fastfood report

Fast Food Restaurant ReportP r o m o t i n g H e a l t h y D i n i n g i n S o u t h L o s A n g e l e s

Nicky Bassford, MPP

Lark Galloway-Gilliam, MPA

Gwendolyn Flynn

Breanna Nicole Morrison, MPL

January 2012

Our thanks to the many organizations and individuals who contributed to this project.

Their cumulative efforts made this publication possible.

ACKNOWLEDGMENTS

Community Health Councils is a non-profit, community-based health advocacy, policy and

educational organization. Established in 1992, our mission is to improve health and increase

access to quality healthcare for uninsured, under-resourced and underserved populations.

This policy report is the second in a series of three on how policymakers, private industry and

community members can change the South LA food resource environment by increasing access

to healthy food outlets and preventing the proliferation of unhealthy food outlets. The first report

in this series, Food Desert to Food Oasis: Promoting Grocery Store Development in South Los

Angeles, focused on food purchased for the home and proposed policy recommendations to

overcome barriers and encourage the establishment of new full-service grocery stores, healthy

corner stores, farmers’ markets and mobile produce vendors. The final report will address the

roles community members can play in advocating for policy changes, researching the needs

and strengths of their neighborhoods, and marketing their neighborhoods to potential healthy

food retailers and developers.

This publication is part of the REACH US project supported with funding from the Centers for Disease

Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not

necessarily represent the official views of the Centers for Disease Control and Prevention. © Community Health Councils, 2011

Public Health Law and Policy

Manel Kappagoda, JD, MPH

Amy Ackerman, JD

Karen Kramer, JD

Heather Wooten, MCP

Samantha Graff, JD

Principal Authors:

Lisa Nicky Bassford, MPP, Policy Analyst

Lark Galloway-Gilliam, MPA, Executive Director

Gwendolyn Flynn, Policy Director

Breanna Nicole Morrison, MPL

Design:

Aaron Makela, Print Media Collective

[email protected]

www.printmediacollective.com

Editor:

Janice Taylor, Communications Director

Los Angeles County Department of Public Health

Paul Simon, MD

Jean Tremaine

Mabel Everette, RD

FOR MORE INFORMATION,

CONTACT:

Community Health Councils

3731 Stocker Street, Suite 201

Los Angeles, CA 90008

Tel.: 323.295.9372

e-mail: [email protected]

www.chc-inc.org

TABLE OF CONTENTSExecutive Summary 2

Background 4

South Los Angeles Restaurant Environment 7

Fast Food and Health 10

Manufacturing Fast Food Demand 13

Regulating Fast Food Restaurant Development 16

South LA Solution 20

Sit-Down Restaurant Incentives 25

Implementation & Monitoring Compliance 27

Preventing Unintended Consequences 29

Conclusion 30

Appendices 31 South LA Fast Food Restaurant Maps Watsonville Healthy Eating Ordinance Points System and National Fruit & Vegetable Program Potential Constitutional Challenges Land Use Planning Tools Encouraging Restaurants to Offer Healthy Meals

Endnotes 39

South Los Angeles is saturated with fast food restaurants that typically serve “unhealthy foods” — foods high in fat,

sodium or sugar with few essential nutrients. Eating fast food has been associated with weight gain and lower intake

of fruits, vegetables and other nutrient-rich foods that help prevent chronic diseases such as heart disease, cancer and

diabetes. A growing body of evidence indicates a correlation between the proximity and density of fast food restaurants

and greater fast food consumption. Americans’ growing dependence on dining out coupled with an abundance of

fast food restaurants and lack of healthier alternatives in urban, lower-income and racial and ethnic communities

like South Los Angeles (South LA) have disproportionately increased vulnerability to diet-related death and disease.

The situation in South LA is critical as this community has the lowest life expectancy in the City of Los Angeles and the

highest rates of obesity and several chronic diseases in LA County.

The residents of South Los Angeles need policies that create equal opportunities for them to purchase a meal or food

consistent with the Dietary Guidelines for Americans when dining out. The Dietary Guidelines are the Federal government’s

authoritative advice about good dietary habits and are designed to promote health and reduce risk for major chronic

diseases. The City of Los Angeles established the Grocery Store and Sit-Down Restaurant Incentive Package in 2006

to attract new healthy food retailers to South LA. The package promoted the available financial incentives and offered

assistance to identify potential sites, navigate the City’s permitting process and find qualified employees. The City

passed an interim control ordinance (ICO) placing a moratorium on permits for new stand-alone establishments in

South LA in 2008 to address the overconcentration of fast food restaurants. It then replaced the temporary policy in

2010 with an amendment to the City’s General Plan requiring that new restaurants locate at least a half mile from

existing ones. The City continues to work on a comprehensive policy for fast food restaurant development in South LA.

This report builds upon these efforts and provides recommendations for strengthening the City’s fast food restaurant

development policy and Sit-Down Restaurant Incentive Program to create a healthier environment in South LA. The

recommendations are specific to the restaurant environment in South LA, which is in the jurisdiction of the City of Los

Angeles. They are based on community knowledge, community-based research, and an extensive literature review

that indicate the need to extend the scope of the policy to all fast food restaurants, not just stand-alone establishments,

and target populations that are most dependent on their neighborhood food environment, particularly children and

individuals who lack private transportation.

2

EXECUTIVE SUMMARY

Fast Food Restaurant ReportPr o m o t i n g H e a l t h y D i n i n g i n S o u t h L o s A n g e l e s

The recommendations also acknowledge that fast food restaurants are defined broadly in the Los Angeles Municipal

Code based on characteristics unrelated to the nutritional quality of the food provided. A fast food restaurant is “any

establishment which dispenses food for consumption on or off the premises, and which has the following characteristics: a

limited menu, items prepared in advance or prepared or heated quickly, no table orders, and food served in disposable

wrapping and containers.”1 The recommendations propose a strategy for limiting the density of unhealthy fast food

restaurants while encouraging new healthy restaurants of all types including healthy limited-service restaurants.

1. Extend the criteria to obtain a construction permit

to all fast food restaurants in South LA, not just stand-

alone establishments.

2. Add an additional criteria requiring new fast

food restaurants in South LA to locate at least a

half mile away from schools, parks, playgrounds,

child care centers, recreation facilities, and other

children-oriented facilities.

3. Add an additional criteria requiring new fast

food restaurants in South LA to locate at least 750

feet from bus, rail and other transit stops.

4. Define a healthy restaurant using criteria based

on the Dietary Guidelines for Americans.

5. Provide an exemption from distance requirements

for fast food restaurants meeting the healthy restaurant

definition.

6. Strengthen the City’s Grocery Store and Sit-Down

Restaurant Incentive Program and extend incentives

to healthy fast food restaurants.

7. Monitor healthy restaurants that receive zoning

and/or financial incentives for continued compliance

with the healthy restaurant criteria and establish

penalties for non-compliance.

The report recommends that the City of

Los Angeles adopt the following policies:

3

Community Health Councils (CHC), a nonprofit health policy and advocacy organization located in South LA, and the

CHC-led African Americans Building a Legacy of Health (AABLH) coalition are among several community organizations

working in partnership with policymakers, institutions and the private sector to increase investment in South LA and

ensure all residents have access to healthy foods and opportunities for healthy living. CHC’s role in addressing the

South LA food retail environment began in 1999 with a cooperative agreement from the Centers for Disease Control

and Prevention’s REACH (Racial and Ethnic Approaches to Community Health) 2010 Initiative. This award allowed

CHC to establish AABLH and bring together organizations and individuals in the community to address the social

determinants of racial/ethnic disparities in diabetes, cardiovascular disease and other diseases.

AABLH developed a model for community change founded on a community-based participatory approach for assessing

community needs, identifying policy and systems solutions and advocating in support of them. With the help of research-

ers at the University of Southern California, AABLH trained community-based organizations and residents to survey

restaurants, food markets and physical activity facilities in South LA and, as a comparison area, West LA. These

community assessments found that South LA neighborhoods have much less diversity in dining options and more fast

food restaurants than West LA neighborhoods. Diners in South LA also have fewer healthy options available to them

in restaurants, both in food selection and preparation (e.g., broiled instead of fried). The assessments found that

restaurants in South LA heavily promote unhealthy menu options to attract residents and are significantly less likely

to promote healthy items compared to restaurants in West LA.2 Similarly, assessments of markets and physical activity

facilities revealed significant disparities in supporting a healthy diet and active living.3-4

South LA City Council Representatives Jan Perry (9th District) and Bernard Parks (8th District) have consistently worked

with CHC and AABLH to develop strategies for improving the South LA food retail environment. As a result of their

leadership, City departments were charged with developing a package of incentives for attracting healthy food retailers and

developers to South LA. Approved by the City Council in 2006, the Grocery Store and Sit-Down Restaurant Incentive

Package combines available financial incentives — such as loans, grants, tax credits, and breaks on utility services

— with assistance identifying potential sites, navigating the City’s permitting process and finding qualified employees.

