RESTAURANT MANAGEMENT VIEWS ON THE NEW NATIONAL MENU LABELING LAW IN THE U.S.

Transcription

1 International Journal of Nutrition and Dietetics 2014 Pushpa Publishing House, Allahabad, India Published Online: June 2014 Available online at Volume 2, Number 1, 2014, Pages 1-18 RESTAURANT MANAGEMENT VIEWS ON THE NEW NATIONAL MENU LABELING LAW IN THE U.S. Ming-Chin Yeh 1,*, Charles Platkin 1, Jennifer Fishman 1, Liza Fuentes 2 and Nina S. Parikh 3 1 Nutrition Program, CUNY School of Public Health, 2180 Third Ave., Room 614, New York, NY 10035, U. S. A. myeh@hunter.cuny.edu * 2 CUNY Graduate Center and CUNY School of Public Health, U. S. A. 3 Brookdale Center for Healthy Aging, Hunter College, City University of New York, U. S. A. Abstract: Objective: Exploring opinions and intentions regarding the soon-to-be implemented menu labeling legislation of restaurant owners and management nationwide. Methods: An message with a link to an online survey was sent to those who were part of the Nation s Restaurant News and Restaurant Hospitality opt-in lists. Data were collected in January-February Participants: 178 participants completed the survey. Variables Measured: The survey included: restaurant operation characteristics, restaurant owners perception about the health impact of the law, restaurant owners plan to change the menu and anticipated costs, and restaurants owners attitudes about the new law. Analysis: Fisher s exact tests were performed, with a critical value of α = to determine significance. Results: In general, respondents with knowledge of and experience with menu labeling laws were more likely to respond that they would make menu changes as a result of the law. The majority of respondents, however, either disagreed or were neutral in response to questions about whether the law has the potential to improve health. Conclusions and Implications: Understanding what motivates restaurant owners to comply with the menu labeling law may contribute to efforts to ensure the success of its implementation. Received: September 25, 2013; Accepted: March 15, 2014 Corresponding author

2 2 Ming-Chin Yeh et al. Keywords and phrases: obesity, overweight, attitudes, menu labeling legislation, restaurants. Introduction More than 35% of adults and 17% of children and adolescents in the United States are considered obese [1, 2]. Research has found that food away from home adds an additional 130 calories per meal for a normal weight adult and an additional 240 calories per meal for those who are overweight or obese [3]. This additional energy consumption can have a significant impact on weight and overall health. Several initiatives have been proposed to combat the rise in obesity rates, including the most recent menu labeling legislation. Section 4205 of the Patient Protection and Affordable Care Act of 2010 requires restaurants or similar retail food establishments that are part of a chain and vending machine operators with 20 or more locations, to list calorie content information on restaurant menus and menu boards [4]. The legislation was originally scheduled for implementation in However the final rules are still pending and the implementation is delayed [5]. It has been suggested that knowledge of the calories contained in foods is essential to choosing and consuming an energy-balanced diet [6, 7]. There are, however, varying perspectives regarding the benefit and potential impact of this new legislation. Several studies have examined the public s opinion as well as the effect of menu labeling. One study conducted in a sample of over 600 randomly selected men and women found that 76% reported that seeing the calorie count of foods in chain restaurants would be very or somewhat useful, and 60% stated that calorie labeling would cause them to select a lower calorie food [8]. Several organizations have also conducted national and statewide polls to assess the public s opinion of nutrition labeling in restaurants and it was found that 67% to 84% support requiring fast-food and chain restaurants to list nutritional information on menus [9]. While consumer polls show a desire for calorie information to be available at the point of purchase in restaurants [10], research on the actual effects of menu labeling on lowering calorie choices and consumption has

