Look for the Health Label

This year at the Kentucky State Fair, a number of culinary marvels were introduced. In addition to standard Fair fare like funnel cakes, deep fried Twinkies, and cheese and bacon hot dogs, Fair visitors were enticed with Krispy Kreme hamburgers. It was not actually brand new: a variation of the burger was sold as early as 2006 at a minor league baseball stadium, and celebrity chef Paula Deen actually has a recipe. This diabolical creation comes with a ¼ lb. beef patty, lettuce, tomato, red onion, with the options of cheese and bacon. Ms. Deen’s recipe calls for a fried egg as well. Finally, instead of a bun, the sandwich comes between two Krispy Kreme glazed donuts. The calorie load is about 1,000 or more, depending on condiments. This was designed to enhance the dining pleasure of Beavis and Butthead. It has the anti-basic four food groups: sugar, salt, cholesterol, and grease.

There is a freak show quality to food like this, and perhaps that’s why it is sold at the State Fair. News stories highlighted the caloric overload, but the themes were mostly the unique charm of State Fair food. The TV and press stories were an invitation to observe this annual celebration of agriculture, including a splurge with these Fairly unique junk foods. More astute Fair goers could look at the Krispy Kreme burger and know that it is not a wise choice from a health promotion perspective. However, no calorie or nutrition information is provided at the point of sale.

One of the more recent innovations in promoting healthy eating is requiring the posting of nutritional information on menus and fast food restaurant item display boards. We have had nutrition labels on food packages since about 1990, though ingredients were posted long before that. Over the last 20 years the labels have been expanded, to include more information, such as transfat content. Because such a large portion (about 1/3) of our diets are obtained from restaurant and fast food meals, a lot of our actual food supply goes unlabeled. Consumers are not able to make health promoting food choices if necessary information is not available.

The federal government (Food and Drug Administration) is developing regulations to require restaurants with 20 or more venues to post caloric content by menu and menu board items. Regulations apply to restaurants, as well as coffee shops, bakeries, candy shops, ice cream shops, mall cookie counters, vending machines, and other commercial food services with at least 20 locations. This will happen by March, 2011. Many local communities are also beginning to enact ordinances for restaurants with fewer than 20 locations. In the next five years, this will become the rule rather than the exception, and many health-activated consumers will be pleased to have another tool to make food choices fact-based.

There is always a but…..

Health promotion theorists have observed that people vary greatly with respect to their readiness to change health habits. It is only a small segment of the public that is ready to use menu calorie labels for food decisions; for most of the dining public the information is totally irrelevant to their daily lives. This is not a reason not to move forward with menu labels, but it is a reason to have modest expectations.

Another problem is that menu labeling relies on what theorists call the information model: if you give people the information they will act in a rational way in their best interest. If only it was that simple. People balance different things that they value, and health doesn’t always come out on top. Furthermore, there are often many other factors which determine change, including social support, skills, sense of risk, and so forth. Most people are not right on the verge of change, waiting for the missing ingredient of health information. Lifestyle change is not like mixing water with Tang in one simple step.

A final problem is that menu labeling, while promising, is not integrated with a strategic plan to improve America’s diet. The FDA will issue these regs, and they will help some consumers in a free-standing way. However, the FDA is a silo among many other agencies in federal, state, local governments and the private sector. All of these can play an important role, but it rarely happens that they are all working together in a coordinated way.

We live in a truly exceptional nation that values divided government and maximum dispersal of decision making authority. It is designed to promote opportunities for all to have a voice. This also means that progress is slow. We can predict two things in this context. Our democracy will continue to move forward, though sometimes in a herky-jerky way, and I expect the Krispy Kreme burger will again be a hit at next year’s Kentucky State Fair.