Cal-gone

On January 1, Seattle started requiring chain restaurants to post calorie counts on the menu. To see what the counts look like, check out this photo album. Right now I’m writing from Starbucks, and the calories are clearly posted.

Nobody asked me my opinion on this topic, so naturally I wrote a thousand words about it.

Here are three plausible results of posting calories on menus:

  1. Positive public health outcome: On average, people choose lower-calorie menu items and lose weight.

  2. Neutral public health outcome: On average, people’s behavior doesn’t change.

  3. Negative public health outcome: People choose lower-calorie menu items, get hungry later, and eat a Snickers.

If I had to put money down, I’d put it on number two, but the others also seem at least possible. The county is planning a study to determine the effect of the new policy. To find out more about what that would entail, I spoke to Matias Valenzuela in the Public Information and Education department of Public Health.

First of all, he said, calories are the only data that have to be posted on the menu, but other numbers must be made available at point of sale, including carbohydrates, sodium, and saturated fat. The carb and sodium counts will be of indisputable value to people with diabetes or salt-sensitive hypertension, so I think this is great.

As for evaluation, Valenzuela said it would be extensive. King County is adding questions to the Behavioral Risk Factor Survey, asking people questions like:

  • In the past 7 days, how many times did you eat at, or buy take out food from a chain or fast food restaurant?
  • What is the name of the last chain/fast food restaurant you ate at or bought take out food from?
  • Did you see any information about the number calories for the items you were interested in ordering?
  • Did you see calorie info before you placed your order?
  • Did you see any information about the amount of saturated fat, sodium, or carbohydrates for the items you were interested in ordering?
  • Did you use the nutrition information to help you decide what to buy?

They are also sending investigators to about 50 sites to ask customers on the spot whether they saw the information and what they are ordering. This will be compared with control data from Multnomah County (Portland, Oregon), whose labeling law hasn’t gone into effect yet.

Additionally, Public Health will be evaluating whether restaurants change their menus in response to customer demand for healthier options.

I hit Valenzuela with my Snickers hypothesis. “We can’t be sure,” he said. “It’s not going into people’s homes or other areas, although there has been labeling for example in supermarkets, when you buy packaged food. Somebody is going to be buying that Snickers bar. They can look at that bar and see how many calories, if they’re interested.”

The program only applies to chain restaurants with 15 or more locations nationwide. I asked whether they’re considering expanding it to non-chain restaurants. “It’s not something that’s being looked at or considered,” said Valenzuela, although he expressed hope that non-chains would follow suit in response to customer demand. “As consumers get more of this information they begin to expect it and begin to use it,” he said. “Savvier consumers will be asking for it when they go to places that currently don’t have this kind of information.” He didn’t know what percentage of restaurant meals in King County are served in chain restaurants.

Still, after talking to Valenzuela I felt better about some parts the program, at least. I’m glad the carb and sodium information is available for people who need it. But the calorie counts bother me. Obviously they’re being posted in an effort to reduce obesity and its related syndromes.

That’s a laudable goal. But are some bad assumptions behind the posting of calorie counts.

Bad assumption #1: Obesity is caused, in part, by people inadvertently consuming more calories than they thought they were.

Bad assumption #2: Obesity can be treated or avoided by counting calories.

I hope it’s as obvious to you as it is to me why these are bad assumptions, because I’m not going to go into it. But I do want to bring this back to the enjoyment of good food, which is what this blog is supposed to be about, because I have to admit that my knee-jerk response to posting calorie counts has nothing to do with its “effectiveness” per se.

Nutritional information makes food less delicious. Imagine how you would feel if you came to my house for dinner and I served homemade lasagna bolognese. “Enjoy the lasagna,” I say. “The serving on your plate contains 1200 calories, 23 grams of saturated fat, and 1500 grams of sodium.” You would strangle me, because I would have ruined the lasagna for you. It wouldn’t taste good. Right?

