Menu labelling for reducing energy ordered and consumed: What’s the evidence?

Welcome!
Menu labelling for reducing
energy ordered and
consumed: What's the
evidence?
You will be placed on hold until the webinar begins.
The webinar will begin shortly, please remain on the line.

Poll Questions: Consent
• Participation in the webinar poll questions is voluntary
• Names are not recorded and persons will not be identified in any way
• Participation in the anonymous polling questions is accepted as an
indication of your consent to participate
Benefits:
• Results inform improvement of the current and future webinars
• Enable engagement; stimulate discussion. This session is intended for
professional development. Some data may be used for program evaluation
and research purposes (e.g., exploring opinion change)
• Results may also be used to inform the production of systematic reviews
and overviews
Risks: None beyond day-to-day living

After Today
• The PowerPoint presentation and audio
recording will be made available
• These resources are available at:
– PowerPoint:
http://www.slideshare.net/HealthEvidence
– Audio Recording:
https://www.youtube.com/user/healthevidence
/videos

What’s the evidence?
Littlewood J, Lourenço S, Iversen C, &
Hansen G. (2016). Menu labelling is effective
in reducing energy ordered and consumed: A
systematic review and meta-analysis of
recent studies. Public Health
Nutrition, 19(12), 2106-2121.
http://healthevidence.org/view-article.aspx?a=menu-
labelling-effective-reducing-energy-ordered-consumed-
systematic-review-meta-29695

• Use CHAT to post comments /
questions during the webinar
– ‘Send’ questions to All (not
privately to ‘Host’)
• Connection issues
– Recommend using a wired
Internet connection (vs.
wireless)
• WebEx 24/7 help line
– 1-866-229-3239
Participant Side Panel in WebEx
Housekeeping

Housekeeping (cont’d)
• Audio
– Listen through your speakers
– Go to ‘Communicate > Audio Broadcast’
• WebEx 24/7 help line
– 1-866-229-3239

Poll Question #1
How many people are watching
today’s session with you?
A. Just me
B. 2-3
C. 4-5
D. 6-10
E. >10

The Health Evidence™ Team
Maureen Dobbins
Scientific Director
Heather Husson
Manager
Susannah Watson
Project Coordinator
Students:
Emily Belita
(PhD candidate)
Jennifer Yost
Assistant Professor
Olivia Marquez
Research Coordinator
Emily Sully
Research Assistant
Liz Kamler
Research Assistant
Zhi (Vivian) Chen
Research Assistant
Research Assistants:
Lina Sherazy
Claire Howarth
Rawan Farran

What is www.healthevidence.org?
Evidence
Decision
Making
inform

Why use www.healthevidence.org?
1. Saves you time
2. Relevant & current evidence
3. Transparent process
4. Supports for EIDM available
5. Easy to use

A Model for Evidence-
Informed Decision Making
National Collaborating Centre for Methods and Tools. (revised 2012). A
Model for Evidence-Informed Decision-Making in Public Health (Fact
Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]

Stages in the process of
Evidence-Informed Public Health
National Collaborating Centre for Methods and Tools. Evidence-Informed
Public Health. [http://www.nccmt.ca/eiph/index-eng.html]

Poll Question #2
Have you heard of PICO(S) before?
A. Yes
B. No

Searchable Questions Think “PICOS”
1. Population (situation)
2. Intervention (exposure)
3. Comparison (other group)
4. Outcomes
5. Setting

How often do you use Systematic Reviews
to inform a program/services?
A. Always
B. Often
C. Sometimes
D. Never
E. I don’t know what a systematic review is
Poll Question #3

Menu labelling can reduce energy ordered
and consumed in the away-from-home
food environment
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
16
Poll Question #4

Jodie Anne
Littlewood
Bachelor in Global
Nutrition and Health,
Danish Cancer
Society
Sofia Lourenço
MSc, Senior Project
Manager, Danish
Cancer Society

Menu Labelling Review
Menu labelling is effective in reducing energy ordered and
consumed: A systematic review and meta-analysis of recent studies
Jodie Anne Littlewood
Sofia Lourenço
Cecilie Lauberg
Gitte Laub Hansen

