The convenience of eating out comes at a price to our health. Since the 1970s, we have doubled the amount of calories we consume eating outside our homes, with a third of adults in the U.S. eating fast food on any given day. Over the past 30 years, the average entree at fast-food restaurants has 90 more calories than it used to, while calories in desserts at these restaurants have increased by double that. Compared to eating in, eating out generally means we eat less fruits and vegetables while consuming more calories, fat and salt. And aside from a brief dip in 2020, over the past decade we have consistently spent more money on food outside the home compared to food we eat at home.
This makes it even more challenging for people to stick to their recommended daily calorie intake, and increasing portion sizes and calories have at least in part contributed to the obesity epidemic. While there is no simple solution to this problem, the federal government implemented regulations requiring restaurants that have 20 or more locations nationwide to display the total calories or calorie range beside food items.
Research is finally starting to trickle in that assesses whether this change is having an effect. According to the findings, calorie label requirements on menus can help - though not necessarily in the way expected. Instead of diners, it's the restaurants themselves most likely to go on diets. While the labeling has been shown to decrease calories consumed by consumers to a small degree, they have likely been shown to decrease the number of calories for new menu items at restaurants.
New data modeling demonstrates that even the very small impact on calories consumed by individuals can make for a significant impact at the national level when it comes to decreasing Type 2 diabetes and cardiovascular disease.
One large study published last year examined the effect of calorie labels in three states - Louisiana, Mississippi and Texas - three years before and one year after national labeling started. Across 300 million meal purchases, researchers found that the average calorie content of each meal was 4.7% lower, which translated into 73 calories. This may seem small, but keep in mind that over the course of a year, that average daily calorie reduction could translate to a 7.5 pound weight loss (if diners don't make up those calories elsewhere).
While we don't yet have long-term data to examine the full effect that this policy will have, the benefits have been modeled through existing data. In 2020, a study published by the American Heart Association about chain restaurants predicted the prevention of nearly 15,000 new cardiovascular disease cases after five years of the labeling recommendation, with nearly 1,600 deaths prevented. For Type 2 diabetes, more than 21,000 cases would be prevented.
While many of the criticisms against calorie labels come from the food industry, which has a strong interest in keeping consumption as high as possible, there are other valid arguments against calorie labels. First, it may do harm to people with eating disorders. There is data to show that it may cause women with anorexia nervosa and bulimia nervosa to eat fewer calories, and women with binge eating disorder to eat more calories.
Another important criticism is these results may not persist over time. In the three-state study looking at meal purchases, the authors themselves noted that, although their finding was valid over two years, a small trend of increasing calories in meal purchases was observed after both the implementation of calorie labels by franchises and at the national level. It's possible that some consumers stop responding to labels over time. But this hasn't been proved, and we need longer-term studies to see if this holds true. What we know at this point suggests the possibility of saving thousands of lives with simple labels, so shouldn't we do it? And perhaps even expand the labels to include more restaurants?
More dramatic is the way restaurants are cutting back when they introduce new menu items. A study published in the Journal of the American Medical Association last year examined more than 35,000 menu items at fast-food restaurants, fast casual restaurants, full- service restaurants and coffee shops. New menu items that were introduced after the regulation contained, on average, 25% fewer calories (though those previously introduced stayed the same). This translated to more than 100 calories per menu item. For fast-food chains specifically, the decrease was even greater, at 180 calories per item.
This reduction in calories was also seen in supermarkets, which were required to show calorie labels on prepared foods beginning in 2018. A study published last year in the American Journal of Preventive Medicine found that while new (and continued) entrees, sides, cheeses and deli meats didn't change in calorie counts, bakery items did show a significant caloric decrease. For newly introduced bakery items, the difference was a whopping 440-calorie reduction per item. (The authors did note that these new bakery items were smaller, and it could not be determined whether consumers would simply buy more.)
It would be helpful to take this idea further and inform consumers about specific nutrients, which calorie labels do not offer. Since 2016, Chile, Israel, Mexico, Peru and Uruguay have required nutrient warnings such as "high in added sugar" on packages, and have been successful. In Chile, for example, sugary beverage purchases decreased by a quarter after the implementation of these warnings. The U.S. should follow suit.
Obesity is a complex problem, and the solutions are also often complex. Calorie labeling alone won't fix the problem, but it's easy to institute and can make a difference. Restaurants are cutting back, and with calorie labels, maybe the rest of us can, too.
This article was originally published on NBCNews.com