2013 cia hsph menus of change full report tas

7/27/2019 2013 CIA HSPH Menus of Change Full Report TAS

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Menus of Change: An Overview 3

Executive Summary 5

Dashboard 7GPS: A Model for Change 10

Green Shoots: Delicious Signs of Change 11

Nutrition, Health, Sustainability, andFood Ethics: Science and Policy Highlights 13

Demographics and Consumer Preferences:Issues, Trends, and Changing Appetites 24

Business Imperatives: The Changing Calculus on Costs,Risks, and Opportunities 29

Principles of Healthy, Sustainable Menus:Executive Summary 33

Culinary Insight: Voices of Chefs and Operators 35

Business Analysis: The Art of the Possible and Protable 38

Marketing Perspectives: The Selling of Delicious, Healthy,Sustainable Food Choices 42

Principles of Healthy, Sustainable Menus 44Further Resources 48

Scientic and Technical Advisory Council 49

Sustainable Business Leadership Council 50Credits 51

Co

ntents

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I. Menus o Change: an overvIew

ood Matters. thIs Isa long-held belIe andpassIon o ours, and oChes and busIness leadersthroughout aMerICanoodservICe.

Fifty years ago, most people ate at home andrestaurants were largely about special occasions;our industry was much smaller and our challengewas to delight our customers with memorablefood and hospitality. Our collective businesssuccess has long been tied to reimaginingthe elemental role that food plays in our lives,including nurturing relationships and buildingcommunity. In many respects, that is still whatdrives innovation and growth in our industry, evenas chefs, entrepreneurs, and business leadersnd themselves operating today on a very

different playing eld. As the sector has grown

to $660 billion in revenues and consumers haveincreasingly turned to chefs to do the cooking,the impacts of away-from-home food choiceshave also grown.

The fact of the matter is that chefs now areresponsible for everyday meals, not justcelebrations. Indulgence is still part of their

creative process, but they must now alsothink about the health and well-being of theircustomers and help them follow their aspirationsfor a more balanced diet, rich in nutritious foodsthat are sourced consciously. This includescustomers buying prepared foods at thesupermarket, on-the-go lunches near work,or family meals at their favorite restaurant. Atthe same time, chefs are called upon to beeducators, advocates, and guides through thecomplexities of our food system; they mustbe informed about key issues so that they caneducate their customers who increasingly lookto them to help when deciding what to buy and

what to eat. Chefs matter.

A host of imperatives have reshaped howwe view the scope of our concerns and

responsibilities. From the pressing issues ofobesity and diet-linked healthcare costs tothe plethora of values and ethical views of ourcustomers, our business has clearly changed. Aswe look to the future, with increased competitionfor declining resources, rising global populations,upward pressures on food costs, seismicchanges in demographics, and more, its obviousthat business models and strategies will need tobe adjustedin some cases, substantially.

With the launch of our new Menus of Changeinitiative, a partnership with Harvard School ofPublic HealthDepartment of Nutrition, we

are calling on chefs and industry leaders tohelp foster this change and to move beyondsometimes reactive, short-term businessplanning to a more integrated, proactive,forward-looking planning framework thatacknowledges our need to continually reinventourselves and our businesses in anticipation ofan ever faster pace of change ahead.

At the CIA, thought leadership and socialresponsibility are now as much a part of who weare as our commitment to advancing the culinaryarts and technical standards of excellenceacommitment we reafrm every day when both

educating tomorrows leaders and collaboratingwith todays decision-makers to further ourindustry. These are not separate concerns. Tobuild a next generation of food choices andfoodservice concepts that truly embrace health,sustainability, food ethics, and an acceleratingdiversity of consumer preferences, we needto spark more creativity and culinary insight inthe form of successful business strategies thatcenter around the best tasting food we canpossibly produce and prepare.

From the consumers perspective, taste andthe food experience trump nearly all else,

and therefore should be at the core of whatdrives innovation. Efforts to inspire new menudevelopment, and advance public health andlighten our environmental footprint, will fail ifcustomers dont nd whats on their plates to

be delicious, even craveable. That deliciousnessstarts at the source, and we must cultivate it atevery stage of production, all the way to the plate.

We invite you to join our table, and this Menus ofChange dialogue about the future of food. Cometaste with us, explore the avors that are going

to redene professional cooking, and add your

voice to how we should be thinkingcarefully,

comprehensivelyabout whats ahead, ve, 10,and 20 years from now.

In 2050, when world population will swell tonine billion, this years bright, young culinarygraduates will be rmly established in leadership

positions in our industry. Lets work togethertoday to forge out of the dark clouds ofcurrent challenges a new and bright horizon ofopportunityand new vectors of creativity andinnovationthat truly secures their future, andthe future of our industry.

Dr. Tim Ryan

PresidentThe Culinary Institute of America

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welCoMe toMenus oChangeAmericans have never been more concerned aboutwhat to eat. And yet, more of us are asking chefs and

the foodservice industry to make more choices, moreoften, about what ends up on our plates. Today, 48

percent of consumer food dollars are spent on foodprepared in restaurants.

