Do you know how many calories are in this cheeseburger? A survey suggests most people don't.

People may realize that fast food isn’t health food, but they don’t realize just how fattening it really is, researchers report.

They surveyed people eating at 10 burger, chicken, sandwich and doughnut chains and found they greatly underestimated just how much they were chowing down. The worst was Subway, which promotes itself as a healthier alternative, the researchers at Harvard Medical School found.

“At least two thirds of all participants underestimated the calorie content of their meals, with about a quarter underestimating the calorie content by at least 500 calories,” Harvard’s Jason Block and colleagues wrote in the British Medical Journal.

They interviewed more than 3,000 adults, children and teens visiting six different fast-food chains in Boston; Providence, Springfield, Mass. and Hartford, Ct., asking  them how much they ordered and how many calories they thought they were getting. The surveys were done in 2010 and 2011, before some regulations about calorie labeling came into effect.

People ate a lot. Checks of the receipts showed adults ate on average 836 calories in a meal, while teens and children ate more than 700.  But they estimated, on average that they were getting 175 calories less.

“The mean underestimation of calorie content was larger among Subway diners than those at other chains for adults,” Block’s team wrote.

The average U.S. adult needs about 2,000 calories a day, and kids need less. So people were getting more than a third of their day's calories in a single fast-food visit. And studies show that eating just 100 calories in excess a day can add up to several pounds of extra fat over a year.

Many states and cities have passed tough calorie and fat-labeling laws. The 2010 health reform law will require major restaurant chains to provide clear calorie labels on menu boards.

Consumer advocates have complained for years that Americans don’t get the information they need to make healthy food choices. Not only are fatty, sugary foods everywhere, but it’s often hard to find out how many calories and how much fat  and sugar these foods pack.

Chain restaurants often list their nutritional information on websites or on menus kept behind the counter. What advocates want – and what governments are starting to require – is information listed right next to the food items on the menu board, so people are forced to see it when they order.

Block’s team looked at the biggets national chains: McDonald’s, Burger King, Wendy’s, KFC, Dunkin’ Donuts  and Subway. “We excluded pizza restaurant chains (such as Pizza Hut) because of the difficulty in determining the quantity that an individual bought for personal consumption,” they wrote.

About two-thirds of the adults taking part were overweight or obese – reflecting the actual U.S. population, the researchers found.  About a third of the teens were, while 57 percent of the school-age children were.

“Over 40 percent of participants in each sample ate at the chain restaurant where they were interviewed at least once a week,” the researchers wrote.

Fewer than one in five had even noticed any calorie information, and only 5 percent said they used that information to help them choose meals.

Subway advertises itself as a healthier option. “Branding could be an important component of Subway’s ‘health halo’,” the researchers said.

They believe the new labeling requirements will do a lot to help people understand how much food they really are getting in a fast-food restaurant. “Previous research has found that information can be most powerful when it contradicts previous expectations (in this case, improper estimation of calorie content of foods with a ‘health halo’),” they wrote.

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Diners will have to wait a little longer to find calorie counts on most restaurant chain menus, in supermarkets and on vending machines.

Writing a new menu labeling law "has gotten extremely thorny," says the head of the Food and Drug Administration, as the agency tries to figure out who the law should cover.

The 2010 health care law charged the FDA with requiring restaurants and other establishments that serve food to put calorie counts on menus and in vending machines. The agency issued a proposed rule in 2011, but the final rules have since been delayed as some of those non-restaurant establishments have lobbied hard to be exempt.

While the restaurant industry has signed on to the idea and helped to write the new regulations, supermarkets, convenience stores and other retailers that sell prepared food say they want to no part of it.

"There are very, very strong opinions and powerful voices both on the consumer and public health side and on the industry side, and we have worked very hard to sort of figure out what really makes sense and also what is implementable," FDA Commissioner Dr. Margaret Hamburg said in a recent interview with The Associated Press.

Hamburg said menu labeling has turned out to be one of the FDA's most challenging issues, and while requiring calorie counts in some establishments might make sense on paper, "in practice it really would be very hard." She did not say what specific types of establishments she was referring to.

