Healthy Food Procurement - · PDF file2 | P a g e health and scientific organizations have...

1 | P a g e WWW.POWERUPFORHEALTH.CA

JULY 2014

OVERVIEW

Overweight and obesity are significant concerns worldwide. In Canada, over half of adults and over a

quarter of children and adolescents are classified as overweight or obese (1, 2). Obesity, in turn,

increases risk of a range of chronic conditions, including type 2 diabetes, hypertension, cardiovascular

disease, and certain cancers (3). Further, economic analyses indicates that, in 2008, obesity cost the

Canadian economy approximately $4.6 billion, an increase of 19% from 2000 (3).

While the causes of overweight, obesity and associated chronic diseases are complex, evidence suggests

that the increased availability of energy-rich and nutrient-poor foods in the wider food environment is

an important contributing factor (4). In the last several decades, unhealthy foods have become widely

available in public settings, such as schools (5), recreational facilities (6), workplaces, and even health

care institutions, such as hospitals and nursing homes. This is concerning as public facilities often

provide a significant amount of food for consumption by members of the public, including vulnerable

populations such as children and seniors (7). Therefore, promoting healthier food environments in these

settings may help to mitigate adverse health outcomes.

The use of policy levers to address the environmental determinants of obesity is an important

component of a population health approach. In particular, the development and implementation of

healthy food procurement policies has emerged as a promising strategy for promoting healthier food

environments (8, 9). Healthy food procurement encompasses the processes of procuring, distributing,

selling, and/or serving food with the goal of facilitating healthier dietary behaviours (10). Nutritional

standards/guidelines are one aspect of healthy food procurement policies, as they determine the types

of foods that may be procured (10).

A number of public institutions around the world have acknowledged the need to promote healthy

choices through healthy food procurement policies. For example, in 2005, British Columbia introduced

“Guidelines for Food and Beverage Sales in BC Schools,” which led to a significant reduction in the

availability of ‘not recommended’ foods in schools across the province (8, 11). Prominent Canadian

EvidenceSynthesis IMPACT OF HEALTHY FOOD PROCUREMENT

POLICIES/PROGRAMS AND NUTRITION STANDARDS

ON SALES, INTAKE AND AVAILABILITY OF HEALTHIER

FOOD, AND BODY WEIGHT STATUS


health and scientific organizations have also called for implementation of healthy food procurement

policies by both government and non-governmental organizations (12).Despite these recommendations,

healthy food procurement policies have not been broadly implemented, perhaps due to limited

knowledge of their potential positive impacts (8). Logistical barriers to institutional policy change may

also be a factor limiting implementation.

The aim of this synthesis paper is to summarize the evidence on the impact of healthy food

procurement policies and nutrition standards on sales, intake, and availability of healthier food, as well

as Body Mass Index (BMI) as an indicator of weight status (overweight/obesity). Selected case studies

are provided to illustrate how healthy food procurement policies are implemented and lessons learned

from such processes.

METHODS

Review of Evidence. This review involved the collection of systematic reviews and meta-analyses from

two databases (Ovid Medline and CINHAL) and three grey literature sources (the Yale Rudd Center for

Food Policy & Obesity website (13), the National Center for Disease Control and Prevention (U.S.)

website (14), and the Public Health Agency of Canada website (15)). To be included in this synthesis,

reviews had to meet the following criteria: (1) French or English reviews published between 2003 and

June 2014; (2) comprehensive or systematic in nature; (3) examine the impact of healthy food

procurement policies/programs and/or nutrition standards on sales, intake and/or availability of

healthier food, and/or BMI and; (4) focus predominantly on public facilities. The first and second round

of screening involved reviewing titles and abstracts, respectively, to remove irrelevant studies (Figure 1).

The third-level screening consisted of a full-review of remaining articles to ascertain relevance in

relation to the inclusion criteria. The AMSTAR appraisal tool was used to rate the strength of evidence of

systematic reviews (16).

Selection of Case Studies. Two case studies identified through the literature review were selected for

inclusion in this synthesis. Case studies were chosen based on their potential to provide rich examples of

the process through which healthy procurement policies may be developed and lessons learned through

such processes.


