title: Exploratory analysis of fast-food chain restaurant menus before and after implementation of local calorie-labeling policies, 2005-2011.
abstract: BACKGROUND
  Since 2008, several states and municipalities have implemented regulations requiring provision of nutrition information at chain restaurants to address obesity. Although early research into the effect of such labels on consumer decisions has shown mixed results, little information exists on the restaurant industry's response to labeling. The objective of this exploratory study was to evaluate the effect of menu labeling on fast-food menu offerings over 7 years, from 2005 through 2011.
  
  
  METHODS
  Menus from 5 fast-food chains that had outlets in jurisdictions subject to menu-labeling laws (cases) were compared with menus from 4 fast-food chains operating in jurisdictions not requiring labeling (controls). A trend analysis assessed whether case restaurants improved the healthfulness of their menus relative to the control restaurants.
  
  
  RESULTS
  Although the overall prevalence of "healthier" food options remained low, a noteworthy increase was seen after 2008 in locations with menu-labeling laws relative to those without such laws. Healthier food options increased from 13% to 20% at case locations while remaining static at 8% at control locations (test for difference in the trend, P = .02). Since 2005, the average calories for an à la carte entrée remained moderately high (approximately 450 kilocalories), with less than 25% of all entrées and sides qualifying as healthier and no clear systematic differences in the trend between chain restaurants in case versus control areas (P ≥ .50).
  
  
  CONCLUSIONS
  These findings suggest that menu labeling has thus far not affected the average nutritional content of fast-food menu items, but it may motivate restaurants to increase the availability of healthier options.
authors.affiliation: School of Public Health, Drexel University, Philadelphia, Pennsylvania 19102, USA.
authors.forename: Alexa
authors.initials: A
authors.lastname: Namba
authors.forename: Amy
authors.initials: A
authors.lastname: Auchincloss
authors.forename: Beth L
authors.initials: BL
authors.lastname: Leonberg
authors.forename: Margo G
authors.initials: MG
authors.lastname: Wootan
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002648:Child; D005515:Food Labeling / Q000331:legislation & jurisprudence; D006291:Health Policy; D006801:Humans; D008612:Menu Planning; D009753:Nutritive Value