Mark Nickolas Prof.

Andrew White The Mayor, the Media & the Politics of Policy in New York City May 12, 2011

New York Citys Calorie-Labeling Law: An Analysis of Formulation and Implementation I. Introduction & Overview On April 30, 2008, after more than 18 months of lawsuits, public hearings, court orders, and regulatory revisions, New York Citys ground-breaking calorie-labeling law (formally Section 81.50 of the New York City Health Code) went into full effect. The regulation, enacted directly by the Department of Health and Mental Hygiene through its regulatory powers thus circumventing the New York City Council, requires the posting of calorie counts on menus and menu boards by all restaurants in New York City that are part of a chain of 15 or more outlets nationally that serve standardized portions. The calorie-labeling law was one in a series of aggressive and controversial, though popular, initiatives undertaken by Mayor Michael Bloomberg and his pioneering Health Commissioner Thomas R. Frieden1 to address preventable chronic diseases, especially those related to for New York Citys obesity epidemic (Frieden, Public Health 972). Other measures included a smoking ban in virtually all indoor workplaces and bars and restaurants in 2002, and a ban on trans fats in restaurants enacted in 2006 (introduced concurrently with the calorie-labeling proposal) (972). The original calorie-labeling proposal, unveiled on September 26, 2006, targeted only those chain restaurants that had already made calorie information voluntarily available to consumers. Establishments which chose not to disclosure information would not be forced to do so. Following a

Nickolas 2 period for public comment and a hearing, the regulation was approved by the Health Board two months later on December 5, 2006 (DOHMH-2). Just as the regulation was set to go into effect, the New York State Restaurant Association (NYSRA) filed a lawsuit on June 14, 2007 in federal court in Manhattan challenging its legality on grounds that existing federal labeling law preempted any such local regulation, and that the mandate was a violation of commercial free speech under the First Amendment (Complaint). On September 11, 2007, U.S. District Court Judge Richard Holwell struck down the calorielabeling law on the grounds that by limiting its mandate to only those businesses that were already voluntarily disclosing calorie information, it conflicted with the federal law and was therefore preempted. However, Holwell also reaffirmed the authority of local governments to mandate calorielabeling, thus opening the door to a much more expansive application of the regulation that could force all chain restaurants to display calorie counts (Memorandum Opinion, 2007). The Bloomberg administration chose not to appeal the Courts ruling, opting instead for a quick redrafting of the original amendment. Barely a month later, on October 24, 2007, the Health Department reintroduced the calorie-labeling rule. Following a period for public comment and hearing, the Health Board approved the revised rule on January 22, 2008, mandating that all chain restaurants with at least 15 stores would be required to post calorie counts on its menus and menu boards. **(CITE)** In February 2008, the NYSRA again filed suit in federal court, repeating its federal preemption and First Amendment claims. This time, Judge Holwell sided with the city on both counts, going so far as to call out the NYSRA for its seeming hypocrisy in arguing against some of the very theories it raised in its original lawsuit. The final rule took effect on April 30, 2008. Later, the U.S. Court of Appeals for the Second District would deny NYSRAs appeal, and despite its repeated

Nickolas 3 efforts to delay implementation and enforcement of the rule, NYSRA opted against taking the matter to the U.S. Supreme Court. **(CITE)** New York Citys first-in-the-nation calorie-labeling rule would become law, delivering a big political victory for the Bloomberg administration in its ongoing war on obesity. II. Objectives This paper will analyze the genesis, rationale, deliberation, legal challenges, implementation, and subsequent effects of Section 81.50 of the New York City Health Code with a particular emphasis on how the original proposal evolved over time into its stricter and much more expansive final form, largely a result of backfiring tactical decisions by the NYSRA. The paper will utilize archival research and academic publications, as well as interviews with a number of the key players involved throughout the process, including Thomas Frieden, former New York City Health Commissioner; Dr. Margo Wootan, Director of Nutrition Policy at the Center for Science in the Public Interest (the main advocacy group in support of the rule); and Marion Nestle, professor of food studies and public health at NYU and one of the nations leading scholars and authors on the role of food marketing in dietary choices. Attempts to contact Charles Hunt, Executive Vice President for the New York State Restaurant Association, who led the opposition against the calorie-labeling law, were not returned. III. Background and Problem According to the 2004 Community Health Survey conducted by the New York City Health Department, more than half of city adults were overweight (34.4%) or obese (21.7%) (Frieden, Declaration 3). The percentage of obese New Yorkers nearly doubled between 1994 and 2004 (from 12% to 22%) and, nationally, the percentage of obese Americans has skyrocketed from 14.5% in 1971-

