With a plethora of research and opinions on the issue of responsibility, is there really any one party directly responsible for the obesity epidemic, or is the issue multi-faceted? Since more than 30 percent of westerners are obese, dramatically impacting healthcare costs, this rapidly growing problem needs to be addressed. Are restaurant owners partly responsible for the obesity the growing rates of obesity?

"Parents want to feed their children healthy meals but America's chain restaurants are setting parents up to fail," says Center for Science in the Public Interest nutrition policy director Margo G. Wootan. "McDonald's, Burger King, KFC, and other chains are conditioning kids to expect burgers, fried chicken, pizza, french fries, macaroni and cheese, and soda in various combinations at almost every lunch and dinner."

Besides being too high in calories, 45 percent of the kids' meals at the 13 chains in a recent study are too high in saturated and trans-fats, and 86 percent are too high in sodium. That's alarming, according to the study's authors, because a quarter pounder has become a commonplace dinner in many households.

"People may not get a heart attack until their 50s or 60s, but arteries begin to clog in childhood," says the Church and Charitable Private Hospital Association's (CCPHA) Executive Director Dr. Harold Goldstein. "Most of these kids' meals put children on the fast track to obesity, diabetes, heart attacks, and premature death.

Researchers at the University of Pennsylvania reported findings of their study on restaurants and the obesity crisis in February's American Journal of Preventive Medicine. Not surprisingly they found that it depends very much on where you're dining out and what you're eating. And in fact, overall, in reports of children between the ages of five and ten, many show early signs of heart disease.

People who ate out most often actually had the lowest body weights. However, once the restaurants are split into components: fast food and full service, those who ate in fast food restaurants most often were the heaviest.

So, the researchers concluded that eating in full service restaurant where you have a wider choice of menu alternatives is important if you don't want to be any wider! Therefore, they feel that the type of restaurant, versus restaurants in general can be responsible for overconsumption and its association with weight control.

Another study performed at the University of California at Berkley looked at data on individual eating habits from a survey conducted between 1994 and 1996. When eating out, people reported consuming about 35 percent more calories on average than when they ate at home. But importantly, respondents reduced their caloric intake at home on days they ate out (that's not to say that people were watching their weight, since respondents who reported consuming more at home also tended to eat more when going out). Overall, eating out increased daily caloric intake by only 24 calories. The results for urban and suburban consumers were similar.

Other research in the causes of rising obesity rates has centered on the role of technological change in modern economic times. In a paper written by Darius Lakdawalla of RAND and Tomas Philipson of the University of Chicago, estimates that 40 percent of the rise in obesity from the 1970's to the 1990's can be attributed to cheaper food thanks to a more efficient agricultural industry. The other 60 percent was chalked up to more sedentary lifestyles. However, others disagree.

Another study had findings that suggest that New York City's move to force many restaurants to list the caloric content of menu items will likely have little to no effect on obesity levels, therefore, they blame restaurants less than the technology and tools restaurants use to serve their customers.

Restaurants that serve unhealthy food (not the consumers who choose to eat it) are to blame for an obesity epidemic in the United States, according to Joy Behar, a co-host of ABC's popular daytime talk show "The View."

"Those companies export their bad food all over the world," Behar said February 4 during a discussion of a Mississippi proposal to prevent restaurants from serving obese customers. "Why aren't they being called to task instead of the victims of this type of eating?" So now people are "victims" of our own "eating."

Did the Hamburger stop stealing burgers and start kidnapping unwitting victims and force-feeding them unhealthy fast food? When was the last time a restaurant manager held customers at gunpoint and demanded they order dessert? According to Joy Behar, they do it all the time.

Blaming restaurants and food producers for diners' health problems is easier for parents to do that actually planning meals, taking kids shopping and spending time in the kitchen defrosting chicken.

In dire disagreement with Joy Behar is the Center for Consumer Freedom (CCF). They call the Mississippi bill "a particularly egregious example of food cops run amok" and said "the food-focused policy completely misses the biggest problem: sedentary lifestyles."

The international journal of behavior nutrition and physical activity reported, the restaurants play a role in the increasing waistlines due to portion size. For example:

In the 1950s, a Burger King® hamburger was 2.8 ounces and 202 calories. In 2006, a Burger King® hamburger is 4.3 ounces and 310 calories.

In the 1950s, McDonald's® offered only one size of fries, a 2.4-ounce portion with 210 calories. In 2006, fries come in orders as large as seven ounces with 610 calories.

Recipes for cookies and desserts in recipe books that have been used for decades produce fewer portions today because portion sizes are larger.

