Counting calories as part of health care reform--who knew? But apparently it's there on page 455 of the health care reform act, according to Marion Nestle, Professor of Nutrition at NYU, writing in the New England Journal of Medicine. There will now be a national effort at posting calorie counts in chain restaurants.
There are many ways to improve the overall health of Americans, but tackling obesity is surely one of the most urgent. The surge in obesity (with its attendant diabetes) has profoundly changed the face of medicine.
I can recall first learning about diabetes as a medical student and thinking of it as a rare disease. As a primary care internist now, I almost think of myself as a diabetes specialist. Easily half of all my patient-visits focus on diabetes, and obesity is an issue for 95% of these patients.
Which is why I was delighted to see the push toward posting calorie counts in restaurants. There's no mystery in the cause of the obesity epidemic--eating more and exercising less--but there are definitely complexities in the reasons people consume more calories now. Average people cannot control the fact that processed food are laden with more high fructose corn syrup, or that portion sizes for soft drinks and food have increased immensely, or that in suburbia it's impossible to walk to anything.
However, when two alternatives are available--a meal with a higher calorie count versus one with a lower calorie count--there's at least the option to choose the less fattening one.
Our hospital recently closed its much-loved local Greek coffee shop. In its place, they brought in the chain Au Bon Pain. Part of the reason was that this chain could post nutritional information. Hospital staff were dismayed at the substitute of a faceless chain for a homey mom-and-pop store, and also indignant about having a high-priced chain as the only option in a public hospital that serves many patients on limited means.
But nutritionally, it is a disaster. Yes it does have some (ridiculously expensive) sandwiches and salads, its mainstay is baked goods and pastries, the absolute worst foods for our patients struggling with diabetes and obesity.
The only bright side is the calorie posting. When I see that muffins have over 600 calories, I can't bring myself to buy one. I know that my fellow doctors as well as my patients have made the same observation.
I'm rooting for health care reform to work, on all its levels. The calorie counting is just a tiny aspect, but if it has any measurable impact on obesity and diabetes, the whole reform process was worth the battle.
Danielle Ofri is a writer and practicing internist at New York City's Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients.
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