American adults consume an average of 3,400 m/g of salt a day (roughly 1½ teaspoons), exceeding the 2,300 mg/day recommended by the 2020-2025 Dietary Guidelines for Americans, and ultimately making the U.S one of the countries with the highest sodium consumption in the world.
In general, Hispanics/Latinos have higher dietary sodium intake, lower dietary potassium intake, and higher rates of obesity compared with non-Hispanic whites.
“When we eat meals, we don’t really think about sodium or salt, it’s such a small part of how we plan our meals, but in the long term we can see how this very small thing can have a huge effect on our health,” said Mónica Acevedo Guerrero, Program Manager of Public Health Advocates (PHA), a social justice nonprofit organization in LA.
Since June, Acevedo Guerrero has been leading the PHA’s latest public campaign, called the Sodium Warning Icon, a grassroots effort with the goal to push Los Angeles County leaders to adopt what is called a “menu disclosure ordinance,” which could require restaurant chains operating in the county to place a warning icon on food items that have more than the daily recommended limit of sodium.
The organization will focus much of its work on helping overlooked low-income communities of color in LA County with the goal of improving the support and guidance these communities desperately need. Individual health improvements, she said, can be unlocked by avoiding food and desserts with high sodium, for example. But people need to be told and taught this to ensure they make conscious choices.
For Acevedo Guerrero, a first-generation Indigenous Peruvian, holding fast food restaurants accountable for their ingredients and reversing health disparities in these communities is both a paid job and a personal mission.
“Many working-class families don’t have the time to go from a 12-hour shift at work to home to cook a meal,” she said, “which is often why we’re seeing people stopping at drive-throughs or fast-food restaurants where they get more food for less money. But it doesn’t make it their fault because that’s what’s accessible to them.”
Acevedo Guerrero added: “I know what it was like to see my mother arrive from work, pick us up from school and have to struggle to make something at home. Or to have to go and buy the cheapest things available to her, choices that weren’t the healthiest.“
PHA’s goal is for residents in these communities to be able to make more informed decisions regarding their health. The Sodium Warning Icon campaign launched last August and is sponsored by the Center for Science in the Public Interest.
The campaign is currently in the community education phase, which include educational workshops spreading consciousness to people deemed “agents of change,” as Veronica Arciga Barriga, a Regional Manager of a non-profit called Vision y Compromiso, calls the approximately 30 Spanish-speaking women and community members partaking in this campaign. “For the first eight months of the campaign we focused on bringing consciousness on why this campaign was important and why the community should care about it,” Barriga said.
The educational workshops offer information on different topics and focus on how high levels of sodium may affect one’s health, the systemic built environment of food desserts, messaging and spokesperson training, and even advocacy workshops.
Norma Benitez, who serves as the Community Promoter (promotora) for Vision y Compromiso, said one of the next steps for the campaign is to transition into community and legislative advocacy, where community members will begin sharing all the information they have learned with other community members and, eventually, with the LA County Board of Supervisors and other elected officials.
The Sodium Warning Icon campaign is intended to target chain restaurant menus because that nutrient information is not typically presented on their menus. Restaurants like Chipotle and Panda Express offer calorie disclosures on menu items, but according to Acevedo Guerrero, that alone does not signal nutrient quality.
She said another reason that the campaign is focusing on fast-food chain restaurants is because they are disproportionately located in low-income communities and communities of color, such as South LA, where there are 12.5 times more fast-food restaurants than grocery stores, according to research by Loyola Marymount University.
The campaign’s biggest goal is to reduce the already growing and prevalent chronic illnesses that exist in low-income communities, including District 9 of the LA City Council, where 13% of residents who are adults are diagnosed with diabetes, greater than the 10% overall population of LA County, as stated in the district’s latest Community Health profile conducted by the LA County Department of Public Health. “With the surging of Covid-19, we saw that people most at risk were people with chronic illnesses like diabetes, hypertension, cancer and asthma,” Acevedo Guerrero said. “With this campaign, we are able to look at the consumption of sodium, which is largely attributed to the long- term development of some of these diseases.”
