Menu-labeling policy in King County, Washington.

Background: Food eaten away from home now accounts for about one third of total calories consumed in the U.S. Policy change could lead to sustainable improvements in restaurant and other nutrition environments. Broadly described, policy development is one of the three core functions of public health, and there is a need to more fully understand and evaluate this function. Policy process research has developed frameworks and models that can be used to understand the policy development process.

Purpose: To describe policy processes associated with the passage of restaurant menu-labeling regulations in order to inform nutrition policy development in other settings.

Methods: Document reviews and interviews with 12 key players in the policy process were conducted and analyzed between June 2009 and October 2010.

Results: Policy process actors primarily belonged to two advocacy coalitions: a public health coalition and an industry coalition. Within the coalitions there were shared values and beliefs about the appropriate role of governmental regulation in protecting the health of the population and the need for environmental change. The process was adversarial at times, but "policy learning" built the trust needed for collaboration to negotiate agreements. Expert technical assistance moved the process forward.

Conclusions: Elements that contributed to the success of a menu-labeling policy initiative in a large, urban health department have been identified. The King County case study can inform the work of others who seek to build healthier nutrition environments through policy change.