Adding Nutritional Information to Texas food chain restaurants Shekinah Harris, MPH student Walden University PUBH 6165-3 Dr. Robert P. Marino  Fall quarter, 2010 Hello, thank you for taking time out and participating in this presentation. My name is Shekinah Harris and I am a MPH student at Walden University. I will be discussing the benefits of including nutritional information to fast-food & food chain restaurants like Subway, McDonalds, Grandy’s, KFC, Burger King, Popeyes, Taco Bell, Wendy’s, and Denny’s here in Dallas, Texas.

Learning Outcomes Motivate fast food & food chain restaurants to include nutritional facts on the menu Implement nutritional facts on the menu Combat ignorance about nutrition, caloric intake, and nutritional facts Recognize potential barriers Identify government policies and standards The purpose of this presentation is to address the importance of including nutritional information on menus at fast food and food chain restaurants here in Dallas, Texas. Including nutritional facts on the menu shows patrons that these establishments are health conscious. By addressing you, the restaurant owners, the managers, the employees, and the patrons of these establishments, I hope to expand your knowledge about the role of nutrition, calories and caloric intake, nutritional facts, barriers, and policies and standards.

Nutrition Process by which organism assimilates food and uses it for growth and maintenance (Princeton University, 2010) A means of sustenance and nourishment (Princeton University, 2010) I will begin by defining nutrition. Nutrition is the process in which humans absorb or convert the food they consume and use it for growth and maintenance (Princeton University, 2010). We all know that it is important to eat healthy, but with our schedules, it can be hard to maintain a healthy diet, which is a problem. (USDA, 2010) Princeton University. (2010, September 20). nutrition . Retrieved from http://wordnetweb.princeton.edu/perl/webwn?s=nutrition United States Department of Agriculture. (USDA) (2010, May 12). News & media. Retrieved from http://www.mypyramid.gov/global_nav/media_resources.html

The Problem Americans Face 1/3 of United States adults are obese (CDC, 2010a) 17% of United States children are obese (CDC, 2010a) 1980 to 2008, obesity rates for adults have doubled and have tripled for children (CDC, 2010a) Consequences of obesity Coronary heart disease Type 2 diabetes High blood pressure Stoke High cholesterol In the United States, obesity has become an epidemic. The CDC (2010a) reports that over 72 million individuals are obese or overweight. Health problems that are associated with obesity include: premature death, type 2 diabetes, heart disease, stroke, hypertension, sleep apnea, gallbladder disease, high cholesterol, stress incontinence, depression, and menstrual irregularities (CDC, 2010a; Powell & Chaloupka, 2009). (Long, 2008) Centers for Disease Control and Prevention (CDC). (2010a, August 17). Obesity: halting the epidemic by making health easier. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm Long, Nancy. (2008, October 7). 20 diseases related to obesity (being overweight). Retrieved from http://teamrich.wordpress.com/2008/10/07/20-obesity-related-diseases/

Most At Risk Children and adolescents are now developing obesity-related- diseases such as type 2 diabetes (CDC, 2010a) obese children and adolescents are more likely to have risk factors associated with cardiovascular disease – high blood pressure, high cholesterol, and Type 2 diabetes than children who are not obese or overweight (CDC, 2010b) approximately 80% of children who were overweight at aged 10–15 years were obese adults at age 25 years (CDC, 2010b) Children are at risk of becoming obese/overweight and developing chronic diseases. Labeling nutritional values on the menu or menu boards has the potential to educate parents and children on what they consume. Children and adolescents need to be more aware of what they are eating, so they can avoid these consequences like high cholesterol, type 2 diabetes, and hypertension (CDC, 2010b). Centers for Disease Control and Prevention (CDC). (2010a, August 17). Obesity: halting the epidemic by making health easier. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm Centers for Disease Control and Prevention (CDC). (2010b, March 31).Childhood overweight and obesity. Retrieved from http://www.cdc.gov/obesity/childhood/index.html

Obesity in Texas The percentage of adults who are obese in Texas is between 25% - 29% (CDC, 2010a) 37% of Texans are considered overweight (CDC, 2009b) 16% of Texan youth from grades 9th – 12th are overweight and 16% are obese (CDC, 2009b) There are approximately 24 million people living in Texas (CDC, 2009b). The statistic reported by the CDC (2010a) states that 25 to 29% of individuals living in Texas have a body mass index greater than 30. The body mass index is the individuals weight divided by their height, which determines if an individual is underweight, normal weight, overweight, or obese for their height. Center for Disease Control and Prevention (CDC). (Designer). (2010). adults-obesity-chart. [Web]. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm Centers for Disease Control and Prevention (CDC) . (2009b, July 21). Overweight and obesity: texas. Retrieved from http://www.cdc.gov/obesity/stateprograms/fundedstates/texas.html

