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6
Private Sector: Strategies and
Actions for Implementation
M EMBERS OF THE private sector must play a large role in helping
consumers select more health-promoting foods. They are pre-
sented with both opportunities and challenges by the scientific con-
sensus that specific changes in eating habits are likely to reduce sub-
stantially the public's risk of heart disease, cancer, and many other
diet-related chronic diseases. Food labels and consumer information
programs as well as specific product formulations and promotions
need to be examined creatively with this in mind.
For the purposes of this report, the private sector is defined broadly
as including producers of several major commodities (fruits and
vegetables, grains and legumes, dairy products, meat, poultry, fish
and seafood, and eggs); food manufacturers and processors and retail-
ers; food service establishments (restaurants, fast-service food estab-
lishments, and institutional food-service providers); and work sites
(cafeterias and vending machines in office buildings and factories).
The private sector is, thus, not a monolith, but a collection of inter-
ests often competing for the same consumer dollar. Since any single
consumer can eat only a given amount of food each year, the ques-
tion of who will provide that food becomes a matter of great economic
importance.
The entire private sector from producer to retailer greatly influ-
ences what consumers purchase and consume. In addition, it adapts
its products and marketing strategies not only to anticipate and respond
to consumer demand but also to create the demand for specific products
and services. The committee recognizes that the private sector is in
140
OCR for page 141
PRIVATE SECTOR
141
business to sell products and services and make a profit doing so. It
therefore recognizes that dietary recommendations will be implemented
to the extent that they facilitate, or are not in conflict with, these
objectives. The marketer's goal is to sell products, yet implicit in this
goal is the responsibility to provide consumers with sufficient prod-
uct choice and the necessary information to make informed selections.
Many nutrition programs and food products consistent with the
principles of dietary recommendations are either already available or
under development by the private sector and have been created in
response to a growing public interest in health and nutrition. Most
of the committee's recommendations in this chapter have already
been heard by this societal sector. The committee believes, however,
that the various segments of the private sector supermarkets, food-
service establishments, and other purveyors of food can be encour-
aged to compete with each other in offering to consumers practical advice
on implementing dietary recommendations as well as products devel-
oped or modified to be lower in fat, cholesterol, and salt and higher in
complex carbohydrates than those currently on the market.
INCENTIVES AND BARRIERS TO IMPLEMENTATION
BY THE PRIVATE SECTOR IN GENERAL
Important incentives and barriers that apply to the private sector
across the board are discussed below.
Incentives
Competitive Advantage
It is common, although technically inaccurate, to speak of the food
industry as though it were monolithic. In reality, as discussed earlier, it
is a heterogeneous collection of private-sector entities that compete
for a share of the market for similar or related food product lines. It
seems increasingly likely that a company will gain a competitive ad-
vantage by introducing nutritionally desirable and appealing prod-
ucts that meet the public's growing interest in purchasing health-
promoting foods. Consumers are likely to purchase good quality
products that help them to meet dietary recommendations as they
become more informed and as the organoleptic properties (e.g., taste,
odor, mouthfeel, and color) of health-promoting foods and the conven-
ience of their preparation are perceived to improve. According to a
national survey conducted by the Food Marketing Institute (FMI) in
January 1990, 97% of respondents reported that nutrition is "very" or
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142
IMPROVING AMERICA 'S DIET AND HEALTH
"somewhat important" to them when they shop for food; 90% re-
ported that they and their families pay at least some attention to the
nutritional content of what they eat; and 40% reported that fat content
is the nutritional attribute of food to which they pay the most attention
(FMI, 1990~.
Consumer Confidence
Manufacturers and companies that offer nutritionally desirable foods,
products that have complete nutrition labeling, or other useful nutrition
information will likely increase customer satisfaction and confidence in
their products, thus increasing their sales through new and repeat bus-
iness. Well-informed customers are generally confident in their product
choices and loyal to products recognized as health promoting.
Enhanced Image and Credibility
Image and credibility are very important to all companies. Com-
panies that offer to their customers nutrition information programs
as well as health-promoting products, and that market them as such,
would be perceived positively by consumers seeking to improve their
diets. Positive word-of-mouth advertising by health-care profession-
als, community organizations, consumer groups, and individual con-
sumers can be as effective as paid advertising in contributing to a
company's image.
Cost Reduction and Improved Programs Through Cooperative Efforts
Cooperation and collaboration in implementing dietary recom-
mendations among the private sector, government agencies, health-
care professionals, consumer and voluntary organizations, and academia
are to be encouraged. This would reduce redundancy, and thus the
costs of implementation programs, and would increase their quality
by drawing on the combined expertise of those who are part of these
various sectors.
