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Mandatory Restaurant Menu Labeling: What Does It Mean for Consumers and RDs?
By Hadley Turner

Americans are eating out now more than ever. From 1970 to 2012, the percentage of food spending on food away from home increased from 25.9% to 43.1%. It's been well established that this increase in eating out has resulted in higher calorie consumption (one study showed an average entrée calorie count of 1,205 kcal in a sample of restaurants) and, as a result, higher rates of obesity.

In an effort to curb calorie consumption in restaurants, former President Obama included mandatory menu labeling in the Patient Protection and Affordable Care Act of 2010. The menu labeling rule requires restaurants with 20 or more locations and vending machine operators with 20 or more machines to post calorie counts for standard menu items. Menus must include the statement "2,000 calories a day is used for general nutrition advice, but calorie needs vary." Full written nutrition information must be provided upon request as well.

The rule was finalized December 1, 2014, with compliance beginning December 1, 2015. However, the compliance date was delayed twice: first until May 5, 2017, and then, most recently, until May 7, 2018, due to lobbying from a group of pizza chains, convenience stores, and supermarkets to renegotiate and relax the rule. The pro-labeling consumer and health advocacy groups Center for Science in the Public Interest and the National Consumers League, represented by nonprofit law firm Earthjustice, sued the USDA and Health and Human Services for the latter delay, arguing that by continuing to push back the rule's implementation, the government and chain restaurants are putting consumers' health at risk. On September 27, US District Court Judge Emmet Sullivan approved a stay—considered a win for the consumer advocacy groups—that allows the lawsuit to reopen should the compliance deadline be extended again from its current May 2018 expected rollout.

Some restaurant chains, such as Le Pain Quotidien, Panera Bread, and Chipotle, committed to voluntary menu labeling years ago. Certain jurisdictions such as New York City and California have menu labeling requirements already in place as well.

RD Boons and Banes
Most RDs can get behind the push to help consumers better understand what their food contains, and not just for public health reasons. Katie Bengston, MS, RDN, LD, nutrition manager for Panera Bread, believes menu labeling will prove to be a professional boon for dietitians across the food industry and sees the law as only one component of the growing value of RDs in retail and restaurant settings.

"I think the Menu Labeling law has increased the value of RDs in the food industry, but the sheer interest consumers have in nutrition information [also] has increased our value in the food industry," she says. "We can help with nutrition analysis, menu development, allergen management, ingredient function, special dietary menus, and different PR and marketing positions, just to name a few ways that our value is increasing in the industry beyond just menu labeling."

Bengston also believes there are opportunities for RDs who work directly with consumers to provide education on what calories mean, what their individual calorie needs are, and how eating out can fit into a healthful lifestyle. "Education is always something we need more of in this field," she says. "So finding ways to make that part of your career is needed, and when something is needed, it's definitely an opportunity."

Amy Myrdal Miller, MS, RDN, FAND, president of Farmer's Daughter Consulting, an agriculture, food, and culinary communications firm, agrees that menu labeling boosts business for RDs in private practice. She cites her experiences in her state of California, which implemented mandatory menu labeling in July 2009.

"Here in California, it created huge opportunities for dietitians to be on the forefront of educating people about what their daily calorie needs are and what it means to treat themselves and indulge one day and how that affects things over the course of a week or month," she says. She adds that RDs can advise clients about what requests to make and what words to look for in menu descriptions in smaller restaurants that aren't required to post calorie information.

But, Myrdal Miller cautions, there have been some drawbacks for retail dietitians. When menu labeling was first implemented in California, there was a boom of restaurant chains hiring RDs, but this bubble burst and many dietitians lost their jobs once the calorie analysis projects were over. She says this was largely due to corporations misunderstanding and underestimating what dietitians do and are capable of; many restaurant chains have an idea of RDs as no more than "number-crunchers" for calorie analysis.

