A Review of Calorie
Posting in the
Workplace Setting
Soracha Mc Kinley and Hazel Dolan
HEALTH SCIENCE AND NUTRITION
DEPARTMENT OF NURSING AND HEALTH SCIENCE
ATHLONE INSTITUTE OF TECHNOLOGY
Abstract
The aim of this literature review is to investigate the impact of calorie posting in the
workplace including the hospital setting. Both national and international research
studies conducted on this topic are included in this review and positive short term
effects are clear in almost all studies. However, the long term effects have yet to be
elucidated particularly since calorie posting is a relatively new initiative. The research
would indicate that combining the caloric information clearly and at point of choice
combined with consumer education provided the best results. Calorie posting is a
potential tool in reducing obesity.
1
Introduction
Obesity is the medical term used to describe the state of being overweight to the
point where it is harmful to health (WHO, 2015). Carrying such a large amount of
weight may have health implications to an individual, physically and psychologically.
The World Health Organisation (WHO) has reported that more than 1.4 billion adults,
20 years of age and older, are either overweight or obese. Of these overweight
adults, over 200 million men and nearly 300 million women are obese (WHO, 2008).
Currently in Ireland 25% of the adult population is obese and 37% are overweight.
Furthermore, four out of five people over the age of fifty are either overweight or
obese and 27% of Irish females and 16% of Irish males under the age of 20 are in
the overweight or obese category (Leahy et al, 2014).
Obesity has long been recognised as a major cause of chronic illnesses. In addition
to the negative health implications and reduced quality of life, the economic burden
of obesity and the health implications that arise from obesity has been increasing
steadily, not only in Ireland and Europe, but worldwide (Muller – Riemenschneider et
al, 2008). It is well recognised that obesity is a complex issue and at present there is
no clear strategy for treating obesity at the population level and reversing the obesity
epidemic. Multilevel approaches may prove beneficial and calorie menu labelling is
one approach to addressing the obesity crisis.
European public health professionals and stakeholders agree that nutrition labelling
is “a main tool for preventing increasing rates of obesity and unhealthy diets” (OECD,
2008). Consumers demand more information about food products including contents,
characteristics of the food, safety information on ingredients, ethical concerns,
potential allergens and the nutrition information. Following on from this, calorie
2
posting is a general term used for providing nutritional information on available food
options in public food outlets. Displaying calorie content on menus in food outlets
aims to provide the consumer with nutritional information allowing them to make an
educated decision about their food choice.
Best practice for calorie menu labelling
Calorie menu labelling should be implemented following best practice principles to
ensure that information is provided in a consistent and effective manner. The
following principles were devised by the Food Standard Authority of Ireland (FSAI) in
the report on calories on menus in Ireland (Reilly, 2012).

Calorie information must be displayed on all food and drink items

Display calorie information at the „point of choice‟ – where options are
displayed

Calorie information must be in terms in terms of portion/meal size

Display information about recommended daily calorie intake for the average
person
View and attitudes towards menu calorie labelling
In June 2012, the Food Safety Authority of Ireland published a report on the views
and attitudes towards displaying calorie information on menus in Ireland. Both
consumer and stakeholders were encouraged to give their opinion on the matter.
Each individual was given an information booklet providing information on obesity in
Ireland, calorie menu labelling in other countries and what to expect from the
3
implementation. Surveys were used to collect the responses over a four week
period. The consumer questionnaires were used to collect information on
participant‟s background, where calorie labelling should be implemented, how
calories should be presented, whether consumers felt that the information would be
trustworthy, whether calories should be put on alcoholic drinks and whether calorie
posting should be mandatory for large food businesses. There were 3,130 responses
from consumers. Over 95% were in favour of the implementation of calorie posting.
The main reason given was calorie posting allows the consumer to make informed
choices when purchasing food and drink from food service outlets.
Stakeholders information was also collected though surveys. Questions were based
on the four best practice recommendations on calorie posting. In this instance, just
over 50% of the stakeholders were in favour of calorie posting. Reasons given were
concerns about effects on business, cost and implementation.
However, most
implied that calorie posting was acceptable once nutritional help was provided to
them.
“The national consultation indicated that as long as adequate support is provided
calorie menu labelling will be welcomed by all stakeholders in Ireland.” (Reilly, 2012)
Calorie posting is becoming more popular in public food outlets, due to public
demand and government legislation. Findings from the FSAI, (2012) demonstrated
that over 95% of consumers are in favour of calorie menu labelling in food outlets.
There were many reasons for this, the main one being that the consumer is allowed
to make a personal informed food choice. Other reasons included the empowerment
the information gives to the consumer and the right to be informed on what we are
4
eating. (Reilly, 2012) Eating outside of the home is becoming more popular due to
convenience and leisure.
“24% of calories are eaten outside the home. Recent data show that 18-64 year olds
consume 24% of their total energy from food and drink outside the home.” (IUNA,
2011)
The introduction of calorie labelling may contribute to tackling the obesity crisis in a
small but effective way. By educating the public about the food they are eating, it
allows a person to make a personal decision on their own health and lifestyle
choices. One comment from a consumer who completed the FSAI, (2012) report
suggested that calorie labelling is more important in sandwich bars and staff
canteens as these are the places where people eat regularly compared to a pub or
restaurant. This is an extremely valid point as some workers consume their main
meals for the day within the workplace setting.
“Nutritional labelling on menus has been proposed as a method to educate the
general public on the nutritional content of food items prepared away from home.”
(Vanderlee & Hammond, 2013)
Calorie posting was first introduced in the United States in 2003 on a voluntary basis.
In 2008, legislation was introduced in New York for calorie menu labelling to be
mandatory in food chain outlets. It requires the outlets to display the amount of
calories in each of the food and beverages available to the public (Bollinger et al,
2010). Part of Australia have also introduced a similar system and public food chains
which have 20 or more outlets are required to provide the number of kilojoules in a
dish. This practice has now been implemented in many food chains both nationally
and internationally.
5
Great Britain introduced calorie posting on a voluntary basis in 2009. The Food
Safety Authority in Britain developed a pilot scheme to investigate the outcome of
introducing this system into public businesses and twenty one UK companies
participated in this intervention. An evaluation was conducted by an independent
research company, which assessed consumers understanding and usability, along
with business costs. The results showed that implementing calorie information is
possible and issues which arise during the initial set up period can be overcome.
