The recent Supreme Court decision on the Patient Protection and Affordable Care Act has cleared the way for national requirements about posting nutritional information at chain restaurants. Listing calories, fat content, and sodium levels of menu items at the point of purchase has been promoted as a way to address the obesity epidemic. Increased awareness may lead to healthier consumer choices, and may encourage restaurants to adapt their menus to meet demand. A new study has evaluated the real-life impact of menu labeling in King County, Washington, after new regulations were implemented, and has found some improvement, although most entrées continue to exceed recommended nutritional guidelines. The study is available online in advance of publication in the August issue of the Journal of the Academy of Nutrition and Dietetics.

“Frequent consumption of food away from home is associated with higher caloric intake and higher fat. As noted by the Food and Drug Administration, the cost of the obesity epidemic to families, businesses, and the government was over $117 billion in 2010,” says lead investigator Barbara Bruemmer, PhD, RD, senior lecturer emeritus of the Program in Nutritional Sciences, School of Public Health, University of Washington, Seattle. “All of these issues underscore the need for environmental approaches to help consumers who are looking for better options.”

King County was one of the first jurisdictions to implement menu labeling, in January 2009. The regulations applied to any restaurant with 15 or more establishments in the United States and at least $1 million in annual sales. Dr. Bruemmer and her colleagues wanted to learn whether restaurants would improve their entrées by reformulating items so that they had fewer calories and would replace some menu items with healthier alternatives.

The investigators audited menus at 11 sit-down restaurants and 26 quick-serve chains. They evaluated the nutritional levels of entrées that were on the menu six months after the regulations went into effect and remained on the menu 12 months later, to determine whether individual menu items had been reformulated to improve their nutritional profiles. They also looked at whether all entrées had a better nutrition profile. “We also wanted to know how healthy foods at chain restaurants were overall. How do these meals stack up compared to what we should be aiming for in a good diet?” Dr. Bruemmer said. So they compared the nutritional values of entrées at the restaurants in their study to US Department of Agriculture dietary guidelines.

“We did find evidence of a decrease in energy, saturated fat, and sodium content after the implementation of menu regulations for items that were on the menu at both time periods,” reports Dr. Bruemmer. “We also saw a trend for healthier alternatives across all entrées over time, but only in the sit-down restaurants.”

However, the study found that the majority of entrées were still very high in energy, saturated fats, and sodium, compared to dietary guidelines. “56% of entrees exceeded the recommended level for 1/3 of an adult’s daily needs, while 77% of the entrees exceeded the guidelines for saturated fats, and almost 90% exceeded the sodium guidelines. Yes, we saw improvements, but there is still a long way to go. Those are pretty hefty servings for adults.”

A decline of 41 calories in entrées was seen between the two time periods. “While that doesn’t sound like very much, it is an improvement and it is statistically significant,” says Dr. Bruemmer. “41 fewer calories could easily translate into several pounds lost over a year for an adult. It’s modest, but it’s a start.”

With national guidelines from the Food and Drug Administration expected later this year, Dr. Bruemmer says that consumers need more options in the marketplace and clearer messages about how to use menu labeling information. “People can only respond to what’s available in the environment. If we haven’t yet seen people say, ‘Oh, I found something that meets my needs,’ well, maybe it’s because there aren’t enough moderate options available on the menu. Menu labeling will help people get a handle on this ‘list’ of calories, at the point where they’re making their decisions and putting down their money. This is where America is providing a lot of food to our children. Let’s give families a chance to make an informed decision,” she concludes.

In an accompanying audio presentation (www.andjrnl.org/content/podcast), Dr. Bruemmer discusses the implications of the menu labeling for chain restaurant management, nutrition practitioners, and policy-makers.

• Full bibliographic information“Energy, Saturated Fat, and Sodium Were Lower in Entrées at Chain Restaurants at 18 Months Compared with Six Months Following the Implementation of Mandatory Menu Labeling Regulation in King County, Washington,” by Barbara Bruemmer, PhD, RD; Jim Krieger, MD, MPH, Brian E. Saelens, PhD, Nadine Chan, PhD, MPH. Journal of the Academy of Nutrition and Dietetics, Volume 112/Issue 8 (August 2012), DOI: 10.1016/j.jand.2012.05.011, published by Elsevier.