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ACSM'S Health & Fitness Journal:
doi: 10.1249/FIT.0b013e3181d9f468
DEPARTMENTS: You Asked For It: Question Authority

You Asked for It: Question Authority

Nieman, David C. Dr.P.H., FACSM

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David C. Nieman, Dr.P.H., FACSM, is professor and director of the Human Performance Laboratory, Appalachian State University, in Boone, North Carolina; an active researcher; and author of several textbooks on health and fitness. Email your questions to niemandc@appstate.edu.

Q:Could you comment on the "calorie rule" that New York City is imposing on restaurants? Will this effort really work to stem obesity?

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A:Your question pertains to a measure introduced in 2007 by the Bloomberg administration of New York City to force chain restaurants to display calorie information on their menus. Enforcement began in 2008, and a federal appellate court in 2009 rejected a challenge by the New York State Restaurant Association. "This is good news for everyone," said Dr. Thomas R. Frieden, the city's health commissioner. "Nearly all chain restaurants are now complying with the law. Consumers are learning more about the food before they order, and the market for healthier alternatives is growing. We applaud the court for its decision, and we thank the restaurant industry for living by the rules."

The calorie rule is an interesting public health strategy to counter the growing waistlines of New Yorkers. Mayor Michael R. Bloomberg has earned health points for other reforms in New York City, including bans on smoking in public places and on trans fats in restaurant cooking.

Although many chains including McDonald's, Burger King, and Starbucks provide calorie information on their Web sites, posters, and tray liners, most people (97% according to one survey) do not see this information before making decisions about what to order.

Caloric awareness is an important concept in achieving success in weight loss and management. Nationwide, only one in five overweight and obese individuals is able to lose 10% of body weight and keep it off for at least one year (3,5). Researchers at the University of Pittsburgh and University of Colorado have formed a national weight registry of people who have lost more than 30 lbs and kept it off for more than a year (1-6) (www.nwcr.ws). More than 5,000 people are being followed in this registry, and findings discovered thus far on the habits of these successful weight losers include:

▸ 98% of registry participants report that they modified their food intake in some way to lose weight

▸ 94% increased their physical activity, with the most frequently reported form of activity being walking

▸ Registry members keep the weight off using a variety of methods. Most report a lifestyle based on low-calorie low-fat diets, avoidance of fast foods, high levels of physical activity, and maintenance of a consistent eating pattern even during weekends and holidays.

* 78% eat breakfast every day

* 75% weigh themselves at least once a week

* 62% watch less than 10 hours of TV per week

* 90% exercise, on average, about one hour per day

In other words, there is no magic in losing weight and keeping it off. The essential equation for success is carefully balancing the energy ingested against energy burned and not letting life events disrupt the balance. The calorie information on restaurant menus is one among many strategies to improve our ability to achieve energy balance.

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Many are not aware of how many calories they need in a given day and how easy it is to exceed this level. This table from the U.S. Department of Agriculture Center for Nutrition Policy and Promotion (http://www.cnpp.usda.gov/) shows that recommended daily calorie needs vary widely depending on sex, age, and physical activity levels (e.g., 1,800 for a sedentary teenaged girl to 3,200 for a physically active teenaged boy).

A typical McDonald's lunch of a Big Mac, large fries, and a medium Coke has about 1,320 calories or two thirds of the daily calorie needs of a sedentary young adult woman. A Burger King triple Whopper with cheese has 1,230 calories or 56% of the calories needed by a sedentary teenaged boy (and I did not mention the 82 g of fat or the 1,590 mg of sodium). Add a large serving of french fries (500 calories), a medium chocolate milk shake (500 calories), and a medium Coca Cola beverage (230 calories), and the Burger King meal total (2,460) now exceeds what is recommended for all sedentary males regardless of age.

The New York City calorie rule is a good start, but so much more is needed to create a society that makes it easier to avoid obesity. Portion control both in restaurants and at home, a greater variety of healthy low-fat foods, more bike trails and walking paths, release time for fitness pursuits at work, daily physical education classes at school…well, I could go on and on. What is happening in New York City is interesting. Instead of waiting for the federal government to legislate practices that lead to good health and fitness, Bloomberg and his staff are pushing their own reforms. The same can happen in many other communities across America.

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References

1. Butryn ML, Phelan S, Hill JO, Wing RR. Consistent self-monitoring of weight: a key component of successful weight loss maintenance. Obesity (Silver Spring, Md). 2007;15(12):3091-6.

2. Catenacci VA, Ogden LG, Stuht J, et al. Physical activity patterns in the National Weight Control Registry. Obesity (Silver Spring, Md). 2008;16(1):153-61.

3. Phelan S, Wyatt HR, Hill JO, Wing RR. Are the eating and exercise habits of successful weight losers changing? Obesity (Silver Spring, Md). 2006;14(4):710-6.

4. Raynor DA, Phelan S, Hill JO, Wing RR. Television viewing and long-term weight maintenance: results from the National Weight Control Registry. Obesity (Silver Spring, Md). 2006;14(10):1816-24.

5. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-41.

6. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1 Suppl):222S-25S.

© 2010 American College of Sports Medicine

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