Now Reading: Meaningful Use for Food – Impact of calorie labeling in New York City

I’m a obsessed with fascinated by transparency because of my heritage working in an industry with built-in information asymmetry.

I feel, as colleague Jane Sarasohn-Kahn does, that “transparency is the new black.” I also have liked Senator Patrick Leahy’s comment: transparency promotes competition. In this case, transparency could promote competition with less optimal food choices.

Beyond the science of changing consumer behavior, I learned that transparency is also promoting competition with old ideas of trust within the consumer….read on.

Several papers/studies have recently come out about the impact of menu-labeling. I posted a news article about a preliminary report, then learned that there was conflicting data, so I decided to take a more thorough look, and there is more to look at.

In Calorie Labeling and Food Choices: A First Look at the Effects On Low-Income People in New York City, a case-control design (comparing New York to nearby Newark) showed that people in New York City definitely noticed calorie labeling after regulations went into effect in 2008, from less than 20 % to 54 %. People also were more likely to report having their choices influenced by menu-labeling. Their actual purchases did not show a change in the calorie counts purchased, so a little dampening of the enthusiasm with which I posted last is in order.

In New York City’s Fight Over Calorie Labeling, a different dimension of this discussion is presented: Trust. The importance of trust is growing, accelerated because of social media.

I almost felt the pages in my hand heat up as I read the account of New York City’s Health Department’s work to implement requirements for menu-labeling, and its contest with the New York State Restaurant Association. NYSRA filed multiple lawsuits to block required provision of the information based on constitutional (First-Amendment and federal preemption) principles. At the time this was happening, I recalled that the NYSRA’s arguments seemed eerily similar to those used to keep patients in the dark about their health information – the customer would be “confused”. A perception of lack of trust seems to strengthen the argument for regulation to provide truthful information.

In Report Suggests New York City Menu Labeling Law is Effective at Promoting Health Changes (data presented at Obesity 2009 Conference), the data is more supportive of actual food choice-changes, with a larger sample size, albeit with study authors being the New York City Department of Health team. It will be interesting to see that study in print.

And the answer is….

There isn’t a definitive answer about consumer food choices yet. That’s one impact. What about this one:

Requiring restaurants to provide calorie information to customers could also have a larger benefit. Restaurants, recognizing that some customers might be alarmed at the high calorie amounts of some items or seeing actual reductions in sales of those items, might reformulate their products to contain fewer calories or include more low-calorie items on their menus, in which case all customers would benefit. (Farley, et. al)

This is in fact what Le Pain Quotidien did, and what Hillstone Restaurant Group (owners of Houston’s) probably won’t do, because it’s refusing to comply.

Which restaurant are consumers going to trust? And therefore, which one will be more competitive?

As usual, I see a lot of analogies to health care.

Three more things

1. A concise and provocative way of saying what I say above can be found here, on the comments section of The Economist.

2. Why this is important, from The Biggest Loser. With information and support, people really can take control of their lives.

3. Let’s not forget about all the data our groceries have and have yet to fully unleash. It’s time for a food PHR.

Links to articles in this post


Fantastic article! I think posting calorie counts for food and beverages will have an impact on New Yorkers, especially those who opt for "healthy" choices like salads and low-carb alternatives only to learn that those choices are sometimes less healthy than a good, old-fashioned burger. A 900 calorie salad? No thank you!

Specialty's, a bakery and lunch place with outlets in northern California has a new web site that provides the calories along with a graphic representation of all the ingredients in their menu items. You can remove say, the cheese, and the calorie count adjusts. It sure changed my eating and buying habits when I saw that my favorite vegetarian Caprese sandwich had 1200 calories!

Ted Eytan, MD