Abstract
IMPORTANCE There is increasing interest in strategies to encourage more environmentally sustainable food choices in US restaurants through the use of menu labels that indicate an item’s potential impact on the world’s climate. Data are lacking on the ideal design of such labels to effectively encourage sustainable choices. OBJECTIVE To test the effects of positive and negative climate impact menu labels on the environmental sustainability and healthfulness of food choices compared with a control label. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial used an online national US survey conducted March 30 to April 13, 2022, among a nationally representative sample of adults (aged ≥18 years) from the AmeriSpeak panel. Data were analyzed in June to October 2022. INTERVENTIONS Participants were shown a fast food menu and prompted to select 1 item they would like to order for dinner. Participants were randomized to view menus with 1 of 3 label conditions: a quick response code label on all items (control group); green low-climate impact label on chicken, fish, or vegetarian items (positive framing); or red high-climate impact label on red meat items (negative framing). MAIN OUTCOMES AND MEASURES The main outcome was an indicator of selecting a sustainable item (ie, one without red meat). Secondary outcomes included participant health perceptions of the selected item and the Nutrition Profile Index (NPI) score of healthfulness. RESULTS Among 5049 participants (2444 female [51.6%]; 789 aged 18-29 years [20.3%], 1532 aged 30-44 years [25.9%], 1089 aged 45-59 years [23.5%], and 1639 aged ≥60 years [30.4%]; 142 Asian [5.3%], 611 Black [12.1%], and 3197 White [63.3%]; 866 Hispanic [17.2%]), high- and low-climate impact labels were effective at encouraging sustainable selections from the menu. Compared with participants in the control group, 23.5% more participants (95% CI, 13.7%-34.0%; P < .001) selected a sustainable menu item when menus displayed high-climate impact labels and 9.9% more participants (95% CI, 1.0%-19.8%; P = .03) selected a sustainable menu item when menus displayed low-climate impact labels. Across experimental conditions, participants who selected a sustainable item rated their order as healthier than those who selected an unsustainable item, according to mean perceived healthfulness score (control label: 3.4 points; 95% CI, 3.2-3.5 points vs 2.5 points; 95% CI, 2.4-2.6 points; P < .001; low-impact label: 3.7 points; 95% CI, 3.5-3.8 points vs 2.6 points; 95% CI, 2.5-2.7 points; P < .001; high-impact label: 3.5 points; 95% CI, 3.3-3.6 points vs 2.7 points; 95% CI, 2.6-2.9 points; P < .001). Participants in the high-climate impact label group selected healthier items according to mean (SE) NPI score (54.3 [0.2] points) compared with (continued)
Generated Summary
This research article presents the findings of a randomized clinical trial aimed at assessing the impact of climate change impact menu labels on the food choices of adults in the United States. The study, conducted online, involved a nationally representative sample of adults who were presented with fast-food menus. Participants were randomized to view menus with one of three label conditions: a control group with quick response (QR) code labels, a positive framing group with green low-climate impact labels on chicken, fish, or vegetarian items, and a negative framing group with red high-climate impact labels on red meat items. The primary outcome was the selection of a sustainable menu item (i.e., one without red meat), with secondary outcomes including participant health perceptions and the Nutrition Profile Index (NPI) score of healthfulness. The study’s objective was to evaluate whether positive and negative sustainability labels, compared with control labels, influenced the environmental sustainability and healthfulness of fast-food menu choices.
Key Findings & Statistics
- The study included 5049 participants, with the following demographic breakdown: 2444 female (51.6%), 789 aged 18-29 years (20.3%), 1532 aged 30-44 years (25.9%), 1089 aged 45-59 years (23.5%), and 1639 aged ≥60 years (30.4%); 142 Asian (5.3%), 611 Black (12.1%), and 3197 White (63.3%); 866 Hispanic (17.2%).
- Compared with participants in the control group, 23.5% more participants (95% CI, 13.7%-34.0%; P < .001) selected a sustainable menu item when menus displayed high-climate impact labels, and 9.9% more participants (95% CI, 1.0%-19.8%; P = .03) selected a sustainable menu item when menus displayed low-climate impact labels.
- Individuals in low-impact (49.4%; 95% CI: 46.3%-52.5%) and high-impact (48.7%; 95% CI, 45.5%-51.9%; P < .001) climate-label conditions were more likely than those in the control condition (21.5%; 95% CI, 18.9%-24.1%; P < .001) to report noticing any label; they were also more likely to report seeing their assigned label (low-impact label: 43.9%; 95% CI, 40.8%-47.0%; high-impact label: 42.8%; 95% CI, 39.7%-46.0%; control label: 17.1%; 95% CI, 14.7%-19.5%; all P < .001).
