NEJM Perspective Article Discusses Obesity Prevention at the Local Level

A perspective article published in the May 9, 2013, issue of the New England Journal of Medicine (NEJM) urges local governments to consider supplementing the federal Affordable Care Act’s (ACA’s) menu-labeling provisions with their own laws designed to improve consumer responsiveness to the calorie listings and increase overall compliance among businesses. Sara Bleich and Lainie Rutkow, “Improving Obesity Prevention at the Local Level—Emerging Opportunities,” NEJM, May 2013. Noting that many local governments “have already begun engaging in innovative regulatory activity related to obesity prevention (e.g., pre-ACA local menu-labeling laws) and will continue to do so,” the authors propose several strategies for influencing consumer behavior through more robust menu-labeling requirements, such as “presenting consumers with calorie information in the form of a physical-activity equivalent (e.g., minutes of running required to burn off a particular food)” instead of a straight calorie count; “replacing the default fries and soda in a child’s meal with apple slices and low-fat milk”; or rearranging menus to list the lower-calorie items first. They also explain how local governments can work to close gaps in the ACA rules by requiring, for example, restaurants with fewer than 20 locations to comply with all menu-labeling provisions.

“Because it is estimated that the ACA provisions will affect less than half of U.S. restaurants—and restaurants with fewer than 20 locations will not necessarily volunteer to comply—state and local menu-labeling regulations remain important,” write Bleich and Rutkow, who nevertheless warn that a handful of states have already enacted laws against such localized actions, in part to avoid burdening the restaurant industry with a patchwork of inconsistent laws. “As they anticipate such concerns, localities should be mindful of the costs associated with menu labeling and… perhaps provide financial support or technical assistance for restaurants’ calculating of nutritional content and reprinting of menus and menu boards. State and local governments should also consider the scope of the first Amendment, which protects commercial speech and may limit the language that can be mandated in menu-labeling regulations.”