Consumers suggested that visibility, understanding and consumer engagement had
an impact on their inclination to use the calorie information. It allowed them to make
healthier choices when eating out whilst enjoying some of their favourite foods. The
consumers felt empowered by this (Ibrahim et al, 2011). This work was then
continued by the UK Department of Health. Eventually in 2011, „out of home calorie‟
labelling was launched. By the end of 2011, thirty eight food companies with 5,000
outlets were participating in displaying the calorie information (Reilly, 2012).
Northern Ireland also participated in a similar scheme to Great Britain in 2012. Nine
large food companies volunteered to take part in a 6 month pilot scheme. The calorie
information was posted in one or more of their food outlets, following the best
practice principles. The University of Ulster assisted in this scheme by calculating the
calorie information for the participating food businesses (Reilly, 2012). The aims of
the scheme were, firstly, to provide consumers with calorie information at the point of
choice, so as to give them the opportunity to choose a healthier option. It was also
put in place to encourage catering businesses to improve the nutritional content of
the food they served. Businesses were asked to display calorie information clearly at
the point of choice and to show the calories per portion, item or meal, so that
customers could use the information when making their food choices. Businesses
6
were also requested to display the estimated average requirement for calories so the
consumers could compare their intake (Ray et al, 2013).
In 2013, the FSA commissioned the Policy Studies Institute in London to carry out an
evaluation of the pilot scheme and published the findings in a report. Views from the
caterers and consumers were considered. Data from the scheme was collected
through interviews with the businesses and other stakeholders, a workshop with the
business stakeholders, interviews with consumers and focus groups with the public
also. The objectives of the report were to investigate the following:
1. Examine the rationale for food catering businesses participating in the
scheme, including for businesses of different types and sizes.
2. Explore the practical implications for food catering businesses of participating
in the scheme, including implementation challenges and perceived effects of
the scheme on the business.
3. Investigate consumer awareness, understanding of, and views on, calorie
labelling in catering outlets.
4. Examine the role of calorie information in decision-making for consumers
when eating outside the home.
5. Identify improvements to the Calorie wise scheme, from the experiences of
businesses and consumers that could be taken forward in any future national
rollout (Ray et al, 2013).
The findings from the evaluation are as follows: Responses from the businesses
stated that they got involved in order to improve public health, remain competitive
and be prepared for future legislation. The biggest challenge for businesses was
7
found to be acquiring the caloric information and that this was both time and cost
consuming. Findings from the focus group research indicated that most views from
consumers were positive. It was stated that it was building a trust between business
and consumer. A minority of views were negative for reasons including the issue that
consumers did not want to see this information when eating out for a treat. However,
overall usage of calorie information was low. Many individuals who were using the
information were currently on weight loss diets. Statements from the public explained
that nutritional labelling was more likely to be used in supermarkets rather than in
restaurants as it was perceived to be more important to eat healthy at home.
As a result of this evaluation the authors, recommended support for businesses
including setting up communication strategies for businesses, more support for
calculating calories and promote guidance for displaying the information. For the aid
of consumers, the information will have to be simple, clear and accessible (Ray et al,
2013). Engaging businesses and consumers more effectively should prove to have a
more beneficial effect on the implementation.
Calorie posting has already been implemented in certain restaurants and fast-food
outlets across Ireland and worldwide. In addition this concept is being extended to
other settings. The introduction of calorie posting into the workplace could be
beneficial in terms of education and changing people‟s food choices. The core aim is
to improve the health of the public by providing them with the essential information
needed for making a food choice.
Effectiveness of menu calorie labelling in restaurants and other food
establishments
8
Three major reviews on the effect of menu labelling in restaurants and other food
service establishments have been published (Larson and Story 2009; Swartz et al,
2011; Sinclair et al, 2014). Larson and Story (2009) reported an increase in the
selection of healthier menu items in several studies. In contrast, the review by
Swartz et al (2011) concluded that calorie labelling does not have the intended effect
of decreasing calorie purchasing or consumption. The most recent systematic review
reported that menu labelling with calories alone did not have an effect on decreasing
calories selected or consumed. However the addition of contextual or interpretive
nutrition information on menus appeared to assist consumers in the selection and
consumption of fewer calories (-67 kcal and -81 kcal, respectively). Some
researchers have questioned these small reductions in calorie intake and whether
this is a substantial reduction- replacing soft drinks consumed with a meal with water
would have a greater impact on caloric intake (Ellison et al, 2014).
However, some studies have found that calorie posting alone has a greater impact
on calorie consumption compared with other „traffic light‟ labelling and calorie posting
with including other nutrients. In a study conducted in Canada by Hammond et al
(2013), 635 adults over the age of 18 were asked to choose a free meal from
Subway (1 sandwich, 1 side and 1 drink) and was given 1 of 4 menus all containing
the same foods. The menus were allocated at random. One menu had no nutritional
information, one had calories only printed beside the item, another had the calories
displayed in the traffic light system and the last menu included calories, fat, sodium
and sugar amounts all presented in the traffic light system. After the subjects had
their meal each individual was asked for information on their socio demographic
background, recall of nutrition information from the menu, perceived influence of the
information, calorie knowledge, calories ordered and calories consumed. The
9
findings showed that recall of information was higher in all experimental conditions
compared to the no information menu with 24.4% of participants able to recall the
calories they ordered within 50 calories of a difference and this was highest from the
calorie only menu group.
“When presented with this longer list of nutrients participants were less likely to recall
the calorie content of their meal compared to when menus displayed calories only.”
(Hammond et al, 2013).
The calorie amounts of ordered meals were not significantly different across menu
labelling conditions, however, participants with the calorie only menus consumed
significantly fewer calories. In comparison to the traffic light system, displaying
calories numerically may be more beneficial (Hammond et al, 2013). This study
demonstrates that calorie labelling increases awareness of food choices. Presenting
calories alone may avoid confusion to the consumer. This study also highlights the
importance of measuring calories consumed in these types of studies as many
studies measure food ordered only. This may of importance when assessing the
impact of menu labelling policies.
Dietary Intervention in the Workplace setting
Menu and calorie labels are in competition with other important factors at the point of
purchase. Environmental, social and situational determinants will impact on the
decision making process and although nutrition can influence food choice, this differs
between and within individuals depending on the context. Understanding and
applying nutrition information also requires a high level of health and functional
literacy.