The City markets these incentives and services by advertising in trade publications, participating in outreach events

and meeting with targeted retailers. These efforts have successfully attracted four grocery store development projects

as of February 2010. The City continues to improve upon this initiative and is working on refining its marketing strategy

and developing a new website to promote the Incentive Package.5 4

BACKGROUND


In 2008, Perry and Parks sponsored an interim control ordinance (ICO) placing a moratorium on the issuance of

permits for new stand-alone fast food restaurants in the West Adams-Baldwin Hills-Leimert, South Los Angeles, and

Southeast Los Angeles Community Plan areas that constitute South LA (see Map 1). The policy was limited to stand-

alone establishments to address developer’s concerns that they rely on fast food chains as leasees of space before

development projects can move forward. Unanimously approved by the City Council, the ICO was designed to

provide sufficient time for the City to study and develop appropriate permanent regulatory controls on new fast food

restaurants that the City planned to include in updates to the three South LA Community Plans.1 Unfortunately, the

community plan updates have been delayed due to the City’s severe budget deficit and the resulting furloughs of

Planning Department staff.6 Having been extended twice for a total of two years, the ICO was ineligible for another

extension and expired September 14, 2010.7

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MAP 1. South LA’s Three Community Plan AreasWith these barriers to the community plan updates,

the City Planning Department developed an alter-

native solution that amends the City’s General Plan

by adding a “footnote” to regulate permits for new

stand-alone fast food restaurants in the three South

LA Community Plan areas. The footnote is in lieu of a

more comprehensive (and time intensive) solution such

as completing the community plan updates or creating

a Specific Plan or Community Design Overlay.i On

December 8, 2010, the Los Angeles City Council

approved the General Plan Amendmentii requiring

new stand-alone fast food restaurants to meet six

criteria to address their overconcentration and re-

quiring design and landscape guidelines to mitigate

their visual impacts on the community.

1. Locate at least a half-mile radius, or 2,640 linear feet, away from any existing fast food restaurant

2. Provide a continuous building wall along the street frontage and sidewalk

3. Have a height, bulk and mass that is compatible with the surrounding area

4. Locate parking at the rear or sides of the building and have it partially screened from view by a 36-inch decorative wall and/or landscaping

5. Landscape at least seven percent of the surface parking lot area

6. Have an adequate trash disposal plan to control litter.

The criteria are the following:

5

i For definitions, see Appendix 6.ii The Amendment had previously been approved by the City Planning Commission on October 14, Mayor Antonio Villaraigosa on November 24, and the Planning and Land

Use Management Subcommittee of the City Council on December 6, 2010.

6

The ICO was arguably the country’s first major use of zoning motivated by health to

limit fast food restaurant development. While the ordinance recognized the deleterious

effect fast food restaurants have on the strength of the commercial sector and

neighborhood aesthetics, paralleling fast food restaurant regulations in other cities,

it also stated that the over-concentrations of fast food restaurants in South LA are

“detrimental to the health and welfare of the people of the community.”1 Furthermore,

it sought to preserve limited land for development that contributes to residents’

health and quality of life, including attracting healthy food outlets using the Grocery

Store and Sit-Down Restaurant Incentive Package.

Representatives of the fast food industry, including McDonald’s, the California Restaurant Association, International Franchise

Association, and Valley Industry and Commerce Association, opposed the General Plan Amendment claiming that it unfairly

targets the fast food industry and could impede economic development and job creation thereby impacting tax revenues.8

However, the 24 McDonald’s restaurants in South LA only employ 1,180 workers. Only 9.5 percent of the jobs are

career positions and the other 91.5 percent make an average of only $4,455 in wages and $2,170 in benefits.9-10

In comparison, obesity is associated with roughly $2,800 higher annual medical costs per person, not to mention

other economic costs such as lost productivity. Among Medicaid recipients, a case of obesity costs taxpayers about

$3,378 annually.11

This report presents evidence for targeting fast food restaurants as part of a strategy to address disproportionately

high rates of obesity and diet-related disease in South LA. It also recommends strengthening the City’s South LA fast

food restaurant development policy and Sit-Down Restaurant Incentive Program to maximize their effectiveness in

improving the balance between access to unhealthy fast food restaurants and restaurants that provide and promote

a significant number of healthy menu options. While the General Plan Amendment is a good first step in limiting the

further overconcentration of fast food restaurants, this evidence makes a case for additional policy solutions. Small

changes to the Incentive Program are also recommended to ensure it complements the policy.

It also establishes the following exemptions:

1. All properties located in Districts 5 and 15, and the portion of District 10 north of the Interstate 10 Freeway

2. New fast food restaurants integrated into mixed-use buildings, shopping centers and mallsiii

3. Construction that consists of interior remodeling, interior rehabilitation, minor exterior repair work, renovations, or routine maintenance

4. Demolition and replacement of an existing fast food restaurant, and additions to existing establishments, are exempt from Criteria #1 but subject to the other five criteria.

iii The policy refers to commercial centers or other joint tenant buildings with a minimum Floor Area Ratio of 1:1, which are often called shopping centers and malls.

7

SOUTH LOS ANGELES RESTAURANT ENVIRONMENT


A rich and diverse food resource environment gives residents a greater opportunity to make choices that support

healthy living. An environment where nutritional resources are limited to fast food restaurants, convenience stores

and corner groceries and where healthy food outlets are scarce, makes it difficult for people to sustain efforts to eat

a healthy diet. Numerous studies show that urban, lower-income and racial/ethnic minority communities have more

fast food restaurants and fewer healthy food outlets like

supermarkets than more affluent and predominantly white

communities.12-15 Food outlets in these communities are less

likely to provide healthy options that enable individuals to

meet dietary recommendations.14,2 Fast food restaurants, in

particular, are increasingly prevalent and taking up a greater

share of total restaurant availability.16

South LA is no different. This densely populated, disproportion-

ately lower-income, and predominantly racial/ethnic minority

community is saturated with fast food restaurants. According to

ESRI Business Analyst Online, the three South LA Community

Plan areas have 4.97 limited-service restaurants per square mile

and 0.44 limited-service restaurants for every full-service restaurant.

In comparison, the more affluent and predominantly white West LA

community has only 4.13 limited-service restaurants per square mile

and 0.39 limited-service restaurants for every full-service restaurant

(see Table 1). While the number of fast food restaurants per capita is

lower in South LA compared with West LA,17 the higher density rate

increases South LA resident’s exposure to fast food restaurants.

Defined as the following zip codes: 90001, 90002, 90003, 90007, 90008, 90011, 90016, 90018, 90037, 90043, 90044, 90047, 90059, 90061, and 90062.

Defined as the following zip codes: 90024, 90025, 90034, 90035, 90045, 90049, 90064, 90066, 90067, 90077, 90272, 90291, 90292, and 90293.

iv

v

Source: ESRI Business Analysis Online. Available at: http://bao.esri.com/.Accessed November 17, 2010.

*Source: Key Indicators of Health by Service Planning Area. Los Angeles County Department of Public Health – June 2009. Available at: http://www.publichealth.lacounty.gov/

docs/keyindicators.pdf. Accessed November 17, 2010. Note: Study areas are defined by Service Planning Areas (SPAs), not zip codes.

Indicator South LA iv West LA v

Population 805,108 people 442,446 people

Population density 15,436 people/sq. mi. 5,163 people/sq. mi.

Average household size 3.61 people 2.15 people

Table 1. South LA and West LA Demographic and Restaurant Comparison

Income

Median household income $33,044 $67,621

Households under the federal poverty level* 28.3% 10.3%

Vehicle Ownership

Households without a vehicle 25.4% 7.9%

Households with 1 vehicle 40.2% 45.8%

Households with 2 vehicles 23.2% 36%

However, these figures as well as data in other national business databases, such as Dunn & Bradshaw and Clarita’s,

significantly undercount the number of restaurants when compared with the Los Angeles County Environmental

Health Office’s listings (which must survey restaurants for food safety annually, resulting in a more accurate count of

restaurants), particularly small chain and independent restaurants commonly found in South LA. The national data-

bases also incorrectly or incompletely classify restaurants by type when compared with researchers’ experience with

many of the South LA restaurants listed. Unfortunately, the County listings do not classify restaurants by type.

