Who's Counting: Will Posting Calories Impact Obesity?

Incentives are often touted as the way to create impact on goals for individuals, governments and businesses. The reality is that sometimes they work and sometimes they don't. There are many variables that affect success, but designing incentives correctly is not simple. The US government is concerned about obesity because it directly affects health care costs; the obese require more health care and can not always pay for it. Posting calorie counts in restaurants has been tried - and the data are not encouraging. The effort is to be applauded but the downside is that when ideas like this do not work, they lessen public confidence in all such initiatives, successful or not.

Nicholas Bagley has the story in Slate:

"Next week, the Food and Drug Administration will propose rules requiring chain restaurants nationwide to post calorie counts for the food they sell. When the agency finalizes those rules—which could take a year or more—parents who read a McDonald's menu board will see that a cheeseburger Happy Meal has as many as 700 calories. That's half a 6-year-old's recommended daily allowance.

The hope is that posting calorie counts at chain restaurants—defined broadly to include Taco Bell, Applebee's, and Starbucks—will lead people to order healthier food for themselves and their children. There's a kind of logic to this. Restaurant calories are big contributors to the obesity epidemic. Americans blow nearly half their food budget at restaurants and spend less than half the time cooking at home than they did 50 years ago. If people only knew how many calories were in that Applebee's cheeseburger (930, plus 400 more for the fries), surely they'd order something lighter. This common-sense assumption drives the public health community's full-throated support for posting calorie counts, and explains why, to name one example, the Center for Science in the Public Interest calls the new measure a "huge victory." Even the restaurant industry heaps praise: It "gives consumers one more way to live a healthy lifestyle."

The trouble? Posting calorie counts won't help. We know because New York City has done it. Since 2008, chain restaurants in the city have had to post calorie information. In two studies, researchers at New York University compared the food choices of low-income children and adults from Newark, N.J. (where calories aren't posted) to the food choices of low-income New Yorkers. Although posting calorie counts raised consumer awareness somewhat, the researchers found that the measure had virtually no effect on what the New Yorkers actually purchased. Most distressingly, kids in New York were still eating as many calories as before. A third study looking at New York City and a fourth out of Seattle likewise found that little good came of posting calorie counts.

The ineffectiveness of similar regulations tells the same story. Since the mid-1990s, we've made food manufacturers print nutrition information, including calorie counts, on packaged foods. Time and again, however, studies show that few people notice nutritional information and even fewer use it effectively. As the FDA lamented in a 2004 report, "It may be that consumers do not take advantage of the available information on the food label to control their weight, perhaps because they do not appreciate how the information could be used for weight management purposes or perhaps because they find it too hard to apply the available information to such purposes."

This shouldn't be surprising. People may generally know that they should avoid excess calories, but they don't often know how many are too many. Even if they do, many can't do the math in their heads to tally the day's calories, much less figure out which combination of dishes would stay within the daily limit. Parents who buy food for their children don't typically keep track of the calories their kids ate earlier or will eat later. They may also have more pressing concerns than the calories in their kids' lunches that day. And parents aren't always in the loop. Adolescents often order their own food, and they rarely account for the long-term costs of what they eat.

Posting calorie counts works on the principle that giving people the right information will help them make good decisions. The same instinct motivates all sorts of mandatory disclosure regimes. Just tell people about risky mortgage terms, and they'll borrow more wisely. Just tell patients about pills' side effects, and they'll make better choices about their meds. Just tell arrested suspects about their right to remain silent, and they'll make smarter decisions about what to say to investigators. Yet with few exceptions, these sorts of informational solutions have failed dismally. Inundated by information that they can't understand and don't have time to process, people routinely ignore mandatory disclosures. And they'll ignore calorie counts, too.

Not so fast, supporters counter. Posting calories might marginally affect behavior in certain populations, as a few studies have suggested. Even if there are no direct dietary consequences, fast-food restaurants might think twice before rolling out yet another high-calorie item. Calorie counts could reinforce the importance of a low-calorie diet and have long-term effects we can't yet measure. And maybe people have a right to nutritional information, even if it doesn't much change how they act.

Maybe. But this obscures what we know for sure: Posting calorie counts will at best make a trivial contribution to reducing people's waistlines. After all, the big problem isn't that people are ordering badly at McDonald's (although they are). It's that they're going to McDonald's in the first place. They might eat fewer cheeseburgers, but they're still eating food packed with salt, fat, and calories. For even the most diligent calorie counter, it's tough to order a healthy meal at a fast-food joint.

Consider, too, the tacit assumption of the calorie-count rules: Adults are fat because they are ignorant, and children are fat because their parents are ignorant. Just educate people, the story goes, and they'll stop overeating. But this gets it backward. People today are no more ignorant than they were 50 years ago. What's changed is our food culture, which makes it cheap, easy, appealing, and socially acceptable to consume ever more empty calories. We might wish that people took greater responsibility for keeping their weight in check, and by all means let's invest in public education to boost their capacity to make good choices for themselves and their children. But getting serious about eating less is going to take a lot more than slapping a number on a menu board.

The travesty here isn't just that posting calories counts is so ineffectual. It's that it lulls us into thinking we've done something meaningful about the problem. We haven't. Posting calorie counts won't push people out of chain restaurants and into their kitchens. It won't eliminate the food deserts that make it hard for people to buy healthy food. It won't stop people from guzzling soda packed with high-fructose corn syrup. It won't encourage exercise or reshape neighborhoods to make them more conducive to play. And it certainly won't end the farm subsidies that make it cheaper to buy junk food than real food. Combating obesity requires a mammoth social commitment, the success of which will depend (among other things) on reversing decades-long trends away from home cooking and toward processed foods and restaurant meals. Posting calorie counts just doesn't cut it.

Given the power of the food lobby, it's no wonder the federal government's boldest effort so far to tackle obesity is such a flop. As two prominent critics of these sorts of informational nonsolutions have recently noted, mandated disclosure is "appealing" to regulators. "The law-maker can be seen to have acted. … The people most visibly burdened—the disclosers—rarely dare resist vigorously and prefer disclosure to yet harsher regulation. Easy alternatives are few." But focusing on calorie counts distracts from politically contentious alternatives that could actually help.

When Michelle Obama rolled out her Let's Move! campaign against childhood obesity, the American Beverage Association—a trade group representing Pepsi, Coke, and other peddlers of liquid candy—trumpeted its ostensible support by announcing that its members would add calorie-count labels to the front of cans and bottles to make the information "clearly visible." Yet the association has fought tooth and nail, and spent tens of millions of dollars, to kill any talk of a tax on sugary drinks. The soda companies can afford to post calorie counts because they know it won't hurt sales. They know a soda tax might. It's worth keeping that lesson in mind, and any enthusiasm in check, when FDA proposes its calorie-count rules next week.