Obese Americans don’t actually realize they are obese

What if you passed a regulation, and nobody cared? Obesity is quickly emerging as a major policy issue, with related health costs consuming 10 cents on every health dollar – and rising. Policymakers, then, are eager for ideas. Top of the list: regulations to force chain restaurants to post calorie counts on their menus. This past Friday, the FDA released proposed regulations to force restaurants to do exactly that.

New York and other cities have implemented the idea; it’s mandated in the president’s health care legislation that was signed into law a year ago this week. Medical studies are an important tool in judging these efforts and policymakers now have several studies to help weigh the effectiveness of the calorie count policy. A quick summary: good politics but dubious policy.

Medical studies are always in the news. Newspapers often report the results of each study but reporters rarely have the time to compare several studies or sift for broader trends. I’m a practicing physician and a health policy analyst, so I track these studies. And let me declare my bias up front: I’m also a fiscal conservative. I believe conservatives should take action to fight obesity in America to help cut public and private health care costs. I also believe America needs a cultural shift in personal wellness and health care to fight obesity, not a long menu of new regulations, new taxes or new federal programs in Washington. We need to inspire Americans to take control over their own health, instead of fixating on top-down solutions to micromanage American diets.

With that bias in mind, I was skeptical when New York mayor Michael Bloomberg pushed for mandatory calorie counts in N.Y. restaurants. I was skeptical when the president’s health reform bill made them mandatory across America. I don’t oppose calorie reporting – but in the absence of a cultural change, mandatory calorie counts seem to be of little use.

Calorie reporting seems premised on the myth that Americans are desperate to buy spinach salads or grilled swordfish, but corporations con them into buying cheeseburgers at the precise moment their cars reach the window of their local drive-thru.

Here’s how that plan has fared so far. Notice the trend.

  • October 2009. Researchers from Yale and the NYU School of Medicine publish a study in Health Affairs they tout as a “first look” at the impact of calorie counts in New York City. Result: “we did not detect a change in calories purchased after the introduction of calorie labeling.”
  • August 2010. Researchers from Stanford University and the National Bureau of Economic Research review sales data for New York City Starbucks. They conclude: “food calories per transaction fell by 14% (equal to 14 calories per transaction on average)” and beverage calories “did not substantially change” for a net calorie drop of just 6 percent per transaction.
  • January 2011. In the American Journal of Preventative Medicine, researchers from Duke – NUS Medical School tracked buying decisions in Taco Time franchises after a Washington State county passed a mandatory calorie posting law. They find: “No impact of the regulation on purchasing behavior was found. Trends in transactions and calories per transaction did not vary between control and intervention locations after the law was enacted.”
  • February 2011. The lead author of the first NYU study expanded on those results for the International Journal of Obesity, focusing on key groups: teens, parents and children in low-income neighborhoods. “We found no statistically significant differences in calories purchased before and after labeling.”

Four studies. Three failing grades and one marginal pass.

But why is this surprising? Remember, a Harris survey in late 2010 found that 70 percent of obese Americans don’t actually realize they are obese. If the average consumer doesn’t know (or care) that he’s facing a health risk, how is reporting the fifty calorie difference between one double burger and another going to change his health outcomes? In a dining culture where millions of people automatically equate “more food” with “better value,” was it really a stretch to believe some people might use calorie counts as a tool to load up, instead of slimming down?

To be fair, there’s one more study. It found calorie counts were a roaring success. In a presentation by the study team at a 2009 conference of the American Obesity Society, this outlier found that the law helped customers cut their consumption by an average 12.3 percent in lunches purchased at New York fast food restaurants.

Who did the research? It was conducted by the New York City Department of Health and Mental Hygiene. Yes, the same bureaucracy that convinced Mayor Bloomberg to embark on this whole exercise in the first place.

David Gratzer is a physician and senior fellow at the Manhattan Institute. He is author of The Cure: How Capitalism Can Save American Health Care.

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  • http://holtxa.myopenid.com/ openid7&

    Providing facts to individuals generally provides the greatest benefits to those who are already at low risk. In this case, the people most likely to act on calorie count information are people who are not obese, in part because they are aware of the risk, aware of their weight, and already acting in a way that keeps them thin. In a like fashion, those who quit smoking after the release of the 1964 report from the Surgeon General were very different from the sort of smokers we see still puffing away today, despite a half-century of lectures about the hazards of smoking.

