Consumers’ estimation of calorie content at fast food restaurants: cross sectional observational study
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2907 (Published 23 May 2013) Cite this as: BMJ 2013;346:f2907
All rapid responses
Tackling the issue of fast food related obesity is likely to require more than just providing information about calorie content. More evidence is needed to prove that awareness of calories affects decision making within fast food venues. (Some studies have shown that it makes little difference.)[1]
Although obesity is clearly a separate issue to smoking, some ideas may be applicable to both problems.
It remains unclear whether pictorial warning labels and plain packaging on cigarette packets are effective in reducing cigarette demand. [2,3,4] However, there is some evidence that these methods may reduce smoking in younger people. [5], in whom fast food consumption is high.
If this is successful within the smoking population, perhaps a similar tactic can be employed within the fast food industry as part of the approach to address the problem?
References
1. Yamamoto JA et al. (2005). Adolescent fast food and restaurant ordering behavior with and without calorie and fat content menu information. Journal of Adolescent Health. 37(5) :397-402.
2. Vardavas CI et al. (2009). Adolescents perceived effectiveness of the proposed European graphic tobacco warning labels. European Journal of Public Health. 19(2): 212-217.
3. White V et al. (2008). Do graphic health warning labels have an impact on adolescents' smoking-related beliefs and behaviours? Addiction. 103(9): 1562-1561.
4. Mccool J et al. (2012). Graphic warning labels on plain cigarette packs: will they make a difference to adolescents? Social Science and Medicine. 74(8): 1269-1273.
5. Rousu et al. (2012). Demand Reduction from Plain and Pictorial Cigarette Warning Labels: Evidence from Experimental Auctions. Applied Economic Perspectives and Policy. 35(1): 171-184.
Competing interests: No competing interests
Block et al. convincingly show that consumers' estimates of calorie content at fast food restaurants differ from actual calorie content. While I appreciate that from a consumer education point of view, this difference is undesirable, I applaud its existence.
Consumers are not omniscient when it comes to calorie content, nor do they know micro- or macro-nutritional value of every bit of foodstuff we are surrounded with. Neither am I - or are Block et al. While many consumers explicitly aim to eat healthy regularly, not all of them do. Most of all, almost everybody consumes (eats, drinks and more) for other reasons than mere health: convenience, appeal, image, taste, enjoyment, public representation, companionship and much more. So do I, and I hope, Block et al. We are rarely completely rational in our choices and the list of motives beyond health is endless and continues to grow.
That consumers misinterpreted the amount of calories in fast food may very well indicate that they employ other strategies towards healthy eating than calorie-counting and spend their time doing other things than crunching calorie-numbers. Bouwman et al have argued that those too preoccupied with healthy eating - dare we group structural calorie counters among them - are considered 'freaks' by those with alternative scripts for healthy living [1].
More and improved information about calorie content would perhaps satisfy certain policy criteria, but one may wonder about its power to direct consumption choices. Information, empowerment and persuasion lie miles apart.
[1] Bouwman, L. et al. (2009). I eat healthfully but I am not a freak. Consumers’ everyday life perspective on healthful eating. Appetite 53(3): 390-398.
Competing interests: No competing interests
To be effective, health education must not only provide information but empower people to use this to make healthier decisions by ensuring that information is understood.(1) This article (2) only tackles the first part of these stages, providing the calorie content of fast food meals, but out of context this will not enable people to lose weight. To properly tackle obesity related to poor diet, we need to promote healthy food choices and eating habits as well as increasing access to healthy food.(3)
References
1. Scriven A (2010) Promoting health: a practical guide. Edinburgh; New York: Bailliére Tindall/Elsevier. WA 590 Scr 2010
2. Block J. Consumers’ estimation of calorie content at fast food restaurants: cross sectional observational study. BMJ 2013; 346:f2907
3. Scottish Government (2008) Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011). Edinburgh, Scottish Government
Competing interests: No competing interests
Fast food, fast life and fast culture leave no time for consumers to note down the calorie content of the food they buy in a hurry or order to quench their appetite. Eating fast food has become a fashion symbol and sometimes a necessity for the white collar professional or Computer specialist, for what is in the mind is to achieve the goal one wants to fulfill or to reach the target set by the boss. In such a hurry there is no time for the fork and spoon to control, for the eyes are on the computer or the balance sheet that occupy one's full attention. It makes no difference, for the numbers on the label of fast food, like the warning symbols pasted on the cigarette pocket or the alcohol bottle, mean nothing to those for whom time is money.
Competing interests: No competing interests
Re: Consumers’ estimation of calorie content at fast food restaurants: cross sectional observational study
Block et al describes findings from a real world study examining adults, children and adolescent’s estimation of calories of meals purchased from different fast food restaurants.1 They reported substantial underestimation of calories particularly for those who purchased food from fast food outlets that were marketed as providing healthier options (i.e. Subway). 1 The authors suggest that the introduction of menu labelling policies that provide easily accessible calorie information, together with overall calorie requirement statements on menus may be useful in addressing these discrepancies in calorie estimation.
Mixed findings regarding the impact of menu labelling 2 suggests that improving consumer awareness of the presence of healthier options in itself may not result in changes to food purchasing intentions or behaviours. Findings from an experimental study suggest that the mere provision of healthier options can result in certain individuals being more likely to choose an unhealthy option.3 We conducted a randomised trial with 192 adults (113 intervention, 79 control) and found that providing healthier options on hypothetical fast food menus did not result in any significant changes in total energy of intended purchases (2130 kJ (intervention) vs 2087 (control); p-value: 0.7967) –unpublished data.
Clearly, the process of fast food selection is complex and driven by multiple determinants beyond consumer awareness and knowledge. Public health initiatives must move beyond the introduction of legislations aimed at improving consumer knowledge in isolation, to multi-level interventions that target other determinants of food selection from fast food outlets (including taste, pricing and advertising/branding).
References
1. Block JP, Condon SK, Kleinman K, Mullen J, Linakis S, Rifas-Shiman S, et al. Consumers' estimation of calorie content at fast food restaurants: cross sectional observational study. BMJ (Clinical research ed.) 2013;346:f2907.
2. Swartz JJ, Braxton D, Viera AJ. Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature. Int J Behav Nutr Phys Act 2011;8(1):135.
3. Wilcox K, Vallen B, Block L, Fitzsimons GJ. Vicarious goal fulfillment: When the mere presence of a healthy option leads to an ironically indulgent decision. Journal of Consumer Research 2009;36(3):380-93.
Competing interests: No competing interests