FOOD AND DRUG ADMINISTRATION AND

DEPARTMENT OF HEALTH AND HUMAN SERVICES,

# OFFICE OF ASSISTANT SECRETARY OF PLANNING AND EVALUATION

> \"EXPLORING THE LINK BETWEEN WEIGHT MANAGEMENT
>
> AND FOOD LABELS AND PACKAGING\"
>
> Thursday, November 20, 2003
>
> Lister Hill Audutorium
>
> National Institutes of Health
>
> Bethesda, Maryland
>
> \[TRANSCRIPT PREPARED FROM A TAPE RECORDING.\]
>
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>
> WELCOME 3
>
> OPENING REMARKS 12
>
> FRAME WORKSHOP AND CHARGE TO PARTICIPANTS 26
>
> \"CURRENT FDA FOOD LABELING POLICIES\" 30
>
> \"CONSUMER INTERFACE WITH THE FOOD LABEL\" 50
>
> \"FOOD INDUSTRY PERSPECTIVE ON CALORIE MODIFIED PRODUCTS AND FOOD
> LABELING\" 63
>
> \"HOW DOES NUTRITIONAL LABELING AFFECT CALORIC INTAKES?\" 80
>
> \"HOW PACKAGING UNKNOWINGLY INFLUENCES CONSUMPTION AND CALORIE
> INTAKE\" 97
>
> \"HOW DOES THE CURRENT LABEL AND PACKAGING HELP OR HINDER THOSE
> ENGAGED IN WEIGHT-LOSS PROGRAMS?\--FROM WEIGHT WATCHERS\" 119
>
> \"HOW DOES THE CURRENT LABEL AND PACKAGING HELP OR
>
> HINDER THOSE ENGAGED IN WEIGHT-LOSS PROGRAMS?\--FROM
>
> A GENERAL DIETICIANS PERSPECTIVE\" 138
>
> \"WHAT LABELING OR PACKAGING CHANGES WITH RESPECT TO WEIGHT MANAGEMENT
> MIGHT STIMULATE PRODUCT REFORMULATION DECISIONS?\" 159
>
> WHAT CAN BE LEARNED FROM EXPERIENCES WITH LOGOS OR
> CERTIFICATION?\--THE CASE OF THE SWEDISH KEY HOLE\" 183
>
> \"MARKETING THE LABEL TO CONSUMERS\" 199
>
> FOOD PACKAGING AND LABELING 209
>
> FOOD PACKAGING AND LABELING: Q&A 244
>
> RESTAURANTS 282
>
> RESTAURANTS: FIRST Q&A SESSION 326

RESTAURANTS PANEL, CONTINUED 341

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> WELCOME
>
> MR. LEVITT: The microphone is working up here. Are we on? Rich
> Williams, can you hear me back there?
>
> MR. WILLIAMS: Yes, I can.
>
> MR. LEVITT: Okay. Terrific. Good morning, everyone. My name is Joe
> Levitts. I am Director of the Center for Food Safety and Applied
> Nutrition at the Food and Drug Administration, Department of Health
> and Human Services. And it is my pleasure to welcome you to today\'s
> workshop entitled \"Exploring the Link Between Weight Management and
> Food Labels and Packaging.\"
>
> Today\'s meeting is being co-sponsored by the Food and Drug
> Administration, led by the Obesity Working Group, which Dr. Lester
> Crawford chairs, and I\'m the vice chair, as well as the Office of the
> Secretary, Office of the Assistant Secretary for Planning and
> Evaluation in the Department of Health and Human Services. And in a
> moment, I\'ll have the pleasure of introducing Ms. Ann-Marie Lynch,
> who is a Principal Deputy Assistant Secretary for Planning and
> Evaluation.
>
> This reflects the very top priority that the obesity issue is
> receiving by the entire Department, led by Secretary Tommy Thompson,
> as well as within our agency, led by our Commissioner Dr. Mark
> McClelland.
>
> This past summer, FDA established an obesity working group, and we are
> moving ahead rapidly. We\'ve already held a public meeting in October,
> also on the NIH campus. And, of course, our workshop today. We have a
> public docket, and we are receiving comments; and we\'ll urge
> additional comments following this meeting to be submitted there for
> our collective use.
>
> And, as people I think by now know, we\'re moving on a fast track, and
> our final report is due to the Commissioner on February 12th of 2004.
>
> Today\'s agenda has three parts. Part One is short opening session. As
> I said, following me, we\'ll also have a welcome by Ms. Ann-Marie
> Lynch, followed by our keynote presentation by FDA Deputy Commissioner
> Lester Crawford and our charge to the group by Tomas Philipson, Senior
> Advisor in the Commissioner\'s Office and a Visiting Scientist.
>
> The bulk of the morning will be devoted to prepared presentations. We
> have a blue-ribbon list of people from FDA, from industry, from
> academia, from the weight loss community, even from foreign countries.
> And in the afternoon, we are going to get a little more informal and
> convert the session into two roundtable discussions, one dealing with
> the food label and packaging, and the second dealing with restaurants.
>
> We want to be very clear that FDA is looking at both of these areas.
> What can we do dealing with food labels and packaging, and what can be
> done vis a vis restaurants, recognizing that we need to look at the
> obesity issue as a whole, looking at both diet issues, as well as
> exercise issues. And, yes, somebody asked me, I do have on my
> pedometer today. And was able to walk over from the Metro.
>
> So, we\'re trying to do our part.
>
> As always, a lot of work goes into putting together a meeting like
> this. I want to thank three people in particular. First, is Rick
> Canady from FDA, who\'s sitting right over here. Second, is Lana Bush,
> from ASPI, who is right behind him. And the third is Amber Jessup from
> my center, who is right back there in the middle. So, thank the three
> of you. We know how much work it is to put on a meeting like this.
>
> Finally, I have just a few housekeeping announcements from the house
> here, so it\'s listed up here. Number one, no food or beverage is
> allowed in the auditorium. Number two, there is a message desk phone
> number. It is as follows: 301-496-4062. Three, pay phones are located
> behind the Visitors\' Center. Four, when we do get later into the area
> of interactive discussion, there is a microphone. You need to press
> the \"MIC\" button, and I think you\'ll see it flash up red, so you
> know your microphone is on. I think by now all presenters have checked
> in at the preparation room. And finally, for those who do not have an
> NIH or a FDA ID, even though I have one, everybody in the building is
> required to wear their pass for\--visitor\'s pass for security
> purposes.
>
> With those introductions, it is my pleasure to introduce to you
> Ann-Marie Lynch, Principal Deputy Assistant Secretary for Planning and
> Evaluation, DHHS. I need to embarrass her for just one moment with her
> background.
>
> Ann-Marie advises the Secretary, Tommy Thompson, on health policy
> initiatives and is responsible for major activities in the areas of
> policy coordination, legislation development, policy research and
> evaluation economic analysis. She joined the Administration in June
> 2001 as a Deputy Assistant Secretary, Office of Health Policy. Prior
> to joining the Administration she had significant public and private
> sector experience, including serving as staff director of the Health
> Subcommittee of the U.S. House of Representatives Ways and Means.
>
> Ms. Lynch holds a master\'s degree in economics from Duke University,
> and a bachelor\'s in economics from Fairfield University. Please, a
> warm welcome for Ann-Marie Lynch.
>
> \[Applause.\]
>
> MS. LYNCH: Great. Good morning. I\'m delighted to be here, and welcome
> you to this wonderful conference. I just wanted to start with a few
> comments.
>
> First, in looking at the latest available information, we find that
> seven out of ten individuals die each year of a chronic disease. More
> than 300,000 Americans will die this year from obesity-related heart
> disease, diabetes, and illnesses directly affected by overweight or
> obesity.
>
> In the year 2000, the total annual cost of obesity in the United
> States was estimated to be \$117 billion\--that includes direct
> medical care costs.
>
> Currently, about 15 percent of children and teenagers are already
> overweight, and excess weight significantly increases our children\'s
> risk factors for a range of health problems, including diabetes, heart
> disease, asthma, and emotional mental health problems.
>
> The good news is that obesity and co-morbidities are preventable
> through healthy eating, nutritious food in proper amounts, and
> physical activity. And the bad news is that many Americans are not
> taking the steps to prevent obesity and its co-morbidities.
>
> The Administration has put forth a prevention agenda focused on a
> healthier U.S., which promotes four fundamentals of good health. These
> are: physical activity, healthy eating, regular preventive checkups,
> and avoiding risky behaviors.
>
> Secretary Thompson supports the Administration\'s prevention agenda
> through the Steps to a Healthier U.S. Steps emphasizes innovative
> community activities, in cooperation among policy makers, local health
> agencies, and the public to invest in disease prevention. And in
> September of this year, the Secretary announced 12 Step grants,
> totaling more than \$13.7 million, strictly to promote community
> initiatives to promote better health and prevent disease.
>
> Our Administration is committed to community-based, evidence-based,
> scientifically-sound public health policies and initiatives that
> ensure that our nation\'s health and well being exist for today and
> most important for the future. And we are pleased to have a role here
> today in helping the Secretary achieve his goal of ensuring that
> Americans are strong, healthy, and independent.
>
> We\'re working with the FDA to explore the connections between food
> labeling and weight management; and, to assist them, we\'ve developed
> a focused research agenda addressing fundamental questions about the
> association, if any, between nutrition information on food labels and
> weight management in the U.S. population.
>
> We\'re pleased to sponsor the workshop, at which we hope will examine
> the available evidence to identify the options for providing
> information to consumers\' weight management decisions.
>
> And right now, I\'m pleased to introduce to you Dr. Lester Crawford.
> Dr. Crawford brings a tremendous amount of experience to his position
> as Deputy Commissioner of the FDA. He has served as the head of the
> FDA Center for Veterinary Medicine, Administrator of the Department\'s
> Agriculture, Food Safety, and Inspection Service, and the Executive
> Director of the Association of American Veterinary Medical Colleges.
>
> During 10 years at FDA and USDA, he played major roles in the
> mandatory nutrition labeling, the Guaranteed Agreement on Tariffs and
> Trade, and the controls of chemicals and microorganisms in the food
> supply.
>
> Most recently, he served as director of Virginia Tech Center for Food
> and Nutrition Policy. He\'s also served as Executive Vice President of
> the National Food Processors Association; Chairman, Department of
> Physiology and Pharmacology at the University of Georgia. He has a
> doctorate in Veterinary Medicine from Auburn University, and also
> earned a Ph.D. in Pharmacology from the University of Georgia. His
> honorary doctorate is from Budapest University. So, with that warm
> up\--I\'d like to \[inaudible\] Dr. Crawford. Thank you.
>
> OPENING REMARKS
>
> DR. CRAWFORD: Thank you very much, Ann-Marie.
>
> \[Applause.\]
>
> And thank you also for your inspired leadership with respect to this
> conference and for your sponsorship of it. We appreciate that very
> much, and it\'s always great to be working together in the Department
> of Health and Human Services. I\'ve been in Health and Human Services
> three other times, and two of those three times the FDA did not have
> diplomatic relations with the Department. So, we\'re happy for what
> you have done to bring all that together. It\'s very much appreciated.
>
> And thanks to Joe Levitt for his leadership. We\--Joe and I have found
> ourselves appointed by Commissioner McClelland to two impossible task
> forces. This is one of them. The previous one was the health claim
> ones. But, through Joe\'s leadership, we actually produced something
> useful out of that one. It was a surprise to me. But I think it\'s
> going to work, and I think this is going to work, too. And we\'ve got
> a major problem, as all of you know, on our hands here. And that does
> not happen to do with my use of the slides. We probably are going to
> move our little cursor around here. That\'s okay.
>
> MR. LEVITT: Of course, figuring out how to move it is challenge.
>
> DR. CRAWFORD: I think I\'d use my middle finger.
>
> MR. LEVITT: It\'s the one that says Koestler on there.
>
> DR. CRAWFORD: All right, Rick, the next thing is the second slide.
> We\'ll just do it this way. Perfect. Yes. You do the left to the
> right. The thing in the middle.
>
> We had a meeting this past weekend in Boston that many of you are
> familiar with is the Harvard food meeting that takes place every year
> under the leadership of former Secretary Glickman of Agriculture and
> Professor Ray Goldberg of Harvard. And in that meeting, this is the
> 10th year of it, and a careful glance at the record, which is
> memorialized in a book I suppose each year, reveals that throughout
> the preceding nine years, there\'s never been a mention nor a paper on
> obesity. This past weekend, 10 of the 16 presentations were on obesity
> and several interesting things came out of that.
>
> There was a person invited who was from the National Health Service in
> England, and her summary comment was that she believed that in the
> very near future that obesity, as it occurs today in England, which is
> about what it is here, would wreck their National Health Service; that
> there was no way they accommodate the increase in health claims and
> payments and in the infrastructure of that system. She thought it was
> going to be compromised by the obesity epidemic in that country.
>
> And then the Deputy Minister of Agriculture of Canada made an even
> more ominous conclusion, based on his study of the situation in
> Canada. We always think of ourselves as the only one having this major
> public health problem. He believed that in their country and perhaps
> in others that for the first time in the last 100 years that the
> longevity increases that are announced at the end of every year by the
> World Health Organization were going to decrease in their country and
> perhaps in much of the developing world.
>
> In our country, we\'re having 300,000 obesity-related deaths per year.
> We believe that can only escalate, and we have to be prepared. Now,
> the other thing that must be said is that out of the flavor of that
> meeting and out of our general meeting on this subject, which we held
> earlier, it is clear that it is very easy, very tempting and facile,
> and, I think, useless to continue to blame the food industry as a
> victim in this kind of thing for some reason. We all eat the food. We
> all have freedom of choice. This country is certainly free in that
> respect. And if the portion size is too large, it doesn\'t take a very
> high intellect to understand that if you\'re gaining weight at the
> rate of 12 pounds a month or something like that, that this might be a
> little too much for you. So I think we need to stop\--we need to hold
> harmless the food industry as they join together, as they certainly
> are today, they did in the first meeting, and they did in some
> follow-up meetings to this as we move forward towards a mutual
> solution. If we blame the psychiatrists of the United States or the
> food industry of the United States or the medical profession or the
> dietetic profession, than we will get nowhere, because we\'ll
> balkanize those interests, and there won\'t be any unifying message
> that we\'ll go forward with. So let\'s get off that, and in order to
> begin that, we\'re going to go forward.
>
> Now, the obesity epidemic, as is mentioned here\--we have now
> completed our circuitry through the slides.
>
> \[Laughter.\]
>
> And with many thanks to you for being here today, Mr. Levitt.
>
> \[Laughter.\]
>
> Here we go. I got it. Don\'t worry, Rick. You can\--over 30 percent of
> the U.S. population\--Ann-Marie mentioned some of this, and the body
> mass index of 30 or higher is what we\'re going with here. Thirteen
> percent of children, which is a doubling of what it was when NLEA was
> passed some 10 years ago, and the deaths I\'ve already mentioned. And
> we\'ll talk further during this session and elsewhere about
> co-morbidities.
>
> The Obesity Working Group has a charge for the Commissioner, which is
> from the Commissioner, which is publicly available. Also, his
> excellent speech at the general meeting, which was held about a month
> ago, is still getting a lot of currency. It was mentioned this morning
> in the Washington Post, in the A-section, and will be again around the
> world, and that is something that we believe is an enlargement of our
> charge and also an indication of the seriousness that he and Secretary
> Thompson take this to be.
>
> The\--we have a six-month time frame. We met yesterday with the
> Department officials about whether or not we\'re going to achieve
> this, and what we\'re going to do with it when it\'s accomplished. But
> we\'re on that time frame, and we\'re obligated to finish by then. And
> we haven\'t talked yet, Mr. Levitt, it was reamplified yesterday. We
> have only that amount of time.
>
> We have an act\--developed an action plan, and this is from the
> charge, to develop a clear, coherent, and effective public health
> message. And the rest of that sentence was that unifies all the
> various sectors in solving this problem.
>
> We need a public education program. Many people believe that the \"E\"
> in NLEA has never really been fully utilized, and I would be one that
> would agree with that. I remember when we were working on
> NLEA\--the\--my part of it was in the Department of Agriculture. We
> did not need the law in FSIS for meat and poultry. What we needed was
> simply a declaration by the Administrator through the delegation of
> authority from the Secretary. And we imposed this. I remember when we
> were talking about it, we planned a major public health information
> program just from FSIS, which was funded at the \$4 million category.
> And I don\'t think that was ever completely funded, and it needs to
> be; and then perhaps even that figure was modest, because as we looked
> through this particular exercise that we\'re going through now and how
> many people actually read the food label, we find the figures to be
> disturbingly low. And we also find it to be associated with people who
> have a real medical need to read the food label, like diabetics and
> people with metabolic diseases of other sorts. And I think that we
> have to take some of the blame for that in the Government and probably
> also in the food industry and in the supermarkets.
>
> But the\--we don\'t need blame. We need a positive message going
> forward. Enhancing the food label, if you\'re going to enhance it, it
> can\'t be like the Sears Roebuck catalogue. It must be targeted. It
> must be readable. It has to accommodate people that have to wear
> bifocals. It has to be something that gets the job done, and just
> changing it willy nilly is not what we\'re about. But I would be
> surprised if in the Obesity Working Group report on February 12th of
> 2004, we don\'t have something in there about recommendations on the
> food label.
>
> The dialogue with the industry is going on. We\'re following this up
> with two other focus group sessions before the end of the time that we
> have to finish the report.
>
> Then we\'re also facilitating the development of more and better
> therapeutics. The Center for Drug Evaluation and Research is very much
> a part of our obesity working group, and they\'re weighing in with the
> latest information, and also the realistic projections of how good
> these medical devices and drugs are going to contribute to the solving
> of this problem.
>
> And I think we can\'t rule out the fact that there is some sort of
> magic potion there. The research on leptins and various other
> compounds is very encouraging, but there\'s nothing in the bottle yet,
> nor in the syringe.
>
> Then identifying research on healthier foods and consumer behavior is
> certainly going to be a major part of it. Then we have to enlist the
> help of the stakeholders. When it\'s all said and done, the authority
> of FDA to solve this problem is not the same as we have to solve an
> illegal drug problem or an illegal food supplement problem, or
> something like that. This is going to be involved I think for a long,
> long time, and the tools that we have at our advantage are some
> regulatory power, but mainly moral suasion and scientific suasion.
>
> The public meeting, which was held on October 23rd, just about a month
> ago, explored six key questions. And the respondents, for those of you
> who weren\'t there, were asked to comment on these things.
>
> The effectiveness of the education campaigns. Has that ever been
> vetted? Has it ever been evaluated and audited. And the answer seems
> to be no. But the question is, how do you do that?
>
> What are the most urgent research needs of the National Institutes of
> Health.
>
> Evan Hubbard is here today, and he has been very much a part of the
> planning of this and the development of it. And there are certainly
> research needs that will be listed in the final report. We need to
> know about those from you, and we need to include them in the report
> in terms of the recommendations to the Commissioner, and ultimately to
> the Secretary.
>
> Data. What data exists on obesity prevention and treatment through
> behavioral and medical interventions. That also should be a major
> part.
>
> Changes needed in food labeling to stimulate development and
> consumption of lower calorie foods. When we talked about calories at
> the time of NLEA, when the Commissioner of FDA and the Administrator
> of FSIS did a country-wide tour of hearings at major medical centers
> and elsewhere, which took about six grueling weeks, we heard a lot
> about the calorie content. But we heard mostly about fats. And we
> heard almost nothing about carbohydrates. And the passion about fats
> in the year 1993 was extraordinary. It was, I think, we deluded
> ourselves into believing that if we could just get prominent labeling
> about fats and the division between saturated and unsaturated fats
> that people would read the label and wind up being svelte and happy
> forever. That did not turn out to be the case, and we probably erred,
> if we erred, we erred on behalf of the prevailing sentiment in the
> medical and nutrition community. And I would say also, looking back on
> those hearings and rereading some of the transcripts, we heard
> inspired commentary from just rank and file individuals. And that\'s
> what we need to hear again. They weren\'t necessarily nutritionists.
> They weren\'t physicians, but they were impassioned about the problem
> of not being able to look on the label and find out what was in the
> food, from a nutritional point of view.
>
> And then what opportunities are there to develop healthier foods and
> what can FDA do to reduce overweight and obesity. Within our authority
> and within what expect FDA to do, what can we do?
>
> Now, the stakeholder engagement, we\'ve already\--I mentioned these
> first two meetings, of course. We\'re having a consumer roundtable to
> follow this up. All of these meetings are open to the public. They\'re
> not\--we\'re not sequestering any group. And then we\'re having the
> medical community roundtable, and then the Secretary\'s Prevention
> Summit is in early 2004. And Ann-Marie and others in the Department
> will be heavily involved in that. And I suspect that our report, if
> it\'s well received, will be major part of that.
>
> The qualified health claims initiative also is part of this. That came
> out of the first task force that Joe and I headed up.
>
> Putting more information on the food label, stimulating competition
> based on health effects, a part of that. Increased consumer
> consciousness of food\'s impact on health.
>
> We think we\'re getting there. Commissioner McClelland has, again,
> made a number of speeches in various sectors, particularly within the
> medical community, and he\'s proclaimed, convincingly, that, of all
> the things that FDA is inspired to do and required to do, that
> prevention through nutrition is probably the most effective public
> health tool at our disposal.
>
> You can mention vaccines as something that\'s very important, but no
> less important is nutrition and nutrition information.
>
> We have to meet three conditions. We have to have some degree of
> scientific evidence for health claims. It has to be pre-approved by
> FDA, and the labeling cannot be misleading.
>
> Now, at this point, I\'m going to pause, with gratitude to the
> Chairman and to everyone involved in this, particularly the audience;
> and introduce Tom Philipson, who is an economist working at FDA, on a
> sabbatical, who has brought commonsense, good judgement, and fine
> taste to the Food and Drug Administration. He\'s from the University
> of Chicago, and, Tom, it\'s all yours.
>
> FRAME WORKSHOP AND CHARGE TO PARTICIPANTS
>
> DR. PHILIPSON: I\'m going to be very brief, sort of setting the charge
> of the conference and also taking care of some logistical details
> because I\'m going to be the main time police once we get going here,
> to discipline people to stay within their time.
>
> As Lester mentioned, the Obesity Working Group has organized this
> conference. This is part of\--this is a part of the effort of the
> Working Group, which, again, was launched in August, and we\'ll have a
> final report in mid-February.
>
> And in sort of setting the stage for today\'s conference, it was\--we
> sort of came to this with a belief that the emphasis should be very
> much on the science as opposed to sort of opinionating around the
> topic. So, we\'re really interested in what people have to bring in
> terms of facts to bear on this topic of labeling obesity.
>
> We\'re coming to the topic of labeling obesity in a sort of\--on the
> Obesity Working Group in a sort of perspective where we\'re currently
> labeling products. And, for good or for bad, that\'s very difficult
> for some consumers to be able to handle, to learn about their diets,
> which are daily diets or weekly diets, in an efficient manner. So the
> type of labeling that we currently have is sort of not as consumer
> friendly, if you want, as you would like it be in order for people to
> understand the impact, in particular, for example, the caloric impact
> of their diet, and the \[inaudible\] on obesity.
>
> So, the conference was organized to try to understand, better
> understand, how current labeling is actually used by people in
> managing their weight and also whether new forms of labeling can help
> them do so better.
>
> And, as you noted on the program, we\'ve included restaurants in this
> conference. And the whole basis for that was that we wanted to think
> about, in a constructive manner, how to go from product-based
> labeling, which we\'re currently doing, into higher level labeling of
> meals, which could potentially more easily be used by consumers to
> learn about their diets.
>
> So, as Lester emphasized, this is not a blame of a restaurant in any
> way or another. It\'s all about trying to facilitate for consumers to
> learn about their overall diets instead of using current product
> labeling to go up on a more aggregate level by potentially thinking
> about ways in which information could be provided, whether through the
> private sector or public sector, about their meals or potentially
> about their overall diet.
>
> So, in that\--with that background, we have sort of two agendas within
> that\--we\'re considering the package foods, both in the morning and
> the afternoon, and then additionally, we\'re considering restaurants,
> which is, of course, sort of the new area that we\'re trying to learn
> about here.
>
> There\'s going to be a report of this conference that will most likely
> be part of the final report of the Obesity Working Group. But also
> we\'re accepting comments for the conference until December 12th, and
> there should be a web site in the packet indicating where public
> comments are available.
>
> We\'re particularly interested in those for the morning session,
> because there will be\--due to time constraints\--there will not be
> any public comments or public participation or audience participation
> in the morning. There will be some limited audience participation in
> the afternoon regarding the panels.
>
> There will also be a transcript of the minutes\--or minutes of the
> conference also on a web site provided in the packet.
>
> With those logistics in place, I\'d like to start the program, and,
> like I said, I will be sort of prodding people. There\'s a
> pretty\--very tight schedule if you open the program, you\'ll see that
> we have a lot of speaker to go through, both in the morning and in the
> afternoon.
>
> But I\'d like to start off with introducing Christine Taylor. She\'s
> Director of the Office of Nutritional Product Labeling and Dietary
> Supplements in the Food Center for Safety and Applied Nutrition at
> FDA. She will talking about current FDA food labeling policies.
>
> \"CURRENT FDA FOOD LABELING POLICIES\"
>
> MS. TAYLOR: Good morning and thank you very much. It\'s indeed a
> pleasure to be here, and I confess I\'m going to need some technical
> help to get my program up.
>
> I\'m pleased to be here despite the fact I have the rather daunting
> task of in 15 minutes trying to set the whole context for the label
> and what it does in terms of calories. So, bear with me as I try to
> set that context, because I think it\'s an important.
>
> UNIDENTIFIED SPEAKER: Use the wheel. Go down.
>
> MS. TAYLOR: Excuse me, I\'m doing a remedial read. If we can start at
> the beginning. Great. Thanks an awful lot.
>
> Anyway, please do bear with me as we try to make a kind of contextual
> background for the discussion we\'ll have today. I think it\'s always
> good to start off with a few simple definitions, and that is the fact
> that when you say \"the label,\" you\'re really talking about a lot of
> things. There is, of course, the nutrition label, which is the
> infamous facts panel that I suppose most of us are very much aware of,
> at least those of use that work at the agency. It\'s a required
> component of the packaged food label in the U.S. It had its start
> really for very different reasons than perhaps we\'re talking about
> today in 1971. But it really got its basis in 1990 with the Nutrition
> Labeling and Education Act, which allowed the agency to create this
> mandatory component of the food label.
>
> With that, we also got voluntary provisions for claims on labels,
> which I think also plays a role in some of the issues we\'re tackling
> today.
>
> But when you do say the label, just to keep in mind there are other
> things that are part of the label. You have product identification.
> You have ingredients statements. You have manufacturer contact
> information. You have other statements on the food label; things such
> as may contain peanuts, and other things such as that.
>
> So, the label itself is a fairly diverse unit.
>
> What I\'m going to try to do today\--these are my touchstones\--is to
> give you a little bit o the conceptual underpinnings for how the label
> got started in 1990, talk specifically about the current provisions
> for calories, and then, at least from my perspective, talk a little
> about what we\'ve been hearing and what the future might hold in
> store.
>
> Again, background definitions just so we are all aware we\'re talking
> about the same thing.
>
> When you talk about food labeling, you have the packaged foods
> component, which is under the purview of FDA. And it is generally
> required, with some exceptions.
>
> You also have labeling on raw meats and poultry. That is withing the
> U.S. Department of Agriculture. Labeling for fruits, vegetable, and
> fresh fish is a kind of voluntary program. It\'s voluntary unless
> it\'s not done. So, it\'s a hybrid in many ways. And that\'s
> implemented through the use of poster signs, placards, where fresh
> fruits, vegetables, and fish are sold.
>
> And then there is the issue of restaurants. NLEA, the Nutrition
> Labeling and Education Act, did not direct the agency to do anything
> about restaurants. And currently, there are no provisions in place for
> restaurant labeling.
>
> Probably the starting point for any kind of contextual background
> would be the nutrition facts panel. The theme, I think, we\'ll sound
> today, and you\'ll hear it from a variety of FDAers, is that a lot of
> work went into developing that nutrition facts panel, as well as the
> claims that were a component of NLEA. But there was a full recognition
> at the time that we were just beginning; that it was a flexible
> environment in which we were working. We were doing the best we could
> with what we had at the time, and that things would change. We would
> get a better understanding of how consumers interact with such things
> as food labels; and that, in the future, there would be a set of
> issues that would need to be addressed in terms of how best to improve
> the label. And I think that\'s part of what\'s happening today.
>
> Certainly, at the time research was done, the question is: was there
> enough research? No, there\'s never enough research done for any of
> these things. But a considerable amount of research was conducted at
> that time so the best possible label, as we understood it, could be
> put out. There was full recognition that to be useful, this is a label
> that had to be used on all packaged foods, and I can\'t emphasize
> enough how the universal mandatory requirement does influence what you
> can and cannot do with the label. And there was full recognition at
> the time that it was to serve as a tool for a variety of endpoints. It
> had to derive from the health initiatives we had at that time. But
> also there was considerable interest in its being stable over time so
> that consumers could have a uniform way of getting the message.
>
> For those of you that need to be reminded what we\'re talking about
> when we talk about the facts panel, this is the shortened version of
> it. Larger packages are allowed to\--or required to have additional
> information. But this is basically the nutrition facts panel in its
> simplest form.
>
> The conceptual underpinnings for the facts panel I think are important
> as we begin to think about the changes that might be in place if
> calories are a particularly important component or some other kind of
> information.
>
> At the time, there was a great deal of interest in making sure that
> this tool, the nutrition facts panel, matched what were current
> recommendations for health initiatives. And so, examination of dietary
> guidelines, health recommendations from the Government, those things
> became the core component of the facts panel. And I do want to
> emphasize that many other declarations were allowed voluntarily; that
> there was not at all an effort to restrict it, but rather, given
> limited space, what was the absolute core amount of information
> consumers used, and then, at the manufacturers\' discretion, if they
> wanted to list the 20 or 15 or however many nutrients that they felt
> were important for their product. The label had that flexibility.
>
> The other component to keep in mind is that by going with what were
> the general recommendations put out by authoritative bodies that
> allowed the label to be stable over time, but we recognized that those
> recommendations would change and that someday we\'d gather in a room
> just like this to begin to talk about modifying the label.
>
> Another important part of the conceptual underpinnings for the
> nutrition facts panel is a consistent format. I remember those heady
> days very well where the design people were probably as powerful as
> anyone else in the room in terms of how that label would look. There
> was considerable interest that it be the same kind of label for each
> and every food with the things in the same place so that consumers
> could use it as easily and as readily as possible.
>
> There was a considerable amount of research done on the design, and
> one of the other components at that time was a complete realization
> that we were dealing with a lot of constraints in terms of space. And
> those were things that get lost sometimes in the shuffle as you think
> about the label. But it is being asked to do an awful lot in a very
> small space, and that\'s something to keep in mind.
>
> Now, as we did think about the core component of the nutrition facts
> panel, we did think a considerable amount about the consumer
> interface. What we found from focus group research was that the most
> useable information was, in fact, the numbers, coupled\--and that\'s
> an important thing to note\--coupled with some kind of context.
>
> NLEA had told us to present the nutrition information within the
> context of the total daily diet. And that meant for us that we had to
> not just only give the numbers, because there was evidence in front of
> us that if you put the number 100 milligrams in front of a consumer,
> they\'re likely to read 100 milligrams as more than one gram. So they
> needed it in some kind of context. But quite clearly, what we got from
> the focus groups was consumer interest in having those numbers anyway.
> So you needed the numbers, and you needed the context.
>
> They felt that if we used pie charts, pictures, graphic signals alone,
> they were somehow being manipulated. They kept saying give me the
> numbers. They wanted to feel empowered that they could make choices.
>
> The context, though, we found was extremely important for how these
> numbers were then interpreted by consumers, and, as it says here, we
> coupled the numbers with the percent daily value.
>
> That being the context.
>
> Now, when we did the research in 1992, we did check to make sure that
> the percent daily value, given that any tool you\'ll use will have
> limitations and perhaps not work for all groups all the time, at least
> that the percent daily value was better than the other options we had
> available\--bar graphs, pie charts, adjectival descriptors\--high,
> low, medium in fat; high, low, medium in sodium. Quite clearly, the
> research at that time indicated that consumers felt much more
> comfortable with the numbers and felt that the pie charts, the pie
> graphs or whatever were in some way fooling them. We\'d also found
> from earlier research that things such as stars and smiling faces and
> thumbs up and thumbs down, those kinds of things came out through the
> research we had as being vague, condescending, and childish.
>
> So we were finding that the consumers needed some kind of numeric
> context; at the same time, we could see from how they were using the
> label and interpreting the label, that they needed a context.
>
> We also were faced with the issue of some of our context being in the
> domain of a percent of calories; that many of the recommendations we
> had were being driven by your caloric intake. We had gone then through
> the National Academy of Sciences\' referenced daily allowances,
> dietary intakes, in order to try and come up with a number for
> calories. And when we did a weighted average of the Academy\'s caloric
> recommendations, we got a number in the neighborhood 2,300 calories.
> We did propose that number, but were convinced by comments that we
> should round it down. And so, as you can see from today\'s label,
> we\'re using as basis for the label, when calories are an issue, the
> 2,000 calorie diet. You do see it listed at the very bottom\--whoops,
> the very bottom here, and then what it does say is the percent daily
> values are based on a 2,000 calorie diet. This is for a slightly label
> where they can also put the context of the 2,500 calorie label.
>
> Finally, returning to conceptual underpinnings and the consumer
> interface, as we\'ve worked with consumers in the food label, as much
> as you\'d like to think that they would use the food label to build
> their diet, track it during the day, that\'s very unusual. You have to
> be a highly motivated person in order to use the food package for that
> purpose. And they get frustrated because frankly packaged foods are
> not the only thing they eat. You do have restaurants and other sources
> of food that are not necessarily labeled. So, the notion that the
> label has to address someone keeping a diary, while it\'s a desirable
> endpoint, for some anyway, it\'s not really pragmatically how the
> label gets used.
>
> What we\'ve seen is that they use the label to compare two like foods.
> They use it to make a choice, which really when you look back at NLEA
> that was part of what the purpose of the label was for is to help
> consumers make choices. If they\'re going to eat cookies, they
> obviously compare, from what we\'ve seen, two packages of cookies.
> They might compare ice cream to frozen yogurt, but they\'re not going
> to compare ice cream to frozen broccoli. It\'s just not a transition
> they make. And consequently, you need to keep that in mind as you
> think about it. If you\'re thinking about red lights, green lights,
> what does a consumer do if both bags of cookies have a red light on
> them? What they\'re really wanting to do is be able to compare them
> numerically. At least that is what they\'ve told us now, and I think
> there\'s always room for more consumer research.
>
> Lastly, in terms of conceptual underpinnings, the nutrition facts
> panel is a tool. It assists consumers in implementing dietary choices,
> and it was never intended to do the whole job. That\'s different than
> being able to do a better job. But there is an expectation that people
> come to the food label both motivated and perhaps informed. And we
> have to look at ways of how that interface affects flexibility in
> terms of modifying the food label.
>
> Also, clearly, it\'s a tool for many purposes. Consumers vary a lot.
> Their interests vary a lot. Their needs vary a lot, and the use of the
> label undoubtedly varies.
>
> One last footnote before we actually talk about the label itself if
> that the Nutrition Facts Panel is based on serving size. We recognized
> early on that when the food label was being constructed, the nutrition
> information had to be presented per some amount. And, for a long time,
> there was a considerable exploration of per recommended serving sizes;
> that it would be incumbent on the agency to develop recommended
> serving sizes. We explored that option and ran into incredible snags
> from someone saying, what do you mean you\'ve got a recommended
> serving size for cheesecake, all the way down to what would that mean
> for a single label value.
>
> So based on notice and comment rulemaking, as well as our own efforts,
> we found that per recommended serving size was not a very viable
> option at that point in time.
>
> The other option that was also considered was per unit measure. Many
> of you who may be familiar with the European approach to labeling,
> it\'s in the domain of 100 grams. Our tests indicated that consumers,
> in fact, had trouble with the per 100 grams because per 100 grams of
> soup is not necessarily is per 100 grams of cookies. And so there was
> a comparison issue.
>
> What we ended up with was on amounts customarily consumed, and we had
> to go to existing food consumption databases and, through an
> incredible resource-intensive effort, try to get average serving sizes
> for the data we had from the 1980s.
>
> By necessity, this is a very complicated, but critical, component to
> the food label, and it had to go across the food supply. So, the
> notion here that serving size is an easy thing to fix is something I
> want to just put on the table. But there are some questions about
> serving sizes that I think do need to be addressed.
>
> We have definitely had limited resources, and I would venture a guess
> that there are a number of products out there that are inappropriately
> labeled for our own rules, and we do need to up our resources to try
> and take care of that. We do recognize there\'s been a change in
> manufacturers\' packaging practices. They\'re definitely using large
> single-serving containers than they were in the 1990s, when we set
> this up. And, while manufacturers can voluntarily declare the contents
> of the entire package for their nutrition label, many don\'t. So,
> there\'s a question of what we need to do about that requires such
> declarations, and then, of course, go back and consider in the last 10
> or 12 years are Americans really eating a lot more and do we need to
> reconsider what we\'ve got for serving sizes.
>
> Let me then just quickly so that I run out of time and eat into Sue
> Borra\'s time, I\'ll go through then what we do have in place for
> calories on the food label.
>
> Starting right off, you can have calories per serving, and that has
> already been mentioned by Dr. Crawford. It\'s there, but, at the time,
> there was a considerable emphasis on fat rather than on calories. And
> we even included calories from fat. Also, at that point in time, we
> didn\'t put any context for the calories. There is no daily value for
> calories. So the question is, is there a need for more emphasis and do
> we need a percent DV.
>
> Also it includes calories from fat. Just so you can visually see it,
> you have up in the very top of the label calories, and then calories
> from fat. And here it is within the context of the whole label. You
> see it up there under amounts per serving.
>
> There is also the option or nutrition claims. Admittedly, they\'re
> done voluntarily, but they do exist. There are nutrient content
> claims, which characterize we\'ve provided for calorie-free,
> low-calorie, which is less than 40K cal per serving, and, of course,
> the infamous if it\'s low in calorie naturally, then it needs to make
> reference to that. Celery a low-calorie food.
>
> We have comparison claims. Reduced calorie, an example being 25
> percent fewer calories than our regular yogurt. So, you have not only
> the facts panel; you have these claims.
