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America’s Health Status

Partnering Together for Healthier Consumers Debra Gilbert, Master of Public Health Student Walden University PH 6165-1 Instructor: Dr. Shana Morrell Summer, 2009. America’s Health Status. 129.6 million or 64% of adults are currently overweight or obese (US DHHS, 2004)

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America’s Health Status

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  1. Partnering Together for Healthier ConsumersDebra Gilbert, Master of Public Health StudentWalden UniversityPH 6165-1Instructor: Dr. Shana MorrellSummer, 2009

  2. America’s Health Status • 129.6 million or 64% of adults are currently overweight or obese (US DHHS, 2004) • Increase in obesity rates in last 20 years (CPSI, 2003) • Adults – doubled • Children – doubled • Teens - tripled • Obesity epidemic is a major national priority (Burton, 2006) Burton, S., Creyer, E., Kees, J., & Huggins, K. (2006, September). Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9), 1669-1675. Retrieved July 11, 2009, from Academic Search Premier database Center for Science in Public Interest. (2003, November ). Anyone’s guess: The need for nutritional labeling at fast-food and other chain restaurants. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/anyone_s_guess_final_web.pdf United States Department of Health and Human Services. (2004, March 9). Citing “dangerous increase” in deaths , HHS launches new strategies against overweight epidemic. Retrieved July 1, 2009, from http://www.os.dhhs.gov/news/press/2004pres/20040309.html

  3. Conditions Associated with Nutrition and Obesity • Obesity • Cardiovascular Disease • Metabolic Syndrome • Type II Diabetes • Asthma • Cancer • Osteoporosis • Hypertension • High Cholesterol • Tooth decay Center for Science in Public Interest. (2003, November ). Anyone’s guess: The need for nutritional labeling at fast-food and other chain restaurants. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/anyone_s_guess_final_web.pdf Donghui, L., Morris, J.S., Liu, J., Hassan, M.M. Day, R.S., Bondy, M.L. & Abbruzzese, J.L. (2009, June 24). Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. Journal of the American Medical Association. 301(24): 2553-2562. Retrieved July 15, 2009, from http://jama.ama-assn.org/cgi/content/short/301/24/2553 United States Department of Health and Human Services. (2004, March 9). Citing “dangerous increase” in deaths , HHS launches new strategies against overweight epidemic. Retrieved July 1, 2009, from http://www.os.dhhs.gov/news/press/2004pres/20040309.html

  4. American Health Issues Increased fat , cholesterol and sodium in diet contribute to obesity (CPSI, 2003) $117 billion/ year on obesity related conditions (US DHHS, 2004) Financial impact on healthcare (Blair Lewis, 2005) Blair Lewis, L., Sloane, D., Nascimento, L., Diamant, A., Guinyard, J., Yancey, A., et al. (2005, April). African Americans' access to healthy food options in South Los Angeles restaurants. American Journal of Public Health, 95(4), 668-673. Retrieved July 11, 2009, doi:10.2105/AJPH.2004.050260 Center for Science in Public Interest. (2003, November ). Anyone’s guess: The need for nutritional labeling at fast-food and other chain restaurants. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/anyone_s_guess_final_web.pdf United States Department of Health and Human Services. (2004, March 9). Citing “dangerous increase” in deaths , HHS launches new strategies against overweight epidemic. Retrieved July 1, 2009, from http://www.os.dhhs.gov/news/press/2004pres/20040309.html

  5. Why Involve Restaurants in Health? Restaurants annual revenue >$400 billion and increasing (Burton, 2006; Variyam, 2005)) Association between regular intake of fast foods and weight gain (Burton, 2006) Restaurant Options Vary According to Socioeconomic Level (Blair Lewis, 2005) Blair Lewis, L., Sloane, D., Nascimento, L., Diamant, A., Guinyard, J., Yancey, A., et al. (2005, April). African Americans' access to healthy food options in South Los Angeles restaurants. American Journal of Public Health, 95(4), 668-673. Retrieved July 11, 2009, doi:10.2105/AJPH.2004.050260 Burton, S., Creyer, E., Kees, J., & Huggins, K. (2006, September). Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9), 1669-1675. Retrieved July 11, 2009, from Academic Search Premier database Variyam, J.N. (2005, April). Nutritional labeling in the food-away-from-home sector: An economic assessment. United States Department of Agriculture Economic Research Report 4. Retrieved July 10, 2009, from http://ageconsearch.umn.edu/bitstream/7235/2/er050004.pdf

