Anna Ipsen

Public Policy Paper: Nutrition Labeling of Standardized Menu

I tems in Restaurants and Similar Establishments
NTR 530-30: Dietetic Internship Practicum
Professor Keri McComb
Summer 2014










I ntroduction
The current obesity epidemic has become a primary concerns for registered dietitians all over the
United States. According to the Center for Disease Control and Prevention, more than one-third
of adults are obese and 2.5 million children and adolescents are obese
1
. Obesity and its related
health consequences have a significant impact on the United States economy and health care
system
1
. In 2008, overall medical care costs as a result of obesity were estimated at $147
billion
1
. The cause of obesity stems from a variety of factors, making the issue difficult to
address
1
. Today, the American society has become characterized by environments that promote
consumption of unhealthy foods and physical inactivity
1
. Public policy and environmental
efforts that make healthy food choices available, affordable, and easily accessible can be used to
raise nutrition awareness and in aiding those who wish to make healthy lifestyle changes
1
.
History & Mission
Several studies have indicated that increased consumption of food at restaurants, particularly
fast-food restaurants, larger portion sizes, and the rise in obesity rates share a strong positive
correlation
2
. With the intent to establish a governmental role in improving nutrition of
Americans, a federal menu labeling law as part of the Health Care Reform Act, signed by
President Obama in March 2010 was passed by Congress
3,4
. The intent of the law is to provide
Americans with the necessary information to make healthier food decisions when eating out and
supporting those who are making efforts to control their diets and weight
2,5
. The Food and Drug
Administration (FDA) was required to submit its proposals within the next year, which were
published in April 2011
4
. Section 4025 of H.R. 3590, mandates that chain restaurants and food
vendors with 20 or more locations featuring the same name and substantially the same menu
items, post calorie information for standardized food items on their menus, menu boards, and
drive-thru displays
2,3,6
. Additional information, such as fat, saturated fat, carbohydrates, sodium,
protein, and fiber must be available in writing upon request
2,6
. Movie theaters, airplanes,
bowling alleys, and other establishments, whose primary purpose is not to sell food, would be
excluded
2,6
. More specifically, the law applies to only menu items that are considered standard,
excluding condiments, special menu items served less than 60 days annually, and market test
items served for less than 90 days annually
2
. Nutrition information would be based on a 2,000
calorie diet reference point, the same amount used currently on Nutrition Facts panels
6
. The
outline of the law proposed by the FDA allowed for a comment period from the public, which
ended in July 2011
4
. The FDA received many arguments both for and against the new law, as
discussed below, that has continued to delay final enactment
5,7
. As of April 3, 2014, the federal
government reports that the menu labeling law is in the final review process
7
. Once published
and made available to the public, restaurants owners will have six months to come into
compliance
5,7
.
Pros & Cons
As mentioned above, during the comment period of the FDAs proposed menu labeling law, both
sides for and against the menu labeling law were argued. A strong opposition from many
resulted in the delay of the final publication of the law, which was originally scheduled for
March 2013
4,6,7
. The Rudd Center for Food Policy and Obesity summarized the arguments
brought to the FDA in a table as follows
5
:
ARGUMENT RESPONSE
Consumers do not want or need this
information.
Five national polls have found that between
67-83% of people support menu labeling.
People just need more willpower to pick the Providing nutrition information raises
carrot sticks rather than the french fries. awareness of menu item content and empowers
people to make healthier options if desired

If customers want nutrition information, they
can consult the posters, brochures, websites, or
kiosks that are available.
People need information at time of purchase.
They are less likely to use it if it is inaccessible
and inconvenient while making a decision.
People already know what is healthy and can
estimate calories and fat on their own.
People tend to underestimate the calorie and fat
content of foods, even experienced
nutritionists.
Most people do not know and cannot guess
how many calories they need every day; they
are not interested in the information.
Three out of four American adults use food
labels on packaged foods. For those how
cannot guess, menu labeling would be a means
of informing.
Providing nutrition information on menus is
not the solution to obesity.
Obesity is a complex problem caused by many
factors. Menu labeling can be a part of the
solution, providing people with necessary
information in making better choices.
Menu labeling by the government is a violation
of an individuals freedom.
Menu labeling offers information to the
consumer about their food purchases, while
they still remain free to choose whatever they
wish to purchase.
Menu labeling will cost too much and put
restaurants out of business.
Many chains periodically update their menus
and menu boards for marketing purposes and
already have performed nutrition analysis of
their menu items. Changing menus is a one-
time cost. The current and proposed policies
only apply to chains, not small restaurants that
may not be able to afford it.