3 Restaurant Management Views on the New National Menu... 3 shown mixed results [11-13]. Previous research has also revealed that the public significantly misjudges the amount of calories they consume. One study found that consumers underestimated the calorie count of restaurant entrees by over 600 calories [8]. This may suggest why one recent survey found that consumers not only want to see labeling on the menus mandated by the new legislation, but also would like to have labeling on menus in movie theaters, on alcoholic beverages, and on menus in convenience stores [14]. Yet, restaurant and store owners may have a differing perspective regarding menu labeling. Several restaurant-related organizations issued their comments to the FDA prior to the implementation of the law. For example, while the National Restaurant Association, compromised of 960,000 restaurant and food service outlets with a total of approximately 13 million employees, supports the new labeling law, its President and CEO filed comments on behalf of the Association to the FDA regarding the new legislation [15]. The International Franchise Association (IFA) also filed comments to the FDA regarding the new labeling legislation. The IFA claims to support menu labeling, however is concerned with the impact of the cost on restaurant operators, especially for the single-unit franchise restaurant owner and local independent contractors, and they are asking for accommodations for these small businesses [16]. Although, the FDA estimates that the initial costs to be $1,100 per covered establishment [17], the economic impact may vary by type of establishment. The public and many restaurant associations have expressed their thoughts on the new menu labeling legislation, but there has been a lack of research conducted on the perspectives of the restaurant owners and management regarding this new law. Therefore, the current study focuses on restaurant owners and management nationwide to gain insight as to their opinions and attitudes regarding the newly proposed menu labeling law. The primary aim of the study is to assess a range of domains regarding menu labeling that have not been asked of restaurant owners and generate potential recommendations for future research.

4 4 Ming-Chin Yeh et al. Methods Study design This survey study explored the attitudes, perceptions, and intentions of restaurant owners and managers whose practices may be affected by the new law. Data were collected via an online survey between January 26th and February 15th The project was reviewed and approved by the Hunter College, City University of New York Institutional Review Board. Study participants Participants included restaurant owners and management who were part of the Nation s Restaurant News (NRN) and Restaurant Hospitality (RH) opt-in lists. NRN and RH are both print and online sources of hospitality news, industry trends, and professional networking utilized by the most influential restaurateurs [18, 19]. The Director of Strategic Planning and Marketing at The Penton Restaurant Group indicated that, via an communication (August 8, 2012), the number of subscribers fluctuates as members opt in and out over time, but there were approximately 8,000 subscribers to the NRN listserv and 15,000 to the RH list serve at the time of the survey. Survey development and pilot testing Two faculty members with nutrition backgrounds drafted the survey questions. Some of the questions regarding the characteristics of the restaurant (e.g., location, size, etc.) were adapted from the National Restaurant Association s monthly restaurant industry tracking survey [20]. Other questions/domains such as barriers, perceptions, and costs regarding menu labeling were derived from prior literature [21]. For pilot-testing, a link to the survey was posted on Nation s Restaurant News and Restaurant Hospitality websites for members to complete. A total of 34 participants responded. The survey was then revised based on their responses. Briefly, the changes made to the pilot survey included reformatting, revising response options, and grouping questions of similar concepts under one main question. The revised final study questionnaire is divided into several domains that include restaurant characteristics, restaurant owners knowledge and

5 Restaurant Management Views on the New National Menu... 5 experience regarding the menu labeling law, their anticipated compliance plan and associated costs, and the restaurant owners perceptions and attitudes about the new law. There were 17 main questions, several of which had sub-questions for a total of 32 questions. All items were closed ended and the survey took approximately 10 minutes to complete. The following is a brief description of each of the sections in the questionnaire: 1. Restaurant operation characteristics: This section consists of questions including the job title of the participant, the restaurant location, type of restaurant, and annual food and beverage sales. 2. Restaurant owners intentions to change menus and anticipated costs as a result of the new law: This section includes three questions. The first asks owners to gauge the likelihood (5-point Likert scale ranging from very likely to very unlikely) that they will offer lower calorie items or reformulate high calorie items as a result of the new law. There are also two multiple choice questions asking about the way the owners comply with the new law and their belief about the anticipated cost per unit. 3. Restaurants owners attitudes about the new law: There are seven questions in this section, and 5-point Likert response options were given. For example, one question asks the owners their belief that the new menu labeling law is a step in the right direction in combating obesity using a 5-point Likert scale (ranging from strongly agree to strongly disagree). 4. Restaurant owners knowledge of and experience with the menu labeling law: This section includes one yes/no question about the owners awareness of the new law, a multiple choice question about the owners familiarity of the law, and whether their restaurant is already under a menu-labeling law. There are also six questions asking the owners to indicate their perception using a 5-point Likert scale (ranging from strongly agree to strongly disagree) regarding their view on the customers desire for the calorie information about the food they purchase, the owners perception of the new law s

