Diet and Disease

• Three NCDs account for almost 60% of all registered death in Hong Kong *:– Cancer (32.4%)– Heart diseases (15.2%)– Cerebrovascular diseases (8.9%)

• Unhealthy dietary habits– increase the risk of chronic illnesses– cause overweight and obesity

* 2006 data

Self-reported BMI in Adults

Female

13.3

54.2

14 13.112.4

50.3

15.2 16.8

0

10

20

30

40

50

60

<18.5 18.5-22.9

23.0-24.9

25.0 ormore

Perc

enta

ge

Male

4.5

46

18.8

27.1

5.6

40.2

20.4

31

<18.5 18.5-22.9 23.0-24.9 25 ormore

Overall

9.1

50.3

9.2

45.6

17.6

23.4

16.319.7

<18.5 18.5-22.9

23.0-24.9

25 ormore

2005 27.1 35.9 36.02006 32.0 51.4 41.0

2005 2006

Data source: Behavioral Risk Factor Surveillance System

Overweight + Obese

* Data Source: DH Student Health Service

• 1997/98 16.4%

• 2005/06 19.4%

• 2006/07 20.3%

Girls TotalBoys

Childhood ObesityChildhood ObesityChildhood ObesityChildhood Obesity

EatSmart Campaigns

@ Schools

@ Restaurants

Strategies

Supportive environment

Publicity and communication

Education and empowerment

Research and evaluation

Strengthen Community Actions

Build partnerships

Strategies

Supportive environment

Publicity and communication

Education and empowerment

Research and evaluation

Strengthen Community Action

Build partnerships

Community Dietetic Service database

Community Dietetic Service database

Community Dietetic Service Database

Today Session

Update EatSmart@school

Introduce EatSmart@restaurant

Q&A

Update of‘EatSmart@school.hk

’ CampaignDepartment of Health

Aim

To improve eating habit of

primary school students

In 2006/07 academic year…

Strategies Alliance building

Publicity and advocacy

Creating supportive environment

Education and empowerment

Research and evaluation

Target groupsSchool personnel

Lunch Suppliers Parents

Students

Department of Health

EMB FEHD

DC & CHEHP HKNA FOOD

Media HKCC

Healthy HKASO BUSINESS

Cities

PTA

HSC

SCHOOLS

Policy - - - $ - - Environment - - Skills Healthy food choices

Inc consumption of healthier food in schools

Family & carers

Inc consumption of healthier food at home

Inc Physical Activity

Dec obesity among children population

Health determinants

Improved health outcome (CHD, DM, HT, stroke,

cancer)

Steering Committee, Task Force and Working Groups

Alliance Building Ceremony

Publicity and advocacy 39 briefings (dietitians, school

administrators, parents, caterers, District Councilors)

Media activities 11 press conference 13 press release 94 media interview

TV ads/road shows >200 visits to schools and caterers School based events

Supportive environment

Making healthier choices easier in schools

Nutritional guidelines on school lunch (Apr 06) Nutritional guidelines on school snack (Jun 06) A guide book to lunch suppliers (Aug 06) Revision of EDB guidelines (May 07)

Education materials

Dedicated thematic website

Web-based teaching kits

Pamphlets to parents

www.eatsmart.gov.hkwww.eatsmart.gov.hk

> 50% 10 schools took part

Students

Strengthen curriculum

Peer Educators collaborated with Scouts and Brownies

Fruit Day 2007

230,000 students took part in 230,000 students took part in Fruit Day 2007Fruit Day 2007

。利口不利腹，零食少接觸，

蔬果加五穀，健康又滿足

Eat more vegetables , eat more fruits.Drink more water , feel so good.Healthy life with healthy food.

