in Hunts Point

A McDonald's Quarter Pounder with cheese has 510 calories. (Photo by: Ernesto Andrade via Flickr)

The McDonald’s on Southern Boulevard in Hunts Point was packed on a recent Sunday afternoon. Two young women, both thin and in good shape, sat down in a booth with a tray full of food in the familiar orange and yellow wrappers: a cheeseburger (300 calories), a chicken wrap (340 calories), French fries (500 calories for a large) and sodas in paper cups (310 calories each).

“I don’t really pay attention,” said Arlene Jamiez, of the calories listed on the restaurant’s main menu board.

Her friend across the booth piped in.

“I don’t think everybody looks,” said Marian Suero. “You order what tastes good. After you eat it—that’s when you feel guilty.”

The women’s sentiments seem to confirm what some researchers are discovering: that posting the caloric content on restaurant menus does not necessarily mean people will pay attention to it, and if they do, it still might not change what they decide to eat.

The 2008 law, which requires chain restaurants in New York City to post nutritional information on menu boards, is just one of a number of food policies enacted by the City in recent years. But are these policies effective? Studies of the menu labeling requirement, as well as the growing number of New Yorkers who are obese and diabetic, suggest that such tactics might not be working to curb the growing prevalence of diet-related illnesses like those that plague this neighborhood in the South Bronx.

Hunts Point, and nearby Mott Haven to its west, has become a microcosm for a health pandemic that’s sweeping the nation. A quarter of the residents in the South Bronx are obese, and the area has the highest proportion of diabetic adults in all of New York City –17 percent of the population, according to the Department of Health.

A study published in October in the journal Health Affairs, the first real look at the impact of the calorie rule in New York, showed that people in low-income neighborhoods like the South Bronx are actually eating slightly more now than they were before the law was passed.

Other studies, including data recently released from the Department of Health, are more optimistic, and most public health advocates argue that informing consumers about the food they’re eating can’t possibly be a bad thing.

“Menu labeling is capitalism—letting the purchaser know what the labeler knows,” said Steven Gardner, a lawyer for the Center for Science in the Public Interest, a consumer advocacy group based in Washington, DC.

“Give me information, and I’ll react.”

As director of litigation, Gardner has spearheaded high-profile lawsuits against fast food giant KFC for their use of artery-clogging cooking oil, and chain restaurant Denny’s for not disclosing that some of it’s meals contain more than an entire day’s worth of sodium (KFC eventually stopped using trans-fat oils, while the Denny’s case was dismissed in a New Jersey court last month).

If it were up to Gardner, labeling would go even further than just calorie postings: he’d like to see restaurants openly disclose their use of things like trans fat, list their sodium contents and be held accountable for their marketing practices.

While most menu-labeling laws are not that stringent, they appear to be a growing trend. Dozens of states and counties continue to introduce legislation similar to the one implemented in New York, and provisions in the Senate’s health care reform bill could make labeling a nationwide policy.

The Menu Education and Labeling (MEAL) Act , introduced last spring by Senator Tom Harkin of Iowa and Congresswoman Rosa DeLauro of Connecticut, would require all restaurants and vendors nationwide with 20 or more locations to post information on the calories, sodium, saturated and trans fat, and carbohydrates in products.

“Overweight, poor nutrition and diet-related diseases are public health threats of the first order,” Senator Harkin said in a press release in May. “It is time to take preventive action and give consumers the tools that they need to take better control of their diet and health.”

WHAT’S FOR DINNER?

If menu labeling does indeed help some people, as the health department’s data claims and as most health advocates will argue, then why is it that neighborhoods with disproportionate health problems—like the South Bronx or South Los Angeles—seem to be the least affected by the rule?

“It’s possible that with the economy the way it is, price might be trumping menu labeling in some instances,” said Christina Roberto, a researcher at the Rudd Center for Food Policy and Obesity at Yale.

The neighborhoods of Hunts Point and Mott Haven make up one of the poorest congressional districts in the country, and 31 percent of the population in the Bronx lives below the federal poverty line, according to census data.

