The ACA: More than Just Healthcare (The Restaurant Labeling Act)
“Obamacare” (The Patient Protection and Affordable Care Act) has created controversy since its passage in 2010. Most of us understand the Affordable Care Act as it relates to our health care access and insurance coverage; however, far fewer are aware of the Act’s Title IV mandate to promote prevention, wellness, and public health—including making nutritional information more widely available to consumers. In response, the Food and Drug Administration passed a restaurant menu-labeling act in 2014—yes, after four full years of industry-lobbying against the act!—requiring that all restaurant chains or similar retail food establishments (including vending machines, supermarkets, food service areas inside entertainment venues, etc.) with twenty or more locations post calorie counts for each standard dish on the menu, with further nutritional information about each dish available on request, and that each food establishment post a statement regarding the average daily intake—2000 calories—as a point of reference.
Why this focus on nutritional information? As of 2102, 69% of US adults were overweight or obese. In addition, food consumption outside the home has been increasing both in number of meals out and in caloric intake. This dining out currently accounts for approximately 33 of adolescent and adult caloric intake, and it has been linked to lower diet quality (more fat, sodium, and sugar; fewer vitamins and minerals; larger portion sizes; etc.) and to increased body weight. The theory (hope) is that by offering consumers more information about their food choices, they will in turn make healthier ones.
What's the problem? Unfortunately, the food industry has been fighting this mandate (and continues to—the implementation of the act has been delayed until December 2016). Menu labeling tells us more about what we’re eating—and clearly, food establishments don’t want us to know that! Supermarkets, convenience stores, and pizzerias have fought particularly hard for exclusion from the ruling, citing forced limitations to their offerings in order to manage labeling for items. The final version of the bill takes into account many of their early arguments, ensuring that only “restaurant-type foods” that are standard menu items are included. Cost, however, remains a contentious issue for these establishments. Is it a legitimate concern? The Center for Science in the Public Interest cited overall costs per CHAIN (not establishment) ranging from $22,000 for supermarkets to $45,000 for restaurants –and this is for restaurants that have not already performed menu analysis, which many chains of this size have but currently do not print on menus or menu boards. Is this expensive? Maybe to you and me, but for a chain like PF Changs, which has approximately $1.2 billion in revenues each year, this is a negligible expense.
So...is it worth the fight? To date, most studies show that calorie-labeling as defined by the FDA ruling has minimal effect on calorie consumption. Two recent meta-analyses cited modest decreases in caloric intake—18–80 calories per meal—when caloric labeling was accompanied by contextual information related to the average, 2000 calorie intake per day, with no other indicators like green lights to indicate healthy options. If the impact of menu labeling is so modest, can we argue that the costs to food establishments is justified? Or will these statistics aid the food industry in eliminating this legislation before its even implemented?
I would argue that the costs are justified and it IS worth the fight!
Maybe the goal should not be to reduce obesity through food and menu labeling. Inarguably, food packaging regulations implemented in the 1990s have not appeared to impact the rise in obesity rates since that time. But what if this ruling is more about our right, as consumers, to additional information in making healthier choices? (How can we fight for the right to know when our food is genetically modified, but ignore the far greater health implications of excess caloric intake?! We’re missing the forest for the trees here!)
As a consumer, I WANT to know more about the content of my food. Some people argue that consumers know when they are eating healthy vs. unhealthy foods, and don’t need this information. However, I’m a soon-to-be-dietitian, and my favorite (seemingly healthy) Cheesecake Factory appetizer of fire-roasted artichokes—what I eat BEFORE my meal!—is 1030 calories! I wouldn’t have known that without looking at the company website today (it is something I’m not inclined to do while sitting in a restaurant with friends or family). You can bet that I’ll be making my artichokes at home from now on, and ordering the 300 calorie edamame the next time I visit. Maybe this is what restaurants are afraid of—that consumers will begin demanding with our dollars a greater number of healthier options, which may increase costs to restaurants in both menu development and fresh produce. But I would argue that this is exactly the response that will, in fact, begin to impact obesity rates and consumer health. Way to go, Obamacare!
Likewise, some argue that as diners we should be allowed to eat out in blissful ignorance. Sharon Begley at Reuters reports that, “U.S. health regulators estimate that consumers will suffer up to $5.27 billion in ‘lost pleasure’ over 20 years when calorie counts on restaurant menus discourage people from ordering french fries, brownies and other high-calorie favorites.” If this is supposed to be an argument against food labeling, it’s not working for me—if I were armed with calorie counts, along with a craving for French fries, I would be happily eating those fries—with a salad on the side or a reduction in calories in my next meal! I return to my argument that this is exactly how we begin to impact obesity rates and consumer health.
I could write pages of arguments in support of the FDA's menu-labeling rule, with or without statistically significant changes in calorie consumption. Alternately, there is no arguing that the ruling will impact various segments of the population differently (though most likely in the form of benefiting some more than others, as opposed to causing harm) or that we would be better armed with information about the nutrient composition of a meal than with a simple caloric count (though this, in turn, would require even greater consumer education!). However, I find it difficult to argue against consumers’ right to easy access to information that does not force, but can guide, healthier food choices.