January 2012
Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
Nicky Bassford, MPP Lark Galloway-Gilliam, MPA Gwendolyn Flynn Breanna Nicole Morrison, MPL ACKNOWLEDGMENTS Our thanks to the many organizations and individuals who contributed to this project. Their cumulative efforts made this publication possible.
Los Angeles County Department of Public Health Principal Authors: Paul Simon, MD Lisa Nicky Bassford, MPP, Policy Analyst Jean Tremaine Lark Galloway-Gilliam, MPA, Executive Director Gwendolyn Flynn, Policy Director Breanna Nicole Morrison, MPL Public Health Law and Policy Manel Kappagoda, JD, MPH Design: Amy Ackerman, JD Aaron Makela, Print Media Collective Karen Kramer, JD [email protected] Heather Wooten, MCP www.printmediacollective.com Samantha Graff, JD Editor: Mabel Everette, RD Janice Taylor, Communications Director
Community Health Councils is a non-profit, community-based health advocacy, policy and educational organization. Established in 1992, our mission is to improve health and increase access to quality healthcare for uninsured, under-resourced and underserved populations.
This policy report is the second in a series of three on how policymakers, private industry and community members can change the South LA food resource environment by increasing access to healthy food outlets and preventing the proliferation of unhealthy food outlets. The first report FOR MORE INFORMATION, in this series, Food Desert to Food Oasis: Promoting Grocery Store Development in South Los CONTACT: Angeles, focused on food purchased for the home and proposed policy recommendations to Community Health Councils overcome barriers and encourage the establishment of new full-service grocery stores, healthy 3731 Stocker Street, Suite 201 corner stores, farmers’ markets and mobile produce vendors. The final report will address the Los Angeles, CA 90008 roles community members can play in advocating for policy changes, researching the needs Tel.: 323.295.9372 and strengths of their neighborhoods, and marketing their neighborhoods to potential healthy food retailers and developers. e-mail: [email protected] www.chc-inc.org This publication is part of the REACH US project supported with funding from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. © Community Health Councils, 2011 TABLE OF CONTENTS Executive Summary 2
Background 4
South Los Angeles Restaurant Environment 7
Fast Food and Health 10
Manufacturing Fast Food Demand 13
Regulating Fast Food Restaurant Development 16
South LA Solution 20
Sit-Down Restaurant Incentives 25
Implementation & Monitoring Compliance 27
Preventing Unintended Consequences 29
Conclusion 30
Appendices 31 South LA Fast Food Restaurant Maps Watsonville Healthy Eating Ordinance Points System and National Fruit & Vegetable Program Potential Constitutional Challenges Land Use Planning Tools Encouraging Restaurants to Offer Healthy Meals
Endnotes 39 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
EXECUTIVE SUMMARY
South Los Angeles is saturated with fast food restaurants that typically serve “unhealthy foods” — foods high in fat, sodium or sugar with few essential nutrients. Eating fast food has been associated with weight gain and lower intake of fruits, vegetables and other nutrient-rich foods that help prevent chronic diseases such as heart disease, cancer and diabetes. A growing body of evidence indicates a correlation between the proximity and density of fast food restaurants and greater fast food consumption. Americans’ growing dependence on dining out coupled with an abundance of fast food restaurants and lack of healthier alternatives in urban, lower-income and racial and ethnic communities like South Los Angeles (South LA) have disproportionately increased vulnerability to diet-related death and disease. The situation in South LA is critical as this community has the lowest life expectancy in the City of Los Angeles and the highest rates of obesity and several chronic diseases in LA County.
The residents of South Los Angeles need policies that create equal opportunities for them to purchase a meal or food consistent with the Dietary Guidelines for Americans when dining out. The Dietary Guidelines are the Federal government’s authoritative advice about good dietary habits and are designed to promote health and reduce risk for major chronic diseases. The City of Los Angeles established the Grocery Store and Sit-Down Restaurant Incentive Package in 2006 to attract new healthy food retailers to South LA. The package promoted the available financial incentives and offered assistance to identify potential sites, navigate the City’s permitting process and find qualified employees. The City passed an interim control ordinance (ICO) placing a moratorium on permits for new stand-alone establishments in South LA in 2008 to address the overconcentration of fast food restaurants. It then replaced the temporary policy in 2010 with an amendment to the City’s General Plan requiring that new restaurants locate at least a half mile from existing ones. The City continues to work on a comprehensive policy for fast food restaurant development in South LA.
This report builds upon these efforts and provides recommendations for strengthening the City’s fast food restaurant development policy and Sit-Down Restaurant Incentive Program to create a healthier environment in South LA. The recommendations are specific to the restaurant environment in South LA, which is in the jurisdiction of the City of Los Angeles. They are based on community knowledge, community-based research, and an extensive literature review that indicate the need to extend the scope of the policy to all fast food restaurants, not just stand-alone establishments, and target populations that are most dependent on their neighborhood food environment, particularly children and individuals who lack private transportation.
2 The recommendations also acknowledge that fast food restaurants are defined broadly in the Los Angeles Municipal Code based on characteristics unrelated to the nutritional quality of the food provided. A fast food restaurant is “any establishment which dispenses food for consumption on or off the premises, and which has the following characteristics: a limited menu, items prepared in advance or prepared or heated quickly, no table orders, and food served in disposable wrapping and containers.”1 The recommendations propose a strategy for limiting the density of unhealthy fast food restaurants while encouraging new healthy restaurants of all types including healthy limited-service restaurants.
The report recommends that the City of
Los Angeles adopt the following policies: 1. Extend the criteria to obtain a construction permit to all fast food restaurants in South LA, not just stand- alone establishments.
2. Add an additional criteria requiring new fast food restaurants in South LA to locate at least a half mile away from schools, parks, playgrounds, child care centers, recreation facilities, and other children-oriented facilities.
3. Add an additional criteria requiring new fast food restaurants in South LA to locate at least 750 feet from bus, rail and other transit stops.
4. Define a healthy restaurant using criteria based on the Dietary Guidelines for Americans.
5. Provide an exemption from distance requirements for fast food restaurants meeting the healthy restaurant definition.
6. Strengthen the City’s Grocery Store and Sit-Down Restaurant Incentive Program and extend incentives to healthy fast food restaurants.
7. Monitor healthy restaurants that receive zoning and/or financial incentives for continued compliance with the healthy restaurant criteria and establish penalties for non-compliance.
3 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
BACKGROUND
Community Health Councils (CHC), a nonprofit health policy and advocacy organization located in South LA, and the CHC-led African Americans Building a Legacy of Health (AABLH) coalition are among several community organizations working in partnership with policymakers, institutions and the private sector to increase investment in South LA and ensure all residents have access to healthy foods and opportunities for healthy living. CHC’s role in addressing the South LA food retail environment began in 1999 with a cooperative agreement from the Centers for Disease Control and Prevention’s REACH (Racial and Ethnic Approaches to Community Health) 2010 Initiative. This award allowed CHC to establish AABLH and bring together organizations and individuals in the community to address the social determinants of racial/ethnic disparities in diabetes, cardiovascular disease and other diseases.
