'I'd like a myocardial infarction with extra pickles, a side of diabetes and a super-sized colon tumor, to go."
That may not be what Americans are ordering when they pull up to the drive-in window at the local fast-food joint, but it's what an alarming number are getting. Obesity, and the serious health conditions that result, are rising sharply in the U.S., in part because portion sizes and fat content at restaurants are growing as fast as our waistlines.
Food choices are a matter of individual preference and not something the government can or should oversee. On the other hand, society is facing a large and growing burden because of the bad choices made by some, and as Congress looks to increase that burden on taxpayers by reforming the nation's healthcare system, it's also looking to play a bigger role in controlling health costs. The upshot: The food police may soon be coming to an Arby's near you.
Among the many provisions of the sweeping healthcare reform bill being considered by the Senate is a requirement that chains with more than 20 restaurants operating under the same name must post the calorie counts of all their dishes on their menus. A similar law is already on the books in California, where chains must comply by 2011; New York City also has one, and other states and cities will probably follow suit in the absence of federal action.
Though the calorie-count rule is only a tiny part of the healthcare reform proposal, it brings up surprisingly controversial and complex issues -- illustrated by the fact that it has provoked a food fight in the restaurant industry, with the National Restaurant Assn. supporting the provision, while a splinter group of 21 big restaurant chains wants it amended.
What's beyond dispute is that obesity is expensive, and not just for the obese. Last month, the journal Health Affairs published a study showing that the medical costs of obesity have nearly doubled since 1998, to $147 billion last year, about half of which was financed through Medicare and Medicaid. Obesity accounts for 9.1% of national healthcare spending, according to the study, up from 6.5% a decade ago. The costs are rising because Americans are getting fatter. The average citizen is now 23 pounds overweight, according to the Centers for Disease Control and Prevention, and obesity rose by 37% between 1998 and 2006.
We're under no illusions that posting calorie counts on menus is the miracle-diet solution to the country's weight problem. Nobody goes to Taco Bell expecting to get health food; some consumers will pay no more attention to the calorie information than they do to the nutritional labels on packaged foods. Yet those labels do make a difference for many people, and although savvy consumers can already find health statistics on common fast-food menu items by checking websites that track them, the group that is least likely to access this kind of information -- people from low-income and minority communities -- is also the group that's most at risk of obesity. The calorie-count mandate would not only give people information that's vital to protecting their health, it would encourage restaurants to offer low-cal alternatives.
The compliance costs are small. Software is available for as little as $20 that can calculate the calorie tab for meals, based on their ingredients. Chains would have to reprint their menus or add numbers to the menu boards above the counter, but that's hardly a budget-buster. The real worry for the eateries is that if consumers discovered, for example, that a Low-Carb Breakfast Bowl at Carl's Jr. (which sounds like a diet-conscious choice) has a whopping 900 calories, they might not buy it, forcing the company to create new offerings -- and that could indeed turn out to be expensive. To which we respond: tough luck.
The chains also argue that they're being unfairly singled out. There are many companies that would be exempt because their restaurants operate under different names and offer different menus. The L.A.-based Patina Restaurant Group, for example, takes in $200 million a year and operates 60 outlets, but because they're not all called "Patina," it's off the hook. The big chains want the calorie rule to apply to any restaurant company with more than $1 million in annual revenues. That would certainly be more fair, but it wouldn't do a thing for American gastronomy. It might constrain the creativity of chefs at independent restaurants who would be less free to experiment with new recipes (though the rule does state that menus don't have to list calorie counts for daily specials).
Of course, it's possible that the menu rule could be the chairlift leading to a slippery slope. We live in a time of increasing awareness not only of food's impact on our health but its costs to society. In the near future, regulators might become as tough on junk food as they are on tobacco. A tax on sugary soft drinks -- an idea backed by the CDC's new chief, Dr. Thomas R. Frieden -- is getting serious consideration in the Senate as Democrats look for a way to pay for their proposed healthcare overhaul. Key lawmakers in California have discussed taxing snack foods to fund programs and services. And more ambitious labeling requirements may be on tap for restaurant menus, which might someday be required to list not just calories but saturated fat, sodium or other health threats.
Yet all reform has to start somewhere. It's counterproductive to avoid action because of fears that it will lead to scarier actions later; the time to stop is when regulations become overly burdensome on businesses and overly restrictive of consumer choice. The calorie-count rule is neither, and it would also avert a patchwork of labeling laws in states such as California and New York by setting a national standard for all chains. As a bonus, it may be the only piece of legislation in 2009 with a strong chance to make Americans look better in their swimsuits.