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Healthy Federal Guidelines with Joel Kimmons and Melissa Walker

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  • Guidelines: imply a gentleness to implementation, as well as a flexibility, both in the creation of guidelines and in their implementation generous considerations around customer demand and the business case must be considered. There will be different approaches.Health: impulse items availability, salt shakers in a central location instead of on tables.NOTE: I have not used the word procurement! will introduce the session and set the stage for the importance of providing sustainable and healthy food in worksites and schools, including obesity and chronic disease rates and the number of people potentially impacted. He will provide a brief discussion and definition of the terms (sustainable, healthy, and local) and address why these are relevant to nutrition and public health. Dr Kimmons will discuss the need to broaden the definition of what constitutes a sustainable diet to include foods and beverages that promote both health & wellness and environmental responsibility. Finally, he will provide an overview of the process of working with HHS, USDA, and GSA to develop food procurement and cafeteria guidelines for federal employees.
  • Guidelines: imply a gentleness to implementation, as well as a flexibility, both in the creation of guidelines and in their implementation generous considerations around customer demand and the business case must be considered. There will be different approaches.Health: impulse items availability, salt shakers in a central location instead of on tables.NOTE: I have not used the word procurement! will introduce the session and set the stage for the importance of providing sustainable and healthy food in worksites and schools, including obesity and chronic disease rates and the number of people potentially impacted. He will provide a brief discussion and definition of the terms (sustainable, healthy, and local) and address why these are relevant to nutrition and public health. Dr Kimmons will discuss the need to broaden the definition of what constitutes a sustainable diet to include foods and beverages that promote both health & wellness and environmental responsibility. Finally, he will provide an overview of the process of working with HHS, USDA, and GSA to develop food procurement and cafeteria guidelines for federal employees.
  • Guidelines: imply a gentleness to implementation, as well as a flexibility, both in the creation of guidelines and in their implementation generous considerations around customer demand and the business case must be considered. There will be different approaches.Health: impulse items availability, salt shakers in a central location instead of on tables.NOTE: I have not used the word procurement! will introduce the session and set the stage for the importance of providing sustainable and healthy food in worksites and schools, including obesity and chronic disease rates and the number of people potentially impacted. He will provide a brief discussion and definition of the terms (sustainable, healthy, and local) and address why these are relevant to nutrition and public health. Dr Kimmons will discuss the need to broaden the definition of what constitutes a sustainable diet to include foods and beverages that promote both health & wellness and environmental responsibility. Finally, he will provide an overview of the process of working with HHS, USDA, and GSA to develop food procurement and cafeteria guidelines for federal employees.
  • How should developing, implementing, and promoting these guidelines work
  • Importance of this work:Children in schoolAdults spend considerable time at work, making worksites ideal locations for reaching a large audience. Worksites provide access to 65% of adults in settings where people consume one or more meals daily. In addition, many worksites are capable of supporting employees in their efforts to achieve adequate levels of physical activity.22Over 100 million workers may eat at their job daily in the United States. 140 million worker but 25% work from home= 105 million workers at 7.5 hrs per day civilian: http://www.bls.gov/news.release/atus.nr0.htmhttp://www.bls.gov/news.release/empsit.t01.htmDirect: Numbers influenced directly by the change in the food environment, GSA in the DC Area- meals per monthHHSStudentsIndirectindividual changes family behavior, changes cultural normsSystem: overall increases in healthy foods production, influences availability and the development of culture norms
  • The new 2010 Dietary Guidelines for Americans focus on balancing calories with physical activity, and encourage Americans to consume more healthy foods like vegetables, fruits, whole grains, fat-free and low-fat dairy products, and seafood, and to consume less sodium, saturated and trans fats, added sugars, and refined grains. Boiled down, these are the two overarching themes of the 2010 Dietary Guidelines—messages are carried throughout the document.
  • Transcript

    • 1. Improving Health and Sustainability in the Food System Through Institutional Food Service Guidelines Joel Kimmons, Ph.D. Centers for Disease Control and Prevention Division of Nutrition, Physical Activity and ObesityThe conclusions in this presentation are those of theauthor and do not necessarily represent the views of the Centers for Disease Control and Prevention.
