1. Legislation for Nutrition Labeling on Restaurant Menus Marie de la Cruz Ph.D. Student Walden University PUBH 8165-2 Dr. Robert Marino Fall Term, 2011

2. After this presentation, you will:  Recognize the burden of obesity on Americans.  Understand the importance of menu labeling.  Describe the benefits of menu labeling.  Be aware of current menu labeling legislation throughout the U.S. LEARNING OUTCOMES

3. WE NEED YOUR HELP!  Nutritional and calorie labeling is provided on a voluntary basis.  Only 54% of the 300 largest chain restaurants provide such information.  Of the restaurants that make nutritional information available to consumers, 86% only do so through the Internet (Wootan & Osborn 2006, as cited in Savage & Johnson, 2006).  Most small chain restaurants and smaller establishments provide little or no nutritional information (Wootan & Osborn 2006, as cited in Savage & Johnson, 2006).  Legislation is needed to make this information available on restaurant menus at the point of sale. THIS IS WHY WE NEED YOU. (Savage & Johnson, 2006)

4. WHY ADD NUTRITION & CALORIE INFORMATION ON MENUS?

5. (1) Reduce obesity epidemic (2) Americans support it (3) Consumers have a right to information (4) Customers make healthier choices (5) Americans eat out more than ever before (Center for Science in the Public Interest [CSPI], 2008)

6. MENU LABELING CAN REDUCE OBESITY

7.  Consuming high caloric foods contribute to obesity epidemic.  Studies link eating out with obesity and higher caloric intakes:  Davis and Carpenter (2009)  French, Story, and Jeffery (2001)  Timmerman (2006)

8. What is Obesity?  Weight greater than what is considered healthy for a specific height.  Ranges determined by Body Mass Index (BMI)  BMI: 25-29  OVERWEIGHT  BMI: >30  OBESE (Centers for Disease Control and Prevention [CDC], 2011)

9. The U.S. Obesity Epidemic  1 out of 3 (33.8%) U.S. adults are obese.  34% of adults are overweight (and not obese)  17% (or 12.5 million) of children and adolescents aged 2—19 years are obese. (CDC, 2011)

10.  Obesity trends continue to increase.  All 50 states have obesity prevalence ≥ 20%.  12 states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) have a prevalence ≥ 30% (CDC, 2011)

11. Data & Statistics for the State of Maryland  Obesity prevalence increased from 17.5% to 26.3% between 1997 and 2007 (50% increase).  62.7% of Maryland adults were overweight or obese in 2007.  By 2007, 22 out of 24 Maryland jurisdictions had an obesity prevalence ≥ 20% and 11 of 24 jurisdictions had obesity prevalence > 30% (Healthy Active Maryland, 2008)

12. Impact of Obesity  Health:  Type 2 Diabetes  Heart Disease  Stroke  Metabolic disorders  Sexual dysfunction & infertility  Certain cancers (Sloane, 2009)  Economic  2008: Medical costs associated with obesity: $147 billion (CDC, 2011)  Medical costs $1,429 higher than those of normal weight (CDC, 2011).  Morbidity costs (CDC, 2011) (CDC, 2011; Obesity in America, n.d.; Sloane, 2009)

13. AMERICANS SUPPORT MENU LABELING

14.  Center for Science in the Public Interest (CSPI) : 78% of Americans support menu labeling.  Yale University Rudd Center for Food Policy and Obesity: Up to 83% favor menu labeling.  Bleich and Pollack (2010): 68% favor posting calorie information on menus.  The Food and Drug Administration (FDA), Surgeon General, U.S. Dept. of Health and Human Services, National Cancer Institute (NCI), & the American Medical Assn (AMA) support menu labeling (CSPI, 2008). (CSPI, 2008; Yale University Rudd Center, 2008; Bleich & Pollack, 2010)