Nickolas 4 1974 to 32.2% in 2003-2004 (2). Studies have shown that an unhealthy diet may be second only to smoking in importance as a determinant of health (Mokdad et al., 1239). Further complicating this public health crisis is how one epidemic obesity is driving another epidemic of even greater concern: the rapidly increasing rate of type 2 diabetes among New Yorkers, from 3.7% in 1994 to 9.5% in 2006 (7). Public health officials and researchers cite two phenomenon that closely parallel the growing obesity epidemic since the 1970s: a doubling in the percentage of Americans who eat meals away from home (11) and a dramatic increase in food portion sizes offered by fast food restaurants (Young and Nestle, 238-239). Compounding this problem is the fact that fast food options tend to be calorie-packed, energy-dense, accessible, and inexpensive (Hill et al., 853). For these reasons, low-income people tend to eat a disproportionately large percentage of their meals in fast food restaurants (Dolnick). For example, a Big Mac combination meal at McDonalds which includes the Big Mac sandwich, medium serving of french fries and 21-ounce soft drink cost just $5.99 in New York City in 2008, but contained 1,130 calories, more than half an average persons daily caloric need (Farley et al., 1098). Our recent economic troubles have only exacerbated these trends. One recent study, published in the Journal of the American Medical Association, argued: [e]conomic adversity induces consumers to replace nutritious but expensive produce with less costly, high-calorie, commodity-based products.. . . In times of economic weakness and/or rising costs, consumers tend to trade down to lower price points rather than prepare food at home (Ludwig and Pollack, 534).

Nickolas 5 Michael Jacobson, executive director of the Center for Science in the Public Interest, told The New York Times in 2009 that [n]utrition is not the top concern of low-income people, who are probably the least amenable to calorie labeling (Hartocollis). While federally mandated nutrition labels are contained on food sold in grocery stores to better inform consumers about their food choices, no such information is required for food eaten in restaurants (Frieden, Declaration 4). Prior to the calorie-labeling proposal, some chains had voluntarily provided nutritional information, but a large Health Department survey of 167 randomly selected New York City fast food chains in 2007 found that, with the exception of Subway restaurants, fewer than five percent reported seeing calorie information in the location they had just exited (Farley et al., 1099). This was an important finding since recent research found that the selection of high calorie, high fat items decreased from 37% to 24% when calorie information was provided (Burton et al., 1674). It was this point that the Bloomberg administrations Health Department decided to act. IV. The Proposal In an affidavit filed during subsequent litigation, New York City Health Commissioner Thomas Frieden offered a general explanation as to why his department chose to act on this issue: The Board took this step because the Board and Department are charged with the prevention and control not just of communicable diseases, but also of chronic disease and its risk factors. This charge is addressed by educational and other means that improve the citys environment in ways that will make it easier for New Yorkers to make the healthy choices needed to prevent or manage chronic diseases (Declaration 4).

Nickolas 6 Specifically, the department has jurisdiction to regulate all matters affecting the health of New Yorkers and may amend or supplement the New York City Health Code for the security of life or health with the force and effect of law (Silver, Menu Labeling 3). In an interview with the writer, Frieden elaborated in greater detail about what motivated his department to pursue calorie-labeling as aggressively as it did. While outside groups, such as the Center for Science in the Public Interest, had lobbied his office for some time to consider action, Frieden made clear that the decision to initiate this effort had come from within his department. Specifically, Frieden credited his departments large restaurant inspection program as the main driver for more aggressive action stating that he wanted to ensure that the program not only prevented food-borne bacterial and toxic illnesses, but that it also promoted health more broadly. He noted that the calorie proposal was introduced to the Board of Health at the same time the artificial trans fat restriction was introduced, as both emanated from the Health Promotion and Disease Prevention division, but were done in close collaboration with the restaurant safety program of the Environmental Health division. This was predicated on the belief that the calorie content of food is the single most important piece of information for consumers to have in helping them make sound and healthy food choices. In the end, according to Frieden, the calorie-labeling effort was not offered as a result of pressure from interest groups, nor was it driven by politics coming out from Mayor Bloombergs office. Instead, this was a deliberate and calculated effort to expand the traditional mission of the Health Department so that it could aggressively pursue actions to help combat some of the chronic diseases plaguing New Yorkers. The original calorie-labeling effort was publicly announced by the Health Department on September, 26, 2006 and received strong public support.2 The proposed amendment would require

