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Background: Excess caloric intake is linked to weight gain, obesity, and related diseases, including type 2 diabetes mellitus and cardiovascular disease (CVD). Obesity incidence is rising, with nearly 3 in 4 US adults being overweight or obese. In 2018, the US federal government finalized the implementation of mandatory labeling of calorie content on all menu items across major chain restaurants nationally as a strategy to support informed consumer choice, reduce caloric intake, and potentially encourage restaurant reformulations. Yet, the potential health and economic impacts of this policy remain unclear., Methods and Results: We used a validated microsimulation model (CVD-PREDICT) to estimate reductions in CVD events, diabetes mellitus cases, gains in quality-adjusted life years, costs, and cost-effectiveness of the menu calorie labeling intervention, based on consumer responses alone, and further accounting for potential industry reformulation. The model incorporated nationally representative demographic and dietary data from National Health and Nutrition Examination Surveys 2009 to 2016; policy effects on consumer diets and body mass index-disease effects from published meta-analyses; and policy effects on industry reformulation, policy costs (policy administration, industry compliance, and reformulation), and health-related costs (formal and informal healthcare costs, productivity costs) from established sources or reasonable assumptions. We modeled change in calories to change in weight using an established dynamic weight-change model, assuming 50% of expected calorie reductions would translate to long-term reductions. Findings were evaluated over 5 years and a lifetime from healthcare and societal perspectives, with uncertainty incorporated in both 1-way and probabilistic sensitivity analyses. Between 2018 and 2023, implementation of the restaurant menu calorie labeling law was estimated, based on consumer response alone, to prevent 14 698 new CVD cases (including 1575 CVD deaths) and 21 522 new type 2 diabetes mellitus cases, gaining 8749 quality-adjusted life years. Over a lifetime, corresponding values were 135 781 new CVD cases (including 27 646 CVD deaths), 99 736 type 2 diabetes mellitus cases, and 367 450 quality-adjusted life years. Assuming modest restaurant item reformulation, both health and economic benefits were estimated to be about 2-fold larger than based on consumer response alone. The consumer response alone was estimated to be cost-saving by 2023, with net lifetime savings of $10.42B from a healthcare perspective and $12.71B from a societal perspective. Findings were robust in a range of sensitivity analyses., Conclusions: Our national model suggests that the full implementation of the US calorie menu labeling law will generate significant health gains and healthcare and societal cost-savings. Industry responses to modestly reformulate menu items would provide even larger additional benefits.

Menu-based 'nudges' hold promise as effective ways to encourage a shift away from ruminant meat and towards more environmentally friendly plant-based food when dining out. One example of a menu-based nudge is including an inferior 'decoy' option to existing items on menus. Decoys have been shown to influence decision-making in other domains (e.g. Lichters, Bengart, Sarstedt, & Vogt, 2017), but have yet to be used to promote sustainable food choices. Two online randomized controlled trials tested whether the addition of higher priced 'decoy' vegetarian options on menus influenced the number of diners choosing a 'target' vegetarian option. Adjusted Generalized Estimating Equations on data from four menu conditions showed no main effect of the intervention in study 1 (decoy absent vs. decoy present; Odds Ratio (OR) 1.08 95% Confidence Interval (CI) 0.45 to 2.57). Replicating the trial in study 2 across seven menu conditions and testing a more expensive decoy also showed no main effect of the intervention decoy absent vs. decoy present; OR 0.68 (95% CI 0.41 to 1.12). Further analyses revealed that our price-based decoy strategy (a 30% price increase) did not significantly influence the number of people choosing the inferior decoy dish, possibly because dish choices were purely hypothetical. Further research is needed to clarify which attributes of a dish (e.g. taste, portion size, signature ingredients etc.) are optimal candidates for use as decoys and testing these in real world choice contexts., Competing Interests: Declaration of competing interest None., (Copyright © 2020. Published by Elsevier Ltd.)

