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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