Diet-Specific Menu Labels

Somewhat Influence
Consumers Choices in
Foodservice
Establishments
Aramark Dietetic Internship
Melissa Tovarez, BS
Sandi Westfal, MS, RDN, CNSC, CDN, Amy DeMage MS, RDN, LD

4/17/15

Introduction

Research Purpose

To determine to what degree consumers in a hospital make healthier

food choices based on diet specific menu label symbols.

Background

Community
Calcasieu Parish in Lake Charles, LA
2010 population: 190,891

Community Health
Current Louisiana obesity rate: 33.1%
2008-2010 mortality rate related in heart disease in the county: 611 per
100,000
2011 diabetes rate: 12.6%

Community Food Establishments

89.7 fast food restaurants per 100,000 people
Food expenditures increased from 32% in 1980 to 44% in 2010 in country

Background: Trends in DieteticsFoodservice

Food service business contribute food to a large portion of an

individuals diet

Food industry must adapt to new consumer preferences of healthful

eating

Food industry must adapt to governments push for public health

2010 Patient Protection and Affordable Care Act

Restaurants with more than 20 locations must have calorie labels on their
menus
Multiple studies done on labeling

Research: Effectiveness of Labels

Ellison B. et al.
Use of caloric symbols significantly
reduced the calorie content ordered by
consumers
Amount of calories decreased by 129
calories compared to those who ordered
food with no menu labels

Pulos E. et al.
Surveyed customers from six
restaurants in Washington
20.4% of patrons reported ordering an
entre lower in calories
16.5% reported ordering an entre lower
in fat

Research: Who Uses Menu labels

Bowers KM, et. Al

Surveyed residents in Hawaii, Minnesota, and Wisconsin
52% of the population used menu labeling

Those most likely to use menu labels:

Females
overweight or obese

Eat more fruits and vegetables

Drinks less soda
Obtain weekly aerobic exercise

Research: Numbers vs Symbols

Swartz J, et al.
Numeric calorie labeling has no effect or
only modest effect on consumer food
choices

Ellison B et. Al
Compared no calorie label, numerical
caloric label, and symbolic traffic light

caloric label
The use of a symbolic traffic light calorie

Symbol of man depicting walking was

more applicable than calorie number
Efficacy of nutrition label depends on
comprehension and/or relevance

label had a greater influence on reducing

the caloric intake
For both high health conscious and low
health conscious consumers

Research: Numbers vs Symbols

Schindler J, et al.
Low income minority residents in New York
Presentation of calories on menu unclear

Some did not understand significance

Menu labeling can be clarified with
Educational materials

Use of symbols
Color coding
Or alternate healthy options menu

Hypothesis

Diet specific menu labeling is theorized to make somewhat of an

impact on consumers food choices

Approximately one third of the population will use diet specific menu
labels

Methodology

Study

Cross sectional study

2 weeks duration in March, 2015

Diners during breakfast, lunch, and dinner

Local hospital in Lake Charles, LA

Inclusion criteria: males and females older than 18 years old

Exclusion criteria: under 18 years old

Labeling Menus

Nutrient analysis conducted based on Aramark nutrient analysis

database

Grill, home line, Grab & Go snacks, candy rack, ice cream freezer,
fruit bar, cereal bar, chips rack

Beverages were not included

Labels

Diet specific menu labels

were used

Heart Healthy

Diabetic Healthy,

General Healthy

Description of
Labels

Posters were displayed at entrance of

cafeteria and throughout

Criteria for each diet based on:

Academy of Nutrition and Dietetics Nutrition
Care Manual for adults
U.S. Department of Food and Agriculture

Survey

Quantitative and qualitative data

Percent who used labels vs percent who did
not
Comments section on back of survey of
qualitative comments

3 questions on use and awareness of menu

labels

2 questions on demographics

Statistical Analysis

Simple statistical tests were performed using the Microsoft Excel

program

% of people who reported using the menu labels out of the total
population who took the surveys calculated

% of consumers who reported being aware of the menu labels out of

the total population who took the surveys calculated

% of usage of each food label calculated

Demographic information, including % usage by age range and

gender calculated

Results

Label Usage

39 customers surveyed over two weeks

64% of the surveyed participants were aware of the menu labels

44% of participants used the menu labels

Out of those who were aware, 68% of the participants used the menu
labels

Type of Label
Used

10 out of 17 surveyed customers

who used the diet labels chose the
general healthy label
10 out of 17 surveyed customers
who used the diet labels chose the
general healthy label

Diagram of Each Menu

Label Usage

GENERAL
HEALTHY
4
3

HEART
HEALTHY
5

2
0

DIABETIC
HEALTHY
2

Age

Only 1% of those participants over

55 years old used the menu labels
64% of those aged 18-35 used the
menu labels

Label Use by Age Range

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

18-35

36-55
Used

Did not use

>55

Gender

A fairly equal amount of males and females used the menu items

53% of the surveyed males used the menu labels

38% of the surveyed females used the menu labels

Qualitative Data
Customer Comments on the Food Labels
Motivation

I wish healthy food tasted better

I am happy being fat

Usefulness of labels

Nice to have as a reference. Very good

It is a good system keep up the good work!!!!
Your labels are amazing! Thank you for
enlightening everyone.
The labels help me out alot on my diet.

