Menu Labels for Food Choice

Overseen By Nina M Carr, MPH, MBA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Johns Hopkins Bloomberg School of Public Health

Disqualifiers: Under 18, Non-US resident, others

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different menu labels influence people's fast food choices, focusing on the healthfulness of selected meals. Participants will view online menus from burger and sandwich restaurants, each featuring one of five types of climate impact labels, such as "High Climate Impact" or "Low Climate Impact." The study examines how these labels affect the total greenhouse gas emissions of the meals, their nutritional content, and participants' perceptions of the labels. This trial suits members of the NORC AmeriSpeak Panel living in the U.S. who are willing to participate in an online survey. As an unphased trial, it offers participants the chance to contribute to understanding how menu labeling can promote healthier and more environmentally friendly food choices.

Do I need to stop my current medications for this trial?

The trial does not specify whether you need to stop taking your current medications. It seems unlikely, as the study focuses on menu labels and food choices, not on medication use.

What prior data suggests that these menu labels are safe for consumers?

Research shows that menu labels, like those used in this study, are generally safe because they don't involve drugs or physical procedures. These labels provide information to help people make food choices. Studies have found that High Climate Impact Labels can influence decisions, leading people to choose non-beef options 23% more often. Low Climate Impact Labels have increased the selection of chicken or salad by about 10%.

Research indicates that Climate Grade Labels help consumers choose more sustainable food options. Traffic Light Labels, familiar from food packaging, guide choices using easy-to-understand color codes.

Since this study focuses on information labels, there is no risk to physical health. Participants make choices based on the information they see, making the study very low-risk compared to those involving new medications or procedures. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative menu labels to influence food choices based on their climate impact. Unlike typical nutrition labels that focus on calories or nutrients, these labels highlight the environmental impact of menu items using various methods. Some labels use a traffic light system to categorize items as low, medium, or high impact, while others assign climate grades from A to F. There's also a straightforward approach with "High" or "Low Climate Impact" labels. By making the climate impact of food choices more visible, researchers hope to encourage diners to make more environmentally friendly decisions, potentially paving the way for a new approach to sustainable eating.

What evidence suggests that this trial's labeling methods could be effective for influencing food choices?

This trial will compare different types of climate impact labels on menus to assess their influence on food choices. Research has shown that climate impact labels can guide people toward more sustainable food choices. Participants may encounter "high climate impact" labels, which have increased the selection of non-beef dishes by 23%, promoting environmentally friendly choices. "Low climate impact" labels may also appear, encouraging diners to choose more climate-friendly meals, resulting in less beef consumption and more sustainable protein choices. Another trial arm will test "climate grade" labels, such as A, B, or C, based on emissions, which have effectively promoted eco-friendly selections. The trial will also evaluate "traffic light" labels, which have shown mixed results in previous studies; some indicate they help improve food choices, while others report little change in preferences. Overall, this trial aims to assess the potential of these labels in guiding people toward greener eating habits. ^{1 3 6 7 8}

Who Is on the Research Team?

Julia A Wolfson, PhD MPP

Principal Investigator

Johns Hopkins Bloomberg School of Public Health

Are You a Good Fit for This Trial?

This trial is for individuals who often choose meals from fast-food chains and are interested in how different menu labels might influence their food choices. There's no specific health condition required to participate, but participants should be able to complete an online survey.

Inclusion Criteria

Member of the NORC AmeriSpeak Panel

Residing in the United States

Exclusion Criteria

Not residing in the United States

Completed the survey in less than one-third of the median completion duration of all participants

Respondents with high refusal rates (skipped or refused more than 50% of questions)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Online Experiment

Participants complete hypothetical online meal ordering tasks using a survey emulating fast-food menus with different labeling conditions

10 minutes

1 online session

Post-Ordering Survey

Participants answer questions about label noticeability, perceptions, and knowledge of climate impact

10 minutes

1 online session

Follow-up

Participants are monitored for data analysis and outcome measures

2-4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Climate Grade Labels
• Control (QR) Labels
• High Climate Impact Labels
• Low Climate Impact Labels
• Traffic Light Labels

Trial Overview The study is testing five types of menu labels: Climate Grade, Low/High Climate Impact, Control (QR code), and Traffic Light Labels. Participants will order meals online from a burger or sandwich shop under one of these conditions to see which labels lead to healthier choices.

How Is the Trial Designed?

Group I: Traffic Light Labels Experimental Treatment 1 Intervention

Traffic Light labels will be placed on two restaurant menus beneath all main menu items. Using predetermined estimated greenhouse gas emission thresholds, each item will be assigned one of three icon-plus-text labels within this scheme: low-, medium-, or high-impact label, set in kgCO2e at \<2.6, \>=2.6 \& \<9.2, and \>=9.2, respectively. Each will read, "HIGH CLIMATE IMPACT" within a red label, "MED. CLIMATE IMPACT" in a yellow label, and "LOW CLIMATE IMPACT" in a green label. Text for all labels written in white, and a white globe icon will precede the text. Explanatory text describing the meaning of the labels will be displayed at the top of the menu.

