Yesterday I shared my position on Section 4205 of the Patient Protection and Affordable Care Act (the Act), that was signed into law on March 23, 2010. I know that I took a controversial position. I think it’s important to further clarify why I wrote we don’t need a menu calorie labeling law.
It’s important to state:
- I do not think ignorance is bliss.
- I am aware that we eat a lot more meals in restaurants than people were eating in the 1950s.
- I am aware that frequent dining out can cause obesity.
- I believe knowledge is power.
- I am dedicated (personally and professionally) to helping people achieve and maintain a healthy body weight and if if I fail at that then I’m failing at my life’s mission.
I like calorie information.
I turn over packages to read nutrition facts. I want to know serving sizes and calories per serving. I am happy when I see calorie information at restaurants even though calories are not useful when calculating Weight Watchers PointsPlus® values. I still use it as a guide, however, to make a satisfying meal selection. I think making the information available voluntarily is a wise business practice. I’m sure that people like me who want to know and know what to do with the information appreciate having it.
If you’re not familiar with Weight Watchers you may be surprised to read that calories is not part of the proprietary formula to calculate the PointsPlus value in a food. The problem with counting calories is it ignores nutrients. Good nutrition isn’t just balancing calories ingested with calories the body burns for fuel. It’s balancing macronutrients and getting all the necessary micronutrients. A diet that is balanced in its macronutrient distribution can help reduce the risk of disease and foster lasting weight loss.
Why then, did I say we don’t need a menu labeling law?
I have several reasons including not everybody wants to know nor do they need to know. In some cases people are better off not knowing and that includes the very group of people this law is targeting hardest to make healthier eating habits.
Not everybody is like me, or like you, if you can’t see potential drawbacks to restaurant labeling.
Some people have deep-rooted food issues. The relationship with food can be very complex.
There are people with the eating disorder, anorexia nervosa (AN).
AN can kill. Recovering from anorexia isn’t easy. Establishing a healthy relationship with food is not easy and not always even possible.
Even in weight-restored patients abnormal eating behavior often persists, as limited diet variety was found to be associated with poor outcomes . From a clinical standpoint, AN individuals appear to become hypermetabolic during weight restoration, [16,17] such that they need an increased caloric intake to maintain a safe weight after recovery [16,18]. The tendency to return to restrictive eating habits after hospitalizations compounds the need for increased caloric requirements due to hypermetabolic state .
Do you think every obese person you meet on the street wants to be fat?
Do you think many aren’t beating themselves up for being such a fat slob? Do you think they haven’t tried multiple times and multiple weight loss plans, pills, and strategies to lose weight?
Do you think that all they needed was having the calories of the foods they order in restaurants flashed in their faces to be successful?
I can tell you from personal experience that there was a time that calorie information would make me feel even more hopeless and powerless in my elusive battle to control my weight. There was much behavioral/cognitive work I needed to do before I could make calories a tool to help me build a thinner, healthier body.
Many obese people suffer from low self-esteem.
They self-flagellate for every perceived “bad” thing they do. They can’t seem to stop doing “bad” things and the guilt and the shame cause more hate and more destructive behavior. When I believed I couldn’t lose weight, I wouldn’t care about how many calories I was eating because “nothing works so why bother.”
I know what it feels like to be ruled by food.
I know what it feels like to vow to be “perfect” and watching my perfectionism fall apart by 11:00 am. I know that once a day isn’t perfect anymore, nothing matters until tomorrow when I can start anew to be perfect. I know what it’s like to think there’s no point in trying to salvage what’s left of my diet for the day with damage control. I know how a mistake is the start of a full-blown feeding-frenzy that may last for weeks or months or even years.
I know that there were people who didn’t understand what drove me to eat.
They didn’t know why “I would let myself go that way.” I know that some people pitied me and wanted to help me. I know others were disgusted by me and thought if they openly displayed their disgust I’d be shamed into changing. I was not affected by the way others thought about me, but many obese people are. Negative reactions from people around them doesn’t help them to help themselves; it exacerbates the closet-eating behavior and the weight gain.
Nutrition facts on food from the supermarket is handy, but discreet.
It’s not right beside the name of the food in the package. It’s private. When I check the serving size and calories in a carton of ice cream only my eyes are seeing it. I’m not sitting at a table with a group of people looking at the same menu with the same information and perhaps watching to see what I order to judge me.
I worked hard to change my relationship with food. I have changed a lot about what I believe I am capable of achieving. I’ve changed my identity. I’m not the overweight victim anymore, but if I were, eating in restaurants with calorie information posted after every standard menu item would be not be helpful by any measure.
The menu law is not supported by scientific research to conclude that overweight consumers will eat less and be healthier if more information is on a restaurant menu. The justification to go forward with the law is ,”nobody is hurt by having too much accurate information,” so the hope for the menu law is at least it’s doing something and that might be better than doing nothing.
It could be a very good thing for many people and for others it could be worse than doing nothing.
There is a better way to help diners manage their weight.
In 2003 the Maine Restaurant Association (MeRA) created an innovative program that had the potential to really advance healthy dining out and promote individual efforts to manage weight.
