1. Implement Policies on Sodium Reduction

2. What is Sodium? NaCl (table salt) Maintain balance of fluids Helps to transmit nerve impulses Aids in contraction and relaxation of muscles

3. Dietary Recommendations Recommended levels of salt intake : Less than 2,300 mg/day Majority of adults’ actual salt intake: More than 3,400 mg/day

4. Where’s the salt? 77 percent of a person’s salt intake comes from restaurant or processed food.

5. High Salt Foods Serving sizeSodium (milligrams) 1 teaspoon of salt2,400 mg instant ramen noodles with flavoring500-1500 mg 2 oz Spam (1/6 can of Spam)790 mg 1 cup of corned beef hash1,230 mg 1 tablespoon of soy sauce1,000 mg 3 links of vienna sausage410 mg ½ cup of canned corn360 mg ¼ of a frozen pepperoni pizza480-860 mg 1 oz bag of regular potato chips (13-16 chips)120-215 mg 1 oz serving of dry roasted, salted peanuts (28-30 peanuts) 230 mg 1 fast food restaurant cheeseburger710-1690 mg ¼ cup of tomato sauce340 mg

6. High Salt Intake’s Effect on Health Heart diseases – High blood pressure / hypertension about 68 million U.S. adults (1 in 3) – Heart Disease – Stroke Only 46 of 100 of adults with hypertension had adequately controlled blood pressure

7. Did you know? High blood pressure is known as the silent killer since usually it does not have warning signs or symptoms.

8. Salt Reduction Benefits on Health Evidence supports a strong, direct relationship between blood pressure and vascular (blood vessels) mortality Average blood pressure was in patients with resistant high blood pressure when switched from a high to low salt diet In most individuals, blood pressure is reduced within days reducing salt intake

9. What should we do? WHO states that population-wide reductions in dietary salt consumption are highly cost effective. There is a need to give priority to implement national strategies and policies aiming at the reduction of dietary salt consumption.

10. Law and Policy Food and Drug Administration – Nutrition labeling Improve effectiveness of the Nutrition Facts Panel through labeling – Menu labeling/Salt Claims Expand regulations under the Nutrition Labeling Education Act of 1990 (NLEA) to cover sodium content claims on menu items – Daily Value Lower salt intake to 2,300mg or less

11. Program Examples USDA School Breakfast Program – National School Breakfast Program guidelines 3 step reduction plan 25%-27% reduction in breakfast meals (2004-2005) 430-500 mg of sodium per meal

12. Culinary Training Camp 29 Greenville County Schools in South Carolina At the training camp, cafeteria workers learn scratch cooking techniques such as roasting, use of herbs and seasonings in place of salt, and knife skills, so they can prepare foods fresh in the cafeteria rather than use highly processed foods. These schools are committed to adopting healthier menus.

13. State and Local Level Menu Labeling Warning Labels Procurement Policies Licensing/Taxing

14. Labeling Menu Labeling – Disclosure of salt content on menus – FDA Waiver Warning Labeling – Under NLEA, state and local authorities can mandate warnings related to safety of food

15. To reduce dietary salt intake Pan American Health Organization & World Health Organization Regional Expert Group suggests: Make salt substitutes (spices and herbs) readily available at affordable prices, such as using basil, garlic and ginger. Institute reformulation schedules for a gradual and sustained reduction in the salt content of all existing salt-containing food products at restaurants and ready-made meals

16. Implement policies that reduce salt consumption An American Samoa Example Target Population: All Department of Health employees Summary: American Samoa Department of Health (DOH) Employee Wellness Policy #13-01  October 2013: DOH implemented a policy for all DOH employees relating to proper nutrition, physical activity and tobacco smoking  Employee Wellness Activities: restricts DOH employees from having incentives, fundraisings and activity vendors advertising and selling unhealthy foods, alcohol, tobacco and gift cards to fast food chains  Increased Access to Healthier Foods: prohibits DOH and its contracted food services from serving unhealthy foods  All DOH internal meetings, conferences, community meetings sponsored and funded by DOH must serve healthy and local options of food and drinks; no red meat, soda products and artificially flavored drinks are to be served

17. Implement policies that reduce salt consumption A Guamanian Example Target Population: All government of Guam employees Summary: PL31-141: Healthy Vending Machine Policy  Guam was awarded with the Communities Putting Prevention to Work Grant to have healthy foods more accessible to the community  PL31-141: mandates all vending machines in government of Guam facilities to be serving at least 50% healthier food options  The Guam Department of Public Health and Social Services (DPHSS) worked with all government agencies, and vending machine operators before the Healthy Vending Machine Policy could be passed  DPHSS took the law a step further by enforcing 100% of all vending machines in all DPHSS facilities to be selling healthy foods and water content only  Guam’s Non-Communicable Diseases (NCD) Consortium is looking towards having the Worksite Wellness Health Coaches in each of the participating government agencies to be the enforcing agency, to ensure vending machine vendors are in compliance to the standards set forth by Healthy Vending Machine Policy

18. Who can I contact for more information? Adrian Bauman Boden Institute of Obesity, Nutrition and Exercise and Prevention Research Collaboration University of Sydney Sydney, Australia Email:  adrian.bauman@sydney.edu.au