Promoting Healthy Promoting Healthy Eating by Listing Eating by Listing

Caloric Information Caloric Information on Restaurant Menuson Restaurant Menus

Kyle Riding MPH studentWalden University

PUBH 6165-3Dr. Howard Rubin

Spring Term, 2010

OverviewOverviewCurrent Overview of the Obesity EpidemicCauses of ObesityNegative Health Outcomes Associated with

ObesityWhy Include Caloric Information on Menus?Public Attitudes/Beliefs on Caloric IntakeCurrent Federal Legislation’s Impact on

Restaurant Menus

The Obesity EpidemicThe Obesity EpidemicThe overall obesity prevalence within the

United States is greater than 30%.During the 1980’s and 1990’s prevalence

increased at an unprecedented rate.Obesity rates have stabilized overall

◦The risk of large increases in obesity occurring again cannot be ruled out.

•Flegal, K.M., Carroll, M.D., Ogden, C.L., Curtin, L.R. (2010). Prevalence and Trends in Obesity Among US Adults, 1999-2008. Journal of the American Medical Association, 303(3), 235-241.

Childhood ObesityChildhood ObesityCurrently 31.9% of children within the

United States between 2-19 years old are overweight or obese◦Falls in line with the overall population statistic

This number has tripled over the last 30 years!

Creates the threat of another large increase in overall obesity prevalence

•Let’s Move. (2010). http://www.letsmove.gov/. Accessed on: 4/15/2010. 

•Ogden, C.L., Carroll, M.D., Flegal, K.M. High Body Mass Index for age among US children and adolescents, 2003-2006. JAMA, 299(20) 2401-2405.

Massachusetts StatisticsMassachusetts StatisticsThe Commonwealth has 4th lowest level of

overweight among all US states◦However, the rate of overweight has increased

by 30% over the past decadeIn 2002 one out of two adults within the

Commonwealth were either overweight or obese!

Bureau of Health Statistics, Research, and Evaluation. (2002). Growing Concerns about Obesity Among Adults in Massachusetts: A Statistical Analysis of BRFSS Data. Mass. Department of Public Health.

Defining Overweight and ObesityDefining Overweight and ObesityThe CDC uses BMI as a scale for measuring

obesity and overweight status◦ BMI is derived from a calculation that compares height

and weightAdult Overweight

◦ BMI between 25 and 29.9Adult Obesity

◦ BMI 30 or aboveChildhood Overweight

◦ Having a BMI between the 85th and 95th percentile for the age of the child

Overweight Obesity◦ Having a BMI over the 95th percentile for the age of the

child

•CDC. (2009). Obesity and overweight. http://www.cdc.gov/obesity/index.html. Accessed on: 4/10/10.

What Causes Obesity?What Causes Obesity?As noted by the CDC the cause of obesity

is very well known◦The body functions by having a balance

between calories taken in and calories exerted◦When the balance tips in favor of too many

calories taken in weight gain occurs

•CDC. (2009). Obesity and Overweight for Professionals: Causes. http://www.cdc.gov/obesity/causes/index.html. Accessed on: 4/10/2010.

Negative Health Outcomes Negative Health Outcomes Being overweight or obese carries with it

the risk of many negative health outcomes:◦type 2 diabetes◦hypertension◦coronary heart disease ◦forms of cancer◦renal and liver disease◦sleep apnea◦osteoarthritis

•Gade, W., Gade, J., Collins, M., Schmit, J., & Schupp, N. (2010). Failures of feedback: Rush hour along the obesity highway. Clinical Laboratory Science, 23(1), 39-50.

The Community Environment & The Community Environment & ObesityObesityThe community environment has been

known to cause obesitySeveral things can be done to limit cases

of overweight and obesity:◦Promote healthier choices ◦Create Opportunity for physical activities◦Encourage the food industry to provide reasonable food and beverage choices

•CDC. (2009). Obesity and Overweight for Professionals: Causes. http://www.cdc.gov/obesity/causes/index.html. Accessed on: 4/10/2010.

Public’s Understanding of Caloric Public’s Understanding of Caloric IntakeIntakeConsumers are not savvy at

understanding their caloric intakeOne study found that actual calories was

almost two times the amount estimated by participants

Creates an environment that is unsuitable for preventing obesity.

•Burton, S., Creyer, E.H., Kees, J., Huggins, K. (2006). Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9).

Adding Caloric Information to Adding Caloric Information to MenusMenusA recent study looked at the effects of

presenting caloric information on menus:◦The study had three groups of menus:

Menus with no caloric information Menus with caloric information Menus with caloric info and recommended

allowances◦The groups that used menus with caloric

information consumed 14% fewer calories

Roberto, C.A., Larsen, P.D., Agnew, H., Baik, J., Brownell, K.D. (2010). Evaluating the Impact of Menu Labeling on Food Choices and Intake. American Journal of Public Health, 100(2), 312-318.

