Obesity in the US: A Burgeoning Crisis

It makes for frightening reading, really.

In the past few years, obesity has been rising rapidly in the United States with the result that today it has reached epidemic proportions.

To make matters worse, a new damning report says that if the current trend continues then by 2030 more than half the population of the United States will be obese!

The report, aptly titled F as in Fat: How Obesity Threatens America’s Future 2012, says that the number of obese adults will increase dramatically in every state in the country over the next two decades – and along with it related disease rates and health care costs.

The report follows analyses of state-by-state data from the Centers for Disease Control and Prevention commissioned by Trust for America’s Health and the Robert Wood Johnson Foundation and conducted by the National Heart Forum.

Obesity is defined as having a Body Mass Index above 30, while overweight means a Body Mass Index of between 25 and 29.9.

Calculate your body mass index.

Obesity increases the risk of heart diseases, diabetes, hypertension and other chronic illnesses.

Key findings of the study:

• If the obesity rise continues on its current path, 13 states could have adult obesity rates above 60 per cent, 39 states about 50 per cent, and all 50 states could have rates above 44 per cent by 2030.
• By 2030, Mississippi could become the fattest state in the United States with an obesity rate of 66 per cent with Colorado at the bottom of the ladder with 44.8 per cent – in 2011, the rates were 34.9 per cent and 20.7 per cent, respectively.
• There could be a 10-fold increase in new cases of Type 2 diabetes, coronary heart disease and stroke, hypertension and arthritis between 2010 and 2020 – and double that by 2030.
• Obesity could contribute to more than 6 million case of Type 2 diabetes, 5 million cases of coronary heart disease and stroke, and more than 400,000 cases of cancer in the next two decades. Currently, more than 25 million Americans have Type 2 diabetes, 27 million have chronic heart disease, 69 million have hypertension and 50 million have arthritis. Besides, 795,000 Americans suffer a stroke each year and nearly a third of the cancer deaths are related to obesity, poor nutrition and lack of physical activity.
• Medical costs associated with treating preventable obesity-related diseases are estimated to increase by $48 billion to $66 billion per year.
• Loss in economic productivity could be between $390 billion and $580 billion annually.
• Nine states could see their obesity-related health care costs shoot up by more than 20 per cent with New Jersey seeing the highest increase of 34.5 per cent.

A grim picture, no doubt. However, all is not lost.

The report suggests that the doomsday scenario can be avoided if only the states could reduce the average Body Mass Index of their residents by just 5 per cent by 2030.

“The study shows us two futures for America’s health,” says Risa Lavizzo-Mourey, president and CEO of Robert Wood Johnson Foundation.

“At every level, we must pursue policies that prevent health, prevent disease and reduce health care costs.

“Nothing less is acceptable.”

Trust for America’s health executive director Jeff Levi says increasing physical activity times in schools and making fresh fruits and vegetables more affordable can help make healthier choices easier.

“Small changes can add up to a big difference,” he says.

“Policy changes can help make healthier choices easier for Americans in their daily lives.”

Not a tall order, surely. But there needs to be a national commitment and will.

What more do you think Americans should do to tackle the obesity crisis? Please, leave your comments below.

New York calls time on super-sized cola

Okay, it’s official now. New York City has added one more weapon in its armory against its war on obesity.

In a groundbreaking move, the city’s Board of Health unanimously passed, by an 8-0 vote, the first U.S. ban on super-sized sodas and other sugary soft drinks.

The ban applies to any establishment, in the city’s five boroughs, with a food-service license, including fast-food restaurants, workplace cafeterias, delis, movie and Broadway theaters, the concession stands at Yankee Stadium and the pizzerias of Little Italy.

Exceptions include supermarkets, groceries and convenience stores because such establishments do not come under the jurisdiction of the board.

Any of the above mentioned establishments caught selling colas larger than 16 ounces (0.47 liters) face a fine of $200.

Exceptions include diet sodas, alcohol (which is regulated by the state), beverages made mostly of milk or unsweetened fruit juice.

The measure will take effect on March 12, 2013, provided no court action is taken against the move.

After the vote, New York City Mayor Michael Bloomberg, who pioneered the move, tweeted: “NYC’s new sugary drink policy is the single biggest step any gov’t has taken to curb #obesity. It will help save lives.”