  6. Influences on Purchases Type of Establishment (Stewart, 2005) • Desire for Healthy Diet • Convenience • Enjoyment/Ambiance Food Selection (Stewart, 2005) • Taste • Cost • Preparation Time • Nutritional Information Advertisements (Blair Lewis, 2005) • Appearance of food on posters, menus • Promotions Blair Lewis, L., Sloane, D., Nascimento, L., Diamant, A., Guinyard, J., Yancey, A., et al. (2005, April). African Americans' access to healthy food options in South Los Angeles restaurants. American Journal of Public Health, 95(4), 668-673. Retrieved July 11, 2009, doi:10.2105/AJPH.2004.050260 Stewart, H., Blisard, N., Jolliffe, D. & Bhuyan, S. (2005). The demand for food away from home: Do other preferences compete with our desires to eat healthfully? Journal of Agricultural and Resource Economics. 30(3): 520-536. Retrieved June 30, 2008 ,from http://ageconsearch.umn.edu/bitstream/30984/1/30030520.pdf United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. (2001). Healthy People 2000 Final Review. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, DHHS Publication No. 01-0256. Retrieved July 2, 2009, from http://www.cdc.gov/nchs/data/hp2000/hp2k01.pdf

  7. How Can Nutritional Information Help? Key to provide information before ordering Highlight healthier food selections Recommended Dietary Allowances 2000 Calories/day Fat - 65 g Saturated fat 20 g Sodium 2400 mg Center for Science in Public Interest. (2006, November 30). FDA urged to create new “healthy food” labeling system. Retrieved July 10, 2009, from http://www.cspinet.org/new/200611301.html Food and Drug Administration. (2008, April). Guidance for industry: A labeling guide for restaurants and other retail establishments selling away-from-home foods. Retrieved July 10, 2009, from http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/ GuidanceDocuments/FoodLabelingNutrition/ucm053455.htm National Restaurant Association. (2009). Public policy issue briefs: Menu labeling/nutrition information. Retrieved July 9, 2009, from http://www.restaurant.org/government/issues/issues. cfm? Issue=menulabel

  8. Menu Content Menu boards • Caloric Value Full Service Menus • Serving Size • Caloric value • Fat • Sodium Center for Science in Public Interest. (2008, October 1). Yum! brands praised for adding calorie counts to KFC, Pizza Hut, Taco Bell menu boards. Retrieved July 10, 2009, from http://www.cspinet.org/new/200810011.html McCann, M.A. (2005, January/February). Comparing legal, economic, and legislative approaches to nutritional labeling of fast food items. Update: Food & Drug Law, Regulation & Education, 1(4). Retrieved June 24, 2009, from http://ssrn.com/abstract=678222 Thomas, L. & Mills, J.E. (2008). Consumer knowledge and expectations of restaurant menus and their governing legislation: a quantitative assessment. Journal of Foodservice. 17: 6-22. Retrieved June 28, 2009, from http://www3.interscience.wiley.com/cgi-bin/fulltext/118732305/PDFSTART

  9. Best Labeling Information Nutritional Information • Caloric Content • Total Fat and Saturated Fat • Macronutrients Easy To Understand Labels • Per Serving • Consistent Symbols Hwang, J. & Lorenzen, C.L. (2008). Effective nutrition labeling of restaurant menu and pricing of healthy menu. Journal of Foodservice. 19:270-276. Doi: 10.111/j.1748-0159.2008.00108.x Thomas, L. & Mills, J.E. (2008). Consumer knowledge and expectations of restaurant menus and their governing legislation: a quantitative assessment. Journal of Foodservice. 17: 6-22. Retrieved June 28, 2009, from http://www3.interscience.wiley.com/cgi-bin/fulltext/118732305/PDFSTART

  10. Nutritional Estimates without Information Underestimate of calories, fat & sodium Miscalculation greater for higher calorie foods Example: Cheese fries w/ ranch dressing Estimated <900 calories Actual 3010 calories Healthier foods often misjudged unhealthy Burton, S., Creyer, E., Kees, J., & Huggins, K. (2006, September). Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9), 1669-1675. Retrieved July 11, 2009, from Academic Search Premier database.

