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One of the things people probably most dislike is getting sick because of some food they have eaten — usually an annoying and unpleasant experience. The sickness can happen within hours or two to three days after eating the contaminated food. The trouble is that oftentimes one has no way of anticipating the disease until feeling sick, and sometimes even after becoming ill it is not easy to connect the disease with consumed food. A food item may come from a respected and trusted brand, the expiry date looks fine, the food may also taste good, and still without suspicion it may cause poisoning and sickness. Food companies are walking on the edge of food safety when they skip necessary precautionary measures to prevent and detect contaminations in time, but furthermore when they conceal problems or try to solve them quietly in the factory without warning of a looming health risk to their customers.

  • The most common infections and poisoning are caused by bacteria of the type of Salmonella, Listeria, and E-Coli. But a foodborne disease may also be viral (e.g., norovirus) or being caused by insects (e.g., food moth). For most people a foodborne disease is not dangerous; it will cause sickness and inconvenience, passing after a few days without medical treatment. Yet, these diseases may be troublesome and cause more serious complications in people whose health is vulnerable (e.g., little children, seniors, pregnant women, prior illnesses, weaken immune system).

This summer there were a number of incidents of food contamination revealed in Israel. Yet two of the cases are more significant and instructive: the cornflakes of Unilever (Telma) and ready-to-eat salads by Shamir Salads.  First, the failures exposed in the conduct of the two concerned companies commend particular attention and taking lesson from them. Second, these incidents were the earliest to become public (late July, beginning of August) and have put the matter of food safety under a spotlight. A number of additional incidents of contamination may have been revealed just because of that, partly reported by alarmed food companies themselves (e.g., salmon fish, halva, frozen potato fries, pre-prepared grilled hamburger).

Unilever (Telma) — A contamination of salmonella was discovered by Unilever in Israel in packages of a few of its cornflakes products under the brand name of Telma (an Israeli-grown brand acquired by Unilever). The company insisted, however, that all contaminated packages remained in a company’s facility to be disposed of (they were converted into corn oil to be used as energy source for another industrial process). When upset consumers and the Ministry of Health pressured Unilever to provide assurances no packages reached food stores, the company claimed they had checked that the marked packages were separated and excluded from delivery in its facility. Only that this information was not accurate, not properly verified. It was soon after revealed that some 240 contaminated packaging parcels found their way out of the facility and distributed to food stores. Some of those cornflakes packages were probably consumed though no complaint of sickness was firmly connected with the cornflakes. Nevertheless, since cornflakes of the type contaminated are largely eaten by children, it is understandable that parents were strongly agitated by that belated discovery.

Unilever directed responsibility for the ‘mishap’ to an employee of a local logistics contractor who apparently mistakenly misplaced labels of some parcels for delivery and sent out the wrong packages. Even so, responsibility for the whole chain of supply of the products of Unilever rests with the company marketing them (not physically distributing them). That is the onus of the brand’s owner towards its customers. That Unilever failed to verify this mistake earlier makes the explanation just weaker.

  • Food safety experts suggest that it is unusual for a dry product like cornflakes to contract bacterial contamination of salmonella. Additionally, the cornflakes are roasted at a very high temperature that kills any bacteria that might have settled in the material. Therefore, it is much more likely that the culture of salmonella developed during the packaging or storage in preparation for distribution.

Shamir Salads — A contamination of salmonella was found in Mediterranean salads that contain tehina. Shamir Salads, like other food producers, buys the tehina mix as a raw material from a supplier, in this case a company named “HaNasich” (meaning “The Prince”). Badly enough, the grave problem for Shamir Salads is that the company did not identify the contamination itself. It failed twice: by not testing initially its raw material and by not testing the final salad product before delivery to retailers for any possible contamination. It should be clarified that laboratory tests are run on samples and therefore they cannot eliminate absolutely any contamination, but if sampling is conducted appropriately it gives a good chance of detecting the traces in time for further checks and corrective action. Skipping any sampling and tests cannot be excused.

The management of Shamir Salads argued in its defence that the company trusted its supplier, HaNasich, and therefore did not see any need to continuously check on the quality and safety of their tehina. The company was deeply disappointed and felt betrayed by its supplier for not advising them of any problems. The reference to the concept of trust between parties is not unfounded, but one can still check internally as a precautionary control measure without violating trust in the other party. A company does not have to trust blindly, especially not when a sensitive matter as health is concerned. It may even be doing a favour to its supplier that could miss contamination in its factory. Much less understandable is the lack of tests on the company’s finished products. If not before or during production, then at the very least testing of the finished salads would have given the company a chance of detecting a contamination before leaving the factory, investigating backwards and identifying the source in the tehina. Other companies (e.g., Strauss, Tzabar Salads) using the same tehina ran tests on their finished products and identified the contamination, linking it to tehina by HaNasich.

