Karla Park

24 April 2013
Conversations About Life (PHIL2085)
Professor John Martin
Provide the Information, Improve the Situation
Many Americans are eating out more frequently and dining away from home has been
linked to the increased instance of obesity in the United States (Barton et al, 1669). This is
probably due to the fact that many Americans make less nutritionally sound food choices when
eating out than when eating food prepared at home (Morrison et al.). In order to improve the
growing problem of overweight and obesity in the United States, people must be informed about
what they are consuming. The United States is a nation that has a huge information industry with
many sedentary jobs, resulting in reduced physical activity. Many people are also pressed not
only for time and money which results in a greater instance of dining out at fast food and chain
restaurants. Requiring restaurants to provide complete and correct nutritional information about
their menu items could result in better nutrition for the population and a reduced rate of
overweight and obese individuals. Furthermore, an improved quality of life for those with
chronic illnesses and special dietary needs and increased compliance with physicians dietary
order, and improved health literacy may also result from the provision of this information.
Although, providing information is simply the first step to improving the overall nutritional
situation in the United States.
If restaurants were required to provide nutritional information to the public in an obvious,
readily available way, may benefits could result. The Menu Education and Labeling [MEAL]
Act would require chain restaurants with 20 or more outlets to provide key nutritional
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information (Burton et al). This act is a step in the right direction. It is a step towards reducing
the obesity percentage of this nation and improving nutrition and quality of life for many
individuals. Knowledge of calories alone often leads to a misconception of the quality of ones
diet. Simply because an item is low calorie does not mean it is nutritious. Inversely, the fact that
an item is high calorie does not mean it is unhealthy. For example, a lot of the 500 calories in a
Big Mac come from fat, whereas the calories in a 500 calorie tuna salad sandwich come from
protein and carbohydrates, as well as fat, thus the tuna sandwich calories are more nutrient dense.
Many people are unaware of the various factors that must be taken into account in order to have
a nutritious diet. However, as stated above, individuals tend to make less nutritious choices when
they are eating away from home than they do if they are eating at home. This indicates that
perhaps it is not a lack of concern for nutrition, but rather a lack of information at the root of the
problem. If data like sodium, fat, sugar, saturated fat, cholesterol, as well as calorie content were
made available to the public, there could be a stark change in the overall nutrition of this nation
over the course of the next decade. According to a study published in the September 2006 issue
of the American Journal of Public Health, the calorie content of less-healthful restaurant items
was under estimated by consumers by an average of over 600 calories. Additionally, the fat
content of the same items was underestimated by a third of the daily recommended value. If it is
assumed that individuals are eating out one time per week, and underestimating these meals by
600 calories, these people are consuming an additional 30,000 calories per year without realizing
it. This could cause an unintentional weight gain of almost ten pounds per year, resulting in
substantial weight gain over time (Barton et al, 1674). This research indicates that Americans are
eating tens of thousands of calories that have not been accounted for and gaining a significant
amount of weight due to a lack of information.
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This detriment to American nutrition may be able to be prevented simply by providing
correct, readily available nutritional information. The study published in the American Journal of
Public Health also reported that when individuals were provided with calorie and other nutrient
information, purchase intention and choice decreased for less-healthful items that were worse
than expected and when calorie and nutrient information were provided, there was a larger
difference in disease-risk perceptions (Barton et al, 1674). These findings indicate that people
do care about what they are eating and do have an idea of what can cause they serious harm in
the future. The study results also suggest that a significant portion of the rationale behind
peoples food choices is already the nutrient content, and that a simple lack of information is
making a great contribution to the poor nutritional choices Americans are making when they dine
outside of their home. These findings clearly indicate that the provision of easily accessible
nutrition information in restaurants may provide significant public health benefits by making it
easier for consumers to make more healthful food decisions (Barton et al, 1674).
There are many individuals who are (or should be) following a restricted diet. As stated
in the December 2012 issue of Business Wire, nearly half of Americans today are living with a
nutrition-related chronic disease like heart disease, diabetes, kidney disease and countless other
conditions (FoodCalc). The health of these individuals relies even more on diet than does the
average persons health. Many of these diets rigidly restrict things like sodium, sugar, fat, and
cholesterol. All of these nutrients are extremely common in foods like soups, burgers,
sandwiches, and burritos, among many others. When they must be strictly regulated, it is
extraordinarily difficult to remain compliant with a diet when the amount of nutrient is unknown.
