Volume 111, Issue 4 , Pages 511-516, April 2011
Identifying Opportunities: A Report on the 2010 American Dietetic Association Environmental Scan on Restaurant Menu Labeling
Article Outline
‘‘Forewarned is forearmed,” as the old saying goes, and never has it been more true than when it comes to informing dietetics practitioners about the professional opportunities generated by recent legislation regarding the inclusion of nutrition information on restaurant menus. Section 4205 of the Patient Protection and Affordable Health Care Act, passed in March 2010, mandates that restaurants and food vendors with more than 20 locations must disclose calorie information on their menus, menu boards, and vending machines, while making other nutrition information available to consumers upon request (1). But where will that nutrition information come from? And how will consumers put it to use? That, of course, is where dietetics practitioners come in. But before you can put your skills to work by calculating nutrient values or advising the public on how to interpret them, you need to be aware of all of the implications of the new legislation, and what they might mean for you professionally. And that's where the American Dietetic Association (ADA) comes in.
Even before the legislation was passed, ADA determined that it would have a significant impact on the dietetics profession, and that it was therefore critical to assess our membership's current level of awareness, involvement, and knowledge with regard to menu labeling, and then to prepare members for the opportunities and challenges this new mandate would provide. As the foundation of that effort, ADA conducted an environmental scan on restaurant menu labeling, which included forming a work group of ADA members familiar with the subject, conducting an extensive survey of our membership, and gathering information from experts and leaders both within ADA and in government, the restaurant industry, and public policy. The knowledge gained was immediately put to use in the form of a series of Journal of the American Dietetic Association articles dedicated to educating ADA membership on both the specifics of this new legislation as well as its far-reaching implications for dietetics practice. This article concludes that series by presenting the results of the environmental scan survey of ADA members conducted from April to October of 2010.
Respondent Profile
ADA members were given the opportunity to participate in the survey by following a link included in the Eat Right Weekly electronic newsletter to an online survey at SurveyMonkey.com. Of ADA's approximately 71,000 members, 3,250 members completed the survey, for a margin of error just under 2%. Before delving into their responses to specific questions on restaurant menu labeling, it's important to know more about the respondents themselves. The typical respondent was a registered dietitian (RD) with at least a 4-year degree from an accredited dietetics program. A wide variety of practice areas and employment settings were represented (Figure 1), with more than a dozen different responses in each category, providing information from a broad cross-section of the dietetics profession.
Figure 1.
Practice areas and employment setting of respondents to the American Dietetic Association Environmental Scan on Restaurant Menu Labeling survey.
The vast majority of respondents (85%) were involved in nutrition education of clients or the public, and approximately two thirds were specifically involved in educating the public about point-of-purchase calorie labeling or other menu nutrition information in restaurants. Seven percent of respondents currently worked with restaurants to provide menu nutrition information to the public, and of those, the majority of them used a database to analyze nutrients, whereas less than 15% conducted laboratory analysis. Most of those surveyed reported a moderate or higher skill level in using nutrition assessment or nutrient analysis software, with a wide variety of different software programs used (Figure 2).
Figure 2.
Nutrition assessment/nutrient analysis software used by respondents to the American Dietetic Association Environmental Scan on Restaurant Menu Labeling survey. Manufacturer locations: ESHA Research (Salem, OR). CBORD (Ithaca, NY). Computrition (Chatsworth, CA). Compu-Cal (Olympia, WA). Dietary Software, Inc (Jacksonville, FL). DietBook LLC (Loveland, OH). GeriMenu (CBORD; Ithaca, NY). NutriBase (CyberSoft, Inc; Phoenix, AZ). Nutrition-Toolbox (Nutrition Software Solutions; Mount Airy, MD). Nutrition and Diagnosis-Related Care (Skyscape; Marlborough, MA). DietMaster (Lifestyles Technologies, Inc; Valencia, CA). SureQuest Systems (Carrollton, TX).
Because Section 4205 of the Patient Protection and Affordable Health Care Act states that nutrition analysis may be performed by software rather than in a laboratory (2), selection and appropriate use of nutrition software will be an important skill for dietetics practitioners involved with menu labeling—and because there is such a broad spectrum of software designed for different specific needs, the Environmental Scan identified this as an area in which further education of ADA membership was warranted, resulting in a Journal article providing guidance to practitioners on how to select the software program best suited to their specific professional needs (3).
