Consumers’ estimation of calorie content at fast food restaurants: cross sectional observational study.


Objective To investigate estimation of calorie (energy) content of meals from fast food restaurants in adults, adolescents, and school age children.

Design Cross sectional study of repeated visits to fast food restaurant chains.

Setting 89 fast food restaurants in four cities in New England, United States: McDonald’s, Burger King, Subway, Wendy’s, KFC, Dunkin’ Donuts.

Participants 1877 adults and 330 school age children visiting restaurants at dinnertime (evening meal) in 2010 and 2011; 1178 adolescents visiting restaurants after school or at lunchtime in 2010 and 2011.

Main outcome measure Estimated calorie content of purchased meals.

Results Among adults, adolescents, and school age children, the mean actual calorie content of meals was 836 calories (SD 465), 756 calories (SD 455), and 733 calories (SD 359), respectively. A calorie is equivalent to 4.18 kJ. Compared with the actual figures, participants underestimated calorie content by means of 175 calories (95% confidence interval 145 to 205), 259 calories (227 to 291), and 175 calories (108 to 242), respectively. In multivariable linear regression models, underestimation of calorie content increased substantially as the actual meal calorie content increased. Adults and adolescents eating at Subway estimated 20% and 25% lower calorie content than McDonald’s diners (relative change 0.80, 95% confidence interval 0.66 to 0.96; 0.75, 0.57 to 0.99).

Conclusions People eating at fast food restaurants underestimate the calorie content of meals, especially large meals. Education of consumers through calorie menu labeling and other outreach efforts might reduce the large degree of underestimation.


In this study of diners at fast food chain restaurants in four New England cities, we found that participants purchased large meals, and adults, adolescents, and (parents of) school age children underestimated the calorie content of those meals by 175 calories, 259 calories, and 175 calories, respectively. Nearly a quarter of adults, adolescents, and (parents of) school age children underestimated meal calorie content by 500 or more calories. Estimated calorie content was strongly associated with actual calorie content for each of the samples. Noticing calorie information in the restaurant had no effect on the accuracy of calorie estimations.

In a study of 147 fast food restaurant diners at food courts, Chandon and Wansink also found that people underestimated the calorie content of purchased meals, with larger underestimation for higher calorie meals and no association with recognition of nutritional information in the restaurants.2 Compared with that study and other previous research,1 4 our study has the advantages of a large sample size, comparison of diners at six restaurant chains across four cities, recruitment of a racially and ethnically diverse study population in three age groups, and investigation of predictors of underestimation.

Adult and adolescent diners at Subway restaurants estimated lower calorie content than diners at the other chains. These findings suggest a consistent “health halo” for Subway in these age groups. In a study of 518 participants eating meals with equivalent calorie content at McDonald’s and Subway, Chandon and Wansink found that participants estimated 151 fewer calories at Subway than at McDonald’s.3 Participants also ordered side dishes with more calories at Subway. Dieticians also falsely considered equivalent calorie meals to be lower calorie at Subway than McDonald’s.3Our study extends these findings by showing that this “health halo” is unique to Subway across the six chains and is present across age groups in a diverse sample.

Branding could be an important component of Subway’s “health halo.” Marketing researchers have found that brand positioning is particularly important in guiding consumer choices when specific information about products is not available.8 For example, simply labeling a food item as “heart healthy” led consumers in one experiment to conclude that the item conferred a lower risk of heart disease and stroke than similar unlabeled foods.9 Subway’s positioning as a “healthier” fast food option might lead consumers to view its food as lower calorie, especially when calorie information is not readily apparent.

The forthcoming US federal regulation on labeling calorie content on menus could alter this “health halo” by providing easily accessible information on menus and menu boards.10 11 Previous research has found that information can be most powerful when it contradicts previous expectations (in this case, improper estimation of calorie content of foods with a “health halo”).12 Unlike previous state and local regulations, the federal regulation will also require an anchoring statement that indicates recommended total daily calorie requirements. In our study, participants’ estimates of meal calories strongly correlated with their estimates of total daily requirements, supporting inclusion of daily requirements on menus as an “anchor.” Thus far, research about the effects of calorie menu labeling, in both real world and experimental settings, has been mixed.113 14 15 16 17 18 19 20 21 22 23 24 25 26 It is difficult to ascertain why these studies had inconsistent results, but differing study designs, demographic characteristics, the rare use of an anchoring statement, and weight status might be involved.

In addition to providing an anchoring statement on menus, policymakers could perhaps improve menu labeling by supporting social marketing campaigns to better explain the concept of calories. These efforts could bolster not only menu labeling but nutritional labeling of packaged foods.