Both Unilever and Shamir Salads were actually forced to order recalls of their products. A recall becomes damaging in the public eye when the company does not seem to control the process and its timing, or is not honest with the consumers about the recall’s reasons and circumstances.

Complicated relations and flawed working of safety procedures in the food industry may have some responsibility for contamination getting lost or hidden from public knowledge. Companies have a reasonable interest to try to solve a problem in production they identify internally in hope they can contain it “behind closed doors”. It is a matter of calculated risk — but risks sometimes realise in a worse way. The Israeli Ministry of Health is criticised for not placing a proper procedure that requires food producers to perform microbiological lab tests on samples of finished product items and that current reporting procedures are vague. For instance, the companies are not required to report to the ministry until after ordering a recall due to contamination. Consequently, there are repeated conflicts over responsibility and blame-exchanges between producers and the Health Ministry. Furthermore, food companies are working with private labs that are in turn required to report directly to the Health Ministry only in case of contamination found in finished products and not in their raw materials. The implied outcome: food companies have a latent incentive to keep anything that happens in the factory silent, handle a “situation” for a longer time, and not report to anyone until the problem becomes severe or an urgent recall is inevitable.

Issues of food contamination and foodborne illnesses concern many countries, gaining particularly growing awareness in Western countries. The Fortune Magazine published an article, kind of special report, on problems of food safety in the United States (October 2015) titled “Contamination Nation“. The number of food recalls has grown more than twice from 2004 t0 2014 (2004: 288 recalls of which 240 of non-meat products; 2014: 659 recalls, 565 non-meat). Nearly half of recalls (47%) in the US are due to microbiological contamination. The highest proportion of recalls (21%) are of ready-to-eat food products.

  • According to the Centers for Disease Control and Prevention (CDC) 48 million Americans suffer each year of foodborne illnesses (128,000 are hospitalised and 3,000 die of a foodborne illness).

The writer, Beth Kowitt, proposes four reasons it is so hard to battle food contamination and poisoning; their relevance extends to Israel and to many other nations:

  • Foodborne illnesses are very difficult to identify and track down their roots — cases of illness are sporadic and therefore hard to tie with a specific “outbreak”; hundreds of components may be involved in isolating a cause of poisoning.
  • The food industry does not trust state regulators, their knowledge and tools — major food companies are performing their own tests for bacteria on food and in factory premises and develop a knowledgebase independent of state departments or agencies (FDA, CDC); companies are reluctant to disclose information they do not have to, part in concern of being implicated before the epidemiological mapping is completed.
  • The more food is imported from other countries, the more difficult it gets to control and verify its safety — exporting countries have different food-safety standards and inspection regimes, and the more steps food passes before entering one’s destination country, there are more opportunities for becoming contaminated.
  • Consumers have to do more to protect themselves — when consumers seek certain ingredients to be reduced or excluded (e.g., potassium, salt, sugar) or refrain from consuming frozen products because of health considerations, they could render their food less protected from bacterial contamination of their food; consumers are responsible for taking active measures to reduce contamination risks at their homes (e.g., washing hands, boiling milk, checking meat temperature).

It may be added to the last reason that safeguarding from food contamination may start from the facilities of the food producer but it should continue through the retailers’ food stores and finally indeed at the consumers’ home kitchens. Retailers are obliged to keep stores and displays cleaned-up at all times and ensure products are not kept beyond their expiry date (e.g., chilled dairy products, ready-to-eat meals, eggs). As for consumers, the American CDC recommends four practices for protecting from contamination: Cook to kill bacteria, Clean working surfaces, Separate more risky items (meat, fruits and vegetables) from other food, and Chill to reduce chance of bacterial cultivation.

Next to the article cited above, Fortune brings the story of the Texan-based Blue Bell ice-cream company which demonstrates what happens when a food company stalls treatment of contamination hazards at its plants and even hides them for too long. The crisis has rolled during 2015 but an investigation found that its roots may have existed since 2010. There were three deaths and two more serious patient ilnesses in the same Kansas hospital in late 2014, and in total ten people were affected by listeria-type infection connected with the ice-cream over five years; establishing the connection with Blue Bell was hard.