6 6 Ming-Chin Yeh et al. impact on the health of their customers, and the impact on their business. Data collection The final questionnaire was posted online via Formstack ( a website dedicated to create an online data collection tool. An message regarding the study with a link to Formstack was sent to subscribers to the NRN and RH listservs. It was posted on January 26, 2012 and the data collection lasted for approximately one month. Slightly over 1,100 of the 7,968 participants from NRN and 1,537 of the 15,000 RH participants opened the message that was sent. Among the participants who opened the messages, a total of 178 participants completed the survey. Our response rate of 0.7% was lower than the typical online survey response rate, which ranges from 2% to 11% [22]. There were no incentives offered for completing this survey. Due to logistic issues, we were not able to send out follow-up reminders. Statistical analysis Stata, Version 12 (Stata Corp, Stata Statistical Software: Release 12. College Station, TX: Stata Corp LP) was used to calculate univariate and bivariate statistics. In order to facilitate data analysis and interpretation, some Likert scale items were collapsed for analyses from 5 categories to 3 (see Tables 2 and 3). Fisher s exact tests (two-tailed) were performed to test associations between variables of interest, with a critical value of α = to determine significance. Demographics Results Of the 178 survey respondents, half were employed in the restaurant business as company officers and 24% were operations managers (see Table 1). Respondents most commonly reported that their restaurant was in a rural (42.5%) or urban (39%) area, and in the South (37%) or West (23%). In terms of business characteristics, nearly half of respondents restaurants had between $1 million and $4.9 million in sales per year (45.5%). Half of

7 Restaurant Management Views on the New National Menu... 7 respondents said their restaurant was an independent operation (50.6%). Two-thirds reported non-franchise operations (66.7%), and nearly threequarters were businesses with 1 to 5 units. Finally, restaurants concepts were diverse; 40% of restaurants were causal/theme/family restaurants, a quarter was fine dining and upscale, and another fifth of the sample worked in fast causal/quick service/fast food restaurants. Attitudes The majority of respondents either disagreed, or were neutral, in response to the 7 questions about whether the law has the potential to improve health (see Table 2). For example, half strongly disagreed or disagreed that the new menu labeling law will reduce consumption of high calorie food; nearly a quarter (22.6%) responded neutral. A greater proportion of those who disagreed that the law would reduce high calorie food intake said they were unlikely to offer low calorie food as result of the law (32%), versus just 10% who thought the law would reduce low calorie food and 15% who were neutral ( p <.05). Disagreeing that the law would improve health was also associated with being unlikely to reformulate high calorie food in response to the law (47% versus 21% of those who agreed the law would improve health and 15% of those who were neutral, p <.05). Notably a significant proportion of all respondents - between 30% to 48%- said they were neither likely nor unlikely to change food items as a result of the law, regardless of attitudes about the law s health effect. Other positive attitudes about the law s potential health benefits were also associated with intentions to improve menus. In terms of the law s business impact, over half of respondents (53%) strongly disagreed or disagreed that the law would help their business, and nearly a third (31%) strongly agreed or agreed that the law would hurt their business. More than half (51%) reported it was very or somewhat unlikely that the law would ward off lawsuits. A higher proportion of respondents who were skeptical about the law s potential to ward off lawsuits reported they were unlikely to offer low calorie items and reformulate foods compared with their neutral and more positively opinionated counterparts.

8 8 Ming-Chin Yeh et al. Knowledge and experience In general, respondents with knowledge of and experience with menu labeling laws were more likely to say that they would make menu changes as a result of the law (see Table 3). For example, only 6% with a local law compared with 26% with no local law stated they were somewhat or very unlikely to offer low calorie items ( p <.05). The findings also showed that a very low proportion of respondents (4-10%) intended to use lab testing of food samples to comply with the new menu labeling law, regardless of their knowledge and experience with it. However, those having knowledge and experience with the law were 2 to 3 times more likely to say they would use a registered dietician compared with those with no knowledge or experience. The most common methods of complying with the law for all respondents seemed to be the least accurate one; having a non-dietician employee use a database to report calorie count. Discussion Our findings indicate that a significant minority of restaurant owners, managers, and other restaurant employees felt that menu labeling will lead to improved health behaviors among their customers, and that they were likely to make healthful menu changes as a result of the law. While menu labeling has primarily been studied and promoted as an intervention that will change the food choices of restaurant customers [10], our results suggest that for the menu labeling law to meet its full potential, the cooperation and buy-in from the restaurant owners and management is important. Moreover, considering the complexity of factors influencing individual food choices [23], and the limited ability of individual-targeted health interventions to improve population health measures [24], it is possible that the mechanism by which calorie labeling is likely to work best is through shifting norms around food choices and portions. It seems future research should incorporate the response of restaurants and other food industries into the proposed change, and therefore evaluations, of policy interventions such as menu labeling [25] or banning of large sugar-sweetened beverages [26].

