Christina A. Roberto, Ph.D. Departments of Social & Behavioral Sciences and Nutrition Designing Nutrition Labels

Simple, Salient, Meaningful Nutrition Labels –Restaurant menu labeling –Front-of-package labeling

Menu Labeling

Menu Labeling Rationale 1.People eat out a lot 2.People don’t know the calories in restaurant food 3.If they did, they’d make lower calorie choices (at least some of the time) See review Roberto et al. Am J Prev Med, 2009

But nutrition information is already available?  Research study - counted people at Roberto et al. Am J Public Health, 2009

Out of 4,311 how many looked at nutrition information? 6

Menu Labeling Rationale 1.People don’t know the calories in restaurant food 1.If they did, they’d make lower calorie choices (at least some of the time)

Test Menu Labeling’s Impact on Behavior in the Lab Roberto et al, Am J Public Health, 2010

Menu Labeling in a Restaurant Lab  303 adults for market research study  Randomized to 1 of 3 menus  Focus group, ordered & ate food, dietary recall Roberto et al, Am J Public Health, 2010

Menu Without Calorie Labels

Menu with Calorie Labels

Menu with Calorie Labels + Daily Calorie Info The recommended daily caloric intake for an average adult is 2000 calories

Calories Ordered for Dinner Calories

Calories Eaten At Dinner Calories

Calories Eaten After Dinner Calories

Dinner + After Dinner Calories Eaten Calories

Summary  Calorie labels led to fewer calories:  Ordered  Eaten  With just calories people ate more later  Putting calories in context led to avg reduction of 250 calories

U.S. Patient Protection & Affordable Care Act SEC NUTRITION LABELING OF STANDARD MENU ITEMS AT CHAIN RESTAURANTS  Number of calories  Statement about daily caloric intake

Product Reformulation

Front-of-Package Nutrition Labeling

Smart Choices Program

What Were Some of the Smart Choices Products?

August 2009 FDA “We are Watching” Letter

Media Suspicion NY Times Article Sept 2009

How Smart Were Smart Choices?  Randomly sampled from 8 packaged food categories on Smart Choices Website  Nutrition info for 100 products  Classified products as “healthy” based on Nutrient Profile Model  Validated & informed policy in UK & Australia Roberto et al. Pub Health Nutr, 2011

64% of Smart Choices Products Did Not Meet Objective Nutrition Score for “Healthy” Results

Smart Choices Under Scrutiny Attorney General Gets Involved Oct 2009

–Institute of Medicine Released First Report –Working on Second Report –Food industry releases Facts Up Front In the meantime…

Not Simple, Salient, or Meaningful

Cautionary Tale of Industry Self-Regulation for Front-of-Package Labeling

Greens Mean Go Red Means Stop

Hospital Cafeteria in Boston  Over 6,000 employees and visitors per day  All register data for 9 months, ~3 million items  Traffic lights + choice architecture for beverages “Consume often” “Consume less often” “There’s a better choice in green or yellow” Thorndike et al., Am J Public Health, 2012

Sales of all cafeteria items during Baseline and Labeling % of total cafeteria sales

Cold beverage sales Baseline vs Labeling % of cold beverage sales

IOM Proposed Label

Simple, Salient, Meaningful Nutrition Labels –Restaurant menu labeling –Front-of-package labels –Nutrition facts labels on packaged foods

Christina A. Roberto, PhD