Calories on menus: The next obesity fight?

Most everyone probably knows by now that New York City is banning trans fats in its restaurants. What most people probably have not heard is that the same city’s health department is working on rules that would require many restaurants to clearly post the number of calories next to the prices on the menu
(http://content.nejm.org/cgi/content/full/356/20/2017).

Many nutritionists have noted that the trans fat ban is unlikely to do much to stem America’s mounting girth, and may even do harm — if folks see the ads that say “zero grams of trans fats” and think that means they can munch away to their heart’s content, even though every other kind of fat has the same amount of calories.

On the other hand, having the calorie count of the triple bacon burger with cheese right in your face as you make your purchase might really alter people’s behavior. At least the food industry thinks so, based on those who are gearing up to fight the New York rules. Wendy’s, for instance, was initially eligible to have to post calories, due to the fact that it had those calorie counts already available on a part of its Web site. Rather than have to post the calorie counts on the menu, Wendy’s elected to take down that part of its Web site.

This discussion seems to pit two serious policy positions against each other. Call it the battle of the nanny state versus the consumer’s right to know.

The nanny state crowd can complain that going into a restaurant to enjoy a meal is hardly ever an act to which we are coerced at gunpoint. If we freely choose to have our meal that way, we should also be able to freely choose what to see, or not to see, on the menu. Ditto the restaurant owner; if we don’t like his menu we can always go elsewhere.

The consumer’s right to know contingent counters with several arguments. Many people would prefer, ideally, to cook and eat at home, where they can read the food labels, but time and scheduling force them to eat out a lot. Once in the restaurant, none of us is usually invited back into the kitchen, so we cannot tell what ingredients the chef uses to prepare the food. The only way we can have a ghost of a chance of eating healthily is for the restaurant to be forced to own up to the calories, at the very least.

I think in this debate the consumer’s right to know has the edge. What will be really interesting to see is, first, whether New York can actually pull this off; second, whether it can be extended past a handful of fast food places; third, whether it is adopted in other places around the country; and, finally, what impact it has on how we eat.

But it seems like a good bet that if I see, right next to the gargantuan combination plate with butter sauce, the figure “4,685 calories,” maybe I’ll think twice before I order. And that presently outsized restaurant portions will immediately start shrinking.

Dr. Howard Brody, a family physician, is director of the Institute for Medical Humanities at UTMB.