The challenges of putting such a law in place - and deciding whom it should cover  - were made clear Monday when a judge struck down New York City's ban on large sugary drinks. State Supreme Court Justice Milton Tingling said in his ruling that the 16-ounce limit on sodas and other high-calorie drinks arbitrarily applied to only some sweet beverages and some places that sell them. The new limits, championed by Mayor Michael Bloomberg, were supposed to take effect Tuesday.

Hamburg said the FDA is in the final stages of writing the menu labeling regulations and the final rules should come out in the "relative near term." The FDA has tentatively said the rules are due this spring, but that deadline may be optimistic as the food industry and regulators continue to haggle over how they will be written.

The 2011 proposed rules would require chain restaurants with 20 or more locations, along with bakeries, grocery stores, convenience stores and coffee chains, to clearly post the calorie count for each item on their menus. Additional nutritional information would have to be available upon request. The rules would also apply to vending machines if calorie information isn't already visible on the package.

The proposed rules exempted movie theaters, airplanes, bowling alleys and other businesses whose primary business is not to sell food. Alcohol would also be exempted.

Supermarkets and convenience stores are looking for similar exemptions in the final rules. Representatives for the supermarket industry say it could cost them up to a billion dollars to put the rules in place - costs that would be passed on to consumers.

"It's a huge problem for us," says Erik Lieberman of the Food Marketing Institute, which represents retail grocery chains. He says fighting the menu labeling rules is one of his group's top priorities.

Lieberman says the rules could cover thousands of items in each store, going beyond just the prepared foods case and extending to cut fruit, bakery items like pies and loaves of bread and other store items that aren't already packaged and labeled. Lieberman says that means each store has to send all of those items out to labs to be tested, do paperwork to justify the ingredient and nutritional information for each item to the FDA and then create signage and train employees to use it.

Convenience stores say they will have similar problems.

"In a small store like a convenience store that is really putting a lot of signage all over the place," says Jeff Lenard of the National Association of Convenience Stores, referring to the calorie labels. "You just hit a point where words become noise and that's not good."

Nutrition lobbyist Margo Wootan of the Center for Science in the Public Interest says consumer advocates heard the same kind of complaining from the packaged foods industry before they were required to put nutrition information on the backs of food items. Supermarkets and convenience stores should be included because they are breaking more and more into the prepared foods business, she says.

"The supermarket industry is positioning itself as a place to buy prepared items so you don't have to go out to eat or cook," Wootan says, arguing that a rotisserie chicken that is labeled with a calorie count at a takeout restaurant should also be labeled at a grocery store.

The idea of menu labeling is to make sure that customers process the calorie information as they are figuring out what to eat. Many restaurants currently post nutritional information in a hallway, on a hamburger wrapper or on their websites. The new law will make calories immediately available for most items.

Menus and menu boards will also tell diners that a 2,000-calorie diet is used as the basis for general nutrition advice, noting that individual calorie needs may vary.

The labeling requirements were added to the health bill with the support of the restaurant industry, which has faced a patchwork of laws from cities and states. New York City was the first in the country to put a calorie posting law in place. Since then, other cities and states have followed.

Scott DeFife of the National Restaurant Association says the supermarkets are exaggerating how much it would cost them to implement the rules. The restaurant industry has lobbied for the prepared foods in supermarkets and convenience stores to be included, saying they are selling essentially the same things.

DeFife says some convenience stores have even joined the National Restaurant Association as many gas stations now include full restaurants in their stores.

"It's about the food, not the format," he says.

Not all restaurants have been fully supportive, though. A coalition of pizza chains - including Domino's, Papa John's and Pizza Hut franchise holders - have pushed for changes to the proposed rules that would allow more flexibility in how calories are posted because of endless combinations of pizza toppings. The coalition claims there are 34 million ways to order a pizza.

"When you're a small pizza operator trying to get by on tight margins, regulations like this really affect your bottom line, hurting your ability to grow and hire," Domino's Pizza franchisee Jonathan Sharp of Abilene, Texas, said last summer.

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AP file

Hot pizza. Mmm, smells good ... and then Oww! You've got pizza mouth burn. We've all been there.

While at a conference in Chicago, Jason McConville was enjoying a slice of deep dish pizza when it happened: the molten cheese burned the roof of his mouth, causing excruciating pain, followed by that all-too-familiar tender, raw sensation for the next few days.