Contamination occurred in two plants: at Brenham, Texas ‘homebase’, and in Oklahoma. It appears that already in 2013 the company discovered contamination in its Oklahoma plant that was not treated properly despite an FDA inspection. Importantly, bacteria were found in that plant on floors and catwalks (i.e., bacteria can be easily passed with movement of workers and objects). Additional flaws were found in further inspections, including “condensation dripping from machinery into ice cream and ingredient tanks; poor storage and food-handling practices; and failures to clean equipment thoroughly”. Because of its stalling, the company drifted into what experts call “recall creep” — it happens when executives think limited action every time they are told of listeria findings is enough to solve the problem and constrain commercial damages, thence find themselves forced to perform greater recalls over and over again.

Blue Bell is the third-largest ice cream maker in the US and its products are widely admired. Many people across the country are said to have saddened by the closure of the plants and loss of their beloved ice cream for a period. This year the company resumed production and marketing, adding gradually more flavours and markets, after a thorough clean-up of plants, change of procedures and rules and training of employees. One of the practices installed is “test-and-hold” where a production series is sample-tested  and all packs are held in storage until it is cleared from bacterial contamination.

A serious fatal crisis related to food safety in Israel occurred in 2003 with the milk formula for babies by Remedia. It should be noted this was not an incident of contamination. In this case the company made a change in the composition of one of its formula versions by which it drastically reduced or eliminated from the product the vitamin B1. This ingredient is vital for the development of the nervous system of babies. As a result, critical damage was caused to the health of babies: four babies died and several more children grew up with irreversible damage to their development (neural, cognitive and motor). Although this event is different, and the consequences in the recent contamination incidents are much less severe, two relevant notions are in order. First, a contamination incident can lead to just as severe consequences when the problem is mishandled and information is concealed from authorities and consumers as the crisis of Blue Bell proves. Second, Remedia made the grave mistake of throwing all the blame on a German company (Humana) that was hired to develop, implement and test the new recipe (and erred in its tests). However, Remedia was responsible and accountable for its product to the parents and babies in Israel, not the faulty German company it worked with. Remedia ceased to exist.

It is probably only human for the company’s managers to direct a justified accusation and blame for a failure on a contractor, supplier or business partner, as a way of saying: “Look, this is not a failure in our own operation; you can still trust us with everything we are doing for you”. It does mitigate responsibility somewhat, though from a consumer viewpoint this kind of ‘clearing’ does not work and is often doomed to be rejected. The companies that market the implicated products did allow them to be distributed to consumers. At the end of the day, it is their brand names on the products that count.

It is impossible nowadays to completely eliminate food contamination, particularly by bacteria. However, food companies (and not them alone) can and should make every effort for preventing bacterial and other types of contamination and poisoning. They are expected to show that they are proactively taking measures to that aim. In addition, the owners and executives have to be open and sincere about the causes or circumstances of recalls to consumers, and consider revealing incidents even beforehand as indication the company is acting responsibly. It is pure investment in the credibility of their brands.

Ron Ventura, Ph.D. (Marketing)

Note:

These articles appeared in Fortune (Europe Edition), Number 13, 1st October 2015:

“Contamination Nation”, Beth Kowitt, pp. 53-56.

“How Blue Bell Blew It”, Peter Elkind, pp. 56-58.

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The World Health Organization (WHO) created a storm of confusion and panic when it published on 26 October (2015) its warning on cancer risks from processed meat as well as red meat. The warning arose as the outcome of a year-long effort by a committee of 22 experts, led by WHO’s International Agency for Research on Cancer (IARC), who reviewed and analysed findings from 800 studies carried out in past years across the globe. The warning itself, alarming enough, is not disputed; the problem concerned here is with the way the IARC made its warning announcement to the public.

Before referring to the content of the cancer warning, it should be emphasised that this research project did not bring any new data as evidence but analysed collectively results from previous studies at various research institutions (i.e., it was a meta-analyis type of research; originally published in the medical journal Lancent Oncology). Thus, warnings about the risks of cancer in consuming larger amounts of processed meat and red meat, and findings that support them, are not new. The IARC added an important authoritative backing with the intention that its voice will receive greater public attention and better succeed in persuading consumers to modify their behaviour. However, the announcement was not made cleverly, and without corrective measures may end in failure of the IARC’s initiative.

The warning of the IARC is actually composed of two warnings, at two different levels of risk. The IARC distinguished in its press release (no. 240) between two categories of risk to which it assigned processed meat and red meat as follows:

Category 1: “Carcinogenic to humans”. Processed meat is classified in this category together with asbestos, tobacco (smoking), alcohol and arsenic. It is causally linked to bowel cancer, particularly colorectal cancer — IARC states that the classification relies on sufficient evidence in humans that consumption of processed meat causes colorectal cancer (i.e., colon and rectal). Processed meat relates to meat products that have gone through processes of curing, salting, smoking and fermentation to improve their preservation. They include popular products like sausage, hot dog, bacon, ham, and salami.