Consequences of overweight
Cardiovascular
diseases
Musculoskeletal
diseases
Cancer
Mental
disorders
Type II
diabetes
BRAIN
BREAST
GALL BLADDER
PANCREAS
UTERUS
BLOOD
COLON &
RECTUM
KIDNEY
LIVER
ESOPHAGUS
THYROID

Overweight in Denmark
PERCENTAGE
YEAR
47%
70%

What is Menu Labeling?
Images: Pumpkin Loaf https://www.bostonglobe.com/lifestyle/2014/12/01/new-fda-rules-will-put-calorie-counts-menus/NcV6aDQYG73CswHGc3KGrM/story.html
Bagel meal: http://www.miradamedia.com/blog/en/tag/digital-menu-board
Menu: http://ottawa.ca/en/residents/public-health/healthy-living/nutrition/healthy-eating-programs-and-services/menu-labelling

Rationale for Menu Labelling
• Increased frequency of eating or ordering out
• People consume more calories when eating out
• People underestimate energy content when eating out
• Improves noticing of calorie information
• Facilitates ‘calorie-enlightenment’
• Enables consumers to exercise personal responsibility
and make informed food choices
• Dissuades up-sizing
• Encourages food reformulation
• Consumer demand

Increased frequency of eating out
24 hour trading has increased 50-100% in some major chains
https://www.wsj.com/articles/SB10001424127887324445904578286421615513846
🇺🇸
⅙ meals now prepared outside the home – contributing to ≈
20% of energy intake for women and 25% for men
Department of Health: https://responsibilitydeal.dh.gov.uk/pledges/pledge/?pl=8🇬🇧
number of fast food outlets doubled between 1992-2002
Magnusson 2010: http://www.biomedcentral.com/1471-2458/10/662
🇦🇺
⅓ of the food budget is spent on restaurant meals
Statistics Canada: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/famil132a-eng.htm
🇨🇦

People consume more calories
when eating out
~ 2000 calories from 3 home-cooked meals... a single fast food meal... or a single drink
Images: http://www.nytimes.com/interactive/2014/12/22/upshot/what-2000-calories-looks-like.html?abt=0002&abg=1

People
underestimate
the energy
content of
foods
prepared
outside the
home
CALORIES
Nando’s 899 Feta and Avocado Wrap
Grill’d 786
Garden Goodness Vege Burger in a
gluten free bun
KFC 565 Grilled Chicken Spicy Hot Twister
Starbucks 562 Green Tea Crème Frappuccino (24oz.)
McDonald’s 520 Caesar Salad with Crispy Chicken
Sumo Salad 508 Chicken Caesar Salad (regular)
Subway 480 6-inch Spicy Italian
Boost Juice 475 Green Tea Mango Mantra
Gloria Jean’s 446 Strawberry Fruzie (large)
https://www.nandosperiperi.com/eat/menu
https://www.grilld.com.au/menu/garden-goodness
https://www.kfc.com.au/menu/twisters/spicy-hot-twister
https://www.starbucks.com/menu/drinks/frappuccino-blended-beverages/tazo-green-tea-frappuccino-blended-cr%C3%A8me#size=11002682&milk=67&whip=125
http://www.mcdonalds.ca/ca/en/food/nutrition_centre.html#/
http://sumosalad.com/menu-category/made-to-order/
http://www.subway.com/en-us/menunutrition/menu/product?ProductId=4272&MenuCategoryId=1
https://www.boostjuice.com.au/wp-content/uploads/2017/02/Boost_Nutrition_Flyer.pdf
http://www.gloriajeanscoffees.com/Drink%20Menu%20-%20Nutritional%20and%20Ingredient%20Info.pdf

‘Calorie enlightenment’
Popcorn + soda + candy can be a day’s worth of calories… “if someone
is selling a 2000 calorie ‘snack’, the least they can do is tell you.”
Image and statement: https://www.youtube.com/watch?v=QifyoBvGt0k
= =
~ 1200 calories

Improves noticing of calorie
information
Image: http://www.economist.com/blogs/babbage/2011/07/menu-labelling

