Implementation of a menu-labeling regulation in S/KC resulted in parents seeing the labels, but no reduction in higher-calorie food purchases. Findings suggest a positive impact of menu labeling in increasing consumer awareness that did not translate into a lower number of calories purchased. Elbel et al. also found that immediately after implementation, the NYC menu-labeling regulation did not influence adolescent food choices or parent food choices for children.29
The lack of change in calories could be the result of the fact that most children in the current sample chose their meals, and most continued to choose the same items before and after labeling was implemented. Children may not have the ability or interest in using nutrition information to inform their choices. Taste continues to be the predominant factor in meal choice.28, 30
Thus, although nutrition information was seen more and reportedly influenced more meal choices postregulation in S/KC, only 13% of S/KC parents who saw it said that it influenced the choice for their child.
The equivocal results for the parents were consistent with a meta-analysis of menu-labeling studies, wherein five of six studies found that calorie information weakly or inconsistently influenced food choices.15
The overall decrease in parent's total calories, particularly overweight parents in both counties, may be the result of a testing effect, a secular trend, or other reasons.
This study has several limitations. The postregulation data collection timeframe, which was only months after the regulation may have been too short to see substantial changes. The sample sizes were small and the power insufficient to detect effect sizes that may be meaningful from a public health perspective. While SDC did not have a menu-labeling regulation, a requirement to make nutrition brochures available went into effect in 2009. The level of nutrition information awareness was generally high among participants in this study, even at baseline in both counties, which may be related to being in a cohort and could have made it more difficult to see an effect from the menu labeling. This study did not capture those who decided to avoid fast food or alter their consumption later in the day in response to nutritional awareness from menu labeling. Finally, the sample may not represent the effects of such an intervention on more diverse populations.
Study strengths included pre- and post-regulation data from families for whom there was demographic and anthropometric information. Findings suggest a need to explore the influence of menu labeling on overweight/obese individuals.
This study is among the first on the in vivo impact of menu labeling on food purchasing for children. As menu labeling becomes implemented nationally, more evidence among larger samples over longer time periods, and further characterization of individual or environmental factors that affect restaurant menu-labeling efficacy are needed.