UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF NEW YORK

NEW YORK STATE RESTAURANT

ASSOCIATION,

Plaintiff,

-againstNEW YORK CITY BOARD OF HEALTH, NEW

YORK CITY DEPARTMENT OF HEALTH AND

MENTAL HYGIENE, and THOMAS R. FRIEDEN,

in His Official Capacity as Commissioner of the

New York City Department of Health and Mental

Hygiene,

Defendants.

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No. 07-CIV-05710 (RJH)

NOTICE OF FILING

PLEASE TAKE NOTICE THAT the Center for Science in the Public Interest,

one of the amici in this case, files the attached declaration of its Director of Nutrition

Dr. Margo Wootan, to assist the Court in its review of the facts relating to Plaintiff’s

request for a preliminary injunction.

Dated: July 16, 2007

Respectfully submitted,

Center for Science in the Public Interest

5646 Milton St., Ste. 211

Dallas, Texas 75206

Telephone: 214-827-2774

Facsimile: 214-827-2787

By:

Stephen Gardner, Director of Litigation

Case 1:07-cv-05710-RJH Document 27 Filed 07/16/2007 Page 1 of 31
Certificate of Service

This Notice and the attached declaration were served on counsel for the parties,

on July 16, 2007, in accordance with the Federal Rules of Civil Procedure and the Local

Rules, using the Court’s Electronic Case Filing system:

Nancy G. Milburn/Peter Zimroth

Arnold & Porter LLP

399 Park Avenue

New York, NY 10022 

Telephone: 212-715-1000

Facsimile: 212-715-1399 

Attorneys for Plaintiff

Michael A. Cardozo/Mark W. Muschenheim

Corporation Counsel of the City of New York

100 Church Street

New York, NY 10007 

Telephone: 212-442-0573

Attorneys for Defendants

Stephen Gardner

Case 1:07-cv-05710-RJH Document 27 Filed 07/16/2007 Page 2 of 31
UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF NEW YORK

------------------------------------------------------------------------x

NEW YORK STATE RESTAURANT

ASSOCIATION, No. 2007 Civ. _______

Plaintiff,

againstDECLARATION OF

NEW YORK CITY BOARD OF HEALTH, MARGO G. WOOTAN

NEW YORK CITY DEPARTMENT OF HEALTH

AND MENTAL HYGIENE, and Thomas R. Frieden,

In His Official Capacity as Commissioner

Of the New York State [sic] Department of Health

And Mental Hygiene,

Defendants.

----------------------------------------------------------------------x

MARGO G. WOOTAN, D.Sc. hereby declares under penalty of perjury:

1. I am the director of Nutrition Policy at the Center for Science in the Public

Interest (“CSPI”), one of the country’s leading health advocacy organizations that

specializes in nutrition and food safety. I have worked at CSPI for more than fourteen 

years. I hold a Bachelors of Science in nutrition from Cornell University and a doctorate

in nutrition from Harvard School of Public Health. As CSPI’s nutrition policy director, I

co-founded and coordinate the activities of the National Alliance for Nutrition and 

Activity, the largest nutrition and physical activity coalition in the country, and am a

member of the Steering Committee and the co-chair of the Policy Subcommittee for the

National Fruit and Vegetable Partnership, a public-private partnership that leads the

nation’s efforts to promote fruit and vegetable intake. In addition, I was a supporting

participant in the Keystone Forum on Away-from-Home Foods, which was funded and 

Case 1:07-cv-05710-RJH Document 27 Filed 07/16/2007 Page 3 of 31
2

convened by the U.S. Food and Drug Administration. The purpose of the Keystone

Forum was to consider what can be done to support consumers’ ability to manage calorie

intake and prevent weight gain and obesity from eating out.

2. Americans’ diets are contributing to health problems ranging from obesity to

cancer. Nutrition labeling on food packages helps millions of people, but when people

eat out, restaurants rarely provide nutrition information at the point where people are

ordering. Yet studies show that in the absence of nutrition information it is difficult for

people to estimate the calorie content of restaurant meals. Without menu labeling, how

are people to know that a tuna sandwich at a typical deli has 50% more calories than a

roast beef sandwich? Or that a grilled chicken sandwich at McDonald’s has as many 

calories as a Quarter Pounder?

3. Because restaurants have not acted on their own, government should fulfill its

responsibility to enable consumers to make informed choices. Unfortunately, the federal

government has done nothing to ensure that consumers have nutrition information in

restaurants. New York City’s menu labeling requirement is an important step toward

addressing obesity and supporting informed food choices and healthy eating.

Obesity is one of the most pressing health problems in the United States

4. Over the last 25 years, obesity rates doubled among U.S. adults and tripled in 

children and teens.

1 Overweight and obesity affect the majority of American adults

(66%).

5. Obesity is a serious public health threat and a leading cause of death. A 2005

study by the Centers for Disease Control and Prevention (“CDC”) estimated that

 1 Ogden C, et al. “Prevalence of Overweight and Obesity in the United States, 1999-2004.” 

Journal of the American Medical Association 2006, vol. 295, pp. 1549-1555.

Case 1:07-cv-05710-RJH Document 27 Filed 07/16/2007 Page 4 of 31
3

approximately 112,000 deaths are associated with obesity each year in the United States.

2

That makes obesity the second leading contributor to premature death (the first is

tobacco). It is equivalent to a jetliner full of 300 people crashing every day.

6. Diabetes rates have risen along with obesity rates. The number of Americans

with diabetes more than doubled (from 5.8 million to 14.7 million) between 1980 and 

2004.3 More than 60% of people with diabetes are under 65 years old. Between 50%

and 80% of diabetes cases are associated with obesity, unhealthy eating patterns, and 

sedentary lifestyles.

4 Obesity also increases the risk of heart attacks, strokes, arthritisrelated disability, and cancer.

5

Calorie content is the nutrition information most relevant to obesity

7. While calorie content is not the only nutrition information important to health,

it is the nutrition information directly relevant to obesity. The Dietary Guidelines for

Americans, the basis of national nutrition advice, programs, and policy, concluded “to 

maintain body weight in a healthy range, balance calories from foods and beverages with

calories expended.”

6 It is total calories that contribute to weight gain – not other

nutrients, such as calcium, iron, potassium, and Vitamins A and C. Given the pressing 

nature of the obesity problem, the New York City Board of Health’s decision to require

menus and menu boards to list calories is sound public health policy.