Dissuades
up-sizing
Difference:
540 calories
110 calories
190 calories
Upsizing total = 840 calories
Energy values calculated from: https://www.bk.com/pdfs/nutrition.pdf
Images: http://visual.ly/skinny-food-portion-sizes-portion-control-tips-prevent-weight-gain

Replacing fries and
soda in kids meals with
milk and apple can save
140 kcal
Allowing consumers to now choose
between a salad or fries in a meal
deal, can help them save 340 kcal
Introducing
grilled chicken,
reduced calories
per purchase by
6%
Reducing fat
content of
default milk to
2%, decreased
average
beverage
calories by 14%
Encourages food
reformulation

Consumer demand
70 - 81% depending on type of food
establishment
https://cspinet.org/new/201206041.html
81%
http://webarchive.nationalarchives.gov.uk/20120206100416/http://food.gov.uk/news/newsarchive/2008/jun/eatout
80%
https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/04809141-ab56-48f3-bcda-0c53d895431c.pdf
90% support ML in fast food restaurants
http://www.opha.on.ca/getmedia/ad9cb6f3-f165-4569-b2ee-734e75e1d740/OPHA-Position-Statement-on-Menu-
Labelling.pdf.aspx?ext=.pdf
66%
Aarup, L., Neilsen, E. & Pedersen T.S., 2013. Kalorier versus Joule : FDB/Coop.
Report provided by The Danish Cancer Society
80%
http://www.nielsen.com/us/en/insights/reports/2012/healthy-eating-trends-around-the-world.html
🇺🇸
🇬🇧
🇦🇺
🇨🇦
🇩
🇰🌎

Aim of the study
P General population (mostly adults)
I Exposure to ML
C Comparing to absence of ML
O Energy consumed, ordered or selected
ML noticing
S Real-world & Experimental settings
Update the most recent evidence (studies published between 2012-2014):
• Differences in energy consumed, ordered or selected
• Compare real-world and experimental settings
• Importance of noticing ML and ML format

Inclusion criteria
• Peer-reviewed articles
• Full text
• In English
• Primary studies
• Reported the effects of ML, measured by
differences in energy consumed, ordered or
selected
• Published after 1 January 2012

Literature search results
Energy ordered n = 6
(menu items purchased)
Energy selected n = 6
(hypothetical choice)
Energy consumed n = 6
(actual portion eaten)
141 articles identified
15 articles retrieved for
full-text review
0 identified from related
citations or personal
correspondence
126 excluded based on title and abstract
•Non-relevant (n = 67)
•Reported only effects of restaurant
environment (n = 10)
•Qualitative studies or did not measure
behaviour change in kcal (n = 24)
•Vending machines (n = 1)
•Not primary studies (reviews or
commentaries) (n = 11)
•Duplicates (n = 13)

Data extraction & synthesis
Systematic across-study comparisons based on:
• Year & authors
• Country
• Aim
• Study design
• Sampling
• Setting
• Type of outcome reported (energy consumed, ordered or selected;
nutrients; interpretative guidance; meal type; ML noticing rate)
• Covariates
• Results
• Limitations of study design

Study characteristics & quality
17,859
participants

Reductions in energy
consumed, ordered or selected
Outcome
measured
✔ ? ✗
E Consumed
(n=3) ✔✔ ✔
E Ordered
(n=6) ✔ ✔ ✔ ? ? ✗
E Selected
(n=6) ✔ ✔ ✔ ? ✗ ✗
✔ Significant energy reduction
? Significant energy reductions in some groups
✗Non-significant or no energy reduction

The effects of ML in various settings
Food establishment
type
Real-world setting
(n=7)
Experimental setting
(n=8)
Fast food
(n=8)
✔ ✗ ✔ ✔ ✔ ✔ ✗ ✗
Table service
restaurants
(n=4)
✔ ✔ ? (depending on ML
format)
? (depending on ML
format)
Café/coffee chain
(n=1)
? (ML was effective in
coffee chains but not food
chains)
Cafeteria
(n=1)
✔
Snack
(n=1)
✔
✔ Significant energy reduction
? Significant energy reductions in some groups
✗Non-significant or no energy reduction