Purpose: Patient satisfaction with hospital food enhances consumption and adequate intake of nutrients required for recovery from illness/injury and maintenance of health; accordingly, the nutrient content of the menu must balance patient preferences. This study of Ontario hospital foodservice departments collected data on current practices of analyzing the nutritional adequacy and assessing patient satisfaction with menus, and it explored perceptions of priority issues., Methods: Foodservice managers/directors from 57 of 140 (41%) hospitals responded to cross-sectional in-depth telephone interviews. Deductive analysis of responses to open-ended questions supplemented quantitative data from closed-ended questions., Results: The hospitals without long-term care facilities (LTCFs) assessed regular (58%), therapeutic (53%), and texture-modified (47%) menus for nutritional adequacy. This differed from hospitals governing LTCFs where there was a higher frequency of assessment of regular (75%), therapeutic (75%), and textured-modified (66%) menus. Most departments (86%-94%) obtained patient satisfaction feedback at the departmental/corporate levels. Many identified budget and labour issues as priorities rather than assessing menus for nutritional adequacy and patient satisfaction., Conclusions: Hospital menus were not consistently assessed for nutritional adequacy and patient satisfaction; common assessment methodologies and standards were absent. Compliance standards seem to increase the frequency of menu assessment as demonstrated by hospitals governing LTCFs.

Background: Internationally, governments have implemented school-based nutrition policies to restrict the availability of unhealthy foods from sale. The aim of the trial was to assess the effectiveness of a multi-strategic intervention to increase implementation of a state-wide healthy canteen policy. The impact of the intervention on the energy, total fat, and sodium of children's canteen purchases and on schools' canteen revenue was also assessed., Methods: Australian primary schools with a canteen were randomised to receive a 12-14-month, multi-strategic intervention or to a no intervention control group. The intervention sought to increase implementation of a state-wide healthy canteen policy which required schools to remove unhealthy items (classified as 'red' or 'banned') from regular sale and encouraged schools to 'fill the menu' with healthy items (classified as 'green'). The intervention strategies included allocation of a support officer to assist with policy implementation, engagement of school principals and parent committees, consensus processes with canteen managers, training, provision of tools and resources, academic detailing, performance feedback, recognition and marketing initiatives. Data were collected at baseline (April to September, 2013) and at completion of the implementation period (November, 2014 to April, 2015)., Results: Seventy schools participated in the trial. Relative to control, at follow-up, intervention schools were significantly more likely to have menus without 'red' or 'banned' items (RR = 21.11; 95% CI 3.30 to 147.28; p ≤ 0.01) and to have at least 50% of menu items classified as 'green' (RR = 3.06; 95% CI 1.64 to 5.68; p ≤ 0.01). At follow-up, student purchases from intervention school canteens were significantly lower in total fat (difference = -1.51 g; 95% CI -2.84 to -0.18; p = 0.028) compared to controls, but not in energy (difference = -132.32 kJ; 95% CI -280.99 to 16.34; p = 0.080) or sodium (difference = -46.81 mg; 95% CI -96.97 to 3.35; p = 0.067). Canteen revenue did not differ significantly between groups., Conclusion: Poor implementation of evidence-based school nutrition policies is a problem experienced by governments internationally, and one with significant implications for public health. The study makes an important contribution to the limited experimental evidence regarding strategies to improve implementation of school nutrition policies and suggests that, with multi-strategic support, implementation of healthy canteen policies can be achieved in most schools., Trial Registration: Australian New Zealand Clinical Trials Registry ( ACTRN12613000311752 ).

