1. The Importance of Including Nutrition Information on Menus
Netheli Toussaint Ph.D. Student: Public health
Walden University
PUBH
Instructor: Dr. Rebecca Heick
Spring, 2010
Good morning ladies and gentlemen. My name is Netheli Toussaint, I am a student at Walden University in pursuit of a doctorate degree in Public Health. Today I will like to discuss why it is important to include nutrition information on menus in restaurants in our area.

2. Key Considerations
Obesity is of epidemic proportion and is the second leading cause of preventable death
Obesity is not just a problem of the individual, but also a problem embedded in environmental and community factors
Multifaceted approaches to change our food and physical activity environments are needed now
There is an urgent need for potential policy and programmatic solutions to the obesity epidemic
Reference:
Institute of Medicine (2010). Bridging the evidence gap in obesity prevention: a framework in inform decision making. Retrieved April 24, 2010 from the Institute of Medicine website:
First lets look at some key considerations. Obesity should be considered a population base health problem instead of an individual problem. It is important that we look at obesity prevention from a system perspective, hence, a multifaceted approach is needed to aid in this fight.

3. Overview of the Problem
Approximately 68% of all adults 20 yrs and older in the United States are overweight or obese
Approximately 32% of children are overweight and obese
Unhealthy eating habits leads to poor health
We pay a high price for poor nutrition: cost on health (coronary heart disease, type 2 diabetes, stroke, hypertension, dyslipidema, and many more) and the economy (over $92.6 billion in 2002)
References:
Centers for Disease Control and Prevention (2010). Overweight and obesity: causes and consequences. Retrieved April 20, 2010 from the Centers for Disease Control and Prevention website:
Institute of Medicine (2010). Bridging the evidence gap in obesity prevention: a framework in inform decision making. Retrieved April 24, 2010 from the Institute of Medicine website:
Office of the Surgeon General (2000). The Surgeon general’s call to action to prevent and decrease overweight and obesity. Retrieved April 20, 2010 from the Office of the Surgeon General website: l
Obesity is at epidemic proportion and is one of the main risk factors to several health issues. In addition it creates a burden on our health care cost. More than half of all American adults are overweight or obese, and ~ 32% of children struggle with this issue.

4. Overweight and Obesity Prevalence & Consequence in Bay County, FL
Approximately 60% of adults in Bay County are overweight and 24.8% are obese
Only 24.7% eat the recommended 5 servings of fruits and vegetables a day
Estimated annual cost of obesity in Florida is $398.7 million
Bay County ranked 32nd out of 67 counties in healthy behaviors such as adult smoking and obesity
References:
Centers for Disease Control and Prevention (2010). Overweight and obesity: causes and consequences. Retrieved April 20, 2010 from the Centers for Disease Control and Prevention website:
Florida Community Health Assessment Resources Tool Set (2008). County chronic disease profile. Retrieved from Florida Department of Health Office of Health Statistics & Assessment website:
Robert Wood Johnson Foundation & the University of Wisconsin Population Health Institute (2010). County health rankings. Retrieved from the County Health Rankings website:
Our community (Bay County Florida) is no exception. Approximately 60% of adults are overweight, and ~25% are obese. On average less than 25% consume the recommended 5 servings of fruits and vegetables daily.

5. Environment + Genetics
Causes
Environment + Genetics
Urbanization
Drop in physical activity
Changes in food supply, portion sizes,
frequency of eating & types of foods
being eaten
Reference:
Centers for Disease Control and Prevention (2010). Overweight and obesity: causes and consequences. Retrieved April 20, 2010 from the Centers for Disease Control and Prevention website:
According the 2001 Surgeon General's report “Call to Action to Prevent and Decrease Overweight and obesity” the majority of Americans are “eating too much and moving too little.” Eating out too often, portion sizes, and consumption of high calorie meals are all reasons for weight gain, in addition to other environmental and genetic factors.

6. Background
Regulation of restaurant food should be a nationwide public health effort. Let’s talk a little about why this regulation can lead to a reduction in overweight and obesity.

7. People are Eating Out More
Since the 1960s, the percent of food expenditures spent on foods eaten away from home has increased steadily, along with obesity rates.
In 2006, away-from-home food purchases accounted for 48% of the American food dollar.
On average Americans age 8 and above consume 4.2 commercially prepared meals per week
Reference:
National Restaurant Association (2002). Americans dining-out habits. Retrieved April 20, 2010 from the National Restaurant Association website:
As mentioned earlier the US obesity epidemic is due in part to excess calorie consumption. Most of which is consume away from home. In 2006 close to 50% of Americans eat out on a regular basis. Americans consume at least 4 commercially prepared meals weekly.

8. Fast Food is Associated With More Calorie Intake
Fast food  higher calorie intake
Adults: 205 more calories/day
Children: 155 more calories/day
At once/week, would lead to 3 pound weight gain/year
More fast food  more obesity
Adults: 27-31% increase in overweight
Young children: twice as likely to be obese
Among adolescents, more days of fast food predicts increases in BMI
Reference:
Angell, S., Sliver, L., D. (2008). Calorie labeling in New York City Restaurants: an approach to inform consumers PPT presentation. Retrieved April 20, 2010 from Google search:
One of any given day over 25% of adults eat fast food, consuming ~ 200 more calories on days when fast food is eaten. Excess calories lead to weight gain over time.

