Perceived Effect of Calorie Count Display on Customers' Eating Behaviors in Food Facilities of Eastern Province, Saudi Arabia: A Mixed Method Study.

BACKGROUND: As the Saudi Food and Drug Authority (SFDA) has recently requested all food facilities to display the calorie count on their menus, this study aimed to identify the perceived changes in costumers' eating behaviours in response to the calorie count display (CCD) policy in the Eastern Province. METHODS: This was a mixed methods study. The first being quantitative, using a cross-sectional questionnaire which included 400 customers of both genders, aged 10 years and older, and was collected at food facilities from three cities in the Eastern Province. Customers completed a self-administered questionnaire and handed their registered receipts. Collected receipts were used to calculate the total calories ordered per customer. The second method is a qualitative in-depth interview with food facility managers. RESULTS: Customers who reported checking the CCD were 30.5% of the total sample, and 58.2% of them changed their order accordingly. The mean calories ordered were 36 kcal less in customers checking the CCD than those who do not (P=0.674). Customers who exhibit healthy lifestyle habits calculate their daily consumed calories, knowledgeable of the recommended daily caloric intake (RDCI), dining in a dine-in restaurant, and have an educational level of above high school were more likely to check the CCD. This study found that customers who cared to check the CCD were more likely to change their eating behavior. It has been found that only a small percentage (12% to 18%) of customers were knowledgeable regarding the RDCI. After the implementation of the policy, restaurant managers reported a positive change in customers eating behavior, which was more profound in females and athletes. CONCLUSION: There is a significant association between checking the CCD and positive behavioral changes in customers' eating behaviors. The results of this study suggest that further enforcement and awareness raising are crucial to increase the number of customers checking and using the CCD.