Figure 1: Selection of Articles

SYNTHESIS OF EVIDENCE

Characteristics of Systematic Reviews. Three systematic reviews met the inclusion criteria (Table 1) (8,

17, 18). This synthesis reports only on the outcomes of interest described earlier. The first review by

Niebylski et al. (8) focused on the impact of food procurement policies/programs on sales, intake, and

availability of healthier foods, and BMI. In total, 34 studies were included in this review. The second

review by Jaime and Lock (18) explored the impact of school food and nutrition policies worldwide on

sales, intake, and availability of healthier foods, as well as menu composition and BMI (18). This review

included 27 articles, reporting on 18 studies. Finally, Chriqui et al. (17) examined the influence of state

and district-level competitive food and beverage (CF&B) policies in U.S. schools on changes to sales,

intake, and availability of healthier foods, and BMI. Twenty-four studies were included in this review.

Two of the reviews (17, 18) were judged to be of moderate quality, receiving between 5 to 8 out of a

possible 11 points using the AMSTAR criteria (19, 20). One review (8) was judged to be of low quality,

reviewing 4 out of a possible 11 points.

Records identified through

database searching (n=160)

After duplicate removal

n=80

After duplicate removal

n=70

Additional records identified through other sources

(n = 70)

Title review

n=150

Title review included

n=34

Abstract review

n=34

Abstract review included

n=12

Full-text review

n=12

Full-text included

n=3

Number of total reviews

n=3


IMPACT OF HEALTHY FOOD PROCUREMENT POLICIES/PROGRAMS AND/OR NUTRITION STANDARDS

Overall. The results of the three reviews indicate that healthy food procurement policies/programs

and/or nutrition standards can result in positive outcomes related to sales, intake, and availability of

healthier food, while findings related to BMI were mixed (17, 18). Overall, the strength of evidence

pertaining to the impact of healthy food procurement policies was limited by gaps in evidence for

certain settings (eg. remote communities) and outcomes (eg. BMI), as well as the need for more long-

term and rigorously designed studies (8, 17).

Schools. In contrast to other settings, a significant body of research has focused on the impact of

healthy food procurement policies/programs and/or nutrition standards in schools. In total, the reviews

included 64 articles related to this setting, with 6 articles included in 2 or more reviews.

Sales and Intake of Healthier Food. All three reviews discussed the impact of healthy food procurement

policies/programs and/or nutrition standards on sales or intake of healthy/unhealthy foods. In relation

to sales, Niebylski et al. (8) found that healthy food procurement strategies in schools, paired with price

reductions or education, resulted in increased sales of healthier foods, such as low-fat snacks or fruits

and vegetables. In terms of food intake, all three reviews suggest that healthy food procurement

policies/programs and/or nutrition standards can contribute to increased consumption of healthy food

or decreased consumption of unhealthy food (8, 17, 18). In Neibylski et al.’s review (8), findings in this

area were particularly strong for interventions that involved healthy procurement paired with additional

strategies such as education or price reductions. Further, in Chriqui et al.’s review (17), CF&B policies

were associated with reduced in-school consumption of unhealthy food and beverages, though results

for overall consumption were mixed (17).

Availability of Healthier Foods. Results from the reviews indicate that healthy food procurement policies,

programs and/or nutrition standards can have a positive influence on healthy food availability in schools

(8, 17, 18). Neibylski et al. (8) outlined a number of healthy food procurement interventions in school

settings that increased availability of healthy foods (21, 22). Further, Jamie and Lock (18) found that, in

all cases, nutrition guidelines led to increased availability of fruit and vegetables [ranging from +.28

servings/day to +0.48 servings/day]. This review also found that in three out of four cases, nutrition

guidelines contributed to a significant decrease in total and saturated fat on school menus (18). In

addition, Chriqui et al. (17) found that CF&B policies decreased availability of unhealthy foods and

beverages, with the majority of studies reporting results in the expected direction. However, CF&B

policies aimed at reducing availability of unhealthy items did not always translate into increased healthy

food availability (23).


BMI. Findings related to the impact of healthy food procurement policies/programs and/or nutrition

standards in schools on BMI were limited and mixed (17, 18). Reviews by Neibylski et al. (8) and Jamie

and Lock (18) each included one study relevant to this area. In both cases, the intervention did not have

a significant impact on BMI (24, 25). In contrast, the Chriqui et al. (17) review reported mixed findings

related to BMI, with two studies reported results in the expected direction (26, 27) and two reporting a

mix of significant, non-significant, and/or unexpected results (28, 29).

