Feeding Frenzy
Is foodservice a scapegoat or a key to the solution in the fight against obesity?

By Allison Perlik, Senior Editor

Begin with the outcries of litigious lawyers and regulatory-happy legislators, add the conflicting voices of nutritionists and health officials and top it off with a healthy chorus of media coverage. The resulting cacophony of controversy over obesity is enough to make any foodservice operators ears ring.

No one disputes that the prevalence of obesity among Americans is growing at an alarming rate. More than 44 million Americans are considered to be obese and at risk for a host of serious health consequences, says the Atlanta-based U.S. Centers for Disease Control and Prevention (CDC). Healthcare for overweight and obese individuals costs an average 37% more than for people of normal weight, says the CDC, and adds an average of $732 to the annual medical bills for every American.

Given the severity of the growing public health crisis and the increasing burden for taxpayers, concerned parties from a variety of sectors are weighing in with possible solutions. As those involved seek to pinpoint the causes of this epidemic, an increasingly volatile national debate has arisen around one question: What responsibility, if any, do the nations foodservice operations have in addressing this problem?

On one side, some legislators, nutritionists, lawyers and public health officials contend that high-calorie entrées, super-sized portions, aggressive marketing by restaurants and many school districts financial dependence on sales of soft drinks and high-calorie snacks not only support but also encourage consumers unhealthy lifestyles. They argue that the foodservice industry has a duty to help protect customers from their own cravings and make them more aware of the health implications of the food they eat.

Foodservice, joined by its own supporters in the legal and healthcare communities, counters that it operates in the manner of any business, shaping offerings around what the marketplace demands. Emphasizing individual accountability, industry members point out that their wide variety of food choices lets customers make their own decisions on whether and when to indulge.

Amid a clutter of opinions that aim to further agendas on both sides, the truth can become somewhat murky for operators searching for the right responses. In the following pages, Restaurants and Institutions breaks down the hot topics surrounding the obesity question and sheds light on all sides of this weighty issue.

Talking Points
As the debate regarding restaurants responsibility for the obesity problem plays out, several themes have emerged on both sides of the argument. Below, nutritionists, public health officials and others weigh in on these oft-mentioned questions and issues.

1. Meals eaten or prepared away from home are a growing part of the American diet. Is this part of the problem?

USDA research shows that the percentage of meals eaten away from home rose from 16% in 1977-78 to 29% in 1995. That same year, food away from home provided 35% of total calories and 38% of total fat intake, suggesting that consumers either ate more food or items higher in fat and calories on those occasions.

Americans are eating a larger percentage of meals outside the home each year, so restaurants are a growing part of the problem, says Anthony Robbins, professor of family medicine and community health at Tufts University and board chairman of the Public Health Advocacy Institute in Boston. While acknowledging that the problem goes beyond restaurants alone, Robbins believes operators must play a role in bringing about a cultural change that leads Americans to eat better and eat less.

On the other side, U.S. Surgeon Generals office spokesman Craig Stevens points out that even if the average person eats out four times a week, that still leaves 17 meals they are eating at home and preparing themselves. Beyond that, it is still the individuals decision where to go to eat and what to eat while they are there, he says. Over the next year, Stevens says, Surgeon General Richard Carmona will target the obesity issue by promoting health literacy among food providers and consumers through education and dialogue.

2. If consumers cannot stop themselves from eating too much of the wrong types of foods, is it up to restaurants to do it for them?

The [foodservice] industry is irresponsible and contributing to this obesity epidemic. This is not a minor factor, says Judith Stern, professor of nutrition and internal medicine at the University of California at Davis and vice president of the American Obesity Association, a Washington, D.C.-based advocacy and education group. While many dining-out options can be part of a healthy diet, Stern believes, indulgences like double cheeseburgers and super-large soft drinks cannot. It isnt just personal responsibility, she says.