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It has been recognised that the workplace may be an ideal setting to promote
healthy behaviours since most individuals spend two-thirds of their waking hours at
work (WHO, 2008). A systematic review carried out by Geaney et al, (2013) studied
the effectiveness of workplace interventions in relation to dietary modifications. To be
eligible for inclusion, the interventions must have included either changes in the
dietary content of food, changes in portion size, changes in food choices available or
an education aspect. Six studies met the criteria including 3 from the United States,
1 from Brazil, 1 from the Netherlands and 1 from Belgium. Each intervention varied
from 3 months to 12 months. Data on participants, intervention design, setting, and
duration, outcome, and outcome measures was collected from all of the studies and
the six studies consisted of 8,443 participants in total. Modifications from the studies
involved food preparation alterations, increased fruit and vegetables availability,
increased availability of low fat products, taste tests on healthier foods and education
programs. Four of the studies used food frequency questionnaires, one used oneday food diaries and one used surveys to measure dietary intakes of the individuals.
The findings suggest that nutrition education and multi-component workplace dietary
interventions have a positive effect on dietary behaviours, especially fruit and
vegetable consumption however, due to the duration of each study, it is unclear if the
improvements can be sustained over a long period of time (Geaney et al, 2013).
A pilot study in Ireland investigated the impact of a structured catering initiative on
food choices in a hospital workplace setting (Geaney et al, 2011). This was a crosssectional comparison study in two hospitals, one of which had implemented a
catering initiative designed to provide nutritious food while reducing sugar, fat and
salt intakes. Participants (n=100, aged 18-64 years) who consumed at least one
main meal in the two hospital staff canteens were recruited. Reported mean intakes
11
of total sugar, total fat, saturated fat and salt were significantly lower in the
intervention hospital when adjusted for age and gender. Findings from this pilot study
indicate that the workplace can play an important role in the promotion of healthy
food choices.
These researchers are currently assessing the effectiveness of diet interventions
which aim to reduce the levels of diet related diseases. The intervention is focused
on environmental dietary modification or nutrition education in the workplace.
(Geaney et al, 2013). The study is a clustered controlled trial with a total of 448
adults within the age range of 18 – 64 years. The subjects were selected from four
multinational manufacturing workplaces and the only requirement being that they ate
at least one meal from the workplace canteen every day. The workplaces were
divided into groups and each had a different intervention technique, as follows,
(a) Workplace A – Control, no intervention technique used.
(b) Workplace B – Nutrition education only provided to workers.
(c) Workplace C – Nutrition education and environmental modification provided.
(d) Workplace D – Environmental education provided only to workers.
The nutrition education provided for workers were group presentations, individual
nutrition consultations and detailed nutrition information. The environmental
modifications made in the canteen setting were restriction of fat, saturated fat, sugar
and salt, Increase of fibre, fruit and vegetables, discounted price for purchase of
fresh fruit, portion size control and strategic positioning of healthier foods at point of
purchase. The changes in dietary behaviours, the knowledge of nutrition and health
status measurements were obtained at baseline and are being monitored throughout
12
at different intervals, 3 – 4 months, 7 – 9 months and 13 – 16 months. The findings
from this intervention are to be published in 2015.
Several other studies have been conducted internationally examining the impact of
nutrition and education interventions in the workplace with mixed results.
Nutrition and education interventions
An intervention was completed in Denmark on eight blue collar worksites. It was a
six month participatory and empowerment based intervention study. The main aims
of the intervention were to examine the employee‟s dietary habits and the effects of
changes in the canteen nutrition environment.
It also investigated possible
opportunities and the impacts of promoting healthy eating specifically with blue collar
workers. Worksites were randomly allocated to either an intervention group or a
control group. All worksites were offered a monthly news magazine which detailed
achievements at other worksites throughout the intervention period (Lassen et al,
2011). The intervention group were offered two kinds of hand-out materials; nutrition
quizzes and dinner mats. They were also repeatedly encouraged to initiate nutrition
related activities which would address both individual and environmental levels.
Regular meetings were also arranged with staff to engage all members of the
intervention, they were advised to set goals for the employees and work site and to
also tailor initiatives directly towards the canteen. The canteen staff were offered
education opportunities in order to provide the employees with sufficient knowledge.
In regards to the employee‟s dietary survey, 25 – 30 employees were randomly
selected to take part in the survey at baseline and at endpoint. The dietary recording
13
methods used to collect the data were personal face-to-face interview and selfadministrated food diaries over a four day period. The employees were encouraged
to take part in this process by receiving individual feedback on both food diaries and
a small prize for taking part, this was a lunchbox or backpack. A total of 229
participated in baseline interviews only. 201 participants completed both baseline
and endpoint interviews. Reasons for participants dropping out included leaving the
workplace and refusing to complete interviews. In regards to the canteen survey data
was collected by using individual level lunch intake data at baseline and endpoint.
Outcomes which were measured included changes in dietary habits, food diaries and
the canteens nutritional environment, changes were noted by analysing the
nutritional status of the individual‟s canteen lunch. The most nutritionally favourable
changes were observed in the intervention group. There was a median daily
decrease in fat intake and sweet intake. In contrast there was a median daily
increase in dietary fibre and fruit. The control group showed no overall significant
change in any food intake. The authors concluded that moderate positive changes
can be achieved in the workplace if the correct practices are used (Lassen et al,
2011).
Another intervention based in the Netherlands on worksites chose to direct attention
towards portion size rather than calories. Larger portion sizes can often increase a
consumer‟s food intake so by directly reducing the portion size it may therefore help
in reducing calorie intake. The main aim of the study was to assess whether offering
a smaller hot meal in addition to existing sizes would stimulate people to replace
their regular chosen portion size. In total 25 worksite cafeterias took part in the
intervention. These worksites consisted of 15 hospitals, 5 companies, 3 universities
and 2 police departments (Vermeer et al, 2011). The main techniques of the
14
intervention was offering smaller portion sizes and employing different pricing
techniques, proportional pricing which was pricing the meal at 65% of the existing
size and value sized pricing which was offering a lower price per unit for larger
portions than for smaller portions.
The 25 worksites were randomly allocated into one of three groups which were,
experimental 1 (9 sites), experimental 2 (8 sites) and control (8 sites). Experimental
site 1 intervention consisted of the offering of smaller portion sizes in addition to
existing sizes along with the use of proportional pricing. Experimental site 2
intervention consisted of adding a smaller portion to an assortment of portion sizes
and implementing value size pricing. The control site did not add any additional
portion sizes. The only difference between experimental sites 1 and 2 was the
pricing method offered. This was to assess whether there was any additional effects
of pricing. A display with pricing information was displayed in the cafeteria and staff
in experimental conditions were instructed to ask the consumers which size they
wanted. This was the only method of advertising that took place.
