onstrate the effects of menu labeling in chain restaurants (the focus of such labeling) or on weight.

A 3-year period of organizing in the community led to a consensus first, that obesity is a problem and second, that consumption of excess calories is the main driver of obesity. From that process emerged a 10-point overweight prevention initiative, which was adopted by the board of health in October 2005 and included menu labeling and reduction of caloric intake among its planks. A new director arrived at the health department who was supportive of menu labeling, and the county council adopted a board of health resolution supporting policies to promote healthy eating and active living. An ad hoc committee of the board of health was thereby empowered to advise the board to adopt a menu labeling regulation, which was passed in July 2007.

Krieger recounted that at this point, the food industry began to take action, working to introduce bills in the state legislature that would explicitly preempt local jurisdictions from enacting menu labeling. Negotiations under the auspices of the state legislature led to a compromise, which modified some parts of the original regulation but left most of the important parts intact. Industry then dropped its opposition to the amended regulation, adopting the position that it was better to cooperate than to further oppose labeling. Krieger noted that a stakeholder working group was able to work out the details of implementation, the rules, and the rulemaking process for the regulation.

More recently, the national health care reform movement has created the possibility of preemption from the federal rather than the state level. King County has amended its regulation to conform with the menu labeling provisions of the Affordable Care Act while awaiting the results of the Food and Drug Administration’s (FDA’s) rulemaking process. Krieger said that public health officials at the state and local levels generally were not aware that negotiations were ongoing within the federal government to reach an agreement with the restaurant industry on menu labeling. He noted that as time has passed, these officials have come to see the benefits of having a federal law because it covers a large number of jurisdictions, many of which would be unable to pass such a bill locally. The federal law also has extended the scope of labeling to include food in vending machines and self-service items. At the same time, however, it has limited labeling in other ways—for example, by not requiring notification of sodium, carbohydrate, or saturated fat levels. According to Krieger, the lesson learned is that advocates at all levels—local, state, and federal—must agree early on as to the desired outcomes of any kind of negotiation.

According to an evaluation of menu labeling after the King County regulation went into effect, the percentage of people who were aware of calorie information rose from 13 to 49 percent. For nutritional informa-

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