9. Increasing Portion Sizes Increase Caloric Intake
Regular food item
Calories and
% recommended daily intake
Larger food item
Calorie difference
Item larger by
Regular cheese burger
360
18%
Triple whopper with cheese
1,230
61.5%
870
242%
Chocolate shake (12ozs)
440
22%
Chocolate shake (32ozs)
1,160
58%
720
164%
Big Breakfast
36%
Deluxe breakfast
1,400
70%
680
94%
Menu items differs in preparation, added ingredients, and portion size. Information on portion sizes is typically not specified or visible at point of purchase.
Reference:
Angell, S., Sliver, L., D. (2008). Calorie labeling in New York City Restaurants: an approach to inform consumers PPT presentation. Retrieved April 20, 2010 from Google search:

10. Dietary Guidelines for Americans
According to US Dept of Health & Human Services a healthy plan is one that:
Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
Includes lean meats, poultry, fish, beans, eggs, and nuts.
Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
Reference:
U. S. Department of Health & Human Services (2005). Dietary guidelines for Americans. Retrieved April 24, 2010 from the website of the U.S. Department of Health and Human Services website:
Nutrition comes second to taste when it comes to influencing food purchase. However, nutrition labels provide information on ingredients and nutrition content and help individuals make better choices when purchasing food.

11. Most Customers Underestimate Calorie Content
Research shows that consumers underestimate the calories in food. Typically Americans underestimate calories in fast food meals by 200 to 600 calories.
Reference:
Angell, S., Sliver, L., D. (2008). Calorie labeling in New York City Restaurants: an approach to inform consumers PPT presentation. Retrieved April 20, 2010 from Google search:

12. Calorie Information Makes a Difference in Amount People Eat
Making calorie/nutrition information visible help consumers make inform choices.
Reference:
Angell, S., Sliver, L., D. (2008). Calorie labeling in New York City Restaurants: an approach to inform consumers PPT presentation. Retrieved April 20, 2010 from Google search:

13. Nutrition Labeling Influences Decision
3/4 of U.S. adults report using nutrition labels on packaged foods
1/2 of U.S. adults say nutrition information influences their purchasing
When nutrition information for menu items is readily available, consumers choose high-calorie items about 1/3 less often
Reference:
Angell, S., Sliver, L., D. (2008). Calorie labeling in New York City Restaurants: an approach to inform consumers PPT presentation. Retrieved April 20, 2010 from Google search:
Approximately 50% of adults report that reading the nutrition information on food labels helped them make healthier decision when purchasing food.

14. Summary Its important to include nutrition content on menus:
Because the obesity epidemic needs to be address with a multifaceted approach
A significant number of families eat out on a daily basis
Eating out is associated with higher calorie intake and obesity
The obesity epidemic needs a multifaceted approach. Since more and more Americans are eating out it is important to include nutrition content on menus. Eating out is associated with more calorie intake, and consumers agree that reading the nutrition information help them make healthier decisions.

15. Additional Resources
Prevention institute. Nutrition labeling Regulations:
US Department of Agriculture. Nutrition and Your Health: Dietary Guidelines for American.
The University of California Center for Weight & Health. Potential impact of menu labeling of fast foods in California:
NYC Department of Health and Mental Hygiene. Notice of adoption of a resolution to repeal and reenact of the New York City Health Code:
Additional information on this issue can be found at these resources.

16. Any Questions ?
Thank you very much for your time. I will now take any questions you may have.

17. References
Angell, S., Sliver, L., D. (2008). Calorie labeling in New York City Restaurants: an approach to inform consumers PPT presentation. Retrieved April 20, 2010 from Google search: Centers for Disease Control and Prevention (2010). Overweight and obesity: causes and consequences. Retrieved April 20, 2010 from the Centers for Disease Control and Prevention website: Florida Community Health Assessment Resources Tool Set (2008). County chronic disease profile. Retrieved April 20, 2010 from Florida Department of Health Office of Health Statistics & Assessment website: Institute of Medicine (2010). Bridging the evidence gap in obesity prevention: a framework in inform decision making. Retrieved April 24, 2010 from the Institute of Medicine website:

18. References cont…
National Restaurant Association (2002). Americans dining-out habits. Retrieved April 20, 2010 from the National Restaurant Association website: Robert Wood Johnson Foundation & the University of Wisconsin Population Health Institute (2010). County health rankings. Retrieved April 20, 2010 from the County Health Rankings website: Office of the Surgeon General (2000). The Surgeon general’s call to action to prevent and decrease overweight and obesity. Retrieved April 20, 2010 from the Office of the Surgeon General website: U. S. Department of Health & Human Services (2005). Dietary guidelines for Americans. Retrieved April 24, 2010 from the website of the U.S. Department of Health and Human Services website: