America’s Health Status

Partnering Together for Healthier Consumers

Debra Gilbert, Master of Public Health StudentWalden University

PH 6165-1Instructor: Dr. Shana Morrell

Summer, 2009

America’s Health Status

129.6 million or 64% of adults are currently overweight or obese (US DHHS, 2004)

Increase in obesity rates in last 20 years (CPSI, 2003) Adults – doubled Children – doubled Teens - tripled

Obesity epidemic is a major national priority (Burton, 2006)

Burton, S., Creyer, E., Kees, J., & Huggins, K. (2006, September). Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9), 1669-1675. Retrieved July 11, 2009, from Academic Search Premier database

Center for Science in Public Interest. (2003, November ). Anyone’s guess: The need for nutritional labeling at fast-food and other chain restaurants. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/anyone_s_guess_final_web.pdf

United States Department of Health and Human Services. (2004, March 9). Citing “dangerous increase” in deaths , HHS launches new strategies against overweight epidemic. Retrieved July 1, 2009, from http://www.os.dhhs.gov/news/press/2004pres/20040309.html

Conditions Associated with Nutrition and Obesity

Obesity Cardiovascular Disease Metabolic Syndrome Type II Diabetes Asthma Cancer Osteoporosis Hypertension High Cholesterol Tooth decay


Donghui, L., Morris, J.S., Liu, J., Hassan, M.M. Day, R.S., Bondy, M.L. & Abbruzzese, J.L. (2009, June 24). Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. Journal of the American Medical Association. 301(24): 2553-2562. Retrieved July 15, 2009, from http://jama.ama-assn.org/cgi/content/short/301/24/2553


American Health Issues

Increased fat , cholesterol and sodium in diet contribute to obesity (CPSI, 2003)

$117 billion/ year on obesity related conditions (US DHHS, 2004)

Financial impact on healthcare (Blair Lewis, 2005)

Blair Lewis, L., Sloane, D., Nascimento, L., Diamant, A., Guinyard, J., Yancey, A., et al. (2005, April). African Americans' access to healthy food options in South Los Angeles restaurants. American Journal of Public Health, 95(4), 668-673. Retrieved July 11, 2009, doi:10.2105/AJPH.2004.050260



Why Involve Restaurants in Health?

Restaurants annual revenue >$400 billion and increasing (Burton, 2006; Variyam, 2005))

Association between regular intake of fast foods and weight gain (Burton, 2006)

Restaurant Options Vary According to Socioeconomic Level (Blair Lewis, 2005)


Burton, S., Creyer, E., Kees, J., & Huggins, K. (2006, September). Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9), 1669-1675. Retrieved July 11, 2009, from Academic Search Premier database

Variyam, J.N. (2005, April). Nutritional labeling in the food-away-from-home sector: An economic assessment. United States Department of Agriculture Economic Research Report 4. Retrieved July 10, 2009, from http://ageconsearch.umn.edu/bitstream/7235/2/er050004.pdf

Influences on Purchases

Type of Establishment (Stewart, 2005) Desire for Healthy Diet Convenience Enjoyment/Ambiance

Food Selection (Stewart, 2005) Taste Cost Preparation Time Nutritional Information

Advertisements (Blair Lewis, 2005)Appearance of food on posters, menus Promotions


Stewart, H., Blisard, N., Jolliffe, D. & Bhuyan, S. (2005). The demand for food away from home: Do other preferences compete with our desires to eat healthfully? Journal of Agricultural and Resource Economics. 30(3): 520-536. Retrieved June 30, 2008 ,from http://ageconsearch.umn.edu/bitstream/30984/1/30030520.pdf

United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. (2001). Healthy People 2000 Final Review. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, DHHS Publication No. 01-0256. Retrieved July 2, 2009, from http://www.cdc.gov/nchs/data/hp2000/hp2k01.pdf

How Can Nutritional Information Help?

Key to provide information before ordering

Highlight healthier food selections

Recommended Dietary Allowances

2000 Calories/day

Fat - 65 g

Saturated fat 20 g

Sodium 2400 mg

Center for Science in Public Interest. (2006, November 30). FDA urged to create new “healthy food” labeling system. Retrieved July 10, 2009, from http://www.cspinet.org/new/200611301.html

Food and Drug Administration. (2008, April). Guidance for industry: A labeling guide for restaurants and other retail establishments selling away-from-home foods. Retrieved July 10, 2009, from http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/ GuidanceDocuments/FoodLabelingNutrition/ucm053455.htm

National Restaurant Association. (2009). Public policy issue briefs: Menu labeling/nutrition information. Retrieved July 9, 2009, from http://www.restaurant.org/government/issues/issues. cfm? Issue=menulabel

Menu Content

Menu boards Caloric Value

Full Service Menus Serving Size Caloric value Fat Sodium

Center for Science in Public Interest. (2008, October 1). Yum! brands praised for adding calorie counts to KFC, Pizza Hut, Taco Bell menu boards. Retrieved July 10, 2009, from http://www.cspinet.org/new/200810011.html