My point (other than that you should junk-filter my Evites) is not just that nutrition information is an impediment to hedonistic gluttony. Healthy populations, poor and rich, rural and urban, tend to really enjoy their food. Yes, that is a highly unscientific statement, but several experiments have been done indicating that interfering with subjects’ enjoyment of food in a lab setting actually causes them to absorb fewer nutrients from the food. As the Boston Globe put it:

Britain’s number-one guideline, ahead of admonitions to eat more fiber and less fat, is simply: “Enjoy your food.” Norway, in its own set of guidelines, reminds its citizens that “food and joy equal health,” while Vietnam counsels people to have food “that is delicious…and served with affection.”

(Everything I know about Vietnam and its food suggests that this would be the world’s easiest advice to follow. Britain and Norway might present greater challenges.)

Maybe the King County initiative is really a sneaky way of making chain restaurants less palatable and driving people to local restaurants. That’s almost clever.

So, to sum up my feelings (finally!), I’m an “information wants to be free” kind of guy. I think nutrition information should be made available at the counter for those who ask for it. I think discriminating between chain and non-chain restaurants is unfair. And I think putting calories counts directly on menus is probably bad for customers’ health. (It would be awesome if someone did a version of the Sweden/Thailand experiment where a control group was served lasagna with no nutritional information and the experimental group got the same lasagna with numbers attached.)

I’ll check back in with King County next year and see how the evaluation is going. In the meantime, I will finish my tall cappuccino. Only 90 calories.

P.S.: Big thanks to Matias Valenzuela at Public Health for spending time with me on the phone and email. I would not have been nearly as patient if some guy with a blog called to run his Snickers-related hypotheticals by me.

21 thoughts on “Cal-gone

  1. Katy

    Once, while waiting far too long for my thai tofu burrito at 360 (not my first choice, but convenient), I noticed the nutritional info and discovered that I was about to consume an 876 calorie lunch. Plus chips. I’m not obese, but prefer to stay a healthy weight, and made the decision to choose a less saucy option next time. Portion control on mexican food isn’t so easy for me. Still, I agree that focusing solely on calories isn’t the best approach, and lots of obese people probably have a sense that their fast food isn’t all that healthy. No mystery there. Though I will say, they can pack a lot of calories into those starbucks drinks. That should probably be printed on the cup. In a big font. Or called out when your drink is ready. “945 calorie Gingerbread Frappuccino for Mike?”

  2. mamster Post author

    Katy, where we diverge, I think, is that I don’t think there’s good evidence that choosing lower-calorie lunches has any effect on people’s weight.

    Moving into the realm of the brutally anecdotal now: I eat an afternoon snack every day at about 3pm. The size of my afternoon snack is determined approximately by the size of my lunch. Sometimes when I eat a really big lunch, I don’t have a snack at all. In no case do I say, “You know, I had a big lunch, I should have a smaller snack.” I have a smaller snack because a large lunch plus a large snack would make me physically ill.

    Weight gain is an indication that a regulatory function has gone awry in the body. Using calorie restriction to forestall weight gain is as effective as using it to forestall height gain.

    Anyway, what would be really funny is if this sparked an arms race between fast-food places to see who can produce the highest-calorie menu item.

  3. Anita / Married ...with Dinner

    oh, I love this: “Vietnam counsels people to have food ‘that is delicious…and served with affection.’”

    That’s going to be my 2009 food resolution.

    And I know you were joking, but we have had some seriously fabulous food on our last few trips to England.

  4. Wendy

    So, I think your theories fall down in a couple of places:

    -the Snickers hypothesis only works on the assumption that most people eat when they’re hungry, and that more calories fill people up more. I don’t think either is true for most people. If people get whipped cream on their Starbucks thing every morning and suddenly stop when they see how many calories that adds, it seems unlikely that they’ll be hungrier later in the day, especially if they’re still eating a small amount of fat from another source.

    -I think both of your “bad assumptions” have a lot of truth to them. Most people think they consume fewer calories than they do, which would be one reason why “writing down everything you eat” has shown to be an effective tool in weight loss. And while this makes it sound simpler than it is, I’ve not read any studies that contradict the idea that the way to lose weight is to consume fewer calories than you burn. But now I feel non-hip because it wasn’t obvious to me why these are bad assumptions, and you are more than welcome to shoot down my statements.

