Purpose: The Howard M. Metzenbaum Menu Education and Labeling (MEAL) Act, recently introduced to Congress, would require chain restaurants with at ≥20 outlets to post calorie information at the point-of-purchase. Similar regulations are already in place in New York City and elsewhere, but the extent to which such regulations are likely to affect the health of the US population remains poorly characterized.
Method: We created a spreadsheet model to evaluate the effectiveness of calorie-posting regulations to prevent weight gain in US adults. We evaluated two types of behavior change that might accrue from such regulation based on the available literature: consumer reductions in calorie consumption and producer-initiated product reformulation. Our primary outcome was body mass index (BMI) gain avoided, which we calculated as: avoided 5-year BMI increase =[5a * (c+u)]/(7700 * h2), where a = annual number of chain restaurant visits (base case:104; varied 26-208); c = caloric reduction per visit due to consumer behavior change (base case: 30; varied 0-100); u= caloric reduction per visit due to restaurant reformulation (base case; 50; varied 20-70); h = average subgroup height in meters (e.g., for black women=1.63m); 7700 = calories per kg (ingesting 7700 excess calories leads to a 1 kg body fat gain).
Result: In the base case, for the US population of black women age 40-59, we expect a 5-year avoided BMI increase of 2.01 kg/m2. The figure shows the range of avoided BMI gain expected over a range of calorie reductions from consumer and producer behavior changes. We found similar results in all subgroups of adults (grouped by age, gender, and ethnicity). Decreasing the number of annual chain restaurant visits to 26 decreases the 5-year avoided BMI gain to 0.50 kg/m2 in the base case; increasing the number to 208 results in 4.02 kg/m2 avoided gain.
Conclusion: Even modest reductions in caloric intake resulting from calorie-posting regulations may significantly slow the growth of obesity in the US. Given that individuals who frequent chain restaurants represent a significant proportion of the obese population, those for whom avoided BMI matters most may receive the greatest benefit from such regulations.
Candidate for the Lee B. Lusted Student Prize Competition