1. Local restaurants can provide nutritional health empowerment: Through nutritional information on dine-in and take-out menus in local restaurants Gladys Crews, MPH student Walden University PUBH 6165-1 Instructor: Dr. Howard Rubin November 4, 2012

2. Learning objectives  South Shore restaurants  Purpose  U.S. FDA regulation of nutritional information on menus  Obesity in the U.S.  Definition of Obesity  Causes and outcomes  Statistics and evidence  Strategies for making an impact  Conclusions  References  Further suggested readings

3. Restaurants in South Shore  Over 100 restaurants in the area  2 vegetarian restaurants  There’s a need for healthy, dine-out, meal choices for the area Grid of City of Chicago neighborhoods used with permission from the City of Chicago

4. Purpose of today’s discussion  Motivate restaurants to include nutritional information on menus  Addressing obesity in dining out situations  Make an impact on obesity  Nutritional empowerment

5. FDA regulation of nutritional information on menus (FDA, 2012)  March 23, 2012 Health care reform became a law  The Patient Protection and Affordable Care Act Section 4205 requires the posting of calories of items on menus  Regulated and enforced by the U.S. FDA  Required for restaurants with 20 or more locations  Not required for restaurants with less than 20 locations  Owners can voluntarily register with the U.S. FDA Source: FDA. (2012). New Menu and Vending Machines Labeling Requirements. Retrieved from http://www.fda.gov/Food/LabelingNutrition/ucm217762.htm http://www.fda.gov/Food/LabelingNutrition/ucm217762.htm

6. Continuation slide: FDA regulation of nutritional information on menus (IRAMB, 2012)  The Act costs the federal government over $238 million  Benefits the lives and health of 0.6% of obese adults  Outweighs governmental monetary costs by saving consumers lives. Source: Office of Information and Regulatory Affairs Office of Management and Budgets (IRAMB). (2012). View Rule: RIN: 0910-AG57. Retrieved from http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201110&RIN=0910-AG57http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201110&RIN=0910-AG57

7. Obesity and overweight (CDC, 2012)  Clinical definitions of obesity  Health outcomes from being obese  Heart disease, hypertension, diabetes, cancer, and other chronic diseases Source: CDC. (2012). Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/adult/defining.htmlhttp://www.cdc.gov/obesity/adult/defining.html

8. Clinical example of and obese adult (CDC, 2012) Height Weight (lbs.)BMI rangesClassification 5' 9" 124 or lessBelow 18.5Underweight 125 to 16818.5 to 24.9Healthy weight 169 to 20225.0 to 29.9Overweight 203 or more30 or higherObese Source: CDC. (2012). Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/adult/defining.htmlhttp://www.cdc.gov/obesity/adult/defining.html

9. Causes of obesity (CDC, 2012) Source: CDC. (2012). Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/adult/defining.htmlhttp://www.cdc.gov/obesity/adult/defining.html  Caloric intake imbalances  Eating too much high caloric and fatty meals  Burning less calories (lack of exercise)  Environments and socioeconomic status (SES)  Restaurants in lower SES communities serve higher caloric and fatty meals  Eating buffet style meals increases caloric intake  Other risk factors and negative health behaviors

10. Prevalence of obesity in adults living in the U.S. (Ogden et al., 2006) Source: Ogden, C., Carroll, M., Curtin, L., McDowell, M., Tabak, C., Flegal, K., (2006). Prevalence of Overweight and Obesity in the United States, 1999-2004. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=202627http://jama.jamanetwork.com/article.aspx?articleid=202627  Obesity, from the National Health and Nutrition Examination Survey (NHANES), was evaluated in White, Black, and Mexican adults (n= 4431) living in the U.S.  Prevalence of obesity in men increased 3.6%  Women showed a 0.2% decrease  Prevalence of obesity and extreme obesity was higher in adult Blacks  Blacks and Mexicans are at risk for being obese and extremely obese

11. Prevalence of obesity in Illinois (CDC, 2012) Source: CDC. (2012). Behavioral Risk Factor Surveillance System: Prevalence and Trends Data. Retrieved from http://apps.nccd.cdc.gov/brfss/ http://apps.nccd.cdc.gov/brfss/  Midwest states are closely following Southern states in prevalence of obesity  Highest prevalence of obesity (29.5%) in the Southern regions of the U.S.  Obesity and race/ethnicity in IL  High prevalence in Blacks and Whites  Obesity in IL compared to the U.S.  IL is 0.7% behind the U.S. prevalence of obesity

12. How local restaurants could make an impact  Register with the U.S. FDA if not registered  Display caloric information on menus  Add more healthy meal choices to menus  Modify the preparation processes of some common meals