Jeanne Goldberg, professor of nutrition with Tufts Friedman School of Nutrition Science and Policy and director of the Center on Nutrition Communication, says that while obesity is indeed a significant problem, at the end of the day Im a great believer that individuals have to be their own keepers. [Foodservice operators] need to figure out their own solutions, and it will depend on the restaurant. Like many, Goldberg suggests offering smaller portion options and healthy choices. People dont want to be hit between the eyes with the diet plate, but you can put things on the menu that look, sound and taste good for people who quietly want to make a healthier selection, she says.

3. How much of a factor are restaurant portion sizes?

Regardless of views on who is most to blame, contributors to the obesity discussion agree on one thing: Restaurant portions often are far larger than generally recommended servings.

Portion size is a major issue at restaurants. Most people are overweight because they have too many calories, no matter where theyre coming from, says John Erdman, who chairs nutrition research at the University of Illinois at Urbana-Champaign and also chairs the Washington, D.C.-based Institute of Medicines committee on dietary reference intakes (DRI), which set daily requirements for essential nutrients.

Public health expert Elizabeth Whelan, president of the New York-based American Council on Science & Health, says she is astonished at todays portion sizes. I barely get through 25% of what is served to me at most restaurants, she says, but the fact that they give me these portions doesnt influence my decision of how much to eat.

Rather than focusing on foodservice, Whelan says consumers need to better understand their own nutritional needs and the caloric content of food. She also believes pharmaceutical options that could help burn calories more efficiently or control appetite and food technology such as fat and sugar substitutes can be part of the solution.

4. Does the glut of news about health trends and advice confuse consumers about what it means to eat right?

In 1995 the Institute of Medicine shifted to the DRI system from the previous recommended dietary allowances (RDA) program, mainly to better address more contemporary issues and employ the wide expansion of scientific knowledge. Another factor in the changes, Erdman says, was that many people were using RDAs in applications for which they were not designed, such as weight loss. They were really meant more for health professionals to give them guidance, not directly for the public, he says. For consumers confused about the myriad diet options available to them, he offers this advice: If something sounds too good to be true, then it is.

Despite the current emphasis on low-carbohydrate and other similarly themed diets, the USDAs dietary guidelines still emphasize the traditional food guide pyramid. Tufts Goldberg notes that while the guidelines have changed somewhat over the past two decades, most Americans still have a good understanding about how they should be eating. What happens is nutrition has become a really hot topic, and every time a new study comes out ... it gets widely reported and the public says, Theyre changing their minds again. Thats really not true, she says. People need to give themselves credit for what they already know and be sensible.

5. Would better access to nutritional information help consumers make more healthful decisions?

At press time, six bills had been proposed in five states that would require nutritional information to be listed on menus or menu boards at certain types of restaurants. Many restaurants offer such information in pamphlets or online, but operators are concerned about the logistics of bringing such details onto menus, citing such issues as customization of dishes and ever-changing menu specials.

Like many in the nutrition and healthcare community, Harold Goldstein, executive director of the California Center for Public Health Advocacy in Davis, Calif., believes simply making calorie counts available on menus and menu boards would be a step in the right direction.

I certainly wouldnt recommend every restaurant become a health food restaurants, but I think every restaurant should offer some healthy options and has a responsibility to let consumers know whats in their products, he says.

Slimming Down and Flying Right
If actions speak louder than words and truth is the greatest defense, many restaurants are taking the right tactic in being proactive about obesity. Chains across America now are publicizing their wide-ranging efforts in this arena, which include more-healthful menu introductions, partnerships with fitness programs and nutrition education efforts.

Compared to 20 years ago, many restaurants today are offering some very good food choices, says Mary Kay Sones, health communications specialist with the U.S. Centers for Disease Control and Prevention in Atlanta. Restaurants are trying to be part of the effort.

Consider the following examples:

ALLIED DOMECQ QUICK SERVICE RESTAURANTS, RANDOLPH, MASS.: Exploring ideas including more fruit drinks and low-fat options at Baskin-Robbins and low-fat baked goods and sandwiches using fat- and cholesterol-free egg alternatives at Dunkin Donuts.