Workplaces. The Neibylski et al. (8) review included six studies exploring the effectiveness of healthy

food procurement policies/programs in workplace settings on sales, intake, and/or availability of

healthier foods.

Sales and Intake of Healthier Food. Six studies examined the impact of healthy food procurement

policies/programs on sales and intake of healthier foods in workplaces. Findings related to sales of

healthier foods were mixed, while those related to consumption were positive (8). In terms of sales, one

intervention added low-fat snacks to 55 vending machines and subjected them to four price conditions,

with price reductions of 10%, 25%, and 50% resulting in significant increases in sales of low-fat snacks in

both adults and adolescent populations compared to a usual price comparison condition (30). By

contrast, sales of healthful entrees were unchanged in one Kansas workplace cafeteria when healthier

entrees were introduced and marketed (31). In terms of food intake, a number of multicomponent

workplace interventions, which involved healthy food procurement along with additional strategies such

as education, reported positive outcomes in terms of increased intake of fruit and vegetables and

reduced intake of fat (32-35).

Availability of Healthier Foods. One study in the review reported on outcomes relevant to healthy food

availability. This study examined changes in the consumption of fruit and vegetables after

implementation of an intervention in five worksite canteens, which aimed to improve the quality of

canteen lunches and also included staff training, goal setting and support groups (8). The study found

that all five canteens, located in both public and private settings, served significantly more fruits and

vegetables per day at follow-up compared to baseline (70 g per customer on average) (32).

Hospitals, Care homes, Correctional Facilities, Government Institutions and Miscellaneous Settings.

Three studies in the Niebylski et al. review (8) explored the impact of healthy food procurement

policies/programs in hospitals, care homes, correctional facilities, government institutions, and other

relevant settings on intake of healthier food.

Sales and Intake of Healthier Food. All of the above studies found that healthy food procurement

policies/programs increased intake of healthier food. For example, one study that implemented a


catering initiative to increase provision of nutritious food and decrease provision of foods high in sugar,

fat, and salt, resulted in significantly lower intakes of total sugars and fats, saturated fat, and salt in the

intervention group (8, 36).

Remote Communities. The Niebylski et al. (8) review included three studies that examined the impact

of healthy food procurement policies/programs on sales, intake, or availability of healthier food, and/or

BMI in remote communities.

Sales and Food Intake. All three of the above studies reported on impacts relevant to food sales or

intake. The Food Mail Project program, which aimed to reduce the cost of healthy perishable foods and

improve nutrition and health, resulted in an increase in the purchase of healthy food across all

communities (37). The second study involved a retail-based intervention aimed at promoting healthier

grocery store environments in Northern First Nations and Inuit communities in Canada. In this study,

increasing the availability and affordability of 32 targeted food items along with provision of educational

resources resulted in an increase in sales of healthy foods, though this increase was not maintained

once promotional activities ended (8, 38). The last study, which focused on a culturally appropriate

nutrition and physical activity intervention called the Healthy Food North program, resulted in

decreased intake of total calories and carbohydrates (8, 39).

Availability of Healthier Foods. The Healthy Food North and the Food Mail Projects demonstrated that it

is possible to increase healthy food availability in remote communities despite significant logistical

challenges (8). In the Food Mail Project, household survey respondents in two communities reported

that fresh fruit and vegetables were more available following the intervention, while respondents from a

third community reported no change in food availability (37).

BMI. Niebylski et al. (8) indicated that the Healthy Food North program resulted in a 2.6% decrease in

average BMI (39). Further details regarding the program’s impact on BMI could not be located.

LIMITATIONS OF REVIEWS

A number of factors limited the strength of the reviews included in this synthesis. For instance, the

majority of studies included in the reviews were conducted in developed countries, such as the U.K.,

Canada and the U.S. (8, 18). Further, few studies were conducted in certain settings, such as hospitals,

care homes and remote communities (8). Many of the studies included in the reviews also reported on

multicomponent interventions, making it difficult to assess the impact of healthy food procurement

specifically (8). In addition, reviews reported difficulty identifying food procurement policies in the

literature. One reason for this may be that, while a number of jurisdictions worldwide have


implemented policies, such policies may not have been evaluated (8, 18) or may not be published in

peer-reviewed journals (8). It is also important to note that two of the reviews indicated that they had

restrictive search criteria, which may have resulted in some relevant studies being excluded from the

reviews (8, 17). Two reviews also identified the short time period between implementation and

evaluation as a limitation of included studies (17, 18).