Many restaurants are increasingly required to display calorie information on their menus. We present a study examining how consumers' food choices are affected by the presence of calorie information on restaurant menus. However, unlike prior research on this topic, we focus on the effect of calorie information on food choices made from a menu that contains both full size portions and half size portions of entrées. This different focus is important because many restaurants increasingly provide more than one portion size option per entrée. Additionally, we examine whether the impact of calorie information differs depending on whether full portions are cheaper per unit than half portions (non-linear pricing) or whether they have a similar per unit price (linear pricing). We find that when linear pricing is used, calorie information leads people to order fewer calories. This decrease occurs as people switch from unhealthy full sized portions to healthy full sized portions, not to unhealthy half sized portions. In contrast, when non-linear pricing is used, calorie information has no impact on calories selected. Considering the impact of calorie information on consumers' choices from menus with more than one entrée portion size option is increasingly important given restaurant and legislative trends, and the present research demonstrates that calorie information and pricing scheme may interact to affect choices from such menus., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: To examine changes in children's meal orders, price, and revenue following the implementation of a healthier children's menu in a full-service restaurant chain., Methods: In April 2012, the healthier menu was implemented, featuring more meals meeting nutrition standards, healthy side dishes by default, and removal of French fries and soda (which could be substituted). Orders (n = 352,192) were analyzed before (September 2011 to March 2012; PRE) and after (September 2012 to March 2013; POST) implementation., Results: Children's meal prices increased by $0.79 for breakfasts and $0.19 for non-breakfast meals from PRE to POST. Revenue continued to increase post-implementation. Orders of healthy meals, strawberry and vegetable sides, milk, and juice increased, and orders of French fries and soda decreased (P < 0.0001). Orders at POST were more likely to include healthy sides (P < 0.0001) and substitutions (P < 0.0001) and less likely to include a la carte sides (P < 0.0001) and desserts (P < 0.01), versus PRE. Total calories ordered by children accepting all defaults decreased (684.2 vs. 621.2; P < 0.0001) and did not change for those not accepting defaults (935.0 vs. 942.9; P = 0.57)., Conclusions: Healthy children's menu modifications were accompanied by healthier ordering patterns, without removing choice or reducing revenue, suggesting that they can improve child nutrition while restaurants remain competitive., (© 2015 The Obesity Society.)

Objective: Obesity is a pressing public health problem without proven population-wide solutions. Researchers sought to determine whether a city-mandated policy requiring calorie labeling at fast food restaurants was associated with consumer awareness of labels, calories purchased and fast food restaurant visits., Design and Methods: Difference-in-differences design, with data collected from consumers outside fast food restaurants and via a random digit dial telephone survey, before (December 2009) and after (June 2010) labeling in Philadelphia (which implemented mandatory labeling) and Baltimore (matched comparison city). Measures included: self-reported use of calorie information, calories purchased determined via fast food receipts, and self-reported weekly fast-food visits., Results: The consumer sample was predominantly Black (71%), and high school educated (62%). Postlabeling, 38% of Philadelphia consumers noticed the calorie labels for a 33% point (P < 0.001) increase relative to Baltimore. Calories purchased and number of fast food visits did not change in either city over time., Conclusions: While some consumers report noticing and using calorie information, no population level changes were noted in calories purchased or fast food visits. Other controlled studies are needed to examine the longer term impact of labeling as it becomes national law., (Copyright © 2013 The Obesity Society.)

Malnutrition in elderly people is one of the major syndromes associated to greater prevalence of chronic diseases and increased morbidity, hospital staying, and mortality. On the other hand, malnutrition in the fourth world is associated to another important risk factor, which is the poor economic status. The aim of this study was to elaborate a balanced menu for the elderly adjusting its price to the mean expense that this population dedicates to its feeding needs. Taking into account the Household expense for 2010 of the National Institute of Statistics, we established that the average price for each menu ought to be less than 5.57 € per day. Two type menus were elaborated, both adapted to this population and to the Mediterranean diet. The economic assessment was 5.02 € and 5.06 €, respectively. Given the prevalence of malnutrition in this population, it is essential being able to appropriately plan their feeding needs, at both the nutritional and economic levels.

Objective: Child-care providers have a key role to play in promoting child nutrition, but the higher cost of nutritious foods may pose a barrier. The present study tested the hypothesis that higher nutritional quality of foods served was associated with higher food expenditures in child care homes participating in the Child and Adult Care Food Program (CACFP)., Design: In this cross-sectional study, nutritional quality of foods served to children and food expenditures were analysed based on 5 d menus and food shopping receipts. Nutritional quality was based on servings of whole grains, fresh whole fruits and vegetables, energy density (kJ/g) and mean nutrient adequacy (mean percentage of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking receipt and menu data. Associations between food expenditures and menu quality were examined using bivariate statistics and multiple linear regression models., Setting: USA in 2008-2009., Subjects: Sixty child-care providers participating in CACFP in King County, Washington State., Results: In bivariate analyses, higher daily food expenditures were associated with higher total food energy and higher nutritional quality of menus. Controlling for energy and other covariates, higher food expenditures were strongly and positively associated with number of portions of whole grains and fresh produce served (P = 0·001 and 0·005, respectively), with lower energy density and with higher mean nutrient adequacy of menus overall (P = 0·003 and 0·032, respectively)., Conclusions: The results indicate that improving the nutritional quality of foods in child care may require higher food spending.

