1. Elena Serrano, PhD Associate Professor, Extension Specialist Human Nutrition, Foods, & Exercise Virginia Tech MENU LABELING: FROM RESTAURANTS TO THE BOTTOM LINE Weight of the State April 11, 2013

2.  Overview of menu labeling  Significance of menu labeling for public health and obesity prevention…the bottom line  FDA Guidance THE MENU FOR THIS SESSION

3.  Americans are eating away from home more frequently. Nearly 57% of Americans eat away from home on a given day (including childcare centers, schools)  In 1999–2000, 41% of US adults reported eating away-from-home foods at least weekly  In 2002: Nearly 50% of Americans’ food expenditures went toward away-from-home food facilities  In 1960: 25%  Restaurant-industry sales alone are $1.6 billion on a typical day in 2010  49% of the food dollar EATING AWAY FROM HOME (USDA, 2000; Bowman, 2004, National Restaurant Association, 2010)

4.  25% of adults and 30% of children 4–19 years old reported eating fast food at least daily  Daily energy intake provided by foods for children and adolescents from fast-food outlets alone rose from 6.5% in 1977-1978 to 19.3% in 1994-1996  In Virginia 73% of youth eat food from a fast food restaurant at least once a week EATING AT FAST FOOD RESTAURANTS (Bowman, 2004, Virginia Foundation for Healthy Youth, 2010)

5.  Several studies have shown strong associations between frequency of eating away from home, particularly fast food restaurants, and:  total calories  fat  saturated fat  fruit and vegetables  milk  negative metabolic outcomes  weight status DIET, HEALTH, AND EATING AWAY FROM HOME (Lin 1999; Paeratakul, Ferdinand et al. 2003; Bowman, Gortmaker et al. 2004; Duffey, Gordon ‐ Larsen et al. 2007 and 2009)

6. A total of 50% of the top 50 restaurants offer menus or meals targeted to children Parents report ordering children’s meals most often at the leading fast food restaurants for their children, especially if they had younger children KIDS MEALS (Serrano and Jedda, 2009; Brownell & co- workers, 2010)

7.  Most consumers underestimate the amount of calories and fat in foods, especially away from home and super-sized items  Most consumers WANT nutrition information  Yet only 6 (0.1%) of 4,311 patrons accessed on- premises nutrition information before purchasing food at McDonald's, Burger King, Starbucks, and Au Bon Pain MAKING HEALTHY CHOICES AT RESTAURANTS (Johnson, Corrigan et al. 1990; Burton, Creyer et al. 2006; Chandon 2007; Wansink, 2007)

8. 73% of adults reported that in the last two years they have tried to eat healthier at restaurants. Nutritious children’s menus is one of the top trends TRENDS

9.  Until mandated menu labeling legislation, menu labeling was limited, but promising, producing more positive than equivocal results, especially for adults who want to make healthier choices (i.e. limit calories) and at restaurants that are full-service:  Young women  Older individuals concerned about chronic disease  NOT fast food MENU LABELING (Milich, Anderson et al. 1976; Cinciripini 1984; Dubbert, Johnson et al. 1984; Davis ‐ Chervin D 1985; Mayer, Heins et al. 1986; Schmitz M 1986; Forster ‐ Coull L 1988; Albright, Flora et al. 1990; Anderson J 1990; Balfour D 1996; Eldridge A 1997; Bassett, Dumanovsky et al. 2008; Driskell, Schake et al. 2008; Aaron J 1995; Fitch, et al., 2009; Harnack, French et al. 2008)

10. Menu labeling = Nutrition labeling on menus = point of selection = point of purchase MENU LABELING HAS EMERGED AS A POINT-OF-PURCHASE, PUBLIC HEALTH STRATEGY TO PROMOTE HEALTHIER EATING AWAY FROM HOME….AND IDEALLY OBESITY REDUCTION

11.  NYC (2006): Required restaurants with 15 or more locations to list calorie information in a prominent location MENU LABELING (CSPI, 2011)

12. Restaurant establishments with 20 or more locations nationwide (or those that voluntarily) post “the number of calories contained in the standard menu item, as usually prepared and offered for sale” “in a clear and conspicuous manner,” and with “a succinct statement concerning suggested daily caloric intake.” CURRENT NATIONAL LEGISLATION (Section 4205 of the Patient Protection and Affordable Care Act of 2010 ) Also vending machines

13. THE BILL WAS TO GO INTO EFFECT JANUARY 1, 2011. SOME ESTABLISHMENTS ARE ALREADY POSTING INFORMATION, BUT THE RULE-MAKING PROCESS IS NOT FINALIZED. FDA IS IN THE FINAL STAGES OF WRITING THE MENU LABELING REGULATIONS…THE FINAL RULES SHOULD COME OUT IN THE “RELATIVE NEAR TERM”

14.  Restaurant or similar retail food establishments:  “the establishment presents itself as a restaurant”  “greater than 50 percent of the establishment's total floor area is used for the sale of food”  May or may not include convenience stores, restaurants at grocery stores and hotels  Movie theaters, airplanes, bowling alleys, and other establishments whose primary purpose is not food-related do not need to comply  Others can “opt in” to the federal menu labeling requirements by registering with the FDA every other year WHO WILL IT IMPACT? Who is included in this?

15.  Calories need to be disclosed on menus  “Calories” or “Cal” next to number of calories  Combo meals (burger, side item, and beverage) and different flavors or varieties of menu items (vanilla versus pumpkin spice latte) would include ranges  Daily caloric intake recommendations:  Proposed: “A 2,000 calorie diet is used as the basis for general nutrition advice; however, individual calorie needs may vary.”  Alcohol is exempt WHAT INFORMATION WILL BE PROVIDED?

16.  Certain food items will NOT be subject to disclosure requirements:  Items not listed on a menu or menu board (i.e. ketchup).  Daily specials  Test items (fewer than 60 days – like McRib)  Custom orders  Additional nutrition information for standard menu items must be available to consumers, including:  total calories, calories from fat, total fat, saturated fat, cholesterol, trans fat, sodium, total carbohydrates, sugars, dietary fiber and protein WHAT INFORMATION WILL BE PROVIDED?

17. WHAT ITEMS WILL BE LABELED?  To be determined:  Guidelines for analysis of calorie content  Considering methods of preparation, variation in serving size  Definitions for: variable menu items, foods on display, self- service, custom order, daily special, temporary menu item, food that is part of a customary market test  Format (font size, final nutrient info., considering space on menus and menu boards)  Currently proposed as displayed “clearly and prominently”

18.  Will a national menu labeling mandate change food purchases and help lower obesity rates?  Will it help shape and change our social and cultural norms toward foods sold at restaurants?  How does it influence what is offered at restaurants, along with sales? FOR DESSERT….

19.  FDA’s Guidelines on Menu Labeling: http://www.fda.gov/Food/IngredientsPackagingLabe ling/LabelingNutrition/ucm217762.htm  Virginia Cooperative Extension: http://www.ext.vt.edu National Restaurant Association: http://www.restaurant.org/ RESOURCES

20. THANK YOU!