Abstract
Objectives
The purpose of this research was to assess key stakeholder attitudes regarding menu labelling in Toronto, the largest municipality in Canada. Menu labelling is a population health intervention where food-labelling principles are applied to the eating-out environment through disclosure of nutrient content of food items on restaurant menus at the point of sale. Menu-labelling legislation has been implemented in the United States, but has yet to be adopted in Canada. As provincial voluntary programs and federal analyses progress, municipal jurisdictions will need to assess the feasibility of moving forward with parallel interventions.
Methods
Data were collected and analyzed in late 2011 to early 2012, including: a consumer eating-out module incorporated into a public health surveillance telephone survey (n=1,699); an online survey of independent restaurant operators (n=256); in-depth key informant interviews with executives and decision makers at chain restaurants (n=9); and a policy consultation with local restaurant associations.
Results
Toronto residents, particularly men, younger adults, and those with higher income or education, frequently eat out. A majority indicated that nutrition information is important to them; 69% note that they currently use it and 78% reported they would use it if it were readily available. Resistance to menu-labelling requirements at the municipal level was articulated by franchise/chain restaurant executives and industry associations. Despite overall low interest among independent restaurant operators, 57% reported feeling some responsibility to provide nutrition information and 50% believed it could be good for business.
Conclusions
This research supports earlier literature that indicates strong public support for menu labelling alongside perceived barriers among the restaurant and foodservices sector. Leverage points for effective operator engagement for menu-labelling adoption were identified, nonetheless, highlighting the need for public health support.
Key Words: Nutrition, public policy, local government
Résumé
Objectifs
Évaluer les attitudes d’acteurs privilégiés à l’égard de l’étiquetage du menu à Toronto, la plus grande ville du Canada. L’étiquetage du menu est une intervention en santé des populations qui applique les principes de l’étiquetage des aliments à l’environnement de la restauration en divulguant la valeur nutritive des produits alimentaires au menu des restaurants, au point de vente. Des lois sur l’étiquetage du menu sont en vigueur aux États-Unis, mais il n’y en a pas encore au Canada. Avec l’évolution des programmes provinciaux volontaires et des analyses fédérales, les administrations municipales devront évaluer la faisabilité d’adopter des interventions parallèles.
Méthode
Entre la fin de 2011 et le début de 2012, nous avons recueilli et analysé nos données: un module sur les consommateurs qui mangent à l’extérieur, intégré dans une enquête téléphonique de surveillance de la santé publique (n=1 699); un sondage en ligne auprès de restaurateurs indépendants (n=256); des entretiens approfondis avec des exploitants et des décideurs de chaînes de restauration (n=9); et une consultation stratégique avec les associations locales de restaurateurs.
Résultats
Les Torontois, surtout les hommes, les jeunes adultes et les personnes dont le niveau de revenu ou d’instruction est élevé, mangent souvent à l’extérieur. La majorité des répondants considèrent que les données nutritionnelles sont importantes pour eux; 69 % disent consulter ces données, et 78 % disent qu’ils le feraient si elles étaient aisément accessibles. Les exploitants de franchises ou de chaînes de restauration et les associations du secteur ont exprimé de la résistance à la perspective d’une réglementation municipale de l’étiquetage du menu. Les restaurateurs indépendants ont manifesté peu d’intérêt, mais 57 % ont quand même dit se sentir responsables de fournir des données nutritionnelles, et 50 % pensent que cela pourrait être bon pour les affaires.
Conclusions
L’étude confirme les résultats des travaux publiés antérieurement, qui font état à la fois d’un large soutien du public à l’étiquetage du menu et d’obstacles perçus par le secteur de la restauration et des services alimentaires. Nous avons néanmoins repéré les éléments les plus susceptibles de convaincre les exploitants d’adopter l’étiquetage du menu, d’où un besoin de soutien par la santé publique.
Mots Clés: nutrition, politique publique, administration locale
Footnotes
Acknowledgements: This research was funded by Toronto Public Health and was previously shared in an oral presentation at the Canadian Public Health Association annual conference in Edmonton, Alberta on June 13, 2012. Thanks to Andrew Thomas and Helen Thang for their contributions to the executive interview portion of the study. Our appreciation to Anne Birks, Monica Campbell, Carol Timmings, and David McKeown for their advice and support.
Conflict of Interest: None to declare.
