Purchasing Behavior and Calorie Information at Fast-Food Chains in New York City, 2007

Mary T. Bassett, MD, MPH; Tamara Dumanovsky, PhD; Christina Huang, MPH; Lynn D. Silver, MD, MPH; Candace Young, MS; Cathy Nonas, MS; Thomas D. Matte, MD, MPH; Sekai Chideya, MD, MPH; Thomas R. Frieden, MD, MPH

Disclosures

Am J Public Health. 2008;98(8):1457-1459. 

In This Article

Discussion

Despite its public availability, the number of food service establishment patrons (excluding Subway patrons) who reported seeing calorie information was very low. This finding is consistent with previous studies.[6,7] In comparison, Subway's placement of limited calorie information on deli cases near the registers, although not prominent, was associated with a much higher proportion of patrons seeing calorie information. Furthermore, over one third of these Subway patrons reported that this information affected their purchase. Objective measurement of calorie content through examination of receipts confirmed that patrons who reported seeing and using calorie information purchased fewer calories than did those reporting that they did not see or use calorie information.

The importance of providing calorie information is supported by the finding that patrons purchased foods with high-energy contents: one third of patrons purchased more than 1000 calories for a single meal. Caloric intake is rising in the United States in parallel with the obesity epidemic: between 1971 and 2000, Americans' average daily caloric intake increased approximately 200 to 300 calories.[1,8,9] Fast food, which represents approximately 74% of all restaurant traffic nationally (marketing research data; The NPD Group/CREST, written communication, October 2007), typically contains more calories per serving than does food prepared at home.[1,2,4]

New York City and several other jurisdictions have considered requiring fast-food chains to post calorie information on their menus and menu boards.[10] In this study, which was limited to chains that made calorie information publicly available, few patrons (less than 5%) saw calorie information when it was provided only in less-prominent formats, such as charts on counter mats, distant walls or posters, or on a Web site. The percentage was higher (32%) at Subway, which displayed information near the point of purchase. This suggests that displaying calorie information even more prominently, such as on menu boards, might increase the proportion of patrons seeing—and using—calorie information.

Our findings regarding the association of caloric content of purchases with observation of calorie information are subject to at least 3 limitations. First, Subway patrons might not be representative of all chain restaurant patrons: Subway patrons purchased fewer calories than did other chains' patrons. This could indicate that food available at Subway was lower in calories or that Subway patrons were more likely to purchase food with fewer calories than other chains' patrons. However, even when the analysis was restricted solely to Subway patrons, those seeing calorie information purchased fewer calories. Furthermore, Subway is the largest noncoffee fast-food chain in New York City, and its popularity suggests broad appeal; it is likely that if other chains were to make calorie information visible at point of purchase, patrons at these chains would be interested in and use calorie information to make healthier choices.

Second, it is possible that Subway patrons who reported seeing calorie information did so because they were more concerned about weight than were Subway patrons who reported not seeing calorie information. However, patrons who reported seeing but not using calorie information and patrons who reported not seeing calorie information purchased similar calories, indicating comparable purchasing patterns.

Third, study respondents may have differed from patrons choosing not to participate. However, data were collected over the busy lunch period, and the proportion of participants providing receipts varied primarily by consumer traffic volume, suggesting that individual patron factors were not major determinants of participation rates. Overall, this report's findings suggest that when fast-food chain patrons are provided calorie information prominently prior to purchase, many will see it and use it to reduce their caloric intake.

Given the frequency of fast food consumption, even modest reductions in calories (e.g., 50 calories per meal) could significantly reduce population-level caloric intake.[11,12] However, the vast majority of patrons purchasing fast food do not have ready access to the information needed to make healthy decisions. In December 2006, the New York City Board of Health mandated posting calorie information on restaurant menus and menu boards. This mandate was legally challenged and overturned in September 2007. In January 2008, the New York City Board of Health approved a new mandate addressing the concerns raised by the legal ruling, to which there was again a challenge. The challenge was rejected by the courts, and an appeal has been made to a higher court.

The per-meal caloric content of fast-food purchases is high. Although fast-food restaurants report publishing nutritional information publicly, most chains' current methods of providing this information to patrons are ineffective. Placement of calorie information at point of purchase is more effective and may be associated with lower calorie purchases among consumers reporting seeing information. Public health authorities and restaurant establishments should consider interventions to make calorie information more prominently displayed at point of purchase to increase information, reduce calorie intake, and reduce obesity-related morbidity and mortality.

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