 2 Flegal KM, et al. “Excess Deaths Associated with Underweight, Overweight, and Obesity.”

Journal of the American Medical Association 2005, vol. 293, pp. 1861-1867. 3Centers for Disease Control and Prevention, National Center for Health Statistics, Division of 

Health Interview Statistics. Data & Trends, National Diabetes Surveillance System, Prevalence

of Diabetes. Accessed at <http://www.cdc.gov/diabetes/statistics/prev/national/tablepersons.htm>

on February 28, 2006. 4 Hu F, et al. “Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women.” The New

England Journal of Medicine, 2001, vol. 345, pp. 790-797. 5 U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to

Prevent and Decrease Overweight and Obesity 2001. Rockville, MD: U.S. Department of Health

and Human Services, Public Health Service, Office of the Surgeon General, 2001. 6 U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary 

Guidelines for Americans, 2005. Washington, DC: USDA and HHS, January 2005.

Case 1:07-cv-05710-RJH Document 27 Filed 07/16/2007 Page 5 of 31
4

8. However, we agree with the NYSRA that other aspects of nutrition are

important to health. Saturated and trans fat contribute to heart disease, too much sodium

contributes to high blood pressure, and not enough fruits and vegetables contributes to 

high blood pressure and heart disease. However, the New York City Board of Health has

chosen to focus menu labeling on the fastest-growing and most wide-spread nutritionrelated health problem in the city: obesity and its consequences. In addition, the New

York City menu labeling regulations do not prohibit restaurants from providing 

additional nutrition information. Restaurants are free to list other nutrition information

they feel is important, as long as it is in addition to calories. Additional nutrition

information could be listed on the menu or through other communications materials and 

approaches.

9. We further agree with the NYSRA that numerous factors contribute to obesity.

Those include soft drink consumption, large portion sizes (which are a problem not only 

at restaurants), community design and transportation infrastructure that inhibit walking

and biking, too little physical activity for children at school, personal food choices, etc.

However, each policy implemented by the city does not need to address each contributor.

New York City is pursuing other policy options to address other contributors to obesity 

and to address other nutrition-related health problems, such as diabetes and heart disease.

Similarly, other factors contribute to good health. The city cannot be expected to have

every nutrition policy also address smoking, brushing teeth, injury prevention, and other

important health behaviors.

Restaurant foods are a significant and growing part of Americans’ diets

10. Americans are increasingly relying on restaurants to feed themselves and their

families. In 1970, Americans spent just 26% of their food dollars on restaurant meals and 

Case 1:07-cv-05710-RJH Document 27 Filed 07/16/2007 Page 6 of 31
5

other foods prepared outside their homes.

7 Today, we spend almost half (46%) of our

food dollars on away-from-home foods.

8 American adults and children obtain about onethird of their calories from restaurants and other food-service establishments.

9

Restaurant food portions commonly are large, and caloric content is typically higher

than food consumed at home

11. Americans are eating more calories than two decades ago, which is likely due

in part to increases in eating out. Studies link eating out with higher caloric intakes and 

higher body weights or fatness (see Appendix A for a summary of studies).

10,11,12,13,14,15,16

12. Children eat almost twice as many calories when they eat a meal at a

restaurant (770 calories) compared to a meal at home (420 calories).

17 Women who eat

out more often (more than 5 times a week) consume about 290 more calories on average

 7 Lin B, Guthrie J, Frazao E. Away-From-Home Foods Increasingly Important to Quality of

American Diet. Washington, DC: U.S. Department of Agriculture, Economic Research Service,

1999. Agriculture Information Bulletin No. 749. 8 National Restaurant Association (NRA). “Industry at a Glance.” Accessed at

<http://www.restaurant.org/research/ind_glance.cfm> on April 12, 2002. 9 Lin B, Guthrie J, Frazao E. Away-From-Home Foods Increasingly Important to Quality of

American Diet. Washington, DC: U.S. Department of Agriculture, Economic Research Service,

1999. Agriculture Information Bulletin No. 749. 10 Zoumas-Morse C, Rock CL, Sobo EJ, Neuhouser ML. “Children’s Patterns of Macronutrient

Intake and Associations with Restaurant and Home Eating.” Journal of the American Dietetic 

Association 2001, vol. 101, pp. 923-925. 11 Pereira, MA, et al. “Fast-Food Habits, Weight Gain, and Insulin Resistance (The CARDIA

Study): 15-year Prospective Analysis.” Lancet 2005, vol. 365, pp. 36-42. 12 Thompson OM, et al. “Food Purchased Away from Home as a Predictor of Change in BMI zscore among Girls.” International Journal of Obesity 2004, vol. 28, pp. 282-289. 13 Binkley JK, et al. “The Relation between Dietary Change and Rising U.S. Obesity.” 

International Journal of Obesity 2000, vol. 24, pp. 1032-1039. 14 Jeffery RW, French SA. “Epidemic Obesity in the United States: Are Fast Food and Television

Viewing Contributing?” American Journal of Public Health 1998, vol. 88, pp. 277-280. 15 McCrory MA, Fuss PJ, Saltzman E, Roberts SB. “Dietary Determinants of Energy Intake and

Weight Regulation in Healthy Adults.” Journal of Nutrition 2000, vol. 130 (Supplement), pp.

276S-279S.

16 McCrory MA, Fuss PJ, Hays NP, Vinken AG, Greenberg AS, Roberts SB. “Overeating in

America: Associations between Restaurant Food Consumption and Body Fatness in Healthy

Adult Men and Women Ages 19 to 80.” Obesity Research 1999, vol. 7, pp. 564-571. 17 Zoumas-Morse C, Rock CL, Sobo EJ, Neuhouser ML. “Children’s Patterns of Macronutrient

Intake and Associations with Restaurant and Home Eating.” Journal of the American Dietetic 

Association 2001, vol. 101, pp. 923-925.

Case 1:07-cv-05710-RJH Document 27 Filed 07/16/2007 Page 7 of 31
6

each day than women who eat out less often.

18 Furthermore, eating more fast-food meals

is linked to eating more calories, more saturated fat, fewer fruits and vegetables, and less

milk.19,20,21,22,23,24

13. Foods that people obtain from restaurants and other food-service

establishments are generally higher in calories than home-prepared foods.

25,26,27,28 It is

not uncommon for a restaurant entree to provide half of a day’s recommended calories.