AABLH developed a model for community change founded on a community-based participatory approach for assessing community needs, identifying policy and systems solutions and advocating in support of them. With the help of research- ers at the University of Southern California, AABLH trained community-based organizations and residents to survey restaurants, food markets and physical activity facilities in South LA and, as a comparison area, West LA. These community assessments found that South LA neighborhoods have much less diversity in dining options and more fast food restaurants than West LA neighborhoods. Diners in South LA also have fewer healthy options available to them in restaurants, both in food selection and preparation (e.g., broiled instead of fried). The assessments found that restaurants in South LA heavily promote unhealthy menu options to attract residents and are significantly less likely to promote healthy items compared to restaurants in West LA.2 Similarly, assessments of markets and physical activity facilities revealed significant disparities in supporting a healthy diet and active living.3-4
South LA City Council Representatives Jan Perry (9th District) and Bernard Parks (8th District) have consistently worked with CHC and AABLH to develop strategies for improving the South LA food retail environment. As a result of their leadership, City departments were charged with developing a package of incentives for attracting healthy food retailers and developers to South LA. Approved by the City Council in 2006, the Grocery Store and Sit-Down Restaurant Incentive Package combines available financial incentives — such as loans, grants, tax credits, and breaks on utility services — with assistance identifying potential sites, navigating the City’s permitting process and finding qualified employees. The City markets these incentives and services by advertising in trade publications, participating in outreach events and meeting with targeted retailers. These efforts have successfully attracted four grocery store development projects as of February 2010. The City continues to improve upon this initiative and is working on refining its marketing strategy and developing a new website to promote the Incentive Package.5 4 In 2008, Perry and Parks sponsored an interim control ordinance (ICO) placing a moratorium on the issuance of permits for new stand-alone fast food restaurants in the West Adams-Baldwin Hills-Leimert, South Los Angeles, and Southeast Los Angeles Community Plan areas that constitute South LA (see Map 1). The policy was limited to stand- alone establishments to address developer’s concerns that they rely on fast food chains as leasees of space before development projects can move forward. Unanimously approved by the City Council, the ICO was designed to provide sufficient time for the City to study and develop appropriate permanent regulatory controls on new fast food restaurants that the City planned to include in updates to the three South LA Community Plans.1 Unfortunately, the community plan updates have been delayed due to the City’s severe budget deficit and the resulting furloughs of Planning Department staff.6 Having been extended twice for a total of two years, the ICO was ineligible for another extension and expired September 14, 2010.7
!@II2K95<&*J>F5M&!@2K:9F4& & _& With these barriers to the community plan updates, MAP& 1. South LA’s Three Community Plan Areas D#-!MN!8&*%B!H.O$!EB+))!;&44*,A%L!>2#,!.+)#$!! the City Planning Department developed an alter- native solution that amends the City’s General Plan by adding a “footnote” to regulate permits for new stand-alone fast food restaurants in the three South LA Community Plan areas. The footnote is in lieu of a more comprehensive (and time intensive) solution such as completing the community plan updates or creating a Specific Plan or Community Design Overlay.i On December 8, 2010, the Los Angeles City Council approved the General Plan Amendmentii requiring new stand-alone fast food restaurants to meet six criteria to address their overconcentration and re-
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5. Landscape at least seven percent of the surface parking lot area 6. Have an adequate trash disposal plan to control litter.
i For definitions, see Appendix 6. ii The Amendment had previously been approved by the City Planning Commission on October 14, Mayor Antonio Villaraigosa on November 24, and the Planning and Land Use Management Subcommittee of the City Council on December 6, 2010. 5 It also establishes the following exemptions: 1. All properties located in Districts 5 and 15, and the portion of District 10 north of the Interstate 10 Freeway 2. New fast food restaurants integrated into mixed-use buildings, shopping centers and mallsiii 3. Construction that consists of interior remodeling, interior rehabilitation, minor exterior repair work, renovations, or routine maintenance 4. Demolition and replacement of an existing fast food restaurant, and additions to existing establishments, are exempt from Criteria #1 but subject to the other five criteria.
iii The policy refers to commercial centers or other joint tenant buildings with a minimum Floor Area Ratio of 1:1, which are often called shopping centers and malls.
The ICO was arguably the country’s first major use of zoning motivated by health to limit fast food restaurant development. While the ordinance recognized the deleterious effect fast food restaurants have on the strength of the commercial sector and neighborhood aesthetics, paralleling fast food restaurant regulations in other cities, it also stated that the over-concentrations of fast food restaurants in South LA are “detrimental to the health and welfare of the people of the community.”1 Furthermore, it sought to preserve limited land for development that contributes to residents’ health and quality of life, including attracting healthy food outlets using the Grocery Store and Sit-Down Restaurant Incentive Package.
Representatives of the fast food industry, including McDonald’s, the California Restaurant Association, International Franchise Association, and Valley Industry and Commerce Association, opposed the General Plan Amendment claiming that it unfairly targets the fast food industry and could impede economic development and job creation thereby impacting tax revenues.8 However, the 24 McDonald’s restaurants in South LA only employ 1,180 workers. Only 9.5 percent of the jobs are career positions and the other 91.5 percent make an average of only $4,455 in wages and $2,170 in benefits.9-10 In comparison, obesity is associated with roughly $2,800 higher annual medical costs per person, not to mention other economic costs such as lost productivity. Among Medicaid recipients, a case of obesity costs taxpayers about $3,378 annually.11
This report presents evidence for targeting fast food restaurants as part of a strategy to address disproportionately high rates of obesity and diet-related disease in South LA. It also recommends strengthening the City’s South LA fast food restaurant development policy and Sit-Down Restaurant Incentive Program to maximize their effectiveness in improving the balance between access to unhealthy fast food restaurants and restaurants that provide and promote a significant number of healthy menu options. While the General Plan Amendment is a good first step in limiting the further overconcentration of fast food restaurants, this evidence makes a case for additional policy solutions. Small changes to the Incentive Program are also recommended to ensure it complements the policy.
6 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
SOUTH LOS ANGELES RESTAURANT ENVIRONMENT
A rich and diverse food resource environment gives residents a greater opportunity to make choices that support healthy living. An environment where nutritional resources are limited to fast food restaurants, convenience stores and corner groceries and where healthy food outlets are scarce, makes it difficult for people to sustain efforts to eat a healthy diet. Numerous studies show that urban, lower-income and racial/ethnic minority communities have more fast food restaurants and fewer healthy food outlets like supermarkets than more affluent and predominantly white communities.12-15 Food outlets in these communities are less likely to provide healthy options that enable individuals to meet dietary recommendations.14,2 Fast food restaurants, in particular, are increasingly prevalent and taking up a greater share of total restaurant availability.16
South LA is no different. This densely populated, disproportion- ately lower-income, and predominantly racial/ethnic minority community is saturated with fast food restaurants. According to ESRI Business Analyst Online, the three South LA Community Plan areas have 4.97 limited-service restaurants per square mile and 0.44 limited-service restaurants for every full-service restaurant. In comparison, the more affluent and predominantly white West LA community has only 4.13 limited-service restaurants per square mile and 0.39 limited-service restaurants for every full-service restaurant (see Table 1). While the number of fast food restaurants per capita is lower in South LA compared with West LA,17 the higher density rate increases South LA resident’s exposure to fast food restaurants.
7 Table 1. South LA and West LA Demographic and Restaurant Comparison Indicator South LA iv West LA v Population 805,108 people 442,446 people Population density 15,436 people/sq. mi. 5,163 people/sq. mi. Average household size 3.61 people 2.15 people Income Median household income $33,044 $67,621 Households under the federal poverty level* 28.3% 10.3% Racial / Ethnic Mix Latino* 63.6% 17.4% African American* 32.4% 6.5% White* 2.2% 63.2% Asian and Pacific Islander 1.6% 12.7% Vehicle Ownership Households without a vehicle 25.4% 7.9% Households with 1 vehicle 40.2% 45.8% Households with 2 vehicles 23.2% 36% Restaurants Limited service restaurants 259 or 30% 354 or 28% Full-service restaurants 592 or 70% 906 or 72% Ratio of limited-service/square mile 4.97 4.13 Ratio of limited-service/full-service .44 .39
iv Defined as the following zip codes: 90001, 90002, 90003, 90007, 90008, 90011, 90016, 90018, 90037, 90043, 90044, 90047, 90059, 90061, and 90062. v Defined as the following zip codes: 90024, 90025, 90034, 90035, 90045, 90049, 90064, 90066, 90067, 90077, 90272, 90291, 90292, and 90293.
Source: ESRI Business Analysis Online. Available at: http://bao.esri.com/.Accessed November 17, 2010. *Source: Key Indicators of Health by Service Planning Area. Los Angeles County Department of Public Health – June 2009. Available at: http://www.publichealth.lacounty.gov/ docs/keyindicators.pdf. Accessed November 17, 2010. Note: Study areas are defined by Service Planning Areas (SPAs), not zip codes.
However, these figures as well as data in other national business databases, such as Dunn & Bradshaw and Clarita’s, significantly undercount the number of restaurants when compared with the Los Angeles County Environmental Health Office’s listings (which must survey restaurants for food safety annually, resulting in a more accurate count of restaurants), particularly small chain and independent restaurants commonly found in South LA. The national data- bases also incorrectly or incompletely classify restaurants by type when compared with researchers’ experience with many of the South LA restaurants listed. Unfortunately, the County listings do not classify restaurants by type.
