00:11:16.140And a bunch of the policy white papers and a bunch of the popular media reporting on this were all like, you know, it takes 3,500 calories cut from your diet to lose a pound of fat.
00:11:30.060All of the research that I read in preparation for this episode, all of the analysis, all of the everything would just go from fat people are a huge problem. We have too many of them. They cost too much. People are going to die because they're so fat. And then the next paragraph is just like, we have to label calories on menus. And I'm like, wait, wait, wait, wait, wait, wait, wait.
00:11:49.580Like, you haven't established that people actually don't have enough information.
00:11:53.500You haven't established that people avail themselves of that information and then make
00:17:45.920in addressing the country's obesity epidemic, he says.0.75
00:17:48.940This whole policy is built on the idea of calories in calories out, which, as we discussed last time, is way the fuck more complicated than anybody wants to think that it is, right? The idea is if you cut 3,500 calories from your diet, you will lose one pound. That's not true. But if you apply that totally outmoded and debunked rule that a lot of people believe, if you're cutting 50 fewer calories each day, you're eating 50 fewer calories each day, you would lose one pound in
00:18:18.920two and a half months every 70 days and what we know is that your metabolism downshifts over time
00:18:24.680and burns fewer and fewer calories so one pound in two and a half months is the most weight someone
00:18:29.940would lose right and it would decrease significantly over time right so what we're talking about here
00:18:35.540functionally is like two to five pounds in a year also one of the things that always bugs me about
00:18:41.300these little nudge things is that you could easily argue that the thing that's affecting people's
00:18:45.620behavior is the novelty of the calorie labels right that the first time you notice it you're
00:18:50.720like oh a big mag is 580 calories i'm not going to get that today or whatever and then you change
00:18:54.900but then once they've been on the menu for a while it's just part of the background it's just
00:18:59.380another thing that you ignore like i think of remember when twitter added that thing that's
00:19:04.060like do you want to read the article before you retweet this and at first you're like oh maybe i
00:19:09.400should read the article but then i was thinking about now i don't even like notice that little
00:19:14.180bar anymore this was on my list in my notes for this episode was i was like no one has actually
00:19:19.700tested in political world you would call it the durability of the message no one's tested the
00:19:25.340longevity of the message like the first time you see it it probably makes a big impact right six
00:19:31.660months from then what's the impact it creates five years from then what's the impact that it creates
00:19:36.920right so this guy scott gottlieb the fda commissioner in this same news media piece
00:19:44.920he says well you know i really like to go to mcdonald's every once in a while and i've
00:19:49.760actually switched from an egg mcmuffin because of this calorie labeling i've switched from an
00:19:54.600egg mcmuffin to an egg white delight okay scott the article to its credit immediately goes that's
00:20:01.560a 20 calorie difference. Yeah. The difference is, is there a yolk in the egg or is there not a
00:20:08.260yolk in the egg? If he made that change every single day, it would take him almost six months
00:20:13.360to lose one pound. Right. But still, the message of so many of the media pieces at the time are
00:20:20.140like, this is one of the greatest tools public health has. Right. So I think it's worth noting
00:20:26.720that the primary supporter of this sort of federal policy was the center for science in the public
00:20:32.260interest which we have talked about before on the show complicated feelings complicated feelings
00:20:37.800real bummer in this particular case i went to their resource page and read all of the resources
00:20:42.160that i could find they included like polling data on the popularity of calorie counts i will say
00:20:48.340that part was really fascinating quite a bit of the media was like these are very popular and
00:20:52.840consumers are clamoring for more calorie counts on menus. Most of the popularity rates were in
00:20:58.220the thirties and forties. Yeah. That's not like a resounding endorsement. It sounds like a
00:21:02.900resounding meh to me. The other thing that I will say is the crosstabs on it are totally fascinating
00:21:10.280and that the support is highest amongst highest income households. Ah, see? Yeah, that's
00:21:16.220interesting. Functionally, as this stuff plays out, you're like, man, the people who are most
00:21:20.020invested in are people who make like more than 100 grand a year. I mean, no offense to Scott
00:21:23.800Gottlieb. But if you're running the FDA, you're probably like an educated guy. You're probably
00:21:27.820a wealthy guy. Yes, your statistical life expectancy if you're Scott Gottlieb is probably
