It is happening!

It has been eight years, but the National Restaurant Menu Labeling Law (part of the Patient Protection and Affordable Care Act) will be in effect on Monday. Restaurant chains with over 20 locations will be required to post the calorie content of their standard offering on menu boards and print menus. The goal is to raise awareness of the amount of calories in the items we choose - and to do so before we make that choice. This law has the potential to change our behavior as consumers as well as the behavior of those providing us with food and beverages. Will the calories available to purchase decline? Will we purchase AND consumer fewer calories? If the answers are yes, will the country's obesity rate plateau or decline? I sure hope so - but that's a lot of ifs. 

Meanwhile, the recommended changes to the Nutrition Facts Panel have been delayed to 2020 - here we go again. The main change on those labels is an emphasis on total calories and added sugar and a de-emphasis on total fat. 

On a personal note, sorry I don't post much anymore, but my students require a substantial amount of my time!

Diet and Health: The Big Picture

After teaching an undergraduate public health nutrition course (i.e., not a course for aspiring dietitians) for a couple of years, I realize that there are a few points that are most important. The first is that healthy is a very squishy word and must be defined when used. In fact, at this very minute the FDA is taking public comments as they consider whether food companies can continue to use the word on their products and what exactly it would mean if they did (same for the word natural). I define healthy in the spirit of the Dietary Guidelines for Americans. Therefore, a healthy food would be high in nutrients that we need and do not get too much of (e.g., we need sodium/salt but we easily get plenty, so a food high is sodium is not considered healthy), and low in calories and things we need less of (e.g., solid fats and added sugars). So healthy foods are usually whole foods (i.e., produce, whole grains), lean proteins (e.g., some fish, legumes), certain oils (e.g., olive oil, omega 3, flaxseed) and some low fat dairy products. Unhealthy foods would be ones likely found in a box or bottle (e.g., sugar sweetened beverages) with high calories, high sodium (e.g., 10% or more of the daily value on a food label), and added sugar. Unhealthy would also include whole foods that were prepared in a way that adds excess calories, sugar or sodium, and cooking with healthy oils instead of adding a small portion (less than a tablespoon) of raw oil after preparing the food.

The remaining points are these:

• Just because something is good for you (aka healthy) does not mean it is free of calories and that you can eat as much of it as you like.

• Just because something is bad for you (aka unhealthy) doesn't mean you should NEVER eat it (with a few exceptions, e.g., raw fish or unpasteurized milk).

• Calories matter no matter what you tell yourself and its important to have a general idea of how many you need and how many are in the foods and beverages (including alcohol) that you consume. On that note, the national calorie disclosure law for restaurant chains and vending companies has NOT BEEN REPEALED and is due to take effect in May.

Start the New Year Informed

Like many or most of you, I am preparing for the new year. What might be different is that to be healthy I simply (or not so simply) need to keep doing what I have been doing. Whereas, many others start every year pledging - resolving - to do things differently. With that in mind, I want so share some truths with you.

The most important things that any of us can do are these (listed, not necessarily, but maybe, in order of impact):

1. Do not smoke tobacco (don't start or do quit).
2. Exercise - everyday (30 to 60 minutes of activity that increases your heart rate).
3. Maintain a healthy weight (this is relative, but for most people it means losing weight).
4. Eat within a calorie appropriate (controlled) recommended dietary pattern, e.g., the Mediterranean Diet, which is plant based.
5. Get some sun, but not more than 10 minutes without protection (also relative to time of year, your skin pigmentation and where you live).
6. Avoid alcohol in excess (for some this means any alcohol, for others excess means more than 1 or 2 a day or 7 to 14 a week (never more than 3 or 4 in one day).
7. Get vaccinated according to the CDC recommendations for your sex and age (and take your children in for their shots).
8. Practice safer sex - i.e., use condoms and discretion.
9. For those suffering from any substance use disorder, SAMHSA can direct you to supportive services
10. Do not fall for diet and supplement scams - nutrition comes from food and weight control comes from balancing intake with expenditure. If whatever supplement or plan you are hearing about was as much of a break through as the ad says, we would NOT have an obesity epidemic. Please believe me.. there is NO pill for you. Reread numbers 1 - 9 above, this is the key to health.
11. Remember these final words of truth:
1. Non-GMO only means something does not contain genetically modified ingredients, not that its low calorie or necessarily good for you.
2. Organic means something has been raised according to specific standards, and so the plant or animal was not treated with chemicals or antibiotics. Organic foods are not scientifically better for you than conventional foods (though there IS concern about antibiotics in the food chain). Organic foods are not necessarily or ever lower in calories than similar non-organic foods.
3. All natural is finally being defined by the FDA - but stay tuned for the final rule and then years before companies have to comply.  Even if something is truly natural - not at all processed - that does not mean it is good for you, wont' hurt you, or is low in calories.
4. There are legal definitions for low calorie, low fat, low sodium, etc.. and 'lower' means something different than low.
5. Read the nutrition facts panels, think about serving sizes.. pay attention to calories (usually a lower calorie item will also be low in sugar). Hopefully, the added sugar declaration will be added to labels this year and that will lead manufacturers to reformulate their products.
6. Some fat is good for you! Especially consider adding omega 3 fatty acids from food, like salmon.
7. ONLY 1% of white people in the United States have CELIAC DISEASE, and even fewer people of other races/ethnicities do. That means, YOU probably don't need a gluten free diet.
8. Gluten free does NOT mean low in calories or good for you.
9. The health promoting property of olive oil is destroyed when you cook in it. To get the nutrition you are seeking, drizzle a teaspoon over your cooked veggies instead.
10. Get your fiber from plant based foods and whole grains, not mixes and pills.

