Challenging Dogma - Fall 2007

...Using the social and behavioral sciences to improve the practice of public health.

Monday, December 10, 2007

Banning Trans Fatty Acids: A Flawed Public Health Approach with Social, Economic, and Health Consequences- Katie Jahreis

In December 2006 the New York City Board of Health voted to limit the use of trans fatty acids (trans fats) in restaurants throughout the city. This proposal gave restaurants six months to change from using trans fatty cooking and frying oils to those which have less than 0.5 grams of trans fat per serving (1). Trans fats are used in restaurants, bakeries, and other food production areas because they have a long shelf life, are stable in deep frying foods, and give a sweeter taste to baked goods (2). Supporters of the initiative to ban trans fats in restaurants and bakeries argue that the fats, which are in so many restaurants foods, are harmful to an individual’s health because not only do they raise a person’s LDL (“bad”) cholesterol, but they also lower a person’s HDL (“good”) cholesterol (3). The New York City Board of Health made this decision to ban trans fats in restaurants and bakeries because as well as being harmful to an individual’s cholesterol, these harmful fats also contribute to heart disease and the nation’s growing obesity epidemic (3).
While removing harmful fats from a person’s diet is important, the New York City Board of Health uses a power coercive approach in this initiative, which has many flaws to it. A power coercive approach uses political and economic authority to exercise power in a situation (4). While a power coercive approach may be appropriate in some situations, there are many times in which this type of method has the ability to divide those in power against society (4). The approach to ban trans fats in New York City has in theory, many advantages because trans fats are so harmful to an individual’s health. However, in reality many problems with the initiative arise though because in using a power coercive approach to completely ban trans fats takes away the public’s choice when they are dining out. One example of public health initiative that successfully uses a power coercive method is the initiative to enact seatbelt laws in certain states. It has been shown that using a seatbelt can reduce serious injury and death due to motor vehicle accidents by as much as 30 to 50 percent (5). It is clear that using seatbelts can greatly lower the chance of injury or death in an accident, so it should be mandated that when driving in a motor vehicle a seatbelt is worn. However, this approach is not appropriate when considering the elimination of trans fats because by implementing this policy, the New York Board of Health has failed to recognize that there are many potential economic and social barriers to the trans fat ban which should be addressed prior to implementing a complete ban (19).
Economic Impact
One factor that seems to have been overlooked by the New York Board of Health is the economic impact that the trans fat ban will have, not only on the restaurants or bakeries, but for the consumer as well. So many restaurants and bakeries use cooking and frying oils that contain trans fats because of their long shelf life. The restaurants are able to purchase large quantities of the oil without fear that it will go bad if not used quickly enough. With the change in cooking oil, restaurants are now forced to purchase more expensive oils which have the potential to spoil more quickly than before. This economic impact does not just affect the restaurants. The American Council on Science and Health reports that farmers are now being forced to look at the type of soybeans they are growing. These farmers will now have to grow a different type of soybean which provides more stability without being partially hydrogenated (6). This means that the farmers will have to replace hundreds of acres of soybean crops with the new more stable crop. This comes at a heavy price to farmers, with the amount of time and money they must spend on equipment, supplies, and labor that is involved in planting and growing this new crop so that healthier oil can be made.
Because of the increased costs of producing the oil, these costs will be passes on to the restaurants buying this cooking oil. While large chain restaurants such as McDonald’s may be able to afford to quickly throw out their harmful oils and replace them with a healthier alternative, this is not the case for all restaurants. There are many small restaurants and bakeries in New York City that are not chains, but are individually owned. The New York City Board of Health may have looked at the economic impact on large chain restaurants but it appears that they did not analyze what financial effects there would be on these small “mom and pop” restaurants and bakeries. Not only will they have to rid themselves of their old and possibly unused oil, but they will be forced to buy the new kinds of oil which are grown from low-linolenic soybeans that do not require partial hydrogenation in making the oil (7). With the added cost of supplies, small restaurants are going to struggle to stay in business. If they are successful in staying in business, they must find some way to deflect extra costs, which is where the consumer comes into the picture.
When there is a greater cost in the production of a product, it is fairly certain that the party that will be hit the hardest by this is the consumer. When analyzing crude oil prices, we can see that when the price of crude oil goes up, the price for consumers can sky rocket, which is very similar to the food service industry. Due to the increase in the cost of producing low-linolenic soybeans, which will be passed onto the restaurants, these restaurants will now have to find ways to deflect those costs and turn a profit. One logical thing for them to do is to raise the prices of their food, forcing the cost increase onto the consumer. Once these new costs are forced upon consumers, how many of them will still be able to purchase food at some of these restaurants? The smaller “mom and pop” restaurants hit the hardest by the trans fat ban, are the ones who will have to increase their prices the most to stay in business. It will be increasingly difficult for the average consumer to continue going to their neighborhood restaurant or bakery without eventually feeling the burden of the cost increase. As stated above, we have seen this happen with the rising crude oil prices, which in turn have raised prices in many goods from gasoline to food, due to the high cost of transporting goods (8).
