Environmental and Individual Factors Affecting Menu Labeling Utilization: A Qualitative Research Study

BackgroundTo date research examining the benefits of menu labelling in the UK is sparse. The aim of the present study was to examine the impact of menu labelling in a UK obese population.MethodsUsing a repeated measures design, 61 patients at a tier 3 weight management service completed four questionnaires to assess their food choice (control) and behaviour change when presented with 3 menu labelling formats (calorie content; nutrient content; and energy expenditure).ResultsAll three forms of labelling increased participants weight control concerns compared to the control condition. There was a significant difference in content of food ordered in the three menu labelling formats compared to the control condition. The calorie condition had the largest percentage decrease in calories selected followed by energy expenditure and nutrient content. However, no difference was observed between the three conditions in the desire for menu labelling in restaurants to be introduced in the UK.ConclusionsThe findings suggest that menu labelling should be enforced in the UK as it is both beneficial to promoting healthy eating and in demand. This study is the first to examine menu labelling in a UK obese population using energy expenditure equivalents to provide nutritional information.

Nutritional labeling on menus has been found to promote informed food choices and reduce information asymmetry between manufacturers and consumers. However, lack of attention to nutritional labels limits their effectiveness. This study manipulated the way in which nutritional information was provided on menus in aim of enhancing visual attention to the most health relevant information. A between‐subject design was implemented with three experimental conditions (nondirective label; directive label; semidirective label). A total of 84 participants chose meals off a starter, main and desert menu whilst their eye movements were tracked using Tobii eye tracking software. Results showed that the menu labels did not significantly differ in their attentional gaining properties, however, the use of color and health logos led participants to choose meals containing significantly less calories compared to when nutritional information was presented in black text alone. These findings indicate that nutritional information should be provided in color or as health logos as this has the largest impact on food choice.Practical ApplicationsA factor contributing to the rise in obesity prevalence is the obesogenic environment that we live in. The population has become increasingly reliant on convenience foods and dining out which has led to excess calorie consumption. Menu labeling has been identified as a possible intervention that could be employed by policy makers to guide informed food choices. However, there are calls for further actions and intervention to improve food choice as menu labeling has had mixed effects on consumer choice and consumption. This study suggests that menu labeling is a viable option when the nutritional information is presented in a visually salient way. The use of colors and health logos attracts consumer's attention to the most health relevant information which could contribute to efforts in reducing obesity and other illnesses linked to unhealthy consumption.

Childhood obesity is a serious public health concern internationally, and population-level interventions are needed to support healthy food choices. Existing reviews of menu labelling have focused predominantly on adults. However, childhood and adolescence are distinct periods of development during which longer term eating behaviours and food preferences are established. Although some studies have examined the effect of menu labelling among children and adolescents, no reviews have synthesised this evidence. To assess whether menu labelling influences the amount of calories ordered by children and adolescents (or parents on behalf of youth) in food outlets including restaurants and cafeterias. Comprehensive literature searches were conducted in Medline, Scopus, PsycINFO, CINAHL, SocINDEX and Embase databases. Eleven relevant studies were identified from an initial search yielding 1,682 results. Studies were assessed using a validated quality assessment tool. Examinations of hypothetical food purchases in artificial environments suggest that menu labelling may be efficacious in reducing calories purchased for or by children and adolescents. Real-world studies are less supportive, although school-based studies were generally positive. It is unclear whether contextual or interpretive menu-labelling formats are more effective compared to numeric calorie information alone. Evidence supporting the impact of menu labelling on lowering the energy content of restaurant and cafeteria food choices made for or by children or adolescents is limited. There remains a need for high-quality studies conducted in real-world settings.