On a sad note, the national vending and menu labeling law which is NOW set for compliance in May of 2017 is part of the Affordable Care Act - and may or may not survive the next presidency. That means that local and state laws could once again begin to populate which could be better for us and a nightmare for industry. Stay tuned

Lastly and sincerely,  I wish you the healthiest of New Years....remember, though I focus on food, physical activity is the sine qua non of health... make sure you get plenty this year... all year.

~ Deirdre

Added sugar and other changes to the back of the pack nutrition label

     I wrote this post on May 20 -21, 2016 after the FDA announced new labeling requirements for packaged food manufacturers. The manufacturers will be required to provide additional information and modified information on the Nutrition Facts Panel (NFP). This applies to all companies, but smaller ones have longer to comply. The FDA announced July 2018 as the official effective date, but we know from past FDA associated labeling initiatives that this date could change.
     The FDA press release - which you can access here - offers highlights of the changes, and many news sources have covered the story. What I want to do is put the changes in the context of my blog re: nutrition disclosures that help us consume fewer calories across venues.
     So does this change help? Probably - or to some extent. First, the revised labels have an increased 'reference serving size'. The noted serving size may merely be a declaration to allow the nutrient content to be calculated, because people rarely (if ever) dole out cups, ounces, or grams and even if they did, it would be more cups, ounces, or grams than the label suggests. The update, a slightly larger serving size, appears to be a compromise between what people are actually eating and what they are supposed to be eating. In other words, it is probably still not realistic.  One example of a serving size change involves ice cream. Instead of a 1/2 cup, a label will say 2/3 cup. I imagine most people scoop out more than 2/3 a cup of ice cream for themselves, therefore, if a person wanted to know the actual calories or sugar they consumed, they'd have to do the math (just as before). Also people may think that the label refers to an actual cup of some sort, not a measuring cup. 
     A similar issue with serving sizes is unchanged. They are not exactly uniform across similar products - the serving sizes may all be a 1/2 cup but the weight - the precise measurement - will vary. Boxes of cereal and cartons of ice cream, as opposed to say, a can of soda, are actually figured by weight, grams usually. So a serving size might be 2/3 cup on five cartons of ice cream but the weight of each 2/3 cup could be different. So to be frugal with our calories like we are with our dollars, we  need to know the calories per unit. You don't get to see an orange shelf tag with this information but you can do the math, e.g. calories per serving divided by grams in a serving gives you the calories/gram.
     Another change on the NFP is that sugar grams will come with a % DV. I've never been much of a fan of the % daily value disclosure on a label. It is based on a 2000 calorie/day diet and the majority of women, myself included, require less, say 1500 to 1800, so again, math is required. There is a trick that can make the percentages useful. If the item on the label is a nutrient of concern (meaning we get too much of it, like calories, sugar and sodium), look for a low %DV.  Low is 10% or less. There are very few nutrients that Americans lack, but for those, look for high %DV. For example, it would be great to have products with vitamin D and calcium at 20% or higher.
    Small packages, ones that people are likely to consume all at once even if they 'technically' contain 2 or 3 servings, will now have dual labels. There will be a column with the serving size nutrient information and a column with the whole package nutrient information. For items like a 20 ounce soda, where the expectation or custom is to drink the entire bottle in one 'sitting' the nutrient and calorie content will only be for the entire package (who drinks 8 ounces of a 20 ounce soda and saves the rest for tomorrow?). BTW, that is why I go for diet sodas in 12 ounce cans, I do not need 20 ounces, its too much; and for some diet sodas, the trace calories will become meaningful beyond 12 ounces.
    There are a couple more changes, which are not as relevant to the theme of my blog. You can review them by clicking on the above link.
    I'll end with two important things the new labels do not address. The information is still on the back of the package and the rule doesn't amend the new vending machine law to include sugar grams with the point of purchase calorie disclosure. Because the Nutrition Facts Panel is still on the back of the package the prospective buyer has to pick up and turn each product around (the new rule does not mandate or standardize front of pack labels and this is a disappointment). And consequently, this rule won't help us purchase low 'added sugar' snacks from vending machines because we can't see the back of the package at the time of purchase.

February Reminder: You said you would eat 'better' this year!

It's the middle of February, how are you doing with your goals to eat healthier in 2016?

Here are a few reminders and helpful hints:
Remember that calories still count and there are plenty of ways to eat delicious, full plates of food if you make some clever choices. For example, when eating out you can order your fish or meat with little to no oil, butter, glaze or sauce and ask for your vegetables to be steamed without butter. (note, pasta is never low calorie and bottomless bowls of it are a mistake) At home, you can prepare your food the same way - without lots of sauces, breading or butter.