    I have a rather strong bias here, because–I’ve been keeping this a secret from you, because I already knew your feelings on calories–I’ve lost thirty pounds over the last four months, basically solely through calorie counting and restriction (since I already have a pretty high level of physical activity).

  5. Jess

    I can only speak from personal experience, but having the nutritional information available to me has actually lost me a few pounds–just not a huge amount.

    For a long time I made a habit of going to a coffee shop ever day and ordering a large [seasonal, sweetened] espresso drink. Then one day I looked at the calorie count on those things–660 calories, and sometimes I’d get them twice!

    I didn’t stop getting coffee, but I switched to lattes and capuccinos, lost about five pounds (which have stayed gone), and re-learned to love the actual coffee in my beverages. There are myriad other ways in which this transition could have been triggered, but for me it was the sobering nutritional data.

    On the other hand, my mother counts calories like CRAZY and claims that’s how she stays thin, but it’s not. She goes on a fast walk for a mile, twice a day.

  6. Susann

    NYC has had the calorie postings in chain restaurants for quite a few months now and, although I don’t know how the postings will affect the general public, I’m personally glad they’re there. They remind me that the “regular” dressing at my favorite salad place adds an extra 300 calories to my meal, and that the snacks at Starbucks are not only mediocre-to-lousy, but are also laden with hundreds of calories that I don’t need and won’t make me happy. I’ve also noticed that when I do walk away from that high-calorie Starbucks snack, my virtuous attitude does last (at least for awhile) and I don’t go for that Snickers from the vending machine.

  7. mamster Post author

    Bill, you are so right.

    Wendy:

    Wendy, before I get started, know that I understand that when I talk about this, I sound exactly like the guy who is sure he has the smoking-gun evidence that the moon landing never happened and 9/11 was an inside job. I feel embarrassed about this, because I hate that guy. Still, it’s probably good for you to share an embarrassing opinion now and then.

    The standard story about diet and weight doesn’t make any sense to me; it doesn’t seem to fit the available evidence. Here are a few problems that come to mind:

    1. It is very difficult for skinny people to intentionally gain weight. If people can blunder into weight gain by accidentally eating too many calories, it should be trivial for people to intentionally gain weight the same way. It’s anything but trivial. Actors talk about how difficult it is (and then how easy it is to lose the weight afterwards), and Ancel Keys (I think) did a famous study in which he recruited thin people and got them to gain weight on a high-calorie diet. The gaining was difficult; the losing was easy.

    2. People who take commonsense approaches to reducing their calorie intake rarely lose weight, and “rarely” is a euphemism for “practically never.” The most obvious example, which I’ve talked about before, is switching from regular to diet soda. According to the standard model of diet and weight, this should work. It should work especially well because, as studies have demonstrated, people radically underestimate how many calories in their drinks, and the body supposedly does the same–i.e., it is said the body doesn’t recognize drinks in the same way as food, so sugary drinks can fool the metabolism. The trouble is, diet soda doesn’t actually work.

    3. People who lose weight through low-calorie diets have to stay on the diet even after they lose weight. In fact, several experiments have demonstrated that people who have lost a lot of weight on a diet have to consume far fewer calories than people of the same weight who were not previously overweight. I’m not arguing that the law of conservation of energy doesn’t apply to humans. The difference is in energy output: obese people on low-calorie diets tend to report lethargy. They also have hormonal and blood sugar profiles comparable to starving people. The body is dying to put those pounds back on. Why?

    4. People tend to get weight in spurts and plateaus, not steadily. This is inconsistent with the “extra calories here and there” hypothesis and consistent with the hypothesis that weight gain is related to metabolic issues.

    Anyway, I should probably do some real work. I know arguing that overeating doesn’t cause overweight is like arguing that falling out a window doesn’t cause broken legs. To me, though, it just doesn’t add up. Now, to jump out this window.

