Elsevier

Journal of Nutrition Education and Behavior

Volume 45, Issue 5, September–October 2013, Pages 404-411
Journal of Nutrition Education and Behavior

Research Article
Predictors of Total Calories Purchased at Fast-food Restaurants: Restaurant Characteristics, Calorie Awareness, and Use of Calorie Information

https://doi.org/10.1016/j.jneb.2013.01.019Get rights and content

Abstract

Objective

To examine purchase patterns at fast-food restaurants and their relation to restaurant characteristics, customer characteristics, and use of calorie information.

Design

Cross-sectional survey.

Setting

Fast-food restaurants in New York State.

Participants

Adult fast-food restaurant customers (n = 1,094).

Variables Measured

Restaurant characteristics (fast-food chain type, presence of calorie labels, and poverty of location), participant characteristics (demographics, calorie knowledge, awareness, and use), and customer purchasing patterns (ordering low-calorie or no beverage, small or no fries, or < 3 items) were used as predictors of total calories purchased.

Results

In a regression model including restaurant and customer characteristics, fast-food chain customer age, sex, calorie use, and calorie awareness were independently associated with total calories purchased (all P < .05; model R2 = .19). When 3 purchasing patterns were added to the model, calorie use (P = .005), but not calorie awareness, remained associated with total calories purchased. The 3 purchase patterns collectively accounted for the majority of variance in calorie totals (Δ model R2 = .40).

Conclusions and Implications

Promoting use of calorie information, purchase strategies, and calorie awareness represents complementary ways to support lower-calorie choices at fast-food chains.

Introduction

The dramatic increase in the prevalence of obesity during the past 3 decades has moved it to the forefront of current public health priorities in the United States (US). Obesity contributes to diabetes and cardiovascular disease and is 1 of the leading preventable causes of death in the US.1 Health care to treat obesity-related conditions costs the US an estimated $75 billion each year in 2003 dollars2 and 32% of the adult population is currently obese.3 One factor contributing to the increase in obesity has been the shift in where people purchase and consume food. Consumption of out-of-home calories has increased significantly during the past few decades4 and Americans now spend about half of their food budget in restaurants.5 Purchases from fast-food venues have also increased6 and frequent fast-food consumption has been linked to high caloric intake and obesity.7, 8, 9, 10

Calorie labeling at the point of purchase has been identified as a way to inform consumers, improve dietary choices, and reduce the number of calories purchased and consumed at restaurants. This strategy is consistent with public health practice emphasizing environmental and policy change as a means for chronic disease prevention, and with nutrition practice and theory regarding the contribution of nutrition information to dietary behavior.11, 12 Numerous cities, counties, and states have already mandated that restaurants in their jurisdictions post calorie labels prominently for customers to use.13 Nationally, provisions included in the Patient Protection and Affordable Care Act of 2010 will require calorie labels in all large chain restaurants with ≥ 20 outlets in the US.14

Previous studies have demonstrated an association between calorie labeling at the point of purchase and increased customer awareness of calories15, 16, 17 and between self-reported use of posted calorie labels and purchasing fewer calories.18, 19 The evidence regarding the impact of calorie labels on customer behavior alone has been mixed.20 The strongest evidence of an association between calorie labels and purchasing behavior has been found in experimental studies with specific menus,21 for particular customers,22 and at specific restaurant chains.19

The current study was completed as part of a national chronic disease prevention initiative, Communities Putting Prevention to Work. It examined the purchase patterns at fast-food restaurants and their relation to restaurant characteristics, customer characteristics, and use of calorie information. The customer and restaurant characteristics measured were informed by both social cognitive23 and social ecological24 theories of behavior, which collectively emphasize the independent contributions of the individual, the environment, and the individual–environment interaction to behavior. It was expected that total calories purchased at fast-food restaurants would be independently associated with customer characteristics (individual) and restaurant characteristics (environment), and with use of calorie information during purchase decisions (individual–environment interaction). The current study also examined the extent to which purchase patterns could account for variations in total calories purchased. It was expected that the association between use of calorie information and the total amount of calories purchased could be partially accounted for by 3 purchase patterns that represent strategies for purchasing fewer calories: ordering low- or no calorie beverages, small or no fries, and < 3 items.

Section snippets

Design and Sampling

This study was completed with baseline data from a pre–post study designed to evaluate a media campaign promoting awareness and use of calorie labels posted at fast-food venues in New York State (NYS). Five counties were selected for inclusion. These included the 3 counties in NYS (exclusive of New York City) that required chain restaurants to label calories at the time of data collection (Albany, Schenectady, and Ulster), 1 county in NYS that had plans to require calorie labels right after the

Results

Table 1 presents data on the characteristics of the 31 fast-food restaurant sites surveyed and the caloric content of customer purchases at these sites. The median poverty level of the restaurant locations was 24% and the poverty levels at individual restaurant locations ranged from 8% to 80%. Calorie labels were displayed in just over half of all restaurants.

Table 2 presents data on participants' demographic characteristics, nutrition knowledge, awareness, and behavior, including the caloric

Discussion

The results of this study suggest that factors associated with the environment, individual, and individual–environment transaction contribute independently to the total calories adults purchase at fast-food restaurants. Results demonstrated that reported use of calorie information at fast-food restaurants during a purchase decision was associated with purchasing fewer calories independent of restaurant characteristics, customer demographics, calorie knowledge, and calorie awareness. Previous

Implications for Research and Practice

Findings from this study have direct implications for development of health education campaigns to support the mandatory calorie labeling provision included in the Affordable Care Act. Results suggest that calorie information provided to consumers should be associated with actionable strategies to assist consumers with reducing the caloric content of items they purchase. They also imply that calorie information provided to consumers should include a calorie reference to a single meal at the

Acknowledgments

This work was supported in part by a cooperative agreement from Centers for Disease Control's Communities Putting Prevention to Work program (grant 3U58DP001963-01S4). The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the US Department of Health and Human Services or the Centers for Disease Control and Prevention. From the Center for Human Services Research, the authors acknowledge Rose Greene for project guidance and the entire

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