Need for and Effectiveness of Menu Labeling

According to the US Affordable Care Act, restaurant chains are required to provide energy (calorie) and other nutrition information on their menu. The current study examined the impact of menu labelling containing calorie information and recommended daily calorie intake, along with subjective nutrition knowledge, on intention to select lower-calorie foods prior to the implementation of the Affordable Care Act. Full factorial experimental design with participants exposed to four variants of a sample menu in a 2 (presence v. absence of calorie information) ×2 (presence v. absence of recommended daily calorie intake). Large, public university in the Southwest USA. Primarily undergraduate college students. Majority of participants were 19-23 years of age (mean 21·8 (sd 3·6) years). Menu information about calorie content and respondents' subjective nutrition knowledge had a significantly positive impact on students' intention to select lower-calorie foods (β=0·24, P<0·001 and β=0·33, P<0·001, respectively); however, recommended daily calorie intake information on the menu board did not influence students' intention to select lower-calorie foods (β=0·10, P=0·105). Gender played a significant role on purchase intent for lower-calorie menu items, with females more affected by the calorie information than males (β=0·37, P<0·001). Findings support the role menu labelling can play in encouraging a healthier lifestyle for college students. College students who are Generation Y desire healthier menu options and accept nutritional labels on restaurant menus as a way to easily and expediently obtain nutrition information.

Introduction: The aim of this study was to explore the relationship between food and mood against the backdrop of increased mental health and nutrition cognizance within public health and scientific discourses. Mood was defined as encompassing positive or negative affect.&#x0D; Methodology: A constructionist qualitative approach underpinned this study. Convenience sampling in two faith-based settings was utilised for recruiting participants, who were aged 19-80 (median,48) years. In total 22 Christian women were included in the research, eighteen were in focus groups and four were in individual semi structured interviews. All were church-attending women in inner London. A thematic analysis was carried out, resulting in four central themes relating to food choice and food-induced mood states.&#x0D; Findings: Women identified a number of internal and external factors as influencing their food choices and the effect of food intake on their moods. Food choice was influenced by mood; mood was influenced by food choice. Low mood was associated with unhealthy food consumption, apparent addiction to certain foods and overeating. Improved mood was associated with more healthy eating and eating in social and familial settings.&#x0D; Discussion: Findings indicate food and mood are interconnected through a complex web of factors, as women respond to individual, environmental, cultural and social cues. Targeting socio-cultural and environmental influences and developing supportive public health services, via faith-based or community-based institutions could help to support more women in their struggle to manage the food and mood continuum. Successful implementation of health policies that recognise the psychological and social determinants of food choice and the effect of food consumption on mood, is essential, as is as more research into life-cycle causal factors linking food choice to mood.

The present study aimed to qualitatively explore the food choice determinants of both Chinese immigrants living in Australia and Chinese people living in mainland China. Eight Chinese Australian participants (female, n = 5; male, n = 3) and ten mainland Chinese participants (female, n = 5; male, n = 5) were recruited from Australia (primarily in Melbourne, Victoria) and China (predominantly in Zhengzhou, Henan province) between June 2021 and March 2022. Participants were diverse in age, socio-economic background, occupation and health status. Semi-structured in-depth interviews were conducted in Mandarin either face-to-face or using online video/voice calls. Interviews were audio-recorded and transcribed verbatim. Investigator triangulation was used to enhance scientific rigour. Four themes were identified: (1) food choice determinants were shaped by traditional and modern nutrition perceptions and personal food philosophy; (2) physiological responses to food provide direct feedback that impacts future food choices; (3) consideration of convenience was a predominant influencer of food choice; and (4) the differences in food environments between China and Australia promoted distinctive food choice determinants for Chinese people. Chinese Australian and mainland Chinese participants' food choices are shaped by traditional Chinese nutrition philosophy, modern Western nutrition science and the contemporary food environment. There are clear cultural characteristics in their food choice determinants that should be considered by health educators, nutrition professionals and nutrition policymakers when developing culturally appropriate health interventions for Chinese people.

BackgroundIndia has seen a rise in consumption of foods high in fat, sugar, and salt that increases risk of diet-related noncommunicable diseases. Information on the drivers that determine food choices among adults will provide insights for policymakers to promote healthier food selection. ObjectiveThis study assessed the determinants of food choices among adults in India. MethodsA cross-sectional study with a nonprobability purposive sampling technique in which adults were selected from residential colonies belonging to the 4 geographic zones of the city Delhi, India. Data was collected using a mixed methods approach on a total of 589 adults (20–40 y) belonging to upper-middle-income and high-income groups. Data was analyzed by the principal component analysis, chi-squared test, and logistic regression with a level of significance set at P value of < 0.05. ResultsMost influential factors of food choices were brand (30%), nutritive value (22%), and taste (20%). The 3 factors that emerged from principal component analysis that determine food choices among adults were “individual,” “social,” and “food quality/wholesomeness.” Focus group discussions also showed that the majority of participants were influenced by the “brand,” “nutritive value,” and “taste” of the food product while making food choices. Food choices were influenced by the company the person was eating food with, i.e., family members or friends. The cost of the food product was also an important driver of food choices among younger adults. ConclusionPublic health policy should utilize the determinants of food choices to bring about changes in the food environment by increasing the availability of healthier yet tasty food, bearing the cost in mind.

