When the New York City Health Department mandated that city restaurants change their menus to restrict trans fats, known to be a health hazard, the action was greeted with resistance and grumbling.
"There were the usual 'nanny state' comments," said Dr. Lynn Silver, assistant commissioner of the department's Bureau of Chronic Disease Prevention and Control.
Initially, the campaign was voluntary, Silver said. "But after one year, there was no change," she said, so public health officials decided to make the ban mandatory.
In December 2006, the city required that artificial trans fats be phased out of restaurant food, and the mandate was in full effect by November 2008. Silver and colleagues from the city's Department of Health and Mental Hygiene report on the effort in the July 21 issue of Annals of Internal Medicine.
And they deem it a success. Total saturated fat and trans fat in French fries, for instance, decreased by more than 50 percent in New York City restaurants, according to the report. Overall, the health officials found, the use of trans fats for frying, baking or cooking and in spreads declined from 50 percent to less than 2 percent.
Consumers didn't seem to mind. "It became clear that trans fats were being successfully replaced, and no one noticed the difference," Silver said. "Foods tasted just as good, and diners are healthier."
Trans fats were often used, she said, because they last longer than traditional vegetable oil, but "there was nothing terribly delicious about trans fat."
Trans fats, also call partially hydrogenated oils, are made by adding hydrogen to liquid vegetable oils to make them more solid. The fats are commonly found in French fries, doughnuts and baked goods, as well as margarine and shortening.
The problem with trans fats, Silver and her colleagues wrote in their report, is that increasing intake by just 2 percent can increase the risk for a heart attack or other cardiovascular problem by as much as 23 percent. Trans fats raise bad cholesterol levels and lower good cholesterol levels.
Restaurants' fears that diners would protest or the ban would affect business didn't happen, Silver said, and the good news for restaurant patrons is that they don't have to guess about what they're eating as much as they once did.
Silver said the idea seems to be catching on, too. At least 13 jurisdictions, including California, have adopted similar laws since New York's took effect, she said.
Dr. Julie Gerberding, former director of the U.S. Centers for Disease Control and Prevention, noted in an editorial accompanying the report that Tiburon, a small community north of San Francisco, actually restricted trans fats in its 18 restaurants as early as 2003.
"The scientific rationale for eliminating exposure to artificial trans fatty acids in foods is rock solid," she wrote. Not only do they not have health benefits, but they are harmful, she said.
Though some experts have called for federal intervention to restrict trans fats, Gerberding said that idea "seems premature," but she doesn't rule it out for the future. Among other actions, she said, the U.S. Food and Drug Administration could enhance educational efforts to inform consumers about the risk.
Connie Diekman, director of university nutrition at Washington University in St. Louis and a past president of the American Dietetic Association, said that banning fats is not enough.
"While mandatory elimination of trans fats can help reduce intake, consumer understanding about healthy food choices is essential," Diekman said. Healthful eating is a joint responsibility, she said, shared by food processors, providers, health-care professionals and consumers.
Silver took it a step further. She compared the trans fat restriction to an earlier public health decision to remove lead from paint, now known to be a health hazard, especially for children.
And once those health risks were known, she said, "you really wouldn't ask a parent to choose a paint with lead or without."