Fast-food labeling that ties eating to exercise may be a weapon against childhood obesity, study finds

February 9, 2015

A new study by researchers at The University of North Carolina at Chapel Hill found that parents ordering fast-food meals for their children were more likely to order meals with fewer calories and encourage exercise when product labeling tied calorie intake to the amount of exercise needed to burn those calories.

Dr. Anthony Viera

Dr. Anthony Viera

The authors of the study are Anthony Viera, MD, MPH, and Ray Antonelli. Viera is director of the Health Care and Prevention Master of Public Health Program in the Gillings School of Global Public Health’s Public Health Leadership Program and distinguished associate professor of family medicine in the School of Medicine. Antonelli, a second-year medical student, is a Primary Care and Population Health Scholar in the School of Medicine.

Viera and his team have conducted a series of studies examining whether food menus labeled with physical activity calorie equivalents (PACE) may help consumers lower calorie intake and increase physical activity. The potential effects of such labeling for children, however, had not been examined previously.

Addressing children’s calorie intake and exercise patterns is vital, given the prevalence of childhood obesity in the U.S. In 2009-2010, nearly one-third of children in the U.S. ages 2 to 19 years was overweight, and one in six was obese. Children and teens who are obese tend to remain obese as adults, and both childhood and adult obesity has known adverse health outcomes in adulthood.

The Department of Health and Human Services and the American Heart Association recommend that children participate in a minimum of one hour of active physical movement daily. Only 42 percent of 6- to 11-year-olds are that active, and only 8 percent of 12- to 15-year-olds are.

Also of significance is the fact that about one-third of the calories in the average American diet is consumed at fast-food restaurants.

The researchers conducted a national survey of 1,000 parents randomly provided with one of four fast food menus – one with no calorie labeling, one with calories only, one with calories plus minutes of exercise needed to burn those calories and one with calories plus number of miles needed to walk to burn those calories.

Parents were asked to imagine they were in a fast food restaurant and ready to place an order for their child. The mean age of children in the families was 9.5 years.

Parents whose menus displayed no calorie labeling ordered an average of 1,294 calories for their child’s meal, whereas the menus with labeling resulted in lower-calorie choices (calories only labeling—1,066 calories; calories plus minutes—1,060 calories; and calories plus miles needed to walk labeling—1,099 calories).

After the survey, parents were asked how likely it was that the menu from which they selected their child’s meal would cause them to encourage their child to exercise. Only 20 percent of parents reported that calories-only labeling would be very likely to prompt them to encourage exercise. The other menus led to stronger prompts (38 percent for calories plus minutes, and 37 percent for calories plus miles).

The researchers concluded that PACE labeling may influence parents’ decisions about which fast food items to order for their children and may help them encourage children to exercise.

The study, “Potential Effect of Physical Activity Calorie Equivalent Labeling on Parent Fast Food Decisions,” was published online Jan. 26 in the journal Pediatrics.


Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or

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