New York City became the first jurisdiction in the country to require sugar warnings on chain restaurant menus when the City Council passed the Sweet Truth Act in 2023. Restaurants with at least 15 locations had to start putting the symbols up this month next to menu items with more than 50 grams of added sugar, the maximum daily amount recommended in federal dietary guidelines.

“As the first in the nation to add a warning icon for added sugars, this rule underlines our longstanding work to ensure New Yorkers have information about the food they eat,” Dr. Michelle Morse, the acting city health commissioner, said in a statement. “Just one large sugary drink can exceed the daily recommended amount of added sugars.”

City officials and public health advocates are lauding the addition of the sugar spoons — which now appear on menus alongside calorie information and sodium warnings in the form of tiny salt shakers — as a way to empower consumers to make healthier dietary choices.

But public health researchers have found that past attempts to nudge fast-food patrons into better eating habits have had mixed results. And some worry New York’s small, black-and-white sugar spoons aren’t as eye-catching as they need to be to get consumers’ attention.

“ Noticing it is step No. 1 because it won’t have an impact unless someone notices it,” said Pasquale Rummo, an associate professor in the Department of Population Health at the NYU Grossman School of Medicine.

During the public comment period on the regulations, Rummo told city officials that research suggested a larger, red symbol with accompanying text would be more effective.

The new rules require chain restaurants to post warnings informing consumers of the health dangers associated with excess sugar consumption, such as an increased risk of type 2 diabetes, weight gain and tooth decay, but the sugar symbols themselves are detached from any text.

On a recent afternoon, sugar spoons were on display next to some, but not all, of the individual beverages and combo meals with more than 50 grams of added sugar at Lower Manhattan locations of McDonald’s, Taco Bell and Shake Shack.

But several customers who spoke to Gothamist said they didn’t notice the new addition to their favorite fast food menus — and weren’t sure they would have changed their orders if they did.

Abalee Reyes, a 16-year-old from the Bronx, said she goes to McDonald’s every couple of days. “ Today I had a Big Mac Meal, so that’s a large fry and a soda,” she said.

The medium Dr. Pepper Reyes got with her meal has 67 grams of added sugar, according to the nutritional information McDonald’s posts online. But at the McDonald’s Reyes visited, only individual sodas, not meals, came with a sugar warning at the self-serve ordering station, Gothamist observed.

“ I feel like it is a good idea in case some people don’t realize what they’re actually eating,” Reyes said of the sugar warnings. But, she said, even if she had seen the symbol, her order would have remained the same.

“I already know what I’m getting,” she said.

Tanner Krewson, a 27-year-old software engineer, was eating lunch at a nearby Shake Shack with his coworkers. “ I think people might be surprised by the amount of salt and sugar in things, but I didn’t notice the symbol,” Krewson said of the sugar spoon. “So, I’m not sure if it’s working.”

He added, “If there was a symbol that really got my attention it might give me some pause.”

Because the city’s Sweet Truth Act only applies to items that are either packaged (such as bottled soda) or identical to packaged items (such as fountain soda), some sugary beverages are notoriously left out. That includes a range of shakes and floats at Shake Shack that are listed online as having far more than 50 grams of sugar.

But that could change. The city will start requiring the sugar warning on more menu items if the U.S. Food and Drug Administration starts requiring chain restaurants to disclose added sugars, the way it does for prepackaged foods, said Gilda Giliam, a spokesperson for the city health department.

A similar law pending in the state Legislature would also extend to a broader range of products.

Will the sugar warnings influence New Yorkers’ orders?

Rummo is leading a study funded by the National Institutes of Health to determine whether the new sugar warnings will influence consumers’ purchasing habits. His team will be analyzing New Yorkers’ receipts before and after the Sweet Truth Act is put into effect.

He said he is expecting positive, but modest results based on past research, which suggests people can be swayed by nutrition labels on menus but are more discerning about their choices at the grocery store than they are when they go out to eat.

After the salt shakers started popping up on chain restaurant menus in New York City in 2016, diners consumed less sodium per order, on average, when eating at full-service chain restaurants (think Applebees), according to a 2023 study by the city health department and the University of Rhode Island. But the study found the icons had little impact at fast food establishments.

Restaurants in the city did not voluntarily lighten the sodium content of their menus to avoid having to display the salt shakers, another study found. But a similar initiative in Philadelphia, which included sodium warnings with text attached, did result in restaurants eliminating some of the high-sodium items on their menus.

DeAnna Nara, campaign manager at the Center for Science in the Public Interest, said she was optimistic about the new sugar warnings being rolled out across the city.

“For the first time, we have an opportunity for consumers to see when a single menu item contains more than an entire day’s worth of added sugars,” Nara said, adding that other jurisdictions will be watching. “ New York City being a leader here.”

She added that public awareness campaigns would be important to help educate New Yorkers about the new symbol, and noted that the health department could always make changes to the logo based on initial findings.

Asked for comment on the concern raised by some consumers that they didn’t notice the new symbol, Giliam of the city health department said the sugar icon, by law, had to be “as wide as it is tall” and “equal in height to the largest letter of the food item’s name.”

Chain restaurants that don’t comply with the new rules will be subject to $200 fines starting next year, the health department said.

This article was updated with additional information.