Sometime last month on a Metro bus in Seattle, I looked up and saw the advertisement you see on this page (minus my commentary in red of course). For an optimistic moment, I thought the poster was telling us that fast food is unhealthy and we should be informed so we can make healthy choices.  But, of course, that’s not what it’s saying at all.  The poster’s message, intended or not, is that health is all about calories; as long as you get the smaller serving of fries and the diet coke with your burger, you’ll be healthy and informed. 

This kind of misinformation frustrates me.  The poster is part of a new King County public health campaign about healthier eating, designed to encourage people to look at nutrition and calorie labeling in restaurants and fast food establishments. Even if unintended, the message here visually equates a lower-calorie fast food meal with the words “healthy” and “informed” which is plainly inaccurate.  Even though public health offices, with limited budgets, are genuinely trying to solve the problem of epidemic-level chronic ill health, ads like this can actually contribute to the problem, and can mean spending money doing so that could be spent elsewhere. 

The problem is that the message in this poster is all about calories, not about what kind of food you put in your body.  The whole calories-in/calories out mantra is a myth.  Our bodies don’t follow simple rules of thermodynamics, as this article nicely explains. Additionally, other ways of eating, such as the paleolithic diet, are much more effective at weight reduction and insulin and appetite control.  There are a number of factors that contribute to metabolic syndrome and weight gain, such as compounds in poor quality food that mess with things like insulin level regulation and the body’s mechanisms for regulating weight and satiety.

However, even if you agree with the notion that weight gain is simply about the number of calories consumed and burned, the poster is still misleading because it implies that excessive weight gain from calorie intake is the only potential detriment of eating a poor diet.  There isn’t a simple correlation between being lighter weight and being healthier.  A bad diet also means missing out on important nutrients in the right (natural) combinations, and it means ingesting substances that are going to damage your body.

Eating a smaller meal of the same bad food is still unhealthy.  In the meal pictured above, even the smaller portions contain high levels of omega-6 fatty acids in the refined vegetable oil in which presumably the french fries have been deep fried, a cheap white flour bun, poor quality grain-fed and possibly hormone-laden meat, and a big cup of diet soda.  Diet soda has been associated with metabolic syndrome.  It’s one of the worst fake-foods you can put in your body.

On the King County Public Health website for this ad campaign, you can download information sheets and games, including a set of quiz cards about how many calories are in a lot of cheap popular foods.  There’s also a fast food game board, an empty plate and a challenge to pick out a fast food meal for your children based on calories.  The message in all these materials, intentional or otherwise, sounds the same: that you can go ahead and eat fast food; simply count the calories and you’ll be just fine.  Especially if you consider heart disease and diabetes markers of being just fine.

There’s a reason simplified messages like this don’t work.  First, they’re based on poor information.  Second, when one wave of messaging doesn’t work, there’s an assumption that it’s because people ignored the message, so the message gets dumbed down more and more in the future. But I don’t think people ignore the message.  I think they try out the mainstream ideas: reduce calories, reduce fat, buy products labeled “lite.”  Then, they don’t lose weight, they’re still really hungry, they still have diabetes.  They give up, and why shouldn’t they?  If you’ve tried what nutritionists tell you to do and it doesn’t work, why continue? And so the cycle continues, of putting out the same information over and over, in increasingly dumbed down ways.  What’s the purported definition of insanity again?  I thought so.

You can make the argument that people are going to eat fast food for every meal no matter what, and at least Public Health can try to reduce the amount of calories people eat at each meal.  I don’t think that’s helpful.  First of all, it doesn’t tend to work, and second of all, if you’re giving up on getting people to reduce the frequency with which they eat fast food, why spend money on a campaign at all?  To me it sounds like buying ads that say, “Go ahead.  Eat Fast Food.  We Give Up.”  Although, of course, I disagree with King County Public Health as to whether calorie counting is significant.

I see the economic argument: we’re living in very difficult times financially, and people are struggling to feed themselves and their families on a tight schedule.  Fast food is cheap, quick, and widely available.  People aren’t going to listen to us if we tell them what’s really healthy, so we might as well “meet them where they’re at” as the jargon goes.  But this is a weak argument for several reasons.  First, encouraging people to eat poor quality food now is going to cost public health systems more money down the line when the same people (without insurance, thanks to the lovely economy) need to get treated for metabolic syndrome.  Second, it is possible to eat reasonably healthful and quick-to-prepare food for very little money (scrambled eggs, anyone?).  Third, I’d rather see local (and federal) government spend money to help people who can’t afford healthy food get greater access to it, not spend money encouraging people to eat bad food.

There’s also the argument that people respond most to immediate threats (danger now as opposed to long-term consequences) and to things that have detrimental effects on their children, and that for this reason, people aren’t going to give up fast food just because it’ll be bad for them in the long run.  This, the argument goes, is why anti-smoking campaigns were less effective when they talked about lung cancer and more effective when they talked about bad breath and harming kids with secondhand smoke. So, why not approach fast food the same way?  If people know that what they’re feeding their kids will have long term consequences on their kids’ metabolism, brain function and longevity, will people be more motivated to make a change in diet?

I’ve learned more about this current ad campaign, and it seems this calorie focus is the first of several stages; later ones will focus on saturated fat, sodium, and carbohydrates.  I think focusing subsequent phases on polyunsaturated fat/vegetable oil, badly processed grains, and sugar might be more useful, rather than going back to the same tired, misleading information about sodium and saturated fat.  However, I don’t think we’re going to win that battle anytime soon.

I could also see other more effective uses of a small grant, such as a community lesson on cooking cheap, healthy and quick food, and perhaps an offer of $25 grocery store vouchers to those who attend.  Or maybe a grant to start a new farmers’ market or subsidize food at an existing one.

A question for readers:

If you were running a $50,000 public health advertising or awareness campaign targeted to low-income, busy families who eat predominantly fast food, what messages and methods would you choose?

Especially: what would you put on a bus ad or a game or a brochure?

How would you spend the money?  Something other than an ad campaign?

Please share ideas in the comments section, and I’m happy to pass any really good ones along to the Office of Public Health (or, of course, you can do so yourself).