1. Jenni Wolfenbarger Walden University PUBH-6165-01
The Use of Common Symbols to Identify Healthy Food Options at Community Restaurants
Jenni Wolfenbarger
Walden University
PUBH
Good Evening. The Cuyahoga County health department decided to gather area restaurant owners to discuss a county wide health initiative. It is currently in early planning process and we would appreciate any feedback or questions you may have at the conclusion of this presentation. Collaboration between the public and private sectors is very important in order to achieve mutual goals.

2. Learning Objectives Identify consumer eating habits and preferences
Highlight successful community wide initiative for healthy eating
Discuss the use of symbols on menus to identify healthy foods
Recommendations for our community
The learning objectives for this presentation are as follows. I will discuss current consumer eating habits and why restaurants are an important part of healthy eating. I will highlight successful programs from different parts of the country. I will discuss possible options for symbols that can be used in menus across the community so that consumers can identify healthy food options. Finally, I will discuss recommendations on the next steps to get a healthy eating program off the ground.

3. Introduction Healthy eating is key in lowering: -stroke -heart disease
-cancer
County wide health initiative to address healthy nutritional options
Reference: Centers for Disease Control and Prevention (2009). Obesity. Retrieved July 18, 2009 from
Healthy eating is key in lowering the three major causes for death: stroke, heart disease and cancer. Establishing healthy eating behaviors in childhood will help to prevent obesity and related illnesses. Only 27% of high school students report eating recommended five servings of fruits and vegetables and 67% of youth exceed the recommended intake of fat daily. Obesity has become an epidemic in our country and in our local community, which demands creative solutions. Today’s presentation will discuss one component of a county wide health initiative, which involves healthy eating strategies.

4. Consumer’s Point of View
Americans use 44 percent of their food budget eating at restaurants and cafeterias.
Half of all adults look for low fat or healthy options in the menu.
Consumers indicate confusion over proper portion sizes when eating out.
Reference: U.S. Food and Drug Administration (2007). Today’s Special: Nutritional Information. Retrieved July 19, 2009 from
Restaurants and cafeterias have become common places for lunch and family dinners. Americans spend 44 percent of their food budget eating out at restaurants and cafeterias. Half of adults that eat out state they look for healthy options such as low fat or meatless menu options. Many consumers choose the wrong items, because healthy options are rarely identified on the menu. Portion sizes can also be deceiving to consumers as they order a healthy item, but consume an entire day’s worth of calories in one meal.

5. Healthy Restaurants Program: Howard County, Maryland
How have other communities addressed the need for healthy eating in restaurants and cafeterias?
Healthy Restaurants Program: Howard County, Maryland
Take ½ home, Pinellas County, Florida
Just Ask Us! Rockland County, New York.
Several communities around United States have created programs that focus on healthy eating and combine the public and private sectors. I will focus on three wonderful programs: The Healthy Restaurants Program in Howard County, Maryland, Take half home in Pinellas County, Florida and Just Ask Us! In Rockland County. Each of these programs have innovative ideas and have engaged the community to participate in healthy eating.

6. Healthy Restaurants Program: Howard County, Maryland
Twenty participating restaurants
Advantages to the community: healthy food options, easy to recognize.
Advantages to restaurant owners: recognition in program, new customers, improved consumer confidence.
Reference: Howard County Health Department (2009). Implementing a Healthy Restaurant Program. Retrieved July 19, 2009 from
The Healthy Restaurant Program in Howard County, Maryland is a part of Healthy Howard initiative that begun in Twenty restaurants applied to be recognized as a Healthy Restaurant. Criteria to be a part of the program include a ban on trans fats, calorie restrictions on entrees and each entrée needed to include fruit and vegetables. The program uses window decals to identify Healthy Restaurants to consumers as well as newspaper and internet listing of participating restaurants. The community embraced the program and participating restaurants were happy to report an increase in customer base and healthy menu items are ordered frequently.

7. Take ½ Home: Pinellas County, Florida.
Program components:
Healthy kid’s meals
smaller portions
cook to order items.
Reference:
Pinellas County Health Department (2009). Healthy Choices Restaurant Program. Retrieved July 19, 2009 from
Another wonderful program began in 2002 in Pinellas County, Florida. The community initiated interest with the local health departments to have a program address large portions at restaurants and lack of healthy options. The program includes children’s meals that within recommended calories and fat content. Patrons can also request a half portion of any meal and the other half is packed to go in order to reduce portion size. Restaurants participating in the program also agree to prepare items grilled, broiled or boiled at customer request instead of frying. Restaurants participating in the program receive a window decal identifying them as well as listing in many publications.

