Opinion: Why Does the American Heart Association Want You to Eat Out?

Doctor critiques new Heart-Check Meal Certification Program

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If you've been to a Subway restaurant recently, you may have noticed that beside some menu items there's a heart-shaped symbol called a "Heart-Check." It means the choice "meets criteria for heart-healthy" as determined by the American Heart Association (AHA).

Yoni Freedhoff
Yoni Freedhoff

These AHA-approved, "heart-healthy" choices are allowed to contain up to 700 calories (nearly half a day's worth) and up to 900 milligrams of sodium (more than half a day's worth). What aren't they allowed to contain? The good stuff. No mayo, mustard, dressings, cheese, pickles, avocado, or olives. You can also forget about ordering a $5 foot-long, cookies, or chips. As for drinks, if you're an adult, only water is allowed; kids can have low-fat milk.

The AHA's position is that since we're all eating out a great deal anyway, it's important to steer people to "healthier" choices. But are people really going to order condiment-free sandwiches with water and skip the cookies and chips when eating at Subway?

There's no question that as a society we eat out a lot. Back in the 1970s eating out was a rare treat. Nowadays more than half of the food dollars spent in the United States are spent in restaurants where we're eating a meal a day, on average. And restaurants are different today. Since the 1970s, restaurant portion sizes have grown dramatically, and the cost of food hasn't kept pace with the cost of inflation, meaning restaurants can afford to sell more for comparatively less—something we consumers perceive as value for our dollars.

Subway is listed as the AHA's first restaurant-based Heart-Check partner (Heart-Check symbols have appeared on grocery store products since 1995), so clearly more restaurants are expected to have their meals certified. But is giving people permission to eat out and explicitly suggesting to them that it's "heart-healthy" actually good medicine?

While there will never be one single intervention that will cure diet and weight-related diseases, encouraging people to become less reliant on restaurants, to rediscover their kitchens, and cultivate love affairs with cooking would go a very long way.

So why does the AHA want you to eat out (as do the Canadian Heart and Stroke Foundation and the Australian Heart Foundation)? In the words of AHA president Gordon Tomaselli: "With Americans increasingly relying on fast, convenient, prepared food, caloric intake is up and nutrition value is down. In fact, Americans have lost touch with what is in the foods they eat. That's why we are making it easy for consumers to make smart choices that are heart-healthy when eating outside the home, knowing they often don't have the benefit of reviewing the nutrition facts," said Tomaselli in an association press release.

But there is also a financial component. According to USA Today, Heart-Check certifications can generate as much as $700,000 annually for the association. The AHA states the proceeds are earmarked to cover expenses, but it is unclear what the expenses are.

And of course it's not just the AHA who stands to benefit from Heart-Checks. Subway will be looking for a return on their investment. Ultimately Subway's in this to sell food, and here the AHA is explicitly helping them to do so, whether it's consequent to Heart-Checks inspiring more frequent customer visits, or, perhaps paradoxically due to Heart-Checks increasing the amounts of ordered foods by perhaps providing customers with the belief their healthy choice earns them the right to a foot long with cookies or chips. 

As a nation we need to spend more time in our kitchens. We need to buy more "produce" and fewer "products." We need to empower our children with the very real-life skill of cooking. For some of us those life skills are now two generations past, with only our grandparents retaining true cultural cooking knowledge. We're a nation of unhealthy eaters and in my view, the very last thing a health organization ought to be doing in this day and age is giving people permission and reasons to skip out on their kitchens.

That's not to say you should never eat out, or that the actual Heart-Check'ed subs are themselves, "unhealthy." Of course eating out is a joyous part of life, but for your health's sake, make sure your meals out count; reserve them for celebrating and socializing, but not simply because you don't feel like packing a lunch.

To truly start maximizing your health, why not lose at least one of your regular convenience meals out, replacing it instead with a true sit-down, home-cooked dinner? Even if you've got a young family, your children can manage one night away from their after-school activities and instead together you can transform raw ingredients into not only a nutritious meal, but also into something that for many has been sadly lost–a dinner-table family meal. One night a week. That's not too difficult, and if slowly built upon, the return on that investment may well be priceless.

Hungry for more? Write to eatandrun@usnews.com with your questions, concerns, and feedback.

Yoni Freedhoff, MD, is an assistant professor of family medicine at the University of Ottawa, where he's the founder and medical director of the Bariatric Medical Institute—dedicated to non-surgical weight management since 2004. Dr. Freedhoff sounds off daily on his award-winning blog, Weighty Matters, and is also easily reachable on Twitter. Look for Dr. Freedhoff's book on the fallacies and future of modern-day dieting to be published by Simon & Schuster's Free Press in spring of 2013.