Categroy 2A: ” Probably carcinogenic”. The classification of red meat in this category is based on limited evidence of its causal link to cancer in humans but strong mechanistic evidence of a carcinogenic effect. Red meat includes beef & veal, lamb & sheep, and pork (e.g., in fresh cuts or mixes).  It has been identified as a probable cause of colorectal cancer but also associated with pancreatic and prostate cancers.

  • Unexplained in the press release, a mechanistic effect relates to the effect of chemical substances or processes at the individual level (i.e., on a single organism). It is enough to suggest here that stating ‘strong mechanistic evidence’ is ambiguous to most people since they cannot understand the significance (even after definition).

There can be little wonder that the announcement of IARC alarmed and puzzled consumers, plausibly holding their heads in their hands and saying: “What should we do now about those meat products that we eat?” Because so many meat products or food items seem to be covered in those warnings, consumers are justified in feeling lost about the drastic reduction in menu that is looming, especially for the more carnivore ones, vis-à-vis a fear of cancer. The news media has tried to fill some of the void with the help of health, food and diet experts, but with little help directly from WHO, in answering questions such as what food made of meat can one continue to consume and how much. Some experts, nonetheless, contributed positive recommendations that go beyond meat consumption.

With regard to the level of risk, the IARC did indicate the estimate of its experts that eating daily 50 grams (1.8 ounce) more of processed meat increases the risk of contracting colorectal cancer by 18%. In a separate comment to Reuters, Dr. Kurt Strife of IARC clarified that the risk of developing colorectal (bowel) cancer in an individual from eating processed meat remains low but this risk increases when a greater amount of meat is consumed. The issue of quantity consumed is material as reflected also in recommendations from other sources. However, the IARC apparently did not see it as its responsibility to explain and recommend to the public how to act following its warning. In the official announcement to the press, Dr. Christopher Wild, director of IARC, called on governments and international regulatory agencies to “conduct risk assessments, in order to balance the risks and benefits of red meat and processed meat and to provide the best dietary recommendations”. The call on other agencies to act is commendable but the self-exemption by IARC is flawed.

The choice of IARC to couple its warning on processed meat as a cause of cancer with the warning on red meat as probable cause raises another problem. First, it produced an excessive warning with an overwhelming effect, asking the public to face a health limitation on a broad range of meat products at once. Consumers were likely to confront the joint-group heading “processed meat and red meat” before they could grasp the difference in level of risk; next they might assess more deeply the specific classes of meat and its products included. Second, adding at this time the warning on red meat could distract consumers from attending to and heeding the more serious cancer warning on processed meat, that is based on more conclusive evidence. It seems most acceptable from academic and clinical perspectives to publish the two warnings together, and it is understandable in regard to public health that the IARC would not want the risk associated with red meat to be neglected. Yet, when it comes to informing the public in the general media, the joint-warning could be superfluous and less effective in persuading consumers about the need to change their diet in view of cancer risks of either processed meat or red meat.

In advertising, brands are often cautioned that over-reaching product claims or promises might be received by consumers with disbelief and suspicion and thereafter be discarded. Conversely, excessive or too harsh warnings might induce disbelief and paralysing fear followed by resentment and rejection. On either side, messages that are perceived as excessive do not invoke trust in consumers, and in this case, not gaining their trust could be detrimental.

Another flaw in the press release that raised particular rage is the insinuated equivalence between eating processed meat and smoking tobacco. Associations in the meat industry attacked this equivalence and the research as a whole (e.g., UK, US, Canada, Australia), and government officials and other experts expressed their respective reservation in the media. It has been noted that there are grades in level of risk among causes of cancer in the first category, and that smoking remains the most dangerous single cause of cancer, much riskier than eating processed meat; excessive drinking of alcohol also bears a higher risk than the latter. But the mere listing of all those causes of cancer together, flatly as members in the same category, makes them equal and non-distinguishable to consumers. The IARC managed to grab attention alarmingly but probably not in the way they desired.

Different interpretations were suggested in the media, mostly in attempt to explain the meaning and implications of the warnings and to calm some of the public scare that was giving signs. Special attention was dedicated to differentiating between the cases of processed meat and red meat. The British Guardian told its readers that it was not advised to stop eating any processed meat or red meat. However, they clarified, consumption of processed meat should be cut considerably, particularly for those who are in habit of eating these food items daily (e.g., in breakfast). In addition, consumers are recommended to sanction their consumption of red meat, eating more moderately (“Processed Meats are Ranked Alongside Smoking as Cancer Causes – WHO”, The Guardian Online, 26 October 2015).

