The recent Supreme Court decision on the Patient Protection and Affordable Care Act has cleared the way for national requirements about posting nutritional information at chain restaurants, and a new study has evaluated the real-life impact of menu labeling in King County, Washington, after new regulations were put in place.

The study has found some healthier menu choices, although most entrees continue to exceed recommended nutritional guidelines. The study is being published this month in the Journal of the Academy of Nutrition and Dietetics.

"Frequent consumption of food away from home is associated with higher caloric intake and higher fat. As noted by the Food and Drug Administration, the cost of the obesity epidemic to families, businesses, and the government was over $117 billion in 2010," says lead investigator Barbara Bruemmer, senior lecturer emeritus of the Program in Nutritional Sciences, School of Public Health at the University of Washington. "All of these issues underscore the need for environmental approaches to help consumers who are looking for better options."

King County was one of the first jurisdictions to implement menu labeling, in January 2009. The regulations applied to any restaurant with 15 or more establishments in the U.S. and at least $1 million in annual sales. Bruemmer and her colleagues wanted to learn whether restaurants would improve their entres by reformulating items so that they had fewer calories and would replace some menu items with healthier alternatives.

The investigators audited menus at 11 sit-down restaurants and 26 quick-serve chains. They evaluated the nutritional levels of entrees that were on the menu six months after the regulations went into effect and remained on the menu 12 months later, to determine whether individual menu items had been reformulated to improve their nutritional profiles. They also looked at whether all entrees had a better nutrition profile.

"We also wanted to know how healthy foods at chain restaurants were overall. How do these meals stack up compared to what we should be aiming for in a good diet?" Bruemmer says. Consequently, they compared the nutritional values of entrees at the restaurants in their study to U.S. Department of Agriculture dietary guidelines.

"We did find evidence of a decrease in energy, saturated fat, and sodium content after the implementation of menu regulations for items that were on the menu at both time periods," Bruemmer says. "We also saw a trend for healthier alternatives across all entrees over time, but only in the sit-down restaurants."

However, the study found that the majority of entrees were still high in energy, saturated fats, and sodium, compared with dietary guidelines.

"Fifty-six percent of entrees exceeded the recommended level for one-third of an adult's daily needs, while 77 percent of the entrees exceeded the guidelines for saturated fats, and almost 90 percent exceeded the sodium guidelines," Bruemmer says. "Yes, we saw improvements, but there is still a long way to go. Those are pretty hefty servings for adults."

A decline of 41 calories in entrees was seen between the two time periods. "While that doesn't sound like very much, it is an improvement and it is statistically significant," says Bruemmer. "Forty-one fewer calories could easily translate into several pounds lost over a year for an adult. It's modest, but it's a start."

With national guidelines from the Food and Drug Administration expected later this year, Bruemmer says consumers need more options in the marketplace and clearer messages about how to use menu labeling information.

"People can only respond to what's available in the environment," she says. "If we haven't yet seen people say, 'Oh, I found something that meets my needs,' well, maybe it's because there aren't enough moderate options available on the menu. Menu labeling will help people get a handle on this 'list' of calories, at the point where they're making their decisions and putting down their money. This is where America is providing a lot of food to our children. Let's give families a chance to make an informed decision."

Based in Chicago, the Academy of Nutrition and Dietetics, formerly the American Dietetic Association, claims to be the world's largest organization of food and nutrition professionals. The Academy says it works to improve the nation's health and advance the profession of dietetics through research, education, and advocacy.

The official journal of the Academy of Nutrition and Dietetics, the Journal of the Academy of Nutrition and Dietetics, is a monthly, peer-reviewed journal that presents original articles prepared by scholars and practitioners. The journal focuses on advancing professional knowledge across the range of research and practice issues, such as nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, food service systems, leadership and management, and dietetics education.