Regulation of Harmful Saturated Fat and Unhealthy Portion Sizes
All restaurants in New York City must adhere to the deadline of July 1, 2008 to remove anything more than 0.5 grams of trans fat per serving from their foods (1). With the help of the American Heart Association, the New York Board of Health has received a grant to launch a Trans Fat Help Center. This support center will include a hotline that can be called for clarity of the regulation, a website, and classes for restaurant owners and operators to instruct them in removing trans fats from their foods and replacing them with better fats (9). In addition to helping restaurant operators by answering questions on phasing out trans fats, the Board of Health will be strictly inspecting restaurants for oils that contain more than the allowed amount of trans fats per serving. If restaurants are found not to be in compliance with the policy, they will be issued fines starting at $200 to encourage them to follow the guidelines (10). Although it is clear that restaurants will be closely monitored for any trans fats, there are other harmful fats in other cooking oils that are not going to be regulated by the Board of Health.
Trans fats are not the only harmful fats that are in many people’s diets. People still eat more saturated fat than trans fat, which needs to be reduced in order to help balance cholesterol and encourage heart health (11). A diet that is heavy in saturated fats can be a significant cause of high cholesterol and heart disease (12). Some of the main sources of saturated fat in a diet include red meat, eggs, cheese, pork, butter, cream, and whole and two percent milk. Limiting or reducing of these types of foods can have a positive impact on an individual’s cholesterol. Trans fat is only part of a person’s diet that can have a negative effect on their health. Given that Americans are still eating more saturated fat than trans fat, and both need to be reduced in order to improve health (12). These saturated fats are not regulated by the Board of Health in regards to the restaurant business. In addition, it has been recommended by the Board of Health that restaurants should change to oils such as palm (9), which contains large amounts of saturated fats. Essentially, restaurants will be replacing harmful trans fats with harmful saturated fats. Due to the fact that saturated fats can be found in such a wide range of foods, they are readily available to the public. Even if trans fats are eliminated completely from a person’s diet, a person will still able to go to a restaurant and consume foods that contain high amounts of saturated fat. Additionally, trans fats will still be available in settings such as grocery stores. Due to the fact that saturated fats are not regulated by the Board of Health and so they will continue to be available to consumers and they will continue to have a negative effect on health.
In addition to the large amounts of saturated fats that people are eating, the portion sizes which are served in many restaurants are astronomical. Just as saturated fats have no regulation, there is also no regulation on restaurant portion sizes. Many of the top fast food chains feature a “super-sized” menu, which has increased in popularity in recent years. It is estimated that items available at most fast food restaurants are at least two to five times larger than they were twenty years ago (13). Because the public is so used to seeing such large portion sizes when dining out there is a skewed vision of what a “normal” portion size looks like. When asked during a study, the majority of chefs said they were serving “normal” portion sizes in their restaurants but it was discovered that the average restaurant served a 12 ounce steak or two to eight ounces of pasta in a dish. The recommended serving of pasta is one cup (or one ounce), while the recommended serving of meat is 5.5 ounces a day (14). Many of the restaurants serve such large portion sizes because the consumer feels like they are getting more for their money. It seems to be a good value when one gets more food for the same price, but the increased portion sizes have no value on one’s health. If there was more regulation on the portion sizes that restaurants are able to serve, it would greatly help the rising obesity epidemic in the United States. In addition, the Board of Health has stated that there must be no more than 0.5 grams of trans fats per serving in a given food (1). Since is no clarity in what a “portion size” is, it is possible that a dish that is four or five times the recommended serving size will still contain a significant amount of trans fats. There needs to be a standard definition whether the amount of trans fat is per serving, or for the whole dish.
Healthy Food Distribution
While trans fats will be banned in restaurants, they will still be available in many of the foods in grocery stores. In July 2003, the FDA issued a regulation which required food manufactures to change nutrition information to include the amount of trans fat per serving (15). However, many people with low socioeconomic status (SES) do not live in areas where there is a large distribution of healthy foods and thus, they may only have access to prepackaged foods containing trans fats.
