Challenging Dogma


...Using social sciences to improve the practice of public health

Tuesday, April 24, 2007

Calorie Labeling Laws at Chain Restaurants: A Quick Way to Avoid Fighting the Obesity Epidemic – Eva Mallis

Obesity keeps growing in America where convenience, tradition, taste, cheap prices, and easy access matter more than consuming a healthy, nutritious, health-promoting meal. Chain restaurants reap high economic benefits selling food that puts a negative dent on many Americans’ health. Foods from most chain restaurants tend to be high in calories and saturated fat and low in fiber and nutrients, such as calcium (1). Yet the average adult or child consumes about a third of their daily calories from foods at these organizations (1). In hopes of decreasing the obesity epidemic by making people aware of the unhealthy food at chain restaurants, many states started requiring calorie labels for chain’s food items. This law, implemented as of 2003, hardly reaches the level of a Health-Belief model (HBM), which assumes that if a person is given the intent to change a behavior that it will be changed (2). A calorie label is a compilation of nutritional data that lacks any aspect for creating the intent to eat healthier. Calorie labels are only beneficial if the person reading it is aware of a problem, motivated to change it, and has a plan or resources to make that change.

To better understand the reasons why this intervention will not help the obesity epidemic, it is helpful to consider behavior through the Trans-Theoretical Model (TTM). Since this model provides information on an individual’s starting behavioral stage, it helps to highlight many factors that affect intent and actual behavioral change (3). The inhibiting factors will differ based upon the individual’s location in the TTM. In addition, it is important to look beyond the individual’s behavior. Many social factors related to societal norms, either directly or indirectly cause poor food choice selection.

Trans-Theoretical Model Stage 1: Pre-contemplative

In the first stage of the TTM, pre-contemplative, a person is unaware of a problem and thus no change will occur without a perceived negative correlation between health and food at chain restaurants. Increasing nutrition information put in a pre-contemplative person’s face will not help without the sense of a problem. Calorie labels lack an educational component or central nutritional message. A consumer can learn what ingredients are in their meal and how many calories of their meal come from fat, carbohydrates, protein, etc, but will never learn about proper nutrition. Thus the claim that calorie labels will help resolve the obesity epidemic at the least, overlooks pre-contemplators.

Trans-Theoretical Model Stage 2: Contemplative

Would the calorie labels help people who know that what they are eating at chain restaurants is unhealthy? The HBM says that these people would be making good health choices since they have the intention. However, the TTM explains that while a problem may be known between eating unhealthy items and health, if the person is contemplating change, they may not have the resources or motivation to actually change. Nutrition facts serve as a poor resource for creating change, offering no sense of motivation other than a sheet full of calorie numbers. A calorie label is a compilation of nutritional data that lacks any direct educational message or motivational tips.

This hardly motivating resource of calorie data is not even always accessible. Same chain restaurants, like a popular soup and salad chain, Quiznos, seemed to have avoided the labeling law altogether, simply not providing nutritional information. On their website, they disclose the number of net carbohydrates in a few of their salads. Such limited and hidden calorie information is not going to motivate a Quiznos’ customer to eat healthier.

Not only do chain restaurants limit resources on how to eat nutritious food, but they encourage eating unhealthy items. If eating Dairy Queen’s new Flame Thrower Grill Burger was advantageous to one’s health, contemplative healthy eaters would have no trouble. Dairy Queen managed to create popular TV ads about their new burger in order to encourage business yet fail to mention that this burger has a high amount of the harmful trans fat, and is also high in overall fat, saturated fat, as well as abnormally high in sodium (4).

Trans-Theoretical Model Stage 3: Preparation

Based on the HBM, people with the intent to stop eating unhealthy food at chain restaurants will stop, but the TTM shows that contemplative people are not ready to change. Change can only happen after a person has successfully passed through the next TTM stage: preparation. At this stage, the person is coming up with a plan to change a behavior. Unfortunately, calorie labels do not come with directions let alone a plan or suggestions to eat healthier. In fact, chain restaurants tend to push customers away from preparations to eat healthy by making the calorie labels often hard to find and by providing only a limited amount of nutritious options.

Preparations to eat healthy suffer since calorie labels are not advertised at most restaurants. It is very easy to walk into a Burger King, wander around, read posters, and have an entire meal, without coming across calorie information. At McDonalds, you can only get the nutrition facts of the menu if you specifically ask for them. At Taco Bell you have to look up the nutrition information online. Even if a customer visits the chain restaurant’s website or receives a calorie handout at the restaurant, the customer may choose what to eat before reading the nutritional information. At Quiznos, one can only guess the nutrition content of their Smokehouse Beef Brisket which is full of cheddar cheese and barbecue sauce. With poor resources to change, people are even less motivated to eat healthier at chain restaurants.

