Nutrition Guidelines for Foods and Beverages in AHS Facilities

Nutrition Guidelines for Foods and Beverages in AHS Facilities Table of Contents What are the Nutrition Guidelines?... 2 A. Food Guidelines... 7 A.1 Entrees: Foods with 501-700 calories... 8 A.2 Lighter Fare: Foods with 301-500 calories*... 8 A.3 Single items, Sides, Snacks*: Foods with 300 calories... 8 A.4 Baked Goods* with < 300 calories... 9 A.5 Soups* < 300 calories... 9 B. Beverage Guidelines... 10 B.1 Vegetables and Fruit Based Beverages*... 11 B.2 Milk and Alternatives Based Beverages*... 12 B.3 Other Beverages... 12 References... 13 Updated June 13, 2018 1

Nutrition Guidelines What are the Nutrition Guidelines? The Nutrition Guidelines (herein referred to as the Guidelines) apply to foods and beverages provided by retail food service operators and third party retailers (including franchises, third party operators and retail outlets) and vending. They were developed to inform decision making about healthy food and beverage choices for sale to customers (staff, patients and the public) in AHS food outlets and contracted outlets (including cafeterias and coffee shops). The Alberta Nutrition Guidelines will continue to apply to other operations such gift shops. A healthy diet emphasizes healthy food choices, variety and portion sizes consistent with Eating Well with Canada s Food Guide. Specific nutrients addressed within the Guidelines include calories, fat, sugar, sodium, and protein. Operators are required to comply with the AHS Trans Fats policy: https://extranet.ahsnet.ca/teams/policydocuments/1/clp-ahs-pol-trans-fats.pdf. Principles of the Guidelines Retail food services operators should follow the principles of the Guidelines for all foods and beverages offered, including: 1. A variety of healthy food and beverage choices are available at all times and at all venues while less healthy options are limited. 2. Portion sizes of foods and beverages are appropriate and align with Canada s Food Guide (CFG) www.healthcanada.gc.ca/foodguide. 3. Healthy ways of cooking are used such as grilling, baking, broiling, poaching or steaming. Deep-fried items are not offered. 4. Recipes are made with ingredients that are low in saturated fat, trans fat, sodium and sugar. 5. Healthy items are competitively priced and placed in a way that they are more likely to be purchased (e.g., in prominent location, at consumer eye level). 2

What products meet the Guidelines? Operators are encouraged to offer items that align with Canada s Food Guide as much as possible. Healthy food is defined as food and beverages listed in Canada s Food Guide, which emphasizes vegetables, fruits, whole grains, legumes, nuts, seeds, dairy, meats, fish, and poultry. These foods are prepared and served in a way that supports provincial and national recommendations for sugar, sodium and fats. Products get a rating based on their nutrient content: Sell More meet guidelines; healthiest choices Sell Less does not meet guidelines but can be offered for sale Do Not Sell food and drinks that should not be offered for sale in AHS facilities Some unhealthy items may technically meet the Sell More criteria, however if they do not align with Canada s Food Guide they are always rated Sell Less choices, unless they are on the Do Not Sell list. If this is the case, they should not be offered in AHS. Examples of items not aligning with Canada s Food Guide include bacon, candy, condiments, dressings, ice cream, instant noodles. What is required of operators? Within AHS, operators are expected to provide foods and drinks that all follow the principles of the Guidelines (page 2). In outlets, the requirement for total food and total beverages is: minimum of 30% Sell More maximum of 70% Sell Less 0% of Do Not Sell In vending, the requirement for total food and total beverages is: minimum of 50% Sell More + Sell Less maximum of 50% Do Not Sell (working towards 0%) All operators are encouraged to continuously improve menu items to increase the number of Sell More choices over time and as products become available. What can outlet operators sell? At least 30% Sell More choices Less than 70% Sell Less choices No (0%) Do Not Sell items Sell Less choices are encouraged to be sold in smaller portion sizes where possible. In outlets, they should be less than 70% of choices offered and excludes Do Not Sell items (page 6). 3