Calories & Caloric Intake Calorie – unit of energy supplied by food (CDC, 2009a) Carbohydrates, fats, sugars, and proteins all contain calories Caloric balance – maintaining body weight, calories consumed from food, calories used from body functions, daily activities, and physical exercise (CDC, 2009a) It is about what we consume and what we burn off. By knowing how much your caloric intake is daily, it allows you to maintain a caloric balance (CDC, 2009a). It is hard to underestimate what you consume, especially since calories are abstract things that cannot be seen, tasted, felt, or smelled (Nestle, 2010). When portion sizes are big and the advertisement says that it is all natural or contains fruit, it is easy to be misguided or over eat. Centers for Disease Control and Prevention (CDC). (2009a, December 7). Overweight and obesity: causes and consequences. Retrieved from http://www.cdc.gov/obesity/causes/index.html

Nutritional Fact Labels & Implementation Nutritional facts labels consist of (FDA, 2009) Serving size Calories Nutrient information Foot note with Daily Values Menu Programs (Pulos & Leng, 2010) Nutritional fact labels will help educate your consumers about their intake. The FDA (2009) advises consumers to look at the serving size because it influences the number of calories in the product. The daily standard or daily value suggested by the Food and Drug Administration (FDA) is 2000 to 2,500 kcal-per-day (Nestle, 2010; FDA, 2009). The daily value helps consumers keep track of their daily caloric consumption. The Smart Menu Program was established by Tacoma – Pierce County Health Department. Smart menus provided patrons with nutrition information to inform patrons about their food options, so that they could make healthy selections at the restaurant (Pulos & Leng, 2010). Restaurant owners and Texas Department of State Health Services can work together and develop a menu program. By putting nutritional facts on your products, it helps your patrons count calories so that they can maintain a healthy weight or diet. NutritionData, . (Designer). (2010). nutritionindex. [Web]. Retrieved from http://nutritiondata.self.com Pulos, E.& Leng, K. (2010). Evaluation of a volunatry menu - labeling in full-service restaurants. The American Journal of Public Health, 100(6)1035-1039, Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=3&hid=9&sid=1cc166d3-3d17-40ab-ac91-255f986ab5a8%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9h&AN=50615789 doi: 10.2105/AJPH.2009.174839 United States Food and Drug Administration (FDA). (2009). How to understand and use the nutrition facts label. Retrieved from http://www.fda.gov/food/labelingnutrition/consumerinformation/ucm078889.htm

Fast-Food & Food Chain Restaurants Meals eaten away from home (Pulos & Leng, 2010) Convenient (Pulos & Leng, 2010) Cheap, energy-dense food (Nestle, 2010) It has been noted that a good portion of food expenditures in the United States occur in fast-food or food chain restaurants - nearly half of $900 billion U.S. food dollars today are spent on restaurant food (Hochberg, 2008).The meals that are eaten away from home tend to be higher in calories and fat; therefore, restaurant meals are an important target for arresting the rise in obesity. Fast food restaurants have been labeled as businesses that supply the community with cheap, energy-dense food (Powell & Chaloupka, 2009). The food is relatively low in price and very convenient. However, fast-food and food chain restaurants can give back to the community and help individuals take control of what they consume. Many chain restaurants have food databases, cookbooks, and other websites that list the nutritional values and calories in the their products. Websites and databases are beneficial, but do not help the individual on the go in need of something fast and nutritional to eat. Nutritional information and caloric values are hard to find or easily overlooked when pulling up to the drive-thru or entering the establishment (Nestle, 2010). Consumers have the right to know what they are about to eat before they eat it. The King County health department in Seattle drew up a food quiz and asked patrons to guess which item contained the most calories (Hochberg, 2008). Three-fourths of the nearly 400 respondents got the questions wrong (Hochberg, 2008). Patrons did not know if the Big Mac, 2 egg Mcmuffins, or large chocolate shake had the most calories. Most assumed that the Big Mac had the most, when in actuality it was the large chocolate shake with 1,160 calories (Hochberg, 2008). Nestle, M. (2010). Health care reform in action - calorie labeling goes national. New England Journal of Medicine, 2343-2345, Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=2&hid=9&sid=6c8fe8e3-8823-4b03-875c-10f1b4ac278c%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9h&AN=51664565 doi: 10.1056/NEJMp1003814 Pulos, E.& Leng, K. (2010). Evaluation of a volunatry menu - labeling in full-service restaurants. The American Journal of Public Health, 100(6)1035-1039, Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=3&hid=9&sid=1cc166d3-3d17-40ab-ac91-255f986ab5a8%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9h&AN=50615789 doi: 10.2105/AJPH.2009.174839