For this reason, many individuals who have strictly regulated diets often do not fully comply
with the restrictions. Many individuals who are prescribed restrictive diets by medical
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professionals, as well as those with voluntary dietary restrictions, such as keeping kosher or
maintaining a vegan lifestyle, find it difficult to eat out at most restaurants. There are several
reasons one might choose to eat away from home, including convenience, time, and
environment. Cost may also play a part in the decision, although in the long term, eating out will
cost more than eating at home. When the reasons most people choose to eat away from home are
examined, it is clear that the quality of life of individuals who do not have the option of eating
out is compromised. Being unable to simply stop at a fast food chain or even any restaurant
along the way on a long car trip, or being unsure of what exactly is in the food available for
consumption on an airplane can greatly increase travel stress. Additionally, dining out is an
extremely common way to socialize, meet new people, and experience new things. Being unable
to do such things as a result of a medical condition is detrimental to more than just the physical
health of individuals who have to deal with such things. By providing even basic nutritional
information in an easily accessible, readily available way, the quality of life for almost half the
American population can be improved.
Opponents of the idea to require the display of nutritional information in restaurants may
note that in many cases nutritional information is available on the internet, via a mobile app, or
upon request from the restaurant. What many fail to realize, however, is that these backdoor
ways of providing information fail to account for the fact that a lot of dining out, particularly at
fast food restaurants is done without advance notice, such as on a car trip. Furthermore, if the
information is provided in a pamphlet, the option of using a drive thru is no longer a reality for
those who require such information, drastically reducing the convenience of many fast food
destinations. When information is only available on the internet or in the form of a mobile app,
socioeconomic discrimination becomes an issue. Individuals of all economic status are affected
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by nutrition-dependent chronic diseases and when nutritional information is posted exclusively
online or in a mobile app, those from lower socioeconomic situations are put at a disadvantage
because they have reduced or no access to computers, the internet, and smart phones. By
providing information in a public, readily available place like a menu, there is no bias,
unintentional or otherwise, toward or against any specific group of individuals. Supplying
information on menus as opposed to in pamphlets or on the internet also helps improve the
quality of life for individuals suffering from these diseases, because they are will have a greater
ability to function in the same way as a health individual.
In the September 2007 issue of the Journal of Renal Nutrition, Duane Sunwold, a chronic
kidney disease patient and culinary expert, wrote an article detailing the plan he has established
for eating out and remaining compliant with his chronic kidney disease diet. In the article,
Sunwold focuses on the four step process he has established for dining out; the process is
involved and requires a lot of special attention from both the customer and the staff at the
restaurant. The process calls for making special requests and potentially drawing attention to
oneself. If nutrition information were provided on the menu, individuals like Duane would likely
have an easier and more enjoyable dining out experience since they would be able to see more
exactly what is in their food and how much is there. With this information, people like Duane
could make more informed choices with fewer special requests, or at least, simpler special
requests that are less likely to seem unusual to the wait staff, chefs, and other patrons. Having a
more normalized dining experience promotes a more positive dining experience, and knowing
exactly what is in particular dishes grants the diner greater regulation of his or her disease,
allowing them to feel as though they control their disease, not vice versa. This can help maintain
a positive self-image and control the disease process, thus improving the quality of life.
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Ensuring the opportunity for achieving the highest quality of life possible is part of the
responsibility the government has to the people. Quality of life is an extremely important concept
that those who experience a high quality of life often overlook. It is often hard to appreciate
something one has never had to be without, and thus it is frequently only those who have an
impaired quality of life who consider ways to improve it. Those who do not struggle with
chronic illnesses or other unavoidable dietary restrictions may find it difficult to understand the
troubles associated with attempting to comply with strict dietary regulations. Often, individuals
must miss out on or only partially participate in activities because of their disease. Additionally,
food is a source of great enjoyment and socialization in American culture. If it is difficult or
impossible to enjoy food or partake in social gatherings involving the consumption of food,
especially outside the home, individuals may not only miss out on important social experiences
and personal enjoyment, but also business transactions and family events. Never being able to go
out to eat without feeling guilty or ostracized can produce severe, negative effects on a persons
outlook on life and their overall enjoyment of their life. By providing the nutritional information
that is needed by these individuals to maintain a good quality of life, the government is doing its
job to ensure every American has their inalienable rights to life, liberty and the pursuit of
happiness.
