A randomized-controlled evaluation of the effects of non-nutrition menu labels on dietary quality

Johns Hopkins University, Baltimore MD

Investigators

Abstract

Poor dietary quality and high rates of diet-related chronic diseases such as type-2 diabetes are urgent national public health priorities. Strategies to effectively shift dietary patterns in the United States (US) toward healthy diets are urgently needed to improve dietary quality and prevent diet-related chronic diseases. Fast-food restaurants are a key environment to promote healthier food choices given the frequency of fast-food consumption, the poor dietary quality of fast foods, and their adverse health effects. Numerous restaurants and food companies use non-nutrition labels that communicate to consumers about qualities of menu items (e.g. grown in the USA, local, gluten-free, pesticide-free). Such menu labels are also garnering interest among policymakers. Existing research shows that nutrition labels can change behavior, but we lack evidence on whether other labels can promote healthier food choices as well. Non-nutrition labels could improve dietary quality via lower red and processed meat intake, but could also promote undeserved perceptions that unhealthy food items are healthy (i.e., a ‘health-halo’ effect). Given the rapid development and growing food industry and policy interest in non-nutrition labels, there is a critical need for timely, rigorous evaluation of the real-world effects of such labels and the optimal design to maximize behavior change. The primary objective of this application is to conduct two sequential randomized controlled trials (RCTs) to determine the degree to which menu non-nutrition labels influence the healthfulness of purchases at fast-food restaurants and overall dietary intake. The first study aim is to conduct an RCT to compare the effects of different menu label designs on the healthfulness of hypothetical fast-food meal orders in a nationally representative sample of 6,000 US adults. We will randomly assign 6,000 adults to view menus from two fast-food restaurants (one burger, one sandwich) that display one of five types of label designs: 1) control (QR code); 2) green, positively framed label; 3) red, negatively framed ‘warning’ label; 4) grade label and 5) traffic-light label. The second aim is to conduct an RCT to evaluate the effect of repeated exposure to menu labels on the healthfulness of real fast- food meal orders, delivered to the participant, over an eight-week period. We will randomly assign 450 adults to one of two label conditions: control label vs. the label from Aim 1 that led to the largest improvements in the healthfulness of menu items ordered. In the third aim, we will evaluate the longitudinal effect of menu labels on overall dietary quality (Healthy Eating Index scores) assessed via multiple 24-hour dietary recalls. Results will provide policy relevant evidence to identify how menu labels, a proven public health policy approach to change consumer behavior, can be used to improve diet quality and diet-related health of Americans.