Nickolas 7 that all restaurants part of a chain of 15 or more outlets nationally that serve standardized portions and who have voluntarily made calorie information available would be required to prominently display that information on its menus and menu board. V. Deliberation and Approval Despite broad popular support, the measure was eventually met with strong opposition from fast food chain restaurants and their trade organizations, most notably the New York State Restaurant Association (NYSRA) and the National Restaurant Association. The October 30, 2006 public hearing would provide a window into the looming fight facing the Health Department as it proceeded with the regulation. Among those speaking was Mark Inzetta, a senior executive with Wendys restaurants. Inzetta largely focused his remarks on what he termed the discriminatory nature of the regulation since it applied only to the restaurants that had already made the decision to offer consumers nutritional information, and not all restaurants: What concerns us here about this proposal is it would not apply to all New York City restaurants and, in fact, would apply to only a select few. Inexplicably, companies that refuse to make any nutrition information available would be entirely exempt from this regulation. Not only do we think this is unfair, but it's counterintuitive to what we believe to be the scapegoat of the Department of Health of increasing consumer education and therefore, creates an incentive for businesses which do not provide this information to not provide it in the future. In fact, some restaurants may consider taking out the information if this proposal were to pass. So if the goal is to empower New Yorkers to make better informed choices when dining out, this proposal, in fairness, should apply to all food service outlets in the City

Nickolas 8 instead of arbitrarily applying it to just a small segment of restaurants (Transcript, 107). Also raising concerns at the hearing were the two main industry witnesses: Charles Hunt, NYSRA executive vice president, and Sheila Weiss, Director of Nutrition Policy at the National Restaurant Association. Both raised objections that since many restaurants were already providing calorie information to consumers in the form they believed was most effective, local government should not meddle with that effort. But their testimony stood out for the fact that both overwhelmingly focused on the proposed trans fat ban regulation, rather than calorie-labeling. A review of the hearing transcript showed that Ms. Weiss devoted just 20 percent of her 773-word remarks to calorie-labeling, while Mr. Hunt barely touched on the subject, allocating just 63 of his 1,014 words to it. Considering that the trans fat amendment would sail to approval and implementation with minor controversy in the subsequent weeks, while calorie-labeling would get mired in two federal lawsuits and a delay of over a year, the industrys initial focus is, especially in hindsight, noteworthy. In fact, most of the media coverage of the Health Department proposals leading up to the October public hearing focused mainly on the trans fat ban, not calorie-labeling. Though, not all involved in the debate would allow the medias narrative to drive the story. In her own New York Times op-ed prior to the public hearing, Marion Nestle, NYU professor of food studies and public health and one of the nations leading scholars on the issue noted that the attention being paid to the trans fat ban was misplaced and overlooking the much more substantive and meaningful proposal on calorie-label:

