In the United States, 34.9% of people 20 years and
older and 17% of people 2-19 years of age are obese (1). For adults, this
means that about 1/3 of the population has a body mass index (BMI) of 30 or
higher. For youths 2-19, this means that their BMI-for-age has plotted at or
above the 95th percentile using the gender-specific Center for Disease Control
growth charts (1). This matters because obesity increases a
person’s risk for developing serious health conditions including
but not limited to high blood pressure, insulin resistance, type two diabetes and
cardiovascular disease. Obese children are at greater risk of developing these health conditions during childhood. BMI is an inexpensive tool used by public health officials to quickly screen large groups of people at increased risk of health problems. It is one of many screening tools used to assess the nutrition status, health and
wellness of the country.
In 2010 a report from the United States Department of
Agriculture’s Economic Research Services division came out. It revealed the results of
a project that investigated the effect of eating out on diet quality and weight
gain (2). The researchers used data obtained as part of the United States' National
Health and Nutrition Examination Survey (NHANES). NHANES is a group of on-going research studies that examines the health and
nutrition status of the people of the United States. It is a cross-sectional study. It captures a moment in time. NHANES researchers collect lots of data about each participant over a brief period of time (a couple of days to a couple of weeks). Some people were assessed during a testing period that occurred between 1994 and 1996 while others were tested between 2003 and 2004. This allowed the researchers to examine changes in the nation's eating patterns and weight patterns.The investigators analyzed two days of diet records from all the survey participants, BMI and body weight. Their research revealed that meals eaten away from home were higher in
saturated fat and added sugars, and lower in vegetables and whole grains. Additionally, they learned that eating away from home
one time a week increased caloric intake by an average of 134 calories. They took this one step further and said that over the course of a year, if everything else remained the same, those extra calories could lead to a 2 pound weight gain (2).
1) Ogden, C. L., Carroll, M. D., Kit, B.
K., & Flegal, K. M. (2014). PRevalence of childhood and adult obesity in
the united states, 2011-2012. JAMA, 311(8),
806-814. doi: 10.1001/jama.2014.732
2) United Stated Department of Agriculture. Economic Research Services. (2010, Feb.) The impact of food away from home on diet quality. ERR 90. Retrieved from http://www.ers.usda.gov/publications/err-economic-research-report/err90.aspx
Why put calorie information on menu labels?
A lot has changed since the 1970s. According to an article written by
Jessica Todd and Lisa Mancino, researchers
with the USDA’s Economic Research Services, the percent of the average household food
budget that gets spent on food prepared outside of the home has increased about 25% since 1970. Regardless of where food is prepared, portion sizes are bigger. Even dishes are bigger than they were in the 1970s. The National Institute of Health has two slide sets focused on portion distortion. Here is a link.
In 2008, the Rudd Center for Food Policy and Obesity at Yale University published a report called "Menu Labeling in Chain Restaurants: Opportunities for Public Policy." This report summarized the results of surveys, polls, and other types of research related to consumer behaviors that impact nutrition awareness (2). Over 80% of adults reported that they read food labels before they purchased products. Multiple surveys and polls found that consumers were in favor of the addition of calorie and nutrient information on menus and menu boards. Data summarized in the 2008 Rudd Report suggests that consumers are in favor of, ready for, and perhaps eager for the opportunity to make informed decisions about food choices for themselves and their families when eating out.
Citations
1) Todd JL, Mancini L (2010, June 1) Eating out increases daily caloric intake. AmberWaves. Retrieved from USDA Economic Research Services http://www.ers.usda.gov/amber-waves/2010-june/eating-out-increases-daily-calorie-intake.aspx#.VHy1zTHF-So
2) Yale University. Rudd Center for Food Policy and Obesity. (2008) Menu Labeling in Chain Restaurants: Opportunities for Public Policy. Retrieved http://yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf
What is the menu labeling requirement?
The menu labeling regulation falls under section 4205 of the 2010 Patient Protection and Affordable Care Act. There are two parts to the menu labeling requirement. One part applies to restaurants and other food establishments with 20 or more locations (chains, franchises, etc.). The other part of calorie labeling applies to vending machines.
Restaurants and related establishments with 20 or more locations:
- Calorie content must be displayed in close proximity to the food item that it describes. It can be on the menu or on a menu board.
- This rule applies to any food establishment with 20 or more locations including any type of restaurant, coffee shop, cafeteria, deli, movie theater concession stand, ice cream parlor, convenience store where food and drinks are prepared on site, etc.
