Saturday, May 12, 2007

Deep thoughts about fat

Stephanie Ebbert writes in the Globe today about an effort in the Town of Brookline to ban the use of trans fats in restaurants and schools in the town. New York City has done this, and there is also a bill pending in the Massachusetts legislature to do this statewide.

I can understand why a municipality would want to vote on this kind of matter for school meals. After all, the town has a responsibility for the quality of food served in its buildings, and students don't have a choice of cafeterias when classes are in session.

But I guess I have a bit of a libertarian streak when it comes to the restaurants. I agree towns should have authority over cleanliness and food protection standards in restaurants (and smoking, too), but I am bothered by the idea that they would legislate what we are allowed to eat. For one thing, is it really the town's business? For another, even if it is, how and where do you draw the line?

Every few years we are told about something that is bad for us based on the latest scientific studies. If I recall properly, I remember this happening at various times with white flour, eggs, avocados, nuts, coffee, processed meats, red meat, pork, fish, shellfish, and chicken. It often feels like this advice is rescinded, or even reversed, after more studies are done.

I am reminded of one of my favorite movies, Sleeper, in which the Woody Allen character wakes up after a 200-year hibernation. His attending scientist caretakers have the following dialogue:

Scientist 1: This morning for breakfast he requested something called wheat germ, organic honey and tiger’s milk.

Scientist 2: [laughing] Oh, yes. Those were the charmed substances that some years ago were felt to contain life-preserving properties.

Scientist 1: [astonished] You mean there was no deep fat? No steak or cream pies or hot fudge?

Scientist 2: [shaking head gravely] Those were thought to be unhealthy, precisely the opposite of what we now know to be true.

Scientist 1: Incredible!


Anonymous said...

Trans fat bans are much more like a smoking ban than they are like, say, an avocado ban.

The primary use of trans fats is to improve profit, not to improve palatability. Restaurants in places like New York and many parts of Europe that have banned trans fats nonetheless manage to make very tasty (and often deliciously unhealthy) food. With the exception of a small amount of trans fats in cows and sheep (produced by bacteria in their stomachs), trans fats are industrial products created in order to make it cheaper and easier to produce food.

That means that trans fats and their use falls under the legitimate interest of government to regulate the potential bad effects of commerce (i.e., the way in which people may use the free market to enrich themselves at the expense of the well-being of society), not under the illegitimate desire to regulate culture. There is a reasonable amount of evidence to suggest that the gains in commerce which trans fats provide are coming at the expense of individuals' health.

A healthcare CEO who serves the community of Brookline should promote this legislation rather than oppose it.

Some reading:
A pithy summary from:
Nature Medicine - 12, 1339 (2006)
You'll never believe it, but...

0%: Intake of trans fats that is considered safe by the Institute of Medicine

5.8 grams: Estimated trans fats consumed by an average adult per day in the US

11 grams: Trans fats in a Double Quarter Pounder with Cheese, large fries and medium soft drink served at a US-based McDonald's

150,000: Average number of heart attacks that could be prevented each year in the US if trans fats were to be eliminated from the diet

$9,196: Estimated amount to treat a heart attack in the US in 2001.

61%: Proportion of New Yorkers in a Wall Street Journal poll who support a ban on trans fats in the city's restaurants

N. Engl. J. Med.; Wall St. J.; NY Times; Am. Heart J.
Mozaffarian, Dariush, et al. Trans fatty acids and cardiovascular disease. NEJM 354(April 13, 2006):1601-1613.

Anonymous said...

The article states: ... a year and a half to stop using trans fats for frying and two years to stop using them in baked goods. Packaged foods, which now list trans fats content on labels, would not be affected.

My take on this is that they want to make sure that people aren't being slipped trans fats without their knowledge. If it's on the label then people can decide for themselves. Much more difficult in a restaurant setting.

An alternative might be to require the restaurants follow the same guidelines as the packaged foods and clearly label the trans fats on the menu.

Patient Dave said...

IMHO, Anonymous #1 hit the nail on the head: a trans fat ban seems more like a smoking ban, with clear (and large) implications for public health.

Plus, I must say, once I saw the movie Supersize Me, it was hard to ignore the issue cited by Anonymous #1, that people sometimes use the free market to enrich themselves regardless of cost to society. It wasn't just the McDonald's info; his coverage of the school lunch industry was shocking and revealing.

I'm for regulation when it halts or stunts a clear and present danger.

Anonymous said...

I imagine trans fat is simply the food issue du jour, not to make a bad pun. There are numerous other chemicals and dyes used in food production (not to mention what is used to grow the stuff) about which one could initiate a political controversy. My somewhat cynical opinion is that between what's in our food, in the air, and in the water we drink, no epidemiologist could hope to sort out one dominant factor that we can "fix" to enhance our health. This year, trans fat. Next year, something else.

Paul Levy said...

Dear Anon 12:06,

While anonymity is certainly permitted on this blog, I wonder why you use it on a public policy issue like this. It undermines your imperative about how I "should" behave when you don't state who you are.