Trans-Theoretical Model Stage 4: Action

Another problem with calorie label information is that it does not always take into account various portion sizes. Chain restaurants encourage customers to eat their products more frequently by offering promotions, such as decreasing the cost of bigger portion sizes. Therefore, even people who plan to eat healthy, understand the significance of calorie labels, and have entered into the next stage of the trans-theoretical model, action, may struggle to escape the influence of unhealthy fast food. Many consumers underestimate how many calories they are consuming. When some fast food consumers were asked to estimate how many calories they had eaten for lunch, McDonalds’ customers were off by at least 40 calories while Subway’s customers underestimated an average of 215 calories (5). Interestingly, Subway is one of few fast food restaurants that use their calorie information to promote business with such tools as the “Subway” diet.

Heavy advertising of chain restaurants gets in the way of choosing the healthier items listed on a calorie label sheet. Prizes that come directly from current children’s movies and shows often come with kids’ meals. Combining attractive media with food directly appeals to this young clientele and motivates them to ask their parents for a particular kids’ meal. Because children see kids’ meals as prizes, parents who feel guilty about working too much and not giving their children enough attention, will take their kids to eat at these chain restaurants as a bribe (6). Since the focus of a bribe is to please the child, parents may be less inclined to select the more nutritious items if they do not make their child as happy as some of the more unhealthy items.

Trans-Theoretical Model Stage 5: Maintenance

If the action phase goes well, the now healthy eater must keep up these good habits in the final stage of the TTM: maintenance. It is challenging to maintain a healthy diet while still eating at chain restaurants. There are many factors mentioned above that keep people frequenting at chain restaurants – yet there is little to control for healthy eating. The calorie labels may serve as a tool for choosing healthier options yet eventually the consumer may get bored with their options for healthy meals. The majority of food items are not healthy and thus it is not surprising that people quickly reverse healthy eating progress from maintenance back to unhealthy eating practices. Calorie labels certainly do not offer any techniques to maintaining a healthy diet. What kind of resources can chain restaurants offer to people who need to get back on track with healthy eating? Chain restaurants have much greater success at maintaining a high rate of consumers who eat unhealthy items.

Obesity – A Social Stigma

Calorie labels may not be enough to increase healthy eating when there are limitations of some of the other resources for decreasing the obesity problem, such as a lack of money, support system, access to fitness facilities, and self-efficacy. On the other hand, fast food organizations promote obesity by offering a lot of food for little money and with no effort for cooking or cleaning. Obese individuals in particular struggle to obtain obesity-limiting resources because with America’s thinness obsession, obesity is not socially acceptable. Escaping bias towards obesity is especially challenging since it not only exists within the general public but also extends to the health professionals. Even registered dieticians (RDs) and dietetic students suffer from America’s thinness obsession. In a study with students in both a dietetic and non-dietetic university program, both groups showed a similarly high fat phobia (7). This bias can affect many facets of an obese individual’s lifestyle, from unfair employment practices to lower wages to limited housing and educational opportunities (7). Unhealthy eating habits may be difficult to overcome when society at large limits many of the resources necessary for improving one’s diet.

The Obesity Problems for the Young

With obesity causing increasingly more nutritionally related diseases such as Type II Diabetes Mellitus, hypertension, and greater incidents of early life heart attacks and strokes, an eating related health intervention needs to target younger populations (8). Of course the very young are stuck with whatever eating decisions their parents make, but teenagers have more freedom with food decisions. Over the last 20 years, the obesity rate among teenagers has tripled while that of adults and children alike has doubled (1). Although people may be aware that eating at chain restaurants can cause obesity, they may not correlate obesity with chronic diseases, since such problems develop later in life. Therefore, whether or not calorie information makes sense to teenagers, there is not a strong enough factor to push dietary change.

Younger populations not yet affected by obesity only associate nutrition related problems with adults and thus ignore the effects of their present eating habits. In fact, an adolescent tends to perceive a high risk of many behaviors yet will discount the future effects and proceed in the behavior anyway. In a study investigating teenage boys and girls’ perception of the nutritional content of fast food, both groups believed that the nutritional quality was poor and could lead to future addictive behavior. However boys and girls continued to eat the food because they valued satiety, getting a fast meal, and convenience over the health consequences (9). The future morbidities play no bearing on the over-powering social needs of eating together with friends at a cheap restaurant. Also these types of restaurants are easily accessible by public transportation and therefore, even the younger teenagers have the resources to get there. There are substantially more fast food restaurants located in major cities where there is public transportation than in the limited public access of many suburbs (10).

Calorie label information does not help adolescents develop long term healthy eating patterns. The majority of adolescents are already very concerned with weight but not health yet the calorie labels only provide information that might help with weight maintenance. In a study that looked at creating an intervention for adolescent girls at risk for being overweight, most of the adolescents agreed that it would be effective to learn about general nutrition related concepts for improving health rather than to focus on nutrition for weight maintenance. A lesson on weight maintenance would require looking at concepts such as calorie labels which could be dangerous and lead to unhealthy weight obsessions and eating disorders (11). Nutrition labels do not provide any further insight since most people do not understand the relationship between nutrition facts and eating healthfully.