    To believe that providing information to individuals who are obese will result in substantial weight loss you have to accept certain propositions:
    - That factual information is as persuasive as comprehensive marketing campaigns that use the full range of emotional appeals and other strategies to influence behavior;
    - That the rise in obesity is the result of millions of people deciding to eat more and exercise less.

    Both propositions have serious weaknesses.

    As mentioned above, people (almost all of them under age 18) continue to taking up smoking despite overwhelming (and constantly repeated) warnings about the hazards. Those old warning labels on cigarette packs were no match for the carefully researched and tested marketing campaigns of tobacco companies. (We will see how the new graphic warnings perform.) The calorie count information is just as dry as those old cigarette pack warnings. They assume consumers act rationally. Marketers know that’s often not the case.

    It seems than rather than a massive decline in will power across the population, the true cause of rising obesity has much to do with changes in our physical environment and the food economy.

    Over recent decades we have steadily engineered physical activity out of our daily lives. We sit in cars to get to and from work and school and other activities. We sit at desks most of the day. Lectures about exercising more can’t magically eliminate the structural reasons that we move less now.

    Our food and agriculture policies and business practices have changed what food is most readily available and at what cost. No matter how big the print on calorie count listings, that information can’t change the fact that a fast food chain’s $1 meals provide a lower-cost hunger fix than fresh fruits and vegetables. (And good produce is unavailable or more expensive in low-income neighborhoods than it is in wealthier areas.)

    You may be right that calorie counts are no magic bullet. But the real problem is that we seem to believe that obesity can be reduced by lecturing fat people… while turning a blind eye to larger policy and economic forces that set us on this path.

  • http://www.practitionersolutions.com Niamh van Meines

    Perhaps we should focus on mandating the food industry to take the sugar and chemicals out of our food and put food back in our food! And then there genetically modified foods which we don’t actually know is doing to us but I’m sure we’ll find out in about 30 years. Then perhaps shutting down a couple of hundred thousand fast chemical restaurants would be great. When the glycemic index decreases along with the cravings for sugar and excessive calorie consumption I’m thinking the obesity problem will be somewhat solved.

  • http://twitter.com/anniebradford Annie Bradford

    I suspect that behavioral economists everywhere are having a good chuckle over this initiative. As much as we would like to believe in people as rational, information-driven consumers, our behaviors are shaped by numerous and highly influential external forces. We are not fatter because we have become mysteriously less able to make rational choices. We are fatter because overeating has become drastically more convenient.

  • http://www.facebook.com/flesheatingemu Bion Alex Howard

    Well, there needs to be more emphasis on what the numbers actually mean–you can post all of the calorie counts you want, but if people don’t know how MANY calories they should be eating, they’re just shooting in the dark. Maybe insurance companies should give gym membership discounts and pay family docs to calculate basal metabolic rates and provide that information to patients? Unfortunately, under fee-for-service, doctors aren’t paid for preventative care…but make a ton from hospitalization. Hmmm, I wonder what that will cause? But, of course, it isn’t just doctors who have control over this stuff. The american people need to take more responsibility. As for how to get THAT ball rolling, I am at a loss. 

  • http://www.HealthcareMarketingCOE.com/ Simon Sikorski MD

    Want another scary statistic on obesity? Here’s one from CDC http://ow.ly/6Lzzv

  • http://twitter.com/JonathanStweetr Jonathan Streeter

    I would think a conservative would be in favor of information disclosure because it allows individuals to take responsibility for their choices. As a WeightWatchers member, I want the information about calories not because I will stop eating a certain food, but rather because it allows me to figure out when, where, and how often I can reasonably eat that food.

    Content labelling seems smart to me. The cost to large corporations is infinitessimal, and it allows people to be informed, responsible eaters.

    As someone who is NOT politically conservative, I don’t think the answer is to force companies to exclude foods or ingredients (unless they damage health). But I wouldn’t be opposed to a warning label on a fast food burger similar to the warning on a cigarette package. Both can kill ya.

    Having lost 50 pounds nine years ago (and maintained that loss since then), I can attest that it’s definitely possible for information to lead to lasting behavior change!!

  • http://www.stephaniefrederick.com Stephanie Frederick, RN, M.Ed.

    Worksite health and wellness promotion is a great place to start.  My first recommendation:  Teach people how to read food labels, and particularly how to identify High Fructose Corn Syrup.  It hides out  in everything and is extremely damaging to the body.  If folks engaged in only one new behavior by eliminating HFCS, the obesity rate in this country would plummet.

