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Appendix J
State and Local Sodium Labeling Initiatives1

The Patient Protection and Affordable Care Act,2 signed into law in March 2010, amends the Federal Food, Drug, and Cosmetic Act to require chain restaurants to provide access to nutrition information for standard menu items. Restaurants with 20 or more outlets are required to post calories on menus, menu boards (including drive-thrus) and food display tags, with additional information (fat, saturated fat, carbohydrates, sodium, protein, and fiber) available in writing upon request. This imposes national uniformity, ensuring consistency in information provided. Before passage of the Patient Protection and Affordable Care Act, some states and localities considered or passed into law proposals to provide customers with sodium information at the point of purchase. Examples of these activities are summarized in this Appendix.

IMPLEMENTED

King County (Seattle), Washington

  • Requires chain restaurants with 15 or more outlets nationwide and $1 million in annual sales (collectively for the chain) to display

1

Compiled and adapted from the Center for Science in the Public Interest’s summary of 2009–2010 activities, available online: http://cspinet.org/new/pdf/ml_bill_summaries_09.pdf (accessed April 1, 2010).

2

Patient Protection and Affordable Care Act, HR 3590, Title IV, Subtitle C, §4205; 111th Congress, 2nd session, March 2010.



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Appendix J State and Local Sodium Labeling Initiatives1 The Patient Protection and Affordable Care Act,2 signed into law in March 2010, amends the Federal Food, Drug, and Cosmetic Act to require chain restaurants to provide access to nutrition information for standard menu items. Restaurants with 20 or more outlets are required to post calo- ries on menus, menu boards (including drive-thrus) and food display tags, with additional information (fat, saturated fat, carbohydrates, sodium, protein, and fiber) available in writing upon request. This imposes national uniformity, ensuring consistency in information provided. Before passage of the Patient Protection and Affordable Care Act, some states and localities considered or passed into law proposals to provide customers with sodium information at the point of purchase. Examples of these activities are sum- marized in this Appendix. IMPLEMENTED King County (Seattle), Washington • Requires chain restaurants with 15 or more outlets nationwide and $1 million in annual sales (collectively for the chain) to display 1 Compiled and adapted from the Center for Science in the Public Interest’s summary of 2009–2010 activities, available online: http://cspinet.org/new/pdf/ml_bill_summaries_09.pdf (accessed April 1, 2010). 2 Patient Protection and Affordable Care Act, HR 3590, Title IV, Subtitle C, §4205; 111th Congress, 2nd session, March 2010. 

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0 APPENDIX J calorie, saturated fat, sodium, and carbohydrate information for foods and beverages on menus (or approved methods at the point of ordering). If the restaurant uses a menu board, calories must be posted on the board, and other nutrition information (including sodium) must be provided in a plainly visible format at the point of ordering. • Exemptions are provided for items on the menu for less than 90 days; unopened, prepackaged foods; foods in salad bars, buffet lines, cafeteria service, and other self-serve arrangements; and food served by weight or custom-ordered quantity. Grocery and conve- nience stores are also exempt. • Required nutrition disclosure at fast food and other chain restau- rants as of December 31, 2008. Labeling regulations for drive- through menu boards went into effect August 1, 2009. Philadelphia Requires that calories, saturated fat, trans fat, sodium, and car- • bohydrates be displayed on menus and calories on menu boards and food tags in restaurants with 15 or more outlets nationwide. If a restaurant serves food in wrappers or boxes, it must display the nutrition information on the wrapper or box in a clear and conspicuous manner. • The menu board provisions of the law went into effect on February 1, 2010, and the menu labeling requirement went into effect April 1, 2010. PASSED INTO LAW State of California • Requires caloric content to be provided for standard menu items on menus, menu boards, and food display tags at chain restaurants with 20 or more outlets in California, and nutrition information to be provided in a brochure placed at point of sale. • Implementation would be carried out in two phases: Phase 1 (July 2009 to December 2010)—Restaurants must pro- vide a brochure placed at the point of sale that includes at least calories, sodium, saturated fat, and carbohydrate information per menu item. For sit-down restaurants, the information must be provided at the table. Drive-thrus are required to have the brochures available upon request and to have a notice of the availability at the point of sale.