In this study of over 3000 diners at six fast food restaurant chains across four diverse New England cities, we found that adults, adolescents, and parents of school age children generally underestimated the calories of meals, especially if the meal was large. Adults and adolescents dining at Subway underestimated calorie content more than diners at other chains. The forthcoming calorie menu labeling requirements of the US Patient Protection and Affordable Care Act might help to correct underestimation of calorie content.

What is already known on this topic

  • Consumers are known to underestimate the calorie content of restaurant meals, especially for large calorie meals
  • Previous studies have been conducted in experimental settings without monitoring consumer choices at actual fast food restaurants, have focused on a narrow range of fast food restaurants, or have enrolled samples with limited racial/ethnic or age group diversity
  • All age groups and racial/ethnic groups studied underestimated the calorie content of meals from fast food restaurants

What this study adds


Source: BMJ



Toilet Issue: Anthropologists Uncover All the Ways We’ve Wiped.


The last time I visited Boston’s Museum of Fine Arts was in 2004 to see a Rembrandt exhibition. But I might have wandered away from the works of the Dutch master in search of an ancient Greek artifact, had I known at the time that the object in question, a wine vessel, was in the museum’s collection. According to the 2012 Christmas issue of the BMJ (preacronymically known as the British Medical Journal), the 2,500-year-old cup, created by one of the anonymous artisans who helped to shape Western culture, is adorned with the image of a man wiping his butt.

That revelation appears in an article entitled “Toilet Hygiene in the Classical Era,” by French anthropologist and forensic medicine researcher Philippe Charlier and his colleagues. Their report examines tidying techniques used way back—and the resultant medical issues. Such a study is in keeping with the BMJ‘s tradition of offbeat subject matter for its late December issue—as noted in this space five years ago: “Had the Puritans never left Britain for New England, they might later have fled the British Medical Journal to found the New England Journal of Medicine.”

The toilet hygiene piece reminds us that practices considered routine in one place or time may be unknown elsewhere or elsetime. The first known reference to toilet paper in the West does not appear until the 16th century, when satirist François Rabelais mentions that it doesn’t work particularly well at its assigned task. Of course, the ready availability of paper of any kind is a relatively recent development. And so, the study’s authors say, “anal cleaning can be carried out in various ways according to local customs and climate, including with water (using a bidet, for example), leaves, grass, stones, corn cobs, animal furs, sticks, snow, seashells, and, lastly, hands.” Sure, aesthetic sensibility insists on hands being the choice of last resort, but reason marks seashells as the choice to pull up the rear. “Squeezably soft” is the last thing to come to mind about, say, razor clams.

Charlier et al. cite no less an authority than philosopher Seneca to inform us that “during the Greco-Roman period, a sponge fixed to a stick (tersorium) was used to clean the buttocks after defecation; the sponge was then replaced in a bucket filled with salt water or vinegar water.” Talk about your low-flow toilets. The authors go on to note the use of rounded “fragments of ceramic known as ‘pessoi’ (meaning pebbles), a term also used to denote an ancient board game.” (The relieved man on the Museum of Fine Arts’s wine cup is using a singular pessos for his finishing touches.) The ancient Greek game pessoi is not related to the ancient Asian game Go, despite how semantically satisfying it would be if one used stones from Go after one Went.

According to the BMJ piece, a Greek axiom about frugality cites the use of pessoi and their purpose: “Three stones are enough to wipe.” The modern equivalent is probably the purposefully self-contradictory “toilet paper doesn’t grow on trees.”

Some pessoi may have originated as ostraca, pieces of broken ceramic on which the Greeks of old inscribed the names of enemies. The ostraca were used to vote for some pain-in-the-well-you-know to be thrown out of town—hence, “ostracized.” The creative employment of ostraca as pessoi allowed for “literally putting faecal matter on the name of hated individuals,” Charlier and company suggest. Ostraca have been found bearing the name of Socrates, which is not surprising considering they hemlocked him up and threw away the key. (Technically, he hemlocked himself, but we could spend hours in Socratic debate about who took ultimate responsibility.)

Putting shards of a hard substance, however polished, in one’s delicate places has some obvious medical risks. “The abrasive characteristics of ceramic,” the authors write, “suggest that long term use of pessoi could have resulted in local irritation, skin or mucosal damage, or complications of external haemorrhoids.”

To quote Shakespeare, “There’s a divinity that shapes our ends.” Sadly, for millennia the materials used to clean our divinely shaped ends were decidedly rough-hewn.

Source: Scientific American.

Dana-Farber compounds or creates medication tailored for individual patients.

