The influence of menu labelling on food choices among children and adolescents: a systematic review of the literature.

INTRODUCTION
Childhood obesity is a serious public health concern internationally, and population-level interventions are needed to support healthy food choices. Existing reviews of menu labelling have focused predominantly on adults. However, childhood and adolescence are distinct periods of development during which longer term eating behaviours and food preferences are established. Although some studies have examined the effect of menu labelling among children and adolescents, no reviews have synthesised this evidence.

OBJECTIVE
To assess whether menu labelling influences the amount of calories ordered by children and adolescents (or parents on behalf of youth) in food outlets including restaurants and cafeterias.

METHODS
Comprehensive literature searches were conducted in Medline, Scopus, PsycINFO, CINAHL, SocINDEX and Embase databases. Eleven relevant studies were identified from an initial search yielding 1,682 results. Studies were assessed using a validated quality assessment tool.

RESULTS
Examinations of hypothetical food purchases in artificial environments suggest that menu labelling may be efficacious in reducing calories purchased for or by children and adolescents. Real-world studies are less supportive, although school-based studies were generally positive. It is unclear whether contextual or interpretive menu-labelling formats are more effective compared to numeric calorie information alone.

CONCLUSION
Evidence supporting the impact of menu labelling on lowering the energy content of restaurant and cafeteria food choices made for or by children or adolescents is limited. There remains a need for high-quality studies conducted in real-world settings.