Choose Health! STRATEGIES TO CREATE A MODEL MENU FOR HEALTH
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1 Choose Health! STRATEGIES TO CREATE A MODEL MENU FOR HEALTH Thomas Thaman, CDM, CFPP Director of Food and Nutrition Margie Fougeron, MS, RDN, CD Culinary Nutrition Specialist Who are Our Customers? Patients, Visitors, Employees 1
2 Who are Our Customers? One out of 3 or 34.9% or 78.6 million are obese. OBESITY MEASURED:BMI Obesity criteria: 2
3 Have The Health Needs Of Our Customers Changed? Behavioral Risk Factor Surveillance System Results: Survey started in 1986 Obesity Trends* Among U.S. Adults BRFSS, 1986 No Data <10% 10% 14% (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) 3
4 Obesity Trends* Among U.S. Adults BRFSS, 1991 No Data <10% 10% 14% 15% 19% Obesity Trends* Among U.S. Adults BRFSS, 1996 No Data <10% 10% 14% 15% 19% 4
5 Obesity Trends* Among U.S. Adults BRFSS, 1997 No Data <10% 10% 14% 15% 19% 20% Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data <10% 10% 14% 15% 19% 20% 24% 25% 5
6 Obesity Trends* Among U.S. Adults BRFSS, 2006 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Obesity Trends BRFSS, 2010 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 6
7 Obesity Trends, BRFSS, 2011 Change to include cell phone surveys) Obesity Trends, BRFSS,
8 Obesity Trends, BRFSS, 2013 Obesity Trends BRFSS,
9 Increases the annual medical cost in the US to $147 billion in 2008 dollars Obese patients medical cost are about $1430 higher than normal weight. Impact of Obesity on Healthcare The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars The medical costs for people who are obese were $1,430 higher than those of normal weight stemming from diet-related chronic diseases: hypertension, heart disease, stroke, Type 2 diabetes and some forms of cancer. JAMA Feb. 26, 2014 & CDC 9
10 Heavy Toll of Diet-Related Chronic Diseases in the US CV disease: 81.1 million Americans (37%) have cardiovascular disease Major risk factors include: High levels of blood cholesterol/lipids Type 2 diabetes/metabolic syndrome Hypertension Overweight and obesity Physical inactivity Tobacco use Heavy Toll of Diet-Related Chronic Diseases in the US Diabetes Nearly 24 million people (almost 11%) 20 years and older have diabetes. About 78 million Americans (35%) ages 20 years or older have pre-diabetes Majority of cases are Type 2 diabetes related to lifestyle, diet and physical activity. 10
11 Heavy Toll of Diet-Related Chronic Diseases in the US Hypertension 74.5 million adult Americans (34%) have hypertension Systolic >140 or Diastolic >90 36% of adult Americans have prehypertension Systolic range: systolic or Diastolic range: Heavy Toll of Diet-Related Chronic Diseases Hypertension Dietary factors that increase blood pressure include: excessive sodium Insufficient potassium intake overweight and obesity excess alcohol consumption 11
12 Heavy Toll of Diet-Related Chronic Diseases in the US Cancer Almost one in two men and women (41%) will be diagnosed with cancer during their lifetime. Osteoporosis One out of every two women and one in four men ages 50 years and older will have an osteoporosis-related fracture in their lifetime. Factors Contributing To Obesity 12
13 Factors Contributing To Increase In Obesity 1answer Availability of more foods and foods with higher energy content & Increased portion sizes Growth of fast food industry & number of meals eaten away from home Increased number & marketing of snack foods Increased time for socializing along with a custom of socializing with food and drink Increased calorie intakes: 220/d in men & 110/day in women ( ) Today BAGELS: 20 Years ago vs today 3-inch diameter 140 calories??? calories How many calories do you think are in today's bagel? 1)150 2)250 3)350 13
14 Today's 6-inch bagel has 350 calories! Today's 6-inch bagel has 350 calories. This is 210 more calories than a 3-inch bagel 20 years ago. How long you will have to rake leaves in order to burn those extra calories?* *Based on a 130-pound person. 1) 1 hour and 30 minutes 2) 50 minutes 3) 2 hours The correct answer is 50 minutes. If you rake leaves for 50 minutes you will burn approximately 210 calories.* *Based on a 130-pound person. 14
15 3 Spaghetti and Meatballs 20 Years Ago Today 1 cup spaghetti with sauce and 3 small meatballs: 500 calories??? calories How many calories do you think are in today's portion of spaghetti and meatballs? 1) 1,025 2) 600 3) 800 Today s spaghetti meatballs: 1,025 calories Today s spaghetti meatballs includes 2 cups of pasta with sauce and 3 large meatballs. This is 525 more calories than a portion 20 years ago. Now guess how long you will need to houseclean in order to burn those extra calories?* 1 hour and 25 minutes 2 hours and 35 minutes 2 hours *Based on a 130-pound person. 15
16 The correct answer is 2 hours and 35 minutes. If you houseclean for 2 hours and 35 minutes, you will burn approximately 525 calories.* 2answer *Based on a 130-pound person. CHEESEBURGER & FRIES 20 Years Ago 543 calories Today How many calories do you think are in today's cheeseburger & fries? 1) 890 2) )