>
> There\'s also, too, the option for other information for nutrients
> that would contain, the maximum nutrients that would contain calories.
> There are declarations for fats, carbohydrates, and proteins, but you
> also have claims for fat, fat-free, low and fat reduced, lite, and
> claims related to sugar.
>
> Finally, before I end, the notion of health messages can\'t go
> unmentioned. There is, of course, always within the NLEA, the option
> for health claims, which is about a relationship between a substance
> and a disease. None are now specifically authorized that I see as
> being specifically related to the obesity problem, and I guess the
> question I have is how attractive are these really. A claim such as
> low-calorie diets may reduce your risk of obesity may not be what\'s
> most grabbing for consumers.
>
> We may need to look more at dietary guidance messages, things along
> the lines of food patterns. Diets rich in fruits and vegetables may
> help you avoid overweight, and those are options I think the agency
> very much wants to put on the table as a way of exploring the obesity
> communication issue.
>
> Finally, my last two slides. I do want to point out we have some
> lessons that we learned in developing the food label, and that is very
> clearly anyone who worked on the label will tell you that there was a
> plethora of commonsense suggestions that made a lot of sense as we sat
> and listened to them for how the label would be developed or
> implemented. I can\'t emphasize enough the importance of research
> here. We had such surprising outcomes when very logical things blew up
> on us, and I think that\'s because the label doesn\'t operate in a
> vacuum. Consumers did need to feel empowered in using the label. They
> were not entirely comfortable with a no-brainer approach, and I think
> we have to be careful of that as we consider our options for the
> future. But skepticism crept in the strangest of ways. A health claim
> on lasagna was not sellable to people. They would accept a health
> claim on yogurt, but not on lasagna. Lasagna is not a healthy food
> from their perspective, at least the research we had in front of us.
>
> The message about transfat that was tentatively put out by the agency
> what it did in terms of detracting from the larger effort on saturated
> fat. So, there\'s a certain need to be wary as you move through this.
> There are strengths to the label; that it\'s consistent and generally
> effective, and its format is very iconoclastic, if you well, or
> iconic. And it has sustained itself over time. Its weakness is, and
> this is the message I do want to leave you with, is that the calorie
> signal on the food label is not as strong as it should be and
> certainly as it could be, and that we do need to think about matching
> calorie declarations with this newer packaging. There are suggestions
> offered to FDA. They\'re not, in any way, meant to preclude a larger
> discussion here, but just so you know that we have been receiving
> messages from groups such as this. Larger type size, bolding, more
> space, why eliminate the percent calories from fat\--is that really
> any longer appropriate. Provide a context for calories. Look at an
> accompanying graphic. If people like numbers and are having trouble
> with the context, take a look at that. Address the single-serving
> containers, which can be very misleading to consumers and encourage
> health messages.
>
> The challenge, as I see it, is to sharpen the calorie signal without
> losing the desirable components of the food label.
>
> So, thanks a lot, and I look forward to hearing the discussions today.
>
> \[Applause.\]
>
> MR. PHILIPSON: It\'s going to move right along. We have Sue Borra.
> She\'s Senior Vice President and Director of Nutrition, International
> Food Information Council.
>
> \"CONSUMER INTERFACE WITH THE FOOD LABEL\"
>
> MS. BORRA: Thank you very much, and thank you for the opportunity to
> talk about my favor subject, the consumer and how they interface with
> not only nutrition, but certainly the food label. And thanks to Chris,
> because she set an excellent stage to then take it from the standpoint
> of let\'s look at the consumer and how they are viewing this. What\'s
> going on in their world, and what are some of the consumer realities
> that we have to keep in mind.
>
> And I did congratulate the meeting planners for putting the consumer
> right up front in these discussions, because if we forget our ultimate
> audience being the consumer, we will not succeed in this endeavor.
>
> To understand that organization that I work with, the International
> Food Information Council, our mission is a communications mission. We
> want to communicate science-based information on nutrition and food
> safety. And the work that we do is supported by the broad-based food
> and beverage and ag industries.
>
> However, to do a good job in communications on nutrition science and
> food safety, we have to do consumer research. And IFIC does a
> tremendous amount of consumer research, as well as looking at consumer
> research that\'s out there and available that we can learn from as
> well.
>
> So, for today, what I would like to share with you very quickly is
> talking from the consumer perspective, what do consumers currently
> believe about nutrition and healthful eating. Where are they at in
> that continuum of information and knowledge? What do they say about
> using the food label? What are they telling us that they\'re doing?
> And, I think the final and most important question that we have today:
> can consumer understanding and use of calorie and serving information
> on food labels, can that be improved and what do we have to do to get
> there?
>
> So what are consumers\' beliefs about healthy diets? I think this
> looks like the typical consumer in the grocery store, trying to figure
> out what to do for that afternoon meal or evening meal, and the
> questions that they come up as they\'re facing the food shelves:
> things like I can\'t eat any dessert snack foods or my favorite foods.
> If it taste good, it must be bad for me.
>
> Healthy eating takes way too much time and then 30 percent of what? So
> that gives you an idea of how they are faced with decisions in the
> marketplace.
>
> From the FMI consumer trends, this is the 2003 data, a general
> question was asked of consumers: how concerned are you about the
> nutritional content of the foods that you eat? And in this year, we
> saw, what is that, 92 percent of folks saying that they were either
> very or somewhat concerned. But it\'s important to look at this trend
> over a period of time of how people have been relating to issues
> related to nutrition. This is the trending of the folks saying they
> were very concerned since 1990. You see it reached a peak of concern,
> if you will, in 1992, at 64 percent, and we\'ve been hovering around
> the mid-50s. But it means that we have a receptive audience to
> nutrition information.
>
> Probably more importantly about this question is what is it
> specifically about nutrition that concerns you most, is the question
> that\'s asked. And this is an unaided answer. They can answer anything
> they want. And, for the most part, dietary fat, the concept of fat, is
> still top most in the mind of consumers when you ask that question.
>
> You seen some changes over the years; however, fat is far ahead of
> anything else in that lump of the list towards the bottom. As you can
> see, calories is the purple circle, and that\'s still not as top of
> mine as dietary fat.
>
> So, if we\'re talking about issues about obesity and how people can
> manage weight, we\'re going to need to see that calorie information
> and interest move up.
>
> Now, consumers\--the good news is that they say that nutrition and
> diet are important to them personally. Eighty-five percent\--that\'s a
> high level of folks\--saying that they think this is very important,
> and this is from ADA trend survey that was released last year.
>
> However, when you talk to them about are you making significant
> changes to achieve a healthful diet. Less than a third say that
> they\'re really able or making that change to do something. So, we
> find that there\'s a high level of interest, but the ability to put it
> into action is the key that we have to understand and understand how
> can we bridge that gap for consumers. How can we help them do a better
> job?
>
> And those of you who do focus group research and work with consumers,
> this is the common thing that you hear. They believe it\'s highly
> confusing when you talk about nutrition, and they always talk
> about\--and \"they.\" I always put \"they\" in quotes. Who\'s that?
> \"They\" keep changing their minds. This is exactly what they tell us
> all the time, and this is what they\'re faced with on just even on
> bookshelves in terms of how to eat a healthful. Everybody has a
> different answer they feel.
>
> Now, what are consumers views on weight and health, because I think
> this is important as we\'re talking about this idea of weight
> management and how they\'re going to deal with this is in a labeling
> context. And this year, my \[inaudible\] Foundation did conduct some
> consumer research with adults on how they were approaching this whole
> issue of weight and health. And some of the things that we found in
> this qualitative research is first of all that consumers do have a
> broad view of health, and it includes things like weight management
> and weight control and wellness. But it\'s a very broad definition for
> them on health. They see that\--they have a commitment to healthier
> living to improve their overall life adjustment, and they think that
> this needs to be something that they have to do to make it last. So,
> while we still have an interest in quick fix, when they really start
> to think about it, they know it\'s about lifestyle. They know it\'s
> about commitment. And one of the quotes there, it\'s really a
> commitment to overall lifestyle is what we heard them talking about.
>
> Interestingly out of this research, we talked about information needs,
> and consumers are feeling overwhelmed and bombarded with information.
> They actually told us, I think we know what we\'re supposed to do.
> We\--I have information that I know I\'m supposed to eat better. I
> know I\'m supposed to get more physical activity. But I\'m not doing
> it, so please help me get to that point. And it\'s things like
> motivation, helping them give the tools, the how-to\'s, versus just
> general information; and they said that they would hopefully then be
> able to do it in both terms of nutrition and physical activity.
>
> Some qualitative research that we conducted this year, getting
> into\--we were actually doing some research on how they were
> perceiving transfat labeling information, but in getting them ready to
> talk about it, we asked how often did they look at the list of
> ingredients and nutrition information when deciding which foods to
> purchase or eat. And certainly, 54 percent said they always or almost
> always do it in at least in this context; though about half of them
> do, half don\'t is probably what the answer is.
>
> We asked them what kind of information were they aware of on the food
> package label. And this was interesting to me were\--can\--the caloric
> information actually rated higher than the dietary fat information. On
> other surveys that I\'ve done in the past, when you talk about food
> labels, they usually talk about fat first. And this was one of the
> first times that I heard them talking about calories first, so that\'s
> showing that there is some changes that are occurring in the mind set.
>
> And then we asked which of the following contents listed on the
> nutrition label do you consider when purchasing a food, and this was
> another interesting fact that calories did come up on top. Calories
> and fat were the top two, but they were definitely up in there, and
> calories did rank.
>
> Another fact from FMI trends of last year\--consumer knowledge and use
> of food labels. What do consumers say they\'re doing. Well, almost 80
> percent said they are looking for and purchasing low-fat products so
> that fat concept is still out there. And 54 percent said they\'ve
> started purchasing a product due to information on a food label, just
> another way to look at how they\'re using this information out there.
>
> But while we\'re talking about nutrition and health, I think this is
> one of the most important slides that I can put out all day; that the
> reason folks choose foods, taste is the ruling component of it. We can
> have the greatest nutrition information and motivation in the world,
> but if the food doesn\'t taste good, it\'s not going to make it
> through the consumer\'s purchase habits.
>
> Now, the concept of consumers understanding and use of calorie and
> serving size, and there is lots of information out there for them.
> There\'s lots of resources, but this is where I think we have a huge
> void in consumer research and consumer understanding, and that we are
> going to have to do this research in order to be able to be helpful in
> this process.
>
> Last year, the Dietary Guidelines Alliance did some research on
> consumers and portion size and serving size. Just a couple of quick
> findings from that.
>
> Consumers use those terms interchangeably. Portion size, serving size,
> they were aware of these terms, but they were not concerned that they
> were that much different. However, some would talk about it and say, a
> serving size is what somebody\'s recommending me to eat, or a portion
> size is what they actually do eat. Very interesting in this research:
> a lot of folks had really strong recommenda\--feelings about who the
> heck is telling me how much food I should eat. It was almost indignant
> about who are they to tell me how much food I should have in my diet,
> which we found that was very interesting and something that we\'re
> going to have to deal with as we come up with information for
> consumers. And one of the consumer comments here: I think it\'s equal.
> If you take a portion of chicken, that\'s a serving. One serving
> equals one portion. However, another consumer said: when they say
> serving size, typically that\'s smaller than an average adult would
> eat. But a portion for me, if it\'s something I like, might be the
> whole plate as opposed to the portion for somebody else.
>
> They looked at, and I think you\'ll find this in many research about
> consumers, is that they talk about serving size information on
> nutrition facts panels as being impractical, and they don\'t really
> say\--they say they don\'t really use this information unless they\'re
> following a dietary regime. They talk about it in terms of if I was on
> a special diet, or if I was really trying to reduce my weight, I might
> use that. But most people, even if they\'re overweight, don\'t think
> that they even necessarily have to be in that category.
>
> They didn\'t feel that it was representative of what people eat.
> Here\'s a great quote: the serving size on the box is always too
> small. It\'s more for a child. You got itty-bitty servings. And then
> when you\--they say, if I think you\'re trying to watch your weight,
> then the serving size guidelines will be very helpful. If you\'re not
> counting calories or on that type of plan, then they\'re not much use.
>
> So, in this need for consumer research, what are some of the questions
> that we need to look at? How do consumers, how do they actually really
> utilize calorie information on a food label? Do they understand this
> concept of energy balance or what can\--does energy balance
> understanding really help them in any way? Can calorie information on
> a food label, can it impact behavior? Will it make some\--help them
> improve their caloric intake? Are there ways to more effectively
> communicate calories in the context of single-serving, multi-serving
> packages that makes more sense for consumers? And then what messages
> about calorie and serving size would be truly motivational, not just
> informational, helping them to bridge the gap between what they know
> and what they\'re doing. And, in fact, I\'m very pleased that GMA is
> going to make\--Grocery Manufacturers of America will be making a
> grant to the IFIC Foundation to conduct this research that we\'re
> hopeful to begin in the beginning of the year, so we\'ll be able to
> share that with our colleagues.
>
> So, in summary, I think these are the key points I\'d like to take
> away with today that consumers are telling us that nutrition
> information is important, but they are certainly telling us that it\'s
> difficult to achieve healthful eating; and certainly the statistics on
> where we were on overweight and obesity bear that out; that they tell
> us that they are using the food label in making their food decisions,
> so it still has some relevance in use in today\'s consumer world. But
> I do believe that we do need consumer research to understand how
> consumers are using calorie and serving information and how can we
> make that more relevant and useful for the consumer in the future.
>
> Thank you very much for the opportunity to talk today.
>
> \[Applause.\]
>
> \"FOOD INDUSTRY PERSPECTIVE ON CALORIE MODIFIED
>
> PRODUCTS AND FOOD LABELING\"
>
> MR. PHILIPSON: Thank you very much. Next speaker will come from
> industry, which is we\'re very happy to have here, and there\'s a lot
> of discussion on what consumers want in terms of both foods and
> information. And, as opposed to my job, where my income is not
> dependent on delivering what consumers want, industry actually has
> that contingency. So we\'re very interested in learning from them.
>
> We\'re going to hear from Robert Earl, who\'s going to talk. He\'s the
> Senior Director of Nutrition Policy at the National Food Processors
> Association, and he\'s going to talk about the food industry\'s
> perspective on calorie modified products and food labeling.
>
> MR. EARL: What do we have to do to\--anyway, while they\'re getting
> the technology up and running, I want to thank the Food and Drug
> Administration and the Department of Health and Human Services, Dr.
> Crawford, and Ann-Marie, and the FDA Obesity Task Force for convening
> this important workshop to discuss these topics today.
>
> I\'m with the National Food Processors Association, and we are the
> principal scientific and trade association representing the broad base
> of the food industry, focusing on food science, food safety, food
> security, nutrition, and health. And we have four locations: here in
> Washington, D.C. Our laboratories and support facilities in Dublin,
> California, and in Seattle, Washington, and also in the past year we
> have opened an Asia office in Bangkok, Thailand to represent more
> global food interests in science and technology.
>
> What we\'re involved with doing? We\'re the voice of the \$500 billion
> food processing industry on science and public policy issues, on the
> issues ranging from food safety to nutrition, technical and regulatory
> affairs, and consumer issues.
>
> Our members produce the widest variety of food products, from foods
> packaged and processed ranging from containers of glass cans, et
> cetera, from beverages through dried, and boxed and canned other
> products. And also our members include suppliers of technology to the
> food industry.
>
> We represent the food industry on issues such as obesity, food
> labeling, food science and technology issues, and provide research
> technical services, education, communications, and crisis management
> support.
>
> So the food processor\'s role in food labeling and also its use in
> weight management. We produce a full range of high-quality nutritious
> food products for American consumers. These products meet consumers\'
> desire for health nutrition, convenience, taste, and value. And just
> underscoring that taste and value are up there at the top of the list,
> as Sue has mentioned, but also we\'re very much involved in responding
> to consumer needs related to health and nutrition.
>
> We\'re firm believers nutrition facts and other label elements provide
> information that is there to be able to make caloric choices and
> choices among food products. And this is via on and off package
> nutrition education messages, not only through information that our
> members use on food products, but also in other advertising and
> marketing.
>
> Back right around the passage of the Nutrition Labeling in Education
> Act, NFPA was a leader in education about nutrition information on
> foods. We led initial efforts about using nutrition facts for food
> choices in our label facts for healthy eating program. This was a
> joint cooperative effort reviewed by the Food and Drug Administration,
> and by the U.S. Department of Agriculture.
>
> And just to underscore, again, that all food products, virtually all
> of them, carry nutrition facts information. And this was a key effort
> in putting the \"E\" in the NLEA, as several of our government
> speakers have already this morning, and to provide a synergy between
> government and industry in overall labeling and education efforts.
>
> But again, Chris has used the food label, and just to highlight, based
> on the topics that we\'re looking at today, the red circle. Serving
> size information up at the top of the nutrition facts panel. Calories
> from fat per serving. With it, where I have the green arrow and
> circle. And dietary pattern information\--that\'s okay, I
> think\--given the time, don\'t need to turn around. Dietary pattern
> information, down at the bottom when the full nutrition facts label is
> used.
>
> But one of the other areas that Christine discussed earlier this
> morning was that we have foods, and they are used in dietary
> modification. The food industry has responded to consumer concerns and
> abundant options to meet diet and health needs, and these are done
> principally through the use and formulation of all food products, but
> also through the use of tools in nutrient content claims that appear
> on food products. And we have nutrient content claims that help
> consumers make choices, such as healthy, lean, light, and lite related
> to fat and calories. And we have reduced and low related to calories,
> fat, saturated fat, and sodium.
>
> It\'s very difficult to assess the numbers of products that are sold
> in the marketplace, but it is very clear: all you have to do is to
> walk into a supermarket, open a consumer magazine, listen to radio, or
> watch television, and you know that there is an abundant and strong
> and vibrant sector of the marketplace in these types of calorie, fat,
> and other modified products for diet and health.
>
> And it\'s very important to underscore that the use and understanding
> of nutrient content claims on food packages is a very important aspect
> and key part beyond the nutrition panel in helping consumers make
> choices.
>
> Now, Sue has talked about use of food products and consumer beliefs
> related to the importance of nutrition and health, and I want to just
> highlight a couple of different sources of information to look at how
> consumers use and feel there is an importance related to calorie
> information.
>
> And this information comes from the Calorie Control Council lite
> product survey. Consumers prefer descriptors on these food products:
> low calorie at 32 percent; sugar free, 29 percent; reduced sugar,
> 23.9; and diet at 13.8.
>
> But what also is interesting how different sectors of the population
> perceive and utilize these terms. Individuals on diets and older
> adults preferred sugar free as the term for signaling calorically
> modified foods, and adolescents preferred low calorie.
>
> Again, other findings: they also ask questions about fat descriptors
> and fat free was highest in recognition and preference and then low
> fat, reduced fat, and lite hovered around 20 percent each. But
> overall, in both categories, for fat and for caloric information,
> approximately 78 percent of consumers felt that nutrient content was
> very important in making food choices.
>
> And looking also at nutrition and self help. Prevention Magazine and
> the Food Marketing Institute in 2001 did their shopping for health
> survey. One in seven consumers feel that eating and choosing foods is
> important to staying healthy. Seventy-percent of consumers believe
> their diets could be better.
>
> Barriers exist over confusion about nutrition, cost, and convenience
> outside of the supermarket. And some of these barriers perceived by
> consumers. There was a perception that healthier foods are not readily
> available outside the grocery store. Healthier foods may cost more.
> Inconvenience of preparation and their desire for pre-prepared foods
> and innovative packaging.
>
> There was also this confusion that appears in the media and the
> scientific literature about the ongoing debate and evolution of
> nutrition and health information; that we have one study saying one
> thing one week, and the other saying something may be bad for you the
> next week. And there\'s consumer confusion about changing health and
> nutrition messages.
>
> But in looking at how the industry has responded, I think it\'s
> important to return back and look at some of the experience in food
> product development and bringing foods to the marketplace. And one of
> the areas where there was collaboration and response by the food
> industry to government recommendations is to look back at the Healthy
> People 2000 objectives.
>
> Objective 2.15 in those objectives requested that the food industry
> increase to at least 5,000 brand items the availability of processed
> food products reduced in fat and saturated fat. The baseline was 2,500
> food products in 1986, as they were developing the health objectives
> for 2000 and the decade beyond.
>
> But interestingly, by 1991, there were 5,618 products, a growth of
> over 125 percent. That category continued to grow across the decade,
> and this one of the few objectives that was met in the Healthy People
> 2000 series.
>
> And I think this underscores that industry can respond, both to
> consumers\' desire for healthful foods and information about diet and
> health, and also to government requests to build healthful diets and
> to help educate consumers.
>
> But when we look at Healthy People 2010, we no longer have an
> objective for modified food products. There are weight and obesity
> goals. We have a breadth of food consumption goals, both to increase
> consumption of foods and to decrease other categories, very consistent
> with the dietary guidelines for Americans\' messages.
>
> There\'s also not really a calorie message in the Healthy People 2010
> objectives. But there are also other areas related to physical
> activity and other lifestyle factors.
>
> But, again, just to briefly go through some of the issues of what
> we\'re confronted with in dealing with preparing food products for the
> public to help modify and make diet and health selections and also to
> address weight issues.
>
> We have a growing problem of overweight and obesity in America. It\'s
> also a growing concern in the international arena, but it\'s very
> complex.
>
> Food is often seen as the target. Processed foods, restaurants, and
> fast food. But I think we all can agree, and, as we heard from Dr.
> Crawford this morning some of the government\'s role, but there must
> be a concerted effort to look at this on all fronts, from a
> biological, medical, environmental, behavioral, and educational arenas
> in nutrition and health, and looking at obesity and weight management.
> We cannot overlook that it is both nutrition and physical activity
> that are important. Also, information is needed about how to eat and
> how to build healthful diets and incorporate them into healthful
> lifestyles versus the good food bad messages and what to eat issues.
>
> We need to avoid and underscore that we need to avoid the good
> food-bad food concept. But education has been stated by our previous
> speakers, and we concur that it is important and needed by all
> parties\--government, industry, health professionals, and consumer
> advocates. Because, again, what is essential for healthy weight? It\'s
> that balance between nutrition and physical activity.
>
> But it goes beyond that. There are other factors in the nutrition and
> obesity paradox: environment and biology, genetics, environment and
> behavior, prosperity versus poverty, knowledge and unknowningness,
> awareness and unawareness. Other factors in this paradox: time versus
> no time. We\'re all very active we say, but is that really that we are
> busy. There\'s care versus apathy. Social activities versus\--excuse
> me, physical activities versus sedentary activities and behavior.
> Information and no information. And societal aspirations versus
> stagnant process.
>
> Again, to underscore at NFPA and our members, we believe that we need
> to move forward and look at how to eat, not what to eat.
>
> But again, the food industry response: over the past several decades
> in meeting consumers\' desire for diet and health. In the \'70s and
> \'80s, there was a focus on sodium, fat, and cholesterol, and we
> responded with modified products.
>
> In the \'80s and \'90s, fat saturated fat and cholesterol continued,
> of course.
>
> In the 1990\'s and early into this new millennium focus on transfat.
> But also as we embark in the new millennium, we\'re in sort of a
> dietary limbo at this point, between fat and carbohydrate. Which is
> best? Which is maximized? Which is minimized in diet? Science is
> evolving, and the debate will continue.
>
> And for 2000 and beyond, there needs to be a continued focus on health
> and wellness, look at overall diet and calories and also the energy
> balance issues.
>
> So now, what are some of the food label issues? Christine Taylor, this
> morning, did talk a bit about this, but I want to underscore that,
> from our perspective, we agree that perhaps the architecture of the
> nutrition facts panel needs some revisiting. Need to look at what the
> appropriate focus is on fat and heart disease risk reduction. Does
> there need to be a change or amplification of calorie information?
>
> Again, any food label modifications require intensive consumer
> research. We need to go back and revisit and look at the issues from
> the past, when the label was developed, and build upon those in any
> future research.
>
> Also, nutrition and lifestyle education in the broad sense, whether it
> be through dietary guidelines or through the government\'s Healthier
> U.S. initiative, need to use information tools like the nutrition
> facts panel.
>
> You know, we know that consumers, although it\'s beginning to change
> possibly, consumers focus on the middle portion, on the macronutrient
> parts of the food label. And there\'s not as much focus on the
> information on servings and calories at the top of the label. These
> are some of the architectural issues that may need to be addressed to
> think about the use of the label as a weight management and toward
> healthy weight tool.
>
> There\'s no daily value for calories. You have calories from fat, but
> not a huge contextual message, except for looking at the top and the
> bottom of the label, to put those two together in looking at overall
> diet.
>
> Also, like to say that in the next few weeks, I believe, we should
> expect the report of the National Academy of Sciences\' Institute of
> Medicine\'s Food Nutrition Board Study on use of the DRI, information
> on nutrition labeling and food labeling information, and perhaps their
> principles and recommendations may be very useful in this debate as
> well, as we move forward.
>
> But the National Food Processors Association and the food industry
> should look at believing that there\'s a synergy of information here,
> using nutrition facts as a tool to build healthful diets, make food
> selections, and then combine that with the messages in the food guide
> pyramid and the dietary guidelines so that consumers can build
> healthful diets and live healthful lifestyles.
>
> But there\'s another issue here as well. When we think about the
> issues related to serving size, there is the disparity between the
> nutrition labeling information about serving size and serving size as
> articulated in the food guide pyramid. It is our opinion and belief
> that there should be a move toward trying to harmonize those two items
> in the direction of commonly consumed and household unit amounts that
> are used in food labeling to most\--provide most benefit to the
> American consumer.
>
> Now, to conclude. We do believe that already the presentation of
> nutrition information on food packages is ample, is abundant on almost
> all food products and available at point of purchase for many fresh
> products, and that expands both into the areas of FDA jurisdiction, as
> well as USDA for meat and poultry.
>
> Education about diet and health is paramount, and this goes beyond the
> food label.
>
> We need to maximize the synergy between dietary guidance and food
> guide pyramid messages by using label information.
>
> We need to focus on development of positive messages. Perhaps with the
> work of the other FDA task force on qualified health claims and
> consumer messages to focus on positive messages to deliver to the
> consumer about how to eat, not necessarily so much what to eat.
>
> And we need to provide a climate for actionable behavior change.
>
> Again, the food label provides information, but it does not provide
> education. Focusing on labeling of single nutrients or food components
> alone is not going to solve the obesity issue. Learn from past
> experience with the nutrition label and carry that forward with future
> research so that we can learn and revisit those important things that
> Chris described this morning when the format research was done in
> developing the current food label.
>
> Thoroughly test and evaluate any changes with consumers to ensure that
> they can use the information as a tool for making decisions about food
> choices and then to incorporate them into their diets.
>
> And finally, the \"E\" in the NLEA cannot be overlooked, even though
> it is a decade beyond that time, government, industry, health
> professionals, consumer groups all need to educate and be part of that
> and really move ahead in educating about diet and healthful
> lifestyles. Thank you very much.
>
> \[Applause.\]
>
> \"HOW DOES NUTRITIONAL LABELING AFFECT
>
> CALORIC INTAKES?\"
>
> MR. PHILIPSON: Next we\'ll hear from the academic community. We\'re
> going to hear Rodolfo Nayga, who is a professor of Department of
> Agriculture Economics at Texas A&M University. He will speak on how
> does nutritional labeling affect caloric intakes.
>
> DR. NAYGA: Thank you. I\'m pleased to be here. What I want to talk
> about today is part of our research that we did a couple of years ago
> on determining whether use of nutritional label has an effect on the
> quality of the diet and on caloric intakes from fats and saturated
> fats.
>
> So what I\'m going to talk about just very briefly since previous
> speakers have discussed this already is about the NLEA, the motivation
> of our study, the dietary impact study objectives, our empirical
> framework, just very briefly, the estimation procedure, and our
> general findings, and very briefly as well, future areas of research.
>
> So there are three aims of the NLEA, as we all know. One is to promote
> consumer nutritional education. So that\'s the \"E\" in the NLEA. But
> another one is to enable consumers to make more healthful food
> choices, and this is really the focus of my talk today.
>
> And the third one is to provide incentive to the food industry to
> create innovative and healthier new products for consumers.
>
> So what we did was focused on this different types of nutritional
> information on food labels. So we examined the nutrition facts panel,
> use of the list of ingredients information, the use of serving size
> information and the number of servings, nutrient content claims, like
> low-fat, low-calorie, and health claims, which characterize the
> relationship between a nutrient and a disease.
>
> So whenever I talk about this topic to my students, I always show this
> picture, because they all love this product, and I love this product
> as well. And so I asked them how many servings there are in this
> product. Right. And all of them say one or two. Right? And I can
> attest to that as well, because I can probably consume this product in
> one sitting. And also wanted them to guess how the much percentage of
> saturated fat per serving, and they all are amazed when I show them
> the back to this picture that shows that there are four servings in
> this particular package; and that there are 55 percent\--there\'s 55
> percent of calories from saturated fat. So the implication of that is
> if you consume the whole ice cream package in one day, then you had
> your share of saturated fat for how many days? Two days; right?
>
> So it shows the importance really of reading nutritional labels.
>
> So the motivation is pretty straightforward. We all know that, despite
> all this talk about us becoming more nutritionally conscious, that
> we\'re not really eating healthfully, just one out of every ten eating
> healthfully. Four of the top ten causes of death, as has been
> mentioned this morning, are associated with poor diets. Diet-related
> health conditions cost society a lot of money; right? Not only in
> medical costs, but lost productivity, because if you get sick you
> can\'t work, obviously.
>
> And we\'re not proud of this, that we lead the world in terms of this
> global epidemic; right? I have given a similar talk around the world,
> and they all are amazed at overweight we are here in the U.S.; right?
>
> These are just some interesting figures, or numbers, if you will. It
> says here the average number of daily calories successful weight
> losers probably eat, 1,800. Number of calories in a plain cinnamon
> crunch bagel, 510. I was amazed by that as well.
>
> But what\'s interesting is I think the last two over there, it says
> the diameter, in inches, of a typical restaurant plate 20 years ago,
> 10. And diameter in inches of a typical restaurant plate today, 12;
> right? Serving size obviously. This is just to show you that, indeed,
> the top causes of death are diet-related, so if you can only improve
> our diet a little, we could save a lot of lives and money, as well.
>
> It costs the food industry a lot of money to do these nutritional
> labels in the past. So the issue is really pretty simple that we
> wanted to examine. We wanted to know does it really affect consumer
> choice; right?
>
> So what we wanted to know, was we wanted to know the effect of general
> nutritional label use on consumers\' intake of selected nutrients.
> And, for this presentation, we\'re focusing on calories from total fat
> and calories from saturated fat.
>
> But I agree with Robert that we also need to, I think, examine the
> overall diet; right? Not just particular nutrients.
>
> So we also wanted to know the effect of nutritional label use and
> health claims on the overall diet quality.
>
> In terms of empirical framework, we used Stigler\'s Economics of
> Information Search, and a lot of studies have been conducted in this
> area, which indicated that some variables need to be\--are important,
> indeed, to be examined, as well.
>
> In addition, for your\--those of you who are economists, obviously the
> famous health demand production model of Grossman is what we used
> here. So, basically, we\'re using nutritional label as a choice
> variable in the utility maximization routine.
>
> The data is from USDA. It\'s the Continuing Survey of Food Intakes,
> the CSFII. And we had a sample size of 5,400 nationwide\--national
> sample.
>
> What we did here was examine the relationship of diet between label
> users and non-label users. And since the characteristics, we found
> out, of these two groups are different, we had to correct somehow for
> that econometrically. And really, so this slide is just showing that
> we did some sample selection models between label users and non-label
> users, and useful information\--maximum likelihood estimation.
>
> This is just to show you as well how we calculated these net impacts
> of label use, between label users and not label users.
>
> So you\'re probably asking, how are we going to examine or measure the
> overall quality of a person\'s diet? Well, that\'s a dilemma, but
> luckily USDA has this measure called the HEI, the Healthy Eating
> Index, which measures how well people\'s diet conform with recommended
> healthful eating patterns. And this index represents a sum total of 10
> different components. So it\'s an index from 0 to 100; right? Each
> component will have a range of 0 to 10.
>
> Components one to five measure the extent to which a person\'s diet
> conforms with the food guide pyramid recommendations; okay? The sixth
> component measures fat consumption as a percentage of energy intake.
> The seventh, saturated fat as a percentage of energy intake. This is
> just the food guide pyramid. The eighth component measures total
> cholesterol intake. The ninth measures sodium intake, and
> interestingly, as well, they included a 10th component, which reflects
> the variety of a person\'s diet; okay?
>
> So this is the HEI. It\'s an index from zero to a hundred. And from
> this sample that we had anyway, we found out that the average HEI in
> the U.S. population, as represented by this sample, is guess what?
> You\'d probably say 80; right? No, it\'s 60s, in the low 60s.
>
> Now, USDA has said that to be considered a health eater, that the
> minimum HEI must be 80; okay? So we\'re way below the recommended
> level or threshhold level.
>
> So these are results from our econometric models; okay? And this is
> the percentage of calories from total fat. These are for the non-label
> users. We found that age has a non-linear effect. It increases
> positively, and then it declines at a certain age level. We found, at
> least for the non-label users, that females have a higher percentage
> of calories of total fat than males by 1.6 percent. This is on a
> daily, average daily basis.
>
> The whites greater than the others, which are the non-Caucasians and
> the non-African Americans, by 4.8 percent. Interestingly, employed
> individuals greater than unemployed by 1.5 percent. Suburban greater
> than city residents by 1.6 percent on a daily basis. Western residents
> greater than southern residents by two percent. Regular exercisers
> greater than non-exercisers by 2.2 percent.
>
> However, there is some\--
>
> \[End of Tape labeled Side 2\]
>
> African Americans higher than whites by one percent. And whites higher
> than the others, which would include Pacific Islanders, American
> Indians, Asian Americans.
>
> Non-metro residents greater than suburban residents by 1.6 percent.
> Midwest greater than southern by one percent. Those who are not on
> special diet greater than those who are on special diet, as
> recommended by a medical doctor, by 4.7 percent. So that\'s pretty
> high.
>
> Smokers greater than non-smokers by 1.3 percent, so there\'s a
> correlation there between this health behavior.
>
> Non-exercisers, as well, greater than regular exercisers, by 1.4
> percent.
>
> Now, these are for the label users in total fat.
>
> We also\--non-vegetarians, I think this is pretty obvious, have higher
> percentage calories from total fat than vegetarians by three percent.
>
> We also examined saturated fat, and these are for the non-label users.
> Age, non-linear. Whites greater than others. Schooling in years had a
> positive effect of .10 percent per year, ceteris paribus.
>
> Midwest greater than southern residents, .8 percent. Those not on
> special diet higher than those who are on special diet by 1.5 percent.
> Regular exercisers higher than non-exercisers by .6 percent.
>
> And then these are for the label users. The whites greater than others
> by 1.6 percent. Non-metro residents greater than suburban residents by
> .6 percent. Schooling in years now, interesting you have\--it has a
> negative effect. But perhaps we should have included a non-linear
> component to this, and I think we\'re going to do that, because I\'m
> curious, as well, about this effect. But it\'s a good result
> obviously.
>
> Food stamp recipients we found, for label users, have higher
> percentage of calories from saturated fat than the non-food stamp
> recipients, by .7 percent.
>
> Knowledge about diet disease negative effect, which is okay. Not on
> special diet greater than special diet, by 2.1 percent. Smokers higher
> percentage of calories from saturated fat compared to non-smokers by
> .6 percent. Non-regular exercisers higher than regular exercisers. And
> non-vegetarians higher than vegetarians. So, at least for the label
> user models, I think they\'re all pretty consistent with our prior
> hypothesis.
>
> So we calculated the net effect based, once again, on our econometric
> models, and this is what we found. Now, this is based on the HEI,
> right, that we\--or based on the percentage of calories from total fat
> or saturated fats, and the difference between label users and
> non-label users, net difference, is minus 6.9 percent for the
> percentage of calories from total fat. And then for the percentage of
> calories from saturated fat, the net difference is minus 2.1 percent
> on a daily basis. Okay, so the signs are obviously the right ones.
>
> We also calculated the percentage of individuals meeting the dietary
> guidelines. This is for calories from total fat. Not surprising that
> the dietary guideline for total fat is 30 percent or less. It\'s not
> surprising that very few of us meet that dietary guideline. But at
> least among those who meet the dietary guidelines, a higher percentage
> are label users compared to non-label users.
>
> But if you go to 31 to 45 percent, that changes a little bit. And it
> even changes more dramatically once it\'s over, greater than, 45
> percent.
>
> For saturated fat, the dietary guideline is less than 10 percent;
> right? And once again, very few of us meet the dietary guideline, but
> at least it\'s higher, much, much higher, among the label users than
> among non-label users. And once again, it drastically changes as you
> go far along, especially when you go greater than 15 percent.
>
> So I think these are really interesting results.
>
> Now, we also did, as a bonus, we also did the cholesterol, fiber, and
> sodium, and we found these net differences. Negative 67.6 for
> cholesterol, which is good. Fiber, we\'re supposed to eat fiber, so
> label users, we found, have higher fiber intake on average than
> non-label users. And then sodium, negative 29.58 milligrams per day.
>
> Now, these are the results for our models related to the overall diet
> quality, okay, using the HEI that I just explained a few minutes ago.
> So we examined this for the five different types of nutritional
> information that I talked to you about earlier. So list of
> ingredients, the net effect difference is 3.5. Serving size, 4.17.
> Nutritional panel, nutritional facts panel, 4.51. Nutrient content
> claims 5.4, and then the health claims, 6.14. I know, Robert, you had
> a slide there earlier that says that perhaps we should get with those
> diet health claims or disease health claims. But based on this
> research anyway, we found that in terms of its effect, okay, or
> correlation, if you will, that health claims can help.
>
> Now, I\'m going to pause here for a minute, because I want to put
> these numbers into perspective. Now, remember that HEI is from zero to
> a hundred. The average HEI in the U.S. population from this survey,
> from this sample, was in the low 60s. USDA mentioned that the
> threshold level is 80, so if you\'re just an average eater, and even
> if you read health claims or use health claims, that will only put you
> closer to 70, not 80. So it\'s not a\--these numbers are not as high
> as some of us would probably hope to be, but at least they\'re
> helping.
>
> Now, we have to be reminded as well that, you know, it takes time for
> these to take the effect, so perhaps if with more education, these
> numbers can be improved.