How do I use the guidelines? 1. Determine what category an item is in. Food Categories A.1 Entrees: Foods with 501-700 calories A.2 Lighter fare: Foods with 301-500 calories A.3 Single items, sides, snacks: Foods with <300 calories A.4 Baked goods with <300 calories A.5 Soups with <300 calories Beverage Categories B.1 Vegetables and Fruit Based Beverages B.2 Milk and Alternatives Based Beverages B.3 Other Beverages 2. Compare the item s nutrient content to the nutrient criteria and cap. Food Criteria Cap Definition levels of specific nutrients that will help customers meet their recommended daily intake highest allowable level for fat, saturated fat, trans fat, sodium and sugar; lowest allowable level for protein and fibre Sell More food choices All food items: at least 4 out of 5 nutrients must meet the criteria with the following additional requirements: Items with bread or cereal products: Fibre criterion is required. In other words, at least 5 out of 6 nutrients must meet the criteria. Baked goods: Fibre criterion is required (at least 4 out of 5 nutrients plus the fibre criterion). Soup: at least 3 out of 4 nutrients must meet the criteria. An item can have one nutrient not meeting the criteria but it must be within the cap 4

Beverages Definition Criteria levels of specific nutrients that will help customers meet their recommended daily intake and reduce risk of chronic diseases Sell More beverage choices Beverages must meet all criteria to be classified as a Sell More item Why are there criteria and caps included in the Guidelines? The cap helps to ensure that items have a reasonable nutrient profile. Allowing one nutrient to be higher than the criteria (but within the cap) allows otherwise healthy items that would not meet the guidelines, such as whole wheat bread that may exceed sodium criteria, or a meat entrée that exceeds fat criteria, to be a Sell More choice. Operators are encouraged to sell more foods that are within the nutrient caps. 3. If the product does not meet criteria, check to make sure it is not on the Do Not Sell list below. If it is not on the Do Not Sell list, then it is a Sell Less choice. 5

Food Do Not Sell Products NOT to be sold or offered for sale in AHS food outlets: Compliance with this Do Not Sell list provides customers a consistent healthy eating message while in the AHS facility. Deep-fried items (e.g., fries, chicken fingers, regular chips) Large portions, as follows: o Baked goods and bread greater than 3 CFG servings Examples: muffins >105g, bagels >135g o Cooked grain products greater than 4 CFG servings Examples: rice, quinoa, pasta >2 cups (500 ml) o Entrées/mixed dishes greater than 800 calories Candy, sweet foods which are predominately sugar and can be hard or soft, chocolate bars and chocolate coated items. Examples include gummies, licorice, jelly beans, gum, hard candies, and caramels Beverages (more information in the beverage guidelines section): Vegetables and Fruit beverages >500 ml or >50 g of sugar, 700 mg of sodium or 330 mg of caffeine Milk and Alternatives beverages >591 ml or >48 g of sugar or 12 g of fat Other beverages such as pop, iced tea, and fruit drinks >591 ml or with >40 g of sugar, 350 mg of sodium or 330 mg of caffeine Vitamin enhanced water Energy drinks Other Products with added herbs and powders with specific quantities of botanical ingredients listed on the labels (e.g., 50 mg ginseng per serving ) Products with health claims on the label which are not approved by Health Canada (e.g., promotes weight loss ) 6

A.Food Guidelines There are five food categories in the Guidelines: A.1 Entrees: Foods with 501-700 calories A.2 Lighter fare: Foods with 301-500 calories A.3 Single items, sides, snacks: Foods with <300 calories A.4 Baked goods with <300 calories A.5 Soups with <300 calories Whole grains are encouraged in items that contain grains, such as whole wheat pizza crust, whole grain bread sandwiches, whole grain pasta or brown rice. Whole wheat is acceptable. At least 30% of choices must meet these Guidelines (For vending requirements, refer to page 3 What is a bread or cereal? Bread = bread, wraps, pitas, buns, naan, roti, pizza crust Cereal = hot or cold cereal How do foods meet the guidelines? To be a Sell More choice, items must meet minimum criteria (see table below) and all nutrients must be equal to or less than the cap for calories, fat, saturated fat, trans fat, sodium and sugar; above the cap for protein. Category A.1 A.2 A.3 Sell More minimum criteria to meet 4 out of 5 Note: Items with bread or cereal products must include the fibre criterion; in other words, 5 out of 6 nutrients must meet the criteria. A.4 4 out of 5 and the fibre criterion Sell More food items Meets all criteria Or, one criterion does not meet but is within cap Sell Less food items Does not meet Sell More rating but not on the Do Not Sell list Do Not Sell food items Item is on Do Not Sell list A.5 3 out of 4 What about half portions? If a full-size item meets the Guidelines, a smaller portion of the same item will automatically meet the Guidelines. For example: a half portion of a sandwich that meets the Sell More is also considered to be Sell More. 7

