1. Gabrielle Gambino Cornell Dietetic Internship December 14, 2012

2. The Problem Since 1970, the number of U.S. adults who are overweight or obese has increased 34%. 1 Out-of-home food expenditures have risen 21%. 2 Much of the food offered at restaurants is energy-dense and missing nutrients. 3 1. USDA. Diet Quality & Nutrition. 30 July 2012. 2. USDA. Dietary Assessment of Major Trends in U.S. Food Consumption, 1970-2005. Economic Research Service, Mar. 2008. 3. Bowman SA, et al. J Am Coll Nutr 2004.

3. Research Questions What do restaurant owners consider to be the most important influences on menu modification decisions? What are the perceived benefits of, and barriers to, offering healthier items? What opinions on the values of customers do restaurant owners currently have? What ideas can restaurant owners offer in the effort to improve the dining habits of customers?

4. Theoretical Framework Attitudes/Beliefs Perceived Subjective Norms/Values Perceived Control Behavioral Intention Behavior Glanz, K. U.S. Dept. HHS, Public Health Service, NIH, National Cancer Institute, 2005.

5. Sample (n=9) –Local restaurant owners & chefs in a rural upstate New York county –6 female, 3 male –24-50 years of age –Cuisines: Italian (2), American-style (2), Local Cafés (1), Fine Dining (1), Bakery (1) –Free-Lance Chef (1) In-depth Interviews –Personal values and priorities –Attitudes towards offering healthier items –Perceived norms of consumers and competitors –Perceived control over menu changes –Behavioral intentions to offer healthier items Methods

6. How Restaurant Owners Define “Healthy Eating” Consuming proper amounts of calories and/or fats (2) Anything made from scratch or unprocessed (2) Watching carbohydrate intake (2) Eating lean proteins Consuming whole wheat Getting adequate vegetables

7. Owners’ Values% Menu Items Owner Perceived as “Healthier” Valued Healthy Eating (6)<10-20% Did not Value Healthy Eating (2)50-60% Discordance between Restaurateurs’ Values and Menu Composition “At the end of the day, it’s still a business.” “It is a burger and fries place and that’s what’s been working for us, as far as getting customers in the door. Our customers want what they want. We have no reason to mess with that.”

8. Value-Portion Size “In America, you want to be at all-you-can-eat buffets, 99-cent burgers. Really not the healthiest options..” Mood/Preference “I think people…come in with their minds already made up. It’s hard to sort of change those habits.” Special Occasion Attitude “You’re going out to have something you normally don’t have at home.” Restricted Diets “We’ve seen an increase in people looking for gluten-free items, a small increase in people looking for more vegetarian items.” Perceived Factors Influencing Customer Menu Selection

9. Menu Changes: Participants’ Main Concerns “I think people are geared towards whether it tastes good, looks good, better be hot, and the price better be right. I think all of those things kind of trump the healthy thing.” Personal Attitudes/Beliefs Perceived Control Subjective Norms “When people put in a request [for a menu change], even if it’s just one person, we try to change and adapt.”

10. Adding Healthier Menu Items Barriers Benefits Healthier option demand rise Reputation No real price difference Adds menu diversity No demand Healthier items cost more

11. What ideas can restaurateurs offer in the effort to improve the dining habits of customers? Consumer Tools“I don’t know if [consumers] have the tools to decide healthy options…” Restaurateur Education“We used to sell these muffins. One night we discovered that it has like, 600 calories… We didn’t know. We just sold them...” Incremental Changes“You gotta stick to subtle, gradual, incremental changes…as opposed to just saying, stop everything you’re doing and start over. You’re doing it all wrong.” Maintain Presentation“Some of it has to do with how the waiting [staff] presents it and describes it.”

12. Conclusions Restaurateurs can name more benefits of, as opposed to barriers to, offering healthier items. BUT… Restaurant Owners value SALES over all. Requests are the fundamental sign for demand. No noticeable demand for healthier menu options Perceived subjective norms out-weigh all other factors leading to behavioral intention. Restaurateur Valued Healthy Eating Offered Healthier Options Knowledge Gap?

13. Implications Research –Work to define specific criteria for “healthier options” –Identify most cost-effective way to modify menus Practice –Train restaurateurs to: Consider nutritional content of menu items Assess demand for healthier choices Present healthier options to customers –Educate consumers to: Utilize point-of-purchase tools Advocate for healthier items to be offered Policy –Support or create national dining programs

14. Thank you!