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We see slogans like these on billboards and at restaurants on a daily basis. Would a nutrition-labeling regulation that requires restaurants to post calorie counts help spur a reduction in the use of these slogans, which are known as “barriers to healthful eating?” That’s what a research team, led by Brian Saelens, PhD, of Seattle Children’s Research Institute, set out to find. The study, “Nutrition-labeling regulation impacts on restaurant environments,” is published this week in the American Journal of Preventive Medicine.
Barriers to Healthful Eating Reduced
Dr. Saelens said that the study findings are a mixed bag: In King County (Seattle area), researchers found a reduction in “barriers to healthful eating” in restaurants from before to after the nutrition- label regulation which was originally put into place in 2008. This was mostly sustained 1.5 years after the regulation began. King County restaurants were less likely to encourage over-eating, through use of things like slogans including “We dare you to mega-size it.” Most of these positive changes were seen in food-oriented and not coffee-oriented establishments.
Slight Improvement in Kids’ Menus
On the flip side, the team saw very few changes in the availability of new healthy menu options like fresh or non-fried vegetables and fruits. Kids’ menus improved slightly, but there was no difference between King County and Multnomah County (Portland area) restaurants (the control comparison in the study). “It is disappointing that restaurants did not offer an increased number of healthier options on menus,” said Dr. Saelens. “It would be great to see that change, and to see restaurants promoting truly healthier options.”
The analyses included 49 King County restaurants (14 burger, 15 sub/sandwich, 11 Tex/Mex and nine coffee restaurants) for Wave 1 to 2 cross-county studies, and 47 of these restaurants (14 burger, 15 sub/sandwich, 10 Tex/Mex and eight coffee restaurants) for Wave 1, 2 and 3 within-county (King County-only) studies. Similar types of restaurants audited in Multnomah County served as the control comparison. Wave 1 (pre-regulation) was conducted in October to December 2008, Wave 2 in April to May 2009 (soon after the regulation) and Wave 3 in May to June 2010. Multnomah County restaurants were evaluated for Wave 1 in May to June 2009 and Wave 2 in November to December 2009.
Background on Nutrition Label Regulations
The King County nutrition-labeling regulation applies to restaurants in the county having at least 15 establishments within the U.S. and exceeding $1 million yearly gross sales. Most food products in coffee- oriented establishments are not subject to King County nutrition-labeling regulation because they are not on the menu board. Multnomah County passed a similar regulation in 2008 that was never implemented because of preemption by the Oregon Menu Labeling Act of 2009 and, subsequently, by the federal menu labeling law of the Affordable Care Act of 2010.
Dr. Saelens said that the U.S. needs more initiatives and efforts aimed at improving children’s food and beverage options. “Strategies could include improvements in the choices available and incentivizing healthy items to children,” he said.
“This type of initiative hasn’t happened on any large scale yet, though Seattle Children’s did recently launch this type of program on a smaller scale,” said Dr. Saelens. Known as Mission Nutrition, the initiative has started by providing healthier food and drink options in Children’s cafeterias, the gift shop and vending machines. French fries and onion rings are baked instead of fried and sugar-sweetened drinks that have more than 10 calories per 8-ounce serving have been eliminated from menus. Kaiser Permanente, which operates 37 hospitals across California, Hawaii and the Pacific Northwest, also announced a similar initiative this month.
This present study is among the first to evaluate changes in restaurant environments from before to after a regulation targeting a change in these environments.
This study was supported in part by the National Institutes of Health/ National Institute of Environmental Health Sciences (ES014240) and the Robert Wood Johnson Foundation Healthy Eating Research Program. Standard protocols for Nutrition Environment Measures Survey-Restaurant version were used to conduct restaurant environment evaluations.
Dr. Saelens is also a professor of pediatrics at the University of Washington. Co-authors on the study include: Nadine Chan, PhD, MPH (Public Health-Seattle and King County); James Krieger, MD, MPH (Public Health-Seattle and King County, University of Washington); Young Nelson, BA (Seattle Children’s Research Institute); Myde Boles, PhD, MBA (Multnomah County Health Department and Oregon Public Health Division); Trina Colburn, PhD (Seattle Children’s Research Institute); Karen Glanz, PhD, MPH (Perelman School of Medicine, Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania) , Myduc Ta, PhD, MPH (Public Health-Seattle and King County); and Barbara Bruemmer, PhD, RD (University of Washington School of Public Health).