I told you so!

Last month, my friend Dr. Yoni Freedhoff sparked a bit of controversy (and panic amongst the Dietitians of Canada exec) when he posted an entry voicing his concern over the lack of support from DC for calories on menus and a survey that was sent out to DC members on the topic with a loaded note that said, "Dietitians of Canada is concerned that there is limited evidence to support a move to posting energy content of foods on restaurant menu boards as a means of influencing consumers to make positive changes in their food selection at this point of purchase."

Dr. Freedhoff's post caught the attention of the Ottawa Citizen, who caught Lynda Corby, Director of Public Relations at DC, giving this unfortunate example of an "unintended consequence" of calorie labelling.

For example, some people might think high-energy foods are tastier.

"If a person looks at food that way," [Corby] said, "would they be more likely to make a higher-calorie choice because they think it's going to taste better?"

In my response, I agreed with Dr. Freedhoff in saying that the survey could have been worded better, but I agreed with DC in saying that there is limited evidence out there on the actual effect that calorie labelling on menus has on people's choices, and their decision to conduct a literature review - they want to have a good idea of what evidence is out there and have solid knowledge of what they're talking about before deciding whether or not they would support it. I added that DC's literature search will probably find that calorie labelling will at least be not harmful, and that they were going to support it, while stressing that it's only a small part in solving the obesity crisis and that more research is needed.

So today, I was pretty pumped (and I guess DC was too, because the email subject was "DC says 'yes' to menu labelling based on our evidence review") to find this press release in my inbox -

Toronto, ON – Does posting calories on restaurant menu boards help Canadians make healthier food choices and possibly prevent obesity? Dietitians of Canada says yes - providing nutrition information in restaurants, including calorie and nutrient content of food served, is one step that may help promote healthier choices. However, a review of the evidence on this issue by Dietitians of Canada (DC) underscores the fact that there are no simple solutions to the complex issue of obesity prevention; a variety of approaches are needed. One such solution is to ensure that settings in which food choices are made, including restaurants and fast-food establishments, support healthy eating. Longer term evaluation of these types of labelling initiatives are needed before we can say whether providing calorie and nutrient information in these settings will affect obesity rates.
“One piece of information alone, such as calories on menus, cannot change the behaviour of a whole population but it is a step towards creating an environment that makes healthier choices easier for consumers,” says Judy Sheeshka, registered dietitian and author of the evidence review titled Does Menu Labelling Make a Difference to Consumers' Choices? “At present, research studies have been conducted in simulated restaurant environments often using ‘mock’ menus designed to include foods that are typically served in fast-food restaurants. We need more research in real-life settings and in other types of restaurants such as family-style, full service chain restaurants.”
The literature shows that it may take a combination of events to motivate some people to consider changing their nutrition behaviours. In addition to nutrition labelling, other factors affecting food choices in restaurants, such as taste and price, need to be considered. The review of existing evidence points to the need to include an evaluation component as an integral element of validating this public policy measure.
Unanswered questions identified in the DC evidence review that point to the need for more research include:
* What are the impacts of menu labelling in family-style, full-service chain restaurants?
* What are the gender differences in the use of menu labelling?
* How do consumers interpret and use information on menu labels?
* How does posting calories on restaurant menus in the style mandated in jurisdictions around North America influence obesity rates?
* What is the best labelling format to grab consumers’ attention?
* What impact does mandating nutrition information on restaurant menus have on menu options?
* What, if any, are unintended negative effects of posting caloric information?

Support? Check.
Small part of solution to obesity crisis? Check.
More research needed? Check.

A copy of their evidence review is available here, and it basically boils everything down to the following practice points:

• Having nutrition information readily accessible as consumers are making their menu choices is consistent with the goal of creating healthier environments, and helping to make “healthy food choices easier”.
  
• Research has consistently shown that consumers underestimate the calories in restaurant items.
  
• Menu labelling has been shown to have a modest but positive effect on the food choices of some consumers.
  
• There is insufficient evidence to recommend which specific nutrients (in addition to calories) might be most appropriate to include on menu labels.
  
• Very little research has examined how consumers would interpret and use information on menu labels.
  
• Little attention has been given to how consumers feel about menu labelling and if there are better alternatives to printing calorie information on the menus.
  
• There is insufficient evidence to determine whether posting menu calories will cause restaurants to provide healthier options. Some anecdotal evidence suggests that when restaurants are required to post calories on menus, they offer lower-calorie or healthier options.
  
• There is insufficient evidence to determine whether there are any negative effects of posting calorie information on menus.

What I dislike about the document is it again highlights the idea that calorie labelling "may lead some people to choose the higher-calorie options" as an unintended consequence, though it does also mention the more legitimate concern that it may have some negative consequences for people who have/are recovering from eating disorders. First of all, extremely active people (though I admit there aren't many) do need to consume more calories so it's not necessarily a bad thing if someone makes a higher-calorie choice. I'm sure people who actually care about this information will know how to use it, and those who don't care are not going to base their choice on the calories. But again, the research on this is limited, so we may be laughing now, but...