  • Dwayne Young

    As a person who is very interested in eating healthy, I appreciate the inclusion of calorie information. Perhaps the “failure” of these policies is misleading.  Think of it this way: Try encouraging people to start running a marathon before you lay out the course. We need the tools in place before we can expect people to use them, and information is one of the most powerful tools we can provide.  So, instead of arguing against mandating calorie disclosure perhaps we should, as healthcare professionals, concentrate our efforts on teaching people how to use it.

  • Anonymous

    Sadly, there has been an explosion of bogus “mental illness” diagnoses/stigmas from psychiatry in bed with BIG PHARMA to push lethal drugs on the most vulnerable to babies in the womb to helpless elderly in nursing homes.  Psychiatry’s most PROFITABLE drugs, SSRI antidepressants and the monstrous atyical antipsychotics used for chemical lobotomy to produce unfeeling zombies CAUSE OBESITY, DIABETES, METABOLIC SYNDROME, HEART DISEASE, STROKE, NEUROLEPTIC SYNDROME, TARDIVE DYSKINESIA, CATARACT AND GLAUCOMA, HIGH CHOLESTEROL and tons of other malignant effects that shorten the victims’ lives by 25 years.

    When is the FDA going to admit this?  Never, because the FDA and other corrupt government officials/politicians/academics/doctors and all too many others have become filthy rich and more powerful by making people’s life problems, social reactions and normal stress reactions to the psychopathic, narcissistic power elite’s increasing assaults on normal people for limitless greed, profit and power.  These “crises” are  designed to cause social upheaval, so the plutocracy running the world can take over more turf  and rob everything like the robber barons of the past.  The books, SHOCK DOCTRINE, SNAKES IN SUITS and POLITICAL PONEROLOGY describe how these robots usurp power by destroying normal people.

    AGAIN, PSYCHIATRIC DRUGS LIKE ATYPICAL ANTIPSYCHOTICS and SSRI ANTIDEPRESSANTS CAUSE OBESTIY.  The victims don’t know their metabolic system has been destroyed and these drugs make them unfeeling zombies so they don’t “know” or care about their obesity or anything else in a vain attempt to survive  the bullly psychopaths destroying their lives!! For those in doubt, check out the basic reference source in every library, THE PHYSICIAN’S DESK REFERENCE the bible for real doctors unlike the bogus satanic bible of psychiatry, the DSM. The white old boy network power elite of psychiatry create bogus stigmas to match the latest lethal drugs of BIG PHARMA or expand old fraud stigmas for the same reason by VOTING THEM IN without a shred of medical or scientific evidence or blood, x-ray or other medical tests to prove anyone has them. Informed observers know they VOTED homsexuality in and out of their bogus DSM due to politics since the DSM is only about politics, greed and power. They have wasted billions in bogus, BIG PHARMA funded studies and hidden negative results and/or published ghost written articles they write while having paid academic, medical shills sign their name to the ADS or “articles” to pass it off as real science or medicine. Those bogus gene studies are no better and no mental illness gene has ever been found though there is evidence that psychopaths like those who can destroy lives with bogus, invented stigmas to push lethal drugs for greed and power may be a result of bad genes or brains per the world authority on psychopaths, Dr. Robert Hare, as he explains in his more popular book, WITHOUT CONSCIENCE, THE DISTURBING WORLD OF THE PSYCHOPATHS AMONG US. Isn’t it odd that the DSM created by psychiatry’s power elite has all but ignored Dr. Hare, the world authority on psychopaths, who created the standard accepted PCL-R test for psychopaths and has exposed the fact that the DSM’s bogus label of antisocial personality disorder is not comparable to psychopathy as they pretend becasue the truth exposing psychopathy hits far too close to home by describing psychiatry to a tee.