Dear patient dave,

A smoking ban in public places makes sense because it affects other people's enjoyment of the place and their health. It is a different story for this issue.

On your other point, the standard you set is so broad that you can't really mean it. Think about all the things you would legislate away that are bad for people.

Along those lines, Anon 9:13 raises a good point. What's the limit of legislation?

To all,
If trans fat is deemed unhealthy by safety regulators (not legislators), why don't THEY outlaw it for the whole country? Why is it the job of a municipal legislative body to do this, for this one substance, and not for so many others.

If the public as a whole cares about this, wouldn't you expect "good" restaurants to advertise the fact that they don't use the stuff, to get a market advantage?

Anonymous said...

As Anon 12:06pm, I'll respond: I post anonymously for a whole bunch of reasons, all of which have nothing to do with policy and everything to do with my other roles in the world besides posting responses to blogs. So I have to choose whether to participate anonymously in this policy discussion and others, which I think are interesting; or not participate. So, I apologize for the "should"; perhaps I'll replace it with "I hope that you reconsider your position." (And I promise that I am in no way personally involved with advancing this legislation or any similar legislation.)

I don't like public health measures that create too paternalistic a governing style, so it's not that I miss your point. But I think this is different. Given the near ubiquity of the use of trans fats in low-cost restaurants, labeling will not really give choice to many consumers. On the other hand, the relative cost to the individual consumer of the price increase of the new fat will be negligible, while the health effects may be potentially significant, especially if they are accompanied by additional pushes to get restaurants to reveal nutrition information. I think this is on the order of lots of restaurant regulations, many of which address far more negligible health risks than this one, and most of which are enacted and enforced on the local level.

In terms of safety regulators: leaving aside the local responsibility to regulate restaurants, it's the FDA who would do this, and perhaps they should, but in reality they won't. It would be a better outcome because it would affect poor states and cities that are unlikely to enact this kind of legislation; Brookline is one of the places in the world where it is not going to have a huge and dramatic effect in the way it would in, say, Kansas. So, while it would be a good thing for the FDA to do, it won't happen. It doesn't make sense to wait for health regulation from the federal government any more than it makes sense to wait for environmental leadership from the feds right now.

Finally, it's worth noting that the restaurant industry nominally agrees that trans fats should be eliminated (and doubtlessly recognizes the liability nightmare that is headed their way if they don't) but state that they disagree on pace and timing. So this isn't one of those cases where someone is out there defending our American right to eat trans fats in restaurants--they're defending their American right to phase them out slowly and voluntarily.

Again, sorry about the anonymity, but I promise it's really not in order to snipe, and the "should" wasn't meant as sniping either--sorry if it came off that way. I'm an avid and enthusiastic reader of this blog--I just happen to disagree with you on this issue.

Paul Levy said...

Thanks, Anon 12:06, for all the clarifications. I guess my underlying question is why here, why now? There are a gazillion regulatory and public health issues on which you could make similar arguments. Doesn't the Brookline town meeting have enough municipal issues (e.g., schools, police, fire, trash) on its docket that deserve the full attention by those elected to this legislative body? I guess you could suggest that even a symbolic act by a municipal government helps. But I have an underlying feeling that Anon 9:38 has it right.

Paul Levy said...

And, I'll apologize back for being overly snippy in my reply. Perhaps too sensitive when told where I should stand because of where I happen to sit during my day job . . .

Anonymous said...

I am anon 9:38. I just want to say that one of the reasons I enjoy reading this blog is the underlying tone of civility and respect exhibited by both the blogger and commenters. The exchange between Paul and anon 12:06 is an excellent example. I contrast this to so much of the rudeness and uninformed partisanship in society today (not to mention many of the other blogs I read). One can disagree, even passionately, and still remain respectful. So thanks to everyone and let's continue setting an example to those other savages! (:

Alexis said...

I avoid trans fats and I support smoking bans. That said, I'd much rather see more nutritional information available to restaurant consumers in general, at every cuisine level (though I realize it might be hard to figure some of that out). Even the "fast food" nutrition info is sometimes hard to find and menus are highly deceptive. I used to study at one "high end" coffee-bakery-food locale, but now that I've looked up their nutrition info online, I can't face another of their "healthy choice" options (because they're simply not).

There is some element of "who can afford to avoid trans fats" just as there's an element of "who can afford to buy organic" and "who can afford to exercise" in every food/health debate. In the end, if the data from trans fats studies pans out over time, the people who will be most hurt will be those who can't afford to go to restaurants that advertise their "trans-fat-free" status. Without having any good clear answer, I wonder: what is our public health responsibility to those people?

On the other hand, the cynic in me suspects that it's much easier to ban trans fats than it is to increase transparency in restuarant cuisine or make hugely progressive changes in the health-supporting environment of a municipality.

kb_ma said...

I'm a little late to this one, but since eating trans fats only hurts me - why not offer trans fat free foods and trans fat included foods? This is still the USA right? Personally I would not go to a restaurant that has banned all trans fat for fear of bland, boring food.