A Big Fat Crisis (33 page)
Authors: Deborah Cohen
It’s a hard truth to accept that, when it comes to eating, the environment may be more powerful than we are as individuals. Nevertheless,
we must accept and embrace our limitations. Let’s stop being so hard on ourselves. Let us heed the lessons learned from the Sanitary Revolution, from the battles against alcohol-related harms, and from the movement to accommodate Americans with disabilities. These movements have proven the benefits of creating environments in which people can be healthy so they can flourish and achieve their goals. Creating healthy environments is not only the mission of public health; it is also the basic foundation of the United States.
We can tackle the obesity epidemic. We just can’t do it alone. Please join me in a new movement that views obesity as a public health crisis—and demands serious public health solutions that will protect us all.
Appendix: Healthier Meal Guidelines for Adults and Children
Healthier Meal Guidelines for Adults and Children
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Adult Meals | Children’s Meals |
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The criteria for healthier meals and healthier restaurants were developed by working groups associated with the NIMHD-funded conference #R13MD006698 on Performance Standards for Away from Home Meals. The authors are:
Deborah Cohen, MD MPH,
RAND Corporation
Rajiv Bhatia, MD, MPH,
San Francisco Department of Public Health
Mary Story, PhD,
University of Minnesota
Stephen D. Sugarman, JD,
School of Law, UC Berkeley
Margo Wootan, PhD,
Center for Science in the Public Interest
Christina D. Economos, PhD,
Tufts University
Linda Van Horn, PhD, RD,
Feinberg School of Medicine, Northwestern University
Laurie Whitsel, PhD,
American Heart Association
Susan Roberts, JD, MS, RD,
Partnership for a Healthier America
Lisa Powell, PhD,
School of Public Health, University of Illinois at Chicago
Angela Odoms-Young, PhD,
University of Illinois at Chicago
Jerome D. Williams, PhD,
Rutgers Business School
Bechara Choucair, MD,
Chicago Dept of Public Health
Brian Elbel, PhD,
New York University School of Medicine
Jennifer Harris, PhD, MBA,
Rudd Center, Yale University
Manel Kappagoda, JD,
ChangeLab Solutions
Catherine Champagne, PhD,
Pennington Biomedical Research Center
Kathleen Shields,
San Antonio Metropolitan Health District
Lenard Lesser, MD, MSHS,
Palo Alto Medical Foundation Research Institute
Tracy Fox, MPH, RD Food,
Nutrition & Policy Consultants, LLC
Nancy Becker, MS RD LD,
Oregon Public Health Institute
Principles for a Healthier Restaurant
Participating restaurants must meet the following criteria, plus adopt a combination of principles below that add up to 20 points:
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Offer three meals or 10% of items listed on the adult/regular menu (whichever is greater) that meet the Healthier Meal Guidelines
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Offer two children’s meals or 25% of the children’s menu items (whichever is greater) that meet the children’s Healthier Meal Guidelines, if the restaurant has a children’s menu
BEVERAGES
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Offer container/cup sizes for sugar-sweetened beverages that are no larger than 16 oz. (3 pt)
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Make low- or no-calorie beverages the default with all bundled adult meals (3 pt)
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Do not offer free refills of sugar-sweetened beverages (2 pt)
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Have free water available and listed on the menu (1 pt)
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Make low-fat or fat-free milk the default milk option (1 pt)
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Serve milk (whole, 2%, 1%, or fat-free) as the default option rather than cream or half-and-half with coffee service (1 pt)
FOOD COMPONENTS
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Offer half portions for at least 50% of menu items and indicate on the menu that option is available (3 pt)
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Do not charge extra or prohibit customers from splitting a meal (3 pt)
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Serve nonfried vegetables and/or fruits as the default side dishes with meals (3 pt); or allow customers to substitute a fruit or nonfried vegetable for any side dish for no extra charge, and list option on the menu (2 pt)
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Offer at least three fruit or nonfried vegetable side dishes (2 pt)
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Serve whole-grain-rich options as the default with meals, when grains are offered (3 pt); or offer 25% of the grain products on the menu as whole-grain-rich options (2 pt)
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Three meals that meet the Healthier Meal Guidelines provide at least 7 grams of dietary fiber (2 pt)
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All meals and menu items are free of artificial trans fats or partially hydrogenated oils (2 pt)
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Offer healthy spreads, such as olive oil, lower-fat margarine, or hummus, with bread in place of butter (1 pt)
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Do not offer free bread, chips, or other starters (e.g., such items must be ordered for an extra charge) (2 pt); or offer only upon request (1 pt)
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50% of the dessert options are available in half-sized portions or are less than 300 calories (2 pt)
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Offer at least one fish/seafood meal meeting the Healthier Meal Guidelines (1 pt)
CHILDREN’S MEALS
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Sugar-sweetened beverages are not offered with children’s meals (excludes flavored milk) (3 pt); or default beverages with children’s meals are water, low-fat or fat-free milk, or 100% juice (2 pt)
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Fruit and/or nonfried vegetable is served as the default side item/s with meals (3 pt)
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Whole-grain-rich options are served as the default with meals, when grains are offered (2 pt)
MARKETING, PROMOTION, AND INFORMATION
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List calories per menu item, as offered for sale, on the menu or menu board (3 pt)
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Meals that meet the Healthier Meal Guidelines are sold at equal price or lower price than equivalent available items (3 pt)
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Train employees to prompt customers to choose nonfried vegetables when ordering (1 pt)
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Train employees to prompt customers to choose low- or no-calorie beverages when ordering (1pt)
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List prominently healthier options and low- and no-calorie beverages on menus, menu boards, or where displayed (1 pt for each approach employed, for a maximum of 3 pt):
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Depict on the children’s menu or section of the menu only options meeting the children’s nutrition guidelines
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Depict at least 50% of the items on the menu as healthier options
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List healthier options first for each category of the menu
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List low- or no-calorie beverages before sugar-sweetened beverages on the menu
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Highlight healthier items on the menu using bold or larger font
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Place healthier items more prominently (e.g., closer to customers and at eye level) for foods on display
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Promote healthier menu options through advertising, coupons, price promotions, window signs, in-store signage, kiosks, table tents, etc. (1 pt for each approach used, for a maximum of 3 pt)
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At least half the promotional signage in the restaurant is for healthier items (2 pt)
Definitions
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Healthier options are those that meet the Healthier Meal Guidelines or are a fruit, a nonfried vegetable, whole-grain-rich grain (excluding sweet baked goods), low- or no-calorie beverage, water, or low-fat or fat-free milk.
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Whole-grain-rich—at least 50% of the grain ingredients are whole grain. This can be determined by the product having whole grain as the first ingredient, from the manufacturer, or if the product has a whole grain claim. Examples include brown rice, whole-grain rolls, corn tortillas, whole-grain pasta, oatmeal, and whole-grain cereal.
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Sugar-sweetened beverages include sodas, fruit drinks, sports drinks, iced teas, coffee drinks, and other beverages (excluding low-fat or fat-free milk) that contain added caloric sweeteners, and that have more than 25 calories per cup/container as offered for sale.
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Low- and no-calorie beverages include water and other beverages with no more than 25 calories per cup/container as offered for sale.
