Banning Trans-Fats in New York City Restaurants: An Effective Approach to Combating Obesity? – Sarah Lim

Obesity and correlating health conditions are growing health issues for children and adults in the United States. Obesity is a cause and contributor to many diseases and conditions, including heart disease, diabetes and cancer. To address this growing problem, the government has begun to intervene by reforming school lunch programs, modifying the food pyramid, and now banning certain ingredients from being served in food service establishments.

In December 2006, the New York City Board of Health passed a law requiring restaurants to stop using trans-fats, which include among other things margarines, shortenings and fry oils. The goal of the ban was to reduce the prevalence of obesity, heart disease and heart attacks by reducing exposure to trans-fat, consumption of which is linked with these conditions. The guidelines set forth by the Board of Health directly targets food service establishments, forcing them to adhere to certain regulations by a set timeline. The regulations require that restaurants no longer use trans-fats in foods with a few exceptions, though they may sell foods containing trans-fats if the food remains in the original manufacturer’s packaging. While it is important that policy-makers are now recognizing trans-fat as a health risk, the Board of Health’s decision is a flawed intervention because its approach lacks a persuasive element, does not concurrently educate its target population on good nutrition, and suppresses the individual’s internal locus of control.

Persuasion: Lacking a Normative-Re-educative Approach

In banning trans-fats from restaurants, the New York City Board of Health implements only one strategy to reduce obesity when it would be more effective to use multiple strategies. In their chapter “General Strategies for Effective Change in Human Systems,” Chin and Benne offer a three-pronged approach that could effectively change an individual’s behavior if each element is used appropriately. They refer to these prongs as Power-Coercive, where a law is used to force a change in behavior, Normative-Re-educative where persuasion is used to change the social norms surrounding a behavior, and Rational-Empirical where education is used to teach a population about behaviors (1). The Board of Health takes only one of these three approaches: the Power-Coercive approach.

By enacting a law that forces restaurants to comply directly with the trans-fat ban and consumers to comply by default, the Board of Health aims to coerce the citizens of New York City into adopting healthier eating habits. The Power-Coercive approach alone is an effective way to reduce a population’s access to trans-fat laden foods but it fails to change an individual’s behavior and will not effectively accomplish the Board of Health’s overall goal of reducing obesity and heart disease in the population. Just as banning smoking from restaurants effectively reduces people’s exposure to second-hand smoke in public places but may not reduce the overall prevalence of smoking, restricting an individual’s access to trans-fats in restaurants will not ensure that he lowers his intake of trans-fats through food purchased elsewhere.

The Board of Health failed to add a persuasive element to their campaign. The ban does not utilize the Normative-Re-educative approach, which aims to change social norms and values on the individual level, engaging the targets of change. As Chin and Benne point out, “man must participate in his own re-education if he is to be re-educated at all” and this is best accomplished by helping individuals achieve a “clarification and reconstruction of values” (1). In banning trans-fats in New York City, the Board of Health may have chosen to target restaurants because they are easy to control, but as a result it has failed to reach those who constitute the principal targets of its campaign: the individuals at risk of developing heart disease and becoming obese.

Education: Lacking a Rational-Empirical Approach

The Board did not utilize the Rational-Empirical approach as described by Chin and Benne, in which individuals are educated as a means to behavior change. The Board failed to implement education addressing general nutritional knowledge, fad diets and the campaign’s misleading slogan, which is “Food will taste the same – but your heart will know the difference” (2). These are three key areas of knowledge without which individuals will not be equipped to understand the trans-fat ban.

Many people do not know the reasoning behind the trans-fat ban and some – particularly individuals who are young, immigrants, and of a low socioeconomic status – may not have received appropriate education about healthy eating. As Williams notes in his article on the socioeconomic disparities in health, “more educated persons are more aware of health risks and more likely to initiate actions to reduce these risks” and thus “education [has] pervasive effects on health apart from health knowledge” (3). Conversely, individuals of a lower socioeconomic status have less access to education and consequently often have poorer eating habits than those of a higher socioeconomic status. The Board’s ban perpetuates health disparities by failing to initiate an educational campaign to equalize basic health education. On the surface, banning trans-fats in restaurants throughout the city purports to reduce disparities by limiting individual’s access to this harmful ingredient, but only educated New Yorkers are likely to understand the reasoning behind the ban and apply that reasoning to their lives in a way that would effectively promote their health.

However, even New Yorkers privy to knowledge about general nutrition are at risk for misunderstanding the trans-fat ban, because the idea that omitting only trans-fats from one’s diet to eliminate the risk for heart disease has been communicated as a simple and quick fix. Fad diets with similar messages have caught the public’s attention due to the appeal of an easy method to become purportedly healthy. For example, the Atkins diet promises that the dieter will shed pounds with little effort, simply by eliminating all carbohydrates from his diet (4-5). For many years, the federal government promoted a low-fat, carbohydrate-rich diet, illustrated by the original food pyramid, as being the key to a healthy diet, yet there are many low-fat foods manufactured that are not necessarily healthier for their lack of fat (4-5). Successful advertisements for fad diets, food brands, and restaurants may mislead consumers to believe that unhealthy foods may be good nutritional choices with quick and easy results in weight or health (6). This sort of “quick fix” message is easy, appealing and exciting compared to the banal plea to “eat more fruits and vegetables.” Unfortunately, though they are easily marketable, these ideas and messages do not express reality, which is that, unless you exercise more, reduce overall caloric intake, and eat mostly plants, the risk of obesity and heart disease will not disappear (7). Education is necessary to correct these misconceptions and to make up for the absence of a Rational-Empirical approach.

