Obesity and diet-related diseases are alarmingly high in all age groups. Healthful eating strategies are needed to address this national epidemic. One strategy that has the potential to make a significant difference is calorie awareness. Individuals are often unaware of the number of calories they need to consume each day or the calorie counts of foods. The International Food Information Council Foundation Survey (2012) found that only one in seven Americans correctly estimated the number of calories needed each day to maintain current weight. This survey also found that more than half of all Americans are trying to lose weight and are unaware of how many calories they consume each day. This lack of calorie awareness contributes to excess intake that can result in weight gain.
Need for Calorie Awareness
In recent years, in an effort to address the increasing obesity rates, policymakers have required the food industry to communicate calorie information to the public through nutrition labeling on prepackaged foods and restaurant menus. In 1994, the Nutrition Label and Education Act required that packaged food include standardized nutrition labels. This stipulation has now expanded to include the restaurant industry. The 2010 Patient Protection and Affordable Healthcare Act mandates that restaurants (with at least 20 locations) post nutrition and calorie information. Policymakers have identified that restaurants have become a staple for families, with Americans obtaining approximately one third of their daily calories from prepared food purchased away from home (Variyam, 2005).
In theory, posting calorie counts and average daily calorie requirements seems like a simple way to help individuals make healthier choices by curbing excess caloric consumption. However, the question is whether people are making suboptimal food choices because of a lack of information. Does providing this information lead to healthier selections? Listing absolute calorie counts in fast food restaurants may not be enough to change behaviors. Some studies have found changes in purchasing behavior as a result of listing calorie counts (Namba, Auchincloss, Leonberg, & Wootan, 2013), and other studies reported no changes (Elbel et al., 2013). Perhaps these decisions are prompted by a lack of understanding of calorie counts, daily calorie requirements, and the physical activity required to expend the calories consumed. Individuals with lower socioeconomic status, those with lower income, and older adults had more difficulty with calorie literacy (Sinclair, Hammond, & Goodman, 2013).
What Can Be Done to Make Calorie Information Easy to Understand?
Some individuals may struggle with computing caloric intake due to difficulty with numeracy and calorie literacy. Many people struggle with calculating numbers and percentages. For example, although people may know that they need 2,000 calories per day to maintain their current weight, some people may have difficulty adding up the calorie counts for each entrée and side dish. When assisting individuals with weight loss, nurses may first want to evaluate their numeracy competency. Simply asking patients if they struggle with calculating calories is a starting point. Numeracy competency tools are available. Some patients may find downloading a free application (e.g., http://www.MyFitnessPal.com) to their phone helpful because it allows them to enter information about their food intake and exercise activities and estimate the daily calories consumed. The Sidebar shows helpful resources.
Calorie literacy is the ability to identify the correct daily calorie intake as well as the calorie counts of foods and balance calorie intake throughout the day. An interesting study examined the effect of including exercise equivalents along with the calorie listings. That study focused on the purchases of sugar-sweetened beverages in a low-income, predominantly Black neighborhood (Bieich, Herring, Flagg, & Gary-Webb, 2012). The calorie counts were displayed next to the sugar-sweetened beverages in three distinct ways: (a) calorie count only (e.g., “Did you know that a bottle of soda or fruit juice has about 250 calories?”); (b) calorie count plus the percentage of recommended daily intake (e.g., “Did you know that a bottle of soda or fruit juice has about 10% of your daily calories?”); and (c) Calorie count plus the physical activity equivalent (e.g., “Did you know that working off a bottle of soda or fruit juice takes about 50 minutes of running?”). The study found that the most effective means to decrease the purchase of sugar-sweetened beverages was to provide the calorie count with the corresponding physical activity equivalent.
This area warrants further research. Identifying the most effective means to communicate calorie information is needed for various age and ethnic groups.
Health care providers need to promote calorie awareness in terms that are easy for patients to understand and implement. Evaluating patients for numeracy and calorie literacy is a great starting point. Another effective strategy is to include exercise equivalents along with calorie listings. One vital service of health care providers is to consistently evaluate whether the information they provide to patients on healthful food choices is understood and used to change behavior. Calorie awareness and calorie understanding can help empower individuals to make healthful food choices.
- Bieich, S. N., Herring, B. J., Flagg, D. D. & Gary-Webb, T. L. (2012). Reduction in purchases of sugar-sweetened beverages among low-income Black adolescents after exposure to calorie information. American Journal of Public Health, 102(2), 329–335. doi:10.2105/AJPH.2011.300350 [CrossRef]
- Elbel, B., Mijanovich, T., Dixon, L. B., Abrams, C., Weitzman, B., Kersh, R. & Ogedegbe, G. (2013). Calorie labeling, fast food purchasing and restaurant visits. Obesity, 21(11), 2172–2179. doi:10.1002/oby.20550 [CrossRef]
- International Food Information Council Foundation Survey. (2012). Food & Health Survey. Consumer attitudes toward food safety, nutrition and health. Retrieved from http://www.foodinsight.org/Resources/Detail.aspx?topic=2012_Food_Health_Survey_ConsumerAttitudes_toward_Food_Safety_Nutrition_and_Health
- Namba, A., Auchincloss, A., Leonberg, B. L. & Wootan, M. G. (2013). Exploratory analysis of fast-food chain restaurant menus before and after implementation of local calorie-labeling policies, 2005–2011. Preventing Chronic Disease, 10, 120224. doi:10.5888/pcd10.120224 [CrossRef]
- Sinclair, S., Hammond, D. & Goodman, S. (2013). Sociodemographic differences in the comprehension of food labels on food products. Journal of Nutrition Education and Behavior, 45(6), 767–772. doi:10.1016/j.jneb.2013.04.262 [CrossRef]
- Variyam, J. (2005, April). Nutrition labeling in the food-away-from-home sector: An economic assessment. U.S. Department of Agriculture, Economic Research Service, Economic Research Report No. 4, 1–28. Retrieved from http://www.ers.usda.gov/publications/err-economic-research-report/err4.aspx#.Up4oH-KmG70