00:21:32.920like 84. Those really aren't the people who like we need to really worry about their mortality
00:21:38.120rates. Ditto for federal policymakers working on the hill. Right. I mean, I think the other thing
00:21:43.800that I wanted to talk about here, which I find really fascinating is the lead sponsors of the
00:21:50.420menu labeling stuff are overwhelmingly Democrats. So it's interesting that this is also sort of like
00:21:56.660a policy that's being pursued without any real science behind it at the same time that Democrats
00:22:01.760are developing this identity around like we're the party of science. There's something very
00:22:06.120unscientific about acting as if providing people information will change their behavior in any
00:22:11.940meaningful way it is also like deeply condescending i think regard like i don't think people mean it
00:22:17.120to be but the idea is like oh hey you just don't know enough right it's not it's not that you're
00:22:24.060making choices for yourself it's not that you know where to get information right it's a very
00:22:29.140enlightenment era kind of approach and again what we know from political research is that those
00:22:35.420kinds of facts and figures don't actually change people's behaviors it's also interesting that
00:22:39.940anti-fatness really does span the ideological spectrum and yet republicans have no interest
00:22:45.400to actually do anything about it which is interesting yes totally like they want to be
00:22:49.700able to make fun of fat people but they don't actually want to do anything to solve the quote
00:22:54.320unquote obesity epidemic but then it seems like the democrats also sort of subtly make the same
00:23:00.700point in that they want these like technological fixes it's like i want something easy i want
00:23:05.720something where like nobody has to make any sacrifices and nobody has to like ask poor
00:23:09.980people what they need. Nobody has to increase welfare. It's like we're going to do this one
00:23:14.580weird trick and then everybody's going to lose weight. I think on this issue, honestly, and I
00:23:19.240feel like I will be struck down for saying this, I would prefer doing nothing. I agree. And I'm
00:23:24.660doing the opposite of striking you down. I'm balling you up. So I looked at a handful of0.90
00:23:32.740meta-analyses on this topic that one of them, so we'll talk about a 2014 literature review that
00:23:39.860looked at 39 studies on this that happened between 2008 and 2013. And then we'll talk about
00:23:46.940one from 2021 that looked at a cohort study of 59 restaurant chains, right? Here is a quote from
00:23:55.280the findings of that 2014 literature review. It says, we find that while there are some
00:24:01.880positive results reported from studies examining the effects of calorie labeling overall the best
00:24:07.200design studies show that calorie labels do not have the desired effect in reducing total calories
00:24:13.440ordered at the population level moving forward researchers should consider novel more effective
00:24:18.580ways of presenting nutrition information while keeping a focus on particular subgroups that may
00:24:24.160be differently impacted by nutritional policies so basically they don't work and in the future
00:24:30.420try to think of what you actually want to achieve with the policy and for whom and like do that
00:24:35.680instead before you pass a bunch of policies. Well, not only that, they're saying this policy
00:24:40.440of providing more information doesn't work. So in the future, you should find more exciting ways to
00:24:45.200present more information. Oh, God. Okay. So very clearly, we looked at 39 studies. This doesn't
00:24:53.020have an effect. The result here is not we should probably give up on these policies. The result
00:24:58.700here is make it more fun when you present the calorie information yeah that's dark it's dark
00:25:04.360dude that's like the president's physical fitness research where it's like this hasn't worked
00:25:09.640forever but it might totally it's dark right and on top of all of this like what we talked about
00:25:17.320last time is there is a dramatic difference between the number of calories in a food and
00:25:23.020the number of calories that your body can put to use. So also all of these calorie labels are
00:25:28.720deeply misleading, right? And unless you're getting the exact same size of scoop of chicken
00:25:35.460at one Chipotle as another, you're not necessarily actually getting actionable information about the
00:25:41.560number of calories. Well, this is my thing is that restaurant portions differ fairly significantly,
00:25:47.820right? I mean, maybe if you're eating it somewhere that's like super duper regimented
00:25:52.100and everything's in like a fucking little sous vide pouch or something, then it would be0.96
00:25:55.160standardized. But oftentimes, if we're talking about like, I don't know, fettuccine Alfredo or0.98
00:25:59.300something, they're just like grabbing a thing of fettuccine and like a of Alfredo, you know,
00:26:04.900it might say like 800 calories on the thing, but it might be like 900, or it might be 700.