Awareness and Opinions
After collecting demographic information from the respondents, the survey assessed their awareness and knowledge of restaurant menu labeling legislation and solicited their opinions on a variety of related issue. When questioned about their familiarity with the new legislation mandating that restaurants provide calorie information at the point of purchase, nearly three quarters of the members surveyed rated their knowledge as moderate or below, with only 7% professing a high familiarity with the new law. A more specific question about different aspects of the legislation revealed that while 90% of respondents were aware of the basic mandate requiring restaurant chains with more than 20 establishments to provided point-of-purchase calorie information, fewer than 50% were aware of several other key details regarding regulation and implementation (Figure 3). Addressing this knowledge gap was a top priority of the Environmental Scan, and in response, the Journal commissioned and published “A National Approach to Restaurant Menu Labeling: The Patient Protection and Affordable Health Care Act, Section 4205,” an article detailing the origins of the legislation, ADA's involvement, the specifics of the new law, and analysis of its impact on restaurants, consumers, and the dietetics profession (1).
Figure 3.
Awareness of specific aspects of Section 4205 of the Patient Protection and Affordable Health Care reported by respondents to the American Dietetic Association Environmental Scan on Restaurant Menu Labeling survey.
Personal Experience
At the time of the survey, only 14% of respondents were currently living in a community that had mandatory point-of-purchase calorie labeling in restaurants, so direct experience of its effect was limited. However, those who did have personal experience with point-of-purchase calorie information were asked how much of an effect it had on their ordering habits. More than a quarter of them indicated that it had a substantial effect (the highest rating choice available), and overall, over 75% of these respondents felt that having access to nutrition information had at least a moderate effect on their ordering and eating behavior. This is an interesting result, as many studies have previously reported that calorie information at the point of purchase had little or no effect on consumer food purchasing decisions (1). Of course, dietetics practitioners are hardly typical consumers when it comes to food, because their education and training allows them to understand the information presented and effectively apply it to their food choices when dining out. As food and nutrition experts, imparting this knowledge and ability to the public will be the major challenge in making point-of-purchase nutrition information a meaningful tool for improving public health, rather than just another dimly understood and easily ignored piece of dietary guidance.
Accuracy of Nutrition Information
A recent report on the accuracy of calorie counts at quick-serve and sit-down restaurants found that those establishments underreported calories by an average of 18% (4), so the accuracy of posted nutrition information has become a concern. Those with personal experience with point-of-purchase calorie information were also asked whether they believed that the nutrition information provided was generally accurate, and more than 90% believed it was accurate sometimes or most of the time. A follow-up question was posed to the 8% of respondents who thought the information was inaccurate more often than not, asking how common they believed errors to be, and why. Among the hundreds of responses to this open-ended question, there was general agreement that nutrient calculation is by its nature an inexact science, and several distinct themes emerged in respondents' explanation of why that is. One popular explanation for possible inaccuracies was the inconsistency in the size of food portions compared to the reference portions used to calculate calories and other nutrient information. One respondent commented: “I used to work in a restaurant, so I know that, in many cases, there was not an emphasis on standardized portions. I hear this from others in the industry as well. I also hear from foodservice staff that there is not always standardization in how food is prepped.”
Speculation that recipes are either not standardized or not strictly adhered to was another common theme. “As an RD who has worked in research and analyzing restaurant menus, I understand how difficult it is to achieve not only accuracy in choosing the ingredients from the nutrient analysis database, but also in standardization of recipes,” remarked one respondent. “Various locations may purchase varying ingredients and different cooks may alter production slightly. Even if all menu items were to be analyzed in the lab, there are still seasonal and locational variations, especially in micronutrients.” Respondents also mentioned that condiments such as ketchup, salad dressing, and salt that are typically added at the table are not included in recipes and, therefore, are not factored into the calorie totals shown at the point of purchase.
In a broader sense, variability in both portion sizes and recipes is the result of human error, which was another frequently mentioned cause of divergence between posted information and actual calorie and nutrient values in a given dish. Several respondents shared their belief that errors were not intentional, but simply the result of human variability, as it is impossible for people to consistently reproduce the level of accuracy of machines. A different type of operator-introduced error that was mentioned was the possibility that untrained individuals such as chefs, owners, or restaurant managers attempted to determine nutrient values themselves, increasing the likelihood of miscalculation. As one respondent said, quite simply, “Nothing that involves people is 100%.”
These responses helped bring to light two significant issues in the Environmental Scan. First, the public must be able to trust the nutrition information that restaurants provide. Second, consumers need to understand that a certain amount of variability is inevitable in even the best nutrient calculations, and that they must interpret posted values accordingly. In response to these challenges, the Journal published articles that analyzed both sides of the restaurant–consumer relationship and identified strategies for dietetics practitioners to use when working with both foodservice providers and clients. A feature on Building a Healthier Chicago's FIT City program provided an example of how dietetics practitioners can collaborate with restaurateurs to promote healthy eating behaviors (5), while another article focused on how dietetics practitioners can enhance the public understanding of how to interpret posted nutrient values and use that information to make informed choices (6).
