The New York City Department of Health and Mental Hygiene (NYC DOHMH) recently adopted a rule requiring larger restaurant chains to post icons on their menus warning patrons of dishes that contain more than the US government’s daily limit for sodium. The National Restaurant Association (NRA) sued to block the rule and lost, but it now seeks to reverse the state supreme court’s decision. Besides the millions of vulnerable New Yorkers who are in need of the warnings, the case has implications for medical and public health organizations nationwide.
What happened in New York
The NYC DOHMH adopted the rule in response to a crisis of hypertension in the city. More than one in four adults in New York City has been told by a health professional that he or she has hypertension, meaning there are almost two million New Yorkers for whom a reduction in sodium consumption is crucial for improved health and a longer life.
Warnings about sodium consumption are also critical for the city’s residents who are at high risk, including African-Americans, people age 51 and older and those with high blood pressure, diabetes or kidney disease, who together make up more than half of the city’s population.
At stake in National Restaurant Association v. New York City Department of Health and Mental Health, currently before the New York Supreme Court’s Appellate Division, is whether the rule is an appropriate response to a public health problem, how the First Amendment applies to required science-based warnings, what constitutes arbitrary and capricious actions by health agencies and when local law may be preempted by the federal Nutrition Education and Labeling Act.
The NRA lost initially in the trial court and again in seeking a preliminary injunction pending appeal.
Local and national importance
In the past several months, the U.S. Department of Agriculture (USDA) and the U.S. Department of Health & Human Services have released the final Dietary Guidelines for Americans for 2015–2020, which recommend that adults consume less than 2,300 milligrams (mg) of sodium per day. Research from the USDA indicates that mean daily sodium consumption for adults is nearly 3,600 mg.
“Notwithstanding the NRA’s attempt to sow doubt and uncertainty about the contribution of sodium consumption to hypertension, there is clear scientific consensus regarding the link,” said the Litigation Center of the AMA and State Medical Societies in an amicus brief defending the rule. “The requirement that chain restaurants post a warning statement and a symbol indicating that a single menu item exceeds the recommended total daily sodium limit is a moderate and reasonable response to a severe public health threat.”
The brief also refuted three NRA claims that have national importance.
“First, the rule comports with the First Amendment, which favors factual disclosures in the commercial context,” the brief said. “Second, far from being arbitrary or capricious, the Rule’s lines are in fact drawn with a keen understanding of the boundaries of the [Department’s] authority. Third, the Rule is not preempted by federal law; savings clauses in the Nutritional Labeling and Education Act explicitly preserve ‘warnings’ of this type.
“The [Department of Health] has taken a modest but vital step to provide information to consumers that may help to save their lives.”
In addition to its work in the courts, the AMA is providing physicians and care teams with strategies and resources to help control high blood pressure and ultimately prevent heart disease. M.A.P.—Measure accurately, Act rapidly and Partner with patients, families and communities—developed in partnership with Johns Hopkins Medicine, features tools for practices and health systems to address hypertension control rates, develop new teamwork and communication strategies and improve workflow processes.
More on the AMA’s work to prevent heart disease:
- The one graphic you need for accurate blood pressure reading
- 3 questions to ask patients when measuring blood pressure
- Rethinking how physicians learn to prevent, manage chronic disease
- Why you should use self-measured blood pressure monitoring
- What successful self-measured BP looks like in practice