Similar to the misleading messages of fad diets, the Board of Health’s message to consumers is a confusing one. The slogan of the trans-fat ban, “Food will taste the same – but your heart will know the difference” (2) is likely to cause the individual to believe that consuming any amount of trans-fat will cause heart disease, and that by omitting this ingredient from his diet, he eliminates his risk of heart disease. Similar messages, like food items labeled with ‘0 grams trans fat’ mislead consumers to believe that they can eat that food in unlimited quantities (8). Contrary to this misconception, a food product is not necessarily safe to eat with impunity simply because it is free of trans-fats. Indeed, the Board’s intervention lacks an educational approach that teaches about general nutrition and fad diets, and sends an unclear message to consumers.

Locus of Control: When an Individual Feels Powerless

Not only does New York City’s recent ban perpetuate health disparities and misconceptions about nutrition, it also damages an individual’s sense of ownership, responsibility and control over his own diet and health. Locus of control, a theory of psychology that recognizes the individual’s unconscious negotiation between the internal and external forces that shape his life, applies to the destructiveness of the Board of Health’s approach. An individual with a strong internal locus of control feels like he has the ability to guide his own life and can control health outcomes. For example, by eating healthfully and exercising, he has the power to maintain good health. On the other hand, an individual with a strong external locus of control feels like the outcomes of his life are determined by external forces like luck, fate, and powerful others (9). Locus of control theory is similar to Bandura’s notion of self-efficacy, in which an individual believes he has the ability to do something (10). This belief in turn affects how much time and effort an individual is willing put into a task (11-12). Unlike self-efficacy, however, locus of control is an unconscious decision that weighs responsibility, choice and control over life decisions of any size or consequence.

The New York City Board of Health’s effort to reduce obesity by banning trans-fats in restaurants is a flawed intervention because it limits an individual’s internal locus of control and enhances his external locus of control. If an individual believed that obesity were determined solely by genetics and not by lifestyle, then he might feel less compelled to eat healthfully and exercise regularly. Research in health psychology indicates that a high sense of efficacy and an internal locus of control is positively associated with health behaviors like eating well and exercising (9-13). Clearly, having a strong internal locus of control is an important factor in maintaining good health behaviors.

Unfortunately, the actions by the Board of Health lead to a strong external locus of control and send the message that health is not achieved through self-determination but through luck and fate (14). This message may lead some individuals to infer unconsciously that they have no real choice over what they eat and therefore no responsibility for what foods they consume. The ban may also lead some individuals to believe that they cannot control, choose or know what restaurants serve, which in turn leads to further questions about the extent to which self-determination influences good health.

Conclusion

The New York City Board of Health’s initiative to ban trans-fats from being served in restaurants is an important step in recognizing that a population can be shielded not only from health threats like lead and asbestos, but also from comestibles like trans-fats. However, intervening by forcing restaurants to comply with the trans-fat ban without persuading and educating the population to change their health behaviors is likely to be ineffective. Providing education on nutritional health and making the campaign’s slogan clearer will empower the individual and, once an individual understands how he can have power over his own health outcomes, ultimately enhance his internal locus of control. The Board’s intervention will be much more effective if it empowers consumers by engaging them in changing their own health behaviors.

References

(1) Chin R and Benne, KD. General Strategies for Effective Change in Human Systems (pp. 22-45). In Bennis, W et al. (eds.): The Planning of Change (3^rd edition). New York: Holt, Rinehart and Winston, 1976.

(2) The New York City Department of Health and Mental Hygiene. Board of Health Approves Regulation to Phase Out Artificial Trans Fats. New York: The New York City Department of Health and Mental Hygiene. http://www.nyc.gov/html/doh/html/cardio/cardio-transfat-healthcode.shtml.

(3) Williams, DR. Socioeconomic Differentials in Health: A Review and Redirection. Social Psychology Quarterly, June 1990; 53:2, 81-99.

(4) Taubes, G. What if It’s All Been a Big Fat Lie? The New York Times, 7 July 2002. http://query.nytimes.com/gst/fullpage.html?res=9F04E2D61F3EF934A35754C0A9649C8B63.

(5) Harvard School of Public Health. Food Pyramids. Boston, MA: Harvard School of Public Health. http://www.hsph.harvard.edu/nutritionsource/pyramids.html

(6) Nestle, M. Food Politics: How the Food Industry Influences Nutrition and Health. Berkeley: University of California Press, 2003.

(7) American Heart Association. ABCs of Preventing Heart Disease, Stroke, and Heart Attack. Dallas, TX: American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3035374

(8) Okie, S. New York to Trans Fats: You’re Out!. The New England Journal of Medicine, 17 May 2007; 365:20, 2017-2021.

(9) Holt, CL et al. Does Locus of Control Moderate Effects of Tailored Health Education Materials? Health Education Research: Theory and Practice 2000; 15:4, 393-403.

(10) Bandura, A. Self-efficacy in Changing Societies. New York: Cambridge University Press, 1995.

(11) Vourlekis, BS. Cognitive Theory for Social Work Practice (pp. 123-150). In Green, RR and Ephross, PH (eds.): Human Behavior Theory and Social Work Practice. New York: Aldine de Gruyter, 1991.

(12) Edberg, M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007.

(13) Schwarzer, R and Fuchs, R. Changing Risk Behaviors and Adopting Health Behaviors. In Bandura, A (ed.): Self-efficacy in Changing Societies. New York: Cambridge University Press, 1995.

(14) Hayes, D and Ross, CE. Concern with Appearance, Health Beliefs, and Eating Habits. Journal of Health and Social Behavior, June 1987; 28:2, 120-130.