbel B. Consumer purchasing patterns in response to calorie labeling legislation in New York City. International Journal of Behavioral Nutrition and Physical Activity. 2011;8:51.

VanEpps 2016 - VanEpps EM, Roberto CA, Park S, Economos CD, Bleich SN. Restaurant menu labeling policy: Review of evidence and controversies. Current obesity reports. 2016;5(1):72-80.