The Benefits Improving customers’ purchases (Nestle, 2010) Restaurants reduce caloric content of their foods (Nestle, 2010) Educate the public about the calories in food they are consuming (Nestle, 2010) Behavioral and environmental play a crucial role in what causes people to be obese and overweight (CDC, 2009). However, the choices a person makes contributes to their diet. Labeling foods helps people not to underestimate what they eat at restaurants (Nestle, 2010). People become interested in what they eat and the foods nutritional value. Studies have found that menu labeling has lead to a slight reduction in the number of calories people purchase (Nestle, 2010). Nestle, M. (2010). Health care reform in action - calorie labeling goes national. New England Journal of Medicine, 2343-2345, Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=2&hid=9&sid=6c8fe8e3-8823-4b03-875c-10f1b4ac278c%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9h&AN=51664565 doi: 10.1056/NEJMp1003814

Potential Barriers Voluntarily posting visible nutritional facts on menus or menu boards (Nestle, 2010) Reducing portion sizes (Nestle, 2010) Reformulating products (Nestle, 2010) Additional cost Logistic problems concerning calorie information (Nestle, 2010) Fast food and food chain restaurants are convenient, but sometimes the nutritional facts are not. Some restaurants only provide caloric information upon request. If they are provided, they are too small or obscure to read (especially if they are written on napkins). It is suggested that calorie numbers are best rounded off to the nearest 10 or 25, so that there will not be wide deviations in the amounts published (Nestle, 2010). Restaurant owners may be concerned about the cost of printing new menus. It is possible that it could $1,000 per menu item for the nutritional data analysis (Hochberg, 2008). In Seattle, the city uses a $500 computer program that calculates nutritional information and prints out the labels for the menu can actually become a money-maker for restaurants with patrons who want the information (Hochberg, 2008). However, it is important that all costumers see nutritional facts upon selling the items. Nestle, M. (2010). Health care reform in action - calorie labeling goes national. New England Journal of Medicine, 2343-2345, Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=2&hid=9&sid=6c8fe8e3-8823-4b03-875c-10f1b4ac278c%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9h&AN=51664565 doi: 10.1056/NEJMp1003814

Policies & Standards Health Care Reform Act – Public Law 111-148 (GPO, 2010) Information is required to be disclosed by restaurants and retail food establishments It should be noticeable – on the menu or menu board The Health Care Reform Act – Public Law 111-148 states that establishments with 20 or more locations nationwide or restaurants with similar retail foods must post nutritional facts and calories in a clear and noticeable location along with the suggested FDA caloric intake of 2000 kcal-per-day (GPO, 2010). It also states that the nutritional facts should be available on the premise of the restaurant, on the menu, or on the menu board (GPO, 2010). Even food on display or cafeteria styled food service must put nutrition facts near the food on display (GPO, 2010). United States Government Printing Office (GPO). (2010). H.r. 3590. Retrieved from http://democrats.senate.gov/reform/patient-protection-affordable-care-act-as-passed.pdf

A New Outlook Taking control of what you consume Avoiding large portion sizes (Nestle, 2010) Why play Russian roulette with your health and what you consume (Hochberg, 2008)? Labeling nutritionals values will show patrons that large portions have more calories. It is an incentive to avoid large portions and combat being overweight or obese (Nestle, 2010). Implementing and utilizing nutritional fact labels that are visible to see by patrons can help the community. This is especially helpful with Americans who have high cholesterol and diabetes. Nestle, M. (2010). Health care reform in action - calorie labeling goes national. New England Journal of Medicine, 2343-2345, Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=2&hid=9&sid=6c8fe8e3-8823-4b03-875c-10f1b4ac278c%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9h&AN=51664565 doi: 10.1056/NEJMp1003814

Conclusion Overweight and Obesity is no longer just personal matters, it is a community effort Chronic disease and premature death is an issue in the United States Adding calorie and nutritional labels to menus or menu boards can help patrons better estimate food consumption As restaurant owners, managers, employees, and patrons, by taking action, you can help our community make healthier food choices than can help the fight against obesity. The following slides will provide you with further reading/information and my references. If you have any questions, please feel free to ask me. Thank you!

