Chain restaurant nutrition labeling: An overview of implementation and evaluation in New York City, Portland/Multnomah County, Seattle/King County, and Philadelphia

Obesity is a major public health issue, in part fueled by excessive caloric intake. The number of meals purchased away-from-home has nearly doubled over the past two decades. Restaurant foods are typically higher in calories than home-cooked meals. Compared to eating at home, children consume about twice as many calories when they eat away-from-home foods. Consumers routinely underestimate the calorie content of menu items, yet information regarding menu item nutritional content is inconsistently available. Limited, although not definitive, evidence suggests that people make more healthful choices when such information is available at the point-of-purchase. To address this concern, mandatory menu labeling has been adopted in several locales and has been approved by the federal government to become a nationwide policy.

New York City, Portland/Multnomah County, Seattle/King County and Philadelphia, PA have implemented regulations requiring chain restaurants to provide nutrition information at the point-of- purchase. At all sites, the regulations cover chain restaurants with at least 15 stores nationally and require that information on calories be available to customers at the point of purchase before ordering. Sites differ regarding method of information display; inclusion of additional information on fat, sodium and carbohydrates; types of foods subject to labeling; and penalties for non-compliance. The details of the federal law have not yet been specified. All sites are implementing a natural experiment evaluation by collecting point-of-purchase customer surveys and receipts from at least two time points on awareness and use of nutrition information and on customer purchases. Sample sizes range from 2500 to 11,000 customers. To describe changes in menu items, each site is conducting pre-post menu audits. Additional evaluation methods being used at some sites include population-level surveys on awareness and use, telephone surveys, analysis of sales data, assessment of restaurant nutrition environments, and qualitative analysis of regulation implementation and impact.