Legislation for Nutrition Labeling on Restaurant Menus Marie de la Cruz Ph.D. Student Walden University PUBH Dr. Robert Marino Fall Term, 2011

After this presentation, you will:  Recognize the burden of obesity on Americans.  Understand the importance of menu labeling.  Describe the benefits of menu labeling.  Be aware of current menu labeling legislation throughout the U.S. LEARNING OUTCOMES

WE NEED YOUR HELP!  Nutritional and calorie labeling is provided on a voluntary basis.  Only 54% of the 300 largest chain restaurants provide such information.  Of the restaurants that make nutritional information available to consumers, 86% only do so through the Internet (Wootan & Osborn 2006, as cited in Savage & Johnson, 2006).  Most small chain restaurants and smaller establishments provide little or no nutritional information (Wootan & Osborn 2006, as cited in Savage & Johnson, 2006).  Legislation is needed to make this information available on restaurant menus at the point of sale. THIS IS WHY WE NEED YOU. (Savage & Johnson, 2006)

WHY ADD NUTRITION & CALORIE INFORMATION ON MENUS?

(1) Reduce obesity epidemic (2) Americans support it (3) Consumers have a right to information (4) Customers make healthier choices (5) Americans eat out more than ever before (Center for Science in the Public Interest [CSPI], 2008)

MENU LABELING CAN REDUCE OBESITY

 Consuming high caloric foods contribute to obesity epidemic.  Studies link eating out with obesity and higher caloric intakes:  Davis and Carpenter (2009)  French, Story, and Jeffery (2001)  Timmerman (2006)

What is Obesity?  Weight greater than what is considered healthy for a specific height.  Ranges determined by Body Mass Index (BMI)  BMI:  OVERWEIGHT  BMI: >30  OBESE (Centers for Disease Control and Prevention [CDC], 2011)

The U.S. Obesity Epidemic  1 out of 3 (33.8%) U.S. adults are obese.  34% of adults are overweight (and not obese)  17% (or 12.5 million) of children and adolescents aged 2—19 years are obese. (CDC, 2011)

 Obesity trends continue to increase.  All 50 states have obesity prevalence ≥ 20%.  12 states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) have a prevalence ≥ 30% (CDC, 2011)

Data & Statistics for the State of Maryland  Obesity prevalence increased from 17.5% to 26.3% between 1997 and 2007 (50% increase).  62.7% of Maryland adults were overweight or obese in  By 2007, 22 out of 24 Maryland jurisdictions had an obesity prevalence ≥ 20% and 11 of 24 jurisdictions had obesity prevalence > 30% (Healthy Active Maryland, 2008)

Impact of Obesity  Health:  Type 2 Diabetes  Heart Disease  Stroke  Metabolic disorders  Sexual dysfunction & infertility  Certain cancers (Sloane, 2009)  Economic  2008: Medical costs associated with obesity: $147 billion (CDC, 2011)  Medical costs $1,429 higher than those of normal weight (CDC, 2011).  Morbidity costs (CDC, 2011) (CDC, 2011; Obesity in America, n.d.; Sloane, 2009)

AMERICANS SUPPORT MENU LABELING

 Center for Science in the Public Interest (CSPI) : 78% of Americans support menu labeling.  Yale University Rudd Center for Food Policy and Obesity: Up to 83% favor menu labeling.  Bleich and Pollack (2010): 68% favor posting calorie information on menus.  The Food and Drug Administration (FDA), Surgeon General, U.S. Dept. of Health and Human Services, National Cancer Institute (NCI), & the American Medical Assn (AMA) support menu labeling (CSPI, 2008). (CSPI, 2008; Yale University Rudd Center, 2008; Bleich & Pollack, 2010)

CONSUMERS HAVE A RIGHT TO INFORMATION

 People need nutritional information to manage weight, diabetes, other conditions.  Burton, Creyer, Keys, and Huggins (2006): Levels of calories, fat, and saturated fat in restaurants were significantly underestimated by consumers.  Companies provide information on everything from cars to appliances.  Nutritional Labeling and Education Act (NLEA)  This should apply to restaurant menus (Burton et al., 2006; CSPI, 2008)

CONSUMERS MAKE HEALTHIER CHOICES

 Studies show that providing nutritional information help consumers make healthier choices:  CSPI (2008)  Dumanovsky, Huang, Bassett, and Silver (2010)  Pulos and Leng (2010)  Roberto, Larsen, Agnew, Baik, and Brownell (2010)  Burton, Creyer, Kees, and Huggins (2006)

“AMERICANS EAT OUT MORE THAN EVER BEFORE” (CSPI, 2008, p. 1) © Michelle Henry

 Americans consume 1/3 of calories from restaurants.  1970: Americans spent 26% of food income on restaurant meals  Today, we spend 48%  More than 130 million Americans eat out  Adds up to more than 70 billion meal and snack occasions in (CSPI, 2008)