The daily sale figures from the canteens were collected daily one month before the
intervention and also throughout the intervention period. Data was also collected
through a screening questionnaire which assessed how frequently the participants
ate hot meals at the worksite cafeteria itself. There was also four online
questionnaires completed throughout the intervention period. This was to collect data
ranging from age, educational levels, body weight and regular eating behaviours.
Results from the intervention indicated that participants involved in the experimental
conditions had a positive attitude towards smaller portion sizes. No significant
differences in small meal sales were found between experimental sites 1 and 2. It
can be concluded that when offered a smaller portion size in addition to the existing
15
sizes available the consumers were inclined to replace their regular choice with this
option. The sales figures collected also indicate that the consumers did not
compensate their smaller option with other snacks such as fried food. For future
studies using these techniques it is recommended that they use a broader range for
more reliable results. On the basis of these results it is concluded that offering
smaller portion sizes did reduce overall food intake (Vermeer et al, 2011).
Calorie posting and contextual or interpretive nutrition information in the
workplace
A quasi-experimental study was completed in two Danish hospital cafeterias in
2014.This study was completed to assess the effect of a healthy labelling
certification i.e. the Keyhole Certification. Improving dietary intake and influencing
edible plate waste were the main aims. The intervention canteen in this experiment
was aiming to achieve the Keyhole certification and had at least half of their available
meals labelled as healthy. They had fixed prices on all food menus. In the control
hospital, there were no plans to become Keyhole certified and therefore made no
changes to the food availability. Also, the food in this canteen was priced by weight.
To measure the food intake and edible leftover food, photographs were taken before
and
after
food
consumption.
Background
information
surveys
and
food
questionnaires were also completed by the consumers to measure food satisfaction
(Lassen et al, 2014).
The intervention and control groups were not significantly different at baseline in
relation to energy intake or any of the examined nutrients or foods. At the six week
end point the intervention group showed significant changes in relation to dietary
16
intake. They were consuming, on average, 30% less energy, 20% less fat and
increased their fruit and vegetable consumption by 47%. After six months, a follow
up was completed and the intervention group were found to be consuming 16% less
energy, 16.8% less fat, and 54% more vegetables, which proved that the intervention
had a somewhat lasting effect. No significant changes were found in food
satisfaction or edible plate waste. The control hospital displayed no positive
nutritional effects. This study highlights that using a healthy labelling certification
program encourages both availability and awareness of healthy meal choices,
therefore improving dietary intake (Lassen et al, 2014).
A clustered randomized controlled trial study conducted in the Netherlands
investigated the effectiveness of labelling foods with choice nutrition logos on
influencing menu selection and behavioural determinants. Choice logos can be
found on a variety of brands in many supermarkets and food outlets. The logo is
assigned to products which meet certain criteria for sodium, added sugar, saturated
fats, trans-fats, fibre and energy (Vyth et al, 2011). The cafeterias were allowed to
assign the choice logo to freshly prepared foods. Catering managers working in
cafeterias are trained to prepare certain food to fit into the criteria. By increasing the
availability and labelling on products, they can facilitate employee selection of
healthier foods. In total 25 cafeterias took part in the intervention. Thirteen of the
cafeterias were classed as intervention cafeterias and used the choice logo to
promote healthier eating. Twelve cafeterias were used as the control group. They
used the same menu but without the use of the choice logo. The intervention was
completed over a three week period. Sales data was collected for nine weeks in
total. A questionnaire was also completed in order to gain insight into the behavioural
determinants of food choice. Employees from the largest intervention and control
17
cafeteria completed an online questionnaire before and after the intervention. It was
also used to measure the use of the choice logo. In earlier research, food choice
motives were found to be significant predictors of selection of foods with the choice
logo (Vyth et al, 2010).
No intervention effects were found in the sale of sandwiches, soups, snacks, fruits
and salads. No significant differences in behavioural determinants were found. No
significant effects on employee‟s lunchtime food choices were observed. There was
a positive association with the intention to eat healthy and attention to the provided
product information and self-reported consumption of choice logo foods.
Work
cafeterias are potentially the most important venues to target as food consumption
during lunch time. The majority of the intervention population had a low intention to
eat healthier at baseline. Labelling might not be an intervention that suits the
motivational phase. Labelling healthy choices in work site cafeterias could be useful
to health conscious employees however extended health education would be
required to impact the choices of employees that are not health conscious (Vyth et
al, 2011).
A study completed in Belgium was based on the provision of simple point of
purchase information in university canteens. Universities are potentially the most
effective setting to promote healthier eating because of the target group available.
The main aims of the study was understanding the process by which point of
purchase nutrition information can have, effects on meal choice and therefore energy
intake (Hoefkens et al, 2012). They also wanted to examine whether information was
more effective in changing meal choice in specific sub groups. The study was a one
group pre-test – post-test design. A convenience sample of 224 students between
the ages of 17 – 35 who were also regular customers of the chosen canteens was
18
selected. This sample completed the baseline and the six month follow up surveys.
The energy intake from the canteen meals at baseline and follow up were calculated
as an average of three days. This information was collected through selfadministrated food records. Participants composed their meals by choosing one
protein, sauce, vegetable and carbohydrate. There were approximately 180 meal
combinations available. Each day in the canteens twelve meals were selected –
three best meal options for each of the components – these suggested meals were
then communicated to the participants. The meals were selected based on their
compliance of the meals contents of energy, sodium, saturated fat and veg portion
size. The nutrition information on these suggested meals consisted of a star rating.
For example when a meal complied with one of the recommendations it received one
star and so on. The top score for a meal was then four stars.
Participants who had a greater knowledge of nutrition and understanding of their
health had a greater understanding of the displayed nutrition information. This
resulted in more effective use of the provided information. Motivation to change their
diet and understanding of the information provided was required to make a change.
This could be a useful practice to apply to other interventions. There was also a
significant relationship between with the liking of the provided information and its
use. The results suggest that nutrition information interventions such as this will be
more effective when the information is “liked” by the target group combined with
educational practices. Increasing nutritional knowledge is key to changing
individual‟s choices (Hoefkens et al, 2012).
A cafeteria intervention study was completed in Boston on the food choices of
minority and low income employees. The purpose of the intervention was to test
whether a two phase point of purchase intervention improved the food choices
19
across all the socioeconomic and ethnic groups. The aim was to develop a labelling
strategy that would minimize cognitive demands at the point of purchase, this
concept would then improve nutritional choices among diverse populations. It was a
nine month longitudinal study that took place in the main cafeteria of Massachusetts
General Hospital Boston with a total of 4,642 employees. Intervention one consisted
of a traffic light style colour coded labelling system (Levy et al, 2012). Healthy items
marked with a green, unhealthy items marked with red. Intervention two consisted of
“choice architecture”, which was physically rearranging certain cafeteria items. The
green labelled food were made more accessible and red labelled foods were made
less accessible. Sales data was collected and analysed at baseline for 3 months and
the two- phase intervention was completed over a period of 6 months, the second
intervention being put in place after 3 months. Permanent signage was placed
throughout the cafeteria and a crew of dieticians were available for a temporary
period in order to explain the labelling intervention to employees.