  11. Restaurant Meal #1 RDA 2000 calories 65 g fat 2400 mg sodium Total Meal 4200 calories 290 g fat 5700 mg sodium Onion Strings & Crispy Jalapeno stack w/ Jalapeno Ranch 2130 calories 213 g fat 1320 mg sodium Boneless Buffalo Chicken Salad 1070 calories 77 g fat 4380 mg sodium No Calorie Beverage Brinker International. (2009). Nutritional information. Chili’s Bar and Grill. Retrieved July 10, 2009, from http://www.chilis.com/menu/default.asp

  12. Restaurant Meal #2 RDA 2000 calories 65 g fat 2400 mg sodium Guiltless Buffalo Chicken Sandwich 390 calories 7 g fat 2300 mg sodium Seasonal Veggies 69 calories 4 g fat 170 mg sodium No Calorie Beverage Brinker International. (2009). Nutritional information. Chili’s Bar and Grill. Retrieved July 10, 2009, from http://www.chilis.com/ menu/default.asp Total Meal 459 calories 11 g fat 2470 mg sodium

  13. Healthier Food Preparation • Blair Lewis, L., Sloane, D., Nascimento, L., Diamant, A., Guinyard, J., Yancey, A., et al. (2005, April). African Americans' access to healthy food options in South Los Angeles restaurants. American Journal of Public Health, 95(4), 668-673. Retrieved July 11, 2009, doi:10.2105/AJPH.2004.050260 GrilledBoiled Poached Sautéed Baked Steamed Rotisserie Stir Fried Roasted Broiled

  14. 1990 Labeling Legislation Food and Drug Administration. (2008, April). Guidance for industry: A labeling guide for restaurants and other retail establishments selling away-from-home foods. Retrieved July 10, 2009, from http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/ GuidanceDocuments/ FoodLabelingNutrition/ucm053455.htm McCann, M.A. (2005, January/February). Comparing legal, economic, and legislative approaches to nutritional labeling of fast food items. Update: Food & Drug Law, Regulation & Education, 1(4). Retrieved June 24, 2009, from http://ssrn.com/abstract=678222 Nutritional Labeling and Education Act (FDA, 2008) • Applied to packaged foods • Exempted prepared food unless making a health claim

  15. City and County Regulations Regional Laws • Caloric Counts on Prepared Foods • July, 2007 King County (Seattle) Washington • Varied Requirements Center for Science in Public Interest. (2008, September 30). California first state in nation to pass menu labeling law. Retrieved July 10, 2009, from http://www.cspinet.org/new/200809301.html Center for Science in Public Interest. (2009, May 13). Nutritional labeling in chain restaurants. Retrieved July 10, 2009, from http://www.cspinet.org/new/ml_bill_summaries_09.html

  16. State Legislation 2008 California Passed State Law • Applies to >20 outlets States with Menu Labeling Laws Oregon Maine Massachusetts Center for Science in Public Interest. (2008, September 30). California first state in nation to pass menu labeling law. Retrieved July 10, 2009, from http://www.cspinet.org/new/200809301.html Center for Science in Public Interest. (2009, May 13). Nutritional labeling in chain restaurants. Retrieved July 10, 2009, from http://www.cspinet.org/new/ml_bill_summaries_09.html

  17. Current US Legislation Center for Science in Public Interest. (2009, May). Menu-labeling map. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/ml_map.pdf

  18. Support for National Nutritional Disclosure Legislation (LEAN Act) • Coalition for Responsible Nutrition Information (CRNI) • National Restaurant Association • Medical Professionals • Consumer Groups National Restaurant Association. (2009). Public policy issue briefs: Menu labeling/nutrition information. Retrieved July 9, 2009, from http://www.restaurant.org/government/issues /issues. cfm? Issue=menulabel United States Senate Bill. (2009, March 10). Senate version of the LEAN Act S.558. Retrieved July 16, 2009, from http://www.nationalnutritionstandards.com/pdfs/LEAN_ACT_SENATE_FINAL.pdf

