Thinking about health: How many calories are in that Big Mac?

When you next eat at McDonald’s, here’s an exercise in consumer choice: Would you choose a Bacon Club House burger with 750 calories, a Big Mac with 550 calories, or the premium McWrap with bacon and grilled chicken giving you 460?

You might think twice if you knew that one option gave you 300 calories more than another and, all by itself, proved you with over one third of the calories you need for the day (based on a 2,000 calorie diet).

Beginning in the summer 2015, you’ll be able to figure it out. That’s when a provision in the Affordable Care Act that requires chain restaurants with 20 or more national outlets to reveal how many calories are in Big Macs, stuffed burritos and breakfast pastries takes effect. That labeling will allow customers to see how many calories contribute to their daily intake and maybe, just maybe, will help Americans eat healthier foods.  

While insurance for the uninsured has grabbed most of the headlines, good and bad, insurance coverage may not be the provision in the Affordable Care Act that will have the biggest on health. A way to pay for medical care is important, but my vote goes to the calorie labeling provisions. The FDA has also proposed in a rule implementing the law that calorie-labeling requirements should also apply to supermarkets and convenience stores serving ready-prepared foods.

“I’ve been stunned by how many calories are in popular restaurant foods and how difficult it is to tell the difference between items,” says Margot Wootan, director of nutrition policy at the Center for Science in the Public Interest, a food advocacy group. “There’s a real difference between a regular hamburger at 200 to 300 calories, a bigger hamburger that has 400 to 500 calories and a triple burger with 700.”

Without calorie labeling, though, it’s not always apparent which is the healthier choice. Sometimes, Wootan explains, a tuna salad sandwich has 50 percent more calories than one made with roast beef.  Why, I asked. A giant scoop of salad, which is all too common in such sandwiches, along with the mayo are the culprits. But only calorie labels will tell you that.

We’ve had calorie labeling for several years in New York City, one of 18 localities and states that have passed labeling requirements. Not all have gone into effect because some jurisdictions have decided to wait for the federal law to kick in. As a consumer I appreciate the labels that prompt me to buy a banana at the airport instead of a big, fat cinnamon roll when I am waiting for a plane.

Over the last decade or so eating out has gone from being a special occasion treat to something families do when they don’t want to cook. As portion sizes in restaurants have gotten much larger, knowing how many calories you are consuming has taken on a new urgency. “The bigger the portion size, the more you eat,” Wootan says. Consumers are sold on the proposition that big servings mean you’re getting more value for your money.

Some early studies evaluating labeling in New York were too small to say whether the labels were changing eating behavior. Larger studies have been more conclusive. A large study in New York found that one in six people purchased 100 fewer calories after labeling took effect.

A Stanford University study looking at labels on products sold at Starbucks found they had no effect on beverage consumption but contributed to a 14 percent decrease in consumption of other foods. In other words, customers were not going to give up on that 470-calorie white chocolate mocha but reconsidered their food choice before buying a 480-calorie old fashioned glazed donut.

When it comes to beverages, Wootan says, customers had a good sense of the calories they contained, but they got the same thing every day. Habit seemed to trump nutrition. It was a different story with other foods. “They were more flexible with food.”

The labeling has prompted sellers to be more aware of their product formulations, too, cutting down calories where they can. A Starbucks store manager told me the company began using 2 percent instead of whole milk in its drinks and took an apple fritter with some 600 calories off the menu when the labeling law took effect.

The labels don’t force consumers to do anything or change the way they eat. They simply provide information that lets them know what they are eating and helps signal that too many calories may contribute to serious health conditions.

Just knowing that McDonalds Filet-o-Fish has 390 calories while a Southwest salad with grilled chicken has only 290 might lead to healthier choices. But the calorie labels still let you have it your way.