Nickolas 9 Lost in the hoopla over the trans fat decision was a second proposal from the health department that might have a far greater impact: to require restaurants that offer foods and drinks made from standard recipes McDonalds and Starbucks, for example to display calorie contents on menu boards. For doing something about obesity, its the calories not the trans fats that count. Labeling restaurant calories is a good idea because nobody, not even a trained nutritionist, can compute the number of calories in a meal without knowing the type and weight of every ingredient that goes into it. Commissioner Frieden disagreed with this suggestion during the writers interview of him. Instead, he argued: Ive always thought that they realized that they couldnt fight transfat because they knew that fighting to preserve their right to put an artificial product no one had heard of and was killing people into food wasnt a winner in the publics eye. Plus, it was clear that we had full authority to do it in the health code. They were always going to challenge the calorie law, there was no question about that. Both public hearings and comments had overwhelming public support. Regarding trans fat, some industries and companies argued, with reason, that they needed time to transition, and we worked with them on that (Frieden Interview). During her interview, Dr. Nestle made clear her strong belief that the restaurant associations were never interested in finding a solution to the obesity issues nor were they ever prepared to meaningfully address the issue by way of disclosure beyond the voluntary efforts of some of its members. She framed the entire debate as a classic example of industry versus consumer interests

Nickolas 10 and that the NYSRA is notoriously uninterested in the health of consumers and this was a typical example of tactics. This time, they backfired. (Nestle, Interview). Meanwhile, the Center for Science in the Public Interest (CSPI), a national public interest organization based in Washington, D.C., was the leading advocacy group pushing for calorielabeling in New York City. According to their website, they describe their mission as follows: The Center for Science in the Public Interest (CSPI) is a consumer advocacy organization whose twin missions are to conduct innovative research and advocacy programs in health and nutrition, and to provide consumers with current, useful information about their health and well-being. In a brief interview with CSPIs Dr. Margo Wootan, Director of Nutrition Policy, she explained that her organization began working on nutritional labeling for more than 20 years, beginning with its successful efforts for a government mandate on labels on packaged food. In 2003, CSPI began an aggressive push for nutrition labeling at chain restaurants and since New York Citys effort was nations first, they played a very prominent and public role. According to Wootan, her group met several times with Commissioner Frieden and his staff and urged them to target calorie-labeling. The media routinely cited Wootan and CSPI in its reporting on the labeling proposal and they were very active during the public hearing as were key players in an amici curiae brief (often termed a friend of the court brief) filed with U.S. District Court Judge Richard Holwell in support of the New York City Health Department during the litigation of the case (**CITE BRIEF**). Along with CSPI, the parties to the brief included U.S. Rep. Henry Waxman, who was the chief sponsor of the federal labeling act cited by NYSRA), Dr. David Kessler, former FDA commissioner at the time the federal law was enacted, and a variety of medical, academic, and advocacy groups and individuals, including Dr. Marion Nestle. The support

Nickolas 11 provided by this group was a central piece to the litigation and eventual ruling by Judge Holwell that opened the door to stricter and more expansive final regulation. INSERT MARGO WOOTAN INTERVIEW COMMENTS + HER AFFIDVAIT IN HAWAII During the period for public comment on the proposed regulation, the Health Department received 2,222 written comments, including an additional 45 people who spoke at the October public hearing. Of those 2,267 comments, 2,245 were in support and just 22 in opposition, a ratio of 100-to-1 (Silver, 1). Moreover, polling across the country consistently showed overwhelming public support for restaurant calorie-labeling (Friedman, 5). On December 5, 2006, the Board of Health unanimously approved the measure requiring all restaurants in New York City that are part of a chain of 15 or more outlets nationally and which serve standardized portions to make calorie information publicly available beginning March 1, 2007. A 3-month grace period would be provided so that enforcement would begin on July 1, 2007. The one major modification from the original proposal that the Health Board agreed to and one it would revisit the following year was to allow businesses the chance to propose alternative ways to display calorie information rather than the manner designated by the city. VI. The Lawsuit On June 14, 2007, the NYSRA filed a lawsuit against the New York City Board of Health in U.S. District in Manhattan seeking relief to prevent enforcement of the calorie-count regulation. The lawsuit asserted two claims: that the federal Nutrition Labeling and Education Act of 1990 preempted any local regulations when it came to food labeling, particularly as a result of the citys decision to only target businesses who had voluntarily provided calorie information; and that the regulation infringed on its members First Amendment rights by forcing them:

