Discussion

In contrast to the food manufacturing industry, the restaurant industry faces some unique operational challenges that may require attention if menu labelling is to be implemented widely and successfully. First, chefs are taught to cook by touch, taste and proportion rather than following standardised instructions. Subsequently restaurants where chefs do not follow a standardised recipe run the risk of unintentionally providing inaccurate information to consumers⁽ Reference Larson and Story ^{2 )}. For these chefs then, creating and adhering to standardised recipes would require more administrative time and greater accuracy in cooking processes. Some have argued that this would hamper chef creativity and kill innovation⁽ Reference Brand ^{21 )}. Furthermore, all staff responsible for preparing and presenting food would need to be thoroughly trained in the importance of adhering to the recipes. These concerns do not apply to the majority of restaurants and fast-food outlets targeted by the menu labelling law in the USA, as many chains already follow standardised recipes and cooking procedures. It may, however, affect the willingness of small independent operators to label their menus voluntarily⁽ Reference Almanza, Nelson and Chai ^{22 )}.

The accuracy of nutrition information is also dependent on the accuracy of the nutrition analysis. There are two methods to analyse the nutrient content of menu items: database and laboratory analysis. Laboratory analysis generally involves high cost in terms of time and money⁽ Reference Bognar and Piekarski ^{23 )}; thus for most restaurant companies, the database method is the quickest and most cost-effective means of obtaining nutrition information. Many restaurant meals contain numerous ingredients and involve complex cooking processes, so it is important to have a qualified nutrition professional perform the computerised analysis. For this reason many chain restaurants employ a registered dietitian who calculates the nutrition information for them. Even then database analysis may not be reliable since nutrient levels are affected by many factors including processing, storage and geographic region where a fruit or vegetable is grown⁽ Reference Peregrin ^{24 )}. The availability of nutrition information for certain foods or exotic cooking ingredients may also affect the accuracy of database analysis. Moreover, it would be difficult to provide accurate measures in a buffet-style restaurant⁽ Reference Alexander, O’Gorman and Wood ^{25 )} and impractical and onerous for ‘variable’ menu items such as pizza toppings that could have calorie ranges. Given that estimates of nutritional information in restaurants are prone to error, it is not surprising that owners have expressed concerns about libel risks⁽ Reference Yamamoto, Yamamoto and Yamamoto ^{26 )}. In summary, an accurate nutrition analysis requires a detailed and accurate recipe, a qualified nutrition professional with expertise in nutrition analysis and a high-quality database and/or laboratory analysis. The difficulties of standardisation and the cost of providing precise nutritional information suggest that it may be difficult for small independent restaurants to achieve and may put them at risk of closure⁽ Reference Alexander, O’Gorman and Wood ^{25 )}. As such, broadening the scope of menu labelling legislation to chains with three or more locations, as some critics suggest, may not be politically viable⁽ Reference Frumkin ^{17 )}. Conversely, some chain restaurants already provide nutrition information on their website, e.g. MacDonald’s. In this instance any additional costs would arise from adjusting the menus and menu boards as opposed the nutrition analysis per se.

There are concerns among restaurant operators that providing nutrition information may affect ordering behaviour and have a detrimental effect on revenue⁽ Reference Yamamoto, Yamamoto and Yamamoto ^{26 )}. For example, there are fears that menu labelling might lead to reduced demand for profitable items or encourage consumers to switch the source of their meals from one food-service outlet to another. Despite concerns over revenue, there is growing evidence that menu labelling does not affect sales⁽ Reference Ellison, Lusk and Davis ^{27 )}. The British Hospitality Association argues that menu labelling is largely ineffective and could result in huge cost to the industry with little benefit to public health⁽ Reference Paskin ^{28 )}. This is backed up by several field studies that show menu labelling has little effect on energy intake and/or eating behaviour⁽ Reference Ellison, Lusk and Davis ^{27 ,} Reference Downs, Wisdom and Wansink ^{29 –} Reference Mayer, Brown and Heins ^{32 )}. Krieger and Saelens⁽ Reference Krieger and Saelens ^{33 )} argue that when assessed among all consumers, not just those who see and use the labels, the impact of menu labelling is only ten to twenty calories (10–20 kcal, 42–84 kJ) per meal. Thus although menu labelling has received a high degree of support from public health, evidence concerning its impact is mixed. Gittelsohn et al.⁽ Reference Gittelsohn, Lee-Kwan and Batorsky ^{34 )} also cast doubt on the generalisability of findings from existing research, stating that many studies are poorly designed and lack a control group and random assignment to conditions.