Main findings from the study concluded that the Latino and black ethnic groups had a
higher percentage of red labelled foods at baseline analysis. Overall labelling
decreased sales on all red labelled food items, with red labelled beverages
decreasing the most. The “choice architecture” further decreased the sales of red
labelled items. Intervention effects were similar across all ethnic and socioeconomic
groups. Simple intervention techniques similar to this can positively affect food
choices. The simple techniques used improved healthy choices among all categories
(Levy et al, 2012). The use of dieticians on site along with simple labelling
techniques could play a major role in the success of the study.
One of the first studies on the effect of calorie posting interventions took place in
Philadelphia in 2003. An intervention took place in two hospital cafeterias in to target
20
the staff‟s energy and nutrient intake. It involved both male and female aged 21-65
years. The aim was to allow access to staff to healthier options and see how they
would respond.
“Modifying the food environment is a novel approach or facilitating changes in eating
behaviour, such as reductions in energy intake that might ultimately prevent weight
gain.” (Lowe et al, 2003)
Two groups were randomly allocated to the EC group (Environmental Change) or the
EC-Plus group (Environmental Change plus Energy Density Education and
Incentives). All of the participants were exposed to food choices where the energy
density of some foods were lowered (e.g. providing low fat mayonnaise, low fat
cheese, whole wheat buns etc.) and nutritional labels on all available foods in a
colour coded system. In addition to this, the EC-Plus group were given training on
how to reduce their energy intake. These sessions were based on the book
„Volumetrics‟ by Rolls & Barnett (2000) and each participant received a copy of this
book. The EC-Plus group were also given discounts on low energy dense foods as
an incentive. ID cards were used by staff to gather information on their purchases.
However there were some limitations to the study as technical faults arose for month
3, which meant not all information on purchases was recorded. Dietary recalls were
also conducted to assess whether food intake outside of the work setting had
changed.
Height, weight, waist circumference, body composition, blood lipids, blood pressure,
and cognitive restraint were all measured before and after the intervention. The
results found that meat intake decreased along with total energy intake and
percentage of energy fat in both groups in the workplace. Because of this, the
21
percentage of energy from carbohydrate intake increased in both groups (Lowe et al,
2003). The results showed no significant changes in either groups in relation to
weight or body fat and the 24 hour recalls did not demonstrate an effect on food
choices outside of the intervention. Waist circumference or blood lipid levels did not
improve either. Participants in both groups were found to have gained a small
amount of weight. This may be caused by the employees eating more less-nutritious
foods at home to make up for the reduction of calorie intake at work. This
intervention did lower the calorie intake of employees, within the workplace, however
no significant changes occurred with regards to any of the health parameters
measured. As the results from both groups were extremely similar, this study
showed that in this instance, the addition of education or financial incentives did not
contribute to improvements. In saying this, total energy and fat intake did reduce in
the workplace, implying that small interventions like this may have a positive effect in
the long term (Lowe et al, 2003).
A cross-sectional study conducted in Canada in 2013 also compared results from an
intervention study in two hospital cafeterias. The aim of this study was to examine
the impact of nutritional information on menus.
“Nutritional labelling on menus has been proposed as a method to educate the
general public on the nutritional content of food items prepared away from home.”
(Vanderlee & Hammond, 2013)
The control setting had limited nutritional information available in the cafeteria. They
displayed energy, sodium, saturated fat and total fat on small paper signs. The
experimental setting had health logos, education campaigns, including posters and
pamphlets, and healthier items highlighted on the menu for the consumers along
22
with the nutritional information at point of sale. There was also a selection of
healthier foods, for example, some foods were grilled rather than deep fried. Data
was collected over a 5 week period by trained interviewers at the exit of the cafeteria
and surveys were completed by the consumers at the end of the intervention.
The results showed that more consumers noticed the labels in the intervention
cafeteria (79.5% Vs 36.2%) and staff and females noticed more than visitors and
males. Energy, sodium and fat labels were most noticed in both control and
intervention settings. The consumers who were most influenced were those in the
intervention cafeteria (26.6% Vs 10.7%). Participants at the intervention site
consumed 21% less calories, 23% less sodium, 33% less saturated fat and 37% less
total fat. In relation to both groups, the individuals who noticed the labels consumed,
on average, 77 kcal less, 159mg less sodium and 4.8g less fat. 95% of individuals
asked agreed that calorie posting was a good idea. This intervention suggests that
calorie posting at point of choice increases awareness. Location and the highlighting
of the nutritional information is critical (Vanderlee & Hammond, 2013).
Additional Considerations
Calorie posting has received major attention as a potential tool in public health
nutrition policy (Bleich & Pollack, 2010). Overall many studies support the role of
menu calorie posting in educating the public and providing them with the appropriate
information when making food choices outside of the home. Some factors have been
highlighted in several studies. A study conducted in 2009 involving a phone survey
with 663 randomly selected adults of different ethnic groups examined the
effectiveness of calorie posting. They found that 78% of men and 69% of women,
23
who were moderately active, from America, were knowledgeable about energy
requirements. 60% of under-active adults underestimated energy requirements.
Whites were found to be more knowledgeable and confident about calorie
information. Blacks, Hispanics and women reported to be more likely to select lower
calorie foods in chain restaurants where calorie information was provided. 68% of
Americans were in favour of the implementation of mandatory calorie information on
the menus at point of purchase, this being significantly higher with blacks, Hispanics
and women.
Additionally providing calorie information allows the already health conscious
individuals to make an informed decision when eating out of the home. Studies have
shown that individuals who are knowledgeable about nutrition and health are more
likely to benefit from calorie posting (Gracia et al, 2007).
Menu labelling will likely encourage consumers to eat more healthily some of the
time. The introduction of the calorie posting as part of public health nutrition policy
could help in improving and changing the public‟s eating habits. Particularly in
restaurant settings, consumers often fail to recognise the high calorie content of
most meal options (Block & Roberto, 2014). People are therefore more likely to
overeat when eating outside the home as they don‟t consider exact contents of a
meal when they themselves are not cooking or preparing it. Giving consumers
usable calorie information at point of purchase could increase awareness of food
choices. From previous discussed studies it was found that the majority of
consumers would like to know what they are eating and also that the menu labelling
can encourage people to order and consume less calories than normal (Block &
Roberto, 2014). However while many potential benefits do exist there is a major gap
in understanding the long term effects because of a lack of long-term data.
