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Cholesterol Control Beyond the Clinic: New York City's Trans Fat Restriction
- Sonia Y. Angell, MD, MPH;
- Lynn Dee Silver, MD, MPH;
- Gail P. Goldstein, MPH;
- Christine M. Johnson, MBA;
- Deborah R. Deitcher, MPH;
- Thomas R. Frieden, MD, MPH; and
- Mary T. Bassett, MD, MPH
Abstract
Decades after key modifiable risk factors were identified, cardiovascular disease remains the leading cause of preventable death, and only one quarter of persons with high cholesterol levels have attained recommended levels of control. Cholesterol control efforts have focused on consumer education and medical treatment. A powerful, complementary approach is to change the makeup of food, a route the New York City Department of Health and Mental Hygiene took when it restricted artificial trans fat—a contributor to coronary heart disease—in restaurants. The Department first undertook a voluntary campaign, but this effort did not decrease the proportion of restaurants that used artificial trans fat. In December 2006, the Board of Health required that artificial trans fat be phased out of restaurant food. To support implementation, the Department provided technical assistance to restaurants. By November 2008, the restriction was in full effect in all New York City restaurants and estimated restaurant use of artificial trans fat for frying, baking, or cooking or in spreads had decreased from 50% to less than 2%. Preliminary analyses suggest that replacement of artificial trans fat has resulted in products with more healthful fatty acid profiles. For example, in major restaurant chains, total saturated fat plus trans fat in French fries decreased by more than 50%. At 2 years, dozens of national chains had removed artificial trans fat, and 13 jurisdictions, including California, had adopted similar laws. Public health efforts that change food content to make default choices healthier enable consumers to more successfully meet dietary recommendations and reduce their cardiovascular risk.
Article and Author Information
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Acknowledgment: The authors thank Elliott Marcus, MSSW, and Robert Edman, BSc, of the Department's Bureau of Food Safety and Community Sanitation, as well as all the Bureau's directors and sanitarians for implementation of the work described here. They also thank Wilfredo Lopez, JD; Thomas Merrill, JD; Martha Robinson, JD; and Anna Caffarelli, MHS; the members of the New York City Board of Health; Walter Willett, MD, MPH, DrPH; Colin McCord, MD; and the other staff and interns of the Department whose work was critical to the success of this initiative.
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Grant Support: By the City of New York. The American Heart Association provided an educational grant to support the Trans Fat Help Center.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Lynn Dee Silver, MD, MPH, New York City Health Department, 2 Lafayette Street, 20th Floor, CN-46, New York, NY 10007; e-mail, lsilver{at}health.nyc.gov.
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Current Author Addresses: Drs. Angell and Silver, Ms. Goldstein, and Ms. Johnson: New York City Department of Health and Mental Hygiene, 2 Lafayette Street, 14th Floor, CN-46, New York, NY 10007.
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Ms. Deitcher: New York City Department of Health and Mental Hygiene, 125 Worth Street, Room 345, CN-24, New York, NY 10013.
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Dr. Frieden: Office of the Director, Centers for Disease Control and Prevention, 1600 Clifton Road, Northeast, Mailstop D-14, Atlanta, GA 30333.
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Dr. Bassett: Doris Duke Charitable Foundation, 650 Fifth Avenue, 19th Floor, New York, NY 10019.