Health Commissioner Thomas Farley said the move is likely to be copied by other cities in the U.S. – or even the world.

“If this new step leads to New Yorkers simply reducing the size of one sugary drink from 20 ounces to 16 ounces every other week, it would help them avoid gaining some 2.3 million pounds a year,” he wrote in the New York Daily News on the eve of the vote.

“This would slow the obesity epidemic and prevent much needless illness.”

Obesity increases the risk of heart diseases, diabetes, hypertension and other chronic illnesses.

It is a growing crisis in New York City and sugary drinks are a leading cause of the obesity epidemic, says a city statement.

Nearly 60 per cent of the city’s adults are overweight or obese, as are 40 per cent of the city’s public elementary school students. One in eight adult New Yorkers now has Type 2 diabetes.

Annually, 5,800 New Yorkers are losing their lives to obesity.

Nearly 10 per cent of the nation’s health care bill is tied to obesity-related illnesses such as Type 2 diabetes, heart disease and hypertension, according to the Organisation for Economic Co-operation and Development.

Health experts believe that colas are high in calories, cheap, served in large sizes and have no nutritional value.

Not all New Yorkers are happy at the ban, though. They hate being told what to do!

A New York Times poll last month showed that six in 10 New Yorkers opposed the restrictions. Some have likened the ban to Prohibition, others have called the clamp an affront to personal liberty and some others have accused Bloomberg of over-reacting and turning New York into a ‘nanny’ state!

Is Bloomberg a modern-day Don Quixote?

Fuelling the opposition are the restaurant, the soft-drinks industry and major theater chains.

A group called New Yorkers for Beverage Choices claims to have gathered more than 250,000 signatures on petitions and is examining legislative and legal challenges to the ban.

“This is not the end,” said Eliot Hoff, a spokesman for the group, after the vote. “We are exploring legal options, and all other avenues available to us.”

When Bloomberg’s proposal was up for public comments, the Board of Health received 38,000 comments of which 32,000 were in favour. However, it also received a petition opposing the ban with 90,000 names on it.

Theatre chains like the AMC and Regal mounted a massive public relations campaign, displaying banners and posters and airing commercials arguing that New Yorkers should be allowed to make their own drink choices.

However, the last word must certainly go to Dr. Deepthiman Gowda, an internist who teaches at Columbia University and a member of the New York City Board of Health, who said:

“(The initiative) is a small step but a bold step and an important one.”

What more do you think New York should do to cut down the obesity rates? Please leave your comments below.

New item on McDonald's menu: Calorie count!

McDonald's, the world's largest and most popular fast-food chain, has announced that, starting as early as next week, it will start listing calorie information on its menus in nearly 14,000 restaurants and drive-thrus across the United States.

This welcome move comes on the eve of a crucial vote on New York Mayor Michael Bloomberg's controversial proposal to ban super-sized colas at local restaurants and, more pertinently, ahead of the introduction of a national health law that will mandate restaurants, with 20 or more locations, to mention calories and other nutrition details on their menus.

The state of California and cities like New York already require restaurants to clearly list calorie information on the menus but many major chains have ignored the call, in the absence of legislation and threat of fines.

Requiring to post calorie counts of Big Macs and french fries is one of many measures US officials are contemplating as they seek to combat the burgeoning obesity crisis.

The problems of overweight people and obesity have worsened sharply in the US since the 1980s with the result that America is today called one of the fattest nations on earth – two-thirds of American adults are overweight or obese as are a third of the children.

Obesity increases the risk of heart diseases, diabetes, hypertension and other chronic illnesses.

McDonald's has been vilified for refusing to assess the impact of its foods on childhood obesity.

McDonald’s has responded to any criticism by claiming that it has incorporated changes to its menu, introducing more fruits and vegetables, reducing the French fry portion by more than half and including apples in Happy Meals for children.

The US Food and Drug Administration (FDA) has issued two proposed regulations that would ensure calorie labeling on menus and menu boards in chain restaurants, retail food establishments, and vending machines with 20 or more locations.

But the million-dollar question is: Does calorie labeling help diners make informed choices?

No, according to a New York University study which found that menu labeling, which came into force in March 2011, has had no impact on consumers' food choices. Even 18 months after the rule took effect, there's no discernible change in the food habits.

Taste almost always triumphed over calories!