Some vegetables are more nutritious than others - high in nutrients but not high in calories, as long as you do not bread, fry or coat them in butter.  For example, summer squashes, spaghetti squash, eggplant, cauliflower, broccoli, asparagus, butternut squash, Brussels sprouts, green beans, greens (kale, broccoli rabe, etc). Use this link to find other low calorie foods, and remember just because they start out low calorie doesn't mean they end up low calorie (how you or the chef prepares them is a crucial factor).

Alcohol and caffeine(particularly in coffee) can be a part of a health promoting diet, but be mindful of two things: 1) excess alcohol and caffeine can have adverse effects on your health (excess is more than one or two drinks a day depending on your sex and size, and probably 3 to 4 8-ounce cups of coffee); 2) both alcoholic beverages and coffee that is flavored with cream and sugar, bring in calories and those calories count towards your individual daily requirements. 

I enjoy a good cup of arabica coffee, black no sugar in the morning (okay 2) and decaffeinated, almond milk infused cappuccino in the evening. (sugar free milk ~ 30 cals a cup). For alcohol, I stick to one 12 ounce light beer, one 4 to 6 ounce glass of wine OR one shot of liquor mixed with a no calorie beverage. I recently made a batch of limoncello which I am enjoying several nights a week! Pictured above.

I hope this post has helped get you back on track or keep you on track and given you some new information for meeting your goals.

Front of Pack Labels vs Labeling Laws

There is a difference in the requirements for vending operators when they post calorie counts for all items in their machines, starting December 2016, and what some candy, chips and pastry manufacturers are doing now - voluntarily.

According to the law, the font type, size and color have to be large enough and stand out enough to get the attention of the customer while the customer is deciding what to buy. I suppose if you go to the snack machine with nothing but Reese's peanut butter cups on your mind, you may not slow down to read calorie counts, but if you are browsing.....

The snack manufacturers, likely because they make their snacks for grocery and convenience stores too, have begun placing industry designed - industry criteria based - front of pack labels on their packages. On the face, this sounds really good. I love calorie disclosures as a general rule. And it looks like the manufacturers are giving counts for the full packages. 

From the pictures below, you can see some problems.

1. The labels are too small
2. The numbers do not stand out on the packages
3. If the package is not placed in the spiral correctly (especially this happens with beverages) you can not see the label at all
4. Sometimes the spiral actually covers the label
5. Only some of the items have labels - how can you compare? 
6. The labels are not in the same spot, so you can't really scan efficiently, and
7. In this particular machine, the snacks with the most calories do not have labels (eg honey buns and tasty kake)

By the way, there doesn't seem to be any detectable pricing scheme - two items of equal calories or 'healthiness' can cost from $ .60 to $1.00. Or maybe there is, the chips or salty snacks in the machine below are 60 cents and the higher calorie items, the honey bun and pop tarts, are a dollar. Contrary to what we are told - the worse items cost more, not less.

Here the Cheetos and Oreos are labeled, possibly the pop tarts too

Notice the different label placements, upper right hand corner and lower right hand corner, and even the small side of a package

Health Halos, Calorie Labeling, and Vending Machines

     Vending Times, a trade magazine for, you guessed it, the Vending Industry (machines, coffee service and micromarkets), recently announced that Mrs. Freshley’s has a new product, 7 Grain Cookies. You can read a little about them here, but the important information (i.e., nutrition content) is not yet posted. Other cookies by this company have, on average, 200 to 300 calories per package – the serving size.

     Without my explaining, can you guess the problem with a 7 grain cookie? Here is a hint and a term nutrition and obesity prevention researchers often use – “health halo.” You probably figured it out. By saying that this high sugar, high calorie item has 7 grains, people are distracted from the fact that it is still an item that should be consumed in extreme moderation. Cookies, pastries and such are in the discretionary category and I believe the latest version of US Dietary Guidelines suggest that discretionary calories take up no more than 10% of a day’s worth of calories (actually the new guidelines refer to added sugar not being more than 10% of calories). Therefore, if you were a small, active women consuming 1800 calories a day, this pack of cookies would be all you were allotted in discretionary calories for the day. The fact that the cookies might supply you with some whole grains, a positive thing, doesn’t change the fact that they are cookies. (BTW, other health halos you might see on discretionary food and beverage items, REAL sugar, raw sugar, honey, molasses– it’s all sugar, and in this context, not different than corn syrup or table sugar).

     Label declarations such as these (e.g., 7 grains) can give us a false sense of the healthiness of an item. Of course, healthiness is a moving target, but let’s stick with sugar and calories – we do want to limit them across the board, throughout each day. In a similar fashion to label 'nutrient disclosures', researchers have found that some Front of Pack labels (of which I am a huge fan) can also create a health halo! Hamlin, McNeill and Moore(2014) conducted an experiment on choices people make after seeing different types of Front of Pack labels and found that across all types (2), having a label led people to buy that product more often than if it did not have a label, regardless of what the label said. This is only one study, and others show that the labels can be helpful in leading to a reduction in calories, salt or sugar purchased, but it is definitely something that should give us pause, especially because one of the label formats tested was my favorite, the multiple traffic light. 

