The Difference Between Informing and Nagging

On Friday I attended a CDC-sponsored obesity conference where I participated in a panel discussion about laws requiring the conspicuous display of calorie counts in restauraunts, the topic of Steve Chapman's latest column. Chapman notes "there is little research to suggest that calorie alerts will make any difference in obesity rates," which is why a new study of fast food customers in New York City that was discussed at the conference is bound to be widely cited.

The researchers, all of whom work for the New York City Department of Health and Mental Hygiene, surveyed about 7,300 customers at 275 randomly selected locations of 11 fast food chains before the city's new menu board requirement took effect. (The regulation, which requires calorie counts as big as prices, is still being contested in court, but some chains are already complying.) The health department researchers found that 32 percent of Subway customers said they had seen calorie information, compared to 4 percent of customers at other fast food restaurants. Since Subway promotes a subset of its menu as lower in calories and fat than its competitors' offerings, using a pitchman who lost hundreds of pounds while eating at the chain every day, this disparity is not surprising. But even at Subway, calorie information seemed to make a difference for a minority of customers. Of those who reported seeing the calorie information at Subway, 37 percent (i.e., 12 percent of all Subway customers) said it affected their purchases. Subway customers who said they used calorie information bought about 100 fewer calories (based on data from receipts and survey questions) than those who said they didn't see it and those who said they saw it but didn't use it.

Notably, "there was no significant difference in mean calories purchased by patrons reporting seeing but not using calorie information and patrons who reported not seeing calorie information." In other words, simply making people aware of calorie content is not enough to affect their food choices. It may be that the information's influence is limited to people who are predisposed to count calories, in which case the impact of regulations like New York's will depend on the extent to which those people are not already taking advantage of nutritional information available on fast food chains' websites and on posters, counter mats, tray liners, and brochures in restaurants.

Already supporters of New York-style menu rules are using this study, which is scheduled to be published in the August issue of the American Journal of Public Health, to estimate how many lives can be saved by making calorie information more conspicuous. Given the uncertainty about who would lose how much weight and what the health consequences would be, this is a dubious exercise. Even if the health risks (or benefits) of extra pounds were well understood (they aren't), it's not clear that the Subway results can be applied to customers of other restaurants. Given its emphasis on healthier options, Subway probably is more likely than other chains to attract weight-conscious customers, the sort who seek calorie information and act on it.

Even so, only 12 percent of Subway customers in this study (i.e., 37 percent of 32 percent) said they noticed the calorie information and took it into account. This suggests that the vast majority of fast food customers are not very interested in nutritional information, as does the fact that most chains make it available without highlighting it in the way that the New York City health department thinks is appropriate. The restaurant business is highly competitive. If people are clamoring for impossible-to-ignore calorie counts, why don't more restaurants voluntarily provide them as a way of attracting customers? A legal requirement is necessary not because diners want conspicuous nutritional information but because, by and large, they don't want it. The information apparently does not enhance their dining experience and may even detract from it. Perhaps they prefer to enjoy their food without being reminded about what it may be adding to their waistlines.

Pretty soon, I suspect, customers of restaurant chains (the focus of the regulations, since it's hard for mom-and-pop restaurants to standardize dishes) will no longer be able to exercise their right not to know. In addition to New York City, jurisdictions requiring conspicuous nutritional information in restaurants include San Francisco; Santa Clara County, California; and King's County, Washington. California, New York state, Chicago, Philadelphia, and Washington, D.C. are considering similar requirements. As the restaurant industry faces a multiplicity of demands from various jurisdictions (Santa Clara County, for example, requires fat, carbohydrate, and sodium information as well as calorie counts), it may start lobbying for a national law that establishes a uniform standard.

Radley Balko criticized menu regulations in his Fox News column last week.