Do you think McDonald's has done the right thing, or is there something more it can do? Please leave your comments below.

Being fat and fit

Obesity is no bar to being healthy, a new study reveals.

It seeks to dispel the notion that being fat or overweight means you are not physically fit.

Researchers, who studied data from 43,625 people in the United States, conclude that some obese people are ‘metabolically healthy’.

These people showed no greater risk of developing or dying from cardiovascular disease or cancer than people who were of normal weight.

However, it is important to remember that being ‘metabolically healthy’ means that you have no high blood pressure, high cholesterol or raised blood sugar, and that you are getting enough exercise.

The findings, following the study at the University of South Carolina, are published in the European Heart Journal.

“Current knowledge on the prognosis of metabolically healthy but obese phenotype is limited due to the exclusive use of the body mass index to define obesity and the lack of information on cardio-respiratory fitness,” says the study.

According to the World Health Organisation, someone who has a body mass index equal to or greater than 25 is overweight and equal to or greater than 30 is obese.

Calculate your body mass index.

Researchers sought to test the following hypotheses:

• metabolically healthy but obese individuals have a higher fitness level than their metabolically abnormal and obese peers;
• after accounting for fitness, metabolically healthy but obese phenotype is a benign condition, in terms of cardiovascular disease and mortality.

Fitness was assessed by a maximal exercise test on a treadmill and body fat percentage by hydrostatic weighing or skinfolds.

Metabolically healthy was considered if meeting 0 or 1 of the criteria for metabolic syndrome.

More than a third of the participants in the study were obese. Of these 18,500, half were assessed as metabolically healthy.

These people, who did not suffer from health problems such as diabetes, high cholesterol or high blood pressure, were generally more fit and exercised more than other obese people.

The risk of these people developing or dying from cardiovascular disease or cancer was the same as those of people of normal weight and half of metabolically less fit obese people.

Lead author of the study Dr. Francisco Ortega, currently a research associate affiliated to the Department of Physical Activity and Sport, University of Granada in Spain, said the findings show that getting more exercise can keep you healthier, even if you are overweight.
"The research highlights once again the important role of physical fitness as a health marker."

Is organic food healthier than conventional food?

Not really! That is, if you compare the nutritional benefits. Considering that sometimes you may have to pay as much as twice what conventional food costs.

The only benefit that organic food has over conventionally grown produce is that it may reduce your exposure to pesticide residues and antibiotic-resistant bacteria. And even that is marginal – since pesticide levels found in conventionally grown produce were found to be within safety limits.

Bursting the myth that organic food is healthier than the conventional alternative is a paper published in the September 4 issue of Annals of Internal Medicine.

"There isn't much difference between organic and conventional foods, if you're an adult making a decision based solely on your health," said Dr Dena Bravata, a senior research affiliate with Stanford University's Centre for Health Policy and senior author of the paper.

"People choose to buy organic foods for many different reasons. One of them is perceived health benefits," added Crystal Smith-Spangler, who led the team of researchers from the university and Veteran Affairs Palo Alto Health Care.

More than 200 studies were reviewed, comparing either the health of people who consumed organic or conventional foods or nutrient and contaminant levels in unprocessed foods such as fruits, vegetables, grains, milk, eggs, chicken, pork and meat.

Key findings:

• No significant differences between populations by food type for allergic reactions;
• Two studies reported significantly lower urinary pesticide levels among children consuming organic versus conventional foods;
• Biomarker and nutrient levels in serum, urine, breast milk and semen in adults did not show clinically meaningful differences;
• Phosphorus levels were significantly higher than in conventional foods, although this difference is not clinically significant;
• Organic produce had a 30 per cent lower risk of containing detectable pesticide levels;
• E-coli contamination risk did not differ between organic and conventional foods;
• Bacterial contamination of retail chicken and pork was common but not related to farming methods. But when bacteria did lurk in chicken and pork, germs in non-organic meats had a 33 per cent higher risk of being resistant to multiple antibiotics.

"The published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods," the research team concluded. "Consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria."

Organic products have soared in popularity in the United States, with sales skyrocketing from $3.6 billion in 1997 to $31.4 billion in 2011. Today, organic foods account for 4.2 per cent of retail food sales, according to the United States Department of Agriculture (USDA).

This is because of a general perception that organic foods are safer and healthier. And this may be true, to a point.