Further Reading Sources Texas, Bringing Healthy Back Texas Department of State Health Services. (2009, August 25). Texas! bringing healthy back presents growing community. Retrieved from http://www.dshs.state.tx.us/obesity/default.shtm Public Law 111-148 (p.455) United States Government Printing Office (GPO). (2010). H.r. 3590. Retrieved from http://democrats.senate.gov/reform/patient-protection- affordable-care-act-as-passed.pdf

Further Reading Sources (cont…) “Taking up Space? How Customers React to Health Information and Health Icons on Restaurant Menus” Jones, C. (2009). Taking up space? how customers react to health information and health icons on restaurant menus . Journal of Foodservice, 12(4 (344-363)), Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=3&hid=9&sid=c2 530d19-cd14-48c8-af91- bf19aa2ab1c4%40sessionmgr14&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaX Rl#db=a9h&AN=45427194 doi: 10.1080/15378020903344299

References Center for Disease Control and Prevention (CDC). (Designer). (2010). adults-obesity- chart. [Web]. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm Centers for Disease Control and Prevention (CDC). (2009a, December 7). Overweight and obesity: causes and consequences. Retrieved from http://www.cdc.gov/obesity/causes/index.html Centers for Disease Control and Prevention (CDC) . (2009b, July 21). Overweight and obesity: texas. Retrieved from http://www.cdc.gov/obesity/stateprograms/fundedstates/texas.html

References (cont…) Centers for Disease Control and Prevention (CDC). (2010b, March 31).Childhood overweight and obesity. Retrieved from http://www.cdc.gov/obesity/childhood/index.html Centers for Disease Control and Prevention (CDC). (2010a, August 17). Obesity: halting the epidemic by making health easier. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm Hochberg, L. (2008, January 14). Bid to print nutrition facts on menus raises debate . Retrieved from http://www.pbs.org/newshour/bb/business/jan-june08/food_01-14.html Long, Nancy. (2008, October 7). 20 diseases related to obesity (being overweight). Retrieved from http://teamrich.wordpress.com/2008/10/07/20-obesity-related-diseases/

References (cont…) Nestle, M. (2010). Health care reform in action - calorie labeling goes national. New England Journal of Medicine, 2343-2345, Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=2&hid=9&sid=6c8fe8e3-8823-4b03-875c-10f1b4ac278c%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9h&AN=51664565 doi: 10.1056/NEJMp1003814 NutritionData. (Designer). (2010). nutritionindex. [Web]. Retrieved from http://nutritiondata.self.com Powell, L.M., & Chaloupka, F.J. (2009). Food prices and obesity: evidence and policy implications for taxes and subsidies. The Milbank Quarterly, 87(1) 229-257, Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=1&hid=9&sid=2a27c3d6-b572-4b35-9a35-c5d45d0de35b%40sessionmgr4&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=mnh&AN=19298422#db=mnh&AN=19298422

References (cont…) Princeton University. (2010, September 20). nutrition . Retrieved from http://wordnetweb.princeton.edu/perl/webwn?s=nutrition Pulos, E.& Leng, K. (2010). Evaluation of a volunatry menu - labeling in full-service restaurants. The American Journal of Public Health, 100(6)1035-1039, Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=3&hid=9&sid=1cc166d3-3d17-40ab-ac91-255f986ab5a8%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9h&AN=50615789 doi: 10.2105/AJPH.2009.17483 Texas Department of State Health Services. (2009, August 25). Texas! bringing healthy back presents growing community. Retrieved from http://www.dshs.state.tx.us/obesity/default.shtm

References (cont…) United States Food and Drug Administration (FDA). (2009). How to understand and use the nutrition facts label. Retrieved from http://www.fda.gov/food/labelingnutrition/consumerinformation/ucm078889.htm United States Department of Agriculture. (USDA) (2010, May 12). News & media. Retrieved from http://www.mypyramid.gov/global_nav/media_resources.html United States Government Printing Office (GPO). (2010). H.r. 3590. Retrieved from http://democrats.senate.gov/reform/patient-protection-affordable-care-act-as-passed.pdf