Nickolas 12 to convey a message with which they do not agree; namely that the nutritional value of a given menu item can be represented by a bare declaration of its caloric content (Complaint, 11). During his interview, Commissioner Frieden noted that the NYSRA lawsuit was one of the most interesting experiences during his seven years leading the Health Department because it provided him a valuable insight into how the fast food industry communicated with its customers and how determined it was to prevent any interference from the outside, especially mandates by government. Specifically, Frieden highlighted comments in affidavits filed by officials from several fast food chains, including from Hector Munoz, Senior Director of Retail Image and Engagement at Burger King Corp., who offered the following insight as to why they opposed any meddling with its menu board: the menu board is the single most valued piece of real estate in a Burger King restaurant. It is the most important way we communicate with our customers in the store about the products we offer and their price. It is what the customers look at, and it is what stimulate their decision to buy (Silver and Nonas, 15). This assertion, which other fast food chains largely mimicked in their own affidavits, suggests this as the reason for the ferocious response by the industry once, the Health Board approved the calorie-labeling regulation. The menu boards were perceived as inviolable sacred ground and the companies were not going to ceded control over them without a fierce fight. On September 11, 2007, U.S. District Court Judge Richard Holwell struck down the calorielabeling law on the grounds that by limiting its mandate to only those businesses that were already voluntarily disclosing calorie information, it conflicted with the federal Nutrition Labeling and Education Act of 1990 and was therefore preempted. However, even more significantly, Judge

Nickolas 13 Holwell specifically reaffirmed the authority of local governments to mandate calorie-labeling, thus opening the door to a much more expansive application of the regulation that could force all chain restaurants to display calorie counts, regardless of whether or not they had offered such information to the public in the first place: [T]he Court concludes that the City has the power to mandate nutritional labeling by restaurants, but that it has done so in a manner that offends the federal statutory scheme for voluntary nutritional claims. Therefore, the Citys regulation, as enacted, is preempted by federal law. The Court does not reach the plaintiffs First Amendment claims (Memorandum Opinion, 2007 2). VII. Repeal and Redrafting

Instead of appealing Judge Holwells ruling, the Bloomberg administration opted to quickly redraft the original proposal, not only to remedy the language per the courts opinion, but also to broaden its mandate to force all chains to comply with the labeling requirement, as was clearly suggested by Holwell. As a matter of tactics, the decision by the NYSRA to appeal the regulation had backfired badly. Even though it had technically won the case, that designation was helpful only for the positive news stories it received in the subsequent days. In fact, Holwells ruling would turn out to be much worse for the NYSRA and fast food chains than if they had simply lost the case. Now, with a small amount of redrafting, the Health Department would be able to mandate calorie-labeling on all chains, not merely a subset who were already disclosing information publicly. Commissioner Frieden acknowledged during his interview that, ironically, his department had believed the limited original regulation was going to be more defensible in court. This turned out to be the opposite of the case.

Nickolas 14 Moreover, the redrafting allowed the Health Department to scrap its previous willingness to allow chains to propose and potentially receive approval for alternate designs for displaying calorie information. Frieden would later say that while the original accommodation was well intentioned, it eventually led to unproductive discussions with restaurants (Farley, 1107). Now, given the green light by the courts to redraft a stricter and more expansive regulation, it simply dropped the alternate design option and instead instructed restaurants on how to display calorie information on its sacred menu boards, highlighting yet another consequence for NYSRAs decision to file its original lawsuit. Barely a month later after Judge Holwells ruling, the Health Department reintroduced the calorie-labeling rule on October 24, 2007. Following a period for public comment and hearing, the Health Board approved the revised rule on January 22, 2008, mandating that all chain restaurants with at least 15 stores would be required to post calorie counts on its menus and menu boards. In February 2008, the NYSRA again filed suit in federal court, repeating its federal preemption and First Amendment claims. This time, Judge Holwell sided with the City on both counts, going so far as to call out the NYSRA for its seeming hypocrisy in arguing against some of the very theories it raised in its original lawsuit (Memorandum Opinion, 2008 5). The final rule took effect on April 30, 2008. Later, the U.S. Court of Appeals for the Second District would deny NYSRAs appeal, and despite its repeated efforts to delay implementation and enforcement of the rule, NYSRA opted against taking the matter to the U.S. Supreme Court. VIII. Implementation

IX.

