Communities Putting Prevention to Work

1. Communities Putting Prevention to Work Wood County

2. Overview • Solution • Planning • Background • Implementation • Evaluation • MAPPS

3. Solution

4. *Source: BRFSS, 2004-2006 **Source: International Journal of Behavioral Nutrition and Physical Activity 2008 ***Source: American Journal of Public Health 2010 The Problem • Wood County’s combined overweight and obesity rate = 64.4%* • Only 25% of WI residents eat 5 daily servings of fruits & vegetables* • U.S. adults spend half of food dollars on meals and snacks away from home** • Many consumers underestimate the amount of calories in their meal***

5. The Solution • Menu labeling: • Adding nutrition info at point of purchase • Allows customers to make informed selections

6. Public Support • National opinion poll shows 83% of Americans favor menu labeling* • Survey/focus group research indicates majority support menu labeling** • 3 out of 4 adults read food labels on packages* • Half say this has helped change purchasing habits* *Source: Rudd Center for Food Policy and Obesity **Source: University of Wisconsin Population Health Institute

7. Federal Regulation • Chains required to print calorie information on menus and menu boards • Other nutritional facts available by request • Implemented next year • Some restaurants are already displaying and adding healthier choices

8. Wood County Focus • Partnering with non-franchised restaurants • 19 or fewer locations • Labeling healthy meals • Adding nutritional information to menus • Implementing voluntary policy • Educating policy makers

9. Planning

10. Set the Stage • Partnered with sanitarian team and identified restaurants • Partnered with restaurant association • Evaluated menu labeling programs • Researched menu analysis approaches/tools • Identified barriers and strengths • Assessed restaurant menus and environment

11. Developed the Plan • Program: Smart Meal™ • Customizable toolkit • Logo and promotional materials • Analysis: MenuCalc • Web-based tool • Training/support for restaurant staff

12. Recruited Restaurants • Recruitment meetings • Letter and invitation mailed • Informative/tradeshow style • Iron chef and calorie guessing contests • Star fruit and reminder delivered

13. Recruited Restaurants • Follow up meetings • Met with restaurant owners who attended meetings • Recruited 10% of restaurants • Marketing/promoting program • Creating awareness • Anticipate restaurants coming to us

14. Successes & Lessons Learned • Successes • Recruited 10% - similar to other communities (large and small) • Partnership with sanitarian team • Lessons Learned • Low attendance for recruitment meeting • Restaurants did not welcome cold calls • Some restaurants don’t want to be first

15. Background

16. Created by the Colorado Physical Activity and Nutrition Program (COPAN) Implemented at 20 full-service restaurants in Colorado (190 locations) Expanded nationally to California, Vermont, Rhode Island, and Connecticut Recommended as practice-tested intervention by UNC & Center TRT About Smart Meal Program

17. Smart Meal Objectives • Provide healthier menu options • Increase fruit & vegetable consumption • Combat obesity and chronic disease • Improve eating environments • Encourage healthy meal selections

18. Nutritional Requirements • Based on recommendations from: • US Dietary Guidelines • Fruits and Veggies: More Matters • Western Dairy Council • The American Heart Association • FDA nutrition labeling guidelines • Winner’s Circle – NC Prevention Partners

19. Adult Meal • Minimum of 2 servings of beans, whole grains, fruits or vegetables. May substitute one for non-/low-fat milk or milk product. • No more than 700 calories • 30% of total calories from fat (23g or < total fat) • 10% of calories from saturated fat (8g or < saturated fat) • 0.5g or less of trans fat (no added or artificial trans fat) • No more than 1,500mg of sodium

20. Smart Meal Kids • Same as adult guidelines except: • 400-600 calories • 600-800mg of sodium • Ranges represent respective ages (4-13 years)

21. Side Dish • Minimum one serving of beans, whole grains, fruits, vegetables or fat-free or low-fat milk or equivalent milk product • No more than 300 calories • 30% of total calories from fat (10g or < total fat) • 10% of calories from saturated fat (3g or < saturated fat) • No more than 650mg of sodium

22. Implementation

23. Implementation Steps • Menu review and identification of potential Smart Meals • MenuCalc introduction and training • Recipe analysis • Recipe/menu adjustments • Recipe analysis/meal qualification • Restaurant agreement signed • Smart Meal Seal added to menu

24. Restaurant Agreement • Qualify four Smart Meals • Use logo to identify and promote Smart Meals • Display window decals • Display Smart Meal program description • Measure customer satisfaction and program awareness

25. 1st Smart Meal Restaurant

26. 2nd Smart Meal Restaurant

27. 1st Smart Meal Catering Co.

28. Cost for Implementing Agency • Menu analysis – $390 per restaurant • Promotional materials/printing costs – window decals, panel cards, table tents, and menu transition stickers • Marketing/advertising campaign

29. Cost for Restaurants • Analyzing additional meals (discount from MenuCalc) • Menu reprints • Menu inserts (if menu not scheduled to reprint soon) • Discount promotions

30. Successes • Partnering to identify potential meals • Clear messaging that little change is required • Offering analysis for free • Training restaurants on menu analysis • Offering hands-on technical support • Flexibility with menu transition options • Agreement form, logos, promos as last step

31. Lessons Learned • Some not interested in training • Lengthy time for analysis and meal modifications • Some delay start time after commitment • Could be cautious of being first • Some not open to menu changes • Restaurants promoting unhealthy foods agreed to participate

32. Evaluation

33. Restaurant Assessment • County-wide assessment • Nutrition Environment Measures Survey for Restaurants (NEMS-R) • Identified supportive factors and barriers • Assessed 96 restaurants for baseline • Conducting post assessment spring 2012 for Smart Meal restaurants to measure improvements

34. Baseline Results • Number of restaurants… • Providing nutrition info on menus = 0 • Identifying healthy meals on menus = 0 • Promoting healthy selections = 0 • Offering fruit without added sugar = 13 • Offering non-fried vegetables without added sauce = 42 • Offering reduced-size portions = 17

35. Smart Meal Evaluation • Sales data collection • Manager interviews • Secret shopper • Quarterly meetings/calls • Customer survey

36. Successes & Lessons Learned • Successes • Assessed every restaurant in county • Smart Meal restaurants agreed to all evaluation steps • Lessons learned • Lengthy and expensive assessment process • Chain restaurants not always willing to share sales data

37. MAPPS

38. MAPPS • M – Media • A – Access • P – Point of Purchase • P – Price • S – Social Support

39. Questions

40. www.getactivewisconsin.org Renee Fox Community Health Educator Aspirus rfox@co.wood.wi.us 715.421.8914