29

Include an appetizer, beverage or dessert, and it is easy to consume a whole day’s

calories in a single meal. No one would mistake a typical order of cheese fries with ranch 

dressing for a health food, but few would guess that a typical serving uses up one-and-a-

 18 Clemens LH, et al. “The Effect of Eating Out on Quality of Diet in Premenopausal Women.”

Journal of the American Dietetic Association 1999, vol. 99, pp. 422-444. 19 Schmidt M, et al. “Fast-Food Intake and Diet Quality in Black and White Girls.” Archives of

Pediatric and Adolescent Medicine 2004, vol. 159, pp. 626-631

20 S.A. Bowman and B.T. Vinyard. “Fast-Food Consumers vs. Non-Fast-Food Consumers: A

Comparison of Their Energy Intakes, Diet Quality, and Overweight Status.” Journal of the

American College of Nutrition 2004, vol. 23, pp. 163-168. 21 S. Paeratakul, et al. “Fast-Food Consumption among U.S. Adults and Children: Dietary and

Nutrient Intake Profile.” Journal of the American Dietetic Association 2003, vol. 103, pp. 1332-

1338. 22 Jeffery RW, French SA. “Epidemic Obesity in the United States: Are Fast Food and Television

Viewing Contributing?” American Journal of Public Health 1998, vol. 88, pp. 277-280. 23 French SA, Story M, Neumark-Sztainer D, Fulkerson JA, Hannan P. “Fast Food Restaurant Use

among Adolescents: Associations with Nutrient Intake, Food Choices and Behavioral and

Psychosocial Variables.” International Journal of Obesity 2001, vol. 25, pp. 1823-1833. 24 McNutt SW, Hu Y, Schreiber GB, Crawford PB, Obarzanek E, Mellin L. “A Longitudinal

Study of the Dietary Practices of Black and White Girls 9 and 10 Years Old at Enrollment: The

NHLBI Growth and Health Study.” Journal of Adolescent Health 1997, vol. 20, pp. 27-37. 25 Lin B, Guthrie J, Frazao E. Away-From-Home Foods Increasingly Important to Quality of

American Diet. Washington, DC: U.S. Department of Agriculture, Economic Research Service,

1999. Agriculture Information Bulletin No. 749. 26 Jeffery RW, French SA. “Epidemic Obesity in the United States: Are Fast Food and Television

Viewing Contributing?” American Journal of Public Health 1998, vol. 88, pp. 277-280. 27 Ma Y, Bertone ER, Stanek III EJ, Reed GW, Hebert JR, Cohen NL, Merriam PA, Ockene IS.

“Association between Eating Patterns and Obesity in a Free-living US Adult Population.”

American Journal of Epidemiology 2003, vol. 158, pp. 85-92. 28 McCrory MA, Fuss PJ, Hays NP, Vinken AG, Greenberg AS, Roberts SB. “Overeating in

America: Associations between Restaurant Food Consumption and Body Fatness in Healthy

Adult Men and Women Ages 19 to 80.” Obesity Research 1999, vol. 7, pp. 564-571. 29 Jacobson MF, Hurley JG. Restaurant Confidential. New York, NY: Workman Publishing,

2002.

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half-day’s worth of calories (3,010 calories).

30 A large milk shake from McDonald’s has

over 1,000 calories, about a half-a-day’s worth.

31

14. It is common for restaurants to serve two to three times more than what is

considered a standard serving size. A Double Gulp soft drink from 7-Eleven contains six 

servings, meaning it provides six times as many calories as a standard serving of soft

drink. A porterhouse steak from a typical steak house restaurant weighs more than a

pound.

32

Without nutrition information, consumers cannot accurately assess the calorie

content of restaurant foods

15. Without nutrition information, consumers substantially underestimate the

levels of calories found in many less healthful menu items.

33,34 For instance, who would

guess that a smoked turkey sandwich (930 calories) at Chili’s has more calories than a

sirloin steak (540 calories), or that on the children’s menu, an order of chicken tenders

(590 calories) has more calories than the baby back ribs (370 calories).

35

16. A representative, state-wide telephone poll in California found that few

Californians are able to identify from among typical fast-food and other chain restaurant

 30 Jacobson, M.F., Hurley, J.G. Restaurant Confidential. Workman Publishing, New York, NY,

2002. 31 McDonald’s Corporation. McDonald’s USA Nutrition Information. Accessed at

http://www.mcdonalds.com/usa/eat/nutrition_info.html on July 10, 2007. 32 Jacobson, M.F., Hurley, J.G. Restaurant Confidential. Workman Publishing, New York, NY,

2002. 33 Burton S, Creyer EH, Kees J, Huggins K. “Attacking the Obesity Epidemic: An Examination of 

the Potential Health Benefits of Nutrition Information Provision in Restaurants.” American

Journal of Public Health, 2006, forthcoming. 34 Johnson WG, Corrigan SA, Schlundt DG, Dubbert PM. “Dietary Restraint and Eating Behavior 

in the Natural Environment.” Addictive Behaviors 1990, vol. 15, pp. 285-290. 35 Chili’s Bar and Grill. Nutritional Info. Accessed at

http://www.brinker.com/gr/nutritional/chilis_nutrition_menu.pdf on July 10, 2007.

Case 1:07-cv-05710-RJH Document 27 Filed 07/16/2007 Page 9 of 31
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menu items those with the fewest/most calories, salt, or fat.

36 Not a single respondent

answered all four questions correctly. Less than 1 percent answered three of four

questions correctly, only 5 percent answered two of the four questions correctly, and

nearly 68 percent were unable to answer even one question correctly. Scores were

equally poor regardless of education or income levels. Analogous results were found 

from a similar state-wide poll in Connecticut.

37

17. One study demonstrated that even trained nutrition professionals cannot

accurately estimate the calorie content of typical restaurant meals shown to them.

38 They 

consistently underestimated the calories, and their estimations were off by large amounts

– by 200 to 600 calories. For example, when shown a typical dinner-house hamburger

and onion rings, the dietitians, on average, estimated that it had 865 calories, when it

actually contained 1,550 calories.

When provided, many consumers use nutrition information to make healthier

choices

18. Since 1994, the Nutrition Labeling and Education Act (NLEA) has required

food manufacturers to provide nutrition information on nearly all packaged foods. Threequarters of adults report using packaged food labels.

39 Using nutrition labels is

 36 California Center for Public Health Advocacy. Statewide poll on March 20-31, 2007

conducted by Field Research Corporation of 523 registered California voters. Accessed at

www.publichealthadvocacy.org/menulabelingpoll.html on June 20, 2007. 37 End Hunger Connecticut. State-wide poll conducted between April 17 and Apri1 23, 2007 by

the Center for Survey Research and Analysis at the University of Connecticut of 501 Connecticut

residents. Accessed at www.endhungerct.org/PDF/pollresults.pdf on June 20, 2007. 38 Backstrand J, Wootan MG, Young LR, Hurley J. Fat Chance. Washington, DC: Center for

Science in the Public Interest, 1997. 39 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,

National Center for Health Statistics. Healthy People 2000 Final Review. Hyattsville, MD: U.S.

Department of Health and Human Services, Centers for Disease Control and Prevention, National

Center for Health Statistics, 2001. DHHS Publication No. 01-0256.

