Food Service Guidelines Implementation and Assessment ...
Transcript of Food Service Guidelines Implementation and Assessment ...
Diane Thompson, MPH, RD
Division of Nutrition, Physical Activity and Obesity, CDC
Jennifer Otten, PhD, RD
School of Public Health, University of Washington
Kristy Mugavero, RN, MSN, MPH
Division of Heart Disease and Stroke Prevention, CDC
The conclusions in this presentation are those of the
author and do not necessarily represent the views of the
Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health Promotion
Division of Nutrition, Physical Activity, and Obesity
Food Service Guidelines Implementation and Assessment: Promoting Healthier Food and
Beverages in Worksites, Hospitals and Communities across the U.S.
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CDC Food Service Priority Implement nutrition standards/food services guidelines in priority settings
Early Care and Education (ECE)
Schools
Worksites and Communities
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Early Care and Education Programs (ECE)
USDA/Child and Adult Care Feeding Program (CACFP) meal patterns
Caring for Our Children: National Health and Safety Performance
Standards (CFOC), 3rd ed
Schools
USDA/Smart Snacks in Schools
Worksites and Communities
Health and Sustainability Guidelines for Federal Concessions and
Vending Operations (HHS/GSA Guidelines)
Healthy Food Service Standards/Guidelines
(FSG)
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HHS/GSA Health and Sustainability Guidelines:
Healthy Food and Beverage Choices
Seasonal vegetables and fruits
Whole grain options, including pasta
Low-sugar, high-fiber cereals etc
Low-fat milk, yogurt, and cottage cheese
Vegetarian and lean-meat entrees
Limit sodium and eliminate trans fat
Low Calorie beverages and 100% fruit juice
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http://www.cdc.gov/obesity/downloads/guidelines_for_federal_concessions_and_vending_operations.pdf
Operationalizing the HHS/GSA Guidelines: Connecting the right people
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Food Service Guidelines: What is our reach? Federal, state and local governments employ 22 million people
Federal Worksites
National Prevention Strategy (20 Federal Departments)
Health and Human Services (CDC, NIH,)
National Park Service
Department of Defense (DOD)
Department of Veterans Affairs (VA)
General Services Administration (GSA)
100 cafeteria contracts & 1,400 Randolph-Sheppard permits
State FOAs
Worksites and communities
ECE
Schools
Communities
Let’s Move Cities, Towns and Counties
Over 200 cities, towns and counties
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2014 Chronic Disease Program FOAs:
Healthy Food Service Guideline Strategy
Healthy
Food
Service
Guidelines
Total
Number of
Awards
ECE Schools Worksites Hospitals Community Other
institutional
settings
1305
Enhanced (includes Basic
Plus)
50 X X X X X X
1422 21 X X X
1416 6 X X
PICH (1417) 39 X
Nat’ Orgs
(1418)
5 X
REACH
(1419)
49 X
Tribal (1421) 22 X X X
In addition, the Sodium Reduction in Communities Program (SRCP) provided 10 awards to support
state coordinated programs and large municipalities to decrease sodium consumption in the
population. This work is coordinated with the Food Service Guideline initiatives.
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CDC Food Service Guidelines Webpage: Resources
http://www.cdc.gov/obesity/strategies/food-serv-guide.html
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Action Step: Assess the Current Food Service Environment
Food Service Environment Assessment
Checklists for implementing FSG
Nutrition Environment Audit tools
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Food Service Assessment Tool
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Food Service Environment Assessment
Example : Assessment of Food Service Environments in County of Los Angeles Departments/Programs.
The interviews provided information on the following:
• types of food venues in the County
• contractual information including expiration dates
• number of vendors
• existing nutrition guidelines pertaining to a department's food services
• number of meals served/sold
• populations served
• staff capacity and
• barriers to improving the nutritional content of meals
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Monitoring of Food Service Guideline Standards
Example of checklist
HHS/GSA Food and Nutrition Concessions Checklist
Food and Nutrition Standard Yes No Not
Applicable
N/A
Fruit
At least 3 whole or sliced fruit options daily. ☐ ☐ ☐
Canned or frozen fruit packaged in 100% water or unsweetened juice, with no
added sweeteners.
☐ ☐ ☐
A variety of seasonal fruits are available. ☐ ☐ ☐
Vegetables
At least one raw, salad-type vegetable option daily. ☐ ☐ ☐
At least one steamed, baked, or grilled vegetable that is seasoned, without fat or
oil.
☐ ☐ ☐
Vegetable offerings contain ≤230 mg sodium, as served. ☐ ☐ ☐
Mixed dishes containing vegetables contain ≤480 mg sodium, as served. ☐ ☐ ☐
A variety of seasonal vegetables are available. ☐ ☐ ☐
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Assessment of Foods Offered: Nutrition Environment Audit Tools
Nutrition environment audit tools for vending and cafeterias
that align with the HHS/GSA Guidelines
Nutrition Environment Measures Survey (NEMS)
• NEMS- Vending (NEMS-V)
• NEMS- Restaurants (NEMS-R)
DNPAO/CDC audit tools
• Healthy Hospital Food and Beverage Environment Scan1
1. Healthy Hospital Food and Beverage Environment Scan adapted from NEMS
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Assessment of Foods Offered: Nutrition Environment Audit Tools
Nutrition environment audit tools for vending and cafeterias
that align with the HHS/GSA Guidelines
Nutrition Environment Measures Survey (NEMS)
• NEMS- Vending (NEMS-V)
• NEMS- Restaurants (NEMS-R)
DNPAO/CDC audit tools
• Healthy Hospital Food and Beverage Environment Scan1
1. Healthy Hospital Food and Beverage Environment Scan adapted from NEMS
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Food Service Guideline Implementation: Gaps and Information Needs
Federal Food Service Operations: GAO Report
Data on implementation is limited (# contracts that require the HHS/GSA guidelines, no
centralized reporting of food service data, )
Challenges
• Limitations on the agency’s ability to require guidelines under preexisting RSA permits
• Perceived conflicts between the goals of vendors to maximize profits and agencies to offer healthier
options
• Limited availability of products to meet guidelines
• Limited information and resources to help vendors meet guidelines
Environment Scan: ChangeLabs Solutions Documentation of use of HHS/GSA guidelines is limited
A core set of indicators for evaluating food service guidelines is needed
More resources are needed to address challenges to implementation
Best practices drawn from success stories are needed
Resources for developing vendor contracts (sample contract language, negotiation tips, etc.)