Barriers
Restrictive, Confusing, or Nonexistent Government Standards
Some government standards of identity may limit or prohibit the
development of new or modified products that are lower in fat, cho-
lesterol, and sodium. Thus, changes in these and in federal or state
regulations will be necessary if more nutritionally desirable products
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PRIVATE SECTOR
143
with easily recognizable names are to be manufactured. In addition,
the lack of uniform definitions for descriptors on food product labels
such as low fat, low cholesterol, or lite creates confusion among con-
sumers and in the private sector itself (IOM, 1990; NRC, 1988~.
Inadequate Federal Guidance on Health Claims
The lack of specific federal guidance creates uncertainty in the
private sector about how best to communicate knowledge of the con-
nections between diet and health in relation to individual products,
thereby permitting the use of confusing, incomplete, or misleading
statements to stimulate consumer purchases of certain products. On
February 13, 1990, the Food and Drug Administration (FDA) proposed
specific guidelines on health claims (Benson and Sullivan, 1990), but
no final rule has been issued as of this writing. Recently enacted
food labeling legislation gives FDA clear authority to regulate health
claims on foods (Food Chemical News, 1990c,d).
Lack of Guidance on Implementation
The lack of practical guidance on how to implement dietary rec-
ommendations limits the private sector's ability to make changes in
the food supply. Many companies do not employ registered dietitians
or nutritionists to evaluate the nutrient content of foods, to develop
high-quality and accurate informational materials on healthy eating,
or to prepare the nutrition-related statements for product labels and
advertising. Chefs and food-service personnel often do not have sufficient
background or training in nutrition or in recipe or menu modification.
Cost of Product Development and Research
Considerable research must be undertaken before a company can
reasonably decide whether or not to invest in the development and
marketing of a nutritionally desirable product. Financial risk can be
minimized by thorough assessments in which the most effective re-
search tools are used.
Consumer Concerns about Food Safety
According to the national survey conducted by FMI in 1990, 20%
of respondents reported that they were "somewhat" or "mostly doubtful"
that the food in their supermarket is safe (FMI, 1990~. Both the private
and public sectors are responding to the concerns of this group by
continuing to take steps to protect the food supply and enlisting the
assistance of food scientists and the nutrition community to inform
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IMPROVING AMERICA'S DIET AND HEALTH
the public about issues related to food safety. Specific widely publi-
cized incidents can erode consumers' confidence level regarding the
safety of the food supply, but it appears to rebound to initial levels
rather quickly. In April 1989, for example, consumer confidence dropped
to 73% as a result of media reports about contaminated imported
grapes and the use of pesticides and growth regulators in produce.
By January 1990, the level of consumer confidence had rebounded
back to 79°/O (FMI, 1990~.
STRATEGIES AND ACTIONS FOR THE PRIVATE SECTOR
Two general strategies, each of which consists of three actions, are
proposed for the private sector. The first strategy focuses on providing
consumers with information on how to improve their dietary patterns
and motivating them to do so, while the second concerns the produc-
tion, manufacture, and marketing of nutritionally desirable foods.
STRATEGY 1: Promote dietary recommendations and
motivate consumers to use them in selecting and prepar-
ing foods and in developing healthful dietary patterns.
ACTION 1: Make consumers aware of dietary recommendations
and their importance and how available products and services
can be used to meet them.
Advertising, public relations, and special promotions can inform
consumers about dietary recommendations and thereby help to develop
markets for health-promoting foods. They can also enhance the reputation
of companies and brand-name products that provide accurate and
practical information to consumers.
The private sector can play a major role in cooperative efforts involv-
ing health-care professionals; academicians; consumer, health, and civic
organizations; and governments to develop a variety of consumer informa-
tion and education programs and materials that would explain ways in
which eating patterns can be adapted to meet dietary recommenda-
tions. The programs must emphasize the total diet as well as gradual
changes in eating habits; messages should be simple, balanced, and consistent.
Chapter 4 identifies some of the major dietary principles that should
form the basis of these programs and materials.
Use of the combined expertise of individuals involved in these
joint ventures has already resulted in the development of nutrition
information programs that go beyond what any individual group can
accomplish. An example is the collaborative effort of the Kellogg
Company with the National Cancer Institute to promote increased
consumption of fiber-rich cereals (Freimuth et al., 1988~. In addition
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PRIVATE SECTOR
145
to pooling their expertise, the participants should be encouraged to
combine their resources, thereby reducing the costs to each.
In advertising and in other consumer materials, health-promoting
foods should be displayed together (e.g., vegetables and fruits should
be shown with low-fat meats, skinless poultry, seafood, nonfat and
low-fat dairy products, and whole grains). This will help consumers
to visualize the kinds of foods and menus that are recommended to
promote good health. Promotional materials should advocate low
fat cooking techniques such as baking, broiling, poaching, steaming,
microwaving, or grilling, rather than frying.