Slogan Competition

E-card Competition

School ‘NutriAgent’ Project (SNAP) targeting school personnel and parents

Healthy Lunch Cooking

Competition

Nutritional workshop for chefNutritional workshop for chef

In 2007/08 academic year…

Way forward

Advocate healthy eating policy in schools

Strengthen educational efforts

Enhance collaboration with caterers

Sustain community interest and demand for healthy food choices

Lunch Guidelines Revision

Aim

To ensure the content of the guidelines is relevant and sound from public health, dietetic, supplier and practical points of view

Major Amendments

Amendment 1 Clarification of 321 message

Grains & cereals, vegetables and meat should be in the ratio of ： ： by volume3 2 1

Amendment 2: Encouraged Food Items

Old version Whole grains Reduced fat dairy

products or other calcium-rich food items

New version Whole grains or

grains and cereals with added vegetable

Lunch suppliers should include the following food category in AT LEAST ONE

menu choice on ALL school days

Amendment 3Strongly Discouraged Food Items

Food belongs to this category are strongly in ALL menu choices in order to help reduce consumption of total fat (especially saturated fat and artificial trans fat), salt and sugar by students.

Amendment 4Strongly Discouraged Food Items

Old version Desserts or

beverages with more than 10 grams or 2 teaspoonfuls of added sugar in each serving.

New version Desserts with

added sugar or beverages in “Snacks to Choose Less” category *

* “Snacks to Choose Less” in Nutritional Guidelines on Snacks for Primary School Students

Amendment 5Healthy Lunch Box Checklist

Other Amendments

Clarifications of the original concepts or guidelines

Further elaborations with examples

Principal Summit

Set healthy eating policy Join SNAP Select the right lunch supplier (19.12) Carry out school lunch and snack surveillance 4.17 Fruit Day 2008

Schools

Parents Join SNAP 07/08

Strengthen parental education effort Territory-wide publicity exercise HEAT Program Letters to parents

Students

Strengthen curriculum

‘Healthy Eating Ambassador’ Program collaborated with Scouts and Brownies

417 Fruit Day

Lunch Suppliers Set up regular working group

Equip chef with skills to make healthy lunch

Build a database of suppliers and healthy snack

Suggest protocols for selection of lunch suppliers

We need your help…

Public education

Problem-solving skills

A “nutrition-sensible” environment

Watch out for “health demotive” practices!

Thank you

‘EatSmart@restaurant.hk’ Campaign

Baseline Study in early 2007

• To examine people’s dinning out habits

• To solicit people’s view on healthy eating promotion in restaurants

Dinning out for 5x/wk +

Source: BRFSS, DH, 2005

52

11

32

52

11

0

10

20

30

40

50

60

70

80

90

100

Breakfast Lunch Dinner

Perc

enta

ge

Comments on Dishes

Source: Baseline Survey for ESR Campaign, DH, 2007

60

40

27

53

84

0

10

20

30

40

5060

70

80

90

100

grea

sy

too sa

lty

too sw

eet

less

veg

etab

les

less

fruit

Perc

enta

ge

Asking for More Healthy Choices

Source: Baseline Survey for ESR Campaign 2007, DH

92 95 93 89 93

0

1020

30

4050

60

70

8090

100

12-1

7yrs

18-3

4yrs

35-6

4yrs

>65

yrs

Overa

ll

Perc

enta

ge

Age

Task Force and Working Group

Content• Principles

• Criteria to become an EatSmart Restaurant (ESR)

• Experience of the Pilot Project

• Final Launch of the Campaign

• Role of Dietitians / Nutritionists

Principles

Supportive Environment to Healthy Eating

AvailabilityAccessibility

Point of Purchase Information

Point of Purchase Information

• Provide information when food is being chosen or purchased

Availability and Accessibility

• Larger variety and quantity

• The lack of healthier choice is one of the key barriers to the adoption of healthy eating habits*

* Source: Qualitative study on dietary and exercise practices of people of Hong Kong, Department of Health, 2004

An ESR….

• Provides EatSmart Dishes of “More Fruit & Vegetables” and “3 Less”

• Indicates the EatSmart Dishes clearly

means that either fruit and vegetables are the sole ingredients of the dish

or they occupy at least twice as much the amount of meat present in the dish

More Fruit and Vegetables

3 Less

means that the dish has less fat or oil, salt and sugar, meeting the “3 Less” requirement

Definition of 3 “Less”

Definition of 3 Less

SuggestionsExamples of

healthier ingredients Examples of less

healthy ingredients

Use healthy vegetable oil

Use low- or reduced-fat salad dressing

Use spread which is reduced-fat and without added sugar

Corn oil, olive oil, canola oil, reduced-fat peanut butter, jam without added sugar

Butter, lard, coconut oil, margarine containing trans fat, salad dressing, jam with added sugar