>
> We also did some simulations based on some of our demographic factors
> that we included in our models, and this is what we found out. So this
> our difference between label users and non-label users for different
> ethnic groups. So the African Americans have lower HEIs, in average,
> compared to others for both label-users and non-label users. We did
> find much significance differences in the region, although the South
> it was a little bit lower. Education level, we found indeed that there
> is that positive trend; okay? That the higher the education level, the
> higher is the diet quality; okay?
>
> However, also included employment status in our model, and this is
> what we found out. So you\'re probably thinking now, why is that
> happening; right? I\'m fully employed. Does that mean my diet is
> poorer than those who are unemployed? Well, I\'m fully employed as
> well; right? And I think this partly reflects what we call in
> economics as the opportunity costs of time. That means the value of
> your time. Sometimes if you\'re fully employed, you don\'t have
> time\--much\--that time to really take your diet into consideration.
> Another thing I want to mention is we included the full-time mothers
> in the unemployed category, and we should have probably separated that
> as a separate category.
>
> Smoking. Smokers have lower HEIs for both label-users and non-label
> users than non-smokers. We also found that those who exercise
> regularly have higher HEIs than those who don\'t exercise regularly.
>
> Not a surprise for special diet; okay? And then for food stamp, now
> this doesn\'t reflect the fact\--it doesn\'t mean that the food stamp
> program is a failure. All it means that despite the food stamp
> program, that the quality of the diet of the food stamp participants
> are still lower than the non-food stamp participants on average.
>
> And I think some future research\--this is a great picture; right? I
> met a Bo earlier from McDonald\'s, and I apologize, Bo. But the reason
> I\'m showing this is because of obviously the topic in the next
> session is about restaurants. I think there\'s obviously a great need
> for more research in that area, nutritional labeling in the food away
> from home market. This is just a picture I took in one of our local
> papers in College Station, Texas. And this is the owner of a
> restaurant trying to capitalize on this issue; right?
>
> A lot of the restaurants now are also taking this into account, like
> Wendy\'s. We all know about the McDonald\'s and the Appleby\'s trying
> to take advantage of this issue. This one, as well.
>
> And I think there\'s also a need for a lot more research on the new
> qualified health claims that are\--that just have been approved. Thank
> you.
>
> \[Applause.\]
>
> \"HOW PACKAGING UNKNOWINGLY INFLUENCES CONSUMPTION AND CALORIE
> INTAKE\"
>
> DR. PHILIPSON: Okay. We actually are right on time, a little bit early
> actually. But we\'ll take a break. We\'re continuing this session at
> 10:35 a.m. here. So, please, be back in time so that we can\--
>
> \[Recess.\]
>
> Illinois in the wonderful City of Chicago.
>
> DR. WANSINK: Champaign. Champaign-Urbana. Thank you, Tomas.
>
> I like what Susan Borra said earlier today, because she said there\'s
> a big dis-link between what people think and actually what they do.
> Everyone wants to eat healthier. Not everybody does eat healthier. And
> that\'s going the folks who we talk about today.
>
> Now, there\'s a couple key take-away on this big slide, and that is
> the notion of consumption. Everything I\'m going to talk about today
> is related to why people consume the amount they do, but more
> importantly why they unknowingly consume how much they do.
>
> Now, this is our research that was done at the food and brand lab,
> which is my lab down at the University of Illinois, and what it is
> it\'s an interdisciplinary group of researchers. The notion here is
> that if you\'re going to study food consumption, we can\'t have all
> nutritionists do it, because they\'ve got a good angle, but not the
> whole picture. We can\'t have our marketing people do it, because
> they\'ve got part of the picture, but not the whole angle, also. So,
> essentially, what we do is we bring in psychologists, people from the
> hotel school, and anthropologists, and we all study why people consume
> what they do, using either controlled-field situations or actually
> field situations such as some test kitchens, some restaurants, snack
> rooms, and things like this we use.
>
> The basic idea is to try to answer these questions not necessarily by
> asking people what they think they\'re going to do, but actually
> seeing what they do do, okay, by looking at lab experiments, field
> studies, consumer panels, and things like this.
>
> The vast majority of what we do is related to consumption, a little
> bit is related to food choice. And in getting started, there\'s three
> general things I want to talk about. Three general sort of principles
> we\'ve sort of just found kind of mistakenly through the last few
> years.
>
> The first is that consumers pretty much follow the law of least
> effort. We don\'t like to do more than we have to do, so that\'s why
> we get convenient packaging and that\'s why we get really wide
> distribution, and, you know, great fast food restaurant at every major
> corner, and it\'s also why we get the chance to essentially buy
> whatever he wants instead of having to buy and prepare what we want to
> eat.
>
> We also have the option of value, okay. So we get super-sizes at lower
> per unit prices, and we get discounted pre-bundled meals; okay?
> That\'s not always to say we want value, but we want the option of
> having value.
>
> We also want a wide variety of choices, which is why we get brand
> extensions and new flavors, and we get the option of having one dollar
> BK salads that are less expensive than the fries. But interestingly
> enough, end up being eaten at a rate of about one to thirty compared
> to the french fries.
>
> Okay, the two key questions that are sort of implied in this talk is
> first of all, why does packaging influence consumption? Hey, and why
> should we care?
>
> Why does it influence consumption? Well, consumption volume is a
> tremendously low involvement decision. Okay, we may make some decision
> as to whether we want to eat salad or soup. Okay, but once we get that
> soup, we\'re not saying, really, how much do I want? Do I want eight
> ounces or really eight and half ounces? You know, we just eat it.
> It\'s very low involvement.
>
> And the second thing is we think a lot about what we eat, but not how
> much. It\'s very automatic, and we\'re very impressionable by the
> environment.
>
> Why should we care? Well, there\'s a couple of interesting studies
> that have been\--one\'s been done and one that\'s forthcoming next
> year that says that just 50 fewer calories a day for most of us would
> decrease or result in weight loss over a year\'s time in 85 percent of
> all adults. And what\'s going on there is that most of us, 85 percent
> of us, yeah, do we eat too much everyday? Yeah, but it\'s a little
> bit; it\'s 25 to 50 calories. Essentially, that doesn\'t mean anything
> on a day-to-day basis, but over the course of 365 days, and we\'ve got
> three pounds right there; okay.
>
> So, essentially, things we can do that can even reverse this a little
> bit, that can even just cut down what the typical person consumes by
> 30, 40, 50 calories can result in decreasing the\--if you call them
> obesity epidemic, decreasing that.
>
> And second of all, I think why we should care is that this provides a
> win-win opportunity for profitable new offerings\--new products for
> people and essentially weight-loss friendly packaging if companies
> chose to do this.
>
> There\'s a very important caveat. Like most of today\'s talks have
> been about packaging, the packaging is only one driver of food
> consumption volume.
>
> Now, if I can be so bold to make a prediction, I think that probably
> in the next six weeks, even if all of us are incredibly vigilant, and
> even though we think a lot about nutrition, and we\'re very concerned
> about this sort of stuff, in the next six weeks, the average one of us
> is going to gain one and half to three to pounds. Okay. And how much
> of that is going to have to do with packaging? None of it. Okay.
>
> Here\'s what it\'s going to have to do with. It\'s going to have to do
> with the eating environment we\'re going to find ourselves in for
> Thanksgiving, the holidays, and for New Years Eve. Essentially, we\'re
> going to be\--we\'re going to be at the phase where there\'s less
> effort. We\'re going to be eating with others. There\'s a lot more
> distractions, and there\'s great atmospherics that encourage us to eat
> a lot more than we otherwise would. And that\'s one of the big drivers
> of why we eat.
>
> The other one ends up being the food environment. And you can see that
> can be the size of packages and portions, but it\'s also the salience
> of food, how it\'s structured and the variety of it, the stockpiling
> and the shape of things. And so if we want to essentially point at the
> problem of obesity, it isn\'t just big packages. Big packages is one
> little thing amidst a whole lot of other stuff that\'s sort of going
> on; okay?
>
> But the two big mediators that I\'m going to talk a little bit about
> today is the fact that, because of these things, we don\'t watch how
> much we eat. Effectively, we don\'t monitor our consumption very
> effectively. And the second thing that happens is large packages,
> large sizes, and even the shape of packages can actually influence
> what we believe is a normal or appropriate amount to eat, and we\'ll
> be looking at data related to that.
>
> So, for those of you who had your muffin, and you\'re saying, I\'m
> just looking for the right time to take a little nap here.
>
> \[Laughter.\]
>
> Especially with the dim lights, it\'s a problem.
>
> I\'ll give the whole presentation in just one slide, and then after
> that, I\'ll give a little more details.
>
> The first part of what I\'m going to talk about is how does packaging
> influence consumption. Well, I\'ll show you that package size
> influences it, and even influences it with foods we don\'t like; okay?
> Then I\'m going to show you that package size influence it through
> visual illusions. Okay, and both of these are ways that unknowingly
> make us eat more than we want.
>
> Then I\'m going to look at three possible solutions, and these are
> preliminary data and three solutions, and first of all, I\'m going to
> conclude that we can\'t rely only on label information. And I\'ll show
> that it\'s because we ignore it. Then I\'ll show that we can\'t rely
> only on small portions, making things smaller, because we
> overcompensate by eating more of those things. Then, I\'m going to
> show some preliminary evidence that shows that structural changes to
> packages make people much more aware of their eating, and they may
> help reduce intake.
>
> Okay, first of all package size increases consumption. Back throughout
> the \'90s, I did a lot of studies related to how if you give people,
> let\'s say, a medium, a large, an extra large package how it
> influences people.
>
> Typically, the studies would go something like this. We might give
> somebody a half-pound bag of M&Ms, or a full pound bag of M&Ms, or a
> two-pound bag of M&Ms, and we give them a videotape. We\'d say, hey,
> we\'re interested in knowing what you think about this videotape. Take
> it home. Take your M&Ms. And as soon as you finishing watching the
> videotape tonight, give us a call.
>
> Well, they do that. As soon as they would call, we\'d say, great.
> We\'re going to be right over to pick up your video and your
> unfinished bag of M&Ms. We\'d do this. We\'d get the M&Ms. And what we
> typically found, and this is over 47 to 48 categories, when you go
> from one size to another size, when you double the size, effectively
> that the consumption of these products goes up from a range of about
> 18 to 48 percent. Okay. Now, eventually these things get so huge that
> they stop having an effect; okay? Because there\'s only so many M&Ms
> you can eat or so much spaghetti you can eat. This is a tremendously,
> tremendously robust effect, and it\'s found across all sorts of
> categories. I think the only exception was bleach.
>
> \[Laughter.\]
>
> It didn\'t work there. So the question is: does this always happen?
> Well, I\'m going to tell you, yeah. What we did, we did a field study
> up in Chicago, and what we did was we took\--we went to a movie called
> Payback. I don\'t know if anybody saw that movie. I really doubt it,
> actually. Other than the people here.
>
> And so when people came in, we gave them, we told them it was Illinois
> History Week; could have been. And we gave free popcorn, either a huge
> bucket or a smaller bucket\--a large or an extra large size. But the
> thing was half the people got fresh popcorn, and half the people got
> popcorn that was 14-days old; okay.
>
> \[Laughter.\]
>
> And this is\--I mean it wasn\'t rancid, because it didn\'t have butter
> on it, but, you know eat it, and you\'re going to go\--aren\'t these
> like those packing styrofoam peanuts. I mean, God it\'s just terrible;
> okay.
>
> What ended up happening was they\--and after the movie what we did is
> we grabbed their popcorn, and we waited and asked them a few
> questions; okay.
>
> And what we found is that if people were given popcorn, and you gave
> them a huge bucket, they ate about 45 to 50 percent more from the huge
> bucket than they did the moderately huge bucket.
>
> \[Laughter.\]
>
> Okay. But even if they had this terrible, terrible popcorn, what
> happened is they still ate 40 to 45 percent more. It still had an
> impact. And if you said, hey, what did you think of that popcorn,
> they\'d go, oh, God, that stuff was terrible.
>
> \[Laughter.\]
>
> You\'d go, well, why did you eat so much of it, and invariably people
> don\'t think that they increased their consumption. And all these
> studies, if you say, how much do you think you eat, people will
> tremendously underestimate how much they eat, and they don\'t realize
> they\'re being influenced by these sort of things.
>
> So this basic relationship between packaging and consumption is really
> automatic, because it\'s not just in food. It\'s not just in foods we
> don\'t like, but it\'s\--we\'ve also done this with dog food. People
> pour more dog food if you give them a big bag of dog food than if
> it\'s a smaller bag. We\'ve even found it with plant food. You know
> that little watery stuff.
>
> And so this is probably is not something that\'s going to be saved by
> a label.
>
> Now, the second thing I\'m going to talk about briefly is how does
> package shape influence how we bias our consumption. And I don\'t know
> if you can think back, back, back to, you know, Psych 101, but they
> talked about Piaget, and Piaget would give these kids these bizarre
> shapes; and what he found if you gave kids something that\'s tall and
> skinny, they thought it contained, the package or contained more than
> if you gave something short and wide to the same volume. And the basic
> idea, you remember this T-test, and somebody goes, hey, hey. Is it
> taller or is it wider? You know, we\'ll go, oh, it\'s taller by about
> 20 percent more. Well, you know, in reality it\'s the same size. And
> the same basic notion of how we look at packages is also why when
> we\'re in St. Louis, we go, wow, look at the height of that arch, and
> we don\'t go, wow, it is so wide.
>
> \[Laughter.\]
>
> Okay. Even though, they\'re essentially the same size. The fact is you
> can say, well, yeah, that\'s just a visual illusion. Those are just
> parlor tricks. Well, no they\'re not, because they have a tremendous
> impact on how much people consume.
>
> Let\'s take a look at some people who should be vigilant and should
> know better. These were teenagers at a nutrition and fitness camp up
> on New Hampshire. I don\'t know if you know about these nutrition and
> fitness camps, but, you know, wealthy parents tend to send their kids
> there to lose a few pounds over the summer, and they, you know, come
> back losing about a thousand\--you know, five pounds, which is about a
> thousand dollars a pound. But over the course of that time, they\'re
> told, they\'re taught about nutrition size. They\'re taught about
> portion size. They\'re taught about estimating calories and all these
> sort of things. And what happens is you should think that these people
> would be immune to a lot of the visual tricks that go around\--go on
> around us.
>
> But what we did is we, at cafeteria time or at breakfast time and at
> lunch time in the cafeteria, when kids came through, we gave them
> either a tall skinny glass or a short fat glass. Now, based on what
> Piaget said, if people think a tall skinny glass holds more than a
> short fat glass, we should find people more in short fat glasses than
> tall skinny glasses, even though they contain the same volume. Well,
> after they exited the line, we asked them, how much they thought they
> poured, and we looked at it.
>
> What we found in general was that if you gave these kids these short,
> wide glasses, they were about 22 ounce glasses, they ended up
> consuming about 88 percent more than if you gave them a tall skinny
> glass. But they had no idea that this was happening. So if they poured
> soda pop, they poured about 88 percent more. If they poured milk, they
> poured more. If they poured juice, they poured more.
>
> This was also true with adults. And to try to see how ubiquitous this
> is, just to see if really somebody who\'s very and who\'s very attuned
> to this can do this, we did it with a third population. And we wanted
> to do it with a very specific target volume, which is 1.5 ounces. Does
> anybody know what 1.5 ounces is? Oh, yeah. Okay. It\'s a shot glass;
> right.
>
> So what we did we went to Philadelphia bartenders and said, look, what
> we want you to do is pour, we gave them some bottles of gin, rum,
> whiskey, and I think vodka, and said, hey, pour how much gin in a gin
> and tonic. Pour how much rum you\'d put in a rum and coke. How much
> whiskey in a whiskey on the rocks and stuff. And the poured these
> things, and what we find out is even those these guys had, these
> people had more than five years of experience, bartenders, even
> experienced bartenders poured about 28 percent more alcohol into these
> short tumblers than they did the highball glasses. And we said, even
> experts aren\'t unaffected by this bias; okay?
>
> So, it\'s hard enough for us to believe that if we eat more from big
> packages, even if you don\'t like the food, and if experts even end up
> being influenced by biases, that we can influence consumers very
> easily. So, a key finding: package size and shape influence
> consumption. They implicitly suggest an amount to eat, and they do so
> almost automatically, regardless of our experience, regardless of
> whether we even like the product, regardless of whether it\'s even
> edible; okay?
>
> \[Laughter.\]
>
> Now, there\'s three possible solutions that have been suggested.
> There\'s a whole lot more, but I will just look at three today. One is
> to provide label information. One is to provide smaller portions, and
> one is to make structural changes to the packaging.
>
> This first option looks at will label information decrease overeating.
> And the conventional view is that if people have nutritional
> information, it will influence their behavior. An alternate view is
> that many people largely ignore package information, and essentially
> if you tell people it\'s healthy, it might even backfire. People go,
> wow, if Snackwell\'s are that low in calorie, I\'ll have ten of them;
> okay?
>
> So we tested this in an environment versus McDonald\'s, and the idea
> here is that Subway is often heralded as being, you know, the
> information god or goddess, because they have these nutrition facts on
> napkins, on glasses, on placemats. You walk in, there\'s posters all
> over. And McDonald\'s is supposed to, and they have it in some places
> in some locations. And the idea is if people read nutritional
> information, does it really help?
>
> We intercepted 500 people after lunch\-- 250 from Subways, and 250
> from McDonald\'s in 10 cities\--and asked them, hey, give us some
> nutritional facts you\'ve learned, and we asked them how much they
> ate.
>
> And what we found is that the average person could recall less than
> one nutritional fact from either Subway or McDonald\'s. And, in fact,
> what happened is though, as you might guess people ate a little more
> if they ate at McDonald\'s than Subway, they were much more accurate
> in estimating how much they ate than the person at Subway. The person
> at Subway said\--he said, how much do you think you ate. And they go,
> about 390 calories worth. In reality, they ate about 610, and part of
> the problem was that they kind of added cheese and mayonnaise and
> chips and cokes and stuff like this, thinking that essentially they
> were bullet proof because they were at a healthy place to eat. Okay,
> and basic\--you can\'t really rely on information because a lot of
> people really, really ignore this sort of stuff.
>
> Option number two, will smaller portions decrease consumption? Well,
> the conventional view is that if you give people smaller portions,
> they\'ll eat less; okay? And it may not be so. We took 180 adults to
> see a movie, and we offered them either big bowels of normal size
> Chips Ahoy cookies, and said, it\'s going to take you an hour and a
> half, take as many Chips Ahoy as you want. Or we offered them a big
> bowel of really those small bitty ones; okay, the mini Chips Ahoy,
> which are about a third of calories. And what we ended up finding is
> that people ate a lot more calories of the small cookies than the
> regular size cookies. Okay, and they underestimated how much they were
> actually eating. So what it looks like is we can\'t really rely on
> small portions either, because we overcompensate by eating more of
> these sort of things.
>
> Okay, so far, we know that we can\'t rely on label information,
> because we ignore it. We can\'t rely on small portions, because we may
> overcompensate for it. Can we structurally change packages to make
> people more aware of what they\'re eating and less mindless.
>
> And we just finished this a short time ago, and all of these things
> are sponsored by either the USDA or the Attorney General has an
> initiative for childhood obesity. So they sponsored all these studies.
> And what we did here is to try to make people more aware of their
> eating. We did a potato chip divider study. We gave people potato
> chips in one of these little tubes, and we modified it so that we put
> in a red potato chip every seven chips, every fourteen chips, or we
> put in no red chips. And they came in, and they said, hey, you\'re
> going to watch a show, sit down, eat away.
>
> And what we ended up finding is that structural dividers in these
> cans, even though they said absolutely nothing on them, even though
> they didn\'t say one serving or whatever, when people ran into
> dividers, they decreased their consumption. So, you can see kind of
> walking up the track there, the seven chip divider people ended up
> eating about, I think it\'s about eight cookies. They ate about twice
> that in fourteen. When they hit the no divider condition, they ended
> up eating about 21. And you can see the gap between the blue and the
> brown\--between the calories they ate and the number they thought they
> ate, because no divider they were much more inaccurate as to how much
> they\'re eating.
>
> Okay. So structural packaging barriers appear to decrease consumption.
> Okay, they can decrease consumption, and they might even be
> profitable. For instance, it might be possible to develop a healthy
> portion line of package and sort of price it appropriately.
>
> The key is to make people aware of how much they\'re eating without
> decreasing their enjoyment in the food. As we know earlier, enjoying
> food and having it taste good is the number one thing people look for.
>
> So the summary of packaging research is that we can\'t rely only on
> label information, because people appear to ignore it. Are there more
> effective ways it can be presented? Well, we\'re working on a few
> different ideas that we hope might be more effective.
>
> We can\'t rely only on small portions, because people seem to
> overcompensate when they eat small portions. Well, are there other
> alternatives to just having small portions?
>
> And the last thing is that structural changes in packaging hold
> promise. There are lot of other forums, and there may be situations
> where it does and doesn\'t work, and that would be the thing to look
> at next. Thank you.
>
> \[Applause.\]
>
> \"HOW DOES THE CURRENT LABEL AND PACKAGING HELP OR
>
> HINDER THOSE ENGAGED IN WEIGHT-LOSS
>
> PROGRAMS?\--FROM WEIGHT WATCHERS\"
>
> DR. PHILIPSON: Thank you. When we, both in the Obesity Working Group
> more generally, have thought about how labeling, whether done in on
> packages or restaurants would help manage people\'s weight, we were
> sort of drawn to the question of how actually programs in the private
> sector interact with the label in terms of guiding, using the label to
> help people manage weight, and that was sort of the motivation for the
> two next speakers.
>
> We\'re going to hear from Karen Miller-Kovach. She\'s the Chief
> Scientist of Weight Watchers, International, and she will speak about
> how does the current label and packaging help or hinder those engaged
> in weight loss programs, a perspective from Weight Watchers.
>
> MS. MILLER-KOVACH: All right. I\'m probably going to need some help
> here. Thank you.
>
> Great. Thank you.
>
> Well, I\'d like to thank you for having me here today, and I am going
> to speak just briefly in terms of what Weight Watchers has done using
> the current nutrition facts panel, but really kind of go more into the
> future, because this is certainly a very future oriented workshop.
>
> And while I\'d like to\--I\'d like to start out by saying as a person
> who is responsible for weight-loss programs and services at 30
> countries, in 30 countries around the world, while our nutrition
> facts, our nutrition labeling, has opportunities for improvement, and
> it\'s great that we\'re moving forward, I can also come and say that
> we are the envy of the world in terms of the kinds of information that
> is available that really is not available in other places.
>
> I\'d also like to make the point that the Weight Watchers Program and
> the services that we offer, we have one of our core beliefs is that
> they need to be based in science. And, as such, Weight Watchers is not
> tied to a single dietary approach. In fact, we have a history of
> evolving our weight-loss program and services, our diets and programs,
> as science has evolved.
>
> And I give you a couple of examples of that. And coming into the more,
> the closer future, in 1997 Weight Watchers introduce the points
> weight-loss system here in the U.S., and this thing off to the right
> for those of you who may not be familiar with it is what we call a
> points finder. And it relies on the nutrition facts panel, using per
> serving the calories, the total fat, and the dietary fiber per serving
> to\--then use your little slide calculator to come up with the points
> value for that. The points value is a single whole number, and the
> Weight Watchers Program is built on the\--on you get so many points
> for the day. Stay within your points target, and you\'ll lose weight.
> And so it\'s a much more easy, portable way to use information than
> counting calories, counting grams of fat, counting grams of fiber. It
> rolls them all down into one single number, and this is an example of
> how we have used the nutrition facts panel, and the information
> that\'s available to the American consumer to make weight loss simple,
> easy, and livable for people.
>
> And since 2000, while we are still on the points weight-loss system,
> we have based, and being convinced by the evidence that\'s been coming
> out associated with more of a dash-type approach to eating, increased
> our emphasis in terms of educational efforts on fruits, vegetables,
> whole grains, and non-fat dairy. We did that before, but we have
> increased our emphasis on that.
>
> Now, being a for-profit business in a specific segment, we are always
> doing market research, because we need to understand the issues, the
> attitudes, the beliefs, and really what\'s going among our core
> market. And our core market, as I should believe should be the core
> market of the people who are here looking at this workshop and how do
> overweight Americans use food packages and labeling, because we do
> have an obesity epidemic, our core market is overweight Americans who
> are interested and motivated to lose weight within the next few weeks
> or to start that weight-loss attempt within the next few weeks.
>
> We do our market research in a number of ways, including quantitative
> surveys, focus groups, one-on-one. And so, would I would like to do is
> spend the bulk of my time doing is to a little bit of a step beyond
> where Sue Borra took this morning and to take you into the minds of
> the typical overweight American in July, August, and September of this
> year, who knows they\'re overweight, and who is planning on taking
> action and starting a weight-loss program within the next month.
> That\'s who we\'re talking about.
>
> One of our motivations for doing this is that, as a for profit
> business who is always doing market research, we look for kernels. We
> look for kernels of trends, and then want to explore them in terms of
> how we can use this. What do we want to do about it. We want to be on
> the forefront. And one of the things that we were seeing is that we
> were seeing kernels, because kernels can build into beautiful plants
> or kernels can build into weeds. And we were seeing these kernels
> developing associated with the use of carbohydrates, and the emphasis
> of carbohydrates, particularly cutting out carbohydrates among our
> segment. And we wanted to really get behind that.
>
> A couple of these kernels that led us to believe this research, and it
> was a concentrated research effort that we did, was that we know
> currently that about 25 to 30 million Americans are on a no- and
> low-carb diet; that 21 percent of women who are aged 18 to 64 say that
> they will go on one of these within the next two to three months. And
> certainly, we shop like everyone else in grocery stores and saw the
> abundance or the rising abundance of these no- and low-carb foods that
> were starting to hit the market. And we were interested in intrigued.
> And we also recently heard that \$13 billion from the food industry, a
> small bit in the \$500 billion food industry, but \$13 billion is
> currently estimated to be in no- and low-carb food sales in 2003.
>
> So, again, to better understand both the consumer and the science
> perspectives taking a look at this, we did a comprehensive
> concentrated market and scientific research initiative in this. And
> I\'d like to share the results with you.
>
> I know the time is limited, so what I\'m going to do is focus on the
> consumer side, to get you into the consumer\'s head. While some of the
> science is presented, I am assuming that you\'re familiar with that,
> and we\'ll stay away from that.
>
> The market research consisted of 75 one-on-one, one-hour interviews
> that were geographically dispersed around the United States. As I
> said, a variety of dieters were targeted. All of them were overweight.
> All of them had between 30 and 75 pounds to lose, and all of them
> expressed a high degree of readiness to change to start a weight-loss
> program within the next month.
>
> The one-on-one interviews were done by a trained clinical psychologist
> who does not work for Weight Watchers, and was then summarized in
> terms of a report. And then we further supplemented these findings
> with 14 focus groups in September and October. So that would add about
> 140 to 150 people to the base that we\'re talking about.
>
> As far as findings go, I\'d like to make clear, although it\'s not on
> a slide, that what I\'m going to be talking about in going into the
> consumer\'s mind is summarizing all of this work. And I will only be
> saying to you things that were expressed by the majority of people who
> were interviewed and were expressed with a strong degree of
> conviction. So, I\'m not going to say, well, one person out of the 75
> said this, and so we hold it as a truth. We don\'t. Again, the views
> that I\'m about to give you, or the synopsis, represents the majority
> of consumers stating beliefs with conviction.
>
> One of the key things that I would like to\--a key point that I would
> like to make, because it was a real learning for me as we were doing
> this, is we hear, and I\'ve heard it this morning already, say that
> consumers are confused. They\'re confused. We asked consumers, are you
> confused, and they said, no, I\'m not confused. I know exactly what\'s
> going on right now. And in the area of weight management, I believe
> this to be true. I have been told this to be true, and I believe it.
> And I am not confused. And I think that that\'s a key point, because
> if you express to someone that you\'re trying to clear up confusion,
> and they don\'t think that they\'re confused, it makes a big
> difference.
>
> Essentially, what we found were three gaps between the current state
> of the science and the state of consumer beliefs as it relates to the
> use of no- and low-carb diets. They have to do with how they work, do
> they work, and what does it do to your health? And there was an
> underlying thought process, again, that was believed to be true among
> the people that we believed\--that we spoke with.
>
> Basically, the American overweight person who wants to lose weight
> today believes that following a no- or low-carb diet leads to weight
> loss, despite eating unlimited amounts of food. And logically,
> therefore, it can only be the carbs that are in the food that turn
> into body fat, because how else can you eat unlimited amounts of food
> and lose weight? And, as we just heard, people are notoriously
> terrible at being able to estimate how many calories they\'re eating.
> And so there is a belief that because you can eat unlimited amounts of
> foods and foods that we have beat into people are a high calorie foods
> that they believe that they\'re actually consuming more calories and
> losing weight. So, it has to be the carbs. There can be no other
> logical explanation.
>
> In addition, the conviction of this belief is strengthened because
> there is a strong belief among these people that a no- and low-carb
> diet is the current recommended treatment for diabetes. Diabetics are
> on controlled carb diets. Controlled carbs must be no-carb; therefore,
> these diets are what\'s used to treat diabetes. Diabetics have to
> watch their diet and be concerned about their health. So, if it\'s
> good for a diabetic, it\'s good for me, because I know I\'m at risk
> for diabetes because I\'m overweight.
>
> And then they\'re bombarded with a lot of information from the media
> when they go grocery shopping again to reinforce this belief that they
> have.
>
> So, let\'s take a quick look at those three gaps that exist between
> what people believe to be, they believe to be today, and perhaps what
> the science is suggesting.
>
> As far as the way it works, there is a popular belief, held by many
> millions and millions of Americans today, that all carbs turn to sugar
> in your diet. Only carbs are converted into body fat. The others\--I
> don\'t know what happens to them, but nothing\--they don\'t go to fat;
> and that on a no- and low-carb diet, you can eat more calories than
> before. In fact, calories don\'t matter. Calories don\'t count; and
> that without the carbs, your body, because only carbs can turn to fat,
> if you don\'t eat the carbs, your body has to get energy from
> somewhere, so it breaks down the fat.
>
> And to add to that, to be synergistic with your body having to cut
> down the fat, if you eat fat, it helps bring more fat out of your fat
> cells, and lose more weight. As it was so eloquently put by one of the
> focus group, or one of the interviewees, I don\'t know how it works,
> but I know the fat eats the fat in your body, and it\'s a beautiful
> thing.
>
> \[Laughter.\]
>
> But do these diets work? Do they work in the short term? Do they work
> in the long term? I think that one area of potential synergy in terms
> of the science and the belief is that in the short term, these no- and
> low-carb diets work faster than other diets. There is a greater weight
> loss in the initial stage than they\'ve seen in terms of their
> previous experience.
>
> And that recent studies have shown, again, this is the popular belief,
> is that recent studies have shown, because I do read the newspaper,
> that these no-carb and low-carb diets work better than other diets in
> the short term, in the long term, for the rest of my life. If I lose
> weight this way, it will stay off. It\'s been proven. I read it in the
> newspaper.
>
> Implications on health. I already spoke to this; that the current
> popular belief among the overweight American today is that these kinds
> of regimens are the preferred recommended treatment for diabetes; that
> these, this methodology has been given a clean bill of health, by
> leading obesity experts; and that the no- and low-carb diets represent
> the latest nutritional thinking by leading experts. And I think that
> in some ways, perhaps we can adjourn and convene and that, because we
> heard from several, not a majority, being clear on that, not a
> majority, but probably about one or two dozen of the consumers that we
> spoke to that the pyramid is coming out in 2005. Meat is on the
> bottom. Bread is on the top.
>
> It\'s been decided. It\'s just going to take the government while to
> get the picture done.
>
> A couple of other things that came out of this research that, again,
> I\--they didn\'t fit into my nice little format, so I can\'t\--so I
> just put them on a different slide. But sitting in the back of the
> room became a bit of concern is that the other overriding belief among
> the adults that we spoke, and it was all adults that we spoke to, is
> that this type of dietary approach, while proven to be safe and
> efficacious, the way you treat diabetes, you know, you really
> shouldn\'t feed it to your kids. Kids needs fruits and vegetables. And
> kids need low-fat milk. And we were concerned about this enough to
> being asking the question later on in the survey process, is do you
> believe that if you eat one way, and you feed your children other, and
> you tell your children not to do what you\'re doing, do you have a
> concern associated with that? An the uniform answer was no. My
> children do what I tell them to do and don\'t look at what I do.
>
> Also, we heard in terms of speaking with people a couple of just fun
> stories. One is that there was a concern associated with the
> continuation of the new habits with the return to bad habits. One
> woman spoke eloquently of her husband, who had lost some weight on a
> low-carb diet, and said for 30 years his breakfast had been toast and
> juice. And then he switched to bacon and eggs. Now, he had bacon and
> eggs, toast and juice. And was enjoying himself.
>
> And the third thing that I just thought was interesting was spousal
> syndrome. That\'s the effect of weight on the other members of the
> household when one was following one of these regimens, because the
> other foods are there, and they eat everything, and there\'s actually
> weight gain.
>
> So, the conclusion based on this research that I thought this group
> wouldn\'t get much to hear this kind of thing otherwise, especially
> with it being so timely, this has only been\--we\'re talking about two
> to three months down\--is that there are currently consumers that have
> strong misbeliefs about carbs, and carbs is definitely the next wave
> in terms of weight management. People do look at the carbs on the
> label.
>
> The gaps in the understanding are making them make decisions, look at
> labels for things that perhaps were not intended, and if there was a
> better knowledge, they might be making different decisions, and that
> these gaps, it is a wave, and it\'s just a little, it\'s just a little
> ripple right now, but it is growing into a wave.
>
> The biggest concern that I have as a health care professional, and I
> would again like to reiterate that Weight Watchers isn\'t tied to any
> specific dietary approach. So if low-carbs, reducing carbs, cutting
> out all carbs, is demonstrated to be safe, efficacious, and the way it
> should be in the future, we can go there. We can go there pretty
> quickly.
>
> But as a health care professional, I have a concern, and I\'ve heard
> it expressed this morning, and I\'m so grateful to hear that others
> are seeing it and are expressing concern before, and that is that we
> not repeat what we did with fat.
>
> Ten years ago, I sat in focus groups, and I heard people talk about
> calories don\'t count. It\'s all about fat grams. Calories don\'t make
> you fat. Fat makes you fat. It\'s the ice cream I eat that makes me
> fat.
>
> Today, I could have listened to those same tapes and just substituted
> fat for carbs. Calories don\'t count. It\'s the grams of carbohydrate
> that I eat. Calories don\'t make you fat. Carbs make you fat, and it
> was that high carb ice cream that did me in.
>
> I\'m concerned because I think that many of us experienced it in terms
> of the low-fat wave; that we thought that we were doing good. We
> overemphasized. We simplified messages too much, and we were left with
> a public who said that they felt that they had gone through the fat
> prod; that they had done what they were told, and the were heavier
> than ever. I see us on the cusp of doing that again.
>
> Weight Watchers so now in terms of the labeling, Weight Watchers is
> really strongly convinced that any regulations regarding the food
> packaging claims and labeling needs to be science-based. I think we
> would all agree on that.
>
> I think perhaps where we have fallen short, and I raise this as just a
> discussion point, has to do with context. We heard about context this
> morning, and I\'d like to just add a thought, if you would, to the
> area of context. I believe that essentially there are three contexts,
> and this is where there\'s a lot of cross coverage, and a lot of the
> confusion comes in, because we eat food for many reasons. But from a
> scientific perspective, we can eat food to prevent a nutritional
> deficiency. We can eat food to optimize health and prevent a disease.
> And we can\--and we do eat food to achieve or maintain a healthy body
> weight, and those contexts get interchanged; and the messages
> associated with them get interchanged. And the context in which things
> are presented is not clear.
>
> Olive oil is healthy. Do you know how many people poured olive oil all
> over everything and thought they were going to lose weight? Olive oil,
> lard, same number of calories. The context wasn\'t there, and so I
> think that that is something, if we are concerned about the obesity
> epidemic in the U.S., and we want to use the labels and the packaging
> and the health claims to convey that, it\'s very\--it needs to very
> clear when a statement is being made the context. What is the outcome
> when you\'re saying something\'s healthy or it\'s good?
>
> And just as a point of information, I appreciated this forum to be
> able to provide you with the small little blip that Weight Watchers is
> trying to express these views out to the public. We have what we\'re
> calling about The Truth About Carbs Initiative. I have provided a copy
> of the brochure for everyone who is here. And what we are doing is
> we\'re trying to get information out in terms of carbohydrates that
> although carbohydrates are created equal, don\'t throw the baby out
> with the bath water; and that we have different forums for this. We
> are providing it to all of our members, which is several million
> people in the U.S., making it available to the public, physicians, and
> professional organizations. Thank you.
>
> \[Applause.\]
>
> \"HOW DOES THE CURRENT LABEL AND PACKAGING HELP OR
>
> HINDER THOSE ENGAGED IN WEIGHT-LOSS PROGRAMS?\--FROM
>
> A GENERAL DIETICIANS PERSPECTIVE.\"
>
> DR. PHILIPSON: The fact that we\'re roughly\--and I heard numbers
> being mentioned in the neighborhood of \$40 billion or \$50 billion
> being spent on dieting-related behavior. And I also heard numbers that
> very few of these diets seem to work in the long run. That fact has
> sort of motivate part of the Obesity Working Group to look at ways in
> which FDA could potentially facilitate any kind of learning or
> certification about diets. Presumably on a voluntary basis; certainly
> on a voluntary basis in the sense that currently FDA
> provides\--evaluates information about the safety and effectiveness of
> a lot of products, devices, and biologics and drugs. And the
> potentially the same model could be applied to diets. That is to say,
> what are the consequences in terms of safety and efficacy of a given
> diet. And so, we very much welcome public comments to this workshop on
> the topic of whether such an effort would be useful in terms of having
> some kind of certification process or evaluation process of the
> science underlying effectiveness claims about particular diets.
>
> That relates to the second speaker on the same topic, which is Susan
> Cummings. She\'s the Coordinator of Clinical Services at HMG Weight
> Center, American Dietetic Association. She\'s going to be talking how
> to\--about how the current labeling and packaging help or hinder those
> engaged in weight-loss programs, from a general dietician\'s
> perspective.
>
> MS. CUMMINGS: Good morning. Well, I want to thank FDA for inviting me
> here, and I\'d also like to thank my colleagues at the Washington
> Office of the American Dietetic Association for putting together the
> testimony that is your packet.
