Nutritional Pearls: Good News About Adding Nutrition Labels

John is a 22-year-old college senior struggling to lose weight before he graduates. He tells you that many of his daily meals consist of prepackaged food sold at his school’s convenience store.

When asked how he chooses which meals to purchase, he says that he buys whatever catches his eye, and never looks at the nutritional information.

How do you advise your patient?
(Answer and discussion on next page)

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Answer: Checking the nutritional information can help patients make informed and healthy dietary choices.

You know they're coming: nutrition information on restaurant menus. The federal government has mandated that all restaurants with 20 or more locations must add the number of calories contained in an item to their menus by December 1, 2016. Further, more detailed information, including calories from fat, total fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrates, fiber, sugars, and protein must be available to consumers upon written request.

The stated reason for adding nutrition information to restaurant menus is to "help consumers make informed and healthful dietary choices," but it was prompted in part by the rise in obesity, and in practical terms seems intended to help people choose fewer calories. Whether it will actually do either of those things has been explored in a fair amount of research, but results have been fairly poor, with several studies concluding that nutrition labeling has little to no impact on what people purchase. These studies have been no more than a few months in length, however.
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The Research

With that in mind, researchers at Cornell University teamed up with their university's dining services to look at on-campus purchasing patterns. At the start of the Spring semester of 2008, Cornell added nutrition information to over 60 of their "FreshTake" meals and snacks. These are pre-packaged meals and snack items that are sold from refrigerated units inside the university's retail food outlets. Cornell Dining was able to provide the researchers with detailed sales information for these meals and snacks for the 3 semesters before the nutrition labels were added as well as the 3 semesters after they were added.

They controlled for variations in product availability by excluding 13 products that were not sold at every location. They also standardized the number of weeks in each semester by excluding the weeks of fall or spring break and weeks including holidays such as Thanksgiving or during the last week of the Spring semester (when people are presumably moving away from campus at various points). Food locations that were intermittently closed for construction were also excluded.

This left the authors of the study with 45 labeled items and 12 weeks per semester. The food items were grouped into "high calorie," "low calorie," "high fat," and "low fat" foods, with the comparison of high versus low being within the group of foods (i.e., a "high-calorie" food is considered high in calories compared to the other 44 items). Along with looking at whether the absolute number of units sold of each food increased or decreased, they also looked at the number of calories purchased by each person as well as the amount of fat.

The Results

Their research shows that the average weekly number of calories purchased by the students fell from approximately 476 calories to 445 calories—about 6.5% to 7%. The amount of fat in the foods they purchased also fell, from 21 grams to about 19.9 grams—a drop of 7.4%.

What's the "Take Home"?

You may think that marginally reducing calories will not make a big dent in people's weight, and that's true—at least, in the short term. Small changes such as these, however, are key to long-term, sustainable dietary change. When you eat out, look for that nutrition information and use it if it's available. If it's not, ask. If enough people ask, restaurants that are not required to implement the labels may choose to do it in response to consumer requests. Small changes can make a big difference.

Reference:

Cioffi CE, Levitsky DA, Pacanowski CR, Bertz F. A nudge in a healthy direction. The effect of nutrition labels on food purchasing behaviors in university dining facilities. Appetite. 2015;92:7-14