According to the National Restaurant Association, people are going out of their way to prove restaurant responsibility for obesity, and then actually bringing lawsuits to sue them for making them obese. The NRA feels the restaurant industry has been active in taking market-driven steps to expand nutritious menu options and educate consumers on the importance of a balanced diet. Frivolous lawsuits do nothing to solve the problem of obesity or convey the importance of maintaining a healthy lifestyle according to the NRA.

Moreover, the restaurant industry prides itself as an industry of choice, providing a range of options that fit any individual's dietary needs and preferences. In fact, 75 percent of consumers customize their restaurant meals, giving flexibility for consumers to make smart dining decisions when ordering.

Even Harvard has an opinion on this. In the Harvard school newspaper, a student wrote about the Debates over the role and responsibility of fast food chains and restaurants for America's weight woes.

Several states, including Texas, California, and Pennsylvania, are considering legislation that would protect restaurants from lawsuits blaming them for obesity and health problems. The Center for Consumer Freedom, a consumer advocacy group has already spent $600,000 on newspaper ads saying that people must take responsibility for themselves and stop blaming restaurants. Availing themselves of the downward revision in mortality, the ads claim that the link between obesity and mortality has been "hyped" and essentially encourages people to worry less about weight, and more to the point, what they put in their mouths.

Caesar Barber doesn't agree. He recently won fame due to his obesity. Doubtless, he had something more heroic in mind. But, since the 264 pound, 56-year-old maintenance worker from New York, filed a lawsuit against McDonald's, Wendy's, Kentucky Fried Chicken and Burger King last month - seeking damages for selling him food that made him obese. Barber's 15 minutes are proving as painful as the two heart attacks he has had.

"Does anyone really believe that Mr. Barber was too dumb to know that gorging himself on saturated fat was less healthy than ordering, say, a fruit dish or a chef salad?" snapped Steve Dasbach, executive director of the Libertarian Party, when Barber ousted himself as a junk-food junkie.

Actually, Barber contends he was in the dark about the nutritional content, or lack thereof, of the fast food he was eating up to five times a week from the 50s onwards. Incredibly, he didn't even stop gobbling burgers and salty fries after his first heart attack in 1996.

In his lawsuit, the first of its kind in the US, he contends that deceptive advertising misled him about the nutritional value of the food, until a doctor pointed it out.

"Those people in the advertisements don't tell you what's in the food," he said. "It's all fat, fat and more fat. Now I'm obese. The fast-food industry has wrecked my life. They said 100% beef. I thought that meant it was good for you."

For days after Barber's public lament, attacks on his character and IQ became a sport in the media. Barber wasn't clueless, columnists and radio hosts shrieked, just out to make a quick buck by failing to take responsibility for his diet. Americans love fast food - a staggering 75 million people eat it every day - but who, they asked, doesn't know that too much will turn you into a Teletubby?

But Barber, a diabetic with high blood pressure, is convinced the chains hooked and then hospitalized him. "Mr. Barber honestly didn't know what the dangers were when he got hooked on fast food in the 50s," says his lawyer, Samuel Hirsch.

"The fast-food chains made no effort then, and little today, to inform consumers about the dangerously high fat, cholesterol or salt content of their food. Nobody is saying that Mr. Barber doesn't accept some responsibility for his situation, but it is comparative."

Hirsch says Barber was shocked by the ferocity of the attacks against him, (he is in hiding) but he himself was not. "Unlike the tobacco companies, who are viewed as malevolent groups who lied to Congress, people love the fast-food chains. McDonald's is an icon in America. We are attacking a beloved icon."

He is also at pains to point out that Barber's goal is not money. Hirsch has told him that the case is a legal minefield and he may only get medical costs; but to get the chains to inform customers that their food is guilty of expanding their waistlines.

"The public have not been educated to the dangers of fast food; they think it's economical to have it. We want the chains to disclose the calorie, fat and sodium content of all their products. We want warning labels on certain foods for people with existing health problems."

In the US, pre-packaged foods in supermarkets must carry nutrition labeling. Restaurant food need not, although a number of chains including those Barber are suing, agreed to post or provide nutritional information after pressure from consumer groups. But many, says Hirsch, flout the agreement or display information in dark corners. "Or they produce them in difficult to understand language. You need to be a rocket scientist to read those charts."

Hirsch's legal strategy will be similar to that used by anti-tobacco lawyers in the 90s, who argued successfully that cigarette makers willfully withheld information from consumers that smoking posed a serious health risk.

Specifically, Barber's lawsuit says that fast-food restaurants negligently and recklessly engage in the sale of food that is high in fat, salt, sugar and cholesterol content, which studies show cause obesity, diabetes, coronary heart disease, high blood pressure, strokes, raised cholesterol intake and related cancers.

