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Figure 2
Bivariate comparison of the types of side dishes, beverages, and entrées purchased by customers of a national fast-food restaurant chain in the Phoenix, AZ, metropolitan area who participated in a menu labeling survey and provided an itemized restaurant receipt between February and April 2013 (N=329). Healthier items were defined as those consistent with the 2015 Dietary Guidelines for Americans, containing fruits (including 100% fruit juice), vegetables, low-fat dairy, and being low in solid fat and added sugar. Healthier sides included apple slices, side salads, and yogurt parfaits. Less-healthy sides included ice cream desserts, cookies, pies, and french fries. Healthier beverages consisted of water, unsweetened tea and coffee, juice, milk, and diet drinks, including diet soda. Less-healthy beverages consisted of sugar-sweetened beverages, including soda, sweet tea, fruit punch, sweetened coffee drinks, and shakes.
Abstract
Background
By May 5, 2017, restaurants with 20 or more locations nationwide will be required to post calorie information on menus and menu boards. Previous research shows that those who use menu labels purchase fewer calories, but how users are saving calories is unknown.
Objective
To assess food and beverage selection patterns among menu label users and nonusers.
Design
Secondary, cross-sectional analysis using data from a study examining sociodemographic disparities in menu label usage at a national fast-food restaurant chain.
Participants/setting
Participants were recruited outside restaurant locations, using street-intercept survey methodology. Consenting customers submitted receipts and completed a brief oral survey. Receipt data were used to categorize food and beverage purchases.
Main outcome measure
Side, beverage, and entrée purchases. Sides and beverages were classified as healthier and less-healthy options consistent with the 2015 Dietary Guidelines for Americans. Healthier options contained items promoted in the guidelines, such as whole fruits, vegetables, low-fat dairy, and 100% fruit juice; less-healthy options contained solid fat or added sugar. Entrées were categorized as lower-, medium-, and higher-calorie options, based on quartile cutoffs.
Statistical analyses
Multinomial logistic regression models were used to estimate prevalence ratios (PRs) for purchases among menu label users and nonusers, controlling for sociodemographic characteristics and total price paid.
Results
Healthier sides were selected by 7.5% of users vs 2.5% of nonusers; healthier beverages were selected by 34.0% of users vs 11.6% of nonusers; and lowest-calorie entrées were selected by 28.3% of users vs 30.1% of nonusers. Compared with nonusers (n=276), users (n=53) had a higher probability of purchasing healthier sides (PR=5.44; P=0.034), and healthier beverages (PR=3.37; P=0.005). No significant differences were seen in the purchasing patterns of entrées.
Conclusions
Targeting educational campaigns to side and beverage purchasing behaviors may increase the effectiveness of menu labeling.
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STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was funded by Arizona State University’s Graduate and Professional Student Association as part of the Graduate Research Support Program.
