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225 million snacks and meals served each year (New York City Department of Health and Mental Hygiene, 2008). They include restrictions on sodium through specifications of maximum levels allowed per serving for all products purchased and maximum sodium content levels allowed in meals served. The standards also make provisions for those locations providing for populations with specific nutritional needs, such as seniors and patients under therapeutic care. The standards are designed to be reviewed and revised regularly, taking into account updated nutritional guidelines and changes in food availability.56

Local and state governments have also been involved in establishing nutritional policies that apply only to select settings under their authority, such as schools, workplaces, and parks. A recent report surveying state school nutrition policies for foods outside of federally funded and regulated school meals identified only five states with policies in place restricting sodium for at least some grade levels (CSPI, 2007).

The introduction of nutrition standards for snacks and drinks sold in vending machines located on government-owned or government-operated property, most commonly schools and hospital systems, is another area of recent local government engagement. When nutrition standards (including sodium criteria) for foods sold in machines are incorporated into vending machine contracts, government further supports normalizing the consumption of lower-sodium foods.

Local and state governments can have considerable influence over a number of diverse food purchase and distribution locations. The introduction of nutrition standards, including sodium specifications, is an area of increasing activity and opportunity to influence population intake.

THE CONSUMER

Given the acknowledged failures to change sodium intake by setting strategies aimed largely at the consumer, it would be helpful if these outcomes could be better understood, set in context, and used to inform future efforts to better engage consumers in the role they must play in the future. Unfortunately, the lack of specific data in this regard relative to sodium intake is noteworthy. In discussions below regarding the consumer and the food environment, paradigms from related fields of study—including economic theory and health behavior theory—are highlighted as useful and can be applied to future work on sodium reduction targeted to consumers. But a specific analysis of reasons for the past experiences and outcomes relative to the interface between consumers and sodium intake reduction is

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Available online: http://www.cspinet.org/new/pdf/nyc_agency_food_standards.pdf (accessed November 18, 2009).



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