To truly understand the South LA restaurant environment, one must turn to community-based participatory research or simply walk the streets of the community. The AABLH restaurant assessment discussed in the introduction is one example of a community-based participatory study. Another community-based study found that in two South LA neighborhoods and a third neighborhood in nearby Central LA, fast food and carry-out restaurants constitute over 60 percent of all restaurants, a figure higher than the 30 percent found using the ESRI database. Fast food can also be easily purchased in neighborhoods and outside school grounds from mobile food vendors.18-19
A walk down South Figueroa Street exemplifies the overconcentration of fast food restaurants common along commercial corridors in South LA (see Appendix 1). Between West 27th Street and West 31 Street (a 0.2 mile stretch), straddling City Council Districts 8 and 9 and just blocks from the University of Southern California, 16 fast food 8 restaurants line both sides of the street: Taco Bell/Pizza Hut, Grinder, Del Taco, McDonald’s, Domino’s Pizza, Subway Sandwiches, Chinatown Express, KFC, Panda Express, Jack in the Box, El Pollo Loco, Carl’s Jr, Chano’s Drive Inn, La Taquiza, Yoshinoya Beef Bowl, and Fatburger. Most of these restaurants are stand-alone establishments, but seven are part of shopping centers or mini-malls. Domino’s Pizza, Subway, Chinatown Express, and KFC all share a shopping center. Yoshinoya Beef Bowl and La Taquiza also share a shopping center. El Pollo Loco shares a building with the 901 Bar and Grill.
Fast food restaurants are also common near transit stops. Over one-quarter of households in South LA do not own a vehicle, compared with only one-twelfth of households in West LA (see Table 1). For example, fast food restaurants are very prominent near transit stops along Crenshaw Boulevard, a major thoroughfare through South LA served by several bus lines, the Metro Green Line and the proposed Expo Line (see Appendix 2). In District 10, between the three bus stops at the intersection with West Adams Boulevard and two bus stops three blocks south at West 29th Street, there are currently four stand-alone fast food restaurants (Phillips Barbeque, Master Burger, McDonald’s, and Taco Bell) and six fast food restaurants in shopping centers (Chef Marilyn’s Place, El Pollo Loco, Subway, Yoshinoya Beef Bowl, Chinese Fast Food, and Little Caesar’s Pizza). Several of these restaurants are examples of independently owned, mom-and-pop restaurants that fall under the City’s definition of a fast food restaurant, but are not always captured as such in national databases.
Children in South LA are also highly exposed to fast food restaurants that appear to cluster near schools, particularly high schools. For example, students who attend Manual Arts High School in District 9 are surrounded by fast food restaurants (see Appendix 3). Eight fast food restaurants can be found just a block away on West Martin Luther King Jr. Boulevard, including four stand-alone establishments (McDonald’s, Pizza Hut, Carl’s Jr., and Yoshinoya Beef Bowl) and four included in shopping centers (Subway, China Express, Panda King, and Little Caesar’s Pizza).
The excessive supply of fast food restaurants in South LA has not deterred fast food chains from wanting to enter this saturated market. During the two-year moratorium, the City received approximately 10 inquiries regarding new stand- alone fast food restaurants but none followed through with an application. About a dozen new fast food restaurants were allowed to open in mixed-use developments or shopping centers permitted under the ICO.20
These recent development efforts and the three examples above show that the overconcentration of fast food restaurants takes place in both stand-alone developments and shopping centers or joint tenant buildings, and they are often found right next to one another. Addressing the overconcentration of fast food restaurants therefore requires a policy that limits the development of both. Failure to extend the density restrictions adopted in the General Plan Amendment to malls and mini-malls will create the market patterns highlighted above and undermine the intent of the policy. As will be discussed in the next section, the clustering of fast food restaurants near transit stops and schools is also a concern because the many individuals who do not own vehicles and children are most dependent on and vulnerable to their local food environment. The link between the location of fast food restaurants and health is particularly strong among these populations. The General Plan Amendment does not address these vulnerable populations, creating additional opportunities for strengthening the City’s policy.
9 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
FAST FOOD & HEALTH
Studies examining the relationship between the food environment and BMI have found that communities with a larger number of fast food or quick-service restaurants tend to have higher BMI … evidence shows that children, adolescents, and adults who eat out, particularly at fast The South LA food environment is of particular concern food restaurants, are at increased risk of weight gain, because of the disproportionately high rates of obesity overweight, and obesity. The strongest association between and chronic disease present in this community. South fast food consumption and obesity is when one or more LA has the highest rate of adult obesity in the County fast food meals are consumed per week. As a result (35 percent) and an additional 38 percent are over- of the changing food environment, individuals need weight. It also has the highest rate of childhood obesity to deliberately make food choices, both at home and (29 percent). In comparison, obesity is found in only away from home, that are nutrient dense, low in calories, 10 percent of adults and 17 percent of children in and appropriate in portion size. West LA, and 22 percent of adults and 23 percent of children Countywide. South LA also has the highest —Dietary Guidelines for Americans, 2010 rate of adults diagnosed with diabetes (12 percent), the highest rate of adults diagnosed with hypertension (29 percent), and the highest death rate due to coronary heart disease (217 per 100,000 population).21 Preventable hospitalizations due to congestive heart failure, hypertension, and both long- and short-term diabetes complications are twice as high in South LA compared with Los Angeles County.22
10 South LA also has some of the highest rates of fast food consumption and other unhealthy dietary practices. Forty-two percent of adults in South LA eat fast food at least once a week, 56 percent drink at least one soda or sugar-sweetened drink a day, and only 13 percent consume five servings of fruits and vegetables a day. Among children, 53 percent eat fast food at least once a week and 55 percent drink at least one soda or sugar-sweetened drink a day. 21
Numerous studies demonstrate that eating fast food is associated with greater intake of calories, fat, sodium, sugar, and sugar-sweetened beverages, and lower intake of fruits, vegetables and dietary fiber.23-28 Fast food consumption has also been associated with weight gain23,26,29 and insulin resistance,29 both of which contribute to diabetes. While it may be possible to compose relatively healthy meals at fast food restaurants,30 researchers believe that the energy densities and fat content of most fast food items are often so high that consuming a meal is difficult without exceeding the average recommended dietary intake.31-32 The trend towards larger portion sizes further encourages overconsumption.33
While meals at sit-down restaurants can be just as high in calories, fat and portion sizes compared with fast food meals, and both are nutritionally inferior to meals prepared at home, several studies indicate that access to sit-down restaurants is not associated with weight gain while access to fast food restaurants is.34 One study found that over a thirteen-year period, consumption of fast food, but not sit-down restaurant food, is associated with higher weight and waist circumference, as well as adverse metabolic health outcomes like higher plasma triglyceride concentrations and lower HDL cholesterol concentrations.35 Another study found that meals at sit-down restaurants result in lower caloric intake for the day compared with fast food because consumers are more likely to compensate for large sit- down restaurant meals by eating less during the rest of the day. African American and Hispanic diners, in particular, are likely to compensate for sit-down restaurant meals resulting in a lower caloric intake than on days when they do not eat out.36 Other possible explanations are the frequency for eating at sit-down restaurants compared to fast food restaurants and that sit-down restaurants are more likely to offer healthier options on the menu and/or allow for recipe alterations.