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 APPENDIX J Phase 2 (would go into effect January 1, 2011)—Calories must be listed on menus, menu boards, and food display tags next to the menu item. Drive-thrus shall continue to have a brochure available upon request and must have a notice that the informa- tion is available. • Note: San Mateo County, San Francisco City and County, and Santa Clara County had menu labeling ordinances that included sodium, but they were superseded by passage of the statewide legislation. Montgomery County, Maryland • Requires chain restaurants with 20 or more outlets nationwide to display calories on menus and menu boards, including drive-thrus, for standard menu items (on the menu for at least 60 days per year). Additional nutrition information (including total fat, satu- rated fat, sodium, fiber, and sugars) will be provided in writing on the premises upon request. • The menu labeling requirement was planned to go into effect July 1, 2010. Oregon • Requires chain restaurants with 15 or more outlets nationwide to visibly post calorie information at the point of purchase for all regular menu items. The policy would require these restaurants to post the number of calories of each regular item in plain view on all of their menus, menu boards, and food tags; restaurants also were required to provide information about each regular menu item’s sodium, saturated fat, trans fat, and carbohydrate levels available at the consumer’s request in the restaurant. • The point-of-purchase calorie information bill was planned to go into effect January 1, 2011; the provision of other nutrition infor- mation took effect January 1, 2010. Note: Multnomah County had an ordinance to disclose sodium • information, and Lane County had introduced a similar proposal, but these were superseded by the passage of the state legislation.

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 APPENDIX J INTRODUCED Delaware (Introduced April 2009) • Would require a foodservice establishment with 10 or more outlets in Delaware or nationwide to post calories, saturated fat, carbohy- drates, and sodium on menus (including carryout menus). Menu boards (including drive-thrus) and food tags would be allowed to post only calories, with additional nutrition information available upon request. • Items on the menu less than 30 days would be exempt. • The bill would require the Division of Public Health to conduct an education campaign and an evaluation of menu labeling. The bill would go into effect 1 year after enactment. District of Columbia (Introduced July 2009) • Would require chain restaurants with 10 or more outlets nation- wide to provide nutrition information for standard menu items; on printed menus the information would include calories, saturated plus trans fats, carbohydrates, and sodium. Nutrition information on menu boards (including drive-thrus) and food tags could be limited to calories, provided that the additional information be available in writing upon request of the customer. • Items on the menu less than 30 days would be exempt. • The policy would take effect 9 months after enactment. Florida (Introduced March 2009) • Would require that chain restaurants with 19 or more outlets in Florida to provide nutrition information on menus, menu boards, and food tags. • Alcoholic beverages, buffets, salad bars, and items on the menu for less than 180 days per year would be exempt. • Implementation would be completed in two phases: Phase I (from January 1, 2010, to June 30, 2010)—Restaurants with sit-down service would be required to provide nutrition information for each standard menu item on menus, in a menu insert, or on a brochure or menu tent at each table. Restaurants that use a drive-thru or indoor menu board would be required

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 APPENDIX J to provide information in a brochure that is available upon request at the point of sale, with a notice indicating its avail- ability. The nutrition information to be provided would include calories, carbohydrates, saturated fat, and sodium. Phase II (after June 30, 2010)—Calorie information would be required to be posted. Indiana (Introduced January 2009) • Would require chain restaurants of 20 or more outlets in Indiana to post calories and carbohydrates on menus and menu boards. Other information including calories, total fat, saturated fat, trans fat, cholesterol, sodium, carbohydrates, fiber, sugars, and pro- tein would be required to be made available to customers in the restaurant. Kentucky (Introduced February 2009) • Would require chain restaurants with 10 or more locations in Kentucky to provide calorie information for menu items on menus or menu boards, including drive-thrus. Additional information in- cluding calories, carbohydrates, saturated fat, and sodium would be required to be made available to customers. Maryland (Introduced February 2009) • Would require chain restaurants with 15 or more outlets nation- wide to post nutrition information for all standard menu items. Restaurants using printed menus would be required to list calories, carbohydrates, saturated plus trans fats, and sodium. Restaurants may list only calories on menu boards including drive-thrus, food tags, salad bars, buffets, and other displayed foods, as long as the other nutrition information is provided in writing at the point of ordering. • The act would take effect October 1, 2010.