Those who live in areas of low SES do not have the wide range of food availability as those in more affluent neighborhoods. Affluent areas have a higher concentration of grocers and organic stores, which provide plenty of fruits, vegetables, and healthy alternatives to processed and packaged foods. In areas of low SES there are more “convenience” type stores, which sell little produce but carry an abundance of inexpensive, high calorie, and low nutrient food (16). Many of the foods that these convenience stores sell to their consumers contain some level of trans fats, so not all trans fats can be completely eliminated from a person’s diet. While there have been many studies that show consuming produce helps to promote health, in areas of low SES, people will most likely shop at convenience stores since they are more easily accessible to them. In cities in particular where many people in lower SES areas rely on public transportation to get from one place to another, it is less likely that they are going to travel further out of their neighborhoods to buy expensive produce. It is unlikely that convenience stores in these neighborhoods will stock produce for consumers because of lack of space, consumer expectations of what they can buy in these stores, the need to compete against larger grocery chains which stock considerable amounts of produce (17).
The Future
Despite the fact that the trans fat ban appears on the surface to be a beneficial public health initiative, if the problems with e ban are not examined closely and remedied, there will be many complications in the future in regards to diet and nutrition. One of the first issues that must be resolved is the lack of regulation on other harmful fats. It can be argued that because Americans are eating more saturated fat than trans fat (11), it would make sense that there should be some sort of regulation on saturated fats in restaurants to get this problem under control. Additionally, portion sizes are another enormous problem in the United States, giving rise to the obesity epidemic in this country. With obesity on the rise, there are many more health problems occurring in the population. These issues will continue long after trans fats are completely banned if something is not done to correct them. Furthermore, an initiative should be implemented to provide lower SES areas with stores that sell healthier alternatives to processed and packaged foods. Unless changes are made and more regulations are put into place to make wholesome food available, the health of many Americans will continue on a downward spiral into high cholesterol, heart disease, and obesity.
Conclusion
While the New York City Board of Health attempted to affect a helpful initiative, it is not as effective as it could be. Many problems arise from the complete ban of trans fats because there are economic, social, and health factors that have not been taken into account when implementing this approach. The Board of Health needs to take a closer look at how the economic impact will not just affect the restaurants, but the consumers as well. In addition, there need to be more regulations put into place to not only closely control trans fats, but saturated fat and exceptionally large portion sizes. With these changes made to this initiative, it could prove to be a positive and useful approach to public health.
REFRENCES
1. Board of Health Votes to Phase out Artificial Trans Fat from New York City’s Restaurants. New York, NY: New York City Board of Health. http://www.nyc.gov/html/doh/html/pr2006/pr114-06.shtml
2. Okie, S. New York to Trans Fats: You're Out!. NEJM 2007; 356: 2017-2021.
3. What are Saturated Fatty Acids? Dallas, TX: The American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4582
4. Bennis, Warren G., Benne, Kenneth D., Chin, Robert, and Corey, Kenneth E. The planning of Change. Holt, Rinehart, and Winston Inc; 1961. 39-41.\
5. Wagenaar, A.C., Wiviott, M.B. Effects of Mandating Seatbelt Use: A Series of Surveys on Compliance in Michigan. Public Health Rep 1986; 101: 505-513.
6. Trans Fat Ban's Economic Impact, from Fries to Soybeans. New York, NY: American Council on Science and Health. http://www.acsh.org/healthissues/newsID.1489/healthissue_detail.asp
7. de Guzman, Dorris. Innovating Away from Trans Fats. Chemical Market Reporter 2005; 268: 23-24.
8. Blum, Justin, and Henderson, Nell. Higher Oil Prices Soon to Squeeze Consumers. Washington, DC: The Washington Post. http://www.washingtonpost.com/ac2/wp-dyn/A14485-2004Oct31?language=printer
9. Health Department Launches Trans Fat Help Center to Support Restaurants in Going Trans Fat Free. New York, NY: New York City Board of Health http://www.nyc.gov/html/doh/html/pr2007/pr022-07.shtml
10. 94% of Inspected Restaurants in Compliance with First Phase of Trans Fat Regulation. New York, NY: New York City Board of Health. http://www.nyc.gov/html/doh/html/pr2007/pr080-07.shtml
11. Ranskov, Uffe, The Questionable Role of Saturated and Polyunsaturated Fatty Acids in Cardiovascular Disease. J Clin Epidemiol 1998; 51:43-460.
12. Trans Fat Ban: Watch Saturated Fats and Calories Too. Somerville, MA: Medical News Today. http://www.medicalnewstoday.com/articles/59768.php
13. Ledikwe, Jenny H., Ello-Martin, Julia A., and Rolls, Barbara J. Portion Sizes and the Obesity Epidemic. The Journal of Nutrition 2005: 135: 905-909
14. Condrasky M, Ledikwe JH, Flood JE, Rolls BJ. Chefs' opinions of restaurant portion sizes. Obesity (Silver Spring) 2007: 15(8):2086-2094
15. FDA Acts to Provide Better Information to Consumers on Trans Fats. Rockville, MD: Food and Drug Administration. http://www.fda.gov/oc/initiatives/transfat/backgrounder.html
16. Chuang YC, Cubbin C, Ahn D., et al. Effects of neighborhood socioeconomic status and convenience store concentration on individual level smoking. J Epidemiol Community Health 2005; 5: 568-73
17. Latham, Jim, and Moffat, Tina. Determinants of Variation in Food Cost and Availability in Two Socioeconomically Contrasting Neighborhoods of Hamilton, Ontario, Canada. Health & Place 2007; 13: 273-287
18. Cassady, Diana, Jetter, Karen, Culp, Jennifer. Is Price a Barrier to Eating More Fruits and Vegetables for Low-Income Families?. Journal of the American Dietetic Association 2007; 11:1909-1915.

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