1. Elevate Your Nutrition Environment Through Standards and Policy
Patrice Isabella, MS, RD, CD
Healthy Living Through Environment, Policy, and Improved Clinical Care

2. Overview
Making the case for healthy food
Assessing your worksite nutrition environment
Nutrition standards and Dietary Guidelines for Americans
Healthy meetings, vending, concessions
Tools and Resources

3. Making the case for healthy food policies
Increase, rather than decrease choice
Healthy foods are the fastest growing segment of the food industry
Healthier employees are sick less often and have lower health insurance costs
Provide healthy choices for our customers

4. Unhealthy food is costly!
“About half of all American adults—117 million individuals—have one or more preventable chronic diseases, many of which are related to poor eating and physical activity patterns.”
Estimated cost of diagnosed diabetes: $245 billion
$176 B direct medical costs
$69 B decreased productivity

5. What’s in your nutrition environment?
Physical Environment
Healthy choices available for purchase
Signage/promotion, placement, pricing encourage healthy choices
Healthy choices at meetings
Refrigerators and microwaves in breakrooms
Water stations
No advertising/promotion/donations of unhealthy foods
Lactation room on-site

6. TCHD Wellness Committee implemented healthy snack stations for employees. They purchase fresh fruits and vegetables from a distributor. Administration agreed to stock the station for a one-month trial period, and the demand was high. They found that ready to eat items move fastest. Employees now pay $5 per month on an honor system to access the healthy snacks. IN addition to this refrigeration unit, they have a 3-tier basket with packaged dry snacks.

7. Access to Water Water Fountains Outdated, not filtered, not used
Difficult to fill water bottles
Bottled Water Service
Expensive
Not sanitary
Waste and electricity costs
Eye sore; takes up space
Heavy bottles to lift (safety issue)

8. Cost Alternative Bottle Filling Stations
Station $1, Install $ Total = $1, vs. Bottle Service $2,820/year Break Even – 7 months Annual filter cost $189

9. What’s in your nutrition environment?
Educational Environment
Employee communications, print media, posters, newsletters, brochures support healthy eating and PA
Information about low-fat cooking, nutrition, weight management
Incentives for employees to participate in educational opportunities
Opportunities for family members

11. What’s in your nutrition environment?
Social Environment
Social events focus on healthy food and physical activity
“Doughnut” culture
Culture of respect for rights of breastfeeding mothers
Walking groups, weight loss support groups
Bear Rifer Health Department Nutrition Guidelines: do not apply to staff potlucks, as they are not department sponsored. However, employees are encouraged to bring nutritious options in addition to the other choices available. Employees also are reminded to maintain a professional presentation of our services by keeping food and snacks out of the direct view of the public.

12. Assessing Your Nutrition Environment
CDC Worksite Scorecard
UDOH/EPICC worksite assessment scorecard
Nutrition Environment Assessment Tool (NEAT)

13. Healthy Utah Assessment Survey, 2015
>50% healthier food/beverage choices for purchase
19%
Signage to identify healthier food/beverage choices or vending machines
14%
Healthy food options offered at company meetings/functions
42%
Onsite cafeteria offers healthy food options
43%
Onsite or nearby farmers market with fruit fruit/vegetables
40%
Written policy or formal communication to make healthier food and beverages available (cafeteria/vending/snack bar)
18%
Written policy or formal communications for healthier food/beverage choices during meetings
13%
Dustin completed survey of PEHP worksites in Utah in 2015, 62 responded to the survey. Here are the results.
All of Utah’s Local Health Departments have been working to implement policies or guidelines in their HDs over the past couple of years. Weber-Morgan implemented a policy to ensure that half of all beverage choices in vending machines (other than 100% juice and unflavored milk) contain less than 40 calories per serving. BRHD does not have food for sale in the premises, so they developed a procurement policy for foods provided at meetings and conferences.
The LHDs would welcome the opportunity to work with businesses in their area to provide assistance toward developing and implementing healthy food and beverage policies.,

14. Apply Nutrition Standards Consistent with DGA
Evidence-based recommendations for a healthy and adequate diet
Focus on disease prevention
Inform Federal food nutrition, and health policies and programs
The Dietary Guidelines for Americans are updated every five years by the Departments of Health and Human Services and Agriculture. They provide evidence-based recommendations…

15. Overarching Guidelines, 2015 DGA
Follow a healthy eating pattern across the lifespan.
Focus on variety, nutrient density, and amount.
Limit calories from added sugars and saturated fats and reduce sodium intake.
Shift to healthier food and beverage choices.
Support healthy eating patterns for all.
The Dietary Guidelines for Americans provides five overarching Guidelines that encourage healthy eating patterns, recognize that individuals will need to make shifts in their food and beverage choices to achieve a healthy pattern, and acknowledge that all segments of our society have a role to play in supporting healthy choices.