USDA standards stipulated that organic farms avoid the use of synthetic pesticides and fertilizers, hormones and antibiotics. The regulations also require organic livestock to have access to pastures during grazing season.

The US Organic Trade Association was quick to capitalize on some of the findings with its executive director and CEO, saying on its  website: "Consumers seeking to minimize their exposure to pesticide residues will find that foods bearing the USDA Organic label are the gold standard."

"And, because organic livestock practices forbid the use of antibiotics, including the routine use of low level antibiotics for growth, organic meat contains less antibiotic-resistance bacteria."

However, sounding a word of caution, some nutrition experts have called for more research to fully explore the potential health and safety differences between organic and conventional foods, saying it was premature to say organic foods are not any healthier than non-organic foods.

"Right now I think it's all based on anecdotal evidence," said Chensheng Lu, who studies environmental health and exposure at the Harvard School of Public Health.

"If I was a smart consumer, I would choose food that has no pesticides. I think that's the best way to protect your health."

Being fat doesn’t make kids dumb

Obesity has been blamed for a lot of things – some justified, others not so.

Of course, from a health point of view there is no denying that obesity is a risk factor for a host of undesirable conditions: high blood pressure, heart disease, stroke, gall bladder disease, breast cancer, prostate cancer, colon cancer and type 2 diabetes.

But what is not socially acceptable is that most often obese people are made the butt of jokes, and children are especially more susceptible to jibes, bullying at school and ostracism.

To make matters worse for kids, previous studies have shown that children who are heavier are less likely to do well at school – probably due to the combined effects of bullying and health problems.

But … hang on! A new study now suggests that obesity is not to be blamed for poor grades at school.

“We sought to test whether obesity directly hinders performance due to bullying or health problems, or whether kids who are obese do less well because of other factors that are associated with both obesity and lower exam results, such as coming from a disadvantaged family,” says Dr Stephanie von Hinke Kessler Scholder from the University of York.

The research funded by the Economic and Social Research Council combined statistical methods with genetic information and concluded that being overweight had nothing to do with not doing well at school.

Researchers studied data on almost 4,000 members of the 90’s Birth Cohort Study. The data included the children’s DNA. According to a report, the researchers combined the latest developments from genetic epidemiology with statistical methodologies in economic and econometric research.

Using two carefully chosen ‘genetic markers’, the team was able to identify children with a slightly higher genetic pre-disposition to obesity.

“Based on a simple correlation between children’s obesity as measured by their fat mass and their exam results, we found that heavier children did so slightly rose in school,” says Dr Scholder.

“But, when we used children’s genetic markers to account for potentially other factors, we found no evidence that obesity casually affects exam results.

“So, we conclude that obesity is not a major factor affecting children’s education outcomes.”

These findings suggest that the previously found negative relationship between weight and education performance is driven by factors that affect both weight and educational attainment.

The finding that obesity is not a cause of poor grades is, the researchers suggest, a positive thing.

“Clearly there are reasons why there are differences in educational outcomes but our research shows that obesity is not one of them,” says Dr Scholder.

When obesity is good for you!

Now here's a modern-day, medical conundrum: Obesity may actually be good for you – if you are a heart patient!

It may sound like something straight out of Ripley's Believe it or Not! but researchers in the United States have found that though being overweight and obese are known risk factors for developing heart disease and heart failure, once the disease has manifest itself, being overweight may provide some protective benefits!!

It's the classic "obesity paradox": A slim waist and normal weight usually associated with better health may not be good for heart failure patients, according to a new study by the University of California and Los Angeles.

"Heart failure may prove to be one of the few health conditions where extra weight may prove to be protective," says senior author Dr. Tamara Horwich, an assistant professor of cardiology at the David Geffen School of Medicine at UCLA.

Medifocus Guidebook on
 Congestive Heart Failure

Researchers found that in both men and women with advanced heart failure, obesity and a higher waist circumference put them at significantly less risk for adverse health outcomes.

The findings are published in the July issue of the American Journal of Cardiology.

Heart failure affects 5.8 million people, including 2.5 million women. Nearly one-half to two-thirds of heart failure patients are either overweight or obese.

Women and men are known to have differences in body composition and body-fat distribution, and this study is one of the first to specifically assess the impact of body mass index and waist circumference on women and compare it with men.