"Dietitians who are doing well in the restaurant industry are those who are pairing with their culinary menu research and development counterparts and have corporate-level support for this approach—that consumer interest in health and wellness isn't going away," Myrdal Miller says. "Executives [in these companies] understand the power of the dietitian, and [these RDs] are doing well; they are having impact and influence. But colleagues who got pigeonholed into 'number-crunching' roles by executives who assume they know calories but not much else about food, culinary development, and what the consumer wants, those are the ones who got cut out."

Consumer Protection
Menu labeling has the potential to empower consumers to make more healthful choices when eating out, Bengston explains. "Menu labeling can impact a guest in several ways. It can change their purchase selection on the spot, or it can give them knowledge they need to adjust their diet at other meals or snacks. We hope that providing that calorie value on the menu … will ultimately help consumers make healthier decisions." That said, she assents, research as to whether listing calorie counts actually impacts calorie consumption has been "inconclusive."

The limited data that are available come mainly from New York City, where mandated menu labeling (with the same parameters as the federal rule) has been in effect since 2008. These data have shown an average decrease of under 100 kcal per transaction, which, in several studies, hasn't been statistically significant.1,2 But that doesn't mean that it's entirely ineffective. Myrdal Miller notes that this amount "doesn't seem like a big deal for an individual. But over the course of a year, looking at weight gain projections in the population, from a public health perspective, that's impact." Still, she says, the data are limited, primarily by location.

Myrdal Miller says that, when menu labeling kicked off in California, consumers started off by buying lower-calorie items, but that trend didn't last. "[Menu labeling] certainly did have an impact, but what operators here in California reported was that after about six months, customers tended not to see the information anymore," Myrdal Miller says. At least anecdotally, "people went back to the attitude that going out to eat is a treat vs a very frequent occasion in Americans' lives. They said, 'I've worked hard today; I deserve to treat myself.'"

This is where Bengston believes education needs to have a seat at the table (or booth): "Knowledge is power. Where I think we can make some improvement is the overall nutrition education for the public," she says. "If a consumer doesn't know what the [calorie values on the menu] mean, then [labeling] isn't going to have a positive impact on them. So we're hoping there will be more federal education opportunities so this menu labeling does have the positive impact on public health we hope it will."

A Different Strategy?
Myrdal Miller makes a different suggestion, based on her work with The Culinary Institute of America's Health Menus R&D Collaborative, a group of culinary, foodservice, and nutrition leaders whose goal is to increase the availability and sales of healthful (and delicious) menu items. She argues that both consumers and restaurants would be best served by not just better menu labeling but also better menu descriptors.

"Nutrition labeling gives consumers powerful information on calories, but the chains that have had the most success have focused on doing better with menu development and using rich descriptive language that draws the consumer in so they feel that what they're ordering is delicious, craveable, crunchy, mouthwatering awesomeness—and, by the way, it happens to have fewer calories, or it happens to have more healthful carbohydrates, or it's lower sodium if you're worried about that," Myrdal Miller says.

Making calorie reductions and more healthful swaps across the board while keeping meals indulgent and appealing is what she believes will make a difference to consumers' health. (Read more about Myrdal Miller's experience and tips for revamping restaurant menus on Today's Dietitian's RD Lounge blog.) Through more strategic calorie design, RDs working in menu development can keep consumers healthy while satisfying them with delicious and craveable meals. According to Myrdal Miller, restaurants that have done this well have "given the consumer permission; but they've used [calorie] guardrails so the diner feels like, 'I'm not going to blow it, cheat, be naughty—I'm just going to enjoy a really great meal.'"

And this is essential, because at the end of the day, she says, "nutrition is important, but deliciousness is more important."

— Hadley Turner is an editorial assistant for Today's Dietitian.

1. Elbel B, Gyamfi J, Kersh R. Child and adolescent fast-food choice and the influence of calorie labeling: a natural experiment. Int J Obes (Lond). 2011;35(4):493-500.

2. Elbel B, Kersh R, Brescoll VL, Dixon LB. Calorie labeling and food choices: a first look at the effects on low-income people in New York City. Health Aff (Millwood). 2009;28(6):w1110-w1121.