Once upon a time there was a rich city. Rich and poor people lived in skyscrapers and spoke as many different languages as was known on the earth. Its name was New (and it was) York (because of an ancestor’s claim). However something became wrong. A third of the population became very fat and started to die from it. Doctors started to claim that something had to be done and some politicians agreed. That’s where a paper by Thomas A. Farley¹ starts and describes a two year struggle, started in 2006, to innovate food regulation. The New York City Health Department tried to launch an original programme, based on epidemiological evidence and preventing unaware overeating.

Show the calorie contents of food

The idea was very simple: show in fast food chain restaurants, the calorie contents of food. No more, no less. The intent was to put an easy to read label near the food items so that the customer could get the information before they made a choice. This goal was chosen by the New York City Health department because 10% of such food chains account for a third of all restaurant traffic and consumer surveys show that these restaurants markedly underestimate the calorie content of the servings. An amazing struggle occurred: the food industry tried to:

1. demonstrate that calorie content was a claim, while it’s only a fact,
   
2. show that this measure was in opposition with the United States constitution since it was violating the First amendment on Freedom of speech. This amendment does not only allow people to say what they want, but also to say things they do not want to say!

   Lawsuits took place at the initiative of the New York State Restaurant Association. Other states were encouraged to take protective measures against labelling. Many scientific societies supported the NYC Health department, except the president elect of the…Obesity Society!

   At the end of the day, some information became mandatory!
   The authors draw lessons from the fight of New York against fast food industry:

• The first one is that obesity is a Public Health concern that must be tackled by an appointed body as should any chronic disease.
  
• The second lesson is that a voluntary basis for action is unlikely to be effective.
  
• The third lesson is that many public health disciplines are needed for success.
  
• The fourth lesson is that local action can prove powerful! Impact of the food labelling

A first look at the effect of the intervention, reported by Elbel et al.² evaluated the impact of implementation of food labelling.
Fourteen fast foods “interventions” in New York were compared to four controls in Newark. Deprived areas were selected in both cases. An analysis was conducted on 55% of 1,156 recipients. Mean calorie selection was not influenced by the labelling.

However, 27.7% of customers who saw labelling said the information influenced their choice. The authors comment on the limited number of fast food restaurants which participated and to the difficulty of influencing people of low socio-economical status who carry the heaviest burden (in all meanings of the word). They conclude that responsiveness of a fourth of the surveyed group is not enough, but encouraging.

Three years later, in 2009, the First Lady herself started taking part in the fight and trying to help schools and the youth of the whole country to get rid of junk foods! Data now shows that the epidemic of obesity is levelling off. Action at local level is necessary but should be backed by the clear message that preventing obesity is a national and global challenge and responsibility.