AMA House of Delegates

Mario E. Motta, MD, a cardiologist and a member of the AMA Council on Science and Public Health. Photo by Ted Grudzinski / AMA

AMA delegates call for price parity in fast-food options

The AMA says restaurants should similarly price nutritious items in children's meals with ones that are less healthy.

By Christine S. Moyer — Posted July 4, 2011

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Offering healthy items in fast-food children's meals is not enough to help curb the nation's childhood obesity epidemic, the American Medical Association said. Nutritious foods need to be priced similarly with less-healthy options, according to policy adopted by the AMA House of Delegates during its Annual Meeting.

"Fast food companies in the past few years have provided healthier options, but they continue to be offered at a higher price. This discourages families" from purchasing these products, said Christopher Paprzycki, a regional medical student delegate from Toledo, Ohio.

Sue Hensley, a spokeswoman for the National Restaurant Assn., said she was not familiar with a price disparity between unhealthy food and more nutritious options at fast-food restaurants. But, she said, the top trend among such companies in 2010 was to add healthy choices to their children's menus.

Food companies spend nearly $2 billion a year marketing foods and beverages to children, according to the Center for Science in the Public Interest. Many of these products are high in calories, fats, sugars and sodium, said the center, a nonprofit consumer organization focused on nutrition and food safety.

Salem, Mass., cardiologist Mario E. Motta, MD, said the problem is that children do not have the same ability as adults to rationalize that the food being advertised is not good for them.

"I know it's a parent's responsibility [to buy nutritious food]," said Dr. Motta, a member of the AMA Council on Science and Public Health, speaking for himself. "But it's very difficult to say no to children."

Delegates approved policy that directs the AMA to encourage corporate social responsibility in the use of marketing incentives that promote healthy childhood behaviors, including eating nutritious foods.

Delegates also said the AMA should support the fact that parents have a responsibility to encourage their children to eat well-balanced meals.

"Through all aspects of health care, the most expensive diseases in our society are related to the things we put in our mouths. So we should encourage patient responsibility" to the patients we see and to the parents of young children, said Aaron Spitz, MD, a urologist in Laguna Hills, Calif., and a delegate for the American Urological Assn.

Childhood obesity epidemic

The house action comes as about 17% (12.5 million) of the nation's children and adolescents are obese, according to the most recent data from the Centers for Disease Control and Prevention. Since 1980, obesity prevalence among this age group almost has tripled, the CDC said.

Communities across the country are addressing the nutritional value of fast-food children's meals.

For example, Santa Clara County in California adopted an ordinance in April 2010 banning restaurants from giving away toys with meals that have more than 485 calories.

In June, fast-food restaurant Jack in the Box, which is based in San Diego, removed toys from its children's meals, said spokesman Brian Luscomb.

Delegates also directed the Association to recognize competitive eating as an unhealthy eating practice with potential adverse consequences.

Jerome Adams, MD, an Indianapolis anesthesiologist and an alternate delegate with the Young Physicians Section, defined speed eating as a subtype of binge eating. He said possible health consequences of competitive eating include stomach rupture.

"Whether it's on TV or at a state fair, speed eating is clearly not a healthy eating habit, even if some people find it entertaining," Dr. Adams said.

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Meeting notes: Public health

Issue: Increased awareness by physicians and the public of sickle cell disease and its treatment is needed.

Proposed action: A Board of Trustees Report called on the AMA to recognize sickle cell disease as a chronic illness; to encourage educational efforts on treatment and prevention; and to support newborn screening programs, genetic counseling and new research designed to speed the clinical implementation of new treatment. [Adopted]

Issue: Exposure to potentially harmful levels of mercury is prevalent in the population and has been implicated in a variety of secondary health effects such as cardiovascular morbidity, leukemia and reproductive toxicity. Approximately 188 cement kilns emit more than 11,000 pounds of mercury each year.

Proposed action: Direct the AMA to support modern and strict monitoring of mercury emissions from cement plants. [Adopted]

Issue: The Centers for Disease Control and Prevention has reported an increase in bloodborne infection transmissions caused by the shared use of fingerstick and point-of-care blood testing devices.

Proposed action: Encourage improved labeling of devices to make clear that multiple-use fingerstick devices made for single patients are intended for use only on single patients. [Adopted]

Issue: Pills are not easily identifiable by patients or physicians, which has led to harmful and sometimes fatal outcomes.

Proposed action: Strongly recommend to drug manufacturers that they put a consumer-friendly, unique identifier on the solid dosage forms and recommend that publishers of medication lists include a list of the identifiers. [Adopted]

Issue: Advertisers often alter photographs to enhance the appearance of models' bodies. Such alterations can contribute to unrealistic expectations of appropriate body image, particularly among children and adolescents.

Proposed action: Urge advertising associations to work with organizations that focus on child and adolescent health to develop guidelines discouraging the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image. The focus should be on ads that appear in teen-oriented publications. [Adopted]

Issue: Transgender patients commonly undergo hormone replacement therapy, during which they experience continuously elevated levels of testosterone, estrogen or other hormones over a period of months, years or even decades. Effects of short and medium terms of treatment have been studied, but the effects of long-term use are unknown.

Proposed action: Direct the AMA to encourage research into the impact of long-term administration of hormone replacement therapy in transgender patients. [Adopted]

Issue: At one year postpartum, almost 25% of women retained at least 10 pounds of the weight gained during pregnancy, according to a 2007 study. Additionally, more than half of all obstetrician-gynecologists surveyed considered their training on weight management to be "inadequate" or "nonexistent," said a 2006 report.

Proposed action: Encourage physician referrals of pregnant and recent postpartum patients for nutrition counseling. The policy also directs the AMA to advocate for the extension of health insurance coverage for nutrition counseling among such patients. [Adopted]

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