Providing nutritional information at restaurants may also be the best first step to
improving health literacy throughout the nation. Health literacy is the ability of an individual to
access, understand, and use health-related information and services to make appropriate health
decisions (Carmona), and many Americans are grossly under informed. Part of the definition of
health literacy is access; people need to have access to information in order to understand what it
means in relation to their health. The United States is making strides to improve health literacy
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among the population (Carmona) and providing nutrition information in a public, nearly
unavoidable place will increase the number of citizens who are informed, and the number of
citizens who would like to be informed about what this information means. If the facts on total
fat content, saturated fat content, trans-fat content, and unsaturated fat content are provided to the
public, some may be prompted to ask what is the difference between these?, which is the best
for me to include in my diet and which should I avoid?, and what might happen to me if I
intake too much of one of these?. With more people asking these questions, medical and health
professionals may be more inclined to answer them publicly or provide the answers in a public
forum. Providing this information to the public may also require companies and professionals to
make the information not only more readily available, but also more understandable.
Most health information is written at a collegiate level, but the average American does
not read at this level. This poses an obvious problem that has yet to be solved. By requiring that
information be posted in a public place (on a menu board or on a menu) there is potential that the
information will be posted in a simpler tone. If more people are informed, more people will be
health literate. By increasing the knowledge of what causes the nutritionally dependent diseases
which commonly plague todays society (coronary artery disease, diabetes mellitus, renal
disease, heart disease, and liver disease) preventative measures can be taught to people,
especially young people, to prevent these diseases from becoming such a problem in the future
and working to shift from a disease care system to a health care system (Carmona). The Food
and Drug Administration is revising the information already provided to the public on food
labels in order to help the public better understand the information (Carmona). This, along with
the many other health literacy initiatives the federal government is putting into place, indicates
an official understanding that the public needs to be educated about such things.
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Providing the nutritional information is simply the first step. There will have to be greater
change throughout time, but making the provision of basic nutritional information a requirement
for all chain restaurants is a step in the right direction. Basic nutritional information should
include a calorie, total fat, saturated fat, unsaturated fat, trans-fat, sodium, potassium,
carbohydrate, sugar, and calcium content. This may seem like a lot, but all these nutrients are
extraordinarily important, not only to the function of the body, but also to the maintenance of
several common diseases. According to a 2009 study published in the International Journal of
Contemporary Hospitality Management, the consumers find fat, saturated fat, and trans-fat to be
the most important nutrients to be included in the nutritional information provided by restaurants.
These nutrients were ranked as extremely important and cholesterol, total calories, sugar,
carbohydrate, protein, omega-3 fats, dietary fiber, a complete ingredient list, and potassium were
ranked as being important to include (Josiam et al., 885).
All of these nutrients are vital not only to the maintenance of chronic diseases and non-
traditional lifestyles, but are also vital in the prevention or causation of many disease processes.
For example, receiving enough protein in the diet is vital to prevent malnutrition, and over
consumption of saturated and trans-fats can lead to heart disease and stroke. Thus, providing this
information would help to prevent disease and improve the quality of life of the ill, as well as
encourage the public to think more about what they are eating. Additionally, if patients knew the
nutritional content of some of their favorite foods, it is possible that they would be more
compliant with diets prescribed to them by physicians or dietitians, and individuals who are not
ill may be more likely to choose foods that will be less likely to cause disease.