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associated with eating more-healthful diets,

40,41,42

and almost half of consumers report

that the nutrition information on food labels has caused them to change their minds about

buying a food product.

43 Studies also show that the provision of nutrition information at

restaurants can help people make lower-calorie choices (See Appendix B).

Menu labeling is unlikely to confuse consumers, as claimed by the NYSRA

19. People are accustomed to using nutrition labeling on packaged foods and want

it on menus.

44 In addition, FDA consumer research finds that people primarily use food 

labels on packaged foods to make side-by-side comparisons of items within similar

product categories (for example, to compare the calories in two different brands of ice

cream). Such comparisons may be easier to make via menu labeling than using food

labeling in grocery stores, because there are fewer items on menus (dozens to one or two

hundred) than in grocery stores (tens of thousands) and items are listed together in a

common place on menus rather than scattered over a large area in the grocery store.

20. With menu labeling, restaurant customers will be able to determine that:

 40 Kim SY, Nayga RM, Capps O. “The Effect of Food Label Use on Nutrient Intakes: An

Endogenous Switching Regression Analysis.” Journal of Agricultural and Resource Economics

2000, vol. 25, pp. 215-231. 41 Kreuter MW, Brennan LK, Scharff DP, Lukwago SN. “Do Nutrition Label Readers Eat

Healthier Diets? Behavioral Correlates of Adults’ Use of Food Labels.” American Journal of

Preventive Medicine 1997, vol. 13, pp. 277-283. 42 Neuhouser ML, Kristal AR, Patterson RE. “Use of Food Nutrition Labels Is Associated with

Fat Intake.” Journal of the American Dietetic Association 1999, vol. 99, pp. 45-50, 53. 43 Levy AS, Derby BM. The Impact of the NLEA on Consumers: Recent Findings from FDA’s

Food Label and Nutrition Tracking System. Washington, DC: Center for Food Safety and

Applied Nutrition, Food and Drug Administration, 1996. 44 Food and Drug Administration. The Keystone Forum on Away-From-Home Foods:

Opportunities for Preventing Weight Gain and Obesity. Rockville, Maryland: Food and Drug

Administration, May 2006, Appendix H.

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• Two jelly-filled doughnuts at Dunkin’ Donuts have fewer calories than a sesame

bagel with cream cheese;

45

• A Frappuccino at Starbucks can have 200 more calories than the same size

cappuccino;46 or

• A whole fried onion appetizer at a typical table service restaurant has 1,300 more

calories than the fried mozzarella sticks.

47

21. In addition, restaurants would be free to put calorie numbers in context on their

menus, if they chose to. For example, they could put an informational message on their

menus, such as, “A 2,000-calorie daily diet is used as the basis for general nutrition 

advice; however individual calorie needs may vary.”

22. See Appendix C for model Starbucks and Wendy’s menus. These model menus

demonstrate that providing calories on the menu can be done without being confusing,

difficult to read, or cluttering the menu.

Product reformulation: a key benefit of nutrition labeling

23. A key benefit of mandatory nutrition labeling on packaged foods has been the

reformulation of existing products and the introduction of new nutritionally improved 

products.

48 In the first four years after implementation of mandatory nutrition labeling of

packaged foods, the number of available fat-modified cheese products tripled and the

 45 Dunkin’ Donuts. Nutrition Information. Accessed at

https://dunkindonuts.com/aboutus/nutrition/ on July 10, 2007. 46 Jacobson, M.F., Hurley, J.G. Restaurant Confidential. Workman Publishing, New York, NY,

2002. 47 Jacobson, M.F., Hurley, J.G. Restaurant Confidential. Workman Publishing, New York, NY,

2002. 48 Silverglade BA. “Food Labeling: Rules You Can Live By.” Legal Times, July 17, 1995, pp. 21-

24.

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11

market share for fat-modified cookies increased from zero percent to fifteen percent.

49 In 

2006 when trans fat, which promotes heart disease, was required to be listed on food

packages, many companies greatly reduced or eliminated their use of trans-fat-containing 

oils. In a similar fashion, nutrition labeling on menus and menu boards is likely to spur

nutritional improvements in restaurant foods.

Providing calorie content on menus is likely to provide significant public health

benefits

24. Americans consume an increasing number of calories away from home,

restaurant foods are higher in calories than home-prepared meals, and without nutrition 

labeling, it extremely difficult to accurately assess the number of calories in a restaurant

meal. Therefore, it is reasonable to conclude that requiring menu labeling is likely to 

yield important health and economic benefits.

25. Federal agencies have estimated significant economic and health benefits

from food labeling. The FDA estimated that requiring trans fat to be listed on packaged 

food labels would save 2,100 to 5,600 lives a year and $3 billion to $8 billion a year.

50

USDA estimated the economic benefits of extending nutrition labeling to fresh meat and 

poultry to be $62 million to $125 million per year.

51

 49 Levy AS, Derby BM. The Impact of the NLEA on Consumers: Recent Findings from FDA’s

Food Label and Nutrition Tracking System. Washington, DC: Center for Food Safety and

Applied Nutrition, Food and Drug Administration, 1996. 50 Food and Drug Administration, U.S. Department of Health and Human Services. Federal Register 1999,

vol. 64, pp. 62772-62774. 51 Crutchfield S, Kuchler F, Variyam JN. “The Economic Benefits of Nutrition Labeling: A Case

Study for Fresh Meat and Poultry Products.” Journal of Consumer Policy 2001, vol. 24, 185-207.

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12

26. The total U.S. health-care costs due to obesity are $94 billion a year.

52 Half

that cost ($47 billion) is paid through Medicare and Medicaid. According to the U.S.

Department of Agriculture, healthier diets could prevent at least $71 billion per year in

medical costs, lost productivity, and lost lives.

53

Experts agree that restaurants should provide nutrition information at the point of

ordering

27. Menu labeling has been recognized by many prominent health experts as an 

important strategy for addressing nutrition and obesity. The National Academies’

Institute of Medicine recommends that restaurant chains “provide calorie content and

other key nutrition information on menus and packaging that is prominently visible at

point of choice and use.”

54 The U.S. Surgeon General has called for “increasing 

availability of nutrition information for foods eaten and prepared away from home.”

55

The Food and Drug Administration through the Keystone Forum on Away-From-Home

Foods recommended that restaurants “provide consumers with calorie information in a

standard format that is easily accessible and easy to use.”

56

28. A number of prominent national health organizations have endorsed menu 

labeling as a key strategy to help people make healthier choices in restaurants, including 

 52 Finkelstein EA, Fiebelkorn IC, Wang G. “State-level Estimates of Annual Medical

Expenditures Attributable to Obesity.” Obesity Research 2004, vol. 12, pp. 18-24. 53 Frazao E. “High Costs of Poor Eating Patterns in the United States.” In America’s Eating

Habits: Changes and Consequences. Edited by Elizabeth Frazao. Washington, DC: Economic 

Research Service, U.S. Department of Agriculture, 1999. Agriculture Information Bulletin No.

