Recently, there has been a push to mandate labelling in fast food restaurants and stores. In the US, this is a huge initiative, passed as part of the 2010 Health Reform Bill (for another view on this, check out Dr Yoni Freedhoff’s post). This Bill mandated that all restaurants with more than 20 locations nationally had to post nutritional information on their website.

There’s a lot of ammo on both sides: some think that people should be responsible for their food choices, and that restaurants shouldn’t have to put up nutritional information. After all, they don’t *force* you to eat it. On the other hand, others advocate that knowing what is in your food will help you make a more informed decision.

Do you know how many calories are in a regular Big Mac? Take a guess. The answer is at the end of this post.

Regardless of your viewpoint, it all becomes irrelevant if the nutritional information doesn’t actually make a difference; if people don’t read and remember them, then what is the point?

And this is where today’s paper comes in.

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What did they do?

Following the introduction of the 2010 Health Reform Bill, the researchers collected data in New York City, and Newark. The former was about to introduce mandatory nutritional labelling, while the latter did not. The collected data both before labelling was introduced in NYC, and again after labelling was introduced. At both time points, Newark acted as a comparison group.

They went into large chains (KFC, McDonalds, Burger King etc) asked people: 1) What they thought their recommended daily intake of calories should be and 2) How many calories were in the food and drink they just ate.

An example of the bill in action: A Subway franchise displays the calorie count next to each sub

What did they find?

In Newark, about 15% of people didn’t know how many calories they should be taking in daily. This compares to an increase from 6% to 13% among pre- and post-labelling New Yorkers. So after labelling less people knew how many calories they should be eating. Of those who did respond, only a third estimated between 1500-2499 calories (which is the correct amount). Twenty-seven percent estimated less than 500 calories is the daily amount – approximately one KFC Zinger Sandwich (530 calories).

When it came to estimating calories in their food, a large percentage of people underestimated the number of calories. For those who only bought food, they underestimated the calories by almost a third before labelling, and this dropped to 18% after labelling. Interestingly, for those who only bought drinks, they overestimated the number of calories by 21% before labelling, and 33% after labelling.

And what now?

I’ve summarized the findings here – I recommend reading the paper for more detailed results. They did stratify by those who knew how many calories you should have daily, as well as stratifying by the mean number of calories, as those who eat more than the norm may view calories differently than those who eat less or the average.

This paper is an excellent start to evaluating whether or not labelling works. As they acknowledge as a limitation, this was done very early on. The legislation had only been in place for a month when the study was started, and it might take a few months for people to remember caloric information.

This is just one area that public health professionals need to focus on. While labelling is important and ideally will allow people to make informed decisions, if people don’t have a basic level of understanding about calories, this is all irrelevant. This is a great start, and one step closer to a nutritionally informed society.

Answer to Big Mac Question: A Big Mac contains 540 calories.

Elbel B (2011). Consumer estimation of recommended and actual calories at fast food restaurants. Obesity (Silver Spring, Md.), 19 (10), 1971-8 PMID: 21779085