Research
Original Research
Energy, Saturated Fat, and Sodium Were Lower in Entrées at Chain Restaurants at 18 Months Compared with 6 Months Following the Implementation of Mandatory Menu Labeling Regulation in King County, Washington

https://doi.org/10.1016/j.jand.2012.04.019Get rights and content

Abstract

Background

Policies on menu labeling have been proposed as a method to improve the food environment. However, there is little information on the nutrient content of chain restaurant menu items and changes over time.

Objective

To evaluate the energy, saturated fat, and sodium content of entrées 6 and 18 months post-implementation of restaurant menu labeling in King County of Washington State for items that were on the menu at both time periods, and across all items at 6 and 18 months and to compare energy content to recommendations provided by the 2005 Dietary Guidelines for Americans.

Setting

Eligible restaurants included sit-down and quick-service chains (eg, burgers, pizza, sandwiches/subs, and Tex-Mex) subject to King County regulations with four or more establishments. One establishment per chain was audited at each time period.

Statistical analyses

Hypothesis one examined entrées that were on the menu at both time periods using a paired t test and hypothesis two compared quartiles at 6 months to the distribution at 18 months using a Mantel-Haentzel odds ratios and 95% CIs, and a Cochrane-Armitage test for trend. The content of entrées at 18 months was compared with one-third (assuming three meals per day) of the nutrient intake recommendations for adults provided by the 2005 Dietary Guidelines for Americans.

Results

The audit included 37 eligible chains of 92 regulated chains. Energy contents were lower (all chains −41, sit down −73, and quick service −19; paired t tests P<0.0001) for entrées that were on the menu at both time periods. There was a significant trend across quartiles for a decrease in energy, saturated fat, and sodium for all entrées at sit-down chains only. At 18 months entrées not designated for children exceeded 56%, 77%, and 89% of the energy, saturated fat, and sodium guidelines, respectively.

Conclusions

Modest improvements in the nutrient content of sit-down and quick-service restaurant entrées occurred but overall levels for energy, saturated fat, and sodium are excessive.

Section snippets

Study Design

We compared entrée items available at one establishment of eligible national restaurant chains at two time periods (6 months and 18 months) following the implementation of mandatory menu labeling at the point of purchase. This research was exempt from Institutional Review Board review.

Study Sample

The study sample was limited to chain restaurants that were subject to the King County Board of Health restaurant menu labeling regulation implemented January 1, 2009, and amended May 2010.26 The regulations

Results

The audit included 37 chains. There were 11 SD chains and 26 QS chains (ie, 6 burger, 9 pizza, 6 sandwich/sub, and 5 Tex-Mex). Across both time periods there were 3941 menu items that included 2,300 entrées, 155 appetizers, 491 beverages, 329 desserts, 494 sides, and 172 condiments/add-ons. There were 932 entrées at SD chains and 1,368 at QS (22% of these entrées were available at burger chains, 24% at pizza, 29% at sandwich/sub, and 24% at Tex-Mex). Very few entrées were labeled by a chain as

Discussion

Our study examined the energy, saturated fat, and sodium provided by entrées and combination meals at national chain restaurants subject to menu labeling regulation soon after the implementation of the regulation. There was evidence of a decrease in energy, saturated fat, and sodium content between the two study periods following implementation of menu regulation for menu items that were present at both time periods with the exception of menu items at pizza chains. These changes in the same

Acknowledgements

The authors thank Meghan Lyle MPH, RD; Marlana Kohn, MPH; and Lisa Higgins, MPH, RD for their assistance with data collection, and Chuan Zhou, PhD, for his assistance with statistical analysis. The authors also thank the Center for Public Health Nutrition at the University of Washington.

B. Bruemmer is a senior lecturer emeritus, Program in Nutritional Sciences, School of Public Health, University of Washington, Seattle.

References (28)

  • J.L. Pomeranz

    The unique authority of state and local health departments to address obesity

    Am J Public Health

    (2011)
  • J.L. Pomeranz et al.

    Legal and public health considerations affecting the success, reach, and impact of menu-labeling laws

    Am J Public Health

    (2008)
  • B. Anderson et al.

    Fast-food consumption and obesity among Michigan adults

    Prev Chronic Dis

    (2011)
  • S.A. French et al.

    Fast food restaurant use among women in the Pound of Prevention study: Dietary, behavioral and demographic correlates

    Int J Obes Relat Metab Disord

    (2000)
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    B. Bruemmer is a senior lecturer emeritus, Program in Nutritional Sciences, School of Public Health, University of Washington, Seattle.

    J. Krieger is chief, Epidemiology and Planning Unit, Chronic Disease and Injury Prevention Department, Public Health-Seattle and King County, Seattle, WA.

    N. Chan is assistant chief, Assessment Policy Development, and Evaluation Department, Public Health-Seattle and King County, Seattle, WA.

    B. E. Saelens is an associate professor of child health, behavior, and development, Department of Pediatrics, Seattle Children's Research Institute, Seattle, WA.

    FUNDING/SUPPORT This project was supported by grant nos. 67291 and 65233 from Healthy Eating Research program of the Robert Wood Johnson Foundation.

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

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