>
> I am here today not only as a representative of ADA, I need to say the
> disclaimer that any subjective information that I provide is my own
> and coming from a dietician out in the trenches perspective. But the
> American Dietetic Association is the\--this nation\'s largest
> organization of food and nutrition health professionals. And
> dieticians are trained to take the science, the very complex science
> of nutrition and bring that to the individual, make it applicable,
> make it interpretable, and then to not only take that education, to
> not only educate with that information, but to help affect behavior
> change.
>
> And so we do that by providing medical nutrition therapy. Now, I\'ve
> been a dietician for years. But the last 16 of those years
> specializing in weight management. And I have to say that my career
> has sort of gone the rocky road of the dieter in this country. You
> know the \'70s and \'80s, we thought of as the dieting decades. I
> think of as the dieting decades.
>
> So if an individual came to me to lose weight, I would go and design a
> diet for them, and give it to them. And if they came back, and they
> didn\'t lose any weight, well, there\'s something wrong with this
> diet. And I would run back and redesign the diet and find another diet
> and give them that. And if they came back and lost weight, great. And
> so that was the great diet.
>
> And then, as time went on, I think the culmination of the dieting
> decade was in the late \'80s, if you remember Oprah Winfrey. Does
> anybody remember Oprah coming in and carrying\--dragging a wagon full
> of fat, 67 pounds of fat that she had lost on this diet. And, at that
> time, it was a protein sparing modified fast. And these diets were
> provided in medical centers, with multidisciplinary teams of
> dieticians, doctors, physical therapists, and the diet was terrific.
> It worked. But what happened a year later? Oprah and everybody else
> who went on this diet regained the weight.
>
> And to me, that was the culmination of the dieting decades. Okay, diet
> doesn\'t work. We\'ve got to stop trying to find the perfect diet.
>
> And we moved into the \'90s, which not only brought on a non-dieting
> movement and a size-acceptance movement, but we started toward, and I
> for one agreed with, looking at a healthy, eating healthfully, and not
> so much focusing on dieting. And so, low-fats became an important
> message because Americans were suffering from heart disease,
> primarily, and we needed to look at fat.
>
> And the problem was is that, when I, as a dietician, recommended a
> low-fat diet, I\'m thinking in terms of more fruits, vegetables, whole
> grains. Well, unfortunately, that message got very misconstrued. And
> the food industry, in their zeal to give Americans what we want,
> consumers what we want, and to address this need of low-fat, you know,
> started making claims on food labels. Low fat. Low fat.
>
> So people who never ate chips were eating chips because they were
> baked, and they didn\'t have any fat. People who maybe didn\'t eat a
> lot of cookies started eating Snackwell cookies because they were
> low-fat.
>
> And so, what happened is, is we started eating less fat and about 150
> more calories a day.
>
> So, we have to be very careful, again, as we\'ve heard a number of
> speakers say today about the message that we give. And I\'d like
> to\--what am I doing? I don\'t want to end my show. I don\'t want to
> end it. Richard? I want to know\--I want to change the slide. There we
> go.
>
> So the American Dietetic Association has always supported mandatory
> labeling and has participated in the talks that had led to the
> Nutrition Labeling and Education Act. And I have to say that, as a
> dietician, currently I work as the Coordinator of Clinical Services at
> the Massachusetts General Hospital Weight Center, where we have a
> research component, and we also provide adult and pediatric clinical
> programs.
>
> Our programs provide a lifestyle intervention programs of diet and
> nutrition, physical activity. We have programs for binge eating
> disorder, and also we provide extensive programs for individuals
> undergoing weight-loss surgery.
>
> And every one of these programs has a protocol that includes label
> reading and teaching labels.
>
> And when I was asked today\--why do I keep doing that? Let me do that.
> When I was asked today to talk, the topic that I was asked to talk
> about was current food\--do current labels and packaging help or
> hinder those engaged in weight loss, a dietician\'s perspective. And I
> thought, well, can we answer that. Do they help? Maybe. Do they
> hinder? Maybe.
>
> But first I think we have to put in the context of which we\'re
> talking about, and that is obesity. What causes obesity? And in the
> very general sense, obesity is caused by some combination of genetics,
> development, and environment. And the environmental influences are
> those that influence our activity, our physical activity, our
> movement, our exercise, our food choices, how much we eat, what we
> eat, the content of what we eat.
>
> Developmental causes, the way I like to think of developmental are
> those things that are hardwired in at a very early age. For instance,
> you could be\--I\'ll use a non-food example. You could be raised in
> Austria, let\'s say, and you learn how to speak Austrian. You\'re not
> born with an Austrian accent. You learn how to speak Austrian.
>
> Then you move to the United States, and you\'re very smart, and
> you\'re very rich, and you may even be very successful. You may even
> become the Governor of California. However, you still speak with an
> Austrian accent. That is something that\'s been hardwired in since a
> very young age, and very difficult to change.
>
> Well, from a food and behavioral perspective, there are a number of
> behaviors that get wired in at a very early age that I find 40- and
> 50-year-olds, people that I work, still struggle with trying to
> change. That may be mom, I don\'t feel good. Honey, let\'s get some
> ice cream. So that we learn to feel better and to comfort ourselves
> with food. And then as we get older, and mom\'s not around, food is
> comforting us.
>
> That may also be\--there was some work done by Barbara Rules
> \[phonetic\] and her colleagues at Penn State. And they looked at the
> influence of portion sizes on children. Now, we all know if you take a
> toddler, and put a toddler in a high chair and give this toddler food,
> when this toddler\'s finished eating, what happens? There\'s still
> more food on the plate, but what does the toddler do? Throws it over.
> Puts the plate of spaghetti on their head. They\'re not going to eat
> it. Their internal regulators are not going to eat the food. But then,
> there\'s some evidence that suggests four-, five-, six-year-olds will
> actually override that and will eat what\'s put in front of them.
>
> In one study that she did, and I\'m going to sip of this, if you
> don\'t mind\--and one study that was done was and they gave four-,
> five-, six-year-olds lunch, a standard lunch over a period of time.
> And then they increased the size of that lunch by 15 percent, and the
> children ate the increased size without commenting, without feeling
> like they were eating more.
>
> They did the same thing with dinner, and increased that size by 30
> percent.
>
> So, in fact, in the early\--portions do matter. And if we have\--if we
> think about food labels, they\'re not only\--or how we\'re going to
> impact food packaging or if we need to impact food packaging. I think
> of it in terms of it does have a place. It has a small place in the
> environment, and teaching people how to change their eating and giving
> them the knowledge to do so. And it may also play a role in the
> developmental stage, because if mom\'s reading the label, or mom\'s
> serving smaller portion sizes, then the child\'s getting smaller
> portion sizes.
>
> Now, all of this, of course, is influenced by genetics. We cannot
> become overweight or have obesity without the predisposition
> to\--without the genetic predisposition. And what makes this such a
> difficult disease to deal with is that we don\'t have one cause. There
> is not one gene, like blue eyes and brown eyes, that cause obesity.
> It\'s a polygenetic disorder. And what may have happened to those
> children who could eat more food when it\'s presented to them is they
> may have a genetic defect where they don\'t have the same fullness
> level or their satiety level, you know, is higher. So that it may take
> more food for them\--you know, they may be able to eat more food
> without feeling uncomfortably full.
>
> Now, if we look at genetics, and we think about then and now, you
> know, we can\'t say that what\'s causing Americans to be heavier now.
> Is it our genes? Because obviously our genetics haven\'t changed. So
> what\'s changed over the course of time?
>
> And basically, if you look at this slide, and you look at then; let\'s
> say then is\--boy, I\'m really challenged here. All right. Let\'s say
> then is 1965, and in 1965, let\'s say that my sister and I share 50
> percent of the same genes, and my genes in 1965, you know, we\'re
> genetically predisposed to obesity on a continuum. So some people may
> have a 20 percent predisposition. Others, 30 percent. Others, 50
> percent. And let\'s say I have a 20 percent predisposition to have
> obesity. Now, obesity is defined as a body mass index of 30 or higher.
> Mild obesity starts at 30. And let\'s say that my\--I stand right here
> in the yellow, and I have a 20 to 30 percent predisposition to
> obesity. And my sister, let\'s say, right here in the red, and she has
> a body mass index of 30, and this is back in 1970, when, in fact, I\'m
> outside the phone rings and I got to run through the house and answer
> the one phone in the house that\'s hanging on the wall. Or I\'m
> sitting and watching TV, and I have to get up and down and change
> those three channels. Or fix\--get up and fix the ears on the
> antennae. Where I have to move a lot more, and where the food\--and
> where food is not as easily accessible.
>
> Now, let\'s fast forward to 2003. I don\'t have to move as much. I can
> actually sit in my chair, change the channels, answer my phone, and
> work on a computer. And I can do that for hours and be very
> comfortable. And I have a sofa with a secret, which was some furniture
> was advertising up in Boston not long ago, I can flip up the little
> pack and take out my snack foods that are there.
>
> So, in this environment, my 20 percent predisposition to obesity is
> pulled right over. My poor sister is now has obesity at, you know,
> severe obesity. So you can think of the environment as an SUV, just
> pulling the genetics right along.
>
> So, how, you know, so how do we deal with this? How do we work with
> this? Well, the American Dietetic Association did a trends and you,
> nutrition and you trends 2000 survey, of 700 consumers, male and
> female, head of households, age 25 and older.
>
> And what we learned from this was that number one: individuals were
> asked what are their biggest concerns that they read about in the
> news; that they\'re aware of. And 65 percent of them were very
> concerned about obesity, and 53 said that their greatest concerns was
> obesity.
>
> Now, if\--one of the things that dieticians are trained in is how do
> you affect behavior change, and there\'s certain tools\--education
> alone, knowledge alone does not change behavior. We know some of the
> smartest people in the world who are smoking. I mean, it just doesn\'t
> change behavior.
>
> However, you do need an awareness, and you do need knowledge to start
> making that change. And there are tools of cognitive restructuring and
> motivational interviewing that help bring people along.
>
> And so, we know now that the first level of awareness is there and
> that that is important for change; okay?
>
> We also know that consumers are increasingly aware of the connection
> between diet and health, that we seek information on nutrition and
> healthful eating, and that we select foods to achieve balanced
> nutrition and healthy diet. The problem is that sometimes that
> information is very confusing. We heard a lot of messages today, a lot
> of information today, about how, you know, the dieters are very
> confused, and I have to say that I spend 65 percent of my
> non-reimbursable time undoing the myths and the information that the
> consumer, that my clients, my patients come in with.
>
> Now, an example is that 77 percent of consumers are aware of low-fat
> foods, and in this survey, 56 percent of those 77 increased their
> consumption of foods based on this awareness. So, awareness is
> important as a first step.
>
> Now the current food labels address heart disease; that\'s why we have
> total fat and saturated fat. They address hypertension through looking
> at sodium. Diabetes through carbohydrate, fiber, and sugars. Renal
> disease and proteins.
>
> Will they help or hinder the individual engaged in a weight management
> for obesity? You know, we don\'t know that yet. I can tell you that as
> a dietician, and we heard Dr. Crawford this morning talk about most
> people who use labels now use it because they have a specific reason
> to use it. They\'re already sick. They already have a reason, somebody
> with diabetes has a reason to look at carbohydrates or has a reason to
> look at fiber.
>
> But what about obesity; okay? Number one, I think if we look at the
> current label, I have to say from somebody in the trenches, working
> with individuals, seeing about 300 patients a month, that I can tell
> you that if you\'re looking for some room on the label, I think we
> heard a little bit about landscape on the label, I would recommend
> that you use the percent daily value space, because most people,
> number one, do not eat numbers and certainly don\'t eat percentages;
> and it\'s very difficult for an individual to look at a label and
> interpret that.
>
> In addition, I agree with the comments we heard from Christine Taylor
> this morning that the label is not, was not designed nor should it be,
> the end all and be all; that most people probably use it to compare
> one item to another item. So using it as a\--you know, looking at a
> percent of a total intake is very confusing.
>
> In addition to that, the reference diet of 2,000 calories is probably
> most people looking at weight loss do not, are not on a 2,000-calorie
> diet. For myself, at my height and my weight, I need about 1,700
> calories to maintain my weight. Most of the people that I would say
> Weight Watchers probably works with are on 27 to 30 points, which
> is\--whoops, how many calories is that? And so 1,400, 1,500 calories
> for women. Men maybe 1,800 to 2,200 calories. So the reference diet
> itself not only is a little bit hard to find on the label, it may not
> pertain to those that are looking or engaged in weight-management
> programs.
>
> In addition to that, the perception is that the serving size\--that
> serving sizes are larger than those on the food guide pyramid. Now, I
> love the food guide pyramid when it came out. I was back\--you know, I
> was raised in the days of the four food groups. Anybody here remember
> the four food groups?
>
> And from a nutrition perspective, the four food groups didn\'t really
> give you a lot of information. So when the food guide pyramid came
> out, I thought this is terrific. At least it\'s a visual. We can see
> that the base of a healthy meal plan is grains, fruits, and
> vegetables, and the problem is that the serving sizes have changed
> over time. And, therefore, a serving size on the food guide pyramid
> obviously is not the same serving size that people consume or nor that
> is used in the marketplace.
>
> And, in fact, in Trends 2000 Survey, the only group that people could
> identify the correct serving size was bread. All others, they
> underestimated the food guide pyramid serving size or they
> overestimated what they were eating.
>
> Okay, another limitation is packaged foods are not usually eaten in
> exact portions listed. So, it makes it very difficult for a consumer
> to translate the information on the package to their daily intake. And
> adding to the confusion is that if a product has half the\--is
> half\--less than half the weight of the standard-sized product, they
> can be\--it can be considered a single-size serving. So, in this case,
> if you look at a 12-ounce can of Coke and an eight-ounce can of Coke,
> the calories listed, the information listed is per serving or per
> container. But if you look at a 20-ounce bottle of Coke, the serving
> size is two and a half.
>
> How many people here have recently seen an eight-ounce bottle of soda,
> Coke? I was walking through the supermarket not too long ago, and I
> saw it, and I\--it looked like play food that I should have brought
> home for my daughter\'s kitchen. Talk about portion distortion. So,
> you know, most kids when they buy soda nowadays or people when they
> buy soda think a single serving is the 20-ounce bottle. Okay. You
> know, candy bars have gone up in size about five times since the \'60s
> and \'70s, and in the last decade about twice its size. How many
> people sit in the movies and eat this half of this 510-calorie
> Snickers bar? Most likely, not much.
>
> And adding also to the confusion of serving sizes is what we actually
> get when we\'re out there. A\--you know, the food guide pyramid
> recommends six to eleven servings of grains, and this here bagel is
> four ounces. How many servings of grains is that? How many servings of
> your six servings a day that are recommended is this four ounce? Yeah,
> it\'s four.
>
> And the bagel place by my house is six ounces. So I have that bagel in
> the morning, I\'m done with the grains for the day.
>
> Okay. So I think it\'s important, and the other thing I want to get
> back to a little\--you know, I just wanted to say is that this whole
> message of low carbohydrate, you know, high fat, low protein, high
> protein, it\'s not only confusing to the consumer. We don\'t really
> have the answers yet. Maybe, in fact, with the new sciences coming out
> around obesity, maybe, in fact, some people do better on a higher
> protein diet. And maybe, in fact, some other people do better on a
> higher carbohydrate diet. And we need to kind of put things in the
> context of, you know, a balanced diet, but also the more information
> that comes out about what causes obesity, what causes us to get
> larger, I think we\'ll be able to talk a little bit more about
> individualizing treatment. But no one diet is going to do it.
>
> Consumers are seeking useful information, and they\'re paying
> attention, so we have their awareness and their interest. But I think
> we have to be careful about how much information we\'re going to put
> on a label. This says, the new food labels are a bit more candid, but
> don\'t let that scare you.
>
> And basically, I think if we give too much information as far as
> health claims, we\'re going to be back here every 10 years thinking
> about how are we going to change the label to meet the new needs. Ten
> years ago, it was low-fat. Today, it\'s high protein. Who knows what
> it will be next. And please, be careful, because, again, you know,
> we\'re out there in the trenches. I\'m seeing people day in and day
> out that are so confused and have no idea what they\'re supposed to be
> doing, never mind translating numbers into a healthful diet. Oh, I did
> something, but that should probably end it.
>
> So, I think I\'ll end there. Thank you for your time, and I hope this
> gave you some perspective of those of us in the trenches dealing with
> this issue.
>
> \[Applause.\]
>
> \"WHAT LABELING OR PACKAGING CHANGES WITH RESPECT TO
>
> WEIGHT MANAGEMENT MIGHT STIMULATE PRODUCT
>
> REFORMULATION DECISIONS?\"
>
> DR. PHILIPSON: Labeling not only affects the choices that people make
> among current products, also the availability of certain products.
> We\'re going to hear next from Bob Smith. He\'s President of R.E.
> Smith Consulting on what labeling or packaging changes with respect to
> weight management might stimulate product reformulation decisions.
>
> DR. SMITH: Thank you, Tomas. You\'ll notice we\'re running just a
> little behind, and so the solution we\'ve come up with is that I can
> speak for the next hour, and we\'ll not have lunch in keeping with
> the\--
>
> \[Laughter.\]
>
> What do you think about that, Tomas? Thank you very much.
>
> You can see the title of the overall\--that\'s it\--got it\--program
> today, and I was asked specifically to talk about what labeling or
> packing changes with respect to weight management might stimulate
> product reformulation decisions.
>
> Well, first of all, I\'d like to say, and, as most of the speakers
> have, I\'d like to make a declaration that I do not speak for the food
> industry. I don\'t believe there\'s anybody in the food industry that
> speaks for the food industry. But I have three decades of work in the
> area, and I have some observations I\'d like to share with you today.
>
> I\'d like to start out with defining what are the factors, some of the
> factors that industry uses today when deciding to develop a new
> product or reformulate an existing one, particularly to make it a
> healthy food.
>
> Well, here are some of the factors, and it\'s certainly not all of
> them. But first of all, you have to define what the health issue is.
> What is it that you are concerned about? What is the consumer
> concerned about? What are we trying to accomplish? Will the product
> make a meaningful contribution towards resolving this issue? And
> that\'s an important point. If you\'re coming out with a healthy
> product, the product must help to resolve it.
>
> Can the health claim be stated is a very big item for the individual
> company that\'s making these products. Is there a consumer awareness
> about the health issue? Will the consumer the product a value added?
> Is the remedy safe? Can an existing product deliver the claim or do we
> have to use a whole new product type? And finally, of course, will the
> product generate a profit?
>
> These are some of the issues that are talked about in the board rooms
> before that product is even considered.
>
> Well, in the past, present, and in the future, the healthy products
> need points of differentiation. And that will be the theme underlying
> everything I say today. A company has to have points of
> differentiation before they can bring a product out on the market and
> make it successful. As I said, there are areas where we can make
> points of differentiation, and we certainly advantage of that in the
> industry. The ingredients statement, for example, is being used widely
> to bring about points of differentiation. For example, changes to more
> nutritious good ingredients; that is, whole grain flours instead of
> white flours. Removal of perceived non-nutrient bad ingredients.
> Colors, stabilizers, preservatives. People use that. Use of organic
> ingredients is used extensively in some areas, and use of good
> additives\--probiotics, added vitamins, minerals, and
> anti-oxidants\--are taken into consideration in ingredient statement
> approval or upgrade, if you like.
>
> The Nutrition Facts Panel allows for some points of differentiation to
> be mentioned. Zero percentage of perceived bad nutrients, such as fat,
> sugar nutrients, cholesterol, sodium, transfats, and high levels of
> good nutrients, then vitamins, minerals, fiber, protein.
>
> We also have other areas on the package that we can use to make these
> points of differentiation. One is the front panel. This is very
> expensive real estate, but it can be used. And that\'s where you would
> flag such things at baked, not fried, sugarless, fat-free, cholesterol
> free, low in perceived bad ingredient nutrients, whatever they might
> be, high in perceived in good ingredients or nutrients, and that\'s
> where you\'d highlight relationships between product and health
> factors, such as the oats in cholesterol lowering or low-fat in cancer
> connections.
>
> And then on the back panel, you can actually tell a story, in many
> cases, about the nutritional value of the product\--fiber and cancer,
> oats and cholesterol, calcium and bone health, cranberries and urinary
> tract health.
>
> In order to underscore the fact that these points of differentiation
> are terribly important, I want to introduce you to a near relative of
> mine that I like to talk about, and it has been talked about today, as
> a matter of fact, Snackwells.
>
> In early to late 1980s, we at the Nabisco Foods Group talked about
> what we could do to bring about a healthy product to the market,
> knowing full well that in that period of time, the population became
> aware of the fact that intake, that fat intake was implicated in many
> chronic diseases. Nabisco management, at that time, again, committed
> to making lower and no-fat products in their snack lines.
>
> There were two challenges obviously. The major challenge for my group
> in the technology area was how to make a good tasting, because that\'s
> terribly important, functional, and a low-fat product. Marketing was
> also challenged in this particular endeavor. How does one position a
> new snack concept so consumers can understand the benefits, and,
> therefore, purchase them.
>
> Well, from the point of view of technology, we pursued two areas. The
> first was the classical R&D fat removal and replacement process, where
> we replaced the fats with contemporary fat replacers at that time. And
> that result in low- or no-fat versions of virtually all the snack
> items at Nabisco, including the Snackwells.
>
> At the same time, our fundamental research organization developed a
> lower-calorie fat, resulting in the commercialization of Salitrim, a
> five-calorie per gram \[inaudible\] stearified fat, later to be called
> Benefat, which is still under commercial use today.
>
> And just so that\--sorry\--we look at the marketing objectives.
> Sometimes people like myself in research don\'t think much of
> marketing, but I certainly give them kudos. In addition to sustaining
> the project over a long time, which is very difficult for marketing
> people to do, they have a very short attention span.
>
> \[Laughter.\]
>
> The marketing folks at Nabisco have contributed three significant
> advances without which, I think, Snackwells may have failed. First,
> they secured the name Snackwells, which was just a wonderful name for
> a product such as we\'re making. Secondly, they undertook for the
> first time to package the product in green packages. That had never
> been done before, and you can see the impact of that. You can hardly
> go through a store now without all the packages being green. And
> finally, when the market demand exceeded our estimates, and that was a
> mistake we made, by about 500 percent, the marketing group developed
> the cookie man advertisements, which clearly stated to the consumer
> that we were in a mess. We weren\'t producing enough of these things.
> Showed how consumers were intercepting our trucks and fighting over
> packages of this material in the storefront. It made an enormous
> communication vehicle for us. And so, that was a major, major
> contribution. And just so that we all know what I\'m talking about, I
> brought along a couple of things here\--these were on overheads. It
> will take too long to put them on overheads, but you\'ve all
> recognized this. This is a picture of the Snackwell front package,
> just so you\'ll know what I\'m talking about. And I have to admit that
> my wife is very unhappy. I carry this package around instead of that
> of the grandchildren.
>
> \[Laughter.\]
>
> She\'s not too happy with that. Also the back panel, and, again, you
> can\'t see it, but it indicates here a serving size is one of these
> cookies. It is a 50-calories per serving size or 50 calories per
> cookie, and it shows zero fat and zero saturated fats and all those
> nice kinds of things that we\'re trying\--attempting to do.
>
> Well, I\'ve got to admit that the initial product sales were
> absolutely phenomenal. They went right off the charts. It was one of
> the biggest successes in the food industry I guess at that time.
>
> The product also was very profitable. Consumer reaction was highly
> favorable, and instead of product cannibalism, which we talk about in
> the industry, where you replace one product with another\--it takes
> the former one out. Sales of all of our crackers and cookie products
> increased, those in the low-fat and zero-fat, as well as the regulars.
>
> And we were heros. Incredible.
>
> All right. But then came the so-called Snackwell syndrome. I titled
> this Snackwell\'s a misunderstood product. Well, why was Snackwells
> misunderstood?
>
> The consumers felt that low- or no-fat products were healthier and
> lower in calories, and they were disappointed to learn that they were
> not lower in calories. And there was a tendency to overconsume the
> product, as you have heard many times this morning already.
>
> What were the lessons that were learned in that particular exercise?
> Well, most importantly, the consumer recognizes, understands, and
> reacts to nutritional trends and information. That\'s a key element,
> particularly for companies that are making products. The consumer will
> purchase healthier products that meet perceived needs.
>
> Healthier products need a clearly identifiable point of
> differentiation to be marketed, again the underlying theme. And, of
> course, every effort must be made to avoid the chance of misleading
> the consumer. And I had one other picture, which I\'d thought I\'d
> like to share with you. It happens to be the sugar-free Snackwells,
> but most importantly what I wanted to point out is a line underneath
> sugar-free on the front panel that says not for weight control. Keep
> that in mind when we\'re trying to differentiate between overt and not
> so overt misleading of the consumer.
>
> Okay. To get to the point today, weight management. Weight management
> products also need points of differentiation. Important points of
> differentiation for weight management products are calorie reduction
> per serving, available calorie reduction per serving, because I am
> convinced that available calories are going to start becoming part of
> our lexicon. Serving size reduction, I still feel that\'s important,
> not to the extent of going to our mini-Oreos, but something less than
> the ordinary Oreo. Serving size packaging I think is important,
> despite my colleague from Illinois. I did graduate from Illinois many,
> many years ago. I can understand why Illinoisans eat corn, even if
> it\'s old.
>
> \[Laughter.\]
>
> I also sense the subtle change over from those high vertical narrow
> cylinders of silage to horizontal. That\'s all part of getting more
> food into animals. Anyway, weight management education is something
> that is suffering, and it\'s an area that I think companies can make
> as a point of differentiation.
>
> Well, that implies there\'s something wrong with what we\'re doing,
> and I don\'t want to overdo that; but there are some things I think
> that we could nudge along a little bit.
>
> First of all, serving size. The way we put serving sizes on labels
> today, I don\'t think it\'s compelling enough. It\'s not prominent on
> the nutrition panel. The reader is overwhelmed by all the other data
> that\'s on that panel. It\'s not displayed on the front panel, where
> people read mostly. The number of servings per package is not
> prominently displayed. That\'s buried. And many products have
> individual pieces that could be a serving size but are totally
> consumed routinely, and we need to address that issue.
>
> Calories also I think needs, an the prominence of calories, needs
> fixing. I don\'t thin the consumer is really fully aware of the
> liability of overconsuming calories. I don\'t think it\'s well
> understood, and that\'s something we should bring to the party. The
> calories are not prominently displayed on the nutrition label, even
> though they\'re there. The consumer is overwhelmed by all the other
> data I\'ve just mentioned. They\'re not displayed on the front panel.
> They\'re not immediately related to serving size in a way that\'s very
> prominent. And it sort of leaves the impression that calories aren\'t
> important, which I don\'t think is a message we\'re trying to get
> across, particularly now.
>
> So what would motivate industry to produce weight-management products?
> Well, obviously, I think what we need to do when specifically
> targeting weight management through labeling, the serving size and the
> calorie content of the product per serving are the most important
> pieces of information the consumer requires.
>
> And I think industry would be motivated to produce more
> weight-management products if they can use this information to
> differentiate themselves from other products that are in the store.
> Whoop. Hit the wrong one. I\'m sorry. That should go away. Let\'s try
> it. Good.
>
> So, what motivators do we need to work on? Obviously, I say calories.
> The total calories per container should be highlighted much more than
> it is. I think that would give the impression if I eat this whole
> thing, I\'m going to get 800 calories. The effect of overeating
> calories could be illustrated somehow with a cartoon portraying the
> activity needed to work off the calories per serving. This is tying
> the excess calories to what it takes to get rid of them, and
> I\--better people than me will work out this, I\'m sure. But a hundred
> calories could, in fact, be related to 2,000 steps a day more or 500
> calories means you have to run a mile to get rid of them. Those are
> the kinds of highlighting I think that are important in calories.
>
> As far as serving sizes are concerned, there serving sizes could and
> should be reduced by industry, not as I said from the mini-Oreo
> to\--the regular Oreo to the mini-Oreo, but something that\'s somewhat
> less than what the Oreo is today, for example.
>
> Serving sizes need to be individually wrapped. That\'s an expensive
> proposition, and I certainly like the idea of the colored chips to
> differentiate between serving sizes. But there may be ways that we
> could reduce that expense by eliminating some of the interior
> packaging costs.
>
> Could products be differentiated by category, based on a number of
> calories per serving? This is an old idea that\'s been kicking around,
> but I think it\'s worth looking at again, even color coding it. For
> example, a serving size that was a hundred calories per serving might
> be green. One that is 200 calories per serving size might be yellow,
> and then red identifying those at 400 more calories per serving.
>
> I think another thing that would motivate industry to make more
> management, weight management products, a good hard look at standards
> of identity. Some standards of identity need to be revised or
> eliminated. Standards of identity reduce the manufacturer\'s ability
> to use novel and innovative ingredients and processes to produce
> products lower in fat and calories with the same or superior
> attributes.
>
> I give, for example, cheeses that require minimum amounts of milk fat
> to qualify for the name. It would be possible to lower the fat content
> several grams without the loss of taste, but we\'d still need to sell
> it as cheeses, if we could. Ice cream has been mentioned a few times.
> That calls for specified solids and butterfat levels, but we have the
> capability right now to change the type of fat from saturated to
> polyunsaturates and such. Higher protein levels could be put in there
> quite easily.
>
> And the thing that we\'re missing most is the fact that it could not
> be called ice cream at this time.
>
> Health claims. That\'s been talked about a awful lot today. Approval
> of health claims needs to be accelerated and expanded, and I know
> there\'s an effort going on from the July 10th interim guidance
> documentation. There isn\'t any question that that could be expanded
> and approvals accelerated. My personal view is that companies who
> invest in claims substantiating should receive some proprietary use of
> the claim. If a company has put a lot of money into a claim
> substantiation, they should have something just as simple as a
> six-month lead time, or one-year lead time on the claim before
> everybody has access to it.
>
> Nutrition quality claims is something I think we need to look at.
> Well, we talk about health claims and then their relationship to
> disease, nutrition quality claims may not necessarily be tied to any
> kind of disease, and we need to explore the nutrition quality
> guidelines for reducing calories. And I\'ve jumped from the idea to a
> possible outcome. This product needs government guidelines for
> reduction of calories. Or this product needs government guidelines for
> weight management foods. I think there\'s a germ of idea that should
> be pursued. Of course, every company would like a seal of approval
> from the government on their product, and would the FDA ever consider
> a seal of approval for foods for weight management. That implies, of
> course, we know what the weight management food is, and that hasn\'t
> been worked out yet I guess.
>
> Education. That\'s the thing that has not been enforced or induced to
> the extent necessary, and there\'s no question that manufacturers can
> bring a lot to the party on weight management education once we decide
> what the message is.
>
> Obesity is caused by excess intake of calories and or insufficient
> activity to burn off these excess calories. That\'s the message
> that\'s got to come in some form, and we\'re going to talk about that
> later I guess.
>
> How do products fit into an overall weight management program? That\'s
> the piece of education that manufacturers can do. How much activity
> expenditure is required to work off the calories that we\'re talking
> about. And, again, that\'s a possibility that we can do on our
> packages quite well.
>
> And so, I may be out of the realm of understanding here totally, but
> from my perspective at least what we need is an FDA industry consumer
> panel to identify the voluntary, and I underscore the word
> \"voluntary\" consumer weight-management messages appropriate for
> packaged goods, particularly for adolescents, because I think if we
> can get to the adolescent about what it is and what happens to excess
> calories, we\'re going to have a generation of people that are far
> more slim as you indicated today. And also parallel to that, of
> course, would be an FDA-FTC industry consumer panel that identified
> voluntary consumer weight management messages appropriate for
> advertising. Remember there\'s a distinction between those two.
>
> As an example of a little farther out of the box thinking, we might
> consider support of the America on the Move Initiative, generated out
> of Colorado. You may all be aware of that, where overweight was
> purported to be caused by small imbalances of calories ingested versus
> expended over extended periods of time. And their key was about a
> hundred calories a day will result in this\--in a pound year of
> increased weight over maintenance. And so they are recommending a
> reduction of the caloric intake of a hundred calories, I think 75 was
> mentioned before\--a hundred calories per day to maintain body weight.
>
> And in thinking that through, for a 2,000-calorie per day person, this
> represents a five percent reduction in the intake of calories.
> Question: would the FDA allow a nutrition quality guideline,
> recognizing such a reduction? Obviously not on a product. That\'s too
> small. But if it were across a full line of products, would, in fact,
> a statement be able to be made that would differentiate that line of
> products from other things. Worth considering.
>
> Okay. Let\'s summarize what I\'ve talked about today real quickly, and
> I think I\'m going to get you almost on time.
>
> The motivators to encourage weight-management food development.
> Expand, accelerate, and diversify health claims; encourage
> single-serve packaging and measurement devices, and by that I mean
> where we have large containers with bulk product, perhaps the producer
> could put a one-serving size scoop in it or something, just to give us
> some idea that when we pour the cereals out in the morning, we\'re
> really getting four servings instead of one. I think that would be
> worthwhile. Encourage serving size reductions; revise the standards of
> identity, where appropriate; utilize nutrition quality guidelines to
> differentiate products for weight management; explore
> weight-management education programs, especially for adolescents; and
> continue enforcement on non-compliance. And this is an issue that
> major companies, who are very responsible have. If, in fact, we devise
> some of these nuances on the packages, it\'s important for them that
> the FDA particularly enforce those who are stepping over the line and
> abusing these possibilities, because it does lose credibility for the
> entire food industry if a segment of it, even though small, is not
> playing by the rules. And so, the request is for a level playing
> field.
>
> And then my last thought is to give you something to talk about over
> lunch perhaps, I would say what about making a weight management facts
> panel, wherein we would highlight calories per serving, possibly by
> color, as indicated before, consider some simple energy expenditure
> characterization so that people will understand the hundred calories
> means two thousand steps extra, and include other relevant
> weight-management information; that is, fat-calorie ratios or
> something. A very small weight management facts panel, if you would in
> order to get the space because space is expensive. Reduce the
> nutrition facts panel to emphasize the macro ingredients as opposed to
> some of the micro ingredients. And work with industry to offer a
> weight management information, such as the America on the Move, which,
> in fact is gaining in popularity, and I think the industry would be
> very supportive of explaining that on their packages.
>
> So what I\'ve talked about today is obviously individual observations.
> They all need study, and that\'s been mentioned many times before, and
> obviously when we come up with a result, it should be studied before
> it\'s implemented.
>
> But I think we have a great challenge and opportunity to bring
> something to the weight- management problem that we\'re dealing with
> today. And I thank you for your attention.
>
> \[Applause.\]
>
> DR. PHILIPSON: Thank you very much. We\'re going to be meeting back
> here at 1:00 p.m. Lunch is best obtained at a big cafeteria in Nather
> \[phonetic\] Hall, which is directly outside. When you get out of the
> building, you just walk straight towards that building. There\'s a
> smaller cafeteria in the bottom of this building, but we suggest,
> given the size of the audience, that people walk over to the\--to
> Nather Hall. Again, we\'ll be back here at 1:00 p.m.
>
> \[Recess.\]
>
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>
> WHAT CAN BE LEARNED FROM EXPERIENCES WITH LOGOS
>
> OR CERTIFICATION?\--THE CASE OF THE
>
> SWEDISH KEY HOLE\"
>
> DR. PHILIPSON: Can everyone please sit down? Can everyone please sit
> down? We have two remaining speakers before our two roundtables.
> We\'re first going to hear from our Swedish colleagues, Åsa Brugård
> Konde. She was a nutritionist at the Swedish National Food
> Administration, and she\'s going to talk to us about the labeling
> system they have developed in Sweden, which is sort of a dichotomous
> labeling system. Her title is what can be learned from experiences
> with logos or certification?\--the case of the Swedish key hole\"
>
> MS. BRUGÅRD KONDE: Okay. First of all, I would like to thank you very
> much for inviting me here. It has been interesting to follow the
> preceding speakers, and, of course, it\'s very stimulating for me and
> my colleagues at the Swedish National Food Administration that you\'re
> showing such great interest in our symbol labeling.
>
> So it\'s a pleasure for me to tell you about it.
>
> The symbol labeling started in 1989, and, before, two years before
> that, a heart symbol was introduced in the northern part of Sweden,
> where they had a project because of the higher coronary heart disease
> frequency that they had in that part. And the key hold labeling\--no,
> the heart symbol was a part of that project.
>
> And it got so popular that it created a demand of a national symbol.
> The symbol stands for low-fat and fiber-rich products. And why did we
> introduce this? Well, it\'s a way to help the consumers to chose
> low-fat and fiber-rich products. It\'s also a way to stimulate
> development of those products, and to facilitate the marketing of
> them.
>
> It was also necessary to create a common and credible symbol for all
> industry and trade interests, because what had happened was that, as I
> said, it was a demand of a national symbol, but we weren\'t\--or the
> National Food Administration weren\'t quick enough to do that. So the
> different food retailers started to have their own symbols.
>
> Well, I\'ll talk more about that later. The main principles for the
> labeling is that it should be low-fat and fiber-rich food products,
> and that it\'s a better choice within different food groups. So it\'s
> not the same criteria for all groups, but it\'s different depending on
> the variation that you can find within the group. And foods that are
> naturally low-fat or fiber-rich are not labeled. And that\'s, for
> example, meat or fish and vegetables may not be labeled.
>
> The symbol may be used on food, on packages, and also on store
> shelves. I think I have the wrong version\--all right. Never mind.
> I\'m looking at that one.
>
> The criteria for labeling are set by the National Food Administration,
> and\--but it\'s the manufacturers that are responsible for fulfilling
> the specified criteria. The symbol may be used without any charge or
> special commission, as far as they do fulfill the criteria, and it is
> voluntary; it\'s not mandatory. And what I would like to add as well
> is that it does not replace the nutrition facts on the packages. It is
> added to other information. It does not replace that kind of
> information.
>
> We have different criteria for different food groups, and I\'m not
> going to get into details about these\--the criteria, because you can
> all get a little brochure that I brought outside here, where you have
> all those details.
>
> But what is interesting is that there are, as I said, there are
> different criteria. This means that you can put labeling\--the label
> on fat spreads, for example, which would be impossible if it was
> according to the fat energy percentage, because the fat energy
> percentage of fat spreads, even if they have lowered the fat percent
> as such, is still a hundred percent of the energy from fat.
>
> On fiber-rich products, the criteria are based either on whole meal
> grain or on dietary fiber.
>
> I don\'t know why if it\'s possible to get the right version, because
> otherwise I will miss half of the presentation. This is the one that I
> sent you before.
