Should we put calorie information on menus?

This news story seemed to spring up from nowhere this week, after the UK government revealed they may make putting calories on menus mandatory.

What does the research say?

Pang & Hammond 2013-

213 students were given a menu that either had no calorie information, had calorie information, had calorie information and a health statement or had a physical activity scale. Those who chose from the menu with calorie info and a health statement chose the lowest calorie items. However, the difference in calorie content between all groups was less than 40kcal.

Breck et al. 2014-

The researchers surveyed half their participants at the point of purchase (POP) and the other half were reached through random digit dialing (RDD). 35.1% of the POP group saw calorie information and 11.8% said it influenced their decision. Of the RDD group, 65.7% saw calorie information and 41.7% reported using it to decide. The researchers noted that likelyhood of using calorie information was associated with education, gender and income.

Gerend 2009-

Studied 288 college students and found that females chose lower calorie meals and food items and lower priced foods when calorie information was provided. Male's choices were unaffected by calorie information provision.

Roberto et al. 2010-

Participants were provided a dinner, where half had calorie information on their menus and half had no calorie information. The group given calorie information consumed an estimated 14% fewer calories (250kcal).

Lassen et al. 2015-

Assessed fast food ordering in Denmark (n=740).

They noted that women had a greater response to health claims and "healthier choices" on menus compared to men.

Many participants expressed a wish for healthier options on menus, however only 7% bought a "healthier choice".

Hammon et al. 2013-

Participants chose from either a normal menu, one with calorie information, one with traffic light calorie information or one with traffic light calorie, fat, sodium and sugar information. Calorie consumption was lower among those with the group who had only calorie information (although it amounted to only 96kcals less the other groups).

Green et al. 2015-

Researchers surveyed 329 people who had visited McDonald's. 60% had noticed calorie information and 16% reported using it to help them decide. Those with a higher income were two times more likely to notice the calorie label and three times more likely to use them. Those who reported using the calorie label to choose, chose items with an average of 146kcals less then the others.

Long et al. 2015-

This analysis of 15 studies found that the presence of calorie information did reduce calorie consumption. However, the authors noted that only 6 studies were carried out in actual restaurants and in these studies the difference in calorie intake was not significant.

Key points from the research:

  • Few studies were undertaken in "real life" settings, and of those carried out in actual food outlets most are fast-food places. The information from these studies will not necessarily translate into similar results in other restaurant types.

  • Researchers (and policy makers) appear to have made an assumption that an increased knowledge in calorie content equals an increase in nutritional knowledge. However, nutrition is more complex than just calories.

  • The research only assesses what food choices people made and how that was affected by calorie information- but most research has not looked at how much food was actually eaten. Therefore, we cannot be sure whether calorie information truly impacts consumption.

  • The differences in calories highlighted by the literature is very little. A reduction of 40-250kcals is not significant at one meal. Humans tend to be able to maintain weight at a stable level despite fluctuations in calorie consumption daily. Most of us do not consume the same amount of calories everyday, and most of us don't eat out everyday. So will there be an impact from this low level calorie reduction?

  • Research seems to indicate that calorie labeling affects the "worried well" the most- i.e. those with education and income, who have the least need for health interventions.

  • Women seem to be more affected by calorie information than men, although no reason has been provided in the literature. This may be due to a greater pressure on women to be "skinny", may be that women are more contentious regarding nutrition and health or any number of reasons. Further research should assess gender differences.

Other considerations for calorie labeling:

It will be costly for food businesses to implement, particularly independent establishments.

It may result in less options for consumers- daily and weekly specials may become less frequent and varied as calorie information will likely have to be obtained for these too.

I'm confident that this would be a nightmare for chefs- an extra spoon of oil or salt would change the calorie or nutritional content of a dish.

Legislation such as this perpetuates the notion that weight is most strongly influenced by personal behaviour, while ignoring the issues that contribute most to poor health. This contributes to weight stigma.

Many people feel that the presence of calorie information will take away from the experience of eating out- something which is a rare occasion for many of us.

The legislation may result in people choosing low calorie option due to guilt ("I shouldn't eat that because it is high in calories")- this is not necessarily healthful. What about satisfaction and choosing what appeals to you at that moment? And what about the fact that everyone has different calorie needs? Calorie labeling is based on the "average" man and woman requiring 2000 and 1800kcals/day.

This legislation assumes that everyone understands the concept of calories and energy requirements, which is certainly not the case. If people don't fully understand calories and energy, is there any benefit to calorie labeling?

The presence of calorie information on all menus could lead to an obsession with calorie counting. This can result in disordered eating behaviour, which can progress to an eating disorder in some people. This legislation may add to the rise in eating disorders over the last several years.

Take home message:

Current research does not indicate any substantial benefits from this legislation. It seems that policy makers continue to take the easy option and lay blame for health problems on individuals, rather than acknowledge the real issues- inequalities in income, health, housing, education. This is another surface level policy that will have limited long-term benefits for any of us.

Lots of love,

Little O x

#nutrition #nutritionadvice #publichealth #healht #healthy #healthyliving #healthyeating #nondietnutrition #weightstigma #calorie #caloriecounting #dit #weightloss #weight

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