Study looks at NYC fast-food menu calorie counts (AP)

NEW YORK � Like any fitness program, it works only if you pay attention to it.

A new study on New York City's effort to encourage healthy eating by posting calorie counts on menus shows that it worked for about one in six customers � or those who paid heed to them. Those who ignored the numbers or didn't see them ordered whatever they wanted, regardless of how fattening it was.

City health officials who conducted the study said that's good news. On any given visit, customers who looked at the counts generally ordered about 100 fewer calories than those who didn't, according to the results of the study published Tuesday in the British medical journal BMJ.

In 2008, New York became the first municipality in the U.S. to require chain restaurants to post the counts, and other places including California and Seattle followed suit. Starting next year, a federal law will require all chains with 20 or more locations to print calorie counts on menus. British fast-food restaurants are set to introduce a similar but voluntary initiative.

The study was the first large-scale look at the initiative's success at several different chains. Lynn D. Silver, assistant commissioner of the city Department of Health and Mental Hygiene and one of the study's authors, said it showed modest gains in getting people to order lower-calorie meals. But she said the law also led restaurants to widen their offerings of healthier food, such as salads.

"Calorie labeling alone won't cure the obesity epidemic but it is one part of trying to address it," Silver said.

About a third of adults in the U.S. are obese, according to the federal Centers for Disease Control and Prevention.

The study looked at lunchtime purchases at 11 fast-food chains around New York in 2007, before the city law was passed, and then again in 2009. Researchers asked customers for their receipts and spoke to them about their orders. There was no significant change overall. But customers did order fewer calories, on average, at three major chains: McDonald's, Au Bon Pain and KFC. The study notes that those restaurants also introduced healthier choices around the same time the law was passed.

Meanwhile, the sandwich shop Subway showed a big increase in the average calorie count of a lunch order, which the authors linked to the popularity of its "$5 foot-long" deal, introduced nationally in 2008.

The study found that more than 20 percent of customers at Subway and Au Bon Pain paid attention to the calorie counts, an increase from the overall average of 15 percent. Women were more likely to use them when deciding what to order, as were people in wealthier neighborhoods. Young people were the least likely to use them.

The study noted that people are increasingly relying on food prepared away from home.

"There is a strong and growing consensus that consumers want to know what they are eating so that they can make informed choices," the authors wrote.

In a separate development on Tuesday, McDonald's announced changes to its iconic Happy Meal, making the portion of French fries smaller and adding fruit.

Marion Nestle, a professor at New York University's Department of Nutrition, Food Studies and Public Health and author of the blog "Food Politics," said the study confirms that once people pay attention to the calorie counts, they make dietary changes.

"The next step has to be to get more people to look at the info," she said.

In New York City's Midtown at lunchtime on Tuesday, Carlos Munoz, a 29-year-old student at a technical school, munched on a chicken wrap, fries and a soda from McDonald's.

"I don't really pay any mind to it," he said of calorie counts. "I figure one bad thing a day I should be able to burn away."

But he supported their presence on menus.

"You should know what you're putting into your body," he said. "If I'm ever curious, I'd like to know I can get the information."

Inside Starbucks, Alexandra Casey, 23, of Worcester, Ma., said she looks at calorie counts when they're posted. But as a vegan and avid runner, she was more concerned with overall nutritional content rather than just calories. For example, nuts might be high in calories but they're still a better choice than cake.

Casey applauded New York for leading the way in posting the counts but said eateries should provide more comprehensive information about the food and beverages they offer.

"It's not just about a number," she said. "The question is, what's the content of those calories."

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Karen Zraick can be reached at http://www.twitter.com/karenzraick

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Online:

http://www.bmj.com/content/343/bmj.d4464

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Study: Medicare drug plan saves hospital costs (AP)

CHICAGO � A new study suggests that Medicare's 5-year-old prescription drug plan is keeping seniors out of hospitals and nursing homes, saving the federal program an estimated $12 billion a year in those costs.

The savings only offset a portion of the $55 billion a year the government spends on Medicare Part D, as the drug plan is known. But the study's authors say it means seniors are staying healthier and enjoying a better quality of life.

"This is what people always hope for: If people get drug coverage, they won't need hospitalization," said Marsha Gold of the nonpartisan Mathematica Policy Research, who wasn't involved in the new study. "If it holds up, that's great news."

The Harvard analysis, appearing in Wednesday's Journal of the American Medical Association, found Medicare saved an average of about $1,200 a year for each senior citizen who had inadequate drug coverage before Medicare Part D. Most of the savings came from hospital and nursing home costs.

That translates to an annual savings of $12 billion, experts said.

With subsidized drug coverage, seniors can afford drugs that prevent trips to the emergency room by lowering cholesterol and blood pressure and controlling diabetes, said lead author Dr. Michael McWilliams of Harvard Medical School.

Other savings come from doctors no longer admitting patients to hospitals just so Medicare would pay for drug treatments � like injectable clot-busting drugs for deep vein thrombosis � that can be given more cheaply in a doctor's office, McWilliams said.

"Spending on one type of service can reduce spending on another type of service," McWilliams said. "By expanding Medicare to include drug benefits, clearly we're spending more, but we're getting a lot of value out of that spending."

The findings suggest that lawmakers, while grappling with reducing the federal deficit, should consider all of Medicare's moving parts and how they affect each other, experts said.

"It's critical to think about the entire program. They can't just be thinking about how to pay hospitals differently," said Julie Donohue, a health policy researcher at the University of Pittsburgh, who wasn't involved in the new study. "They have to think about the whole delivery system and the whole Medicare system."

It's tough for researchers to pinpoint the effect of a policy change because they usually can't randomly assign people to participate in a program or not. Medicare Part D is voluntary. Enrollees pay premiums that cover about 25 percent of the cost. There were 23 million Part D beneficiaries last year.

For the new study, researchers analyzed nondrug Medicare spending for about 6,000 seniors from 2004 through 2007.

The Medicare drug benefit started in January 2006. Before then, about 2,500 of the seniors in the study reported having generous drug coverage, which many bought as supplemental insurance. About 3,500 reported having limited or no drug coverage.

By comparing spending trends before and after 2006, the researchers were able to calculate any nondrug savings.

Previous studies show Medicare Part D increased use of antibiotics and drugs for diabetes, high blood pressure, depression and other chronic conditions.

The nation's 1-year-old health care law is gradually closing the Medicare drug coverage gap, the "doughnut hole," which also should keep seniors out of hospitals, McWilliams said.

But another view on the doughnut hole came from Joseph Antos, a health policy expert at the conservative-leaning American Enterprise Institute. Antos said the doughnut hole "turned out to be a very good idea" because it encourages seniors to use cheaper generics instead of more expensive brand-name drugs.

"It's disastrous policy to whittle away at the doughnut hole," Antos said. "If we see generic usage drop, that means the program is going to cost more."

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Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson.

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Online:

JAMA: http://jama.ama-assn.org

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