Food choice is complex and is heavily influenced by the environment one lives in(1). Pacific Island food environments, including those in Tonga, have changed considerably in recent years, making healthier food choice more challenging(2). A widespread nutrition transition across the region has contributed to an increase in the availability of, and accessibility to, highly-processed foods, and high rates of diet-related non-communicable diseases(3). While system change is needed to support the availability, accessibility and affordability of healthy foods, nutrition education plays an important role in supporting individuals, communities, and populations to navigate their rapidly changing food environments, and to encourage healthy food choice and behaviour change. Approaches to nutrition education in the Pacific Islands region vary and do not always consider the socio-cultural aspects of the food environment, especially when focusing on fruit and vegetable consumption. This work was driven by an intent to develop contextually appropriate nutrition education plans using a structured process, Design Online(4). However, to develop a nutrition education plan a critical analysis of the current motivators and facilitators for the behaviour are required. When reviewing the scientific literature there is limited information on determinants of food choice within Tonga, and more broadly within the Pacific Islands context. Therefore, the aim of this cohort study was to qualitatively explore and document the motivating and facilitating determinants of fruit and vegetable consumption in Tonga. Data collection took place during August and September 2023 on the main island of Tongatapu. Semi-structured interviews (n = 5 men, 3 women) and a focus group (n = 4 women) based on the most appropriate method of engaging with participants, were conducted in Tongan. Guiding questions were derived from Design Online and proposed within the following categories: motivating determinants and facilitating determinants. Interview responses were qualitatively analysed using an inductive content analysis model. Key categories for motivating determinants included health and nutrition knowledge, normal consumption patterns, availability and access, production, financial considerations and preferences, perceptions and practices. Key categories for facilitating determinants included education, community engagement, environmental factors, food preference, finance, and accessibility. While this work has explored motivating and facilitating determinants for fruit and vegetable consumption in Tonga with a small sample, it makes an important contribution to the limited literature. The findings of this study can be used to underpin activities, such as the design of nutrition education plans. The findings also provide a foundation for further exploration of determinants of food choice. This study was undertaken on the main island of Tongatapu, but it is of interest to explore determinants with communities who live in the outer islands, and at different time points during the year to reflect seasonality.

There is increasing interest in strategies to encourage more environmentally sustainable food choices in US restaurants through the use of menu labels that indicate an item's potential impact on the world's climate. Data are lacking on the ideal design of such labels to effectively encourage sustainable choices. To test the effects of positive and negative climate impact menu labels on the environmental sustainability and healthfulness of food choices compared with a control label. This randomized clinical trial used an online national US survey conducted March 30 to April 13, 2022, among a nationally representative sample of adults (aged ≥18 years) from the AmeriSpeak panel. Data were analyzed in June to October 2022. Participants were shown a fast food menu and prompted to select 1 item they would like to order for dinner. Participants were randomized to view menus with 1 of 3 label conditions: a quick response code label on all items (control group); green low-climate impact label on chicken, fish, or vegetarian items (positive framing); or red high-climate impact label on red meat items (negative framing). The main outcome was an indicator of selecting a sustainable item (ie, one without red meat). Secondary outcomes included participant health perceptions of the selected item and the Nutrition Profile Index (NPI) score of healthfulness. Among 5049 participants (2444 female [51.6%]; 789 aged 18-29 years [20.3%], 1532 aged 30-44 years [25.9%], 1089 aged 45-59 years [23.5%], and 1639 aged ≥60 years [30.4%]; 142 Asian [5.3%], 611 Black [12.1%], and 3197 White [63.3%]; 866 Hispanic [17.2%]), high- and low-climate impact labels were effective at encouraging sustainable selections from the menu. Compared with participants in the control group, 23.5% more participants (95% CI, 13.7%-34.0%; P < .001) selected a sustainable menu item when menus displayed high-climate impact labels and 9.9% more participants (95% CI, 1.0%-19.8%; P = .03) selected a sustainable menu item when menus displayed low-climate impact labels. Across experimental conditions, participants who selected a sustainable item rated their order as healthier than those who selected an unsustainable item, according to mean perceived healthfulness score (control label: 3.4 points; 95% CI, 3.2-3.5 points vs 2.5 points; 95% CI, 2.4-2.6 points; P < .001; low-impact label: 3.7 points; 95% CI, 3.5-3.8 points vs 2.6 points; 95% CI, 2.5-2.7 points; P < .001; high-impact label: 3.5 points; 95% CI, 3.3-3.6 points vs 2.7 points; 95% CI, 2.6-2.9 points; P < .001). Participants in the high-climate impact label group selected healthier items according to mean (SE) NPI score (54.3 [0.2] points) compared with those in the low-climate impact (53.2 [0.2] points; P < .001) and control (52.9 [0.3] points; P < .001) label groups. This randomized clinical trial's findings suggest that climate impact menu labels, especially negatively framed labels highlighting high-climate impact items (ie, red meat), were an effective strategy to reduce red meat selections and encourage more sustainable choices. ClinicalTrials.gov Identifier: NCT05482204.

