Americans are wildly underestimating the amount of salt in their food


SALT
Flickr

Which do you think has more salt: a Panera Bread wild blueberry scone or a large
order of Burger
King french fries
?

Starting May 5, restaurants and food stores across the US were
going to be required to include calorie counts on their menus.
The Trump administration has delayed calorie labeling until next year,
and is considering relaxing the requirements for certain food
service establishments, a push that’s been led by the supermarket
and pizza lobbies.

In the meantime, some businesses will likely start implementing
the labels anyway. The push toward transparency in nutrition is
popular – more than 60 percent of Americans across
political parties are in favor of the policy. Even the National
Restaurant Association, the country’s largest food service trade
organization, supports it.

But calories don’t capture everything about your food – like the
fact that the Panera scone has twice as much salt as the large
fries.

This led us to wonder whether consumers accurately estimate the
salt in their restaurant meals. We analyzed the meals of more
than 1,000 diners and discovered big misperceptions. This
suggests consumers need more information about what’s in their
restaurant meals. Adding information about the sodium content of
menu items could help.


saltReuters/Thierry Roge

Calorie labeling

Over the last decade, it has become increasingly common for
restaurants to post calories on menus. New York City started the
trend in 2008 by making this a requirement for chain restaurants,
and several cities and states soon followed.

Some restaurant chains even started posting this information
voluntarily nationwide. For example, Starbucks and McDonald’s
label all of the food on their menus (revealing that,
surprisingly, a Starbucks Venti Frappuccino has more calories
than a McDonald’s Cheeseburger!).

As part of the Affordable Care Act (ACA), chain restaurants,
supermarkets, movie theaters and similar food retailers with 20
or more locations will be required to include calories on menus.
Places like Chipotle, AMC Theaters and even Whole Foods will need
to post calories on nearly all foods that don’t have a nutrition
facts label. Menus will also note that most Americans need to
consume about 2,000 calories per day, so consumers have a point
of reference. (So far, these rules are not affected by the push
to reform the ACA.)

It’s not yet clear whether the initiative will
push consumers to change their purchases. But there is some
evidence that it may motivate restaurants to cut
the calories
in popular menu items. In recent years,
restaurants have introduced new lower-calorie options, possibly in preparation for
the labeling law.

Calorie labeling may seem like a win-win, supported by consumers
and restaurants alike, but it has a downside. Because there’s now
a federal rule about nutrition disclosures on restaurant menus,
state and local governments can’t create a rule with different
requirements. This means that cities can’t require chain
restaurants to post other nutrients – like sodium – on their
menus.


salt shaker
Flickr/Steve
Snodgrass


Sodium on the menu

Prior to the federal law, state and local governments had
considered adding sodium to menu boards. They hoped consumers
would use this information to choose lower sodium items and that
restaurants would reformulate menu items to be lower in salt.

High sodium intake increases blood pressure, a major risk factor
for heart disease and stroke. Though scientists disagree about
optimal levels of sodium intake, there is widespread agreement that current levels of
consumption among Americans are too high. In the US, the average
adult consumes about 3,400 milligrams of sodium each day. That’s
nearly 50 percent higher than the
current recommended upper limit of 2,300 mg per day
.
Researchers estimate that a 40 percent reduction in sodium over
10 years could avert up to half a million deaths.

Very little of the sodium in your diet comes from the salt
shakers on your kitchen table. More
than 70 percent
is from packaged and restaurant foods. Salt
may be used to make foods more palatable or as a preservative to
extend shelf life.

As a result, high-sodium foods often don’t even taste salty. For
example, Panera’s blueberry scone contains 900 mg of sodium –
nearly 40 percent of the daily upper limit. Other items can vary
widely in sodium content. A tuna sandwich at Au Bon Pain
has 560 mg of sodium, while Cosi’s has
1,099 mg.

In a 2015 survey across 26
states
, most Americans reported taking action to reduce
sodium in their diets. But if high-sodium foods don’t always
taste salty, and similar items can have drastically different
amounts of sodium, do consumers really have the information they
need to make low-sodium choices?


salt and pepper
Flickr/Didriks

Massively underestimating sodium

We sought to answer this question by surveying adult and
adolescent diners at six fast food restaurants in four New
England cities.

We set up shop in restaurant parking lots and asked customers to
estimate the recommended daily sodium intake, as well as to
identify the amount of sodium in their meal purchase. We then
calculated the actual sodium content of their meals by collecting
each diner’s receipt and matching purchases to sodium information
from restaurant websites.

In our study, the sodium content of fast food
meals was very high. On average, adult and adolescent meals
contained about half of the recommended daily sodium intake. More
than 10 percent of meals contained more than an entire day’s
worth of sodium.

Yet, awareness of sodium in meals was low. One-quarter of
consumers could not provide an estimate. If they did, it was way
off the mark. Eighty-eight percent of adolescents and 90 percent
of adults underestimated sodium in their meals. On average,
adults underestimated sodium by 1,013 mg and adolescents by 876
mg.

Underestimation worsened as sodium content of the meal
increased, meaning consumers who purchased the highest-sodium
meals had the hardest time with estimates. Most diners also
underestimated their daily sodium recommendation, indicating a
general lack of awareness both about how much sodium to consume
in a day and how much restaurant foods contribute.


Food Label
Flickr

The case for sodium labels

People likely underestimate the sodium in their meals because
there is no visible, prominent information at point of
purchase. All of the restaurants in our study provided sodium
information in some way – on websites, napkins, cups or
posters. This doesn’t appear to be an efficient means of
communicating. Prior research has shown that fewer than 1 percent of consumers read nutrition
information when provided in locations other than menus or menu
boards.

Although federal laws prohibit cities and states from requiring
sodium information on menu boards, there are policy options for
addressing the underestimation problem. For example, New York
City recently required chain restaurants to post sodium warning
labels on menu boards next to items with more than 2,300 mg of
sodium. The labels are considered food safety warnings, as
compared to nutrition disclosures, which means they are not
preempted by the federal law and are within the city’s
authority to regulate. This policy provides information about
sodium at point of purchase and encourages restaurants to
reformulate their highest sodium items. Other cities and states
could enact similar policies.

Alternatively, restaurants could choose to voluntarily add
sodium to their menu boards, making healthy choices easier for
the 53 percent of Americans actively trying to
reduce sodium intake.

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