News of unclean facilities and lax safety standards at the New England Compounding Center in Framingham has cast a public spotlight on compounding — a critical, but not widely known, sector of the pharmaceutical industry. To learn more about compounding, its role in cancer treatment, and its use at Dana-Farber, DFCI Online spoke recently with Sylvia Bartel, RPh, MHP, the Institute’s vice president of Pharmacy Services.


What is pharmaceutical compounding?

It’s the preparation of sterile products used to treat patients intravenously. Such medications could be chemotherapy agents, antiemetics (which prevent nausea and vomiting), support medications, or vaccines.

Does Dana-Farber’s pharmacy do compounding?

Yes. The dose of chemotherapy a patient receives is based on his or her height, weight, and individual health circumstances. Because those factors vary from patient to patient and visit to visit, we prepare patient-specific doses on-site.

What are the main types of medications compounded here?

In general, they’re chemotherapy agents and biotherapies (drugs that stimulate the body’s immune system defenses) that treat a patient’s cancer. We also prepare antiemetics, as well as intravenous fluid solutions that could contain potassium or magnesium to prevent the depletion of these nutrients in patients receiving chemotherapy.

Does Dana-Farber use products from the New England Compounding Center?

The only products we’ve purchased from the New England Compounding Center are two topical solutions (agents applied to tissue) used in gynecologic procedures.

What is done to ensure the safety of products compounded here?

We have numerous safeguards to ensure the proper preparation of sterile products. We train and monitor our staff in correct preparation techniques. We routinely test staff members’ sterile technique and the work environment for microbial growth. We’ve implemented a series of quality-control checks and report regularly to the Institute’s Infection Control Committee.

What specific safety precautions are in place?

We follow USP 797, a set of regulations developed by the United States Pharmacopeial Convention, a scientific organization that sets standards for the purity of medicines. The standards govern the preparation of sterile products in “clean rooms” where dust and foreign matter is kept below certain levels. Products are prepared within biological safety cabinets within the clean rooms. Before entering a clean room, the staff washes their hands and put on special clothing, much like that used in an operating room. Clean rooms undergo specific cleaning procedures on a daily, weekly, and monthly basis, and we routinely test surfaces from to ensure there is no microbial growth.

Watch the video on youtube.URL:

Source: Dana-Farber cancer institute.

Compounding Pharmacies Come Under Scrutiny in Light of Meningitis Outbreak.

Compounding pharmacies are getting widespread attention in the midst of the fungal meningitis outbreak that has affected at least 170 patients and claimed 14 lives. The outbreak has been linked to methylprednisolone acetate injections distributed by the New England Compounding Center (NECC) in Massachusetts.

Compounding pharmacies are not regulated by the FDA but rather “are subject to a patchwork of state oversight,” Reuters notes. A second compounding pharmacy in Massachusetts, Ameridose, temporarily closed pending an inspection by state officials. NECC and Ameridose share an owner.

In other outbreak-related news, the CDC says that 10 of the meningitis patients have tested positive for the fungus Exserohilum and 1 for Aspergillus.

In Tennessee, the hardest hit state, health officials estimate that 5% of patients who received the implicated injections from NECC have contracted meningitis.

Source: Wall Street Journal


World of Warcraft hobby sparks US political row.

The gaming hobby of a political candidate has become an issue in a state senate race in New England, US.

Maine Republicans have created a webpage revealing that Democrat candidate Colleen Lachowicz plays an orc rogue in World of Warcraft (WoW).

Ms Lachowicz’s liking for back-stabbing and poison in WoW raise questions about her “fitness for office”, they claim.

Ms Lachowicz has hit back saying the attack showed the Republicans were “out of touch”.

Weird focus

The state senate seat known as District 25 in Maine, is currently being contested by Ms Lachowicz and incumbent Republican Tom Martin. Voting takes place on 6 November.

As part of its campaign efforts, the Republican party in the state created “Colleen’s World” – a website that compiles information about Ms Lachowicz’s orc rogue Santiaga. An orc is a mythical human-like creature, generally described as fierce and combative.

In a statement that accompanies the webpage, Maine Republicans said playing the game led Ms Lachowicz to live a “bizarre double life” that raised questions about her ability to represent the state.

The page also detailed some of the comments Ms Lachowicz has made while talking about her orc rogue, in particular it highlights her affection for Santiaga’s ability to stab things and kill people without suffering a jail sentence.

“These are some very bizarre and offensive comments,” said Maine Republican Party spokesman David Sorensen in a statement. “They certainly raise questions about Lachowicz’s maturity and her ability to make serious decisions for the people of Senate District 25.”

The site also lists many of the 400 comments she has posted to left wing political news and discussion site Daily Kos. Maine Republicans have also posted leaflets that reproduce the information on the website.