15. CONSUMERS HAVE A RIGHT TO INFORMATION

16.  People need nutritional information to manage weight, diabetes, other conditions.  Burton, Creyer, Keys, and Huggins (2006): Levels of calories, fat, and saturated fat in restaurants were significantly underestimated by consumers.  Companies provide information on everything from cars to appliances.  Nutritional Labeling and Education Act (NLEA)  This should apply to restaurant menus (Burton et al., 2006; CSPI, 2008)

17. CONSUMERS MAKE HEALTHIER CHOICES

18.  Studies show that providing nutritional information help consumers make healthier choices:  CSPI (2008)  Dumanovsky, Huang, Bassett, and Silver (2010)  Pulos and Leng (2010)  Roberto, Larsen, Agnew, Baik, and Brownell (2010)  Burton, Creyer, Kees, and Huggins (2006)

19. “AMERICANS EAT OUT MORE THAN EVER BEFORE” (CSPI, 2008, p. 1) © Michelle Henry

20.  Americans consume 1/3 of calories from restaurants.  1970: Americans spent 26% of food income on restaurant meals  Today, we spend 48%  More than 130 million Americans eat out  Adds up to more than 70 billion meal and snack occasions in 2009. (CSPI, 2008)

21. Counties & States with Menu Labeling  New York City  Westchester County, New York  San Francisco, California  Santa Clara County, California  San Mateo County, California  King County (Seattle), Washington  Multnomah County (Portland), Oregon  Montgomery County, Maryland  Philadelphia, Pennsylvania  Other localities that have or are presently considering menu labeling legislation include:  Boston  Chicago  Minneapolis  Nassau County, New York (CSPI, 2008, as cited in Public Health Law Center, 2009

22. New York, New York  January 2008: Regulations require calorie disclosure on menus, menu boards, and food tags by all chain restaurants with 15 or more locations nationwide.  Fines are issued to noncompliant restaurants.  According to a September 2008 study: 86% of respondents reported that they considered the law a positive measure and 75% of respondents reported that seeing calorie information on menus made an impact on their ordering decisions. (Public Health Law Center, 2009)

23. State of California  The first state to enact menu labeling legislation in the fall of 2008.  Restaurants with 20 or more locations in the state  Must disclose the caloric content of standard menu items on menus, menu boards, and menu tags.  Two-year phase-in periods and an eight-month delayed implementation gives restaurants ample time to comply. (Public Health Law Center, 2009)

24. King County, Washington  Example of the struggle between restaurant industries and legislators regarding menu labeling laws.  Menu labeling applies to chain restaurants with at least fifteen locations in the U.S.  Excludes grocery stores, convenience stores, and movie theaters.  Gave restaurants more flexibility in how they can label their menu items. (Public Health Law Center, 2009)

25. Montgomery County, Maryland  Resolution 16-1194: Any eating and drinking establishment with at least 20 locations.  Grocery stores, convenience stores, and movie theaters exempt.  Three things must be posted:  Calories must be clearly posted next to menu item.  A statement as to the current suggested daily caloric intake (2,000 calories) determined by the U.S. Department of Health and Human Services.  A statement that additional nutrition information is available in writing upon request. (Montgomery County MD Department of Health and Human Services., n.d.)