13. References Bezerra, I., Curioni, C., and Sichieri, R. (2012). Association between eating out of home and body weight. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22300594 http://www.ncbi.nlm.nih.gov/pubmed/22300594 CDC. (2012). Behavioral Risk Factor Surveillance System: Prevalence and Trends Data. Retrieved from http://apps.nccd.cdc.gov/brfss/ http://apps.nccd.cdc.gov/brfss/ CDC. (2012). Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/adult/defining.htmlhttp://www.cdc.gov/obesity/adult/defining.html City-data. (2012). South Shore neighborhood in Chicago, Illinois (IL), 60619, 60637, 60649 detailed profile. Retrieved from http://www.city-data.com/neighborhood/South-Shore-Chicago-IL.html http://www.city-data.com/neighborhood/South-Shore-Chicago-IL.html FDA. (2012). Calories Count and Keystone Report FDA Obesity Working Group Report and Related Information Keystone Report Documents. Retrieved from http://www.fda.gov/Food/LabelingNutrition/ReportsResearch/ucm081114.htm#keyhttp://www.fda.gov/Food/LabelingNutrition/ReportsResearch/ucm081114.htm#key FDA. (2012). New Menu and Vending Machines Labeling Requirements. Retrieved from http://www.fda.gov/Food/LabelingNutrition/ucm217762.htm http://www.fda.gov/Food/LabelingNutrition/ucm217762.htm FOX Chicago News. (2012). The Talker: Soda vending machines to display calorie labels. Retrieved from http://www.myfoxchicago.com/story/19768401/the-talker-calorie-labels-will-soon-be-on-vending-machines http://www.myfoxchicago.com/story/19768401/the-talker-calorie-labels-will-soon-be-on-vending-machines Office of Information and Regulatory Affairs Office of Management and Budgets (IRAMB). (2012). View Rule: RIN: 0910- AG57. Retrieved from http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201110&RIN=0910-AG57http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201110&RIN=0910-AG57 Office of the Legislative Counsel. (2010). Title IV—Prevention of chronic disease and improving public health: Subtitle A- Modernizing disease prevention and public health systems. Retrieved from http://housedocs.house.gov/energycommerce/ppacacon.pdf http://housedocs.house.gov/energycommerce/ppacacon.pdf Ogden, C., Carroll, M., Curtin, L., McDowell, M., Tabak, C., Flegal, K., (2006). Prevalence of Overweight and Obesity in the United States, 1999-2004. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=202627jama.jamanetwork.com/article.aspx?articleid=202627 Wikipedia. (2012). South Shore, Chicago. Retrieved from http://en.wikipedia.org/wiki/South_Shore,_Chicagohttp://en.wikipedia.org/wiki/South_Shore,_Chicago

14. Further reading recommendations For more information please read or access the following: The Mayor’s comments about calorie labels on vending machines: http://www.myfoxchicago.com/story/19768401/the-talker-calorie-labels-will- soon-be-on-vending-machines#ixzz29pXI7qyrhttp://www.myfoxchicago.com/story/19768401/the-talker-calorie-labels-will- soon-be-on-vending-machines#ixzz29pXI7qyr Patient Protection and Affordable Care Act Health-Related Portions of the Healthcare and Education Reconciliation Act of 2010: http://housedocs.house.gov/energycommerce/ppacacon.pdf http://housedocs.house.gov/energycommerce/ppacacon.pdf DHHS/FDA Menu And Vending Machine Labeling Voluntary Registration form http://www.fda.gov/downloads/Food/LabelingNutrition/UCM219677.pdf http://www.fda.gov/downloads/Food/LabelingNutrition/UCM219677.pdf Need assistance with filling out voluntary registration form call: 240-402-2371 The FDA (2012) works closely with stakeholders, including the restaurant industry to implement this important new law and all stakeholders are encouraged to share their thoughts about the proposed rules. Submit your comments electronically to the docket at www.regulations.govwww.regulations.gov Choose “Submit a Comment” from the top task bar Enter the following docket number in the “Keyword” space FDA-2011-F-0172 (menu) Then select “Search” To submit your comments to the docket by mail, submit to: The Division of Dockets Management HFA-305 Food and Drug Administration 5630 Fishers Lane, Room 1061 Rockville, MD 20852 Be sure to include the appropriate docket number on each page of your written comments. Source: FDA. (2012). New Menu and Vending Machines Labeling Requirements. Retrieved from http://www.fda.gov/Food/LabelingNutrition/ucm217762.htm http://www.fda.gov/Food/LabelingNutrition/ucm217762.htm