Study: Calorie counts on menus not always helpful

On fast-food chain restaurant menus, even calorie listings that meet federal labeling requirements might not effectively help consumers trying to make healthy meal choices, according to a study by nurse researchers.

Elizabeth Gross Cohn, RN, NP, DNSc, assistant professor of nursing at the Columbia University School of Nursing, and colleagues studied the calorie counts for 200 food items on menu boards in fast-food chain restaurants in the Harlem neighborhood of New York City. Since 2006, the city has had a standard menu labeling law that includes some of the new federal requirements.

"Although most postings were legally compliant, they did not demonstrate utility," the authors wrote in the Journal of Urban Health. "Menu postings for individual servings are easily understood, but complex math skills are needed to interpret meals designed to serve more than one person. In some items, calories doubled depending on flavor, and the calorie posting did not give enough information to make healthier selections."

Terms of the Affordable Care Act require restaurants with 20 or more locations to provide calorie data and additional nutritional information for menu items and self-service foods. The Food and Drug Administration is considering how best to guide chain restaurants in posting calorie counts on menu boards.

The researchers noted that easily-understood calorie listings could be helpful to consumers trying to make healthy food choices, a relevant issue in light of the increasing prevalence of obesity among American adults and children. The trend is a particular problem in low-income and inner-city neighborhoods where sources of healthier foods might not be as common as fast-food fare. Other studies have suggested that consumers are generally unaware of, or inaccurately estimate, the number of calories in restaurant foods.

To collect the data, volunteers equipped with digital cameras photographed 70 menus and menu items from 12 restaurant chains. The researchers then rated 200 items using a measure of practical utility they developed to calculate what constitutes a single serving and the number of calories in a single serving. The researchers combined the measure with FDA guidelines to develop a seven-item menu rating tool.

Although most restaurants had posted calorie counts, the researchers found in the majority of cases there was insufficient information to utilize the counts at the point of purchase. One reason was that the majority of items on the menu boards studied were combination meals rather than individual items. Furthermore, calculating calories per meal became increasingly difficult when the posting included anything more than an individual unit of measure.

Calorie counts became more challenging as the food items became more complex, especially combination and multi-serving items, which represented the largest percentage of items recorded. These required several mathematical and nutritional calculations, which the authors noted might be more challenging among low socioeconomic groups in urban areas where fast-food restaurants tend to be most concentrated.

For example, the authors reported, a bucket of chicken was listed as containing 3,240 to 12,360 calories, but the menu board did not contain enough information to determine the number of pieces of chicken in a serving size. Similarly, a hero combo meal ranged from 500 to 2,080 calories, but no information was provided on how a consumer would order within the lower range of the item. Specialty pizzas were offered in wide ranges without a clear explanation of how they differed, since the calorie count was based on a standard size and standard set of toppings.

The authors noted their study was limited to one urban community and did not focus on actual food purchasing behavior but rather on the posted menu boards in chain restaurants. Still, they said, their work suggests the need for more understandable and useful calorie information in posted menus.

The authors support a system that uses dashes or slashes to more intuitively associate calorie counts to food combinations instead of the current system of ranges. In such a revised system, a breakfast sandwich would be listed as "egg with ham/bacon/sausage 350/550/750."

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