Restaurant Menu Labeling Jabri J 052110

WIth American's eating nearly half of their meals outside of the home, this presentation discusses the need for nutritional information on menus and menu boards at restaurants, in order for the public to make informed decisions regarding food choices. This is one factor that may contribute to the epidemic of overweight and obesity in the U.S.

1. Restaurant Menu LabelingRestaurant Menu Labeling
Tackling One Environmental Factor Contributing to the Obesity EpidemicTackling One Environmental Factor Contributing to the Obesity Epidemic
Jennifer Jabri, PhD Student
Walden University
PUBH 8165-1: Environmental Health
Instructor: Dr. Rebecca Heick
Spring, 2010

2. Why do we need Menu Why do we need Menu
Labeling?Labeling?
Restaurants tend to serve larger portions of higher fat,
higher calorie foods.
Americans eat half of their meals “prepared and
consumed elsewhere” (p. 292).1
Most people, including nutritionists, underestimate the
number of calories in restaurant meals.2
 1. Mikkelsen, L., Erickson, C.S., & Nestle, M. (2007). Creating healthy food environments and preventing chronic disease. In L. Cohen, V. Chavez, & S. Chehimi (Eds).
Prevention is Primary: Strategies for Community Well-Being. (p. 287-311). San Francisco, CA: Jossey-Bass.
 2. Rudd Center for Food Policy & Obesity. (2008). Menu labeling in chain restaurants: Opportunities for public policy. Retrieved from:
http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf

3. Larger PortionsLarger Portions
Portion sizes have nearly
doubled in the last 20 years.
Calories/serving 20 years ago
compared to today1:
Fries: from 210 to 610 cals
Cheeseburger: from 333 to
590 cals
Spaghetti: from 500 up to
1025 cals
Bagel: from140 to 350 cals
 1. National Heart, Lung and Blood Institute. (n.d.). Obesity (OEI) slide
sets. Retrieved from: http://hp2010.nhlbihin.net/oei_ss/menu.htm#sl2
educatgioninitiative
.

4. People Eat More at RestaurantsPeople Eat More at Restaurants
When eating out of the home, both
children and adults tend to eat larger
portions, consuming more calories.1,2,3
One study found that a third of 7318
restaurant patrons consumed at least
1,000 calories or more for lunch.4
 1. Binkley, U.K., Eales, J., Jekanowski, M. (2000). The relation between dietary change and rising U.S. obesity. International Journal of Obesity; 24:1032-1039.
 2.Paeratakul, S., Perdinand, D., Champagne, C., Ryan, D., & Bray, G. (2003). Fast-food consumption among U.S. adults and children: Dietary and nutrient intake
profile. Journal of the American Dietetic Association; 103(10):1332-1338.
 3.Zoumans-Morse, C., Rock, C., Sobo, E., Neuhouser, M. (2001). Children’s patterns of macronutrient intake and associations with restaurants and home eating.
Journal of the American Dietetic Association; 101(8):923-925.
 4.Bassett, M.T. (2008). Purchasing behavior and calorie information at fast-food chains in New York City, 2007. American Journal of Public Health; 98(8):1-3.

5. We require nutritional labeling on our packaged foods,
so why not for restaurant meals? In fact, three-fourths
of Americans use food labels to help them make food
choices.1
Many surveys have found that the majority of
Americans support the addition of nutritional
information to menus and menu boards. 2
 1. Rudd Center for Food Policy & Obesity. (2008). Menu labeling in chain restaurants : Opportunities for public policy. Retrieved from:
http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf
 2, Rudd Center for Food Policy & Obesity. (2008). Menu labeling in chain restaurants : Opportunities for public policy. Retrieved from:
http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf

6. Epidemic of Overweight and ObesityEpidemic of Overweight and Obesity
Eating out at restaurants is contributing to the epidemic
of overweight and obesity in the U.S.
◦Less than one-third of Americans are at a healthy
weight1
◦Dramatic increase in extreme obesity 1, 2
 1. Flegal, K.M., Carroll, M.D., Ogden, C.L., Curtin, L.R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. JAMA; 303(3):235-241. Retrieved from:
http://jama.ama-assn.org/cgi/content/full/2009.2014; http://jama.ama-assn.org/cgi/content/full/303/3/235/JOC90148T3
 2. Hensrud, D.D., & Klein, S. (2006). Extreme obesity: A new medical crisis in the United States. Mayo Clinic Proceedings; 81 (Suppl. 10):S5-10.