By providing information at popular restaurants, the likelihood of compliance with both
treatment and prevention diets and practices is increased. This is because rather than avoiding
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their favorite eateries all together because the food at that particular place is labeled as
unhealthy or the nutrients the patient needs to be conscious of are unknown, individuals could
visit the restaurant and make a choice from the menu based on their diet. Many people often
attempt to employ this tactic already, but with much often very wrong- guesswork. For
example, a patient who needs to monitor his sodium intake or is trying to prevent hypertension
may choose Subway over McDonalds because he believes Subway to be healthier when, in
fact, Subway sandwiches carry some of the highest sodium content of all fast food, and salt
sensitivity is a major factor in hypertension in approximately 30-50% of the population (Whitney
et al. 606). Similar mix-ups can occur with salads. Patients often choose salads over sandwiches
or burgers because they believe salads are better for them when in reality, many salads served by
fast food and even sit down facilities are just as bad, if not worse for the individual, depending
on what they are monitoring and what is put into the salad. With the provision of nutritional
information, mix-ups like theses would occur much less frequently, and patients would be able to
make informed decisions about their food choices.
Assisting the public in making informed decisions about food is another reason the
provision of nutritional information should be required. Some opponents of the MEAL act have
suggested that requiring restaurants to provide nutritional information is a violation of the
companies rights. However, requiring restaurants to provide nutritional information does not
violate any rights. The company still has the freedom to produce any type of food they wish, sell
it at any price, and produce it in any way they wish (within the confines of established law). The
freedoms of the consumer are not revoked either. While the customer would still have the
absolute freedom to choose whatever items they wish, and even to completely ignore the
information provided to them.
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One of the greatest benefits that may come from the provision of nutritional information
at restaurants is that the concept of thinking about what foods one is eating would be introduced
to the public on a large scale. The concept of thinking about what they are consuming is an idea
that seems to be diminishing in popularity in the United States. Perhaps because it is so much
easier to forgo thought and simply eat, especially if the ever-important commodities of time and
money are in short supply. However, it is vital not only to eat food, but to think about food as
well. Food is what runs the body and without the proper amounts of all nutrients, the body does
not function effectively. Thinking about food may also lead consumers to read food labels on
groceries more carefully, and greater thought about food by the general population may prompt
restaurants and fast food facilities to change their foods to be healthier and more desirable to a
healthier population.
In conclusion, the provision of complete and correct nutritional information about their
menu items could result in better nutrition for the population and a reduced rate of overweight
and obese individuals. Providing information may also result in an improved quality of life for
those with chronic illnesses and special dietary needs and increased compliance with physicians
dietary order, and improved health literacy; although providing the information is simply the first
step to improving the overall nutritional situation in the United States. Providing the information
will by no means cure the United States obesity problem, or immediately improve the nutritional
quality of the foods offered by restaurants. Nevertheless, providing this vital information is a
wonderful step in the right direction - towards a preventive culture, improved quality of life for
many Americans as well as an increase in health literate individuals, and a nation that thinks as
well as eats.

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Works Cited
1. Burton, S., E. H. Creyer, J. Kees, and K. Huggins. Attacking the Obesity Epidemic: The
Potential Health Benefits of Providing Nutrition Information in Restaurants. American
Journal of Public Health 96.9 (2006): 1669-675. Print.
2. Carmona, R. Improving Americans Health Literacy. Journal of the American Dietetic
Association 105.9 (2005): 1345. Science Direct. Web. 24 Apr. 2013.
3. FoodCalc Launches Nutritional Dining App for the 150 Million Americans Living with
Chronic Diseases. Business Wire Dec 05 2012. ProQuest. Web. 24 Apr. 2013.
4. Josiam, Bharath, and Charles Foster. "Nutritional Information on Restaurant
Menus." International Journal of Contemporary Hospitality Management 21.7 (2009):
876-91. ProQuest. Web. 24 Apr. 2013.
5. Morrison, Rosanna, Lisa Mancino, and Jayachandran Variyam. "Will Calorie Labeling in
Restaurants Make a Difference?" Ers.usda.gov. USDA Economic Research Service, n.d.
Web. 24 Apr. 2013.
6. Sunwold, Duane. Notes From the CKD Kitchen: Restaurant Dining. Journal of Renal
Nutrition 17.5 (2007): 355-56. Ohio Link. Web. 24 Apr. 2013.
7. Whitney, Ellie, Linda Kelly DeBuryne, Kathryn Pinna, and Sharon Rady Rolfes. Nutrition for
Health and Healthcare. 4th ed. Belmont, CA: Brooks Cole, 2011. Print.