Food choice determinants in the general population are influenced by sociocultural, sensory, nutritional, and economic factors, among others(1). For athletes, these choices are further complicated by additional sporting and nutritional demands(2). The objective of this study is to conduct the first large-scale analysis of the determinants of food choice in athletes and active individuals, and to conduct comparison of these determinants across competition levels and sporting categories.Participants, aged over 18, residing in Ireland, and engaged in competitive sport or structured physical activity at least twice weekly, completed an online survey via Qualtrics. The survey included the previously validated Athlete Food Choice Questionnaire (AFCQ)(3,4). The AFCQ comprises of 32 statements divided into 9 categories where athletes rate the frequency that their food choice is affected by various factors. Data were collected in February 2024, analysed using SPSS V28.0, with statistical significance set at P&lt;0.05.A total of 1,148 athletes (38% male, 62% female), median [IQR] age 26 years [21-40 years], reported participating in 7 hours [5-10 hours] of structured physical activity per week, spanning 32 sports. Participation levels ranged from non-competitive (32%) to those involved in international competitions (6%). Sensory appeal was highlighted as the most influential factor on food choices (P&lt;0.01), followed by food and health awareness (P&lt;0.01)—encompassing cooking ability, nutrition knowledge, and food planning. Performance-related factors were joint second most influential, with no significant difference with food and health awareness (P = 0.30). This included statements related to choosing food that enhances fuelling for competition, recovery and feeling energetic during training.Ordinal logistic regressions showed variables such as age, gender, education level, and sporting variables such as competition level, sport type and average hours of exercise per week showed distinct impacts on food choice. For example, the nutritional attributes of a food impacts choice more as participants got older (Odds Ratio (OR) 1.02, 95% CI [1.01, 1.04], P = 0.01). However, the nutritional attributes had less influence if the participant was born in the USA (OR 0.37, 95% CI [0.16, 0.86], P = 0.02) or the rest of the world (OR 0.38, 95% CI [0.18, 0.81], P = 0.01) compared with those born in Ireland, and if the participant was a team sport athlete rather than an endurance athlete (OR 0.55, 95% CI [0.37, 0.81], P&lt;0.01).The determinants of food choice for athletes are multifaceted and more complex than those of the general population, attributed to additional exercise-related factors. Despite this complexity, sensory appeal remains the predominant influence across all sport types and competition levels. Understanding the dynamics of this food choice matrix in athletes allows for more personalised nutrition advice and identification of those at risk of poor dietary practices that may negatively impact upon their performance and health.

