Knowledge is power. Sometimes the power goes out.
Brian Elbel, who studies health policy at New York University, has re-confirmed that while posting calorie and nutrition information at restaurants sounds like a great idea, in practice it has little effect on patrons’ dining habits. And sometimes, what little effect it may have is to increase consumption.
If this sounds familiar, Melinda Wenner Moyer just outlined this peculiarity, and the work of Dr. Elbel, in "The Affordable Calorie Act" in these pages. Obamacare, apart from offering fodder for the nightly news, includes a provision mandating that any chain restaurant with at least 20 locations has to post the calorie count for every item sold.
"Given the limits of labeling reported here and in other studies, it's clear that just posting calories is often not enough to change behavior among all populations.”
A good idea, to be sure, kinda like making sure all Americans have access to cheap and comprehensive health insurance. You know where this is going. Fighting fat by fiat, as we’ve noted before, is a tough job.
Wenner’s article offered a litany of good intentions gone nowhere—people opting to buy cheaper items with lots of calories to get the most bang for their buck, or not seeing the postings, or ignoring them, or even having the information hamper their battles with eating disorders. “According to the Robert Wood Johnson Foundation,” she wrote, “four out of five controlled studies have found no evidence that labeling reduces calorie consumption at chain restaurants.”
Elbel’s latest bite from this apple—presented at last week’s Obesity Society annual scientific meeting—examines data from a study of Philadelphia fast food emporiums. The receipts of 2,000 McDonald’s or Burger King patrons between the ages of 18 and 64 were collected before and after labeling was instituted in February 2010. The patrons were also surveyed about their fast-food habits (which turns out to be the exact right word) and their reaction, if any, to labeling.
A decent chunk of people saw the notices—49 percent at Burger King vs. 34 percent at McDonald’s—but only one in 10 reported downsizing their meal as a result. Those with a high school education or lower were less likely to notice the labels—remember, this was when the program was shiny and new. Those surveyed on average visited a fast food joint at least five times a week, and nobody cut down that rate after labeling began.
Despite this, Elbel, neither in the latest study or Wenner’s piece, comes out against labels. He’s only noting that at present they aren’t working. "Given the limits of labeling reported here and in other studies, it's clear that just posting calories is often not enough to change behavior among all populations,” he explained.
This all pretty much replicates what was known in a broader sense, but with data from lower income, urban areas. Elbel’s team conducted similar studies in poorer New York neighborhoods when that city’s pre-Obamacare labeling law went into effect, and had similar results. And as the doctor explained in a release, "Studies have not generally examined whether labeling is more or less effective for particular subgroups." In this case, about 70 percent of those surveyed were African American, similar to a control group in Baltimore (where calorie labeling had not yet been instituted). Based on the latest surveys, while the U.S. doesn’t exactly have obesity on the run, it’s at least jogging in place. But in low-income, urban neighborhoods (and Arkansas) it’s the menace it always was.
“We need to consider," Elbel concluded, "other, more robust interventional policies in places where obesity is most prevalent." Add it to the Obamacare to-do list, but I suspect fixing the website will prove much easier than changing habits.