Counties & States with Menu Labeling  New York City  Westchester County, New York  San Francisco, California  Santa Clara County, California  San Mateo County, California  King County (Seattle), Washington  Multnomah County (Portland), Oregon  Montgomery County, Maryland  Philadelphia, Pennsylvania  Other localities that have or are presently considering menu labeling legislation include:  Boston  Chicago  Minneapolis  Nassau County, New York (CSPI, 2008, as cited in Public Health Law Center, 2009

New York, New York  January 2008: Regulations require calorie disclosure on menus, menu boards, and food tags by all chain restaurants with 15 or more locations nationwide.  Fines are issued to noncompliant restaurants.  According to a September 2008 study: 86% of respondents reported that they considered the law a positive measure and 75% of respondents reported that seeing calorie information on menus made an impact on their ordering decisions. (Public Health Law Center, 2009)

State of California  The first state to enact menu labeling legislation in the fall of  Restaurants with 20 or more locations in the state  Must disclose the caloric content of standard menu items on menus, menu boards, and menu tags.  Two-year phase-in periods and an eight-month delayed implementation gives restaurants ample time to comply. (Public Health Law Center, 2009)

King County, Washington  Example of the struggle between restaurant industries and legislators regarding menu labeling laws.  Menu labeling applies to chain restaurants with at least fifteen locations in the U.S.  Excludes grocery stores, convenience stores, and movie theaters.  Gave restaurants more flexibility in how they can label their menu items. (Public Health Law Center, 2009)

Montgomery County, Maryland  Resolution : Any eating and drinking establishment with at least 20 locations.  Grocery stores, convenience stores, and movie theaters exempt.  Three things must be posted:  Calories must be clearly posted next to menu item.  A statement as to the current suggested daily caloric intake (2,000 calories) determined by the U.S. Department of Health and Human Services.  A statement that additional nutrition information is available in writing upon request. (Montgomery County MD Department of Health and Human Services., n.d.)

YOU CAN MAKE A DIFFERENCE SUPPORT MENU LABELING LEGISLATION

THANK YOU Questions?

REFERENCES: Bleich, S. N., & Pollack, K. M. (2010). The publics' understanding of daily caloric recommendations and their perceptions of calorie posting in chain restaurants. BMC Public Health. Retrieved from the Academic Search Premier database. (Accession No ) 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), Retrieved from the Academic Search Premier database. (Accession No ) Center for Science in the Public Interest [CSPI]. (2008). Nutrition labeling at fast-food and other chain restaurants. Retrieved from Centers for Disease Control and Prevention [CDC]. (2011). Overweight and obesity. Retrieved from Davis, B., & Carpenter, C. (2009). Proximity of fast-food restaurants to schools and adolescent obesity. American Journal of Public Health, 99(3), doi: /AJPH Dumanovsky, T., Huang, C. Y., Bassett, M. T., & Silver, L. D. (2010). Consumer awareness of fast-food calorie information in New York City after implementation of a menu labeling regulation. American Journal of Public Health, 100(12), doi:0.2105/AJPH

REFERENCES (cont) French, S., Story, M., & Jeffery, R. (2001). Environmental influences on eating and physical activity. Annual Review of Public Health, 22(1), 309. Retrieved from the Academic Search Premier database. (Accession No ) Healthy Active Maryland. (2008). Burden of overweight and obesity in Maryland: Data update summary, Retrieved from AND_Final1.pdf Montgomery County MD Department of Health and Human Services. (n.d.). Nutrition labeling in eating and drinking establishments: Moving to a healthier Montgomery County. Retrieved from Obesity in America. (n.d.). Obesity-related diseases. Retrieved from Public Health Law Center. (2009, January). Menu labeling legislation: Options for requiring the disclosure of nutritional information in restaurants. Retrieved from Pulos, E., & Leng, K. (2010). Evaluation of a voluntary menu-labeling program in full-service restaurants. American Journal of Public Health, 100(6), doi: /AJPH

REFERENCES (cont) 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), Retrieved from the Academic Search Premier database. (Accession No ) Savage, L. C., & Johnson, R. K. (2006). Labeling in restaurants: will it make a difference?. Nutrition Bulletin, 31(4), doi: /j x Sloane, M. (2009). Obesity responsible for 100,000 cancer cases annually. Retrieved from endometrial-cancers?_s=PM:HEALTH Timmerman, G. M. (2006). Restaurant eating in nonpurge binge-eating women. Western Journal of Nursing Research, 28(7), doi: / Yale University Rudd Center. (2008). Menu labeling in chain restaurants: Opportunities for public policy. Retrieved from

FOR FURTHER INFORMATION: Center for Science in the Public Interest [CSPI]. (2008). Nutrition labeling at fast-food and other chain restaurants. Retrieved from Public Health Law Center. (2009, January). Menu labeling legislation: Options for requiring the disclosure of nutritional information in restaurants. Retrieved from labeling.pdf labeling.pdf Yale University Rudd Center. (2008). Menu labeling in chain restaurants: Opportunities for public policy. Retrieved from belingReport2008.pdf belingReport2008.pdf