    THE GOVERNMENT KNOWS THESE DRUGS CAUSE OBESTITY AND ARE LETHAL, BUT PERPETRATES THE EVIL LIE that the benefits of these lethal but useless poisons justify the murder of countless people just like Germany did when psychiatry experimented first by gassing those THEY LABELLED MENTALLY ILL.  Wake up America/world!  One older psychiatrist admitted his fear that the DSM might include “short, fat, bald Irishmen” and he’d be labelled mentally ill to make the point that this evil profession tries to prove normal people are mentally ill so they can murder their minds, bodies and souls!!. The bogus DSM bible of psychiatry has a fraud, bogus label that will get any normal person who makes the fatal error of going to them for “help.”  Within 15 minutes you will get a bogus  life destroying stigma with the latest fraud fad, bipolar disorder, exposed by Dr. David Healy in MANIA and other books to push these lethal antipsychotics and so called mood stabilizers (the latter another drug company marketing ploy). Like SSRI antidepressants, these poisons cause suicide and other violence for which the victims are blamed to create more laws to force more of these lethal drugs on their victims when they created the nightmare in the first place with their deadly drugs.  Almost every school or public shooter if not all has been on these lethal drugs!!! Now, WHO IS REALLY INSANE AND IN NEED OF COMMITMENT AND THEIR OWN NUREMBURG TRIALS FOR THE SAFETY OF DECENT, NORMAL PEOPLE?

    AGAIN, ATYPICAL ANTIPSYCHOTICS NOW PSYCHIATRY’S AND THE MEDICAL PROFESSION’S NUMBER ONE DRUG OF CHOICE MAKING THEM BILLIONS IN BED WITH BIG PHARMA CAUSES OBESITY, ONLY ONE OF THEIR TONS OF LETHAL EFFECTS.  SEE THE MANY LAWSUITS FOR OBESITY INDUCED DIABETES CAUSED BY THESE TOXIC DRUGS BUT HIDDEN BY BIG PHARMA AND THEIR MANY COHORTS IN THE POWER ELITE MAKING PROFIT CENTERS OF THE SUFFERING AND TRAUMA OF NORMAL PEOPLE!!! A good place to start is Seroquel by Astra Zenca!! I read these fiends may be pulling out of psychiatric drugs like some others seeing their fraudulently gained profits may be endangered now that they’ve gotten so much exposure of their evil and lawsuits are growing by leaps and bounds. Though medicine whines about lawsuits bankrupting medicince, if we did not have so many morally bankrupt doctors like psychiatry, patients wouldn’t have such a huge need to protect themselves from those supposedly under oath to “FIRST DO NO HARM” that has become the “hypocrital oath!!” Any doctor or citiznen who serves as a silent but knowing bystander is just is guilty of this evil by his silence as is any other bully, murderer, evil person, especially those profiting from BIG PHARMA.

    See books, ANATOMY OF AN EPIDEMIC, THE MYTH OF THE CHEMICAL CURE, TOXIC PSYCHIATRY, YOUR DRUG MAY BE YOUR PROBLEM, 2nd ed., ADHD FRAUD, PSYCHIATRY UNHINGED, MEDICATION MADNESS, THE TRUTH ABOUT THE DRUG COMPANIES, and many other books and web exposures of the fraud and evil in the history of bogus psychiatry that is only about social control for a growing police state and not in the least about anyone’s health, but the opposite to discredit, silence and destroy anyone who questions or challenges the power elite.  They are more aptly named the mental death profession with their speciality on the order of witchcraft, unicorns, astrology or anything but science or medicine per Dr. Thomas Szasz, Dr. Loren Mosher, Dr, David Kaiser, etc. I thank God there are some noble, moral, courageous people in psychiatry and medicine exposing this despicable evil and fraud. Psychiatry is the worst plague ever unleashed on humankind. And please don’t call me a Scientologist because though I am not one, I greatly admire their excellent research and exposure of toxic psychiatry. I have two master’s degrees with much training in research and evaluation of informational resources, so before you attack, please do your own homework before responding unless you are a paid shill of BIG PHARMA and their paid front people in medicine and the public at large like NAMI, etc. I will expect bogus attacks and the ususal lies based on the laughable but sad fact that billions has been spent with public funds no less to prove so called mental illnesses are real brain diseases/disorders, etc. when this wasted money has proven nothing but the lengths these frauds will go to keep the bogus biological psychiatry gravy train in bed with BIG PHARMA going invented originally to boost the low prestige of psychiatry. All their bogus labels are fables with lists of symptom divorced from their environmental, life sources to invalidate and destroy the victims while denying them any justice from the power elite.

  • http://www.facebook.com/people/David-Brown/692744221 David Brown

    Fifty years ago most Americans were slim. Counting calories? Not necessary because appetite regulated caloric intake. Why doesn’t that work today? Dietary advice furnished by the U.S. Department of Agriculture has created a fat-phobic mindset causing Americans to consume, in excess, foods that dis-regulate the appetite. http://freepressonline.net/node/144

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