Children’s MenusChildren’s MenusWhile the previous study shows that food

labeling can effect calorie consumption for adults, can the same be true for children?◦One study says YES!

The study was conducted on a small sample (n=99)◦The group of parents who had calorie

information ordered meals with an average of 102 fewer calories.

Tandon, P.S., Wright, J., Zhou, C., Rogers, C.B., Christakis, D.A. (2010). Nutrition MenuLabeling May Lead to Lower-CalorieRestaurant Meal Choices for Children. Pediatric, 125(2), 244-248.

Public Perception Public Perception Will including this information on all

restaurant menus be acceptable to the public?

One study set up several focus groups across 4 U.S. cities◦Results indicated

Individuals were interested in having info available to them (even if they wouldn’t use it)

Food serving sizes should represent a true portion size Symbolic icons indicating healthy food options would

be welcome•Lando, A.M., Labiner-Wolfe, J. (2007). Helping Consumers Make More Healthful Food Choices:Consumer Views on Modifying Food Labels andProviding Point-of-Purchase Nutrition Information atQuick-service Restaurants. J Nutr Educ Behav, 39, 157-163.

New Federal RegulationsNew Federal RegulationsWithin the recent healthcare reform

legislation there was a provision for labeling menus with calorie information

This part of the legislation only affects large chains and does not affect any other types of restaurants

Rosenbloom, S. (2010). Calorie Data to Be Posted at Most Chains. The New York Times, March 23, 2010.

Why are the New Federal Why are the New Federal Regulations Not Enough?Regulations Not Enough?Targeting large chain restaurants will

allow consumers to make healthier decisions at many fast food chains

However, one recent study indicates that fast food chains are not always the worst option

The federal legislation may not provide enough coverage

Serrano, E.L., Jedda, V.B. (2009). Comparison of Fast-Food and Non-Fast-Food Children’sMenu Items. Journal of Nutrition Education and Behavior, 41(2), 132-137.

What would it look like??What would it look like??

ConclusionConclusionThe country and the state of Massachusetts

are in the midst of an obesity epidemicCaloric imbalance is the cause of weight gainAn environment that doesn’t provide

information about caloric content of food can lead to obesity

The Commonwealth should have all restaurants include caloric information onto their menus

The addition of this information is effective, supported by the public, and must occur across all types of restaurants

ReferencesReferences Bureau of Health Statistics, Research, and Evaluation. (2002). Growing Concerns about Obesity

Among Adults in Massachusetts: A Statistical Analysis of BRFSS Data. Mass. Department of Public Health.

Burton, S., Creyer, E.H., Kees, J., Huggins, K. (2006). Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9).

CDC. (2009). Obesity and overweight. http://www.cdc.gov/obesity/index.html. Accessed on: 4/10/10.

CDC. (2009). Obesity and Overweight for Professionals: Causes. http://www.cdc.gov/obesity/causes/index.html. Accessed on: 4/10/2010.

Flegal, K.M., Carroll, M.D., Ogden, C.L., Curtin, L.R. (2010). Prevalence and Trends in Obesity Among US Adults, 1999-2008. Journal of the American Medical Association, 303(3), 235-241.

Gade, W., Gade, J., Collins, M., Schmit, J., & Schupp, N. (2010). Failures of feedback: Rush hour along the obesity highway. Clinical Laboratory Science, 23(1), 39-50.

Lando, A.M., Labiner-Wolfe, J. (2007). Helping Consumers Make More Healthful Food Choices: Consumer Views on Modifying Food Labels and Providing Point-of-Purchase Nutrition Information at Quick-service Restaurants. J Nutr Educ Behav, 39, 157-163.• Let’s Move. (2010). http://www.letsmove.gov/. Accessed on: 4/15/2010. • Ogden, C.L., Carroll, M.D., Flegal, K.M. High Body Mass Index for age among US children and adolescents,

2003-2006. JAMA, 299(20) 2401-2405. Roberto, C.A., Larsen, P.D., Agnew, H., Baik, J., Brownell, K.D. (2010). Evaluating the Impact of

Menu Labeling on Food Choices and Intake. American Journal of Public Health, 100(2), 312-318. Rosenbloom, S. (2010). Calorie Data to Be Posted at Most Chains. The New York Times, March 23,

2010. Serrano, E.L., Jedda, V.B. (2009). Comparison of Fast-Food and Non-Fast-Food Children’s Menu

Items. Journal of Nutrition Education and Behavior, 41(2), 132-137. Tandon, P.S., Wright, J., Zhou, C., Rogers, C.B., Christakis, D.A. (2010). Nutrition MenuLabeling May

Lead to Lower-CalorieRestaurant Meal Choices for Children. Pediatric, 125(2), 244-248.