In addition to the above, the review by Chriqui et al. (17) identified limitations specific to their review on

CF&B policies in U.S. schools. Specifically, as many studies were natural experiments, randomization was

not possible, creating threats to internal validity (17). Another potential limitation identified in this

review is the lack of longitudinal studies (17). It is also important to note that the Niebylski et al. (8)

review was deemed to be of poor quality based on its AMSTAR ranking (19, 20). For this reason, findings

from this review should be interpreted with caution.

CASE STUDIES

The following case studies highlight the process in which healthy procurement policies have been

developed and implemented, as well as lessons learned.

Los Angeles County. In 2010, the Los Angeles County Department of Public Health (DPH) launched

a number of initiatives aimed at increasing procurement of healthy food (10). From 2010-2012, the

DPH engaged in a five-step process to assist selected institutions in adopting and implementing

healthy food procurement practices, including nutrition standards. This process involved: (a) needs

assessment; (b) stakeholder education and strategy development; (c) policy adoption; (d) policy

implementation and; (e) compliance and quality control. Overall, the targeted institutions

incorporated new or updated existing nutrition standards and recommended practices related to

food services and vending machines. However, these standards and practices varied by institution

according to their specific priorities (10). Robles et al. (10) have highlighted a number of facilitators

and barriers that were encountered during the process (Box 1).

Box 1: Facilitators

Understanding past and/or current institutional food procurement practices and readiness to adopt new

approaches

Examining institutional authority to adopt nutrition standards and/or other food procurement practices

Educating key partner/stakeholders to build support for proposed changes

Working with institutional champions

Capitalizing on external influences and/or institutional interest to change

Building momentum for proposed modifications to the food environment

Educating end-users through social marketing and other communication channels


Proving on-going, high quality technical assistance to facilitate the adoption and implementation of

recommended practices

Conducting ongoing monitoring and evaluation to support program improvement efforts

Barriers

Complex and time-consuming administrative processes

Variable levels of consumer acceptance for healthier food offering

Reproduced from: Robles, B., et al., Comparison of nutrition standards and other recommended procurement

practices for improving institutional food offerings in Los Angeles County, 2010–2012. Advances in Nutrition: An

International Review Journal, 2013. 4(2): p. 191-202.

New York City (NYC). City agencies in NYC provide an estimated 260 million meals and snacks each

year at more than 3,000 sites, either directly or through city contracts (7). Since 2003, NYC has

engaged in a variety of activities aimed at improving the nutrient quality of meals served in these

locations (7). Building on this earlier work, in 2009, NYC introduced the NYC Standards for

Meals/Snacks Purchased and Served. According to Lederer et al. (7), at the time, these standards

were the first to comprehensively outline nutrition recommendations covering all foods purchased

by a local government.

In creating the standards, NYC went through a process of partnership formation, drafting the

standards and implementing them. In relation to partnership formation, in 2006, Mayor Michael

Bloomberg and the City Council established a Food Policy Task Force led by a Food Policy

Coordinator within the Office of the Mayor (7). The Task Force then created a Food Procurement

Working Group, including representatives from all 12 city agencies, to develop nutrition standards.

Within this group, the NYC Health Department served as a technical advisor, responsible for

researching and drafting the standards (7).

To inform development of the standards, the Working Group developed an agency survey, as well

as relied on guidance from leading health authorities and relevant published literature. Following an

initial drafting, the Working Group engaged in an iterative process of feedback and revisions (7).

Ensuring adequate engagement at this point helped to generate buy-in. After finalizing the

standards, a draft assessment tool was created by the department to help agencies determine if the

standards could be met (7).