  19. Menu Board Concerns Overcrowded Brochures or posters near point of sale Frequent Menu changes Center for Science in Public Interest. (2008, September 30). California first state in nation to pass menu labeling law. Retrieved July 10, 2009, from http://www.cspinet.org/new/200809301.html Center for Science in Public Interest. (2008, October 1). Yum! brands praised for adding calorie counts to KFC, Pizza Hut, Taco Bell menu boards. Retrieved July 10, 2009, from http://www.cspinet.org/new/200810011.html Frumpkin, P. (2009, March 11). Congress to reconsider LEAN Act. Nation’s Restaurant News. Retrieved July 17, 2009, from http://www.nrn.com/breakingNews.aspx?id=364160 United States Senate Bill. (2009, March 10). Senate version of the LEAN Act S.558. Retrieved July 16, 2009, from http://www.nationalnutritionstandards.com/pdfs/LEAN_ACT_SENATE_FINAL.pdf

  20. Full Service Menus Concerns Room on menu Chef discretion Frequent changes Customer adjustments Center for Science in Public Interest. (2009, May 13). Nutritional labeling in chain restaurants. Retrieved July 10, 2009, from http://www.cspinet.org/new/ml_bill_summaries_09.html

  21. Nutritional Analysis • Laboratory Analysis • Nutrient Databases • Cookbooks • Other sources that provide reasonable information United States Senate Bill. (2009, March 10). Senate version of the LEAN Act S.558. Retrieved July 16, 2009, from http://www.nationalnutritionstandards.com/ pdfs/LEAN_ACT_SENATE_FINAL.pdf

  22. Possible Impact Post Labeling Healthier choices • Lower in fat • Lower calories • Reduced carbohydrates • Reduce sodium • More vegetables Center for Science in Public Interest. (2009, May 13). Nutritional labeling in chain restaurants. Retrieved July 10, 2009, from http://www.cspinet.org/new/ml_bill_summaries_09.html

  23. More Possible Changes Reduced portion sizes Half the size ≠ Half the price Encourage take home containers or sharing entrees Hwang, J. & Lorenzen, C.L. (2008). Effective nutrition labeling of restaurant menu and pricing of healthy menu. Journal of Foodservice. 19:270-276. Doi: 10.111/j.1748-0159.2008.00108.x

  24. Additional Considerations Labeling Exemptions Voluntary labeling Consumer Education

  25. Sources of Additional Information Center for Science in the Public Interest http://www.cspinet.org/menulabeling/ Coalition for Responsible Nutritional Information http://www.nationalnutritionstandards.com FDA Food Labeling & Nutrition http://www.fda.gov/Food/LabelingNutrition/default.htm National Restaurant Association http://www.restaurant.org/government/issues/issue.cfm?Issue=menulabel

  26. References Blair Lewis, L., Sloane, D., Nascimento, L., Diamant, A., Guinyard, J., Yancey, A., et al. (2005, April). African Americans' access to healthy food options in South Los Angeles restaurants. American Journal of Public Health, 95(4), 668-673. Retrieved July 11, 2009, doi:10.2105/AJPH.2004.050260 Brinker International. (2009). Nutritional information. Chili’s Bar and Grill. Retrieved July 10, 2009, from http://www.chilis.com/menu/default.asp Burton, S., Creyer, E., Kees, J., & Huggins, K. (2006, September). Attacking the Obesity Epidemic: The Potential Health Benefits of Providing Nutrition Information in Restaurants. American Journal of Public Health, 96(9), 1669-1675. Retrieved July 11, 2009, from Academic Search Premier database. Center for Science in Public Interest. (2003, November). Anyone’s guess: The need for nutritional labeling at fast-food and other chain restaurants. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/anyone_s_guess_final_web.pdf Center for Science in Public Interest. (2006, November 30). FDA urged to create new “healthy food” labeling system. Retrieved July 10, 2009, from http://www.cspinet.org/new/200611301.html

