Author + information
- ↵*Address correspondence to:
Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 400, San Diego, California 92122, USA.
My daughter Christine recently finished reading a book in which she was deeply absorbed with the exhortation, “Dad, you’ve got to read this book.” Since Chris and I do not always share literary interests, my curiosity was immediately piqued. The book in question, entitled “Fast Food Nation,” was written by Eric Schlosser (1)and had been on the New York Timesbestseller list. Schlosser was interested in fast food not only as a commodity that was capable of influencing health and wellness but also as a social and economic force. His book, as summarized by a review, examined “the fallout that the fast food industry has had on the American social and cultural landscape: how it has affected practices from ranching and farming to diets and health, from marketing and labor practices to larger economic trends.”
The growth of the fast-food industry has been nothing less than astonishing. From its birth in the late 1940s in Southern California (the source of many new trends, both good and bad), fast food has become “so routine, so thoroughly mundane, that it is now taken for granted like brushing your teeth.” More dollars are now spent on fast food in the U.S. than on newspapers, magazines, books, movies, videos, and recorded music combined: $110 billion in 2001. Three hamburgers and four orders of French fries are eaten weekly by the average American. McDonald’s Corporation alone operates 30,000 restaurants worldwide, annually hires more employees than any American business (about 1 million), and is the nation’s largest purchaser of beef and potatoes. It is not surprising, therefore, that this enormous growth has had a proportionate impact on economic, political, social, and cultural aspects of American life.
The astounding success of the fast-food industry is not an accident. It is primarily attributable to the dual achievements of uniformity and mass production. Providing an identical product at multiple locations has created familiarity and induced confidence regarding quality among customers. Assembly-line production and the removal of virtually all input of individual workers into the contents of fast food has not only ensured standardization but also enabled mass production. The industry now enjoys the success begotten by a product that appeals to most tastes and has the attributes of being quick, convenient, inexpensive, and hand-held.
The formula for success employed by the fast-food industry has now been adopted as the standard model for business in virtually every segment of society. From clothes (Gap, Foot Locker) to real estate (Caldwell-Banker) to toys (Toys R Us) to office supplies (Staples), independent businesses have been replaced by franchised chain stores. As pointed out by Schlosser, even health care (Columbia/HCA maternity wards) and death (Service Corporation International with over 3,500 funeral homes) have been subjected to the fast-food approach. The result has been a homogenization of society, evidenced by malls and highway interchanges that are virtually indistinguishable throughout the country and even in some foreign locations. Although no causal effect has been shown, it is clear that there is a definite association between low-density suburban sprawl so prevalent in the U.S., fast-food, and other mall chain franchises. Whether or not this similarity is found to be mind numbing, it cannot be denied that the fast-food mentality has permeated virtually every aspect of daily life in America. It is, perhaps, not surprising that the fictional character best known in America after Santa Claus is Ronald McDonald, a figure recognized by 96% of school children. Moreover, this dedication to uniformity and mass production has had an immense impact on the image of the U.S. throughout the world.
In addition to economic and cultural impact, the growth of the fast-food industry has had significant implications for the health of the country. Thus, fast-food restaurants have had a major influence on the incidence of food-borne infections, workplace injuries, and most importantly from a cardiovascular standpoint, obesity. The epidemic of obesity affecting the U.S. has been well documented. The condition affects not only adults, more than half of whom are overweight or obese, but also children, in over 25% of whom these conditions are found. As of 1999, nearly 50 million adults in the U.S. were obese or super-obese. Although the precise cause of this epidemic has not been fully defined, it is clear that it cannot be attributed to genetic changes. Rather, obesity appears to be due to a combination of environmental factors that includes the consumption of excess calories and the reduction of physical exertion. In this regard, the fast-food industry has likely contributed to the increased caloric intake of many Americans. Specifically, the size of portions served at these restaurants has increased in response to competitive pressures. Thus, Burger King now sells a triple decker, and the slogan of Little Caesar’s pizzas is “Big, Big.” A large Coke at McDonald’s is 32 ounces (310 calories), and Super Size Fries have 610 calories, while a Double Western Bacon Cheeseburger and Cross Cut Fries at Carl’s Jr. restaurant contains 73 grams of fat. Given the documented consumption of fast food in our country, the contribution of this dietary content to obesity is apparent. Moreover, the introduction of fast food overseas has been accompanied by a similar increase in obesity in those countries.
The consequences of obesity with respect to health are well known to cardiologists. Obesity has been associated with an increase in hypertension, diabetes, heart disease, cancer, and arthritis. Individuals who are moderately overweight are twice as likely to die prematurely than those with normal weight. Obesity is second only to tobacco smoking as a modifiable environmental risk factor for cardiovascular mortality. As is true of smoking, obesity is often refractory to treatment and has a high rate of recidivism.
In defense of the fast-food industry, it must be acknowledged that a number of attempts have been made to sell healthier, more hygienic meals. Thus, hamburgers and chicken dishes with less fat and fewer calories have been marketed in the past. However, such healthy options have not received wide acceptance in the marketplace. The preference for high-fat, high-calorie food has been attributed to tastes that are cultivated in childhood and preserved in adulthood. In this regard, the aggressive marketing of fast food to children would seem to be a serious error. The practice of advertising fast food in elementary schools would seem to be a particularly egregious mistake, opening the industry to accusations of putting profit above the public good. The cessation of aggressive marketing of fast food to children would almost certainly lead to a reduction in childhood obesity and a decrease in the preference for high-fat, high-calorie dietary content among adults. In fact, legislation imposing restrictions on advertising to children has already been implemented in much of Europe.
The enormous success of the fast-food industry has conveyed economic reward and political influence. Schlosser provides evidence that this influence has sometimes been used to oppose measures that would be beneficial to consumers and/or employees. Examples include thwarting measures to eliminate or minimize the risk of bacterial contamination of food, to increase the pay of employees, or to reduce employees’ risk being assaulted in the workplace. However, this same economic and political clout enables fast-food companies to effect major changes of considerable benefit. Schlosser provides an example in which FDA restrictions on feed to animals, imposed to prevent “mad cow disease,” were fought by meatpackers until McDonald’s announced that they would purchase only meat for which FDA rules were followed. Meatpackers immediately acquiesced to the restrictions. Thus, just as the fast-food industry has acquired great power to take actions that can be detrimental to society, so they are in a position to exert this power to be an agent to produce beneficial changes. In this regard, it can be predicted that the fast-food industry will behave in a manner to maximize profits. If society demands healthy food provided by an environmentally and socially concerned industry before they purchase, that is almost certainly what they will get.
In many respects the fast-food industry represents the best and the worst of contemporary American society. The technical innovation and entrepreneurial spirit has created successful new businesses and provided more food more conveniently at less cost than at any time in history. However, these advances have come with substantial social, cultural, and health consequences. The fast-food mentality has permeated every corner of American life and had an impact far beyond the world of food. That the “attitudes, systems, and beliefs” that characterize the fast-food industry require some modification appears clear. In fact, changes are already beginning to occur due primarily to market forces. The same talent that enabled the fast-food industry to contribute to the widespread and profound societal and cultural changes we have witnessed in the past 50 years provides an opportunity for beneficial changes of comparable magnitude. If only we could harness the innovation and entrepreneurship that led to the enormous growth of the fast-food industry and direct it toward inducing society to consume low-calorie, nutritionally balanced meals, we would go a long way in addressing many of the cardiovascular risk factors present in the American lifestyle.
↵1 Editor-in-Chief, Journal of the American College of Cardiology
- American College of Cardiology Foundation
- Schlosser E.