24
No studies were found to provide an estimate of the economic value of nutritional
information on restaurant or canteen menus. In 2009 it was found that Americans
spend 42% of their income on purchasing food outside of the home (Ellison et al,
2014). Food intake outside of the home tends to be high in calories and low in
nutritional value. The introduction of nutritional labelling in restaurants and canteens
could work towards promoting healthier choices outside of the home. It was found in
a study completed in Oklahoma that when prices on menus were manipulated
according to caloric value along with nutritional information it did change the
individual‟s willingness to pay for said item (Ellison et al, 2014). Three menus were
used in a restaurant, control, two a traffic light coded menu and, three a numerical
display of calories. All prices on menus were then changed according to a “fat tax” or
a “thin subsidy”. The “fat tax” was placed on items which were more than 800
calories and it was an increase in price by 10%. The “thin subsidy” was placed on
items which were less than 400 calories and it was a decrease in price by 10%.
When the calorie labelling was present a negative relationship then existed between
the willingness to pay and the calories (Ellison et al, 2014). From a business point of
view the introduction of nutritional policies may have a negative effect on net returns.
However pricing policies are unlikely to produce the desired effect by itself, symbolic
and numerical displays of calorie contents are much more affective in influencing
consumer‟s choices.
Discussion
The existing research proves that clear, concise labelling at point of choice provides
the best results. Excess information was found to be off putting to consumers, as
25
shown in one of the Canadian studies. Interventions worked best when different
methods were combined, such as introducing calorie posting along with an
educational intervention, so that the consumer was provided with nutritional
knowledge. It was noted that people who are more knowledgeable about nutrition,
acknowledged and used the caloric information. Workplaces which were reaching for
a goal, such as obtaining „Keyhole‟ certification in Denmark, was found to be positive
and have a beneficial effect on consumers.
There were no significant differences in studies varying in ethnic or socio-economic
groups. However, this has not been extensively researched and additional research
needs to be conducted to cover populations from different backgrounds. In many
studies, those participants who are conscious of their nutrient intake are most likely
to use it information from calorie posting. Individuals who were concerned about
weight loss or their general health benefited most but the aim of calorie posting is to
tackle the population‟s obesity problem as a whole. Providing education on the topic
is seen to be beneficial and therefore, the overall underlying finding was that
combining calorie posting with an educational aspect provides the best results.
26
Summary of the research investigating the effectiveness of calorie posting in a
workplace setting
Preference, hunger and habitual ordering habits are important considerations when
people are making food choices and may act as potential barriers to the success of
calorie posting. These combined with the consumer‟s general lack of awareness in
relation to the calorie contents of restaurant and cafeteria food are major barriers
that need to be addressed before developing intervention techniques in the
workplace setting.
It is important to acknowledge that calorie labelling in a restaurant/canteen/work
setting may place the pressure of weight gain or weight reduction directly on the
consumer at place and time of purchase. It may cause anxiety and internal conflict
on one‟s self when purchasing high calorie food in public.
The workplace setting may provide a more favourable environment for behaviour
change. Users will have more regular access to information and may also be
provided with more opportunities to observe and act on the information.
Interventions which used menus that were overloaded with nutritional information
were found to have a negative effect. Consumers were unable to recall the
information and did not find it useful.
27
Health and functional literacy are important considerations. For this reason, calorie
posting in a workplace setting may be more beneficial as these factors can be
addressed in the intervention.
The existing research demonstrates that clear, concise labelling at point of choice
provides the best results. The consumer benefits when the information is in clear
sight and in an understanding context.
Many studies have shown that those concerned with weight loss benefited.
Motivated participants benefited more form these interventions. Motivation should be
addressed in the intervention approach.
Interventions worked best when different methods are combined, such as introducing
calorie posting along with an educational intervention, so that the consumer is
provided with nutritional knowledge. When the individual is empowered with the
knowledge, they have the opportunity to make an informed food choice.
Workplaces which were reaching for a goal, such as obtaining the „Keyhole‟
certification in Denmark, which is a healthy labelling certification, was found to be
positive and had a beneficial effect on consumers.
28
While the effects of calorie posting in the workplace were found to have worked,
many studies report no changes in weight measurements. This suggests that the
information was not being used outside of the intervention setting.
When assessing the impact of menu labelling policies it is important to consider
measuring consumption and not just food ordering as there may be a difference.
Long term studies are required to examine if any changes are maintained and
extended outside of the work environment.
29
References
Alliance, I. U. (2011). National Adult Nutrition Survey Summary Report.
Bleich, S, N., Pollack, K, M. (2010). The Public‟s Understanding of Daily Caloric
Recommendations and their Perceptions or Calorie Posting in Chain Restaurants.
BMC Public Health. 10(121)
Block, J, P & Roberto, C, A. (2014). Potential Benefits of Calorie Labelling in
Restaurants. The Journal of the American Medical Association. 312(9), pp. 887 –
888.
Bollinger, B., Leslie, P., & Sorensen, A. (2010). Calorie posting in chain restaurants
(No. w15648). National Bureau of Economic Research.
Drewnowski, A., & Darmon, N. (2005). Food choices and diet costs: an economic
analysis. The Journal of nutrition. 135(4), pp. 900-904.
Ellison, B., Lusk, J., & Davis, D. (2014). The Impact of Restaurant Calorie Labels on
Food Choice: Results from a field experiment. Economic Inquiry (ISSN 0095-2583)
52 (2), pp. 666-681.
Falk Müller-Riemenschneider, T. R. (2008). Health-economic burden of obesity in
Europe. European Journal of Epidemiology. pp. 409-599.
Geaney, F., Di Marrozzo, J, S., Kelly, C., Fitzgerald, A, P., Harrington, J, M., Kirby,
A., McKenzie, K., Greiner, B., Perry, I, J., (2013). The Food Choice at Work Study:
effectiveness of complex workplace dietary interventions on dietary behaviours and
diet related disease risk – study protocol for a clustered controlled trial. Biomed
Central. 14(370), pp. 1 – 14.
30
Geaney, F., Harrington, J., Fitzgerald, A, P., Perry, U. (2011). The impact of a
workplace catering initiative on dietary intakes of salt and other nutrients: A pilot
study. Public Health Nutrition. 14(8), pp. 1345-1349.