"The study provides us with more insight about how both genders of heart failure patients may be impacted by the obesity paradox," adds Dr Horwich.

For the study, researchers analyzed data on advanced heart failure patients treated at UCLA Medical Center from 1983 to 2011.

The two-year study involved 2,718 patients who had their BMI measured at the beginning of heart failure treatment and 469 patients who had their waist circumference measured at the beginning of the treatment.

At the follow-up, researchers found that in men, a high waist circumference and high BMI were associated with event-free survival from adverse outcomes like death, the need for a heart transplant, or the need for ventricular assist device placement.

Women with a higher BMI also had better outcomes than their normal-weight counterparts, and women with a high waist circumference also tended toward improved outcomes.

Incidentally, in January a report said that the global market for congestive heart failure devices was worth $3.1 billion in 2010. The following year it reached $3.4 billion and is expected to reach $5.9 billion by 2016.

In the United States alone, in 2010 the market was worth $1.6 billion – nearly 52.5 per cent – and is expected to reach $3.2 billion in 2016. For Europe the figures were $936 million in 2010 and forecast to increase to $1 billion by 2016, as the following graph shows:

Source: BCC Research. Email: editor@bccresearch,com
Global Markets for Devices for Treating Congestive Heart Failure (HLC095A)

Cancer group seeks obesity study

New York City Mayor Michael Bloomberg has really set the cat among the pigeons – by proposing, in May, to limit the sale of soft drinks to 16 fluid ounces in restaurants, movie theaters and other public venues!

The latest to jump on the anti-obesity bandwagon is the American Cancer Society Cancer Action Network, which has urged the Surgeon General of the United States for a sweeping study of the impact of sugar-sweetened beverages on consumer health.

It has emphasized the scientific evidence linking a third of all cancer deaths to poor diet and lack of exercise – two behaviors also associated strongly with obesity.

Such a study “could have a major impact on the public’s consciousness and perhaps begin to change the direction of public behavior in their choices of food and drinks”, says the lobby group’s president Christopher W. Hansen in a letter to the U.S. Department of Health and Human Services Secretary Kathleen Sebelius.

“We know there is a direct link between excessive consumption of sugar-sweetened beverages and obesity, and the adverse health effect can be profound.”

Obesity has become a talking point in America after it was found that two-thirds of the people are overweight or obese and health costs are spiraling.

Obesity accounts for $190 billion in annual medical costs in the United States – or almost 21 per cent of the total, according to a study.

Sugary drinks have become the latest target in the fight against burgeoning obesity after the American Medical Association declared that 46 per cent of the nation’s intake of added sugars comes from these beverages.

Also supporting Bloomberg’s point of view was the National Academy of Sciences’ Institute of Medicine, which has called for more policies to reduce the over-consumption of sugary drinks.

The beverage industry is, as expected, not happy.

In response to the letter, Karen Hanretty, a spokeswoman for the American Beverage Association, said: “We already have studies from the federal government and independent third parties that demonstrate soft drinks are not a unique or significant contributor to obesity.”

However, Dick Woodruff, vice-president of federal affairs of the Cancer Action Network, says the group is seeking an unbiased review of all available science.

"There is an obesity epidemic. One in three cancer deaths are due to nutrition and physical activities, including overweight and obesity," he tells Reuters.

But, as Hansen points out: “There seems to be a consensus about the problem and the cause, but what is lacking is an articulate, science-based and comprehensive national plan of action.”

He is hoping for a repeat of the landmark 1964 report by the Surgeon General first revealing to the American public the dangers of tobacco consumption and which led to a drastic reduction in smoking.

Scientists discover control mechanism for obesity

This from Channelnewsasia.com:

Scientists from the Institute of Molecular and Cell Biology and the Singapore Bio-imaging Consortium today announced the path-breaking discovery of the mechanism that controls obesity, atherosclerosis and, potentially, cancer.

The findings were published in the journal, Cell Metabolism, and may help doctors in the treatment of obesity and atherosclerosis.

Atherosclerosis is a progressive disease of the large arteries that can lead to many cardiovascular diseases and along with obesity is blamed for more than a third of deaths in the Western world.

Obesity and atherosclerosis are accompanied by the accumulation of lipid droplets in fat cells and foam cells, respectively.

Foam cells can rupture, damage blood vessels and worsen atherosclerosis.

