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The Affordable Calorie Act

Will an Obamacare anti-obesity tactic make things worse?


By the end of this year, every Big Mac you order will come with an extra side of guilt. Among its many provisions, the Patient Protection and Affordable Care Act mandates that all chain restaurants with at least 20 U.S. locations must start posting the calories contained in each item on their menus. The hope is that consumers will make healthier choices. After all, how many people would get an Outback Steakhouse Bloomin’ Onion knowing about every one of its 1,959 greasy calories?

Actually, the answer might be “a lot.” Several recent studies suggest that menu labels not only often fail to encourage people to eat better, but for certain folks may actually backfire.

Activists warn that posting calorie counts might only make it harder for people who suffer from disorders such as anorexia and bulimia to bring themselves to order a proper meal.

Posting calorie counts isn’t a new notion. New York City started requiring chains to do so in 2008, and nearly a dozen other states and cities have since enacted their own menu-labeling schemes. But according to the Robert Wood Johnson Foundation, four out of five controlled studies have found no evidence that labeling reduces calorie consumption at chain restaurants.

That’s bad enough, but worse is that labeling might actually encourage some people to eat more. In the months before and after New York’s law went into effect, New York University health-policy researcher Brian Elbel tracked the fast-food purchases of people in low-income neighborhoods. He found that, on average, customers bought more calories after the labeling started. If your priority is getting the most food for the fewest dollars, this makes perfect sense; $5.99 for an 800-calorie hamburger is a better deal than the same price for a 600-calorie turkey burger.

Even when menu labels do sway people toward healthier choices, that doesn’t mean those people eat better overall. Making one abstemious choice seems to free some people to indulge on others. In a 2010 study, Yale University researchers found that people who saw menu calorie counts ate fewer calories than people who didn’t. But those who saw the calorie listings then went home and ate, on average, nearly 300 calories more, making up for the difference.

Why are so many people so set on overeating? Habit, for one.

“I don’t think many people walk into a restaurant thinking a burger is healthy,” says Elbel. “People are eating these foods for a lot of reasons that trump health concerns. It’s about convenience, it’s about price, and fast foods tend to taste pretty good to most people.”

Then there are those for whom counting calories is itself unhealthy: the millions of Americans who suffer from eating disorders. There’s little research on the subject, but activists warn that posting calorie counts might only make it harder for people who suffer from disorders such as anorexia and bulimia to bring themselves to order a proper meal. Harvard University scuttled a menu-labeling system a few years ago after several students and parents raised this concern.

To be sure, labeling will help some health-conscious people make better choices. And research suggests that it can be made more effective with various tweaks. People choose healthier options when menus also specify total recommended daily calorie intakes, for instance, or when lower-cal items are listed higher up.

Most studies, moreover, have only evaluated the impact of menu labels in the short term, so it’s possible they might become more effective with time.

But it’s also possible that we will quickly learn to ignore them. Or that we’ll dutifully eat the low-fat fajita wrap, and reward ourselves later with an extra scoop of ice cream.