Listing the calorie content on foods served at restaurants is clearly an idea whose time has come. Several states already have laws demanding the display of calorie information on fast-food menus and menu boards, and the Food and Drug Administration will soon issue final guidance on a national restaurant menu labeling law.
But studies so far on the impact of menu labeling show little impact on consumers' food choices. An enhanced type of nutritional menu labeling program is needed to meet the objective of getting people to avoid foods known to cause obesity and diet-related illnesses, according to a leading authority on national public health law.
In a commentary published in the December issue of the American Journal of Public Health, James G. Hodge, Jr., the former president of the Public Health Law Assn., and co-author Lexi C. White propose an enhanced type of nutritional menu labeling law that provides additional information on the fat, sodium and sugar content of meals to help people understand the overall health value of a particular food.
"Absent more data, calorie information alone won't get this job done," Hodge told TakePart. "Calorie information alone is easily overlooked."
The FDA's national menu labeling regulations are folded into the Affordable Care Act—otherwise known as Obamacare—and are meant to raise consumer awareness about calories in restaurant foods as well as prompt the restaurant industry to reduce calories and offer more low-calorie choices.
The federal program follows several smaller programs—such as in California, Massachusetts, Washington and New York City—that have already established menu labeling programs. The federal law will pertain to chain restaurants nationwide with more than 20 establishment (about 275,000 restaurants and retail food establishments). Calorie information must be printed on menus, menu boards and drive-through boards in a text and font similar to that used to describe the menu items and prices. Restaurants must be able to inform consumers on where they can get additional nutritional information besides calories on menu items.
Under the law, "The places where you're going to see this type of data show up is more inclusive," says Hodge, the Lincoln Professor of Health Law and Ethics at the Sandra Day O'Connor College of Law at Arizona State University. "But it still leaves out so many food outlets."
He says the law will not apply to three quarters of the nation's restaurants because they are not chains. And it won't apply to hotel restaurants, movie theaters, convenience stores or other establishments.
While the regulation will give many Americans more information than they have now—which is none—the program will still lack the ability to influence consumers' purchases and help them make healthier choices, Hodge argues. Consumers may not notice calorie information or they may not understand it.
"We don't know for sure how effective it is to post mere calorie information on a menu," Hodge says. "There are times with special consumers, like minors, where the data appear to be all but irrelevant."
For example, he says, someone may view a food item that's 500 calories and sells for $2 as a better value than a food item that is 300 calories and sells for $2. Moreover, calories are only a small part of the health equation, he says. U.S. consumers have been advised to cut down on sodium, sugar and saturated fat intake to lower the risk of obesity and diet-related disorders like diabetes and heart disease.
A consumer attempting to lower his or her sodium intake is not helped by the posting of only caloric content, Hodge notes. "You can't make an accurate judgment about the menu item. You just have to guess."
Moreover, calorie-only information as presented now isn't enough to counter industry marketing, huge portion sizes and cheap prices. To change behavior will require a stronger effort in the way of enhanced menu boards, Hodge says. He proposes supplementing menu labeling with information on sodium, sugar and fat and/or giving the food item a health score.
In one of his proposed models, a menu would list calories as well as four simple pie charts that depict how much of an individual's recommended daily value of calories, fat, salt and sugar are fulfilled by eating a particular food item. For example, the pie chart would show that a 550-calorie burger takes up 61 percent of the day's recommended sodium intake.
Another model uses a stoplight icon of red, yellow or green to denote the health value of the food—such as healthy, use caution or unhealthy.
The idea is to give consumers a rapid, at-a-glance idea of a food's impact on health.
"What you cannot do on a menu is you cannot replicate the nutritional panel that you see on a box of cornflakes," Hodge says. "On a menu in a fast-food environment or even a sit-down restaurant, consumers aren't going to study something like that. With these models, they have a chance to look at the menu to make some quick judgments."
A third model he proposes uses a heart symbol or a heart with an X through it to denote a judgment value of "healthy" or "unhealthy" based on national nutrition standards.
That model will generate more controversy, Hodge notes, but is not out of line with other government programs designed to protect consumers from harm.
"This is the one where someone has to say, 'Hey, this item is not healthy,' " he says. "We know this will be unpopular with restaurants and unpopular with consumers at times. People may think this is government going too far."
But, he notes, government rules already permit "heart healthy" emblems to be affixed to some grocery-store items, and health warnings are printed on alcohol and tobacco product labels.
Supplemental nutritional menu labeling doesn't impinge on consumer freedom, Hodge says. It provides people with information that they can act on or ignore.
"We are not limiting what's on the menu," he says. "We're not banning anything."
Already some restaurant chains provide graphics, such as pie charts, and detailed nutritional information on their web sites or in booklets available in the restaurants. Hodge says he believes some retailers will embrace the concept.
"Certain food retailers and vendors will be looking to take nutritional menu labeling to the next step." he says. "They will not require the government to have to mandate it. And I do think you'll see more demand from consumers for this data to be shown on site."
Question: Should restaurants be required to list more than just calorie information on menus in a clear, understandable way? Tell us what you think in the comments.
Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.