The program was called Diner’s Choice.
The program was created because the MeRA recognized that…
“Education and information at a grassroots level is a long-term, far-reaching
solution to the problem of increasing obesity in America. Nutritional labeling in restaurants is not an effective solution because ordering food in a restaurant is not like buying an item in a grocery store. When ordering in a restaurant there are literally hundreds of thousands of variables. °
1) A consumer buying a sandwich with a choice of 9 items of toppings,
i.e. bread, meat, cheese, lettuce, tomato, pickles, ketchup, mustard,
onion can order it 362,880 ways.
2) An individual presented with 15 items for a sub or sandwich can order
it 1.3 Trillion ways, making labeling virtually unworkable.”
MeRA recognized the challenges of giving accurate caloric information and they also worked hard to find a solution that would work. As the general manager of Weight Watchers of Maine, I was approached and asked to be a consultant in the development of the program to ensure it would have value to people actively managing their weight.
(So for those of you who think I want people to remain overweight so I keep my job, let me assure you that my life’s work is helping people lose weight. If I can’t do this, then I fail at my passion. If I wanted dining out to support obesity rather than fight it I would not have volunteered my services to helping develop DIner’s Choice.)
Other experts and I worked with members of the MeRA to find a solution to provide real help to Maine diners to support their health and weight-related goals.
Maine diners, however, weren’t ready to use it to their advantage. It was a phenomenal program that could have made a positive difference.
- Through Diner’s Choice® MeRA will highlight the options available while dining out and empower individual choice at Maine restaurants
- The Bureau of Health (BOH) is designing programs that will address healthy eating at home, the power of good food choices and the importance of regular physical activity.
“Our studies have shown that over half (56%) of Maine adults are either overweight or obese and it’s the fastest growing epidemic this decade,” said Dr. Dora Mills, State Health Officer. “The Bureau of Health and the Maine Restaurant Association are going to address this epidemic together and we are honored to part of this initiative. Diner’s Choice ensures that healthy portion sizes and healthy options will be promoted to Maine diners.” –An excerpt from MeRA press release
For patrons, the Diner’s Choice seal means a knowledgeable wait staff:
- Servers have been trained to make a good faith effort to inform their customers of dining options available.
- Staff and servers have been trained to know the menu thoroughly. This includes knowing portion sizes, understanding the ingredients used, and the chef’s preparation of each item.
- Dining tips that promote option requests are available to patrons in the form of signage, table tents, brochures, and/or placemats.
For patrons, eating at a Diner’s Choice restaurants means alternate portions are available, such as:
- A half-portion (or a smaller percentage) served at the table with the remainder of the dish packaged (“doggie bag”) to take home.
- If the restaurant is known for its large portions patrons can request the restaurant’s standard alternate portion.
A variety of appetizers and side dishes can be offered to those seeking options to an entrée.
The Diner’s Choice seal means the restaurant offers plentiful menu choices and options:
- Low fat salad dressings, low-cal sweeteners and margarine.
- Condiments, sauces and dressings can be served “on the side” so diners can use less.
- Lower-fat milk and water are among beverage choices for adults.
- Milk, 100% fruit juice and water are among beverage choices for children.
- Dishes are available baked, broiled, steamed, poached or sautéed.
- Steamed vegetables, fresh fruit or salad can be offered as a side dish.
- Salsa, pepper or chives are available for potatoes.
- Low fat desserts such as fresh fruit, low fat ice milk (soft serve) or sorbet are available.
The Board of Directors of the Maine Restaurant Association has endorsed the Diner’s Choice program. Restaurants across the state implemented the program in their establishments.
The Diner’s Choice program was created by a generous grant from the Safe Fund of the National Restaurant Association.
Education results in knowledgeable choices at the kitchen table. Diner’s Choice® empowers informed choices at the restaurant table.
I saw the Diner’s Choice logo in fast food restaurants, national chains doing business in Maine, and independent restaurants.
The promises made by participating Diner’s Choice restaurants were sincere. If people asked about food preparation, or requested help with portion control or sauces to be served on the side, they got what they wanted and needed.
DIner’s Choice was an excellent solution that was widely ignored because people were either unaware it was available or didn’t care. It provided much more information and education that calories on menus and even written nutritional information. It was discreet and empowering. It helped diners make better choices not because they were choosing a lower-calorie meal but because they were customizing their meals to meet their needs and preferences.
While the FDA still flounders with a final Restaurant Labeling Law maybe that idea should be scrapped. It was supposed to be completed in March 2011. Then we expected the final version to be drafted by October 2013. It’s August 2014 and still no final draft.
Instead of wasting time and money trying to address how to implement menu labeling, we should renew efforts to establish and promote a national Diner’s Choice program!
 Dietary energy density and diet variety as predictors of outcome in anorexia nervosa.
  Dietary energy density and diet variety as predictors of outcome in anorexia nervosa.
  Abnormal caloric requirements for weight maintenance in patients with anorexia and bulimia nervosa.
 A one-year follow-up study in anorexia nervosa. Dietary pattern and anthropometrical evolution.