Why do we have to count calories at restaurants?

<span style="font-size: large;">    Three studies recently published speak to the nutritional content of away from home meals and the public's lack of awareness of just how 'unhealthy' those meals can be.</span><br /><span style="font-size: large;">   I am going to give you a <strike>brief</strike> bottom line summary from the research.  The citations for the studies are:</span><br /><span style="font-size: large;"><br /></span><div style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 16px; margin-left: 0.5in; margin-right: 5px; text-indent: -0.5in;">Block, J. P., Condon, S. K., Kleinman, K., Mullen, J., Linakis, S., Rifas-Shiman, S., & Gillman, M. W. (2013). <b>Consumers’ estimation of calorie content at fast food restaurants:</b> cross sectional observational study. <i>BMJ, 346</i>. doi: 10.1136/bmj.f2907</div><div style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 16px; margin-left: 0.5in; margin-right: 5px; text-indent: -0.5in;">Urban, L. E., Lichtenstein, A. H., Gary, C. E., Fierstein, J. L., Equi, A., Kussmaul, C., . . . Roberts, S. B. (2013). <b>The energy content of restaurant foods without stated calorie information.</b> <i>JAMA Internal Medicine, May 13</i>, 1-8. doi: 10.1001/jamainternmed.2013.6163</div><div style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 16px; margin-left: 5px; margin-right: 5px;"></div><div style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 16px; margin-left: 0.5in; margin-right: 5px; text-indent: -0.5in;">Scourboutakos, M. J., Semnani-Azad, Z., & L’Abbe, M. R. (2013). Restaurant meals: <b>Almost a full day's worth of calories, fats, and sodium</b>. <i>JAMA Internal Medicine</i>, 1-2. doi: 10.1001/jamainternmed.2013.6159</div><div style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 16px; margin-left: 5px; margin-right: 5px;"></div><br /><div style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 16px; margin-left: 5px; margin-right: 5px;"></div><div style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 16px; margin-left: 5px; margin-right: 5px;"></div><span style="font-family: inherit; font-size: large;">    In the Block study, researchers found that American's continue to underestimate the amount of calories in quick service (counter service) restaurants, in general, but do an especially poor job estimating calories in restaurants perceived to be healthier (e.g., Subway, Panera Bread).  There was a slight difference in how accurate people were based on whether they were adults, children or teenagers, but everyone underestimated the total calories by about 200 calories.  Most interestingly, teenagers and adults were off by 300 and 400 calories, respectively, for Subway meals. T</span><span style="font-size: large;">he more calories a meal had, the worse people did at guessing them.  By the way, the average calorie content for a meal at KFC and Wendy's was less than the average calorie content for a meal at Subway.  Adult meals from McDonald's, on average, had more calories than Burger King (606 v 530).  This study supports the need for onsite, in your face, nutrition labeling.  The restaurants in this study are covered by the national menu labeling law.</span><br /><div><span style="font-size: large;">   The Urban team reviewed the calorie content of meals at restaurants that will not be covered by the national law. They studied independent or small chain restaurants (less than 20 stores nationwide), that were within 15 minutes of downtown Boston (USA).  They included 9 popular types of restaurants (e.g., Italian, Indian, Vietnamese, American) in their study.  They determined which 4 meals were the most popular at each establishment and focused on those.  They ordered each meal, with one side item, and brought the food back to a lab.  They determined </span><span style="font-size: large;">the exact number of calories in each meal</span><span style="font-size: large;"> through chemical analyses.  They also determined the number of calories per gram of food (energy density).  In their paper, they provided the average total calories and density for each of the 9 restaurant types. In some instances, they were able to make a direct meal comparison between an independent, local restaurant and a national chain.  For example, a lasagna dinner at a quaint Italian bistro in Boston, compared to a lasagna dinner at Olive Garden or Macaroni Grill.  The average calories for one meal at all but the Vietnamese restaurant was more than a third of a days worth of calories!  The average calorie content (1327 kcal) was HIGHER than the average for chain restaurants covered by the law (890 kcal)!  The highest averages of the local restaurants were at the Italian, Indian, Chinese and American restaurants.  Italian was the worst - 1755 calories for an average meal.  That is just about what I consume in a whole day but  I split it up so I can eat about 8 times.  The average amount of calories for a Vietnamese meal was 922 and they had the lowest calorie per gram.  When the researchers matched meals to a national chain, there were still more calories in the independent restaurants, but the difference was less.  Bottom line - too many calories in restaurant foods and your local restaurant isn't doing any better.</span></div><div><span style="font-size: large;">   Lastly, and quickly, Scourboutakos looked at more than just calories in 24 sit down chain restaurants in Canada.  Her team found that for breakfast, lunch and dinner - each average meal provided over 50% of a days worth of calories, total and sat fat, sodium/salt and trans fat.  If you ate your 3 main meals at these restaurants, you would consume over 3000 calories in one day and I bet you are not Michael Phelps.</span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">   When did it become necessary to count calories at a restaurant?  When we started eating at them several times a week instead of several times a year.</span></div>

