1. Why Restaurants Should Add Nutritional Information to Their Menus?
Winifred Beckles
Dr. Raymond Thron
Environmental Health (PUBH )
Walden University
January 31, 2010
My targeted audience is lawmakers or public health officials who can influence the laws regarding standards of practice in the food industry. Stakeholders are the citizens, community organizations and leaders, research and academic institutions, government at all levels, schools/educators, healthcare professionals, and the food industry.

2. Learning Outcomes
To establish adding nutritional information to restaurant menus is a public health issue
Nutritional information to restaurant menus is used best if placed at the point of sale
Adding nutritional information to restaurant menus is a strategy to reduce obesity rates in the United States
Consumers will be able to make informed decisions about food choices
This presentation is designed to support all stakeholders especially lawmakers who are in support of adding nutritional information to restaurant menus. Because of obesity rates and the amount of time and money we spend away from home, it is important we know the content of the food we are eating at restaurants. The ability to make an informed choice should be available to individuals at restaurants just as it is available to us in the grocery store. Traffic accidents and chemical spills are public health issues and this slide will explore why adding nutritional information to restaurant menus is one also. . The presentation will also provide information on where restaurant menu labeling is most effective, how it can reduce obesity rates, and why consumers need nutritional informational to make wise choices. Adding nutritional information to restaurant menus is a effective strategy and health promotion technique.

3. Public Health
Public Health is defined as the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals. (Schneider,2006)
What is public health? It’s where we get our shots, where people get healthcare who don’t have any money, and it’s where you can get your birth certificate. Public Health is that and a whole lot more. Charles Winslow, who was a leading public health advocate in the 1st half of the 20th century, defines public health as the science and art of preventing disease , prolonging life and promoting health through the organized efforts and informed choices of society, organizations , public and private , communities and individuals.
Reference:
Schneider, M.J. (2006) Introduction to public health (2nd edition). Sunbury, MA. Jones and Bartlett

4. Public Health Vision: Healthy People in Healthy Communities Mission:
Improving the health, safety, and well-being of America (HHS, 2010)
When we are healthy , we are more productive. Public health’s vision is to inform, educate, and empower us with information to be healthy as well as improving, identifying , and investigating health disorders (Health, 2010). It order to accomplish the vision of public health, you and I must work together with public health. For instance, to stop the spread of germs, the CDC recommends that we wash our hands. We must adhere to their recommendations for us to be healthy and live in a healthy community. The mission of public health simply put is to promote healthy behaviors and to prevent disease and health hazards.
References:
The Georgia Division of Public Health website. Retrieved on January 28, 2010 from
U. S. Department of Health and Human Services website. Retrieved on January 28, 2010 from

5. Food is essential for us to live and grow.
Food is a substance from a plant or animal that is composed of carbohydrates, fats, protein, and water. Food usually comes from a plant or animal and is consumed for nutrition or pleasure. According to Merriam-Webster, nourishment is the act or process of getting nourishment . Nourishment from food and other substances is necessary for us to live and grow( Merriam-Webster, 2010).
References:
Merriam-Webster website (2010). Retrieved on January 20, 2010 from

6. United States Department of Agriculture
One of the roles of theUSDA is to provide Americans:
Nutrition policy coordination
Nutrition education
Dietary guidance
For more information on the
dietary guidelines for Americans:
Dietary Guidelines 2005
According to the 2005 Dietary Guidelines, humans should eat foods that includes lean meats, poultry, fish, beans, eggs and nuts (USDA, 2010). Fruits, vegetables, whole grains and reduced or fat free milk and milk products are also recommended (USDA, 2010). Limits are placed unsaturated fats, trans fats, cholesterol, salt (sodium) and added sugars (USDA, 2010). All foods should be consumed according to intake recommendations, and the USDA Food Guide 2000 calorie level should be used as a reference. To be a healthy individual, the USDA publishes a dietary guidance reference tool to establish a pattern of eating for Americans (USDA, 2010). Dietary Guidelines 2005 is the dietary guidance until 2010.
References:
United States Department of Agriculture(2010). Retrieved on January 10, 2010 from
United States Department of Agriculture(2010). Retrieved on January 10, 2010 from

7. United States Department of Agriculture
The USDA also recommends eating less and exercising to maintain a healthy lifestyle.
In addition to healthy eating, the USDA also recommends physical activity, eating less calories, and making wiser food choices. Because public health promotes healthier lifestyles, food consumption and nutrition education is important since and imbalance in physical activity, and consumption of food leads to individuals being overweight or obese.