The team of scientists found that mice deficient in a particular gene, even when fed a high-fat diet, were resistant to obesity and atherosclerosis by preventing the accumulation of lipid droplets.

Dr. Dmitry Bulavin, senior principal investigator at the Institute of Molecular and Cell Biology and lead author of the paper, says: “We are building on this research to investigate if the same mechanism could also control tumor progression and hence potentially unlock new treatments in cancer.”

Cola companies fight back over NYC plan

The multi-billion-dollar beverage industry in the United States has fired the first salvo in its fight against New York City's plan to ban the sale of large colas, according to a report in The New York Times newspaper.

In May, New York City Mayor Michael Bloomberg had tabled a proposal to ban the sale of large colas and other sugary drinks at restaurants, movie theaters and street carts, in a  major push to combat rising obesity.

If approved, the first-of-its-kind ban on any cup or bottle of sweetened drink larger than 16 fluid ounces could come into effect as soon as March next year.

The expected, aggressive action by the big soda companies has come in the form of a coalition called New Yorkers for Beverage Choices which will co-ordinate public relations efforts in the campaign to fight Bloomberg's proposed plan.

The campaign, being led by the Washington-based American Beverage Association, includes lobbyists meeting mayoral candidates and New York City Council members, New Yorkers being urged to sign petitions and Facebook and Twitter pages telling readers to "say no to a #sodaban".

The association also distributed a 'fact sheet' to New York City Council members, detailing data showing calories from sugar-sweetened beverages declining even as obesity figures keep going up.

"Food is the No. 1 source of added sugars, not sugar-sweetened beverages," says the document, insisting that calories from soda and other sugary drinks form a small fraction of the American diet.

However, NYC officials are also doing their bit to raise awareness, spending almost $3 million since 2009 over advertisements showing a link between sodas and obesity.

The day of reckoning in this battle between federal officials and big industry is July 24 when the New York Board of Health, which must approve the proposed restrictions, plans a public hearing on the proposal.

Eating out and obesity

Restaurants across the world need to be more transparent in helping diners make informed meal decisions while eating out, a global survey has found.

It’s not that consumers are not aware of healthier options but they need that extra push to opt for foods that are nutritionally beneficial, or at least not harmful. Poor levels of information were cited as a significant barrier to leading a healthier lifestyle.

This can be achieved by the food services industry providing more information about the foods they offer.

The biannual 2011 Unilever Food Solutions World Menu Report, aimed at measuring people’s attitudes and behaviors towards eating out, polled consumers in seven countries – the United States, United Kingdom, China Germany, Russia, Brazil and Turkey.

The study, titled “What’s in Your Food?”, found that as people become more health conscious there is a rise in concern regarding the nutritional values of the food they eat.

“Eating habits have changed dramatically and rapidly over the past few decades, largely as a result of more choices, larger portions and increased access to fast foods,” says the survey.

Though the report does not mention obesity, it is an issue of growing concern today with the easy availability of fast food and convenience foods.

Obesity has reached epidemic proportions globally with at least 2.8 million people dying each year as a result of being either overweight or obese, according to the World Health Organisation.

Being overweight or obese raises the risks of coronary heart disease, ischaemic stroke, type 2 diabetes mellitus and some common cancers.

Between 1980 and 2008, obesity has doubled worldwide. By 2008, 10 per cent of men and 14 per cent of women (half a billion people) in the world were obese, compared with 5 per cent of men and 8 per cent of women in 1980.

The World Menu Report found that people are demanding the right to enjoy food that is healthy but still delicious.

Those polled mostly wanted to know about fat, calorie content, additives and preservatives. Also, in the West people wanted to know more about salt content while in China people demanded more information about the vitamins and proteins in their food.

Key findings of the report:

• In all countries, there is a need for more information – 9 out of 10 people demand truth about food when eating out
• Nutritional information could help people make healthier choices
• Food labels including low fat and calorie content would be welcome

Gaby Vreeken, President Marketing, Unilever Food Solutions, says: “We believe that all of us in the food service industry have a responsibility to tackle the global obesity crisis.

“The insights from this major new study show that the challenges of encouraging healthier diets can be addressed with small changes to existing menus.

“In essence, it’s no more than a nudge to help guests choose a healthier option. Small steps can have an enormous impact on the health of diners across the world and help to tackle rising obesity levels.”