The private sector should be encouraged to develop incentive pro-
grams for corporations and businesses to promote nutrition messages
responsibly. Special awards programs could be established, for ex-
ample, to increase the visibility of companies that are judged to pro-
mote responsible nutrition messages in effective ways.
ACTION 2: Contribute to efforts to improve the nutrition la-
beling offood so that it better assists consumers in making informed,
nutritionally desirable food choices.
It is recognized broadly that nutrition labels on food products can
help consumers to design diets that meet dietary recommendations.
To be more useful, however, they need to be available on more food
products and improved in both content and format. The private
sector has been actively involved in seeking a solution to current
concerns in several areas. For example, they have distributed informa-
tion to consumers on how to make use of nutrition labeling. An
increasing number of foods-now estimated at approximately 60% of
all packaged food products carry nutrition labeling (IOM, 1990~. In
addition, consumers have been surveyed by segments of the private
sector about their interest in and use of food labels and their suggestions
for improved labeling (see, for example, FMI, 1990, and Opinion Re
-
search Corporation, 1990~. Some segments have also developed posi-
tion statements and provided comments in response to regulatory
and congressional efforts to revise food labeling (IOM, 1990~. The
private sector should continue these activities and avidly support
new labeling regulations as issued. As an example, the National
Food Processors Association recently organized the Food Label Edu-
cation Coalition to help consumers use the new food labels that are
developed (Coleman, 1990; NFPA, 1990~. The coalition is composed
of representatives of government agencies; education, consumer, and
health organizations; and the food industry. Another committee of
the Food and Nutrition Board has addressed nutrition labeling of
foods in depth (IOM, 1990~.
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IMPROVING AMERICA 'S DIET AND HEALTH
ACTION 3: Provide consumers with information at points of
purchase so that they may assess quickly some of the nutrition
attributes of specific products and brands
According to a national survey of consumers by FMI in 1989, the
preferred methods of providing nutrition-related information in stores
were, in order of priority, pamphlets, nutrition tags on shelves near
food items, recipe cards, and in-store demonstrations or videos; but
only 55°/O of those surveyed responded that supermarkets do an excellent
or good job in this respect (FMI, 1989b). It appears that food retailers
have an opportunity to improve their performance in this area.
STRATEGY 2: Continue to increase the availability of a
wide variety of appealing foods that help consumers to
meet dietary recommendations.
ACTION 1: Develop more nutritionally desirable products that
appeal to consumers.
The private sector has been modifying traditional products as
technology permits to make them more nutritionally desirable-usually
by reducing their total fat, saturated fat, sodium, or sugar content or
by increasing their fiber content. In addition, the private sector is
developing an increasing number of nutritionally desirable food pro-
ducts that are appealing. Examples include whole-grain, ready-to-eat
cereals with no added sweeteners; low-fat dairy products; fat-free or
very-low-fat pastries and baked goods; frozen dinner entrees low in
total fat, saturated fat, and sodium; and lower-fat hamburger patties
served in fast-service food establishments. Of course, each food need
not meet specific target levels specified in dietary recommendations
(e.g., 30°/O or less of calories from fat; see chapter 4~. Nevertheless,
consumers are more likely to meet these recommendations if their
diets are composed largely of nutritionally desirable products.
ACTION 2: Contribute to efforts to revise, or develop as appro-
priate, food-quality criteria (such as standards of identity and
grading), pricing structures, andfood product descriptors to promote
the production of more nutritionally desirable food products.
Standards of identity developed by the government specify man-
datory ingredients for many common foods such as catsup, cheese,
ice cream, frankfurters, bread, and mayonnaise. These standards have
helped to ensure the quality and consistency of products by prohibiting
manufacturers from substituting less expensive ingredients. Food
products that deviate from these standards (e.g., ice cream with less
fat than specified) must be renamed in most cases (e.g., frozen des-
sert) or labeled as imitation (e.g., imitation ice cream). Thus, standards
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PRIVATE SECTOR
147
of identity can inhibit the replacement of high-fat or high-cholesterol
components of foods with nonfat or low-fat ingredients. They should
be updated whenever possible to promote the production of more
nutritionally desirable versions of food products. The FDA is allow-
ing the test marketing of several products that deviate from their
standards of identity but still carry their traditional names (e.g., nonfat
cottage cheese iShank, 1990al, light eggnog [Shank, 1990b], lowfat ice
cream Mood Chemical News, 1990b], and light sour cream [Food
Chemical News, 1990a]) to measure consumer acceptance.
The carcasses of red meat animals are graded to indicate the qual-
ity of table meats. Yet the current U.S. grading system, which is
basic to the marketing and pricing of red meat, deters the production
of lean meat by linking quality grades to fat content. The nomencla-
ture is not identical for beef, pork, and lamb, but generally, the higher
the fat content of the muscles (marbling), the higher the quality grade,
since marbling improves the chances of the meat being flavorful, juicy,
and tender when cooked (NRC, 1988~. Prime and Choice are the two
highest grades, but most meat sold is Choice and Select. A marketing
system that promoted the leaner grades, primarily Select, would increase
the availability of lower-fat meats, which consumers say they want
(Sweeten et al., 1990~.
