The impact of menu energy labelling across socioeconomic groups: A systematic review

doi:10.1016/j.appet.2015.12.022

Appetite

Volume 99, 1 April 2016, Pages 59-75

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Abstract

Introduction

Menu energy labelling at point of purchase is gaining traction worldwide, yet the potential impact for different socioeconomic groups is unclear. We aimed to summarise evidence on the effectiveness of menu energy labelling by socioeconomic position (SEP).

Methods

A systematic search for papers published to September 2015 was conducted using terms for labelling, food outlets, and SEP. Quality of studies was assessed. Results were summarised across stages of an intervention logic pathway.

Results

Eighteen papers were identified. Of twelve studies reporting the effect of menu energy labelling in low SEP populations, six reported on purchase outcomes. All but one of these reported no positive effect of the policy for this population. Two of the five studies that compared purchase outcomes of menu labelling across SEP groups reported that the policy was effective overall. These two studies reported either a significant decline in fast food calories purchased from consumers in high (but not low) SEP neighbourhoods or a significantly greater decline in calories purchased among consumers visiting stores in higher SEP neighbourhoods post policy implementation. None of the included papers reached the highest quality score.

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 in high compared to low SEP neighbourhoods. It is difficult to know whether the absence of effectiveness reported in low SEP populations represents a true lack of effectiveness or is a result of a more general lack of policy effectiveness or the limited quality of the reviewed studies.

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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Citation 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.
Mixed findings have been reported in the literature on the effectiveness of menu labeling in assisting consumers to make informed purchase decisions when eating out. Therefore, this study examined factors that influenced consumers’ intentions to use menu labeling and whether these intentions influenced caloric purchases relative to actual caloric needs. While other researchers have assessed impacts of menu labeling on total calories purchased, our study assessed the impact relative to caloric needs, therein recognizing that each consumer has different caloric needs. An extended theory of planned behavior (TPB) incorporating health consciousness served as the theoretical underpinning. The TPB addresses reasons why an individual takes action on a certain behavior; in the case of this research, that behavior was purchasing food. Food purchases were further operationalized using the calorie content of foods and comparing that number of calories to caloric needs. Two-step structural equation modeling was used to analyze 316 surveys from restaurant consumers. Results indicated that attitudes, subjective norms, and health consciousness positively influenced intentions to use menu labeling. Intentions to use menu labeling also significantly influenced actual purchase behaviors (measured as the difference between caloric purchases and caloric needs). Overall, the current research findings provide novel insights for researchers to further explore the role of menu labeling on purchase behavior by using the TPB model with integration of health consciousness.

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¹: Current address: Division of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.

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Research reviewThe impact of menu energy labelling across socioeconomic groups: A systematic review

Abstract

Introduction

Methods

Results

Conclusions

Introduction

Section snippets

Logic pathway

Results

Discussion

Conclusions

Acknowledgements

Appetite

Journal of the Academy of Nutrition Dietetics

Appetite

Journal of Nutrition Education Behavior

Journal of the Academy of Nutrition and Dietetics

Preventive Medicine

American Journal of Preventive Medicine

Social Science & Medicine

Appetite

Journal of the Academy of Nutrition and Dietetics

Journal of American Dietetic Association

Patient protection and affordable care act

Using logic models to capture complexity in systematic reviews

Research Synthesis Methods

The effect of obesity prevention interventions according to socioeconomic position: a systematic review

Obesity Reviews

The publics' understanding of daily caloric recommendations and their perceptions of calorie posting in chain restaurants

BMC Public Health

Restaurants with calories displayed on menus had lower calorie counts compared to restaurants without such labels

Health Affairs (Millwood)

Calorie posting in chain restaurants

American Economical Journal Economic Policy

Changes in awareness and use of calorie information after mandatory menu labeling in restaurants in King County, Washington

American Journal of Public Health

Research review
The impact of menu energy labelling across socioeconomic groups: A systematic review