By Sophie Terbush, USA TODAY
The study, led by Brian Elbel, assistant professor of medicine and health policy at New York University School of Medicine, shows that although calorie labels do increase awareness of calories, they do not necessarily influence food choices or the number of calories consumed.
The study surveyed customers and collected their purchase receipts at four major fast-food chains (Wendy’s, Burger King, McDonald’s and Kentucky Fried Chicken) in July 2008, before New York City’s implementation of a new calorie labeling regulation, and again at the same locations one month after labeling began.
Both sets of samples were taken from low-income areas of the city, including East Harlem, South Bronx and Central Brooklyn; a control group sample was taken from Newark, an area with similar demographics and an urban setting.
Elbel says he assessed low-income neighborhoods because they tend to be of more fragile health and at higher risk for obesity, and they tend to be surrounded by higher concentrations of fast-food restaurants without other, more healthful food options.
“You’d like to see the effects of labeling on these at-risk groups, but it also makes it harder to see an impact on these groups because they’re also choosing based on availability and price of food,” not necessarily nutritional value, he says.
The 349 participants were children and adolescents ages 17 and under who visited the restaurants with their parents (69%) or alone (31%). About three-fourths of participants were from New York City, and 90% were from racial or ethnic minority groups. Adolescents who visited with parents tended to be younger and were not surveyed; instead, the parents completed the interviews.
The study shows that just over half of adolescents and adults noticed the calorie counts after labeling began in New York, but only 9% of adolescents and 16% of adults who saw the information said it mattered to them.
“Both populations are seeing it, but it’s not translating into a change,” Elbel says.
People purchased the same amount of calories before labeling began and after, the study shows; for adolescents, it was about 725 calories, and for adults, about 600 calories. Elbel says adolescents who were alone tended to buy more food than parents bought for their children.
In the choice of food for teens, habit, access, price and location matter some, but “taste is the most important factor,” Elbel says. He also looked at how parents worked with their children to make fast-food choices.
In deciding what the children would eat, 57% of parents chose for their children, 31% let the child choose, and 6% said they chose together. Elbel says parents who chose for their children did not choose fewer calories than when the children were allowed to choose.
A national calorie-posting mandate also was part of the Patient Protection and Affordable Care Act of 2010. The U.S. Food and Drug Administration says it must issue proposed regulations by March 23 for national calorie labeling.
That will include restaurants with 20 or more locations posting calorie counts on menu boards and in retail stores and having nutrient information available in writing upon request. Vending-machine operators with 20 or more machines also would be required to post caloric content for certain items.
For now, Elbel says that while many health researchers, policymakers and restaurant-chain owners are backing the national legislation, there is much more that can be done. “What we’re starting to see is that (labeling) won’t be enough to influence obesity by itself in a large-scale way,” he says. “One of the best things for restaurant owners to do is to reformulate their menus.”
Elbel’s findings in the study are similar to those in a study he published in the October 2009 issue of the Journal of Health Affairs conducted in the same area of New York City, comparing calorie consumption of customers based on receipts gathered outside fast-food restaurants.
He is also analyzing data for a study with the same methodology that he conducted in Philadelphia, before and after calorie labeling took effect there, using Baltimore as a comparison city.
This study will assess a larger sample, looking at higher- and lower-income areas, and may provide more information about the effects of calorie labeling on a more diverse population.
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