Obesity and physical inactivity are responsible for more than 400,000 deaths per year and contribute substantially to rising healthcare costs in the US. Effective public health interventions are greatly needed to help curb the epidemic of obesity. Policymakers are looking toward interventions such as the mandate in the Affordable Care Act that chain restaurants display "clear and conspicuous" calorie information for the food on their menus. However, studies examining this type of menu labeling suggest that it may not have the intended effect of decreasing actual calories of meals that people choose. Labels that convey information in a more readily understandable context may be more effective at motivating behavior change. Recently, we found in a randomized trial using hypothetical scenarios that people select foods totaling fewer calories when shown physical activity calorie expenditure (PACE) food labels. In this project, we now will test the effect of our PACE food labels on actual point-of-decision food purchasing behavior as well as physical activity. We will partner with Blue Cross and Blue Shield of North Carolina to test the effects of our labels in three of their campus cafeterias that serve over 3600 employees. Primary outcomes will be amount of calories purchased by individuals in three cohorts (tracked by receipts and self-report) and physical activity as measured by accelerometry and gym use. As secondary measures, calories purchased and gym use will also be measured in aggregate (campus level). Secondary outcomes will also include changes in body mass index, blood pressure, glucose level, and cholesterol level among individuals in the cohorts. We will compare pre-intervention to post-intervention outcomes using interrupted time-series analysis as well as intervention to a control group. The groups will be followed for a total of 24 months. The results of this project will provide valuable evidence on the effectiveness of menu labeling and inform new policy intervention approaches which might in time lead to healthier Americans.
One of every three American adults is overweight or obese. The high-calorie content of foods obtained at restaurants and cafeterias contributes to this public health problem. One policy approach to try to curb the obesity epidemic is to require calories of foods to be prominently displayed on menu boards. However, such labeling may not have the intended effect of lowering caloric intake. In this project, we will test a novel approach of labeling foods using physical activity energy equivalent labels on outcomes of calories in foods purchased and physical activity.