      When I think of this in the context of our soon to be implemented calorie disclosure law for vending machines, it occurs to me that maybe, simpler IS better. In other words, if every single product has a label and the only thing on the label is calorie content – then choosing the smallest number would be the (usually) right thing to do. I have that parenthetical usually, because a 100 kcal pack of cookies might not be a better choice than the 200 kcal package of granola bars, BUT – it would still be the least caloric.

      Lastly, the 2016 calorie label law (passed in 2010) is very specific about the placement, color, font and size of the calorie disclosure. If you take a look at the pictures below, you can see why that is important.

I took these photos at vending machines where I work and offer some comments in the captions.

This is industry criteria, notice the calorie, sugar and sodium limits to be called a Choice Plus snack

Notice the sodium  - its too high to be a Choice Plus but the snack is in a Choice Plus Slot. Also this snack has a Front of Pack label which could be a health halo.

Great example of how different a Choice Plus snack can be and if you look closely you see some calorie disclosures on the package. You have 250, 190 and 100 here.  Importantly, they are ALL the same price ~ busting that myth.

In my opinion, this is not as helpful as the machines with the calories on the front inside the picture of the sodas. I was within inches of this display when I took the picture and you can barely read the calories on these sugar sweetened ice teas (120 per 20 oz)

Calorie Awareness While Traveling

I recently spent a week at a Residence Inn in Alabama. I attended a research methods workshop for obesity prevention and treatment. On several occasions, I was aware of the 'conspicuous' absence of calorie disclosures. The biggest one... the hotel 'free breakfast.' Except for the cartons of yogurt and milk, nothing was labeled. Considering that a slice of bread can have as little as 40 calories (if you search hard) and as many as 100+, that's a big deal. I imagine the range for the available muffins, bagels and waffles make them equally hard to 'estimate.' Sure a day or two of incidental over consumption should't have lasting effects on your health, but if you travel  - and eat away from home - often, the information will come in handy. 
When I travel, attend workshops, meetings and just go to work, I try to keep within the bounds of what is healthy for me. That is another observation I had while at the workshop. It is not enough for the planners to serve 'healthy' food, because healthy, especially these days, is a relevant term and a moving target. Healthy for me mostly meets with the updated recommendations from the Dietary Guidelines Advisory Committee: 

The overall body of evidence examined by the 2015 DGAC identifies that a healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meat;i and low in sugar-sweetened foods and drinks and refined grains. Vegetables and fruit are the only characteristics of the diet that were consistently identified in every conclusion statement across the health outcomes.

*The fruits and vegetables are highlighted as being prepared with spices and without adding salt and saturated fat. See the full report here.

So for me, healthy is not about organic or 'all natural,' and healthy doesn't mean no artificial sweeteners, but that is exactly how some others might define healthy for themselves. My healthy diet includes mostly whole foods, minimally processed; no meats, lots of vegetables, soy based lean protein, fish, almond milk and no or low fat dairy (yogurt, cheese, ice cream), fruit, coffee, plenty of whole grains, like popcorn!, fiber and yup, alcohol and diet soda. So to eat the way I like, I usually bring my own food, and in Alabama, though I ate out a few nights, I went to the grocery store and prepared my lunch and dinner in the nice hotel room kitchen.  (The reason the workshop lunches weren't 'healthy' to me is because they were often sandwiches, pasta, or meat based. I did enjoy the fruit and diet soda though!)
Interestingly, my friends and I were out walking one evening and one or two got very excited when we passed the Insomnia Cookies store. (remember this was an obesity prevention workshop, and cookies can be part of a calorie controlled diet). So, my friend was more than a little excited as she went into the store - there was quite a line at the counter - but she came right back out, with a brochure (for me) and disgust. WHY? THEY POSTED THE CALORIE CONTENT!  HAHAHAHA, she said that seeing the calories took all the fun out of it. Hilarious. (BTW, we have one of these Insomnia Cookie food trucks at Temple University, and the shop in Alabama was within a mile of the UAB campus. Sense a theme?)

Notice the ranges, also on the right is ice cream

The delay is NOT the demise of menu labeling

The FDA has granted restaurants and similar retail establishments a delay in posting calorie amounts  -  how that delay actually came about and why, warrants some clarification.

The National Restaurant Industry, like the National Automatic Merchandising Association for vending machines, supports calorie disclosures on menus and menu boards as mandated for large (20 or more) chain restaurants. Large chain restaurants are probably ready to roll with the disclosures - several cities and at least 1 state already have calorie (+) disclosure laws in place (though they are preempted by the federal law). It is not likely that restaurants need or even want the delay, after all, the industry(through its trade group) supported the federal law; a nationwide, preemptive law is good for them.

What is really going on is that the 'similar retail establishments,' ones that sell ready to eat food as a major part of their enterprise, for example, grocery stores, movie theatres, bowling alleys, convenience stores, tried to get out of the mandate. Once they realized the law did indeed apply to them, they asked for and received more time to get their act together.

I do not see the delay as a bad thing and I do not read it as the demise of the legislation. Too many big players AND consumers want calorie displays across the many places where food choices are made. 

Including the similar retail establishments (and vending machines) in the law makes it 1) fair to the sellers of the food - why should some have to disclose and other not? and 2) easier - possible - for us to monitor our calorie intake if we so choose. Whether we will choose to do it or understand how to do it, is a separate discussion.