Relevant laws and policies
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FOOD AND BEVERAGE SERVICE
GUIDELINES IN WASHINGTON STATE
Jennifer Otten, PhD, RD
University of Washington
Executive Order 13-06
Gov. Inslee
October 2013
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In 2013, WA state passed the most
comprehensive policy to date: EO 13-06
http://www.cspinet.org/nutritionpolicy/foodstandards.html
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• WHY? Ensure healthy food access.
• HOW? Implement food and beverage policies that meet WA State Healthy Nutrition Guidelines and affect food served or sold.
• WHO/WHERE?
– Served in programs (prisons, juvenile rehab., senior centers), ~9,000 individuals
– Sold (vending, cafeterias, on-site retail, meetings and events) to employees at 39 EXECUTIVE branch agencies,~67,000 employees
• WHEN? 2.5 year implementation (beginning July 1, 2014, end of 2016)
Executive Order 13-06 impacts ~76,000 people.
http://copcwa.org/gov-inslee-makes-washington-first-state-
to-ensure-healthy-food-access/
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Implementation Guides were developed by WA DOH.
http://www.doh.wa.gov/Portals/1/Documents/Pubs/340-224-VendingImplementationGuide.pdf
http://www.doh.wa.gov/Portals/1/Documents/Pubs/340-224-CafeteriasImplementationGuide.pdf
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Cafeterias had to meet basic food-based criteria and additional
criteria (food- and nutrient-based, behavioral economics)
http://www.doh.wa.gov/Portals/1/Documents/Pubs/340-224-CafeteriasImplementationGuide.pdf
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VENDING:
At least 50%
need to meet
healthiest and
healthier
criteria.
http://www.doh.wa.gov/Portals/1/Documents/Pubs/340-224-VendingImplementationGuide.pdf
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• Cafeterias (n=8 affected, 1 unaffected)
• Vending (n= 22 surveyed….out of)
• Meeting and events (not surveyed)
• Semi-structured interviews (worksite wellness
coordinators, cafeteria owner/operators, agency
leadership)
UW CPHN: EO 13-06 evaluation
Early implementation phase
(Conducted: July-Sept 2014)
Funded by WA DOH via CDC grant,
Otten, Bachaus, Hulbrock, 2014
http://depts.washington.edu/uwcphn/
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No cafeterias met basic criteria
Basic Criteria Compliance (n=9 cafeterias)
Area of focus for criteria # cafeterias
meeting criteria
Lean protein 9
Deep-fried 8
Fruit 7
Low- and non-fat milk 5
Water 1
Whole Grain 0
Oils (trans-fat, partially
hydrogenated)
unknown
Vegetable N/A
Met all basic criteria 0
Otten, 2014; http://depts.washington.edu/uwcphn/
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No snack vending machines complied at
implementation outset.
Green=in compliance; yellow: within 15% of compliance; red: out of compliance Otten, 2014; http://depts.washington.edu/uwcphn/
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2 of 14 beverage vending machines complied at implementation outset.
Green=in compliance; yellow: within 15% of compliance; red: out of compliance Otten, 2014; http://depts.washington.edu/uwcphn/
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Semi-structured qualitative Interviews:
Evaluation of implementation
Interviewee Category Number Contacted Number
Interviewed
Cafeteria Operators (COs) 8 5
Worksite Wellness
Coordinators (WWCs)
25 2
Agency Leadership (ALs) 12 9
DOH Healthy Eating Active
Living (HEAL) Representative
1 1
Total 46 17
http://depts.washington.edu/uwcphn/
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• Top barriers:
– Cafeteria owner/operators: cost concerns
– Agency leaders, WWCs: lack of support and communication,
lack of resources (staff, staff time, marketing materials)
• Widespread support: providing more healthy options
• Many cafeteria operators thought they were already in
compliance
Interviews revealed
Otten, 2014; http://depts.washington.edu/uwcphn/
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• This has informed DOH for rolling out TA and
support during implementation phase.
• Follow-up evaluation: summer 2015
Next steps
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Demonstration: 2010; Round 2: 2013
10 sites currently funded
Program outcomes:
Increased availability of lower sodium food products
Increased accessibility of lower sodium food products
Increased purchase and/or selection of lower sodium food
products
Reduced sodium intake
Program Strategies
Food service guidelines/nutrition standards
Menu/ meal modifications
Behavioral economics strategies
Consumer information activities (venue-specific)
Sodium Reduction in Communities Program
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Funded Sites and Venues
*State coordinating the work with specific counties
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Worksites X X X X X
Private
Worksites X X
Independent
Restaurants X X
Hospitals X X X X X X X
Congregate/
Distributive/
Institutional
Meal
Program
X X X X X X X X
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Data Collection Picture
For discussion purposes only. Not intended as official CDC recommendation or guidance.
Food Environment
Kitchen Preparation
Practices
Contracting and Purchasing
Nutrient Analysis
Purchase or Selection
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