by on June 6, 2015

in Monthly

Calorie counts posted on menus are considered by some public health experts to change behaviour. But do they really change behaviour in a significant way? What has research shown thus far—not only in adults, but also in children and youth? Are the studies robust enough to justify some jurisdiction’s decisions to mandate labeling?

At a recent conference In Toronto organized by the Canadian Obesity Network ( the question was raised: Is evidence rooted in research sufficient to determine policies set by government?

The answer is that it may not be sufficient and that a number of over-zealous, but well-meaning advocates, may feel good about mandating policies—and yet a number of these policies are put in place when the science is still very thin at best.

Researchers from Chapel Hill, North Carolina, provided us in February 2015 with the first study in children, looking at the impact of not just labeling menus with calories, but also displaying the physical activity calorie equivalents (PACE)

Over 1,000 parents were surveyed nationally. They were given four hypothetical menus of fast food restaurants: a menu with no caloric labels; a menu where only calories appeared; a menu with calories plus minutes to burn those calories and a menu showing how far one had to walk to burn of those calories.

Only 20% of parents reported that calories-only labeling would be very likely to prompt them to encourage their children to exercise. Close to 40% of parents surveyed indicated that they will be very likely to encourage their children to exercise when labels also showed how much exercise is needed to burn calories.(Pediatrics. Volume 135, number 2, Feb 2015)

In the USA the Affordable Care Act, engineered by the Obama administration, mandated that restaurants with more than 20 locations must post calorie counts. The Ontario Medical Association also supported the posting of calories on menus. National organizations such as the Canadian Medical Association often lament the fact that the Federal Government should mandate national policies more often—in contrast to the current Harper government’s tendency to allow various provinces to “do their own thing.”
None of the above policies mandated that calorie counts also be linked with the amount of exercise required to burn off those calories.

Research shows that the average meal parents selected for their child totaled 1125 calories; for teens meals averaged 1336 calories. Some studies show that when parents are also given calorie counts on menus 20 % may order 200 fewer calories on average. Thus the vast majority of consumers are not influenced by calorie labeling—it only gets slightly better when additional information is offered.
The potential of labels influencing behavior also depends on the health literacy of parents. Health literacy is validated by using the well-respected Newest Vital Sign (A Google search of this tool will provide more information about the specific questions used to determine health literacy)

Although hypothetical PACE labels influenced parent’s decisions on what fast food items to order for their children, most researchers agree that real-world research is needed to evaluate the effects of PACE labeling for adults and children.

A number of experts argue not just for improved labeling, but they want to take things further, advocating also for a soda tax. These experts are particularly upset with the makers of sugar sweetened beverages. Personally I am puzzled that they would single out soda drinks while they allow iconic Canadian outlets such as Tim Hortons a free ride in providing the public with high sugar content foods.
Where does all of this leave an average Canadian parent? I would suggest that we take labels with a pinch of salt and instead of focusing so singularly on calories, we need to do a better job of teaching families to eat more consistently at home; to consume more fruits and vegetable and to pay more attention to the sweetness factor (Glycemic Index) of foods.

Schools are also well positioned to raise health literacy and the Apple Schools Research Project in Edmonton, funded by a Calgary philanthropist, shows us what great results are possible if this education is done properly. Projects like this teach us that education has a tremendous impact to change behavior at a young age. Personally I often wonder if this impact may be far wider than mandating labeling.(See


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