ACTION 3: Engage in practices leading to the greater availability
of nutritionally desirable products that will assist consumers in
meeting dietary recommendations.
The private sector should fund and conduct research on nutritional
attributes of products as well as on consumer attitudes, knowledge, and
practices for ideas to provide consumers with products they want and
need. They should also conduct marketing and informational campaigns
to increase consumption of health-promoting products. It is important
that this research be wide-ranging and help commodity producers,
manufacturers, processors, retailers, and food-service establishments
learn how to improve their products and their promotional campaigns.
This information should be shared throughout the private sector, including
supermarkets and the media, as well as with health-care professionals.
STRATEGIES AND ACTIONS APPLIED TO
SPECIFIC SEGMENTS OF THE PRIVATE SECTOR
Fruits and Vegetables (Produce)
The committee recommends that the produce industry implement
a national fruit and vegetable campaign based on social marketing
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IMPROVING AMERICA'S DIET AND HEALTH
approaches with extensive use of the media to promote consumption
of five or more servings of fruits and vegetables daily as a goal to be
reached by the year 2000. The goal should be to increase consumer
awareness of the health benefits of fruits and vegetables; to motivate
people to eat more of them while emphasizing their convenience,
taste, great variety, and relatively low costs; and to provide tips on
how to incorporate at least five servings of these foods into the diet
each day. Successful implementation of this campaign will require
leadership and coordination from both the Produce Marketing Asso-
ciation and the United Fresh Fruit and Vegetable Association; large
commodity producer groups and fruit and vegetable corporations;
and leaders from the food industry, public health agencies, and vol
untary health organizations.
There is precedent for such a campaign. In 1988, the fruit and
vegetable industry, in cooperation with the California Department of
Health Services and the California Department of Food and Agricul-
ture, began a 3-year statewide campaign to promote the consumption
of five servings of fruits and vegetables per person per day and at
least 500 lbs of produce per person per year by the year 2000 (Foerster
and Bal, 1990~. This California initiative, entitled "5 A Day For
Better Health," has been very successful in generating positive media
coverage and encouraging the participation of supermarkets and other
segments of the produce industry in promoting and implementing
the campaign.
The creation of a national, federally mandated research and promotion
program for all produce would provide a mechanism for raising funds
from growers and the produce industry to enhance the positive image
of fruits and vegetables through paid advertising and would ensure
the necessary cooperation among the produce industry (especially
the leading producers), its trade associations, and the U.S. Depart-
ment of Agriculture (USDA). In the past, promotion programs for
beef, milk, watermelon, and potatoes have led to increased sales (Hits,
1977; Mayer, 1990~.
The produce industry should promote and support government
efforts to develop innovative programs that will help low-income
families attain greater access to fruits and vegetables. For example,
10 states have received federal funds as part of a demonstration project
to provide participants in the Special Supplemental Food Program
for Women, Infants, and Children (the WIC program) with coupons
that can be used to purchase fresh fruits and vegetables at local farmers
markets (U.S. Congress, 1988; USDA, 1990~. If implemented more
broadly, this program could increase the consumption of fruits and
vegetables by those with economic limitations.
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149
Some consumers are concerned about residues of pesticides on
some foods (FMI, 1990), and may therefore be reticent to eat more
fruits and vegetables. The produce industry should promote the mes-
sage that the health benefits of produce outweigh any possible nega-
tive effects from pesticides or other residues. The food industry is
responding to consumers' pesticide fears in several ways, for example,
public education about the safety and benefits of pesticides and ef-
forts in the agricultural sector to reduce their use (Ravenswaay, 1989~.
Grains and Legumes
Consumption of grain products in the United States has increased
over the past two decades. This has been in forms that include cere-
als, pastas, and baked goods. The formulation of grain food prod-
ucts involves millers, wholesale bakeries, food processors, cereal
manufacturers, and food retailers with their in-store bakeries. The
number of in-store bakeries grew from 18,850 in 1987 (Boisisio et al.,
1990) to an estimated 23,007 in 1990 (Malovany, 1990~. Wholesale
bakers are producing more varieties of bread and reformulating their
products to contain less-saturated fats and oils (Malovany, 1990~. The
committee encourages the baking industry to expand its output of
whole-grain and lower-fat products, such as whole-grain, low-fat breads,
rolls, bagels, pitas, and pastas, and baked rather than fried grain-
based snacks, such as corn chips.