  • It is noted that in its press release the IARC stressed that their findings support previous recommendations to limit the intake of those types of meat, and in a later clarification to the media they iterated that IARC did not recommend to stop eating those meat products. In the press release Dr. Wild also acknowledges the nutritional value of red meat, confirming that there are benefits to consuming it.

The Guardian brings specific recommendations from the World Cancer Research Fund that people should not eat more than 500 grams of red meat (beef, sheep and pork) a week, and to reduce as much as possible their consumption of processed products (e.g., ham, bacon, salami). Dr. Elizabeth Lund, an independent consultant in nutrition and gastrointestinal health, offers yet a more balanced approach in face of IARC’s warnings with helpful practical recommendations to consumers: “A much bigger risk factor is obesity and lack of exercise. Overall, I feel that eating meat once a day combined with plenty of fruit, vegetables and cereal fibre, plus exercise and weight control, will allow for a low risk of colorectal cancer and a more balanced diet.” 

Beef products attract great attention in their defence. Advocates emphasise the importance of how beef items are prepared and the method of heating. The problem is argued to be mostly with products prepared and packaged in advance by mass food manufacturers, but that is only a partial factor in the generation of cancer risk. Beef is often recommended for its content of iron [as well as proteins and other nutritional components.] However, scientists suggested that iron may lead to release of nitrates that act as a carcinogenic agent. This process may happen during preparation, grilling or frying, but also during digestion. According to this assertion, the main cause for alarm is attributed not to the ingredients added to meat but to compounds created during the heating of meat (e.g., quick, high temperature) or digestion. Beef items like hamburgers and kebab prepared at home or in small private-business premises from fresh mixes could be safer, but it does not eliminate the risk completely. This issue appears as a sensitive subject of controversy and friction between large manufacturers, small butcher enterprises, and restaurants (competing among themselves) and health agencies and experts.

Raising fear in consumers can move them to take necessary action to reduce the risk (e.g., not driving after drinking alcohol) — research has provided support for a positive effect of fear inducement. Scaring people, such as by an excessive demonstration of a threat (e.g., car accidents) or its scope, may cause a paralysing effect but even that may not be the main problem. Goldstein, Martin and Cialdini suggest that a greater problem occurs when inducing fear without guiding people how they can reduce the danger. If the producer of the risk warning does not accompany it with recommendations for action in order to reduce it, a consumer is left with the fear with no way out. He or she is more likely in this situation to deal with the fear by “blocking-out” the message, dissociating oneself from the threat, and indeed be paralysed into taking no action (1). This is where IARC failed — they introduced the fear by itself. It was IARC’s responsibility as issuer of the warning to recommend actions to consumers like how to change their diet and taking other supportive measures.

Another viewpoint concerns the way consumers approach the risk and respond to it. Pennings, Wansink and Meulenberg propose decoupling the risk perception (i.e., how consumers assess the level of uncertainty) from the risk attitude (e.g., the extent to which consumers are risk-aversive) in anticipating consumer response to a risk (e.g., decreased food safety) and confronting it. What counts first is the chance a consumer perceives that he or she will be personally affected and then how to deal with it (e.g., stop or reduce consuming the risky food). Furthermore, the researchers suggest that segments which differ in their risk perception and attitude, and how they weigh them, should be distinguished; they may require each a different treatment (2).

The case here is different from the crisis case studied by Pennings et al. (‘mad cow disease’) because it did not arise due to an epidemic outbreak or a company’s malpractice (e.g., crisis of Remedia’s milk formulae for babies in Israel) — it is not a particular event but a more ongoing condition. Yet, at this point in time it is a crisis for consumers evoked by a new warning about a health threat. Health authorities and agencies will have to decide, for example, if the more appropriate strategy in any market or segment is to provide clearer information about the level of risk (reducing uncertainty) or tighten controls and supervision of food production of meat (i.e., because consumers do not tolerate cancer risk at almost any level of probability).

  • Special consideration may also be needed to persuade segments like young consumers in their 20s who do not care how their behaviour will impact their health thirty years away, partly because they simply cannot imagine what bad impact it could have — they are concentrated on enjoying their lives today; or consumers in lower socio-economic decile who eat those types of meat products (e.g., hamburgers, hot dogs) out of necessity, because these are cheaper food items for their meals.

