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Int J Behav Nutr Phys Act. 2019 Nov 4;16(1):99. doi: 10.1186/s12966-019-0865-7.

Evaluation of the impact of calorie labeling on McDonald's restaurant menus: a natural experiment.

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Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Brigham and Women's Hospital, Boston, MA, USA.
Departments of Population Health and Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.



The long-term effect of calorie labeling on fast-food purchases is unclear. McDonald's voluntarily labeled its menus with calories in 2012, providing an opportunity to evaluate this initiative on purchases.


From 2010 to 2014, we collected receipts from and administered questionnaires to 2971 adults, 2164 adolescents, and 447 parents/guardians of school-age children during repeated visits to 82 restaurants, including McDonald's and five control chains that did not label menus over the study period in four New England cities. In 2018, we analyzed the data by using difference-in-differences analyses to estimate associations of calorie labeling with calories purchased (actual and estimated) and predicted probability of noticing calorie information on menus.


Calorie labeling at McDonald's was not associated with changes in calories purchased in adults (change = - 19 cal pre- vs. post-labeling at McDonald's compared to control chains, 95% CI: - 112, 75), adolescents (change = - 49 cal, 95% CI: - 136, 38), or children (change = 13 cal, 95% CI: - 108, 135). Calorie labeling generally increased the predicted probability of noticing calorie information, but did not improve estimation of calories purchased.


Calorie labeling at McDonald's was not associated with changes in calories purchased in adults, adolescents, or children. Although participants were more likely to notice calories on menus post-labeling, there was no improvement in ability to accurately estimate calories purchased.


Calorie labeling; Menu labeling; Natural experiment; Nutrition policy; Obesity prevention

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