17 Today's cheeseburger & fries: 1200 calories This is 657 more calories than a portion 20 years ago. Now guess how long you will have to walk in order to burn those extra calories?* 1) 1 hour 30 minutes 2) 2 hour 10 minutes 3) 45 minutes *Based on a 130-pound person. The correct answer is: 2hours and 10 minutes, If you walk for 2 hour and 10 minutes, you will burn approximately 657 calories.*. *Based on a 130-pound person. 6.5 ounces 85 calories SODA How many calories do you think are in today's 20 oz. portion? 1) 250 2) 300 3)200 17
18 A 20-ounce soda has 250 calories This is 165 more calories than a portion 20 years ago. Now guess how long you will have to work in a garden in order to burn those extra calories?* *Based on a 130-pound person. 1) 1 hour 30 minutes 2) 35 minutes 3) 50 minutes Increase in 2800 calories with only 5 items! Calorie Day One pound weight increase with an extra 3500 calories. 18
19 Small Changes Can Have A Big Impact!! Women: 110 extra calories/day X 30 days/month = 3300 extra calories/month (or about 1 pound weight gain/month) Men: 220 extra calories/day X 30 days/month = 6600 extra calories/month (or about 2 pounds weight gain/month) Calories per pound: 3500 Influences on Eskenazi Health Food & Nutrition Services Nutrition Policy 19
20 Nutrition Best Practices The goals are to: provide best practices for healthier and sustainable foods allow employees to make informed choices about what they are eating through labeling of menu items. Dietary Guidelines for Americans Control total calorie intake to manage body weight For people who are overweight or obese, consume fewer calories from foods and beverages. 20
21 Nutrients to Consider: Fiber Consume at least half of all grains as whole grains. Limit consumption of refined grains, especially those that contain solid fats and increased sugar and sodium. Increase vegetable and fruit intake. Nutrients to Consider: Trans & Saturated Fat Consume <10% calories from saturated fat Limit trans fat to <2 gm/day Increase seafood replacing some meat and poultry Consume a variety of protein foods: lean meats and poultry, eggs, legumes & unsalted nuts and seeds Consume low-fat or fat-free dairy products 21
22 Nutrients to Consider: Sodium Reduce daily sodium to < than 2300 mg/day Further reduce sodium intake to <1500 mg/day for persons: >51 years of age Those of any age who are African American Those of any age who have hypertension, diabetes, or chronic kidney disease Choose Health Initiative Successful Strategies 1.Product 2.Pricing 3.Placement 4.Promotion 22
23 Successful Strategies: Product Provide a menus with a wide range of products meeting nutrition standards to increase choices. Modify ingredients in recipes. Offer healthier portion sizes. Remove fryers and fried foods. Review purchasing policies and contracts. Reduce access to products that don t meet the nutrition standards. Increase access to drinking water. Stealth Strategies 23
24 Increase Availability Of Fresh Fruits And Vegetables Grab & Go Entrée Salads 24
25 Water Stations and Vending Healthier Grab & Go Options 25
26 Successful Strategies: Pricing Reduced price for vegetarian options Lower prices for selections/products that meet the nutrition standards. Offer promotions or discounts on selections/products that meet the nutrition standards. Meatless Monday s Choose Health meals Daily special: < 600 calories <35% calories from total fat <10% calories from saturated fat 0 trans fat < 800 mg sodium <35% calories from sugar 26
27 Successful Strategies: Placement Rearrange beverage and grab and go planograms to give favorable placement to foods that meet the nutrition standards. Healthier Items At Cash Register 27
28 Grab & Go Successful Strategies: Promotion Provide signs, shelf tags, banners, and, posters to draw attention to healthier messages and foods. Provide free sampling to build customer awareness for new products. Audit signage from vendors that do not support healthy messages. 28
29 Signage: Healthier Messages Signage: Healthier Messages 29
30 Traffic Signal Strategy Salad and yogurt bar Green <200 calories, <230 mg sodium, 0 trans fat <10% calories from saturated fat, <35% calories from fat, <35% calories from sugar Yellow Provide health benefits from healthier fats Sodium limit increased to 400 mg Red Foods do not meet green or yellow criteria Salad Bar and Yogurt Bar 30
31 Salad Bar with Red Yellow Green Pans & Nutrition Information Salad Bar Weight Study Results 31
32 Self-op Vending Vending Changes & Messaging Removed candy/gum Removed tea, water or sodas with added sugar Changed to smaller portion size products Purchased red, yellow, green spirals 32
33 Strategies To Create A Model For Health For Our Customers STRATEGIES TO CREATE A MODEL MENU FOR HEALTH Questions/comments? Thomas Thaman, CDM Director of Food and Nutrition Margie Fougeron, MS, RDN, CD Culinary Nutrition Specialist 33
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