A.1 Entrees: Foods with 501-700 calories Examples: rice bowl, burger, pizza, pasta, wrap Nutrient Criteria Cap Fat 20 g 25 g Saturated Fat 6 g 8 g Trans Fat 1.0 g 1.2 g Sodium 700 mg 900 mg Protein 15 g 11 g Fibre (items with breads/cereals) >2 g 0 g Nutrition Guidelines for Foods and Beverages in AHS Facilities A.2 Lighter Fare: Foods with 301-500 calories* Dressings are to be served on the side and are not included in the analysis of entrée salads. Examples: Sandwich, salad, sushi Nutrient Criteria Cap 14 g 19 g Fat (items with fat mostly from salmon/ nuts/ seeds/ avocado exempt) Saturated Fat 4 g 8 g Trans Fat 0.7 g 0.9 g Sodium 700 mg 900 mg Protein 12 g 7 g Fibre (items with breads/cereals) >2 g 0 g A.3 Single items, Sides, Snacks*: Foods with 300 calories *Sandwiches with less than 300 calories are analyzed as A.2 Lighter Fare so that protein is considered. Examples: Salmon filet, fruit cup, vegetables and dip, yogurt, side dish, cheese portion, hot or cold cereal, fruit & nut bar (first ingredient is fruit, nuts or seeds), mixed nuts. Nutrient Criteria Cap 7 g 10 g Fat (items with fat mostly from salmon/ nuts/ seeds/ avocado exempt) Saturated Fat 3 g 4 g Trans Fat 0.3 g 0.5 g 15 g 20 g Sugar (items with unsweetened fruit as first ingredient exempt) Sodium 300 mg 500 mg Fibre (items with breads/cereals) >2 g 0 g A.1, A.2, A.3 food items must meet at least 4 out of 5 nutrients. Items with a bread or cereal product, must include the fibre criterion; in other words, at least 5 out of 6 nutrients must meet the criteria. 8

A.4 Baked Goods* with < 300 calories *Baked goods are analyzed on a 35 g amount or a Canada s Food Guide serving and can be sold in a larger portion up to a maximum of 300 calories or 105 g. Items larger than these amounts do not meet the guidelines. Examples: Muffin, loaf, cookie, pastry, cinnamon bun, granola bar (first ingredient is grain) Per 35 g Nutrient Criteria Cap Fat 5 g 10 g Saturated Fat 2 g 4 g Trans Fat 0.25 g < 0.5 g Sugar 12 g 16 g Sodium 200 mg 300 mg Fibre >2 g >2 g A.4 baked goods must meet at least 4 of 5 nutrients criteria and the fibre criterion A.5 Soups* < 300 calories *Soup will be analyzed based on a 250 ml Canada s Food Guide serving and can be sold in a larger portion up to a maximum of 300 calories. Soups with greater than this amount do not meet the guidelines Examples: chicken noodle, vegetable soup, chowder, stew Per 250 ml Nutrient Criteria Cap Fat 7 g 10 g Saturated Fat 2 g 4 g Trans Fat 0.3 g 0.5 g Sodium 400 mg 700 mg A.5 soups must meet at least 3 out of 4 criteria 9

B. Beverage Guidelines There are 3 beverage categories in the Nutrition Guidelines: Vegetable and Fruit Based Beverages Milk and Milk Alternative Based Beverages Other Beverages A beverage must meet all the criteria to be a Sell More choice. Sell More beverage Sell Less beverage Do Not Sell beverage Meets all criteria One or more criteria are not met Item is on Do Not Sell list Within AHS, retail food service operators and third party retailers (including franchises, third party operators and retail outlets) are expected to provide beverage choices that meet the Guidelines. What can outlet operators sell? At least 30% Sell More choices Less than 70% Sell Less choices No (0%) Do Not Sell items As a starting point, the requirement is for total beverages is: Outlets: at least 30% Sell More choices; the remaining 70% (or less) can be from the Sell Less. Beverages that are in the Do Not Sell list are not to be sold by AHS retailers. Note: In vending, the requirement for total food and total beverages is: minimum of 50% Sell More + Sell Less items and maximum of 50% Do Not Sell items (working towards 0%) All operators are encouraged to continuously improve menu items to meet the nutrient guidelines as much as possible and strive for higher proportions of Sell More choices. 10