    • 2. DisclaimerThe mention of organizations and commercial entities andproducts in this presentation is for illustrative purposes only anddoes not represent an endorsement by the National Institute forOccupational Safety and Health, Centers for Disease Controland Prevention (CDC), or the U.S. Department of Health andHuman Services (HHS).The views herein represent those of the authors and presenter.For official guidance from CDC, visit www.cdc.gov. 2
    • 3. HHS and GSA CollaborationGoalIncrease healthy food and beverage choices and sustainablepractices at federal worksitesApply the Dietary Guidelines for Americans, 2010 to federalfood-service operationsHHS and GSA Health and Sustainability Guidelines for FederalConcessions and Vending Operationshttp://www.cdc.gov/chronicdisease/resources/guidelines/food-service-guidelines.htm
    • 4. Terms: HealthHealthAlign the food choices with the Dietary Guidelines for Americans, 2010Atmosphere, architecture, cleaning, serving ware, cooking methods
    • 5. Terms: SustainabilitySustainabilityBuilding design and facilities, energy use, waste, cleaning materials,packaging, serving wareSourcing of foods• A sustainable food system—  Integrates production, processing, distribution, and consumption  Regenerates rather than degrades natural resources  Is socially just and accessible  Supports the development of local communities
    • 6. Terms: GuidelinesGuidelineA statement by which to determine a course of action • Guidelines aim to streamline particular processes according to a standard • Following guidelines is never mandatory • Guidelines are not binding and are not enforced • (U.S. Department of Veterans Affairs, http://www.va.gov/trm/TRMGlossaryPage.asp)Assist staff, management, and contractors in aligning the foodenvironment with healthier and more sustainable choices and practices
    • 7. Approach: Health and Sustainability GuidelinesGuidelines? standards? policy?GentleFlexibleDietary— • Food vs. nutrient level • Choice vs. restrictionFeasible—business and customer, all stakeholdersAppropriately targeted for population and setting
    • 8. Making Healthy Choices… Default, Convenient, Easy, ImmediateIndividual and Family EnvironmentExposure, norms Policy AccessSkills, knowledge Legislation AdvertisingUse of time Economics AffordabilityIndividuality Healthy eating and physical activity Social structures, cultural norms, values
    • 9. Approach: Libertarian Paternalism IndividualsAre economic Are behavioralAre rational Make choices dictated byMake optimal choices • Culture • Information • The present • Resources • Measurable, tangible • Status-quo bias, default bias, opting out • Choice architecture • Making the healthy choices default Thaler and Sunstein. AER 93 (2), 2003; Loewenstein, et al JAMA 298 (20), 2007.
    • 10. The Power of Food Service GuidelinesDirect • Influence individuals by changing the food environment • Adults spend considerable time at work as do children in school • More than 100 million Americans eat at work daily1,2Indirect • Influence family behavior and community normsSystem • Increase healthy food production—coupled with demand • Develop social structures and culture, norms, and values 1 Bureau of Labor Statistics 2 Linnan L, Bowling M, Childress J, et al. Results of the 2004 National Worksite Health Promotion Survey. Am J Public Health. 2008; 98(8):1503-9.
    • 11. Settings and TargetsSettingsFederal, state, local governments TargetsSchool systemsWorksites CafeteriasHospitals Snack barsInstitutionalized populations VendingAssisted living communities Lunch roomsColleges and universities MeetingsCommunity‐based organizations Conferences(including faith‐based)Day care centers
    • 12. Guideline ExamplesCity: NYCCounty: LA CountyState: Michigan, California, OregonFederal: Health and Sustainability Guidelines for FederalConcessions and Vending Operations • GSA National Capital Region—more than 20 million annual transactions • Nationwide, GSA manages 10,000 buildings • HHS—120,000 employeesBusinesses, universities, schools
    • 13. Health and Sustainability Guidelines for Federal Concessions and Vending Operations -Apply to all HHS and GSA Facilities-All food-service concession operations and vending machinesmanaged by HHS and GSAFirst contract: HHS Humphrey Building Cafeteria, Washington, D.C.Now in facilities nationwideConferences, meetingsEvents onsite and offsite
    • 14. Make Healthy Choices the Easy ChoiceMore accessibleMore appealingMore affordable
    • 15. ImplementationAs contracts are renewedGradually but progressivelyCafeterias, snack bars, shops, vendingVarious settings • Geographic, demographicOverall feasibility issuesApproach
    • 16. Providing Healthy ChoicesSeasonal vegetables and fruits 100% fruit juiceWhole grain options, Freely available drinking water including pasta Foods with less sodiumHigh-fiber, low-sugar cereals Foods free of syntheticLow-fat milk, yogurt, and sources of trans fats cottage cheese Smaller portion sizesVegetarian entreesLean-meat entrees
    • 17. Sustainable Practices• Participate in waste reduction, recycling, and composting programs• Promote and incentivize reusable beverage containers• Use green cleaning and pest-control practices• Use compostable and bio-based trays, flatware, plates, and bowls• Offer food that is organically, locally, or sustainably grown and labeled accordingly• Offer certified sustainable, shade-grown, or bird-friendly coffee and tea• Offer drinking water
    • 18. Letters of SupportAmerican Diabetes Association Public Health Law and PolicyAmerican Public Health Association Prevention InstituteCalifornia Pan-Ethnic Health Network Robert Wood Johnson FoundationNational Association of Chronic Center to Prevent Childhood Disease Directors ObesityNational Business Coalition on Health Society for Nutrition EducationNational Association of Local Boards Others of Health
    • 19. Support for the GuidelinesA diverse array of public health organizations affirm— “The Guidelines make important, needed changes to worksite environments.” “…offer a more holistic and comprehensive approach to promoting healthful food.” “…can serve as a model for state and local governments, businesses and non-governmental organizations seeking to make healthy choices easier for their employees.”
