1. Communities Putting Prevention to Work Wood County

2. Overview Solution Planning Background Implementation Evaluation MAPPS

3. Solution

4. The Problem Wood Countys combined overweight and obesity rate = 64.4%* Only 25% of WI residents eat 5 daily servings of fruits & vegetables* U.S. adults spend half of food dollars on meals and snacks away from home** Many consumers underestimate the amount of calories in their meal*** *Source: BRFSS, 2004-2006 **Source: International Journal of Behavioral Nutrition and Physical Activity 2008 ***Source: American Journal of Public Health 2010

5. The Solution Menu labeling: Adding nutrition info at point of purchase Allows customers to make informed selections

6. Public Support National opinion poll shows 83% of Americans favor menu labeling * Survey/focus group research indicates majority support menu labeling ** 3 out of 4 adults read food labels on packages * Half say this has helped change purchasing habits * *Source: Rudd Center for Food Policy and Obesity **Source: University of Wisconsin Population Health Institute

7. Federal Regulation Chains required to print calorie information on menus and menu boards Other nutritional facts available by request Implemented next year Some restaurants are already displaying and adding healthier choices

8. Wood County Focus Partnering with non- franchised restaurants 19 or fewer locations Labeling healthy meals Adding nutritional information to menus Implementing voluntary policy Educating policy makers

9. Planning

10. Set the Stage Partnered with sanitarian team and identified restaurants Partnered with restaurant association Evaluated menu labeling programs Researched menu analysis approaches/tools Identified barriers and strengths Assessed restaurant menus and environment

11. Developed the Plan Program: Smart Meal Customizable toolkit Logo and promotional materials Analysis: MenuCalc Web-based tool Training/support for restaurant staff

12. Recruited Restaurants Recruitment meetings Letter and invitation mailed Informative/tradeshow style Iron chef and calorie guessing contests Star fruit and reminder delivered

13. Recruited Restaurants Follow up meetings Met with restaurant owners who attended meetings Recruited 10% of restaurants Marketing/promoting program Creating awareness Anticipate restaurants coming to us

14. Successes & Lessons Learned Successes Recruited 10% - similar to other communities (large and small) Partnership with sanitarian team Lessons Learned Low attendance for recruitment meeting Restaurants did not welcome cold calls Some restaurants dont want to be first

15. Background

16. Created by the Colorado Physical Activity and Nutrition Program (COPAN) Implemented at 20 full-service restaurants in Colorado (190 locations) Expanded nationally to California, Vermont, Rhode Island, and Connecticut Recommended as practice-tested intervention by UNC & Center TRT About Smart Meal Program

17. Smart Meal Objectives Provide healthier menu options Increase fruit & vegetable consumption Combat obesity and chronic disease Improve eating environments Encourage healthy meal selections

18. Nutritional Requirements Based on recommendations from: US Dietary Guidelines Fruits and Veggies: More Matters Western Dairy Council The American Heart Association FDA nutrition labeling guidelines Winners Circle – NC Prevention Partners

19. Adult Meal Minimum of 2 servings of beans, whole grains, fruits or vegetables. May substitute one for non-/low-fat milk or milk product. No more than 700 calories 30% of total calories from fat (23g or < total fat) 10% of calories from saturated fat (8g or < saturated fat) 0.5g or less of trans fat (no added or artificial trans fat) No more than 1,500mg of sodium

20. Smart Meal Kids Same as adult guidelines except: 400-600 calories 600-800mg of sodium Ranges represent respective ages (4-13 years)

21. Side Dish Minimum one serving of beans, whole grains, fruits, vegetables or fat-free or low-fat milk or equivalent milk product No more than 300 calories 30% of total calories from fat (10g or < total fat) 10% of calories from saturated fat (3g or < saturated fat) No more than 650mg of sodium

22. Implementation

23. Implementation Steps Menu review and identification of potential Smart Meals MenuCalc introduction and training Recipe analysis Recipe/menu adjustments Recipe analysis/meal qualification Restaurant agreement signed Smart Meal Seal added to menu

24. Restaurant Agreement Qualify four Smart Meals Use logo to identify and promote Smart Meals Display window decals Display Smart Meal program description Measure customer satisfaction and program awareness

25. 1 st Smart Meal Restaurant

26. 2 nd Smart Meal Restaurant

27. 1 st Smart Meal Catering Co.

28. Cost for Implementing Agency Menu analysis – $390 per restaurant Promotional materials/printing costs – window decals, panel cards, table tents, and menu transition stickers Marketing/advertising campaign

29. Cost for Restaurants Analyzing additional meals (discount from MenuCalc) Menu reprints Menu inserts (if menu not scheduled to reprint soon) Discount promotions

30. Successes Partnering to identify potential meals Clear messaging that little change is required Offering analysis for free Training restaurants on menu analysis Offering hands-on technical support Flexibility with menu transition options Agreement form, logos, promos as last step

31. Lessons Learned Some not interested in training Lengthy time for analysis and meal modifications Some delay start time after commitment Could be cautious of being first Some not open to menu changes Restaurants promoting unhealthy foods agreed to participate

32. Evaluation

33. Restaurant Assessment County-wide assessment Nutrition Environment Measures Survey for Restaurants (NEMS-R) Identified supportive factors and barriers Assessed 96 restaurants for baseline Conducting post assessment spring 2012 for Smart Meal restaurants to measure improvements

34. Baseline Results Number of restaurants… Providing nutrition info on menus = 0 Identifying healthy meals on menus = 0 Promoting healthy selections = 0 Offering fruit without added sugar = 13 Offering non-fried vegetables without added sauce = 42 Offering reduced-size portions = 17

35. Smart Meal Evaluation Sales data collection Manager interviews Secret shopper Quarterly meetings/calls Customer survey

36. Successes & Lessons Learned Successes Assessed every restaurant in county Smart Meal restaurants agreed to all evaluation steps Lessons learned Lengthy and expensive assessment process Chain restaurants not always willing to share sales data

37. MAPPS

38. M – Media A – Access P – Point of Purchase P – Price S – Social Support

39. Questions

40. Renee Fox Community Health Educator Aspirus rfox@co.wood.wi.us 715.421.8914 www.getactivewisconsin.org