APPLEBEES NEIGHBORHOOD GRILL & BAR, OVERLAND PARK, KAN.: Developing co-branded, dedicated menu section with Weight Watchers that will feature seven to 10 lower- fat and calorie choices and include Weight Watchers points designations.

AU BON PAIN, BOSTON: Installed touch-screen kiosks in stores that allow customers to access extensive nutritional information on site, including details on individual sandwich fillings, dressings and breads.

CAMILLES SIDEWALK CAFÉ, TULSA, OKLA.: Offering low-carbohydrate wraps including the chicken Caesar (7grams carbohydrates), Tex Mex Club (8 grams) and quesadilla (9 grams).
McDONALDS, OAK BROOK, ILL.: Multiple efforts including:

• Forming a Global Advisory Council on Healthy Lifestyles to handle efforts including menu choices, physical activity programs and health education
• Partnering with well-known author and personal trainer Bob Greene to educate public on living a healthy, active lifestyle
• Offering items in certain markets such as veggie burgers, chicken wraps and bagged fruit (above) as an option for Happy Meals.

RUBY TUESDAY, MARYVILLE, TENN.: Testing three initiatives: offering low-carb menu choices with chicken, fish or beef; switching to lower-fat, cholesterol-free canola oil for frying; and introducing new items that will be denoted by menu icons as being lower in fat, calories or carbohydrates.

7-ELEVEN, Dallas: Introduced a calorie-free, diet-cola-flavored Slurpee as an alternative to sugary drinks.

TACO BELL, IRVINE, CALIF.: Introduced Fresco Style salsa topping instead of higher-fat cheese and sauces.

WENDYS, DUBLIN, OHIO: Promoting meal combinations with fewer than 10 grams of fat in five test markets (choices include such items as grilled chicken sandwiches, chili, baked potatoes, junior hamburgers and side salads); placing statements on carryout bags and menu board strips announcing availability of nutritional information.

Something To Prove
While none of the handful of restaurant-aimed obesity lawsuits filed to date has found success in the courts, these high-profile cases are among the most talked about and most serious actions against restaurateurs. The legal community holds varying viewpoints regarding these lawsuits potential for success as well as exactly what prosecutors would have to prove to make their cases.

As a matter of tort law doctrine, the basic standard is whether the defendants product was a substantial factor in bringing about the bad outcome. Would they have an argument to support that? Maybe, says Richard Nagareda, a law professor specializing in class actions and litigation at Vanderbilt Law School in Nashville, Tenn.

Prosecutors face two main obstacles with such suits, Nagareda says. First, they must convince the foodservice industry that the lawsuits pose a credible threat, making defendants more likely to settle. Second, they must convince jurors to reject the argument of personal responsibility.

To accomplish these goals, lawyers are not focusing solely on the sales of allegedly harmful products but instead charging restaurant companies with providing incomplete or misleading nutritional information and using unfair and deceptive marketing practices, specifically those targeting children.

The foodservice industrys response has been fairly uniform. It has frequently condemned the lawsuits as baseless and has supported broad-based legislative efforts to prevent such actions in the future (see The Tobacco Link: Strong Enough?; p. XX). In many cases, operators also are introducing more options for consumers to make more healthful choices if they so choose (see Slimming Down and Flying Right, p. XX).

Gerald Thain, a consumer law professor at the University of Wisconsin Law School in Madison, who has studied the impact of litigation on tobacco control, says the restaurant industrys public relations strategy just may work with juries.

The question is, are people really that uninformed? The response of the people bringing these cases will be that there is a difference between having a general perception and knowing more specific detail [about the health consequences of fast food], he says.

