Specifying calorie counts for each item on restaurant menus is likely linked to lower rates of obesity-associated cancers and associated healthcare costs in the United States, suggests a modeling study, published in open access journal BMJ open.
Thousands of cancer cases and deaths could potentially be prevented and billions of dollars saved through this policy, the figures show, prompting researchers to suggest that further reformulation of food industry products could significantly increase its impact. .
One in three Americans is obese, and obesity is an established risk factor for 13 types of cancer, the researchers note. Obesity-related cancers account for 40% of all newly diagnosed cases of the disease and 43.5% of cancer care costs.
Restaurant meals account for 1 in 5 calories consumed by American adults, and to help diners reduce their calorie intake, the Affordable Care Act of 2010 required all restaurant chains with more than 20 outlets to display calorie counts on menus and menu boards for all standard items.
Previously published research suggests that the policy would prevent a large number of cases of cardiovascular disease and type 2 diabetes among American adults. But the health and economic impacts on obesity-related cancers have not been assessed.
The researchers therefore used the DiCOM (Diet and Cancer Outcome) model to estimate the impact of the policy on reducing obesity-related cancer rates and associated costs among 235 million American adults aged at least 20 years, over a simulated lifetime from 2015.
The model consists of 4 health states ranging from good health to death, taking into account the annual probability of health changes plus the lifetime consequences of these changes on health outcomes and health/social costs, and drawing on multiple demographic, health, economic, dietary intake and industry data sources.
American adults in 2015-2016 had an average age of 48; nearly two-thirds were of non-Hispanic white ethnicity, and 71% were overweight or obese.
Daily calorie intake from full-service restaurants or fast food restaurants averaged 332. But young people (20-44) consumed an average of 425 calories/day, men 388, people of non-Hispanic black ethnicity 361 and those of Hispanic origin 367.
Calorie counts on menus have been estimated to reduce daily restaurant food calories by an average of 24 and total daily calories by 12. Potential industry reformulation would reduce average intake by an additional 16 calories/ day and total calories of 8/day.
Based on consumer behavior alone, the policy was associated with preventing 28,000 new cases of cancer and 16,700 cancer deaths; 111,000 additional years of life lived in good health (QALY); and US$1.48 billion saved in related medical costs over an average follow-up period of 34 years.
Estimates indicated that the greatest number of new cases averted were cancers of the endometrium (uterine lining) (5,700), liver (5,180), kidney (5,090), breast after menopause (4 840) and pancreas (1,400).
The greatest number of cancer deaths averted were for liver (4530), postmenopausal breast (3080), endometrium (2060), kidney (1980) and pancreas (1230).
The policy was associated with net savings of, respectively, US$1.46 billion and US$1.35 billion in health and social costs.
Health gains and cost savings would likely be greater for young adults and people of Hispanic and black descent, the figures suggest.
According to the researchers, further reformulation of food industry products could significantly increase policy impact, with estimated total health gains more or less doubling, averting 47,300 new cancer cases and 28,200 cancer deaths, and earning 189,000 QALYs.
“Given the nature of modeling research, this study does not provide an actual assessment of the impact of policy implementation on health and economic outcomes,” the researchers warn.
And they acknowledge that menu calorie counts might have a greater impact on people with higher incomes and higher education levels.
“We only modeled the impact of menu calorie labeling on calories, although the policy may also lead to potential changes in the nutritional quality of restaurant meals,” they add.
But they conclude: “Using the best available estimates, our study further suggested that the federal menu calorie labeling policy is cost effective in the short term and economical in the long term in reducing the cancer burden associated with obesity.”
Source:
Journal reference:
Du, M., et al. (2023) How cost-effective is calorie labeling on menus to reduce the cancer burden associated with obesity? An economic evaluation of federal policy intervention with 235 million adults in the United States. BMJ open. doi.org/10.1136/bmjopen-2022-063614.
