Major restaurant chains in Massachusetts would be required to prominently post the calorie counts for all their offerings - at the counter or on the menu - under a far-reaching anti-obesity campaign that Governor Deval Patrick's administration is expected to announce today.
The administration's battle against bulging waistlines also calls for public schools to measure the height and weight of first-, fourth-, seventh-, and 10th-graders and calculate whether a child is overweight.
The finding would be sent home with students along with detailed advice on eating better and exercising more, with the goal of reducing the incidence of health conditions once almost unheard of in the young, including type 2 diabetes and high cholesterol.
Those measures would go into effect next fall if approved by the Public Health Council, an appointed board of doctors, consumer advocates, and medical leaders that generally follows the recommendations of the administration.
Last night, one council member, Dr. Alan Woodward, said he expected broad support on the panel. Woodward, a former president of the Massachusetts Medical Society, said, "The "obesity epidemic is one of the primary public health threats we face now."
The Public Health Council is expected to give the rules initial approval next week; a final vote would follow a public comment period.
Other steps to improve nutrition and boost physical activity are being implemented directly by the Patrick administration.
The governor, for example, is ordering state agencies to serve more healthful food to patients at state-run hospitals and other facilities. And the government, in conjunction with private foundations, will make grants to employers and to cities and towns for programs in the workplace and communities.
"Our approach here is comprehensive - like with smoking cessation and HIV-prevention, a single message is not enough," said John Auerbach, the Massachusetts public health commissioner and chairman of the Public Health Council.
The nation has been on a collective eating binge in recent decades, even in a state like Massachusetts, long recognized as one of the most health-conscious. The percentage of Massachusetts adults who were overweight or obese rose from 43 percent to 59 percent from 1990 to 2007. And one-third of high school and middle school students now weigh too much.
Massachusetts is joining New York City and California at the forefront of efforts to reduce obesity. The cornerstones of the campaign - posting calorie readings as prominently as prices in restaurants and measuring the body mass index of students - employ classic public-health strategies by putting information about dangerous habits directly in the faces of people who might not fully appreciate the peril.
Like New York City, Massachusetts is targeting the giants of the fast-food world, both because of the uniformity of their products and because of their broad appeal, especially to lower-income consumers who are more often overweight. The state estimates that more than 2,000 restaurants would fall under the rules, which cover chains with at least 15 stores in Massachusetts.
"People often really are not aware of what's sitting on their plate - it's a big portion, they're talking to their friends, they have no way of knowing exactly what they're eating," said Dr. Caroline Apovian, director of the Nutrition and Weight Management Center at Boston Medical Center. "But if the information is sitting right in front of you . . . it's hard to deny."
For several years, restaurant chains have provided information on calories, sugar, and fat on websites. But New York City's health commissioner, Dr. Thomas R. Frieden, said a survey by his agency showed that fewer than 5 percent of fast-food diners were aware of calorie information.
In statements they provided yesterday, some of the nation's biggest purveyors of burgers, fries, doughnuts, and creamy coffee drinks offered mixed reactions to the Massachusetts plan.
Dunkin' Donuts, with headquarters in Canton, said it embraced a "responsibility to provide health-related public information." But the company bristled at the state's mandate.
"For multistate operators . . . the increasingly complex, highly localized regulatory approach to menu labeling is both costly and disruptive to our franchisees and our business, especially in these challenging and increasingly uncertain economic times," the company's statement said.
In New York, posting calorie readings on menu boards has been mandatory at all fast-food chains since last spring. The reaction from consumers?
"It was sticker shock," Frieden said. "Who knew a bran muffin could have 450 calories?"
In fact, muffins can have even more calories, and burger-and-fries combos eaten by millions, chased down with a big soft drink, can total 1,300 calories - more than half the daily amount recommended for most adults.
Listing calories on menu boards appears to work. In a 2007 study, New York researchers found that diners at Subway, which had already begun displaying some information, were substantially more likely to be aware of calorie counts, and that if they took note, their food intake was about 50 calories less than for customers who hadn't noticed the calorie information.
It is unprecedented weight gain among children that has stoked some of the deepest concerns. In the past two decades, the percentage of overweight adolescents has tripled in Massachusetts.
Starting as early as next school year, thousands of students could be issued report cards showing their body mass index, a formula based on height and weight that tells whether someone is overweight; New York City and some other states, including Arkansas, already use this approach. A specialist at Children's Hospital Boston said that information must be accompanied by expanded efforts to help children and parents do something with the diagnosis.
"Providing that information without taking comprehensive efforts to improve diet and physical activity . . . is a recipe for increasing stigmatization," said Dr. David Ludwig, director of the Optimal Weight for Life program at Children's. "To be providing a BMI report card, while feeding junk to students at school and not providing opportunities for physical education, is the ultimate of ironies."
Auerbach pledged that the obesity findings wouldn't just be "folded up and put in the child's backpack," and that parents would get written advice on healthier meals and exercise.
Stephen Smith can be reached at firstname.lastname@example.org