  8. mamster Post author

    P.S.: If you’re wondering whether there are any other topics where I hold bizarre opinions, NEVER GET INVOLVED IN A CONVERSATION WITH ME ABOUT PARKING. This is not a joke.

  9. Wendy

    I agree with some, but not all of what you say; my basic thought is that most of the difficulties and rarities surrounding weight loss are more tied to the difficulties of changing deepset personal habits than to the futility of calorie counting and restriction. (And that’s why my money is on #2, Neutral Public Health Outcome.) Or let me put it this way–I can’t think of any studies I’ve read where people cut calories (actually, and significantly–not just thought they did, and not just a hundred calories per day) and did not lose weight.

    But probably of more interest to you, though completely anecdotal: I’m convinced that the reason I’ve so far been successful in losing weight, never feel unbearably hungry, and have never had any problems with lethargy, despite consuming what many (uninformed) people have told me is a “dangerously low” number of calories, is that I eat Really Good Food. Olive oil, butter, Tillamook cheese, avocado, etc–along with all the organic produce and whole grains and legumes–and no low-fat cheese or diet soda or slim-fast.

  10. mamster Post author

    Wendy, someone who cuts out 100 calories a day should lose about 12 pounds per year. If they don’t, that’s a problem with the underlying theory.

    Again, I don’t see how it’s possible to square the four points I made (any of which certainly may be invalid, especially #2, as you rightly point out) with the theory that “mindless eating” causes weight gain. It just doesn’t make sense. Beyond not making sense, it encourages to look at the issue in terms of “habits” or “willpower,” which is extremely unfair to overweight people (who, in my view, get fat the same way tall people get tall) and overly kind to smug thin people.

    Also, it’s almost always funny to misread “uninformed” as “uniformed,” as I did.

  11. Wendy

    But as you have mentioned, there are definite hormonal/metabolic influences, and my understanding is that it’s easy for the body to compensate for a small change like 100 fewer calories per day. That doesn’t change the idea behind calories in/calories out, just points out that “calories out” is not always within our control. The range of calorie consumption that results in “weight maintenance” (rather than loss or gain) is pretty big.

    I don’t know that I’d use the term “mindless eating” to describe what I’ve talked about above. And I recognize that it’s easier for me to talk about habits and willpower than it is for you, because of our personal situations, even though a lot of people would still get upset over what I say. It was really difficult to get over the idea that I OUGHT to be thin because I eat so much more healthily than–well, pretty much anyone I know. But even though I carry out part of your tall-people-get-tall thing, since I gained weight in the first place because of thyroid disease, I always do come back to the idea of habits and willpower. And I think what we (by “we” I mean, I don’t know, healthcare professionals or the media or something) need to talk about more is how hard it is to change habits, and maybe how unfair it is that some people have a tendency to weight gain and others don’t, not “this isn’t about willpower”. And of course we have to continue avoiding the erroneous idea that overweight people have LESS willpower than thin people, because that isn’t true. It just takes EXTRA willpower to lose weight, or make any kind of significant change–but perhaps especially weight, because of the oft-pointed-out things about food being a necessity and an important part of culture and a coping mechanism for many people.

    But if you think people get fat the same way tall people get tall–isn’t that like saying permanent/significant/purposeful weight loss is impossible? (Um, I don’t mean that confrontationally, or anything, just genuinely curious.)

  12. mamster Post author

    You probably know better than I do what the stats are for long-term weight loss, but I would be surprised if the success rate over five years was better than 5 percent. (It depends how you measure, of course.) “Impossible” is a strong word, but those are pretty terrible odds.

    When I say people get fat the way tall people get tall, perhaps a better comparison would be with a condition like pituitary gigantism. It might be possible to treat pituitary gigantism by putting the patient on a low-calorie diet. Without sufficient calories, you just can’t grow that tall. And people with pituitary gigantism eat a lot.

    But a better solution is to cut out the tumor causing the gigantism. That doesn’t mean I think obesity is caused by tumors. I don’t. But I don’t think it’s caused by eating too much food, either.