PROXIMITY & HEALTH
Growing evidence suggests there is a correlation between geographic access to fast food restaurants and rates of consumption and health outcomes. A California-wide study found that adults who live near an abundance of fast food restaurants and convenience stores compared to grocery stores and produce vendors have a greater prevalence of obesity and diabetes regardless of individual or community income. The highest rates of obesity and diabetes are found among adults who live in lower-income communities with a higher ratio of fast food restaurants and convenience stores to grocery stores and produce vendors.37 11 Individuals lacking private transportation are especially dependent on their neighborhood food environment. A study of adults in Los Angeles County found that, even though car ownership is generally associated with higher BMIs, individuals who do not own cars and live in areas with high concentra- tions of fast food restaurants weighed approximately 12 pounds (2 BMI units) more than non-car owners residing in areas with no fast food restaurants and 2.7 pounds (0.45 BMI units) more than car owners who live in areas of high fast food concentration.38 Other vulnerable populations that face barri- ers to traveling to access healthier food outlets include the elderly, disabled and homeless. Older adults, particularly African Americans who live near fast food restaurants, are more likely to eat fast food and be obese.39
Children, particularly urban, lower-income and minority youth, are also influenced by the food choices in close proximity to their schools and homes because most are unable to drive. Adolescents are increasingly likely to purchase foods.40 Fast food restaurants have been found to cluster within a short walking distance from schools41-42 and are most prevalent in urban lower-income neighborhoods43-45 with higher proportions of Hispanic34,44,46 and African American47 students. A study of schools in California reveals that 65 percent have a fast food restaurant within a half mile and schools in closest proximity to a fast food restaurant are more likely to be located in urban lower-income neighborhoods and have more Hispanic students.34
Researchers have found that schools near fast food restaurants have higher rates of student obesity. A study of ninth graders in California found that a fast food restaurant within a tenth of a mile of a school is associated with at least a 5.2 percent increase in obesity rates with the effect being largest among Hispanic students and female students. This implies that students in close proximity to a fast food restaurant consume approximately 30 to 100 calories more per school day compared with students whose schools are further away from a fast food restaurant.34 Given 3,500 calories is equal to about a pound of body fat,48 eating an extra 100 calories per school day during a 180 day school year would result in a gain of over five pounds. Another study found that California students with fast food restaurants within one-half mile of their schools are more likely to be overweight, consume fewer servings of fruits and vegetables, and drink more soda than students whose schools are not near fast food restaurants.49 Moreover, fast food restaurants near schools reduce student participation in the National School Lunch Program that provides nutritious lunches to lower- income children50 and could lower the effectiveness of nutrition education by exposing children to highly visible food cues that counter educational messages.51 Seventy-four percent of schools in Council Districts 8 and 9 (South LA) had higher student body compositions (BMI) than the LAUSD average.52
12 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
MANUFACTURING FAST FOOD DEMAND
The fast food industry has criticized public efforts at regulation by claiming that individuals are responsible for their food choices and neither industry nor government has the right to tell people what they should or should not eat. It also argues that no food by itself causes obesity and any food can be part of a balanced diet if consumed in moderation. However, several factors contribute to fast food restaurants’ overwhelming popularity, including market domination, targeted advertising, pricing practices, and product design, all of which encourage consumption and none of which warn consumers about the dangers of frequent consumption. With about half of the healthcare costs of obesity footed by taxpayers through Medicare and Medicaid, what would otherwise be a matter of personal choice is a matter of public concern.53
In lower-income and racial/ethnic minority communities like South LA, fast food is often the only available dining option. These communities tend to be marginalized and underserved by financial institutions making investment capital difficult for small businesses to obtain. This allows fast food restaurants backed by large national corporations to dominate commercial corridors squelching competing business before it can develop.
The fast food industry also influences individuals’ dining choices through heavy advertising that dwarfs public health messages to eat a healthy diet. In 2009, the fast food industry spent more than $4.2 billion marketing its products on television and other media.54 Fast food restaurants spent $294 million on marketing directly targeting children and adolescents, and distributed $360 million worth of toys with children’s meals in 2006.55 In comparison, the budget to promote the Federal government’s 5 A Day Campaign was only $9.55 million.56
The fast food industry’s marketing practices disproportionately target racial/ethnic minority communities. African American children and teens see at least 50 percent more fast food television ads than their white peers. McDonald’s and KFC specifically target African American youth, and these teens see 75 percent more television ads for McDonald’s and KFC compared with white teens.54 A comparison of magazine ads revealed that food products advertised to African American women differ from those advertised to the general female population. Fast food ads made up 13 percent of Essence magazine’s consumption ads, but only one percent of the ads in Cosmopolitan.57
13 The Institute of Medicine58 and World Health Foundation59 have both stated that marketing energy-dense, nutrient-poor foods and beverages to children increases their consumption and adversely affects their health. The White House Task Force on Childhood Obesity has further indicated that restaurant marketing practices undermine the efforts of parents and other caregivers to encour- age healthy eating among children and prevent obesity.60 While some fast food restaurants have responded (McDonald’s and Burger King) by joining the industry-sponsored Children’s Food and Beverage Advertising Initiative pledging to limit children’s advertising to “better-for-you” menu choices, studies have shown that their ads do not encourage consumption of healthier choic- es and instead focus on toy giveaways and building brand loyalty.54 Moreover, a recent study commissioned by the World Health Organization to assess how well Kraft Food and McDonald’s fulfilled voluntary promises to market food to children more responsibly concluded that food companies “cannot — and will not — stop making and marketing nutritionally questionable food products to children.”61
Fast food restaurants’ pricing practices and product design target people who are lower-income, are driven by cost and taste more than nutrition concerns, and have limited time to prepare meals at home. Fast food restaurants are able to sell energy-dense, nutrient-poor foods at low prices because they are cheaper than fruits, vegetables and oth- er healthy foods.62 It is no surprise that fast food consumption is most prevalent among individuals with lower-incomes who regard cost as an important factor in determining dining choices.25-26 These restaurants appeal to cost-conscious consumers by offering larger portion sizes for only a small price increase —a marketing strategy referred to as value size pricing. Although portion sizes have increased in almost all food categories beginning in the 1970s, the largest in- crease has occurred at fast food restaurants.63 In 1955, the only available McDonald’s hamburger patty weighed 1.6 ounces. In 2006, the 1.6 ounce patty is still available along with several larger portions, including an 8 ounce patty that is five times larger than the original.64 Larger portions en- courage people to consume larger quantities and make it difficult for people to self-regulate what they eat.65
14 While it is unlikely anyone ever demanded more saturated fat, trans fat, sugar, or sodium from a restaurant, they do make foods taste good, an important driver of food choice when dining out.66-67 Individuals drawn by taste who have a low concern for nutrition and maintaining a healthy weight have the highest rates of fast food con- sumption.26-27,66,68 In fact, concerns about reduction in taste deter many people from making healthier food choices at fast food restaurants,69 and this negative attitude toward healthy foods is more common among lower-income and racial/ethnic minorities.70 Individuals who are concerned with nutrition and have better dietary practices are less likely to dine at fast food restaurants, but do dine at sit-down restaurants likely because they are perceived as having more healthy options.68
Fast food restaurants also employ food preparation and service methods that result in fast dining convenient for people pressed for time or needing food “on the go.” Drive-through service and food items in portable containers also cater to consumers who eat on the run.71 Individuals most attracted to convenient dining are those who lack the time or have difficulty preparing food at home. Individuals with lower incomes often face higher costs of time preparing food at home, which increases the incentive to dine out.72 Employment status is also a factor, and working single-parents and dual-income households tend to have high time costs. Many people also have difficulty preparing food at home because they do not know how to cook, have limited mobility, or do not have access to a kitchen. Examples include adolescents, college students, seniors, the disabled, and the homeless. The choice to dine at fast food restaurants is not only driven by the low cost of meals, but also convenience (i.e., low time costs).68,71
15 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
REGULATING FAST FOOD RESTAURANT DEVELOPMENT
Local municipalities do not have the financial resources to counter fast food chains’ investment and marketing practic- es. The Institute of Medicine and National Research Council,73 Centers for Disease Control and Prevention,74American Planning Association,75 Center for Law and Public Health at Johns Hopkins and Georgetown Universities76 and other public health and planning professionals64,77 suggest that one way to mitigate the influence of fast food restaurants on people’s diets and increase access to healthy foods is through zoning. By limiting the development of unhealthy fast food restaurants and encouraging the development of healthy restaurants, zoning laws can help create an environment that supports making healthy food choices and contributes to a reduction in the prevalence of obesity and chronic disease.
