Maybe Policy Will Make Us Trim Calories and Health-Care Costs

The calorie content of each food item is listed on a McDonald's drive-through menu in New York.
The calorie content of each food item is listed on a McDonald's drive-through menu in New York. (By Ed Ou -- Associated Press)
By Ezra Klein
Wednesday, July 15, 2009

Archaeologists say the modern human originated in East Africa about 200,000 years ago. For the next 199,950 years or so, this intrepid organism spent most of its time trying to avert the devastating consequences of insufficient food and drink. Various strategies were developed and employed. Evolution. Civilization. War. Agriculture. The exchange of round bits of metal and rectangular pieces of paper. Drive-through windows.

Over the past 50 years, however, some privileged humans have been faced with a largely novel problem: the consequences of too much food and drink. For a while, the primary impact seemed to be extra lumps of flesh, which had their downsides so far as mating went but, overall, weren't too bad. But in recent years, the problem has become much worse. In particular, the modern, privileged human has developed such chronic ailments as diabetes and heart disease. Unlike acute starvation, these diseases kill slowly, painfully and, above all, expensively.

The consequences are not confined to the individual. As I write, Congress is considering an overhaul of the health-care system. But the concern isn't health: It's money. If trends continue, health-care costs will chew up 100 percent of the gross domestic product by the end of the century. And estimates suggest that half to two-thirds of that growth is coming from chronic diseases related to diet. We're eating our way through the national budget.

Chronic illness is often the result of personal decisions but nevertheless has a tremendous public consequence. All of us, as taxpayers, bear the burden through Medicare or Medicaid. And all of us with private health insurance see our premiums rise when our office mates fall ill. And all of us would suffer if our government has to default on its debt because health-care costs overwhelm the treasury. If that is to be averted, however, we will have to get less sick. And that means changing how we eat.

But how we eat is hard to change. And the government has, at best, blunt tools. The first thing the feds are likely to reach for is the tax code. That makes some sense: The simple story of the past few decades is that calories got plentiful, which made them cheap, which led us to purchase more of them, which left us fat and sick. The answer to that, some think, is to run the process in reverse and make calories more expensive. One way is to slap a tax on them.

Recently, three researchers at Rand Corp., a nonprofit and nonpartisan research institution, tried to figure out how quickly we would react to policies that trigger a change in the price of calories. The available data was for price reductions, so that's what they examined: a 10 percent drop in the cost of each calorie. The effects are modest. After two years, body mass index increases by 0.6 percent as weight is gained. After 30 years, it ticks up by 3.6 percent. It's not nothing. Neither is it much.

Another idea gaining momentum is calorie labeling on restaurant menus. The concept is simple: Chain restaurants will have to list caloric information on their menus and menu boards. Not behind the desk, or off to the side, or up on the ceiling. Where you can see it. New York, among other cities, has already instituted that policy. Every Starbucks in Manhattan now must post the calories in a MochaFrappaWhatsIt right next to the drink name.

Studies show that we wildly underestimate the calorie content of meals we order in restaurants. Worse, as meals get larger, we underestimate the calorie content by even more. Meanwhile, we eat out a lot more than we did in, say, the 1970s, and the portion sizes are much larger. Not coincidentally, so are we.

But will putting calorie counts where we can see them make a difference? Possibly. Early studies, along with some anecdotal evidence, show that this practice is driving eaters to choose lighter items.

We're still waiting for the full data from New York's experiment. But the researchers there shared unpublished numbers with the County of Los Angeles Public Health Department, which was preparing an analysis in case Los Angeles wanted to follow New York's lead. Based on those numbers, Los Angeles researchers settled on a "conservative" estimate: 10 percent of chain restaurant patrons would order meals that were merely 100 calories lighter.

Surprisingly, that mild change in behavior has a huge and immediate effect: It would avert 38.9 percent of the county's expected weight gain in the next year. If 20 percent of patrons order meals with 150 fewer calories, it would avert 116 percent of the expected weight gain, which is to say that the County of Los Angeles would actually lose weight.

There's also a long-term impact worth considering here. In recent years, chain restaurants have vastly increased the caloric content of their meals. Since the '70s, the average soft-drink serving has increased by 49 calories, fries have jumped by 68 calories, burgers by 97 calories. And why not? Customers like abundance, and food is cheap. But if customers began exhibiting a preference for lower-calorie meals, chain companies could turn some of that research and development wizardry to reformulating their products. The calories on our plates would get a little less abundant. And that could have the biggest impact of all.

All of this, of course, is somewhat speculative. These policies could fail, or restaurants could evade them, or consumers could ignore them. But given the rise in health-care costs, something needs to work, and soon. It took human beings hundreds of thousands of years to protect themselves from famine. They'll have to learn how to deal with abundance much more quickly.

Ezra Klein can be reached at or through his blog at

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