7. Changes in the Prevalence of Obesity 1986-2008Changes in the Prevalence of Obesity 1986-200811
1. Centers for Disease Control (CDC). (2009). U.S. obesity trends: Trends by state 1985-2008. Retrieved from: http://www.cdc.gov/obesity/data/trends.html#State

8. Research on Menu LabelingResearch on Menu Labeling
In a study to evaluate whether having nutrition labels
on menus would affect the food choices of study
participants, researchers found that those who had
menus without nutrition information ate several
hundred calories more than participants who received
menus with nutrition information. 1
 1. Roberto, C.A., Larsen, P.D., Agnew, H., Baik, J., & Brownell, K.D. (2010). Evaluating the impact of menu labeling on food choices. American Journal of Public Health;
100(2): 312-318.

9. Research on Menu Labeling Research on Menu Labeling
Only about half of chain restaurants offer nutritional information .
Not always accessible as is oftentimes located in a non-visible area,
or the patrons must ask for it.1,2
If it is not visible, many people will not think to look for it.1,2
In an observational study, it was reported that, “Only 6 (0.1%) of
4311 patrons accessed on-premises nutrition information before
purchasing food. This very small percentage suggests that such
information should be more prominently displayed, such as on
restaurant menu boards, to help customers make informed
decisions” (p. 820).3
 1. Silver, L. & Bassett, M.T. (2008). Food safety for the 21
st
century. JAMA; 300:957-959.
 2. Rudd Center for Food Policy & Obesity. (2008). Menu labeling in chain restaurants : Opportunities for public policy. Retrieved from:
http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf
 3. Roberto, C.A., Agnew H., & Brownell, K.D. (2009). An observational study of consumers’ accessing of nutrition information in chain restaurants. American
Journal of Public Health; 99(5):820-821 .

10. What Nutritional Information would be What Nutritional Information would be
included on the Menu/Menu Boards?included on the Menu/Menu Boards?
Standard food items on the menu, not for specially
ordered dishes, or for specials that are on the menu for
a brief period of time.1
The number of calories “clearly associated with each standard
menu item.”2
A statement regarding recommended daily caloric intake limits for
adults. 2
Written nutritional information available to patrons. 2
 1. Rudd Center for Food Policy & Obesity. (2008). Menu labeling in chain restaurants : Opportunities for public policy. Retrieved from:
http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf
 2. Buckberg, J.R., & Chestler, A.L. (2010). Congress passes menu labeling in health care reform. Retrieved from: http://www.lexology.com/library/detail.aspx?
g=eeff77b9-f95f-485b-a827-2ada0d6132bc

11. What about the Costs?What about the Costs?
“Many chain restaurants already analyze
the nutritional contents of their menus.
Changing menu boards is a one-time
cost” (p. 7).1
 1. Rudd Center for Food Policy & Obesity. (2008). Menu labeling in chain restaurants : Opportunities for public policy. Retrieved from:
http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf

12. How Can Federal Menu Labeling Legislation How Can Federal Menu Labeling Legislation
Benefit the Restaurants? Benefit the Restaurants?
It would make them subject to federal
regulations rather than different local,
county, or state regulations, which is
important for chain restaurants with
locations across the country.1
 1. National Restaurant Association. (2010). National Restaurant Association says nutrition information provision is win for consumers and restaurants. Retrieved
from: http://www.restaurant.org/pressroom/pressrelease/?ID=1910

