Changes in Calorie Content of Menu Items at Large Chain Restaurants After Implementation of Calorie Labels

IMPORTANCE: Calorie labeling on menus is required in US chain food establishments with 20 or more locations. This policy may encourage retailers to offer lower-calorie items, which could lead to a public health benefit by reducing customers’ calorie intake from prepared foods. However, potential reformulation of restaurant menu items has not been examined since nationwide enforcement of this policy in 2018. OBJECTIVE: To examine the calorie content of menu items at large chain restaurants before and after implementation of federally mandated menu calorie labels. DESIGN, SETTING, AND PARTICIPANTS: This pre-post cohort study used restaurant menu data from MenuStat, a database of nutrition information for menu items offered in the largest chain restaurants in the US, collected annually from 2012 to 2019. The study comprised 35 354 menu items sold at 59 large chain restaurants in the US. Statistical analysis was conducted from February 4 to October 8, 2021. INTERVENTION: Nationwide implementation of menu calorie labeling. MAIN OUTCOMES AND MEASURES: Changes in menu items’ calorie content after restaurant chains implemented calorie labels were estimated, adjusting for prelabeling trends. All menu items, continuously available items, items newly introduced to menus, and items removed from menus were examined separately. RESULTS: Among the 59 restaurant chains included in the study, after labeling, there were no changes in mean calorie content for all menu items (change = −2.0 calories; 95% CI, −8.5 to 4.4 calories) or continuously available items (change = −2.3 calories; 95% CI, −11.5 to 6.3 calories). Items that were newly introduced after labeling, however, had a lower mean calorie content than items introduced before labeling (change = −112.9 calories; 95% CI, −208.6 to −25.2 calories), although there was heterogeneity by restaurant type. Items removed from menus after labeling had similar calorie content as items removed before labeling (change = 0.5 calories; 95% CI, −79.4 to 84.0 calories). CONCLUSIONS AND RELEVANCE: In this cohort study of large chain restaurants, implementing calorie labels on menus was associated with the introduction of lower-calorie items but no changes in continuously available or removed items.