Group II: Low Climate Impact Labels Experimental Treatment 1 Intervention

A green icon-plus-text label that reads "LOW CLIMATE IMPACT" in white text against a green background will be placed on two restaurant menus beneath main menu items with a low climate impact using a predetermined threshold of estimated greenhouse gas emissions set at \<2.6 kgCO2e. Labels will include a white globe icon directly preceding the label text. Explanatory text describing the label's meaning will be displayed at the top of the menu.

Group III: High Climate Impact Labels Experimental Treatment 1 Intervention

A red icon-plus-text label that reads "HIGH CLIMATE IMPACT" in white text against a red background will be placed on two restaurant menus beneath main menu items with a high climate impact using a predetermined threshold of estimated greenhouse gas emissions set at \>=9.2 kgCO2e. Labels will include a white globe icon directly preceding the label text. Explanatory text describing the label's meaning will be displayed at the top of the menu.

Group IV: Climate Grade Labels Experimental Treatment 1 Intervention

Climate Grade labels will be placed on two restaurant menus beneath all main menu items, using predetermined estimated greenhouse gas emission thresholds to assign one of five icon-plus-text labels which indicate a specific climate impact grade (A, B, C, D, and F). Thresholds are set in kgCO2e as follows: \[A\] \<1.7, \[B\] \>=1.7 \& \<2.6, \[C\] \>=2.6 \& \<9.2, \[D\] \>=9.2 \& \<28, \[F\] \>=28. All labels are solid black with a white globe icon followed by white text which reads "CLIMATE GRADE". On the left side of each label, a grade is displayed, capitalized and in a white font within a solid-colored box. The color of the box corresponds with each letter grade: A = dark green, B = light green, C = yellow, D = orange, F = red. Beneath the letter grade, a gradient of all possible grades is displayed horizontally in smaller font, each grade atop a small solid box in the respective grade color. Explanatory text describing the meaning of the labels will be displayed at the top of the menu.

Group V: Control (QR) Labels Placebo Group 1 Intervention

A black label featuring a QR code and white text that reads "SCAN HERE" will be placed beneath all main menu items on two restaurant menus. Explanatory text describing the label's meaning will be displayed at the top of the menu.

Who Is Running the Clinical Trial?

Johns Hopkins Bloomberg School of Public Health

Lead Sponsor

Trials

441

Recruited

2,157,000+

University of Pennsylvania

Collaborator

Trials

2,118

Recruited

45,270,000+

University of California, Davis

Collaborator

Trials

958

Recruited

4,816,000+

Harvard School of Public Health (HSPH)

Collaborator

Trials

283

Recruited

17,030,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9857560/

Effect of Climate Change Impact Menu Labels on Fast ... Climate impact labels were effective at encouraging sustainable selections from the menu (Figure 3). In the high–impact and low–impact-label ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S0195666325001540

Climate change menu labels in a university cafeteria The majority of students reported that the labels did not influence their food choices at the dining hall (56 %) or elsewhere (67 %). More than ...

3. supplysidefbj.com supplysidefbj.com/labeling/climate-impact-labels-on-food-menus-drive-sustainable-selections

Climate impact labels on food menus influence consumer ... Results showed both labels, low climate- and high climate-impact, were effective at swaying participants to opt for more sustainable options.

4. ajpmonline.org ajpmonline.org/article/S0749-3797(23)00304-5/fulltext

Menu Calorie Label Use and Diet Quality: a Cross- ... Using menu calorie labels was associated with modestly healthier diet quality than not noticing labels, regardless of weight status.

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10270829/

Menu labelling is effective in reducing energy ordered and ... The meta-analysis showed statistically significant effects of menu labelling: overall energy consumed was reduced by a mean of 419·5 kJ (100·2 kcal) and energy ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT06651060?locn=%22University%20of%20California,%20Davis%22&rank=10

NCT06651060 | Climate Labels for Restaurant Menus Pilot The aim of this study is to compare responses to 6 different types of labels for restaurant menus: 1) a QR code on all items (control); 2) High Climate ...

7. researchgate.net researchgate.net/publication/366628591_Effect_of_Climate_Change_Impact_Menu_Labels_on_Fast_Food_Ordering_Choices_Among_US_Adults_A_Randomized_Clinical_Trial

Effect of Climate Change Impact Menu Labels on Fast ... A recent US experiment similarly found that negatively framed high climate impact labels outperformed positively framed low climate impact ...

8. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/cesm.12039

Menu labeling and portion size control to improve the out‐ ... Menu labeling and portion size control interventions may be effective strategies to mitigate the health risks posed by the out-of-home food environment.