8. Consequences of Overeating
Some of the consequences of not maintaining a healthy weight and eating a healthy diet are:
Type 2 diabetes -
Cardiovascular disease-
Overweight or obese-National epidemic-Two thirds of Americans
Poor diet and inactivity has been linked to a variety of illness such as type 2 diabetes, hypertension, and heart disease. Most individuals in the United States are overweight because there is a imbalance between calories expended and calories consumed. Because of these health conditions, healthcare costs are skyrocketing. Public health is concerned about these factors so it is important to find out where and what we are eating. According to Centers for Disease Control and Prevention, national costs related to individuals being overweight or obese were around 9.1% of the total US expenditures in 1998 or 78.5 billion (92.6 billion in 2002 dollars; CDC, 2010)) and two-thirds of Americans are overweight or obese (NIH, 2010). When individuals are overweight or obese, they are at risk of developing coronary heart disease, type 2 diabetes, hypertension, and cancers such as endometrial, breast, colon cancer (CDC, 2010). The healthcare costs of type 2 diabetes in the United States are $174 billion; $116 billion in direct costs and $58 billion indirect costs and over 7.8 % of the United States population has diabetes (American Diabetes Association, 2010).
References:
American Diabetes Association (2010). Retrieved on January 23, 2010 from
Centers for Disease Prevention and Control Retrieved on January 23, 2010 from
National Institute of Health (2010).Weight control information network. Retrieved on January 23, 2010 from

9. Away From Home Eating
The average expenditure for away from home eating is $2, 698 and the restaurant share of the food dollar is 49% (Restaurant, 2010) .
For more restaurant statistics:
In America, the average expenditure for food away from the home is $2,698 in 2010 and forty percent of Americans feel that purchasing meals from restaurants, delivery and take out places make their lives more productive. Because so many Americans eat away from home, a logical approach is for public health to inform Americans what they are consuming when they eat away from home. One approach is for restaurants to add nutritional information to their menus.
Reference:
National Restaurant Association (2010).Retrieved on January 17, 2010 from

10. Nutritional Information on Restaurant Menus
Benefits:
Wiser and informed choices
Aid to individuals with certain health conditions
Reduce obesity
Since obesity is a national epidemic mainly related to overeating, nutritional information would be helpful in aiding Americans to choose healthier options and for the benefit of diners who have certain medical conditions. Basic information such as calories, carbohydrates, trans fat, saturated fat, and sodium would aid individuals trying to attain or maintain a healthy weight. It would also assist individuals who have health conditions such as high cholesterol, type 2 diabetes, and hypertension. Nearly half of the $900 billion US food dollars is spent on restaurant food. Without nutritional information, we are unaware of what and how much we are consuming.
Reference:
National Restaurant Association (2010).Retrieved on January 17, 2010 from

11. Point of Purchase Options for restaurants: Internet Separate Menu
Posted in restaurants
Best option: Point of purchase
Restaurants can use a variety of options to provide diners with nutritional information. Many restaurants have their nutritional information on separate menus, on the Internet, or posted in the restaurant. However, the best option to me is at the point of purchase on the main menu. Many of us don’t always have access to the Internet or don’t think about checking it before we leave for a restaurant. Point of sale would have the information right where we are about to make our selection and purchase.

12. Nutritional Labeling and Education Act of 1990
Predecessor for restaurant menu nutrition labeling
Valuable information for U.S. grocery shoppers
The Nutritional Labeling and Education Act requires most packaged food have nutrition labeling and all nutrient content, and health claims must meet FDA regulations (FDA, 2010). According to one study, nutrient labeling does affect what consumers purchase. Two-thirds of Americans understand mostly what they read on nutrition labels and more than half (51 percent) always check the fat content on nutrition labels (Nielson,2010). Almost half check food labeling for calories (48 percent) and forty three percent check for trans fats (Nielsen, 2010). 
References:
Food and Drug Administration (2010). Retrieved on January 10, 2010 from
Nielsen Company (2010) Retrieved on January 20, 2010 from