The researchers and officials at IARC and WHO are clearly concerned about the possibility that consumers will become ill with cancer due to the amounts of processed meat and red meat that they eat, aiming at causing consumers to change their diet habits and reduce the threat and suffering. But they left a void by launching an incomplete persuasion effort — it was taken as over-threatening on one hand and lacking guidance on the other hand through practical recommendations to consumers how to act to improve their health prospects. In order to increase the chance that consumers will heed the risk and act as desired the IARC will be required to provide guidance and support to the public on its own and through collaboration with other agencies for a quicker response to consumer confusion and fear.

Ron Ventura, Ph.D. (Marketing)

Notes:

(1) Yes! 50 Secrets from the Science of Persuasion; Noah J. Goldstein, Steve J. Martin, & Robert B. Cialdini, 2013; Profile Books.

(2) A Note on Modeling a Consumer Reaction to a Crisis: The Case of the Mad Cow Disease; Joost M.E. Pennings, Brian Wansink, & Matthew T.G. Meulenberg, 2002; International Journal of Research in Marketing, 19, pp. 91-100.

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Obama’s administration is taking a bold step in fighting overweight and moreover obesity: requiring chain restaurants and similar food establishments to post information on food calories for their items or dishes on menus and menu boards. The new directive published in November 2014 by the United States’ Food and Drug Administration (FDA) is mandated by the Affordable Care Act passed by Congress in 2010. The expectation is that restaurant customers will consider the nutritional values, particularly calories, of  food items on the menu if the information appears in front of them, inducing them to make more healthy choices. It is estimated that Americans consume a third of their calories dining out. But will consumers, who are not voluntarily concerned about healthy dietary, change their eating behaviour away-from-home just because the information is easily and promptly available?

The new requirements of the FDA apply to restaurant chains with 20 or more outlets, including fast food chains — likely a primary target of the new directive. Detail of total calorie content of food items should appear on print menus (e.g., at full-service restaurants) and menu boards positioned above counters for ordering (e.g., at fast-food restaurants). The rule covers meals served at a table or taken to a table by the customer to be consumed, take-away food like pizzas, and food collected at drive-through windows. Also included are sandwiches-made-to-order at a grocery store or delicatessen, coffee-shops, and even ice-cream parlours. (1)

  •  The FDA directive also refers in a separate section to food sold through vending machines by owners or operators of 20 or more machines.

Calorie content in a food item (actually kilocalorie) indicates the amount of energy it provides. Usually the energy intake of consumers from meals, snacks and refreshments is more than the body requires, and the surplus not “burned”   accumulates and adds to body weight. The rule maintains that additional information on components such as calories from total and saturated fat, sodium, carbohydrates, protein, and sugars should be made available on request in writing. Critics could argue that while a summary measure of energy is an important nutritional factor, other nutritional values as those mentioned by the FDA, and more (e.g., fat in grams, Vitamins A and C), also need to be transparent to consumers. Practically, loading menus, and foremost menu boards, with too many nutritional details may be problematic for both business owners and their customers. Therefore, there is logic in focusing on an indicator regarded of higher priority. Nonetheless, restaurants should offer a supplementary menu with greater nutritional values to customers who are interested. Again, the question is how many customers will request and use that extra information.

The food service industry overall reacted positively to the new rules. The National Restaurant Association in the US (representing 990,000 restaurant and food-service outlets) is satisfied with the way the FDA has addressed its major concerns. Contention remains over food sold in amusements parks and cinemas, and regarding fresh sandwiches and salads and ready-to-eat meals made by supermarkets for individual consumers (i.e., single-serving). In fact,  several restaurant chains have already been displaying nutritional information on menus voluntarily for several years to cater for more health-conscious customers and improve their retail-brand image (e.g., Starbucks, McDonalds, Subway). Some chains also provide detailed nutrition information and assistant tools for customers to plan their meals on the chains’ websites. It should further be noted that regulations for posting nutrition information in food-service establishments are in place at the level of local authorities in various cities and counties across the US. Business and regional administrative initiatives are not new in the US as well as in Canada and other countries. However, such measures will be obligatory in the US at a country-level within a year ahead.

Consumers are likely to have some general guidelines (a schema of rules) in memory that they can consult on what is more or less healthy to eat and how much to eat of different items (e.g., “high levels of calories, fat and salt in hamburgers and french fries”, “cream cakes are rich with calories and sugar”). When arriving to a restaurant or coffee-shop, the more conscious consumer may apply those guidelines to compose one’s meal with greater care for his or her health. Yet, the ability to extract accurate nutrition values of food items offered on the menu is likely to be rather limited — our memory is not accurate and retrieving information may also be biased by prior goals or hypotheses. Even if we consider only total calories, we would recall gross estimates or value ranges for general food categories. Consumers furthermore tend to take into account only the alternatives explicitly presented and attribute information available on them in a choice setting (a “context effect”). Information not provided (e.g., has to be retrieved from memory) is likely to be ignored. Customers anxious enough may pull out a mobile device and look up some more accurate nutritional information from an app or a website of the company or a third-party source. But for most consumers, it should appear, there is strong logic as well as justification to provide the nutrition information on specific food items easily accessible at the food outlet to allow them to consider it on-the-spot in their choices.