Geaney, F., Kelly, C., Greiner, B, A., Harrington, J, M., Perry, I, J., Beirne, P. (2013).
The effectiveness of workplace dietary modification interventions: A systematic
review. Preventive Medicine. 57, pp. 438-447.
Hammond, D., Goodman, S., Hanning, R., & Daniel, S. (2013). A randomized trial of
calorie labelling on menus. Preventive Medicine. 57, pp. 860-866.
Hoefkens, C., Pieniak, Z., Van Camp, J., Verbeke, W. (2012). Explaining the effects
of a point-of-purchase nutrition-information intervention in university canteens: a
structural equation modelling analysis. International journal of behavioural nutrition
and physical activity. (9)111.
Ibrahim, U., Earl, R., Hooper, P., & Turner, G. (2011). Health Works: A look inside
eating-out.
British
Hospitality
Association.
pp.
14.
Available
at:
http://www.bha.org.uk/wordpress/wpcontent/uploads/2013/08/BHAHealthReportAdobePrint.pdf [Accessed: 23 Feb 2015]
Lassena, A, D., Beckb, D, A., Leedob, E., Andersenc, E, W., Christensena, T.,
Mejborna, H., Thorsena, A, V., & Tetensa, I. (2014). Effectiveness of offering healthy
labelled meals in improving the nutritional quality of lunch meals eaten in a worksite
canteen. Appetite. 75, pp. 128-134.
Lassen, A, D., Thorsen, A, V., Sommer, H, M., Fagt, S., Trolle, E., Biltoft- Jensen, A.,
Tetens, I. (2011). Improving the diet of employees at blue collar worksites: results
from the food at work intervention study. Public health nutrition. 14(06) pp.965-974
31
Leahy, S., Nolan, A., O' Connell, J., & Kenny, R, A. (2014). Obesity in an Ageing
Society. The Irish Longitudinal Study on Ageing 2014.
Levy, D, E., Riis, J., Sonnenberg, L, M., Barraclough, S, J., Thorndike, A, N. (2012).
Food Choices of Minority and Low-Income Employees – A Cafeteria Intervention.
American Journal of Preventitave Medicine. 43(3), pp. 240-248.
Lowe, M, R., Tappe, K, A., Butryn, M, L., Annunziato, R, A., Coletta, M, C., Ochner,
C, N., & Rolls, B, J. (2010). An intervention study targeting energy and nutrient
intake in worksite cafeterias. Eating Behaviors. 11, pp. 144-151.
Lowenstein, G. (2011). Confronting reality: pitfalls of calorie posting. The American
Journal of Clinical Nutrition. 93(4), pp. 679-680.
Müller-Riemenschneider, F., Reinhold, T., Berghöfer, A., & Willich, S. N. (2008).
Health-economic burden of obesity in Europe. European journal of epidemiology.
23(8), pp. 499-509.
Organisation for Economic Co-operation and Development. (2008). Promoting
sustainable consumption - good practices in OECD countries.
Raj, M., Kumar, R., (2010) Obesity in children and adolescents. The Indian Journal
of Medical Research. 132(5), pp. 598-607.
Ray, K., Clegg, S., Davidson, R., & Vegeris, S. (2013). Evaluation of Caloriewise: A
Northern Ireland pilot of the display of calorie information in food catering
businesses. Policy Studies Institute. pp. 1
Reilly, A. (2012). Calories on Menus in Ireland. The Food Safety Authority of Ireland.
32
Sinclair, S, E., Cooper, M., Mansfield, E, D. (2014). The Influence of Menu Labelling
on Calories Selected or Consumed: A Systematic Review and Meta – Analysis.
Journal of the Academy of Nutrition and Dietetics. 114(9), pp 1375 – 1388.
Vanderlee, L., & Hammond, D. (2013). Does nutrition information on menus impact
food choice? Comparisons across two hospital cafeterias. Public Health Nutrition.
17(6), pp. 1393-1402.
Vermeer, W, M., Steenhuis, I, H, M., Leeuwis, F, H,. Heymans, M, W., Seidell, J, C.
(2011). Small portion sizes in worksite cafeterias: do they help consumers to reduce
their food intake. International journal of obesity. 35(9). Pp.1200-1207
Vyth, E, L., Steenhuis, I, H., Heymans, M, W., Roodenburg, A, J., Brug, J., Seidell, J,
C. (2011). Influence of Placement of a Nutrition Logo on Cafeteria Menu Items on
Lunchtime Food Choices at Dutch Work Siteurnal of the American Dietetic
Association. 111(1) pp. 131-136.
World Health Organization. (2000). Obesity: preventing and managing the global
epidemic (No. 894). World Health Organization.
World Health Organisation (2008). 2008-2013 Action plan for the global strategy for
the prevention and control of noncommunicable diseases. WHO.
World
Health
Organization.
(2015).
Obesity.
Available
at:
http://www.who.int/topics/obesity/en/ [Accessed: 28 Jan 2015]
33
Table 1. Nutrition interventions in the workplace
Study
Location
Study Type
Aims/Objectives
Intervention
What they
measured
Results/outcome
Four workplaces using
different techniques
 A – control
 B – nutrition education
provided
 C – nutrition education
and environmental
modification
 D – environmental
modification only
Nutrition education - monthly
group presentations, individual
consultations, detailed
nutrition information, traffic
light coded system on food in
canteen.
Environmental modification restrictions on fat, saturated
fat, sugar and salt. Increase of
fibre, fruit and veg, portion size
control, discounted prices on
fresh fruit and strategic
positioning at point of
purchase.
Measurements
obtained at
baseline and
measured
throughout at
intervals.
Changes in
dietary
behaviour.
Knowledge of
nutrition and
health status
measurements
Ongoing
Ireland
Ireland – Cork
Workplace
Clustered
controlled
trial
completed in
a workplace
setting




To assess
the
effectiveness
of diet
interventions
To develop a
long term
dietary
change on
participants
Investigate
motives
behind
employees
food choice
Evaluate and
compare
alternative
intervention
methods
35
Europe
Denmark 1
Worksite
“food at
work” study
6 month
participatory
and
empowermen
t based
intervention
study.
Worksites
Examine employees‟
dietary habits and
effect of changes in
the canteen nutrition
environment.
Investigate
opportunities and
impacts of promoting
healthy eating in
worksites.
Worksites were randomly
allocated to either
1- Intervention group –
offered two kinds of
hand-out materials and
repeatedly encouraged
to initiate nutrition
related activities
1- Control group – no
additional support or
information provided.