Significant energy reductions
not likely when <70% of
participants noticed
Significant energy
reductions likely
when ≥70% noticed ML
20%
40%
60%
80%
100%
70%
The effects of noticing ML

ML format - Interpretative
guidance
No information Calories only
Calorie Traffic light Multi-Traffic light
[None]
CALORIES
480
CALORIES
480
MED
CALORIES
480
MED
FAT
23 (g)
HIGH
SUGAR
6 (g)
LOW
SODIUM
1220 (mg)
HIGH
Hammond et al. 2013: http://www.sciencedirect.com/science/article/pii/S0091743513003666

ML format – Interpretative
guidance
Dowray et al. 2013: http://www.sciencedirect.com/science/article/pii/S0195666312004655

ML format – Contextual
guidance
Menu: http://ottawa.ca/en/residents/public-health/healthy-living/nutrition/healthy-eating-programs-and-services/menu-labelling

Sociodemographic aspects
Variances in:
• BMI,
• Ethnicity,
• Age or
• Socio-economic status
had any particular influence on the
effectiveness of ML.

Meta-analysis
12 out of 15 studies used for a meta-analysis:
• Stratified by type of outcome – energy consumed, ordered or
selected
• Comparisons limited to controls (no labels) vs. energy-labels
alone
• Random-effects meta-analysis
• Publication bias was assessed with funnel plots and Egger’s
test
• The I2 statistic was used to quantify the effect of
heterogeneity

Meta-analysis findings
Mean reduction = -419.5 kJ / 100.2 cal (P<0.0001)
95% CI [-613.25; -225.76 kJ]

95% CI [-508.6; -142.7 kJ]

95% CI [-453.14; -173.19 kJ]

95% CI [-343.66; -59.76 kJ]

Strengths & limitations
Strengths:
• Meta-analysis results – ML is effective
• Focus on studies from 2012 – 2014
• Quality rating reflects differences between real-world and
experimental settings
Limitations:
• Methodological shortcomings of the included studies
• Meta-analysis include few studies
• Publication bias tests are underpowered – it might not have been
detected

Conclusion
• ML is effective in reducing energy ordered and
consumed, in real-world settings
• ML is effective in various types of food-service outlets,
positively affecting a large proportion of the population
• Prominent and noticeable labeling of all menu items,
with reference values, is important
• ML is essential for consumers to make informed food
choices
• ML is an important overweight and obesity prevention
tool

Menu labelling can reduce energy
ordered and consumed in the away-
from-home food environment
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
Poll Question #5

Poll Question #6
The information presented today was
helpful
A.Strongly agree
B.Agree
C.Neutral
D.Disagree
E.Strongly disagree

What can I do now?
Visit the website; a repository of over 5,000+ quality-rated systematic reviews
related to the effectiveness of public health interventions. Health Evidence™ is
FREE to use.
Register to receive monthly tailored registry updates AND monthly newsletter to
keep you up to date on upcoming events and public health news.
Tell your colleagues about Health Evidence™: helping you use best evidence to
inform public health practice, program planning, and policy decisions!
Follow us @HealthEvidence on Twitter and receive daily public health review-
related Tweets, receive information about our monthly webinars, as well as
announcements and events relevant to public health.
Encourage your organization to use Health Evidence™ to search for and apply
quality-rated review level evidence to inform program planning and policy
decisions.
Contact us to suggest topics or provide feedback.
info@healthevidence.org

Poll Question #7
What are your next steps? [Check all
that apply]
A. Access the full text systematic review
B. Access the quality assessment for the
review on www.healthevidence.org
C. Consider using the evidence
D. Tell a colleague about the evidence

Thank you!
Contact us:
info@healthevidence.org
For a copy of the presentation please visit:
http://www.healthevidence.org/webinars.aspx

Menu labelling for reducing energy ordered and consumed: What’s the evidence?

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Semelhante a Menu labelling for reducing energy ordered and consumed: What’s the evidence?

Semelhante a Menu labelling for reducing energy ordered and consumed: What’s the evidence? (20)

Mais de Health Evidence™

Mais de Health Evidence™ (13)

Último

Último (20)

Menu labelling for reducing energy ordered and consumed: What’s the evidence?