Consumption of legumes (i.e., dried beans and peas; see Chapter
4) increased from 6.9 lbs per capita in 1970 to 8.3 lbs in 1987 (Putnam,
1989~. Producer-supported organizations such as the American Dry
Bean Board and the USA Dry Pea & Lentil Industry have developed
promotional materials that include product information and recipe
ideas for use by food editors in the media, food and nutrition profes-
sionals, restaurants, and consumers in an effort to increase consump-
tion of legumes. Budget constraints limit the scope and reach of these
promotional initiatives (Dry Pea & Lentil News, 1990; Hays, 1990~.
In light of the dietary recommendation to increase consumption of
grains (particularly whole grains) and legumes, both industries should
consider a campaign similar to that recommended for the produce
industry to encourage consumption of these products. Since these
segments of the private sector are relatively fragmented, such cam-
paigns should include regional components and other efforts applicable
to the similarly dispersed fish and seafood industry. Both should
begin to promote dietary recommendations to encourage consumption
of their products.
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IMPROVING AMERICA'S DIET AND HEALTH
Dairy
The dairy industry and companies that sell dairy foods should
promote more aggressively nonfat and low-fat dairy products and
explain to consumers the differences in their fat and calorie contents.
In the committee's judgment, the industry has not promoted adequate-
ly these products in its advertising and educational materials, nor in
some cases has it made them widely available. For example, con-
sumers in California did not have 1% fat milk in the marketplace
until January 1990 (CMAB, 1990; Times Delta, 1990~. At that time,
however, the California Milk Advisory Board made a commendable
effort to educate consumers by comparing the nutrient contents of
fresh milk with different levels of fat.
The committee concluded, after discussion with several dairy
economists, that one of the major barriers to promoting nonfat and
low-fat dairy products may be an unwillingness by some segments of
the dairy industry to imply that their full-fat product line (whole
milk, cheese, butter, and ice cream) the focus of their traditional
image may be less nutritionally desirable. The impetus for making
changes has evolved from recognition of the need to reduce the fat
content of dairy products to take advantage of consumers' increasing
interest in diet and health. A recent report commissioned by the
National Dairy Council suggested that it would be "self-defeating"
for the dairy industry to continue to "ignore" or "fight" the growing
scientific consensus on reducing dietary fat (NDC, 1989, p. 5~. This
industry should work with voluntary health and professional organi-
zations to develop consumer education materials that promote the
consumption of a variety of nonfat and low-fat dairy products that
help people to meet dietary recommendations.
The committee believes that dietary recommendations and national
campaigns to encourage the U.S. population to reduce substantially
its dietary fat intake should be perceived by the dairy industry as an
opportunity rather than as a threat, since many low-fat products are
available. These include low-fat (and, in some cases, fat-free) milk,
cheese, yogurt, ice cream, and sour cream.
The committee encourages the dairy industry to work toward chang-
ing the milk pricing system to encourage dairy producers to breed,
feed, and manage their herds for production of lower-fat milk in ac-
cordance with changing consumer demands. loins initiative, willing-
ness, and action by the dairy industry and USDA will be required to
change the current price support system for dairy products. Admit-
tedly, a change that reduces the price for the butterfat component of
the milk will penalize dairy farmers whose cows produce milk with a
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157
low in sodium or high in fiber). FMI (1989a) has compiled a list and
brief description of nutrition information programs in supermarkets
across the United States.
One example of a successful collaborative industry-sponsored con-
sumer information program is Meat Nutri-Facts, which was developed
by FMI, the American Meat Institute, and the National Live Stock
and Meat Board in 1985 (FMI/AMI/NLMB, 1985~. In 1987, this pro-
gram was joined by Poultry Nutri-Facts, produced by FMI with the
National Broiler Council and the National Turkey Federation (FMI/
NBC/NTF, 1987), and in 1988 it was joined by Seafood Nutri-Facts,
developed by FMI and the National Fisheries Institute (FMI/NFI,
1988~. Elements of these programs, which are available in many su-
permarkets throughout the United States, provide point-of-purchase
consumer information, including nutrient and calorie data and recipes,
on various products and cuts. This information is conveyed by store
signs, recipe cards, brochures, and videos that identify relatively low
fat cuts of animal flesh as well as low-fat cooking methods and nutrition
information for a 3-oz cooked serving. Information derived from this
program is also supplied to the industry and to health-care professionals.
The results of consumer surveys conducted by retailers on the effec-
tiveness of their nutrition information programs should be shared with
government agencies and health-related organizations. Supermarket
trade associations can also play a key role in evaluating consumer
nutrition information programs and disseminating results widely. The
committee encourages retailers and their trade associations to go even
further by conducting, funding, or collaborating on research to deter-
mine consumer attitudes about nutrition, the effectiveness of point-of-
purchase nutrition information programs, and topics related to di-
etary recommendations. This information should be shared throughout
the food industry as well as with health organizations, educators,
and governments. The FMI annual Trends report (FMI, 1990) and its
cooperative research studies on nutrition and food trends in conjunction
with Better Homes and Gardens magazine (FMI/BHG, 1988a,b,c,d, 1989)
are two examples of an ongoing effort by the retail food industry to
monitor consumer attitudes. Supermarket trade associations should
continue to provide their members with information and studies on
nutrition issues from a variety of sources.
