title: Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys.
abstract: OBJECTIVE
  To assess the impact of fast food restaurants adding calorie labelling to menu items on the energy content of individual purchases.
  
  
  METHODS
  Cross sectional surveys in spring 2007 and spring 2009 (one year before and nine months after full implementation of regulation requiring chain restaurants' menus to contain details of the energy content of all menu items). Setting 168 randomly selected locations of the top 11 fast food chains in New York City during lunchtime hours.
  
  
  METHODS
  7309 adult customers interviewed in 2007 and 8489 in 2009.
  
  
  METHODS
  Energy content of individual purchases, based on customers' register receipts and on calorie information provided for all items in menus.
  
  
  RESULTS
  For the full sample, mean calories purchased did not change from before to after regulation (828 v 846 kcal, P = 0.22), though a modest decrease was shown in a regression model adjusted for restaurant chain, poverty level for the store location, sex of customers, type of purchase, and inflation adjusted cost (847 v 827 kcal, P = 0.01). Three major chains, which accounted for 42% of customers surveyed, showed significant reductions in mean energy per purchase (McDonald's 829 v 785 kcal, P = 0.02; Au Bon Pain 555 v 475 kcal, P<0.001; KFC 927 v 868 kcal, P<0.01), while mean energy content increased for one chain (Subway 749 v 882 kcal, P<0.001). In the 2009 survey, 15% (1288/8489) of customers reported using the calorie information, and these customers purchased 106 fewer kilocalories than customers who did not see or use the calorie information (757 v 863 kcal, P<0.001).
  
  
  CONCLUSIONS
  Although no overall decline in calories purchased was observed for the full sample, several major chains saw significant reductions. After regulation, one in six lunchtime customers used the calorie information provided, and these customers made lower calorie choices.
authors.affiliation: tamara.dumanovsky@gmail.com
authors.forename: Tamara
authors.initials: T
authors.lastname: Dumanovsky
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Huang
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Nonas
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Matte
authors.forename: Mary T
authors.initials: MT
authors.lastname: Bassett
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Silver
mesh_terms: D000328:Adult; D003258:Consumer Behavior / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D002149:Energy Intake; D057140:Fast Foods / Q000032:analysis / Q000706:statistics & numerical data*; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D005504:Food Analysis / Q000706:statistics & numerical data; D005515:Food Labeling / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005518:Food Preferences / Q000523:psychology; D006801:Humans; D008297:Male; D009519:New York City; D012044:Regression Analysis; D012147:Restaurants / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data