Food labelling regulation to promote healthy eating.

• Author: von Tigerstrom, Barbara

Chronic diseases are leading causes of death and disability in Canada and worldwide, and many of these diseases arc associated with preventable risk factors. (1) For example, a recent analysis found that a significant proportion of cancers - at least a quarter, and up to 40 per cent or more for some types - could be prevented through changes in diet and physical activity. (2) Taking more effective preventive action is clearly an urgent public health priority. The World Health Organization (WHO) has called for global action to stave off the "impending disaster" of increased mortality and disability from these diseases. (3)

Even once we recognize the importance of preventive action, however, it can be difficult to know what steps to take. There are many different options and competing priorities. We want to implement measures that will be effective, but effectiveness can be difficult to predict. It is not always feasible to study public health interventions in the same way as other health interventions like new drugs, so looking for the same type or level of evidence can be problematic. (4) These challenges are exacerbated in the case of chronic disease prevention. (5) Chronic disease is often the result of a complex matrix of factors, interacting in ways that are sometimes unpredictable. (6) If we insist on waiting for solid evidence that a preventive measure will be effective, this could mean deferring action indefinitely. Given the serious public health problems we face, such delays are not acceptable. We should not abandon our efforts to search for useful evidence, but should act on the best evidence that is currently available, while committing to monitor and adapt measures as needed. (7) In choosing strategies, we can also consider factors such as the proportion of expected costs and benefits, feasibility, and whether measures have a plausible basis according to everyday experience and accepted theories of human behaviour. (8)

Food labelling

The regulation of food labelling is one part of a public health strategy to promote healthy eating. Improving consumers' access to accurate and reliable information about their food can enable healthier choices. This approach focuses on empowering consumers with information, rather than trying lo dictate choices in a paternalistic way. However, consumers need to be able to trust information in order to act on it, and many consumers are sceptical of the claims on food labels. (9) The government has a crucial role to play in ensuring that nutrition information is reliable and adequately accessible.

Many jurisdictions around the world, including Canada's most important trading partners, are actively engaged in reforming their food labelling legislation. They are moving to expand mandatory nutrition labelling to restaurants and to regulate front-of-package food labelling more effectively.

Menu labelling

Restaurant foods are not currently required to carry nutrition information (unless a nutrient content claim is made, in which case the supporting information must be displayed). (10) Legislation to require some nutrition information to be displayed in chain restaurants has been passed by a number of city, county, and state governments in the United States, and some of these laws have already been implemented. (11) The new United States federal health reform legislation includes provisions mandating nutrition disclosure in restaurants with more than twenty outlets nationwide, (12) and the Food and Drug Administration recently released the regulations that will put this requirement into effect. (13) most of the U.S. laws require calorie amounts to be posted on menus or menu boards, with other nutrition information available in each outlet as a poster or brochure.

Surveys have consistently found high levels of public support for menu labelling. (14) Studies show that without disclosure, people find it very difficult to estimate the nutritional content of restaurant food. (15) Advocates suggest that menu labelling could help to enable consumers to make healthier choices, which is important considering the amount of restaurant (and take-out) food that is consumed by North American populations and the large portions of high-calorie food that are often served in restaurants. (16)

Some argue, however, that mandatory menu labelling is unnecessary because many restaurant chains already make some nutrition information available, usually on a web site and sometimes on pamphlets, posters, or packaging. (17) These voluntary efforts are useful, but too limited to fully realize the benefits of more easily and consistently accessible information that could be achieved by mandatory regulations. We might also worry about the cost to businesses, especially at a time of economic difficulty. The cost involved will depend partly on how the regulations are designed, for example, what menu items are covered and what forms of analysis are acceptable. However, the cost does not appear to be unreasonably high, (18) especially bearing in mind that the requirements would only be imposed on chains above a certain size. Furthermore, as the major chains operating in Canada also have outlets in the United States that would already be subject to mandatory labelling, the marginal costs of meeting similar requirements in Canada would be much lower.

There are many questions to be addressed regarding the design of mandatory restaurant disclosure laws, e.g. what restaurants and what products are covered, but experiences in other countries, especially the United States, give us examples from which to learn. Some have questioned the value of requiring only calories to be shown on the menu. (19) However, most menu labelling laws also require information on a range of nutrients lo be readily accessible in food outlets (though not on the menu). This should be mandatory, whether or not calories are also required to be printed on menus.

The most difficult question is whether menu labelling will actually affect consumers' buying and eating habits. Most experimental studies have found that providing calorie or other nutrition information does have an effect on individuals' choices, (20) although a few did not. (21) Where researchers have studied the behaviour of individuals in response to calorie labelling in restaurants or cafeterias, the results have also been mixed. Most studies conducted in the 1990s found no significant effect. (22) Among more recent studies, a majority have found significant, though modest, effects on purchases, (23) while others have found no, inconsistent, or small but not statistically significant effects. (24)

Research can help to explain why labelling appears to influence behaviour in some instances and not others. For example, not surprisingly, individuals who are trying to lose weight are more likely to be influenced by calorie information. (25) A number of studies have found gender differences in the effect of menu labelling. (26) Others have found that calorie information is more likely to have an impact on consumption when the calorie amount is higher than expected (regardless of the actual amount). (27)This may help to explain why calorie information does not influence choices in some cases, because if people are expecting calorie amounts to be high, it is less likely that the information will affect their decisions. However, it could still influence choices in other cases. Furthermore, some research suggests that even when calorie information does not affect a particular product selection, it can influence future purchase intentions as well as the consumption of other food items on the same day. (28)

Arguably either the federal or provincial governments could legislate on this issue, and bills have been introduced in both levels of government. (29) Federal government leadership would be desirable, either through the enactment of federal legislation, or at a minimum...