Consumer Choice in the Presence of Menu Labeling

S. Becker1, K. Jackson2, K.Yates3

Aramark Distance Learning Dietetic Internship- Facilities: Shore Memorial Health1, Central DuPage Hospital2, Blessing Hospital3
ABSTRACT
Menu labeling has been present in some capacity for years. The National Menu Labeling Act (NML) has
fought to make menu labeling mandatory by December 2016. Restaurants will be required to disclose
nutrition information to the public for the majority of items sold. Customers need to understand what
different types of menu labeling means and how to use the information to make healthier choices. The
three main types of menu labeling are a traditional full nutrition label, front of package labeling, and traffic
light labeling.
This project focused on menu labeling in three different hospital cafeterias in Winfield, IL, Quincy, IL, and
Easton, MD. Two main entrees were chosen for each hospital, one healthier than the other. Menu labels
were provided at all hospitals. Customers who got one of these entrees were surveyed in order to
evaluate whether or not they noticed the labels, if the labels had an effect on their entre choice, and
ways to make the labels more noticeable and/or effective. A total of 102 participants were surveyed and
56% noticed the labels while 44% of them did not notice labels. Of the 56% that noticed labels, 58%
stated that it affected their choice while 42% stated that it did not affect their choice. Of the 44% of
customers that stated they did not notice labels the most common suggestion was to make the labels
bigger and brighter. Overall, this study showed that menu labels do have a significant effect on customer
choice.

INTRODUCTION
In past years, the intakes of calorically dense foods have increased outside the home. So when eating out
on occasions, there are plenty of obstacles that influence food choices, such as unavailable nutrition
information which leads to the underestimation of caloric content in the food, cost worthy food purchases,
or the time frame one has to eat.1 Eventually these influences take over consumers choices, leading to
possible futuristic disease, illness or obesity problems.
Unfortunately, there is not a substantial amount of menu labeling research available which indicates the
need for further research. However, there have been studies that have yielded positive outcomes when
visual aide labels are utilized as well as menu labeling. A study done in Canada performed a crosssectional study comparing 2 hospitals in order to examine the impact of available nutrition menu labeling
on consumers choices and food consumption.2 Conclusions from this experiment revealed positive results
for the impact of menu labeling in a cafeteria setting, specifically when examining the consumers noticing
the additional information, perceived influence of the information provided with the food, and nutrition
value of the food offered. Another study conducted by Sonnenberg et al in 2013 evaluated the
effectiveness of traffic light labels in a hospital cafeteria.3 It concluded from both the surveys and cash
register data that consumers acknowledged the labeling information and choose healthier choices
because of it.

REFERENCES
References: 1. Kuo T, Jarosz C, Simon P, Fielding J. Menu Labeling as a Potential Strategy for
Combating the Obesity Epidemic: A Health Impact Assessment. A J Public Health. September 2009:
99(9): 1680-1686. Available from: PUBMED.
2. Vanderlee L, Hammond D. Does Nutrition Information on Menus Impact Food Choice? Comparisons
across two hospital cafeterias. Public Health Nutrition. May 2013: 1-10
3. Sonnenberg L, Gelsomin E, Levy DE, Riis J, Barraclough S, Thorndike AN. A traffic light food labeling
intervention increases consumer awareness of health and healthy choices at the point-of-purchase.
Preventive medicine. 2013;57(4):253-257. doi:10.1016/j.ypmed.2013.07.001.

DISCUSSION

RESEARCH QUESTION
When menu labels are present do employees, visitors, and patients of the hospital choose healthier food options?

The findings between the three different hospitals supported the overall research question.The
use of nutrition menu labels does have a positive effect on healthier meal choices for consumers.
This type of information promotes awareness of the food available and its nutritional content,
especially if this is their only choice of meal options throughout the week in regards to employees.

METHODOLOGY

Participants reasons why they view the menu labeling:

Trying to live healthier lives.
Wanted awareness of what they are consuming.
Following a specific diet plan that needed to count calories or fats.
Certain disease states (obesity, cardiovascular disease, hypertension, diabetes) that made them
pay more attention to specific nutrient contents including sodium, fat, and carbohydrates.

The study followed a correlational research design. The variables of this correlational study included the presence of nutrition labels and participant entre choice.
Participants food choice was between two entres differing in nutritional value. Researchers used observational techniques to evaluate if hospital employees and
visitors chose healthier food options when the nutritional information was present and visible. After observation, researchers administered a verbal survey. This brief
survey was used to determine if participants took the nutritional menu signage into account while making food choices in the cafeteria or if the menu signage had no
impact. Data collection occurred within the peak lunch hour of 11:30am to 1:00pm in the three different facilities that vary in location, facility size, and number of
employees.