Analysis, Lessons & Criticism

Nickolas 15 ADDRESS NANNY STATE Also, it can be argued that the industrys lack of traction on repelling what they viewed as an assault on their most vital communication link to their customers was the result of being caught seemingly flat-footed in the first few weeks of the debate and that rendered them unable to mount an effective pushback in subsequent months. As is the case in political fights, the failure to launch an assertive response at the beginning of engagement is often fatal especially when initial popular support is likely not to be on your side. Beyond allowing your opponent to start galvanizing public opinion, a delay can cause the media to downgrade any such fights as unworthy of front page attention. In fact, it is not unusual for a group to launch a pre-emptive strike even before a proposal is formally announced in hopes of gaining an upper hand once the debate formally begins. In this case, the fast food industry initially chased the wrong the target, were divided between those restaurants who were not opposed to labeling, but wanted control over how to display it (such as Wendys), versus those which were simply not interested in voluntarily participating in the first place. X. Conclusion New York Citys successful development and implementation of its calorie-labeling law is an example of how local government can execute strong policy goals that can achieve public health benefits. In this case, a number of factors can be cited for the proposals success: the clear objectives set from the outset by Commissioner Frieden and the Health Department; setting realistic and attainable requirements for the restaurants affected; conducting considerable research on the proposal well before publicly discussing them; strong political backing throughout the process by from Mayor Bloomberg; a willingness to circumvent potential political gridlock by utilizing existing

Nickolas 16 regulatory authority rather than seeking city council approval; and maintaining the momentum to finalize the amendment, even while navigating legal hurdles that required redrafting the rule. Additionally, as Commissioner Frieden has since noted, given the political clout of the fast food industry, it is not surprising that an appointed body (the Health Department), rather than elected one (the City Council), was the first in the nation to mandate calorie-posting. Despite the efforts by some council members to assert jurisdiction and offer a business friendly compromise, the Bloomberg administrations political deftness quashed the effort before it could build any momentum. Also, there is no doubt that the decision by the NYSRA to challenge the original proposal in the court was a key factor in the Bloomberg administration emerging from the process with a stricter, more expansive, and fairer rule that placed a mandate on all chains, rather than a portion of them. Without the courts intervention, it is possible that a large number of restaurants would have exempted themselves from the posting mandate (by no longer offering voluntary nutritional information) and rendered the final regulation relatively toothless and ineffective, leaving many of us to wonder how the Health Department managed to fumble away its chance to add another tool to combating the obesity epidemic. Instead, New York Citys success proved to be a model for other states and localities, and eventually a similar provision to mandate calorie-labeling nationally found its way into the landmark federal health care bill that President Obama signed into law in 2010, which the FDA is currently finalizing. As one would fully expect of any controversial public policy proposal, the original calorielabeling amendment did change as it weaved its way through the approval process. It encountered obstacles, entrenched moneyed interests, lawsuits, as well as pressure from advocacy groups which pushed for the strictest possible regulation. However, in each instance of modification, the original

Nickolas 17 proposal became stronger, tighter, and stricter. It morphed from being voluntarily applied to becoming a mandate on all chain restaurants. Also, while the first iteration allowed restaurants to propose an alternative mechanism for display of calorie information, the final regulation removed that option and simply mandated how it was to be done. Throughout this process, the Health Department, and the Bloomberg administration, was unbowed by the tumult and methodically plodded ahead, seemingly to remain a step or two ahead of its opponents at all times, who often appeared flat-footed against the bulldog efforts of Commissioner Frieden and his team. They launched the original proposal with a punch (and kept punching throughout), kept elected officials who might try to tinker with the proposal (or took campaign money from the fast food industry) at bay, did not dither after the initial setback in the courtroom, and they made sure to incorporate public opinion into their broadside efforts against the opposition (CITE FRIEDEN COMMENT RE ASHAMED OF THEIR FOOD PRESS RELEASE). The steadfast backing at all stages by Mayor Bloomberg cannot be underemphasized. As the CEO of the City of New York, any hesitation by Bloomberg during some of these crucial phases might have provided critically needed oxygen for opponents looking for a way back into the game. They never got it. Substantively, there is good reason to believe that the effectiveness of the calorie-labeling law in the long term will prove to be less about the food choices that consumers make, than about the fast food industrys decisions to provide healthier options and more reasonable portion sizes in the face of sticker shock from consumers who had no idea that a typical combination meal itself contains more than half the calories required for an entire day. The evidence is undisputable that such changes are being made. The question is whether this trend continues. Works Cited