9 Restaurant Management Views on the New National Menu... 9 It is notable that a large proportion of all respondents were neutral in their attitudes and intention regarding menu labeling. As Table 3 indicates, this is not just associated with lack of knowledge or familiarity with the law; for example among those extremely, very or somewhat familiar with menu labeling laws 44% said they were neither likely nor unlikely to offer lowcalorie items as a result, and 41% said they were neither likely nor unlikely to reformulate high calorie foods. The other results reflect this indifference. The large proportion of neutral responses in this study may indicate that restaurants main concern with laws such as menu labeling may not be their public health benefit or their customers behavior. Finding out what motivates restaurant owners to comply with menu labeling laws may contribute to efforts to ensure the success of their implementation. For example, even 55% of those who were neutral and 20% who disagreed that menu labeling would reduce the consumption of high calorie food said they were still likely to offer lower calorie items as a result of the law. However, a very low proportion of all respondents said they would use lab testing to comply with labeling calorie counts. It is possible that administrative costs and time are greater barriers to compliance than negative attitudes about the effectiveness of the law [19]. A major limitation of this study was the very low response rate. As stated in the methods, we offered neither incentives nor follow up reminders, which could have explained in part why we observed a low response rate in the study. As a result, the sample likely suffered from selection bias in that those who chose to respond may have stronger feelings in favor of or against menu labeling than most restaurant owners and employees. In addition, although the survey questions/domains were derived from prior literature [21] and pilot-tested, its validity and reliability were not formally assessed. Future studies may need to do so to establish the survey s validity and reliability. Conclusions and Implications for Future Research In this study we did not seek to infer characteristics of the population of restaurant owners and employees in the U.S. Instead, our aim was to pilot a data collection method of an online survey using a restaurant professional

10 10 Ming-Chin Yeh et al. listserv, and to pilot a range of domains regarding menu labeling that have not been asked of restaurant owners previously. Our aim was to make recommendations for implementing such a survey and generate hypotheses for future research regarding this group s perceptions, attitudes and behaviors regarding food operations, restaurants and food policy. This pilot suggested several issues to consider for research attempting to understand restaurant owners and managers behaviors and attitudes toward menu labeling. First, this study had a very low response rate. It has been shown that response rates tend to vary based on population type, incentive provided, and follow-up reminders [27]. Both incentives and multiple follow up reminders will be important in improving a response rate in this group. Although the majority of respondents did not think the new menu labeling law would contribute to improved health or health behaviors, a high proportion of neutral responses to items about intentions may mean that skepticism or ambivalence about the law s benefits will not necessarily translate into resistance to implementation. One reason could be that other factors, such as cost and time needed to implement may be more important, though this study could not examine these reasons in depth. Public health professionals concerned about local implementation of the law should ensure they understand the practical and instrumental barriers that restaurateurs face, not just focus on extolling the law s health benefits. Therefore, a future survey instrument should include domains regarding other concerns or factors that might influence restaurateurs attitudes and behaviors besides the laws efficacy and the cost of implementation. Focus groups or other qualitative methods may be needed to identify those domains. This study is a timely contribution to the public health literature on the menu-labeling requirement of the Affordable Care Act [28], as well as various state and local menu labeling law requirements [29]. To our knowledge, no other studies to date have sought to understand the perception, attitudes and intention of the group that must comply with the law, which are restaurant owners and their employees. There may be opportunities for public health workers to partner with restaurants owners in promoting and implementing the menu labeling successfully, and research

11 Restaurant Management Views on the New National Menu that identifies key motivators and barriers to complying with these laws could contribute to fostering these collaborations effectively. This pilot study indicates that a national survey of restaurant owners regarding menu labeling laws is feasible but will need significant effort to ensure an acceptable response rate and would need to include a range of domains that go beyond the health effects of the laws. Table 1. Descriptive statistics of survey respondents

