One-Ingredient Recipe?

Robert emailed me this article "Solving the Problem of Childhood Obesity" from Reason magazine. Last night, I asked him: So, what was the point of that? He wasn't sure, and neither was I.

"We’re fat. Really fat. And it’s not just us—it’s our kids, too. Have you seen them? They’re enormous."

Well, this is true. About 60% of American adults are overweight, though only about 40% believe that they are. 19% of American children ages 6-11 are obese and other 14% are at risk for obesity. But a major problem is that so many parents are blind to their children's weight problems. Studies in the United States and Britain have found that between 50% and 80% of overweight or obese children have parents who believe them to be of a healthy weight or underweight.

One thing that frequently strikes me, when looking at photographs of me, my sister, and our classmates/friends when were young, is how very skinny kids (used to) look. I wonder if too many parents are looking at their children, seeing that they look a lot like adults miniaturized (a kind of "Mini Me" appearance), and think that their weight must be just about right. But a healthy weight kid should look really thin by adult standards. Other parents are probably just oblivious to their children's size. And since people are likely to be influenced in their perceptions of their children's weight by the size of kids around them, the commonality of overweight probably normalizes it to a certain extent.

"And because it’s their fault, these restaurateurs, we must give them their due regulatory dickens. Help is here, America. Trans fat bans. Menu-labeling here, there, and everywhere. More help is on the way, too. Caffeine and sugar and salt be gone. It’s for the children."

Although I am sympathetic to the position that restaurants are being unfairly demonized as the culprit behind the "super-sizing" of the American child, and am not quick myself to look immediately to government regulation as the solution to every problem, I do have to wonder: How is it that paternalism must be considered an inappropriate position to take for children? It's one thing to say that a grown adult is fully responsible for their own actions and must suffer the consequences of whatever bad decisions they make, but we (rightly) empower the government to act on behalf of children all the time. Yes, the overuse of the phrase "for the children" by cynical politicians to justify meddling in markets is annoying, but this doesn't de-legitimize the basic concept for all situations.

"In some alternate universe, one that actually assigns blame to deserving people, it might be your fault, not theirs. Maybe it is your fault your kids are fat, since you feed them. Maybe the food that parents supply to their kids—and demand restaurants feed their kids—is making the kids fat. Which means parents need to do a better job of making sure their own kids eat healthy, and get some exercise. Wouldn’t that be a refreshing message?"

So is the writer suggesting that he would get behind the government programs and legislation to promote such an effort? Great, the social marketing people will appreciate his support (financial and otherwise) because despite the bizarre, starkly dichotomous way he is painting things, people who support government intervention in regulating fast food restaurants do not believe that such efforts are a full, simple solution to the problem and that parents doing a "better job" is not necessary. One of the articles this person cites quotes the author of a federal menu labeling bill as saying, "This bill is not going to magically solve our obesity problems." The issue (as I see it) is that even parents who are attentive and focused on helping their kids eat healthy do not have the information needed to make good decisions in restaurant environments. (Neither do we adults who may be concerned about our own health, by the way.)

And what does he propose to do about the kids whose parents do not "get the message" that they need to do a better job? Nothing? What about situations like school lunchrooms, where parents have very little control over what their children do and administrators are clearly working in their own interests (generating money from soda machine and snack vending machine sales) and not those of the kids?

"To learn whether home cooking might be a chief culprit behind America’s portliness, Wansink and Payne pored over seven decades of The Joy of Cooking, one of America’s most popular and durable cookbooks. After identifying recipes for 18 foods that had appeared in each edition of the book, the authors examined the calorie counts and serving sizes for those food [sic] over the years [1936 to 2006].

'If you look at all the common recipes, their calories and serving sizes, there’s about a 43% increase,' Wansink told Reason. 'About two-thirds can be attributed to ingredients—more butter, more sugar, more use of sauces, nuts, and raisins—but the other third can be attributed to increases in portion size.'"

I'm a big fan of Brian Wansink's work, and this is a pretty interesting little study. I had wondered when the increase had occurred -- was it linear since 1936 or whatever -- and the journal article indicates that a lot of it happened between 1997 and 2006. The average calories per serving was mostly stable from 1936 to 1997 (268 to 289) but jumped in 2006 to 384, a 33% increase from 1997.

This conforms with observations Robert and I have made when looking at the suggested recipes on the back of canned and boxed food packages also. Just last night, we were making my mom's classic mac and cheese recipe and Robert compared the ingredients and quantities to that of the on-box recipe; the box recipe called for fewer noodles but more milk and cheese (yielding a higher calorie allotment per serving, I suspect, and certainly a higher percentage calories from fat -- not that they reported the nutrition information for this recipe, of course!).

In general, the servings suggested by these on-box recipes seem larger and frequently less healthy from a macronutrient standpoint than recipes I have from other sources. I cook from a combination of "healthy" recipes gathered online, from magazines like Cooking Light, and cookbooks, old family recipes, and recipes from older editions of classic cookbooks like Betty Crocker or Better Homes and Gardens. I haven't looked at a new, non-"healthy" cookbook in a very long time, and it's depressing to see that new cooks turning to The Joy of Cooking are being offered recipes with higher calorie servings.

But it does make me wonder -- they looked at 18 recipes that have been in the cookbook since 1936. What do the newer recipes look like? It is possible that the calories of some of these "classic" dishes has increased but that there are also new recipes that present a more favorable calorie-per-serving number and better overall nutritional profile. I don't know what these 18 dishes were, but if they were foods that people would consider special luxuries in the modern era (e.g. home-made chocolate brownies), the calories very well could have gone up for this select subset of recipes that represents a kind of outrageous indulgence. Also, I suspect that The Joy of Cooking does not occupy the same place in American homes that it did in 1936 (and for all I know, 1997) that it does now. How many people today do any significant amount of their cooking from the current edition? What is the relative contribution in the average American's (esp. American child's) diet from fast food versus these 18 recipes or any Joy of Cooking recipes?

