Wednesday, June 17, 2009

Dietitians of Canada opposed to calories on menus?

Calories on menus.

I would have thought it's pretty much a no-brainer for any one who cared about nutrition and heath. I mean who could possibly have a problem with providing consumers with information that might help them make better dietary decisions? The information isn't meant to be judgemental. It's not meant to teach people that calories are bad any more than price tags are meant to teach people that dollars are bad. It's just there to help allow consumers to actually make informed choices.

So who's come out vocally in favour of calorie labeling?

The list grows daily and among many others includes:

  • American Association of Retired Persons
  • American Cancer Society
  • American Diabetes Association
  • American Dietetic Association
  • American Heart Association
  • American Medical Association
  • American Public Health Association
  • Canadian Obesity Network
  • Canadian Society for Exercise Physiology
  • Canadian Teachers' Federation
  • Canadian Women's Health Network
  • Centre for Science in the Public Interest
  • Heart and Stroke Foundation
  • Institute of Medicine
  • National Eating Disorder Information Centre
  • Newfoundland and Labrador Medical Association
  • Ontario Medical Association
  • Ontario Society of Nutrition Professionals in Public
  • Rudd Center for Food Policy and Obesity
  • Society for Nutrition Education
  • United States Food and Drug Administration's Obesity Working group
  • World Health Organization

  • So who else wants calories on menus?

    The public. Polls have consistently placed public support of mandatory calories posting on menus at around 80%.

    Who else?

    The food industry. Recently in the United States the National Restaurant Association has joined hands with lawmakers to support the passing of a federal bill that would mandate chain restaurants post menu board calories in every single chain restaurant across their country.

    So who doesn't want calories on menus?

    The Dietitians of Canada.

    Yup, that's right, the Dietitians of Canada upon review of Ontario's Bill 156, a bill designed to force chain restaurants in Canada to publish calories on menu boards, decided to send out an email to its members to ask their opinions. You might be thinking that clearly here I'm out to lunch, that there's nothing wrong with DC gathering members' opinions, and you'd be right, assuming that the email simply asked for opinions. But the email didn't simply do that though. No, instead the email primed members' opinions by stating that DC was "concerned" regarding providing Canadians with information about the single most important nutritional determinant of food - calories,
    "To: DC Members

    Posting of caloric information on menu boards or through a tag attached to individual food items is being proposed through a bill introduced in the Ontario legislature by Frances Gelinas, MPP and NDP Critic for Health. The proposed bill would apply to foodservice operations with annual revenues greater than $5 million, and non-compliance would be fined. The bill also proposes limits on artificial trans fats.

    Dietitians of Canada is concerned that there is limited evidence to support a move to posting energy content of foods on restaurant menu boards as a means of influencing consumers to make positive changes in their food selection at this point of purchase. We are interested in identifying your views on this issue as well as identifying relevant evidence to support your views.

    Your input will help shape the DC response to this issue. Please take a few moments to complete this brief survey.

    The survey should take no more than 5 - 10 minutes to complete. Your response by April 17 is appreciated.

    Thank you
    Posted by
    Linda Dietrich, Regional Executive Director Central and Southern Ontario"
    So just to put this in perspective - nutrition advocacy and professional organizations (including the American Dietetic Association - the DC's American counterpart) support mandatory menu labeling, medical organizations support mandatory menu labeling, non-profit health groups support mandatory menu labeling, the public supports menu labeling, even Big Food supports mandatory menu labeling and the Dietitians of Canada have concerns?

    What could they possibly be concerned about? They talk of a lack of evidence, but yet there's ample evidence that menu board calories are both an important need and a great idea. But really, even if there wasn't yet ample evidence, what possible reason could DC have to deny Canadians the ability to make more thoughtful dietary decisions by ensuring restaurants provide them with more information? Does DC feel that the calorie section on nutrition facts panels should be removed as well?

    Dietitians out there? Do you have any thoughts as to what the Dietitians of Canada might be afraid of and why they seem to be having more difficulty assessing the evidence base than even the food industry?

    [If you want your voices heard and you didn't happen to notice the email above, feel free to write to Linda Dietrich and let her know how you feel about the need for menu board labeling by clicking here.]

    UPDATE: Thanks to RD who in the comments posted the results of the incredibly skewed survey (meaning if you prime your members by telling them the organization "has concerns" go figure people aren't going to support the concern in question).

    So unbelievably only 47% of Canadian dietitians who participated in the survey felt that posting calorie information on menus is an effective means of public education and modifying food choices.

    Even more unbelievably only 71% of Canadian dietitians who participated in the survey felt that trans-fats should be banned.

    If I were a Canadian dietitian, I'd be absolutely mortified.

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    1. DC's "argument" against posting calories doesn't make much sense to me.

      Let's assume for the sake of argument that DC is right - the evidence doesn't support the proposition that posting calories affects consumer choices. Well, so what? DC is not being asked to make any sort of financial investment in the implementation of this scheme. This is something that is supported by the restaurant industry. If they have no problem expending the funds to post calories, why should DC take issue with it?

      Secondly, why would there need to be strong evidence in support of this project before it could be implemented? We are not talking about implementing something that has the potential to harm consumers. Thus, even if there is a lack of evidence now, why not view this bill as a test phase to gather the needed evidence to support or deny the hypothesis that calories influence consumer choices for the better?

      Lastly, and maybe most importantly, even if posted calories only influences a small portion of consumers, isn't that enough? Granted, governments don't usually make policy decisions based on benefiting a few members of the population. But DC, supposedly being concerned with the health of Canadians, should be supporting changes even if they benefit only small percentage of the population.