>
> MR. LEVITT: Yeah.
>
> MS. BRUGÅRD KONDE: So if we can get out of this one. Ah, but you have
> the other one on your copies I think. You have a lot of pictures,
> don\'t you? Yeah, well, so it\'s a pity, because it was the
> opposite\--it was this version that I thought that you would get, and
> then I was going to show you the pictures with the animation and
> everything.
>
> \[Laughter.\]
>
> And now, it\'s the opposite. So, I\'m sorry.
>
> Well, I\'ll go on talking. Unfortunately, I cannot tell you about all
> these\--the pictures. The symbol may also be used on ready-made
> dishes. And that was quite difficult to make it in a way that it
> shouldn\'t\--that it should be useful. But, and it\'s written in the
> regulation that it should be a complete meal, and, with that, we mean
> a dish with meat, fish, or a vegetarian alternative with potatoes,
> rice, or pasta and sauce and vegetables. So this complete meal should
> contain not more than 30 percent of the\--the fat energy percent
> should be less than 30.
>
> For meals that are served in restaurants, there is a separate rule to
> make it easier for the cooks and to calculate; and that was that 17
> grams of fat in the portion could be committed, but not more than
> that. And that is good if the dish gives around 500K calories. That\'s
> equivalent to 30 percent of fat energy. But now we have discovered
> that some restaurants serve very small meals, 200K or 300K calories,
> and, in that case, 17 grams of fat is quite a lot. And the problem
> with such a dish is that you will not get satisfied, and then you\'ll
> go and have a chocolate bar afterwards, and then you haven\'t gained
> anything.
>
> There is also a very new project, called Key Meal. Even in Swedish, we
> call it Key Meal, and it\'s a development of the key hole for
> certified restaurants. This has come from one of the restaurant chains
> that are serving meals in universities. But now, it\'s getting spread
> in other chains as well. To be certified, the restaurants have to have
> 75 percent of their staff educated. They\--the criteria are the same,
> but, as you can see, they have modified the symbol. They need\--the
> restaurants have to have one key meal dish on the menu every day, and
> this thing is ruled by something which is the called the Society of
> Key Meal. And we are collaborating with them.
>
> Now, do this\--the knowledge of the symbol lead to better dietary
> practices? There have been quite a lot of master theses done on the
> Key Hole labeling. Not many scientific articles published on it, but
> there are some, and I\'ll tell you about the first two that were made
> in \'96 and \'99 by Lauschen \[phonetic\] and Listner \[phonetic\].
> The first one was a 24-hour dietary recall. And then they analyzed the
> fat and fiber intake, especially. They combined this with an
> open-ended question on the meaning of the symbol. And the result was
> that 62 percent understood the meaning of the symbol. But, in this
> first study, they couldn\'t see any association between the symbol
> knowledge and the total fat intake.
>
> However, there was a small association between the symbol knowledge
> and a higher relative fiber intake. And the fatty acid quality of
> their diets, of those who knew the symbol, was also better.
>
> Three years later, they made a food frequency questionnaire, and with
> the same kind of open description of meaning. That means that they
> didn\'t have to\--they didn\'t have any alternatives. They had to
> invent the responses themselves. This time 65 percent understood the
> meaning, and both women and men with the knowledge of the symbol
> seemed to have adopted the low-fat message, and the women also had
> adopted the fiber-rich message.
>
> The\--one year ago, there was another study. This one is only in
> Swedish until now. I think they will publish something in English as
> well, but now we only have a report in Swedish. Here, you can see that
> 72 percent knew\--associated the symbol with low-fat. This time it was
> that they had\--the\--all these alternatives to respond. Only 31
> percent knew that it is fiber rich. And 33 percent thought it is low
> in calories. And that is often true, but it\'s not really the meaning
> of the symbol.
>
> As you can see, it\'s also quite many that think that the symbol means
> ecological. And that, I think, is because of the green color.
>
> \[Laughter.\]
>
> Now, do they use this symbol while shopping? Well, 44 percent doesn\'t
> say that they do. It\'s always or often, and about as many do it
> sometimes in general. But for the products they asked, it was lower.
> So probably it\'s other products that they buy with the symbol,
> perhaps ham or other\--I don\'t know what kind of products, but not
> very much milk, bread, or fat spreads. Fat spread is a little bit more
> than the other two.
>
> Now, what impact has the Key Hole labeling had in Sweden? On product
> development, I would say definitely yes, it has had an impact. When it
> was introduced, for example, those who are producing cheeses said that
> it wouldn\'t be possible to make delicious cheeses with less than 17
> grams of fat. And now you can find a lot of those products. And there
> are\--it is very much used, and you can more and more products with
> the symbol.
>
> Does it have an impact on the purchasing practices? Difficult to say.
> The studies I told you about say that the consumers use the symbol
> when they are purchasing. So, probably it has. What is interesting is
> that you can\--I think it\'s the last year\--you can see more and more
> of the symbol in this kind of publicity. You can see it even on the
> front page, at least you\'re sitting in the front here. I\'ll put
> these things so that you can look at them afterwards if you want.
>
> So and I think those\--the food retailers and the industry have much
> more money than we have to study the consumers. And since they are
> using the symbol so much, there must be a reason for them to do it.
>
> This can also be said to be a sign that there is an increase in
> consumer demand for low-fat and high-fiber rich product. But, of
> course, there may also\--even if we hadn\'t had the Key Hole labeling
> in Sweden, it could have been the same situation. I don\'t know.
>
> A negative impact that the key hole labeling may have is that it can
> encourage overeating of low-fat products. I mean, even if the cheese
> is\--has 17 grams of fat, it\'s still a lot of fat. And if it has\--if
> the Key Hole symbol makes you eat slices instead of one, then it\'s no
> good.
>
> Does the knowledge have an impact on the behavior? Probably, but we
> can\'t be sure of that. There are some shortcomings with the present
> criteria that I would like to share with you so that if you\'re going
> to introduce a similar symbol, you won\'t make the same mistakes as we
> have made.
>
> The first one, which is very evident now, is that there are products
> with very high levels of sugar. For example, fruit, yogurts, and
> breads. Although they fulfill the criteria for low-fat, but if they
> are very rich in sugar, they are not nutritious food, actually. And
> the same thing is with the breakfast cereals, which may have a high
> fat content, even if they are also fiber-rich.
>
> A perhaps even worse thing can be that the message is\--can be
> misleading. We don\'t know enough about this. There is a student right
> now who is trying to make a study on this. If the consumers may
> believe that the lean sausage, which contains less than 15 grams of
> fat, perhaps they\'d believe that that\'s a better choice than to buy
> fresh meat or fish, which is probably much lower in fat.
>
> And, as I said before, the green color associates to ecologically
> produced products. So that\'s also an advice; that if you\'re going to
> introduce a symbol, a similar symbol, don\'t take the green color.
>
> The National Food Administration has now decided that we should make a
> revision, and very unpredictable overview or revision. We\'re going to
> look at the limits for sugar and salt contents. Some of the ready-made
> dishes are very\--contain a lot of\--a high amount of salt. And
> that\'s, of course, not good, either. There should be some exclusion
> criteria for sugar rich or sodium-rich products for the not only
> restaurants meals, as I\'ve written here, but, as it\'s written in
> your copies, for ready-made dishes I think we need to add more
> criteria to make it better. We may put energy levels, maximum,
> minimum. We may put something on carbohydrate content because, up to
> now, it says it need\--it has to be a carbohydrate content, but
> perhaps that could be only maccaroni. I don\'t know.
>
> And we could put perhaps a criteria that says that it has to contain a
> certain amount of dietary fiber, or what I would like more perhaps
> vegetables, because many of those products\--ready-made dishes that
> you can buy frozen don\'t contain much vegetables, and, to be a good
> dish, they would.
>
> We are also going to look at the possibilities to use labeling of
> recipes in booklets and in this kind of publicity, because, until now,
> it\'s not. It\'s only permitted for recipes for restaurants. And we
> even have a book that I will leave for you. Unfortunately, it\'s all
> in Swedish, but perhaps you ask Tomas Philipson to translate the
> recipes if you look at the pictures and find them appetizing.
>
> But what is happening now is about what happened when the symbol
> labeling started, because one of the pictures that I missed now since
> we have the late\--we don\'t have the latest version on the
> PowerPoint\--was how\--there were two different symbols that the food
> retailers had started with, and that\'s why we got the Key Hole
> symbol. And now, they are also starting with their own symbols, since
> they are not allowed to use the Key Hole on recipes. So I think we
> will have to rethink about that. And the reason why it\'s not
> permitted on recipes for consumers is that it is\--we have believed
> that perhaps they will change one of the ingredients and then the\--it
> won\'t be fulfilling the criteria. But that I think we have to rethink
> of that.
>
> Perhaps we should introduce labeling of naturally lean meat and fish,
> because we can\'t just think that people know. There have also been
> suggestions of putting the label on fruit and vegetables, but I think
> people know that fruit and vegetables are good food without even if we
> don\'t put the label on them. And if we do start that labeling, there
> will be a lot of difficult things to solve on\--for example, ketchup,
> should it be labeled or not? And many of that kind of products.
>
> Perhaps we should include new food groups, salads, like coleslaw or
> potato salad or dressing, are products that may be in the future could
> get the label.
>
> The symbol needs to be developed. We need to increase the credibility
> of this symbol. One thing is to revise the criteria, as I just
> described. Another is to increase the control. There is very little
> control actually done on the Key Hole. And I don\'t think that the
> products that are selled in the stores that we would find any problems
> with those. But for the meals served in restaurants, I think that they
> may be a lot of meals that are getting\--that\--where the restaurants
> are putting the label on foods which are not fulfilling the criteria.
>
> There is also a discussion if we should continue with the same system
> that the authority are having the criteria and the manufacturers are
> responsible for fulfilling them, or if we should have a similar system
> as with the Key Hole labeing; that there should be a certification.
> That will be also discussed during the coming year.
>
> We are also now discussing in Sweden the possibilities to introduce
> differentiated taxes as a way to combat the overweight or the obesity
> that is increasing in Sweden, as well as here. And if the Key Hole
> gets really good, I mean, if we change the criteria in a good way,
> perhaps it could also be used as a tool for these differentiated taxes
> so that all foods that fulfills the criteria for Key Hole labeling
> could also have a lower tax.
>
> In the future perhaps the Key Hole could become a common European or
> international symbol for helping consumer making informed choices.
>
> So my conclusions are that the Key Hole labeling is very widespread
> and well known, both among manufacturers and consumers. You have to
> remember it\'s one of several important tools for making conscious
> choices, and there is an increased interest among manufacturers and
> retailers and restaurants, but the revision is necessary in many
> aspects. Thank you for listening.
>
> \[Applause.\]
>
> \"MARKETING THE LABEL TO CONSUMERS\"
>
> DR. PHILIPSON: Okay, we\'re going to conclude the individual speakers
> with Allison Kretser, who is with\--the Director of Scientific and
> Nutrition Policy at the Grocery Manufacturers of America. She\--her
> talk is entitled Marketing the Label to Consumers.
>
> MS. KRETSER: Great. Good afternoon. I\'m delighted to be here this
> afternoon. I know that I spoke at the first FDA meeting, and so any of
> those comments I won\'t be resharing today; a little I will go back
> over.
>
> First of all, I wanted to share GMA\'s Statement of Commitment on this
> issue; that the food and beverage industry is committed to helping to
> arrest and reverse the growth of obesity around the world.
>
> Achieving this goal will require multiple strategies, the integrated
> efforts of many sectors, and long-term resolve. And the industry is
> committed to doing our part, and will support others in doing theirs.
> And this is an issue where our member companies are collectively
> working, discussing, trying to see where we best can leverage our
> expertise in helping to arrest the growth.
>
> Our member companies GMA helps to facilitate on various different
> issues of concern to the industry. An example that I work on is food
> allergen management. So, collectively, the industry works and looks at
> best practices. They don\'t do it in isolation. And this issue of
> overweight and obesity you do have the commitment of this industry to
> work together.
>
> We want to continue to provide industry leadership to promote
> science-based efforts that positively impact critical nutrition and
> public health issues. We want to ensure that the global food and
> beverage industry is a positive force, and is a valid and responsible
> partner in addressing the obesity issue.
>
> What is our commitment? Our commitment includes providing consumers
> with products to meet their health needs and goals. We have innovative
> product research, and research into nutritious products. We are
> assessing portion size and packaging. There\'s a lot of innovation
> that is going on in that\--in both areas. I think you\'ll see change
> coming; is on the way.
>
> Our industry is committed to responsible advertising and marketing
> practices. And we\'re supporting health and wellness activities for
> employees.
>
> And we know that parents serve as role models. As they become engaged
> at the workplace, they can take that and bring that back to their
> families, as well.
>
> On the issue of the label, there\'s a few things that\--areas that I
> would like to discuss today. The first is on qualified health claims;
> that food choices are not a black and white decision, but it\'s a
> matter of finding the right balance. Qualified health claims provides
> a new tool for improved nutrition communication that will help to
> drive product innovation. Point of purchase we know that that\'s
> helpful. As consumers read about information in their newspapers, in
> magazines, if they see something on an advertisement, then that can be
> reinforced on the label.
>
> We need to focus on empowering consumer choice, and not dictating
> purchases. We feel that the visual rankings that are under
> consideration for qualified health claims, whether or not a letter
> grade or perhaps some type of color coding for the use of qualified
> health claims would cover\--would carry over to the entire food. So
> that if you had a B-grade, a C-grade, you know, what would be that
> impact to the consumer thinking about the food, the entire food. And
> it negates the point of giving consumers the information to make their
> own choices.
>
> GMA submitted comments to the food guide pyramid revision process, and
> we are calling for a harmonization of servings and portion sizes. We
> know that the differences to the consumer between a serving, what
> represents a serving, what represents a portion; it\'s been discussed
> this morning. It\'s unclear to consumers, and it\'s confusing. And we
> support that servings should correspond to common household
> measurements. That\'s easily, the consumer relates to that.
>
> Serving size, as referenced on the food label, should be aligned with
> the dietary guidelines and the food guide pyramid. And one of the
> things that the food industry has done is put the food guide pyramid
> on labels. We\'ve seen that. We know that the pyramid is recognized by
> 80 percent of consumers. So now, we need to take it a step further so
> that we can begin to relate from the food label how that positions to
> the pyramid, so it increases the opportunity for the food and beverage
> industry to communicate recommendations to consumers.
>
> And you can cross reference how a serving fulfills the food guide
> pyramid recommendation directly to the consumer, so if you have a
> product like a casserole, you could then quickly see that if you had a
> portion of that food, then you\'d have, you would have met two grains,
> half a meat, and one vegetable, as just one example. But that would
> begin to help provide some dietary guidance further.
>
> In the area of nutrient content claims, the industry feels that
> incremental, but industry wide reductions in calories, fats, sodium
> can have a resounding impact on consumer health. Currently, we have
> reduced, it\'s 25 percent, you know, a minimum of 25 percent before
> you can use the word reduced, but sometimes what happens is the
> consumers sees that. If they see reduced sodium soups, we do not have
> a high market volume in those products because it\'s perceived perhaps
> for only those individuals that have been given dietary instructions
> that they need to reduce their sodium intake, and they already have a
> chronic disease in place. Those are the individuals who typically do
> look for those types of products. If there were smaller incremental
> changes, we could begin to make a significant impact for all
> Americans.
>
> Labeling changes could also provide new industry incentives to improve
> their nutritional profiles, even, in fact, if we could say 10 percent
> calorie reduction versus a 25 percent reduction. We know it\'s
> on\--you know, you don\'t have to hit a home run every time you eat
> one particular product. A base hit can add up and get some runs in
> there as well.
>
> Another area in the nutrient content claim area is the 50-gram rule,
> and it applies to foods that have a smaller reference amount
> customarily consumed of less than 30 grams. So one-ounce foods, which
> fall to 20 grams, have\--it\'s very difficult to be able to make a low
> calorie claim, because it\'s based on, you must, even though the food,
> the serving size is 30 grams, you have to meet it on a 50-gram basis.
> So you\'d have to have only 24 calories per serving instead of what
> the actual criteria is for low-calorie, less than or equal to 40
> calories. The same is true on the low-fat. That it\'s a little bit
> tighter. So the restrictive standards have had limited opportunities
> to market low-calorie or low-fat foods in these types of products.
>
> We\'ve heard a little bit about next steps in the consumer research
> and what we want to look at. We know that consumer understanding is
> based on accurate and clear messages, and we feel very strongly that
> as we look at how can the food label change, we need to make sure that
> consumer research is done so that we understand how does the consumer
> see these changes or additions to the food label. So GMA will be\--has
> commissioned consumer research to gauge consumer understanding of
> calories, serving, and single- and multiple-serve packaging. Since,
> NLEA has been in existence since the early \'90s, we have seen a
> growth in the number of single-serve packages that wasn\'t an issue
> when NLEA was first implemented. So now, it\'s time to take a look and
> see how whether or not we can find ways to enhance the message about
> the caloric content of those products, moving forward.
>
> The other area that is a huge void is helping Americans to balance the
> calories in and the calories out, and how to balance that total
> equation of what they eat against what they do.
>
> We heard a little bit about that this morning, and I know Bob
> mentioned whether or not you would have if you had a hundred-calorie
> food, and what you would have to do to burn off that hundred calories.
> We have great reservation about moving forward with something like
> that because you don\'t have to burn all the energy that you consume.
> You need the fuel for your body to function. And so that would be very
> misleading to the consumer if they had an entree that they thought
> that they would\--you know, they had to go out and run it off, their
> slice of pizza that I had for lunch today. It\'s the excess. And so we
> hope that, through this consumer research, we can begin to be\--to
> capture how to communicate that information and use it to help
> consumers.
>
> Marketing the message. Nutrition education is about more than the
> label, but it can serve as a springboard for other efforts. The
> industry is committed to leverage product marketing across all
> segments to amplify the health and nutrition message, and, again,
> getting that message about energy balance. And we can do that through
> labeling, marketing, and advertising, retail displays within
> supermarkets, that whole channel. Consumer education campaigns. Public
> service announcements, web sites, and brochures. And, as HHS moves
> forward with their Healthier U.S. Initiative, and their campaign in
> getting the word out to consumers, the industry is committed to
> helping to use our collective reach to helping Americans. Thank you.
>
> \[Applause.\]
>
> DR. PHILIPSON: Thanks for that. We\'re a little ahead of schedule, but
> while I propose we take a break until 2:00 p.m. Before so, I wanted to
> thank Rich Cannady, who is actually the main organizer of this
> conference, not me. He basically pulled the whole thing together and
> should be acknowledged as the main organizer. Me, myself and Peter
> Pitts \[phonetic\] and others who will be moderating the afternoon
> helped him do it. But without Rich, this wouldn\'t be possible. So I
> suggest we take a break, and we\'ll back at 2:00 p.m. with our two
> panels.
>
> \[Recess.\]
>
> FOOD PACKAGING AND LABELING
>
> DR. PITTS: Your seats. The feature is about to begin. Good afternoon.
> My name is Peter Pitts. I am the Associate Commissioner for External
> Relations at the Food and Drug Administration, and welcome to the
> expert views panel on food packaging and labeling.
>
> I am going to introduce the panel in neither left, nor right order.
> I\'m going to introduce them based on the piece of paper that I have
> in front of me. So, when I mention your name, just smile and nod to
> the crowd. I note immediately to my right, to your left, is Carol
> Tucker Foreman, of the Consumer Federation of America; Julie Caswell,
> Department of Resource Economics, University of Massachusetts,
> Amherst; Ron Henry, Senior Financial Officer, Program Officer, Robert
> Wood Johnson Foundation; Bill Dietz, my colleague from the CDC; Sue
> Borra, from the International Food Information Council\--IFIC is so
> much easier; Bob Earl, from the Nutrition the Policy, National Food
> Processors Association; Rudy Nayga, Professor of Department of
> Agriculture Economics, Texas A&M; Brian Wansink, Director of Food and
> Brand Lab, University of Illinois; Karen Miller-Kovach, Chief
> Scientist, Weight Watchers, International; Susan Cummings, MGH Weight
> Center, American Dietetic Association; Bob Smith, R.E. Smith
> Consulting; Asa Brugard Konde, Swedish National Food Administration;
> and Allison Kretser, Grocery Manufacturers Association.
>
> A couple of ground rules before we get started. Panelist, we have
> three minutes per panelist, and we have 13 panelists; that\'s 39
> minutes. Let\'s call it 40 minutes to make the math easy. If we stick
> to three minutes, we\'ll have just under an hour for conversation and
> comments, so let\'s try to do that.
>
> Also, when we do turn the questions to the audience, I would ask you,
> and I\'ll remind you, if you please identify yourself, your
> affiliation, as well as who you are directing your question to. That
> way, the audio record will assist us in the transcripts. I\'m going to
> ask the panelists to address three major questions:
>
> The first is: what are the messages suggested by the available data
> that are likely to affect weight gain, weight management, or weight
> loss?
>
> Second: how might those messages be communicated through labeling?
>
> And lastly: what are the pros and cons of communicating through
> labeling the messages that the data suggest?
>
> So why don\'t we begin all the way down at the end, my right, your
> left, and it\'ll be interesting.
>
> DR. WANSINK: What I\'m going to do is reiterate a little bit of what I
> said in the talk that relates to these three questions.
>
> And basically, eating is a very, very low involvement activity,
> particularly when it comes to making the decision as to how much
> we\'re going to eat. So we might be able to decide soup versus salad.
> But once we decide on soup, we have a hart time figuring out exactly
> how much soup we\'re going to eat; okay? And for many people, labeling
> is really largely ignored when it comes to a lot of food things.
>
> As you might remember when I talked about the Subway versus
> McDonald\'s and we intercepted people coming out of Subways, less than
> one\--in the most part, people had very little idea as to any of the
> health messages that Subway offered, even though they\'re on every
> napkin, cup, whatever. And that\'s one point is that people tend to
> ignore these labels. The second point is that they\'re very abstract.
> Calories are abstract for a lot of people, and there\'s a study that
> was reported in the U.S.A. Today today, and what we did is we gave
> people some food that either had no calorie, it had a calorie label
> that said 200 calories, or a label that said that you would
> essentially would have to walk two miles to burn the calories in this
> food.
>
> What we found is that if you label 200 calories, it made no difference
> in how much people ate. But if you actually talked about the
> consequence, you\'re going to have to exercise in order to burn this
> off, it was at that point that it reduced things about 18 percent;
> okay.
>
> But there\'s other ways that we can actually go about doing this. We
> can make it monitor, and where I talked a little bit about the chip
> study, and we had the colored chip every seven or fourteen chips, when
> people hit colored chips, they kind of said, huh, you know maybe I
> have had enough. I didn\'t realize I was eating that much.
>
> So in summary, this doesn\'t mean we shouldn\'t try to modify labels
> to be very clear, but essentially we need to be realistic of the
> impact, which I don\'t think is going to be very much. And we need to
> think beyond labels to think about ways we can alter packaging to make
> this much more easy for people to monitor.
>
> DR. SMITH: Well, I really don\'t need three minutes. I\'ve had these
> three questions for a month, and I still don\'t have the answer.
>
> \[Laughter.\]
>
> However, in order to consume my time, I will offer the fact that I
> think the message has to relate specifically and be focused on
> calories\-- intake and excess calories over intake. I think that\'s a
> very important point.
>
> In terms of how it should be on the labels. It should be focused. It
> should be simple, and it should be consistent across all foods that
> are going to be required or volunteer this kind of information.
>
> As to the pros and cons, I will reiterate my position where we get too
> much on the label, the consumer will not use it. I think whatever
> messages and information we have should be categorized in a box or in
> some way that immediately draws attention to that point, pretty nearly
> to exclusion. And then we might have an impact. Thanks.
>
> DR. NAYGA: I\'m like Bob, I don\'t really know the answers, either. I
> guess as an academic, I want to emphasize, I think there\'s a lot of
> research needs. For one, I think it might be helpful if we can
> research\--if we provide total calorie information in the packaging,
> and also what Bob mentioned earlier about the single-serving size
> packaging, if that will help.
>
> But I also want to reiterate that we need to focus as well on the
> overall diet, not just on single nutrients, because who knows ten
> years from now, we\'ll be talking about some other things.
>
> The calorie obesity health claim might be a thing as well that could
> be evaluated. And I just read this recent article from the Journal of
> Economic Perspectives. A couple of Harvard professors, and they
> concluded that what\'s really causing obesity in the U.S. are these
> time saving food technologies that we have now in terms of food
> preparation, so that might be something that we can think about as
> well.
>
> DR. PITTS: Thank you. I\'ve forgotten one ground rule. Would you
> please introduce yourself prior to your comments? Thank you. Thank
> you, Rudy.
>
> MS. MILLER-KOVACH: Hi, I\'m Karen Miller-Kovach with Weight Watchers.
> And I\'d like to kind of pick up. I think say the same thing that Bob
> said, but in a little bit of a different way. And that\'s by way of a
> story.
>
> About 10 years ago, Weight Watchers had an exchange-based system, and
> we started out very weight focused. And, as new information and new
> science became available, we wanted to incorporate it. And so we
> layered and layered and layered and layered information in, and it got
> very confusing. We had people counting egg yolks because of the
> cholesterol. We had people counting different kinds of fats or being
> given information about different kinds of fats for health reasons and
> not necessarily weight loss reasons. And when we took a good hard
> look, around 1995, what we found is that we\'d done so many things
> right. We did the right thing associated with health, and we did it
> right, and we got the whole thing wrong, because it had just gotten
> too complicated.
>
> We went back to basics, and we said, what are we about? We\'re about
> weight loss. That had to be our primary focus. In every decision that
> we make associated with doing anything with the program, the first
> thing we ask ourselves, what is our primary mission? And what is our
> secondary and tertiary missions? And to make sure that we are very
> focused. I guess I would say that if the nutrition label is to be used
> for weight management purposes to stop the obesity epidemic in
> America, it has to be focused. It has to be the primary and overriding
> being of its existence, and other information has to be considered
> secondary or tertiary.
>
> MR. EARL: Thank you. Bob Earl with the National Food Processors
> Association.
>
> I think just to, you know, echo a couple things that the other
> speakers will probably run out of ideas by the time we get to the end.
>
> DR. PITTS: I wouldn\'t worry about that.
>
> MR. EARL: That Karen said that we have positive, you know, we need to
> have positive messages and really give people tools on being able to
> learn how to eat, and not continue with messages about what to eat in
> a micro sense.
>
> I think that this morning there were a number of things shared that is
> worth reemphasizing related to myths versus realities about different
> food components. But that\'s really an objective that needs to be
> carried out from a broad nutrition education perspective from health
> professionals, government, industry, and others. And the food label
> can\'t do that, but that\'s absolutely critical for Americans\' health
> and weight management.
>
> I think we maybe should look back at history and look at how the food
> industry dealt with the sodium issue over a large number of decades,
> and slowly reducing and using technology to change to change the way
> foods were composed; and that, with or without, nutrient content
> claims, label statements, health claims and a whole variety of things,
> there have been a wide variety of changes to improve the nutrition
> profile of products.
>
> And then one thing that I didn\'t hear mentioned this morning that is
> probably worth noting, particularly since there was an emphasis on
> serving sizes and single-serving packages is that we have to remember
> that that\'s not always driven by consumer desire or by the food
> manufacturer. But the retailer that is buying those products does
> sometimes make significant demands upon the food manufacturer, and
> that perspective actually isn\'t here at all today.
>
> MS. CUMMINGS: My name is Sue Cummings. I\'m with the American Dietetic
> Association, and I have to say that I think what I\'m most impressed
> with today is the theme that\'s coming out of here. It seems like
> there\'s a lot of agreement. I haven\'t heard anything that, from any
> one person, that everyone didn\'t agree with, which is nice, because
> it seems like we don\'t have to go through years of battling the
> issues.
>
> From my perspective, I think labels are very useful, and when you talk
> about sodium, if you have hypertension, it\'s very easy to look at
> your sodium and know what to take and what not to take. How much to
> eat. How much not to eat. To add it up in the course of a day without
> carrying a calculator.
>
> For obesity it\'s very different. And it\'s a complex disorder, and I
> don\'t\--and surely, the food labels alone aren\'t going to fix that.
> But I have to concur with some of the former speakers that it needs to
> be a simple message on the label; that the bottom line with overweight
> is energy in and energy out, so we should focus on the energy coming
> in and focusing on calories on the label and making them stand out and
> making them interpretable, relatable, as very, very important. And I
> hope we learn from the whole no-fat movement that if we focus on one
> nutrient, or we start labeling foods good or bad, if you put low-fat
> on something, you\'re\--then that\'s assuming that high-fat is bad.
>
> And I think we have to be very careful about that, because, like I
> tell my clients, you\'re not bad unless you kill somebody. You know,
> over and over and over, people say I was bad today. I was bad today,
> because they ate something that wasn\'t, you know, had more saturated
> fat than they thought they should have.
>
> In addition to that, we\'re into, you know, another cycle of
> high-protein diets, and I think we have to be careful about following
> the dieting industry as far as our messages go. Three times a week at
> least, I\'ll have somebody ask me, I heard I shouldn\'t eat carrots
> because they have a lot of sugar, and sugar turns into fat. And, you
> know, my message is always if you\'re here because you ate too many
> carrots, I think you should stop eating carrots. But in the big
> picture, carrots aren\'t the issue.

So I think we have to be very, very careful about going after one single
nutrient.

> MS. BORRA: Hi, I\'m Sue Borra. Thank you. I\'m Sue Borra with the
> International Food Information Council, and just to be maybe more
> additive than duplicative, I look at these message and look at what is
> our goal.
>
> Our goal is to help consumers do a better job in healthy lifestyles
> and health behaviors. And I look at these three questions, and I
> almost suggest that we\'re not the group to even begin to answer these
> questions; that we should be going to the consumer with these
> questions to find out what their needs are. How they are dealing with
> these issues in the world that they\'re living in, and trying to have
> healthy lifestyles; and that should be the guide for whatever we do in
> this area.
>
> While we\'re good professionals, we sometimes don\'t have our hands on
> exactly what consumers need.
>
> MS. KRETSER: I\'m Allison Kretser with the Grocery Manufacturers of
> America. A couple of things that I might add or have almost been
> already said is when I looked at the first question, what was the
> messages suggested by the available data that are likely to affect
> weight gain, weight management, or weight loss, it\'s almost like you
> disengage the consumer right away, because consumers may understand
> that, yes, I\'m overweight. But they don\'t want\--the would rather
> approach it from how can I look at a lifestyle, a healthier lifestyle.
> How can someone help me and engage me to take small steps to improve
> the quality of my diet; to improve the amount of physical activity
> that I get each day. And so, it\'s almost like trying to get that
> person to step onto the escalator. You\'re very hesitant. Sometimes,
> if you get your arms full with various different things, and I think
> consumers today are\--that our lives are very, very busy between work
> and family and community activities and so forth.
>
> So how can we help to engage and meet consumers the way that they live
> today is critically important.
>
> And we do need to ask consumers how do they use the information. If
> they see information on the front, how does that affect whether or not
> they turn the package over to look at the nutrition facts panel. The
> nutrition facts panel is extremely useful for providing nutrition
> information. Thank you.
>
> DR. BRUGARD KONDE: Asa Brugard Konde from the Swedish National Food
> Administration.
>
> As I said when I started my presentation, it has been very interesting
> to be here and listening to what you are saying about this problem.
> Many things are similar to what we are discussing in Sweden. One thing
> that has not been mentioned very much is the socio-economic
> differences behind the obesity problem. There was a recent study in
> Stockholm, in Sweden, where you can see\--the results showed that
> obesity were six times higher, the frequency of obesity was six times
> higher among children in less socio-economic\--in poorer areas of
> Stockholm, although Stockholm or Sweden is known for not being a very
> segregated region, but, even there, it was such big differences. And I
> don\'t know how much labeling is important for the socio-economic weak
> groups, but I think we have to take that thing into consideration as
> well; that if it\'s possible the labeling should also apply or be
> understandable about in those groups.
>
> DR. DIETZ: Bill Dietz. I\'m from the CDC.
>
> I\'d like to begin by congratulating the FDA on assembling a really
> stimulating meeting, and I\'m very grateful to the speakers from this
> morning and this afternoon for really providing me with insights into
> this field, which I didn\'t have before.
>
> And finally, I need to emphasize that I\'m not speaking for the CDC or
> HHS.
>
> This issue of messages I think is very important. And from the
> perspective of weight management, the issue is calories, and it
> doesn\'t matter whether you\'re talking about weight gain, weight
> maintenance or weight loss. The issue is calories, and I think that\'s
> what we need to provide information to for consumers.
>
> I think there\'s another essential element of messaging that we
> haven\'t addressed. And that is how do we engage consumers around this
> issue? We haven\'t talked about that.
>
> And, although Sue said, in one of her slides, I think it was Sue, that
> concern about obesity was increasing, I suspect that most people who
> are obese, with a BMI over 30, don\'t consider themselves obese.
> That\'s not me.
>
> How do we engage the general population in this issue of weight, and I
> think that\'s something we haven\'t addressed.
>
> Now, I was also impressed by the confusion about serving size and
> portion, and I suspect that we\--that what we should be aiming at
> if\--in this issue of educating consumers about calories is telling
> them about the calories in a container. I don\'t think that we can
> stop there, but the ice cream example, I think, would respond\--people
> would be much more responsive to the calories in that container of ice
> cream than the calories per serving size or portion, which are going
> to be individually interpreted.
>
> And, in the case of more compact items, like cookies, maybe calories
> per item within the container.
>
> But if we\'re really going to allow people to compare products, it
> seems to me, we might want to consider calories per volume; that is
> caloric density, which is not something that we\'ve discussed, and
> I\'ll come back to in a minute.
>
> Based on Karen Miller-Kovach\'s presentation, I don\'t think we can
> assume that we\'re going to educate consumers about things like
> glycemic index, or the sensory specific satiety, or the satiating
> effects of protein, but for consumers to make educated choices about
> what diet they\'re going to follow to control their weight, they need
> information about carbohydrate and protein and fat on the label.
>
> And just because we\'re focusing now on weight, doesn\'t mean we can
> dispense with what we know about these other elements of the label,
> which are so relevant to health, like saturated fat, transfat, and
> sodium.
>
> It seems to me, though, we also need to think beyond, a little bit
> beyond the label, about biological and behavioral strategies which
> favor the intrinsic regulation of energy balance. And one of those,
> which several speakers alluded to, was the volume of food; that there
> is this emergent field that we eat volumes of food, in which case the
> density becomes a significant consideration. If you eat, less dense
> foods, and you\--volume is what\'s satiating, then you\'re going to
> eat less and you\'re going to autoregulate. You don\'t need a label or
> something to tell you about that, except to tell you what the caloric
> density is. The other promise of that strategy is that it gets around
> this deprivation issue. You don\'t have to eat less to maintain your
> weight, which I think is a significant element.
>
> The other behavioral piece, which I hadn\'t thought about before
> Brian\'s presentation, was the issue of packaging. And that seems to
> me to be a win-win situation, because if you can offer a consumer
> something which looks big, but contains the same amount of calories as
> something that looks smaller, then, it seems to me, you meet the added
> value demand; and that\'s not a labeling issue, but that\'s a supply
> issue, which I think if quite promising.
>
> My final comment is that I think we have to be prepared to change.
> After all, this is a new epidemic. And, as every speaker said, we have
> limited information regarding cause, and this is going to change as
> new research becomes available. And I would say that if they\'re not
> changes that we need to make in the label within 10 years, then we
> haven\'t been doing the right research.
>
> DR. CASWELL: Good afternoon. I\'m Julie Caswell from the University of
> Massachusetts. I\'d like to make some comments that have to do with
> the experience under NLEA in the 1990s that might point to the future
> and some ideas for the future in terms of messages on labels.
>
> One of the obvious impacts of NLEA was the increase in the amount of
> information that was available in the market on nutrition, and it was
> a dramatic increase in the amount of information from the mandatory
> nutrition facts side.
>
> The other thing that happened in the 1990s from pre-NLEA to post-NLEA
> was a total, a very large distribution of which types of products were
> making nutrient content claims. We\'d done some research on this.
> There\'s a slide in your notebook. Some product categories, as much as
> a 30 percent decrease in the percentage of products in those
> categories that were making nutrient content claims. So you had some
> categories of products where claim, voluntary claim activity went down
> dramatically, and you had other categories where voluntary claim
> activity went up dramatically. And so the impact of the labeling
> regulation on the signaling in the market as to who can make a claim,
> who can\'t make a claim. And that experience that we\'ve had in the
> 1990s, I think is very important as we think about how to change the
> labels in the near future.
>
> The other thing I want to comment about what happened and didn\'t
> happen under NLEA: there was an expectation or some thought that the
> fact that we had this nutrition labeling so widely available would
> lead to a trend towards product reformulation, and that we would have
> kind of an effect where the whole nutrient\--the whole food supply got
> more nutritious in some respect. Our research, we looked at 10 product
> categories, and we found, at least up until 1999, that that really
> didn\'t happen; had a lot of entry of products that were more
> nutritious in one dimension or another, but you also had a lot of exit
> of those products as well. And the overall impact in terms of what is
> happening to the nutritional quality if you want to think about it on
> fat dimension, calorie dimension, et cetera, in the 1990s, we didn\'t
> see that impact.
>
> So, I\'m more skeptical now than I was 10 years ago that labeling can
> influence product formulation in the market. What it can, of course,
> influence is the amount of information that people have generally
> available to them. And a point that I would make to preview into or
> segue into our next panel is that as we think about changes to the
> nutrition panel on packaged, that it be consistent with the messages
> that we\'re giving on away-from-home food. As you all know, we\'re now
> to the point where the breakdown of expenditures is about 50 percent
> away from home and 50 percent at home. And so, if we\'re doing
> something in the at-home market to emphasize weight management, then
> that information platform needs to extend across the whole food supply
> and be consistent across the whole food supply. Thank you.
>
> MS. HENRY: Hi. I\'m Rona Henry with the Robert Wood Johnson
> Foundation. And based on what I\'ve heard today, and the discussions
> at the Foundation, my priorities, my conclusions about priorities can
> be summarized with four P\'s: populations, portions, prominence, and
> policy.
