Study: Weekly Text Message Could Encourage Healthier Food Choices

10 Sep 2014 --- Many people are unaware that the U.S. Food and Drug Administration's mandated nutrition labels are based on a 2,000-calorie-a-day diet, but a simple weekly text message reminder can greatly improve that awareness, according to a new study from the Johns Hopkins Bloomberg School of Public Health.

While not an outright recommendation, the 2,000-calorie benchmark is what the FDA considers a reasonable daily calorie intake for many adults. More importantly, nutrition labels on food products sold in the U.S. are based on it.

The key to translating nutrition labels and using them to make healthy food choices, researchers say, may be an understanding of this basic fact.

The study, published online in Health Promotion Practice, surveyed 246 participants dining in the Johns Hopkins Hospital cafeteria to assess their initial knowledge of the 2,000-calorie value. The cafeteria included calorie labels for food choices but no information on the daily context.

Participants were then randomly assigned to receive either a weekly text message reminder, a weekly email reminder, or no weekly reminder about the 2,000-calorie value. Participants received the reminder messages each Monday for four weeks; after the four weeks, their knowledge of the 2,000-calorie value was assessed with a follow-up survey.

Prior to receiving the weekly reminders, 58 percent of participants could not correctly identify the 2,000-calorie value, even those with college or graduate degrees. After the study period, those receiving the weekly text messages were twice as likely to correctly identify the 2,000-calorie value as compared to those who received no weekly reminder.

"While daily energy needs vary, the 2,000-calorie value provides a general frame of reference that can make menu and product nutrition labels more meaningful," says study leader Lawrence J. Cheskin, MD, director of the Johns Hopkins Weight Management Center at the Bloomberg School of Public Health. "When people know their calorie 'budget' for the day, they have context for making healthier meal and snack choices."

The FDA has proposed new menu-labeling regulations, which will soon require chain restaurants with 20 or more outlets to list calories on menus, menu boards, and drive-through displays. Cheskin says that those calorie counts are not helpful tools for making good food choices if people don't understand roughly how many calories they should consume each day.

"Given the low level of calorie literacy, simply posting calorie counts on menu boards is not sufficient," Cheskin says.

The weekly text and email reminders were based on The Monday Campaigns' model for health communications, which leverages the idea that Monday provides a weekly opportunity to start fresh and commit to new healthy habits, such as exercise regimens, healthy eating plans or smoking cessation. The Monday Campaigns is a nonprofit organization that started in 2003 with research support from the Johns Hopkins Bloomberg School of Public Health.

"There are many simple ways to convey calorie information to consumers, including point of sale communication, text messages, emails and even smart phone apps," Cheskin notes. "Ideally, these could work together, with calories posted on menus, restaurant signage and food labels along with personal reminders delivered through the latest technology. Our data indicate that weekly text messages are one element in this mix that can be effective."

Reference: "Consumer Understanding of Calorie Labeling: A Healthy Monday E-Mail and Text Message Intervention" was written by Michelle L. Abel, MSPH; Katherine Lee, MA; Ralph Loglisci, BS; Allison Righter, MSPH; Thomas J. Hipper, MSPH, MA; and Lawrence J. Cheskin, MD.