"Whenever I go into a restaurant, I order both a chicken and an egg to see which comes first"

Wednesday, September 19, 2012

Losing Weight–Does Product Labeling Help?

Martin Bruegel writing in the New York Times (9.19.12) provides a short history of public education on nutrition, an activity which surprisingly began almost 150 years ago.

Nutritional recommendations were born at the end of the 19th century with the discovery that humans need 20 calories per pound of weight each day; 55 to 65 percent of this energy intake ought to come from carbohydrates, a quarter from fats and something over 10 percent from proteins.

Yet very little has worked, and people’s appetites and the need for that special gratification that only food can give have always trumped logic and science.  We eat what we do for many reasons.  Poor people in India have always been reluctant to give up the mounds of rice that not only provide energy but a feeling of satiety.  In their constrained and often miserable existence, there is still the feeling of a full stomach.  Poor people in America may like to try sushi or confit de canard but are stuck with pork chops, cornpone, and fatback because they cannot afford much more.  A Happy Meal at McDonalds may be loaded with calories, salt, and sugar, but it’s cheap and an entertaining evening out for a family of four.

In an era of stagnant wages, dystopian politics and cultural anomie, eating indulgent if unhealthful food has become a last redoubt of enjoyment for Americans who don’t feel they have much control in their lives.

Shortly after the fall of Ceausescu, the Romanian dictator, I suggested to the Ministry of Health that they apply for a World Bank loan to address lifestyle health problems.  Romanians were smoking like chimneys, getting drunk on vodka, and eating the fattiest imaginable foods, and public education campaigns designed to change these pernicious habits might be a good idea.  The Minister replied that while this might be a good idea in the long run, now was not the time.  “Our people have been deprived for 50 years”, he said.  “Let them enjoy themselves for a while longer”. 

While most people in America agree that weight is a function of calories, and that despite decades of public information about diet, cholesterol, sodium, and trans-fats, they keep getting fatter.  Clearly there is a serious disconnect between science and popular reality.

In 1888, the American chemist Wilbur O. Atwater devised a series of formulas that would help people get the most energy from the least food and pioneered a movement that came to be known as “scientific eating.”

French physicians promoted a program of “rational eating” aimed at instructing the poor to keep food expenses within the limits of their (modest) budgets. They urged the substitution of protein-rich legumes for red meat, pasta for sausages, and sugared beverages for wine.

Nutrition facts were put next to the items on the menu cards in factory canteens and in working-class restaurants. Scales at the entrance to eating places helped customers to monitor their weight. A menu board, listing carefully calibrated culinary options, would allow workers to assemble nutritious meals from a set of limited options.  The program flopped.

Despite these European failures, Americans took up the fight with typical vigor.

In 1914 the New York State Board of Health introduced a “scientific restaurant,” where staff luncheons were made according to “the most modern dietary theories.” Restaurants across the country began to list energy and protein content on their menus.

Childs Restaurants, an ancestor of today’s global fast-food chains, provided “a complete lesson in dietetics, mathematics, food conservation, patience, economy, and patriotism and a meal thrown in for good” to its clientele.

These programs withered and died.  No matter how much they tried, public reformers could not make a dent in Americans’ eating habits, and nothing much has changed in 100 years.

This does not mean we have given up.  There has been one iteration after another of some kind of food pyramid or pie explaining nutritional balance. They have all been confusing, unhelpful, and ultimately ignored.  Simple charts showing recommended daily allowances of particular nutrients are rarely read, for the percentages of Recommended Daily Allowances (RDA) mean little. “Is 15 percent of my sodium RDA a lot or a little?  Wow, only 200 calories per serving and zero grams cholesterol?”.  Even the most committed nutritious eater has to calculate based on some denominator to make sense of these figures.

Now, because people have done nothing on their own to curb obesity, the state is stepping in with Mayor Bloomberg’s nanny state legislation to outlaw calorie-rich popular drinks. 

New York City has mandated that chain restaurants post calories since 2008, and the federal health care law adopted in 2010 will eventually require fast-food restaurants across the United States to do so.

Chains like McDonalds are jumping on the bandwagon and beginning to provide calorie information for some of its products.

Why do we assume that this will do any good?.  Why should a patron of McDonalds pay attention to nutritional content of a mega-calorie burger when he can say, reasonably, “Hey, I know it’s high calorie, but what the hell, how often do I eat out?” Marketers will surely find a way around the NYC ban on large-size soft drinks if consumer demand is there.

Unfortunately Bruegel resorts to the old prescriptive saw – more education in the schools; but this, too, has been tried; and in these days of performance-based testing, there is no room in curricula for such fluff.  The common denominator of obesity is not education but income – poor people cannot afford the expensive fresh fruits and vegetables available for the well-off; nor can they afford the gyms, spas, racing bikes, or skiing vacations in Aspen; nor do they have the time to enforce ‘no-junk-food’ regulations for their children or regulate the amount of television (and gloppy food commercials) they watch. 

If looked at cynically, the health care system for all its sanctimony about obesity, does little to control it.  Drugs to control hypertension, Type II diabetes, and other weight-related problems are available under private insurance and Medicare.  No conditions concerning weight govern insurance eligibility.  There is little or no incentive for individuals to control their weight.

So, tinkering with labeling and food pyramids, adding a calorie line to Happy Meals, or outlawing super-drinks are unlikely to do any good – just as they have done no good in the last 100 years.

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