Under the police power granted to the states in the Tenth Amendment of the US Constitution, states have the sole authority to regulate private individuals in the interest of the public’s health, safety, morals, and general welfare. Like all states, the California Constitution delegates zoning authority to local governments.78 The courts have repeatedly upheld the validity of using the police power to enact zoning ordinances in the interest of the public’s health, and public health has provided the strongest legal basis for zoning ordinances. While until recently, no zoning laws had been enacted specifically to address the obesity epidemic, researchers believe a carefully crafted ordinance should survive constitutional challenges.76,79-81
Los Angeles has a long history of employing land use regulations to achieve public health goals. However, affluent communities have achieved more meaningful land use planning than lower-income and racial/ethnic minority communities like South LA, exacerbating economic and racial segregation and inequality.82 South LA has only two specific plans: the South LA Conditional Use Approval for the Sale of Alcoholic Beverages Specific Plan and the Crenshaw Corridor Specific Plan (see Box 1).More meaningful planning is needed to protect residents of South LA from the further overconcentration of uses that are detrimental to health.
16 Box 1: South LA Specific Plans
Adopted in 1987, the South LA Alcoholic Beverages Specific Plan requires establishments in portions of the three South LA Community Plan areas that wish to dispense alcoholic beverages for off-site consumption to first obtain con- ditional use approval. In its decision, the City considers the number and proximity of other such establishments within a one thousand foot radius and the proximity of residential areas, religious institutions, schools, and public parks.
The Crenshaw Corridor Specific Plan, adopted in 2004, seeks to ensure the development and redevelopment of the Crenshaw Corridor in the West Adams-Baldwin Hills-Leimert Community Plan area stimulate economic revitaliza- tion, address the retail needs of the community, enhance community aesthetics, and promote pedestrian activity. Uses found incompatible with these goals are prohibited or limited. For example, drive-through fast food restaurants are prohibited in certain areas, such as Leimert Park and Park Mesa Heights, and limited in others to a maximum of one within a 750 foot radius of another. Bans on drive-through service can have a similar effect as a ban on fast food restaurants because over 60 percent of fast food business is conducted by drive-through service and new fast food restaurants may not be profitable without it.76 Signage is also limited to one window identification sign, one wall sign, and either a projecting sign attached to a wall or a sign attached to an awning.
Communities across the country, including several cities and towns in California, have enacted regulations on fast food restaurants in several different ways. These ordinances were primarily passed to preserve the aesthetic qualities of the community, maintain retail diversity and promote tourism. Some also include a public health justification, such as preventing excess traffic congestion to protect pedestrian safety and air and envi- ronmental quality. The City of Watsonville, California, adopted an ordinance in October 2010 with the goal of promoting healthy eating and reducing obesity and disease. These policies are examined below to inform the recommendations for strengthening the South LA fast food restaurant policy beyond the General Plan Amendment.
17 1. Bans on fast food restaurants and/or drive-through service: The City of Concord, Massachusetts, bans both fast food restaurants and drive-in service. The purpose of the ordinance is to reduce traffic congestion and preserve and enhance the community’s aesthetic qualities. The City of Carlsbad, California, has a city-wide ban on drive-through restaurants and other drive-through businesses, like banks, are generally permitted with a conditional use permit. The Crenshaw Corridor in South LA also has restrictions on drive-through service as described in Box 1.
2. Bans on formula restaurants: Formula restaurants refer to restaurants similar to those located elsewhere, such as having a common business name and logo, standard- ized menus, and similar interior and exterior decor. The City and County of San Francisco prohibits all formula retail (including fast food restaurants) in the Hayes-Gough Neighborhood Commercial District and requires a conditional use permit in other districts. The purpose of the ordinance is to protect the small business sector and preserve the distinctive character of certain commercial districts. The ordinance states that the unregulated growth of formula retail businesses could limit or eliminate opportunities for smaller businesses and non-traditional or unique businesses, decreasing the diversity of goods and services and deterring visitors and tourists.
3. Limits on the total number of fast food restau- rants: The City of Berkeley, California, has a quota on the number of food service establishments in the historic Elmwood Commercial District near the University of California, Berkeley to preserve the shopping area that serves the surrounding community and the character of the neighborhood. Elmwood is permitted three carry-out restaurants, seven fast food restaurants and seven full-service restaurants.
4. Limits on the density of fast food restaurants: Within the City of Los Angeles, the General Plan Amendment, which requires new stand-alone fast food restaurants to locate at least a half mile from any existing fast food restaurant, is an example of a density regulation. Another example is the Westwood Village Specific Plan, addressing the area of Los Angeles that surrounds the University of California, which limits the density of fast food restaurants through spacing requirements. The total number of fast food restaurants along any public street cannot exceed a ratio of one for every 400 feet of lot frontage, except on Broxton Avenue where one fast food restaurant is permitted for every 200 feet. The purpose of the ordinance is to preserve the area’s unique character and ensure the retail serves the needs of the surrounding community.83
18 5. Regulations based on distance from other uses: In 1978, the City of Detroit, Michigan, passed a zoning ordinance that established a minimum distance of 500 feet between carry-out, fast food and drive-in restaurants and the nearest point of an elementary, junior high or senior high school. The reasons for the zoning were concerns about truancy and school delinquency, litter, noise, air pollution and youth exposure to marketing of unhealthy foods. Health concerns included exposure to “highly processed, minimally nutritious foods associated with unhealthy diets and air pollution from cars associated with asthma.”
6. Regulations based on healthy menu criteria: On October 12, 2010, the City of Watsonville, Califor- nia, approved an ordinance requiring restaurants to offer healthy options in order to obtain a building permit as a way of promoting healthy eating choices that reduce obesity and diseases. The Healthy Eating Ordinance uses a point system (see Appendix 4) modeled after the City’s Green Building Ordinance that establishes minimum environmental standards for obtaining building permits and a reward system for projects meeting specific goals. The Watsonville ordinance requires that restaurants earn at least six out of 18 available points to obtain a permit to build or remodel. Restaurants earning nine points are awarded a certificate; for 13 points they get a Golden Carrot Award, both of which come with promotional benefits.
Most community members do not desire a complete ban on new fast food restaurants, and the difficulty in counting the number of existing fast food restaurants precludes establishing a limit on the total number of fast food restaurants. The recommendations for strengthening South LA’s fast food restaurant development policy build upon the examples of regulations based on density, distance from other uses, and a healthy menu criteria to meet policy needs.
19 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
SOUTH LA SOLUTION
The City of Los Angeles must build upon and strengthen the General Plan Amendment by adopting a more comprehensive fast food restaurant development policy for South LA and other over-concentrated areas. This policy must have the expressly stated purpose of improving the health of the community by creating a restaurant environment that provides consumers with access to a meal or food that is consistent with the Dietary Guidelines for Americans when dining out. It also should include a goal of increasing the number of healthy food outlets (like healthy restaurants, grocery stores and farmers’ markets) relative to unhealthy food outlets (like unhealthy fast food restaurants and convenience stores).
The policy must extend to all fast food restaurants and not be limited to stand-alone establishments. The case studies of South Figueroa Street, Crenshaw Boulevard and West Martin Luther King Jr. Boulevard show that the over- concentration of fast food restaurants takes place in both stand-alone developments and shopping centers/joint tenant buildings and that these are often found next to one another. Moreover, fast food chains continued to enter the South LA community during the ICO by locating in shopping centers and joint tenant buildings. This indicates that a permanent policy limited to stand-alone establishments is insufficient to curtail development. Fast food restaurants in mixed-use developments are particularly troubling because they represent the ultimate level of access for individuals who live there.
The policy must also address over-exposure for those individuals most vulnerable to their local food environment. As previously described, many transit stops and schools in South LA are surrounded by multiple fast food restaurants. Research suggests the regulations on new fast food restaurants should target individuals lacking private transportation and children by limiting development near transit stops, schools and other uses where children congregate, like parks, playgrounds, recreation centers, and child care centers.
20 Finally, the policy must differentiate between healthy and unhealthy fast food restaurants. Demand for low-cost, tasty and convenient foods is likely to remain strong among individuals who live and work in South LA. Having a limited menu, no table orders and foods served in disposable wrapping and containers (the City’s definition of a fast food restaurant) allows restaurants to lower their menu prices and increase the convenience of the dining experience. However, these characteristics should not mean that a restaurant has to sacrifice the healthfulness and nutritional quality of the food provided.
