Potential Effect of Physical Activity Calorie Equivalent Labeling on Parent Fast Food Decisions

Objectives: Menu labels displaying food energy in physical activity calorie equivalents (PACE) is a possible strategy to encourage ordering meals with fewer calories and promoting physical activity. Potential effects of such labeling for children have never been examined.

Methods: We conducted a national survey of 1000 parents randomized to 1 of 4 fast food menus: no labels, calories only, calories plus minutes, or calories plus miles needed to walk to burn the calories. Respondents were asked to imagine they were in a fast food restaurant and place an order for their child. At the survey's conclusion, all respondents were shown a calorie-only label and both PACE labels and asked to rate the likelihood each label would influence them to encourage their child to exercise.

Results: We excluded respondents whose meals totaled 0 calories or >4000 calories, leaving 823 parents in the analysis. The mean age of the child for whom the meal was "ordered" was 9.5 years. Parents whose menus displayed no label ordered an average of 1294 calories, whereas those shown calories only, calories plus minutes, or calories plus miles ordered 1066, 1060, and 1099 calories, respectively (P = .0001). Only 20% of parents reported that calories-only labeling would be "very likely" to prompt them to encourage their children to exercise versus 38% for calories plus minutes (P < .0001) and 37% for calories plus miles (P < .0001).

Conclusions: PACE labeling may influence parents' decisions on what fast food items to order for their children and encourage them to get their children to exercise.