Why do we have to count calories at restaurants?

    Three studies recently published speak to the nutritional content of away from home meals and the public's lack of awareness of just...

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Do Menu Labels Matter?

<span style="font-size: large;">   I am certain that you have heard the news that starting next week all of McDonald's indoor and drive through menu boards will show calorie content of all foods. Recently I shared <a href="http://yourhealtheducator.blogspot.com/2012/07/fast-food-customers-walk-ins-vs-drive.html" target="_blank">a study</a> by Christina Roberto regarding the percent of customers who actually use the drive through lane.  Her study informed the decision to include both menus.</span><br /><span style="font-size: large;">   There are a few things in the news that are wrong or otherwise worth noting.  First of all, McDonald's IS doing something that it will have to do anyway.  The National Menu Labeling law has been passed.  A reporter from USA Today said that the law had merely been proposed.  That is untrue.  What is pending is the final rule.  I have also seen some negative response to McDonald's.  I feel that is inappropriate.  I am not fooled into thinking that they will become a healthy eating establishment, and I think that they are mostly interested in sales.  But why make an enemy out of a restaurant that I assure you is NOT going to disappear.  </span><br /><span style="font-size: large;">   I love that McDonald's made a decision to post early.  They made preparations when the law was passed.  The law has been supported by the National Restaurant Association.   Others will follow their lead, to move forward now.  This gets the conversation back into the public where it needs to be and may get the FDA moving on that final rule.</span><br /><span style="font-size: large;">   McDonald's <u>will</u> respond to its costumers.  They are planning on introducing more fruits and vegetables.  They were the first to rid their oils of trans fats and to offer fruit in the happy meal.  I only hope that people will buy the new items.  Most of us do not go to McDonald's for their salads and such.</span><br /><span style="font-size: large;">   Which brings me to another issue that needs to be cleared up.  Some have said, in response to McDonald's actions, that menu labeling does not have an impact on purchases.  That is not true.  We do have a number of studies that show no effect, but the ones that show a change in behavior help us to understand why the others do not.  Most people who see the information, understand the information, and know the relevancy of calories to a their daily diet will choose the lower calorie items.  However, there are also those who decide to go to McDonald's or Burger King to get that Bic Mac or Whopper and they do not look at anything... they order what they came to order.  There is nothing wrong with that.  </span><br /><span style="font-size: large;">   We do have evidence that the public wants the information and will use the information when the conditions are conducive to this use.  Remember too that anybody can do a study and share their result with reporters, but not every study meets scientific rigor.  If you hear a news report that says the labeling does not work, ask yourself a few questions.  How do they know that?  Did they go to a restaurant and watch people?  Did they survey people?  Did they compare a restaurant's sales before and after labeling went into affect?  Did they call people on the phone?  Who did they call?  Did the people they called or watched or had fill out a form understand how calories impact their weight and health?  How many establishments or people were in their study?  1?  30?</span><br /><span style="font-size: large;">   Check out this <a href="http://cspinet.org/new/pdf/is-menu-labeling-working-factsheet.pdf" target="_blank">fact sheet</a> for some evidence and this <a href="https://www.cspinet.org/nutritionpolicy/Yale%20Lit%20Rev%2008.pdf" target="_blank">website</a> for a list of research studies. </span>

Do Menu Labels Matter?

   I am certain that you have heard the news that starting next week all of McDonald's indoor and drive through menu boards will show ca...

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