Nutritional knowledge, attitudes, and practice are important ways of assuring a healthy pregnancy start, which can be shaped during the pre-pregnancy period by the intervention of healthcare providers. In this cross-sectional study, the main objective was to explore contextual determinants of diet quality in women of fertile age, including socioeconomic factors and sources of information. Data on socioeconomic background, sources of nutritional advice, and determinants of food choices were collected through an anonymous web-based questionnaire completed by 465 women. Diet quality was assessed with the International Federation of Gynaecology and Obstetrics diet quality score (FIGO-DQS). Better food choices (OR = 1.73; 95% CI: 1.16-2.51), higher knowledge level (OR = 1.66; 95% CI: 1.119-2.466), and healthcare advice (OR = 1.70, 95% CI: 1.119-2.466) increased the chances of having a better diet. Both healthcare providers (β = 0.503, p = 0.018) and determinants of food choices (β = 0.520, p = 0.011) had a significant influence on the FIGO score, although the advice provided by the healthcare professionals did not yield a significant influence on the determinants of food choices (β = 0.310, p = 0.125); Conclusions: Knowledge had a mediator effect on the impact of healthcare guidance on nutrition practices, but it does not fully explain the adherence to healthy lifestyle choices.

This paper is about how we should and how we cannot employ the psychological, neurophysiological and socio-epidemiological evidence regarding food choices in the discussion about paternalism in public health. There are two ways of using this wealth of data to rebut anti-paternalism and they correspond to two very different versions of liberal anti-paternalism, which we could attribute, respectively, to John Stuart Mill (1859) and Joel Feinberg (1986): utilitarian anti-paternalism and liberty-based anti-paternalism. In this paper I argue that liberty-based anti-paternalism is not relevant in the case of public interferences against unhealthy lifestyles and that evidence on the determinants of food choices cannot be employed against liberty-based paternalism but can be employed against its utilitarian version. In brief, we may want to intervene in dietary choices not so much because food choices are beyond our control but because they are often bad. This argument will be developed at length in Sects. 16.4 and 16.5, which together form the theoretical core of the paper. While Sect. 16.4 collects arguments from the literature, Sect. 16.5 contains contributions that, as far as I know, are new for the debate. Section 16.2 explains why the topic is relevant with reference to the epidemics of nutrition-related diseases and the kind of policy responses that might be mounted by public authorities. Section 16.3 distinguishes the two versions of anti-paternalism and develops some conceptual tools that will be used afterward. Section 16.6 sums up the main results and anticipates further issues stemming from this approach.

Food preferences, systems, and policies influence the health of individuals and communities both directly, through food consumption choices, and indirectly, through environmental, economic, and social impacts. To aid student understanding of these complex determinants of food choice, a student-driven, community-engaged learning course on food systems and food choices was developed. Guided by the socio-ecological model for health and the goals of the Emory Sustainability Initiative and supported by the Center for Community Partnerships (CFCP), the course objectives, curriculum, and activities were determined by the students in collaboration with the faculty advisor and community partners. Two central components of the course were student-led learning modules and community-engaged research on food systems. The four learning modules included: (1) determinants of individual food preference and choice; (2) food and agriculture systems; (3) food access and food justice; and (4) agricultural policy. Community research projects described the role of farmers' markets, community supported agriculture, conventional markets, community gardens, and farm-to-table restaurants in the production and distribution of food in metro Atlanta, with an emphasis on locally produced fruits, vegetables, meats, and milk. Where possible the projects mapped the reach of these distribution models to low-income communities and food deserts, and identified strategies to improve access to healthy food options in these communities. The course culminated in a student-organized symposium for community members and in research reports for community partners. The symposium drew diverse participants, including growers, farmers' market managers, advocacy groups, public-health scientists, policy-makers, students, and academicians. Discussions with symposium participants assisted in refining the research reports for community partners and helped identify strategies and topics for future collaborative efforts and course improvements. A grant from Emory's CFCP facilitated collaboration with community partners, community research, and dissemination of research findings.

This article discusses the evidence for menu labeling as obesity prevention public health policy. While sympathetic to providing nutritional information, whether food is consumed at restaurants or purchased for home consumption, the authors raise a word of caution against the assumption that menu labeling will significantly lead to healthier food choices, lower obesity rates, and decreased obesity disparities. The authors find little empirical evidence that this will be the case, critique the theoretical model that informs menu labeling as obesity prevention public health policy, and instead encourage policies that draw on a fundamental social causes approach to obesity prevention and health promotion generally.