Designing
Nutrition Labels
Christina A. Roberto, Ph.D.
Departments of Social & Behavioral Sciences
and Nutrition
Simple, Salient,
Meaningful Nutrition Labels
–Restaurant menu labeling
–Front-of-package labeling
Menu Labeling
Menu Labeling Rationale
1.
People eat out a lot
2.
People don’t know the calories in restaurant food
3.
If they did, they’d make lower calorie choices (at
least some of the time)
See review Roberto et al. Am J Prev Med, 2009
But nutrition information
is already available?
Research study - counted people at
Roberto et al. Am J Public Health, 2009
Out of 4,311 how many
looked at nutrition
information?
6
Menu Labeling Rationale
1. People don’t know the calories in
restaurant food
1. If they did, they’d make lower
calorie choices (at least some of the
time)
Test Menu Labeling’s Impact
on Behavior in the Lab
Roberto et al, Am J Public Health, 2010
Menu Labeling in
a Restaurant Lab
 303 adults for market research study
 Randomized to 1 of 3 menus
 Focus group, ordered & ate food, dietary recall
Roberto et al, Am J Public Health, 2010
Menu Without Calorie Labels
Menu with Calorie Labels
Menu with Calorie Labels +
Daily Calorie Info
The recommended daily caloric intake
for an average adult is 2000 calories
Calories Ordered for Dinner
2500
2300
2189
2100
1862
1859
Calories
Calories+Info
Calories
1900
1700
1500
1300
1100
900
700
500
No Calories
Calories Eaten At Dinner
1700
1459
Calories
1500
1335
1256
1300
1100
900
700
500
No Calories
Calories
Calories+Info
Calories Eaten After Dinner
400
294
350
Calories
300
250
179
177
200
150
100
50
0
No Calories
Calories
Calories+Info
Dinner + After Dinner Calories Eaten
1900
1630
1625
Calories
1700
1379
1500
1300
1100
900
700
500
No Calories
Calories
Calories+Info
Summary
 Calorie labels led to fewer calories:
Ordered
Eaten
 With just calories people ate more later
 Putting calories in context led to avg reduction of 250
calories
U.S. Patient Protection &
Affordable Care Act
SEC. 4205.
NUTRITION LABELING OF STANDARD MENU ITEMS AT
CHAIN RESTAURANTS
Number of calories
Statement about daily caloric intake
Product Reformulation
Front-of-Package
Nutrition Labeling
Smart Choices Program
What Were Some of the
Smart Choices Products?
August 2009 FDA
“We are Watching” Letter
Media Suspicion
NY Times Article Sept 2009
How Smart Were Smart Choices?
 Randomly sampled from 8 packaged food
categories on Smart Choices Website
 Nutrition info for 100 products
 Classified products as “healthy” based on
Nutrient Profile Model
Validated & informed policy in UK & Australia
Roberto et al. Pub Health Nutr, 2011
Results
64% of
Smart Choices Products
Did Not Meet
Objective Nutrition Score for
“Healthy”
Smart Choices Under Scrutiny
Attorney General Gets Involved Oct 2009
In the meantime…
–Institute of Medicine Released
First Report
–Working on Second Report
–Food industry releases Facts Up
Front
Not Simple, Salient, or
Meaningful
Cautionary Tale of Industry
Self-Regulation for
Front-of-Package Labeling
Red Means Stop
Greens Mean Go
Hospital Cafeteria in Boston

Over 6,000 employees and visitors per day

All register data for 9 months, ~3 million items

Traffic lights + choice architecture for beverages
“Consume often”
“Consume less often”
“There’s a better choice in
green or yellow”
Thorndike et al., Am J Public Health, 2012
Sales of all cafeteria items during
Baseline and Labeling
% of total cafeteria sales
45
40
35
30
25
20
15
10
5
0
Red items
Yellow items
Green items
Cold beverage sales
Baseline vs Labeling
% of cold beverage sales
60
50
40
30
20
10
0
Red items
Yellow items
Green items
IOM Proposed Label
IOM Proposed Label
Simple, Salient,
Meaningful Nutrition Labels
–Restaurant menu labeling
–Front-of-package labels
–Nutrition facts labels on packaged
foods
Christina A. Roberto, PhD
croberto@hsph.harvard.edu
www.peachlab.org
@RobertoCA