1. Christina A. Roberto, Ph.D. Departments of Social & Behavioral Sciences and Nutrition Designing Nutrition Labels

2. Simple, Salient, Meaningful Nutrition Labels –Restaurant menu labeling –Front-of-package labeling

3. Menu Labeling

4. Menu Labeling Rationale 1.People eat out a lot 2.People don’t know the calories in restaurant food 3.If they did, they’d make lower calorie choices (at least some of the time) See review Roberto et al. Am J Prev Med, 2009

5. But nutrition information is already available?  Research study - counted people at Roberto et al. Am J Public Health, 2009

6. Out of 4,311 how many looked at nutrition information? 6

7. Menu Labeling Rationale 1.People don’t know the calories in restaurant food 1.If they did, they’d make lower calorie choices (at least some of the time)

8. Test Menu Labeling’s Impact on Behavior in the Lab Roberto et al, Am J Public Health, 2010

9. Menu Labeling in a Restaurant Lab  303 adults for market research study  Randomized to 1 of 3 menus  Focus group, ordered & ate food, dietary recall Roberto et al, Am J Public Health, 2010

10. Menu Without Calorie Labels

11. Menu with Calorie Labels

12. Menu with Calorie Labels + Daily Calorie Info The recommended daily caloric intake for an average adult is 2000 calories

13. Calories Ordered for Dinner Calories

14. Calories Eaten At Dinner Calories

15. Calories Eaten After Dinner Calories

16. Dinner + After Dinner Calories Eaten Calories

17. Summary  Calorie labels led to fewer calories:  Ordered  Eaten  With just calories people ate more later  Putting calories in context led to avg reduction of 250 calories

18. U.S. Patient Protection & Affordable Care Act SEC. 4205. NUTRITION LABELING OF STANDARD MENU ITEMS AT CHAIN RESTAURANTS  Number of calories  Statement about daily caloric intake

20. Product Reformulation

21. Front-of-Package Nutrition Labeling

23. Smart Choices Program

24. What Were Some of the Smart Choices Products?

25. August 2009 FDA “We are Watching” Letter

26. Media Suspicion NY Times Article Sept 2009

27. How Smart Were Smart Choices?  Randomly sampled from 8 packaged food categories on Smart Choices Website  Nutrition info for 100 products  Classified products as “healthy” based on Nutrient Profile Model  Validated & informed policy in UK & Australia Roberto et al. Pub Health Nutr, 2011

28. 64% of Smart Choices Products Did Not Meet Objective Nutrition Score for “Healthy” Results

30. Smart Choices Under Scrutiny Attorney General Gets Involved Oct 2009

32. –Institute of Medicine Released First Report –Working on Second Report –Food industry releases Facts Up Front In the meantime…

33. Not Simple, Salient, or Meaningful

35. Cautionary Tale of Industry Self-Regulation for Front-of-Package Labeling

37. Greens Mean Go Red Means Stop

38. Hospital Cafeteria in Boston  Over 6,000 employees and visitors per day  All register data for 9 months, ~3 million items  Traffic lights + choice architecture for beverages “Consume often” “Consume less often” “There’s a better choice in green or yellow” Thorndike et al., Am J Public Health, 2012

39. Sales of all cafeteria items during Baseline and Labeling % of total cafeteria sales

40. Cold beverage sales Baseline vs Labeling % of cold beverage sales

41. IOM Proposed Label

43. Simple, Salient, Meaningful Nutrition Labels –Restaurant menu labeling –Front-of-package labels –Nutrition facts labels on packaged foods

44. Christina A. Roberto, PhD croberto@hsph.harvard.edu www.peachlab.org @RobertoCA