Purpose: Regular, nontherapeutic menus were compared before and after an increase in the Ontario long-term care (LTC) raw food cost allowance (RFCA). The purpose was to determine whether any significant nutritional differences existed between the old and new menus and whether they met target values for adequacy, according to the Dietary Reference Intake (DRI) nutrient recommendations or other target values relevant to Ministry of Health and Long-Term Care standards., Methods: A southeastern Ontario LTC facility fall/winter 2006/2007 menu and fall/winter 2007/2008 menu were used for nutrient analysis with ESHA Food Processor SQL 10.1.0. Each menu was compared with target values based on Canada's Food Guide (CFG) for 1992 and 2007, and with DRI nutrient recommendations., Results: The 2007/2008 menu provided significantly more servings of vegetables and fruit, meeting the 2007 CFG recommendations, and significantly greater amounts of some nutrients (e.g., vitamin C, protein, magnesium, potassium, fibre, and total water). It also came closer to meeting DRI target recommendations., Conclusions: While some improvements have been made to the menu in this specific facility, further improvements, possibly through supplementation, must be made to ensure nutritional adequacy for all residents.

The US Department of Agriculture's Child and Adult Care Food Program (CACFP) serves 2.3 million children by providing monetary subsidies for food to participating child-care providers. This cross-sectional study tested the hypothesis that higher reimbursement rates for food result in higher food expenditures and higher nutritional quality of foods served in family child-care homes participating in CACFP. Sixty family home child-care providers were recruited in 2008-2009 from King County, Washington. Half the sample received higher reimbursements and the other half received the lower rates. Participants provided a 5-day menu of meals/snacks served and food shopping receipts. The nutritional quality of foods served was assessed from portion-standardized menus. Nutritional quality was quantified as the mean adequacy (mean percent of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking menus with receipts. Student's t tests for independent samples and general linear models were used to test for between-group differences. The two groups of providers were socioeconomically and demographically similar with comparable professional backgrounds. However, higher reimbursement providers had significantly greater menu expenditures than the lower reimbursement group ($2.36 vs $1.96/child/day; P=0.031). Reimbursement level was not associated with a difference in calories, but menus of higher reimbursement providers showed a significantly higher mean nutritional adequacy (64.5% vs 56.3%; P=0.033). The finding that reimbursement rates were positively associated with food expenditures and the nutritional quality of foods served suggests that raising CACFP reimbursements can improve child nutrition., (Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

A look at what fine restaurants served in mid-nineteenth century America, using the New York Public Library’s collection of menus from the Fifth Avenue Hotel in New York City for the years 1859 to 1865. With particular paid attention to the entrée category, 1,250 menus were analyzed. There are 900 different dishes mentioned, and the article discusses what were the most popular and the setting and customs governing such meals.

Objective: To test the use of cost-effectiveness analysis as a decision making tool in the production of meals for the inclusion of the recommendations published in the World Health Organization's Global Strategy., Methods: Five alternative options for breakfast menu were assessed previously to their adoption in a food service at a university in the state of Sao Paulo, Southeastern Brazil, in 2006. Costs of the different options were based on market prices of food items (direct cost). Health benefits were estimated based on adaptation of the Diet Quality Index (DQI). Cost-effectiveness ratios were estimated by dividing benefits by costs and incremental cost-effectiveness ratios were estimated as cost differential per unit of additional benefit. The meal choice was based on health benefit units associated to direct production cost as well as incremental effectiveness per unit of differential cost., Results: The analysis showed the most simple option with the addition of a fruit (DQI = 64 / cost = R$ 1.58) as the best alternative. Higher effectiveness was seen in the options with a fruit portion (DQI1=64 / DQI3=58 / DQI5=72) compared to the others (DQI2=48 / DQI4=58)., Conclusions: The estimate of cost-effectiveness ratio allowed to identifying the best breakfast option based on cost-effectiveness analysis and Diet Quality Index. These instruments allow easy application easiness and objective evaluation which are key to the process of inclusion of public or private institutions under the Global Strategy directives.