Chain Restaurants as Social Institutions

What makes it especially challenging to eat healthy at such places is that these restaurants are social institutions. Because it is a chain restaurant, the products, the seating, the prices, and the atmosphere must be uniform. Customers even can predict how long it will take to wait for food, how long to eat it, and how it will taste. Most customers never even question how it is possible to get food so quickly (12). To a neo-food phobic, chain restaurants are a godsend. To the average consumer, it creates some stability in their life. Even the feel of the seats is uniform and memorable. The plastic seats at McDonalds are not particularly comfortable which basically encourages the customer to eat fast. Eating fast food items such as fries and burgers takes a lot less time than consuming some of the healthier options such as a green salad. With so much of a set social culture at these chain restaurants, it is easy to keep things the same and ignore any minor changes such as the introduction of a healthier item and nutrition information.

Even the calorie information that McDonalds’ has begun to put directly on their burger wrappers will most likely not stop the consumer who already has purchased the food. For the nutritionally knowledgeable consumer, he may feel guilty upon looking at the nutrition facts about his burger, but the information is still being provided too late to change what will be eaten. Clearly, chains like McDonalds just want the business but have to keep up a good reputation by responding to the obesity epidemic with a few more healthy options and calorie information. After all, how can storing a stack of calorie label sheets behind the counter have any bearing on changing obesity promoting behaviors?

A Failed Intervention and Future Change

In the future, improving eating behavior at chain restaurants could occur by providing better education and encouragement via big posters about proper nutrition and trendy labels on the healthier menu items. Perhaps if chain restaurants greatly increased their healthy options, they would not make finding and understanding their products’ calorie information such a challenging endeavor. The calorie labeling laws hardly even reach the level of the Health Belief Model. Although calorie labels are full of useful information regarding nutritional health, to think that people will get the message about healthy eating, let alone apply it, is an incorrect assumption. Not all food consumers at chain restaurants have the same ability to interpret calorie label information. For the consumer who does not think about nutritional health or simply does not care, looking at a calorie label will never make a difference in healthy eating. If chain restaurants truly care about the well being of their customers and resolving the obesity epidemic, they would come up with a more attractive method for making their customers eat healthier.

REFERENCES

  1. Wootan, Margo G; Osborn, Melissa. Availability of Nutrition Information from Chain Restaurants in the United States. American Journal of Preventative Medicine 2006; 30: 266-268.
  2. Health Belief Model. (2007, March 30). In Wikipedia, The Free Encyclopedia. Retrieved 02:38, April 16, 2007, from http://en.wikipedia.org/w/index.php?title=Health_Belief_Model&oldid=119010753
  3. Transtheoretical Model. (2007, March 12). In Wikipedia, The Free Encyclopedia. Retrieved 02:43, April 16, 2007, from http://en.wikipedia.org/w/index.php?title=Transtheoretical_Model&oldid=114564265
  4. Fast Food News. DQ Flame Thrower ad a hit. Fast Food News. March 14, 2007. http://www.foodfacts.info/blog/2007/03/d9-flamethrower-ad-hit.html.
  5. TAKE-OUT FAKE OUT. Prevention 2006; 58:45
  6. Ward, Elizabeth M. Good Eats for School-Age Kids. 2005-2007 WebMD,inc. http://www.webmd.com/diet/guide/good-eats-school-age-kids
  7. Berryman, Darlene E; Dubale, Gavri M; Manchester, Diana S. Dietetics Students Possess Negative Attitudes toward Obesity Similar to Nondietetics Students. Journal of the American Dietetic Association 2006; 106: 1678-1682.
  8. MacDonald, Kenneth G Jr. Overview of the Epidemiology of Obesity and the Early History of Procedures to Remedy Morbid Obesity. Archives of Surgery 2003: 138: 357-60.
  9. Mattsson, Jan; Helmersson,Helge. Eating fast food: attitudes of high-school students. International Journal of Consumer Studies 2007: 31: 117-121.
  10. Fast Food News. Fast Food Maps. Fast Food News. April 2, 2007. http://www.foodfacts.info/blog/2007/04/fast-food-map.html.
  11. Shepherd, Linda M; Neumark-Sztainer, Dianne; Beyer, Katrina M; Story, Mary. Should We Discuss Weight and Calories in Adolescent Obesity Prevention and Weight-Management Programs? Perspectives of Adolescent Girls. Journal of the American Dietetic Association 2006; 106: 1454-55.
  12. Schlosser, Eric. Fast Food Nation: The Dark Side of the All-American Meal. Mifflin Company 2002: New York, NY.

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