Opportunities and Challenges
Restaurant Response
Approximately two thirds of all respondents predicted that restaurants would respond to menu labeling legislation and consumer curiosity about it by offering menu items with an improved nutrition profile. Respondents also overwhelmingly favored voluntary disclosure for restaurants with 20 or fewer establishments not included in the new legislation. Even though they have no legal obligation to do so, many individual restaurants and smaller chains may choose to register with the US Food and Drug Administration because doing so means they would “no longer be subject to any state or local nutrition labeling requirements unless those requirements are identical to federal requirements” (7). They may also want to conform to the standards set by their larger competitors in order to present an image of responsible professionalism to their customers, especially as consumers gradually become accustomed to point-of-purchase nutrition information and learn to expect and rely on it. In fact, 70% of respondents believed teaching consumers to ask for nutrition information was the best way to encourage voluntary disclosure by restaurants not subject to menu labeling legislation. Educating restaurant owners and managers about the benefits of disclosing nutrition information, as in the FIT City program, was the second most popular response at more than 60%.
Consumer Knowledge
Some studies of have suggested that consumers either won't pay attention to calorie information or won't understand how to apply it correctly (8, 9), while others believe that menu labeling would affect the decisions of enough people to create a public health benefit (10). In general, survey respondents were optimistic about the public's ability to use restaurant menu labels, with more than three quarters believing that some or most consumers would be able to knowledgably apply point-of-purchase nutrition information to their food purchasing decisions. And more than 90% thought consumers would make at least somewhat better food choices due to the new labels. Even among those who were less confident in consumers' ability to use menu labels, nearly 80% believed that public education efforts providing consumers with information about daily calorie and nutrient needs, portion sizes, and other nutrition information would help them.
This optimism is encouraging as dietetics practitioners prepare to face the challenges that educating both foodservice providers and the public will present. When asked about the opportunities restaurant menu labeling legislation could present for dietetics practitioners, respondents were bullish, with more than 50% seeing potential in all six choices provided (Figure 4).
Figure 4.
Areas of professional opportunity created by restaurant menu labeling legislation as ranked by respondents to the American Dietetic Association Environmental Scan on Restaurant Menu Labeling survey.
The 2010 American Dietetic Association Environmental Scan on Restaurant Menu Labeling has identified, evaluated, and prioritized the key issues practitioners will confront, and the ADA is developing the resources members will need in order to seize the many professional opportunities this new legislation will provide. The rest is up to you.
References
- . A national approach to restaurant menu labeling: The Patient Protection and Affordable Care Health Care Act, Section 4205. J Am Diet Assoc. 2010;110:1280–1289
- . Draft Guidance for Industry: Questions and answers regarding implementation of the menu labeling provisions of Section 4205 of the Patient Protection and Affordable Care Act of 2010. http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/FoodLabelingNutrition/ucm223266.htmAccessed August 25, 2010
- . It all adds up: Nutrition analysis software can open the door to professional opportunities. J Am Diet Assoc. 2011;111:214–218
- . Coming to the menu: Calorie counts (The Wall Street Journal). http://online.wsj.com/article/SB10001424052748704211704575140171439748274.htmlAccessed May 1, 2010
- . Making wellness delicious: Building a Healthier Chicago's FIT City program. J Am Diet Assoc. 2010;110:1620–1625
- . Nutrition beyond the numbers: Counseling clients on nutrient value interpretation. J Am Diet Assoc. 2010;110:1800–1803
- . CSFAN Constituent Update: FDA releases details on how retail food establishments and vending machine operators with fewer than 20 locations can choose to become subject to the new federal menu labeling requirements. http://www.fda.gov/Food/NewsEvents/ConstituentUpdates/ucm219124.htmAccessed August 2, 2010
- . Consumers may not use or understand calorie labeling in restaurants. J Am Diet Assoc. 2006;106:917–920
- . Task Force Report on Restaurant Nutrition Labeling Research. http://www.eatright.org/Members/content.aspx?id=11331Accessed April 27, 2010
- . Calorie data to be posted at most chainsNew York Times. http://www.nytimes.com/2010/03/24/business/24menu.htmlMarch 23, 2010;Accessed April 29, 2010
This article was written by Ryan Lipscomb, editor at the Journal, Chicago, IL.
PII: S0002-8223(11)00231-8
doi:10.1016/j.jada.2011.02.023
© 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.
Volume 111, Issue 4 , Pages 511-516, April 2011
