Feb. 15, 2011 -- Whenever we visited my parents in upstate New York, my husband, daughter and I would grab lunch at the local Ruby Tuesday. We would feel morally superior ordering our turkey burgers, figuring turkey is a healthy option, lower in calories and better for you than the fast-food burgers people were sucking down at the McDonald's across the street.
Those burgers tasted so good that we used to joke that the secret ingredient was beef.
Then, in 2008, nutritional information began to appear on chain-restaurant menus. Our virtuous lean ground poultry? A whopping 832 calories (48 grams of fat); with add-ons such as cheese and condiments, the calorie count shot up to more than 1,100 calories (and 71 grams of fat); a few sips of a soft drink, one or two French fries dipped in mayo sauce and you'd easily rack up 2,000 calories or more.
That's an entire day's worth of calories, according to most health groups. By way of contrast, those low-rent Big Mac-ers were only ingesting 590 calories and 34 grams of heart-clogging fat.
Seeing the staggering fat-and-calorie counts conjured up images of narrowing arteries and middle-aged spread. It was enough to drive my husband and me out of Ruby Tuesday forever.
Plus, the thought of serving our daughter up to two days' worth of fat in one meal did not sit well with us, as parents. That's why the findings of a study published in today's issue of the International Journal of Obesity seem particularly puzzling to me.
The study, performed jointly by New York University's School of Medicine and Wagner Graduate School of Public Service, reviewed the choices made by 349 children and adolescents ages 1 to 17 from low-income communities in New York City and Newark, N.J., both before and after calorie labeling was introduced.
The youngsters who patronized four of the largest fast-food chains -- McDonald's, Burger King, Wendy's and KFC -- didn't order any differently when the number of calories was posted in plain view. Although more than half of the adolescents admitted they noticed the calorie information, only 9 percent considered it when placing their order.
For the most part, it didn't seem to stop them from purchasing an average of 650 calories per visit and an even higher number of calories when they weren't accompanied by an adult.
Know Your 'Anchor' Number
After years of alarm about a national "obesity epidemic," Congress recently introduced a law as part of the Affordable Care Act (ACA) requiring restaurant chains throughout the nation with 20 or more outlets to display the caloric content of their menu items. It goes further than many of the local and state laws; the calorie counts must be adjacent to the name of the menu item and printed in the same sized font.
But this latest study suggests that children, at least, don't pay much attention to those labels when making food choices. Other investigations have come to similar conclusions.
It surprised me that the findings aren't surprising to the researchers. "I don't think anyone really expected this kind of move would make a big difference in consumption practices," notes Rogan Kersh, associate professor of public policy and associate dean for academic affairs at Wagner and one of the study's authors.
"To combat obesity among adolescents, we're going to need a whole array of solutions," Kersh says.
Such as? All manner of educational, behavioral encouragement and public policy changes could be adopted but Kersh believes that providing an "anchor number" to give the calorie counts of menu items some context would be an inexpensive yet major improvement.
For example, the national menu labels that go into effect under the ACA will also include a statement reminding consumers that a healthy adult should eat around 2,000 calories a day. "All of a sudden you have a frame of reference for that 800-calorie meal you're about to order. If that anchor number isn't there, the menu calorie counts are just numbers," Kersh says.
He points to behavioral economics studies where having a free-floating number became a license to gorge. In other words, having the individual calorie counts without an anchor number may actually drive people to eat more calorific meals than if they had no information at all.
Other Countries Do Better
Another far more controversial step recommended by some experts is the much-talked-about "Twinkie" or "soda" tax where foods high in calories, fat and sugar and low in nutrition would be taxed much the same as cigarettes and liquor. But in order for a move such as that to be effective, Kersh suspects, it would have to gouge consumer pockets in a deep and meaningful way so those foods ceased to be attractive options.
"It would need to be proportionate to what you are consuming, like a penny per ounce, which would certainly add up on a liter bottle of soda," Kersh says.
Other countries have been more successful than the United States in driving down rising childhood obesity rates. France, for example, has taken entire school districts and hit them with a dozen or more interventions at once, including banning TV advertisements for fast food and junk food, limiting the number of fast-food joints near schools and cleaning up the nutritional choices of school lunches and vending machines.
Considering that the Rudd Center for Food Policy & Obesity at Yale has observed that the average U.S. child views one McDonald's ad on television every day and one Burger King ad every two days, both companies continue to increase their budgets for advertising to children, and their sites are among the most visited by children on the Internet, these seem like sensible moves.
Japan -- a country where an obesity crisis was once unimaginable -- has also seen some reduction in childhood obesity rates but with an entirely different tactic. Every school-age child has his or her Body Mass Index (BMI) measured and those who fall into the unhealthy range are sent home with a stern note of warning to their parents. I suspect this sort of shaming move would not go over well in the United States.
Solutions to the ballooning waistlines of our children must be culturally sensitive but we can no longer throw up our hands and say it's impossible to make a difference. Some chalk it up to personal responsibility and say we should simply educate consumers the best we can so they will make better choices. But the allure of fast food is powerful. It's engineered to taste wonderful.
Consumption is skillfully reinforced with billions of dollars' worth of advertising, much of it aimed at those just learning to talk. In many neighborhoods, fresh fruits and vegetables aren't available and when they are, they're often far pricier than the dollar menu. In this sort of toxic environment, even well-educated people have trouble navigating the nutritional landscape.
Obesity Cuts Across Class
And, by the way, if you think burgeoning childhood obesity rates are restricted to lower income households, Kersh says, think again.
"Obesity is blind to demographics," he notes. "Lower income, minority populations have a slightly higher BMIs across all different age groups but the rate of increase in obesity among all income groups is rising pretty constantly."
Although many higher-earning families wouldn't dream of dining at a McDonald's or Burger King, Kersh points out, higher-priced restaurants are often just as bad. "If you eat out a lot regardless of where you go, it's pretty much impossible to keep your weight down," he says.
Simply put, childhood obesity is a literally growing problem. Calorie postings and nutritional labeling aren't perfect solutions but at least they're a start. For the first time in U.S. history, scientists predict the average expected lifespan is lower for the youngest generation than for their parents. We simply can't let this toll continue to mount.
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