Effect of restaurant menu labelling on food choices and operational feasibility of menu labelling at workplace food outlets

Globally, 11 million deaths and 257 million DALYs are attributable to dietary risk factors. Along with increasing food availability and purchasing power, eating out behaviour also has influenced the ongoing nutrition transition in South East Asia.(Lipoeto, Geok Lin, & Angeles-Agdeppa, 2013) Eating out has been associated with less healthy food choices leading to higher energy and saturated fat intake alongside lesser micronutrient intake.(Lachat et al., 2012) Excess weight gain and adverse cardiometabolic outcomes have also been reported in those frequently eating out.(Bezerra, Curioni, & Sichieri, 2012). Enabling the consumer with nutritional information about food served in restaurants may influence their choice of foods and promote healthy eating.

Food Safety and Standards Authority of India(FSSAI) India have mandated menu labelling in restaurants since January 2022. Menu labelling includes displaying the calorific value of the food product/dish, serving size, reference information, allergen information, declaration of specific ingredients, logo indicating vegetarian or non-vegetarian. It is essential to understand the impact of menu labelling on consumer’s food choices and health to advocate for its implementation.

The two broad questions that this proposal sets out to answer are - What is the effect of nutritional value labelling of food items in restaurant menus on food choices? What is the feasibility and effect of implementing nutritional labelling of menu items in a workplace?

We propose a mixed methods study which will be carried out in three phases. Phase 1 will involve stakeholder analysis to understand the perceptions about various stakeholders in nutritional labelling at restaurants about their perceived utility, enablers and challenges. Phase 2 will involve a randomised controlled trial(RCT), to determine the effect of three types of menu labeling against no menu labeling. Adult customers exiting a restaurant will be randomized to receive one of the four types of menu of the restaurant they just exited- not labelled, labelled with quantitative nutrient information, labelled with interpretational guidance, labelled with contextual guidance. We will calculate the mean difference between the four arms in the Calorie, Salt content, Refined sugar content, Trans fat, Overall Fats and Price and the difference in the proportion choosing a healthier (operationally defined) option when presented with nutritional information/cheaper healthy food choices/ both.

Subject to the evidence from phase 2 favouring the effectiveness of nutritional labelling in promoting healthier food choices, phase 3 will be implementation research where we implement nutritional labelling of the menu served in a selected workplace canteen/ mess and document the effectiveness, the enablers and barriers in implementation.

The expected outcome of the study will be evidence on effectiveness of nutritional labelling of menus on food choices of consumers and the operational challenges in implementing the same. The study results will have relevant and valuable input for the policy for effective implementation of nutritional labelling of menus in food establishments.