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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)
(a) "Chain Restaurant" means a Restaurant within the City and County of San Francisco that offers for sale substantially the same Menu Items, in servings that are standardized for portion size and content, and is one of a group of 20 or more Restaurants in California that either: (1) operate under common ownership or control; or (2) operate as franchised outlets of a parent company, or (3) do business under the same name.
(b) "Director" shall mean the Director of Health, or his designated agents or representatives.
(c) "Food" means any substance in whatever form for sale in whole or in any part for human consumption such as, for example, meals, snacks, desserts, and beverages of all kinds.
(d) "Food Tag" shall mean a label or tag that identifies any Food item offered for sale at a Chain Restaurant, such as, for example, a label placed next to a cherry pie showing a picture of a cherry and listing the price per slice.
(e) "Menu" means any list or pictorial display of Food, and price(s), offered for sale at a Restaurant including menus distributed or provided outside of the Restaurant, but does not include a Menu Board.
(f) "Menu Board" means any list or pictorial display of Food, and price(s), offered for sale at a Restaurant that is posted in a Restaurant and intended for shared viewing by multiple customers such as, for example, back-lit marquee signs above the point of sale at fast-food outlets and chalk boards listing offered Food items or any list of Food offered for sale at a Restaurant that is posted and intended for viewing by customers purchasing Food to go, such as, for example, a drive-through menu.
(g) "Menu Item" means an item described on a Menu, a Menu Board, or a Food Tag that is prepared, un-prepackaged Food; and also means a combination item appearing on a Menu, a Menu Board, or a Food Tag such as, for example, a "kids meal," that contains any prepared, un-prepackaged Food, such as a hamburger, and any prepackaged Food, such as a carton of milk.
(h) "Restaurant" means a facility at which any prepared, un-prepackaged Foods are offered for sale and consumption on or off the premises such as, for example sit-down restaurants; cafes; coffee stands; and fast-food outlets, but not grocery stores. "Restaurant" may also include separately owned food facilities that are located in a grocery store but does not include the grocery store.
(Added by Ord. 347-86, App. 8/15/86; Ord. 40-08, File No. 071661, App. 3/24/2008; Ord. 195-08, File No. 080826, App. 8/7/2008)
(a) Required Nutritional Information. Except as provided in Subsection (h), each Chain Restaurant shall make nutritional information available to consumers for all Menu Items. This information shall include, but not be limited to, all of the following, per Menu Item, as usually prepared and offered for sale:
(1) Total number of calories, expresses to the nearest 10 calories for values above 50 calories and to the nearest 5 calories for values 50 calories and below;
(2) Total number of grams of saturated fat, expressed to the nearest gram for values 5 grams and above, to the nearest half gram for values below 5 grams, and as 0 for values below one-half gram;
(3) Total number of grams of carbohydrates, expressed to the nearest gram for values 1 gram and above, as "less than 1g" for values below 1 gram, and as 0 for values below one-half gram; and
(4) Total number of milligrams of sodium, expressed to the nearest 10 milligrams for values above 140 milligrams, to the nearest 5 milligrams for values between 5 and 140 milligrams, and as 0 for values below 5 milligrams.
(b) Information on Menus.
(1) Each Chain Restaurant that uses a Menu shall provide the nutritional information required by Subsection (a) next to or beneath each Menu Item using a size and typeface that is clear and conspicuous.
(2) Each Chain Restaurant that uses a Menu shall include the following statement on the Menu in a clear and conspicuous manner: "Recommended limits for a 2,000 calorie daily diet are 20 grams of saturated fat and 2,400 milligrams of sodium."
(c) Information on Menu Boards.
(1) Each Chain Restaurant that uses a Menu Board shall provide on the Menu Board the nutritional information required by Subsection (a)(1) next to or beneath each Menu Item on the Menu Board using a font and format that is at least as prominent, in size and appearance, as that used to post either the name or price of the Menu Item.
(d) Information on Food Tags. Each Chain Restaurant that uses a Food Tag shall provide on the Food Tag the nutritional information required by Subsection (a)(1) using a font and format that is at least as prominent, in size and appearance, as that used to post either the name or price of the Menu Item.
(e) Range of Nutritional Information for Different Flavors and Varieties.
(i) If a Chain Restaurant offers a Menu Item in more than one flavor or variety (such as beverages, ice cream, or doughnuts) and lists the item as a single Menu Item, the range of values for the nutritional information for all flavors and varieties of that item (i.e., the minimum to maximum numbers of calories) shall be listed for each size offered for sale. If the Menu Item's flavors and/or varieties include diet items containing less than 10 calories, the Chain Restaurant shall post a separate range of values for such diet items.