To truly understand the South LA restaurant environment, one must turn to community-based participatory research

or simply walk the streets of the community. The AABLH restaurant assessment discussed in the introduction is one

example of a community-based participatory study. Another community-based study found that in two South LA

neighborhoods and a third neighborhood in nearby Central LA, fast food and carry-out restaurants constitute over

60 percent of all restaurants, a figure higher than the 30 percent found using the ESRI database. Fast food can also

be easily purchased in neighborhoods and outside school grounds from mobile food vendors.18-19

A walk down South Figueroa Street exemplifies the overconcentration of fast food restaurants common along commercial

corridors in South LA (see Appendix 1). Between West 27th Street and West 31 Street (a 0.2 mile stretch), straddling

City Council Districts 8 and 9 and just blocks from the University of Southern California, 16 fast food 8

Racial / Ethnic Mix

Latino* 63.6% 17.4%

African American* 32.4% 6.5%

White* 2.2% 63.2%

Asian and Pacific Islander 1.6% 12.7%

Restaurants

Limited service restaurants 259 or 30% 354 or 28%

Full-service restaurants 592 or 70% 906 or 72%

Ratio of limited-service/square mile 4.97 4.13

Ratio of limited-service/full-service .44 .39

restaurants line both sides of the street: Taco Bell/Pizza Hut, Grinder, Del Taco, McDonald’s, Domino’s Pizza, Subway

Sandwiches, Chinatown Express, KFC, Panda Express, Jack in the Box, El Pollo Loco, Carl’s Jr, Chano’s Drive Inn, La

Taquiza, Yoshinoya Beef Bowl, and Fatburger. Most of these restaurants are stand-alone establishments, but seven

are part of shopping centers or mini-malls. Domino’s Pizza, Subway, Chinatown Express, and KFC all share a shopping

center. Yoshinoya Beef Bowl and La Taquiza also share a shopping center. El Pollo Loco shares a building with the

901 Bar and Grill.

Fast food restaurants are also common near transit stops. Over one-quarter of households in South LA do not own

a vehicle, compared with only one-twelfth of households in West LA (see Table 1). For example, fast food restaurants

are very prominent near transit stops along Crenshaw Boulevard, a major thoroughfare through South LA served by

several bus lines, the Metro Green Line and the proposed Expo Line (see Appendix 2). In District 10, between the

three bus stops at the intersection with West Adams Boulevard and two bus stops three blocks south at West 29th

Street, there are currently four stand-alone fast food restaurants (Phillips Barbeque, Master Burger, McDonald’s, and

Taco Bell) and six fast food restaurants in shopping centers (Chef Marilyn’s Place, El Pollo Loco, Subway, Yoshinoya

Beef Bowl, Chinese Fast Food, and Little Caesar’s Pizza). Several of these restaurants are examples of independently

owned, mom-and-pop restaurants that fall under the City’s definition of a fast food restaurant, but are not always

captured as such in national databases.

Children in South LA are also highly exposed to fast food restaurants that appear to cluster near schools, particularly

high schools. For example, students who attend Manual Arts High School in District 9 are surrounded by fast food

restaurants (see Appendix 3). Eight fast food restaurants can be found just a block away on West Martin Luther King

Jr. Boulevard, including four stand-alone establishments (McDonald’s, Pizza Hut, Carl’s Jr., and Yoshinoya Beef Bowl)

and four included in shopping centers (Subway, China Express, Panda King, and Little Caesar’s Pizza).

The excessive supply of fast food restaurants in South LA has not deterred fast food chains from wanting to enter this

saturated market. During the two-year moratorium, the City received approximately 10 inquiries regarding new stand-

alone fast food restaurants but none followed through with an application. About a dozen new fast food restaurants

were allowed to open in mixed-use developments or shopping centers permitted under the ICO.20

These recent development efforts and the three examples above show that the overconcentration of fast food restaurants

takes place in both stand-alone developments and shopping centers or joint tenant buildings, and they are often

found right next to one another. Addressing the overconcentration of fast food restaurants therefore requires a policy

that limits the development of both. Failure to extend the density restrictions adopted in the General Plan Amendment

to malls and mini-malls will create the market patterns highlighted above and undermine the intent of the policy. As

will be discussed in the next section, the clustering of fast food restaurants near transit stops and schools is also a

concern because the many individuals who do not own vehicles and children are most dependent on and vulnerable

to their local food environment. The link between the location of fast food restaurants and health is particularly strong

among these populations. The General Plan Amendment does not address these vulnerable populations, creating

additional opportunities for strengthening the City’s policy.

9

10

Studies examining the relationship between the food

environment and BMI have found that communities with

a larger number of fast food or quick-service restaurants

tend to have higher BMI … evidence shows that children,

adolescents, and adults who eat out, particularly at fast

food restaurants, are at increased risk of weight gain,

overweight, and obesity. The strongest association between

fast food consumption and obesity is when one or more

fast food meals are consumed per week. As a result

of the changing food environment, individuals need

to deliberately make food choices, both at home and

away from home, that are nutrient dense, low in calories,

and appropriate in portion size.

—Dietary Guidelines for Americans, 2010

The South LA food environment is of particular concern

because of the disproportionately high rates of obesity

and chronic disease present in this community. South

LA has the highest rate of adult obesity in the County

(35 percent) and an additional 38 percent are over-

weight. It also has the highest rate of childhood obesity

(29 percent). In comparison, obesity is found in only

10 percent of adults and 17 percent of children in

West LA, and 22 percent of adults and 23 percent of

children Countywide. South LA also has the highest

rate of adults diagnosed with diabetes (12 percent),

the highest rate of adults diagnosed with hypertension

(29 percent), and the highest death rate due to

coronary heart disease (217 per 100,000 population).21

Preventable hospitalizations due to congestive heart

failure, hypertension, and both long- and short-term

diabetes complications are twice as high in South LA

compared with Los Angeles County.22

FAST FOOD & HEALTH


11

South LA also has some of the highest rates of fast food consumption and other unhealthy dietary practices. Forty-two

percent of adults in South LA eat fast food at least once a week, 56 percent drink at least one soda or sugar-sweetened

drink a day, and only 13 percent consume five servings of fruits and vegetables a day. Among children, 53 percent eat

fast food at least once a week and 55 percent drink at least one soda or sugar-sweetened drink a day. 21

Numerous studies demonstrate that eating fast food is associated with greater intake of calories, fat, sodium, sugar, and

sugar-sweetened beverages, and lower intake of fruits, vegetables and dietary fiber.23-28 Fast food consumption has also

been associated with weight gain23,26,29 and insulin resistance,29 both of which contribute to diabetes. While it may be

possible to compose relatively healthy meals at fast food restaurants,30 researchers believe that the energy densities and

fat content of most fast food items are often so high that consuming a meal is difficult without exceeding the average

recommended dietary intake.31-32 The trend towards larger portion sizes further encourages overconsumption.33

While meals at sit-down restaurants can be just as high in calories, fat and portion sizes compared with fast food

meals, and both are nutritionally inferior to meals prepared at home, several studies indicate that access to sit-down

restaurants is not associated with weight gain while access to fast food restaurants is.34 One study found that over a

thirteen-year period, consumption of fast food, but not sit-down restaurant food, is associated with higher weight and

waist circumference, as well as adverse metabolic health outcomes like higher plasma triglyceride concentrations

and lower HDL cholesterol concentrations.35 Another study found that meals at sit-down restaurants result in lower

caloric intake for the day compared with fast food because consumers are more likely to compensate for large sit-

down restaurant meals by eating less during the rest of the day. African American and Hispanic diners, in particular,

are likely to compensate for sit-down restaurant meals resulting in a lower caloric intake than on days when they

do not eat out.36 Other possible explanations are the frequency for eating at sit-down restaurants compared to fast

food restaurants and that sit-down restaurants are more likely to offer healthier options on the menu and/or allow

for recipe alterations.