Many mom-and-pop, ethnic and fast casual restaurants (e.g., Panera Bread and Baja Fresh) fall under the definition of a fast food restaurant, but offer a greater number of healthy options than conventional fast food restaurants. Fast food chains have started adding healthy options to their menus, like salads and grilled chicken, and could step up this effort. Industry analysts believe that offering healthier options is a trend that will likely continue to grow in the coming years.84 Restaurants are beginning to acknowledge that when people go out to eat in groups, one person who considers healthier eating important can sway the restaurant choice for the entire group through what the industry calls a “veto vote.”85 While limits on new unhealthy fast food restaurants are clearly necessary, healthy fast food restaurants are needed in South LA to meet the demand for low-cost and convenient dining options.
In addition to the six criteria for obtaining a construction permit in the General Plan Amendment, the policy should also do the following:
1. Extend the criteria to obtain a construction permit to all fast food restaurants in South LA, not just stand-alone establishments.
2. Add an additional criteria requiring new fast food restaurants in South LA to locate at least a half mile away from schools, parks, playgrounds, child care centers, recreation facilities, and other children-oriented facilities.
3. Add an additional criteria requiring new fast food restaurants to locate at least 750 feet from bus, rail and other transit stops.
4. Define a healthy restaurant using criteria based on the Dietary Guidelines for Americans.
5. Provide an exemption from distance requirements for fast food restaurants meeting the healthy restaurant definition.
Exempting fast food restaurants that meet the healthy restaurant criteria from density and distance requirements acknowledges that these restaurants contribute to a healthy restaurant environment and creates a zoning incentive for these restaurants to invest in South LA by limiting competition from potential unhealthy fast food restaurants. Additionally, the exemption could encourage new fast food restaurants to improve the healthfulness of their menus to gain entry into the South LA market. This policy should withstand constitutional challenges. A rational and evidence- based relationship exists between limiting access to unhealthy fast food restaurants and the public health objective of creating a better balance between access to healthy and unhealthy foods when dining out to encourage healthy choices and reduce obesity and chronic disease (see Appendix 5).
21 DEFINING A HEALTHY RESTAURANT
A restaurant classified as “healthy” should at a minimum provide consumers with equivalent access to purchase meals or foods that are part of a diet consistent with the Dietary Guidelines for Americans. Equivalent access means that a restaurant’s regular menu offers an equal number of meals, main dishes, side dishes, and desserts that meet criteria for being healthy, or half of all types of menu items meet the healthy criteria. This gives restaurants with large and small menus flexibility. Additionally, a healthy restaurant must have at least one fat free or low fat salad dressing, if salads are offered, and provide water free of charge.
To meet the healthy restaurant classification, the regular menu (not including specials) must offer:
1. At least 4 choices of meals OR half of all meals on the menu that are healthy 2. At least 4 choices of main dishes OR half of all main dishes on the menu that are healthy 3. At least 3 choices of side dishes OR half of all side dishes on the menu that are healthy 4. At least 1 healthy dessert 5. At least 1 fat free or low fat salad dressing (if salads are offered) 6. Water free of charge.
For a meal, main dish, side dish, or dessert to be considered healthy, criteria are also needed that take into account nutrients to limit — like fat, sodium and sugar — and meeting minimum requirements for the five food groups. The following criteria are modeled after the Federal Government’s Fruit and Vegetable Program, which sets standards for recipes that may feature the Fruits & Veggies – More Matters logo (based on the 2005 Dietary Guidelines for Americans’ recommendations),vi and include the updated 2010 Dietary Guidelines for Americans.86 They assume the average 2,000 calorie a day recommendation, which is divided by three for meals, four for main dishes, and eight for side dishes and desserts. They also assume a maximum intake of 1,500 milligrams of sodium per day, which is the recommendation for individuals who are over the age of 51, who are African American, or who have hypertension, diabetes, or chronic kidney disease.
vi See Appendix 4. 22 The following criteria are used to define a healthy meal, main dish, side dish, or dessert:
Food Type Total Fat vii Saturated Fat Trans Fat Added Sugars Calories Sodium Food Groups Combo/Meal <35% <10% <0.5 grams <15% 700 500 mg At least 40 grams of at least 3 different food groups (2 being fruits and vegetables)
Main Dish <35% <10% <0.5 grams <15% 500 375 mg At least 40 grams of food from 2 food groups
Side Dish/Dessert <35% <10% <0.5 grams <15% 250 190 mg N/A
Source: US Department of Health and Human Services. A Healthier You. US Government Printing Office. Available at: http://www.health.gov/dietaryguidelines/dga2010/healthieryou/contents.htm. Accessed July 12, 2011. Page 19. viiThe fat naturally found in fruits and vegetables does not contribute to the limits above.
In addition to meeting the requirements for offering healthy menu options, the “healthy” classification should also be lim- ited to restaurants that promote healthy menu items and do not promote unhealthy menu items in signs, table tents, other dis- plays, and promotional giveaways, particularly those targeted at children. Pricing should also not promote unhealthy menu items relative to healthy items, such as larger portions for a few cents more, “all-you-can-eat” or “unlimited portions,” charging more for a smaller versus regular portion of a dish, or charging more if customers wish to split a meal. Restaurants that price healthy items lower than unhealthy items should be given spe- cial consideration as price decreases — even as small as 20-30 percent — tend to have a greater effect on healthy choices compared with health messages.69 Moreover, healthy restaurants should both train their staff to know the menu thoroughly to provide calorie information when asked and/or identify healthy options with a sticker.
23 Using the Watsonville Healthy Eating Ordinance point system as a modelvii restaurants could be expected to meet some, rather than all, of these additional requirements.
To be classified as healthy, a restaurant must also meet at least half of the eight criteria described below:
1. Signs, table tents and other displays highlight healthy menu items, available healthy substitutions, and if reduced-size portions are available; displays do not promote un healthy menu items or encourage large portions.
2. Promotional giveaways, particularly those targeted at children, are only given with healthy options.
3. “Super-sized” and other forms of value size pricing for foods and beverages are not available.
4. “All-you-can-eat” or “unlimited portions” are not available.
5. Smaller portions or half portion meals are priced at a lower cost.
6. Customers are allowed to split a meal at no extra cost.
7. Staff members are trained to know the menu thoroughly, including portion sizes, ingredients and preparation methods.
8. Calorie information is visible at the point of purchase or health option stickers are provided on the menu.
ZONING TOOLS
The South LA fast food restaurant development policy could take the form of an update to the three South LA Community Plans, a specific plan, an overlay zone, or other zoning regulations (see Appendix 6). A specific plan seems most appropriate because the overconcentration of unhealthy fast food restaurants and lack of restaurants offering healthy options is a policy issue of major concern. It also provides the long-term land use planning needed to significantly change the South LA restaurant environment not found with an overlay zone. It is also a better and more time sensitive way to address this pressing issue in all of South LA rather than completing three separate community plan updates. Moreover, the South LA Alcoholic Beverages Specific Plan, Crenshaw Corridor Specific Plan, and Westwood Village Specific Plan set a precedent for using a specific plan to address an overconcentration of uses that is detrimental to the community’s welfare. However, an effort should also be made to incorporate the underlying principles of the proposed recommendations in the General Plan Framework at some future date.
viii See Appendix 4. 24 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
SIT-DOWN RESTAURANT INCENTIVES
Improving the South LA restaurant environment requires attracting new healthy restaurants in addition to regulating new fast food restaurants. While limits on unhealthy fast food restaurant development are likely to encourage investment by new healthy restaurants, the City’s efforts to market South LA to potential investors can also be improved by strengthening the Grocery Store and Sit-Down Restaurant Incentive Package in the following ways:
1. Shift the focus from sit-down restaurants to new restaurants of any type that meet the healthy restaurant definition. 2. Include additional incentives directly related to the added cost and complexity of meeting the healthy restaurant definition, such as assistance with nutritional analysis of menu items, recipe modifications and identifying suppliers of fresh produce. 3. Develop a promotional campaign to educate the public about restaurants meeting the healthy definition and drive consumer demand.