Researchers and proponents of the law do not know if calorie disclosure by itself is going to change the behavior of people most in need of changing their behavior (i.e., people who exceed their average daily calorie needs), but it makes it possible and before we can do anything else (e.g., tell people how many calories, from which types of foods, are too many), we have to put the information out there. The early positive change that I, and many others envision, is that the retailers are going to reformulate recipes or reduce serving sizes in order to 'present' calorie counts that are more reasonable. Hey, there is a thought, maybe one of the things that 'similar retail establishments' will do with their extra year is reduce calories  - say in that bucket of popcorn!

Anyway, I am not disheartened and as a researcher, I hope to take advantage of the extra time to conceptualize some new evaluation studies!

Calorie Stealth

Calories, calories, calories. That is all this girl talks about… well, mostly true. I also talk about making sure that you are as physically active as possible (that means sit less) and that you try to exercise every day. And a few other things, like not smoking or tanning… and, well by now, you can fill in the rest yourselves.

So YES, calories.  First, restaurant (and similar venue) menu labeling is coming and I have noticed an increasing number of commercials that include a calorie count within the TV (or internet) ad.  Here is the most recent:

Second, I want to pass along a ‘be on the lookout’ note:

Little Bites and mini donuts are not low calorie options, but calling something little bites sure makes you think so. Right? Actually, a serving of Little Bites muffins has 180 calories, a regular muffin 190 and a 'mini' cake 260.  All of these are made by Entenmann’s. TastyKake sells mini-donuts with over 200 cals per serving. Take home message: read the calorie AND serving size information regardless of the words, light, little, diet, mini, good for you, all natural, organic...etc.

And back to the lemonade: 240 calories for a beverage is a bit much… more than half those calories are from sugar - 39 grams or about 10 teaspoons. The rest is from protein and fat, which comes from the milk. Below is the ingredients list from ChickfilA. The ingredients in the “Icedream” read like a chemistry book.

Frosted Lemonade: Icedream (whole milk, sugar, nonfat dry milk, artificial flavor, corn starch, mono & diglycerides, microcrystalline cellulose, carrageenan, guar gum, Yellow 5 & 6), water, freshly-squeezed lemon juice, sugar.

Diet Frosted Lemonade: Icedream (whole milk, sugar, nonfat dry milk, artificial flavor, corn starch, mono & diglycerides, microcrystalline cellulose, carrageenan, guar gum, Yellow 5 & 6), water, freshly-squeezed lemon juice, Splenda® (dextrose, maltodextrin, sucralose).

SO – the picture above, with the 240 calories, that is the diet one…. the regular lemonade has 330 calories and 63g of sugar (16 teaspoons). Sigh…and by sigh, I mean that's crazy! (PS I didn't see the fine print in the picture at first, “starting at…. 240 cals.”)

The case of South LA, Obesity and the Meaningless Law

You may have heard about the 'absolute failure' of a fast food zoning ban in South Los Angeles, California.  The ban on new, stand alone - very distinctly defined - fast food restaurants did not lead to a loss of weight for city residents, in fact, overweight/obese rates went UP after the law was 'on the books.'

Notably, the rates of overweight and obesity went up for ALL of Los Angeles and LA County. According to the study authors (Sturm and Hattori), South Los Angeles residents - ones whose behaviors and weights were captured in the California Health Interview Survey- had a higher rate of overweight obesity to begin with and their rates increased faster - or to a higher degree - than either the whole of Los Angeles city or LA County (their behaviors and weights were also assessed through the survey).

Whether or not a ban on new fast food restaurants - and it was not a total ban - was a good idea is for someone else to argue, but whether or not the study results are conclusive or even meaningful falls into the bailiwick of this (increasingly infrequent) blogger.  Yes, I end up giving an opinion about the law, I can't help myself sometimes.

This LA Times article provides a bit of information, though it does not describe the study methods. I accessed the journal article, the abstract is here. My main interest was in how the researchers went about collecting their data and answering their research questions. Sturm and Hattori (2015), used two main sources of data. They used establishment/restaurant permit records from the Department of Health and existing survey responses from a recurring/repeating survey - the California Health Interview Survey.  The survey responses (people) could be categorized by city, county, zipcode etc, so the researchers compared results between 3 groups, only one of which, South Los Angeles, was 'exposed' to the new regulation.

The regulation didn't really do much, I mean literally - it didn't do anything.  Fast Food Restaurants (FFR) still opened in Los Angeles, new business rose about 2% in all three locations. So from time 1 to time 2 there were actually MORE not less places for residents (or commuters?) to eat foods that were likely very high in calories. Between the time that the law went into effect and when the researchers evaluated the survey respondents FFR patronage frequency and their BMIs a second time, the environment did not change 'for the better'. There were not fewer FFR at time two, but would that have mattered? Research has shown that even sit down restaurants, fast casual or otherwise, serve foods that are calorically dense.  All away from home eating is associated with excess calorie consumption - so a law that prevents a certain sub category of FFR from adding more locations might make sense on its face, the result won't necessarily - or likely - be lower weights for the people who live in that area,

With an understanding of what did and didn't happen as a result of the law - i.e., FFR locations did not decrease or remain stable, they increased - how can one say that restricting FFRs does not lead to less FFR patronage or less calories consumed.  The law was flaccid at best - the first outcome - a decrease in number of restaurants or restaurant density did not happen. There was NO change in the obesogenic environment - people had as many if not more options for calorie dense food as before the law. So the answer to the first question: "Does a law restricting FFR lead to fewer FFR?" is no. Therefore, we can't answer anymore questions! But lets say the answer was yes, that five years later there were less restaurants in the area; the second question is: "Did the law lead to less consumption of fast food - or even better, much better, did it lead to few calories purchased/consumed?"