750, pp. 5-32. 54 Koplan JP, Liverman CT, Kraak VA, Editors, Committee on Prevention of Obesity in Children

and Youth, Food and Nutrition Board, Institute of Medicine. “Preventing Childhood Obesity:

Health in the Balance.” Washington, DC: National Academies Press, 2005. 55 U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to

Prevent and Decrease Overweight and Obesity. Rockville, MD: U.S. Department of Health and

Human Services, Public Health Service, Office of the Surgeon General, 2001. 56 Food and Drug Administration. The Keystone Forum on Away-From-Home Foods:

Opportunities for Preventing Weight Gain and Obesity. Rockville, Maryland: Food and Drug

Administration, May 2006, pp. 76-79.

Case 1:07-cv-05710-RJH Document 27 Filed 07/16/2007 Page 14 of 31
13

the American Academy of Pediatrics

57

, the American Medical Association58, the

American Heart Association59, AARP60, the American Public Health Association61, and

the Society for Nutrition Education.

62

Calories must be listed on menus to be useful and visible to customers

29. Public support for nutrition labeling on menus and menu boards is

strong. According to an industry-backed nationally representative poll, 83 percent of

Americans believe restaurants should make nutrition information available for all menu 

items.

63 When asked specifically about requiring chain restaurants to provide nutrition 

information on menus, state-wide polls in Connecticut and California show that over 80 

percent of people support menu labeling.64,65

30. Menu labeling is easier to find and use at the point of ordering than other

approaches. The Keystone Forum on Away-from-Home Foods,

66 funded and convened 

by the U.S. Food and Drug Administration, concluded that restaurants “should provide

 57 American Academy of Pediatrics. Resolution 6: Posting of Caloric Content of Foods on Menu

Boards of Quick Service Restaurants, AAP National Leadership Conference 2006/2007. 58 American Medical Association. Increasing Customer Awareness of Nutrition Information and

Ingredients in Restaurants. AMA Annual Conference, July 27, 2007. 59

American Heart Association. Position Statement on Menu Labeling. Dallas, Texas, AHA, 2007. 60 AARP. Nutrition Labeling at Fast Food and Other Chain Restaurants. AARP Public Policy

Institute, July 2004. 61 American Public Health Association. Support for Nutrition Labeling in Fast-Food and Other

Chain Restaurants. Policy Statement, 2004. 62 Society for Nutrition Education. Resolution to Support Nutrition Labeling and Nutritionally 

Improved Menu Offerings in Fast-Food and Other Chain Restaurants. SNE Annual Meeting,

July 2006. 63 ARAMARK Corp. 2005, nationwide online survey of 5,297 adults. As cited by Nanci

Hellmich. “Diners Want More Info and Smaller Entrees.” October 19, 2005. Accessed at

http://www.usatoday.com/news/health/2005-10-19-diners-less-food_x.htm. 64 California Center for Public Health Advocacy. Statewide poll on March 20-31, 2007

conducted by Field Research Corporation of 523 registered California voters. Accessed at

www.publichealthadvocacy.org/menulabelingpoll.html on June 20, 2007. 65 End Hunger Connecticut. State-wide poll conducted between April 17 and Apri1 23, 2007 by

the Center for Survey Research and Analysis at the University of Connecticut of 501 Connecticut

residents. Accessed at www.endhungerct.org/PDF/pollresults.pdf on June 20, 2007. 66 Food and Drug Administration. The Keystone Forum on Away-From-Home Foods:

Opportunities for Preventing Weight Gain and Obesity. Rockville, Maryland: FDA, May 2006.

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consumers with calorie information in a standard format that is easily accessible and easy 

to use.” “Information should be provided in a manner that is easy for consumers to see

and use as part of their purchasing and eating decisions.”

31. As a member of the Keystone Forum, I know that there were several key

points to that recommendation, including that calorie information be 1) provided in a

standardized format, 2) easy to find, and 3) easy to use at the point where people are

making purchasing decisions.

32. Currently those restaurants that do provide nutrition information do so in a

variety of formats. As a result, customers who are interested in nutrition information do 

not know where to look to find it.

33. A restaurant is most likely to provide no nutrition information, as is the case

for at least half of chain restaurants.

67 The second most common approach is to provide

nutrition information on a website or other format that is not available in the restaurant.

On-premise nutrition information is provided through posters, pamphlets, handouts,

reference book, kiosks, tray liners, table tents, counter signs, napkins, fast-food packages,

receipts, or other means. Most of those formats do not permit customers to make

informed decisions at restaurants prior to placing their orders. Providing calories on 

menus and menu boards, as the New York City Board of Health has required, would cut

through the current chaos and lack of useful information in the market place by providing 

a standard, accessible place where consumers can find calorie information in restaurants

that must comply with New York City’s regulation.

 67 Wootan, MG, Osborn, M. “Availability of Nutrition Information from Chain Restaurants in the 

U.S.” American Journal of Preventive Medicine 2006, vol. 30, pp. 266-268.

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34. Websites are the most common means by which restaurants provide nutrition

information.68 Although websites are versatile, can be comprehensive, and interactive,

they are only accessible to customers with a computer and Internet access and require

considerable forethought prior to going to a restaurant. If people had time to go home,

log on to the Internet, and study various websites, they might instead just choose to cook 

their meal at home. Convenience is a key reason people eat out. In addition, because

websites organize information differently, nutrition information can be hard to find and 

use in the absence of standardization.

35. Requiring customers to ask servers to verbally provide nutrition information,

although personal and available at the point of purchase, would demand additional

training of staff, and vary in its accuracy and helpfulness depending on the server. It also 

would make it difficult to compare items on the menu.

36. Putting nutrition information on tray liners and fast-food packaging does not

present the information to the customer until the food has been ordered and served,

regardless of how detailed (or simplified) that information is. People need nutrition 

information in an accessible and easy-to-read format before they order for it to be helpful

in their decision making.

37. Table mats, table tents, pamphlets, and signs on stanchions could be made

available at point of purchase, but are easily misplaced or moved to less visible locations.

CSPI conducted a study of the availability of nutrition information at McDonald’s

restaurants in Washington, D.C. in 2005.69 We chose McDonald’s because it is the

 68 Wootan, MG, Osborn, M. “Availability of Nutrition Information from Chain Restaurants in the 

U.S.” American Journal of Preventive Medicine 2006, vol. 30, pp. 266-268. 69 Wootan MG, Osborne M, Malloy C. “Availability of Point of Purchase Nutrition Information at

a Fast Food Restaurant.” Preventive Medicine 2006, vol. 43, pp. 458-459.