But unlike cigarettes, where levels of nicotine were found to be spiked by tobacco companies to hook smokers, Steven Anderson, president of the Restaurant Owners' Association and no fan of Barber's lawsuit, argues that chains do not spike their food to keep you coming back. You do that, he says, of your own free will.

"To say his obesity is just due to the fast-food chains is twisted logic. Being overweight is a function of genetics, exercise and diet. Mr. Barber should have exercised common sense. What's next, putting warning labels on the sofa and the remote control so that we don't watch too much TV?"

But not everyone in the US thinks Barber's case is a joke. The Physicians Committee for Responsible Medicine rushed to applaud the lawsuit. The committee's research coordinator, Brie Turner-McGrivey, says, whether Barber wins or loses, the hype surrounding the case has been a windfall for doctors, spotlighting America's obesity epidemic and the role fast food plays in it.

Today, one in four American adults is obese; almost double the rate in 1980. According to the American Obesity Association, obesity is characterized as a body mass index of 30 or higher. The association claims that the condition, which is often a precursor to diabetes and cardiac failure, causes about 300,000 deaths a year, costing $117million a year in healthcare costs. "What this case highlights is that even if you think choosing fish in a fast-food restaurant is a healthy choice, it isn't," says Turner-McGrivey. "At McDonald's, a 'fillet of fish' contains 26g of fat. (The daily requirement is 65g). I think women would be surprised to learn that some of the supersize hamburgers contain the equivalent of an entire day of their calories."

While Turner-McGrivey admits fast food isn't addictive in the same way as cigarettes, she claims the high levels of sodium, sugar and fat make it so palatable consumers get hooked. Which is why, she says, Barber is right to demand labeling. "Labeling would limit people ordering larger servings. Once they saw how much fat was present, they would order the small fries instead of the supersize. That's a good start. I think this lawsuit is going to create a conversation about obesity and the link to fast food that is long overdue. The debate will also probe the way the chains market heavily to children, because getting them young sets up a lifetime of bad eating habits."

Speaking of children, Hirsch is to file another lawsuit in the coming months in which three obese children sue the fast-food chains for ruining their health."The argument that people are responsible for their actions is a bit harder to make with children," says Hirsch. "Yes, parents are responsible for them, but children are exploited through aggressive advertising and toy promotions. At a certain age, they start to go by themselves. These restaurants market themselves as benevolent friends of the kids, when the bottom line is really profit."

But Steven Anderson of the National Restaurant Association says public awareness about balanced eating - due to government schemes and a culture obsessed with being thin - has never been higher, and anyone suggesting that McDonald's has duped them into having a heart attack has to be joking.

"For Mr. Barber to blame his health problems solely on the restaurant industry is really a stretch. Nobody held a gun to his head, and shoved fast-food down his throat."

News correspondent Mark Strassmann reports that restaurants only add to the difficulty of trying to eat healthy. "Many restaurants don't post the calories or fat in their food," Strassmann says. "Chick-Fillet does, but not the kids' meals. That's another complaint of this survey. Restaurants should make it easier for parents trying to make smart choices."

While there are some healthy choices on restaurant menus, "Parents have to navigate a minefield of calories, fat and salt to find them," the report said.

Subway's kids' meals came out the best among the chains examined in the report. Only 6 of 18 "Fresh Fit for Kids" meals - which include a mini-sub, juice box, and one of several healthful side items such as apple slices, raisins or yogurt - exceed the 430-calorie threshold. But Subway

Whereas evidence suggests that when nutrition information is available, people are likely to use it. Three-quarters of adults report using food labels on packaged foods, and associated it with eating a more-healthful diet. Studies have found that the provision of Nutrition information for away-from-home foods can have a positive influence on food purchase decisions even though other studies have shown that most people don't even interpret the label correctly.

In a study published in the American Journal of Public Health (AJPH), researchers from the New York City Department of Health and Mental Hygiene examined the effect of prominently displayed calorie information on food purchases at fast-food chains. One finding found that patrons of Subway restaurants who saw calorie information purchased an average of 52 fewer calories than did Subway patrons who did not see calorie information at the point of purchase.

So who is really the culprit; Restaurants or the patrons that fill them? Everyone seems to have a different opinion so before you go blaming anyone, look at your refrigerator and cabinets and see what you find.

Shari Portnoy, MPH, RD, LD/N is a Registered and Licensed Dietitian. She holds degrees in both Nutrition and Public Health and has completed the U.S. Food Laws course at the Michigan State University Institute of Food Laws. She has been a featured speaker at the American Culinary Federation National Convention and a board member of the American Dietetic Association.

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