Op-Ed: I am a Type 1 Diabetic. Here’s Why the FDA’s Menu Labeling Law Should Include Small Entities

Julia Vanella is contributing writer. She graduated from Trachtenberg with an MPP in December 2022.

Personal Experience With the Lack of Nutritional Information at Restaurants 

In February 2022, I was diagnosed with Type 1 diabetes after a life-threatening case of diabetic ketoacidosis (DKA): when blood sugar levels are too high due to the lack of insulin. 

Type 1 diabetes is an auto-immune disease that occurs when the body’s pancreas stops producing insulin. Adjusting to life as a diabetic continues to be a daily struggle. I’ve had to relearn how to eat and understand how every food item I consume impacts my blood sugars. I count carbohydrates and inject insulin using a “carb-to-insulin” ratio to cover the amount of carbs I eat. I also use insulin to control my blood sugar to prevent hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar), which both have adverse, and sometimes life-threatening, health impacts if not treated.

Since getting diagnosed, eating out has become extremely challenging because I have to determine how many carbs are in each menu item. However, the U.S. Food and Drug Administration (FDA) requires chains and fast-food restaurants to include all carbs, fats and protein on their menus, so dining at these establishments has been easier than at small and local venues. Small entities are exempt from these rules so navigating their menus and estimating how many carbs I may be consuming is a struggle. 

This is a major health concern for me and the other 34 million diabetics in America. Meticulous tracking of one’s carb intake is critical for our survival and for preventing further complications from the disease. Not having nutritional information easily accessible when we dine out turns a commonplace activity into a significant health risk. 

Small entities should be required to comply with the FDA’s regarding nutritional information provision. This would allow diabetics, as well as folks with other food and/or health restrictions, to easily determine important nutritional information when dining out.

Current Nutritional Information Requirements for Retail Food Establishments

Congress passed the Food Labeling: National Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishment law in 2010. Enforced by the FDA, it requires chain restaurants to present calorie information on menus. Although the law was delayed for eight years by the restaurant and grocery industry, it was officially implemented on May 7, 2018. 

The law’s objective was to inform the public of the nutritional facts in each meal and encourage customers to make healthier food choices. The menu labeling requirements apply to restaurants and “retail food establishments” with 20 or more locations. These establishments must display the number of calories in their standard menu items, and, if requested by a customer, present nutritional information on fat, carbohydrates, sugars and proteins. In 2020, the FDA granted the regulated entities “flexibility” of the rule due to the COVID-19 pandemic, supply chain issues and related business challenges. The agency, however, does not have a planned date for when the full requirements will resume.

Although small businesses aren’t required to comply with the rules, if they wish, they can voluntarily register to comply with the FDA’s statutory requirements in the published FDA’s Small Entity Compliance Guide. However, there doesn’t seem to be any publicly available online information available regarding how many small entities choose to participate, suggesting to me that because this is optional, may choose to opt out.

Why Greater Enforcement and Tighter Regulations Should Be Implemented

Small entities should have to comply with the same FDA rules as larger and chain entities. This would provide and promote greater transparency from all restaurants and retail establishments, which is particularly important for customers with food restrictions and/or health concerns. 

Opponents of tightening restrictions for small entities may claim that requiring smaller establishments to include this information may not be feasible because menus change regularly. However, the regulation provides some flexibility to the regulated community in these instances. Foods covered by the law include “standard menu items (including alcoholic beverages), combination meals, variable menu items, food on display (including ‘grab and go’ items), self-service food and beverages.” Exempt foods include, “custom orders, daily specials, foods that are part of a customary market test, temporary menu items, general use condiments, foods and are not on a menu or menu board and are not on display or self-service.” This allows people like me to still receive important nutritional information about most menu items while also providing restaurants with flexibility as menus change.

Others may argue that requiring small entities to label their menus imposes unreasonable burdens on businesses – like increased menu labeling, designing, and printing costs – which would lead to higher prices for consumers. However, this concern is largely unwarranted. The FDA examined the economic impacts of nutrition labeling on small entities and found it would not have significant economic impacts on most. Businesses that cannot afford the extra compliance costs can also receive financial assistance and loans from the FDA — a program that should be expanded to support more small businesses in their compliance efforts. The FDA also provides a small business assistance program that offers technical assistance to help ease compliance challenges.

Including small entities in this regulation would allow me, and all consumers, to benefit from the nutritional information listed on menus. If all food businesses were required to comply, I would no longer have to “guesstimate” how many carbs may be in each food item, making it easier for me to determine how many units of insulin to inject for the meal, therefore preventing the rollercoaster of trying to correct high and low blood sugar levels. Their compliance would also allow me, and others with food restrictions, to feel more confident when eating out at local restaurants by knowing the nutritional values of each menu item and no longer worrying about the potential impacts the food may have on my health and life-long condition. Implementing and enforcing this law would encourage the public to be more aware of what ingredients the establishments include in their food, and may encourage the average consumer’s eating habits, as well as inspire restaurants to incorporate healthier food options and ingredients into their meals and menus.

This piece was edited by Deputy Editor Annie Robey and Executive Editor Lancy Downs.

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