Participants reasons why menu labeling does NOT affect their choice:
At their current age they did not care what the nutrition content of their food was.
Too busy to look at the information.
Choose options based on personal preference.
Look at the nutrition content out of curiosity, but still choose the option that is most appetizing.
Others stated they should look at the nutrition information, but are not ready for change.

RESULTS
There were 102 total participants included in the study from the three medical care facilities. Central DuPage Hospital (CDH) in Winfield, IL has prominent electronic labels located on the menu
that are easy for customers to see on a regular basis. Shore Memorial Health (SMH) in Easton, MD has very small nutrition labels on select items. Larger, more noticeable printed nutrition
labels were added to selected entres at Blessing Hospital (BH) in Quincy, IL. The majority of participants (56%) noticed the menu labeling, of these 58% stated that the nutrition labels did
impact their decision while making an entre choice. Almost all participants were employees of the hospitals at 95%. Gender of participants were mostly female at 74%. Ages of all participants
varied greatly the majority being between the ages of 26 -65 years old. Out of all 102 participants survey 32% stated that the menu labels affected their choice. This percentage is including
participants who may have not noticed the labels at all.
Figure 1: Label Visibility

Table 1: Labels and Consumer Choice

Did Labels Affect Consumer Choice?

Hospital

Of the 102 participants who took part in the verbal survey, 56% noticed the
nutrition labels prior to making their selections.
Table 2: Demographics
Hospital Number of
Female Male Employee Visitor Age Age Age Age Age
Participants
18- 26- 36- 46- >65
25 35 45 65
CDH
SMH
BH

32
21
49

22
17
37

10
4
12

30
19
48

2
2
1

2
2
7

8
5
14

7
8
11

10
6
14

Totals

102

76

26

97

11

27

26

30

The majority of participants surveyed were female employees of the facilities

between the ages of 18 to 65.

5
0
2

7

Participants who noticed

the labels

Effect on Entre choice

No effect on entre
choice

CDH

18

16

SMH

BH

30

13

17

Totals

57

33 (58%)

24(42%)

When participants answered no to noticing nutrition labels they were asked what could be done
to make the labels have a larger impact. Common responses included making the signage bigger,
more colorful, and positioned directly in front of each item. One participant was also interested in
the food allergy information being displayed as well as the nutritional information.
Limitations to this study:
Size of the population being study could have been increased by including nutrition labels on all
food choices being sold within each facilities cafeteria and not limited to two entre choices.
Each facility used different entre choices as they were unable to be changed. If the nutritional
content of each facilities entre choices was identical results would be more stable.
Multiple aspects were viewed during this study, including different forms of menu labeling. This
could also skew results of participants noticing menu labeling as it varied in each facility.

CONCLUSION

Of the 56% of participants who noticed the labels over half (58%) stated that the nutrition
labeling effected how they chose their entre. The remaining participants who noticed the
labels stated it had no effect on choice and picked entres based on what was most
appealing.

In conclusion, the feedback from the study highlights a positive correlation of

consumers valuing nutritional information being present on menus. The National Menu
Labeling initiative can only benefit consumers in the long run, and the only
repercussions for those who simply choose to ignore it are the increased risks for
developing chronic diseases in the future. Future research with stronger study designs
should continue identifying the best approaches to menu labeling to impact on both
adult and pediatric food choices and consumptions.

Table 3: Amount of Entres Sold Based on Sales Reports on Data Collection Day
Hospital
Portions of Entre 1 Served
Portions of Entre 2 Served

CONTACT INFORMATION

CDH
101 (beef steak)
SMH
*52 (flank steak)
BH
114 (meat loaf)
* indicates healthier entre choice based on nutrition labels provided.

*50 (pork chop)

100 (asiago chicken)
*67 (tilapia)

All entres had varying types of nutrition labeling present. According to the detailed sales
reports from research data collection day sales, healthier options were sold in less quantity
than inferior choices. This does take into account the entire day, not just the peak lunch
hour.

For additional information, please contact:

Aramark Dietetic Interns:
Kristy Yates - kristyyates13@gmail.com
Stephanie Becker - seb418@gmail.com
Kayleigh Jackson - kayleighmarie45@gmail.com
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