Diabetes Forecast

On the Menu

By Katie Bunker ,

Eating out has become a national pastime. Americans get a third of their calories from meals prepared outside the home, according to the Center for Science in the Public Interest (CSPI), a Washington, D.C., health advocacy group. And restaurant bills account for 48 percent of U.S. spending on food, the National Restaurant Association reported last year. At the same time, it's not uncommon for popular restaurants to serve 1,000-calorie appetizers and 2,000-calorie entrées, with supersized portions that are high in carbohydrates and fats. No wonder it's so easy to gain weight—especially when diners don't, or can't, keep a close watch on exactly what they're eating.

Eat Smart

Want to dine out more healthfully? Here are some tips:

• Check the restaurant Web site for nutrition information before you go. Be aware of differing portion sizes, condiments, and other add-ons that may alter those numbers.

• Visit a calorie-counter Web site, like CalorieKing.com or MyFoodDiary.com. Many list information for specific restaurant items. Some sites are free; others require you to register for a fee.

• Don't forget your drink: Sodas, juices, and other beverages often contain a lot of sugar and calories.

• Ask your server or the person behind the counter for nutrition information if it's not posted.

• Find a few restaurants you enjoy that have healthy menu options. These may still be high in carbs but usually will be lower in fat than regular menu items. Examples include T.G.I. Friday's "Right Portion, Right Price" menu and Ruby Tuesday's "Smart Eating Choices." But remember: Just because a restaurant calls it healthy doesn't mean it is. Read the nutrition information carefully.

In New York City and a growing number of other places across the country, customers can find out exactly how many calories they're ordering in their Whopper, Big Mac, or soft taco, thanks to the spread of laws requiring chain restaurants to post calorie counts. And now, menu labeling may be moving to a bigger stage. Federal lawmakers, health advocates, and restaurant industry leaders agreed in June on language to be included in health care reform legislation taking shape in Congress. It would require any chain restaurant with 20 or more locations to post calorie counts on menus and menu boards, including at drive-throughs. In addition, there would be a clear notice that all the information that is currently listed on the nutrition facts label on packaged food, including the amount of carbohydrates, sodium, and saturated and trans fats per serving, is available on request at the restaurant.

Health advocates hope the menu-labeling requirements will be part of any health care reform package that emerges from Congress and is signed by President Barack Obama. Many health organizations, including the American Diabetes Association (ADA), have supported the menu-labeling agreement. ADA has made the issue a priority for years. "We've been advocating for it on a state-by-state basis [and in some cities]," says George Huntley, CPA, chair of the board of ADA. "Now you see national legislation coming about largely because of what the people in those cities, with ADA supporting them, did for their own population."

The Big Apple's Example

In New York City, calorie counts have appeared on chain-restaurant menus since 2008, making it one of the few places where the effect of menu labeling can be measured. According to online surveys conducted this February by Technomic Inc., a food industry consulting firm, 89 percent of New Yorkers support the city's new menu-labeling law. Ninety percent say restaurant dishes have more calories than they had realized—and 82 percent say the published calorie counts have had an impact on what they order.

Advocates argue that calorie and other information at restaurants should be just as accessible as the nutrition-facts labels that Americans have come to rely on. Unless such information is easy to see when ordering, they add, it will have little impact. "We think nutrition info has to be on the menu for it to be useful," says Margo G. Wootan, DSc, director of nutrition policy for CSPI. "You don't see Burger King putting prices of their items on a poster back by the bathroom. [And yet in many restaurants] you pretty much have to engage in a scavenger hunt to track [nutrition] information down."

A CSPI poll taken in 2006 at Washington, D.C., McDonald's locations found that 62 percent of patrons had to ask two or more employees before they could get nutrition information. Many other restaurants offer such information only on the Internet, or on tray liners or food packaging that consumers see only after buying food. What information is available is often listed for different serving sizes than the ones actually used at the restaurant, say labeling advocates.

This press for more information comes at a time when lawmakers and the Obama administration are touting better prevention as a key way to reduce the nation's $2 trillion annual health care bill—75 percent of which is spent treating chronic diseases. Diabetes alone cost the United States $174 billion in 2007 in direct and indirect medical costs, according to ADA. Making it easier for Americans to eat more healthfully could help stem an obesity epidemic that is driving the rate of type 2 diabetes higher—and, from the government's point of view, it would be relatively inexpensive. "This is seen by legislators as something that's not going to cost them.… It doesn't require a whole new staffing structure or government expenditures," says Stephen Habbe, ADA advocacy director for the northeastern states. "They're struggling with enormous medical costs, so if someone has a low- or no-cost solution that could have a meaningful impact, then, boy, it attracts attention."

Dining With Diabetes

Menu labeling could also be a big help to people with diabetes. Not knowing how many carbohydrates or calories are in a dish makes it hard for people with diabetes to make healthful choices about eating. In particular, people taking insulin injections need to know carbohydrate content to calculate a mealtime dosage.

Kay Mullin, RD, CDE, says her patients at Maine Medical Partners Endocrine and Diabetes Center in Scarborough, Maine, frequently struggle with eating nutritiously at restaurants. Mullin, a registered dietitian, recalls one couple for whom splitting a small order of fried mozzarella sticks was more than they had bargained for. "Their blood sugars were quite high for up to 12 hours afterward because of all the fat and hidden carbohydrate in the meal," she says.

Mullin is one of the experts ADA has enlisted to push for calorie counts on restaurant menus. This spring, she testified before a state legislative subcommittee in support of a Maine menu-labeling bill, explaining in particular how the legislation would help people with diabetes. The Center for Science in the Public Interest had first lobbied Maine state legislators on the issue in 2003; it was not until this June that Maine's governor signed a bill into law, to take effect in 2011.

Gaining Momentum

In general, state and local efforts to enact menu-labeling laws were slow at first to attract support. But since the New York City law was passed in 2006, advocates say, menu labeling has rapidly gathered steam. As of this August, menu-labeling laws had taken effect in four local jurisdictions—New York City; Westchester County, N.Y.; King County, Wash. (Seattle); and Multnomah County, Ore. (Portland)—and measures have passed in the states of California, Maine, Massachusetts, and Oregon, as well as in a number of localities. In November 2008, Philadelphia gave the nod to the most far-reaching menu-labeling law in the nation, which is set to go into effect in January. Not only will the city's chain restaurants be required to list calorie counts on menu boards, but they'll also have to detail carbohydrate, saturated fat, trans fat, and sodium content on the printed menus. (If passed, federal legislation would override state or local laws.) Whether Congress will approve federal menu-labeling legislation this year was unclear at press time. But support for requiring calorie counts seems unlikely to diminish, and some restaurants are taking the initiative to include nutrition facts on their menus. The result should be more healthful eating—and maybe a healthier America.

Food Sense

Think you know the nutritional value of your favorite fast foods? Here are a few menu favorites that might surprise you. Try to pick which option has fewer calories:

Burger King Tendercrisp Sandwich


Burger King Whopper

Tendercrisp: 800 calories
Whopper: 670 calories

McDonald's Large TripleThick Chocolate Shake


Two McDonald's Big Macs

Shake: 1,160 calories
Two Big Macs: 1,080 calories

Subway 6-inch Big Philly Cheesesteak


Subway 6-inch Chicken & Bacon Ranch

Cheesesteak: 520 calories
Chicken: 570 calories



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