Healthy Menu Choices Act Case Study

In am writing in response to the Ontario Healthy Menu Choices Act that has become effective January 1, 2017. I would like to address some key concerns of whether this intervention will likely succeed in Toronto. In this letter, I will compare the pros and cons of the new regulations from both a behaviourlist and a social determinants of health perspective. The new legislation of requiring “restaurant chains” to provide customers with specific calorie information should be praised for providing consumers with the opportunity to make informed decision. This initiative provides a small step in decreasing rates of obesity, diabetes, hypertension and other related disease. To successfully decrease rates of these diseases in the population as a whole,

the next step would be to address key socio-economic risk factors. To improve the existing Act, additional labels (ie. traffic light colours) could be added in addition to the caloric label to better help consumer make healthy decisions.

We can use the concepts of behaviourism to better understand the human response to seeing a calorie label on a food menu. The behaviour model assumes that human behaviours are reflexes to environmental circumstances. Therefore, personality and learning occurs through a pattern of reinforcement with time as individuals make an active effort to adapt to the world around them. Using this theory, we can apply behaviour modification therapy to extinguish undesirable behaviour and replace it with desirable behaviour – to substitute high calorie unhealthy foods with lower calorie healthier options. This behaviour can be positively reinforced by those who eat in a social setting among those who care about their health. For example, at the end of the volleyball season, the University of Toronto Pharmacy girls team decided to celebrate their win at Milestone. We were all shocked to see the number of calories in each dish. I decided to have a burger with a side of garden salad without dressing instead of sweet potato fries to spare an extra 500 calories on top of a 1200 calorie burger. Many of us did the same, and we praised each other. As a result, the positive reinforcement from my teammates helped shape the choices I made and the future choices I will make next time we eat out. I have learned predictable patterns of reward (praise from my friends for making healthy choices) as well as punishment (judgement for making unhealthy choices). The goal for behaviour modification therapy is to establish good learned patterns, such as making healthy choices. Once learned, they will become difficult to extinguish (or “unlearn”)(1). However, making healthy choices depends on the kind of reinforcement provided by. Eight of the ten girls that night wanted to celebrate with a fishbowl cocktail, despite seeing the 400 calories that comes along with the drink. The negative reinforcement in reaction to the two girls not drinking succumbed them to peer pressure. In this situation, the desirable outcome of making a healthy choice was negatively reinforced, and the undesirable outcome was positively reinforced. Under the behaviourism model, calorie labeling could benefit some groups more than others. Those that order and eat alone may not receive any kind of reinforcement from their environment, but can be intrinsically motivated and self-rewarding or punishing. The behaviourist approach in analysing the Healthy Menu Choices Act states the importance of the kind of reinforcement response that is associated with making a meal choice based on not only it’s caloric value, but also other factors, such as the group of people and purpose of eating out.

The social determinants of health is another perspective we can use in analyzing the Healthy Menu Choices Act.

Research has shown that economic and other social factors are better predictor of health than individual behaviours or lifestyles (2). According to the McKeown hypothesis, many major improvements in population health was due to improving economic conditions (ie. improved nutrition, sanitation and social policies). Important determinants of health are upstream, such as those related to economic and social resources that promote living and working conditions, which result in healthy choices. These upstream determinants are mainly established through national economic, political and social welfare systems. Addressing obesity through regulations through a macro, top-down approach, such as law enforcement, is an effective way to make population changes. An important question to ask is: will this new policy help those who are at high risk of obesity-related diseases? The group of people associated with increased odds of obesity, coronary artery disease, hypertension, diabetes and dislipidaemia are those of a lower social economic position (SEP)(3). Studies have shown that when it comes to purchasing fast foods, calorie labeling benefits higher social economic position neighbour hoods significantly more than lower SEP neighbourhoods (4). People in lower SEP may not prioritize calories when they are making choices on a menu. They are looking to get the most out of their dollar. Therefore, calorie labeling may help those of higher SEP, who have the privilege to make informed decisions about their health. However, calorie labeling may not be as beneficial to those of lower SEP who are at greatest risk of obesity related

disease.

On average, Canadians eat out for 30% of their meals (5). The Healthy Menu Choices Act makes a good effort to help inform people about their choices, since consumers are poor at estimating the nutritional content of food (5). However, single changes rarely make dramatic impact. According to Firkin Chef Godfrey, calorie labeling has helped sales of some lower calorie menu items, but “unhealthy items are still selling like hotcakes” (5). Calorie labeling solely will not likely be successful at decreasing rates of obesity, diabetes, hypertension, etc. To truly improve population health and decrease rates of diseases, we must address the factors associated with low SEP such as: chronic stress, aboriginal status, income and place using a top-down approach (6, 7). The social determinants of health perspective is more useful in determining whether calorie labeling will be successful at decreasing rates of obesity-related diseases. It emphasizes the upstream approach needed to create sustainable change and places importance on the people who are most at risk. The behaviourist perspective oversimplifies the complexity of public health, in which the social determinants of health addresses. The behaviourism perspective may hold value to certain groups of people, under conditional circumstances, assuming everyone makes an active effort.

To maximize the success of this calorie labeling, an important amendment should be considered. An addition traffic light colour label indicating “healthy” menu items could help consumers make better choices, since calories are not the only important nutritional factor. To put in perspective, Boston Pizza’s Cobb grilled chicken salad has the same number of calories as one full container of Ben and Jerry’s ice cream. By soley examining calories, consumers are neglecting other important factors of what makes foods healthy. The Healthy Menu Choice Act should to encourage consumers to choose nutritious foods with high fibre, lean protein, healthy fats, vitamins and minerals etc., rather empty calorie foods. I hope you take this amendment into consideration, as well as the suggestions about address the key social determinants of health.