13. How Would Menu Labeling Make a How Would Menu Labeling Make a
Difference in the Obesity Epidemic?Difference in the Obesity Epidemic?
It will help people to be informed decision makers
regarding their food choices, as they will know the
nutritional count of what they are eating.
This may influence them to choose healthier options to
control the fat and calories they consume. 1, 2
This may be a form of primary prevention of
overweight and obesity.
It may also cause restaurants to offer healthier options
and alter some of their recipes.
 1. Khan, L.L., Sobush, K., Keener, D., Goodman, K., Lowry, A., Kakietek, J., et al. (2009). Recommended community strategies and measurements to prevent obesity
in the United States. MMWR;58(RR-7):1-32. Retrieved from: http://www.cdc.gov/mmwr/pdf/rr/rr5807.pdf
 2. Rudd Center for Food Policy & Obesity. (2008). Menu labeling in chain restaurants : Opportunities for public policy. Retrieved from:
http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf

14. A Grassroots MovementA Grassroots Movement
There have been menu labeling laws
passed in numerous cities, counties, and
states throughout the U.S. with various
rules and regulations regarding the
requirements for menu labeling.1.
 1. Robert Wood Johnson Foundation. (2009). Menu labeling: Does providing nutrition information at the point of purchase affect consumer behavior? Retrieved
from: http://www.healthyeatingresearch.org/images/stories/her_research_briefs/her_menu_labeling_brief_06_29_09_final.pdf

15. Current LegislationCurrent Legislation
In March 2010, the healthcare reform bill (H.R. 2590)
was signed into law in order to amend the Federal
Food, Drug, and Cosmetics act (Section 4205), which
had menu labeling requirements for chain restaurants
with 20 or more locations.1 Small businesses are
exempt from this.
The National Restaurant Association supported this
bill.2, 3 , 4
6.Buckberg, J.R., & Chestler, A.L. (2010). Congress passes menu labeling in health care reform. Retrieved from:
http://www.lexology.com/library/detail.aspx?g=eeff77b9-f95f-485b-a827-2ada0d6132bc
7.Center for Science in the Public Interest. (2010). Health reform to deliver calorie counts to chain restaurant menus nationwide. Retrieved from:
http://cspinet.org/new/201003211.html
8.National Restaurant Association. (2010). National Restaurant Association says nutrition information provision is win for consumers and restaurants. Retrieved from:
http://www.restaurant.org/pressroom/pressrelease/?ID=1910
9.Robert Wood Johnson Foundation. (2010). Restaurant industry backs menu-labeling legislation. Retrieved from: http://www.rwjf.org/publichealth/digest.jsp?id=11101

16. What About Smaller Restaurants?What About Smaller Restaurants?
They should consider posting the calorie content of
standard menu items.
Customers will come to expect this information after
being accustomed to obtaining it from chain
restaurants.
However, it can also benefit smaller restaurants as they
can voluntarily opt in and would then be subject to
these federal standards rather than being subject to
varying requirements set by different communities, or
states.

17. ConclusionConclusion
Menu labeling requirements can benefit
both the restaurants and consumers.
Smaller restaurants should also post
caloric information on their menus.
It is one step toward combating the
epidemic of overweight and obesity in the
U.S.