The area has been pegged by the health department as a “food desert,” or neighborhood where supermarkets that sell fresh foods are scarce in proportion to the population. While nearly every block has a bodega, the stores supply relatively few fruits and vegetables.

Until this year, food stamps were not accepted at the local farmer’s market—despite the fact that nearly 60 percent of residents in the district are on some kind of public assistance. And in a landscape littered with all kinds of fast food choices, it’s can be easy to see how tempting the dollar menu at a McDonald’s or Burger King can look compared to buying pricier fruits and vegetables.

Knopf says that even patients who do their own cooking and shopping often make unhealthy choices based on what’s cheap.

“The price is huge,” she said. “What’s cheap and what’s on sale is all the junk and all the stuff that’s horrible for diabetics.”

Jhack Sepulveda, a nutritionist at the Albert Einstein School of Medicine in the Bronx, agreed.

“Food choices here are based on cultural preference and affordability,” he said.

Sepulveda is the lead dietician on the Hispanic Community Health Study

Study of Latinos (HCHS/SOL) , a nationwide study examining the health of Hispanic populations.

A healthy lifestyle is harder in low-income neighborhoods, Sepulveda says, where families might not have the time and resources that people in wealthier neighborhoods do.

STICKER SHOCK

Everyone knows fast food is bad for you, so why should anyone be surprised by how many calories are in a Whopper? If you drop into a Burger King, you’ve probably already resigned yourself to a high-calorie, high-fat meal.

“Everything sweet has a lot of calories in it,” shrugged one patron at a Hunts Point Baskin Robbins, as she pondered which flavor ice cream to order. “I don’t really even think about it.”

But many nutrition experts say it’s not that simple.

“Myself, as a dietician who has gone to school for this for years and years, even I’m surprised by the calorie count,” Knopf said. Posting the nutritional information can help clear up confusion for consumers who might mistakenly think they’re picking a healthier option.

The classic example: a Caesar salad.

“People who don’t eat any vegetables at all, that’s like their first foray into vegetables,” Knopf said. “They think they’re making a healthier choice, and I hate to shoot them down, but it often has a lot more calories in it than even a hamburger. The dressing, and if they get the extra crispy chicken in it instead of the real chicken, it’s even more fattening.”

Another purpose of calorie labeling is not just to get the consumer to order healthier, but to get retailers to offer healthier.

“It has the potential to get restaurants to reformulate foods,” said Roberto, of the Rudd Center. “Anecdotally, you hear a lot of, ‘Oh my God, I walked into Starbucks, and the muffin had this many calories, I can’t eat there anymore – it’s like that shaming.”

Many chains have already responded to health policy’s nudging: Starbucks now uses 3 percent milk as their standard in coffee drinks, instead of whole; KFC introduced Kentucky Grilled Chicken as an alternative; kids meals at places like McDonald’s and Burger King now offer milk or juice instead of soda and apple slices in place of fries.

“I think if restaurants are taking initiatives, and making these changes on their own, then that’s great,” Roberto said. An article she published this month in the American Journal of Public Health added further credit to the idea of menu labeling.

The study examined the way people ate under three different circumstances: a first group of diners was presented with a regular menu, the second was given a menu with calorie information listed, and a third had menus that contained both the caloric content of the food, plus a label stating the recommended daily caloric intake for an average adult.

The last group, with the recommendation label on their menus, consumed an average of 250 fewer calories than both of the other groups. Even the diners with just the calorie information showed little difference from the group that had none.

“The take home message is that you need to put that contextual menu on the label,” Roberto said. The postings will be the most effective when used in combination with other health policies that encourage education about nutrition, she said.

Elbel, from the NYU/Yale study, made the same conclusion, but insists we shouldn’t throw in the towel on menu labeling just yet.

“People can make solid arguments that even if there’s not a huge response, it’s still worth doing. We don’t have to prove that exit signs are effective, but we still have them everywhere,” he said.

“I think it just means that we don’t know yet if we can rely on labeling to be the by and end-all. This isn’t going to be enough. This just reaffirms that we’re going to have to do other things as well.”