1. Centers for Disease Control and Prevention Division of Nutrition, Physical Activity and Obesity The conclusions in this presentation are those of the authors and do not necessarily represent the official position 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: Evidence Base & Public Health Role 1

2. 2 Outline 1. What are food service guidelines? 2. Who is affected by this strategy? 3. Why is this strategy important? 4. How do we know this strategy works? 5. How much difference will this strategy make? 6. What is the public health role? Who are key partners?

3.  Food service guidelines are used to create food environments where healthier choices are made easier for consumers. These guidelines are used to increase the availability of healthier food and beverages, and to display them more prominently, so that healthier options are more easily available for customers.  Food service guidelines are best as part of a comprehensive strategy to promote health and wellness. 1. Keener, Goodman, Lowry, Zaro, & Kettel Khan, 2009 2. National Research Council, 2010 What are Food Service Guidelines? The Center for Disease Control and Prevention (CDC) and The Institute of Medicine (IOM) have identified the adoption of healthy purchasing standards as an important component of strategies to improve diet-related public health outcomes 1,2 3

4. HHS/GSA Food Service Guidelines http://www.cdc.gov/chronicdisease/resources/guidelines/food-service-guidelines.htm 4 Translate evidence-based recommendations into food service practices  Align food choices with the Dietary Guidelines for Americans, 2010  Based on FDA labeling standards  Executive Order 13423 and 13514: Strengthening federal leadership in environmental, energy, transportation management and economic performance  USDA sustainable agriculture practices

5.  Standard Criteria  Nutrition menu and calorie labeling  Nutrient requirements: Trans fat and sodium  Healthier foods  Healthier beverages  Other considerations – behavioral design  Sustainability practices HHS/GSA Guidelines 5

6. Who is affected by this strategy? Worksites Federal, state, and local government facilities Hospitals For-profit and nonprofit organizations Community Settings Government facilities/public institutions Parks and recreational facilities Transportation welcome centers and rest areas Colleges and universities Senior centers or out of school time centers such as YMCA’s Venues Settings Cafeterias Snack Bars Vending Lunch Rooms Meetings Conferences 6

7.  The workplace provides an opportunity to encourage and enable healthier behaviors, thus preventing chronic diseases in a large segment of the population.  More than 65 million Americans work at places with food service 1,2  In 2012, federal, state and local governments employed 22 million people 3  Approximately half of the American workforce purchases lunch at least twice a week, and a quarter of the employees usually visits workplace cafeterias and sandwich shops 4  Consumption of healthier foods at the workplace can be encouraged by Food Service Guidelines that:  Increase the ease of access to healthier foods  Provide nutritional information and healthier product labeling  Reduce the price of healthier foods  Establish policies that guide foods served at meetings and conferences 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 3. http://www2.census.gov/govs/apes/2012_summary_report.pdf 4. Blanck, H.M., et al., Factors influencing lunchtime food choices among working Americans. Health Education & Behavior, 2007. 36: p. 289-301. Why is this strategy important? 7

8.  Evidence that healthier food means a healthier population  There is a growing body of evidence linking better access to healthy food with higher consumption of those foods and access to unhealthy food as a predictor of poor diet 1  Extrapolating from this evidence, food service guidelines requiring the availability of healthier options may improve population health.  Food Service Guidelines include evidence- based strategies 2  Changing Access and Availability to Favor Healthy Foods and Beverages  Point-of-Purchase and Point-of-Decision Making to Favor Healthy Foods and Beverages  Food and Beverage Marketing to Favor Healthy Foods and Beverages How do we know this strategy works? 1. Briefel, Crepinsek, Cabili, Wilson, & Gleason, 2009; Fox, Dodd, Wilson, & Gleason, 2009; Story, Kaphingst, Robinson-O’Brien, & Glanz, 2008 2. Center for Training and Research Translation (Center TRT). The evidence for strategies can be downloaded at www.centertrt.orgwww.centertrt.org 8

9.  Healthier Snack Vending: Chicago Park District 1 evaluated the implementation of a 100% healthier snack vending initiative. Results showed consumer acceptance and increased vending revenues.  Healthy Food Procurement in the County of Los Angeles is a practice-tested institutional policy 2 developed to include nutrition standards and food service requirements into their Requests for Proposals.  Healthy Vending Iowa is a practice-tested environmental change intervention 2 designed to evaluate and improve the worksite vending machine environment. The intervention’s focus is on modifying the food environment to increase access, availability, and purchase of healthy food and beverages from vending machines.  Health Food Environments Pricing Incentives is a practice-tested policy intervention 2 developed by North Carolina Prevention Partners to increase availability, visibility, and affordability of healthy foods and beverages for employees, volunteers, and visitors on hospital campuses. Evidence of Food Service Guidelines from the Field 1. Mason M, et al. Working with community partners to implement and evaluate the Chicago Park District’s 100% Healthier Snack Vending Initiative. Prev Chronic Dis 2014;11:140141. http://www.cdc.gov/pcd/issues/2014/14_0141.htmhttp://www.cdc.gov/pcd/issues/2014/14_0141.htm 2. Center for Training and Research Translation (Center TRT). The Center TRT evaluates and disseminates promising interventions. The interventions above can be downloaded at www.centertrt.orgwww.centertrt.org 9

10. 10 How much difference will this strategy make? Benefits of Food Service Guidelines…  Contribute to health and wellness of consumers  Set a positive example for employees, stakeholders, community members, or other employers  Increase food service demand for healthier foods, increasing production and potentially overall availability of healthier foods  Strengthen local food systems  Build awareness and support among decision makers, budget managers, and purchasing staff for healthier food and beverage options

11. 11 What is the public health role?  Assist in placing food service guidelines into all new state/local government food service contracts  State program/partners disseminate training and resource materials and use social media to promote their use  State program/partners conduct train-the-trainer activities to implement food service guidelines in targeted sites  Establish/access food buying cooperatives so targeted sites can economically purchase food items meeting the food service guidelines standards  State program/partners develop and disseminate a sustainable social marketing communication campaign to effectively promote healthy food choices

12. 12 Who are key partners?  For state agencies: State department of administration/finance, State Licensing Agency representative who directs the Business Enterprise Program (Randolph Sheppard Act), worksite health and wellness committees  For non-government worksites: State Chamber of Commerce, Society for Human Resource Management state councils, large worksite health insurers  For communities: State agencies that administer state park food service and highway rest stop concessions; National Recreation and Park Association state affiliate (regarding park food service)  For hospitals: State hospital associations and Partnership for Healthier America’s Healthy Hospital Initiative  For food supply chains to provide healthy, affordable foods: Local food hubs, large food service companies servicing worksites, hospitals, and communities