- Any regular menu item must have calorie information displayed
- Calorie information must be easy to read.
- It must clearly state on the menu or menu board that the following nutrient information is available upon request (in written form):
- Total calories
- Total fat
- Saturated fat
- Trans fat
- Cholesterol
- Sodium
- Total carbohydrates
- Fiber
- Sugars
- Protein
Vending Machines
- Someone who owns or operates 20 or more vending machines is required to display calorie information for all of the items in the machine.
- Calorie display options: sticker, poster, placard, digital display
- Calorie display requirement: must be near the food selection button
- Contact information requirement: required to provide information about how to contact the vending machine operator/owner who is the lawfully responsible party for the calorie information in the vending machine so that the Food & Drug Administration can follow-up with them.
Resources:
1) U.S. Department of Health and Human Services. Food and Drug Administration (2014, Nov.) Overview of FDA Labeling Requirements for Restaurants, Similar Retail Food Establishments, and Vending Machines. Retrieved from http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm248732.htm (accessed 12/1/2014).
2) U.S. Department of Health and Human Services. Food and Drug Administration (2014, Nov.) Menu and Vending Machine Labeling Requirements. Retrieved from http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm217762.htm (accessed 12/1/2014).
When is menu and vending machine labeling mandatory?
Labeling menus and menu boards for restaurants and similar establishments with 20 or more locations will be mandatory in November of 2015. Throughout the next year you can expect to see more places roll out their revised menus and menu boards. This ruling is not a surprise. This has been at least 10 years in development and more actively debated for the past 4 years. Next fall, you will probably hear about all of this again as the mandatory compliance date approaches.
The vending machine requirement has been given a 2 year grace period to put things into place. You may encounter vending machines with calories displays at anytime between now and 2016, however, it will not be required until the latter half of November of 2016. There are logistical challenges faced by the vending machine businesses to navigate as they work their way to compliance.
3 Is providing calorie information really going to make a difference?
3)
2) Some cities and states were early adopters and started requiring calorie labeling a few years ago. By 2011, 5 states and 3 cities had specific labeling requirements (1). New York City, San Francisco, and Philadelphia are examples of early adopting cities.
Because some cities started implementing requirements early, there is a limited amount of preliminary research starting to emerge regarding how people initially react and respond to calorie content on menus. According to a NY Times blog (The Upshot) posted on November 26, 2014, the initial reaction to the 2008 calorie labeling of menus in New York city was ambivalence (2). Apparently, only about half of people even noticed the presence of calories on menus. An even smaller percent of those who did notice calories on the menus used that information to make food choices. In 2010, similar results were noted shortly after Philadelphia introduced calorie labeling on menus (2).
The regulation is not required until next year. Please keep in mind that no matter how it is dressed and presented, the limited research available now is important but preliminary.
Citations:
1) Robert Wood Johnson Foundation. The State of Sbesity. Menu Labeling. http://stateofobesity.org/menu-labeling/ (accessed 12/1/2014).
2) Tavernise, S. (2014, November 26). Calories on menus: Nationwide experiment into human behavior. The New York Times (web log The Upshot). Retrieved from http://www.nytimes.com/2014/11/27/upshot/calories-on-menus-a-nationwide-experiment-into-human-behavior.html?ref=health&_r=1&abt=0002&abg=0 (accessed 12/1/2014).
Organizations including the American Heart Association, the American Medical Association, the Academy of Nutrition and Dietetics, the Center for Science in the Public Interest, and the National Restaurant Association openly support the FDA's final regulations on menu labeling. The technology to do this is widely available and is not complicated. It takes time, patience and persistence, but it is not complicated.
Calorie labeling on menus and vending machines is a new public health policy that has not yet been fully implemented. In fact, the full scope of this will not be implemented until 2016. After that, it will take time (years of time) to determine how and in what ways this policy impacts society. This new policy has not been in place in any state or city long enough to know if putting calories on labels has a meaningful impact on consumer choice, diet quality and weight. It takes time to introduce and adopt public policy change of any kind. It will take many years to find out what impact, if any, calorie labeling has on the overall nutrition status, health and wellness of the nation.
If you would like to listen to a brief news story or read a transcript, Allison Aubrey of NPR's Morning Edition, filed a story about it on November 24, 2014 (FDA Menu Labeling).