In 2008, Mayor Bloomberg signed an executive order giving the NYC Health Commissioner and the

Food Policy Coordinator authority to implement the standards. Following this executive order,

technical assistance was provided to all agencies to assist with implementation (7). A key action at


this point was incorporating standards into city agency contracts to help ensure sustainability. After

implementation, the Department tracked progress related to compliance with the standards

through bi-yearly progress reports (7). Results from the progress reports indicated that the

standards produced a number of positive outcomes, including a decrease in added sugar and fat in

the foods provided by some agencies, elimination of industrial produced trans-fat, reduced sodium

content, and replacement of sugary drinks with healthier alternatives (7).

Key Lessons Learned

It is feasible to create nutritional standards for publicly procured and served food that address obesity and

cardiovascular disease prevention, as well as sustainability.

Nutrition requirements can be developed that apply to a wide range of agencies that serve diverse populations

and have differing food infrastructures.

Using a formal policy mechanism, such as an Executive Order, can codify requirements in public sector agencies

without requiring laws to ensure that changes are made.

Support from high-level central authority, such as a Food Policy Coordinator, is key to ensure engagement and

accountability across multiple agencies.

Technical assistance support to agencies and their community partners is essential, especially those that lack

staff with nutrition training.

A reliable mechanism for incorporating requirements into contracts is important to ensure lasting sustainability.

Tracking progress in implementation helps ensure compliance and informs ongoing technical assistance.

Reproduced from: Lederer, A., et al., Toward a Healthier City: Nutritional Standards for New York City Government.

American Journal of Preventive Medicine, 2014. 46(4): p. 423-428

FUTURE RESEARCH

A number of research gaps were identified during the course of this synthesis. In particular, additional

research is needed to understand the impact of healthy food procurement policies in a broader range of

settings, such as low and middle income countries, in public facilities such as hospitals and care homes,

and in remote communities (8). There is also a need for more rigorously designed studies to understand

the long-term impacts of healthy food procurement policies on outcomes related to food intake and

BMI (8, 17, 18).

CONCLUSIONS

This synthesis of the evidence indicates that healthy food procurement policies/programs and/or

nutrition standards are likely to contribute to increased intake, sales and availability of healthier foods.

Evidence of effectiveness in these areas was particularly strong in school settings. Overall, results

related to BMI were mixed, indicating a need for continued research and evaluation in this area (8, 17,


18). Case studies highlighted the role of contextual factors, such as institutional history, stakeholder

engagement, and high-level support, in ensuring successful development and implementation of healthy

food procurement policies and/or nutritional standards. Ultimately, while future research is required to

understand the impact of healthy food procurement, there is a sufficient body of evidence to support

policy action in this area (8).


Table 1. Characteristics of reviews evaluating the impact of food procurement policies/programs and/or nutrition standards

Author Years Study design Number of studies included

Types of studies included1

Number of studies that overlap with other included reviews

Setting of Studies

Location of studies

Relevant Outcomes

AMSTAR ranking

Niebylski et al. (2014) [8]

1965 -Jul 2012

Comprehensive review examining the impact of healthy food procurement policies and programs

n=34 Randomized and non-randomized controlled trials; Prospective and retrospective designs

n=5 Schools (n=19); Worksites (n=6); Hospitals and other settings (n=6); Remote communities (n=3)

Canada (n=6); U.S. (n=21); England (n=3); Scotland (n=1 ); Denmark (n=1); Ireland (n=1); U.K.(n=1)

Sales of healthier food; Intake of healthier food; Availability of healthier food; BMI

4/11 (Weak)

Jaime and Lock (2009) [18]

Up to Nov 2007

Systematic review examining the impact of nutrition policies

n=181 Randomized and

non-randomized controlled and uncontrolled trials; Cross-sectional studies

n=6 Schools (n=18) U.S (n=11); Europe (n=7)

Sales of healthier food; Intake of healthier food; Availability of healthier food and Menu composition; BMI

6/11 (Moderate)

Chriqui, Pickel, & Story (2014) [17]

Jan 2005 – Mar 2013

Systematic review examining the impact of competitive food and beverage policies

n=24 Cross-sectional studies; Longitudinal studies; Combination of cross-sectional and longitudinal

n=1 Schools (n=24) U.S. (n=24) Sales of healthier food; Intake of healthier food; Availability of healthier food; BMI

5/11 (Moderate)

1 27 articles were included in this review, reporting on 18 studies.


REFERENCES

1. Statistics Canada. Health profile. Ottawa: Statistics Canada; 2010; Available from:

http://www12.statcan.gc.ca/health-sante/82-228/idex.cfm?Lang=E.