Example: Fats & Oils / Salad Dressing / Spread

Definition of 3 Less

SuggestionsExamples of

healthier ingredients Examples of less

healthy ingredients

Use grains and cereals which is low in fat and without added sugar

White bread, whole wheat bread, white rice, red rice, egg noodles, spaghetti, rice vermicelli, Chinese noodles

Croissant, pastry, “cocktail bun”, “pineapple bun”, bun with lotus seed paste, stir-fried rice and noodles, fried instant noodles, E-Fu noodles

Example: Grains and Cereals

Definition of 3 Less

SuggestionsExamples of

healthier ingredients Examples of less

healthy ingredients

Use natural ingredients to replace seasonings or sauce which are high in salt or fat

Garlic, ginger, spring onion, onion, lemon or lime juice, vinegar, parsley

Shrimp paste, fermented soybean curd, salted black bean, chicken powder. MSG, ready-to-use sauces (e.g. black pepper sauce, curry, satay), oyster sauce

Example: Seasonings

Definition of 3 Less

SuggestionsExamples of

healthier cooking Examples of less healthy cooking

Replace frying with blanching to prepare meatBlanch canned vegetables to reduce sodium contentUse low-fat cooking methods

Boiling, steaming, grilling, baking, stewing, stir-frying or pan-frying with small amount of oil

Deep-frying (including the frying process of meat prior to cooking),Pour salad dressing or condiments over the dishes

Example: Food Preparation / Cooking Methods / Mode of Serving

Checklist for the “3 Less” Dishes

• Use as the final Ax

• “3 Less” dishes must pass all the 12 criteria in the checklist!!!

店內宣傳產品 Restaurant Interventions

Door decal

Door decal

Table tent

Table tentMenu

Certificate

vegetables occupy at least twice as much the amount of meat present in the dish

Pilot Study

Healthier dishes offered on any day in August 2007: 685 dishes

Pre-intervention: 243 dishes

Data from 50 outlets

Sales in EatSmart Restaurants

Sales

94.5% of restaurant staff perceived more customers choosing Healthier Dishes

62% of restaurants reported increased sales in healthier dishes

98.0% of restaurant staff thinks it is viable to promote healthy eating in restaurant settings

Customers’ feedback

Customers

• >95% are satisfied with the healthier dishes

• 85.8% said the campaign attracted them to choose the EatSmart Dishes

• 98.8% supported restaurants providing the healthier dishes

• 75.2% would patronize this restaurant again for the healthier dishes

Awareness and Ordering pattern

500 Customers

263 237

114

123

27

236

Awareness of the Pilot Project

Ordered Healthier Dish

48.1% 10.3%

4.7 times more likely to order

Staff

• Welcomed the campaign

• Difficulties encountered • Matching ingredients• Knowing the customers’ want

Benefits to ESR

1. Brings business

2. Exclusive use of the EatSmart Decal

3. Free use of “More Fruit and Vegetables” and “3 Less” logos

4. Identification as customer-centric business operators

Benefits to ESR

5. Free promotion materials

6. Listed on the EatSmart Website for maximum exposure

7. ES Campaign promotional activities and collaborative programmes.

8. Training, resources and professional support

Posters, API, pamphlets

www.eatsmart.gov.hk

7.30 Press Event in an EatSmart Restaurant

0

500

1000

1500

2000

2500

3000

Sun

day

Sun

day

Sun

day

20-J ul-

21 22 23 24 25 26 27 28 29 30 31 1-Aug-

2 3 4 5

720 Kick off ceremony 730 Lunch at新皇朝觀景

Chinese version

English version

Hit rate of CHEU web

Media monitoring

Entry requirement

• Licensed food premise

• Compulsory attendance in a 2-hour nutrition training session

• Submission of 5 healthy recipes

• Provide clear point-of-purchase information

• Committed to healthy eating promotion and incentive programme

Time Table

Dec 2007 Recruitment

Training

Mar 2008 Territory-wide launch– Kick-off ceremony– Launch of the ESR website – Serial of promotion activities

Roles of Dietitians / Nutritionists

• As a patron

• Recommend to your family members, friends and also clients

• Provide dietetic service to the ESRs• Recipe development• Recipe vetting• Promotion strategies