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Don't buy the kids' menu hype
The Kids LiveWell program was started in 2011 by the National Restaurant Association to "provide... parents and children with a growing selection of healthful menu options when dining out." The 19 initially participating restaurant chains, which at its start included Denny's, Burger King, and Outback Steakhouse, agreed to offer a selection of children's items that meet the following criteria....

Red Light / Green Light
Researchers in Australia recently assessed an even simpler way to present calorie information: using traffic light imagery. Almost 1,300 adults responded to an online survey asking them to imagine they were choosing their evening meal from a sample fast food menu. The participants were randomly assigned to choose from one of five menus, all presenting the same food items but differing in the additional information displayed alongside:

Calories vs. Minutes
Fast Food Burger and FriesIf you live in the United States, there's a good chance that you've already seen calorie information listed on a restaurant menu. The state of California and both Philadelphia and New York City already require it, and many restaurants are already doing it voluntarily. If you haven't yet, don't worry: the 2010 Patient Protection and Affordable Healthcare Act requires it for all restaurants.


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Putting calories and sodium information on restaurant menus may backfire

a group of young people dining outdoors at a restaurant

For years chefs have resisted marking certain menu items as "healthy:" they know that it's the kiss of death. Nobody will order it. That may be changing, but the fact still remains that many people believe that healthy food just can't taste good.

Yet the belief that people will make healthier decisions if they have the right information is behind the idea of drawing attention to healthier items. The natural extension of that is the recent proposal that restaurants with more than a certain number of locations be required to provide the number of calories and the amount of sodium in every menu item.

In 2015 the state of New York implemented the requirement that the New York locations of restaurant chains with 15 or more locations must place a warning next to menu items that contain more than the recommended daily allowance of sodium (about 2,300 milligrams). The warning looks like this:

warning label reads: Warning: indicates that the sodium (salt) content of this item is higher than the total daily recommended limit (2300 mg). High sodium intake can increase blood pressure and risk of heart disease and stroke

A team of scientists at Purdue University and Murray State University were curious to know if the warning label - or other ways of providing calorie and sodium information on menus - was actually effective, and if people's perceptions about whether healthier food tastes good affected their menu choices when that information was available (Appetite 2018;125:474-485).

Accordingly, they surveyed over 500 men and women, all over 21, who reported dining at a casual dining restaurant such as Applebee's, TGI Friday's, or Ruby Tuesday within the last three months. First the authors assigned the participants a score based on multiple survey questions, all essentially measuring how strongly they agreed that unhealthy food was tastier. Those with a lower score believed that healthy food does taste good, while those with a higher score believed healthy food did NOT taste good and that unhealthy food tasted better. The authors termed this score a SCUTI score: Sodium and Calorie Unhealthy=Tasty Intuition.

The authors then asked showed the participants sample menus including appetizers, entrees, desserts, condiments, and drinks based on items from Applebee's, TGI Friday's, and Ruby Tuesday. There were four variations: while the menu items were the same, one menu had no nutrition information, a second menu included specific calorie information for each item but no sodium information, a third included both calorie and sodium information for each item, and the fourth included the warning symbol and verbiage as in the New York State warning (above).

The menus with any combination of nutrition information all included advisories of the daily recommendation for the nutrition information listed: the one listing only calories advised of total calories (2,000 calories per day), the one including both calories and sodium included advisories for both (2,000 calories and 2,300 milligrams per day), and the one with the NY warning label included both the daily limits of sodium and calories as well as the warning verbiage.

The participants were randomly assigned one of the four menus and instructed to look at the sample menu and choose a meal for themselves as if they were going to have dinner at this fictitious restaurant. If they planned to share any items, they could indicate which item they planned to share and were asked to estimate how much they believed they would eat of each item selected. After finalizing their selection, the participants were asked if they had noticed the calorie or sodium information on the menu and if that information, if they noticed it, had any influence on what they chose.

The authors then calculated the total number of calories and sodium in the items each participant selected, according to how much of that item they planned to consume. They could then analyze the interaction between those with high or low SCUTI scores, which menu type they were presented with, and the number of calories and milligrams of sodium in their selected foods.

For those with a low SCUTI score (meaning they believed that healthy food could indeed taste good), having both the calories and sodium information on the menu meant they chose items totaling 26% less sodium than when the menu only had calorie information and 16% less sodium than when their menu had no nutrition information.

By contrast, those with a high SCUTI score (believing that unhealthy food tasted better) ordered meals with 11% more sodium when they had calories and sodium information presented to them, and 26% more sodium when they had no nutrition information.

Interestingly, people with the same level of SCUTI score seemed to order about the same number of calories as others with the same SCUTI score regardless of which menu they were presented with.

What this means for you

Those with a high SCUTI score represented about 21% of the participants, while about 36% had low scores (believed healthy food could taste good). The largest group, with about 41%, were those in the middle, who did choose items with a lower total sodium content when they were presented with both sodium and calorie information. The good news is that some people will make better choices when given the right information, but the bad news is that we still have a ways to go to convince people that food that is great for you can also taste great (this is why Dr. Gourmet exists, after all).

On a personal note, this further supports my contention that instead of disclosing the amount of sodium in foods, chefs would do better to simply reduce the amount of sodium in their dishes across the board - without telling anyone.

First posted: April 25, 2018