18. ReferencesReferences
Bassett, M.T. (2008). Purchasing behavior and calorie information at fast-food chains in New York City, 2007.
American Journal of Public Health; 98(8):1-3.
Binkley, U.K., Eales, J., Jekanowski, M. (2000). The relation between dietary change and rising U.S. obesity.
International Journal of Obesity; 24:1032-1039.
Buckberg, J.R., & Chestler, A.L. (2010). Congress passes menu labeling in health care reform. Retrieved from:
http://www.lexology.com/library/detail.aspx?g=eeff77b9-f95f-485b-a827-2ada0d6132bc
Centers for Disease Control (CDC). (2009). U.S. obesity trends: Trends by state 1985-2008. Retrieved from:
http://www.cdc.gov/obesity/data/trends.html#State
Center for Science in the Public Interest. (2010). Health reform to deliver calorie counts to chain restaurant menus
nationwide. Retrieved from: http://cspinet.org/new/201003211.html
Flegal, K.M., Carroll, M.D., Ogden, C.L., Curtin, L.R. (2010). Prevalence and trends in obesity among US adults,
1999-2008. JAMA; 303(3):235-241. Retrieved from: http://jama.ama-assn.org/cgi/content/full/2009.2014;
http://jama.ama-assn.org/cgi/content/full/303/3/235/JOC90148T3
Hensrud, D.D., & Klein, S. (2006). Extreme obesity: A new medical crisis in the United States. Mayo Clinic
Proceedings; 81 (Suppl. 10):S5-10.
Khan, L.L., Sobush, K., Keener, D., Goodman, K., Lowry, A., Kakietek, J., et al. (2009). Recommended community
strategies and measurements to prevent obesity in the United States. MMWR;58(RR-7):1-32. Retrieved from:
http://www.cdc.gov/mmwr/pdf/rr/rr5807.pdf
Mikkelsen, L., Erickson, C.S., & Nestle, M. (2007). Creating healthy food environments and preventing chronic
disease. In L. Cohen, V. Chavez, & S. Chehimi (Eds). Prevention is Primary: Strategies for Community Well-
Being. (p. 287-311). San Francisco, CA: Jossey-Bass.
.

19. ReferencesReferences
National Heart, Lung and Blood Institute. (n.d.). Obesity (OEI) slide sets. Retrieved from: http://hp2010.nhlbihin.net/
oei_ss/menu.htm#sl2 educatgioninitiative
National Restaurant Association. (2010). National Restaurant Association says nutrition information provision is win
for consumers and restaurants. Retrieved from: http://www.restaurant.org/pressroom/pressrelease/?ID=1910
Paeratakul, S., Perdinand, D., Champagne, C., Ryan, D., & Bray, G. (2003). Fast-food consumption among U.S. adults
and children: Dietary and nutrient intake profile. Journal of the American Dietetic Association; 103(10):1332-1338
Robert Wood Johnson Foundation. (2010). Restaurant industry backs menu-labeling legislation. Retrieved from:
http://www.rwjf.org/publichealth/digest.jsp?id=11101
Roberto, C.A., Agnew H., & Brownell, K.D. (2009). An observational study of consumers’ accessing of nutrition
information in chain restaurants. American Journal of Public Health; 99(5):820-821 .
Roberto, C.A., Larsen, P.D., Agnew, H., Baik, J., & Brownell, K.D. (2010). Evaluating the impact of menu labeling on
food choices. American Journal of Public Health; 100(2): 312-318.
Rudd Center for Food Policy & Obesity. (2008). Menu labeling in chain restaurants : Opportunities for public policy.
Retrieved from:
http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf
Silver, L. & Bassett, M.T. (2008). Food safety for the 21
st
century. JAMA; 300:957-959.
Zoumans-Morse, C., Rock, C., Sobo, E., Neuhouser, M. (2001). Children’s patterns of macronutrient intake and
associations with restaurants and home eating. Journal of the American Dietetic Association; 101(8):923-925.

20. Recommended ReadingRecommended Reading
Robert Wood Johnson Foundation. (2009). Menu labeling: Does providing nutrition
information at the point of purchase affect consumer behavior? Retrieved from:
http://www.healthyeatingresearch.org/images/stories/her_research_briefs/her_menu_labeling_brief_06_29_09_final.pdf
Rudd Center for Food Policy and Obesity. Retrieved from:
http://www.yaleruddcenter.org/news.aspx?id=35
Legal Issues With Menu Label Laws:
◦Pomeranz, J.L. (2009). Compelled speech under the commercial speech
doctrine: The case of menu label laws. Journal of Health Care Law and Policy;
12:159-194. Retrieved from:
http://www.yaleruddcenter.org/resources/upload/docs/what/law/CompelledSpeech_MenuLabelLaws.pdf
◦Public Health Law Center. (2010). Menu labeling legislation. Retrieved from:
http://www.publichealthlawcenter.org/topics/healthy-eating/menu-labeling-legislation