Calories, Fat and Salt: How NYC Helped Redefine Modern Food Safety July 7, 2015 Mary T. Bassett, MD, MPH Commissioner New York City Department of Health and Mental Hygiene CONFIDENTIAL AND PROPRIETARY Any use of this material without specific permission of DOHMH is strictly prohibited
Overview • Status of NCD’s in U.S. and NYC • Policy Focus Areas ─ Trans Fat Regulation ─ Calorie Posting ─ Sugary Drinks ─ Sodium Warning Label
US Life Expectancy is Too Low Source: APHA Website - http://action.apha.org/site/MessageViewer?dlv_id=59346&em_id=54801.0
US Mortality: Bottom of the Pack Source: Woolf, S. H., & Aron, L. (Eds.). (2013). US Health in International Perspective:: Shorter Lives, Poorer Health . National Academies Press.
Diabetes: Wrong Direction Source: McKinlay, J., & Marceau, L. (2000). US public health and the 21st century: diabetes mellitus. The Lancet , 356 (9231), 757-761.
Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Footprint of Obesity in NYC NYC Obesity and Overweight 2013 Under/normal weight Overweight but not obese Obese 23% 44% 33% Source: Bureau of Epi Services. 2013 Community Health Survey New York City Department of Health and Mental Hygiene
Obesity and Diabetes in NYC Source: Bureau of Vital Statistics New York City Department of Health and Mental Hygiene
In New York City: Policy to Improve the Environment Fresh fruits and vegetables Consumer-price index Sugar and sweets Carbonated drinks Source: Brownell, K. D., & Frieden, T. R. (2009). Ounces of prevention — the public policy case for taxes on sugared beverages. New England Journal of Medicine , 360 (18), 1805-1808.
NYC DOHMH Food Regulation • Responsible for inspection of all food service establishments (FSE) in NYC • Ensure FSE’s are in compliance with city and state food safety regulations as outlined in NYC health code • NYC implemented letter grades in 2010
NYC Board of Health- 1865 • Oversees NYC Health Code • 11 members appointed by the Mayor with consent of City Council • Board has enacted countless measures to improve wellbeing of New Yorkers: – lead paint ban, window-guards,TB control, calorie labeling, elimination of trans fat
TRANS FAT REGULATION
Trans Fat Timeline Date Event February 1994 CSPI petitions the FDA to require trans fat to be listed on Nutrition Facts labels March 2003 Denmark bans artificial trans fat in all foods July 2003 FDA requires food manufacturers to list trans fat on Nutrition Facts labels by 2006 May & July 2004 CSPI petitions the FDA to prohibit use of PHOs and to require restaurants to immediately disclose use of PHOs August 2005 – NYC DOHMH conducts educational campaign to reduce artificial trans fat May 2006 use in food service establishments December 2006 NYC Board of Health passes restriction on use of artificial trans fat in NYC food service establishments • Numerous cities, counties and states enact similar restrictions July 2008 NYC’s rule takes full effect in all food service establishments • Based on inspection results, an estimated 98% of restaurants were not using artificial trans fats 6 months later June 2015 FDA determines that partially hydrogenated oils are no longer “Generally Recognized As Safe;” sets a compliance date of 3 years
Trans Fat Regulation • Artificial trans fat poses a substantial risk to heart health. • Amendment to New York City’s health code (2006) • Prohibits restaurants from the following – Storing, using or serving foods containing partially hydrogenated vegetable oils, shortenings, margarines – if 0.5 grams or more artificial trans fat per serving.
Evaluations Show Decrease in Trans Fat Consumption • Study examining consumption before (2007) and after (2009) trans fat regulation showed: – A significant decrease in mean trans fat content per purchase (by 2.4 grams) – An increase in purchases with 0 grams of trans fat increased from 32% to 59% • Post ban (2008), use of artificial trans for frying, baking, or cooking decreased from 50% to less than 2%
Trans Fat Regulation - Impact
Trans Fat National Policy • FDA will give manufacturers three years to remove artificial trans fat from national food supply
CALORIE POSTING
Fight for Calorie Labeling in NYC • 2006 – NYC BOH adopts calorie labeling rule, making NYC the first locality to require chain FSEs to post calorie information on menus • 2007 – First lawsuit against BOH in attempt to stop calorie labeling • 2008 – NYC BOH adopts revised calorie labeling rule, implementation begins • 2009 – Calorie labeling rule is upheld by US Court of Appeals, Second Circuit, creating a legal framework for others to follow
Menu Labeling becomes National Trend
Calorie Labeling Becomes a National Model • 2009 – Seattle requires calorie labeling on restaurant menus • 2010 – Menu labeling requirements included in the Affordable Care Act • 2014 – Federal regulations issued requiring all chain restaurants/retailers to post calorie information • 2015 – Federal regulation effective December 1
Calorie Labels Increase Awareness • Labels increase awareness – Exposure to calorie labels is critical to educating consumers about calorie content • Studies have shown customers using labels purchase fewer calories – Patrons who used calorie information purchased > 100 fewer calories
Calorie Awareness Campaign
Majority of New Yorkers Find Calorie Labeling Useful Useful, 79% Don't Know/ No Answer, 2% Not Useful, 19% 2011: Do you think the New York City law requiring fast-food restaurants to post calorie information is useful or not useful?
Corporations respond to Sticker Shock
Proposed Amendments Applicability to Retail Food Establishments • Chain Retail Food Establishments – Federal regulation covers chain supermarkets, convenience stores, other food retailers – Sale of prepared, restaurant-type food – Chains 20+ locations nationwide
Proposed Amendments Nutrition Statements, Information • Federal regulation newly requires nutritional statements, information • Nutrition statements – Every menu, menu board • ―2,000 calories a day is used for general nutrition advice, but calorie needs vary.‖ • ―Additional nutritional information is available upon request‖
SUGARY DRINKS
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