Calorie counts in health reform is significant for patients

Counting calories as part of health care reform—who knew? But apparently it’s there on page 455 of the health-care reform act, according to Marion Nestle, Professor of Nutrition at NYU, writing in the New England Journal of Medicine. There will now be a national effort at posting calorie counts in chain restaurants.

There are many ways to improve the overall health of Americans, but tackling obesity is surely one of the most urgent. The surge in obesity (with its attendant diabetes) has profoundly changed the face of medicine.

I can recall first learning about diabetes as a medical student and thinking of it as a rare disease. As a primary care internist now, I almost think of myself as a diabetes specialist. Easily half of all my patient-visits focus on diabetes, and obesity is an issue for 95% of these patients.

Which is why I was delighted to see the push toward posting calorie counts in restaurants. There’s no mystery in the cause of the obesity epidemic—eating more and exercising less—but there are definitely complexities in the reasons people consume more calories now. Average people cannot control the fact that processed food are laden with more high fructose corn syrup, or that portion sizes for soft drinks and food have increased immensely, or that in suburbia it’s impossible to walk to anything.

However, when two alternatives are available—a meal with a higher calorie count vs one with a lower calorie count—there’s at least the option to choose the less fattening one.

Our hospital recently closed its much-loved local Greek coffee shop. In its place, they brought in the chain Au Bon Pain. Part of the reason was that this chain could post nutritional information. Hospital staff were dismayed at the substitute of a faceless chain for a homey mom-and-pop store, and also indignant about having a high-priced chain as the only option in a public hospital that serves many patients on limited means.

But nutritionally, it is a disaster. Yes it does have some (ridiculously expensive) sandwiches and salads, its mainstay is baked goods and pastries, the absolute worst foods for our patients struggling with diabetes and obesity.

The only bright side is the calorie posting. When I see that muffins have over 600 calories, I can’t bring myself to buy one. I know that my fellow doctors as well as my patients have made the same observation.

I’m rooting for health care reform to work, on all its levels. The calorie counting is just a tiny aspect, but if it has any measurable impact on obesity and diabetes, the whole reform process was worth the battle.

Danielle Ofri is an internal medicine physician and author of What Doctors Feel: How Emotions Affect the Practice of Medicine.

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  • Egghead

    “Average people cannot control the fact that processed food are laden with more high fructose corn syrup, or that portion sizes for soft drinks and food have increased immensely, or that in suburbia it’s impossible to walk to anything.”

    While I cannot control what a company decides to put in their food, I do have control whether or not I eat it. I don’t eat high fructose corn syrup and it really isn’t that hard. Why is anyone drinking soda? I would suggest water.

  • Steffan Lozinak

    I have to agree with Egghead. The truth is, I blame the country far more for the obesity epidemic then any of the people. I also blame it for the vast amount of heart disease that goes around. I recently became vegan and I started avoiding high fructose corn syrup a while ago.

    Now going grocery shopping is a game of “what can I eat”. There exists HFCS in literally just about everything. It’s disturbing how much food has this substance in it. Meet or dairy is also in just about everything. Even baked beans have it in them unless specially noted vegetarian. Now I mind less about the meat being in everythign then the HFCS, after all, being a vegetarian is my choice, HOWEVER having good quality healthy food to choose from should be the standard, not the rarity.

  • Tex Bryant

    Studies have shown that a public health prevention approach to an epidemic–and obesity is certainly one–can be very effective. For instance, the use of tobacco has declined considerably over the past 40 years and is still in decline among youth, although not as fast as I would like.

    Not long ago a university in the Boston area did a controlled study of reducing childhood obesity by using a community approach–the mayor encouraging walking, teaching the kids in elementary school how to eat and cook healthy foods and then following up with their parents, etc. The approach worked; after one year the BMI of the children in the study group declined significantly while the control group did not improve. A full write up of the project can be found in the May 2007 edition of “Obesity”. You can find the article online if you search for “A Community Intervention Reduces BMI z-score in Children”.

  • Mary Brighton, MS, RD

    I think calorie counts for major chain restaurants and vending machines are a step in the right direction. However, I am also happy that ALL restaurants will not have to abide by these rules.
    While I agree that it is a move forward to have informed consumers on the amount of calories they are eating, I don’t want to know calorie counts in that wonderful dish I am eating at that special restaurant for that special occasion.
    It is a delicate balance between “normal” eating, listening to your “I am full” cues or focusing too much on calorie counts and feeling guilty about food.

    Maybe calorie counts will push these restaurant chains to think of smaller meals…more “realistic” portion sizes, rather than putting down a plate of food that 2 people could eat, and that we take home for lunch the next day.
    Mary Brighton

  • Doc D

    There are equally good studies that show restricting availability of high fat, high salt, high carb foods from school children has little affect on obesity. I don’t think we’ve found the right approach yet. People who are motivated to eat poorly will continue to find ways to do so. The study of calorie labeling in NYC showed no impact on calorie choices. The South LA ban on new fast food restaurants only forced residents to choose street vendors and vending machines. The Santa Clara County law requiring the removal of toys from children’s fast-food meals seems misdirected: I doubt small children will now say they don’t want a Happy Meal because it doesn’t have a toy.

    In my opinioin, we need to continue to look at ways to address the underlying “cause” of overeating, not just clamp down on the “act” of overeating…otherewise, there are always other opportunities and other addictions.

  • Kat

    Let me get this straight…you are mortified that your much loved Greek coffee shop got the boot because of reform but you are glad there is reform? Because they did not list calorie counts? Someone lost their livelihood because you think it is okay to force someone to do something as mundane as list calorie counts? No one points a gun to my head making me eat a muffin that is 600 calories. As with everything lately, it seems that transparency is the key. If you want to know how many calories are in a food, there seems to be myriad ways to do so.

    When will people say enough is enough…don’t use legislation and the force of law every time someone thinks their problem is so important it demands a law.

    There is probably a business opportunity in their for some enterprising person with access to a lab to go to these small businesses and figure out the calorie counts for their foods. That might bring the cost down of figuring it out because from what I understand it can be an expensive process to calculate calorie counts.

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