“This has plagued humankind since we discovered fire, it seems. Since the first caveman cooked his turkey over an open fire [humans have burned their mouths],” he says.

We’ve all been there -- biting into hot food or chugging a boiling drink then scalding our mouths. But McConville, an associate professor of pharmaceutical sciences at the University of New Mexico, Albuquerque, decided to do something about it. He designed a dissolvable mouth strip with the local anesthesia benzocaine, sometimes found in cough drops, and also used by dentists, to provide some pain relief. The strips resemble popular breath freshening strips and can be used to sooth burns for a few hours up to a few days.

“That compound itself is a really, really rapidly acting, stable compound that lasts for a long time on the shelf. It seems very logical [to use this] ingredient as it is readily available,” he says.

Someone suffering from the much-hated scalded mouth can slip a strip into her mouth where it will rest on the roof, cheek, or tongue slowly releasing the pain-reliever. Even though the strip will dissolve slower than its breath-freshening cousin, it won’t impair people’s ability to talk or use their mouths.     

“The mouth is a very, very quick part of the body to heal; a couple of days is probably the maximum you would need. In addition to that, we have included a semi-active ingredient that promotes healing,” McConville adds.

While the mango-flavored strips exist as a prototype, McConville hopes to find an industry partner to help manufacture the strips for consumers; he doesn’t anticipate facing many barriers—most of the ingredients are readily available in other over-the-counter medications. In a few months, he plans on starting a small study in human participants to test the efficacy of the strips (but assures us that he won’t force subjects to eat scorching food to induce mouth burns). Within a few years, McConville hopes that the pain-relieving strips will be available over the counter, possibly in more flavors than mango.

“We can change the flavor to suit the mood—the sky’s the limit to the flavoring. We need to do to appeal to a wide range of people and this wide variety of people have all burned their mouths.”

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Seth Perlman / AP

A San Francisco judge has dismissed a proposed class-action lawsuit that sought to stop McDonald's Corp. from using toys to market its meals to children in California.

Children in California will still be able to get toys with their Happy Meals.

A San Francisco judge has dismissed a proposed class-action lawsuit that sought to stop McDonald's Corp. from using toys to market its meals to children in the Golden State. The suit had been filed in late 2010 by Monet Parham, a California mother of two, and The Center for Science in the Public Interest, a consumer advocacy group based in Washington, D.C.

The suit had claimed that the world's biggest hamburger chain was violating consumer protection laws and exploiting children's vulnerability by using toys to lure them to eat nutritionally unbalanced meals that can lead to obesity. The lawsuit did not seek damages.

McDonald's spokeswoman Danya Proud said that the lawsuit was without merit and detracted from "the important issue of children's health and nutrition."

"We are proud of our Happy Meals and will vigorously defend our brand, our reputation and our food," Proud said in the statement. "We stand on our 30-year track record of providing a fun experience for kids and families at McDonald's."

The Center for Science in the Public Interest said in a statement that it will discuss with Parham whether to appeal the case. The group called the use of toys to market food a "predatory practice that undermines parents, causes rifts in families and harms kids' health."

The suit, filed in the county of San Francisco, was dismissed by Judge Richard Kramer on Wednesday.

Commentary

Do you have the right to know what you’re eating? The food industry apparently doesn’t think so.

The prestigious Institute of Medicine issued a report today urging the Food and Drug Administration to clear the gobbledygook language off food labels and replace it with an easy-to-read rating symbol, like the Energy Star tag on your appliances.

The idea is to help busy shoppers make better choices with a simple icon with zero to three check marks rating how healthy a food is.

The industry does not like this idea.  They’ve launched a new lobbying group called Facts Up Front, devoting a hefty $50 million budget to battling this simple labeling system. The industry wants to keep confusing matters by slapping on information about nutrient fortification even though most people don’t  really know what that means.

The food industry is using an ethical argument, claiming consumers don’t want the government telling them what to eat to defend a lack of clarity, uniformity and simplicity in labeling.

Big government is an easy target but the industry argument misses the point.  The government’s role is to get industry to give you trustworthy useful information.  Telling you that Captain Crunch is fortified with iron does not make it healthy for kids to eat sugary breakfast foods. 

The industry ought to embrace what consumers need and want — simple facts about their food.

Food labels needs Energy Star-like ratings, report says