A probable cause of resistance from consumers to take into account the nutritional content of the food they are about to order is that this might spoil their pleasure of eating the meal.  People commonly prefer to concentrate on which items to order that will be more enjoyable for them on a given occasion. The negative nutritional consequences of the desired food could be considered as ‘cost’, just like monetary price and perhaps even worse, a notion consumers would like to avoid. There is also a prevailing belief that healthier food is less tasty. To make consumers more receptive they would have to be persuaded beforehand that this belief is false or that nutritional components have both positive and negative consequences to consider. Surely consumers have to account for constraints on their preferences; health advocates have to help and ease any barriers to embracing health constraints, or turn pre-conceived constraints into consumers’ own preferences.

We may gain another insight into consumer food choices by considering the comparisons consumers utilise to make decisions. Simonson, Bettman, Kramer and Payne (2013) offer a new integrative perspective on the selection and effect of comparisons when making judgements and choice decisions — how consumers select the comparisons they rely upon vis-à-vis those they ignore, and what information is used in the process. They propose that the comparisons consumers seek have first to be perceived relevant and acceptable responses to the task (e.g., compatible with a goal); these comparisons fall within the task’s Latitude of Acceptance (LOA). They also need to be justifiable. Then, consumers will prefer to rely upon comparisons that are cognitively easier to perform (i.e., greater comparison fluency), given the information available on options. Importantly, even if bottom-up evidence suggests that certain comparisons require less effort to apply, these will be rejected unless they are instrumental for completing the task. Information factors that can facilitate the comparison between options may affect, however, which comparisons consumers perform among those included in the LOA. The following are factors suggested by the researchers that increase the probability that a comparison will be performed: attribute values that can be applied “as-is” and do not need additional calculation or transformation (i.e., “concreteness effect”); alignable input (i.e., values stated in the same units); information perceptually salient; and yet also information that can generate immediate, affective responses. (2)

Let us examine possible implications. Suppose that you visit a grill bar-restaurant of a large known chain. You have to choose the food composition of your meal, keeping with one or more of the following personal goals: (a) “not leave hungry” (satiated); (b) pleasure or enjoyment (taste/quality); (c) “eat healthy” (nutrition); (d) “spend as little as possible” (cost). Calorie values are stated on menu in a column next to price. If the primary goal is to keep a healthy diet you would most likely use calorie information to compare options. However, if “eat healthy” is not a valued goal for you, there is greater chance that calorie information will be ignored — even if values of calories are very easy to read-out, assess and compare. They may be perceived as distraction from considering and comparing, for instance, the ingredients of items that would determine your enjoyment from different food options. Consumers often have a combination of goals in mind, and thus if your goals are nutrition and price, there is an advantage to displaying numeric calorie and price values next to each other across items. It would be more difficult to weigh-in calories with information on ingredients that should predict enjoyment or satiation as your goals. Therefore, it can be important to display nutritional values in a format that facilitates comparison, and not provide too many values. Yet, if “eat healthy” is not one’s goal all those measures are unlikely to have much effect on choice.

  • Some would argue that a salient perceptual stimulus can trigger consumer response in the desired direction even unconsciously. That is a matter for debate — according to the viewpoint above strong perceptual or affective stimuli will not be influential if the consumer’s goal is driving him in another direction.
  • Given the growing awareness to health, justifying decisions based on calories to others may be received more favourably. Can this be enough to induce consumers to incorporate a nutrition comparison in their decision when it is not their personal goal?