    • 20. Next StepsEncourage widespread adaption/adoption —States, hospitals, universities, parks and recreation, etc.Designed to be adaptable to most environmentsA “living” document, to be updated as society and science change
    • 21. HHS/GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operationshttp://www.cdc.gov/chronicdisease/resources/guidelines/food-service-guidelines.htm
    • 22. Dietary Guidelines for Americans, 2010Overarching ConceptsConsume nutrient-dense foods and beveragesBuild healthy eating patterns • Include vegetables, fruits, whole grains, low-fat and fat-free dairy products, seafood, lean meats and poultry, eggs, beans and peas, and nuts and seeds • Limit sodium, solid fats, and added sugarsMaintain calorie balance over time to achieve andsustain a healthy weight 1
    • 23. Details
    • 24. Nutrition Menu LabelingStandard CriteriaCalorie labeling must be displayed at the point of purchase in aclear, conspicuous manner on the menu board or posted onsigns near food items or menusAll items must be labeled with calories per serving
    • 25. Nutrition InformationAvailable upon request, including— Protein Total fat Saturated fat Cholesterol Sodium Total carbohydrate Sugars Dietary fiberA prominent statement regarding availability of additionalnutrition information must be placed on menu or menu board
    • 26. ExceptionsCondiments and items for “general use”Daily specialsTemporary menu items on the menu for less than 60 daysCustom orders
    • 27. Trans FatsStandard CriteriaEliminate use of partially hydrogenated vegetable oils,shortenings, or margarines unless label for oil indicates 0 gramstrans fat per serving. (0 grams trans fats on the Nutrition Factslabel must contain less than 0.5 grams trans fat per serving)Oils and fats used must also be low in saturated fats
    • 28. SodiumStandard CriteriaAll individual food items must contain ≤480 mg sodium as servedAll meals must contain ≤900 mg sodium as served
    • 29. VegetablesStandard Criteria• At least 1 raw, salad-type vegetable and at least 1 steamed, baked, or grilled vegetable seasoned without fat or oil should be offered daily• All vegetable offerings must contain ≤230 mg sodium as served• Mixed dishes containing vegetables must contain ≤480 mg sodium as served• Offer a variety of seasonally available vegetablesAbove Standard• Offer at least 1 prepared vegetable option with ≤140 mg sodium as served
    • 30. FruitsStandard CriteriaAll canned or frozen fruit must be packaged in 100% water orunsweetened juice, with no added sweetenersOffer a variety of at least 3 whole or sliced fruits dailyOffer a variety of seasonally available fruits
    • 31. Cereals and GrainsStandard Criteria• When cereal grains are offered (e.g., rice, bread, pasta) then a whole grain option must be offered for that item as the standard choice• All cereal offerings must contain ≤230 mg sodium per serving• At least half of breakfast cereals must contain at least 3g of fiber and less than 10g total sugars per servingAbove Standard• When cereal grains are offered, a 100% whole grain option must be offered for that item as the standard choice• If cereal is offered, offer at least 1 cereal with ≤140 mg sodium per serving
    • 32. Dairy: Milk, Yogurt, and CheeseStandard Criteria• If milk is offered as a beverage, only 2%, 1%, and fat-free• If cottage cheese items are offered, only low-fat (2% or less) or fat- free• If yogurt is offered, only 2%, 1%, or fat-free• If yogurt is offered, only yogurt with no added caloric sweeteners or yogurts labeled as reduced or less sugar according to FDA labeling standards• Processed cheeses must contain ≤230 mg sodium per serving
    • 33. Protein FoodsStandard CriteriaWhen protein entrees are offered, offer lean meat, fish, or low-fatvegetarian entrée choicesAt least twice per week, offer an entrée with a vegetarian proteinsourceAbove StandardA vegetarian entrée must be offered every day
    • 34. BeveragesStandard CriteriaAt least half of available beverage choices (other than 100% juiceand unsweetened milk) must contain ≤40 kcalories/servingIf juice is offered, only 100% juice with no added caloric sweetenersVegetable juices must contain ≤230 mg sodium per servingDrinking water, preferably chilled tap, must be offered at no chargeat all meal-service events
    • 35. Beverages, continuedAbove StandardFor beverages with more than 40 kcalories/serving, only offer servingsof 12 oz. or less (excluding unsweetened milk and 100% juice)At least 75% of beverages (other than 100% juice and unsweetenedmilk) must contain ≤40 kcalories/servingOffer a non-dairy, calcium-fortified beverage (such as soy or almondbeverage). These beverages— • Must not provide more sugars than milk (12 g sugar/8 oz. serving or less) • Provide the same amount of protein (at least 6 g/8 oz.), calcium (250 mg/8 oz.) • Provide less than 5 g total fat (equivalent to 2% milk)Offer at least 1 low-sodium vegetable juice ≤140 mg sodium/serving