  27. References Center for Science in Public Interest. (2008, September 30). California first state in nation to pass menu labeling law. Retrieved July 10, 2009, from http://www.cspinet.org/new/200809301.html Center for Science in Public Interest. (2009, May). Menu-labeling map. Retrieved July 10, 2009, from http://cspinet.org/new/pdf/ml_map.pdf Center for Science in Public Interest. (2009, May 13). Nutritional labeling in chain restaurants. Retrieved July 10, 2009, from http://www.cspinet.org/new/ml_bill_summaries_09.html Center for Science in Public Interest. (2008, October 1). Yum! brands praised for adding calorie counts to KFC, Pizza Hut, Taco Bell menu boards. Retrieved July 10, 2009, from http://www.cspinet.org/new/200810011.html Donghui, L., Morris, J.S., Liu, J., Hassan, M.M. Day, R.S., Bondy, M.L. & Abbruzzese, J.L. (2009, June 24). Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. Journal of the American Medical Association. 301(24): 2553-2562. Retrieved July 15, 2009, from http://jama.ama-assn.org/cgi/content/short/301/24/2553

  28. References Food and Drug Administration. (2008, April). Guidance for industry: A labeling guide for restaurants and other retail establishments selling away-from-home foods. Retrieved July 10, 2009, from http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/ GuidanceDocuments/FoodLabelingNutrition/ucm053455.htm Frumpkin, P. (2009, March 11). Congress to reconsider LEAN Act. Nation’s Restaurant News. Retrieved July 17, 2009, from http://www.nrn.com/breakingNews.aspx?id=364160 Hwang, J. & Lorenzen, C.L. (2008). Effective nutrition labeling of restaurant menu and pricing of healthy menu. Journal of Foodservice. 19:270-276. Doi: 10.111/j.1748-0159.2008.00108.x McCann, M.A. (2005, January/February). Comparing legal, economic, and legislative approaches to nutritional labeling of fast food items. Update: Food & Drug Law, Regulation & Education, 1(4). Retrieved June 24, 2009, from http://ssrn.com/abstract=678222 National Restaurant Association. (2009). Public policy issue briefs: Menu labeling/nutrition information. Retrieved July 9, 2009, from http://www.restaurant.org/government/issues/issues. cfm? Issue=menulabel

  29. References Stewart, H., Blisard, N., Jolliffe, D. & Bhuyan, S. (2005). The demand for food away from home: Do other preferences compete with our desires to eat healthfully? Journal of Agricultural and Resource Economics. 30(3): 520-536. Retrieved June 30, 2008 ,from http://ageconsearch.umn.edu/bitstream/30984/1/30030520.pdf Thomas, L. & Mills, J.E. (2008). Consumer knowledge and expectations of restaurant menus and their governing legislation: a quantitative assessment. Journal of Foodservice. 17: 6-22. Retrieved June 28, 2009, from http://www3.interscience.wiley.com/cgi-bin/fulltext/118732305/PDFSTART United States Department of Health and Human Services. (2004, March 9). Citing “dangerous increase” in deaths , HHS launches new strategies against overweight epidemic. Retrieved July 1, 2009, from http://www.os.dhhs.gov/news/press/2004pres/20040309.html United States Department of Health and Human Services , Centers for Disease Control and Prevention, National Center for Health Statistics. (2001). Healthy People 2000 Final Review. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, DHHS Publication No. 01-0256. Retrieved July 2, 2009, from http://www.cdc.gov/nchs/data/hp2000/hp2k01.pdf

  30. References United States Senate Bill. (2009, March 10). Senate version of the LEAN Act S.558. Retrieved July 16, 2009, from http://www.nationalnutritionstandards.com/pdfs/LEAN_ACT_SENATE_FINAL.pdf Variyam, J.N. (2005, April). Nutritional labeling in the food-away-from-home sector: An economic assessment. United States Department of Agriculture Economic Research Report 4. Retrieved July 10, 2009, from http://ageconsearch.umn.edu/bitstream/7235/2/er050004.pdf

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