13. Menu Nutrition Labeling
What does research tell us?
Health Impact Assessment-Los Angeles County, California
With modest changes in consumer behavior, menu labeling would have a positive impact on obesity.
Data from the Los Angeles County Health Surveys from was use to quantify the number of obese people aged eighteen and older in Los Angeles, County, CA. A random telephone structured interview was done with participants self reporting their height and weight. There were two random samples of 8004 (52% response rate) and 8648 (47% response rate). The study concluded that if individuals would make small changes to reduce calorie and fat intake aided by menu labeling, the rate of weight gain of 40.6% annually would be prevented in the Los Angeles County population aged 5 years and older. The study also suggested price incentives, price reductions, smaller portion size, and community involvement would be helpful strategies for restaurants to use along with menu labeling.
Reference:
Kuo, T.,Jarosz, C. J., Simon, P., Fielding, J. E.(2009). Menu Labeling as a Potential Strategy for Combating the Obesity Epidemic: A Health Impact Assessment. American Journal of Public Health; Sep2009, Vol. 99 Issue 9, p , 7p

14. Menu Nutrition Labeling
What does research tell us?
Observational study-New York City, New York
An observational study was conducted at eight locations of four restaurants. Of the 4311 participants, only 6 or .1% accessed separate nutritional menu at the restaurant before they purchased their meal. This supports the view around point of purchase menu labeling.
Reference:
Roberto, Christina A., Agnew, Henry, Brownell, Kelly D.(2009). An Observational Study of Consumers' Accessing of Nutrition Information in Chain Restaurants. American Journal of Public Health, May2009, Vol. 99 Issue 5, p , 2p

15. Menu Nutrition Labeling
What does research say?
Consumer Selections –Study dinner
Researchers conducted a study dinner where 303 participants were given menus with calorie information, no calorie information, or calorie information and calories needed per day. The study concluded that consumers who received information about calories needed per day and caloric information for each meal ate fourteen percent less calories than the group with no calorie information.
Reference:
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, Feb 2010; 100:

16. Menu Nutrition Labeling
Public Health Issue??
Basic Public Health Characteristics
Health promotion and prevention of diseases
Epidemiology
Studies the patterns of disease occurrence in human populations and the factors that influence these patterns.
A collaborative effort will be needed with partners in health promotion.
Most Americans would consider crime rates a public health concern, but obesity is a threat also to public health. As public health officials, providing American citizens with nutritional information at restaurants with enable them to know what they are consuming away from home. Epidemiology studies have shown a clear link between unhealthy eating and a sedentary lifestyle to several chronic diseases such as hypertension and type 2 diabetes. Mandating menu nutrition labeling is not the only solution. A collaborative effort is needed with community organizations and leaders, schools/educators, health professionals, research and academic institutions, food service industry, public health, and government at all levels. Menu labeling is only one resource that can assist individuals with wiser choices but it must be combined with education on nutrition and exercise.

17. Key Goals
Mandate all restaurants with at least ten menu items to list nutritional information in the restaurant preferably at point of purchase
Collaborate with other organizations dedicated to health promotion to reduce obesity and chronic diseases linked to obesity and a sedentary lifestyle
I hope this presentation will serve as a reference tool of why nutritional menu labeling at restaurants is important to public health and open a forum for all stakeholders to pool together resources and ideas to reduce obesity rates in America.

18. Additional Sources
Labeling Education and Nutrition (LEAN) Act of
National Institute of Health-
United States Department of Agriculture-
White House-First Lady Michelle Obama takes on childhood obesity

19. References
American Diabetes Association (2010). Retrieved on January 23, 2010 from
Centers for Disease Prevention and Control Retrieved on January 23, 2010 from
Food and Drug Administration (2010). Retrieved on January 10, 2010 from
Georgia Division of Public Health website. Retrieved on January 28, 2010 from
Kuo, T.,Jarosz, C. J., Simon, P., Fielding, J. E.(2009). Menu Labeling as a Potential Strategy for Combating the Obesity Epidemic: A Health Impact Assessment. American Journal of Public Health; Sep2009, Vol. 99 Issue 9, p , 7p
Merriam-Webster website (2010). Retrieved on January 20, 2010 from

20. References
Roberto, C. A., Agnew, H., Brownell, K. D.(2009). An Observational Study of Consumers' Accessing of Nutrition Information in Chain Restaurants. American Journal of Public Health, May2009, Vol. 99 Issue 5, p , 2p
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, Feb 2010; 100: 312 – 318
National Institute of Health (2010).Weight control information network. Retrieved on January 23, 2010 from
National Restaurant Association (2010).Retrieved on January 17, 2010 from
Nielsen Company (2010) Retrieved on January 20, 2010 from
Schneider, M.J. (2006) Introduction to public health (2nd edition). Sunbury, MA. Jones and Bartlett

21. References
United States Department of Agriculture(2010). Retrieved on January 10, 2010 from
United States Department of Agriculture(2010). Retrieved on January 10, 2010 from
U. S. Department of Health and Human Services website. Retrieved on January 28, 2010 from