Remember the dieter's plate? For many years, it was the only menu item that really catered to the health conscious among us. It usually came with cottage cheese, several pieces of fruit, and a few crackers neatly arranged atop a lettuce leaf. If you looked carefully, you could usually spot it on the menu between other such fine restaurant fare as gelatin cubes and fruit cocktail in syrup.
These days, restaurants have a lot more to offer consumers concerned about calories and cholesterol, fat, and other nutrients that may help reduce their risk of certain diseases. Menus now may carry items ranging from low-fat, low-calorie tostados to full-course meals featuring seafood or chicken dishes that are low in sodium and fat and high in fiber and vitamins A and C. And restaurants boast about their nutritionally modified dishes with symbols, such as a big red heart signifying that the dish fits in with a diet that is consistent with general dietary recommendations or with claims such as "low fat," "light," or "heart healthy."
But the question is: Are these claims accurate and can they be trusted?
Regulations from the Food and Drug Administration effective May 2 are designed to ensure that the answer is "yes." The regulations, published in the Aug. 2, 1996, Federal Register, apply the Nutrition Labeling and Education Act (NLEA) of 1990 to restaurant menu items that carry a claim about the food's nutritional content or health benefits.
Under NLEA, FDA established regulations mandating specific nutrition information on the labels of most store-bought products and set up criteria under which nutrient and health claims can be used in food labeling. Claims like these that appear on signs or placards in most restaurants have been covered by the requirements of the food labeling regulations since 1994.
The new menu regulations affect all eating establishments--whether a small-town corner tavern or a big-city four-star restaurant, a grocery store deli or a deli that delivers. All will have to follow requirements for nutrition and health claims for menu items that bear a claim and give customers the appropriate nutrition information for these items when requested.
"The idea is for the claims to mean the same thing wherever they show up--on food labels in the store or on menus in a restaurant," said Michelle Smith, a food technologist in FDA's Office of Food Labeling.
Eating Out in the 1990s
According to Smith, nutrition and health claims on menus can help people better understand the role of diet in health and choose restaurant foods that contribute to a healthy diet.
This is important, considering that more and more Americans are eating their meals outside the home. According to the National Restaurant Association, Americans spent 44 percent of their food dollars outside the home in 1996, up from 25 percent in 1955.
According to the association's report, Tableservice Restaurant Trends--1995, more than half of consumers 35 and older and 2 out of 5 consumers 18 to 34 look for lower fat menu options when eating out. Also, restaurateurs report that their customers are increasingly requesting meatless dishes.
The frequency with which eating establishments have been catering to these preferences by making claims about menu items is not well known. In its final rule on claims for restaurant foods, FDA cited information from the National Restaurant Association's annual menu contest, in which the group found that 89 percent of all printed menu entries had at least one nutritional or health claim. But it is not known how representative this number is for menu practices across the country.
In 1996, after a federal district court ordered FDA to include menu claims under food labeling regulations, Bruce Silverglade, legal director for the Center for Science in the Public Interest, said in a press statement: "For years, many restaurant menus have made misleading health and nutrition claims from 'low fat' claims for high-fat desserts to claims that foods flavored with Chinese herbs will lower blood pressure and improve vision. A restaurant menu should not be a work of fiction." (CSPI and another public advocacy group, Public Citizen, filed suit in 1993 against the government for excluding menu claims from the labeling regulations.)
There are indications that interest in healthier restaurant fare is growing. Heart Smart Restaurants, an Arizona-based company that helps restaurants, food processors, and vending companies develop and promote products suitable for nutrition and health claims, has seen a steady rise in the number of its restaurant clients since the early 1990s. Judy Peters, director of customer relations for the company, reports that the company's restaurant clients now number in the hundreds and offer from one to many Heart Smart dishes. The clients are located across the country and include both single restaurants and national chains, ranging from juice bars to steakhouses and ethnic restaurants.
Heart Smart is among a number of companies, health professionals, and other consultants that offer such services to restaurants, usually for a fee. Their services are not endorsed by FDA because, as a federal agency, FDA cannot endorse any particular third-party certification programs.
On a smaller scale, the health, fitness and nutrition program of Suburban Hospital in Bethesda, Md., a suburb of Washington, D.C., found considerable interest from area restaurateurs in its Heart Healthy Restaurant Program. This program, which helps chefs create and promote heart-healthy foods on their menus, signed up 20 fine-dining restaurants within a county-wide area in the first six months of its operation, according to Linda Dolan, a registered dietitian and director of Suburban's Well Works program. Many of the participating restaurants offer Italian and French cuisine.
Look to the Menu
FDA's regulations permit restaurants to promote their healthier menu fare using the following:
Restaurants do not have to provide nutrition information about foods that do not bear nutrient content or health claims or that are referred to in general dietary guidance messages. However, restaurateurs need to be careful that the general guidance they provide on the menu doesn't turn into a claim, such as "Fruits and vegetables can help reduce the risk of cancer." This, then, would require the item to meet FDA's nutrition information and claims' requirements.
