The food truck debate has re-ignited In London this past week, after last May the previous council narrowly voted down the proposal 8-6. Political momentum for the food trucks certainly seems stronger than it has been previously, and public support generally appears to be favourable. As far as the economic implications go, I will leave that debate to those with far more experience than I.
What about the health implications? The projected small scale of this project (eight food trucks were proposed at the previous vote) provides a tremendous opportunity for the City of London to be a trailblazer in the area of menu nutrition labelling.
The epidemic of obesity in our society, and the wide-ranging health consequences of obesity should not be news to any citizen. Obesity increases the risk of cancer and cardiovascular disease, and is now challenging smoking as the number one cause of premature preventable death. This is established fact. Dining out has been well-identified as a major contributor to obesity, both from higher-calorie meals at restaurants compared with homemade meals, as well as from a consistent underestimation of calories consumed when dining out. Over 60% of Canadians eat out at least once a week, and 7% eat out daily (1). It has been well established in the literature that providing diners easy access to nutritional information will lead them to make better choices. The World Health Organization (WHO) declared over ten years ago that better nutrition labelling could have a major impact on the burden of global obesity (2).
But does the public want this? And will it help? A study from 2013 in the Canadian Journal of Public Health showed that in a mock restaurant simulation where detailed nutritional information was provided, individuals who changed their order after seeing labels decreased their caloric intake by 200-500 calories. A menu labelling pilot project in Tacoma, Washington, found that 71% of customers had the seen the nutrition information, and 59% acted on it in some way (3). The largest study on this issue was done in New York, Boston and Philadelphia, using Starbucks locations. Among individuals who ordered more than 250 calories per transaction, there was a 26% reduction in calories ordered in the NYC labelling group compared to the Boston/Philly non-labelling group (4). Two recent Canadian surveys found that over 90% of Canadians support menu labelling in fast food restaurants, and that 86% of Canadians want nutrition information visible at the point of purchase (5,6). The two most common nutritional values that customers would request are calorie and sodium information (79% and 74%, respectively) (7).
There doesn’t seem to be much controversy as to whether menu labelling would improve health outcomes, so why don’t we see prominent menu labelling at every restaurant? Currently menu labelling is voluntarily across Canada, and done sparingly. The majority of large chains provide nutritional information hidden from view, which is known to be a barrier to customers incorporating it into their decision-making. Numerous private members’ bills have come forward both at the federal and provincial level advocating for mandatory menu labelling, but unfortunately there has been more debate than action. Bill 45 was introduced in November 2014 which would include mandatory menu labelling for chain restaurants with 20 or more locations (it is important to note that initiatives like Bill 45 have the full support of our local Health Unit). Like anything at the federal and provincial level, things are moving at a snail’s pace. Lobbyists with the Canadian Restaurant and Foodservices Association (CRFA) and the Ontario Restaurant Hotel and Motel Association (ORHMA) are not in favour of mandatory menu labelling, arguing they are providing the information through other means. The evidence in favour of mandatory menu labelling is very much in contrast to their opinions.
From a municipal level, I have been quite impressed with the work Toronto Public Health has done in this area. They created a comprehensive technical report in April 2013 that addresses all of the relevant issues to consider when implementing mandatory menu labelling within a municipality. They are quite clear that the jurisdiction for menu labelling can fall within any of the three levels of government. Implementing this magnitude of program in a city the size of Toronto is no small feat, and I understand that they continue to work towards their goal of mandatory labelling.
London is in a unique situation. Our size allows us to implement innovative programs on a smaller scale, and this food truck situation specifically will be on a very manageable scale.
My proposal would be this: Each food truck would be required as part of their city permit to post calorie and sodium content clearly on the menu for each item, on the front of the truck. They must also have pamphlets or brochures available with comprehensive nutritional information (calories plus 13 core nutrients). The owner/operator will not be required to have nutritional analysis done by an outside laboratory, but can simply calculate the nutritional content using an easy-to-use program (e.g. MasterCook, etc.) to analyze the recipe. The truck will be required to have printed complete nutritional analysis available for inspection by the DineSafe program run by the Health Unit. The issue of penalties for non-compliance would be analogous to penalties for current inspection failures under the DineSafe program.
It’s as simple as that. The typical barriers that are argued by opponents of mandatory labelling are cost to the restauranteur for the new menus and the nutritional analysis. As new startups with the self-report analysis I have proposed, these barriers would not exist. What has been shown in a few studies is that mandatory labelling actually leads to the business improving their nutritional offerings as a means of attracting more customers.
This is by no means a comprehensive program, and some would argue a needless drop in the bucket of obesity management. But I think its primary value lies not solely in the nutritional value to the specific customers of the food trucks, but also by increasing the awareness of the need of this type of nutrition knowledge among our population. Our local Health Unit has come out in favour of measures like Bill 45, and this type of small project will make the path to passing that legislation smoother. Once successful, the next logical steps for the program could include mandatory labelling at all city-run food services including City Hall and Budweiser Gardens.
As the first municipality in Canada to implement a mandatory menu labelling program, London would be seen as an innovative pioneer in the area of public health, and I look forward to seeing this type of program take shape.
1. CBC News, July 10, 2012. Visa Canada Report. Retrieved November 1, 2012 from http://www.cbc.ca/news/health/story/2012/07/10/lunch-eat-out-survey.html?cmp=rss
2. World Health Organization. (2003). Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation. Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases. Geneva: World Health Organization
3. Pulos, E. & Leng, K. (2010). Evaluation of a voluntary menu-labeling program in full-service restaurants. American Journal of Public Health, 100(6), 1035-9
4. Bollinger, B., Leslie, P. & Sorensen, A. (2010). Calorie posting in chain restaurants. National Bureau of Economic Research, Working Paper 15648. Retrieved February 7, 2013, from http://www.nber.org/papers/w15648
5. Ipsos Reid, for Public Health Agency of Canada. (2011). Canadians’ Perceptions of, and Support for, Potential Measures to Prevent and Reduce Childhood Obesity, Final Report. Retrieved on February 7, 2013, from http://www.sportmatters.ca/files/Reports/Ipsos%20Obesity%202011.pdf
6. Canadian Obesity Network/Ipsos-Reid. (2012). What Do Canadians Know and Think About Calories?A National Survey, October 2011. Presented at Calories Count Symposium, October 25, 2012.
7. Scourboutakos, M. & L’Abbé, M. (2013). Restaurant Menu-Labelling Survey Results. Prepared for Toronto Public Health.