Movie theater chains will have to inform patrons how many calories are in those giant buckets of popcorn and restaurants with at least 20 locations will have to reveal the calorie content of their specialty cocktails under new rules unveiled by the Food and Drug Administration.
The FDA rules, published Tuesday, aim to set a national standard for posting calorie information on virtually all menu items sold in chain restaurants, entertainment venues and vending machines. When fully implemented two years from now, they will bring uniformity to the patchwork of state and local calorie-posting requirements that exist today.
The rules, drafted under a provision of the Affordable Care Act, will apply to chains that have 20 or more locations operating under the same name and offering "basically the same menu items," the FDA said.
"Increased awareness about the choices we make certainly does not mean that we always eat what is healthy," FDA Commissioner Margaret Hamburg wrote Tuesday on her blog. "But whether we choose to eat French fries or a tuna sandwich, those selections should reflect informed decision-making. That can only happen if the right information is available to make those choices."
Hamburg underscored that for all the political wrangling over Obamacare and anti-obesity measures such as soda taxes, calorie posting is a measure that has enjoyed bipartisan support, inasmuch as it aims to inform consumers and leave buying decisions in their hands.
Several years in the making, the new standard relieves hungry consumers of some arithmetic judgments while adding others.
It requires restaurants and other establishments to post calorie counts per serving. A diner planning to eat two or three slices of pizza, for instance, would have to do a little math.
At the same time, the new rules will challenge consumers to understand their food choices in the context of their overall daily diet. Menus and menu boards will be required to advise customers that "2,000 calories a day is used for general nutrition advice, but calorie needs vary."
That leaves consumers — who are by and large poor at making complex calculations while gazing at a menu — to decide what proportion of their daily calorie allotment they are willing to expend in a single order.
During a drive-through visit to McDonald's, for instance, an individual must determine whether she can afford to add a sweet tea (150 calories) and an order of French fries (230 calories) to her crispy chicken club sandwich (670 calories) and still wrap up her day consuming 2,000 calories or fewer. In the process, she might also ponder whether she can, in fact, maintain a stable weight while consuming 2,000 calories a day — a total that may be low for a teenage athlete and high for a post-menopausal office worker.
Research suggests that the consumers most poorly equipped to perform such mental calculations on the fly are also those most likely to be obese: Americans from low-income households, members of ethnic minorities and those with literacy challenges.
The new slate of rules comes amid an ongoing debate among doctors, nutritionists and public health experts over how to get Americans to make better food choices. Studies have shown that fewer than 40% of consumers even notice calorie labeling where it is available, and only a small portion of those say the postings influence their orders.
Evidence that calorie counts improve consumers' choices "is pretty weak," said Sara Bleich, an obesity expert at Johns Hopkins' Bloomberg School of Public Health in Baltimore. While she called the FDA's national standards "a great first step," she added that researchers have already found better ways to convey the significance of a menu item's calorie content and nudge consumers toward better choices.
A 2011 study of teenagers pondering the purchase of a soft drink after school showed that they were half as likely to choose a sugar-sweetened soda or bottle of fruit juice when a sign informed them it would take 50 minutes of running to work off the calories. Posting such "sweat equivalents" was more powerful than posting calories alone.
Other strategies that have been shown to work include listing menu offerings in order of their caloric density, displaying healthful foods more prominently than their high-calorie counterparts, and making lower-calorie offerings the default option in pre-set meals.
But Bleich said calorie-labeling rules have had a powerful effect on restaurants and other businesses that sell food and drinks. In an article published last month in the American Journal of Preventive Medicine, Bleich and her colleagues calculated that new menu offerings at large chain restaurants induced diners to consume 60 fewer calories per visit, on average, compared with levels seen in 2012 and 2013.
That 12% reduction appeared to be the result of the restaurants' voluntary decision to offer lower-calorie entrees, beverage and children's meals, and to reformulate some popular items to reduce their calorie counts.
Faced with the prospect of publicly acknowledging they serve 800-calorie muffins and 400-calorie specialty coffee drinks, chain restaurants responded by revamping their menus, Bleich said. In the end, "the biggest effect of this national legislation will be less on consumer choices and more on the supply side," she said.
For those watching their intake of salt, carbohydrates or fiber, the new FDA rules require chains to offer more detailed information upon request. Consumers must be notified on menus and menu boards that they can ask for and receive written nutrition information about total calories, total fat, calories from fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrates, fiber, sugars and protein.