Objective: The present study aimed to investigate whether organic conversion in catering has positive effects on the nutritional quality of menus offered., Design: The methodology was based on a self-administered questionnaire. The self-declared priority given to the use of organic foods was measured as the basis for assigning catering managers to one of two groups: 'green' or 'non-green' caterers. These groups were then compared with regard to the relative nutritional quality of the menu options offered to customers., Setting: The study was carried out among randomly selected Danish worksite catering outlets., Subjects: The subjects participating in the study comprised 526 Danish worksite catering managers., Results: The results showed a strong correlation between caterers' 'green-ness' and the nutritional quality of the menu options offered. Green caters had more healthy options in their menus than non-green caters, which is likely to result in improved nutritional quality of the diets of end consumers. The reason for this may partly be the increased service training efforts that green caterers practise in order to be able to implement organic foods successfully. It may also be associated with the fact that the price premiums and availability of the organic products forces caterers to serve menus with higher amounts of root and non-green leafy vegetables, pulses and seasonal vegetables., Conclusion: The present findings suggest that organic conversion of public canteens may be a good opportunity to promote healthier eating in public catering.

As part of a multi-purpose study, the monetary value of edible plate waste was estimated in 18 large capacity Ministry of Health (MOH) general hospitals in Saudi Arabia. Direct measurement of the plate waste was carried out over 2-days, in which 6 consecutive regular diets were served to 554 Saudi patients (male 268 and female 286) and their 205 attendants (male 12 and female 193). It was estimated that the average plate waste represented approximately 40% of the meal cost/participant/day, and the estimated annual monetary loss for the 5.625 million regular meals to be served to patients and attendants will be around 35 million Saudi Riyals.

Cedars-Sinai Medical Center has recently switched to a kitchenless patient foodservice program. In addition to cutting 15 FTEs & contributing to nearly $500,000 in annual savings, foodservice has also released $1.5 million worth of real estate for revenue-generating activities.

This study examined changes in sales of low fat/low cholesterol foods targeted in a restaurant menu labeling program. Sales of labeled items were tracked before and after the program was introduced, and a subsample of patrons were surveyed for information on visibility and comprehension of the menu labels. Two of the four restaurants had significant increases in the sales of targeted foods following labeling. Comparisons between patrons dining in restaurants which had an increase in sales (I--increase restaurants) to those dining in restaurants which had no overall shift in sales (NI--no increase restaurants) revealed no differences in patron awareness or comprehension of the menu labels. There were age and gender differences between I and NI restaurants, with I restaurants having proportionally more males, and a younger clientele. Taste was the primary reason given by patrons for their entree choice, regardless of whether or not it was labeled. In all four restaurants women and older patrons were more aware of the program and more responsive to its recommendations. These findings suggest that environmental strategies may be an effective method of encouraging dietary changes in the general population, but patron characteristics such as age and gender may influence receptivity to this type of intervention. Future studies aimed at developing effective point of purchase education programs should evaluate these patron characteristics and include more powerful behavior change strategies.

The forecasting efficiency of two- and three-echelon menu item forecasting systems was compared. Two forecasting models were used with each system, adaptive exponential smoothing and a Box-Jenkins model. The two systems were compared in terms of forecast error costs. The two-echelon system, using adaptive exponential smoothing, was recommended. This technique resulted in the lowest forecast error costs at a majority of the lead times which probably would be used most frequently. Also, this technique was the least complicated of the four techniques which were compared.

Cost containment can be achieved through the use of methods of measuring, controlling, and modifying food costs and quality, labor costs, and departmental procedures.

Recent developments brought about by the government's prospective payment system as well as by new restrictions on hospitalization imposed by private insurance companies are placing greater emphasis on cost-containment measures within hospital foodservice systems. The research reported in this article focuses upon the development of a microcomputer technique that produces direct (labor and ingredient) cost information on menu items. Such information can assist foodservice directors in identifying and controlling costs associated with their current menu offerings. In addition, this information can assist in planning and decision making for future menu planning efforts as well as in make-or-buy decisions.