    2. Yoni, here are some results of that poll to dietitians. Some of the concerns I have heard include factors such as nutrition being excluded by just looking at calories (ie. diet pop vs milk), the possibility of promoting eating disorders, and the food companies have put out some concerns that need to still be worked through. Personally I fall in the portion of RD that supports posting calories.

      From survey:
      Calorie Posting
      Almost half (47%) of respondents agree that posting calorie information on menus is an effective means of public education and modifying food choices, while 23% do not agree, and 30% are not sure.
      Trans Fat
      71% of respondents agree with the statement that a mandatory trans fat ban or restriction is needed, while 11% disagree and 18% are not sure.
      DC Direction
      DC is fully supportive of initiatives that provide consumers with nutrition information to assist them to make healthy food choices. This includes the energy value of food, within the context of other nutrients.
      DC will advocate for further research to establish evidence of effectiveness of different types of nutrition information at point of purchase and monitor evaluations in other jurisdictions such as New York

      DC will Advocate to provincial governments to work with the foodservice industry and health professionals to implement and evaluate pilot projects to establish effective policy direction

    3. Anonymous12:03 pm

      I also am a RD supporting the posting of calories and was shocked when I received that email from DC. I don't see any concerns about posting nutrition facts at restaurants. Nutrition facts are available on (almost) all the food found at the grocery store and I don't see how having this information available at restaurants would be any different. The public is entitled to know and it could make the life of people with diabetes and other conditions that simpler.

    4. Anonymous1:32 pm

      My husband is one of those that doesn't want labeling on menus. He eats well most of the time and makes smart choices, but when we go out for dinner, he wants to be able to enjoy a treat without feeling guilty that it's a calorie bomb.

      I say if the information will make him think twice about his decision to eat that food, then that's information he needs to have access to.

      My right to that information shouldn't be refused so that someone else can mindlessly overeat with a clear conscience.

      I would support a format that doesn't force the information on those that don't want to see it though. I don't see any problem with putting the nutritional information for all menu items on the last page of menu, leaving the original menu design intact. Then the info is there for those that wish to know it, and if you just avoid that page, you can stay in blissful ignorance.

    5. This comment has been removed by the author.

    6. I was recently at a Burger King in the US and I wasn't sure what to order as I now watch my calories and more. Off to the side, there was a big bulletin board (I would say 3ft x 4 ft?) with every menu item and all the nutritional info. For me, it was wonderful to have that information available and I was glad to see my choice was a decent one considering the other selection I had been pondering. No one else looked at it - it was discretely posted but for me, who wanted to get this information, it was readily at hand and easy to read/access.

      For the life of me, I can't see why the DC wouldn't want this posted anywhere. Do they think they'll be responsible for policing it? Otherwise, what's the harm? Education - it's a wonderful thing folks.

    7. I don't think it's possible for many dieticians to be mortified. I have heard more crackpot theories from dieticians than from any other health professional -- except perhaps chiropractors.

      They have an inflated sense of their own expertise that is sadly lacking in reality.

    8. Ha...I think this just adds further proof to my theory that Dieticians are the absolute last people you want to consult about food or health.

    9. Anonymous2:13 pm

      Today, I am sad to be a member of Dietitians of Canada! I sincerely hope that DC will come to their senses and realize that they were wrong. But, saying that, it's already too late! The public will already have a distorted view of ALL dietitians, even the ones that agreed with the calorie labeling.

    10. I am a dietitian who supports posting calorie content on menu boards. The consumer will become more aware of the absurdly high calorie content of some of the food AND drinks they consume on a regular basis at QSRs, and research has shown that consumers take in 52 less calories when they are provided with calorie information.

      I have heard some dietitians voice concern that this could place an exaggerated emphasis on calories to the point of sacrificing nutritional quality. I on the other hand think this would be a step in fighting the public health problem of obesity. I also hope that menu labeling will encourage the food industry to reformulate their products to present the consumer with healthier food items.

      This may not be the perfect solution, but as John Henry Newman stated, "A man would do nothing if he waited until he could do it so well that no one could find fault."

    11. I hate to burst your bubble, Dr. Freedhoff, but the National Restaurant Association in the US is for anything BUT menu board calorie labeling. They supported that particular legislation because it doesn't mandate labels on menu boards...just somewhere "accessible." As your colleague Marion Nestle pointed out, that leaves a whole lot of room for not-menu-board labeling.

    12. Yes Susan, the LEAN bill which I also blogged about in March didn't insist the calories be posted on menus.

      The compromise bill, reached last week does.

      Click the link I provided and feel free to read for yourself.

      No bubbles burst here.

    13. Anonymous1:48 pm

      I am also a dietitian.
      Simply posting the caloric value of menu items is not sufficient or useful for the average person. Information on sodium, saturated fat, trans fat, and fibre would be more beneficial. However, most people know nothing about nutrition or what these numbers mean... or even how many calories they should be having in a day.

      Also- "Jack at Fork and Bottle" and "BC cook"- I would be interested in knowing what your basing your opinions on... They are slightly harsh wouldn't you say?

    14. Anonymous10:59 am

      Isn't "hiding" the caloric content at the back of the menu on another page kind of like sticking your head in the sand?
      It's OK to indulge once in a while, but I certainly would prefer to indulge knowingly not deceitfully. This is not about guilt.
      This is like some "keep 'em fat" conspiracy.
      (I lost 60 pounds in 10 months and I'd LOVE to see the calories on any and every menu).