The Board of Supervisors hereby finds and declares as follows:
Chronic diseases and obesity are concurrent, serious and growing public health crises affecting states and localities across the country. In California and the City and County of San Francisco, the two epidemics are among the greatest public health challenges, as evidenced by the following:
• Chronic diseases, including cardiovascular disease, diabetes, hypertension, cancer, asthma, are the leading cause of death and disability in San Francisco and California;
• Seventy percent of all U.S. deaths are attributable to chronic disease;
• Hypertension and diabetes are the leading reasons for San Francisco Department of Public Health primary care clinic visits;
• Obesity rates have doubled in children and tripled in teenagers over the past twenty years;
• The rate at which obesity is increasing in California is among the fastest in the country;
• One-third of California children, one-fourth of California teenagers, and one-half of California adults are either overweight or obese;
• Fifty percent of overweight children and teenagers remain overweight as adults;
• Over half of Californians are at greater risk for heart disease, type-2 diabetes, high blood pressure, stroke, arthritis-related disabilities, depression, sleep disorders, and some cancers because of increasing obesity rates;
• In San Francisco, 43% percent of adults are overweight or obese and 24% of school-age children are overweight or obese.
The burden of increasing overweight and obesity and accompanying chronic diseases manifests itself in premature death and disability, health care costs, and lost productivity. Obesity greatly increases the risk of chronic diseases such as high cholesterol, high blood pressure, asthma, and type-2 diabetes. 22% of San Franciscans have high blood pressure and 6.5% of San Franciscans have diabetes. Heart disease is the leading cause of death in San Francisco. The financial cost of chronic disease and obesity is evidenced by the following:
• Health care costs rose nearly two billion dollars in inflation adjusted dollars between 1987 and 2000. Fifteen conditions including diabetes, hypertension, heart disease, cerebrovascular disease accounted for more than half the overall growth;
• Medicare costs for those who were obese when they were middle aged are roughly twice as great as those who were at ideal weight;
• In 2005, California's costs related to obesity; overweight, and lack of physical activity were projected to reach $28 billion for health care and lost work productivity;
• The indirect and direct costs of adult obesity in America are between $69 and $117 billion each year;
• If 10% of currently obese or overweight Californians were to reach and maintain a healthy weight over a five-year period, savings would amount to $13 billion;
• Obesity-related expenditures are thought to have accounted for more than 25% of the increase in national health care spending between 1987 and 2001;
• The San Francisco Department of Public Health estimates that the obesity epidemic costs San Francisco $192 million a year in medical expenses, lost productivity and workers' compensation. The estimated costs to the Department for diabetes for the year 2005 was $25 million.
The rise in obesity rates has coincided with Americans eating more meals outside of the home. Such meals contribute to the growing rate of obesity, as evidenced by the following:
• In 1970, Americans spent just 26% of their food dollars on restaurant meals and other foods prepared outside the home. Today, Americans spend 47.9% of their food dollars on away-from-home foods;
• Between 1972 and 1997, the per capita number of fast-food restaurants doubled, and the per-capita number of full-service restaurants rose by 35%;
• The increase in per capita restaurants accounts for 65% of the increase in the percentage of those who are obese;
• About one-third of the calories in an average American's diet come from restaurant or other away-from-home foods;
• On average, children and youth aged 11-18 visit fast food outlets of twice a week;
• Studies have shown a positive association between eating out and higher caloric intakes and higher body weights;
• Children eat almost twice as many calories (770) when they eat a meal at a restaurant as they do when they eat at home (420);
• Restaurant foods are generally higher in those nutrients for which over consumption is a problem, such as fat and saturated fat, and lower in nutrients required for good health, such as calcium and fiber;
• It is not uncommon for a restaurant entree to provide half of a day's calories, saturated and trans fat, or sodium;
• Portion sizes are often large at restaurants and people tend to eat greater quantities of food when they are served more, whether or not they are hungry;
• Observational studies have shown that people who frequently consume food away from home tend to weigh more.
Without nutrition information, consumers consistently underestimate the nutritional content of restaurant foods, as evidenced by the following:
• In a California field poll about the nutritional value of typical fast food and restaurant menu items, not a single respondent was able to answer all four questions correctly. Less than 1% answered three out of four questions correctly, and only 5% answered two out of four questions correctly. Nearly 68% were not able to answer a single question correctly;
• An FDA-commissioned report concluded that without access to nutritional information, consumers are not able to assess the caloric content of foods;
• One study illustrated that restaurant foods contain almost twice the number of calories estimated by consumers;
• Another study showed that even trained nutrition professionals consistently underestimate the calorie content of restaurant foods by 200 to 600 calories;
• The public's knowledge of the nutritional content of restaurant foods is incomplete, especially compared to pre-packaged foods. Moreover, the fact that chain restaurants' serving sizes are so varied and large, and their prices are so low, can mislead and even deceive the public regarding the amount of an actual serving size and how many calories a portion contains.
When nutrition information is provided, consumers use it to make healthier choices, as evidenced by the following:
• Three-quarters of American adults report using nutritional labels on packaged foods;
• Studies show that the use of food labels is associated with eating more healthful dies;
• Almost half of consumers report that the information provided on food labels has caused them to change their mind about buying a food product;
• With nutrition information, consumers are 24%-37% less likely to select high-calorie items.
The Federal Nutrition Labeling and Education Act requires food manufacturers to provide nutrition information on nearly all packaged foods, but explicitly exempts restaurants from that requirement.
The current system of voluntary nutritional disclosures by restaurants is inadequate. Approximately two-thirds of the largest chain restaurants fail to provide any nutritional information about their menu item to customers. Those that do provide such information often do not do so at the point of sale, but rather on websites or in brochures available only by request.
Competition within the food service industry is healthy and desirable but cannot lead to healthier food options when consumers are not able to make choices based upon the nutritional value of the food offered.
84% of Californians are in favor of nutritional labeling in restaurants. The United States Surgeon General, the Food and Drug Administration, the National Academies' Institute of Medicine, and the American Medical Association have all recommended nutritional labeling of restaurant food as a strategy to address rising obesity rates.
The aforementioned findings are based on studies referenced in the "Statement of Legislative Findings," a copy of which is on file with the Clerk of the Board of Supervisors in File No. ____________ and is incorporated herein by reference.
Therefore, it is the intent of the Board of Supervisors, in enacting this ordinance to provide consumers with basic nutritional information about prepared Foods sold at Chain Restaurants so that consumers can make informed Food choices; and to foster fairness and encourage beneficial competition among the Chain Restaurants of the City and County of San Francisco.
(Added by Ord. 347-86, App. 8/15/86; Ord. 40-08, File No. 071661, App. 3/24/2008)