PROXIMITY & HEALTH

Growing evidence suggests there is a correlation between geographic

access to fast food restaurants and rates of consumption and health

outcomes. A California-wide study found that adults who live near an

abundance of fast food restaurants and convenience stores compared to

grocery stores and produce vendors have a greater prevalence of obesity

and diabetes regardless of individual or community income. The highest rates of obesity and diabetes are found

among adults who live in lower-income communities with a higher ratio of fast food restaurants and convenience

stores to grocery stores and produce vendors.37

12

Individuals lacking private transportation are especially dependent on their

neighborhood food environment. A study of adults in Los Angeles County

found that, even though car ownership is generally associated with higher

BMIs, individuals who do not own cars and live in areas with high concentra-

tions of fast food restaurants weighed approximately 12 pounds (2 BMI units)

more than non-car owners residing in areas with no fast food restaurants

and 2.7 pounds (0.45 BMI units) more than car owners who live in areas of

high fast food concentration.38 Other vulnerable populations that face barri-

ers to traveling to access healthier food outlets include the elderly, disabled

and homeless. Older adults, particularly African Americans who live near fast

food restaurants, are more likely to eat fast food and be obese.39

Children, particularly urban, lower-income and minority youth, are also influenced by the food choices in close proximity to

their schools and homes because most are unable to drive. Adolescents are increasingly likely to purchase foods.40

Fast food restaurants have been found to cluster within a short walking distance from schools41-42 and are most prevalent

in urban lower-income neighborhoods43-45 with higher proportions of Hispanic34,44,46 and African American47 students.

A study of schools in California reveals that 65 percent have a fast food restaurant within a half mile and schools in

closest proximity to a fast food restaurant are more likely to be located in urban lower-income neighborhoods and

have more Hispanic students.34

Researchers have found that schools near fast food restaurants have higher rates of student obesity. A study of ninth

graders in California found that a fast food restaurant within a tenth of a mile of a school is associated with at least

a 5.2 percent increase in obesity rates with the effect being largest among Hispanic students and female students.

This implies that students in close proximity to a fast food restaurant consume approximately 30 to 100 calories more

per school day compared with students whose schools are further away from a fast food restaurant.34 Given 3,500

calories is equal to about a pound of body fat,48 eating an extra 100 calories per school day during a 180 day school

year would result in a gain of over five pounds. Another study found that California students with fast food restaurants

within one-half mile of their schools are more likely to be overweight, consume fewer servings of fruits and vegetables,

and drink more soda than students whose schools are not near fast food restaurants.49 Moreover, fast food restaurants

near schools reduce student participation in the National School Lunch Program that provides nutritious lunches to lower-

income children50 and could lower the effectiveness of nutrition education by exposing children to highly visible food

cues that counter educational messages.51 Seventy-four percent of schools in Council Districts 8 and 9 (South LA) had

higher student body compositions (BMI) than the LAUSD average.52

13

MANUFACTURING FAST FOOD DEMAND


The fast food industry has criticized public efforts at regulation by claiming that individuals are responsible for their

food choices and neither industry nor government has the right to tell people what they should or should not eat.

It also argues that no food by itself causes obesity and any food can be part of a balanced diet if consumed in

moderation. However, several factors contribute to fast food restaurants’ overwhelming popularity, including market

domination, targeted advertising, pricing practices, and product design, all of which encourage consumption and

none of which warn consumers about the dangers of frequent consumption. With about half of the healthcare costs

of obesity footed by taxpayers through Medicare and Medicaid, what would otherwise be a matter of personal choice

is a matter of public concern.53

In lower-income and racial/ethnic minority communities like South LA, fast food is often the only available dining

option. These communities tend to be marginalized and underserved by financial institutions making investment

capital difficult for small businesses to obtain. This allows fast food restaurants backed by large national corporations

to dominate commercial corridors squelching competing business before it can develop.

The fast food industry also influences individuals’ dining choices through heavy advertising that dwarfs public health

messages to eat a healthy diet. In 2009, the fast food industry spent more than $4.2 billion marketing its products on

television and other media.54 Fast food restaurants spent $294 million on marketing directly targeting children and

adolescents, and distributed $360 million worth of toys with children’s meals in 2006.55 In comparison, the budget

to promote the Federal government’s 5 A Day Campaign was only $9.55 million.56

The fast food industry’s marketing practices disproportionately target racial/ethnic minority communities. African

American children and teens see at least 50 percent more fast food television ads than their white peers. McDonald’s

and KFC specifically target African American youth, and these teens see 75 percent more television ads for McDonald’s

and KFC compared with white teens.54 A comparison of magazine ads revealed that food products advertised to

African American women differ from those advertised to the general female population. Fast food ads made up 13

percent of Essence magazine’s consumption ads, but only one percent of the ads in Cosmopolitan.57

14

The Institute of Medicine58 and World Health Foundation59 have

both stated that marketing energy-dense, nutrient-poor foods and

beverages to children increases their consumption and adversely

affects their health. The White House Task Force on Childhood

Obesity has further indicated that restaurant marketing practices

undermine the efforts of parents and other caregivers to encour-

age healthy eating among children and prevent obesity.60 While

some fast food restaurants have responded (McDonald’s and

Burger King) by joining the industry-sponsored Children’s Food

and Beverage Advertising Initiative pledging to limit children’s

advertising to “better-for-you” menu choices, studies have shown

that their ads do not encourage consumption of healthier choic-

es and instead focus on toy giveaways and building brand loyalty.54 Moreover, a recent study commissioned by the

World Health Organization to assess how well Kraft Food and McDonald’s fulfilled voluntary promises to market food

to children more responsibly concluded that food companies “cannot — and will not — stop making and marketing

nutritionally questionable food products to children.”61

Fast food restaurants’ pricing practices and product design target people who are lower-income, are driven by cost

and taste more than nutrition concerns, and have limited time to prepare meals at home. Fast food restaurants are

able to sell energy-dense, nutrient-poor foods at low prices because they are cheaper than fruits, vegetables and oth-

er healthy foods.62 It is no surprise that fast food consumption is most prevalent among individuals with lower-incomes

who regard cost as an important factor in determining dining choices.25-26 These restaurants appeal to cost-conscious

consumers by offering larger portion sizes for only a small

price increase —a marketing strategy referred to as value

size pricing. Although portion sizes have increased in almost

all food categories beginning in the 1970s, the largest in-

crease has occurred at fast food restaurants.63 In 1955, the

only available McDonald’s hamburger patty weighed 1.6

ounces. In 2006, the 1.6 ounce patty is still available along

with several larger portions, including an 8 ounce patty that

is five times larger than the original.64 Larger portions en-

courage people to consume larger quantities and make it

difficult for people to self-regulate what they eat.65

15

While it is unlikely anyone ever

demanded more saturated fat,

trans fat, sugar, or sodium from

a restaurant, they do make foods

taste good, an important driver of

food choice when dining out.66-67

Individuals drawn by taste who

have a low concern for nutrition and

maintaining a healthy weight have

the highest rates of fast food con-

sumption.26-27,66,68 In fact, concerns

about reduction in taste deter many

people from making healthier food choices at fast food restaurants,69 and this negative attitude toward healthy

foods is more common among lower-income and racial/ethnic minorities.70 Individuals who are concerned with

nutrition and have better dietary practices are less likely to dine at fast food restaurants, but do dine at sit-down

restaurants likely because they are perceived as having more healthy options.68

Fast food restaurants also employ food preparation and service methods that result in fast dining convenient for people

pressed for time or needing food “on the go.” Drive-through service and

food items in portable containers also cater to consumers who eat on

the run.71 Individuals most attracted to convenient dining are those who

lack the time or have difficulty preparing food at home. Individuals with

lower incomes often face higher costs of time preparing food at home,

which increases the incentive to dine out.72 Employment status is also a

factor, and working single-parents and dual-income households tend to

have high time costs. Many people also have difficulty preparing food at

home because they do not know how to cook, have limited mobility, or

do not have access to a kitchen. Examples include adolescents, college

students, seniors, the disabled, and the homeless. The choice to dine at

fast food restaurants is not only driven by the low cost of meals, but also

convenience (i.e., low time costs).68,71

16

Local municipalities do not have the financial resources to counter fast food chains’ investment and marketing practic-

es. The Institute of Medicine and National Research Council,73 Centers for Disease Control and Prevention,74American

Planning Association,75 Center for Law and Public Health at Johns Hopkins and Georgetown Universities76 and other

public health and planning professionals64,77 suggest that one way to mitigate the influence of fast food restaurants on

people’s diets and increase access to healthy foods is through zoning. By limiting the development of unhealthy fast

food restaurants and encouraging the development of healthy restaurants, zoning laws can help create an environment

that supports making healthy food choices and contributes to a reduction in the prevalence of obesity and chronic

disease.