McCann, M.A. (2005, January/February). Comparing legal, economic, and legislative approaches to nutritional labeling of fast food items. Update: Food & Drug Law, Regulation & Education, 1(4). Retrieved June 24, 2009, from http://ssrn.com/abstract=678222

Thomas, L. & Mills, J.E. (2008). Consumer knowledge and expectations of restaurant menus and their governing legislation: a quantitative assessment. Journal of Foodservice. 17: 6-22. Retrieved June 28, 2009, from http://www3.interscience.wiley.com/cgi-bin/fulltext/118732305/PDFSTART

Best Labeling Information

Nutritional InformationCaloric ContentTotal Fat and Saturated FatMacronutrients

Easy To Understand LabelsPer Serving Consistent Symbols

Hwang, J. & Lorenzen, C.L. (2008). Effective nutrition labeling of restaurant menu and pricing of healthy menu. Journal of Foodservice. 19:270-276. Doi: 10.111/j.1748-0159.2008.00108.x Thomas, L. & Mills, J.E. (2008). Consumer knowledge and expectations of restaurant menus and their governing legislation: a quantitative assessment. Journal of Foodservice. 17: 6-22. Retrieved June 28, 2009, from http://www3.interscience.wiley.com/cgi-bin/fulltext/118732305/PDFSTART

Nutritional Estimates without Information

Underestimate of calories, fat & sodium Miscalculation greater for higher calorie

foods Example: Cheese fries w/ ranch dressing

Estimated <900 caloriesActual 3010 calories

Healthier foods often misjudged unhealthyBurton, S., Creyer, E., Kees, J., & Huggins, K. (2006, September). Attacking the Obesity Epidemic: The Potential Health Benefits

of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9), 1669-1675. Retrieved July 11, 2009, from Academic Search Premier database.

Restaurant Meal #1

RDA

2000 calories 65 g fat 2400 mg sodium

Total Meal4200 calories

290 g fat 5700 mg sodium

Onion Strings & Crispy Jalapeno stack w/ Jalapeno Ranch 2130 calories 213 g fat 1320 mg sodiumBoneless Buffalo Chicken Salad 1070 calories 77 g fat 4380 mg sodiumNo Calorie Beverage Brinker International. (2009). Nutritional information. Chili’s Bar and Grill. Retrieved July 10, 2009, from http://www.chilis.com/menu/default.asp

Restaurant Meal #2

RDA

2000 calories 65 g fat 2400 mg sodium

Guiltless Buffalo Chicken Sandwich 390 calories 7 g fat 2300 mg sodiumSeasonal Veggies 69 calories 4 g fat 170 mg sodiumNo Calorie BeverageBrinker International. (2009). Nutritional information. Chili’s Bar and Grill. Retrieved July 10, 2009, from http://www.chilis.com/ menu/default.asp

Total Meal 459 calories 11 g fat 2470 mg sodium

Healthier Food Preparation

Grilled BoiledPoached SautéedBaked SteamedRotisserie Stir FriedRoasted Broiled


1990 Labeling Legislation

Nutritional Labeling and Education Act (FDA, 2008)

Applied to packaged foods Exempted prepared food

unless making a health claim

Food and Drug Administration. (2008, April). Guidance for industry: A labeling guide for restaurants and other retail establishments selling away-from-home foods. Retrieved July 10, 2009, from http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/ GuidanceDocuments/ FoodLabelingNutrition/ucm053455.htm

McCann, M.A. (2005, January/February). Comparing legal, economic, and legislative approaches to nutritional labeling of fast food items. Update: Food & Drug Law, Regulation & Education, 1(4). Retrieved June 24, 2009, from http://ssrn.com/abstract=678222

City and County Regulations

Regional Laws Caloric Counts on Prepared Foods July, 2007 King County (Seattle) Washington Varied Requirements

Center for Science in Public Interest. (2008, September 30). California first state in nation to pass menu labeling law. Retrieved July 10, 2009, from http://www.cspinet.org/new/200809301.html

Center for Science in Public Interest. (2009, May 13). Nutritional labeling in chain restaurants. Retrieved July 10, 2009, from http://www.cspinet.org/new/ml_bill_summaries_09.html

State Legislation

2008 California Passed State Law Applies to >20 outlets

States with Menu Labeling LawsOregonMaine Massachusetts



Current US Legislation

Center for Science in Public Interest. (2009, May). Menu-labeling map. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/ml_map.pdf

Support for National Nutritional Disclosure Legislation (LEAN Act)

Coalition for Responsible Nutrition Information (CRNI)

National Restaurant Association

Medical Professionals

Consumer Groups

National Restaurant Association. (2009). Public policy issue briefs: Menu labeling/nutrition information. Retrieved July 9,

2009, from http://www.restaurant.org/government/issues /issues. cfm? Issue=menulabel

United States Senate Bill. (2009, March 10). Senate version of the LEAN Act S.558. Retrieved July 16, 2009, from http://www.nationalnutritionstandards.com/pdfs/LEAN_ACT_SENATE_FINAL.pdf

Menu Board Concerns

Overcrowded

Brochures or posters near point of sale

Frequent Menu changes



Frumpkin, P. (2009, March 11). Congress to reconsider LEAN Act. Nation’s Restaurant News. Retrieved July 17, 2009, from http://www.nrn.com/breakingNews.aspx?id=364160


