Wednesday, October 07, 2009

For the poor in NYC costs count more than calories

On July 18th, 2009 New York City's mandatory menu calorie law went into action and restaurants with 15 or more locations were forced to post calories on menu boards and/or menus for their patrons.

The hope has always been that armed with this information people would choose fewer calories.

Well, so far the results aren't too promising - at least not for a very specific population.

In a paper published online in the journal Health Affairs, Brian Ebel and colleagues explored the purchasing behaviour of 1,156 adults at 4 different fast food locations in New York City. Researchers tracked purchases 2 weeks prior to the labeling law's implementation and 4 weeks after its implementation. Participants were told before purchasing that if they provided researchers with their receipt and answered a brief survey that they would receive $2. Prior studies using similar methodology for recruitment reported roughly 55% of restaurant goers participate. Researchers then used the receipts to determine the calories of the menu items ordered.

The population studied was quite distinct. 85% were from minorities, and half had only a high school diploma or less education. The neighbourhoods were poor neighbourhoods and on average respondents reported that they frequented fast food restaurants an average of 5x weekly.

What the researchers found was that for this sampling of poor, uneducated, fast-food addicted, minorities unless they specifically stated that they both noticed calories on the menu boards and changed their behaviours accordingly, calories consumed were the same both before and after the labeling law came into effect.

Given the sample, these data are clearly not necessarily representative to the rest of the population. I would also expect that there will be far less change in caloric purchasing in fast food restaurants with fairly limited menus than in fast casual restaurants with more varied fare and patrons with more disposable income. Looking at McDonald's menu specifically, there really isn't much variety in calories in that even salads, when combined with dressings, tend to have calories comparable to their burgers. Furthermore given the nature of the sample and the recruitment I wonder whether or not they selected for the poorest of these poor patrons who actually would bother taking time out of the middle of their weekday for $2.

The authors also admit that because the study took place so soon after the law went into effect perhaps they hadn't had enough exposure to have the numbers sink in. Personally I suspect that the exposure that truly would be necessary wouldn't be the actual calories on the menu boards but rather exposure to education as to just how many calories the body needs per day and in fact there have been studies that suggest menu labeling works far better when combined with that type of information.

At the end of the day what this study tells me is that cost matters to this group far more than calories, and pragmatically I don't blame them one bit. It also impresses upon me the real need of finding innovative means to provide affordable, healthy food for the poorly educated and impoverished.

So should we shelve these initiatives?

Of course not, though it will certainly make the results from the much larger sampling of 12,000 receipts being collected by the public health department of New York that much more interesting.

It's still a hill I'd be willing to die on.

Brian Elbel, Rogan Kersh, Victoria L. Brescoll, & L. Beth Dixon (2009). Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City Health Affairs

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  1. Its also possible that some of the poorest people might chose to eat items with more calories. If you only have $2 to spend on food today then the item with the most calories will fill you up better. However, I think that is a very extreme case.

  2. An important point that was stated here was that the average person doesn't know how many calories, g of fat, mg of sodium, etc. they should intake in a day. A filly support posting of nutritional information, and I support basic nutritional education even more-so. Consumers need to be able to determine that 510 calories, 34g of fat and 1200mg of sodium in a sandwich does not equate to a healthy choice. I am currently co-leading a program for individuals recovering from stroke and we spend quite a bit of our time on basic nutritional education, such as label reading, portion sizes and how our diets contribute to risks such as hypertension and high cholesterol. The more basic education like this (i.e. schools, community wellness programs, etc.), the better.

  3. Perhaps the calorie content of food could be given as percentages of average calorie intake for a normal child/woman/man. For example, a given burger could work out to 25/20/17 percent of daily calories (or something like that).

  4. I have been following a pattern for the last 9 months of trying to maximize the calories per dollar I spend. I budget myself about 300 kilocalories per dollar. It interestingly rules out most fast food as well as a lot of other things. I hope someday to have improved my crcumstances enough to start taking nutrition and flavor more into account. But even then it violates my sense of thrift to buy certain items which are being marketed as lite. From what I have seen they offer no greater nutritional value or flavor, just smaller portions.

  5. It is expensive eating healthy. I grew up financially deprived and the food we could afford were definitely not Fruits and Vegetables.

    I was an obese child and adult peaking at 450lbs. I am thankfully on my way down the scale, at 331lbs last month!