Establishing financial incentives to supplement the additional costs of initial and continuing compliance with the healthy restaurant guidelines is essential to encourage the development of new healthy restaurants in the community. The costs of a comprehensive nutritional menu analysis can be burdensome for some restaurants, particularly for smaller “mom and pop” restaurants that are not as financially secure as larger chain establishments. Many of these smaller, locally owned restaurants do not have standardized recipes for menu items, which could make menu analysis more labor intensive and potentially more expensive. Outcomes from similar healthy menu modification initiatives indicate, however, that the standardization of recipes actually results in an expense reduction in the long-term, which can help to compensate for the added expense of analysis.
25 Additionally, menu analysis costs can be supported by grants and loans provided by municipal and/or non-profit entities. A number of community-based organizations, such as community finance and development corporations, provide loans for new businesses to assist with the start-up costs of permitting and development. These low-interest loans can range in quantity, and are usually enhanced through financial consulting and cost-sharing opportunities with other businesses within the area. A pipeline between businesses applying for the healthy restaurant classification and these financial organizations should be established to help ensure that the food environment in South Los Angeles is positively impacted by these regulations.
Promotional campaigns for healthy restaurant initiatives in other cities have been particularly successful at encouraging restaurants to offer healthy options while increasing consumer patronage of participating restaurants and de- mand for the healthy selection (see Appendix 7). An aggressive promotional campaign could be developed in partnership with the County of Los Angeles that includes a brand and logo; provides participating restaurants with window signs and promotional materials; highlights participating restaurants in a brochure and website; and purchases advertisements on television, radio, billboards, and print media. The City and County could also distribute the menus of participating restaurants to public offices, schools and organizations in South LA and encourage them to use these restaurants to fulfill their catering needs.
In the long run, the City could make South LA more attractive to new healthy restaurants and other desirable retail by investing in neighborhood infrastructure. Projects are already underway to develop transit-oriented shopping centers and improve store façades. Decades without sufficient public investment mean that these types of projects are needed throughout South LA. Investments in murals and other art and cultural projects have also been successful at catalyzing development in other communities.87
26 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
IMPLEMENTATION & MONITORING COMPLIANCE
Successfully implementing the Healthy Restaurant Incentive Program will require collaboration and coordination between the County Department of Public Health and the City Department of Planning. The current functions of both organizations in the permitting process would need to expand to implement and monitor the healthy restaurant designation. Public Health should be required to evaluate restaurants’ compliance with the healthy guidelines during the application review process to determine whether the restaurant is eligible to participate in the incentive program. City Planning in turn would be responsible for granting designated restaurants the exemptions necessary to build in areas typically restricted for fast food restaurants.
The City of Los Angeles has an existing Restaurant and Hospitality Express Program that helps restaurants navigate the complicated and time-intensive permit review process. The Healthy Restaurant Incentive Program should be integrated into the framework of this program to expedite the process and prevent protracted processing from the additional application review requirements. A case manager from the Restaurant and Hospitality Express Program should be designated to help restaurant owners through the permitting process described below.
Healthy Restaurant Incentive Program: Building Permit Approval Process
To qualify for the Healthy Restaurant Incentive Program, restaurants must first receive a certificate of compliance based on an evaluation of the restaurant’s proposed menu items and corresponding nutritional content. This certification should be conducted by any Department of Public Health-approved nutritionist with a registered dietician degree and be based on the qualifications included in the Healthy Restaurant Guidelines.
For building permit approval, restaurant owners should submit to the Los Angeles Department of City Planning the certificate of compliance, a completed building permit application, and a signed form under penalty of perjury that includes the owner’s commitment to continued compliance with the Healthy Restaurant Guidelines. After approval is granted by City Planning, the restaurant must continue to undergo the standard building permit review process, which includes receiving site plan approval from the Environmental Health Division of the Los Angeles Department of Public Health. Once the standard application approvals have been granted, a Certificate of Occupancy will be given to the restaurant owner, which would allow the restaurant to finally open its doors to the public.
27 In order to ensure continuing compliance, City Planning should conduct a compliance monitoring evaluation one year from the Certificate of Occupancy issuance date. This evaluation will require the restaurant owner to resubmit the menu for verification that the food items certified in the previous year’s evaluation continue to be served at the restaurant. If a restaurant no longer serves the certified menu items, the new menu items must be certified and veri- fication submitted to Planning.
The restaurant owner must also provide verification that the restaurant has successfully implemented 3 of the 8 ad- ditional Healthy Restaurant Incentive requirements indicated in the initial program application. If these qualifications are verified and approved by City Planning, a Letter of Continuing Compliance will be issued to the restaurant owner. City Planning will conduct re-evaluations on an annual basis, and the Department of Public Health will also conduct “spot checks” on randomly selected restaurants in the program to monitor continued compliance throughout the year.
Restaurants lacking current certifications will be deemed noncompliant and will be subject to significant financial penalties. The penalties should be substantial enough to induce the non-complaint restaurants to make changes to re-align with the healthy restaurant guidelines and include a significant weekly penalty while not in compliance. If the restaurant remains out of compliance for an entire year, a fee equivalent to the City’s cost of granting the exemption should be charged in addition to the weekly fees.
28 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
PREVENTING UNINTENDED CONSEQUENCES
Finally, the City should ensure that these and other policies do not unintentionally increase food insecurity, particularly among the most vulnerable populations. For example, the City should monitor the number and location of restaurants that accept food stamps and food insecurity among low-income households. Individuals who are elderly, disabled and homeless are able to use food stamps at restaurants under the Restaurant Meals programs. Only a limited number of restaurants accept food stamps, and the majority are fast food restaurants. The City should ensure policies do not reduce access to restaurants accepting food stamps and encourage more restaurants, particularly healthy fast food restaurants, to accept them.
As with all development efforts, the City should also monitor potential displacement. Establishing new healthy restaurants could lead to higher rents, displaced locally-owned businesses and reduced affordable housing for lower-income families. If this occurs, the City should strengthen eviction and vacancy controls and target small business development and homeownership assistance to residents at risk for potential displacement.
29 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
CONCLUSION
The prevalence of fast food restaurants in South LA and other urban, lower-income and racial/ethnic minority communities across the country combined with the lack of access to healthy foods contributes to an overwhelmingly disproportionate incidence of obesity and diet-related chronic disease compared with more affluent and predominantly white neighborhoods. These communities are often further disadvantaged by lacking adequate healthcare and education, compounding the effects of a poor food resource environment. The burden of obesity and diet-related chronic disease is borne by families, their communities, and local and state governments as a result of lost productivity and premature death.
Many factors contribute to the increase in obesity and diet-related chronic disease — including poverty, lack of opportunities for physical activity, inadequate healthcare, lack of nutrition education, and limited health literacy — and no single step will solve these complex and multi-faceted epidemics. However, doing nothing or refusing to acknowledge the consequences of an overconcentration of un- healthy fast food restaurants will magnify their role in encouraging obesity and disease. We must work to create a food environment in South LA where healthy foods are accessible and messages that support health are common.
30 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
APPENDICES
31 Community Health Councils 25
APPENDIX 1 AppenSouthdix Figueroa 1 Street Between West 27th Street and West 31st Street
South Figueroa Street Between West 27 th Street and West 31 st Street
32 !"##$%&'()*+,-'.)!"$%/&-0) ) 12) ) ! APPENDIX 2 "##$%&'(!)! Crenshaw Boulevard Between West Adams Boulevard and West 29th Street ! *+$%,-./!0123$4.+&!0$5/$$%!6$,5!"&.7,!0123$4.+&!.%&!6$,5!)85-!95+$$5!