2. Statistics Canada. Overweight and obese adults (self-reported), 2011. 2012 [cited 2012 August

14]; Available from: http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11664-eng.htm.

3. Public Health Agency of Canada. Obesity in Canada: A joint report from the Public Health Agency

of Canada and the Canadian Institute for Health Information. 2011; Available from:

https://secure.cihi.ca/free_products/Obesity_in_canada_2011_en.pdf.

4. Slater J, Green CG, Sevenhuysen G, Edginton B, O’Neil J, Heasman M. The growing Canadian

energy gap: More the can than the couch? Public Health Nutrition. 2009;12(11):2216-24.

5. Winson A. School food environments and the obesity issue: Content, structural determinants,

and agency in Canadian high schools. Agriculture and Human Values. 2008;25(4):499-511.

6. Chaumette P, Morency S, Royer A, Lemieux S, Tremblay A. Food environment in the sports,

recreational and cultural facilities of Quebec City: a look at the situation. Canadian Journal of

Public Health. 2009;100(4):310.

7. Lederer A, Curtis CJ, Silver LD, Angell SY. Toward a healthier city: Nutrition standards for New

York City government. American Journal of Preventive Medicine. 2014;46(4):423-8.

8. Niebylski ML, Lu T, Campbell NR, Arcand J, Schermel A, Hua D, et al. Healthy food procurement

policies and their impact. International Journal of Environmental Research and Public Health.

2014;11(3):2608-27.

9. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating

environments: Policy and environmental approaches. Annu Rev Public Health. 2008;29:253-72.

10. Robles B, Wood M, Kimmons J, Kuo T. Comparison of nutrition standards and other

recommended procurement practices for improving institutional food offerings in Los Angeles

County, 2010–2012. Advances in Nutrition: An International Review Journal. 2013;4(2):191-202.

11. BC Ministry of Education, BC Ministry of Health. School food sales and policies provincial report

II. 2008 [cited 2014 September ]; Available from:

http://www.bced.gov.bc.ca/health/sales_policy_feb08.pdf.

12. Heart and Stroke Foundation of Canada Canadian Institute for Health Research (HSFC-CIHR)

Chair in Hypertension Prevention and Control. Improving Canada's eating environment: A call to

action to buy and sell healthy foods and beverages. Calgary, AB2013.

13. Rudd Center for Food Policy and Obesity. Home. Yale University; 2013 [cited 2014 September

22]; Available from: http://www.yaleruddcenter.org/.

14. National Center for Disease Control and Prevention. 2014 [cited 2014 September]; Available

from: http://www.cdc.gov/.

15. Public Health Agency of Canada. Home. 2014 [cited 2014 September]; Available from:

http://www.phac-aspc.gc.ca/index-eng.php.

http://www12.statcan.gc.ca/health-sante/82-228/idex.cfm?Lang=E

http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11664-eng.htm

http://www.bced.gov.bc.ca/health/sales_policy_feb08.pdf

http://www.yaleruddcenter.org/

http://www.cdc.gov/

http://www.phac-aspc.gc.ca/index-eng.php


16. Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, et al. AMSTAR is a reliable

and valid measurement tool to assess the methodological quality of systematic reviews. J Clin

Epidemiol. 2009 Oct;62(10):1013-20.

17. Chriqui JFP, M.; Story, M. Influence of school competitive food and beverage policies on obesity,

consumption, and availability: A systematic review. JAMA Pediatrics. 2014;168(3):279-86.

18. Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity?

Preventive Medicine. 2009;48(1):45-53.

19. Melchiors AC, Correr CJ, Venson R, Pontarolo R. An analysis of quality of systematic reviews on

pharmacist health interventions. International Journal of Clinical Pharmacy. 2012;34(1):32-42.

20. Miktona C, Butcharta A. Child maltreatment prevention: a systematic review of reviews. Bulletin

of the World Health Organization. 2009;87:353-61.

21. French SA, Story M, Fulkerson JA, Hannan P. An environmental intervention to promote lower-

fat food choices in secondary schools: outcomes of the TACOS Study. American Journal of Public

Health. 2004;94(9):1507.