An increasing number of retailers are preparing their own prod-
ucts in the store (such as salads, entrees, and desserts) and thus can
modify the ingredients used and the methods of preparation to reduce
fat and sodium. Some of them have their own processing facilities
(e.g., a bakery, dairy, ice cream plant, or canning facility). Retailers
can use these resources to produce more nutritionally desirable prod
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IMPROVING AMERICA'S DIET AND HEALTH
ucts. They should also ask suppliers of store-brand products to modify
the products to make them more nutritionally desirable. In some
cases, retailers can develop specifications for items they are willing
to purchase. If efforts are made to ensure that the products are ap-
pealing, consumer demand for them should increase.
In some parts of the United States (e.g., very small towns, rural
areas, and economically deprived areas of cities), people may depend
heavily on a small area supermarket or grocery store for their food
purchases. The committee believes that these small retailers have a
special responsibility to stock as great a variety of health-promoting
foods as they are able at reasonable prices to help their patrons meet
dietary recommendations.
Food-Service Establishments
The average U.S. consumer eats one of every five meals away from
home (Sweet, 1989~. The food-service share of a consumer's food
dollar has risen from 25% in 1950 (NRA, 1988) to more than 40°/O in
1987 (NRA, 1989~. Thus, food providers (e.g., restaurants, fast-service
food establishments, and institutional food-service companies) provide
a substantial share of the U.S. diet, and their policies and procedures
can have a considerable impact on the foods that are consumed. They
can thus have an important role in helping consumers make health-
promoting food choices. Their future profits may well depend on
how well they accommodate the increasing number of people who
wish to eat nutritiously when they eat out (Granzin and Bahn, 1988~.
Restaurants, fast-service food establishments, institutional food-ser-
vice providers, and even caterers have special opportunities and in-
centives to improve the nutritional quality of their menus and prod-
uct offerings. For example, they can make available one or more items
for each course (e.g., entree and dessert) that are consistent with the
principles of dietary recommendations and, in general, initiate chang-
es in food preparation practices to comply with dietary recommenda-
tions. Increased customer satisfaction, loyalty, or increased sales pro-
vide the major incentive for restaurants to make changes that are
consistent with the principles of dietary recommendations. Accord-
ing to a 1986 Gallup Poll, 4 of 10 consumers said they were trying to
consume more vegetables and fewer fats, meats, and fried foods when
they ate out (NRA, 1990~. Fifty-nine percent of respondents in a 1988
poll conducted for the National Restaurant Association (NRA) said
they rank nutritious menu items second on a list of 10 features they
like to see in a restaurant (Sweet, 1989~. At present, approximately
40°/O of restaurants offer menu items that are reduced in fat, calories,
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PRIVATE SECTOR
159
salt, and cholesterol (Sweet, 1989~. In mid- and upscale restaurants,
health-promoting items account for 15% of all sales (Regan, 1986~.
Many of the expensive to moderately priced restaurants that have
added nutritionally desirable menu items are achieving success, as
reflected in increased sales (Framkin, 19881. Experimental pilot projects
have shown that the addition of health-promoting items to a menu
need not require extensive effort and expense and that they can re-
sult in increases in sales (Scott et al., 1979~.
Food-service establishments should also accept a social responsi-
bility to make health-promoting foods easily accessible both to those
who explicitly seek them and to those who do not. For example,
managers could add fresh fruit alternatives to menus or dessert carts
so that they would not have to be specially requested. Some nutritionally
desirable items may not have sold well in the past simply because
diners were unaware that they were available.
Restaurateurs should encourage the NRA to (1) develop a manual
with health-promoting alternatives, including specific information on
ingredients, preparation, training, costs, and successful introduction
in various markets; (2) track and publish the types of health-promoting
alternatives that are most popular with consumers; and (3) engage in
research on the most effective means of presenting dietary informa-
tion on menus. In addition, the industry should encourage its trade
magazines to carry more stories on dietary recommendations and to
provide examples of successful and unsuccessful means of imple-
mentation. These actions will help convince restaurant owners and
chefs that the adoption of healthful alternatives is feasible and economi-
cal and will assist them in determining the best times (primarily in
terms of public acceptance) to introduce new items and how to do it.
The NRA's Nutrition Guidefor the Restaurateur (NRA, 1986) is one step
that has already been taken in this direction.