“I think it’s weird that I’m being targeted for playing online games,” saidMs Lachowicz in a statement. “Apparently I’m in good company since there are 183 million other Americans who also enjoy online games.

“Instead of talking about what they’re doing for Maine people, they’re making fun of me for playing video games,” said Ms Lachowicz.

It is not clear what effect the Republican tactic will have on the state senate race in Maine. However, many messages of support have been left on Ms Lachowicz’s own webpage with some pledging cash to her campaign.

Gaming researcher Ladan Cockshut said the row revealed how gaming can be seen as a bad thing to do.

“In my work, I’ve spoken with many people who in their regular lives have roles of significant responsibility (as doctors, managers, or educators) but who choose carefully with whom they disclose their gaming activity,” she told the BBC. “And disclosing their gaming activity is often accompanied by a degree of apology or embarrassment.”

But, she added, having a gamer run for office was a “heartening” development.

“This would seem to run contrary to the other stereotypes that we love to assign to gamers: that they are lazy, antisocial people who don’t have a ‘real life’,” she said. “Maybe this will trigger some dialogue about our perceptions of gamers and the role that games can and should play in modern society.”


Whales & Sharks from Above: A Fish Spotter’s Amazing Tale.

Wayne Davis has been spotting fish for 40 years, flying his airplane low over the water in search of bluefin tuna and swordfish. Usually he guides commercial fishermen to them.

But in all of his flights over the Atlantic from his home in Wakefield, R.I., he’s seen a lot of other animals, including sharks and whales. And he’s taken photographs.

“A lot of people don’t believe me when I tell them about seeing these animals in New England,” Davis said. The photographs are proof.

Having worked with fishermen since purchasing his single-engine Citabria airplane in 1973, he recently tired of chasing fish. So he has strayed even farther from shore to find whale sharks, hammerheads, great white sharksbasking sharks, humpback whales, mobula rays and other giants of the deep.

He’s partnered with underwater cinematographers and researchers to help them film and study these amazing animals. [Images: Sharks & Whales from Above]

Hammerhead close encounter

Two weeks ago, on Aug. 22, Davis helped underwater cinematographers Tom Burns and Eric Savetsky find a school of about 20 hammerhead sharks above Oceanographer’s Canyon, 100 miles (160 kilometers) southeast of Nantucket, Mass. Davis saw the sharks from his plane and radioed their position to Burns and Savetsky. They piloted their boat toward the sharks and hopped into the water.

After failing at first to get close to the scalloped hammerheads, which are usually pretty shy, the school approached and surrounded the duo, Savetsky told OurAmazingPlanet. “It was fantastic from a visual experience, but a little unnerving because they were acting bolder than I typically know them to be,” he said. But they didn’t get too close, and swam off after a couple passes.

“It was an amazing experience, to swim among them, that never would have been possible without Wayne,” Burns said.

At some point, Savetsky took his eye off the camera to gauge his surroundings. “When I looked up, there was a 500-pound [230 kilograms] tiger shark about 10 feet [3 meters] away, and I actually screamed into my snorkel,” he said.

Savetsky put his camera in front of him not only to film the animal but to protect himself, since tiger sharks can occasionally become aggressive toward swimmers on the surface. Luckily it seemed merely to be curious, and it soon disappeared into the deep.

Finding great whites

Davis has also worked with Greg Skomal, a scientist with the Massachusetts Division of Marine Fisheries, helping Skomal find great white sharks and other animals. On Aug. 27, 2010, off the coast of Chatham, Mass., Davis helped guide Skomal and other researchers to the carcass of a dead humpback whale, which was being circled by a great white.

The researchers tied the humpback whale to the boat and put down a cage to observe the shark up close. This also allowed them to tag the animal, to find out where it spends its time. Sharks are often found near dead whales, which they feed upon.

Davis grew up in New England and was always interested in flying. After serving in Vietnam, he decided to become a spotter pilot and bought his own plane. For 25 years he did hard labor as a deckhand on commercial vessels and worked a fish-spotter in the offseason. Now he just flies.

Skomal said Davis’ expertise is invaluable in finding and correctly identifying animals, as is his ability to photograph what he sees. Sometimes Davis will tell Skomal if he finds anything interesting, and other times Skomal will hire Davis to locate animals.

Davis’ photographs allow Skomal to know what animals show up where, but they also give an idea of the animals’ size and condition. The photograph of the great white, for example, tells Skomal the animal is about 18 feet (5 m) long, as it’s half the size of the 35-foot (11 m) boat. The animals are known to reach about 22 feet (6.7 m) in length.

“That was a big one,” Skomal said.

Source: Amazing planet