00:26:09.620If what we're talking about is like people choosing 50 calories less a day, the margins are so small
00:26:16.280here. And the differences are so big. Like, I think people are deeply in denial about the fact
00:26:20.520that you just don't know how many calories people are eating. Right. And like the difference in
00:26:25.920calories of like this idea of cutting 20 or 50 calories, like 20 or 50 calories is like a
00:26:31.240tablespoon or two of sour cream at Chipotle or whatever. You know what I mean? It takes so
00:26:36.160little to correct for even the big claims of quote unquote success that are coming with calorie menu
00:26:44.460labeling. So over time, the sort of arguments around menu labeling started to shift in subtle
00:26:52.700ways that I think most people didn't track particularly closely. Initially, it was sort
00:26:57.760of like, we'll provide more information. Consumers will make more and different and better decisions.
00:27:03.640And by better, in this case, we mean less caloric. And over time, that shifted to actually,
00:27:09.000this is going to provide pressure from consumers onto businesses and then the businesses will have
00:27:14.880to offer less caloric things right i remember at the time a lot of talk of when starbucks had to
00:27:23.180start menu labeling in new york city they switched their lattes or something from whole milk to two
00:27:30.060percent milk yep that was like the little parable that went around that it's like ah once you force
00:27:34.900them to disclose how many calories they'll change how many calories are in it. Right. It's sort of
00:27:40.040transformed after its passage into like corporate responsibility. And you're like, well, that's not
00:27:45.100what it was before. Yeah. Okay. So that idea was explored in a 2021 cohort study that came out of
00:27:52.480Harvard School of Public Health, another frequent flyer on maintenance. Friend of the pod. They
00:27:59.080did this large cohort study looking at 59 restaurant chains. So this is a quote from
00:28:05.240the findings of that cohort study out of Harvard. It says this cohort study comprising 59 large
00:28:11.440restaurant chains followed up from 2012 to 2019 found that restaurants did not change the calorie
00:28:17.260content of continuously offered items. However, new items introduced after calorie labeling had
00:28:23.160a mean of 113 fewer calories, approximately 25%, compared with new items introduced before
00:28:30.880labeling a statistically significant reduction.
00:28:34.360So it didn't affect anything on the foods that have been on the menu, but when they
00:28:39.080introduced new stuff, they have 25% fewer calories.
00:28:43.440If you believe that people need to cut calories, this sounds pretty good, right?
00:28:47.840It sounds like this is sort of like doing what it's designed to do.
00:28:50.28025% reduction in calories sounds pretty good.
00:28:52.720We're on our way team. Yeah. No, Michael, we're not on our way. So this is one of the first
00:28:59.900large scale studies that has looked in a real way at like, how does this actually impact folks
00:29:06.060calories consumed? Because that's what it was ostensibly aimed at. And what it found is on an
00:29:11.580individual level, it doesn't change people's behavior. And on a corporate level, when you
00:29:16.140drill down into their actual findings section, they did find that there was a decrease in
00:29:22.540calories, this 25% decrease in calories. So 113 fewer calories per new menu item. So anything that
00:29:28.920was introduced that was new, that was only true at fast food chains. Okay. In sit down chains. So
00:29:36.100like Applebee's, Olive Garden, whatever, and coffee places like Starbucks, those places had
00:29:43.500pretty statistically insignificant decreases in calories per menu item. It went down like 15
00:29:49.280calories to 17 calories is the range that they offer okay so like you have a whole meal at
00:29:55.240applebee's black angus think about how big that meal would be think about how caloric it would
00:29:59.740be now imagine that it has 16 fewer calories right now i want a baked potato and in fast
00:30:06.240casual chains places like chipotle or panera or qdoba the calories actually went up on new menu
00:30:14.420items. Oh. So they're saying, oh, we put this policy into place. And now when they add new
00:30:19.300menu items, they have fewer calories. That's only true of fast food places. Every other kind
00:30:24.540of establishment that is governed by this policy either had their calories stay the same or go up.