“I can talk from experience living in South Central. You see that in every corner there’s a fast food restaurant, there’s a liquor store but very rarely do you see substantial investments in food markets in healthy food. It’s no accident that our communities have the highest rates of different diseases, because the system has been built like that,” Benitez said. “What we are doing with this campaign is giving power back to the community, building leaders that will help us make the change from within.”
For Dr. Meg Byrne, an internal medicine resident physician at UC Davis, the most alarming chronic illness that is linked to overconsumption of sodium is high blood pressure. “A basic science principle is that water will follow salt. This is the easiest way I visualize sodium consumption causing high blood pressure, because if there is more sodium in your blood, there will be more water in your blood, causing the blood vessels to be very full, and high-pressured,” she said. “Almost half of adults in the U.S have high blood pressure, and one of the worst things about high blood pressure is that most people do not feel anything wrong with their body when they have it.”
Dr. Byrne said she has met several patients who found out they had high blood pressure when they show up at the hospital with a stroke, one of the leading consequences of high blood pressure, that caused them to lose balance, have difficulty swallowing and talking, or weakness on one side of their body. She encourages and advises her patients who do have high cholesterol, high blood pressure or diabetes, to not be too hard on themselves.
“As a country, we did not have this many people with this amount of chronic illnesses 50 years ago, and I think individuals have not been the ones who have been drastically changing. It’s the food and accessibility around us that has changed,” she said. “This is why I like this campaign because it focuses on the bigger picture, on the societal and structural entities that impact our health.”
She said seeing this campaign unfold has inspired her. “I’m very inspired to see community members organizing to protect themselves, their family, and ultimately their own community.”
According to Barriga, one component that Vision y Compromiso is trying to emphasize in the campaign is that there is no shame, blame, or finger-pointing toward the community. “Sometimes society tries to put the guilt for these chronic illnesses onto our communities, but in reality it’s the constructed and built environment already in place which have pushed us to have easy access to this type of food and many times politicians do not make any changes,” Barriga said.
The campaign, although it is new to the city and state of California, is not new to the U.S., already achieving success in places such as New York and Philadelphia. In 2015 restaurants in New York City with 15 or more locations nationwide had to include a warning icon in menu items containing 2,300 m/m or more.
Acevedo Guerrero said that having a reference from a state like New York, which implemented a similar icon, is a great model when it comes to recreating that win in LA County. “We have a lot of that campaign’s paperwork and written plan to look into,” she said. “For example, we have guidelines on how to connect and address the chain restaurants, and the list of menu items and their ingredients. Many restaurants serve the same items in California as they do in N.Y.”
One of the things that will differentiate the LA campaign from that of N.Y. is the actual design of the sodium icon logo. According to Acevedo Guerrero, community leaders have expressed they want the icon to be red and instead of having a salt icon, they want the icon to have white letters that read: “high in sodium.” They also want the icon to be both in English and Spanish so it’s accessible to more people.
Another big difference that the LA community wants to push for is the amount of sodium that restaurants should be placing a warning icon for. Although the 2020-2025 Dietary Guidelines for Americans recommend that Americans consume less than 2,300 m/g of sodium each day as part of a healthy eating pattern, LA community advocates want to push restaurants to have a warning icon in their menus if the food exceeds 1,500 m/g of sodium a day.
According to Acevedo Guerrero, community members in the workshops they have held have expressed they feel this new number will be more impactful.“Because the sodium limit is lower for the youth, community members expressed how they believe we should be setting that standard for everybody,” she said. “2,300 m/g would be the end of our limit, whereas at 1,500 m/g, we have a little bit more leeway to be able to make our decision strategically about the nutrients in our food.”
“We know it’s hard to stop consuming fast food when we have consumed it for a long time, when we see it in our city for years, when we see it on our kitchen table. But we hope this will inspire small changes because those are the ones that make the biggest difference,” Barriga said. “Ultimately those changes will make such a difference in your health. Many of us are conscious of that, but knowledge does not do much if it is not put into practice.”
For more information about the campaign and how to get involved, please visit Public Health Advocates website and Vision y Compromiso or contact Veronica Arciga Barriga, firstname.lastname@example.org.
Public Health Access has also created a “Fast Food Sodium Quiz” available here, which is intended to identify the amount of sodium contained in popular fast food menu items.