Ah, this LA Times article talks more about the specific recipes that were used in the analysis: "In addition to beef stroganoff and waffles, recipes chosen for analysis included macaroni and cheese, goulash, Spanish rice, brownies, sugar cookies and apple pie."

Of course, that the calorie content of these Joy of Cooking recipes has gone up since 1997 does not mitigate the fact that fast food and table-service restaurant meals continue to be overwhelmingly huge and unhealthy compared to what they used to be and to what current home-cooked meals are. Even at a "higher" average calories-per-serving of 384, these recipes are much lower in calories than many (most?) restaurant dishes. With the possible exception of Spanish rice and sugar cookies, I doubt that any of those dishes could be eaten in a restaurant for anything close to 384 calories. Remember my 1200 calorie piece of chocolate cake? The evil 220 calorie mini-muffins at Jason's deli?

I would love to know whether restaurant meals have increased in calories by more or less than 33% since 1997 as a point of comparison.

"But what about those menu-labeling and trans fat bans? Aren’t those efforts making kids healthier? Again, Wansink says the data doesn’t support that conclusion. 'They’ve either been ineffective or disturbingly counterproductive,' he says. 'All the data we’ve seen about menu labeling doesn’t show a consistent answer at all.'"

From my reading, I agree with Wansink that the data on menu labeling is inconsistent. However, I think much of the variation comes from how and what things are labeled; it appears to me that the effectiveness of such efforts is in the details. (Sorry, I am not going to elaborate because I do not want to scoop my own journal article on this topic.) Of course, it's quite possible that menu labeling will not have a large influence on people (children's) weight overall. But I would say that it is too early in the research stream to say one way or another whether it is effective or to what extent; there has been surprisingly little academic research done on the topic. I (and others) suspect that a lot of proprietary market research has been done by restaurants, however. I would guess that the continued resistance from industry to providing the data has more to do with (justifiable based on their research?) fear that people will rebel at the mind-bogglingly high calorie content of the foods they serve than to the costs of making the nutrition information available at point of sale.

Also, there is some evidence from previous research that menu labeling can have an effect on a segment of the population, and there may be a reasonable cost-benefit to requiring this labeling even if the majority of people are not affected by it.

One of my own issues with the push toward mandatory menu labeling (apart from the fact that insufficient research has been done to demonstrate its effectiveness or to provide guidance on the best way to display the information so that people will attend to it, understand it, and act accordingly) is that I believe it is quite unfair to demand that fast food and full-service restaurant chains provide nutrition data while other restaurants do not. Is the food at Olive Garden higher in fat and calories than the stand-alone Italian restaurant down the street? I seriously doubt it. (And of course, I can't compare them because even though chain restaurants frequently disclose the nutrition information on their website where it has the least possible impact on people's purchase decisions, individual restaurants basically never provide the data at all.) If the mandatory disclosure is required of Olive Garden, it should be required of its competitors as well on the simple basis of fairness. I do recognize the fact that Olive Garden as a company can pay once to have its menu items analyzed and then provide the information to all its franchises does lead to a lower cost of regulation compared to a stand-alone restaurant. (This is true of a lot of things.)

But back to this article -- I suppose the "one-ingredient solution" to the childhood obesity problem provided by this writer is parental responsibility for what their kids eat. Um, okay. I don't think the recognition of the influence of parents on children's eating habits comes as a surprise to anyone. But seeing it as a "one-ingredient solution" is taking this way too far. I would be willing to say that parental responsibility is a necessary condition, but not a sufficient one, for ensuring that children eat a healthy diet. (Perhaps the most obvious example being that good intentions amount to about squat when families do not have safe, affordable access to healthy food.) I mean, adults view themselves as basically responsible for their own eating habits and it's not like this responsibility has magically resulted in successfully eating healthy diets. Even adults who are consciously attempting to manage their weight and eat for health frequently fail.

This being said, I do basically agree that parents need to wake up, recognize that their kids are fat and in increasingly poor health, and do something about it. But this doesn't mean that people will not also being looking to external changes to make this easier to do. It's like if I said that parents should take more responsibility for their children's education -- this doesn't suggest that the government should stop funding schools, stop requiring school attendance for kids under a certain age, and so forth.

Fundamentally, libertarian arguments about "freedom" from government oversight are not particularly strong when children's interests are at stake, and I think many libertarians even realize it themselves. When the moral argument fails, there is a major motive for them to switch to arguments about efficiency or effectiveness. And in many ways, this is actually a good thing. It's important to have people who take the position, So you think this is a good idea, well, justify it! (And I don't think I only believe this because it could result in funding for people like me to do research.) But too often, the proposed action is treated as obviously ineffective, either by definition (government action = can't work) or by cherry-picking the evidence that exists. (In other words, libertarians are biased like every single other person on the planet.) But at least in the case of childhood obesity, they are willing to admit that it actually is a problem. Where adulthood obesity is concerned, a lot of them are of the opinion that being overweight is a revealed preference.

And god, reading the comments of Reason-ites (and those on libertarian blogs) justifying that their own fatness is not unhealthy is priceless reading. It's an issue where the chubby libertarians and the left-wing fat acceptance people can join together to agree that that one (deeply flawed) study that found that, among elderly people, being slightly overweight was better for life longevity than being "normal" weight validates every unhealthy habit and extra dozen pounds they have.

On this note, I am going to have a bowl of macaroni and cheese for lunch. Because of the Nutrition Labeling and Education Act of 1990, I was able to calculate its nutritional profile and deign it a reasonable thing to eat.