    • 36. Other ConsiderationsStandard CriteriaDeep-fried options are not marketed or promoted as the specialor feature of the day • Limit deep-fried entrée options to no more than 1 choice per dayOffer half- or reduced-size choices for some meals andconcessions items, when feasibleWhere value meal combinations are offered, always offer fruit orvegetable as the optional side dish, instead of chips or cookie
    • 37. Other ConsiderationsAbove StandardMake healthier options more appealing to the consumer byoffering them at a reduced price as compared to less healthyalternativesOffer desserts that use less or no added sugars— • For example, offer desserts prepared with fruits, vegetables, nuts, seeds, apple sauces, and yogurts without added sugars
    • 38. Sustainability Guidelines General OperationsStandard Criteria• Participate in waste reduction, recycling, and composting programs, as available• Promote and incentivize the use of reusable beverage containers• Promote use of tap water over bottled water• Use green cleaning practices• Use integrated pest-management practices and green pest-control alternatives to the maximum extent feasible• Provide materials for single-service items (e.g., trays, flatware, plates, and bowls) that are compostable and made from bio-based products
    • 39. General FoodStandard CriteriaOffer 25% of the product line to be organically or locally ordocumented sustainably grown (e.g., integrated pestmanagement, pesticide free, other labeling programs)Offer seasonal varieties of fruits and vegetablesAbove StandardOffer 35% of the product line to be organically or locally ordocumented sustainably grown (e.g., integrated pestmanagement, pesticide free, other labeling programs)
    • 40. Sustainability LabelingStandard CriteriaLabel organic, local, or documented sustainably grown food itemsavailable in food service at the point of choiceAbove StandardEducate about the value of agricultural best practices that areecologically sound, economically viable, and socially responsible inagency concessions services with— • Signage • Informational programs or • Other means of communicating the benefits of the items that are labeled organic, local, or sustainableFor locally grown foods, include information that identifies the farmsand sustainable practices used
    • 41. Animal ProductsStandard CriteriaOnly offer fish/seafood identified as “Best Choices” or “GoodAlternatives” on the Monterey Bay Aquarium’s Seafood WatchList or certified by Marine Stewardship Council (or equivalentprogram)Above StandardOffer certified organic or documented sustainably or locallyproduced milk and milk productsOffer certified organic or documented sustainably or locallyproduced eggs and meat (e.g., grass-fed, free-range, pasture-raised, grass-finished, humanely raised and handled)
    • 42. BeveragesStandard CriteriaOffer drinking water, preferably chilled tapAbove StandardIf providing coffee or tea, include offerings that are certifiedorganic, shade-grown, or bird friendlyIf composting is available, bottled water must be offered incompostable bottles
    • 43. VendingMenu LabelingNutrition Facts Label should be visible, but if not, should be visibleat the point of purchase. The vending machine operator shouldprovide a sign close to each article of food or near the selectionbutton that includes a clear statement disclosing the number ofcaloriesOnly items that contain 0 grams trans fat per serving as definedby FDA should be offeredOnly offer snack items that contain ≤230 mg of sodium per serving(excludes refrigerated meals)Refrigerated meals items must contain ≤480 mg sodium perserving
    • 44. Vending, continuedIn addition to meeting the requirements listed above, at least 25% ofall packaged food choices must meet the following criteria: • Limit all snack (not refrigerated meals) items to ≤200 calories per item (excluding nuts and seeds without added fats, oils, or caloric sweeteners) • Limit total calories from saturated fat to ≤10% (excluding nuts and seeds without added fats or oils) • Limit calories from sugars to ≤35% total weight (excluding fruits or vegetables without added caloric sweeteners)Beverage Requirements • At least half of available beverage choices (other than 100% juice and unsweetened milk) should contain ≤40 kcalories/serving • If milk is offered, only 2%, 1%, and non-fat milk dairy-type products should be offered .
    • 45. Benefits of the GuidelinesProcurement officers can use the Guidelines to createproposals for contractorsLeadership can ensure healthy and sustainable food servicefor employeesThe Guidelines help increase availability of healthy choicesin cafeterias and vendingThey bring the overall food environment in line with theDietary Guidelines for Americans, 2010
    • 46. Web Resourceshttp://www.cdc.gov/chronicdisease/resources/guidelines/food-service-guidelines.htmwww.health.gov/dietaryguidelineswww.cdc.govwww.gsa.govwww.nutrition.gov

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