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 APPENDIX J Oklahoma (Introduced February 2009) • Would require restaurants with 10 or more outlets in the state to provide nutrition information for standard menu items and post calorie content information next to menu item on menus, menu boards, and food tags. • Implementation would be completed in two phases: Phase I (from July 1, 2010, to December 31, 2011)—Res- taurants with sit-down service would be required to provide calories, saturated fat, carbohydrates, and sodium content for each standard menu item on menus, in a menu insert, or on a brochure or menu tent on each table. Restaurants that use a drive-thru or indoor menu board would be required to provide information in a brochure that is available upon request at the point of sale under a notice indicating its availability. Phase II (would take effect January 1, 2012)—Restaurants would be required to post calorie content information adjacent to each standard menu item on menus, indoor menu boards, and food tags. Pennsylvania (Introduced June 2009) • Would require chain restaurants with an average of at least $500,000 in food sales over the past 3 years to post calories and provide nutrition information for standard menu items. • Implementation would be completed in two phases: Phase I (January 1, 2011, to June 30, 2012)—restaurants must provide a brochure at the point of sale listing calories, saturated fat, carbohydrates, and sodium content for each standard menu item. For sit-down restaurants, this information must be pro- vided at the table and drive-thrus, in a brochure that is available upon request at the point of sale under a notice indicating its availability. Phase II (by July 1, 2010)—Restaurants would be required to post calorie content information adjacent to each standard menu item on menus, indoor menu boards, and food tags. • Within 60 days after enactment, the law would supersede and replace any existing or future local menu labeling ordinances in Pennsylvania.

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 APPENDIX J Tennessee (Introduced February 2009) • Would require chain restaurants with 20 or more outlets nation- wide to disclose calories (per serving) for each standard menu items. Additional nutrition information would be required to be located on the premises and available to customers upon request prior to the point of ordering. For each standard menu item, infor- mation required would include calories, calories from fat, total fat, saturated fat, cholesterol, sodium, total carbohydrates, complex carbohydrates, sugars, dietary fiber, and protein. • Items on the menu for less than 90 days per year would be exempt. Texas (Introduced February 2009) • Would require that chain restaurants with 19 or more locations in Texas to provide nutrition information on menus and menu boards. • Implementation would be completed in two phases: Phase I (January 1, 2010, to December 31, 2010)—Restaurants with sit-down service would be required to provide nutrition information for each standard menu item on menus, in a menu insert, or on a brochure or menu tent at each table. Restau- rants that use a drive-through or indoor menu board would be required to provide information in a brochure that is available upon request at the point of sale with a notice indicating its availability. The nutrition information to be provided would include calories, carbohydrates, saturated fat, and sodium. Phase II (after December 31, 2010)—Restaurants would be re- quired to post calorie information adjacent to each menu item on menus, indoor menu boards, and food tags. Vermont (Introduced February 2009) • Would require restaurants with 10 or more outlets nationwide to post nutrition information next to each item as offered for sale. If a restaurant uses a printed menu, it would be required to include calories, saturated fat, carbohydrates, protein, and sodium for each menu item. If a restaurant uses a menu board, it would be required

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 APPENDIX J to post calories next to each item on the board and have additional nutrition information available in writing upon request. • The Department of Health would have 12 months from enactment of the bill to adopt rules to implement the policy.