>
> Under populations, I think we need to be considering the 40 million
> Americans over age 16 who have low literacy skills, who are
> non-English speaking, the children and adolescents, and the group that
> I call the too busy. Lauren Haldemann and colleagues have done a nice
> job with their bilingual color-coded label. But I think it\'s still
> more work needs to be done to further simplify it. Children and
> adolescents now have spending power\--are spending more than \$30
> billion a year. And I think that\'s a consumer group we need to think
> about. They\'re learning about the food pyramid, and food labels in
> schools, but we still need to make that easy for them to use. And then
> the group that\'s too busy. The reason that people say that they
> don\'t use the labels is it\'s too complicated and too time consuming.
> So we need to really think about keeping it simple and keeping it
> understandable. So we need to use creative marketing techniques to
> make it understandable. For instance, using teaspoons, common
> measurements, instead of grams that are more abstract and other kinds
> of abstract measurements.
>
> Under portions, I would agree with the talk about getting some
> harmonization between portion sizes on the food pyramid and the food
> label. But I think the key question is which way to do you go? Do you
> try to promote the lower portion to reduce how much people are eating
> or do you go with what\'s actually being eaten?
>
> I think we also in terms of portions need to be paying attention to
> kids. Obviously, this is going to be challenging because kids come in
> all shapes and sizes. But I think we do need to try and acknowledge on
> the label that kids should not be eating adult-sized portions.
>
> And I am intrigued with this notion of trying to equate the energy
> intake of the servings with the energy expenditure needed to use the
> calories listed. I think that\'s an area, you know, how many minutes
> of jumping rope might be kind of interesting to do some research on,
> and see if it makes any difference.
>
> On prominence. Related also to the portion sizes is that the I think
> that the portion sizes and the serving sizes need to be much more
> prominent on the front of the label in big letters. This is especially
> true for eat-on-the-go packaging that appear to be single-serving,
> but, in fact, are often more than two. Beverages are particularly
> problematic in this area. And I think we should really try to decide
> what are the most important elements to highlight in a concise clear
> message. We need to simplify things. Try to gain a scientific
> consensus on the few things that could be communicated in the logo.
> And a logo is very interesting and promising and shows that people do
> understand that logos\--studies have shown that people understand that
> logos are for healthy foods. But they also have found that people
> would see that foods without logos can be healthy. So perhaps we need
> to be thinking about a kind of movie rating or TV rating system where
> everything gets rated.
>
> And then on the policy, there\'s\--I think we need to be striving for
> closer alignment with the public translation of three important policy
> and communication initiatives unfolding right now in parallel fashion.
> The labeling reforms that we\'re talking about today. The dietary
> guidelines revisions. That\'s a process that\'s underway, and should
> be scheduled to wrap up in a year or so. And the revision of the
> current food guide pyramid.
>
> A final word about implementation: I think we\'ll need to keep in mind
> that a significant education campaign will need to accompany any
> changes on the labeling, not only to raise awareness of the changes,
> but also the energy equation as a factor that consumers now need to
> think about. As the one percent or less milk campaign has shown and
> been successful with, you need multiple and varied distribution
> channels to get your message out in order to make a difference.
>
> We\'re just delighted at the Foundation that the FDA and other\--and
> HHS and other people in government are taking on this issue, and we
> would be delighted to work with them and others to address this.
>
> MS. TUCKER FOREMAN: Can I stand up here, please?
>
> DR. PITTS: Absolutely.
>
> MS. TUCKER FOREMAN: Since I have to\--I want to make one click. What
> happened to the blue screen that has it? I\'ve lost my\--oh, thank
> you. I see. Great. Thanks. I\'ll do it. Thanks a lot.
>
> Hi. Thanks very much. I think better if I stand up. I\'m delighted
> that FDA is going into a serious consideration of the need to update
> the labels. We\'ve got some experience now, and it\'s time to move on.
>
> I\'m going to try to talk very quickly. I missed this morning, but I
> read Professor Wansink\'s paper, and I was very impressed with the
> question that he asked about how do we make food labels more effective
> by asking not just what we eat, but how much we eat, which I think is
> especially important. He pointed out that a 50-calorie a day change
> could result in a weight loss for 82 percent of U.S. adults.
>
> The current food label really does not address controlling total
> caloric intake. There\'s really no effective message there about total
> calories. Last night, I pulled a box of cereal out, and went through
> it; and, you know, you got to look down in the itty-bitty type with
> two asterisks before it to say that the measurements are based on a
> 2,000 calorie a day diet. And I think it was Dr. Cummings who noted
> that a lot of her clients are people who, if they ate 2,000 calories a
> day, would keep gaining weight. I\'m afraid I may be into that
> category as well.
>
> Current labels should be changed to emphasize the need to control
> total intake. The labels might state that, based on 2,000\--they\'re
> based on 2,000 calories a day, but that many adults will want to
> consume fewer calories in order to maintain weight.
>
> You know, consumers really shouldn\'t have to have a degree in
> nutrition or carry a calculator, put on their reading glasses, or be
> prepared to spend an hour at the supermarket, strolling through the
> aisles in order to be able to understand what it takes to buy healthy
> foods and to consume a healthy diet.
>
> We\'re all rushed. The Food Marketing Institute has talked about
> consumers being driven the three C\'s: convenience, cost, and
> confusion. That shouldn\'t be the case, at least the confusion
> shouldn\'t be the case.
>
> I come from a political background. We believe messages need to be
> clear and simple, and pictures and symbols work better than words. One
> way to communicate with consumers about how much we can eat would be
> to adopt some simple graphics, and let me see if I can\--I am not a
> graphic artist, but even I could come up with that one, where, if you
> had\--if you were to adopt the walking stick figure, you might be able
> to say on each, for each food, that the serving of that food would
> require that much brisk walking in order to work it off.
>
> A simple graphic could also be used to show the relative proportion of
> a day\'s fat, sugar, and salt contained in a serving of food. Let\'s
> see\--yeah, once again, you have to forgive my poor artwork, but if
> you were to have a four tube thermometer\--I thought about this while
> I was looking at the measurement on the hot sauce, and it\--you know,
> the pepper goes up and down\--and I thought, well, you know, you might
> use four tubes like that and have one for total calories, one for fat,
> one for sugar, and one for sodium. And, you know, that one\'s so
> simple that you could put it up on the menu board in fast food
> restaurants so that, as you\'re standing in line trying to decide what
> to buy, you could think well, if I\'m going to have that size
> hamburger, maybe I better skip the milkshake today.
>
> Messages are a lot more effective when they\'re repeated constantly
> and used in a variety of settings. The same graphic should be used in
> restaurants, in nutrition education materials, and food
> advertisements.
>
> Now, I want to talk for just one minute about food advertising. We
> can\'t go the whole day without doing this. A big chunk of\--there are
> about \$15 billion dollars a year in advertising directed at our
> children. And a big chunk of that goes to promote foods. Half of all
> the ads shown during children\'s programming on weekday afternoons and
> Saturday morning are about foods.
>
> I don\'t believe the government\'s going to come in and tell food
> companies that they\'re prohibited from advertising food to kids. But
> I think responsible people, and I do believe that the people who run
> our big food companies are responsible, should stop and think for a
> minute about whether or not food advertising has gone way beyond
> what\'s acceptable. Frankly, when you look at that amount of money
> being spent on advertising and you know what percentage of our
> children are overweight or obese. I think it comes close to child
> abuse.
>
> The\--you could, however, make use of that advertising to advance
> these messages. If you had some agreed upon graphics, you could put
> down in the corner somewhere in every single food ad, some version of
> this. Some version of how the stick figure of how long it would take
> to work off a serving of those products. That\'s the kind of thing
> that could at least begin to balance out the enormous wave of food
> advertising and promotion that kind of sweeps over all of our
> children. Thank you. I\'m sorry I went on a little long.
>
> DR. PITTS: That was Carol Tucker Foreman. Thank you, Carol. Thank you,
> panel. This has been a, and Carol, I tell you that Georgia O\'Keefe
> has nothing on you.
>
> \[Laughter.\]
>
> This has been an excellent\--this is an excellent panel for two
> reasons, and I\'ll tell what they are.
>
> Firstly, your comments on the questions have been very insightful and
> thoughtful. And secondly, you have actually, while addressing the
> three questions, raised more questions. So that being the case, I\'d
> like to just follow up\--I\'ll take the prerogative to asking the
> first question to Bob Earl.
>
> You raised the issue of the retailer. And if you were representing the
> retailer, what would you be telling us?
>
> MR. EARL: Well I can\'t\--
>
> DR. PITTS: Bob Earl.
>
> MR. EARL: I really can\'t speak for the retailer, and I\--but there
> are at least I though I saw a few here that\--I mean, one of the
> issues that sometimes, particularly in the largest chains, what I
> sometimes hear from my members is that packaging sizes are specified
> and demanded. And if you\'re\--if you\'re, you know, it\'s either
> Sue\'s product or Bob\'s product that\'s getting into a\--into a
> supermarket, and in a competitive environment, you know, what
> are\--what\'s the rationale and what\'s the perspective there related
> to health apart from just selling volume of product to consumers.
>
> DR. PITTS: Thank you. Well, in that case, let me give the second
> prerogative to members of the panel to augment their comments or
> question other members of the panel. Panel?
>
> MS. KRETSER: I\'d just like to add to that\--this is Alison Kretser.
>
> DR. PITTS: I\'m sorry. Kretser.
>
> MS. KRETSER: As we work to\--what we hear from the consumer is that
> they want to hear a common message everywhere that they go, and so
> we\'re working at having a framework for a common communication
> message that then can be amplified and taken out and so retailers
> might have. And we\'re exploring the possibility of having like a
> national healthy month, similar to other months that may have a focus
> within the retail business. And so then you have an opportunity
> throughout the store to communicate to consumers.
>
> DR. PITTS: Panel, any other comments or questions to each other before
> we go to the floor? Carol?
>
> MS. TUCKER FOREMAN: This is Carol. I\'d just add that I think that
> it\'s true that you want that repetition everywhere, but if you were
> to go to more specific things, for example, symbols and graphics that
> deliver those same messages, you could have those at point of purchase
> in the supermarket. You could\--as well as on the labels, as well as
> in the advertising. And I think that if you had that repetition it
> would be perhaps more effective than a healthy eating month.
>
> FOOD PACKAGING AND LABELING: Q&A
>
> DR. PITTS: Thank you. Let me turn to the audience and ask for your
> questions and comments. Let me remind that if you do have a comment to
> please tell me what your name is and who you represent, and who
> you\'re directing your question to. Yes, sir?
>
> MR. KATZ: David Katz, Yale School of Medicine. First, I\'d like to
> echo Dr. Dietz\'s comments regarding health above all rather than
> weight loss above all. If our focus truly were exclusively weight
> loss, probably the most important thing we could put on a nutrition
> label is this product contains salmonella, which pretty reliably
> produces weight loss in the short term, and I make that comment
> obviously facetiously just to point out that means of weight loss need
> not always be consistent with means of promoting health. And I think
> we want foods that promote health and are conducive to the regulation
> of weight within that context.
>
> I then like to raise something of a challenge to Mr. Earl and Ms.
> Kretser, and that is we\'ve talking what we want labels to do. We
> haven\'t really been talking about what we would like to them to stop.
> Dr. Smith noted that the front of the package is prime real estate,
> and it\'s there that, for example, some 10 years ago, we saw things
> like contains oat brain in products that contained vanishingly small
> amounts of oat brain, and were not nutritionally prudent, but perhaps
> had essence of oat brain waived over a large vat. I\'m quite concerned
> that in 2006, when transfat labeling is required to kick in, products
> that offer very little in nutritional value will say in large letters
> on the front contains no transfat.
>
> And to pick on two products specifically, or rather one and compare it
> to another, in the juice aisle, a busy mother, who\'s committed to
> doing well by her kids, is looking for a hundred percent juice. Well,
> a product like Juicy Juice, which is all juice, says a hundred percent
> juice. A product like Kool Aid Jammers, which has a strawberry-kiwi
> variety and has big pictures of strawberries and kiwis on the cover,
> in the same font, in the same position, on the prime real estate on
> the front of the package, says a hundred percent, and in fine print
> underneath of a day\'s supply of Vitamin C, because, in fact, it\'s 10
> percent pear juice. There\'s no other fruit in the product.
>
> So I\'d like to know what we need to do, whether it\'s a simplified
> overarching nutrition quality label that\'s color-coded. Green,
> yellow, red, we heard about today. There may be other ways to go.
> That\'s my one challenge. I\'d like a response to that.
>
> The other is we\'ve heard nothing about the fact that we produce more
> calories in the U.S. than we need for energy balance. And if we really
> are committed to promoting weight regulation in our population and
> curtailing the obesity epidemic, ultimately that implies less than
> purchasing of food. And it\'s difficult to think that we won\'t cross
> a line when the interests of the public health establishment, and the
> interests of the food industry will diverge, because we are reaching
> into their pockets.
>
> DR. PITTS: Panel?
>
> \[Laughter.\]
>
> Alison?
>
> MS. KRETSER: Actually, you asked so many questions, now I\'ve forgot
> various different thoughts that I had\--
>
> DR. PITTS: Kretser.
>
> MS. KRETSER: And what I was going to say.
>
> Oh, gosh.
>
> MR. KATZ: It\'s\--should I distill down?
>
> MS. KRETSER: Oh, I know you\'ve raised this issue about this conflict
> that we want to sell more food. I will say that the area of growth
> within the food industry today is the category of healthier or better
> for you foods. That is the area that is growing most rapidly within
> the food industry, and that that is what consumers are asking for and
> the industry is responding to.
>
> The industry is committed to advertising and providing good
> information to the consumer, and we will continue to do that. And,
> yes, you know, you will always find specific examples, the one that
> you brought up about Kool Aid or whatever product. Overall, there are
> many, many good products there. You know, is it a hundred percent
> across the board? No, maybe you\'ve found it an exception there, or
> you take issue with that. I don\'t know if there\'s\--is there any
> other question you wanted me to\--
>
> MR. KATZ: Well, I guess to distill it down again, I do think that
> ultimately if the consuming public purchase less food, my
> understanding is that we produce something on the order of 3,800
> calories a day for every man, woman, and child in the country, after
> export. That\'s a lot more than people need. And consequently, if we
> guide them toward the purchase of a dietary pattern, whether it be in
> the supermarket or in restaurants, that actually meets their energy
> requirements, they should be purchasing less than we\'re producing;
> and there are implications of that. So you address that.
>
> The other is what, in your opinion, would a food label need to convey
> to trump, and I gave just the one example. In fact, there are many of
> situations where the prime real estate on the front of the package
> gives a message that frankly trumps all of the details provided in the
> nutrition fact label on the reverse. What would need to appear on a
> package of processed food to fix that?
>
> MS. KRETSER: Well, that\'s one of the things we want to determine when
> we do the consumer research, to better understand how consumers are
> using serving sizes and calories.
>
> The other thing I would add is, as I talk to reporters on various
> different issues about the nutrition facts label, for instance, around
> transfat, from this summer, as I would point out and discuss the
> amount of calories in our diet that come from
> transfat\--represents\--the average American is about three and a half
> percent, and that we need to be encouraging consumers to look at the
> serving size and the calories in the product, and that\'s what
> concerns me most, and I always lead with that. And I\'ve never seen it
> in print. It\'s what the one specific issue is that they are reporting
> on and looking at when I talk to a reporter about trans and the link
> to obesity and go over, wait a minute; let\'s back up. We\'re talking
> about three percent of the calories, and then walking through what
> that meant. Then, you know, a light bulb goes on.
>
> But I am certainly pointing out that it\'s important for consumers to
> look at the serving size on the package and look at the number of
> calories.
>
> DR. PITTS: Panel, any other comments? Yes, ma\'am.
>
> MS. HENRY: One of the things that you were talking about with the
> industry\'s food supply\--I\'m sorry.
>
> DR. PITTS: I\'m sorry. We were just identifying you for the audio
> transcript.
>
> MS. HENRY: Oh, Rona Henry.
>
> DR. PITTS: It wasn\'t a little voice talking to you.
>
> MS. HENRY: Voice of God. With the food supply, the things that I\'ve
> been seeing with the industry is where they\'re thinking about making
> money, because, you\'re right, if they\'re going to eat less, they\'re
> going to make less money is the trend toward more processing of foods,
> making things taste better. But also, I was just at the Food and then
> Beverage Exchange conference, and a lot of talk about fortifying foods
> and adding things like zinc, and Vitamin D, and anti-oxidants and so
> on. And I think that that actually is an issue for the FDA to be
> thinking about. That might be sort of the next wave of things we need
> to pay attention to, because it\'s possible with some of those things
> that they\'re using to fortify may be more than we need. And so I
> think that\'s just another element to be looking for in the future.
>
> The other thing is, the comment that you said is sort of what are
> going to put on the label, and that\'s kind of my question. What are
> the\--I\'ve asked different people what are the top three things that
> consumers should be concerned about, and depending on who I ask, I get
> different answers. They all seem to agree calories. And fat comes up a
> lot. But then, it starts deviating. Is it sugar? Is it sodium? Is it
> what kind of fat? So, I think that that\'s an area where more research
> and consensus needs to happen.
>
> DR. PITTS: Thank you. Any\--yes?
>
> MS. CUMMINGS: I wanted to address your question about the prime real
> estate on the front and the idea of a hundred percent and then ten
> percent. I think it\'s a very, very good point, and I think we need to
> just take\--make note of it, because the same thing happened with
> peanut butter.
>
> When we went to low-fat, peanut butter started saying no cholesterol.
> Well, peanuts have never had cholesterol, and they never will have
> cholesterol. Many of them, though, have hydrogenated fats, which is
> going to make their\--people\'s cholesterol go up higher than
> cholesterol. So I think we have to think about those messages on the
> front, and how they are portrayed.
>
> And I think\--believe that was one of the points that you were making.
>
> MR. KATZ: And thank you for the response. If I may close, just by
> saying I would strongly encourage a simple, overarching symbol. I had
> the privilege of conveying this directly to the Commissioner over the
> summer. Whether it\'s green, yellow, red, A, B, C, or some variation
> on the theme, but I think there is the authority here, potentially, to
> empanel a group of nutrition experts who do for foods what we\'ve done
> for the diet. We heard about the healthy eating index earlier today.
> We could have a nutrient quality index that prioritizes factors
> related to weight regulation, such as energy density, factor in
> volume, think about the nutrient composition of the food, and provide
> an overarching guidance to the consumer so that much of the detailed
> work is no longer their burden, because people really do not want an
> encyclopedic experience in the supermarket. Thank you.
>
> DR. PITTS: Thank you. That was David Katz, and before that Susan
> Cummings.
>
> DR. WANSINK: Let me just make a comment. I mean, there\'s providing
> guidance and there\'s actually\--
>
> DR. PITTS: Mr. Wansink.
>
> DR. WANSINK: Telling the consumer what he or she should eat, and
> that\'s the problem, I think, with a red, yellow, green sort of thing.
>
> There\'s definitely a nice way to be able to tell people and inform
> about things without saying Big Brother says this is what you should
> eat.
>
> DR. PITTS: Thank you. Audience. Yes, sir.
>
> MR. GRAY: My name is Ken Gray. I\'m from Lincoln, Nebraska, and I
> don\'t know how to address this, whether it\'s with my company that I
> have now called Best of Health, Nebraska, or to go back when I had a
> popcorn company up until two years ago, or to just address it as a
> consumer.
>
> Dr. Dietz is the only person I heard here today that mentioned fat,
> protein, and carbohydrates in one sentence. I remember in 1990, when I
> started my popcorn company, and we had the new nutritional label come
> out; and we weren\'t able to determine how to determine whether it was
> low-fat or low-sodium, because the laboratory procedures had not been
> written. And thanks to a lovely lady, Dr. Joyce Salzmann at FDA that I
> happened to know when I lived back here in \'80s, she and the
> University of Nebraska Food Science Center Laboratory worked out the
> procedures so that we could come up with that determination. And, in
> 1992, we had the first low-fat microwave popcorn.
>
> The problem is, is that four years ago, I weighed 258 pounds, and I
> was a diabetic. And I did everything I was told to do. And the real
> problem you\'re going to have with the new nutritional label or any
> changes you make to it is that, in conjunction with the food pyramid
> that came out in the \'90s, you lost your credibility. And I don\'t
> mean that harshly. We\'ve got to work together on this.
>
> But it was bad science, your bad recommendations. We\'ve increased
> carbohydrates over the last 30, 40 years, and I\'m not a Dr. Atkins
> fan, don\'t get me wrong there. And we\'ve gone after fat and proteins
> and minimized those. And what\'s resulted? We have a 40 percent
> increase almost in heart disease and stroke and cancer and diabetes
> and obesity. And put to you that obesity is not a disease. It\'s a
> condition that we used to qualify. I know there may be some
> psychological aspects of somebody that\'s obese. But the American
> consuming public I will tell, because I used to do food demonstrations
> in the grocery stores, they lost confidence in the food pyramid. They
> read the nutritional labels like crazy. They\'ve done it since the
> early \'90s. But what happened was what they were seeing there and
> what they were being told, and then they started putting on a pound
> and a half, two pounds a month.
>
> DR. PITTS: Excuse me, sir. Could I ask, do you have a question for the
> panel?
>
> MR. GRAY: My question is, are we going to get back to the basic
> science of fat, protein, and carbohydrates? I mean, you\'re talking
> about calories, but I can eat a lot more calories of meat, and I\'ll
> still put on weight if I eat a lesser amount of calories of light
> carbohydrates.
>
> DR. PITTS: Okay, well, let\'s hear what the panel has to say. Thank
> you very much.
>
> Bill, do you want to take a crack at that? Dr. Dietz.
>
> DR. DIETZ: Dr. Dietz. Thank you for that comment. At the risk of
> disagreeing, I think the science says that a calorie is a calorie, and
> there have been some very nicely controlled studies. That the\--I
> think what you may be alluding to, though, is the differential impact
> of a calorie from protein on satiety versus the impact of a
> carbohydrate calorie on satiety. And my view is that for people like
> you and others, we need to provide that information, because, until
> the science is clear, people are going to be making their own choices
> about what they need to do to regulate their weight. And some people
> are going to follow the Atkins Diet, and some people are going to
> follow a low-glycemic index diet, and who knows what else?
>
> The bottom I think here is that we may\--I think the issue is weight
> regulation, and we need to give consumers as much information as they
> need to do that, while the science becomes clearer.
>
> MR. EARL: Just to tag on to what\--
>
> DR. PITTS: Mr. Earl.
>
> MR. EARL: This is Bob Earl. To tag on to what has just said, I think
> we need to\--you know in the discussion of the label and weight
> management a calorie is a calorie is a calorie. That\'s very true.
>
> Some of the things that Dr. Katz mentioned: I think you need to look
> at what are some of the pieces of food regulatory policy that relate
> to claims about foods and those types of things that may have or not
> have direct relationships to the topic of this panel related to
> obesity.
>
> Again, I think the issue is very simple messages, but I agree with
> Bill that we have to\--you know, no one I think has advocated today to
> move away from macro nutrient listings on the food nutrition facts
> panel in protein, fat, and carbohydrate. But that for weight
> management, more information or some different presentation about
> calories may be very important as long as we\'re doing it in a way
> that works well for consumers through testing.
>
> And then the final piece of that is that we have to take this one step
> further. And how do we put this into overall dietary lifestyles. We
> can\'t necessarily completely change the nutrition facts panel to
> serve just people that want to lose weight. There are a lot of
> individuals that use the nutrition facts panel for a multiple set of
> purposes, and we have to address all of them because with, you know,
> low-fat, non-fat products and the calorie message getting lost over
> the last 20 years, we don\'t want to repeat those types of issues.
>
> DR. PITTS: Yes, sir.
>
> MR. BLACK: Richard Black, Hilsey, North America. I\'d like to make on
> comment on fortification of foods, Ms. Henry raised that issue. The
> FDA, to my knowledge, as well as Health Canada, has supported the food
> nutrition board to undertake a review of that. That report is, I
> believe, going to be\--is due for release on the 11th of December. It
> not only will refer to how the DRI numbers should be used on a panel,
> but also make some policy suggestions regarding fortification of
> specific foods.
>
> I really want to make a comment, following the gentleman who did
> the\--made the comment on the popcorn business and so on. It\'s a
> comment that we hear often as nutritional scientists that we have no
> credibility. But let me put it to you this way, because I get
> frustrated with that comment.
>
> Nutrition is a very young science. It\'s a very, very young science.
> If I said to people here, we know everything we need to know about
> computers. They\'ll never get any better. What we have is what we
> have. You\'d all call me crazy. And consumers would call me crazy. And
> consumers are fully willing to say, yeah, I know nothing about
> computers. I\'ll buy what they tell me. Oh, I got a buy one this year?
> Yeah, okay, that\'s just the way consumers think of computers.
>
> Same thing for drugs. We don\'t know everything about drugs, but if I
> had said, yeah, we\'ve discovered all the anti-cancer things we\'ll
> ever discover, you\'d say he\'s crazy.
>
> And yet, because we eat food every day, and because it\'s such an
> intimate thing for the consumer, the consumer feels a personal
> knowledge for the food. Even though it is a science, it doesn\'t
> appear that way to the consumer. So it\'s not that scientists change
> their minds. It\'s not that we get off message. This is a science, and
> science evolves. And I think we\'ve just done a very bad job of
> conveying that to the consumer. I don\'t know how to do it, but I
> think that\'s the big issue.
>
> DR. PITTS: Thank you. Panel, any comments on that? Yes, sir.
>
> MR. HILL: Doug Hill with the Kellogg Institute for Food and Nutrition
> Research. There was some discussion\--Sue particularly talked about
> the idea that graphical interpretation of nutritional data was
> condescending; that we\'ve heard a lot of people say, oh, well,
> graphics would be good. Would you respond? Maybe I misunderstood what
> you said. I thought I was.
>
> MS. BORRA: I\'m sorry. Maybe I didn\'t understand your question. We
> didn\'t hear you.
>
> MR. HILL: I\'m sorry. No, it wasn\'t.
>
> MS. BORRA: Me?
>
> MR. HILL: It was Chris. I\'m sorry. Yeah, she\'s right. I\'m
> interested in the\--someone said\--let\'s do it that way.
>
> \[Laughter.\]
>
> Someone said at some point that graphical\--
>
> MS. BORRA: Christine said.
>
> MR. HILL: Christine said, okay. Somebody said that graphical
> presentation of nutrition label information was condescending. We\'ve
> now heard several people say, oh, yes, we think graphics would be
> good, and, as a practitioner, I\'d like to know where we might want to
> go.
>
> MS. TAYLOR: That was Chris Taylor.
>
> DR. PITTS: Christine Taylor.
>
> MS. TAYLOR: I think what I remember saying was the research in 1990
> showed that things like smiling faces and stars were considered
> somewhat childish and condescending. We found that consumers had some
> difficulty using the graphics compared to numbers, but I think as we
> went through, we talked about the idea of taking numbers and
> supplementing them with graphics. And so that\'s what I remember from
> my own presentation, which was\--
>
> \[Laughter.\]
>
> long, long, time ago.
>
> DR. PITTS: Panel?
>
> DR. DIETZ: I mean, has\--I mean, have any of you all that have focus
> group data tested graphics? I mean, kind of industry\--
>
> DR. PITTS: It\'s Dr. Dietz. Ms. Borra.
>
> MS. BORRA: I have not\--as people talk about graphics\--Sue Borra\--I
> have not seen any data that I\'ve had my hands on that shows how
> they\'re utilized. How consumers are using them. What\'s happening. I
> know\--I think there\'s some research that\'s possibly going on even
> at FDA looking at qualified health claims and some graphic
> representations there which may shed some light on some of this.
>
> I think, as we explore the calorie information, we may look at is
> there anything graphically that can help there and have consumers
> design that and see then what the actions are. But I have not seen any
> good research based on consumer information that says that that\'s the
> way to go.
>
> MR. EARL: Bob Earl. I just want to add that back in the experience
> when the formats for nutrition labeling were tested back in the early
> \'90s, again, there were adjectival and graphical representations
> tested, and those, you know, not to the magnitude that Chris described
> about smiley faces and some other, you know, iconic types of things,
> but those did not perform as well as the format that was finally
> chosen and something that was very much just what we had in the
> voluntary system for nutrition labeling that added the selection of
> nutrients that were called for by the NLEA.
>
> DR. PITTS: Yes, ma\'am.
>
> MS. FOREMAN: Can I say something?
>
> DR. PITTS: Oh, sure, Carol, go ahead.
>
> MS. FOREMAN: Carol Tucker Foreman. As the consumer on the panel down
> here, our folks tell us that they really would like to see the
> simplest possible formatting of the message. And I don\'t find the
> detail on the current nutrition label very helpful to them. It\'s
> helpful if you\'re on Weight Watchers, and you\'re really spending
> time examining the labels. But for somebody, and the Food Marketing
> Institute stuff on confusion in the supermarket is pretty persuasive
> to me. You want to get through the supermarket as quickly as you can,
> and take care of your family as best you can. And the study of
> messages would indicate that if you have simple graphics that are
> repeated, not just on the labels, but with regard to nutrition
> education and advertising and in restaurants, that pretty soon people
> do catch on to what the message is. This assumes you can agree on a
> few messages. I\'m not sure we could.
>
> DR. PITTS: Ladies and gentlemen, we have about 20 more minutes, so
> please keep your questions and comments crisp. Yes, ma\'am.
>
> MS. CHILDS: Yes, Nancy Childs, St. Joseph\'s University.
>
> I just want to say consumers are complex. Nutrition is dynamic. And so
> we have our work cut out for us, but a concern I have is that when we
> pursue this consumer research that we do it in a comprehensive way.
> We\'re trying\--right now, we\'re dissecting the label in the sense
> that the qualified health claims are being evaluated over here. Maybe
> this weight management over there. Are going to and how do you suggest
> we bring this to the consumer as a total package, where it\'s coherent
> and cohesive in totality.
>
> DR. PITTS: Panel? Bob.
>
> MR. EARL: Bob Earl with NFPA. Just to add to what Nancy says I agree
> completely that you need to look it at for all the purposes, because,
> you now, even with the statistics of two-thirds of Americans that are
> overweight, they\'re still a third that would probably be using the
> label for purposes that doesn\'t necessarily relate to weight loss,
> certainly. And you have a whole set of issues of why consumers look to
> and use different aspects of the food label. So, again, that the label
> needs to be comprehensively evaluated by consumers that, you know,
> there are as many options as there are people in this room of what we
> think is the best way to do it. But until we thoroughly test it with
> consumers to understand what works, what performs, we\'ll really be
> nowhere.
>
> DR. PITTS: Sir. Yes, ma\'am.
>
> MS. WIEMER: Kathy Wiemer from General Mills. I was just going to
> comment on the symbol question. I don\'t know if there\'s anyone here
> from American Heart, but the one symbol that has been used fairly
> significantly on a number of food packages is the American Heart Check
> symbol. And I know that they have done some research on that, and I
> believe that that is positively viewed, and it is a symbol that
> consumers seem to understand that that means that part is good for
> your heart. And in the case of using that symbol, the product needs to
> qualify for the saturated, or the fat heart disease health claim. So I
> just wanted to add that, because that is something that I think there
> might be some value in exploring this whole graphic arena, which we
> haven\'t done a lot of work on that I\'m aware.
>
> DR. PITTS: Thank you. Rona.
>
> MS. HENRY: There is another\--
>
> DR. PITTS: Ms. Henry.
>
> MS. HENRY: Rona Henry. There is another example of a food logo being
> used in Australia called Check the Tick\--Pick the Tick. They
> obviously don\'t have Lyme\'s disease there, but that it\'s been
> successful and is well recognized, and, as I recall, incorporates a
> number of different factors into their logo. It\'s not just, you know,
> fiber and fat.
>
> MS. BORRA: It\'s the same \[inaudible\] our Association \[inaudible\]
> in this country. It\'s modeled after Heart Check \[inaudible\].
>
> DR. PITTS: Sue Borra. Yes, sir.
>
> MR. KATZ: David Katz, Yale. Just to exploit the earlier comment about
> computers. It was used to make a point, but I wonder if we might
> consider, and I\'d invite Panel reaction to this, the need for an
> overflow valve here. As we talk about many ideas, not all of which
> could fit on a nutrition label, what about
> www.fda/nutritionlabeluse.gov. And, you know, for more tips on how
> best to use the nutrition label for the specific health goals of your
> family, and whatever doesn\'t fit on the label, we could actually have
> an interactive web site, advertised right on food labels to empower
> consumers to use nutrition information. All those that can read the
> label and have an Internet access might benefit.
>
> DR. PITTS: Panel, any thoughts on that?
>
> MR. EARL: Just that\--just to\--Bob Earl with NFPA. This is\--this was
> an item that was part and a core part of our label facts for healthful
> eating curriculum that was done early on in the process and reviewed
> by FDA and USDA, where we did have separate materials to look at. Is
> it weight management? Weight loss? Diabetes? Heart disease? Those
> types of things. We\'re in the process of updating those and hopefully
> to move them to a more interactive web-based tool for consumers that
> supplements the already good information on basics on using the label
> that FDA has on its web site.
>
> DR. PITTS: Thank you. Yes, ma\'am.
>
> MS. FOX: \[inaudible\] Medical Foundation. And I have a comment and
> then a question for\--
>
> DR. PITTS: I\'m sorry. I\'m sorry. Ma\'am, I can\'t hear you. Would
> you speak up please?
>
> MS. FOX: Can you hear me now? Hello, can you hear me?
>
> DR. PITTS: Just ever so vaguely.
>
> MS. FOX: Tracy Fox. I\'m a nutrition consultant representing the
> Produce for Better Health Foundation. A comment and then a question
> for the panelists.
>
> In terms of the\--an effective graphic, I think a couple of them have
> been mentioned. I know the Produce for Better Health Foundation has
> launched a pretty successful consumer education campaign to be used in
> grocery stores on promoting foods and vegetables, and it\'s the
> color-way campaign that tries to communicate the importance of variety
> through color issues so that\'s something to look at in terms of
> promoting a message in a fairly simple way, hopefully effectively.
>
> And I think the information that Dr. Dietz presented, or touched upon,
> in terms of volumetrics and the idea of taking a look at volume, and I
> think Dr. Katz also mentioned the nutrient density type of approach is
> appealing as well, because it really doesn\'t focus necessarily on one
> or two nutrients, but it also does provide the message that, for
> example, fruits and vegetables are items that consumers are not eating
> enough of. And it\'s a message that is positive in terms of promoting
> those types of things. I just am thinking about that, and we thought
> about this a lot. How do you convey what can kind of be a complex sort
> of issue to consumers in a fairly simple way on the label? I think
> it\'s worth looking at. I think it would present challenges, but it
> would certainly take the approach of promoting those things that are
> right now underconsumed. We know what\'s overconsumed in America, and
> we\'re trying to address that. We also need to look at what\'s
> underconsumed, like fruits and vegetables. So, I don\'t know if the
> panelists have thought about how to best address that approach. I
> think the visual, the graphic would help that in terms of taking a
> look at overall diet quality as well.
>
> DR. PITTS: Thank you. Panel?
>
> MS. CUMMINGS: It seems like\--Sue Cummings. It seems like that\'s a\--
>
> DR. PITTS: Sue Cummings.
>
> MS. CUMMINGS: That\'s a tall order for one small label, and that we
> definitely need an education program to go along with this. And,
> although the food guide pyramid has come under attack and may be
> changed, it is a visual. And I think it\'s a worthwhile visual. The
> problem is, is that the message has just got a little confused. So
> where it says carbohydrates, fruits, and vegetables at the bottom, it
> doesn\'t say white flour, white bread, white muffins, white crackers.
> And maybe we just need to work on that message that we\'re talking
> about whole grains, whole fruits, and whole vegetables.
>
> DR. PITTS: Yes, sir.
>
> MR. ADAMSON: Dick Adamson, National Soft Drink Association.
>
> This is for anybody on the panel. Does the panel agree that any change
> that you make to the food label, that it be consumer tested and make
> sure that the consumer understands it before we go into full blown,
> total full industry of changing of the panel?
>
> \[Panel chorus of \"yes.\]
>
> MS. FOREMAN: No, I want to\--please, not if it takes 20 years to get
> any change.
>
> DR. PITTS: Carol Foreman.
>
> MS. DODDS: Could I address that?
>
> DR. PITTS: Yes, ma\'am.
>
> MS. DODDS: It\'s Karen Dodds with HELS, Canada. And we were in the
> position of just last January putting into regulations essentially the
> nutrition facts table that the Americans have had for a number of
> years. And I would discuss that one point, because you can use the
> nutrition facts tables and other things to educate consumers. I don\'t
> think you necessarily have to have the consumer education ahead, and
> understanding, ahead of the tool. The tool is to achieve education
> information, not to follow education information necessarily. You have
> to have a strategy that you agree will achieve what you want.
>
> So, I\'d be interested in all those heads that nodded that yes,
> consumers should understand. Do you really think that? Or do you
> really think, no, you should be able to know that you\'re going to
> have the outcome that you want?
>
> DR. PITTS: Anybody want to address that question?
>
> DR. DIETZ: Bill Dietz. I agree with you. I mean, I think what I was
> agreeing to was the need to pre-test the revision of the label, not
> that it demonstrably change the population, because, as you point out,
> that\'s the ultimate goal.
>
> MR. EARL: Bob Earl. I would just say that I just agree that it takes
> much more than this educational effort for outcomes and behavior
> change takes far more than the nutrition facts panel or any piece of a
> food product label; and that, you know, I think that with\--I think we
> all were nodding our heads in agreement that it was testing to make
> sure that changes to label information provide information that\'s
> what you\'re expecting. But as far a moving toward behavior change
> among a population, it\'s going to require far more than the label,
> and the label will never be able, and I don\'t think was ever
> intended, to do that.
>
> DR. PITTS: Yes, sir. Oh, pardon me. Yes.
>
> DR. CASWELL: This is Julie Caswell. I think that I agree with your
> point, and the overarching issue is what is the public health goal. If
> we\'re using the labeling to try to achieve public health goals, then
> the tool has to be lined up for that in the end. And you can\'t expect
> a label to do everything. And the label\--when we\'re designing
> labels, we\'re making choices; and, from a public health perspective,
> we have to make choices about which are the most important issues to
> address in a labeling format, given that it\'s a limited resource, and
> there\'s limited amounts of information that you can transmit through
> a label.
>
> DR. PITTS: Yes, sir.
>
> MR. BERENDS: Paul Berends, Adkins Nutritionals. My question for Bob
> Smith. Bob, you were kind enough to share what you thought would be
> the future trends in the industry, and you mentioned calorie reduction
> per serving among others. What did you envision by available calorie
> reduction per serving?