A research study performed by the Economic Research Service (ERS) of the US Department of Agriculture (USDA) examined consumer response to display of nutrition information in food service establishments, comparing between fast-food and full-service chain restaurants. The researchers (Gregory, Rahkovsky, & Anekwe, 2014) show that consumers who see nutrition information have a greater tendency to use it during choice-making in full-service restaurants; overall, women are more sensitive to such information than men (especially using it in fast-food restaurants). Furthermore, they provide support that consumers who are already more conscious and care about a healthful diet are more likely to react positively to nutrition information in restaurants:

  • Consumers who inspect always or most of the time the nutrition labeling on food products purchased in a store (enforced in the US for more than twenty years) are more likely to see and then use the nutrition information presented in full-service restaurants (notably, 76% of those who inspect the store-food labeling regularly use the information seen in the restaurant versus 18% of those who rarely or never use the labeling on store-food).
  • Additionally, the researchers find that a Healthy Eating Index score (measuring habitude to using nutrition information and keeping a healthy diet) is positively correlated with intention to use nutrition information in fast-food or full-service restaurants (those who would often or sometimes use the information in full-service restaurants score 57-54 versus those who would use it rarely or never who score 50 on a scale of 1 to 100).

Gregory and his colleagues at USDA-ERS argue that following these findings, displaying nutrition information on menus at food-away-from-home establishments may not be enough to motivate consumers not already caring about healthful diet to read and use that information — “It may be too optimistic to expect that, after implementation of the nutrition disclosure law, consumers who have not previously used nutrition information or have shown little desire to use it in the future will adopt healthier diets.”

A research study in Canada involved an interesting comparison between two hospital cafeterias, a ‘control’ cafeteria that displays limited nutrition information on menu boards and an ‘intervention’ cafeteria that operates an enhanced programme displaying nutrition information in different formats plus educational materials (Vanderlee and Hammond, 2014). The research was based on interviews with cafeteria patrons. A significantly higher proportion of participants in the ‘intervention’ cafeteria reported noticing nutrition information (80%) than in the ‘control’ cafeteria (36%). However, among those noticing it, similar proportions (33% vs. 30%, respectively) stated that the information influenced their item choices. Hospital staff were more alert and responsive to the information than visitors to the hospital and patients. This research also indicates that customers who use more frequently nutrition labels on pre-packaged food products are also more likely to perceive themselves being influenced by such information.

Vanderlee and Hammond subsequently found lower estimated levels of calories, fat and sodium in the food consumed in the ‘intervention’ cafeteria than the ‘control’ cafeteria (using secondary information on nutrition content of food items). In particular, customers at the ‘intervention’ cafeteria who specifically reported being influenced by the information consumed less energy (calories).(3)

Actions to consider: Fast-food restaurants may place menus with extended nutrition information, beyond calories, on or next to the counter where customers stand for ordering. Full-service restaurants may place extended menus on tables, or at least a card inviting customers to request such a menu from the waiter. It may be advisable to add one more nutrition value next to calories as a standard (e.g., sugars because of the rise in diabetes and the health complications it may cause). Notwithstanding, full-service restaurants could be allowed to implement the rule during the day (e.g., for business lunch), but in the evening spare customers the pleasure of dining-out as entertainment without worries. Nonetheless, menus with nutrition information should always be available on request.

Nutrition information displayed on menus and menu-boards can indeed help consumers in restaurants, coffee-shops etc., to make more healthy food choices, but it is likely to help mostly those who are already health-conscious and in habit of caring about their healthful diet. Information clearly displayed has a good chance to be noticed; yet, educating and motivating consumers to apply it for a healthier diet should start at home, in school, and in the media. A classic saying applies here: You can lead a horse to the water but you cannot make it drink. Nutrition information may be a welcome aid for those who want to eat more healthy but it is less likely to make those who do not care about healthful diet beforehand to use the information in the expected manner.

Ron Ventura, Ph.D. (Marketing)

Notes:

(1) Overview of FDA Labeling Requirements for Restaurants, Similar Food Retail Establishments and Vending Machines, The Federal Food and Drug Administration (US), November 2014 http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm248732.htm; Also see: “US Introduces Menu Labeling Standards for Chain Restaurants”, Reuters, 24 Nov. 2014. http://www.reuters.com/article/2014/11/25/usa-health-menus-idUSL2N0TE1KP20141125

(2) Comparison Selection: An Approach to the Study of Consumer Judgment and Choice; Itamar Simonson, James R. Bettman, Thomas Karamer, & John W. Payne, 2013; Journal of Consumer Psychology, 23 (1), pp. 137-149

(3) Does Nutrition Information on Menus Impact Food Choice: Comparisons Across Two Hopital Cafeterias; Lana Vanderlee and David Hammond, 2013; Public Health Nutrition, 10p, DOI: 10.1017/S136898001300164X. http://www.davidhammond.ca/Old%20Website/Publication%20new/2013%20Menu%20Labeling%20(Vanderlee%20&%20Hammond).pdf; Also see: “Nutrition Information Noticed in Restaurants If on Menu”; Roger Collier; Canadian Medical Association Journal, 3 Aug., 2013 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735740/

 

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