    We don’t know the etiology of obesity. I wish everyone in health care would say that over and over.

    As for “willpower,” that makes me want to equate obesity with depression. Some people apparently overcome depression through nothing more than willpower. Prescribing willpower and positive thinking to a patient presenting depression, however, would be malpractice.

    You said yourself that some people have a tendency to gain weight and some don’t. Shouldn’t we be trying to figure out what the difference between these populations is? Of course, this has been investigated already to some extent. Some things we do know: obese people don’t have poorer impulse control than thin people; they don’t have different psychological profiles than thin people on the whole; they do tend to have different populations of gut bacteria (whether this is a cause or effect is unknown).

    You know, I think I get now why this bugs me so much. We have a real medical mystery here: a serious condition that affects millions of people and is on the rise. Instead of trying to figure out what’s causing the problem, though, we want to jump right ahead to the conclusion. That’s a shameful lack of curiosity.

    Thanks for the conversation.

  13. Wendy

    (My last sentence originally read “do you think it’s impossible, or are you just waiting for better science, so you answered even my unspoken question.)

  14. O.C.

    Mamster, your position in this discussion is wonderfully refreshing, coming as it does from a food writer rather than a “health at any size” activist.

    You’re dead on about the research. And nothing that you’re saying contradicts the fact that yes, people can lose some weight by cutting back on calories. But, unless they are naturally thin, it takes great and increasing effort to keep it off.

    You can’t make a naturally thin person fat. You can’t make a naturally fat person thin.

    A dietician’s take on this: http://junkfoodscience.blogspot.com/

    And an entertaining group of cursing Chicagoans’: http://kateharding.net

  15. Ross

    I’m with Mamster on this one. Calories on menus are like warnings on cigarette packs and “Abstinence-only” sex ed: by and large, they don’t cause people to make healthier lifestyle choices, they just make sure that you make your unhealthy choice while feeling a great deal of guilt. Which, of course, will make you feel sad, which is easily fixed by overeating, smoking, and having unprotected sex.

    (That said, it would be totally awesome if we could somehow have a system that put a little asterisk next to menu items whose calorie (or, more importantly for me personally, carbohydrate) count is much higher than you’d think. Seriously, 900 calories for a latte? Really?)

  16. Troy

    Matthew, for every person who eats when they’re hungry, I think there’s one for whom food and eating is a pleasure mostly or almost entirely disconnected from hunger (at least in the US).

    The first category includes you (and I feel fortunate to say, me, so take this comment with a grain of salt). The second category includes folks we’ve all seen regularly and knowingly put down way more than is required to be full, and the stereotypical example of an obese person ordering a mocha after lunch.

    I don’t know where they fall in your hypothesis. My guess is they’re more likely to find something that’s 40% the calories, 80% as good, and still involves eating or drinking something (latte vs. mocha, rice vs. salad, slice of pumpkin bread vs. half a slice of it). A ton of calories are elective, so it’s hard not to see that adding up.

    Also, your #3 inaccurately implies that the lower calorie item is less filling, and for that reason, I don’t think is very common.

    But my guesses may be way off. My point is that your and my (and probably most R&G readers’) interactions with food are different than about half the population, and in ways that aren’t changing anytime soon.

  17. caleb

    I’m noticing that you don’t put the word ‘epidemic’ in your post at all. Remember, fat people are more than jolly – we are at higher risk for heart disease, diabetes, sleep apnea, cancer, you know the drill – and the problem is out of control.

    I think it’s a good idea to base public policy on the available science (that too many calories cause obesity, that too many people have this problem, and that it is killing us) than on our gut feeling about there being more to the story.

    Pun intended.

    Good reading at http://www.cdc.gov/nccdphp/dnpa/obesity/contributing_factors.htm

  18. mamster Post author

    I’m going to give caleb the last word and close comments, because I’m having too much fun researching this, when I should be doing actual work, including finishing a long overdue post about fondue night. (If you prefer to think of it as “mamster can’t handle the truth,” that’s fine too.)

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