00:30:30.860But also to know what to make of this, you would have to know how much of their sales are made up
00:30:37.160of new items. Yeah, absolutely. I have no idea, but I feel like most people that go to McDonald's
00:30:41.580probably get like a quarter pound or a big mac or something fries milkshake something like fairly
00:30:46.440standard it's actually a pretty big deal that like it doesn't it doesn't affect their continuously
00:30:53.420offered items totally also isn't i mean 2012 to 2019 has also appeared where there's just a lot of
00:30:59.620like wellness diet stuff happening there's been a trend especially among fast food corporations
00:31:06.180to have like more healthy menu items so to say that this is all due to menu labeling also seems
00:31:12.760a little bit superficial oh michael oh did i predict it did i spoil it i love it when you
00:31:18.380cue up a quote so this is like a slightly longer quote this is from eater the website eater did a
00:31:26.980roundup on like here is sort of the impact of these policies and here is there they did a great
00:31:33.900little summary so here's michael here's what we know it says it's true the average american's
00:31:39.360calorie consumption has overall gone down since 2003 though there's no clear evidence that shift
00:31:44.720has been directly linked to calorie counts on menus in 2015 researchers at nyu reported that
00:31:50.360while diners changed their ordering patterns in the short term over the years the percentage of
00:31:55.300respondents noticing and using the information declined and that overall there were no statistically
00:32:00.660significant changes over time in levels of calories or other nutrients purchased or in
00:32:05.880the frequency of visits to fast food restaurants. Also, even if calorie consumption has fallen
00:32:11.080nearly 15 years after the implementation of the first laws, obesity rates around the country
00:32:16.240have continued to increase. So people paid attention for a little while. It didn't change
00:32:21.720their behavior. And no one is less fat. So in other words, we did it. Nailed it. And there's
00:32:28.900another quote also from that Harvard study where they say, quote, analyses revealed a long-term
00:32:34.760decrease about 17 calories per year in the calorie content of items removed from restaurant menus
00:32:40.700that began before labeling implementation. Labeling was not associated with additional
00:32:46.620changes independent of this secular trend. So well before menu labeling, there was already a
00:32:54.520slight decrease happening in terms of calories offered on fast food and fast casual menus.
00:33:00.860Right. And these policies don't appear to have affected that trend one way or the other.
00:33:06.580It seems to continue in this like very shallow downward slope in calories. So basically this
00:33:14.380was already happening. And then we made a bunch of policies and the policies don't appear to have
00:33:18.520had an effect. I do think that it's telling that I don't know if there's menu labeling in America
00:33:24.380i like i think i just either we have it and i've completely tuned it out or we don't have it we
00:33:31.640have it and you have completely tuned it out like the last time i went to panera were there were
00:33:37.320there numbers on the menu i mean i guess there were and i just completely edited them out yeah
00:33:41.880so despite all of this evidence in 2021 the uk introduces and proposes a policy
00:33:49.440to mandate calorie labeling on menus in restaurants and takeout places and coffee
00:33:56.680shops and all of that sort of stuff, right? Yes. And 400 people emailed us and were like,
00:34:01.320you should do an episode on it. So many people emailed us.
