This month, restaurant inspectors from New York City's Department of Health and Mental Hygiene, scourge of both smokers and trans-fat lovers, will add a new violation to their checklist: the failure to display, in large type and directly on the menu board, the calorie counts of every item on the menu.
The city claims that the new law (PDF), which applies to restaurants with 15 locations or more nationwide, will lead to 150,000 fewer New Yorkers becoming obese and 30,000 fewer developing diabetes over the next five years. Other cities are following the city's lead, from San Jose to Seattle. Public-health officials have praised the plan, arguing that anything that might reduce obesity is worth trying.
This is the latest salvo in a war that local governments are fighting against Americans' diets; other examples include Chicago's ban on foie gras (reversed by the city council this year, with two aldermen citing the law as "an embarrassment") and New York City's restrictions on "sous-vide" vacuum cooking and its ban on trans-fats, which took full effect Tuesday.
The case for calorie labeling rests on several arguments, some sturdier than others. High-calorie diets have been shown to contribute to obesity, and fast-food restaurants often have higher calories per meal than food prepared at home. "People eat about half their calories outside the home," said Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale. "And when they do eat out, they tend to eat more, and what they do eat has higher calories."
Second, New York cites studies showing that people do a poor job of estimating the calorie count of the food they buy at restaurants. According to Brownell, even dieticians grossly underestimate the number of calories in dishes served at restaurants.
But will telling people how many calories are in their meals actually change what they order? To answer that question, New York City commissioned a study last year in which researchers interviewed customers leaving fast-food restaurants about their purchases. Since Subway was the only restaurant that displayed calorie counts on the menu board (rather than on its Web site or tray liners), the researchers focused on Subway customers, to see whether the calorie information had an impact.
Nearly one-third of those customers reported seeing the calorie information, and more than one-third of those in turn reported an impact on what they ordered—a result the researchers backed up by looking at customers' receipts. The difference was significant: Those who said they saw the calorie information bought meals with 52 fewer calories, on average, than those who didn't.
Does this mean that menu labeling causes people to eat better? Maybe. As the study's authors write: "Subway patrons might not be representative of all chain restaurant patrons: Subway patrons purchased fewer calories than did other chains' patrons." After all, for years Subway has shoved Jared Fogle's shrunken waist size in our faces, directly targeting people concerned about their weight.
So, the survey's results may not be easily applied to other restaurants. Yet the Department of Health does just that: Its projections for reducing obesity and diabetes are based on the premise that Subway customers are representative.
Christopher Flavelle asks diners in Times Square whether the new menus are likely to change their eating habits:
Historically, the health benefits of food labeling are hard to pin down. In 1994 Congress passed the Nutrition Labeling and Education Act, which required companies to put a standardized list of ingredients on most packaged food products. The NLEA was a victory for advocates of consumer information, but its ability to make those consumers buy healthier products seems to be limited.
Researchers Jayachandran N. Variyam and John Cawley used data from the annual National Health Interview Survey to see if the NLEA had an impact on obesity rates. They divided people into two groups: a test group, made of those who said they read the nutrition labels, and a control group, those who said they ignored them. The premise was that factors other than nutrition labels would affect both groups equally, allowing the researchers to judge the effectiveness of the labels by measuring the body mass index of both groups, before and after the NLEA came into effect.
Variyam and Cawley's study, published in 2006 by the National Bureau of Economic Research, found that nutrition labeling did reduce obesity but only among a single demographic: white, non-Hispanic women. For all other demographics—Hispanic and black women and men of every ethnic group—they found no significant impact after nutrition labeling became required.
Will menu labeling be any more effective? Slate's New York reporting (see video on previous page) indicated that most fast-food patrons said it wouldn't affect their meals. For some people, the question is moot. Julia Patterson is the chairwoman of the board of health in King County, Wash., where menu labeling will go into effect on Jan. 1. Asked whether King County had studied the link between menu labeling and obesity, Patterson rejected the very premise.
"When we made the decision to warn people about the fact that cigarettes can cause cancer on a pack of cigarettes," she said, "nobody demanded that a study be done to determine whether or not that information would have an impact on smoking habits of Americans."
Actually, the example of cigarette labeling is cause for more studies, not fewer. The Surgeon General began putting warning labels on cigarette packs in 1965. Sixteen years later, the Federal Trade Commission found that fewer than 3 percent of adults even read the labels, leading Congress to pass the Comprehensive Smoking Education Act in 1984, making the warning labels more explicit. Meanwhile, ineffective warning labels had been used for nearly two decades. That message isn't lost on the people running New York City's menu-labeling program. Cathy Nonas, director of physical activity and nutrition programs for the city's health department, said the city will use its earlier study as a base line, then commission a similar study after the regulation goes into effect.
The restaurant industry isn't waiting for the numbers to come in. "They have absolutely no scientific backup for any of their claims," said Chuck Hunt, executive vice president of the New York State Restaurant Association, which claims the menu-labeling law violates the First Amendment and is suing to have the law struck down. Hunt said more-prominent calorie information won't change enough people's decisions to make a difference. "I don't care if you stamp it on their foreheads, some people are not going to pay attention to it."
Hunt may have a credibility issue when it comes to public-health legislation: He's the same person who claimed, in 2002, that a smoking ban in New York restaurants would cause business to decline drastically—in fact, business went up.
The law may have the salutary effect of getting restaurants to change their ways. Nonas uses the example of Starbucks, which has reacted to the debate over menu labeling by switching its default milk from whole to 2 percent. Margo Wootan, director of nutrition policy for the Center for Science in the Public Interest, said getting restaurants to change what they serve can be just as important as getting customers to change what they order. "Maybe McDonald's will rethink whether a large shake really needs to have 1,200 calories," she said. "Could people be happy with a 900-calorie shake?"
The calorie rule is an example of informing everyone in the hopes that they will make healthier choices, which is hard to oppose in principle. So, perhaps everyone wins. Yet the absence of unbiased opponents of menu labeling means that lost in the debate over Big Macs and cheesecake has been any serious consideration of whether government agencies ought to be responsible for influencing how many calories we eat.
This summer's outbreak of salmonella in tomatoes, which has made more than 800 people sick nationwide, suggests that government's culinary hyperfocus would be better trained elsewhere. Regardless, it's a strange moment in the history of American municipal government: Banning the sale of most handguns—which undeniably kill thousands of people a year—is prohibited, but it's OK to tell McDonald's how to run its business, based on a plausible but scarcely proven theory of human behavior.