Now, is this the right policy?  Banning restaurants?  In some ways, it makes sense.  If there isn't a FFR on every corner, then FFRs become less popular, less 'normal.' And if FFRs were the only source of our passive overconsumption of calories, fewer of them might change our intake.  But they are not - there are plenty of sources of too many calories. The goal, in my opinion, should be to get existing establishment to reduce the amount of calories - across the board - that they put out for sale.

NB. Another possible 'confounder' for South LA is that people may not eat where they live - so capping the number of fast food restaurants does not change behavior if people are not eating where they live. 

~~~~~~~~~~~~~~~~
Mom, you would be happy to know that I had three more paragraphs, but I realized I had already said what I needed to say so I deleted them.

The 2015 Dietary Guidelines: The Advisory Committee Makes Recommendations

I am not going to spend many hours of our time creating numerous posts to break down the newest (and pending) edition of the Dietary Guidelines for Americans, as I did 5 years ago.  Holy cows! Five years ago?!

I am not going to do it because others, with better nutritional backgrounds, have already been hitting the highlights and controversies and because you can read the report yourself.

But as is my style, I will say a few things before I link you to the document and one of my favorite blog posts related to it.

• Calories are as important as ever and a majority of the population - all ages - consume more than they need to maintain a health weight.  A healthy weight, better measured as waist circumference or waist to hip ratio than on a scale or BMI, is one in which the body does not have excess fat.
• Sugar quickly increases calories without adding nutrients - except naturally occurring sugar in fruits and vegetables - and dietary fat, though not necessarily harmful, has a lot of calories and therefore should be limited in the diet - animal sources and full fat dairy are a continuing concern in these guidelines.
• Plant based diets are still the best.
• Exercise is key to better health - better health.  Let's just stop talking about it as a way to lose weight or eat more, whether it helps with that or not does not matter as much as this:  Exercise in and of itself is a necessary component of good health!
• Taxes and info: Environmental strategies, the likes of which I focus my research on, are promoted in the recommendations. The Dietary Guideline Advisory Committee talks about the need for information disclosure at the point of purchase and taxes on sugar sweetened beverages.

Two excerpts from the full report of the Scientific Report of the 2015 Dietary Guidelines Advisory Committee

What to eat: 

Following a dietary pattern associated with reduced risk of CVD, overweight, and obesity also will have positive health benefits beyond these categories of health outcomes. Thus, the U.S. population should be encouraged and guided to consume dietary patterns that are rich in vegetables, fruit, whole grains, seafood, legumes, and nuts; moderate in low- and non-fat dairy  products and alcohol (among adults); lower in red and processed meat; and low in sugar-  sweetened foods and beverages and refined grains. These dietary patterns can be achieved in many ways and should be tailored to the individual’s biological and medical needs as well as socio-cultural preferences. 

The food environment:

Align nutritional and agricultural policies with Dietary Guidelines recommendations and  make broad policy changes to transform the food system so as to promote population  health, including the use of economic and taxing policies to encourage the production and  consumption of healthy foods and to reduce unhealthy foods. For example, earmark tax revenues from sugar-sweetened beverages, snack foods and desserts high in calories, added sugars, or sodium, and other less healthy foods for nutrition education initiatives and obesity prevention programs.  

Click here for a great blog post by Dr. David Katz 

Calories as Currency

The reason I appreciate, support and take advantage of calorie disclosures on pre packaged, ready to eat, and bulk food items (see e.g., the USDA nutrient data base) and prepare 90% of my meals - over the course of a year - is because I LOVE to eat and want to stay thin.

Exercise is important - it is vital to health - but unless one can do moderate to vigorous physical activity for more than an hour a day every day - or be in some other way unusual (e.g., have genetically, hyper metabolism), exercise is not going to keep you thin - at best, it will allow you to eat a 100 or so more calories than you could eat without exercising, and maintain a certain weight.

So to meet my goals, I monitor - stay aware of - my calorie intake.  Calories are currency and I do not spend them lightly.  In other words, I would rather have a plateful of 200 calories than a tablespoonful.  To be truthful, it took me years of self education - reading and research - to understand what 200 calories means in relation to my daily needs.  I eat 5 or 6 meals a day and consume between 1500 and 1800 calories a day depending on my current level of physical activity and fitness. 

For all of us, calories have always mattered and up until recently, the calorie content for most of our foods has been hard to access. With new nutritional labeling requirements for away from home foods (e.g., snacks in vending machines and movie theatres, restaurant meals), existing labeling on packaged foods, emerging but imperfect front of pack labeling and unprecedented access to legitimate calorie information on line, people have a real opportunity to consume the right amount of calories for their bodies.  The information is there, but the understanding of calorie moderation and the desire to moderate are both lacking.

Now more than ever, we need health educators and promoters to:

• assure the public that calories do count, 
• educate the public on the amount of calories most people need in a day,
• provide the public with the reasons the amount of calories needed may vary, per person and per day, and
• note that food volume alone does not signify calorie amount - for example a CUP of kale and a TEASPOON of oil or butter have about the same amount of calories (30 to 40), such that more can sometimes be less and less can certainly and often is quite more..