26. YOU CAN MAKE A DIFFERENCE SUPPORT MENU LABELING LEGISLATION

27. THANK YOU Questions?

28. REFERENCES: Bleich, S. N., & Pollack, K. M. (2010). The publics' understanding of daily caloric recommendations and their perceptions of calorie posting in chain restaurants. BMC Public Health. Retrieved from the Academic Search Premier database. (Accession No. 49161865) Burton, S., Creyer, E. H., Kees, J., & Huggins, K. (2006). Attacking the obesity epidemic: The potential health benefits of providing nutrition information in restaurants. American Journal of Public Health, 96(9), 1669- 1675. Retrieved from the Academic Search Premier database. (Accession No. 22304271) Center for Science in the Public Interest [CSPI]. (2008). Nutrition labeling at fast-food and other chain restaurants. Retrieved from http://cspinet.org/new/pdf/fact_sheet_2008.pdf Centers for Disease Control and Prevention [CDC]. (2011). Overweight and obesity. Retrieved from http://www.cdc.gov/obesity/index.html http://www.cdc.gov/obesity/index.html Davis, B., & Carpenter, C. (2009). Proximity of fast-food restaurants to schools and adolescent obesity. American Journal of Public Health, 99(3), 505-510. doi:10.2105/AJPH.2008.137638 Dumanovsky, T., Huang, C. Y., Bassett, M. T., & Silver, L. D. (2010). Consumer awareness of fast-food calorie information in New York City after implementation of a menu labeling regulation. American Journal of Public Health, 100(12), 2520-2525. doi:0.2105/AJPH.2010.191908

29. REFERENCES (cont) French, S., Story, M., & Jeffery, R. (2001). Environmental influences on eating and physical activity. Annual Review of Public Health, 22(1), 309. Retrieved from the Academic Search Premier database. (Accession No. 5366831) Healthy Active Maryland. (2008). Burden of overweight and obesity in Maryland: Data update summary, 2008. Retrieved from http://www.healthyactivemaryland.org/2008_BURDEN_OF_ADULT_OVERWEIGHT_AND_OBESITY_IN_MARYL AND_Final1.pdf Montgomery County MD Department of Health and Human Services. (n.d.). Nutrition labeling in eating and drinking establishments: Moving to a healthier Montgomery County. Retrieved from http://www.montgomerycountymd.gov/content/hhs/license/Administrative/WhatsNew/menulabelingfaq.pdf Obesity in America. (n.d.). Obesity-related diseases. Retrieved from http://www.obesityinamerica.org/understandingObesity/diseases.cfm Public Health Law Center. (2009, January). Menu labeling legislation: Options for requiring the disclosure of nutritional information in restaurants. Retrieved from http://publichealthlawcenter.org/sites/default/files/resources/phlc-policy-menu-labeling.pdf Pulos, E., & Leng, K. (2010). Evaluation of a voluntary menu-labeling program in full-service restaurants. American Journal of Public Health, 100(6), 1035-1039. doi: 10.2105/AJPH.2009.174839

30. REFERENCES (cont) 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, 100(2), 312-318. Retrieved from the Academic Search Premier database. (Accession No. 47521828) Savage, L. C., & Johnson, R. K. (2006). Labeling in restaurants: will it make a difference?. Nutrition Bulletin, 31(4), 332-338. doi: 10.1111/j.1467-3010.2006.00591.x Sloane, M. (2009). Obesity responsible for 100,000 cancer cases annually. Retrieved from http://articles.cnn.com/2009-11-05/health/obesity.cancer.link_1_cancer-cases-cancer-research- endometrial-cancers?_s=PM:HEALTH Timmerman, G. M. (2006). Restaurant eating in nonpurge binge-eating women. Western Journal of Nursing Research, 28(7), 811-824. doi: 10.1177/0193945906289501 Yale University Rudd Center. (2008). Menu labeling in chain restaurants: Opportunities for public policy. Retrieved from http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf

31. FOR FURTHER INFORMATION: Center for Science in the Public Interest [CSPI]. (2008). Nutrition labeling at fast-food and other chain restaurants. Retrieved from http://cspinet.org/new/pdf/fact_sheet_2008.pdf http://cspinet.org/new/pdf/fact_sheet_2008.pdf Public Health Law Center. (2009, January). Menu labeling legislation: Options for requiring the disclosure of nutritional information in restaurants. Retrieved from http://publichealthlawcenter.org/sites/default/files/resources/phlc-policy-menu- labeling.pdf http://publichealthlawcenter.org/sites/default/files/resources/phlc-policy-menu- labeling.pdf Yale University Rudd Center. (2008). Menu labeling in chain restaurants: Opportunities for public policy. Retrieved from http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLa belingReport2008.pdf http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLa belingReport2008.pdf