Research reviewThe impact of menu energy labelling across socioeconomic groups: A systematic review
Introduction
In high-income countries, overweight and obesity are socioeconomically patterned whereby the prevalence of overweight and obesity is disproportionally higher among those with a lower socioeconomic position (SEP) compared to those with a higher SEP (Devaux and Sassi, 2013, McLaren, 2007). Nevertheless, very little is known about the impact of specific obesity prevention interventions on these existing inequalities. A recent systematic review on the effectiveness of obesity prevention interventions on adiposity outcomes according to SEP concluded that health equity is rarely considered in the evaluation of obesity prevention interventions. In the studies that did evaluate the differential effect of an intervention by SEP, information based interventions were more likely to have a greater impact for higher SEP groups compared to lower SEP groups (Beauchamp, Backholer, Magliano, & Peeters, 2014).
As an increasing amount of meals are consumed out of home, (Kant & Graubard, 2004) the provision of energy information on menus and menu boards at restaurants and food outlets (i.e. menu energy labelling) has become an increasingly valuable tool to empower consumers to make healthy choices at these outlets (New South Wales Food Authority, 2010, Stein, 2010). A number of countries and jurisdictions around the world have implemented, or are implementing, menu energy labelling policies, (New South Wales Food Authority, 2010, Stein, 2010) most notably in the United States. (Stein, 2010, 111th Congress, 2010) Current evidence in this area suggests that menu energy labelling may have a small to negligible effect at improving dietary choices at the population level (Harnack and French, 2008, Kiszko et al., 2014). However, significant heterogeneity exists between studies. Although several studies have attempted to examine the effect of menu energy labelling across different SEP groups, there has been no systematic review and critical analysis of the current evidence base to conclude on the likely health equity impact of this policy.
This study aims to review evidence of the impact of menu energy labelling across socioeconomic strata. For the purpose of this review we analysed the effect of menu energy labelling on a range of outcomes, including: awareness of exposure, understanding, food or energy purchased or consumed, and body mass index (BMI; or other adiposity indicators).
Section snippets
Logic pathway
Based on the available literature on the topic, a simplified intervention logic pathway was developed to identify and summarise the key intended consequent outcomes of menu energy labelling to be examined in this review (Anderson et al., 2011). This included process indicators (awareness of exposure, understanding, purchase intentions and self-reported use), behavioural outcomes (purchase and consumption), and physiological outcomes (energy balance, and individual and population adiposity).
Results
The literature search resulted in 2460 papers (see Fig. 2) with eighteen relevant papers (representing fourteen studies) identified as eligible for inclusion in this review. Of the studies that underwent a full-text evaluation (n = 103), the majority were excluded because they either did not report on a (specific) menu energy labelling intervention or policy, or they reported on menu energy labelling but did not represent results by a measure of SEP. Twelve of the eighteen papers (eleven
Discussion
This review summarises, for the first time, evidence on the likely impact of menu energy labelling both across SEP groups and within low SEP populations, according to a number of different outcomes across an intervention logic pathway. Based on the six studies that evaluated awareness of exposure to menu energy labelling, it appears that both high and low SEP groups notice energy labelling, when introduced, however studies comparing awareness between high and low SEP groups suggest that
Conclusions
The current evidence describing the impact of menu energy labelling within or across SEP is limited in quantity and quality. Of the two studies that reported a positive benefit of menu energy labelling overall, both identified a greater effect on fast food purchases among consumers visiting stores located in high compared to low SEP neighbourhoods. It is difficult to know whether the paucity of evidence of effectiveness reported in low SEP populations represents a truly limited impact in such
Acknowledgements
We would like to acknowledge the “Reducing inequalities in overweight and obesity” (RIO) advisory committee for their advice and input on this research.
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2024, American Journal of Preventive MedicineMenu labeling influence on purchase behaviors: Applying the theory of planned behavior and health consciousness
2022, AppetiteCitation Excerpt :Menu labels have a positive influence on consumers’ food choices (Gruner & Ohri-Vachaspati, 2017; Roberto et al., 2009) and potentially help decrease obesity and related chronic diseases (Fernandes et al., 2016). However, the effectiveness of menu labeling is still inconclusive (Bleich et al., 2017; Lee & Thompson, 2016; Liu et al., 2012; Sarink et al., 2016); some empirical and review studies conducted among various settings reported that menu labels influenced consumer behaviors (Bollinger et al., 2011; Brissette et al., 2013; Christoph & An, 2018; Dumanovsky et al., 2011; Dowray et al., 2013; Hobin et al., 2016; Morley et al., 2013; Roseman et al., 2013; Sinclar et al., 2014), whereas others did not (Cantu-Jungles et al., 2017; Finkelstein et al., 2011; Scourboutakos et al., 2019; Tapper et al., 2020; Vasiljevic et al., 2019). In assessing the effectiveness of menu labeling on consumer behaviors, no extant studies considered consumer's own caloric needs in comparison to purchased calories.
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Current address: Division of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.