Support for Nutrition Labeling in Fast-Food and Other Chain Restaurants

The American Public Health Association is concerned and working to address the rising obesity rates in adults and children.^1,2 Poor eating habits contribute not only to obesity, but also to heart disease, cancer, osteoporosis, and other serious and costly diseases. This statement extends that policy by calling for nutrition labeling of fast food and other chain restaurants.

Several factors contribute to obesity and poor diets. One is the increase in the frequency of eating out. Nationally representative studies have shown that Americans are eating out twice as much as in 1970. In 1970, Americans spent just 26 percent of their food dollars on restaurant meals and other meals prepared outside their homes. Today, we spend almost half (46 percent) our food dollars at restaurants.³ Adults and children are eating about a third of their calories from away-from-home foods.⁴

Increases in Americans’ caloric intake over the past two decades may be due in part to increases in eating out.^4,5 Children eat almost twice as many calories when they eat a meal at a restaurant (770 calories) compared to a meal at home (420 calories).⁶ Women who eat out more often (more than 5 times a week) consume an average of 290 more calories each day than women who eat out less often.⁷ Most studies have found a positive association between eating out and body weight or body fatness.^8-13

Foods that people eat from fast-food and other food-service establishments are generally higher in nutrients for which over-consumption is a problem (like fat and saturated fat) and lower in nutrients that people need to eat more of (like calcium and fiber) as compared to home-prepared foods.^4,7,10,11,13 The foods that children eat from fast-food and other restaurants also are higher in fat and saturated fat and lower in fiber, iron, calcium, and cholesterol than foods from home.^6,14

Portion sizes in America have increased since the 1970s paralleling the increase in energy intake.^15,16 Calorie counts of restaurant foods can be high. A white chocolate mocha and a cinnamon scone at a coffeehouse can have about a half-day’s calories (1,030 calories.) A large fast-food chocolate shake has over 1,000 calories.

While the Nutrition Labeling and Education Act (NLEA) requires nutrition information on nearly all packaged foods, fast-food and other restaurants are exempt. Yet, the nutritional content of restaurant foods is often hard to estimate. A tuna salad sandwich has 50 percent more calories than the roast beef with mustard at a typical deli. A porterhouse steak has twice the calories of the sirloin.

The current system of voluntary labeling at restaurants is inadequate given the growing and significant role of restaurant foods in Americans’ diets. The majority of the largest chain restaurants do not provide any nutrition information to their customers.¹⁷ Those that do have nutrition information generally provide it on Web sites, which have to be accessed before leaving home, or on brochures or posters that can be hard to find and difficult to read. Evidence suggests that when nutrition information is available, people are likely to use it.

Three-quarters of adults report using food labels on packaged foods,¹⁸ and using food labels is associated with eating more-healthful diets.^{19, 20, 21} Two-thirds of Americans support requiring restaurants to provide nutrition information, including calories, on menus.^22,23

A number of policies and approaches should be undertaken to reduce obesity and help support Americans’ efforts to eat better. Nutrition labeling at fast-food and other chain restaurants is particularly important given how much of our calories are consumed at restaurants, the large portion sizes and high calorie contents often served, and the lack of nutrition information at restaurants. It also is a practical, low-cost solution in these times of tight government budgets.

APHA urges:

1. Federal, state or local policies to require fast-food and other chain restaurants (smaller, neighborhood restaurants could be exempt) to provide consumers with nutrition information. That information should include calorie, carbohydrate (important to people with diabetes), saturated plus trans fat, and sodium labeling on printed menus and calories on menu boards (where space is limited), and that such information be easily readable and accessible.
2. Federal and state health agencies and other health organizations to teach people how to use the new nutrition information provided in restaurants to make healthier food choices for themselves and their families. 
3. Restaurants to improve the nutritional quality of their menu offerings, for example by reducing caloric content, offering smaller portions, offering more fruits, vegetables and whole grains, and using healthier cooking fats (lower in saturated and trans fat).