Under the police power granted to the states in the Tenth Amendment of the US Constitution, states have the sole

authority to regulate private individuals in the interest of the public’s health, safety, morals, and general welfare. Like

all states, the California Constitution delegates zoning authority to local governments.78 The courts have repeatedly

upheld the validity of using the police power to enact zoning ordinances in the interest of the public’s health, and

public health has provided the strongest legal basis for zoning ordinances. While until recently, no zoning laws had

been enacted specifically to address the obesity epidemic, researchers believe a carefully crafted ordinance should

survive constitutional challenges.76,79-81

Los Angeles has a long history of employing land use regulations to achieve public health goals. However, affluent

communities have achieved more meaningful land use planning than lower-income and racial/ethnic minority

communities like South LA, exacerbating economic and racial segregation and inequality.82 South LA has only two

specific plans: the South LA Conditional Use Approval for the Sale of Alcoholic Beverages Specific Plan and the Crenshaw

Corridor Specific Plan (see Box 1).More meaningful planning is needed to protect residents of South LA from the

further overconcentration of uses that are detrimental to health.

REGULATING FAST FOOD RESTAURANT DEVELOPMENT


17

Box 1: South LA Specific Plans

Adopted in 1987, the South LA Alcoholic Beverages Specific Plan requires establishments in portions of the three

South LA Community Plan areas that wish to dispense alcoholic beverages for off-site consumption to first obtain con-

ditional use approval. In its decision, the City considers the number and proximity of other such establishments within

a one thousand foot radius and the proximity of residential areas, religious institutions, schools, and public parks.

The Crenshaw Corridor Specific Plan, adopted in 2004, seeks to ensure the development and redevelopment of

the Crenshaw Corridor in the West Adams-Baldwin Hills-Leimert Community Plan area stimulate economic revitaliza-

tion, address the retail needs of the community, enhance community aesthetics, and promote pedestrian activity. Uses

found incompatible with these goals are prohibited or limited. For example, drive-through fast food restaurants are

prohibited in certain areas, such as Leimert Park and Park Mesa Heights, and limited in others to a maximum of one

within a 750 foot radius of another. Bans on drive-through service can have a similar effect as a ban on fast food

restaurants because over 60 percent of fast food business is conducted by drive-through service and new fast food

restaurants may not be profitable without it.76 Signage is also limited to one window identification sign, one wall sign,

and either a projecting sign attached to a wall or a sign attached to an awning.

Communities across the country, including

several cities and towns in California, have

enacted regulations on fast food restaurants

in several different ways. These ordinances

were primarily passed to preserve the aesthetic

qualities of the community, maintain retail

diversity and promote tourism. Some also

include a public health justification, such

as preventing excess traffic congestion to

protect pedestrian safety and air and envi-

ronmental quality. The City of Watsonville,

California, adopted an ordinance in October

2010 with the goal of promoting healthy eating and reducing obesity and disease. These policies are examined

below to inform the recommendations for strengthening the South LA fast food restaurant policy beyond the General

Plan Amendment.

18

1. Bans on fast food restaurants and/or drive-through service: The City of Concord, Massachusetts,

bans both fast food restaurants and drive-in service. The purpose of the ordinance is to reduce traffic congestion and

preserve and enhance the community’s aesthetic qualities. The City of Carlsbad, California, has a city-wide ban on

drive-through restaurants and other drive-through businesses, like banks, are generally permitted with a conditional

use permit. The Crenshaw Corridor in South LA also has restrictions on drive-through service as described in Box 1.

2. Bans on formula restaurants: Formula restaurants refer to restaurants similar to those located elsewhere,

such as having a common business name and logo, standard-

ized menus, and similar interior and exterior decor. The City and

County of San Francisco prohibits all formula retail (including fast

food restaurants) in the Hayes-Gough Neighborhood Commercial

District and requires a conditional use permit in other districts.

The purpose of the ordinance is to protect the small business sector

and preserve the distinctive character of certain commercial districts.

The ordinance states that the unregulated growth of formula retail

businesses could limit or eliminate opportunities for smaller businesses

and non-traditional or unique businesses, decreasing the diversity

of goods and services and deterring visitors and tourists.

3. Limits on the total number of fast food restau-

rants: The City of Berkeley, California, has a quota on the number of food service establishments in the historic

Elmwood Commercial District near the University of California, Berkeley to preserve the shopping area that serves

the surrounding community and the character of the neighborhood. Elmwood is permitted three carry-out restaurants,

seven fast food restaurants and seven full-service restaurants.

4. Limits on the density of fast food restaurants: Within the City of Los Angeles, the General Plan Amendment,

which requires new stand-alone fast food restaurants to locate at least a half mile from any existing fast food restaurant,

is an example of a density regulation. Another example is the Westwood Village Specific Plan, addressing the area of

Los Angeles that surrounds the University of California, which limits the density of fast food restaurants through spacing

requirements. The total number of fast food restaurants along any public street cannot exceed a ratio of one for every

400 feet of lot frontage, except on Broxton Avenue where one fast food restaurant is permitted for every 200 feet.

The purpose of the ordinance is to preserve the area’s unique character and ensure the retail serves the needs of the

surrounding community.83

19

5. Regulations based on distance from other uses: In 1978, the City of Detroit, Michigan, passed a zoning

ordinance that established a minimum distance of 500 feet between carry-out, fast food and drive-in restaurants and the nearest

point of an elementary, junior high or senior high school. The reasons for the zoning were concerns about truancy and school

delinquency, litter, noise, air pollution and youth exposure to marketing of unhealthy foods. Health concerns included exposure to

“highly processed, minimally nutritious foods associated with unhealthy diets and air pollution from cars associated with asthma.”

6. Regulations based on healthy menu criteria: On October 12, 2010, the City of Watsonville, Califor-

nia, approved an ordinance requiring restaurants to offer healthy options in order to obtain a building permit as a way

of promoting healthy eating choices that reduce obesity and diseases. The Healthy Eating Ordinance uses a point

system (see Appendix 4) modeled after the City’s Green Building Ordinance that establishes minimum environmental

standards for obtaining building permits and a reward system for projects meeting specific goals. The Watsonville

ordinance requires that restaurants earn at least six out of 18 available points to obtain a permit to build or remodel.

Restaurants earning nine points are awarded a certificate; for 13 points they get a Golden Carrot Award, both of

which come with promotional benefits.

Most community members do not desire a complete ban on new fast food restaurants, and the difficulty in counting

the number of existing fast food restaurants precludes establishing a limit on the total number of fast food restaurants.

The recommendations for strengthening South LA’s fast food restaurant development policy build upon the examples

of regulations based on density, distance from other uses, and a healthy menu criteria to meet policy needs.

20

The City of Los Angeles must build upon and strengthen the General Plan Amendment by adopting a more comprehensive

fast food restaurant development policy for South LA and other over-concentrated areas. This policy must have the

expressly stated purpose of improving the health of the community by creating a restaurant environment that provides

consumers with access to a meal or food that is consistent with the Dietary Guidelines for Americans when dining out.

It also should include a goal of increasing the number of healthy food outlets (like healthy restaurants, grocery stores

and farmers’ markets) relative to unhealthy food outlets (like unhealthy fast food restaurants and convenience stores).

The policy must extend to all fast food restaurants and not be limited to stand-alone establishments. The case studies

of South Figueroa Street, Crenshaw Boulevard and West Martin Luther King Jr. Boulevard show that the over-

concentration of fast food restaurants takes place in both stand-alone developments and shopping centers/joint tenant

buildings and that these are often found next to one another. Moreover, fast food chains continued to enter the

South LA community during the ICO by locating in shopping centers and joint tenant buildings. This indicates that a

permanent policy limited to stand-alone establishments is insufficient to curtail development. Fast food restaurants in

mixed-use developments are particularly troubling because they represent the ultimate level of access for individuals

who live there.

The policy must also address over-exposure for those individuals most vulnerable to their local food environment. As

previously described, many transit stops and schools in South LA are surrounded by multiple fast food restaurants.

Research suggests the regulations on new fast food restaurants should target individuals lacking private transportation

and children by limiting development near transit stops, schools and other uses where children congregate, like

parks, playgrounds, recreation centers, and child care centers.