Nickolas 18

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Nickolas 19 Hartocollis, Anemona. Calorie Postings Dont Change Habits, Study Finds. The New York Times. 6 Oct 2009. Web. 29 Apr 2011 <http://www.nytimes.com/2009/10/06/nyregion/06calories.html>. Health Department Launches Calorie Education Campaign. New York City Department of Health and Mental Hygiene. 6 Oct 2008. Web. 29 Apr 2011 <http://www.nyc.gov/html/doh/html/pr2008/pr066-08.shtml>. Health Department Proposes Two Changes to Citys Health Code For Public Comment: First, to Phase Out Artificial Trans Fat in All Restaurants; Second, to Require Calorie Labeling in Some Restaurants. New York City Department of Health and Mental Hygiene. 26 Sep 2006. Web. 29 Apr. 2011 <http://www.nyc.gov/html/doh/html/pr2006/pr093-06.shtml>. Hill, James O. et al. Obesity and the Environment: Where Do We Go from Here? Science (New York, N.Y.) 299.5608 (2003) : 853-855. Web. 7 May 2011. How Many Calories in that Fried Triple Whopper with Cheese?" The New York Times. 17 Oct 2008 Web. 29 Apr 2011 <http://theboard.blogs.nytimes.com/2008/10/17/how-many-calories-inthat-fried-triple-whopper-with-cheese/>. In Tug of War on Calories, Mayor Pushes for Amended Rule." [] The New York Times. 12 Sep 2007. Web. 29 Apr 2011 <http://cityroom.blogs.nytimes.com/2007/09/12/in-tug-of-war-on-caloriesmayor-pushes-for-amended-rule/>. Ludwig, David S., and Harold A. Pollack. Obesity and the Economy. JAMA: The Journal of the American Medical Association 301.5 (2009) : 533 -535. Web. 8 May 2011. Memorandum Opinion and Order. New York State Restaurant Association v. New York City Board of Health, et al. 2007 Civ. 5710 (SDNY). 11 Sep 2007. Web. 29 Apr 2011 <http://www.citizen.org/documents/nysra_distdecision.pdf>. Memorandum Opinion and Order. New York State Restaurant Association v. New York City Board of Health, et al. 2008 Civ. 1000 (SDNY). 16 Apr 2008. Web. 29 Apr 2011 <http://www.citizen.org/documents/NYSRAOpinion_1.pdf>. Mokdad, A.H. et al., Actual Causes of Death in the United States, 2000, JAMA: The Journal of the American Medical Association 291.10 (2004) : 12381245. Web. 3 May 2011 <http://reps.ku.dk/PhD_Courses/reps/pahealth/readinglist/mokdad2004.pdf>. Nestle, Marion. Personal interview. 6 May 2011. Nestle, Marion. Trans Fat Nation. The New York Times. 1 Oct 2006. Web. 8 May 2011 <http://www.nytimes.com/2006/10/01/opinion/01nestle.html>.

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Nickolas 21 Wootan, Margo. Personal interview. 6 May 2011. Young, Lisa R, and Marion Nestle. Portion Sizes and Obesity: Responses of Fast-food Companies. Journal of Public Health Policy 28.2 (2007) : 238-248. Web. 7 May 2011.

Dr. Thomas Frieden served as Commissioner of New York Citys Department of Health and Mental Hygiene for more than seven years beginning with his appointment by Mayor Michael Bloomberg in January 2002. On May 15, 2009, President Barack Obama named Frieden the 16th director of the Centers for Disease Control and Prevention (CDC).
2

The Dept. of Health simultaneously announced the calorie-labeling proposal along with another amendment to the health code which would phase-out the use of trans fats in New York City restaurants. Unlike calorie-labeling, the trans fat ban garnered considerably less opposition and was enacted and implemented several months later.