00:34:06.880Do you have a sense of like why the UK did this? Because there's this whole trend of like
00:34:11.840evidence-based policymaking and data-driven, ma-ma-ma. Did they say like, this is why we're
00:34:18.180doing this the interesting thing about this policy in the uk is that it's being presented
00:34:24.760in two separate frames one is combating the obesity epidemic right and the other interestingly0.99
00:34:32.240is as a covid strategy oh oh fuck off oh fuck off it is rich for the uk to be doing this1.00
00:34:43.400Oh, the reason why our COVID deaths were so high is fucking fat people.1.00
00:34:48.400Mr. Like having a party during lockdown.1.00
00:35:08.960When this study came out, because the regulations had already been passed, this study became heavily covered in the UK because I suspect many journalists just read the executive summary and didn't read the actual findings and saw, oh, there's a 25% decrease in the calories on new menu items.
00:42:14.640and also i would love it honestly even just if someone would check in with a fat person after
00:42:20.120that stuff happens which also doesn't happen everyone just falls silent and pretends like
00:42:24.700nothing happened which is i can't express a more isolating experience than being like publicly
00:42:31.120shamed or humiliated and having nobody say or do anything or even acknowledge that it happened that
00:42:37.020happened to me at one point i was reseated on a plane like absolutely no one said or did anything
00:42:41.440Oh, that's yeah, that's and it is the quickest way to feel like fully worthless as a person.
00:42:46.800The baller move in that situation is to like wait five minutes and then walk up to you and
00:42:50.860be like, excuse me, miss, I just keyed that guy's car.
00:42:55.900I'm just gonna come back in with a giant like, five very fancy shopping bags in each hand
00:43:02.860and what have one of them be a hat box and just be like big mistake.0.98
00:43:11.440that's what you reached for the julia roberts just the full julia roberts pretty woman
00:43:16.980i don't know why it would matter to the dude at chipotle that i went shopping
00:43:21.440this lady has shopping bags now but whatever i feel owned for some reason it's not clear to me
00:43:27.900why yeah i don't know why but like listen i handled it so like it just feels like there is
00:43:35.480a categorical disinterest in what if this isn't good? Right. Much less. What if there are people
00:43:42.220for whom this is like harmful to them? Right. You know, in the UK, they made some sort of
00:43:47.180placating kind of response in the policy where you can under the UK policy, you can go into a
00:43:52.680restaurant that has calories labeled on the menu and you can ask for a paper copy of a menu that
00:43:58.660doesn't have calorie labels on it. Oh, in like much smaller font and you have to like go out
00:44:03.780of your way to get it basically you have to go ask somebody so again if you think about going
00:44:07.740into like a chipotle or whatever where the menu is hanging on the wall right you then go up to the
00:44:14.040counter you ask someone for a copy of the menu that doesn't have calories on it right that doesn't
00:44:20.000change the social context around you right and it doesn't mean that that person with an eating
00:44:24.940disorder doesn't still see all of those calorie counts and still have a really hard time with it
00:44:29.620depending on the nature of their eating disorder depending on a lot of different things right
00:44:33.000So like, it just seems extremely wild to me that we're talking about eating disorders, which, you know, depending on who you ask and sort of the source of the numbers is up to one in five people will have an active eating disorder in their lifetime. That is not an insignificant number of people. Right. There is this sort of categorical disinterest in anything that seems to indicate that maybe this policy wouldn't be like universally helpful and good.
00:45:00.220There's also something – this is why it's so good you host a show with a thin person.
00:45:05.060Aubrey, this is the insights that I bring to the show.
00:45:09.240Because to me, those calorie counts are invisible.
00:45:13.600Because I'm not counting calories, I'm not dieting, and I'm not a fat person who gets scrutinized on the basis of those numbers.
00:45:20.040But then if you're somebody who had an eating disorder or has an eating disorder or a fat person who's afraid of getting comments from somebody else,
00:45:27.020those numbers are probably the most hyper visible part of the menu for you. And I think
00:45:31.680most of the people making these policies, I'm assuming, are approaching it like me and are
00:45:37.940like, oh, it's invisible and nobody even notices. But like to some people, those numbers are not
00:45:42.600invisible. Well, and it's just more information. What could that hurt? Yeah, there was a piece in
00:45:48.020Bloomberg writing up the UK change that said, quote, surveys suggest people underestimate how
00:45:53.340much they eat by up to 50% and also tend to underestimate how many calories certain foods
00:45:58.340contain. So information and transparency can hardly be a bad thing. The main argument here
00:46:04.760seems to be like, couldn't hurt. And then a bunch of people go, oh, it does hurt though. For me,
00:46:10.300it hurts. Is there another way we could do it? And they're like, nope, couldn't hurt.