SOUTH LA SOLUTION


21

Finally, the policy must differentiate between healthy and unhealthy fast food restaurants. Demand for low-cost, tasty

and convenient foods is likely to remain strong among individuals who live and work in South LA. Having a limited

menu, no table orders and foods served in disposable wrapping and containers (the City’s definition of a fast food

restaurant) allows restaurants to lower their menu prices and increase the convenience of the dining experience.

However, these characteristics should not mean that a restaurant has to sacrifice the healthfulness and nutritional

quality of the food provided.

Many mom-and-pop, ethnic and fast casual restaurants (e.g., Panera Bread and Baja Fresh) fall under the definition

of a fast food restaurant, but offer a greater number of healthy options than conventional fast food restaurants. Fast

food chains have started adding healthy options to their menus, like salads and grilled chicken, and could step up this

effort. Industry analysts believe that offering healthier options is a trend that will likely continue to grow in the coming

years.84 Restaurants are beginning to acknowledge that when people go out to eat in groups, one person who considers

healthier eating important can sway the restaurant choice for the entire group through what the industry calls a “veto

vote.”85 While limits on new unhealthy fast food restaurants are clearly necessary, healthy fast food restaurants are

needed in South LA to meet the demand for low-cost and convenient dining options.

1. Extend the criteria to obtain a construction permit to all fast food restaurants in South LA, not just stand-alone

establishments.

2. Add an additional criteria requiring new fast food restaurants in South LA to locate at least a half mile away from

schools, parks, playgrounds, child care centers, recreation facilities, and other children-oriented facilities.

3. Add an additional criteria requiring new fast food restaurants to locate at least 750 feet from bus, rail and

other transit stops.

4. Define a healthy restaurant using criteria based on the Dietary Guidelines for Americans.

5. Provide an exemption from distance requirements for fast food restaurants meeting the healthy restaurant definition.

In addition to the six criteria for obtaining a construction permit in the General Plan Amendment, the policy should also do the following:

Exempting fast food restaurants that meet the healthy restaurant criteria from density and distance requirements

acknowledges that these restaurants contribute to a healthy restaurant environment and creates a zoning incentive

for these restaurants to invest in South LA by limiting competition from potential unhealthy fast food restaurants.

Additionally, the exemption could encourage new fast food restaurants to improve the healthfulness of their menus to

gain entry into the South LA market. This policy should withstand constitutional challenges. A rational and evidence-

based relationship exists between limiting access to unhealthy fast food restaurants and the public health objective

of creating a better balance between access to healthy and unhealthy foods when dining out to encourage healthy

choices and reduce obesity and chronic disease (see Appendix 5).

22

DEFINING A HEALTHY RESTAURANT

A restaurant classified as “healthy” should at a minimum provide consumers with equivalent access to purchase

meals or foods that are part of a diet consistent with the Dietary Guidelines for Americans. Equivalent access means

that a restaurant’s regular menu offers an equal number of meals, main dishes, side dishes, and desserts that meet

criteria for being healthy, or half of all types of menu items meet the healthy criteria. This gives restaurants with large

and small menus flexibility. Additionally, a healthy restaurant must have at least one fat free or low fat salad dressing,

if salads are offered, and provide water free of charge.

To meet the healthy restaurant classification, the regular menu (not including specials) must offer:

1. At least 4 choices of meals OR half of all meals on the menu that are healthy

2. At least 4 choices of main dishes OR half of all main dishes on the menu that are healthy

3. At least 3 choices of side dishes OR half of all side dishes on the menu that are healthy

4. At least 1 healthy dessert

5. At least 1 fat free or low fat salad dressing (if salads are offered)

6. Water free of charge.

For a meal, main dish, side dish, or dessert to be considered healthy,

criteria are also needed that take into account nutrients to limit —

like fat, sodium and sugar — and meeting minimum requirements

for the five food groups. The following criteria are modeled after

the Federal Government’s Fruit and Vegetable Program, which sets

standards for recipes that may feature the Fruits & Veggies – More

Matters logo (based on the 2005 Dietary Guidelines for Americans’ recommendations),vi and include the updated

2010 Dietary Guidelines for Americans.86 They assume the average 2,000 calorie a day recommendation, which is

divided by three for meals, four for main dishes, and eight for side dishes and desserts. They also assume a maximum

intake of 1,500 milligrams of sodium per day, which is the recommendation for individuals who are over the age of

51, who are African American, or who have hypertension, diabetes, or chronic kidney disease.

vi See Appendix 4.

The following criteria are used to define a healthy meal, main dish, side dish, or dessert:

23

In addition to meeting the requirements for offering healthy

menu options, the “healthy” classification should also be lim-

ited to restaurants that promote healthy menu items and do not

promote unhealthy menu items in signs, table tents, other dis-

plays, and promotional giveaways, particularly those targeted

at children. Pricing should also not promote unhealthy menu

items relative to healthy items, such as larger portions for a few

cents more, “all-you-can-eat” or “unlimited portions,” charging

more for a smaller versus regular portion of a dish, or charging

more if customers wish to split a meal. Restaurants that price

healthy items lower than unhealthy items should be given spe-

cial consideration as price decreases — even as small as 20-30

percent — tend to have a greater effect on healthy choices compared with health messages.69 Moreover, healthy

restaurants should both train their staff to know the menu thoroughly to provide calorie information when asked

and/or identify healthy options with a sticker.

Food Type Total Fat vii Saturated Fat Trans Fat Added Sugars Calories Sodium Food Groups

Combo/Meal <35% <10% <0.5 grams <15% 700 500 mg At least 40 grams of at least 3 different food groups (2 being fruits and vegetables)

Main Dish <35% <10% <0.5 grams <15% 500 375 mg At least 40 gramsof food from 2food groups

Side Dish/Dessert <35% <10% <0.5 grams <15% 250 190 mg N/A

Source: US Department of Health and Human Services. A Healthier You. US Government Printing Office. Available at: http://www.health.gov/dietaryguidelines/dga2010/healthieryou/contents.htm. Accessed July 12, 2011. Page 19.

viiThe fat naturally found in fruits and vegetables does not contribute to the limits above.

24

Using the Watsonville Healthy Eating Ordinance point system as a modelvii restaurants could be expected to meet

some, rather than all, of these additional requirements.

1. Signs, table tents and other displays highlight healthy menu items, available healthy

substitutions, and if reduced-size portions are available; displays do not promote un

healthy menu items or encourage large portions.

2. Promotional giveaways, particularly those targeted at children, are only given with

healthy options.

3. “Super-sized” and other forms of value size pricing for foods and beverages are not available.

4. “All-you-can-eat” or “unlimited portions” are not available.

5. Smaller portions or half portion meals are priced at a lower cost.

6. Customers are allowed to split a meal at no extra cost.

7. Staff members are trained to know the menu thoroughly, including portion sizes,

ingredients and preparation methods.

8. Calorie information is visible at the point of purchase or health option stickers are

provided on the menu.

To be classified as healthy, a restaurant must also meet at least half of the eight criteria described below:

ZONING TOOLS

The South LA fast food restaurant development policy could take the form of an update to the three South LA Community

Plans, a specific plan, an overlay zone, or other zoning regulations (see Appendix 6). A specific plan seems most

appropriate because the overconcentration of unhealthy fast food restaurants and lack of restaurants offering healthy

options is a policy issue of major concern. It also provides the long-term land use planning needed to significantly

change the South LA restaurant environment not found with an overlay zone. It is also a better and more time sensitive

way to address this pressing issue in all of South LA rather than completing three separate community plan updates.

Moreover, the South LA Alcoholic Beverages Specific Plan, Crenshaw Corridor Specific Plan, and Westwood Village

Specific Plan set a precedent for using a specific plan to address an overconcentration of uses that is detrimental to

the community’s welfare. However, an effort should also be made to incorporate the underlying principles of the

proposed recommendations in the General Plan Framework at some future date.

viii See Appendix 4.

25

Improving the South LA restaurant environment requires attracting new healthy restaurants in addition to regulating new

fast food restaurants. While limits on unhealthy fast food restaurant development are likely to encourage investment by

new healthy restaurants, the City’s efforts to market South LA to potential investors can also be improved by strengthening

the Grocery Store and Sit-Down Restaurant Incentive Package in the following ways:

1. Shift the focus from sit-down restaurants to new restaurants of any type that meet the healthy restaurant

definition.

2. Include additional incentives directly related to the added cost and complexity of meeting the healthy

restaurant definition, such as assistance with nutritional analysis of menu items, recipe modifications

and identifying suppliers of fresh produce.