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largest chain restaurant in the country and has a longstanding practice of providing 

nutrition information to its customers. We found that even at the largest chain restaurant

in the country, nutrition information at the point of decision-making is often difficult to

find or completely absent. Forty percent of the McDonald’s outlets did not provide instore nutrition information for a majority of their menu items. In 62% of the restaurants,

it was necessary to ask two or more employees in order to obtain a copy of that

information.

38. Some restaurants provide posters, signs, stanchions, and electronic kiosks for

customers to use prior to ordering, however these approaches to information-sharing 

require additional time and effort from customers to track down and read and do not

allow people to consider both calorie information and price together. When price and 

nutrition information are not in the same place, consumers cannot make tradeoffs

between nutrition and cost. This approach also puts an extra burden on people who want

to make informed choices; they become the exception rather than the norm (i.e., it does

not “make the healthy choice the easy choice,” as some health officials put it). Yet polls

show that the overwhelming majority of people want restaurants to provide nutrition 

information.70

39. Several approaches to providing nutrition information, including kiosks, onpackage labeling, and having servers provide nutrition information verbally, do not

present the information in a way that allows people to easily compare nutrition

information of different menu items. That is the key way people use nutrition labeling on

packaged foods.

 

70 Food and Drug Administration. The Keystone Forum on Away-From-Home Foods:

Opportunities for Preventing Weight Gain and Obesity. Rockville, Maryland: Food and Drug

Administration, May 2006, Appendix H.

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40. We are skeptical of some restaurants’ contention that they do not want to

provide nutrition information on menu boards because it will slow down the line and 

ordering. Providing information on counter mats or in brochures at the counter, which 

several restaurants argue is a more favorable approach, would cause greater delays than

information on menu boards. People would not have access to such information until

they reached the counter to order, whereas with calories on menu boards, they could

make their decision while waiting on line. In addition, Hector Munoz of Burger King

wrote in his declaration (p.3) “that customers tend to finalize their food purchasing 

decisions before they reach the counter.”

41. Restaurants contend that “menus and menu boards are among the most

important ways that restaurants communicate with their customers.” The restaurant

industry seems agreeable to the idea of providing calorie information in almost any 

format except the most effective way – on the menu. The NYSRA wrote (p.29 of their

motion) that “providing comprehensive nutritional information (including calories) on (i)

countermats; (ii) tray liners; (iii) brochures placed by cash registers; or (iv) on separate

billboards, posters, or stanchions” are alternatives that “give consumers similar access to 

calorie information in a manner less likely to be offensive to restaurants.”

42. At the same time, restaurants also state that “menus and menu boards are

among the most important ways that restaurants communicate with their customers”

(p.22). Hector Munoz of Burger King Corporation, in his declaration on this matter (p.2),

wrote:

The menu board is the single most valued piece of real estate in a Burger King 

restaurant. It is the most important way we communicate with our customers in 

the store about the products we offer and their price; it is what our customers look

at, and it is what stimulates their decision to buy.

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43. The New York City Board of Health rightly requires that nutrition information

be provided where customers get other information about what to order, including the

menu options, product descriptions, and price.

44. Calorie information is too important to New Yorkers’ health to relegate to

hard-to-find pamphlets or kiosks or to tray liners or packaging that people do not receive

until after they order their food. Calorie information should be provided in the most userfriendly manner, which is on the menu or menu board. In studies going back over thirty

years, research has shown that in a cafeteria setting signs immediately adjacent to foods

indicating the calorie content of those foods can significantly decrease the number of

calories that people purchase.

71 More recently, studies have specifically linked more

healthful choices with calories placed directly on the menu.72,73

I declare under penalty of perjury that the foregoing is true and correct.

Executed July 12, 2007

Margo G. Wootan, D.Sc.

 71 Milich R, Anderson J, Mills M. “Effects of Visual Presentation of Caloric Values on Food

Buying by Normal and Obese Persons.” Perceptual and Motor Skills 1976, vol. 42, pp. 155-162. 72 Burton S, Creyer EH. “What Consumers Don’t Know Can Hurt Them: Consumer Evaluations

and Disease Risk Perceptions of Restaurant Menu Items.” Journal of Consumer Affairs 2004, vol.

38, no. 1, pp. 121-145. 73 Kozup KC, Creyer EH, Burton S. “Making Healthful Food Choices: The Influence of Health

Claims and Nutrition Information on Consumers’ Evaluations of Packaged Food Products and

Restaurant Menu Items.” Journal of Marketing 2003, vol. 67, pp. 19-34.

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Appendix A: Research Regarding the Association of Away-fromHome Foods and Body Weight

The following is a brief annotated bibliography of sources regarding the

association between away-from-home foods and overweight/obesity, as reviewed

in a presentation by Dr. Alice Lichtenstein of Tufts University at the April 26-27,

2005 meeting for the Food and Drug Administration (FDA) for the Keystone

Forum on Away-From-Home Foods: Opportunities for Preventing Weight Gain

and Obesity. Please note that studies use different terms for away-from-home

foods establishments; including “restaurants,” “away-from-home food outlets,”

and “quick-service” or “fast-food restaurants.” Furthermore, researchers may 

define these terms differently. Thus, one should consult the individual studies for

more detail and clarity.

1. Binkley, JK et al. “The Relation between Dietary Change and Rising U.S.

Obesity.” International Journal of Obesity 2000;24:1032-1039. Using

CSFII data from 1994 to 1996, the researchers found that source of food

is a significant determinant of Body Mass Index (BMI). This association

was shown for both restaurants generally and fast-food outlets specifically.

For females, the correlation was significant for fast-food outlets only but

for males, the correlation was significant for restaurants generally as well

as fast-food outlets specifically.

2. Bowman, SA et al. “Effects of Fast-Food Consumption on Energy Intake

and Diet Quality among Children in a National Household Survey.”

Pediatrics 2004;113:112-132. Using CSFII data from 1994 to 1996 and

the Supplemental Children’s Survey from 1998, the researchers found for

four to nineteen year olds, thirty percent (30%) of the sample population

consumed fast food on a typical day. Those who ate fast food consumed

more calories per gram of food and had poorer diet quality. The higher

fast food consumption was associated with males, older children, higher

household income, non-Hispanic Afro-Americans, and residence in the

South.

3. Bowman, SA et al. “Fast-Food Consumption of U.S. Adults: Impact on

Energy and Nutrient Intakes and Overweight Status.” American College of

Nutrition 2004;23:163-168. Using CSFII data from 1994 to 1996, the

researchers found that 25% of adults reported eating fast food. The study 

found that such fast food provided greater than 33% of total calorie intake

and found a positive association between fast-food consumption and

overweight status.

