Thinking About Health: If you knew how many calories are in that sandwich, would you still eat it?

By Trudy Lieberman
Rural Health News Service

Not long ago my husband showed up with a sandwich for lunch that he bought at a local supermarket. I thought it was going to be our usual: turkey and provolone with lettuce on a hard roll, always plenty for both of us. At $6.50, how could you go wrong?

This time the sandwich was different. It now cost $9.50 and was piled high with turkey and cheese on a roll that was much bigger than what we were used to. In short, it was awful – enough meat and cheese for four people on squishy bread that tasted more like a morning sweet roll. But the bigger serving probably looked like a good deal to a lot of people who thought only about size relative to cost and nothing about size or cost relative to calories.

After surgery on the sandwich, the two of us ate some of it and saved slices of the meat and cheese for later. My guess is most buyers would have eaten the whole thing believing they were getting great value for the money. Maybe they were, but they were also getting at least half the calories most of them needed for the day.

Take the calories we consume at breakfast and dinner plus a bunch of Cokes and other sweet drinks we sip through the day, and that sandwich likely would put people well over their ideal daily caloric intake.

Too many calories, as we all know, leads to obesity and serious health complications. The picture isn’t pretty. According to the National Institutes of Health, more than two‐thirds of adults are overweight or obese and more than one-third are obese.

Yet if we connect the dots, we see more and more of this money-for-value proposition in the foods we buy away from home, which prompts us to consume more calories than we need. An average American eats about one-quarter of his or her calories from chain restaurants, says Margo Wootan, the national nutrition director for the advocacy group Center for Science in the Public Interest.

Think about how many times you want a Coke in the afternoon. I do, but I won’t pay for a 16 or 20‐ounce soda. It’s way more than I can drink, and for me a waste of calories at any price. But if it seems like we’re getting more for less money, people will probably drink more.

Would our collective behavior change if the food we eat outside our kitchens came with calorie labels that clued us in on what exactly we were consuming? The Affordable Care Act called for supermarkets, movie theaters, convenience stores and restaurant chains with more than 20 outlets to post the calories for the items they sell.

The Food and Drug Administration issued regulations late last year, but the final rules have been delayed until the end of 2016. In the meantime, several localities like New York City and Philadelphia now require calorie labeling.

What prompted me to take a second look at what seems a sensible public health measure was a post I read recently on the blog of the Incidental Economist where Aaron Carroll, one of the editors-in-chief and a professor of pediatrics at the University of Indiana, argued that a systematic review of all the studies done in the few localities where labeling exists showed “Although current evidence does not support a significant impact on calories ordered,” labeling is a “relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.”

Carroll quarreled with the idea that labeling is actually a low-cost strategy. I tried to reach him, but he did not respond. So I phoned Wootan, who said the studies and the conclusions were based on very small numbers of participants.

Besides that, she said, small dietary changes can make a big difference. “The whole obesity epidemic can be explained by 100 to 150 calories more than people need on average per day,” she said. It boils down to choices like the one we made not to eat the overstuffed sandwich at one sitting.

My neighborhood Chipotle says a burrito could have 450 calories or 1,025 depending on what you put on it. The order taker said salsas had fewer calories than cheese and sour cream. Chicken, she said, was the most popular meat. Apparently customers believe that calorie-wise it’s better to eat chicken than the beef or pork options. But chicken with sour cream and cheese could pack more of a caloric hit than pork carnitas with salsa.

That’s why calorie labeling is an important step toward sensible eating and better health.

We’d like to hear what you think of calorie labeling. Write to Trudy at

Editor’s note: The Rural Health News Service is funded by a grant from The Commonwealth Fund and is distributed through the Nebraska Press Assn. Foundation, Colorado Press Assn., South Dakota Newspaper Assn., Hoosier (IN) State Press Assn., Illinois Press Assn., Wyoming Press Assn. and California Newspaper Publishers Assn.