New York City could become the first city in the U.S. to require a warning label on high-sodium menu items at chain restaurants, health officials told The Associated Press on Tuesday.
The city's Health Department will propose Wednesday that all chain restaurants add a symbol resembling a salt shaker on menus next to food products that contain more than the recommended daily limit of 2,300 milligrams of sodium, equal to about 1 teaspoon of salt.
Sodium increases the risk of high blood pressure, which can lead to heart attack and stroke. Studies have found that the vast majority of dietary salt comes from processed and restaurant foods. But average sodium consumption is about 3,400 milligrams of sodium each day. Only about one in 10 Americans meets the 1 teaspoon guideline.
"This doesn't change the food. It enables people to identify single items that have a level of salt that is extremely high," said Dr. Mary Travis Bassett, commissioner of the New York City Department of Health and Mental Hygiene. "So that they can modify their menu selections accordingly."
The proposal will be introduced at the city's board of health meeting. If the board votes to consider the rule, it will move to a public comment phase before a final vote in September. The department hopes the sodium warnings will appear on menus by December.
The salt-reduction campaign is part of Mayor de Blasio's goal to reduce premature mortality by 25 percent by 2040, health officials said.
Michael Jacobson, executive director for the Center for Science in the Public Interest, a Washington-based advocacy group, called it "an extremely important proposal."
"High sodium levels are probably the biggest health problem related to our food supply," Jacobson said. "New York City is showing true leadership in doing what it can do to lower sodium levels in restaurants by highlighting to consumers the dishes that are the most outlandishly high in sodium."
Still, he called it a conservative approach, given that items would only get special labels if they have a full day's worth of sodium. A meal with even half that amount would still have too much salt, he said.
Marion Nestle, a food policy expert at New York University, said the proposal might encourage restaurants to help figure out ways to cut down on salt.
"The big problem here is nobody wants to go first. Food companies don't want to start reducing their salt unless everybody else does," Nestle said. "That's why we need regulation in my view."
The head of the Salt Institute, a trade association for salt producers, called the proposal "misguided" and based on old information.
"The symbol is based on faulty, incorrect government targets" that have been discredited by research over the last decade, said the group's president, Lori Roman. "They're too low ... and if followed, could actually harm people."
Last year, a large international study questioned the conventional wisdom that most people should cut back on salt, suggesting that the amount most folks consume is OK for heart health.
The study followed 100,000 people in 17 countries and found that very high levels of salt were a problem, especially for people with high blood pressure, but that too little salt also can do harm. Other scientists have disagreed about the need to cut back on sodium, saying most people still consume way too much.
Bread and rolls are the No. 1 source of salt in the American diet. They represent 7 percent of the salt that the average American eats in a day, according to a 2012 study by the Centers for Disease Control and Prevention. The U.S. Food and Drug Administration has been pressing the food industry to voluntarily reduce sodium content and is working on new sodium guidelines.
Salt reduction has been the focus of public health campaigns. For years, New York City and other groups have been trying to persuade food manufacturers and chain restaurants to reduce salt content by more than 50 percent over the next decade. The Centers for Disease Control and prevention and other federal agencies have had sodium-reduction talks with food companies.
Under former Mayor Bloomberg, the city led development of salt-reduction targets for various table staples and got companies to start commit to them voluntarily, starting in 2010.
While many companies said they were able to shrink the salt without customers complaining — or sometimes even seeming to notice— that wasn't always the case. The Campbell Soup Co. reversed course two years after announced in 2009 that it was lowering salt in half its soups; the company said it brought back some higher-sodium soups out of concern about the taste.
New York City made a series of groundbreaking healthy-eating moves during Bloomberg's tenure: banning trans fats from restaurant meals, forcing chain eateries to post calorie counts on menus and trying, unsuccessfully, to limit the size of some sugary drinks. While city officials and health experts hailed the initiatives, some critics saw them as nannyish.