Behavioral healthcare

Will Food Labels Help Us Choose Healthier Foods?

Feeling embarrassed. Beautiful lady holding plate with fast-food in one hand and vegetables in another feeling temptation to eat sandwich

In December of 2016, chain restaurants and many food establishments in the US will be mandated by the Food and Drug Administration (FDA) to display calories associated with their menu items.  The purpose of this mandate is to inform consumers with the goal of decreasing their consumption of high caloric restaurant food items.  Recent research in the area suggests that food labeling might be effective in decreasing customers’ caloric consumption.  However, the projected consumption decreases will likely be due to changes in restaurant menu offerings, rather than changes in consumer food purchasing behavior.

One such study (Bleich, Wolfson, Jarlenski, & Block, 2015) compared the calories associated with food items for restaurant chains that voluntarily displayed caloric information with restaurants that did not list caloric information. The results of the study indicated that throughout 2012, 2013, and 2014, restaurant chains that voluntarily posted caloric information offered lower calorie foods than those that did not display caloric information.  Restaurants that posted caloric information introduced more new food items compared to the restaurants that did not post the information.  Further these new foods also yielded less calories than those introduced by restaurants that did not post caloric information.  Throughout the study, calories associated with food items decreased over time with the restaurants that did not label their foods.  However, the calories remained higher compared to the foods offered by the voluntary labeling restaurants.

Another study (Cantor, Torres, Abrams, & Elbel, 2015) evaluated the effects of food labeling on consumers’ food purchases.  During 2008, 2013, and 2014, the investigators collected data on consumer food purchases from fast-food restaurant chains mandated to display the caloric information of menu items and similar restaurant chains that did not display the calories associated with menu items.  Consumers were also surveyed regarding their awareness of the food labels and the food labels’ impact on their food purchases.  Consumers of the food labeling restaurants reported being more aware of the labels and reported using the information to purchase lower calorie foods.  However, the data indicated no caloric differences in consumer food purchases from fast-food chains with food labels compared to those without food labels.  The survey results also indicated no difference in how often consumers purchased fast-food items. Although consumers of the food labeling restaurants reported being more aware of the food labels, their awareness, as well as reports of adjusting their food purchases decreased over time.

The combined results of these studies suggest the FDA’s mandate for restaurants to display calories associated with menu items will most likely not produce the intended changes in consumer behavior.  However, mandatory food labeling might encourage restaurants to offer healthier, lower calorie food options.  I am guessing these results are not quite what policy makers were expecting, as the stated purpose of the mandate is to inform consumers and promote healthier food choices.

Why is food labeling unlikely to change consumer behavior?

The answer is related to reinforcement and individual food preferences.  The consumption of high caloric food tends to be immediately reinforced by food taste, among other factors.  Menu labeling, on its own, is an antecedent-based intervention.  It does nothing to address the powerful reinforcers associated with eating high caloric foods.  Without the incorporation of consequence-based strategies designed to compete with powerful naturally occurring reinforcers, food labeling is likely to be ineffective at changing consumer food selections.

How might mandating food labels change restaurant menu offerings?

The mandate might do so by altering motivating operations related to sales.  Restaurants currently offering high calorie food options may introduce healthier items in an effort to compete with restaurants already offering healthier options. In this scenario, the mandate would increase the value of having lower calorie food items on the menu.  The mandate might also be indicative of potential increased regulations in the future.  If so, restaurants might introduce healthier food options to avoid further regulations.  In this scenario, the mandate would create an aversive condition that restaurants would attempt to avoid.

Can you think of other behavioral principles that might impede or contribute to the efficacy of food labeling?  Let us know and continue to follow BAM Network!


Bleich, S. N., Wolfson, J. A., Jarlenski, M. P., & Block, J. P. (2015). Restaurants with calories displayed on menus had lower calorie counts compared to restaurants without such labels. Health Affairs, 34, 1877-1884.

Cantor, J., Torres, A., Abrams, C., & Elbel, B. (2015). Five years later: Awareness Of New York City’s calorie labels declined, with no changes in calories purchased. Health Affairs, 34, 1893-1900.

Food and Drug Administration, HHS. (2014). Food labeling; nutrition labeling of standard menu items in restaurants and similar retail food establishments. Final rule. Federal register79, 71155-259.

Behavioral strategies to increase health insurance enrollment

Health insurance form with stethoscopeNovember 1st marks the third year of open enrollment for the Affordable Care Act’s federal healthcare exchange. The Affordable Care Act was created to make quality healthcare more affordable, thus more accessible to the general public. Its primary goal is to increase health insurance coverage among eligible individuals. Enrollment in select health insurance plans (via an online health plan marketplace) is made more affordable with the use of income-based tax credits that can be applied toward monthly health plan premiums. Eligible individuals are also encouraged to obtain some form of health coverage (e.g., through the marketplace, employer, or privately), as those who opt out may receive a tax penalty.

The use of income-based tax credits and tax penalties have been a part of the program since its launch in 2013. However new strategies have been arranged to increase enrollment for 2016. For example, the site is projected to be faster and easier to use. It will include a calculator tool to help consumers assess total out-of-pocket expenses across various plans. Eligibility and tax credit information will be immediately accessible, so consumers can use the information to further assess the cost of various health plans. Information about covered doctors and prescriptions are also set to be included to help consumers choose the health plan that best meets their needs.

This federal healthcare exchange is packed full of behavioral strategies to increase consumer enrollment in the health insurance plans provided by its system. Let’s pick out some of them for discussion!

  • The plan is designed to reduce the monthly cost of the consumer’s health insurance. This sounds like an antecedent manipulation in response effort. It makes it easier to pay for/access the health insurance.
  • There is a tax penalty for opting out/not signing up. This is an attempt to negatively punish opting out (by taking away some of your money).
  • The site will be faster and easier to use. Here’s another response effort manipulation. Consumers are more likely to enroll if the process is as easy as possible.
  • The inclusion of an out-of-pocket expense calculator, immediate access to tax credit information, and information about covered doctors and medications are also antecedent manipulation strategies that will help consumers select the most appropriate health insurance plans. The inclusion of these features makes it more likely that consumers will contact the relevant reinforcers (i.e., health care plans that meets their needs) for enrolling in health plans. When health care enrollment is reinforced, the consumer is more likely to maintain coverage throughout the year and re-enroll next year.

The Affordable Care Act and the federal healthcare exchange enrollment system have incorporated both antecedent and consequence-based behavioral strategies aimed at increasing the number of individuals with health insurance. The use of these strategies represents how behavioral technologies might improve consumer access to quality healthcare via their application in the administration of healthcare policies.

Have you noticed the implementation of behavioral strategies into other policies that directly affect you? Tell us about it and keep an eye out for more discussions from BAM Network.