Calorie Counts, Food Choice, and the War on Obesity

Earlier this month, New York State Health Commissioner Nirav Shah went on a tour of shopping mall food courts to declare war on obesity. Two-thirds of Americans are overweight or obese. The economic impact of this epidemic is enormous — over $150 billion dollars a year in medical costs alone.

One of the latest weapons in this war, heavily promoted by Dr. Shah, is New York’s iChoose600 campaign. This campaign encourages fast food patrons to select meals that are 600 calories or less.

It’s not that easy to know which meals contain less than 600 calories. We routinely underestimate the number of calories in foods we eat, particularly those foods that we consider healthy. It will soon be a little easier to gauge how many calories you’re eating, however, thanks to a new federal calorie-posting law passed earlier this year.
New York City was the first to enact such a law, and similar mandates have been passed in other states and municipalities around the country. Starting in 2012, federal law will require all restaurants with 20 or more locations to post the calorie count for all items on their menus (except, oddly enough, for alcoholic beverages).

The restaurant and beverage industry supports the new calorie-posting law, but not for reasons you think. They support this new federal mandate because it will supplant the existing patchwork of state and municipal laws, often preempting more restrictive local requirements for the posting of nutritional information.

When such laws were first proposed, however, food industry lobbyists opposed them. Some free-enterprise activists still do. They are seen as yet one more example of government interference in the American marketplace and a violation of individual liberties.

That argument is wrong. Americans should have the right to make their own dining decisions, such as whether to eat dinner at home or go out to McDonald’s. Such economic freedom is a central tenet of our market society. But one of the fundamentals of the free enterprise system is unfettered and honest flow of information about goods and services. Deceptive marketing — such as disingenuously promoting a chicken Ceasar salad as a healthy eating option when it actually contains 60 grams of fat — violates that. If anything, free-market activists should be championing these laws.

I’m a strong supporter of calorie-posting laws as weapons in the war on obesity. Recent studies show that they work. However, I don’t think that calorie posting laws or the iChoose600 campaign are enough to stem the rising tide of fat.

The causes of the obesity epidemic are complex, and include environmental and socioeconomic factors that go beyond the food choices of individual Americans. The urban poor have some of the highest rates of obesity in the US. One reason is they lack the money to buy healthy foods. A box of macaroni and cheese is cheaper than a bunch of bananas, and packs far more of the calories needed to satiate the hunger of a family of four. It should come as no surprise then, that a single mother living in the Bronx spends the bulk of her limited food budget on unhealthy processed foods rather than on healthy fruits and vegetables. So pervasive is this problem that most stores and supermarkets in poor urban neighborhoods don’t even stock much in the way of fresh produce.

If we want to reduce obesity, we need more than just slick public health campaigns. We need to make healthy eating an economically viable choice for all Americans. We need to restructure the workplace so that employees are encouraged to exercise, by providing gym memberships or giving lunch breaks long enough that people can go for a walk. We need to redesign our cities and neighborhoods so that residents have safe opportunities for exercising out-of-doors, such as providing sidewalks on busy streets, walking and biking trails, and well-maintained public facilities like basketball courts. Helping individuals to make better food choices has a role to play in the fight against obesity, but we also tackle some these more fundamental issues if we are going to win this war.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on April 14, 2011. It is also available on the WAMC website.]


About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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4 Responses to Calorie Counts, Food Choice, and the War on Obesity

  1. Pingback: Excellent commentary on obesity, NYS’s iCHoose600 and calorie posting laws | JoAnn Stevelos

  2. dogwalker says:

    I completely agree except that studies show most people DO NOT use the calorie guides. There appears to be this ongoing sense that, if I’m paying for it I’ll eat darn well what I want. And if that’s the case, there is still a disconnect between what we eat, for many, and how that affects our well being.

    • Well, they do affect my choices but I’m not always a good representative of the average American. However, the more recent and better designed studies show that calorie guides do have an impact at the macro level. The overall number of calories ordered at a restaurant, for example, drops after the posting of calorie counts on the menus (there’s a link to one of these studies embedded in the blog post). This doesn’t always show up in the analysis of individual decision making because of a number of factors, including self-reporting bias.

      Overall, calorie posting is only one tool in the fight against obesity but certainly not a panacea for this serious problem.

  3. Michael says:

    Just a note about the slick “Ichoose600” campaign. Mr. Subb, a chain of sub shops in the Capital District of NYS wanted to support the campaign. We tried to contact the Health Department to get onboard. They ignored all of our emails. We decided to support the program anyways and downloaded the graphics from their “Toolkit” menu on their website. We put one of our meals that fit their criteria on their graphics and placed in our stores. Unfortunately they didn’t want our help. We received a “cease and desist’ notice ordering us to remove any “ichoose600” material. This happened shortly after we tried to inquire why only 5 burger places were included on their calorie counter on Facebook and them deciding to delete such inquiry. If they really wanted results won’t you think they would want as many organizations working with them?

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