3. Develop a promotional campaign to educate the public about restaurants meeting the healthy definition

and drive consumer demand.

Establishing financial incentives to supplement the additional costs of initial and continuing compliance with the

healthy restaurant guidelines is essential to encourage the development of new healthy restaurants in the community.

The costs of a comprehensive nutritional menu analysis can be burdensome for some restaurants, particularly for

smaller “mom and pop” restaurants that are not as financially secure as larger chain establishments. Many of these

smaller, locally owned restaurants do not have standardized recipes for menu items, which could make menu analysis

more labor intensive and potentially more expensive. Outcomes from similar healthy menu modification initiatives

indicate, however, that the standardization of recipes actually results in an expense reduction in the long-term, which

can help to compensate for the added expense of analysis.

SIT-DOWN RESTAURANT INCENTIVES


Additionally, menu analysis costs can be supported by grants and loans provided by municipal and/or non-profit entities.

A number of community-based organizations, such as community finance and development corporations, provide loans

for new businesses to assist with the start-up costs of permitting and development. These low-interest loans can range

in quantity, and are usually enhanced through financial consulting and cost-sharing opportunities with other businesses

within the area. A pipeline between businesses applying for the healthy restaurant classification and these financial

organizations should be established to help ensure that the food environment in South Los Angeles is positively

impacted by these regulations.

Promotional campaigns for healthy restaurant

initiatives in other cities have been particularly

successful at encouraging restaurants to offer

healthy options while increasing consumer

patronage of participating restaurants and de-

mand for the healthy selection (see Appendix 7).

An aggressive promotional campaign could be

developed in partnership with the County of Los

Angeles that includes a brand and logo; provides

participating restaurants with window signs and

promotional materials; highlights participating

restaurants in a brochure and website; and purchases

advertisements on television, radio, billboards,

and print media. The City and County could also

distribute the menus of participating restaurants to public offices, schools and organizations in South LA and encourage

them to use these restaurants to fulfill their catering needs.

In the long run, the City could make South LA more attractive to new healthy restaurants and other desirable retail by

investing in neighborhood infrastructure. Projects are already underway to develop transit-oriented shopping centers

and improve store façades. Decades without sufficient public investment mean that these types of projects are needed

throughout South LA. Investments in murals and other art and cultural projects have also been successful at catalyzing

development in other communities.87

26

IMPLEMENTATION & MONITORING COMPLIANCE


27

Successfully implementing the Healthy Restaurant Incentive Program will require collaboration and coordination

between the County Department of Public Health and the City Department of Planning. The current functions of

both organizations in the permitting process would need to expand to implement and monitor the healthy restaurant

designation. Public Health should be required to evaluate restaurants’ compliance with the healthy guidelines during

the application review process to determine whether the restaurant is eligible to participate in the incentive program.

City Planning in turn would be responsible for granting designated restaurants the exemptions necessary to build in

areas typically restricted for fast food restaurants.

The City of Los Angeles has an existing Restaurant and Hospitality Express Program that helps restaurants navigate

the complicated and time-intensive permit review process. The Healthy Restaurant Incentive Program should be

integrated into the framework of this program to expedite the process and prevent protracted processing from the

additional application review requirements. A case manager from the Restaurant and Hospitality Express Program

should be designated to help restaurant owners through the permitting process described below.

Healthy Restaurant Incentive Program: Building Permit Approval Process

To qualify for the Healthy Restaurant Incentive Program, restaurants must first receive a certificate of compliance

based on an evaluation of the restaurant’s proposed menu items and corresponding nutritional content. This

certification should be conducted by any Department of Public Health-approved nutritionist with a registered dietician

degree and be based on the qualifications included in the Healthy Restaurant Guidelines.

For building permit approval, restaurant owners should submit to the Los Angeles Department of City Planning the

certificate of compliance, a completed building permit application, and a signed form under penalty of perjury that

includes the owner’s commitment to continued compliance with the Healthy Restaurant Guidelines. After approval is

granted by City Planning, the restaurant must continue to undergo the standard building permit review process, which

includes receiving site plan approval from the Environmental Health Division of the Los Angeles Department of Public

Health. Once the standard application approvals have been granted, a Certificate of Occupancy will be given to the

restaurant owner, which would allow the restaurant to finally open its doors to the public.

In order to ensure continuing compliance, City Planning should conduct a compliance monitoring evaluation one

year from the Certificate of Occupancy issuance date. This evaluation will require the restaurant owner to resubmit

the menu for verification that the food items certified in the previous year’s evaluation continue to be served at the

restaurant. If a restaurant no longer serves the certified menu items, the new menu items must be certified and veri-

fication submitted to Planning.

The restaurant owner must also provide verification that the restaurant has successfully implemented 3 of the 8 ad-

ditional Healthy Restaurant Incentive requirements indicated in the initial program application. If these qualifications

are verified and approved by City Planning, a Letter of Continuing Compliance will be issued to the restaurant owner.

City Planning will conduct re-evaluations on an annual basis, and the Department of Public Health will also conduct

“spot checks” on randomly selected restaurants in the program to monitor continued compliance throughout the year.

Restaurants lacking current certifications will be deemed noncompliant and will be subject to significant financial

penalties. The penalties should be substantial enough to induce the non-complaint restaurants to make changes to

re-align with the healthy restaurant guidelines and include a significant weekly penalty while not in compliance. If the

restaurant remains out of compliance for an entire year, a fee equivalent to the City’s cost of granting the exemption

should be charged in addition to the weekly fees.

28

Finally, the City should ensure that these

and other policies do not unintentionally

increase food insecurity, particularly

among the most vulnerable populations.

For example, the City should monitor the

number and location of restaurants that

accept food stamps and food insecurity

among low-income households. Individuals

who are elderly, disabled and homeless

are able to use food stamps at restaurants

under the Restaurant Meals programs.

Only a limited number of restaurants accept

food stamps, and the majority are fast

food restaurants. The City should ensure

policies do not reduce access to restaurants accepting food stamps and encourage more restaurants, particularly

healthy fast food restaurants, to accept them.

As with all development efforts, the City should also monitor potential displacement. Establishing new healthy restaurants

could lead to higher rents, displaced locally-owned businesses and reduced affordable housing for lower-income

families. If this occurs, the City should strengthen eviction and vacancy controls and target small business development

and homeownership assistance to residents at risk for potential displacement.

PREVENTING UNINTENDED CONSEQUENCES


29


CONCLUSION

The prevalence of fast food restaurants in South LA and other urban,

lower-income and racial/ethnic minority communities across the

country combined with the lack of access to healthy foods contributes

to an overwhelmingly disproportionate incidence of obesity and

diet-related chronic disease compared with more affluent and

predominantly white neighborhoods. These communities are often

further disadvantaged by lacking adequate healthcare and education,

compounding the effects of a poor food resource environment. The

burden of obesity and diet-related chronic disease is borne by families,

their communities, and local and state governments as a result of

lost productivity and premature death.

Many factors contribute to the increase in obesity and diet-related

chronic disease — including poverty, lack of opportunities for physical

activity, inadequate healthcare, lack of nutrition education, and limited

health literacy — and no single step will solve these complex and

multi-faceted epidemics. However, doing nothing or refusing to

acknowledge the consequences of an overconcentration of un-

healthy fast food restaurants will magnify their role in encouraging

obesity and disease. We must work to create a food environment in

South LA where healthy foods are accessible and messages that support

health are common.

30

APPENDICES


31

APPENDIX 1South Figueroa Street Between West 27th Street and West 31st Street

Community Health Councils 25

Appendix 1

South Figueroa Street Between West 27th Street and West 31st Street

32

APPENDIX 2Crenshaw Boulevard Between West Adams Boulevard and West 29th Street

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33

APPENDIX 3Manual Arts High School

Community Health Councils 27

Appendix 3

Manual Arts High School

34

APPENDIX 4

Points are earned by providing the following:

At least four choices of fruits or vegetables prepared in a low fat way

Fruits or vegetables as a substitute for less healthy side dishes such as fries

At least one fat free or low fat salad dressing

Skim or 1% milk

Water free of charge

Whole grain bread instead of white bread or a no-bread option

Meat, fish, poultry, or meat alternative with visible fat removed and prepared in a low fat way such as broiling, baking, poaching, roasting,

steaming, or stir frying

At least one vegetarian dish not exceeding 500 calories

Butter, margarine, sour cream, salad dressing, or mayonnaise on the side or not at all

Smaller portions or half portion meals at a lower cost and allowing customers to split a meal

Training for staff members about knowing the menu thoroughly, including portion sizes, ingredients and preparation methods

Calorie information visible at the point of purchase or provide healthier option stickers on the menu

Corn tortillas instead of flour tortillas

Whole beans instead of refried beans

TOTAL POINTS

Points

2

1

1

1

2

1

2

1

1

1

1

2

1

1

18Source: Watsonville, Cal., Council File 101210 (2010). Available at: http://www.ci.watsonville.ca.us/agendas/101210CC_6.2d_101210.pdf. Accessed March 7, 2011.

