The effect of menu labeling with calories and exercise equivalents on food selection and consumption

Background: Better techniques are needed to help consumers make lower calorie food choices. This pilot study examined the effect of menu labeling with caloric information and exercise equivalents (EE) on food selection. Participants, 62 females, ages 18-34, recruited for this study, ordered a fast food meal with menus that contained the names of the food (Lunch 1 (L1), control meal). One week later (Lunch 2 (L2), experiment meal), participants ordered a meal from one of three menus with the same items as the previous week: no calorie information, calorie information only, or calorie information and EE.

Results: There were no absolute differences between groups in calories ordered from L1 to L2. However, it is noteworthy that calorie only and calorie plus exercise equivalents ordered about 16% (206 kcal) and 14% (162 kcal) fewer calories from Lunch 1 to Lunch 2, respectively; whereas, the no information group ordered only 2% (25 kcal) fewer.

Conclusions: Menu labeling alone may be insufficient to reduce calories; however, further research is needed in finding the most effective ways of presenting the menu labels for general public.

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Alex’s Notes: Have you ever noticed that every fast-food outlet and even most restaurants provide the calorie information of their products? It started back in 2010 when the US federal health care reform bill was signed into law, requiring that all restaurant chains with at least 20 nationwide outlets post calorie labels on their menus. While the hope was that people would make healthier choices, the majority of individuals who consistently eat out don’t have an understanding of the value of a calorie. For the average layman who has never given a second thought to their nutrient intake, there needs to be a way to communicate nutritional information in a manner that they can relate to.

Something that everyone can sympathize with is doing stuff. Exercise equivalents if you want to be politically correct. A previous study highlights how effective this can be. Participants were randomly assigned to see one of four menus (calories only, calories and number of minutes to walk to burn off that amount of calories, calories and number of miles to walk off that amount of calories, or no information). The group shown the calories and miles to walk ordered significantly less (19%) than those shown no information and was more effective than the other labels. Additionally, 82% of their participants reported a preference for exercise equivalents on menu labeling.

The benefits of exercise equivalents likely stems from the fact that people are more familiar with their physical ability, preferences, and distances than they are with nutritional information. For the layman at least, communicating that a burger contains 300 calories is less meaningful than mentioning that they would need to walk for 75 minutes to “burn it off.” With all that said, the current study aimed to see how exercise equivalents impacted the point-of-purchase behavior of overweight and obese (BMI of 25-40 kg/m2) college females (avg. age of 22 years).

None of the females had dieted within the last three months, required a special diet, had an eating disorder, had a food allergy, had a chronic disease, or – amusingly – were a health major. Of the 62 recruited females, 73% were black or Hispanic and 63% were unrestrained eaters.

The participants attended two meal sessions (lunch 1 & 2) where they ordered food from Burger King off menus that were similar to those found in a Burger King restaurant. The researcher recorded the quantity of food ordered and consumed through weighing and measuring, and told the ladies that they could not take anything home with them to ensure that they did not order more than normal. Lunch 1 was a normal session with regular menus. Lunch 2 took place one week later and had the participants divided into one of three groups: no information (same as lunch 1), calories only, or calories and exercise equivalents (distance walking assuming 3.0 mph pace & bodyweight of 160 lbs).

There were no statistically significant changes in anything, but this is likely due to the small sample size. Although not significant, all groups ordered and consumed less food during lunch 2 than lunch 1, and the differences were most pronounced in the experimental conditions. The calorie only and calorie plus exercise equivalents ordered about 16% (206 kcal) and 14% (162 kcal) fewer calories from Lunch 1 to Lunch 2, respectively; whereas, the no information group ordered only 2% (25 kcal) fewer. It should also be noted that the difference for the calories only group did approach significance (p=0.06).

In subgroup analysis of restrained and unrestrained eaters, the greatest significant proportionate decrease in calories ordered was seen in restrained eaters in the calories-only group (24.7%), which is likely due to them having a greater understanding of what a calorie signifies. Unrestrained eaters in the calories and exercise equivalents group ordered also ordered an average of 14% less during lunch 2 than lunch 1, but this wasn’t significant. Despite the lack of statistical significance in the outcomes, during an exit questionnaire, 57 participants (92%) said they believed that a combination of calories and exercise equivalents would influence the foods they ordered at a fast food restaurant; again suggesting that the small sample size was the limiting factor.

In addition to the small sample size, the study was limited to female college students who were overweight and obese and predominantly non-white. This greatly limits the generalizability. Moreover, the participants were getting their meals for free, which took financial aspects out of the picture when those are known to play a role in food selection.

Nonetheless, while I would prefer to see more people cooking and eating at home with a focus on fresh foods, we must be realistic. People eat at fast food chains because of its convenience and because it tastes good. Lower calorie foods do not necessarily make a food “healthier,” but not many people order the avocado, fatty fish, or almonds at Burger King (assuming it’s even offered). Thus, at least in fast food outlets, lower calorie options are generally going to be more nutritious, and finding a way to put the calories into a context that people can understand it critical. Exercise equivalents are one method of doing so, and I believe it holds promise.

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