Fast Food Restaurants Getting Healthier

One of the reasons I’m often critical of government policies that attempt to force healthy eating on the public (say through ingredient bans or fat taxes) is that I have a different view of “Big Food” than many foodies.  Big Food is often portrayed as powerful, nefarious entity preying on helpless consumers.  I’m more apt to seeing fast food restaurants as responding to consumer demand for convenient, inexpensive, quick food.  They offer burgers and fries because this is what consumers are willing to pay for. 

However much we may want McDonald’s et al. to offer healthier alternatives, at the end of the day they must make enough money to stay afloat.  If more salads are offered than consumers want or are willing to buy, that’s a recipe for disaster.  As one organic farmer put it: the first rule of sustainability is that you have to make enough money this year to do it all over again next year.  I have little doubt that the McDonalds of the world would offer a lot more salads if they thought they could make money doing it. 

Against this backdrop, I noticed a recent study by the Hudson Institute that examined the offerings of fast-food restaurants over the past five years (it was covered by the WSJ here).  Here’s what the study found:

“between 2006 and 2011, lower-calorie foods and beverages were the growth engine for the restaurants studied. In 17 of the 21 restaurant chains evaluated, lower-calorie foods and beverages outperformed those that were not lower-calorie. In addition, chains that increased their servings of lower-calorie items saw positive returns as a result. These chains generated:

• a 5.5 percent increase in same-store sales, compared with a 5.5 percent decline among chains selling fewer lower-calorie servings;
• a 10.9 percent growth in customer traffic, compared with a 14.7 percent decline; and
• an 8.9 percent increase in total food and beverage servings, compared with a 16.3 percent decrease.”

The lesson is that you don’t always need government regulation.  The market will deliver healthy foods when the public decides that’s what they want.

The Economics and Politics of Obesity

That was the title of a talk I gave last week at the University of Alabama-Birmingham in the seminar series run by the Nutrition Obesity Research Center.  I talked about emerging trends associated with obesity (some of which defy popular narratives), the government's role in "combating" obesity, reasons why I find justifications for government action in this area less compelling than many public health professionals, evidence from empirical research on effectiveness of policies designed to "fix" the obesity problem, and finally I concluded with my thoughts on what caused the rise in obesity and what "we" should do about it.  

If you'd like to watch my talk (which runs about 50 minutes), click here.  

Obesity Myths

Last week, I gave a talk at the Nutrition Obesity Research Center at the University of Alabama-Birmingham.  It turns out that several of the folks I met with published an article in the New England Journal of Medicine a day after my talk entitled, "Myths, Presumptions, and Facts about Obesity."  Here is an expert from the coverage at New York Times, in interviews with the team leader, David Allison:

His first thought was that, of course, weighing oneself daily helped control weight. He checked for the conclusive studies he knew must exist. They did not.

“My goodness, after 50-plus years of studying obesity in earnest and all the public wringing of hands, why don’t we know this answer?” Dr. Allison asked. “What’s striking is how easy it would be to check. Take a couple of thousand people and randomly assign them to weigh themselves every day or not.”

Yet it has not been done.

Instead, people often rely on weak studies that get repeated ad infinitum. It is commonly thought, for example, that people who eat breakfast are thinner. But that notion is based on studies of people who happened to eat breakfast. Researchers then asked if they were fatter or thinner than people who happened not to eat breakfast — and found an association between eating breakfast and being thinner. But such studies can be misleading because the two groups might be different in other ways that cause the breakfast eaters to be thinner. But no one has randomly assigned people to eat breakfast or not, which could cinch the argument.

As their study shows, there are no easy "quick fixes" to the state of obesity in America.

Is Fast Food Making Us Fat?

Eating fast food might have been one of the myriad factors affecting people's weight over the past 40 years.  But, according to this new study in the American Journal of Preventive Medicine, the calorie content of fast food hasn't appreciably changed in 12 to 13 years.  From the abstract:

Spanning 1997–1998 and 2009–2010, the number of lunch/dinner menu items offered by the restaurants in the study increased by 53%. Across all menu items, the median energy content remained relatively stable over the study period. Examining specific food categories, the median energy content of desserts and condiments increased, the energy content of side items decreased, and energy content of entrées and drinks remained level.

Conclusions

Although large increases in the number of menu items were observed, there have been few changes in the energy content of menu offerings at the leading fast-food chain restaurants examined in this study.

Stigmatize the Obese - Even More?

File this one under candidates for Worse Ideas, Ever.  

A so-called bioethics leader, Daniel Callahan, has written an article, that according one source,  argues that 

the public health community can learn from one of the most successful public health campaigns: the anti-smoking campaign. A primary strategy has been to stigmatize smokers, he says, making it clear that their behavior is not only unhealthy for them but is also socially unacceptable. While the public health community has decisively rejected the stigmatization of obesity, Callahan directly challenges that rejection.

In original report, which you can find here, the author proposes "stigmatization lite" to exert social pressure on people by asking overweight folks question like:

If you are overweight or obese, are you pleased with the way you look?

Are you happy that your added weight has made many ordinary activities, such as walking up a long fight of stairs, harder?

Would you prefer to lessen your risk of heart disease and diabetes?

Are you aware that, once you gain a signifcant amount of weight, your chances of taking that weight back off and keeping it off are poor?

Are you pleased when your obese children are called “fatty” or otherwise teased at school?

Fair or not, do you know that many people look down upon those excessively overweight or obese, often in fact discriminating against them and making fun of them or calling them lazy and lacking in self-control?

What I don't follow is that the author fully acknowledges that the overweight are already stigmatized.  Not only to the extremely obese earn lower wages, spend more on health care, and die sooner than normal weight folk, I have yet to see the supermarket tabloids do anything but make fun of even the skinniest celebrity who has put on a few pounds.  Does anyone doubt the clear message our culture sends? Thin is cool, fat is not.  

I don't doubt that a bit more cultural shame (or stigmatization lite) might result in a few pounds being lost.  But, at what cost?  How many pounds would someone need to lose for it to be ethically justifiable to make them feel bad about themselves?  Moreover, why do I have any interest in making someone else feel bad about themselves?    And, as already mentioned, there are already many costs to being obese - why add insult to injury with even more social shame?

What one weights is a complex result of factors related to personal decisions, preferences, technology, genetics, and environmental factors like food prices and availability.  I suspect there are many obese individuals who would say they'd like to weight less, but that's just talk.  I'd like to drive a Porsche.  I don't drive one (and the obese don't weigh less) because life involves constraints and a series of difficult tradeoffs.  So, what's the use in telling me that I'm a loser because I haven't chosen to allocate my salary toward a 911 Carrera Cabriolet?   Perhaps I just need to apply some stigmatization lite to this problem: 

If you drive a Chevy, are you pleased with the way you look in your car?

Are you happy that owning a Chevy has made many ordinary activities, such as driving to work or washing the car in the drive, uncool?

Would you prefer to drive zero to 60 in under four seconds?

Are you aware that, once you buy a Chevy, your chances of every getting a Porsche are poor?