June 12, 2008 -- It's the classic fast-food dilemma: Do you stick with the small fries or splurge on the large? What if the latter means an extra 270 calories? Though the restaurant industry remains skeptical, a new study finds that seeing calorie information may convince customers to place healthier -- or at least smaller -- orders.
In the study, published today in the American Journal of Public Health, researchers surveyed more than 7,300 fast-food customers in New York City. Their average purchase totaled 827 calories. That's a Burger King Double Whopper Sandwich With Cheese (hold the mayo).
What's worse, one-third of customers bought 1,000 calories or more. At that rate, just two meals fulfill the recommended daily intake of 2,000 calories. Go for three, and hit nearly 3,500 calories — equivalent to a whole pound of weight.
But when Subway customers saw calorie information before ordering, they purchased an average of 52 fewer calories than customers who overlooked the calorie counts. Translation: They went for the 6-inch turkey sub instead of the steak and cheese.
At the time of the study, Subway was the only restaurant that posted nutritional information near the register. So while 32 percent of Subway customers reported seeing calorie information, only 4 percent at other chains saw it.
The researchers say that calorie-posting can make a difference, but only if restaurants are upfront with the numbers.
"People need to have information posted prominently," says lead study author Mary Bassett, deputy commissioner of the Division of Health Promotion and Disease Prevention for the New York City Department of Health and Mental Hygiene.
The average American eats three meals a week from fast-food establishments, according to the NPD Group, a consumer market research firm.
"We all need to eat, and we all need fast food," Bassett says. "We lead very busy lives, and it's very convenient."
But many people don't realize that they're packing on the calories. Fewer than 15 percent of New Yorkers could identify the highest or lowest-calorie items on a chain restaurant menu in a poll released today by the Center for Science in the Public Interest.
"It's very easy to walk into a fast-food chain and walk out with your entire daily calorie intake, and you think you've just had breakfast," Bassett says.
Because the New York City study was based on a survey, the results can show only that calorie displays are associated with lower-calorie purchases, not that they're the reason for them. But experts still say the findings are clear: Knowledge equals power for consumers.
"If we build menu boards that provide meaningful information about the food people are putting into their bodies, many people will use the information to help guide their choices," says David Katz, director of the Prevention Research Center at Yale University School of Medicine. "In this case, ignorance of calories and nutrients is anything but bliss. It's epidemic obesity and diabetes."
Over the past two years, more than 20 cities and states have considered legislation involving menu-labeling policies. Varying versions have been adopted in San Francisco, King County in Washington, Santa Clara County in California and New York City. However, the New York State Restaurant Association is challenging the New York City Board of Health's regulations.
Chuck Hunt, executive vice president of the association's New York City chapter, says that restaurants are happy to provide nutritional information. They will even reveal fat, sodium and carbohydrate content along with calorie facts. But they want to do it their own way — on Web sites, posters or tray liners, instead of on the menu board as the regulations require.
Many nutrition experts say that restaurants are trying to hide the facts.
Putting nutrition information on tray liners and posters is like "putting [the speed limit] on the back of a speeding ticket," says Margo Wootan, director of nutrition policy at CSPI. The information is inaccessible and unusable before making a purchase.
"You don't see them putting the price on posters," Wootan says about fast-food restaurants. "They put the price on the menu board because that's what people look at."
Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, has a similar view of restaurants' motives. "I think the real reason is that they don't want people to have the sticker-shock they'll experience when they see the numbers," he says.
Hunt, however, says restaurants aren't worried about customers seeing nutrition facts. He believes that any change in behavior would be short-lived.
"It's like dieting," he says. Customers will watch their calories for a few days, and then they'll go back to their less-nutritious favorites, he says.
But if the pattern in the study proves true across America, customers may gravitate toward grilled chicken instead of double-decker burgers when they catch a glimpse of calorie counts.
"The fast-food industry's going to have to deal with people's astonishment," Bassett says. "We're hopeful that the food will, in fact, become food that people can eat."
Making the Decision
Customers will always hold the purchasing power, even if calorie information is prominently displayed. "People can choose to drive Hummers despite their low-fuel efficiency, and they can choose to eat high-calorie foods," Katz says. "But in each case, it's better for both the individual and for society that it be an informed choice."
However, Madelyn Fernstrom, director of the UPMC Weight Management Center in Pittsburgh, says laws mandating calorie displays are neither practical nor helpful. A KFC customer craving a chicken pot pie might still place the order after seeing that it packs 770 calories.
"I think a better solution is for every restaurant — fast foods and regular — to have a section of the menu with smart calorie buys … for consumers who want to save calories," she says.
For those who want to stay healthy when calorie information isn't available, Katz has a few tips: Stick with grilled, baked or broiled foods; use sauces, spreads and dressings sparingly; and add extra veggies.
And an even simpler option? "No matter where you are, order a kids' meal," Fernstrom says. "It's always around 500 calories if you order a diet soda or bottled water."