Portion sizes Portion sizes are included in the criteria. In general, operators are encouraged to sell beverages in 355 ml portions (or smaller) and in bottles with screw top caps where possible. Plain water can be offered in any size (plain or carbonated with no added sweetener or sugar substitute). 355 ml 500 ml Any size B.1, B.2, B.3 beverages must meet all the criteria to be classified as Sell More (green shading) Refer to Do Not Sell list (page 5) for items that cannot be sold. B.1 Vegetables and Fruit Based Beverages* *Beverages with fruit or vegetable as the first ingredient other than water. Examples: 100% vegetable or fruit juice or smoothies, coconut water, fruit and vegetable juice blends, fruit cocktails Sell More Sell Less Do Not Sell Serving Size 355 ml 500 ml > 500 ml Total Sugar No Added Sugars 50 g > 50 g Sodium 200 mg 700 mg >700 mg Sugar Substitutes May Contain Sugar Substitutes Not Applicable Caffeine 330 mg > 330 mg Additional Ingredients No cautionary statements 1. No specific quantity of botanical ingredients 2 listed on the label Food label has a cautionary statement or a specific quantity of botanical ingredients listed on the label 11

B.2 Milk and Alternatives Based Beverages* *Beverages with milk or milk alternative as the first ingredient. Nutrition Guidelines for Foods and Beverages in AHS Facilities Examples: plain and flavoured milk, soy beverage, almond or nut beverage, rice beverage, yogurt drinks, specialty coffees, fruit smoothie (made with milk, yogurt and fruit) Sell More Sell Less Do Not Sell Serving Size 355 ml < 591 ml > 591 ml Fat < 7.5 g 12 g > 12 g Total Sugar 36 g 48 g > 48 g Calcium 30% Daily Value (DV) per 250 ml Not Applicable Vitamin D 44% Daily Value (DV) per 250 ml Not Applicable Sugar Substitutes May Contain Sugar Substitutes Not Applicable Caffeine 330 mg > 330 mg Additional Ingredients No cautionary statements 1. No specific quantity of botanical ingredients 2 listed on the label 1 Example of cautionary statement do not consume more than 2 bottles per day 2 Example of specific quantity 50 mg ginseng per serving B.3 Other Beverages Use this category for all beverages that do not fit in the other two categories. Plain water (still or carbonated with no added sweetener or sugar substitute) can be served in any size. Food label has a cautionary statement or a specific quantity of botanical ingredients listed on the label Sell More Sell Less Do Not Sell Serving Size 355 ml 591 ml > 591 ml Fat 12 g >12 g Total Sugar No Added Sugars 40 g > 40 g Sodium 150 mg 350 mg > 350 mg Sugar Substitutes May Contain Sugar Substitutes Caffeine 330 mg > 330 mg Additional Ingredients No cautionary statements 1. No specific quantity of botanical ingredients 2 listed on the label 1 Example of cautionary statement do not consume more than 2 bottles per day 2 Example of specific quantity 50 mg ginseng per serving In order to be a Sell More choice, a beverage must meet all the Sell More criteria. Food label has a cautionary statement or a specific quantity of botanical ingredients listed on the label 12

References Alberta Government. Alberta Nutrition Guidelines for Adults [Internet]. 2012 [cited 2015 Jun 1]. Available from: https://open.alberta.ca/publications/alberta-nutrition-guidelines-for-adults Alberta Health Services. Healthy Eating Environment Policy [Internet]. [cited 2015 June 1]. Available from: https://extranet.ahsnet.ca/teams/policydocuments/1/clp-ahs-pol-healthy-eating.pdf Alberta Health Services. Healthy Eating Starts Here [Internet]. [cited 2015 June 1]. Available from: http://www.albertahealthservices.ca/nutrition/page12600.aspx Alberta Health Services. Trans Fat Policy [Internet]. [cited 2015 June 1]. Available from: https://extranet.ahsnet.ca/teams/policydocuments/1/clp-ahs-pol-trans-fats.pdf British Columbia Ministry of Health. Guidelines for Food & Beverage Sales in BC Schools. [Internet]. [cited 2015 June 1]. Available from: http://www.healthlinkbc.ca/healthyeating/everyone/schools-communities.html Dietary References Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2002/2005) [Internet]. [cited 2015 Jun 1]. Available from: https://www.nap.edu/catalog/10490/dietary-reference-intakes-for-energy-carbohydrate-fiber-fatfatty-acids-cholesterol-protein-and-amino-acids Federal, Provincial, Territorial group on Nutrition Working Group on Improving the Consistency of School Food and beverage Criteria (working Group). Provincial and Territorial Guidance Document for the development of Nutrient Criteria for Foods and Beverages in Schools 2013. 2013 p.6. Government of Canada HCHP and FB. Eating Well with Canada s Food Guide Main Page Health Canada [Internet]. 2007 [cited 2015 Jun 1]. Available from: http://www.canada.ca/foodguide 13