00:46:13.380In order to get to that point, you already have to be kind of irrationally invested in a policy
00:46:17.960that had no data behind it and now has bad data behind it. If you're like, we can make it work
00:46:22.220for everyone i'm like but even when it quote unquote works it doesn't fucking work right it's0.84
00:46:26.900like look i know you hate this but on the other hand it's not achieving any of its goals have you0.87
00:46:35.260considered it's not looking for anyone else it makes people feel nothing or terrible well great
00:46:42.620i think one of the central dilemmas here too is that the quote unquote benefits of this policy0.91
00:46:48.160this weak shit about 113 fewer calories or whatever of new menu items, that's quantitative.0.93
00:46:54.300That's a number, right? And policymakers love numbers. They love pretending to be all data0.99
00:46:57.920driven. Like, I have no ideology. I'm just following the data. But then when you talk
00:47:01.760about something like this contributes to weight stigma, which I think it absolutely does. I see
00:47:06.840no scenario in which it makes weight stigma better. At best, it's neutral, right? I can't
00:47:11.600imagine a scenario in which it doesn't add to weight stigma. But that's really hard to quantify.
00:47:16.200oh yeah the the the harms of it either haven't been studied or they're so hard to quantify that
00:47:22.440you can't really put them in like a pros and cons column against like 113 fewer calories versus
00:47:27.640contributes to this inchoate thing called weight stigma that like kind of nobody really cares about
00:47:32.520anyway yeah yeah we don't create the research around it we don't fund the research around it
00:47:37.300and then we go oh you don't have any numbers too bad pack it in right right like that we just
00:47:41.740refuse to pay attention because it's not quantified and conveniently ignore the fact
00:47:47.640that collectively we refuse to quantify it. Right, right. You know, if you wanted to do
00:47:53.120food labeling stuff, there is a ton of stuff that we could do that would materially improve
00:47:58.100health outcomes for lots of people. For people who are hypertensive or dealing with heart disease,
00:48:04.240sometimes the recommendation that will come along with that is reducing salt intake.
00:48:08.040you could have a check mark that's like this is low sodium and approved right for low sodium
00:48:14.140consumption right or you could for diabetic people who need different levels of carbohydrates in
00:48:20.460different scenarios with different levels of fiber you could decide to come up with a labeling scheme
00:48:25.660that is designed to help people with diabetes the most common chronic illness in the u.s
00:48:31.160right navigate their foods and improve their health outcomes which would also drive down
00:48:35.080health care costs and all of the things that we say matter to us about reducing fatness, right?
00:48:40.540I think a great example is like, for people who have celiac, the only way that we really got
00:48:46.020reliable gluten labeling was when people thought gluten made you fat and a bunch of people stopped
00:48:50.320eating gluten as a functionally a diet, right? I guess it reveals the extent to which these labels
00:48:55.780are designed as weight loss tools. When it comes to actual health stuff, it seems like that's kind
00:49:01.940of functionally taking a backseat. It's totally about weight loss. And I don't feel like at all
00:49:07.080opposed to people having access to more food information. And for a lot of people, particularly
00:49:10.720disabled and chronically ill people, that's like really important information to have.
00:49:14.360That's not what these policies are doing, right? These are ways that we calm ourselves down,
00:49:18.400right? That like a bunch of our public conversation around fatness and weight loss and health
00:49:22.940is all about spinning us up and getting people way the fuck anxious about their own mortality
00:49:28.720and about policing other people's food choices and all that sort of stuff.
00:49:32.320And policies like this, which are not rooted in science,
00:49:35.140which don't create the effects that they say they do,