The need for interventions delivered through restaurants is established through documentation such as the Resource Guide for Nutrition and Physical Activity Interventions to Prevent Obesity and Other Chronic Diseases, developed by the National Center for Chronic Disease Prevention and Health Promotion. This report cites evidence of the dramatic increase in the consumption of food prepared away from the home in the United States and notes that frequent consumption of foods away from the home has been associated with a diet high in fat and calories, and therefore energy density.
Menu Labeling: Does Providing Nutrition Information at the Point of Purchase Affect Consumer Behavior? Healthy Eating Research, Robert Wood Johnson, June 2009, reports on the following research results:
- The number of U.S. restaurants that provide nutrition information has increased over the past decade; however, the majority of restaurants do not provide consumers with nutrition information at the point of purchase
- Most consumers underestimate the number of calories and fat in away-from-home foods and tend to make greater errors when menu items are high in calories or when ordering from establishments that promote their menu items as healthy
- Most consumers would like to see nutrition information at places where they go out to eat; however, only limited research has explored how well this information is understood by consumers and which consumers may be most likely to use menu labels in making decisions about what to purchase
- Menu labeling reduces consumers’ intentions to purchase items high in calories and fat, especially when there is a greater discrepancy between the perceived content and actual content
- Requiring restaurants to provide point-of-purchase nutrition information could help reduce obesity by promoting the introduction of healthier menu options. The field currently lacks research that evaluates the impact of menu labeling regulations on changes in the nutritional quality of menu options
As anecdotal evidence, several restaurants have their own process for labeling healthier menu items, such as the “Guiltless” selections at Chili’s or the Weight Watchers items at Applebee’s. Principles of business practice would suggest that these and other restaurant chains would not continue those promotions if they were not popular with some segment of their customer base.
Sloan Trends & Solutions, which is an acknowledged expert in restaurant marketing, cites a survey showing that about 50% of fast food customers report thinking about health, including concerns about carbohydrates, fat, calories, and vegetarian choices. The same survey showed that 40% of respondents were eating more grilled menu selections in fast food restaurants than they had in the past few years.
As a public health program, COPAN’s charge is to implement population-level interventions reaching as high as possible on the socio-ecological model. Restaurants as a venue offer significant access to consumers. Providing customers with a tool for identifying healthier choices has the potential for changing social norms for restaurant dining and ultimately changing restaurant practice.
Smart Meal Data
The first large-scale quick-serve establishment to enthusiastically join the Smart Meal program was McDonald’s. In terms of the success of the Smart Meal™ Seal, there can be no greater visibility for the program than its use in more than 110 McDonald’s restaurants in the Denver Metro area. The program evaluator completed the analysis of 2.5 years of raw sales data.
Qualitative Evaluation Data: Observation Checklists for compliance and Manager Interview Questionnaire.
Quantitative Evaluation Data: From July 2007 to June 2008, 110 McDonald’s restaurants in metro Denver completed a twelve-month pilot test of the Smart Meal program. At the conclusion of the pilot, weekly aggregated totals of Smart Meal sales along with McDonald’s most popular meal items were provided to the Colorado Department of Public Health and Environment (CDPHE) for evaluation. An identical set of sales data were provided to CDPHE for a second Colorado metro population with 34 McDonald’s stores not participating in the pilot. These data provided a valid and complete picture of sales trends over the two and a half-year period for tens of thousands of customers.
A two and a half-year period Interrupted Time Series Autoregression design tested for change in Smart Meal sales in the intervention group relative to the comparison metro city. This analysis approach takes into account seasonal trending and complications of autocorrelation that violate assumptions of the normal linear regression model. Time series data are usually autocorrelated (i.e. each week's sales data is not random since last week's sales data is a very important predictor of this week's), so the Durbin-Watson test was used to identify autocorrelation. The order of Durbin-Watson tests takes into account seasonal trends, and stepwise autoregression fits a high-order model removing autoregressive parameters that are not statistically significant.
Results:
Currently there are over 200 Denver Metro and surrounding-area restaurants participating in the Smart Meal program. A total of 1,630 Smart Meals are available to consumers each day in Colorado.
Qualitative Data Results:
- Of the current 20 participating restaurants, 17 are in full compliance with the program guidelines: window decals, program descriptions posted for customers, employees trained to provide program information, logos on menus and/or menu inserts
- Manager interviews revealed that all recognized that obesity was an issue and wanted to promote healthier foods. All wanted greater visibility for the program to increase customer recognition of the Smart Meal Seal™
Quantitative Data Results:
Statistically significant increases in Smart Meal sales (i.e.11 meals together) were reported in the intervention group during the 12-month pilot test but not in the comparison metro area. Additionally, sales of Smart Meals in the intervention group mediated a statistically significant decrease in the sales of side orders including French fries, soft drinks, cookies, pies, and ice cream. Effect size measures were mostly small, based on Cohen’s (1992) conventional interpretation of magnitude of effects.
Conclusions
Increasing the positive health impacts of restaurant food environments is critical to population health and reducing obesity. The Smart Meal™ Seal program recognizes restaurants willing to promote health messages, and to highlight specific healthy meals. Sustainable change in restaurants’ food environments depends on the engagement and commitment of the business infrastructure. Identification of specified menu options can lead to changes in purchasing habits.
For a complete overview, click here for the Smart Meal abstract poster.