Full Service Menus Concerns

Room on menu

Chef discretion

Frequent changes

Customer adjustments


Nutritional Analysis

Laboratory Analysis

Nutrient Databases

Cookbooks

Other sources that provide reasonable information

United States Senate Bill. (2009, March 10). Senate version of the LEAN Act S.558. Retrieved July 16, 2009, from http://www.nationalnutritionstandards.com/ pdfs/LEAN_ACT_SENATE_FINAL.pdf

Possible Impact Post Labeling

Healthier choices Lower in fat Lower calories Reduced carbohydrates Reduce sodium More vegetables


More Possible Changes

Reduced portion sizes Half the size ≠ Half the price Encourage take home containers or sharing entrees

Hwang, J. & Lorenzen, C.L. (2008). Effective nutrition labeling of restaurant menu and pricing of healthy menu. Journal of Foodservice. 19:270-276. Doi: 10.111/j.1748-0159.2008.00108.x

Additional Considerations

Labeling Exemptions

Voluntary labeling

Consumer Education

Sources of Additional Information

Center for Science in the Public Interest http://www.cspinet.org/menulabeling/

Coalition for Responsible Nutritional Information http://www.nationalnutritionstandards.com

FDA Food Labeling & Nutrition http://www.fda.gov/Food/LabelingNutrition/default.htm

National Restaurant Association http://www.restaurant.org/government/issues/issue.cfm?Issue=menulabel

References


Brinker International. (2009). Nutritional information. Chili’s Bar and Grill. Retrieved July 10, 2009, from http://www.chilis.com/menu/default.asp

Burton, S., Creyer, E., Kees, J., & Huggins, K. (2006, September). Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9), 1669-1675. Retrieved July 11, 2009, from Academic Search Premier database.

Center for Science in Public Interest. (2003, November). Anyone’s guess: The need for nutritional labeling at fast-food and other chain restaurants. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/anyone_s_guess_final_web.pdf

Center for Science in Public Interest. (2006, November 30). FDA urged to create new “healthy food” labeling system. Retrieved July 10, 2009, from http://www.cspinet.org/new/200611301.html

References


Center for Science in Public Interest. (2009, May). Menu-labeling map. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/ml_map.pdf



Donghui, L., Morris, J.S., Liu, J., Hassan, M.M. Day, R.S., Bondy, M.L. & Abbruzzese, J.L. (2009, June 24). Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. Journal of the American Medical Association. 301(24): 2553-2562. Retrieved July 15, 2009, from http://jama.ama-assn.org/cgi/content/short/301/24/2553

ReferencesFood and Drug Administration. (2008, April). Guidance for industry: A labeling guide for

restaurants and other retail establishments selling away-from-home foods. Retrieved July 10, 2009, from http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/

GuidanceDocuments/FoodLabelingNutrition/ucm053455.htm

Frumpkin, P. (2009, March 11). Congress to reconsider LEAN Act. Nation’s Restaurant News. Retrieved July 17, 2009, from http://www.nrn.com/breakingNews.aspx?id=364160

Hwang, J. & Lorenzen, C.L. (2008). Effective nutrition labeling of restaurant menu and pricing of healthy menu. Journal of Foodservice. 19:270-276. Doi: 10.111/j.1748-0159.2008.00108.x

McCann, M.A. (2005, January/February). Comparing legal, economic, and legislative approaches

to nutritional labeling of fast food items. Update: Food & Drug Law, Regulation & Education, 1(4). Retrieved June 24, 2009, from http://ssrn.com/abstract=678222

National Restaurant Association. (2009). Public policy issue briefs: Menu labeling/nutrition information. Retrieved July 9, 2009, from http://www.restaurant.org/government/issues/issues. cfm? Issue=menulabel

References

Stewart, H., Blisard, N., Jolliffe, D. & Bhuyan, S. (2005). The demand for food away from home: Do other preferences compete with our desires to eat healthfully? Journal of Agricultural and Resource Economics. 30(3): 520-536. Retrieved June 30, 2008 ,from http://ageconsearch.umn.edu/bitstream/30984/1/30030520.pdf

Thomas, L. & Mills, J.E. (2008). Consumer knowledge and expectations of restaurant menus and their governing legislation: a quantitative assessment. Journal of Foodservice. 17: 6-22. Retrieved June 28, 2009, from http://www3.interscience.wiley.com/cgi-bin/fulltext/118732305/PDFSTART


United States Department of Health and Human Services , Centers for Disease Control and Prevention, National Center for Health Statistics. (2001). Healthy People 2000 Final Review. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, DHHS Publication No. 01-0256. Retrieved July 2, 2009, from http://www.cdc.gov/nchs/data/hp2000/hp2k01.pdf

References


Variyam, J.N. (2005, April). Nutritional labeling in the food-away-from-home sector: An economic assessment. United States Department of Agriculture Economic Research Report 4. Retrieved July 10, 2009, from http://ageconsearch.umn.edu/bitstream/7235/2/er050004.pdf