Measurements
included:
changes in
employees
dietary habits
with the use of a
food diary. At
baseline and
end-point the
canteen
nutritional
environment
was monitored
with the use of
nutritional
analysis.
Participants also
completed a
dietary survey.
Several positive nutritional effects
were observed in the intervention
group, including a decrease in fat
intake and an increase in dietary
fibre and fruit and veg.
Moderate positive changes are
possible in workplace settings.
36
Denmark 2
Hospital
Quasiexperimental
study design
in 2 hospital
cafeterias
To study the effect
of a healthy labelling
certification in
improving dietary
intake and
influencing edible
plate waste.
2 hospital cafeterias.
1. Intervention group.
Goal to achieve the
Denmark keyhole
certification. At least
half of the meals
healthy labelled and
fixed prices on all
menus.
2. Control hospital. No
plan to become
keyhole certified and
priced food by weight.
Food intake and
edible plate
waste was
measured. Food
was
photographed
and weighed
before and after
consumption.
Food
satisfaction was
measured by
questionnaires.
Intervention group showed significant
decrease in fat and energy intake but
no significant changes in food
satisfaction or plate waste.
No positive changes in control group.
Netherlands 1
Workplace
Clustered
Randomized
Controlled
Study,
cafeterias in
the
workplace
Investigate the
effectiveness of
choice logo
influence (choice
logos being placed
on food items which
fit in specific criteria
for sodium, added
sugar, saturated
fats, trans fat, fibre
and energy)
13 cafeterias – experimental
12 cafeterias – control
All using the same/similar
menus with only difference
being use of choice logo.
Intervention was
completed over
3 weeks.
Sales data was
collected over 9
weeks.
A questionnaire
was completed
on the
behavioural
determinants of
food choice.
Questionnaires
were used to
measure the
use of the
choice logo.
No significant differences in
behavioural determinants were
found.
No significant effects on employee‟s
lunchtime choices were found.
Labelling healthy choices in
workplaces may be beneficial to
health conscious employees,
extended health education would be
required to impact on employees
who do not fit this criteria.
37
Netherlands 2
Worksite
Longitudinal
randomized
controlled
trial in Dutch
worksite
cafeterias.
To assess whether
offering smaller hot
meal portions
stimulates people to
replace their larger
meal.
Assess impact of
introducing a smaller
portion size.
Assess impact of
pricing strategies.
Worksites were randomly
allocated to:
2- Experimental 1 –
smaller portions
offered with existing
and proportionate
pricing
3- Experimental 2 –
smaller portions
offered and value size
pricing.
Control – only existing sizes
available
Daily sales of
meals were
monitored (1
month before
intervention and
3 months
throughout
intervention)
Screening
questionnaire
completed
Online
questionnaires
completed
throughout
Participants
were also asked
about attitudes
to portion size
Ratio of smaller portion sizes in
relation to larger portion sizes scales
were 10.2%
No effect of proportional pricing
found.
Participants in experimental
conditions had a positive attitude
towards smaller portions being
offered.
38
Belgium
University
One group
pre-test –
post-test
design.
University
Canteen
setting
To understand the
process by which
point of purchase
nutrition information
can have an effect
on meal choice and
energy intake.
Participants were informed
about purpose of study only.
Participants could compose
their meal by choosing 1
protein, 1 sauce, 1 veg, and 1
carbohydrate.
Approx.: 180 combinations
available
Each day a selection of 12
meals (made of the best
components) were
communicated.
Provided was a 3-star rating
for components and a
descriptor of nutrients that did
not comply with
recommendations.
Participants
completed a 3
day food diary.
Questionnaires
were selfadministered at
baseline and at
follow up
Significant relationship with liking of
information and its use was found.
Participants that had a greater
knowledge and understanding of
nutrition showed more effective use
of provided information.
Increasing students‟ motivation to
change their diet is recommended.
39
Philadelphia
Hospital
Hospital Cafeteria Intervention techniques
Allow access to
healthier options
and observe
response of staff
members.
Target staffs
energy and
nutrient intake
2 groups
1- EC group
(environmental
change)
2- EC – plus
(environmental
change and
education and
incentives.)
All participants were
exposed to energy
density of foods being
lowered.
Nutritional labelling on
available foods with
colour coded system.
EC – plus were
additionally provided
with training on how to
reduce energy intake
and given discounts
on low energy dense
foods as incentive.
ID cards of staff
were used to
gather
information of
changes in
dietary intake.
Measurements
at baseline and
after
intervention:
height, weight,
waist
circumference,
body
composition,
blood lipids,
blood pressure,
cognitive
restraints.
Dietary recalls
(24hrs)
conducted to
note change in
diet outside of
workplace.
(Results from both groups)
Meat intake decreased.
Total energy intake decreased.
Percentage of energy fat
decreased.
Carbohydrate intake
increased.
Body fat, waist circumference
and blood lipids did not
improve.
Recalls did not prove to show
changes in diet outside of
workplace.
No significant changes in
relation to weight and body fat.
Total energy and fat intake did
reduce in workplace only.
40
Canada
Hospital
Cross Sectional Study,
comparison of 2 hospital
cafeterias
Examine the
impact of
nutritional
information on
menus
2 settings
1- Control setting,
limited
information
available.
Displayed
energy,
sodium, total
fat and
saturated fat
on small paper
signs.
2- Experimental
setting, health
logos on food
items,
education
campaigns,
healthier
options
highlighted on
menus and
nutritionally
information at
point of
purchase.
Data was
collected over a
period of 5
weeks.
Interviews were
conducted at
exit of cafeteria.
Surveys were
also completed
by consumers
at the end of
intervention.




More consumers
noticed signs and
labels in intervention
cafeteria.
The experiment site
consumed less
calories, sodium,
saturated fat and total
fat.
In relation to both
groups the individuals
who noticed labels
consumed less
calories, sodium and
fat.
Calorie posting and
labelling at point of
purchase increased
awareness.
41
North America
Food Outlets
Systematic Review and
Meta – analysis
Determine whether
format of nutritional
information affects
selection and
consumption of
calories in food
services
Calorie posting on
menus along with the
use of contextual
and/or interpretive
information.
Ex. Posting
recommended calorie
intakes or use of
colour codes systems
on menus
Two reviewers
screened titles
and abstracts
for appropriate
articles.



Menus with calorie
posting alone did not
have intended effect of
decreasing calories
consumed
Overall women were
more likely to use
provided information
Findings support the
inclusion of
contextual/interpretive
information along with
calorie posting.
42
43