1. 1 Keystone Forum on Away-from-Home Foods: Opportunities for Preventing Weight Gain and Obesity

2. 2 The Keystone Forum Purpose: Proposing strategies to support consumers’ ability to manage calorie intake when selecting and eating away-from-home foods. Scope: Restaurant foods (eat-in and take-away), prepared food counters in grocery stores, institutional foodservice venues such as employee work-site cafeterias. (The Forum did not address the federally-funded school meals program.) Origin: Requested by FDA as part of the follow-up to its 2004 Counting Calories report.

3. 3 The Forum’s Rationale Away-from-home foods are an important and growing source of calories in the diets of many Americans. Managing calorie intake, wherever the source, is an essential part of weight management and obesity prevention. More of Americans’ total food budget is used for away-from-home foods (from 26% in 1970 to 46% in 2002). [1][1] The total number of foodservice establishments in the United States has almost doubled in the last three decades (from 491,000 in 1972 to 878,000 in 2004).[2][2] Sources:  [1] From B. Lin, et al. Away-From-Home Foods Increasingly Important to Quality of American Diet, Agriculture Information Bulletin #749 (Washington, DC: ERS, 1999); and the National Restaurant Association, “Restaurant Industry Facts,” www.restaurant.org/research/ind_glance.cfm, accessed April 12, 2002. [1]  [2] From the National Restaurant Association. [2]

4. 4 Who was involved? Participants: Forty-four individuals from industry, government, academia, public health organizations, consumer organizations, and others Planning group: Diverse subset of participant group that refined scope and objectives, and helped to develop protocols and agendas FDA’s role: Providing funding and the initial scope Keystone’s role: Serving as independent convener and facilitator

5. 5 The Forum’s activities Format: Three 2-day plenary meetings, several concurrent work groups. Participants engaged in joint fact-finding and dialogue, with support from facilitators. Output: Final report presenting findings, recommendations, and suggested implementation steps.  Publicly released on June 2, 2006  Presents consensus where possible, and a range of viewpoints where necessary  Lists “supporting participants” (who chose to advance the report as a whole document, while potentially feeling more positively about some aspects than others)

6. 6 Relationship of away-from-home foods to obesity incidence? The Forum did not seek resolution on the question of whether an association exists, focusing instead on promising prevention strategies. The report does contain a review of studies that examine this question. Participants noted that the problem of overweight and obesity has no single cause and is the result of multiple factors acting together over time.

7. 7 Some of the Forum’s considerations in developing recommendations Individual choice should be respected Broad changes need to address both supply and demand Decision-makers should be cognizant of potential unintended consequences The need for additional research should not preclude reasonable action—the evidence base may never be perfect, and the problem of obesity is immediate

8. 8 Three groups of recommendations… Understanding consumer behavior and attitudes Increasing the availability of lower-calorie products, menu items, and meals Providing consumers with nutrition information

9. 9 Consumer behavior and attitudes— marketing and education Shift the emphasis of marketing. The marketing of lower-calorie and less-calorie-dense foods should increase, accompanied by a reduction in marketing that highlights higher-calorie (or calorie-dense) foods or encourages large portions. Update marketing standards. Industry, government, health and nutrition experts, consumer representatives, and other stakeholders should work together to review and update standards for marketing away-from-home foods to children.

10. 10 Consumer behavior and attitudes— marketing and education Promote low-calorie-dense dietary patterns. Strengthen and/or create education and promotion programs regarding away-from- home foods that promote the consumption of fruits, vegetables, no- and low-fat milk and milk products, whole grains, and foods low in saturated fats and trans-fatty acids, as recommended by the 2005 Dietary Guidelines for Americans. Promote enhanced “lifestyle education” programs. Use a combination of existing (or, if necessary, new) social marketing campaigns and consumer education programs to provide “healthy lifestyle” education to help individuals eat more healthfully in today’s food environment.

11. 11 Consumer behavior and attitudes— information needs Review the effectiveness of existing programs. The U.S. Department of Health and Human Services (HHS) and the USDA should, in partnership together, coordinate a comprehensive survey and analysis of existing government-sponsored education and social marketing campaigns related to managing weight gain and reducing obesity in the context of away-from-home foods.

12. 12 Consumer behavior and attitudes— information needs Improve government access to data on consumer behavior and attitudes. Federal agencies should act immediately to increase the access of government researchers and policymakers to syndicated commercial databases. Key agencies should establish recurring line items in their respective budgets, thereby ensuring continual and timely access to the needed commercial data sets. Ensure public availability of information. A means must be developed for continually improving the publicly available knowledge base regarding consumer interests, attitudes, and behaviors regarding away-from-home foods.

13. 13 Availability of Lower-Calorie Products, Menu Items, and Meals Promote the wider inclusion in foodservice of less-calorie-dense menu items and calorie- sparing cooking techniques that are widely accepted by consumers and that take into account constraints on operators. Foodservice providers should develop and promote portion-size, plate composition, and menu-pairing options that help consumers in their efforts to manage their energy intake.

14. 14 Lower-Calorie Products, Menu Items, and Meals Foodservice providers should develop, make available, and promote beverage options that help consumers to reduce calorie intake. A scientific survey should be conducted about the experiences of operators and restaurateurs in developing menu items that could aid in weight management.

15. 15 Providing consumers with nutrition information Away-from-home food establishments should provide consumers with calorie information in a standard format that is easily accessible and easy to use. Research by multiple sectors should be conducted into how consumers use nutrition information for away-from-home foods; how this information affects their calorie intake at that venue; how and why nutrition information affects operators’ decisions, costs, and revenues; and unanticipated consequences of providing the information.