The way I eat, this calorie as currency approach, is possible because I choose foods with low energy density - Dr. Barbara Rolls at Penn State terms it Volumetrics and has written books on the style - it is not a diet, it is a way of choosing and preparing foods - all the time.  I know January is diet focused but I encourage you to think instead about calories and nutritious foods on which to spend them.

[I did not discuss carbs, protein, fats and sugar - you understand there is a current debate and the evidence is contradictory, but calories have not changed - too many of them from any source is a cause of weight gain.  Most will agree that salty, sugary and fried foods should be substantially reduced if not eliminated from the diet, and that complex carbs and fat are important dietary components.]

How to include cereal in your diet

Earlier this week I caught a segment on CNBC in which the hosts were discussing falling prices for cereal stocks.  The analysts mentioned General Mills and Kellogg by name and noted that the companies were seeking to expand their market share by introducing new products to their portfolios.  One of the analysts, originally from the UK, recalled his surprise at the American’s reliance on cold cereal as a breakfast staple.  He then opined about the changing preferences of Americans - turning away from “all that sugar and those carbs.”  He added a dig about the use of the term ‘all natural’ to indicate that people were less likely to be fooled into thinking that anything in a box was natural.  I found little to disagree with, but there was this one thing… it is not carbs that are the problem but the type of carbs found in cold cereal.  Try as cereal producers may with the ‘whole grain’ caveat, breakfast cereals are packed full of refined carbs, mostly sugar, and thus are calorie dense, nutrient poor, and not very satiating.  Tasty?  Oh YES, filling, no.

So do I eat cereal?  You betcha!   I LOVE cereal.  It reminds me of a happy sugar, laden childhood.  But I am a nutrition savvy grown up now and I have found that when there is something I like so much I want it often, then it has to be a low calorie food or a calorically safe dose (for my own calorie vs nutrient needs) of a high calorie food.  Every night I have maybe a  ¼ cup of almond milk and cereal combined; it’s a tiny serving, maybe three teaspoons full.  Sounds crazy right?  Maybe not.  What if I told you that it was chocolate that I loved and craved every day?  I have a friend who does and she buys a package of Hershey miniatures and has one piece as a treat, every day.  That Hershey miniature has around 45 calories, and my itty-bitty cereal bowl has about the same.  

My educated understanding of energy balance and dietary guidance is that each person has energy needs (calorie amounts) unique to himself/herself and the unique amount is very complicated to calculate.  If your weight has been stable for some time and you can accurately track your calorie intake, you might figure out what your daily energy requirement is - to maintain your weight.  That is not my area of expertise and not the point I wish to make.  Meaning, I am digressing.

Within a person’s unique amount of necessary calories, there are nutritional requirements for optimum health leaving little room for discretionary calories (like chocolates and refined carbs).  I never preach ‘everything in moderation’ because 1) I don’t believe it and 2) I don’t think I can do it.  But, I do tell people when they ask about me, that I consider my overall needs, which change based on my activity level, when deciding what to eat.  Within those needs I make space for my wants and cravings.  One of those wants is a little bit of cereal - only at night and only as a snack. (Ok, not true, sometimes I sprinkle a little All Bran or Kashi on my ice cream or yogurt (oh, you know that they are light versions!)).   

It would take multiple normal size bowls of cold cereal for me to feel like I had breakfast, but that would give me about 200 more calories than usual and they would be nutrient poor calories at that.  (Note, I am referring to cold cereals.  I do have loose oat bran (cooked in water) with almond milk for breakfast at least once a week.) 

All that being said, breakfast cereals are neither the main source nor even a top source of sugar in the diet.  Click here to see information from the RUDD Center on sources of added sugar in the diet.

The other effect of a national restaurant menu labeling law

You have probably read news stories suggesting that calorie information on restaurant menus and menu boards does not work.  It does appear that state or city nutrition menu labeling laws have not had a big impact on the average amount of calories customers purchase.  However, I have noted several research studies that are exceptions to these findings and I continue to believe that providing nutrition information at the point of decision making is a good idea.  The labeling can help reduce the over consumption of calories that occurs when people eat out.  I also believe, based on the research of others (see e.g., Ellison), that using a traffic light presentation (i.e., green, amber or red based on calorie amount) will enhance the effectiveness of menu labeling.  

For the most recent scientific review of menu labeling please click here.

Today I want to mention progress on another hoped for outcome related to menu labeling - changing the amount of calories in meals restaurants offer. The FDA still hasn't issued the final rule on how restaurants are to present the information, but in expectation, it would seem, restaurants are promoting special menus that offer lower than 'usual' calorie amounts.  (Recall the studies I have cited in past posts which showed the average chain restaurant meal having over 900 calories.)

In my anecdotal review (i.e., I have not systematically studied restaurant menus before and after the legislation was passed, or as the final rule approaches, or controlled for the fact that it is the first of the year), I found at least 9 major chain restaurants (e.g., Apple Bees, Outback, Macaroni Grill, Subway, McAlisters, Long John Silvers, IHOP, TGIF) who are promoting entrees with 500 to 600 calories or less.  Subway is advertising breakfast options at 200 or less.

