Calorie Labels on Menus Could Avert Thousands of Cancer Deaths

Tens of thousands of potential cancer cases and deaths could be dodged through the implementation of calorie labeling on menus, suggests a new study from Tufts University’s Friedman School of Nutrition Science and Policy.

Calories cut

In 2018, the U.S. Food & Drug Administration introduced the requirement that all chain restaurants with more than 20 outlets add calorie labels to their menus. The change, a mandatory requirement of the Affordable Care Act, may already be having small but significant impacts.

Analysis of food choices post-implementation has indicated the change has produced a net decrease in calorie intake by between 20–60 calories per meal at an affected restaurant. A study published in the journal BMJ Open indicates that this change may snowball over an individual’s lifetime to prevent over 28,000 cancer cases related to obesity and 16,700 deaths over a lifetime period. The savings to healthcare infrastructure and society total $2.8 billion, say the authors. The study was part of a National Institutes of Health project to discover beneficial nutrition strategies called the Food Policy Review and Intervention Cost-Effectiveness (Food-PRICE) initiative.

“It’s important for us to continue to show consumers, policymakers, and industry how small changes can lead to big benefits,” says study lead author Mengxi Du, a PhD candidate in Nutrition Epidemiology and Data Science at the Friedman School. “Our population-level view suggests that these labels can be associated with substantial health gains and cancer-related healthcare cost savings that could be doubled with additional industry response, such as by replacing high-calorie menu items with lower-calorie options or reformulating recipes.”

The study data was created using nutritional survey data taken from adults over 20 in the years 2015–2016. These figures were combined with national cancer statistics to enable researchers to model their cohort’s risk of developing any of 13 obesity-related cancers and how those health impacts may weigh on the healthcare system. This is a modeling study and therefore not a direct measurement of how the calorie-label policy has changed cancer rates, but the researchers’ findings were backed up by extant cancer numbers.

92% of meals eaten at restaurants contained too many calories. Meals eaten out often include additional sugars and saturated fats too. This additional calorific intake can have significant downstream impacts on cancer care. One estimate suggests that two in five new cancer cases are related to obesity. Cancers linked to obesity are estimated to represent up to 43.5% of direct cancer care costs.

Targeting diverse communities

The new modeling strategy suggested that the reduced calorie intake produced by calorie counts on menus could result in a pound of weight loss per year. Even with the model anticipating no further weight loss, the effects noted by the model were substantial. Young adults aged 20–44, who are seeing the greatest increases in obesity-linked cancers, showed the biggest benefits from the policy. Also majorly impacted were Hispanic and non-Hispanic Black people, who were likely to see a greater reduction in cancer deaths.

There remains more work to be done to share the beneficial impacts of calorie counts among underrepresented communities, suggested Du. “People with higher education or income levels are aware of the information in menu labels and how to understand it, but we need to put some effort into education among underrepresented, low-income, or at-risk communities because we still see some disparities,” says Du. “I think people would like to see calorie numbers when they go to a restaurant—even if menus don’t provide comprehensive nutrition information, it helps us all make quick calculations about the food we’re about to purchase.”

“From this research, we can see how labeling policies that effectively encourage consumers to make healthier dietary decisions are a form of cancer prevention—they reduce an individual’s chances of being obese and getting an obesity-associated cancer, while improving quality of life,” says senior study author Fang Fang Zhang, a cancer epidemiologist and Neely Family Professor at the Friedman School. “These policies don’t require a lot of spend, especially when compared to cancer screening costs, but provide a lot of benefits.”

Reference: Du, Griecci CF Cudhea F et al. What is the cost-effectiveness of menu calorie labeling on reducing obesity-associated cancer burdens? An economic evaluation of a federal policy intervention among 235 million adults in the USA. BMJ Open. 2023;13:e063614. doi:10.1136/bmjopen-2022-063614

This article is a rework of a press release issued by Tufts University. Material has been edited for length and content.