22. Lytle LA, Kubik MY, Perry C, Story M, Birnbaum AS, Murray DM. Influencing healthful food

choices in school and home environments: results from the TEENS study. Preventive Medicine.

2006;43(1):8-13.

23. Peart T, Kao J, Crawford PB, Samuels SE, Craypo L, Woodward-Lopez G. Does competitive food

and beverage legislation hurt meal participation or revenues in high schools? Childhood Obesity

(Formerly Obesity and Weight Management). 2012;8(4):339-46.

24. Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J. Evaluation of implementation and effect

of primary school based intervention to reduce risk factors for obesity. Bmj.

2001;323(7320):1027.

25. Saksvig BI, Gittelsohn J, Harris SB, Hanley AJ, Valente TW, Zinman B. A pilot school-based healthy

eating and physical activity intervention improves diet, food knowledge, and self-efficacy for

native Canadian children. The Journal of Nutrition. 2005;135(10):2392-8.

26. Coffield JE, Metos JM, Utz RL, Waitzman NJ. A multivariate analysis of federally mandated school

wellness policies on adolescent obesity. Journal of Adolescent Health. 2011;49(4):363-70.

27. Taber DR, Chriqui JF, Perna FM, Powell LM, Chaloupka FJ. Weight status among adolescents in

States that govern competitive food nutrition content. Pediatrics. 2012;130(3):437-44.

28. Sanchez-Vaznaugh EV, Sánchez BN, Baek J, Crawford PB. ‘Competitive’food and beverage

policies: are they influencing childhood overweight trends? Health Affairs. 2010;29(3):436-46.

29. Riis J, Grason H, Strobino D, Ahmed S, Minkovitz C. State school policies and youth obesity.

Maternal and Child Health Journal. 2012;16(1):111-8.

30. French SA, Jeffery RW, Story M, Breitlow KK, Baxter JS, Hannan P, et al. Pricing and promotion

effects on low-fat vending snack purchases: the CHIPS Study. American Journal of Public Health.

2001;91(1):112.


31. Perlmutter CA, Canter DD, Gregoire MB. Profitability and acceptability of fat-and sodium-

modified hot entrees in a worksite cafeteria. Journal of the American Dietetic Association.

1997;97(4):391-5.

32. Lassen A, Thorsen AV, Trolle E, Elsig M, Ovesen L. Successful strategies to increase the

consumption of fruits and vegetables: Results from the Danish ‘6 a day’Work-site Canteen Model

Study. Public Health Nutrition. 2004;7(02):263-70.

33. Beresford SA, Thompson B, Feng Z, Christianson A, McLerran D, Patrick DL. Seattle 5 a Day

worksite program to increase fruit and vegetable consumption. Preventive Medicine.

2001;32(3):230-8.

34. Sorensen G, Stoddard A, Hunt MK, Hebert JR, Ockene JK, Avrunin JS, et al. The effects of a health

promotion-health protection intervention on behavior change: the WellWorks Study. American

Journal of Public Health. 1998;88(11):1685-90.

35. Sorensen G, Stoddard A, Peterson K, Cohen N, Hunt MK, Stein E, et al. Increasing fruit and

vegetable consumption through worksites and families in the treatwell 5-a-day study. American

Journal of Public Health. 1999;89(1):54-60.

36. Geaney F, Harrington J, Fitzgerald AP, Perry IJ. The impact of a workplace catering initiative on

dietary intakes of salt and other nutrients: A pilot study. Public Health Nutrition.

2011;14(08):1345-9.

37. Glacken JB. The Food Mail Projects: Achievements and challenges Ottawa, ON: Minister of Indian

Affairs and Northern Development and Federal Interlocutor for Metis and Non-Status Indians;

2009. p. 1-52.

38. Retail based nutrition program. Ottawa, ON Food Security and Nutrition Unit, Health Canada;

2009.

39. Sharma S, Gittelsohn J, Rosol R, Beck L. Addressing the public health burden caused by the

nutrition transition through the Healthy Foods North nutrition and lifestyle intervention

programme. Journal of Human Nutrition and Dietetics. 2010;23(s1):120-7.

Healthy Food Procurement - · PDF file2 | P a g e health and scientific organizations have...

Documents

Transcript of Healthy Food Procurement - · PDF file2 | P a g e health and scientific organizations have...