Claims that promote a nutrient or health benefit must meet certain criteria established by FDA and the U.S. Department of Agriculture; for example, the food must provide a requisite amount of the nutrient or nutrients referred to in the claim. In addition, a menu item carrying a health claim must provide significant amounts of one or more of six key nutrients, such as vitamin C, iron or fiber, and cannot contain a food substance at a level that increases the risk of a disease or health condition. For example, a restaurant meal that contains 26 grams of fat (40 percent of the Daily Value for fat) or 960 milligrams of sodium (40 percent of the Daily Value for sodium) is disqualified from making a heart-healthy claim.
These same rules apply to claims used in the labeling of commercial food products. But the requirements for further information differ between restaurant and commercially manufactured foods.
To meet FDA's criteria, food manufacturers may choose to do chemical analyses to determine the nutritional value of their products. But the criteria for menu items are more flexible, and, under FDA's requirements, restaurants may back up their claims with any "reasonable" base, such as databases, cookbooks, or other secondhand sources that provide nutrition information.
Also, restaurants do not have to provide the standard nutrition information profile and more exacting nutrient content values required in the Nutrition Facts panel of packaged foods. Instead, restaurants can present the information in any format desired, and they have to provide only information about the nutrient or nutrients that the claim is referring to. They can say simply that the amount of the nutrient in question does not exceed the limit imposed by FDA--for example, "This low-fat restaurant dish provides no more than 5 grams of fat per serving."
"It should be accurate," FDA's Smith said, "but not necessarily precise."
Although nutrition information is not required to appear on the menu, it must be made available to consumers when they request it. Restaurants can present it in a printed format--such as a notebook--or by having the staff recite it.
FDA is granting restaurants more flexibility because they don't produce foods according to the more exacting standards that food manufacturers follow, Smith said. She notes that restaurants change their menus frequently and produce smaller quantities than commercial food operations. And restaurant products often vary, depending on the type of ingredients available.
"A commercial operation has more stability than a restaurant," she said. "It would be an unreasonable burden to require restaurants to follow the same labeling regulations for packaged foods."
Much of the enforcement of the menu claims' regulations will likely be provided by state and local public health departments. The reason, Smith said, is that state and local health departments have direct jurisdiction over restaurants, including monitoring their food safety and sanitation practices, and regularly visit them to ensure compliance with various federal and state laws. Also, she said, FDA doesn't have the resources.
Whether restaurants will continue to make claims on menus now that they will be more closely monitored remains to be seen. "We're not sure what the result will be," said Bob Harrington, vice president of technical services for the National Restaurant Association. "Our fear is that the rules are so complex and compliance so confusing that [restaurants] will quit giving claims at all."
Healthful Foods with Flair
But some restaurants that have added healthier menu choices highlighted with claims report that those dishes sell well. Barbara Hartman, head chef for Geppetto, an Italian restaurant in Bethesda, Md., and a participant in Suburban Hospital's Heart Healthy Restaurant Program, said the restaurant's "Healthy Menu" items account for 5 to 10 percent of daily sales. The sandwiches--Tuna Sandwich Dijon, Grilled Vegetable Sub, and others--represent as much as 20 percent of all sandwich sales, she said.
"We've had an excellent response," she said. "Better than we thought we would have."
Although most of the customer feedback has been positive, she noted that customers sometimes complain about the blandness of the food. "There's no salt, no sugar, no oil added," she said. "So I coach the waiters to let customers know that the food may not be as tasty as what they're used to. Then they won't be taken aback by what they're getting."
Healthy menu choices aren't going to appeal to every customer, either. Heart Smart's Peters noted that one previous client, a restaurant that offered only healthy-type foods, went out of business because its selection was too narrow. "People need a choice," she said.
And not every dish is suitable for dietary modification. Some lose their palatability when the fat and sodium contents are reduced to low levels, Peters said, citing fettuccine Alfredo as a prime example. Dishes containing cheese or cream sauces are difficult to modify, dietitian Dolan noted. And chef Hartman said the poached salmon that used to be on her restaurant's Healthy Menu had to be removed because the salmon didn't fit the criteria for a "heart healthy" claim.
But there still are plenty of other dishes that can easily be used or reworked as more healthful food offerings. Among those cited by restaurant menu experts are grilled seafood, chicken, venison, and ostrich; spaghetti with turkey meatballs; several Mexican dishes; salads; and pasta dishes and other entrées traditionally made with wine or herb sauces. Geppetto, for example, offers a single-serving California Bambino Pizza with a whole-wheat crust, fat-reduced mozzarella cheese, tomato basil sauce, roasted garlic, fresh mushrooms, broccoli, and roasted peppers. It provides 506 calories, 10 grams of fat, and 24 milligrams of cholesterol.
Tasty, yet healthful. And, one might add, a far cry from its predecessor, the dieter's plate.
Paula Kurtzweil is a member of FDA's public affairs staff.
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FDA Consumer magazine (May-June1997)