Discussion and Recommendations
Several restaurants, in anticipation of the menu labeling law being passed, have already began
changing their menus, menu boards, and drive-thru boards. With these alterations, researchers
have used various methods of investigation to determine if the law would have an impact in
consumers choices, resulting in mixed results
3
. For example, one study providing calorie
information on a fast-food menu at the point of purchase to teens and adults resulted in less than
one fifth of the participants noticing the posted calorie information
8
. In contrast, another study
found in posting calorie information on restaurant menus the total amount of calories people
ordered and consumed for a meal decreased and improved their ability to estimated calories
consumed
9
. It can therefore be suggested that an additional intervention may be needed to make
the new menu labeling law effective to the public. The American Dietetic Association, as well
as other groups, believe that dietitians in particular can be of use to meet the desired outcome of
the new menu labeling law. Many consumers do not know how to use nutrient information and
therefore providing the information is unlikely to have an impact
3
. Thus, the menu labeling law
is an opportunity for dietitians to help educate the public on how to use the information being
provided to make healthier decision when dining out
3
. Additionally, the new law opens potential
career opportunities for registered dietitians. Dietitians can assist with menu analysis for chain
restaurants and help in the creation and reinvention of more healthful dishes without sacrificing
taste while meeting demand of consumers and adhering to the governmental policy
3
.
Conclusion
The menu labeling law for restaurants and food vendors has still not been finalized by the
government. However, the last update indicates that the law will be published and in effect
soon
7
. Further research on the impact of the menu labeling law is needed to determine if it will
play a role in changing consumers choices to healthier options, and ultimately if a decline in
American obesity rates will be noted
2
. Dietitians can play a major role in the success of this
policy
3
. They can work with restaurants involved in the law to improve their menu offerings and
by educating the public to increase comprehension of nutrition information so it can be used as a
tool in improving the health of Americans
3
.



References
1. Overweight and obesity. Centers for Disease and Control Prevention.
http://www.cdc.gov/obesity/data/childhood.html. Updated August 2013. Accessed April
29, 2014.
2. Wilbur K. The informed consumer is a healthy consumer? The american obesity
epidemic and the federal menu labeling law. Loyola Consumer Law Review. 2011;
23(4): 505-540.
3. Stein K. A national approach to restaurant menu labeling: The patient protection and
affordable health care act, section 4205. Journal of the American Dietetic Association.
2010; 110(9): 1280-1289.
4. Federal menu label law. Yale Rudd Center for Food Policy & Obesity.
http://www.yaleruddcenter.org/what_we_do.aspx?id=350. Published 2013. Accessed
April 29, 2014.
5. Friedman RR. Menu labeling in chain restaurants; opportunities for public policy. Rudd
Report: Rudd Center for Food Policy & Obesity. 2008: 1-11.
6. Overview of FDA proposed labeling requirements for restaurants, similar retail food
establishments and vending machines. U.S. Food and Drug Administration.
http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm248732.h
tm. Updated April 24, 2013. Accessed April 2014.
7. Gov't serves notice: Menu labeling in final review. National Restaurant Association.
http://www.restaurant.org/News-Research/News/Gov%E2%80%99t-serves-notice-Menu-
labeling-in-final-review. Published April 3, 2014. Accessed Aril 29, 2014.
8. Hartnack LJ, French SA, Oakes JM, Story MT, Jeffery RW, Rydell SA. Effects of
calorie labeling and value size pricing on fast food meal choices: Results from an
experimental trial. International Journal of Behavioral Nutrition and Physical Activity.
2008; 5:63.
9. Roberto CA, Larsen PD, Agnew H, Baik J, Brownell KD. Evaluating the impact of menu
labeling on food choices and intake. American Journal of Public Health. 2010; 100:312-
318.