16. A healthy eating pattern includes…
A variety of vegetables, all types and colors
Fruits, especially whole fruits
Grains, at least half whole grains
Fat-free or low-fat dairy
Includes fortified soy
Decrease proportion from cheese
A variety of proteins, including vegetable sources
Oils
Nutrition Standards should be based on the Dietary Guidelines for Americans. The DGA are established by a joint expert committee of the Departments of Agriculture and Health and Human Services, based on extensive scientific evidence review. They are updated every 5 years, so the 2015 committee is working on the 2015 guidelines.

17. A healthy eating pattern limits…
Saturated and trans fats (<10% calories)
Added sugars (<10% calories)
Sodium (<2300 mg)
Recommend replacing saturated fats with unsaturated fats and oils rather than carbohydrates

18. CDC Guidelines
The Centers for Disease Control and Prevention, which provides funding for our program, has published Health and Sustainability Guidelines for Federal concessions and Vending Operations. These include nutrition standards consistent with the 2010 DGA. The standards cover meal components, snacks, and beverages, and include food-based (e.g., fruits, non-fried vegetables, whole grains, water) and nutrient-based standards. Nutrient standards are set for calories, trans- and saturated fat, sugar, and sodium. The CDC website includes an excellent resource page for food service guidelines, which you can link to from our EPICC website.

19. AHA Toolkit
The American Heart Association has an excellent toolkit that can guide you through the stages of developing and implementing worksite food and nutrition policies based on evidence-based nutrition standards.

20. Healthy Meetings
You can also find a wealth of resources on the EPICC website supporting healthy meetings. These are just a couple of examples. The American Cancer Society’s Meeting Well toolkit is quite good.,

21. UDOH Healthy Food Policy
“As the lead health authority for the state, UDOH will model the Governor’s Work Well Recommendations by offering healthy menu choices at each work meeting, conference, and training where food is purchased and served.”

22. UDOH Policy: General Guidelines
1. Offer healthy food choices at UDOH functions as per this policy, which includes
meetings, conferences, and receptions.
Workplaces can promote healthier food choices by offering:
a. Fruits and vegetables
b. Fat-free or low-fat milk and milk products
c. Whole grains in place of refined grains
d. Foods low in saturated and trans fat
e. Foods low in sodium and added sugars
f. Appropriate portion sizes
g. Whole foods, rather than processed foods
h. Water
2. Consider not offering food at mid-morning or mid-afternoon meetings,
presentation and seminars.
Consider offering only beverages.
If you choose to serve food at mid-morning and mid-afternoon breaks, offer fruits, vegetables and/or other healthy foods. Avoid offering high calorie and nutrient poor foods (e.g. pastries, cookies, doughnuts etc.).
For examples of healthy choices and appropriate portions sizes, refer to Healthy Suggestions for Meals, Snacks and Beverages and Comparisons of Food and Beverage Options on pages 3-7.
The policy also requires that special dietary needs are addresses and meals always include a vegetarian option.

23. UDOH Policy - Lessons Learned
Use food-based, rather than nutrient-based standards
Get upper management on board (this may require repeated attempts)
Provide training and resources to all managers
Find a caterer who will work with you
Buy-in can be a challenge, especially desserts!

24. CDC Vending Standards <200 kcal per serving
Trans fats – 0 gm/serving
Sodium - <230 mg sodium per serving for snacks and <480 mg for meal items
At least 25% of packaged food choices must meet criteria for
Calories: <200 per item (excluding nuts and seeds)
Saturated fat: <10% calories
Sugars: <35% of total weight (excluding fruits without added caloric sweeteners)
Beverages: at least 50% of choices
<40 calories/serving
Milk: 2%, 1%, non-fat
Juice: at least one 100% juice
Vegetable juice <230 mg/serving
The CDC standards for vending machines address certain nutrients, including calories, trans and saturated fat, sugar, and sodium.

25. NEMS-V Nutrition Environment Measures Survey-Vending
Tools to assess vending machines
Based on GSA/DHHS Health and Sustainability Guidelines
Healthy Choices calculator to determine red/yellow/green coding of items
On-line and phone app
Promotional materials including sample awards for worksites, employee communications
The NEMS-V is a good resource to assess your vending machines. It includes a healthy choices calculator to determine whether an item meets the CDC nutrient standards. The website also includes a variety of tools , including promotional materials for white- and blue collar worksites.

27. Key steps for working with blind vendors
Assess the food environment
Engage the SLA and blind vendors early in the process
Make the case that healthy sells
Jointly agree to healthier food, snack and beverage guidelines
Offer training and technical assistance
Help with marketing healthy choices – taste tests, newsletter articles, etc
Collaboration is the key
Compliance may be challenging

28. Utah Department of Health
Assessment
Wellness Council employee survey
58% wanted healthier choices
NEMS-V assessment
One yellow, no green items in vending machine
Convene meeting of partners
UDOH executive management, EPICC staff, BEP management
EPICC provided a list of recommended items that meet green/yellow criteria (requested 25% of slots)
BEP brought in a second vending machine with healthier choices, provided product during initial stage, working with vendor to track sales
Compliance still a challenge!
Wellness Council promotion through fliers, signage, newsletter

29. UDOH Cafeteria

30. Resources: EPICC Program webpage
We want to hear from you!
Resources: EPICC Program webpage
Contact us!