Watsonville Healthy Eating Ordinance Points System

For meals, main dishes and sides:

Source: “About the National Fruit and Vegetable Program: Program Guidelines.” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Available at http://www.fruitsandveggiesmatter.gov/health_professionals/program_guidelines.html. Accessed October 19, 2010.

National Fruit and Vegetable Program: Criteria for Recipes that May Feature the Fruits & Veggies

Each serving of food must contain at least one serving of fruit or vegetable per 250 calories

Each serving of food must contain limited amounts of added sugars or caloric sweeteners

1. Added sugars cannot exceed 15% of total calories 2. Concentrated fruit juice sweeteners, jams, and jellies count as added sugars

Each serving of food must contain limited amounts of fat

1. Total fat < 35% of total calories

2. Saturated fat is < 10% of calories

3. Trans fat is < 0.5g per serving

Each serving of food must contain ≤ 600mg of sodium per serving

Each serving of food must offer ≥ 0.014g/kcal naturally occurring fiber (28g of fiber/2000 calories)

4. The fat found naturally in fruits and vegetables does not contribute to the limits above. Further ¼oz. of nuts is allowed per serving without their fat content contributing to these restrictions. Nuts must be in their natural form without anything added or removed (e.g., no added oils, removed oils, added sodium, or added sugars)

For meals:A meal product is defined as a food that makes a major contribution to the total diet by:

1. Weighing at least 10oz. per labeled serving

2. Containing not less than 40g for each of at least 3 different foods from 2 or more of the following (5) food groups:

a. bread, cereal, rice, and pasta group b. fruit group c. vegetable group d. milk, yogurt and cheese group

e. meat, poultry, fish, dry beans, eggs, and nuts group

For main dishes:A main dish product is defined as a food that makes a major contribution to a meal by:

1. Weighing at least 6oz. per labeled serving

2. Containing not less than 40g of foods from 2 of the 5 food groups noted above

35

APPENDIX 5Potential Constitutional Challenges

The possibility of a constitutional challenge is very real and would likely be based on the Equal Protection Clause of the

Fourteenth Amendment to the Constitution and the Dormant Commerce Clause. The Fourteenth Amendment assures

citizens that no state can deprive them of fundamental rights and allows people to challenge government acts that

are discriminatory. A challenge to a fast food restaurant zoning ordinance based on Equal Protection grounds would

likely be analyzed under the rational basis standard, which requires the legislation to have a rational relationship to

a legitimate governmental purpose of promoting the public’s health, safety, morals, or general welfare. Restricting

the issuance of permits to new fast food restaurants that do not meet standards for providing healthy options should

pass constitutional muster because there is ample evidence of the link between fast food restaurants and obesity and

chronic disease.76,81

The Dormant Commerce Clause prevents state and local laws from placing too great a burden on interstate commerce

because its regulation falls under the jurisdiction of the federal government. State and local laws can be invalidated

even in areas where federal law does not exist, such as zoning of particular areas to preclude certain businesses.

An unhealthy fast food restaurant ban would not distinguish between intra- and inter-state commerce or restrict new

permits to California-based businesses. All unhealthy fast food restaurants, originating both within and outside California,

would be treated the same. Since most fast food restaurants are part of national and even international chains, a

ban could greatly impact interstate commerce. In this case, the courts would weigh whether the economic burden

imposed on commerce is clearly excessive in relation to the predicted benefits to the health and safety of South LA

residents. Considering the oversaturation of fast food restaurants in South LA, the fast food industry has clearly not

been shut out of the market. The ban also impacts locals in the fast food industry just as much as national and

international chains. Given this and the extent and nature of the local benefits, the ban would likely survive a Dormant

Commerce Clause attack.79,81

36

APPENDIX 6Land Use Planning Tools

General plan: a City-wide blueprint for future development consisting of the goals and policies used by policymakers

to determine their land use decisions.

Community plan: a portion of the general plan focusing on a designated community and the issues relevant to that

community (a community plan supplements the policies of the general plan).

Specific plan: a plan for the systematic implementation of the general plan developed in response to one or more

policy issues and encompassing a contiguous area of any size; it can be as general as establishing broad policy

concepts or as detailed as directing every facet of development (it is not technically part of the general plan, but must

be consistent with the general plan).

Zoning regulations: laws that spell out the immediate allowable uses for each parcel of land and standards such as

lot sizes, building heights and setbacks; they can take the form of the following zoning techniques:

• Conditional zoning: an area of land is zoned for a broad category of uses (e.g, commercially), but under the

condition that only specific new uses are allowed or that certain uses (that would otherwise be allowed) are

prohibited.

• Incentive zoning: the construction of certain uses are encouraged by establishing predetermined trade-

offs between things the zoning code does not permit (e.g., building above height restrictions) in return for

things the zoning code does not require (e.g., creating a mixed-use building).

• Performance zoning: specific standards that anyone who uses the land must meet (e.g., standards for pollution

or noise levels) which can be implemented independently or as a supplement to use restrictions.

• Overlay zone: a set of zoning requirements that is superimposed upon existing zoning regulations to

further regulate development in an area of special concern, such as commercial corridors, historical areas

and environmentally sensitive areas, and has been used to encourage or discourage certain types of

development.

37

APPENDIX 7Encouraging Restaurants to Offer Healthy Meals

Smart Meal Colorado: The Colorado Department of Public Health’s Colorado Physical Activity and Nutrition

Program established the Smart Meal Colorado initiative to highlight healthy menu items at restaurants. To participate,

restaurants must offer at least two meals that qualify for a Smart Meal Seal. An independent service analyzes meals

for meeting minimum servings of beans, whole grains, fruits, and vegetables and maximum amounts of calories,

fat, saturated fat, trans fat, and sodium for a discounted rate of approximately $90 per meal. The initiative has been

successful at increasing purchases of healthy meals and decreasing purchases of soft drinks, fries, and desserts. As of

2009, 20 restaurants with 200 locations were participating, including over 100 McDonald’s, which see promotion

and being viewed as a community leader as key benefits to participation.88

Shape Up Somerville Restaurant Initiative: In Somerville, Massachusetts, Tufts University sought to improve the

availability of healthy options at local, family-friendly restaurants and sandwich shops. Chain restaurants, including

fast food, were not recruited because local franchises need corporate level approval to participate and make menu

changes. The initiative developed participation criteria based on interviews with restaurant owners that indicated

the criteria must be straightforward, clearly discriminate between restaurants that are and are not offering healthy

choices, specify that calories be reduced, and provide visibility and brand awareness for the initiative. The nutritional

criteria were limited to offering some entrees as smaller-size portions, making fruits and/or vegetables available as

a side dish in place of fries or chips, and offering low-fat or nonfat dairy products (Asian restaurants were exempted

from this requirement for cultural reasons).

Similar to Smart Meal Colorado, publicity was a strong incentive for participation, as was the perception of caring

about the community. Restaurant owners’ lack of time and concerns about revenue loss were the biggest barriers to

program participation. Cultural acceptability of the menu changes was also an issue and flexibility of the criteria

allowed a large number of ethnic restaurants to participate. Researchers indicated that the initiative could have been

more successful had it included someone with restaurant experience to assist with recruitment.

Winner’s Circle is a healthy dining partnership between North Carolina Prevention Partners and local communities,

restaurants, schools, worksites, and other food service providers. The program uses a logo to identify healthy foods

at participating eating establishments. Similar to Smart Meal Colorado, foods that bear the Winner’s Circle logo

must meet strict nutritional standards, including minimum servings of fruits, vegetables, whole grains, or beans, and

maximum amounts of calories, sodium, fat, saturated fat, trans fat, and sugar. However, the program is not limited to

identifying healthier meals, but also promotes healthier side items, snacks and beverages (e.g., water, flavored water,

non- or low-fat milk or soy milk, 100% real fruit juice).

38

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