The menu is one of the most important components in a restaurant. It is a major communication device that projects the personality and concept of the restaurant and an advertisement tool⁽ Reference Din, Zahari and Othman ^{35 )}. Besides pricing, descriptive and evocative names for foods are frequently found on restaurant menus⁽ Reference Wansink, Painter and Ittersum ^{36 )} and, in more expensive restaurants, the ingredients and method of cooking are often provided in an attempt to impress the consumer. Operators then are confronted with the challenge of finding space for nutrition information on menus that are already overcrowded. This is complicated even further when there are menu variations. For example, restaurants and cafés typically sell hot drinks in a range of different sizes with various types of milk. From an operational perspective listing nutrition information for all options on the menu may be impractical due to lack of space. Adjusting menus and menu boards to provide information for all possible choices may also be time-consuming and expensive. Adding additional information might also mean that operators have to downplay or remove some other valuable piece of information about their product^{( 13 )}. For the consumer, listing information for all options on the menu may lead to information overload^{( 37 )}. Furthermore, given that consumers want menus that are aesthetically pleasing⁽ Reference Drydale and Galipue ^{38 )}, improper menu presentation may lead to customer dissatisfaction, decreased profit and the ultimate failure of a restaurant operation⁽ Reference Din, Zahari and Othman ^{35 )}.

Long-term implementation of menu labelling entails additional cost and planning, especially when menus are updated regularly. As such, some restaurant operators worry that providing nutrition information may limit flexibility in changing the menu, resulting in longer implementation times. Limited flexibility and long implementation times for menus may mean that consumers find food choices restrictive. Operators are also concerned that it may be too difficult and time-consuming to provide information about foods and drinks that are one-offs given the extra time required to calculate or obtain nutritional values^{( 37 )}. Under new Food and Drug Administration⁽ Reference Butland, Jebb and Kopelman ^{11 )} regulations calorie information is not required for specials or ‘one-off’ items; however, Guilding⁽ Reference Guilding ^{39 )} argues that the unpredictable nature of the hospitality industry means that food preparation methods and menus are continually adjusted. For example, to make sure that restaurants operate in a cost-effective fashion they change their menus on a regular basis to ensure efficient use of highly perishable foods.

Regular nutrition training for waiting staff may be necessary so that they can guide customers on menu choices, answer customer questions or respond to unusual requests⁽ Reference Zick, Wake and Reeves ^{40 )}. Nothwehr et al.⁽ Reference Nothwehr, Snetselaar and Dawson ^{41 )} report that customers ask more questions about food content and preparation methods when signs promoting healthier options are available. Given high staff turnover in the catering industry, it is likely that training will need to be repeated regularly⁽ Reference Zick, Wake and Reeves ^{40 )}. In addition to staff training, communication between different members of staff is also vital for the success of menu labelling. Zick et al.⁽ Reference Zick, Wake and Reeves ^{40 )} report that the creation of six weekly menus, labelled for calories, saturated and polyunsaturated fat, fibre and sodium, in a hotel restaurant took two weeks and depended on the cooperation of the head chef, restaurant manager, operations manager and the nutritionist. As such, chefs will need to become more familiar conversing with nutritionists and ensure that the administration team is updated on a regular basis so that team members have the correct information to present on the menu. Another worry for restaurant operators is how the impact of regularly updating the constant stream of product and recipe data will affect their already stretched catering team, as there is likely to be some resistance by employees to change their current practice. For example, a recent survey found that 64 % of independent restaurant operators felt that they were too busy to provide nutrition information on their menus⁽ Reference Mah, Vanderlinden and Mamatis ^{20 )}. Indeed, perceived burden and perceived lack of benefits are reported as a barrier to menu labelling, as is mistrust of health educators by restaurant owners⁽ Reference Gittelsohn, Lee-Kwan and Batorsky ^{34 )}.