Five Years Later: Awareness Of New York City's Calorie Labels Declined, With No Changes In Calories Purchased.

To follow up on a previous study that examined how the mandated displaying of calorie information on menu boards in fast-food restaurants in New York City influenced consumers' behavior, we analyzed itemized cash register receipts and survey responses from 7,699 consumers at four fast-food chains. Using a difference-in-differences study design, we found that consumers exposed to menu labeling immediately after the mandate took effect in 2008 and at three points in 2013-14 reported seeing and using the information more often than their counterparts at fast-food restaurants without menu labeling. In each successive period of data collection, the percentage of respondents noticing and using the information declined, while remaining above the prelabeling baseline. There were no statistically significant changes over time in levels of calories or other nutrients purchased or in the frequency of visits to fast-food restaurants. Menu labeling at fast-food chain restaurants, which the Affordable Care Act requires to be implemented nationwide in 2016, remains an unproven strategy for improving the nutritional quality of consumer food choices at the population level. Additional policy efforts that go beyond labeling and possibly alter labeling to increase its impact must be considered.