Waiters and waitresses should be given basic information about
how the restaurant's chefs prepare various dishes so that they can
respond knowledgeably to questions asked by consumers trying to
follow dietary recommendations. Many food-service establishments
may find this recommendation difficult to implement because of fre-
quent staff turnover. The menus themselves could be more descrip-
tive by containing information on how foods are prepared.
In their publicity and advertising, food-service establishments
should highlight the availability of menu items that help consumers
meet dietary recommendations. This information should also be con-
veyed to local restaurant reviewers, food editors, and health organizations
to inform consumers where nutritionally desirable foods can be
obtained. Messages to consumers should focus not only on the health
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IMPROVING AMERICA'S DIET AND HEALTH
promoting features of these foods but also on their good taste and
appealing presentation.
Restaurants, fast-service food establishments, and food-service
providers (e.g., cafeterias at work sites and hospitals), can also help
consumers by providing certain information (e.g., total calories, calo-
ries from fat, and types of oils used in preparation) on menus or on
display cards. Many consumers might be surprised to learn that the
salad dressing added to a garden salad at a fast-service food restaurant
could supply the same number of calories as a roast beef sandwich
and trench fries but as much as 50% more fat, depending on the type
and amount of dressing used. It is important that consumers know
not only the total fat content but also the kind of fat contained in the
food. Managers of fast-service food establishments could also display
signs notifying consumers that they will prepare items in special ways
upon request (e.g., eliminating mayonnaise-based sauces).
Fast-service food restaurants enjoy great popularity. On any day,
20% of the U.S. population is estimated to consume their products;
young families with children are most likely to frequent these restau-
rants (ACSH, 1985), and three in five report they are worried about
the nutritional value of such food (Consumer Reports, 1988~. The
major incentives for making changes in the fast-service food industry
are similar to those for table-service restaurants. That is, the major
chains may benefit by increasing customer satisfaction, loyalty, and
sales. Fast-service food purveyors have less of a problem in implementing
changes than table-service restaurants do because their menus are
more limited and food preparation is more standardized. There is
evidence that health-promoting changes in fast-service food offerings
can be successful.
1 (A ~ ~
For example, the introduction of salads has met
with considerable success. At McDonald's, salads account for sales
of seven cents of every dollar (Consumer Reports, 1988~. Other examples
of newly introduced products include skinless grilled or baked chicken
in addition to hamburger, lower-fat hamburgers, low-fat or fat-free
frozen yogurt in addition to ice cream, and 1% or skim milk instead
of 2% or whole milk (NRA, 1990; Sugarman, 1990~. Confidence in the
success of such changes has led to new initiatives in this industry,
such as the development by McDonald's of a prominently displayed
listing of the ingredients and nutrient content of its offerings.
Restaurants and other meal providers should move toward 100%
vegetable shortening in all frying and should adopt other food prepara-
tion methods (e.g., reducing fat and salt content in trench fries) to
help consumers follow dietary recommendations. For fast-service food
chains, specific long-term goals should be set as a matter of company
policy. Some have already done so. In 1985, most major fast-service
OCR for page 161
PRIVATE SECTOR
161
food chains fried with an oil mixture containing beef fat (Jacobson
and Fritschner, 1986~. They have now shifted to vegetable oil for
frying (Food Chemical News, l990e; Sugarman, 1990~.
Representatives of the restaurant industry (e.g., the NRA) and the
managers and owners of restaurants should encourage schools that
train chefs and cooks to place greater emphasis on dietary recom-
mendations, and they should reward the schools that comply by hir-
ing their graduates. Restaurants could also help to defray (or-pay)
the costs of tuition for employees who take courses in nutrition and
new ways to prepare foods. Meals consistent with the principles of
dietary recommendations are not likely to become available in restau-
rants unless chefs and cooks understand the importance of these rec-
ommendations and how to implement them into their food selection
and preparation practices.
There are several successful models for this action. For example,
the Culinary Institute of America in Hyde Park, New York has in
corporated the principles of nutrition into its curriculum and runs a
public restaurant specializing in nutritious foods (CIA, 1990~. Diners
are provided with a computer printout showing the amounts of nutrients
in each course and the percentage of their meal that is fat, protein,
and carbohydrate. The American Culinary Federation Educational Insti-
tute has also incorporated a mandatory nutrition component into its
curriculum. Community college and technical schools should also
provide nutrition education to those planning to enter the restaurant
business.
Approximately 1,800 food-service operations in the United States
supply meals to businesses, schools, and other institutions. Among
these are a few national companies (e.g., ARA Services and Marriott),
which control much of the market. For example, Marriott's InFlite
Services (which it sold in late 1989) prepared approximately 150 million
meals a year for 150 different airlines (Gibbs, 1989~. These large
companies currently offer a line of health-promoting food alternatives;
for example, ARA Services has developed Treat Yourself Right, a nu-
trition education program that merchandises healthful eating at its
contracted facilities (Alice Smitherman of ARA Services, personal
communication, 1988~.
