{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:59:30Z","timestamp":1787507970828,"version":"build-2736575974"},"reference-count":57,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Restaurants are increasingly interested in capitalizing on consumer interest in environmental sustainability by marketing their products with ecolabels, which signal when foods are more environmentally sustainable. Ecolabels could improve the healthfulness of restaurant meal selections and reduce their carbon footprint, but this potential remains largely untested.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test whether displaying ecolabels on restaurant menus improves the healthfulness and reduces the carbon footprint of restaurant meal selections.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This randomized clinical trial was conducted online in September to October 2024. A national sample of US adults (aged \u226518 years) was recruited. Participants were randomly assigned to the ecolabel or control arm. Participants viewed a restaurant menu mimicking a popular full-service restaurant and selected items they wanted to order. Statistical analyses were based on the intention-to-treat principle.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n \n In the ecolabel arm, participants viewed a menu that displayed ecolabels next to entr\u00e9es and appetizers with a lower carbon footprint (ie, below the median of 1.625 kg of carbon dioxide equivalent [CO\n 2<\/jats:sub>\n e] emissions per item). In the control arm, participants viewed a menu that did not display ecolabels.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The outcomes included overall healthfulness (assessed using Ofcom Nutrient Profiling Model scores; range: 0-100, with higher scores indicating healthier items), nutrient content, and total carbon footprint of participants\u2019 entr\u00e9e and appetizer selections and entire orders (including beverages and desserts).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 3147 participants completed the online trial (1560 men [50%]; mean [SD] age, 34.5 [12.5] years). Participants in the ecolabel arm did not select entr\u00e9es and appetizers (average differential effect [ADE], 0.45 [95% CI, \u20130.18 to 1.09];\n P<\/jats:italic>\n \u2009=\u2009.16; Cohen\n d<\/jats:italic>\n \u2009=\u20090.05) or entire orders (ADE, 0.47 [95% CI, \u20130.09 to 1.03];\n P<\/jats:italic>\n \u2009=\u2009.10; Cohen\n d<\/jats:italic>\n \u2009=\u20090.06) that were statistically significantly healthier compared with the selections of participants in the control arm. Participants in the ecolabel arm selected entr\u00e9es and appetizers (ADE, 0.87 [95% CI, 0.12-1.62] g;\n P<\/jats:italic>\n \u2009=\u2009.02; Cohen\n d<\/jats:italic>\n \u2009=\u20090.08) and entire orders (ADE, 0.82 [95% CI, 0.07-1.56] g;\n P<\/jats:italic>\n \u2009=\u2009.03; Cohen\n d<\/jats:italic>\n \u2009=\u20090.08) with more fiber, compared with the selections of participants in the control arm, but did not select entr\u00e9es and appetizers or entire orders with statistically significantly different amounts of protein, sugar, saturated fat, or calorie content. Participants in the ecolabel arm selected entr\u00e9es and appetizers (ADE, \u20130.78 [95% CI, \u20131.25 to \u20130.32] kg of CO\n 2<\/jats:sub>\n e emissions;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001; Cohen\n d<\/jats:italic>\n \u2009=\u2009\u20130.12) and entire orders (ADE, \u20130.81 [95% CI, \u20131.27 to \u20130.34] kg of CO\n 2<\/jats:sub>\n e emissions;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001; Cohen\n d<\/jats:italic>\n \u2009=\u2009\u20130.12) with lower carbon footprints than the selections of participants in the control arm.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, menu ecolabels reduced the carbon footprint of restaurant meal selections without worsening nutritional quality. Ecolabels could be a scalable, low-cost strategy to reduce the carbon emissions of restaurant food choices.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT06584539<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.24773","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T15:00:24Z","timestamp":1754319624000},"page":"e2524773","source":"Crossref","is-referenced-by-count":8,"title":["Ecolabels and the Healthfulness and Carbon Footprint of Restaurant Meal Selections"],"prefix":"10.1001","volume":"8","author":[{"given":"Anna H.","family":"Grummon","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California"},{"name":"Department of Health Policy, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda B.","family":"Zeitlin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina J. 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