References

1. American Public Health Association Policy Statement 2000-5: Effective Interventions for Reducing Racial and Ethnic Disparities in Health, 1948-present, cumulative. Washington, DC. APHA current volume.
2. American Public Health Association Policy Statement 2001-7: Resolution on Overweight in Childhood, 1948-present, cumulative. Washington, DC. APHA current volume.
3. National Restaurant Association (NRA). "Industry at a Glance." Accessed at on April 12, 2002.
4. Lin B, Guthrie J, Frazao E. Away-From-Home Foods Increasingly Important to Quality of American Diet. Washington, DC: U.S. Department of Agriculture, Economic Research Service, 1999. Agriculture Information Bulletin No. 749.
5. Nielsen SJ, Siega-Riz AM, Popkin BM. "Trends in Food Locations and Sources among Adolescents and Young Adults." Prev Med 2002;35:107-113.
6. Zoumas-Morse C, Rock CL, Sobo EJ, Neuhouser ML. "Children’s Patterns of Macronutrient Intake and Associations with Restaurant and Home Eating." J Am Dietetic Assoc 2001;101:923-925.
7. Clemens LHE, Slawson DL, Klesges RC. "The Effect of Eating Out on Quality of Diet in Premenopausal Women." J Am Dietetic Assoc 1999;99:442-444.
8. French SA, Story M, Neumark-Sztainer D, Fulkerson JA, Hannan P. "Fast Food Restaurant Use among Adolescents: Associations with Nutrient Intake, Food Choices and Behavioral and Psychosocial Variables." Internat J Obesity 2001;25:1823-1833.
9. Binkley JK, Eales J, Jekanowski M. "The Relation Between Dietary Change and Rising US Obesity." Internat J Obesity 2000;24:1032-1039.
10. Jeffery RW, French SA. "Epidemic Obesity in the United States: Are Fast Food and Television Viewing Contributing?" Am J Public Health 1998;88:277-280.
11. Ma Y, Bertone ER, Stanek III EJ, Reed GW, Hebert JR, Cohen NL, Merriam PA, Ockene IS. "Association between Eating Patterns and Obesity in a Free-living US Adult Population." Am J Epidemiol 2003;158:85-92.
12. McCrory MA, Fuss PJ, Saltzman E, Roberts SB. "Dietary Determinants of Energy Intake and Weight Regulation in Healthy Adults." J Nutrition 2000;130(Suppl):276S-279S.
13. McCrory MA, Fuss PJ, Hays NP, Vinken AG, Greenberg AS, Roberts SB. "Overeating in America: Associations between Restaurant Food Consumption and Body Fatness in Healthy Adult Men and Women Ages 19 to 80." Obesity Res 1999;7:564-571.
14. Lin BH, Guthrie J, Blaylock JR. The Diets of America’s Children: Influence of Dining Out, Household Characteristics, and Nutrition Knowledge. Washington, DC: U.S. Department of Agriculture, Economic Research Service, 1996. Agricultural Economic Report No. 746.
15. Jacobson MF, Hurley JG. Restaurant Confidential. New York, NY: Workman Publishing, 2002.
16. Nielsen SJ, Popkin BM. "Patterns and Trends in Food Portion Sizes, 1977-1998." JAMA 2003;289:450-453.
17. Almanza BA, Nelson D, Chai S. "Obstacles to Nutrition Labeling in Restaurants." J Am Dietetic Assoc 1997;97:157-161.
18. U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention, National Center for Health Statistics. Healthy People 2000 Final Review. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2001. DHHS Publication No. 01-0256.
19. Kim SY, Nayga RM, Capps O. "The Effect of Food Label Use on Nutrient Intakes: An Endogenous Switching Regression Analysis." J Agricultural Resource Econ 2000;25:215-231.
20. Kreuter MW, Brennan LK, Scharff DP, Lukwago SN. "Do Nutrition Label Readers Eat Healthier Diets? Behavioral Correlates of Adults’ Use of Food Labels." Am J Prev Med 1997;13:277-283.
21. Neuhouser ML, Kristal AR, Patterson RE. "Use of Food Nutrition Labels Is Associated with Lower Fat Intake." J Am Dietetic Assoc 1999;99:45-50, 53.
22. Global Strategy Group. Nationally representative poll commissioned by the Center for Science in the Public Interest. Washington, D.C.; September 4-8, 2003.
23. Harvard Forums on Health. Obesity as a Public Health Issue: A Look at Solutions." National poll by Lake Snell Perry & Associates, June 2003.

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