>
> MR. SMITH: This is Bob Smith. Paul, what I had in mind there was if,
> in fact, we get the right message, and we get the right conveyance for
> that message, and we do feel that we\'re going to make some progress,
> there\'s obviously going to be a great deal of effort concentrated on
> getting the energy per serving, if you will, or per hundred grams or
> whatever, down. And there\'s no doubt in my mind that the industry is
> quite capable of doing that. And they may be doing it by using
> unavailable calories, and I think you know where I\'m going with that
> one. I think that\'s an important new issue for us, and we\'d have to
> study that fairly carefully: just what impact does that have on the
> whole digestive system and everything else. But that\'s what I had in
> mind about reducing calories that way.
>
> DR. NAYGA: Can I just make a comment? Just an observation, really. I
> think most of our discussion today is more on the input side. I think
> we can represent this issue of obesity with an equation or some sort.
> It\'s really an input-output part. And I guess my question is, is it
> possible to also focus on the output part of it? I think a major
> source of this problem is the less inactivity, if you will, of the
> whole population, perhaps because of TV or improved technologies and
> convenience and so on. And we\'re talking about packaging here. I
> wonder if there will be some\--if there\'s a need for packaging
> innovations that would include information related to physical
> activity.
>
> DR. PITTS: That was Dr. Nayga. Any other questions from the audience?
> Yes, sir.
>
> MR. KATZ: David Katz, Yale. I would just react to that with a
> cautionary note. I agree with you this is about energy input and
> energy output. But we ought not to let perfect become the enemy of
> good in efforts to revise and improve food labeling. Food labeling can
> only do so much. And it\'s likely that efforts in other areas will be
> better investments in promoting physical activity. If we ask too much
> of the food label, we\'ll never get where we want to go.
>
> In terms of energy balance, I agree with you entirely, but we\'re here
> primarily to address what\'s the\--what\'s the most we can get out of
> optimal food labeling. Thank you.
>
> DR. PITTS: Panelists, we have\--I\'m sorry, Bob.
>
> DR. SMITH: Just quickly. I was going to react to the comment here\--
>
> DR. PITTS: Dr. Smith.
>
> DR. SMITH: I hope you were not inferring that we have these\--get away
> with easy open packages and make them more difficult. It\'s something
> that I faced\--
>
> MR. KATZ: It\'s an open question.
>
> DR. SMITH: That\'s what I faced all my life. And the other question on
> packaging that I would like to comment on; there\'s a bigger world
> than just us in terms of making package sizes maybe taller rather
> than\--or shorter rather than taller and that sort of thing. We do
> have a distribution problem, and whenever packages are made, they\'re
> made on a cost effective basis. If, in fact, we come out with much
> taller packages, it has an enormous impact, not only the market
> shelves, but on your home shelves. So, they\'ll be another whole area
> that you have to investigate before that goes on.
>
> I personally feel that today is a wonderful day for expressing what I
> call this is a conversation for opportunity. This is not a
> conversation today to decide what\'s good and what\'s bad, and all
> that sort of stuff. And I think the opportunities that are being sent
> out today are magnificent. I just hope somebody\'s smart enough to
> take all this, distill it into something very useful. Thank you.
>
> DR. PITTS: Ladies and gentlemen, we have two minutes left, so rather
> than a lot each of you 10 seconds for a closing statement, I would ask
> if any of you would like to make any comments before we close out the
> panel?
>
> DR. KONDE: I was hoping that I could get the question on the symbol
> labeling so that I can clear some things that I forgot to say. And one
> thing that I forgot in my presentation is that there has been
> suggestions of adding a short text to the symbol. For fiber-rich, you
> should simply add fiber rich. And for the low-fat, and low-fat that
> would enormously increase the understanding and the risk of not\--of
> misunderstanding of the symbol. And I would just like to tell you
> about that possibility, because I think it won\'t make it more
> difficult in any way, but it can make it much easier to understand the
> symbol.
>
> DR. PITTS: Ms. Konde. Thank you. Panel? Ladies and gentlemen,
> panelists, thank you very much for a stimulating session.
>
> \[Applause.\]
>
> We\'ll take a break. We\'ll take a 15-minute break until 3:35 p.m., at
> which point, we will reconvene for our restaurants. So your
> reservations are for 3:35 p.m. Thank you.
>
> \[Recess.\]
>
> RESTAURANTS
>
> DR. PITTS: Let\'s wait for some stragglers to come in.
>
> 3:35 p.m. to 5:00 p.m. panel on restaurants. Let me read to you the
> panel objective, and pass the microphone over to my co-host.
>
> The panel objective is an exploration of whether lessons learned
> through examination of food labeling and packaging can improve our
> understanding of dietary messaging in restaurants. This session will
> provide a restaurant perspective on the issue of consumer information
> and promotion of food choice as a part of healthy lifestyles. This
> session will explore consumer research and industry programs used to
> help consumers make more informed choices in restaurants. Panelists
> will discuss successes and challenges in providing menus and
> information to meet customer demands.
>
> Let me introduce my co-host, Steve Grover, Vice President, Health and
> Safety Regulatory Affairs for the National Restaurant Association.
> Steve.
>
> MR. GROVER: Thank you very much, Peter. AT the outset, I want to say
> that the restaurant industry recognizes the growing problem of obesity
> in the United States, and we are committed to promoting healthy
> lifestyles with our customers. Choices available in restaurants today
> will be part of the solution to the problems we face.
>
> I want to leave you with three quick words before I turn it over to
> the panelists. Those words are: diversity, people, and competition.
>
> When you think of the restaurant industry, you must think of
> diversity. With 11.7 million employees, serving over 70 billion meals
> a year, we serve a meal to just about every culture and every ethnic
> group in the United States. And it is very important that there
> literally is no other industry as diverse as the restaurant industry
> in the United States.
>
> People. This is a people to people business. You walk into a
> restaurant. You talk to a person, and people prepare your food usually
> within minutes of your order to your exact specifications. The food is
> not prepared in a plant some thousand miles away, weeks or months
> before you buy it. It\'s prepared on the spot to your order, to your
> exacting specifications.
>
> And competition. We work, and the people that you\'re going to talk to
> today, work in a very, very competitive industry. As we sit here,
> hundreds of new restaurants will open with a hope for developing a new
> demand, a new market. And sadly, hundreds of restaurants will close,
> because they did not meet consumer demand or did not find a market.
> Sixty percent of new restaurants fail in their first five years.
>
> So, as we say, I will turn it over to the panelists.
>
> Our first panelist is Hudson Riehle. He\'s Senior Vice President for
> Research and Information Services for the National Restaurant
> Association in Washington, D.C. And Hudson is going to do a
> presentation on the latest research.
>
> Our second panelist is Linda Bacin. She\'s Vice President of
> bella!Bacino\'s in LaGrange, Illinois, and Co-Chair of our
> Communications Committee of the National Restaurant Association Board
> of Directors.
>
> Our third panelist is Mats Lederhausen, President, Business
> Development Group, McDonald\'s Corporation, Oakbrook, Illinois.
>
> Our fourth panelist is Chris Ricchi, President of i Ricchi Restaurant
> in Washington, D.C.
>
> Our fifth panelist is Brian Yost, Vice President of Restaurant and
> Beverage, Marriott International, Inc., Washington, D.C. And our final
> panelist is Rob Dowdy, Vice President, Strategic Communications,
> Burger King Corporation, Miami, Florida.
>
> I\'ll let each panelist introduce their company a little bit as they
> come up. Our first panelist will be Hudson Riehle.
>
> MR. RIEHLE: Well good afternoon, everybody. On behalf of the National
> Restaurant Association and its research and information services
> division, I\'m pleased to have a few minutes to talk with you today
> about really what are the drivers regarding consumer patronage at
> restaurants.
>
> The presentation is basically divided into three distinct areas.
> First, we\'ll quickly go through and do a restaurant industry
> overview, and then we\'ll take a closer look at what are the consumer
> drivers of patronage in the industry today. And finally, we\'ll do a
> wrap up and look at some of the conclusions that the research shows.
>
> Basically, in a quick overview, industry sales this year for the
> industry will exceed \$420 billion. That is four percent of the
> nation\'s gross domestic product, an average of about \$1.2 billion
> per day.
>
> At presently, there about 870,000 individual restaurant locations in
> the country. On average that number will exhibit a net increase per
> year of about 8,000 to 12,000, 14,000. Employees. Almost 12 million.
> The restaurant industry today is considered one of the most
> labor-intensive industries in the country today, and there\'s a reason
> for that, which I\'ll get into in just a few minutes.
>
> The restaurant industry is by no means monolithic. It is an extremely
> complex and fragmented industry. The Association, each year, tracks
> sales for 39, 39, distinct segments within the industry. And this
> slide I put up there just to give you a basic idea. This is not all
> 39, but I\'ll quickly run through some of these to give you an idea of
> the diversity and breadth and depth of the industry.
>
> Basically, full-service restaurants are those that you would know with
> waiter-waitress service, and generally the consumer pays for the meal
> after it is consumed.
>
> Quick service, generally the consumer will pay before the meal is
> consumed. Those two segments are the largest segments out of the 39
> within the industry. But there are also cafeterias, social and
> business caterers, snack and non-alcoholic beverage bars. A rapidly
> growing segment within the \$420 billion industry is what we call
> managed services contractors. And those are restaurants and food
> service operations that are run at industrial plants, such as
> manufacturing plants, and different office complexes.
>
> There\'s also hospital and nursing home food service. There\'s
> schools\--primary, secondary, and university food service. There\'s
> transportation, for example, airlines, steamships. There is also
> recreation and sports centers. Then there\'s lodging places. One of
> the more rapidly growing segments is what we call retail host. That
> is, for example, food services now available in bookstores, service
> stations, and convenience stores. They\'re also what we call
> self-operated, or, in other words, what is known as non-commercial, in
> other words, organizations that run their food service by themselves.
> And this group over here is contractors and generally this group is
> enlarging and this group is diminishing.
>
> There\'s also military restaurant food services.
>
> One characteristic of the industry is its labor intensity, as I\'ve
> mentioned. Government data shows that for eating and drinking places,
> the average sales per full-time equivalent employee is just \$57,000.
> Now, compare that to grocery stores, at \$172,000. Gasoline service
> stations, at almost half a million per full-time equivalent employee.
> And even appliance stores at \$1.5 million. And there are certain
> capital intensive industries which will exhibit sales for full-time
> equivalent of \$2 million and \$3 million. But the main point here to
> be made is the extreme, extreme labor intensity of the industry.
>
> And why is the industry so labor intensive? It\'s labor intensive
> because there are so many consumer customization demands, and that is
> a pivotal underpinning of the restaurant industry
> today\--customization.
>
> It is also an extremely competitive industry. I\'m sorry, the sequence
> seems to be out here. All right. Well, let me just\--basically, the
> competitiveness of the industry\--I\'m sorry.
>
> DR. LEVITT: You want me to go back?
>
> MR. RIEHLE: Yes, thank you. Okay. Thank you. Sure. All right. The
> competitiveness of the industry is a hallmark in terms of consumers\'
> usage of the industry, because basically customers today, with the
> 870,000 locations, vote with their feet and palates. There is, in
> terms of competitiveness within the industry, unequaled growth in
> terms of the number of units and also in terms of the variety within
> those restaurants. And we continually do consumer research, as you
> would expect, and what we find is that basically, 80 percent of
> adults, four out of five, agree that they have a larger selections of
> restaurants available to them than they did two years ago.
>
> Also, too, another hallmark of the industry is that even though
> everybody is quite familiar with a lot of the chains, it is still an
> industry that is dominated by small business. Average unit sales at
> the typical quick service restaurant were just \$599,000, and at table
> service, \$676,000. And more than seven out of ten eating and drinking
> places are single-unit, independent operations.
>
> Also, too, using the latest Census information that is available, we
> can document that less than one of five restaurants, 19 percent, are
> part of companies which operate ten or more restaurants. And the
> restaurant has, and for the foreseeable future, will basically be
> small mom and pop businesses.
>
> Amazingly enough, when you look at the 21 meal period per week for the
> typical American consumer, 76, in other words, over three out of four
> meals, are still prepared at home. In other words, if you take that
> 21-meal period, roughly about five are restaurant prepared, two are
> skipped, and the fourteen remainder are prepared at home. And that is
> a very important point in terms of when you look at the food
> consumption patterns in America today.
>
> Now, that 76 percent over the past 20 years has been moving up slowly,
> but relatively is at a glacial pace still compared to the at-home
> dominance.
>
> Perhaps one of the most important drivers of restaurant industry
> growth is household income. Various statistical studies have confirmed
> time and time again that restaurant patronage is very strongly
> correlated with increases in household income. It is correlated in
> primarily two ways: it is correlated with the level of household
> income, as well as the growth in household income. And when you look
> at the household income levels within America today in real dollars,
> the number of higher income households has been increasing at
> double-digit rates. And basically, that\'s a reflection that America,
> as a whole, has become a wealthier country, and that is reflected in
> the per capita incomes of its citizens.
>
> If you look at the real disposable economic income indicator, since
> 2000, you can see in that year it had a solid growth of 4.8 percent.
> In 2001, the year of the nine-month recession, it did taper off to
> 1.8, but it is important to keep in mind that that was still a
> positive number. Even in a recessionary year, the real disposable
> household income for America continued to advance as a whole.
> Consequently, restaurant patronage did taper off, but continued to
> advance. 2002, there was a rebound to 4.2, and this year we\'re
> estimating somewhere around three percent in terms of disposable
> income growth.
>
> So now, let\'s quickly go over and look at some of the primary
> consumer drivers.
>
> Obviously, the restaurant industry has and always will have as an
> interesting and repetitive driver consumers seeking entertainment and
> stress reduction. Eating out at restaurants has been and will continue
> to be fun. Over 92 percent of adults agree that they enjoy going to
> restaurants.
>
> Now, an interesting statistic that we picked up on over the past
> couple years is the proportion of adults that feel the need to reduce
> stress. And this is an important component, again, in the consumers
> decision to use restaurants. For example, and these are all\--all
> these consumer statistics I use are from nationwide projectable
> telephone surveys. Roughly about 53 percent of all adults in 2001, in
> the post-9/11 fielding period for this, felt they need to reduce
> stress. In one year, one year, that number went from 53 percent to 72
> percent. That is a 19 percentage point gain, and those of you that are
> familiar with consumer surveys know that that is a very, very huge
> movement in one period.
>
> Also, too, in terms of going out to a restaurant with family or
> friends, consumers feel it does give them an opportunity to socialize
> and make better use of their leisure time than cooking and cleaning
> up. Almost four out of five adults agree with that statement.
>
> And perhaps also importantly from our industry\'s perspective, because
> restaurants are used for many special occasions, when consumers go out
> for a special occasion, such as a birthday, Mother\'s Day,
> anniversary, consumers are less concerned about the nutritional value
> of the food they eat. Seventy-one percent of adults agree.
>
> Now, let me just touch upon quickly a moment about the customization
> demand. I mean, in our industry, the consumer has been and will always
> continue to be king.
>
> Adults know that they have lots of choices on restaurant menus, so
> they can decide exactly what they want to eat. Eighty-eight percent of
> adults agree with that.
>
> Seventy percent of consumers customize their food orders, and this
> goes back to why the industry is so labor intensive. Consumers
> constantly, daily, in and out, among all of the 39 different segments
> request that their meals prepared away from home be customized to
> their own wants and needs.
>
> And it\'s interesting. When you get into the mathematical permutations
> of this, if you take a typical sandwich with five food items, for
> example, bread, meat, cheese, ketchup, there are 120 possible
> combinations of those five items. But, as you know, diversity and
> variety in the industry has exponentiated over the past years.
>
> A sandwich with 15 individual food items, has approximately 1.3
> trillion combinations. And if you are familiar with a lot of these
> restaurants today. There are, in many situations more than 15 possible
> items that can be put on those sandwiches.
>
> Another driver among the consumers is the issue of control. Preparing
> daily meals at home takes up more time than they want to spend on that
> activity. Time control and how restaurants satisfy consumers\' wants
> and demands in terms of meeting time demands is very important.
> Forty-seven percent, in other words, almost one out of two adults say
> that it takes up more time than they want to spend on that activity.
>
> Interestingly enough, when you look at some of the demographics,
> almost three out of five 25- to 34-year-olds agree that it takes up
> more time.
>
> Having carryout or delivery meals means they have more time to spend
> on other activities. Almost three out of four adult Americans agree,
> 72 percent. Once again, it\'s substantially higher in the younger age
> groups. Eighty-three percent of 18- to 34-year-olds agree with that
> statement.
>
> Also, too, in terms of portion size, seven out of ten adults report
> ordering larger portions to turn tonight\'s dinner into leftovers. And
> this is a very important component because there are more consumers
> now that are ordering, in other words, to take up more than just one
> individual meal item. And, back in the \'60s, they used to call them
> doggie bags, but now the proportion of consumers that actually take
> leftover food to use for other meal periods has grown substantially.
>
> There is also increased emphasis on self-service within a variety of
> restaurant operations, and this ties back into the control issue.
> There is a greater increase of food bars, where the customer can
> actually prepare those items to his or her specifications. There\'s an
> increase in self-serve beverage kiosks. Even in table service,
> there\'s an increased ability to make reservations over the Internet.
> And this is all responding to the increased consumer demand to have
> control over their dining experience.
>
> The industry has continued to respond to these evolving consumer wants
> and needs. Basically, 71 percent, over seven out of ten adults, report
> that there are more nutritious foods available to them in restaurants
> compared to five years ago.
>
> As I said before, it is a consumer driven industry. The operators are
> responding to the wants and needs of consumers as their lifestyles
> evolve now.
>
> Restaurants are usually responsive to their special food preparation
> requests, such as hold the mayonnaise and serve the salad dressing on
> the side. Ninety-five percent of adults agree, and those of you that
> know survey research, it is darn hard to get 95 percent of American
> adults to agree on much anything. But the fact is the restaurants are
> responsive, and the consumers know they are responsive.
>
> Almost two out of three fine dining operators report customers
> ordering more seafood entrees than two years ago. And more than half
> of family dining and casual dining operators report customers ordering
> more salad entrees than two years ago.
>
> The fact is the restaurants respond to the evolving wants and needs of
> consumer food items on the menu.
>
> And it\'s interesting. When you look at where consumers get their
> information about restaurants, and particularly food items within
> those specific operations, advertising does play a role. But when you
> look at the top three sources of information, how consumers chose a
> table service restaurant, it is basically word of mouth from friends
> and family members, as well as restaurant reviews.
>
> The restaurant industry is a very, very strong word of mouth industry
> in terms of patronage, in terms of which signature food items they
> chose at those establishments.
>
> And the industry, because it is consumer driven and operators remain
> in business by meeting those consumer tastes, over eight out of ten
> are satisfied with their restaurant experiences. And compared to other
> industries, this is a very high satisfaction rating.
>
> So, in wrapping up, when you think about the restaurant industry
> primary characteristics, it is and has been and will continue to be a
> very, very intensely consumer driven industry. It is large, fragmented
> and diverse. It is still dominated by small businesses, extremely
> competitive, and one of the most labor intensive industries in the
> country.
>
> In terms of consumer drivers, entertainment, convenience,
> socialization, control and household income. And customer satisfaction
> levels remain high as the industry has and continues to be responsive
> to their wants and needs. So that\'s it for me. Thank you. Linda.
>
> \[Applause.\]
>
> MS. BACIN: Thank you, Hudson. And thanks very much for the opportunity
> to be here today to talk to you about the issues of nutrition and the
> role that restaurants play in helping people live a healthy lifestyle.
>
> I am Linda Bacin, a restaurant operator from the great City of
> Chicago. We own and operate eight Italian trattorias there, and our
> format is known as a contemporary Italian cuisine.
>
> Some may refer to us as a chain, as we employ over 600 talented
> individuals, and we\'re very proud to be a part of the restaurant
> industry.
>
> Our industry has become known to be the cornerstone of the economy,
> the cornerstone of career and employment opportunities. As Hudson
> said, the nation\'s 870,000 restaurants employ 11.7 million people,
> and we are the cornerstone of most of the communities.
>
> I am very glad to be here today because specifically I and the
> restaurant industry generally are committed to helping individuals
> live a healthy lifestyle. We recognize for some people the problems of
> overweight and obesity are real, and we want to be a part of the
> solution. We believe strongly in balance, moderation, personal
> responsibility, and physical activity are keys to helping people live
> a healthy lifestyle.
>
> At Bacino\'s on every takeout and delivery order that goes the doors,
> we attach one of the brochures that was developed by the National
> Restaurant Association and positively reviewed by the USDA, that
> conveys the importance of balance, moderation, and exercise. I
> strongly believe that all foods can fit into a healthy lifestyle, and
> that no food should be deemed good or bad.
>
> As we all know, determining whether someone is healthy involves more
> factors than just what they eat on a regular basis. You need to take
> into account if they\'re exercising, what their family history may be,
> if they have other medical conditions, and so forth.
>
> Perhaps no industry has its finger more on the consumers\' pulse than
> the restaurant industry. We see consumers asking for menu changes, and
> we in the industry make them on a day-in and day-out basis, and it\'s
> just that simple.
>
> For decades, and I dare say possibly since the beginning, the
> restaurant and the food service industry has been leading the way in
> providing a diverse constituency with a whole variety of restaurants
> to chose from and not to mention a whole range of menu items once the
> consumer steps into the restaurant.
>
> Look on the panel here today as we walk\--and as you would walk down
> any main street in America. You can see all the options consumers
> have. We certainly are not a one-size fits all industry.
>
> And consumers certainly have the right not to come at all.
>
> At Bacino\'s, we have always been nutritious conscious. Our foods are
> made fresh to order, appropriately sized for a normal appetite. And in
> 1985, long before it was trendy, we ventured off on a path to develop
> America\'s first heart healthy pizza, which was the first pizza to be
> included in the Chicago Heart Association\'s Eat Well Guide, and still
> today meets the nutritional criteria of the American Heart
> Association.
>
> Interestingly enough, the development of our spinach pizza came at the
> request of a core group of runners who were in training for the
> Chicago marathon and loved our spinach pizza. But they did not want to
> consume the fat from the whole milk mozzarella. So, over a nine-month
> period of time, we slowly and very calculated changed whole milk
> cheese to part skimmed cheese. And, as we proceeded in the development
> over this nine-month period of time, the spinach pizza remained and
> still remains today our number one product; and it is our signature
> item.
>
> This is something that I am very proud of, and have felt strongly
> about to be able to provide to these customers who wanted it 18 years
> ago, and who still order it and want it today.
>
> As you see, I\'m very supportive of the consumers\' rights to
> customize their order. That is what our industry is truly all about.
> And for the 25 years that I\'ve been in the business, we\'ve been
> doing exactly that. As Hudson said, we accommodate the needs of every
> customer that walks in our door, and because we are flexible in the
> preparation, we allow our guests to personalize their orders and
> enable them to pick and or combine any items they see listed on the
> menu, and we prepare it in a manner that meets their dietary needs.
>
> I operate Italian restaurants, so it\'s certainly fair to say that a
> vast majority of items on my menus have a number of carbohydrates. As
> you all might expect, we see a lot of diet trends being practiced in
> our restaurants, and we\'ve seen a lot of changes over the years.
> Consumers are smarter today than they\'ve ever been. They know what
> they want and they know exactly how they want it prepared.
>
> For example, I am sure it\'s not a surprise to anyone in the room
> right now, that we are seeing a lot of people coming in the door who
> are on the Atkins diet. Just last week, I had an order for a spinach
> pizza that the customer wanted ordered without the crust.
>
> \[Laughter.\]
>
> And on a side note, it was very humorous actually. When the pizza
> maker came to me and said, how do I make a pizza, a spinach pizza
> without the crust, and I said just make it exactly the same way, and
> when it comes out of the oven, just slice the crust off and present it
> on the plate as if the crust were really under there.
>
> In addition, we had someone order our best-selling pasta, the cavotopi
> \[phonetic\], which consists of grilled chicken, fresh spinach,
> Alfredo sauce, and, of course, cavotopi pasta. And they too ordered
> the cavotopi without the pasta.
>
> In changing the menu seasonally, it requires a tremendous amount of
> effort and energy to coordinate when you allow unlimited
> modifications. At Bacino\'s, we have over 23 modifier buttons on the
> order entry system, which would allow you to include ingredients, add
> ingredients, delete items, change from sauteed to grill, or simply
> having something on the side.
>
> As Hudson earlier said, a large percentage of our menu items come into
> the kitchen with a modifier button, and every pizza, short of a cheese
> pizza, has been modified.
>
> In addition to that, I can honestly not think of a food item that is
> more customized than pizza. By its sheer nature, every pizza is built
> exactly for the customer as they order it. And because of the
> prominent role that customization plays in my restaurants, our chefs
> and cooks proudly view their profession as an art, and not necessarily
> as an exact science. And don\'t get me wrong, consistency is the
> number one key to being successful in the restaurant. But I\'m really
> saying is that if someone does customize an order, the kitchen does
> not really\--they\'re looking at it in an art form more than a science
> form. And they\'re preparing that order exactly as the customer
> required it.
>
> And because of the prominent role that customization plays in our
> restaurants, it takes an inordinate amount of training and an
> inordinate amount of time convincing young employees today that it is
> our job to give the customer exactly what they want, because there\'s
> so many options out there. If we don\'t do that, we will not have them
> as customers in the future.
>
> And I know that one of the questions that you are looking at this
> issue is menu labeling. And I hope my comments have clearly conveyed
> to you that, in fact, for my business, it would be completely
> unworkable. Again, I thank you very much for the opportunity to be
> with you today, and I hope that I have shed some light on our industry
> and from my own personal perspective as to what our business is all
> about. Thank you.
>
> \[Applause.\]
>
> MR. LEDERHAUSEN: I did it all by myself. Isn\'t that quite something.
>
> Hello, everybody. Thank you, Linda. I have a couple of disclaimers
> before we get started here. Ronald is not overweight. If you\'ve seen
> him recently, he\'s fitter than ever. And I have another interesting
> observation: I think we\'re making progress. We started this morning
> by kind of, to me, it was a reflection of the exact we\'re here to
> debate or discuss, which is, we\'ve been sitting all day\--I don\'t
> know how many steps you\'ve taken today, but not many. And we started
> eating like four serving sizes of muffins. But I was happy to see this
> afternoon that I think we\'re making improvements. So that\'s good.
>
> Responsibility, I find is a very difficult thing to talk about,
> because most discussions about responsibility is frustratingly enough
> always about someone else\'s responsibility.
>
> I think, personally, that this is perhaps the biggest epidemic of our
> modern society. It\'s, therefore, refreshing and very encouraging that
> the spirit of this day and of this workshop recognizes that we all
> have a role to play when reversing the negative weight management
> issues we face in our society.
>
> And I hope you\'ll be glad to know that McDonald\'s will never shy
> away from doing our part to make the lives of all human beings better.
> That\'s the route we were given, and that\'s the role we continue to
> play.
>
> We recognize the growing public health issues related to weight
> management, and we are committed to playing a constructive role in
> developing solutions. We\'re obviously grateful for being invited to
> take part here today. And we are looking forward to eagerly engaging
> in a constructive dialogue geared towards reversing the weight trends
> of our society.
>
> As you know, we\'ve taken some steps already to encourage customers
> and employees, through our initiative, Eat Smart, Be Active. We are
> increasing the variety of menu choice, particularly toward younger
> customers.
>
> Our menu today includes grilled chicken sandwiches, fruit and yogurt
> parfaits, fresh premium salads, fruit juice, one percent low-fat milk,
> and, at many restaurants now, soup. And we\'re adding additional
> nutritious options for our Happy Meals. We\'re promoting physical
> activity through partnerships, alliances, and creative promotions.
>
> One of our most exciting ideas is our popular Step With It campaign
> that includes an adult Happy Meal launched earlier this year in
> Indianapolis that provides people with a new premium salad, a bottle
> of water, and a pedometer that encourage them to increase their
> walking, along with guidelines for how to live a more physically
> active lifestyle.
>
> And finally, we are supporting consumer education with a number of
> ongoing activities, some of which I will mention in more detail later.
>
> We\'re supporting Eat Smart, Be Active because we\'ve always stayed
> close to our customers and paid attention to what they want and need.
> And that is one of the most beneficial things of being in business,
> because if you lose your customers, you kind of lose yourself.
>
> And we are eager to work in collaboration with the FDA and many of you
> to help solve the issues we\'re facing.
>
> We believe humbly, but confidently, that we have some assets and
> competencies that can be useful in a massive effort to help reverse
> these trends. We have marketing expertise and experience that can help
> sharpen messages. We think we can help sell healthy lifestyles as
> effectively as we sell the good taste and good times at McDonald\'s.
> We have a brand strength from a 50-year relationship with customers
> that have made us a pretty recognized brand. Oops, I forgot to
> introduce the company, but I think you know who we are.
>
> Every day, we have a face-to-face connection with more than 24 million
> U.S. customers, and we have numerous vehicles that we can use to
> deliver educational messages, such as our tray liners and other
> impactful channels of communication. And we also have a strong
> relationship and a productive collaboration with agencies and others
> such as the FDA.
>
> In June, for example, we issued a global policy to reduce uses of
> antibiotics in farm animals raised for the McDonald\'s system. This
> initiative was based on part of the FDA\'s conclusion that overuse of
> antibiotics fuels resistance to drugs important to human and animal
> health. We consulted with the FDA in shaping the policy and briefed
> the agency before announcing it.
>
> Last year, we supported the FDA\'s proposed nationwide ban on
> fluroquinalones \[phonetic\], sharing our experience as the first U.S.
> restaurant chain to adopt the voluntary fluroquinalone ban. We
> recently provided assistance to the FDA and USDA Fight Back campaign,
> bringing in marketing experts to help refine messages and provide
> advice in handling an iconic figure. Something we learned about.
>
> And several years ago, we collaborated with the Centers for Disease
> Control on a home safety campaign, using tray liners and bag hangers
> to deliver CDC messages.
>
> This is a good example of the kind of activity that we collaboratively
> could use to promote healthy eating and active lifestyles. So we have
> a history of a positive, proactive initiative in the background, and
> we approach the current issue of today in the same manner.
>
> So, and given that background and in the spirit of cooperation and
> collaboration, and given that we are just a few weeks away from
> Thanksgiving, or actually just one week, let\'s talk a little turkey.
>
> I\'d like to share two related axioms that I think are important to
> keep in mind as we approach different solutions to the problems we\'re
> trying to attack.
>
> First, for every complex problem, there is a simple solution, and it
> is usually wrong.
>
> Second, every simple solution invokes the law of unintended
> consequences.
>
> The history of public policy making is rife with examples of
> well-intended actions that were not only wrong, but that also produced
> counterproductive consequences.
>
> Prohibition is a classic example of a simple approach to change
> people\'s behavior that not only didn\'t work, but created a lucrative
> business for organized crime.
>
> A simple solution to bring down education costs was eliminating soft
> programs, such as physical education and home economics, but that has
> resulted in less physical activity and lack of knowledge of
> nutritional issues, and I would argue contributed to the problems
> we\'re here to discuss today.
>
> And labeling, while it might seem like a simple step, has become so
> ubiquitous, that it\'s losing its effectiveness. And even consumer
> product food labels have not had an appreciable effect on weight
> management, as we will discuss in greater detail later. That\'s why we
> need to be vigilant in guarding against simple solutions with
> unintended consequences in the weight management arena.
>
> McDonald\'s is eager to support measures to address weight management
> problems that will be effective and reasonable. We take this position
> from our experience and imperatives as one of the world\'s largest
> companies, and certainly the world\'s largest quick service restaurant
> chain. We know our customers concerns and issues, and we try to
> respond with what is acceptable to them and what they will support.
> And even then, of course, we\'re not always right. For example, we
> introduced a low-fat hamburger in the early \'90s in response to
> customers. You remember? McLean Deluxe. But they voted with their
> feet, and they didn\'t buy the product.
>
> We also approached this issue as a franchising company. Independent
> businessmen and women own and operate 85 percent of our restaurants.
> The impact of sales and increases of costs fall directly upon them.
> Therefore, we\'re looking for initiatives that will have a truly
> positive impact on weight management issues and that our customers
> will accept.
>
> The only sustaining effect will be measures that work for business.
> Because if they don\'t, it means people are ignoring them. If we see
> sales rise as a consequence of our actions, it means it is working. We
> see no conflict between doing good and doing well.
>
> Our experience is that nutrition data is of limited value in changing
> the behavior of individuals, and does not address key weight
> management issues. McDonald\'s has been providing nutritional
> information about our food products for three decades, because we
> believe it\'s important to give people the information they need.
> However, recent consumer research we\'ve conducted in this area
> provides interesting insight.
>
> Most customers say they don\'t need more information about nutritional
> values. Different groups of consumers also have different priority
> needs when it comes to information. Diabetics, coeliac disease,
> lactose intolerance, allergies\--the point is different people need
> different type of information.
>
> In addition, increased nutrition information does not necessarily
> reduce weight management problems. The FDA\'s labeling regulation,
> under the Nutrition Labeling and Education Act, became effective in
> 1992, covering 76 percent of all meals. If nutrition information were
> effective, you would have expected weight management problems to
> decrease. Instead of decreasing, weight management problems have
> increased\--that\'s why we\'re here.
>
> QSR meals account for only 10 percent of the meals eaten. So adding
> nutrition data in QSRs would have little impact even if was effective
>
> Furthermore, physical activity is an equally important part of the
> energy balance equation. I frankly and personally think it is getting
> less attention than it should.
>
> Here\'s what was reported in a study by University of North Carolina
> researchers to this year\'s meeting of the Federation of American
> Societies for Experimental Biology.
>
> They found that the calorie intake of American teenagers increased by
> one percent between 1980 and 2000. At the same time, physical activity
> among teens fell by 13 percent.
>
> As I mentioned earlier, this is a partly\--it\'s partly an unintended
> consequence from educational cuts in physical education, where
> Illinois and Texas are the only two states that still require physical
> education in high school.
>
> It is clear to us that increasing physical activity for all age groups
> is at the heart of an effective weight management approach.
>
> As a food retailer, we know from our marketing experience that if you
> want to change behavior, you have to associate the behavior you want
> to promote with positive, pleasurable feelings. Guilt, fear, and
> anxiety are not good motivators. That\'s why most anti-smoking and
> anti-drinking and driving campaigns do not change behaviors. Fun,
> happiness, and music are good motivators. That\'s what Ronald McDonald
> is all about. That\'s why we call some of our meals Happy Meals.
>
> Embedding desired weight management behavior in the popular culture
> can be successful by using culturally relevant music, images, and
> spokespeople. As one example, we\'ve just launched a new Ronald
> McDonald show to encourage daily physical activity in children and
> families, songs, games, stories, and popular McDonald\'s characters,
> but no warnings, no lectures.
>
> We\'ve also revived and updated the successful What\'s on Your Plate
> nutrition education program for kids from the early \'80s. This is a
> series of videos and PSAs featuring Willie Munchright and his friends
> that we have provided to television stations across the country. Take
> a look at how What\'s on Your Plate uses adventures, memorable rhymes
> to teach children about a balanced diet and healthy lifestyle. I
> apologize for the quality. I don\'t think it\'s great.
>
> \[What\'s on Your Plate video.\]
>
> Cute, huh?
>
> Obviously, the most important aspect of anything and everything we do
> is what our customers think. They are our reason for being and
> certainly our boss, and they\'re many drivers that affect what they
> think.
>
> Among the most important is, of course, execution. Customers expect
> quality service, cleanliness and value from us. And recently, we
> announced actually the best sales month in recent history in the
> McDonald\'s U.S. company, and I think the introduction of premium
> salads as a new menu choice helped bring in new customers, as did a
> veggie burger in some parts of the country. In fact, I thought you
> might enjoy how Jay Leno and some other California customers reacted.
>
> \[Jay Leno video.\]
>
> \[Healthier alternative news video.\]
>
> \[Salads and more news video.\]
>
> I\'m going to try to run a little bit faster because we\'ve
> all\--we\'ve all running a little bit late.
>
> In terms of the subject at hand, menu boards, we\'ve done some
> pictures here. I\'m going to show you. One of the ideas is, of course,
> to put information up on our menu boards, and just to show you how
> hard that would be and how impractical that would be, we\'ve done a
> couple of tests here for you.
>
> This is just drinks, and, by the way, that\'s probably the easiest one
> in terms of consistency. And this is just the drink side. And if you
> just want to put calories, it would look something like this, even if
> you took away the actual pictures to make the font size larger, it
> becomes very complicated. And not to speak about the products, which
> actually often, even at McDonald\'s, are customized.
>
> So that\'s just an idea. We do provide brochures with complete
> ingredient and nutrition information, and we plan to include it on the
> back of our tray liners next year, as well.
>
> And the same information is also available on our website:
> mcdonalds.com. Where our new Bag a Meal programs allow consumers to
> build their own meal and find out calorie information.
>
> There are also a few other ideas we\'re working on that we\'re pretty
> excited about. One idea we working on is maybe to provide nutrition
> information on the receipt from what your own purchase has been.
> There\'s some technology challenges with 13,000 restaurants, believe
> me, but we\'re working hard on it, and we hope to be able to crack
> that code, as well as self-ordered kiosks, where you actually can go
> into the restaurant and get the information on your meal right there
> and then.
>
> We recommend that the FDA plan focus on elements that can inspire the
> nation\'s restaurants to deliver powerful healthy lifestyle messages
> that can change people\'s behaviors.
>
> McDonald\'s believes that there are many opportunities to help people
> make good choices through icons and visual keys on menu boards. Many
> restaurants use the heart symbol to highlight menu choices that are
> low in fat content. In Sweden, as we heard earlier today, they use the
> Key Hole approach to signify good choices, and so do actually we in
> Sweden. Here\'s an example of light approach that our partners in
> Canada have developed, where light options have their own location on
> the menu. Here\'s how our restaurants in California right now are
> treating their menu listings. And our McDonald\'s Australia partners
> have developed a fresh approach to their menu that is very attractive.
>
> Looking forward, the adoption of the new food pyramid and nutritional
> guidelines next year presents an outstanding opportunity to partner
> with McDonald\'s and other restaurants and deliver positive messages
> in innovative and creative ways.
>
> To summarize, we are anxious to play a positive role in solving weight
> management issues, because it is the best interest of our customers.
> McDonald\'s has obligations to our customers and the public at large,
> as a leader in corporate social responsibility to our brand and to our
> franchisees.
>
> We are proud of our food, and we will not support any effort that
> associates visits to our restaurants and or consumption of our food
> with negative feelings.