- Among participants who reported noticing a label on the menu, nearly 90% in both label conditions correctly reported seeing their assigned label (low-impact label: 89.0%; 95% CI, 85.9%-92.0%; high-impact label: 88.0%; 95% CI, 85.0%-91.0%).
- In the high-impact and low-impact-label conditions, respectively, 61.1% (95% CI, 58.0%-64.2%; P < .001) and 54.4% (95% CI, 52.3%-57.5%; P = .03) of participants ordered a sustainable item compared with 49.5% (95% CI, 46.3%-52.7%) of participants in the control condition.
- The predicted probability of selecting a beef hamburger, plant-based hamburger, chicken or fish item, or salad by experimental condition is shown in eFigure 4 in Supplement 2. Compared with participants in the control group (11.1%; 95% CI, 9.1%-13.0%), participants in climate-impact-label conditions were more likely to order salad items (low-impact label: 15.2%; 95% CI, 12.9%-17.5%; P = .007; high-impact label: 15.9%; 95% CI, 13.4%-18.4%; P = .003).
- No menu items met the threshold to be considered healthy, and NPI scores ranged from 36 points, for a beef hamburger, to 62 points for a plant-based hamburger (eTable in Supplement 2).
- Items selected by individuals in the high-climate impact label condition had higher mean (SE) NPI scores (reflecting healthier choices) compared with items selected by those in the low-climate impact label condition (54.3 [0.2] points vs 53.2 [0.2] points; P < .001) and control label condition (52.9 [0.3] points; P < .001).
- Individuals who selected a sustainable item compared with those who did not regardless of label condition, according to mean perceived healthfulness score (control label: 3.4 points; 95% CI, 3.2-3.5 points vs 2.5 points; 95% CI, 2.4-2.6 points; P < .001; low-impact label: 3.7 points; 95% CI, 3.5-3.8 points vs 2.6 points; 95% CI, 2.5-2.7 points; P < .001; high-impact label: 3.5 points; 95% CI, 3.3-3.6 points vs 2.7 points; 95% CI, 2.6-2.9 points; P < .001).
Other Important Findings
- Participants in the high-climate impact label condition perceived their selection to be healthier compared with those in the control label condition (P = .01).
- Among individuals who selected a low-climate impact item, participants in the low-climate impact label condition perceived their selection to be healthier compared with those in the control label condition (P = .003).
Limitations Noted in the Document
- The online experiment measured one-time, hypothetical selections rather than actual food purchases and consumption from an in-person fast food restaurant setting.
- Participants may have been susceptible to social desirability bias, so results may overstate label effects on shifting food choices.
- Participants were exposed to the labels only once; in real-world settings with repeated exposures to climate impact labels, effects may be greater.
- The online menu used had a limited selection of items and did not include side dishes or beverages.
- Only 1 item from the PME measure was used, which limits understanding of all dimensions of perceived message effects.
- The study may not have had sufficient power to detect subgroup differences.
Conclusion
This randomized clinical trial indicated that climate impact menu labels can effectively encourage more environmentally sustainable choices from fast food restaurants, with negatively framed labels highlighting high-climate impact items (like red meat) proving the most effective. The study reveals that while these labels influenced healthier item selections in the high-climate impact condition, the same effect was not observed in the low-climate impact condition. The health halo effect, where sustainable items are perceived as healthier, even if they are not particularly healthy, emerges as a key consideration. This has important implications because sustainable items might still be high in calories, fat, and sugar. This is consistent with prior message framing research, which suggests that labels warning of high climate impact on red meat items may be an effective means of promoting more environmentally sustainable choices. The study’s findings align with the increasing consumer demand for plant-based options and the restaurant industry’s sustainability initiatives. However, the adoption of negatively framed labels might be challenging, as such approaches could require mandates or incentives. The research also suggests that sustainability labels might create an undeserved health halo effect, potentially leading to overconsumption of unhealthy items. Future studies should investigate different label designs, considering their impact on promoting sustainable food choices and their overall effect on health outcomes. The impact of climate labels did not differ based on sociodemographic characteristics other than sex, with the effect of high-climate impact labels being stronger for female participants. The study’s limitations include the online setting, the limited number of menu items, and the use of a single item from the PME measure. The study’s findings are particularly relevant because the healthfulness of menu choices is not always directly correlated with environmental sustainability. This underscores the need for more research into how sustainability labels can be designed to avoid misleading consumers and promoting healthier eating habits. As sustainability gains prominence in the restaurant industry, careful consideration of how labels influence both environmental and health perceptions is critical.