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Taking A Bite out of the Big Apple

Section 4205 of the Affordable Care Act requires certain restaurants to report calorie information on menu boards beginning March 23, 2011; New York City recently implemented a similar law.

On March 31, 2008, an amended New York City regulation became effective. The regulation required restaurant chains with 15 or more locations nationwide to post calorie counts on menus, menu boards, and item tags.  This study assessed the impact of the regulation both pre- and post- enforcement on customer’s awareness of calorie information and their report of its use in their food choices.

Three randomly sampled locations from each of the 15 of the most popular chains in New York City were included.  Customers exiting each location were asked 1) if they purchased a food item, 2) if they saw calorie information in the restaurant that day or had ever seen calorie information for that restaurant chain, 3) where they had seen the calorie information, and 4) if the information affected their purchase that day.

During the pre-enforcement phase, customers were 3 times more likely to see calorie information when calories were posted on the full menu board compared with all other methods (61 percent vs. 18 percent; P<0.001).  During the post-enforcement survey, overall customer awareness of calorie information increased 25 percent to 64 percent.

Of the locations that posted calorie information on the full menu board, 74 percent of consumers reported seeing the calorie information post-enforcement, up from 61 percent pre-enforcement (P<0.005).  Of the locations that posted calorie information on the partial menu board, 73 percent of consumers reported seeing the calorie information post-enforcement, up from 34 percent pre-enforcement (P<0.001).  Of the locations that posted calorie information in some form other than menu boards, 70 percent of consumers reported seeing the calorie information post-enforcement, up from 25 percent pre-enforcement (P<0.005).

At both pre- and post-enforcement, 27 percent of consumers reporting using the calorie information in making their menu choice.  Thus, the percentage of all customers reporting that calorie information had affected their purchase doubled from 10 percent to 20 percent (P<0.001).


Moving forward from our , this study seeks to provide actual data as to the impact of public health policy.  Now that New York City will be joined by the rest of the nation in publicizing large restaurant-chain calorie information, the question is not so much about the political successes that brought us to this point, but instead the actual data that such interventions bring forth.

The authors correctly acknowledge how the posting of calorie information may need to be partnered with other strategies to reduce the negative effect of fast food.  Unfortunately, through the political processes, similar large scale dilemmas are reduced in complexity by means of sound bites and single page editorials.  While only 27 percent of consumers might adjust their menu choices based on posted calorie content, additional consumers might be impacted by additional interventions.  Purposeful research on the additive effects of multiple interventions are necessary and should be systematically built into the adoption of similar regulations across the nation.

Dumanovksy, T, Huang CY, Bassett, MT, Silver LD.  “Consumer Awareness of Fast-Food Calorie Information in New York City After Implementation of a Menu Labeling Regulation.” American Journal of Public Health. 2010; 100: 2520-2525.


Kameron Matthews, MD, Esq.

Kameron Matthews, MD, JD, FAAFP
About Kameron Matthews, MD, JD, FAAFP

Lead Analyst – Access to Care Kameron Matthews MD, JD is a board-certified family physician and currently serves as Deputy Executive Director of Provider Relations and Services in the Office of Community Care at the Veterans Health Administration in Washington, DC. She earned her medical degree from Johns Hopkins University and her law degree from the University of Chicago. Contact: Facebook | Twitter | More Posts