(ii) If a Chain Restaurant offers pizzas in different sizes as Menu Items, the nutritional information required by Subsection (a) may be listed on the Menu and/or Menu Board by serving size for each type of pizza if the Chain Restaurant does both of the following: (1) displays the definition of the serving size (i.e., 1 slice) on the Menu and/or Menu Board using a size and typeface that is clear and conspicuous, and (2) displays the number of servings for each size of each type of pizza next to or beneath the price for each size using a font and format that is at least as prominent, in size and appearance, as that used to post either the name or price of the Menu Item.
(f) Disclaimers. Menus, Menu Boards, and Food Tags may include a disclaimer that indicates that there may be minimal variations in nutritional content across servings, based on slight variations in overall size and quantities of ingredients, and based on special ordering.
(g) Verifiable and Reliable Information Required.
(1) The nutrition information required by this section and Section 468.4 shall be based on a verifiable analysis of the Menu Item, which may include the use of nutrient databases, cookbooks, laboratory testing, or other reliable methods of analysis.
(2) A Restaurant is in violation of this section and Section 478.4 if the provided nutritional information required by these sections:
(i) Is not present in the location or in the form required by these sections:
(ii) Is different than what the Restaurant knows or believes to be the true and accurate information; or
(iii) Deviates from what actual analysis or other reliable evidence shows to be the average content of a representative sample of the Menu Item by more than 20%.
(h) Food Items Excluded. This section and Section 468.4 shall not apply to:
(1) Items placed on the table or at a counter for general use without charge, such as, for example, condiments:
(2) Alcoholic beverages; and
(3) Items that are on the Menu, Menu Board or Food Tag for less than 30 consecutive days in a calendar year.
(Added by Ord. 347-86, App. 8/15/86; Ord. 40-08, File No. 071661, App. 3/24/2008; Ord. 195-08, File No. 080826, App. 8/7/2008)
(a) Each Chain Restaurant shall make the following nutrition information available to consumers per Menu Item, as usually prepared and offered for sale, on the disclosure media provided for in Subsection (c): calories, protein, carbohydrates, total fat, saturated fat, artificial trans fat cholesterol, fiber and sodium. The nutrition information shall consist of the following items:
(1) A heading titled "Nutrition Information" or equivalent heading acceptable to the Department of Public Health.
(2) The nutritional information required by Section 468.3(a).
(3) Protein shall be expressed to the nearest gram for values 1 gram and above, as "less than 1g" for values below 1 gram, and as 0 for values below one-half gram.
(4) Cholesterol shall be expressed to the nearest 5 milligrams for values above 5 milligrams, expressed as "less than 5 mg" for values between 2 and 5 milligrams, and expressed as zero for values below 2 milligrams.
(5) Fiber shall be expressed to the nearest gram for values 1 gram and above, as "less than 1g" for values below 1 gram, and as 0 for values below one-half gram.
(6) Total fat and artificial trans fat shall be expressed to the nearest gram for values 5 grams and above, to the nearest half gram for values 5 grams, and as 0 for values below one-half gram.
(b) Customers must be able to obtain nutrition information without the necessity of purchasing food.
(c) The information required by Subsection (a) must be disclosed, in a size and typeface that is clear and conspicuous, either on a printed poster of a size no smaller than 18 inches by 24 inches or in a printed brochure or booklet, that is displayed in a conspicuous place and readily visible to customers either: (1) at the point of sale; (2) near the front door; (3) on or near the host/hostess desk or reception area; or (4) at any point in or near the entryway or waiting area of the restaurant.
(Added by Ord. 347-86, App. 8/15/86; Ord. 40-08, File No. 071661, App. 3/24/2008; Ord. 195-08, File No. 080826, App. 8/7/2008)
(Added by Ord. 347-86, App. 8/15/86; Ord. 40-08, File No. 071661, App. 3/24/2008; Ord. 195-08, File No. 080826, App. 8/7/2008)
(a) Cumulative Remedies. The remedies provided by this section are cumulative and in addition to any other remedies available at law or in equity.