References
- 1.IOM Institute of Medicine. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press; 2009. [PubMed] [Google Scholar]
- 2.IOM Institute of Medicine. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington: The National Academies Press; 2012. [PubMed] [Google Scholar]
- 3.World Health Organization. A framework for implementing the set of recommendations on the marketing of foods and non-alcoholic beverages to children. Geneva, Switzerland: WHO; 2012. [Google Scholar]
- 4.Canadian Council of FoodNutrition. Tracking Nutrition Trends VII. Mississauga, ON: Canadian Council of Food and Nutrition; 2008. [Google Scholar]
- 5.Garriguet D. Canadians’ eating habits. Health Reports. 2007;18(2):17–32. [PubMed] [Google Scholar]
- 6.Guthrie J, Biing-Hwan L, Frazao E. Role of food prepared away from home in the American diet, 1977–78 versus 1994–96: Changes and consequences. J Nutr Educ Behav. 2002;34(3):140–50. doi: 10.1016/S1499-4046(06)60083-3. [DOI] [PubMed] [Google Scholar]
- 7.Roberto CA, Schwartz MB, Brownell KD. Rationale and evidence for menulabelling legislation. Am J Prev Med. 2009;37(6):546–51. doi: 10.1016/j.amepre.2009.07.015. [DOI] [PubMed] [Google Scholar]
- 8.Pomeranz JL, Brownell KD. Legal and public health considerations affecting the success, reach, and impact of menu-labelling laws. Am J Public Health. 2008;98(9):1578–83. doi: 10.2105/AJPH.2007.128488. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Pulos E, Leng K. Evaluation of a voluntary menu-labelling program in fullservice restaurants. Am J Public Health. 2010;100(6):1035–39. doi: 10.2105/AJPH.2009.174839. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Nestle M. Health care reform in action - calorie labelling goes national. N Engl J Med. 2010;362(25):2343–45. doi: 10.1056/NEJMp1003814. [DOI] [PubMed] [Google Scholar]
- 11.Bollinger B, Leslie P, Sorensen AT. National Bureau of Economic Research. Calorie posting in chain restaurants. 2010. [Google Scholar]
- 12.Dumanovsky T, Huang CY, Bassett MT, Silver LD. Consumer awareness of fastfood calorie information in New York City after implementation of a menu labeling regulation. Am J Public Health. 2010;100(12):2520–25. doi: 10.2105/AJPH.2010.191908. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Dumanovsky T, Huang CY, Nonas CA, Matte TD, Bassett MT, Silver LD. Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: Cross sectional customer surveys. BMJ. 2011;343(1):d4464–d4464. doi: 10.1136/bmj.d4464. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Roberto CA, Larsen PD, Agnew H, Baik J, Brownell KD. Evaluating the impact of menu labeling on food choices and intake. Am J Public Health. 2010;100(2):312–18. doi: 10.2105/AJPH.2009.160226. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Centre for Science in the Public Interest Canada. Writing on the wall: Time to put nutrition information on restaurant menus. Prepared by Bill Jeffery and Natalee Cappello. Ottawa, ON: Centre for Science in the Public Interest; 2012. [Google Scholar]
- 16.Gelinas F. Bill 86, Healthy Decisions for Healthy Eating Act, 2012. Legislative Assembly of Ontario. 2012. [Google Scholar]
- 17.Cancer Care Ontario, Ontario Agency for Health ProtectionPromotion Public Health Ontario. Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario. Toronto, ON: Queen’s Printer for Ontario; 2012. [Google Scholar]
- 18.Healthy Kids Panel. No Time to Wait: The Healthy Kids Strategy. Toronto: Queen’s Printer for Ontario; 2013. [Google Scholar]
- 19.von Tigerstrom B. Mandatory nutrition disclosure for restaurants: Is menu labelling coming to Canada? Windsor Rev Legal Soc Issues. 2010;28:139–70. [Google Scholar]
- 20.British Columbia Ministry of Health. Informed Dining. Healthy Families BC. 2012. [Google Scholar]
- 21.Centers for Disease ControlPrevention. National Health and Nutrition Examination Survey (NHANES 2009–2010), Flexible Consumer Behaviour Survey Module. Hyattsville, MD: National Center for Health Statistics; 2009. [Google Scholar]
- 22.Monday Report on Retailers. Directory of Restaurant and Fast Food Chains in Canada. Toronto: Rogers Media Inc.; 2011. [Google Scholar]
- 23.Ontario Ministry of HealthLong-Term Care. Ontario Public Health Standards, pursuant to Section 7 of the Health Protection and Promotion Act, R.S.O. 1990, c. H.7. Toronto: Queen’s Printer for Ontario; 2008. [Google Scholar]
- 24.Ipsos Reid. Canadians’ perceptions of, and support for, potential measures to prevent and reduce childhood obesity. POR 100-10. Ottawa: Public Health Agency of Canada; 2011. [Google Scholar]
- 25.Almanza BA, Nelson D, Chai S. Obstacles to nutrition labelling in restaurants. J Am Diet Assoc. 1997;97(2):157–61. doi: 10.1016/S0002-8223(97)00041-2. [DOI] [PubMed] [Google Scholar]
- 26.Berman M, Lavizzo-Mourey R. Obesity prevention in the information age: Caloric information at the point of purchase. JAMA. 2008;300(4):433–35. doi: 10.1001/jama.300.4.433. [DOI] [PubMed] [Google Scholar]
- 27.Glanz K, Resnicow K, Seymour J, Hoy K, Stewart H, Lyons M, Goldberg J. How major restaurant chains plan their menus: The role of profit, demand and health. Am J Prev Med. 2007;32(5):383–88. doi: 10.1016/j.amepre.2007.01.003. [DOI] [PubMed] [Google Scholar]
- 28.Johnson DB, Payne EC, McNeese MA, Allen D. Menu-labelling policy in King County, Washington. Am J Prev Med. 2012;43(S2):S130–S135. doi: 10.1016/j.amepre.2012.05.014. [DOI] [PubMed] [Google Scholar]
- 29.Morestin F, Hogue M-C, Jacques M, Benoit F. Public Policies on Nutrition Labelling: Effects and Implementation Issues. Montreal, QC: National Collaborating Centre for Healthy Public Policy; 2011. [Google Scholar]
- 30.Toronto Public Health. Environmental Reporting and Disclosure Consultation Document on a Proposed Program for Toronto. Toronto: Toronto Public Health; 2008. [Google Scholar]
- 31.Pomeranz JL. The unique authority of state and local health departments to address obesity. Am J Public Health. 2011;101(7):1192–97. doi: 10.2105/AJPH.2010.300023. [DOI] [PMC free article] [PubMed] [Google Scholar]