8. Just Ask Us! Rockland County, New York
“We Bake, Broil or Grill” slogan became easy to recognize by customers.
Restaurants experienced an increase in healthy food orders for adults and children.
Reference: Rockland County Department of Health (2008). Just Ask Us! Retrieved July 19, 2009 from
The Just Ask Us! Initiative in Rockland County New York is another great example of a county wide nutritional initiative. This program began in 2005 by educating local restaurant owners about the program’s purpose and it generated the interest of 20 local establishments. People in the community began to recognize the symbols in the menus, the restaurants that offered healthy choices and also learned about healthy living strategies from variety of promotional materials. The restaurants became visible in the community and noticed an increase in orders for grilled and baked food items as well as an increase in whole wheat bread and pasta requests. The Just Ask Us! Program has become a success due to the collaboration in the community between and public and the private sectors.

9. Examples of Food Symbols
The first symbol on the left is used in United Kingdom to identify how often a food should be eaten. The colors familiar from traffic lights, is included in nutritional labeling of foods, but could also be used in menu item labeling for sodium, fat and calories. The middle symbols is used at Stop and Shop stores to identify healthy food items. The symbol on the right belongs to the Heart and Stroke Foundation. There are many ways to convey to consumers which items are healthy. The important factors is to choose a labeling system that is easy to understand and consistent throughout the community.
Reference: Heart and Stroke Foundation (2009). Health Check… Helping You Eat Well. Retrieved August 7, 2009 from

10. Recommendations Committee of stakeholders
Educational campaign to recruit restaurants
Clear expectations on healthy food items
Nutritionist services offered
Consumer educational campaign
Reference: Cowdrey, L. (2006). Restaurants Must Do More in Fight Against U.S. Obesity. Nation’s Health, 36(6),
To begin a similar program in Cuyahoga County (Ohio), I would recommend beginning by forming a committee that includes experts from the health department, restaurant association and community members. Once a theme and purpose of the program has been established, the information would be shared with restaurants and cafeterias in the area. A smaller target area may be advisable to learn of possible barriers before a county wide launch. There should be clear guidelines what healthy food items are and a nutritionist to help restaurants ensure each healthy item meets the criteria. Once a sufficient amount of restaurants have been recruited, consumer education on the new program would begin. Having a common theme and symbols in restaurants will help identify participation and choosing healthy food options.

11. Recommendations cont.
Ongoing collaboration is essential in the success of the program
Surveys
Customer comments
Visibility in the community
Reference: Howard County Health Department (2009). Implementing a Healthy Restaurant Program. Retrieved July 19, 2009 from
Any program of this magnitude will require ongoing collaboration in the community. Surveys are a useful tool in assessing restaurant satisfaction with the program as well as consumer recognition of the campaign. Also, using health department resources such as health fairs and community events would be a wonderful way to educate the community about the program and participating restaurants. As restaurant owners, you may find an increased customer base, a greater visibility in the community and a listing in campaign materials.

12. Sources for Further Reading
Hands-On Social Marketing by Nedra Klein Weinreich
American Diabetes Association Guide to Healthy Restaurant Eating by Hope S. Warshaw
Howard County Health Department (2009). Implementing a Healthy Restaurant Program. Retrieved July 19, 2009 from
Schenker, S. (2009). People Still Confused About Healthy Eating Says Study. Practice Nurse, 3(09), 2-3.
Barton, R.L., Whitehead, K. (2008). Review of Community Based Healthy Eating Interventions. Journal of Human Nutrition & Dietetics, 21(4),
Here are some resources for further information gathering. If you have any questions or comments, I will be available to discuss them at this time. There is also an information sheet to take with you that has the health department contact information if you should have questions later on.

13. References:
Centers for Disease Control and Prevention (2009). Obesity. Retrieved July 18, 2009 from
Cowdrey, L. (2006). Restaurants Must Do More in Fight Against U.S. Obesity. Nation’s Health, 36(6),
Heart and Stroke Foundation (2009). Health Check… Helping You Eat Well. Retrieved August 7, 2009 from
Howard County Health Department (2009). Implementing a Healthy Restaurant Program. Retrieved July 19, 2009 from
Pinellas County Health Department (2009). Healthy Choices Restaurant Program. Retrieved July 19, 2009 from
Rockland County Department of Health (2008). Just Ask Us! Retrieved July 19, 2009 from
U.S. Food and Drug Administration (2007). Today’s Special: Nutritional Information. Retrieved July 19, 2009 from
Thank you for your time and interest.