>
> We also can\'t support any effort that will impair our service times.
> Our goal is to sell great food to our customers. McDonald\'s is eager
> to share our marketing experience, to help create campaigns with the
> potential to change consumer eating and physical activity behaviors.
>
> Finally, I\'d like to close with an observation about the idea that
> giving more people more information will change their behavior. I
> think the problem in our society is not one of needing more
> information. I personally think we\'re drowning in information, and
> what we need is knowledge and wisdom. Data and information is passing
> by; knowledge and wisdom is grabbing hold to stay. Data and
> information is ignored at the moment of truth; knowledge and wisdom is
> what influences the choices we make. Ultimately, wisdom comes from
> within, and information sits outside. And in order to change a
> culture, which is exactly what the weight management problems needs to
> have in order to change, we need a cultural massive shift. A culture
> shift that recognizes the huge importance that our lifestyle choices
> have on our health. Culture shifts of this magnitude can only be
> achieved when all institutions in our society are aligned and work
> collaboratively together\--government, education, health care,
> businesses, and special interest group. In short, it will take all of
> us to be successful.
>
> I\'d like to end by showing a brand new commercial we call Work Out
> Mom. I think it\'s a great example of what kind of new attitude we can
> help create when we put our marketing dollars towards a new changing
> consumer who actually wants to live a healthier and more active
> lifestyle. Thank you.
>
> \[Work Out Mom commercial.\]
>
> \[Applause.\]
>
> RESTAURANTS: FIRST Q&A SESSION
>
> DR. PITTS: Ladies and gentlemen, I have to apologize. We\'ve practiced
> very poor time management. This panel runs until 5:00 p.m. It\'s now
> 4:30 p.m., and this is an open public meeting, and we\'ve done three
> presentations, and we have three to go. So I\'d like to insert, at
> this point, questions from the audience, after which point, we can
> continue with the three following presentations, and those who are
> willing to stay after 5:00 p.m. are certainly willing to do so.
> Hopefully, the panelists will stay as well.
>
> Yes, ma\'am.
>
> MS. UTAN: Hi. I\'m Margot Utan with the Center for Science in the
> Public Interest. While the presentations have been interesting so far,
> I think it\'s very disappointing that the Restaurant Association was
> unwilling to allow any other perspectives to be presented on the
> panel, and that the Food and Drug Administration caved to this demand,
> and that there is no other perspective provided; that not
> surprisingly, you know, in our very extensive on nutrition labeling
> and providing better nutrition information in restaurants, we have
> some different interpretations of some of the data that has presented.
> People are eating out a lot, about twice as much as in 1970. It\'s a
> growing part of their diet. It\'s about a third of calories, and
> studies show that when people eat out, they don\'t eat as well. They
> eat more calories, more saturated fat, fewer key nutrients, like
> calcium and fiber. And a number of state legislatures have agreed, and
> as has the U.S. House of Representatives, that this is an important
> issue to help provide people with better nutrition information in
> restaurants.
>
> So, I just express very deep disappoint that this panel provides only
> one and very limited perspective.
>
> DR. PITTS: Well, I should add that, you know, we are having two
> additional panels, one of which is on consumer issues, which your
> group is invited to. Do you have a question for the audience\--for the
> panel?
>
> MS. UTAN: Just a comment.
>
> DR. PITTS: Okay. Thank you. Yes, sir.
>
> MR. KATZ: David Katz at Yale. Just in passing earlier, Dr. Dietz made
> reference to sensory specific satiety. I don\'t know how well informed
> this group is about that, but it\'s the tendency to stay hungry longer
> when a variety of flavors are put in any given meal, snack, or, for
> that matter, food, and it\'s a very prevalent practice with packaged
> foods to add salt to sweet food; sugar to salty foods. We obviously
> have an experience, and I\'m reticent to compare anything about food
> to tobacco, but that\'s been done many times. And there\'s certainly
> were things done to make tobacco products as enticing as they could
> be, in essence adding to their addictive tendencies.
>
> Is there any willful practice in the retail food industry, in the
> restaurant industry, if you will, to maximize the appeal of foods in
> ways that are, let us say, subliminal.
>
> DR. PITTS: Steven?
>
> MS. GROVER: You know, I\'ve answered that question on numerous
> occasions, and the answer is guilty. We make food taste as good as
> possible. Everybody here is in the business of making good tasting
> food, and so if you mean do we combine flavors and spices and
> ingredients so the customers like that taste? The entire industry is
> guilty of that. Yes. And I would also say that do consumers combine
> spices and tastes so that their foods taste good at home? Yes.
> They\'re guilty, too. I\'m guilty. I do that in my own kitchen. So
> guilty on combining flavor and tastes so that things taste good.
>
> Quite frankly, if you\'re in the restaurant industry, and consumers
> don\'t like the taste of your food, you don\'t stay in the restaurant
> industry very long. That\'s it. Any other questions?
>
> DR. CASWELL: I\'d just like to make a comment on the first
> presentation. In terms of talking about the structure of the industry
> and focusing so much on numbers of establishments, et cetera. When you
> look at the structure of an industry, what you need to look at, in
> addition to just numbers of operations out there, you need to look at
> the sales volume and where is the sales volume concentrated. And so
> I\'d like to ask the question of what is the structure\--when you look
> at the entire restaurant industry, the top 10 firms, for example, or
> the top 20 firms, what is their percentage of sales, because I think
> that\'s a much better or a different indicator of market structure
> than looking at numbers of operations.
>
> DR. PITTS: Ms. Caswell. Panel?
>
> MR. RIEHLE: Basically, there\'s very good data on that from the Census
> Bureau. And what you find is that the industry is not concentrated at
> all. If you look at other industries in terms of industry
> concentration because the sales volume per units are so low, you have
> a situation where the industry\--for example, in table service sales,
> the proportion of sales that come from chain firms with ten or more
> establishments is roughly about 24, 25 percent. So when you go in and
> you look at the data, and that\'s why we say it\'s an industry of
> small businesses, because this is not a concentrated industry, unlike
> other industries, and what you find in service, because it is so labor
> intensive, the concentration index is probably one of the most diffuse
> indexes that exist.
>
> DR. PITTS: That was Mr. Riehle. Thank you. Are there any further
> questions from the audience? Yes, sir.
>
> MR. MARTIN: I\'m Andy Martin. I\'m from the Chicago Tribune. I had two
> questions. The first is pertaining to what Ms. Utan said. I do think
> it\'s strange on a panel that\'s supposed to talk about the pros and
> cons of restaurant labeling that it\'s all industry people, and I
> wondered who put together this panel. And my second question unrelated
> and that is, we\'ve heard a lot about new nutritional offerings at
> restaurants like McDonald\'s and Bacino\'s, but I wonder what
> percentage of some of these restaurants\' business\--sorry to pick on
> McDonald\'s, but that\'s the one I could think of right now\--is
> this\--these biggy offerings that were introduced several years ago,
> or super-sized portions. Biggy\'s not your term, I understand, but
> these super-sized portions of\--
>
> MR. LEDERHAUSEN: Super-sized portions account for about less than five
> percent of our total volumes.
>
> MR. MARTIN: Okay. Thank you.
>
> MR. LEDERHAUSEN: And one interesting fact that people may shock you,
> and I\'m sorry if I shock you, the hamburgers on our menu, the regular
> hamburgers, the Big Macs, all our products, including the serving
> sizes of all fries, are exactly the same as in 1955, when we launched
> them. So our serving sizes have not increased. It is true that on
> fries and drinks, people tend to buy a few more larger than what they
> did before, but the actual serving sizes have not changed, and super
> sizing accounts for about five percent of our sales.
>
> DR. PITTS: It\'s Mr. Lederhausen.
>
> Andy, in answer to your question, FDA decided that it would be best on
> an industry panel to have people from the industry, which is why
> we\'re having separate panels for people from the field of medicine
> and also from consumer groups. Yes, sir.
>
> DR. NAYGA: Rudy Nayga, from Texas A&M. I want to know what you think
> about the value of nutritional\--of having a nutritional quality index
> in the restaurant industry.
>
> MR. GROVER: I\'ll answer that from a restaurant industry perspective:
> by what standard of measurement would you use that quality? I mean,
> you\--
>
> DR. NAYGA: It\'s a hypothetical question. It could be\--
>
> MR. GROVER: If there\'s no standard of measurement, then it would be
> premature to talk about what we would think about an index. You know,
> if you can\'t develop a standard of measurement, if none exists today,
> I don\'t know how you would do that; how you would qualify it. For
> what group? For what diet? For what\--I mean, for the average
> American? For the obese American? For me or for, you know, a
> 105-pounder? What are we talking about?
>
> DR. NAYGA: I\'m not a nutritionist.
>
> MR. GROVER: Well, neither am I, but I mean, but, you know, you\'re
> asking in abstract, and it\'s very difficult to answer a question if
> it\'s thrown out in abstract, without, you know, a qualifier. You said
> a quality index. Well, what would that quality index look like? What
> are we talking about?
>
> DR. NAYGA: Well, I think part of the reason for that question is
> because I know that McDonald\'s has offered this nutritional
> information for years now, but I wonder how many of your customers
> really know that that\'s available or and how many really has availed
> of that, you know, that option to be informed?
>
> MR. GROVER: I\'ll answer from personal example just to move along. My
> wife has been on a diet for many years. She eats in every restaurant
> and has probably eaten in every one of the restaurants where the
> people hear, and she knows before she walks before she walks in. I
> mean, it\'s not\--for the people that want to watch their diet, for
> the educated, for people who have knowledge, as Mats says, that\'s
> very easy. The information is easily available. It\'s available over
> the Internet. It\'s available in brochures. It\'s even available in
> books. She carries a book with her that has everything by someone
> who\'s on the panel. I hate to use the name brand, but she uses the
> points system. So, for those seeking information, for those that have
> knowledge, it\'s easily available.
>
> Maybe we need to work on ways to make that information more easily
> available, and more understandable to more people, but that\'s what
> the restaurant industry is here to do and to talk about.
>
> DR. PITTS: That\'s Mr. Grover.
>
> UNIDENTIFIED SPEAKER: Peter, may I suggest we go regular order. People
> have flow in.
>
> DR. PITTS: I beg your pardon?
>
> UNIDENTIFIED SPEAKER: May I suggest you take another question and then
> go to the panelists?
>
> DR. PITTS: You can certainly make that suggestion. Is there another
> question. Rona, did you have a question?
>
> MS. HENRY: I was interested in all your data about who was eating at
> restaurants and so on. What is the correlation between household
> income and particularly patronage at fast-food restaurants?
>
> DR. PITTS: Ms. Henry.
>
> MR. RIEHLE: Basically, what you find is that when you look at
> household income levels, the frequency goes up of patronage of both
> establishments. In other words, restaurant patronage is what I call
> basically a cash on hand business. It is dependent upon literally the
> amount of cash that an individual at a point in time. And the higher
> income household obviously have more cash on hand. So, consequently,
> what you find is that their patronage of different segments increases
> as that household income increases.
>
> DR. PITTS: Mr. Riehle.
>
> DR. LEVITT: Great, one more question and then we\'ll move on with the
> presentations.
>
> DR. PITTS: Yes, sir.
>
> MR. KATZ: David Katz, Yale. I think those of us representing the
> public health community in the audience are reluctant to push against
> the line of personal choice. I think we agree that that\'s valid with
> regard to nutrition. On the other hand, the health of children is very
> much at stake, and, for the sake of time, I won\'t cite the statistics
> about the ominous trajectory our kids are on. I would like the
> panel\'s reaction to regulation of food advertisement to children. We
> did invoke different standard with regard to tobacco when kids were
> involved than when adults were involved. We feel adults should be
> entitled to make their choices in our society, but children deserve
> our protection. Your reaction, please.
>
> DR. PITTS: Panel? Steve?
>
> MR. GROVER: I think as an industry, I hate to get into the marketing
> aspects of any one business or business decisions, but I can tell you
> that most of the marketing that I do see is very responsible. It
> doesn\'t include a specific food product. It\'s mostly focused on a
> feeling of happiness or dealing with an establishment, and not focused
> on any particular food. I think those food choices need to be made by
> the parents. I hate to say that. But, you know, I have two young
> daughters, an eight-year-old, and a five-year-old, and they do not get
> to choose the foods they eat, no matter what the marketing is.
>
> Now, I watch a lot of children\'s shows because I have to, because I
> have to sit with them, and I like them. And I\'ve found the marketing
> very responsible. I do reject any analogy to food and tobacco. I think
> that is actually sensationalizing it, and, you know, I have a 25-year
> career in public health, too. And that\'s what my job is here. And the
> bottom line is that I don\'t think tobacco and food are the same. I
> think food is a necessary component. So, marketing, I think there is
> responsible marketing. I would encourage everyone to take a look at
> the marketing of food products as it is to children today and see.
>
> But without that marketing, you don\'t have a lot of children\'s
> programs, so I believe it\'s a very complex issue, and there\'s a lot
> of unintended consequences if you were to remove marketing to
> children. I would say, you know, TVs and game cubes and everything
> else need to be taken into consideration, because that might create a
> sedentary or promote sedentary lifestyles.
>
> So, here again, you know, we can take this to exception, but I reject
> that marketing is irresponsible or marketing in the food industry has
> been irresponsible.
>
> DR. PITTS: That\'s Mr. Grover.
>
> MR. LEDERHAUSEN: I just add one comment to that, and that is that I
> resent the fact that there are some people in workshops like this and
> other places where we go that claim that they represent people more
> than we do. We have 23 or whatever million customers visiting our U.S.
> restaurants every day. We care deeply about them and their health. And
> everything we can do to help them make better choices, we\'re doing.
> We\'ve replaced items on our\--for our younger children this year with
> many items trying to replace some other items to help them make better
> food choices, but we can\'t force people to make choices that they are
> not willing to make.
>
> RESTAURANTS PANEL, CONTINUED
>
> DR. PITTS: Mr. Lederhausen. Thank you. Thank you, ladies and
> gentlemen. Let\'s continue with our panel. Christianne Ricchi.
>
> MR. GROVER: Christianne Ricchi.
>
> MS. RICCHI: Good afternoon, everyone. I\'m here representing yet
> another segment of the restaurant industry. I own a fine dining
> Italian restaurant here in Washington, D.C., 1220 19th Street, if
> anyone wants to come to dinner tonight.
>
> I\'m here as a director of the National Restaurant Association, as a
> restauranteur, as a chef, as a small business owner, a consumer, who
> is very interested in healthy lifestyles, and as a mother.
>
> I am very concerned about this obesity issue, as well as the effect
> that menu labeling could have on my business. I\'m convinced that if I
> were forced to label my menu, I would not be able to continue doing
> business the way I am today, and or even worse, I\'d be forced to go
> out of business.
>
> Let me give you a little bit of background about myself and my
> restaurant. I\'ve been in the restaurant business for over 35 years.
> It began in the early \'70s in Italy, when I was living there, and I
> became acquainted with a family who owned and still owns and runs a
> little trattoria on the hills outside of Florence. That\'s when my
> cooking experience began. I was working in the kitchen with the women
> of the community, and I learned how to cook from them. They used no
> recipes. They used no measurements. They prepared food the same way
> that their generations had done before them, and that\'s the way I
> learned how to cook.
>
> Then, in 1988, I came to Washington, D.C., to open i Ricchi, on, as I
> said, 19th Street. It\'s a very authentic. We pride ourselves on the
> fact that the recipes are the same as we had prepared in Italy. It\'s
> a very authentic Italian menu. We seat about 150 people, and we employ
> about 60 full-time staffers. We have a very elaborate training
> program, both for our kitchen help as well as our servers.
>
> Just to give you an idea of some of the changes that we\'ve had to
> make in the past 15 years. When we first opened, we didn\'t have,
> because I was so concerned about having the menu be authentic, we
> didn\'t have a lot of seafood on the menu. But in the early 1990s, the
> American consumer wanted seafood, so we added seafood to the menu.
>
> What we found in the last few years is that people now want more red
> meat, so in the last two or three years, based on that fact and the
> fact that I am surrounded by very high quality steak houses, we have
> had to add more red meat and more beef items to our menu.
>
> We\'ve also had to change our recipes over the years to adapt to the
> taste of the American palate. For example, the authentic Italian
> recipes that I learned how to cook were very salty for the American
> palate, so that\'s something that we learned very quickly if we wanted
> to stay in business, we had to change.
>
> In those 35 years of restaurant experience, I\'ve come up with a very
> simple recipe for success. Three\--there are three important things
> necessary to be successful in a restaurant.
>
> First, you must offer good tasting and satisfying food. We at the fine
> dining establishment like i Ricchi view cooking as an art, as Linda
> mentioned before. No two dishes are ever prepared exactly the same
> every time. We have over 50 different items offered daily on our menu.
> Now, Hudson, if we have 50 different menu items offered on the menu,
> how many kajillion combinations do we have?
>
> And everything on our menu is cooked to order. So when you order it,
> we cook it for you. Nothing is prepared before hand.
>
> We use fresh seasonal ingredients. We use nothing that\'s canned or
> frozen, and everything is made in house, from butchering our own meats
> to baking our own breads, making our own sauces and pastas, desserts;
> we even make our own gelato.
>
> The second ingredient for the recipe for success is that we must
> conform to the special needs and requests of our customers. My staff
> and I are always present to oversee food preparation. We are available
> to give dietary information and to discuss in detail ingredients and
> food preparation. Well over 60 percent of the tables that order at i
> Ricchi have special requests. It\'s not my job to ask them whether
> it\'s just dietary or personal preference; whether it\'s a health
> issue; personal tastes; or religious. If someone says they want it
> made their way, if I want to stay in business, that\'s what I have to
> do.
>
> Anybody who knows me well will know that on any given Saturday night,
> they can come into the kitchen and they can hear me screaming at the
> waiters\--don\'t customize. It\'s busy. It\'s eight o\'clock. There\'s
> a flow in the kitchen. We can\'t stop the entire kitchen to customize.
> But they are quick to remind me of their excellent waiter training in
> that that\'s what the hospitality business is all about. We are here
> to respect the rights to chose and meet the needs of our customers.
>
> We had a\--if I can just take a second just to give you an
> illustration. A couple of weeks ago, we had a local radio station call
> us; wanted us to offer some dinners that they were doing a contest.
> And I said, sure, we\'ll give you dinners, but what I\'d like you to
> do is have your two radio personalities come to the restaurant so at
> least that maybe they could put a good plug in for the restaurant.
>
> Well, little did I know that one of the radio celebrities is former
> Congressman Fred Grandy, who is a staunch vegan. For those of you who
> don\'t know what that means, that means no face, no mother. They will
> not eat anything that has a face or anything that has a mother. Now,
> you tell me in an Italian restaurant, you would think that that would
> be hard. How could I not use dairy, cheese, eggs, meat or fish. Well,
> needless to say, we developed a menu for him, and he was ecstatic, and
> gave us a really nice plug.
>
> The third and probably, for me, the most important ingredient for a
> recipe to success is that you must execute the aforementioned two
> items in a manner to ensure reasonable cost to the consumer, while
> maintaining an ability to make a profit.
>
> Now, I have a couple of respectful or questions that I would like to
> respectfully pose to the panel. In order to maintain this recipe for
> success, if I\'m forced to label every offering on my menu, how can I
> offer new items, using new ingredients, while cooking each item to
> order as I do now? How can offering specific written dietary
> information be relevant to something that\'s always changing? Is menu
> labeling the most effective method of communicating dietary
> information to my customer? Or, is my personal interaction more
> effective, relevant, and timely? How can I possibly continue to offer
> an ever-changing variety of items on my menu if I must have everything
> analyzed in a lab? And fifth, how can I continue to maintain my price
> points to the customer while still making a profit if I\'m burdened
> with the additional cost of analyzing my food?
>
> In my opinion, the answer is not labeling my focacha or pasta or fish
> in white wine sauce. The answer to obesity, in my opinion, is
> moderation in consumption, physical activity, and education, the most
> important of these being education.
>
> Restaurants can provide information. But education is the missing
> component, and it must be done by the FDA, health practitioners, our
> schools, and in the family settings at home. Thank you for allowing me
> this opportunity to share my comments with you, and I look forward to
> being part of this ongoing dialogue to help Americans find practical
> and workable approaches to attaining and maintaining healthy
> lifestyles.
>
> \[Applause.\]
>
> MR. YOST: Good afternoon, everyone. My name is Brian Yost, and I am
> the Vice President of Restaurants and Beverage for Marriott
> International.
>
> First of all, I\'d like to thank the National Restaurant Association
> for recognizing that restaurants and hotels do count. Thank you for
> the invitation to participate. And as well, the FDA for putting
> together a panel of industry experts to discuss this very important
> topic.
>
> I\'ll start with a story, because I think it illustrates a lot of what
> my co-panelists have said here. I have a 12-year-old son, who\'s going
> through that painful but\--it happens to many of us\--bout with
> braces. And yesterday was the big day when he got all the stuff on his
> teeth, and I called from work before I left to ask what was for
> dinner, and he said, dad, please California Pizza Chicken, potato leek
> soup. That was about the only thing he could think of. But please,
> dad, no cheese, no onions. Got my wife\'s order, called the
> restaurant, stopped on my way from work, and as I was picking up the
> food, realized that all three of the items that I had ordered for
> dinner for myself, my wife, and my son, were customized.
>
> The soup was probably the easiest order. The server had to work
> through the complexities of the vegetarian pizza with select items,
> and the salad, without many of the items, on her own did a great job.
> But when I apologized, probably the most telling thing for me was the
> server said, there\'s no need to apologize. That\'s my job. You\'re
> one of almost everybody that comes in and changes their order. Don\'t
> worry about it, sir.
>
> That\'s what the industry faces every day. If not every customer, most
> every customer.
>
> Now, how do we fit into that? Marriott International is a leading
> worldwide hospitality company. We have 2,600 hotels around the world.
> For the purpose of what we\'re talking about today, I\'m only going to
> address about our 350 full service Marriott and Renaissance properties
> that we manage or franchise here in the United States.
>
> For those of you from the area, you may know that Marriott started as
> a nine-stool root beer stand here in Washington, D.C. I bring that
> up\--it started in 1927, by the way. We celebrated 75 years last year.
> I bring that up because it, too, is very relevant to today\'s
> discussion.
>
> Mr. and Mrs. Marriott, when they started it, were a franchisee of A&W
> Root Beer, but they quickly learned that changing tastes, changing
> requirements of them, forced them to change their concept into a Hot
> Shoppe Restaurant, where they could meet the demands of their guests.
>
> Seventy-years has passed, and we still recognize that food and
> beverage is a key ingredient in our lodging operations. In fact, it\'s
> so key that our food and beverage mission statement articulate our
> commitment to guests\' needs very succinctly. We say that we want to
> deliver to our guests what they want, when they want it, where they
> want, and how they want it. Everyone of our food and beverage
> operations in over 350 managed, full-service hotels subscribes to that
> theory.
>
> Now, we do recognize that healthy options represent an important
> expectation for a growing number of our guests. And for the past
> several years, we\'ve been working to set standards for our hotels to
> address those needs during the various day parts.
>
> For us, breakfast is probably our largest food and beverage
> opportunity. It represents an important meal period to us, not because
> we capture a large percentage of our hotel guests, but additionally
> because the guest satisfaction ratings that we receive at breakfast
> have a direct statistical correlation to a guest\'s overall
> satisfaction with their hotel stay, and, most importantly, with their
> satisfaction and intent to return to one of our branded hotels.
>
> At breakfast, over 75 percent of our guests today choose the buffet
> option. Now, we recognize that the value perception, speed of service,
> could be contributing factors, but when we talk to guests, they tell
> us it\'s because they have the opportunity to customize their meal, to
> get it the way they want it and to get it how and when they want it.
>
> Having said that, we\'ve created standards for our buffet around
> healthier options, healthier alternatives so that guests have access
> to the foods that they want, that they need. Things like minimum
> numbers of fresh fruits, hot oatmeal, low-fat pastries, et cetera.
>
> Our work around breakfast has also manifested itself in our a la carte
> menus. This past summer we launched in our breakfast a la carte menu a
> Fit for You Program. It\'s designed to recognize the dietary lifestyle
> choices that our guests are making as they seek items that are perhaps
> lower in fat, lower in cholesterol, or higher in protein. We back that
> a la carte menu up with options for egg substitutes, butter
> substitutes, as well as mandates for fresh juices and other healthier
> options.
>
> The implementation materials that support the breakfast meal period go
> into greater detail about what each of these dietary trends mean to
> our guests, and, more importantly, provide training materials that our
> chefs and restaurant managers can use to execute throughout the rest
> of the day parts to meet the needs of the guests as they come through
> our hotels.
>
> For lunch and dinner, the Marriott philosophy for restaurants is to
> create destination quality experiences in our hotels, quality
> experiences that might rival many of my fellow panelists\' restaurants
> or many restaurants in the communities.
>
> In order to do that, we require market-based unique concepts. The days
> of cookie-cutter restaurant concepts in hotels are gone. In order to
> have unique, market-driven restaurant concepts, you also have to allow
> chefs the flexibility to create signature food items that reflect
> local flavors, indigenous products and preparations, and seasonality.
>
> Our chefs are encouraged, in fact urged, to create daily specials, and
> to change their menus seasonally. It is not uncommon for a Marriott
> restaurant to have a quarterly menu cycle.
>
> Having said that, proposed menu labeling laws would significantly
> reduce the ability of our chefs to react to these changing parameters,
> and maybe more importantly impact the guest experience; and,
> therefore, the viability of the business of these restaurants.
>
> Other example of our company\'s commitment to providing healthy
> alternatives include our kid-zine program. It\'s our children\'s menu.
> At breakfast, all of the items can be made with the egg substitutes
> and things that I spoke about earlier.
>
> At lunch and dinner, we include a green salad option for children\'s
> menu items so that children don\'t necessarily take the default of
> perhaps a less nutritious offering with their entrees.
>
> Further evidence of our work toward providing high-quality, nutritious
> food offerings includes the education that we provide for our chefs.
> We created a very successful five-day, week-long class with the
> Culinary Institute of America. Over the course of two years,
> approximately 300 of our chefs attended that class and received
> education in balanced nutrition, as well as other core culinary
> principles.
>
> Additionally, approximately 45 of our chefs from around the country
> have received the certified executive chef accreditation from the
> American Culinary Federation, which has, as a component a very
> rigorous requirement in nutrition education and testing.
>
> In summary, our experience over the course of the past three or four
> years has been that our guests are getting much more educated about
> food and beverage. Thanks to publications like Gourmet Magazine, Food
> and Wine, and pretty much all of the programming on the Food Network
> these days, our guests know more, and I\'m somewhat embarrassed to
> state this in a public forum, than our staffs at times, as it relates
> to food ingredients and compiling those ingredients into meal
> selections.
>
> If we are forced to label our menus to reflect those variety of
> offerings, it could significantly impact our ability to address these
> guests\' needs, and, more importantly, significantly impact our
> ability to be a true hospitality partner as we have an obligation to
> react to individual needs. And that obligation, by the way, is
> heightened when we look all of our restaurants being at the bottom of
> essentially hundreds of hotel rooms, because now we\'re forced to
> provide an away-from home\--at-home experience away from home. And we
> know that the at-home experience is a very customized one.
>
> From our perspective, the true source of change in consumer dining
> habits is going to be continued education, continued options, and a
> holistic approach. It\'s not going to be menu labeling. Thank you.
>
> \[Applause.\]
>
> MR. LEDERHAUSEN: Rob, this is going to look very bad, because the
> McDonald\'s guy is now going to walk out when the Burger King guy
> speaks. So, it\'s not what you think. I just need to run and catch a
> plane.
>
> MR. DOWDY: You\'re totally excused.
>
> MR. LEDERHAUSEN: So sorry.
>
> MR. DOWDY: Thank you.
>
> DR. PITTS: Mr. Lederhausen.
>
> MR. DOWDY: I know that we\'ve run over the time, and so I intended to
> make my comments very brief to be sensitive to all of you and all of
> us. I also wanted to thank you for allowing us to be a part of this
> discussion.
>
> I represent the Burger King system. Let me tell you a little bit about
> it. We operate, our franchisees and us, we have 1,500 franchisees. We
> operate a little more than 11,300 restaurants around the world; 8,000
> of those restaurants are in the United States. We employ 320,000
> people, and we serve about 15 million or 16 million guest every day.
>
> Our company is 50-years-old this coming, in 2004. From the very
> beginning, when it was founded in Miami, we were always about
> customization. So customization is not a new concept. You\'ve heard a
> lot about it here this afternoon. I will also tell you that next year
> will be the 30th anniversary of a trademark that we created in 1974
> that is one of the most\--the best known trademarks in the country and
> even in the world, which is have it your way. Many of you, I think, in
> the room will recall the lyrics to what a song that has now become of
> an American icon. I won\'t sing it for you, but I will remind you of
> the lyrics: hold the pickle, hold the lettuce, special orders don\'t
> upset us. All we ask is that you let us serve it your way.
>
> That has been the philosophy at Burger King Corporation for the 50
> years of its existence. And I\'ll tell you it resonates, that idea,
> that concept that our advertising agency in 1974 devised, resonated
> with the American people very, very well, and it continues today.
>
> One-third of the sandwiches that we serve in our restaurants are
> customized. But let me focus on our flagship product, for which we
> sell the most, is the Whopper. Just a little under one-half of all
> Whopper orders are customized. Now, that may sound easy, but you need
> to know, as you\'ve heard the story of combinations and how they can
> multiply. There are 1,535 ways to have a Whopper. One-half of the
> Whoppers that we sell are customized.
>
> We also know that, as we\'ve learned more and more about how customers
> have used that term, originally we believed that people customized
> their sandwich and had it their way for taste. What we\'ve learned
> over the years is that people have also had it their way to suit their
> diet. When we introduced our BK Veggie Burger two years ago, which has
> become\--it was the first non-soy based veggie burger offered by a
> national chain. We\'re very proud of it. We had a small operational
> problem that we didn\'t realize until we started getting complaints
> from customers. As people would go in to get the BK Veggie, and they
> were handed a veggie Whopper, which was basically a Whopper with no
> meat.
>
> What we found out is that our restaurants were very used to having
> customers coming in ordering a veggie Whopper for many years, and they
> knew very well what the customer wanted. And so when they\--we had to
> make it\--go back and retrain our crews that when they ordered a BK
> Veggie, it was very different from a Veggie Whopper. And even though
> we have now the BK Veggie, we still have a loyal following of Veggie
> Whopper people who order the Whopper with no burger. It is one of the
> 1,535 ways to have a Whopper.
>
> I want to read to you quickly our vision, because combined with Have
> it Your Way, what we stand for is that we take pride in serving our
> guests the best burgers and a variety of other great tasting healthy
> foods, cooked over an open fire. That\'s what we\'re all about.
>
> This is important because best burgers means that we\'re not walking
> away from the Whopper. It\'s one of the most popular sandwiches in
> America. In fact, it\'s the most preferred sandwich in America. But
> are offering and we do offer and we have offered for many years
> variety. I mentioned the BK Veggie Burger. We also offer variety in
> sizes. We offer the Whopper as a junior size. We have a Chicken
> Whopper. We have a Chicken Whopper Junior. We have salads. We have one
> percent milk. We have a lot of variety, and we\'ve always done so,
> because of the same reason you\'ve heard here: we have to listen to
> our customers and we\'ve been listening to them for years. We do a
> tremendous amount of consumer research to know what\'s on their minds
> and what\'s on their palates, what they want to eat.
>
> In September we launched new line of fire-grilled chicken baguettes.
> And we\'re very proud of these. They come in three flavors. Our new
> CEO, Brad Bloom, set as a standard for these products that they had to
> be under five grams of fat. They had to be under 360 calories, and
> they had to taste good, and you\'ve heard that theme resounded here by
> my colleagues. I\'m very proud that we believe that we have
> accomplished that, and our consumers are loving the sandwich. So if
> you haven\'t tried them, the fire-grilled chicken baguettes. Five
> grams of fat. Less than 360 calories. They come\--the flavor comes
> from fire grilling, not from fat. The flavor also comes from fresh
> baked bread that we bake in our restaurants every day, not from fat.
> And the flavor comes from exotic herbs and spices that we\'ve added to
> add flavor, not from fat.
>
> We have more products to come. We\'re working on a very exciting line
> of salads that will also meet nutritional hurdles that we\'ve set for
> ourselves.
>
> Enough on food. We\'re here today to talk about information.
>
> In 1991, we started offering brochures in our restaurants that have
> all of our products with their nutritional information, their
> ingredients, and I\'ve brought some of those here today on this corner
> of the table, and you can feel free to take them.
>
> We also offer that same information, and I had to fold this
> because\--to get it on the plane this morning, but we have a poster
> that we make available in all of our restaurants, and this is mandated
> that all restaurants have to post this and make it available to the
> public. You know, I applaud my colleague from McDonald\'s attempting
> to show what a menu board would look like with nutritional information
> on it, and he did pick the easiest, which is drinks.
>
> I didn\'t even try to visualize it, because as I tried to in my mind,
> just the Whopper alone with 1,535 variations of the Whopper on a menu
> board would take virtually all the walls and maybe a little bit of the
> ceiling in each restaurant to provide.
>
> We provide information in other means. We also have a web site. Seven
> years ago, we modified it so that you can, with the beauty of
> technology today, you can now customize your sandwich on the web site
> and tell the computer how you like your Whopper, and it will provide
> for you what the nutritional information is for the way you like your
> Whopper.
>
> We\'ve just upgraded that web site a few weeks ago and made it a
> little bit better, and we\'re looking at some alternatives now that we
> are very comfortable with the way it\'s working and the way consumers
> are reacting to it. We\'re also looking to add a feature that you can
> input the type of diet that you\'re on, whether you\'re on a
> low-sodium or a high-protein low-carb diet, whatever you\'re looking
> at, and it will then tell you what options you have to eat a Burger
> King.
>
> In the interest of time, I\'d just like to go to the end, and I\'d
> like to resound another theme that you\'ve heard today and also what
> my colleague at McDonald\'s said is that the information is available
> today. That\'s not the problem.
>
> I think the problem is educating people and the knowledge that I think
> Mats mentioned as well. It is a shame to me that the Department of
> Education is not a part of this dialogue, because the information is
> available, and I think what we need to do is a better job of helping
> people understand and equip them with the knowledge of nutrition so
> that they can make personal decisions about what they need to do and
> how they choose their food. Thank you.
>
> \[Applause.\]
>
> MR. GROVER: Well, from the National Restaurant Association, I want to
> thank you for your tireless attention, you know, staying after 5:00
> p.m. here to listen to restauranteurs, but thank you very much, and we
> really appreciate your attention and your questions. And believe you
> me, the restaurant industry wants to be part of the solutions to this
> issue. We recognize the problem, and I think as you can see here,
> everyone one of the panelists is doing something and actually doing
> quite a bit to try to address this in a responsible way.
>
> MS. MORRISON: I\'m sorry. I apologize. Do you have time for just one
> quick comment?
>
> DR. PITTS: By all means. Sure.
>
> MS. MORRISON: Thank you. My name is Alicia Morrison. I work for
> Senator Harkin. I just wanted to take a quick second to address a
> couple of things. He unfortunately can\'t be here today with
> everything\--
>
> DR. PITTS: Actually, that\'s---
>
> MS. MORRISON: Going on on the Hill.
>
> DR. PITTS: If\--
>
> MS. MORRISON: Pardon me?
>
> DR. PITTS: With expedition. If you have questions specifically, let\'s
> get to them. I know the panelists have to leave, too. So if you
> have\--make your comments, mostly if you have questions, please bring
> those forward.
>
> MS. MORRISON: Sure. Sure. I just want to say that I think what you\'re
> all saying is completely correct that we all need to work together and
> that the restaurant industry alone cannot address the obesity problem.
> But I think that the legislation that\'s introduced in the House of
> Representatives and the one that Senator Harkin is working on in terms
> of this restaurant labeling will not address\--will not impact small
> businesses, so folks like Ms. Ricchi and others\--this is only for
> chain restaurants with 20 or more restaurants.
>
> But I do have a question. I know we talked quite a bit about\--in the
> beginning\--about packaging and for the actual food manufacturers, and
> I\'m just wondering what the restaurant industry is doing to look at
> portion sizes, because we know when that\'s in front of people, it\'s
> a little bit\--it\'s not as easy, especially for kids to just say, no,
> I don\'t want to eat anymore. I\'m just wondering what kind of
> creative things you\'re looking at to address that?
>
> DR. PITTS: So the question to the panel is just observations or
> thoughts on portion size.
>
> MR. GROVER: Well, I\'ll give you the industry perspective\--
>
> DR. PITTS: Mr. Grover.
>
> MR. GROVER: I think we offer\--
>
> DR. PITTS: Well, I\'m sorry. Panel, do you have any comments on that?
>
> MR. GROVER: As an industry, we offer a wide variety of portion sizes,
> everything from a very small to a half portion, to a large. That\'s
> the idea of the restaurant industry. It\'s an industry of choice. The
> consumer decides. And so, to say that either the small or the large is
> the only thing that the restaurant industry can offer would be
> severely limiting and completely unworkable.
>
> MR. DOWDY: I\'d like to just echo that. As I mentioned in my comments,
> we do offer a variety of sizes, including small orders of fries and
> small drinks and so forth.
>
> DR. PITTS: Mr. Dowdy. Are there any more questions from the audience?
> I know that we\'ve all been talking about food. Yes, ma\'am.
>
> DR. CASWELL: Customized has been the word that I\'ve heard from all
> the panelists, and I understand that in a, you know, fine restaurant
> setting. I\'m wondering if you could comment on the Subway approach to
> labeling in the customizing; that is, you nutrition label the base
> product and then whatever is added on is added on. But this seems to
> me be an approach to this issue of customization that all of the
> panelists have focused on.
>
> DR. PITTS: Ms. Caswell. Panel.
>
> MR. DOWDY: A very good question, but\--and I\'ll give you my personal
> belief, is from what we know in talking to consumers, I would very
> concerned that we\'re misleading consumers; that they might make
> choices based on what they think they\'re getting and they\'re not
> actually getting. So I think we have to be very careful with that
> approach.
>
> DR. PITTS: Mr. Dowdy. Ladies and gentlemen. Thank you, panel. It\'s
> been a very educational experience and a delicious one. Ladies and
> gentlemen, thank you for your participation and thank you for
> attending the conference.
>
> MR. GROVER: Thank you.
>
> \[Applause.\]
>
> \[Whereupon, the conference was adjourned.\]

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