Calorie Counting in NYC

Posted on: November 5, 2009  |   Author: Karla
Filed Under: Legislation, Public Health Policy   |   Leave a Comment

New York City was the first city in the United States to legally require caloric content to be posted clearly next to menu item prices in chain restaurants.  Since this “ground-breaking calorie labeling law” was passed, 16 states and localities have passed similar laws.  Two recent studies reported findings that contradict one another.  However, the discrepancies are due to variations in study focus and size.

The first study focused on low-income, minority neighborhoods.  Researchers assessed the effect of calorie labeling on individuals purchasing chain food within these neighborhoods.  The results of the low-income neighborhood study show that the calorie labeling law had no effect on the meals purchased at chain restaurants.  “We looked at a population that’s much more price sensitive, so calorie information could have taken a backseat to pricing in our group,” said Brian Elbel, assistant professor of medicine and health policy at New York University School of Medicine and author of the study.  Elbel also noted that he would have liked to have seen a larger impact on this population because obesity rates tend to be higher within the low-income, minority neighborhoods.

The health department’s study assessed the effect of the calorie labeling law on a citywide level.  The results of this study showed little change in the amount of calories purchased at 8 of 13 chain restaurants surveyed.  People purchased fewer calories at Au Bon Pain, Kentucky Fried Chicken, McDonald’s and Starbucks. Despite the lack of change among the majority of chain restaurants, there were two interesting findings.  First, the amount of calories purchased at Subway has increased significantly.  Researchers attributed the increase to the ongoing “$5 footlong” sandwich promotion. Secondly, the number of calories purchased at coffee shops decreased by nearly 10 percent.  In 2007, the average amount of calories purchased at coffee shops was 260.  Now, the calorie average is down to 237 calories.

Among chain restaurant customers, only 56% said they noticed the calorie information posted with the prices.  An even smaller number, 15%, used the calorie information when deciding what to order.  On average, the 15% of individuals that take the calorie information into account purchased 106 fewer calories than consumers who did not notice or use the calorie information.  “Dietary changes come slowly,” said Dr. Lynn Silver, an assistant commissioner in the city’s Department of Health and Mental Hygiene, while explaining the results.

Commentary: Although New York City’s calorie labeling law has not achieved significant results in reducing caloric consumption throughout the city and within low-income, minority neighborhoods, the law has made an impact in a short amount of time.  This law was the first of its kind, and it is promising to see that 16 other states and localities have followed in New York City’s footsteps.  Further, the 10 percent decrease in the amount of calories ordered at coffee shops is a step in the right direction.  Many of the calories that people overlook are liquid calories, such as those found in flavored lattes and blended coffee drinks.  Unfortunately, the results from the low-income neighborhood study show that caloric content is less influential than lower prices.  In order to decrease caloric intake in low-income neighborhoods, healthy foods need to be more affordable and available.  Despite these challenges, the law is still young and could make a larger impact in the years to come.

The New York Times, November 2, 2009

Personal Responsibility: Part of Healthcare Reform?

Posted on: August 16, 2009  |   Author: Karla
Filed Under: Access to Care, Healthcare Reform, Public Health Policy   |   Leave a Comment

“Preventative care works only if Americans take responsibility for their health and make the right decisions for their own lives - if they eat the right foods, stay active and stop smoking,” President Barack Obama said in a statement.  He also noted during his campaign that the success of health reform hinged on individual actions.  However, critics argue that such comments about personal responsibility have not been heard since the President’s campaign statements.

In the current healthcare reform debate, a multitude of ideas have been brought to the table.  Some critics believe that two words are missing from the debate: “personal responsibility.”  Dr. Steven Spady is among a growing number of medical professionals, researchers, and ordinary citizens that are concerned with the lack of conversation regarding personal responsibility in the debate about healthcare reform.

“Having health insurance coverage doesn’t make a person healthy.  It’s what you do with that coverage and your personal choices that make the difference,” said Lisa Herrington, a former health industry administrator.  Much of the discussion surrounding the healthcare reform is focused on extending insurance coverage to 46 million Americans and how to pay for such an expansion.  Critics believe Congress members should be equally concerned about encouraging personal responsibility as they are with expanding coverage.

John F. Banzhaf, director of the anti-smoking agency Action on Smoking and Health, argues that it is a matter of fairness. His agency has pressured Congress members to enact a $60 monthly user fee for smokers.  The purpose of the fee would be to make smokers pay part of the health insurance costs of their habit. Smoking costs $193 billion in medical expenses and lost productivity. “If you don’t have a user fee on smokers, that forces everyone else to pay those health care costs,” said Banzhaf.

One concern about personal responsibility and related fines is where to draw the line.  If smoking and obesity can be fined, what other preventable risks will be penalized?  “Could the same logic be applied to people who have unprotected sex and turn up with a disease?”

Instead of fining unhealthy habits, there are approaches aimed at increasing personal responsibility. The 2006 West Virginia Medicaid experiment was a plan that required patients to sign agreements promising to be healthy, follow their doctors’ advice and aim to improve their health.  By signing up, individuals received enhanced health care, nutrition education, and free stop-smoking and chemical dependency programs.  The “stick” approach of this plan meant that those who did not sign up received only limited basic services.  More than 90% of the participants failed to sign the health agreement.  Children made up 85% of those enrolled, and were penalized by the “stick” approach due to the actions of their parents.

“Carrot” approaches are programs that offer incentives for healthful behaviors.  A Florida Medicaid program offered patients the opportunity to accumulate drug store points by taking actions such as keeping their doctor’s appointments or getting immunizations.  Despite such incentives, this program has not created meaningful change.

Although personal responsibility may seem fair and necessary, not everyone can agree which health problems are the responsibility of the individual, and which are considered wider social concerns.  “When kids don’t have a way to safely bike or walk to school because there are no sidewalks, that’s not personal responsibility”, said Rob Gould, president of the Partnership for Prevention, a nonprofit agency aimed at decreasing disease.

Joan Alker, co-executive director of the Georgetown University Health Policy Institute Center for Children and Families, notes that part of the problem is that many people may not be in a position to make healthful choices.  Such examples would be the family that eats fast food because it is cheaper or areas in which there are no supermarkets to buy fresh vegetables.  “We just have to remind ourselves that individual choice is taking place in a social context,” said Alker.

Commentary: Personal responsibility adds an interesting spin to the current healthcare reform debate. It seems unrealistic to categorize what is or is not a personal responsibility in terms of one’s health. It is not possible to say that each person is completely responsible for their own health because we would be forgetting about all of the children that are dependent upon their parents to provide healthy foods and encourage healthy habits. Further, I agree that social context plays a large role in how individuals make their choices. It is important to include personal responsibility in the healthcare reform debate, but it will also be vital to discuss how communities affect individual decisions regarding health.

Msnbc.com, August 10, 2009