Limitations to using
labels

Don't know where the signs are

Labels are unuseful not enough info

Discussion

Findings

Consumers make healthier food choices based on health menu labels

to somewhat of a degree

Nearly half of the participants use menu labels, surpassing the

studys initial estimation of one third of the population

The general healthy and heart healthy labels were most frequently
used

Age seems to have an influence on whether or not consumers use

menu labels

Factors influencing use of menu labels:

consumers awareness of the labels, the consumers motivation to eat
healthy foods, and the usefulness of the labels themselves

Implications

Individuals with specific health conditions including heart disease,

obesity, and diabetes can use disease specific menu labels to aid in
healthy eating choices and behavior change.

Another method may need to be used to deliver nutrient information

to older consumers in the foodservice industry- more research needs
to be done

Limitations and Strengths

Limitations

Effect of the nutrient and caloric

intake of the individuals who used the
food labels is unclear

Strengths

Unique study

Reveals the usage of disease specific

menu labels through symbols

Small sample size

Heart healthy label: used by over half

Diabetic label: used by nearly one third

Labels are simple, easy to

comprehend, and relevant for
individuals with specific health
conditions

Conclusion

Simple and relevant symbolic diet labels can be used by consumers

with heart disease, obesity, and diabetes to help guide them on
which foods to eat.

Those who are aware of the labels, those who are motivated to eat
healthy foods, and those between 18 and 35 years old may be more
likely to use the menu labels.

Foodservice establishments may benefit from using diet specific

menu labels to guide the growing number of consumers interested in
the nutrition of the food served to them.

Future research on diet specific menu labels and on the usage of

menu labels among various age groups should be conducted.

References
1.

Centers for Disease Control and Prevention. Health Data Interactive Web site. http://www.cdc.gov/nchs/hdi.htm. Accessed Janua ry 11, 2015.

2.

Rhea M, Bettles C. Future changes driving dietetics work force supply and demand: Future scan 2012-2022. J Acad Nutr Diet. 2012; 112(3Suppl):S10S24.

3.

Ellison B, Lusk JL, Davis D. Looking at the label and beyond: the effects of calorie labels, health consciousness, and demogr aphics on caloric intake in
restaurants. Int J Behav Nutr Phys Act. 2013; 10: 21.

4.

U.S. Department of Health and Human Services. Health Care Web site. http://www.hhs.gov/healthcare/rights/law/index.html. Acce ssed December 2014.

5.

Pulos E, Leng K. Evaluation of a voluntary menu-labeling program in full-service restaurants. Am J Public Health. 2010; 100 (6): 1035-1039.

6.

Namba A, Auchincloss A, Leonberg BL, Wootan MG. Exploratory analysis of fast-food chain restaurant menus before and after implementation of local
calorie-labeling policies, 2005-2011. Prev Chronic Dis. 2013; 10:E101.

7.

Bowers KM, Suzuki S. Menu-labeling usage and its association with diet and exercise: 2011 BRFSS sugar sweetened beverage and men u labeling module.
Prev Chronic Dis. 2014; 11:E02.

8.

Swartz JJ, Braxton D, Viera AJ. Calorie menu labeling on quick-service restaurant menus: an updated systemic review of the literature. Int J Behav
Nutr Phys Act. 2011; 8: 135.

9.

Schindler J, Kiszko K, Abrams C, Islam N, Elbel B. Environmental and individual factors affecting menu labeling utilization: a qualitative research
study. J Acad Nutr Diet. 2013;113(5):667-672.

10.

Swartz JJ, Dowray S, Braxton D, Mihas P, Viera AJ. Simplifying healthful choices: a qualitative study of a physical activity based nutrition label format.
Nutr J. 2013; 12:72.

11.

Academy of Nutrition and Dietetics. Nutrition Care Manual Web site.

http://www.nutritioncaremanual.org/category.cfm?ncm_category_id=1&ncm_heading=Meal%20Plans&client_ed=1. Accessed January 10 2 015.

12.

U.S. Food and Drug Administration. Guidance for Industry: A Food Labeling Guide Web site.
http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm064916.htm. Accessed J anuary 11 2015.

Questions?