Given that restaurants are far from the only providers of Americans meals, many restaurateurs wonder why lawyers are targeting their industry rather than food manufacturers or distributors. Eric Feldman, who specializes in public health law as an assistant professor at the University of Pennsylvania Law School in Philadelphia, says three factors likely came into play in choosing defendants: company size, assets and name recognition. It is a lot more newsworthy when you sue McDonalds, Burger King and Wendys than when you sue the maker of mini-donuts that nobodys ever heard of, he says.

Foodservice companies could benefit from viewing the lawsuits as an opportunity rather than a threat, Feldman says. [If I were them], I wouldnt be panicking about being put out of business or being forced into a multibillion-dollar settlement ... but I would be concerned enough to take a few steps to decrease the possibility that would ever happen.

The Tobacco Link: Strong Enough?
In legal and non-legal circles alike, many theorize that prosecutors success in securing multibillion-dollar settlements for states in their fight against the tobacco industry blazed the trail for similar results in obesity cases. With such emphasis placed on the connections between the two issues, it is important to note several key differences and similarities, as noted by law professors Nagareda, Thain and Feldman:

The tobacco victories were not as clear cut as many make them out to be: Most individual suits were unsuccessful, with payouts coming only after state governments filed suit and won rich settlements.

• Class actions are less likely in obesity suits because plaintiffs must be harmed in identical or very similar ways.
• In the tobacco cases, the states claimed that the defendants products caused them to pay more in medical expenses; this is more difficult to prove with obesity given numerous contributing factors such as sedentary lifestyles, lack of exercise and genetic predisposition.
• Prosecuting specific foodservice companies will be more difficult than targeting the tobacco industry, where a small number of large companies dominated the market like an oligopoly; smokers also tend to be brand loyal for long periods, unlike fast-food consumers.
• Unlike cigarette smoking, there has been no scientific proof of addiction to high-fat foods.
• No amount of tobacco smoking has proven to be healthy; food is necessary to sustain life.

Come Together, Right Now?
Restaurants are under fire from a host of critics who charge them with contributing to Americans growing struggle with obesity. Does the foodservice industry need to take some sort of collective action regarding this issue to protect itself from litigation and legislation?

Every single thing that is required by law or by pressure, the consumer ultimately pays for, and Im sensitive to that as well. Many companies will overreact, and that creates problems. ... As an industry, we need to have a uniform position so politics dont create cost for the consumers. JON LUTHER, CEO, Allied Domecq Quick Service Restaurants, Randolph, Mass.

[The lawsuits argument is] ridiculous, and we shouldnt validate it with anything but letting people know how ridiculous it is. ... But we have to do that. If people only hear [the opposing] message, over time public perception is going to shift in their favor. ... I definitely think there needs to be a coordination of the effort. SHANNON FOUST, president and CEO, Damons Grill, Columbus, Ohio

The industry as a whole absolutely needs to get together, not to lobby but work as a group to better educate the public as to what is going on and better educate them about food. ... We also need to work on this issue individually. LARRY REINSTEIN, CEO, Fresh City, Needham, Mass.

Im not in favor of anything in this country that forces us to do anything. It can happen, but Im sure not in favor of it. Thats why Im being proactive. ... We have a responsibility as a group to get together and nip this in the bud before it hits us. DAVID RUTKAUSKAS, president and CEO, Camilles Sidewalk Café

We want to be the leader in this. We want to be part of the solution. We will continue to work with industry and the National Restaurant Association on all subjects of common interest. KEN BARUN, corporate vice president, healthy lifestyles, McDonalds Corp., Oak Brook, Ill.

There are just enough differences in the industry [that] I dont know if theres a single, unified approach that is more effective than all of us doing what best suits our operating capabilities and our customers needs. RICK JOHNSON, senior vice president, Ruby Tuesday Inc., Maryville, Tenn.

When the marketplace is left alone, it comes up with the appropriate solutions. I think youll see modifications on existing restaurant menus as the public demands those ... and you may see one or two new brands come on line with a focus on healthy food, but beyond that I think its a mistake to spend a lot of energy on this issue. ANTONIO SWAD, owner and founder, Pizza Patrón, Dallas