Food-service companies can do more to sell the benefits of health-
ful eating to their client companies. Benefits to these companies would
include increased sales to employees interested in health-promoting
food choices, employees' perception that the company cares about
their health, and the potential for savings in medical and other com-
pany expenses for employees who eat properly. Nutritionally desir-
able food items should be incorporated into the regular food-service
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162
IMPROVING AMERICA'S DIET AND HEALTH
program, thereby obviating the need for people to make a special
effort (e.g., stand in a special line) to obtain them.
Hospitals, voluntary health associations, local health departments
and government agencies, and other community-based associations
should enlist the help of food-service establishments to (1) develop
and advertise health-promoting food alternatives for the community,
(2) sponsor seminars for cooks and chefs emphasizing dietary recom-
mendations, and (3) sponsor tastings, food fairs, and contests, award-
ing and recognizing food-service establishments that support dietary
recommendations. Liaisons between restaurant chefs and dietitians
also can be successful (Renggli, 1986~.
Work Sites
An excellent opportunity for implementing dietary recommenda-
tions exists within the business world. Many companies maintain
restaurants, cafeterias, snack bars, or vending machines for their employ-
ees and provide special meals for meetings, employee recognition
events, and other occasions. Through these food-providing activi-
ties, they exert an influence on the eating habits of millions of U.S.
citizens. Work sites are, therefore, excellent channels for health pro-
motion efforts, including the provision of nutrition services and in-
formation (ADA/SNE/DHHS, 1986; Glanz, 1986; see also Chapter 3~.
According to a national survey of work-site health promotion ac-
tivities by the U.S. Department of Health and Human Services in
1985,66% of work sites with more than 50 employees had at least one
health promotion activity (DHHS, 1987~. Unfortunately, programs on
weight control and general nutrition education were among the ac-
tivities cited least often (in 15 and 17% of work sites, respectively).
Although few work-site health promotion activities have been for-
mally evaluated, most employers reported that program benefits out-
weighed costs; among the benefits cited in this survey were improved
health and productivity among their employees and reduced health
care costs.
Comprehensive health promotion programs have been established
at many work sites, although nutrition activities, if present, have
been low-cost, low-intensity programs aimed primarily at increasing
employee awareness and knowledge (ADA/SNE/DHHS, 1986; DHHS,
1987; Glanz, 1986~. Such programs are not designed to facilitate eat-
ing behavior changes, even though work sites offer the opportunity
for long-term interventions as well as environmental and structural
changes that can enhance educational messages and support individ-
ual behavior changes. Management might be reluctant to make a long
OCR for page 163
PRIVATE SECTOR
163
term commitment of resources to implement comprehensive programs
and to contract time with health-care professionals to implement the
educational programs, assist in the development of appropriate new
policies, and work with the food-service staff to improve the nutri-
tional quality of foods made available to employees.
The committee recommends that corporations provide authorita-
tive information to employees on the relationship of dietary practices
to health promotion arid disease prevention and promote dietary rec-
ommendations. Depending on their size and the resources at their
disposal, employers could provide this information to their employ-
ees through such means as classes, brown bag seminars, payroll stuffers,
newsletter articles, contests, posters, displays, articles in in-house
publications, and health-promoting menu offerings in company cafeter-
ias. Corporations should consider offering incentives to employees
who modify their dietary practices and consistently make health-pro-
moting food choices, and their executives should serve as models of
healthful eating. See Chapter 3 for a further discussion of nutrition
education programs at work sites.
Corporations should establish a corporate nutrition policy that con-
firms the company's commitment to healthy dietary practices consistent
with dietary recommendations and specifies that stated standards will
be applied to meals served in company food-service operations and at
company functions. Small corporations without policies should also
provide healthful meals at all opportunities, and those without food-
service operations should, at Me least, offer more fruits, vegetables, whole
grams, and low-fat, low-sodium foods in their vending machines.
NOTE
1. In 1980, FDA published voluntary guidelines for manufacturers to promote the
rational fortification of foods (Goyan, 1980). This committee supports those guidelines
and encourages manufacturers and processors to comply with them. According to
FDA, fortification is appropriate (1) to correct a dietary inadequacy recognized by the
scientific community to result in a deficiency disease; (2) to restore nutrient levels to
those present in a food before conventional processing and storage; (3) to balance the
protein, vitamin, and mineral content of the food in relation to the calories it supplies;
and (4) to ensure that a substitute food is nutritionally similar to the traditional food it
replaces (NRC, 1989; Quick and Murphy, 1982). FDA does not consider it appropriate
to fortify fresh produce; meat, poultry, or fish products; sugars; or snack foods such as
candies and carbonated beverages.
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Representative terms from entire chapter:
nutritionally desirable