4. Clemens, LH et al. “The Effect of Eating Out on Quality of Diet in

Premenopausal Women.” Journal of the American Dietetic Association

1999: 99:422-444. The study group was composed of premenopausal

women. Groups were categorized as “low eating out” for meals consumed

out five times or less per week and “high eating out” for meals consumed

out six to thirteen times per week. The researchers found eating out

frequency associated with higher intakes of calories, fat, and sodium.

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5. Ebbeling, CB et al. “Compensation for Energy Intake from Fast Food

among Overweight and Lean Adolescents.” JAMA 2004: 291:2828-2833.

In the first part of this study, the participants were instructed to eat as

much or little as they desired in a one-hour period in a food-court setting.

The participants, thirteen to seventeen years old, had large caloric intake

(1652 calories) and overweight participants ate more than leaner

counterparts in both absolute terms as well as in estimated daily calorie

requirements. In the second part of this study, caloric intake was 

determined for participants under “free-living” conditions for two days

when fast food was eaten and not eaten. The researchers found that

overweight adolescents consumed significantly more total calories on fast

food days (almost 18% more). Lean adolescents had no significance

difference in total calorie intake between fast food and non-fast food days.

6. French, SA et al. “Fast Food Restaurant Use among Women in the

Pound of Prevention Study: Dietary, Behavioral and Demographic 

Correlates.” International Journal of Obesity 2000;24:1353-1359. This 

three year prospective intervention trial found that frequency of fast-food

restaurant use was associated with higher caloric intakes and higher fat

intake (as percent of calories) and lower consumption of fiber and fruit.

The frequency of fast-food restaurant use was also positively associated

with younger women, those with lower income, and those with non-White

ethnicity.

7. Guthrie, JF et al. “Role of Food Prepared Away from Home in the

American Diet, 1977-78 Versus 1994-96: Changes and Consequences.”

Society for Nutrition Education 2002;34:140-150. Using data from 1977-

78 NFCS and 1994 to 1996 CSFII data, the researchers found changes in

source of calories consumed over time. Food prepared away from home

(restaurants, schools, daycare, or other) increased from 18% to 34% of

total calories. Meals and snacks prepared away from home contained

more calories per eating occasion and those meals and snacks were

higher in fat and saturated fat and lower in fiber, calcium and iron per

calorie consumed.

8. Jeffery, RW and French SA. “Epidemic Obesity in the United States: Are

Fast Foods and Television Viewing Contributing?” American Journal

Public Health 1998: 88:277-280. The study considered the correlation

between fast-food intake and energy intake and body mass (the study also

looked at TV, VCR, and cable TV watching). Recruitment was done via

the USDA Women, Infants, and Children program (WIC) for those not

pregnant one year prior to or following WIC enrollment. Total calorie

intake and BMI were positively associated with fast-food consumption.

9. Lin, BH et al. Diets of America’s Children: Influence of Dining out,

Household Characteristics, and Nutrition Knowledge. Washington, DC:

USDA, 1996. Ag Economic Report No. 726. Using data from USDA’s 

1989-91 Continuing Survey of Food Intakes by Individuals and the Diet

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and Health Knowledge Survey, USDA researchers found that the foods 

that children eat from fast-food and other restaurants are higher in fat and

saturated fat and lower in fiber, iron, calcium, and cholesterol than foods 

from home.

10.Maddock, J. “The Relationship between Obesity and the Prevalence of

Fast-Food Restaurants: State-Level Analysis.” American Journal of

Health Promotion 2004: 19:137-143. The researchers consider statelevel data on percent of population which is obese, fast-food restaurants 

per square mile, and self-reported behaviors from physical activity to fruit

and vegetable consumption. The study found state levels of obesity 

inversely related to the number of residents per fast-food restaurant

density and the number of square miles per fast food establishment.

Other factors associated with obesity were income, fruit and vegetable

intake, and percentage population of African-Americans.

11.Manchino, L et al. “The Role of Economics in Eating Choices and Weight

Outcomes.” USDA, Economic Research Service, WDC 2004. Ag Info

Bulletin No. 791. The researchers used data from USDA’s 1994-96

Continuing Survey of Food Intakes by Individuals and the 1994-96 Diet

and Health Knowledge Survey. The researchers found that overweight

and obese women go significantly longer intervals between meals than

healthy-weight women, and receive more of their daily calories from fastfood restaurants.

12.McCrory, MA et al. “Overeating in America: Association between

Restaurant Food Consumption and Body Fatness in Healthy Adult Men

and Women Ages 19 to 80.” Obesity Research 1999: 7:564-571. The

study group was comprised of “healthy” men and women. Restaurant

consumption averaged 7.5 times per month. After controlling for age and

gender, frequency of restaurant consumption was associated positively 

with body fatness (as measured by underwater weights). The association

was unaltered after controlling for education, smoking status, and alcohol

intake. The association increased after controlling for physical activity.

13.Paeratakul, S et al. “Fast-food Consumption among U.S. Adults and

Children: Dietary and Nutrient Intake Profile.” Journal of the American

Dietetic Association 2003;103:1332-1338. Using data CSFII from 1994 to

1996 and 1998, the researchers found that 37% of adults and 42% of

children reported eating in fast-food establishments. On the basis of two

non-consecutive twenty-four hour diet recalls, adults and children who

reported eating fast foods had higher intakes of calories, fat, saturated fat,

sodium, and soft drinks and lower intakes of vitamins A and C, milk, fruits

and vegetables than people who did not eat fast food.

14.Pereira, MA et al. “Fast-Food Habits, Weight Gain, and Insulin Resistance

(The CARDIA Study): 15-year Prospective Analysis.” Lancet

2005;365:36-42. This study used data from the Coronary Artery Risk 

Development in Young Adults (CARDIA) study. The CARDIA study 

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22

included 3031 females and males from eighteen to thirty years of age in

1985/86, and included a follow-up fifteen years later. The analysis found

that change in fast-food frequency was positively associated with changes

in body weight. Those who frequented fast-food restaurants more than

two times per week at baseline and follow-up gained an additional 4.5 kg

(about 10 pounds) over the fifteen years and had a two-fold greater

increase in insulin resistance.

15.Satia, JA et al. “Eating at Fast-Food Restaurants is Associated with

Dietary Intake, Demographic, Psychosocial, and Behavioral Factors 

among African Americans in North Carolina.” Public Health Nutrition

2004;7:1089-1096. This study considered a cross-sectional sample of

658 African-Americans from twenty to seventy years of age in North

Carolina. The study found eating in fast-food restaurants to be associated

with higher total fat intake, saturated fat intake, and lower vegetable

intake. Frequent eaters in such establishments were more likely to be

younger, never married, obese, and/or physically inactive.