(b) Administrative Remedies. The Director may enforce the provisions of Sections 468.3 through 468.5 by serving a Notice of Violation requesting a Chain Restaurant to appear at an administrative hearing before the Director at least 20 days after the Notice of Violation is mailed. At the hearing, the Chain Restaurant cited with violating the provisions of these sections shall be provided an opportunity to refute all evidence against it. The Director shall oversee the hearing and issue a ruling within 20 days of its conclusion. The Director's ruling shall be final. If the Director finds that a Chain Restaurant has violated any of the provisions of Sections 468.3 through 468.5 or refuses to comply with these sections, the Director may order either of the following penalties:
(1) Suspension or revocation of the permit issued by the Director pursuant to Sections 451 et seq. of this Code; or
(2) An administrative fine in an amount (1) not exceeding one hundred dollars ($100.00) for a first violation; (2) not exceeding two hundred dollars ($200.00) for a second violation within one year; (3) not exceeding five hundred dollars ($500.00) for each additional violation within one year. In assessing the amount of the administrative penalty, the Director shall consider any one or more of the relevant circumstances presented by any of the parties to the hearing, including but not limited to the following: the nature and seriousness of the misconduct, the number of violations, the persistence of the misconduct, the length of time over which the misconduct occurred, the willfulness of the Chain Restaurant's misconduct, and the Chain Restaurant's assets, liabilities, and net worth. Any penalty assessed and recovered pursuant to this paragraph shall be paid to the City Treasurer and credited to the Department Environmental Health Section Special Revenue Account.
(c) Civil Penalties. Violations of Sections 468.3 through 468.5 are subject to a civil action brought by the City Attorney, punishable by a civil fine not less than two hundred fifty dollars ($250.00) and not exceeding five hundred ($500.00) per violation. Unless otherwise specified in this section, each day of a continuing violation shall constitute a separate violation. In assessing the amount of the civil penalty, the court shall consider any one or more of the relevant circumstances presented by any of the parties to the case, including but not limited to the following: the nature and seriousness of the misconduct, the number of violations, the persistence of the misconduct, the length of time over which the misconduct occurred, the willfulness of the defendant's misconduct, and the defendant's assets, liabilities, and net worth. Any penalty assessed and recovered in an action brought pursuant to this paragraph shall be paid to the City Treasurer and credited to the Department Environmental Health Section Special Revenue Account.
(f) Enforcement Agency. The Department of Public Health shall supervise compliance with Sections 468.3 through 468.5 and shall enforce those sections. The Director may adopt rules and regulations to give effect to those sections. In addition to the reporting requirements of Section 468.5, the Director may request information from Chain Restaurants that is reasonably necessary to the enforcement of those sections. The Department may impose the penalties provided in this Section for failure to comply with such a request. Notwithstanding, any other person legally permitted under Federal law, under State law, under Sections 468.3 through 468.5, or under other provisions of this Code to enforce a provision of these sections may enforce that provision. Such persons may include, for example: peace officers; code enforcement officials; and City officials, employees, and agents.
(g) Fees. In order to implement the requirements set forth in this ordinance, the Department of Public Health is hereby authorized to impose a surcharge of $350.00 for the permit issued to Chain Restaurants pursuant to Sections 451 et seq. of this Code.
(Added by Ord. 347-86, App. 8/15/86; Ord. 40-08, File No. 071661, App. 3/24/2008; Ord. 195-08, File No. 080826, App. 8/7/2008)
It is the intent of the Board of Supervisors to supplement applicable State and Federal law and not to duplicate or contradict such law and this ordinance shall be construed consistently with that intention. If any section, subsection, subdivision, paragraph, sentence, clause or phrase of this ordinance, or its application to any person or circumstance, is for any reason held to be invalid or unenforceable, such invalidity or unenforceability shall not affect the validity or enforceability of the remaining sections, subsections, subdivisions, paragraphs, sentences, clauses or phrases of this ordinance, or its application to any other person or circumstance. The Board of Supervisors hereby declares that it would have adopted each section, subsection, subdivision, paragraph, sentence, clause or phrase hereof, irrespective of the fact that any one or more other sections, subsections, subdivisions, paragraphs, sentences, clauses or phrases hereof be declared invalid or unenforceable.
(Added by Ord. 347-86, App. 8/15/86; Ord. 40-08, File No. 071661, App. 3/24/2008)
In order to promote enforcement of Section 114094 of the California Health and Safety Code, the Board of Supervisors suspends Sections 468.3 through 468.8. During the period of suspension, Sections 468.3 through 468.8 shall have no force or effect and shall not be enforced. The Department of Public Health shall take any and all appropriate actions to enforce Section 114094 of the California Health and Safety Code.
(Added by Ord. 260-08, File No. 081377, App. 11/25/2008)
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