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Posts Tagged ‘health care reform’

Okay, so this is really just an add-on to my previous post regarding the new health care reform bill and having calories posted on all menu boards.  I believe that the makers of the new health bill believe that having calorie information in everyone’s face in every restaurant venue will insight people to choose differently, and hopefully, healthier.   I understand their good intentions.  But, hasn’t this information been around a long time?  Now, I realize that not having knowledge about food puts one at a disadvantage for making the best choices, but having that knowledge does not necessarily mean that one will make a alternative choice, or better one, for that matter.  This is the case in many areas of our lives, but food is what I am here to discuss today.

Let’s look at Oprah, for instance.  I don’t like to pick on people, well only in private, but we have all witnessed her enormous fluctuations in weight over the years.  And, those that watch her show, probably heard all about her current diet choices and exercise regimes.    She is the epitome of a yo-yo dieter, or what my department likes to call a “dieting casualty.”  Oprah is one of the wealthiest women in the world, has a great deal of power, and an educated woman….she did graduate from college, I had to check.  But, somehow, with all this education, wealth and power, even Oprah cannot seem to get it together when it comes to weight and health. Now, I think she has learned some things over the years and just like anyone is figuring out what is right for her.  But, even someone that can pay a personal chef, a private trainer, and a private food purchaser, she can’t maintain a consistent and healthy weight.  I am not in any way making fun of Oprah here, it is a struggle than many share.  I am just making the point that even with all the knowledge and resources, people don’t necessarily make the best decisions.

I am a dietitian and have struggled with weight over the years, not quite as wildly as Oprah considering my highest weight ever was 135lbs, but that is not a good look for me, and I have tons of knowledge about nutrition and diet.  I have seen and worked with numerous dietitians that were obese.  I even did crazy diets in hopes of losing weight and even resorted to bulimia for years.  I “knew” this was very bad for me, but I always thought I would stop after just 5 more pounds….apparently, eating disorders don’t work that way.  We, dietitians, are just like everyone else, knowledge does not mean action.

Obesity is not discriminatory, it preys on all humans, and some pets.  It is sitting there waiting for us to overeat the French fries dipped in garlic aioli, chicken wings, and M&M’s.  It doesn’t care who we are.  White or Black.  Low income or high income.  Educated or uneducated.  Rural or urban.  It doesn’t seem to matter.  Obesity doesn’t seem to be a disease that we can blank out with more education, although we are certainly trying, aren’t we?

So, will putting calorie amounts on menus really help our nation get healthier?  I suppose it will help some make better choices, but still they have a choice, which if there wasn’t a choice, it wouldn’t be America.  People need to take personal responsibility for their behaviors and I suppose being more educated will enable them to do this, but again, that doesn’t necessarily mean they will.

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With the new health care bill, restaurants that have 20 or more outlets will be required to post the calorie content of standard menu items along with suggested daily intake of calories. I am not saying that this part of the health care bill isn’t a good idea, but I have some reservations. Full details can be found at: http://http://healthcarebillindex.com/HR3962/DIVISION_C/TITLE_V/SUBTITLE_C/PART_1/SEC_2572/#HC039386C50B448BBB3B7CFBEBC156536

THE GOOD
I will talk about my positive reactions first. I do believe that restaurants should be obligated to provide calories, fat, carbohydrates, etc for those that are interested in such information. For some, this is vital information. For instance, a child with Type 1 diabetes who uses an insulin pump needs to input an accurate amount of carbohydrates into their pump in order to receive the correct amount of insulin for that meal. An error in guessing can result in blood sugars being too high or too low.

And, I also think this may enlighten some to the high amount of calories found in items that most consider “healthy” such as entrée salads, which I’ve seen top 2000 calories, which for most is a average daily intake. Certainly, change begins with knowledge, I will not deny that. So there will certainly be some that will benefit from this.

And, to add one more good point, this may ignite restaurants to start making reasonably-sized portions, although, I am sure most of the patrons would be disappointed, especially when the cost of the meal doesn’t fall as well. I don’t think those that are super-sizing and visiting buffets necessarily want their portions smaller anyway. These restaurants are in the business of customer service and have provided what most Americans demand, extra-large portions. You’d think we all had grown up in a third world country the way we heap food on our plates and keep heaping.

THE BAD
I am not trying to throw stones here. I am fairly certain that the proponents of this section of the bill have very good intentions. I imagine that they believe that having this information at restaurants and vending machines would somehow make Americans choose better, and thus, be healthier and we would spend less money on healthcare. I get it. The theory is sound; just not sure that’s what happens in reality, though. Fast Food restaurants have been providing this information, now even on the wrappers, for years. This information has not stopped people from super-sizing their meals nor has it stopped 50,000,000 Americans from eating at Fast Food restaurants daily. I am pretty sure Americans did not get skinnier in the last 10+ years of this information being available.

Another not so great thing is that the suggested daily intake of calories will also be listed on the menus. Did I miss something? From my education, calorie needs are dependent on a combination of factors including weight, lean muscle mass, gender, age, and activity level of an individual. I am not under the impression that Americans are actually going to abide by this “calorie law” since the nutrition facts label has had this for years, however, if someone did want to follow it, they may be getting too few or too many calories for their needs.

THE UGLY
I suppose you could classify these next two points as “The Bad,” but they have more to do with emotions, and emotions can sometimes be ugly. I am learned to be okay with eating whatever I want and not feeling guilty about it, however, I didn’t used to be and know a quite a few of my friends and coworkers that still cling to this guilt after eating cake, cookies, French fries, bread, etc. Should I, or anyone, be made to feel guilty or feel as if they aren’t healthy because they want to order the 1500 calorie meal? I imagine I order this amount of calories often, I probably don’t finish it, but sometimes I would especially after running a 20-mile training run. So, now can I expect the restaurant staff to be peering at me over their soft-drink station after they find out that “she’s the one that ordered the 1500 calorie meal?” It’s not just the makers of this bill that are pointing fingers, but now the restaurants and possibly our dinner-mates? In my own experience and of those of my patients, I have witnessed this guilt back-firing with binging. I know I’ve done it, for more reasons than just feeling guilty, and I’ve heard my patients talk about how guilty they felt after having 1 or 2 pieces of cake, that they then decided to just eat the whole thing. I suppose some would argue that this guilt might stop some from indulging and for some, I am sure it will. Significant enough to make an impact on America’s health? Probably not.

The last issue I want to address is similar to above, but it has to do with well-intentioned parents and their kids. As a dietitian, who typically works with adults, I probably can’t look at a kid and determine their calorie needs. But, now parents are going to be the keepers of their kids’ calorie intake. Yes, I understand that parents make all, well most, of the purchasing decisions. But, imagine a child ordering a grilled cheese and fries and mom chimes in: “no honey, that is too many calories for you” or “you’re too big to be eating that.” But, how can I expect parents to trust their kids to internally know when to stop eating when they, themselves, don’t know when to stop. I do believe that comments such as these, good intentions or not, can lead to eating disorders, low self-esteem, closet-eating, food hoarding, and lack of trust for one’s own regulation of hunger and satiety.  I realize these may sound like extremes, but I am an ex-bulimic and work with chronic dieters, this stuff happens.  How have we gotten so far away from our natural instincts that we have to have calories listed on everything in order to know how much we should eat?  Have we lost all of our hunger and satiety sensation?

And, finally, do we really think the obesity epidemic is going to be solved by mandating that restaurants include calories on the menu and fat taxes? I suppose it might help, but considering much of this information has been around for a long time and Americans keep getting fatter, probably not.  I guess only time will tell.

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