33 Community Health Councils 27
APPENDIX 3 Manual Arts High School Appendix 3
Manual Arts High School
34 APPENDIX 4
Watsonville Healthy Eating Ordinance Points System Points are earned by providing the following: Points At least four choices of fruits or vegetables prepared in a low fat way 2 Fruits or vegetables as a substitute for less healthy side dishes such as fries 1 At least one fat free or low fat salad dressing 1 Skim or 1% milk 1 Water free of charge 2 Whole grain bread instead of white bread or a no-bread option 1
Meat, fish, poultry, or meat alternative with visible fat removed and prepared in a low fat way such as broiling, baking, poaching, roasting, 2 steaming, or stir frying
At least one vegetarian dish not exceeding 500 calories 1 Butter, margarine, sour cream, salad dressing, or mayonnaise on the side or not at all 1 Smaller portions or half portion meals at a lower cost and allowing customers to split a meal 1 Training for staff members about knowing the menu thoroughly, including portion sizes, ingredients and preparation methods 1 Calorie information visible at the point of purchase or provide healthier option stickers on the menu 2 Corn tortillas instead of flour tortillas 1 Whole beans instead of refried beans 1
Source: Watsonville, Cal., Council File 101210 (2010). Available at: http://www.ci.watsonville.ca.us/agendas/101210CC_6.2d_101210.pdf. Accessed March 7, 2011. TOTAL POINTS 18
National Fruit and Vegetable Program: Criteria for Recipes that May Feature the Fruits & Veggies For meals, main dishes and sides: Each serving of food must contain at least one serving of fruit or vegetable per 250 calories
Each serving of food must contain limited amounts of added sugars or caloric sweeteners 1. Added sugars cannot exceed 15% of total calories 2. Concentrated fruit juice sweeteners, jams, and jellies count as added sugars
Each serving of food must contain limited amounts of fat 1. Total fat < 35% of total calories 4. The fat found naturally in fruits and vegetables does not contribute to the limits above. Further ¼oz. of nuts is allowed per serving without their fat content contributing to these 2. Saturated fat is < 10% of calories restrictions. Nuts must be in their natural form without anything added or removed 3. Trans fat is < 0.5g per serving (e.g., no added oils, removed oils, added sodium, or added sugars)
Each serving of food must contain ≤ 600mg of sodium per serving
Each serving of food must offer ≥ 0.014g/kcal naturally occurring fiber (28g of fiber/2000 calories) For meals: A meal product is defined as a food that makes a major contribution to the total diet by: 1. Weighing at least 10oz. per labeled serving 2. Containing not less than 40g for each of at least 3 different foods from 2 or more of the following (5) food groups: a. bread, cereal, rice, and pasta group b. fruit group c. vegetable group d. milk, yogurt and cheese group e. meat, poultry, fish, dry beans, eggs, and nuts group For main dishes: A main dish product is defined as a food that makes a major contribution to a meal by: 1. Weighing at least 6oz. per labeled serving 2. Containing not less than 40g of foods from 2 of the 5 food groups noted above
Source: “About the National Fruit and Vegetable Program: Program Guidelines.” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Available at http://www.fruitsandveggiesmatter.gov/health_professionals/program_guidelines.html. Accessed October 19, 2010. 35 APPENDIX 5 Potential Constitutional Challenges
The possibility of a constitutional challenge is very real and would likely be based on the Equal Protection Clause of the Fourteenth Amendment to the Constitution and the Dormant Commerce Clause. The Fourteenth Amendment assures citizens that no state can deprive them of fundamental rights and allows people to challenge government acts that are discriminatory. A challenge to a fast food restaurant zoning ordinance based on Equal Protection grounds would likely be analyzed under the rational basis standard, which requires the legislation to have a rational relationship to a legitimate governmental purpose of promoting the public’s health, safety, morals, or general welfare. Restricting the issuance of permits to new fast food restaurants that do not meet standards for providing healthy options should pass constitutional muster because there is ample evidence of the link between fast food restaurants and obesity and chronic disease.76,81
The Dormant Commerce Clause prevents state and local laws from placing too great a burden on interstate commerce because its regulation falls under the jurisdiction of the federal government. State and local laws can be invalidated even in areas where federal law does not exist, such as zoning of particular areas to preclude certain businesses. An unhealthy fast food restaurant ban would not distinguish between intra- and inter-state commerce or restrict new permits to California-based businesses. All unhealthy fast food restaurants, originating both within and outside California, would be treated the same. Since most fast food restaurants are part of national and even international chains, a ban could greatly impact interstate commerce. In this case, the courts would weigh whether the economic burden imposed on commerce is clearly excessive in relation to the predicted benefits to the health and safety of South LA residents. Considering the oversaturation of fast food restaurants in South LA, the fast food industry has clearly not been shut out of the market. The ban also impacts locals in the fast food industry just as much as national and international chains. Given this and the extent and nature of the local benefits, the ban would likely survive a Dormant Commerce Clause attack.79,81
36 APPENDIX 6 Land Use Planning Tools
General plan: a City-wide blueprint for future development consisting of the goals and policies used by policymakers to determine their land use decisions.
Community plan: a portion of the general plan focusing on a designated community and the issues relevant to that community (a community plan supplements the policies of the general plan).
Specific plan: a plan for the systematic implementation of the general plan developed in response to one or more policy issues and encompassing a contiguous area of any size; it can be as general as establishing broad policy concepts or as detailed as directing every facet of development (it is not technically part of the general plan, but must be consistent with the general plan).
Zoning regulations: laws that spell out the immediate allowable uses for each parcel of land and standards such as lot sizes, building heights and setbacks; they can take the form of the following zoning techniques:
• Conditional zoning: an area of land is zoned for a broad category of uses (e.g, commercially), but under the condition that only specific new uses are allowed or that certain uses (that would otherwise be allowed) are prohibited.
• Incentive zoning: the construction of certain uses are encouraged by establishing predetermined trade- offs between things the zoning code does not permit (e.g., building above height restrictions) in return for things the zoning code does not require (e.g., creating a mixed-use building).
• Performance zoning: specific standards that anyone who uses the land must meet (e.g., standards for pollution or noise levels) which can be implemented independently or as a supplement to use restrictions.
• Overlay zone: a set of zoning requirements that is superimposed upon existing zoning regulations to further regulate development in an area of special concern, such as commercial corridors, historical areas and environmentally sensitive areas, and has been used to encourage or discourage certain types of development.
37 APPENDIX 7 Encouraging Restaurants to Offer Healthy Meals
Smart Meal Colorado: The Colorado Department of Public Health’s Colorado Physical Activity and Nutrition Program established the Smart Meal Colorado initiative to highlight healthy menu items at restaurants. To participate, restaurants must offer at least two meals that qualify for a Smart Meal Seal. An independent service analyzes meals for meeting minimum servings of beans, whole grains, fruits, and vegetables and maximum amounts of calories, fat, saturated fat, trans fat, and sodium for a discounted rate of approximately $90 per meal. The initiative has been successful at increasing purchases of healthy meals and decreasing purchases of soft drinks, fries, and desserts. As of 2009, 20 restaurants with 200 locations were participating, including over 100 McDonald’s, which see promotion and being viewed as a community leader as key benefits to participation.88
Shape Up Somerville Restaurant Initiative: In Somerville, Massachusetts, Tufts University sought to improve the availability of healthy options at local, family-friendly restaurants and sandwich shops. Chain restaurants, including fast food, were not recruited because local franchises need corporate level approval to participate and make menu changes. The initiative developed participation criteria based on interviews with restaurant owners that indicated the criteria must be straightforward, clearly discriminate between restaurants that are and are not offering healthy choices, specify that calories be reduced, and provide visibility and brand awareness for the initiative. The nutritional criteria were limited to offering some entrees as smaller-size portions, making fruits and/or vegetables available as a side dish in place of fries or chips, and offering low-fat or nonfat dairy products (Asian restaurants were exempted from this requirement for cultural reasons).
Similar to Smart Meal Colorado, publicity was a strong incentive for participation, as was the perception of caring about the community. Restaurant owners’ lack of time and concerns about revenue loss were the biggest barriers to program participation. Cultural acceptability of the menu changes was also an issue and flexibility of the criteria allowed a large number of ethnic restaurants to participate. Researchers indicated that the initiative could have been more successful had it included someone with restaurant experience to assist with recruitment.
Winner’s Circle is a healthy dining partnership between North Carolina Prevention Partners and local communities, restaurants, schools, worksites, and other food service providers. The program uses a logo to identify healthy foods at participating eating establishments. Similar to Smart Meal Colorado, foods that bear the Winner’s Circle logo must meet strict nutritional standards, including minimum servings of fruits, vegetables, whole grains, or beans, and maximum amounts of calories, sodium, fat, saturated fat, trans fat, and sugar. However, the program is not limited to identifying healthier meals, but also promotes healthier side items, snacks and beverages (e.g., water, flavored water, non- or low-fat milk or soy milk, 100% real fruit juice).
38 Fast Food Restaurant Report Promoting Healthy Dining in South Los Angeles
END NOTES
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