One of the distal (or immediate) outcomes of a menu labeling law is that it heightens peoples awareness of calories and makes calories seem more important. I believe that menu labeling IS effective for these outcomes. The restaurant industry is aware of this and that is why menu labeling laws also work to change what is available - in other words, law can change the environment. Law can have a greater impact on population health than interventions aimed at individuals.  I am confident that once the labeling rule is published and restaurants nationwide fulfill their obligations to post calorie information, we will begin to see a change in the amount of calories purchased and in the future, perhaps, a reduction in the prevalence of diseases associated with being over fat.

Easy Weight Loss

Sorry, there is no such thing. My headline should be, “Weight Loss Not Easy,” but then fewer people would read the post - and people need to read this post.  Right now, masses of people are searching for that one pill, powder, or cream that will melt away excess fat with no behavioral change required.  Said pill, powder, cream DOES NOT EXIST.  It does not! Think about this carefully.  There are more overweight/obese adults in the United States and similar countries than there are normal weight adults. Because excess fat is associated with disease and being overweight can affect ones physical and psychological health, a simple remedy would be groundbreaking.  If this remedy currently existed, 70% of the US would not be overweight.

Products promising weight loss – fast, substantial, permanent, and painless – are simply fraudulent.  Unfortunately, the makers of these products do not have to submit them to clinical trials where efficacy is established or to post market trials where effectiveness is established – i.e., the FDA does not regulate the products.   However, the companies that sell supplements/weight loss products must tell the truth about them in advertisements. 

Truth in advertising is a law and the Federal Trade Commission (FTC) is responsible for its enforcement.  The FTC is understaffed and it takes years for them to get a falsely advertised product off the market.  The FTC went after 4 companies this week – read here, and has started the year with increased efforts to protect consumers, updating their guidance to both businesses and consumers for the first time since 2003.

I like the guidance the FTC provides to businesses, because in their communication to them, the FTC enlists the support of businesses and suggests that by screening the ads that they publish, businesses are protecting themselves from being associated with a ‘bad’ company – an unscrupulous company.  This is a good strategy because if media polices the ads, the FTC caseload could be reduced.  The FTC could go after and prosecute violators quicker.  I will benefit, too.  There will be fewer sensational, commercials that raise my blood pressure.

The FTC encourages media to stop and think about an ad before publishing or airing it. They offer 7 ‘gut checks’, but I can be more concise.  If an advertisement sounds too good to be true, it is too good to be true. You cannot lose weight if you do not change something about your eating and activity: the number of calories you consume, the type of calories you consume, the amount of exercise you do, the type of exercise you do. It is best to address all of these, but research suggests that diet alone will work to some extent.

You can read all the claims for businesses to watch out for here.

The scientific study of fat gain and loss is dynamic.  It feels like we learn something new every day, and indeed some of the things we believed to be true are not.  (I didn’t ‘know’ this before grad school, but in science things are never proven, only disproved).  Nutrition scientists once thought that all fat was bad in excess, but that no longer appears to be true.  They, and we – the public, also believed that a calorie is a calorie, but that truism is under current scrutiny as well.  I tell you this because I know many of you have become frustrated with and distrustful of science.  That is no reason to turn to supplement makers, I assure you; the makers of weight loss supplements deserve much less of your trust.  The fact that we are learning more about fat gain and loss through science is a good thing.  One of the most important new findings is that being over fat – as a population or as individuals – is caused by multiple factors.  Researchers have not identified all the factors, and the ones they have identified are not completely understood.   But we know some things in the aggregate.  For example, calories (amount and type) matter most and genetics matter least (by matter, I mean the amount of impact these factors have on body fatness).  Somewhere in between these two extremes is the amount and type of physical activity one engages in and metabolism.  An important note about metabolism is this:  an individual’s metabolism is affected by what and how much he or she has eaten over his or her lifetime and the amount of body fat he or she has carried.  In other words, a metabolism can become dysfunctional and this individual dysfunction makes it hard for anyone to prescribe generic weight loss advice - not everyone who cuts their calories and increases exercise will have the same results.  This is the painful truth.  In addition, I’d like to disavow you of the notion of a set point weight.  Instead, consider this: if a person does a certain thing and loses 10 pounds but then stops doing that certain thing, their weight will return to its previous level.  That is not destiny – the weight returned to its previous level for a specific reason – a person’s actions. 

In summary and in closing, no diet supplement leads to easy weight loss.  In the absence of disease, body fat does not melt away. Please consider this before you spend your money and invest your hopes in a weight loss supplement. The FTC is cracking down on companies who market products as if the products were weight loss miracles, and is asking businesses to give ads a ‘gut check’ before they agree to publish them.  Losing excess body fat is important and safe ways to do so exist.  One way to maintain a healthy weight is to follow the guidelines suggested by the Harvard Nutrition Source and to commit to daily or near daily exercise that increases your heart rate for 30 or more minutes.