16.Schmidt, M et al. “Fast-Food Intake and Diet Quality in Black and White

Girls.” Archives of Pediatric and Adolescent Medicine 2004;159:626-631.

In a longitudinal multicenter cohort study of 2379 girls (ages 9 to 19

years), increased fast-food intake was associated with increased intake of

energy and fat and saturated fat intake (as a percent of calories).

17.Thompson, O M et al. “Food Purchased Away From Home as a Predictor

of Change in BMI z-score Among Girls.” International Journal of Obesity

2004: 28:282-289. The researchers conducted a longitudinal growth

study with girls eight to twelve years of age as the baseline with a followup when they were eleven to nineteen years of age. The study showed

that at baseline, eating at quick service restaurants more often was 

associated with increases in BMI. This was most evident when quick 

service frequency was two times a week or greater.

18.Zoumas-Morse, C et al. “Children’s Patterns of Macronutrient Intake and

Associations with Restaurant and Home Eating.” Journal of the American

Dietetic Association 2001;101:923-925. This study combined data from

two populations: 1) 376 children, seven to eleven years old; and 2) 435

adolescents, twelve to seventeen years old. It found that the largest

consumption of calories took place in restaurants. The study found that

children typically eat almost twice as many calories when they eat a meal

at a restaurant (765 calories) compared to an average meal at home (425

calories). Children and adolescents also ate more energy from fat and

saturated fat when eating at a restaurant compared to at home.

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Appendix B: Summary of Findings: Influence of Nutrition

Information Provision

The following studies assessed if consumers can accurately estimate caloric 

content of their food choices, and, when reliable nutrition information was 

provided, how it affected people’s food choices.

Burton, Creyer, Kees, and Higgins (2006)

Burton and his colleagues (2006) explored how much the average consumer

knows about the calories, fat and other macronutrient levels found in foods 

served at restaurants. Their results show that consumers substantially 

underestimated the levels of calories, fat, saturated fat and cholesterol found in

many less healthful menu items. When objective, quantitative nutrition

information was provided, consumers had more unfavorable attitudes towards 

the less healthful menu options. Consumers’ purchase intentions for the less 

healthful items were also significantly diminished by the provision of nutrition

information.

Backstrand et al, (1997)

A study conducted by the Center for Science in the Public Interest and New York 

University found that even well-trained nutrition professionals could not

accurately estimate the calorie content of typical restaurant meals. Although the

dietitians were able to accurately estimate the caloric content of a cup of whole

milk (the control in the study), they consistently underestimated the calories in

restaurant foods and meals. Their estimations were off by large amounts – by

200 to 600 calories. For example, when shown a typical dinner-house hamburger

and onion rings, the dietitians on average estimated that it had 865 calories,

when it actually contained 1,550 calories. Since not even experts in the field of

nutrition are able to accurately estimate the caloric content of restaurant foods,

consumers are unlikely to do better.

Conklin, Lambert, and Cranage (2005)

Conklin, Lambert, and Cranage examined the use of nutrition and ingredient

information by college freshman at the point of sale in campus dining facilities.

Results showed that females were more likely than males to use the nutrition

information labels to make food choices. Females used to nutrition information to

identify and select lower fat, lower calorie foods. These results confirm the

findings of a previous research that found that the provision of nutrition

information can have a positive influence on the food purchase behaviors of

college students.

Kral et al. ( 2002)

The relationship between dietary restraint (that is, whether or not the consumer

was consciously trying to regulate food consumption for the purpose body weight

regulation) and food intake differed depending on whether or not nutrition

information was presented. While the intake of food by restrained eaters was not

influenced by information provision, unrestrained eaters consumed less food

when nutrition information was presented.

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Kozup, Creyer, and Burton (2003)

A series of laboratory studies conducted by Kozup and his colleagues 

demonstrated that many consumers have very little knowledge of the high levels 

of calories, fat, and saturated fat found in many popular, less healthful restaurant

items. For example, for some items such chicken fajitas and chef salad, actual

calorie levels were twice what consumers expected. When levels of calories, fat,

and saturated fat substantially exceeded consumers’ expectations, the provision

of nutrition information had a significant negative effect on product attitude,

purchase intention, and choice. The authors suggest that the provision of

nutrition information on restaurant menus could potentially have a positive impact

on public health by reducing the consumption of less healthful menu items.

Burton and Cryer (2004)

Burton and Creyer found that when favorable nutrition information was presented

on restaurant menus, consumers had more favorable attitudes toward the items

and higher purchase intentions. When unfavorable nutrition information was 

presented, there was a negative influence on product attitudes and purchase

intentions. The authors note that the results imply that if restaurants were

required to disclose nutrition information, consumers would be more likely to

choose more healthful menu items. In addition, requiring restaurants to provide

nutrition information may encourage restaurants to improve the healthfulness of

their menu options.

Milich Anderson, and Mills (1976)

In a study in a cafeteria setting, signs indicating the calorie content of available

foods significantly decreased the number of calories that people purchased

(Milich et al., 1976).

References

Backstrand J, Wootan MG, Young LR, Hurley J. Fat Chance. Washington, DC:

Center for Science in the Public Interest, 1997.

Burton S, Creyer EH. “What Consumers Don’t Know Can Hurt Them: Consumer

Evaluations and Disease Risk Perceptions of Restaurant Menu Items.” Journal of

Consumer Affairs 2004, vol. 38, no. 1, pp. 121-145.

Burton S, Creyer EH, Kees J, Huggins K. “Attacking the Obesity Epidemic: An

Examination of the Potential Health Benefits of Nutrition Information Provision in

Restaurants.” American Journal of Public Health, forthcoming.

Conklin MT, Lambert CU, Cranage DA. “Nutrition Information at Point of

Selection Could Benefit College Students.” Topics in Clinical Nutrition 2005, vol.

20, no. 2, pp. 90-96.

Kozup KC, Creyer EH, Burton S. “Making Healthful Food Choices: The

Influence of Health Claims and Nutrition Information on Consumers’ Evaluations

of Packaged Food Products and Restaurant Menu Items.” Journal of Marketing

2003, vol. 67, pp. 19-34.

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Kral TVE, Roe LS, Rolls BJ. “Does Nutrition Information about the Energy 

Density of Meals Affect Food Intake in Normal-Weight Women?” Appetite 2002,

vol. 39, pp. 137-145.

Milich R, Anderson J, Mills M. “Effects of Visual Presentation of Caloric Values 

on Food Buying by Normal and Obese Persons.” Perceptual and Motor Skills 

1976, vol. 42, pp. 155-162.

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