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16 16 Ming-Chin Yeh et al. References [1] K. M. Flegal, M. D. Carroll, B. K. Kit and C. L. Ogden, Prevalence of obesity and trends in the distribution of body mass index among US adults, , JAMA 307 (2012), [2] C. L. Ogden, M. D. Carroll, L. R. Curtin, M. M. Lamb and K. M. Flegal, Prevalence of high body mass index in U.S. children and adolescents, , JAMA 303 (2010), [3] L. Mancino, J. Todd and B. H. Lin, Separating what we eat from where: measuring the effect of food away from home on diet, Food Policy 34 (2009), [4] U.S. Food and Drug Administration, Food. New menu and vending machine labeling requirements. Accessed: June 5, [5] U.S. Food and Drug Administration, Implement Section 4205 of the Patient Protection and Affordable Care Act. &id=aca-4205-implementation. Accessed: May 7, [6] G. A. Zarkin, N. Dean, J. A. Mauskopf and R. Williams, Potential health benefits of nutrition label changes, Am J. Public Health 83 (1993), [7] Center for Science in the Public Interest. Menu labeling. Accessed: July 22, [8] S. Bleich and K. Pollack, The publics understanding of daily caloric recommendations and their perceptions of calorie posting in chain restaurants, BMC Public Health 10 (2010), 121. [9] Center for Science in the Public Interest, Summary of polls on nutrition labeling in restaurants. Accessed: June 7, [10] Technomic Inc. Update: Consumer reaction to calorie disclosure on menus/menu boards in New York City. Project Number 13267; Accessed: April 16, [11] B. Elbel, R. Kersh, V. L. Brescoll and L. B. Dixon, Calorie labeling and food choices: a first look at the effects on low-income people in New York City, Health Aff. (Millwood) 28(6) (2009), [12] C. A. Roberto, E. Hoffnagle, M. A. Bragg and K. D. Brownell, An observational study of consumer use of fast-food restaurant drive-through lanes: implications for menu labeling policy, Public Health Nutr. 13 (2010),

17 Restaurant Management Views on the New National Menu [13] P. S. Tandon, J. Wright, C. Zhou, C. B. Rogers and D. A. Christakis, Nutrition menu labeling may lead to lower-calorie restaurant meal choices for children, Pediatrics 125 (2010), [14] G. Goetz, Survey: consumers want widespread calorie labeling on menus, Food Safety News Accessed: June 15, [15] National Restaurant Association, National Restaurant Association files menu labeling comments Files-Menu-Labelin. Accessed: April 16, [16] International Franchise Association, FDA should consider economic burden of menu labeling on franchise restaurant owners. Accessed: June 15, [17] Federal Register Volume 76, Number 66 Food Labeling; Nutrition labeling of standard menu items in restaurants and similar retail food establishments; Proposed Rule April 6, Accessed: December 15, [18] Nation s restaurant news. Accessed: August 23, [19] Restaurant Hospitality, About restaurant hospitality. Accessed: August 23, [20] NRA Restaurant Industry Tracking Survey, National Restaurant Association. Accessed: December 15, [21] J. W. Britt, K. Frandsen, K. Leng, D. Evans and E. Pulos, Feasibility of voluntary menu labeling among locally owned restaurants, Health Promot. Pract. 12(1) (2011), [22] M. C. Monroe and D. C. Adams, Increasing response rates to web-based surveys, J. Extension 50(6) (2012), Article 6TOT7. [23] R. Shepherd, Social determinants of food choice, Proc. Nutr. Soc. 58 (1999), [24] M. Sharma, School-based interventions for childhood and adolescent obesity, Obes. Rev. 7 (2006), [25] A. K. Corby-Edwards, Nutrition labeling of restaurant menus. Congressional Research Service. R42825; Accessed: April 16, 2013.

18 18 Ming-Chin Yeh et al. [26] B. Elbel, J. Cantor and T. Mijanovich, Potential effect of the New York City policy regarding sugared beverages, N. Engl. J. Med. 367 (2012), [27] T. H. Shih and F. Xitao, Comparing response rates from web and mail surveys: a meta-analysis, Field Methods 20 (2008), [28] Patient Protection and Affordable Care Act, HR 3590, Title IV, Subtitle C, 4205; 111th Congress, 2nd session, March Accessed: December 15, [29] M. K. Vadiveloo, L. B. Dixon and B. Elbel, Consumer purchasing patterns in response to calorie labeling legislation in New York City, Int. J. Behav. Nutr. Phys. Act 8 (2011), 51.