摘要：Objectives . We conducted a health impact assessment to quantify the potential impact of a state menu-labeling law on population weight gain in Los Angeles County, California. Methods . We utilized published and unpublished data to model consumer response to point-of-purchase calorie postings at large chain restaurants in Los Angeles County. We conducted sensitivity analyses to account for uncertainty in consumer response and in the total annual revenue, market share, and average meal price of large chain restaurants in the county. Results . Assuming that 10% of the restaurant patrons would order reduced-calorie meals in response to calorie postings, resulting in an average reduction of 100 calories per meal, we estimated that menu labeling would avert 40.6% of the 6.75 million pound average annual weight gain in the county population aged 5 years and older. Substantially larger impacts would be realized if higher percentages of patrons ordered reduced-calorie meals or if average per-meal calorie reductions increased. Conclusions . Our findings suggest that mandated menu labeling could have a sizable salutary impact on the obesity epidemic, even with only modest changes in consumer behavior. During the past several decades, increased consumption of calorie-dense foods outside the home, 1 – 4 “supersizing” of food and beverage portions at large chain restaurants, 5 , 6 and an underestimation of caloric content by restaurant patrons 7 , 8 have contributed to the increase in the prevalence of obesity in the United States. Not surprisingly, during this same time period, obesity-related health conditions, 9 , 10 including diabetes, hypertension, fatty liver, sleep apnea, arthritis, and depression, and restaurant expenditures ($400 billion annually by consumers 11 ) have paralleled the trajectory of the obesity epidemic. These factors and others have made the failure to disclose nutrition content at the point of purchase a growing and significant public health concern. Whereas the Nutrition Labeling and Education Act of 1990 increased the availability of nutrition information on packaged foods, prepared foods at the point of purchase are exempt from such disclosures. At present, most fast-food and sit-down chain restaurants typically disclose nutrition information only upon request, via the Internet, or in a manner not readily visible to individuals placing their food orders on site (e.g., small-print table inserts, table tents, or brochures). 11 Laws mandating the provision of calorie information at the point of purchase in large chain restaurants have garnered growing public and legislative support as a potential strategy for addressing the obesity epidemic. 12 , 13 This interest is reflected in the recent passage of menu-labeling ordinances in some jurisdictions, including New York City, New York; San Francisco, California; Multnomah County, Oregon; and King County, Washington. In California, Senate Bill (SB) 1420, 14 introduced and passed in 2008, has received considerable national attention as it awaits implementation. When implemented, SB 1420 would require all restaurant chains across the state with 20 or more facilities to post calorie information next to each item on their menus and menu boards. An earlier version of the bill included restaurant chains with 15 or more facilities in the state, and required, in addition to the calorie information, the provision of information on saturated fat, sugar, and sodium content on menus (but not on menu boards). Despite this increased interest and legislative action, no published studies have sought to quantify the potential impact of menu labeling on the obesity epidemic. To address this gap, we conducted a health impact assessment of menu labeling, as specified in the original version of SB 1420, on population weight gain in Los Angeles County. Los Angeles County is the largest county in the United States, home to more than 10 million residents.
