Calorie Labeling in New York City Restaurants An

Calorie Labeling in New York City Restaurants: An Approach to Inform Consumers October 22, 2008 Gail P. Goldstein, MPH Deputy Director CVD Prevention and Control Program NYC Department of Health & Mental Hygiene

New York City Adults Gained More than 10 Million Pounds over 2 -Year Period • ~173, 500 adults became obese and > 73, 000 were newly diagnosed with diabetes from 2002 to 2004 • Obesity rates increased by 17% as opposed to 6% nationally • Diabetes rates increased by 17% as opposed to no increase nationally Van Wye G, Kerker BD, Matte T, Chamany S, Eisenhower D, Frieden TR, et al. Obesity and diabetes in New York City, 2002 and 2004. Prev Chronic Dis 2008; 5(2). http: //www. cdc. gov/pcd/issues/2008/apr/07_0053. htm.

NYC Approaches to Battling Obesity • Community Programs • Policy – SPARK, Shape Up, – Daycare Regulations School PE – Calorie Labeling – Healthy Bodegas, – No junk food in Health Bucks government buildings – Food & Fitness – Public Procurement Partnership – Fruit & Vegetable • Environmental Access – Shelf Labeling – Built Environment • Media Campaign (Stairwells, Water Access, Construction) – Read ‘em before you Eat ‘em – Parks

People Are Eating Out More Meals eaten away from home are higher in calorie Source: Guthrie JF, Lin BH, Frazao E. Role of food prepared away from home in the American diet, 1977 -78 versus 1994 -96: changes and consequences. J Nutr Educ Behav. 2002; 34(3): 140 -150.

Fast Food Associated with Higher Caloric Intake & Obesity • Fast food higher calorie intake – Adults: 205 more calories/day – Children: 155 more calories/day – At once/week, would lead to 3 pound weight gain/year • More fast food higher BMI – Higher BMI associated with children in families that primarily eat fast food – Among adolescents, more days of fast food predicts increases in BMI

Most Consumers Underestimate Calorie Content 956 cal. (58%) 796 cal. (53%) 516 cal. (44%) 463 cal. (37%) Burton S, Creyer EH, Kees J, Huggins K. 2006 & Backstrand J. Wootan MG. Young LR. Hurley J. , 1997

Nutrition Labeling Influences Decisions • 3/4 of U. S. adults report using nutrition labels on packaged foods • 1/2 of U. S. adults say nutrition information influences their purchasing • When nutrition information for menu items is readily available, consumers choose high-calorie items about 1/3 less often

NYC Calorie Labeling Regulations Saga December 2006 First regulation of calorie posting on menus in US to be approved June 2007 Lawsuit Filed by NYSRA September 2007 Judicial decision October 2007 Existing § 81. 50 Repealed Modified § 81. 50 for Public Comment January 2008 Board of Health Approved February 2008 Lawsuit filed April 15, 2008 Court rules in favor of calorie labeling April 28, 2008 New lawsuit filed, Stay denied May 2, 2008 Violations began July 17, 2008 Large chains began posting July 18, 2008 Fines began

NYC Calorie Labeling Regulation • Round #1 - 2006 Rule - based on voluntary disclosure. Judge ruled it preempted but reaffirmed local governments right to require posting • Round #2 - 2008 Rule - applies to all chains with >= 15 locations. NYSRA sues again, judicial decision favorable for City, appeal pending. The law is in effect.

Why Restaurant Chains in NYC? • Serve food clearly associated with high calorie intake and obesity • Standardized preparation and portion size make accurate calorie information feasible to provide • Disproportionate share of customer traffic assures substantial public health impact – 10% of restaurants serve 35% of NYC meals

What is in the law: • Applies to all chains with > 15 locations nationally • Calories must be posted prominently on menu boards and menus is association with menu item • Calories must be posted on item tags as well where present • Calories must be posted for combos

The Argument of Menu Boards vs. Brochures “the menu board is the single most valued piece of real estate in a Burger King restaurant. It is the most important way we communicate with our customers in the store about the products we offer and their price. It is what the customers look at, and it is what stimulate their decision to buy. ” Hector Munoz of Burger King

2007 NYC DOHMH Fast Food Survey • 11, 835 diners at 275 restaurants in all five boroughs representing 13 chains • Conducted March-June 2007 as baseline prior to implementation of Health Code Regulations • Brief exit questionnaire: – Did you purchase for you only? – Did you see calorie information? – Did you use it? • Asked to provide receipt Bassett MT, Dumanovsky T, Huang C, Silver LD, Young C, Nonas C, Matte T, Chideya S, Frieden TR. Purchasing Behavior and Calorie Information at Fast-Food Chains in New York City, 2007. American Journal of Public Health, 2008; 98: 1457 -1459.

Lots of Calories… Little Information • Except at Subway, only 4% of patrons reported seeing calorie information as provided in 2007 Does nutrition information on a tray liner work? According to our study, not as much as fast food chains would like you to believe. Bassett MT, Dumanovsky T, Huang C, Silver LD, Young C, Nonas C, Matte T, Chideya S, Frieden TR. Purchasing Behavior and Calorie Information at Fast-Food Chains in New York City, 2007. American Journal of Public Health, 2008; 98: 1457 -1459.

1 out of 3 Lunchtime Purchases Had More Than 1, 000 Calories 33% Preliminary data from 7, 308 customers purchasing for themselves only at 11 chains serving lunch

Calorie Information Makes a Difference in Amount People Eat Bassett MT, Dumanovsky T, Huang C, Silver LD, Young C, Nonas C, Matte T, Chideya S, Frieden TR. Purchasing Behavior and Calorie Information at Fast-Food Chains in New York City, 2007. American Journal of Public Health, 2008; 98: 1457 -1459.

Examples of Posted Calorie Information Auntie Anne’s Menu Board July 2007 Subway Menu Board July 2007

Most Covered FSE’s Have Posted Calories Mc. Donald’s, July 21, 2008

NYC Now Has Calorie Information Posted! Starbucks, 2008

Success Already… “Some restaurants have had their own sticker shock and started offering lighter options. Cosi had a nutritionist look for ways to save on every item. Switching to low fat mayo brought the Cosi Club from more than 700 calories to 447… “Having to post this information in New York really focused us on paying attention as well” says Chris Carroll, the chain’s chief marketing officer” - Wall Street Journal July 29, 2008

CALORIES MAKE THE NEWS… The Shocking Secrets of Chain. Restaurant Calorie Counts Dunkin' Donuts to offer healthier menu items Do Calories on the Menu Make a Difference? Calorie Counts for Big Macs, Burritos and More Can Be Hard to Swallow CALORIE-COP TIX ON THE MENU New York Gets Ready to Count Calories

Estimated Impact of Calorie Posting Regulation in NYC • If calorie reduction in covered FSEs is similar to Subway’s reduction (50 calories per meal), over the next 5 years: – at least 150, 000 fewer New Yorkers would be obese, leading to – at least 30, 000 fewer cases of diabetes, – and many other health benefits

‘Read ‘em before you eat ‘em’ Campaign Launched

For more information, visit www. nyc. gov/calories Gail P. Goldstein, MPH Deputy Director CVD Prevention and Control Program NYC DOHMH 212 -513 -0522 ggoldste@health. nyc. gov