Those choices affect not only whats for dinner.They affect public health, the environment, culinaryculture, and the protability of dining establishments.

Long-term trends, ranging from rising rates ofobesity to climate change, already are reshapingopportunities and costs for the industry, from thelargest foodservice and restaurant groups to small,independent eateries.

The good news is that the latest ndings about whatto eat from both public health and environmentalscience research are now converging with businessneeds and opportunities. Serving less meat, forinstance, can help improve diners health, reduce thelevel of greenhouse gases and pressure on limitedresources such as water, and, if done carefully,enhance restaurants bottom lines.

The Menus of Change initiative, a partnership of TheCulinary Institute of America and Harvard Schoolof Public HealthDepartment of Nutrition, aims todo the essential, difcult, and unprecedented work

of integrating the latest ndings from both nutrition

and environmental science into a single set ofrecommendations to help foodservice and culinaryprofessionals make better choices and successfullynavigate the rapidly changing landscape

This annual report is a part of that mission. It aims toadvance a long-term, practical vision that integratesoptimal nutrition, environmental stewardship andrestoration, and social responsibility within thefoodservice industry. It represents a GPS to guideyou through the key issues that face the foodservicecommunity, and includes recommendations forimproving business performance. It also provides adashboard to show the progress the industry hasmade over the past yearwhere it is moving fast and

where it needs to make greater efforts. The indicatorson the dashboard will help businesses to evaluatetheir own efforts in the areas that matter most. Forculinary professionals and R&D teams, there alsois a comprehensive set of principles to guide menudevelopment and design.

Along with the report, the Menus of Change initiativehosts an annual leadership conference for food-industry executives, culinary leaders, investors,entrepreneurs, and change makers to fostercollaboration and speed progress in critical areas.It also informs educational programs for workingchefs and culinary students at The Culinary Instituteof America, and offers a platform to bring togetherculinary and investment professional to promoteinnovation in healthy and sustainable food concepts.

All of this work is supported by the energy, vision, andeffort of two remarkable groups: the CIA SustainableBusiness Leadership Council, made up of forward-thinking executives and chefs, investors, and changemakers, and the CIA-Harvard Science and TechnicalAdvisory Council, which brings together leadingscientists and other experts working in the areasof nutrition, environment, food and agriculture, andbusiness and management. Over the next severalyears, these two councils will continue to meet inan ongoing effort to help the industry sharpen itsfocus on the issues where it can make the greatestdifference and combine rapidly evolving science andbusiness imperatives to provide clear guidance to theprofession.

The CIA and Harvard School of Public Healthinvite businesses to use this report to measuretheir progress and to navigate new and complexchallenges. Not all culinary professionals and

foodservice companies will take the same pathforward. But most increasingly have a similar goal:to create and grow successful businesses servinghealthy, sustainable, and delicious food.

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II. exeCutIve suMMary:a taste o whatsto CoMe

Tens of thousands of publications have,perhaps ironically, made it incredibly complicatedfor the average eater to read, interpret, andsynthesize this vast body of knowledge intouseful guidelines.

people. planet. proIt. the trIple bottoM lIne Is theholy graIl or 21st Century busInesses. but orrestaurants and oodservICe, the quest to both dogood and grow Can seeM quIxotIC: gIve the peoplewhat they want and theIr health May suer, orMan Cannot thrIve on a dIet o burgers, pIzza, rIes,and soda. but gIve theM what Is healthy, loCal, andsustaInable and the busIness May or May not survIve.

The Menus of Change report is designed to help foodservice and culinary professionals balancecompeting priorities and make the hard choices that will allow them to continue to ably servetheir customers, grow their businesses, and tackle key health and environmental imperativeswell into the future. It surveys the culinary and business landscape, highlighting the latestinnovations and proling companies in food production, distribution, and foodservice that have

made healthy, sustainable food an ingredient for success. The report also includes commentaryfrom a select, diverse group of chefs and restaurant operators about what challenges andopportunities they believe the future holds.

The centerpiece of Menus of Change is a concise analysis of 13 issues that sit at the intersectionof public health, the environment, and the business of food. These summaries synthesize thelatest health and environmental data to provide a clear picture of the industrys challenges andopportunities, as well as practical next steps for foodservice operations. The report also assignseach issue a score that rates the i ndustrys efforts in these critical areas. These scores arefeatured in a summary dashboard on page 7. Menu of Changes scores will be updated annuallyso that executives, entrepreneurs, and food-reform advocates can see at a glance where

progress is being made and where there is still work to be done.

aMong the Issues Covered are:

Protein Consumption and Production:

For the rst time, Americans are eating less meat. Between 2011 and 2014, U.S. beef

consumption is expected to decline by more than 12 percent. This may result in a small boostfor health in the United States. But the growing demand for meat in the developing world means

that intensive production will continue to adversely impact the environment. Chefs shouldcreate and market new and delicious plant-centric foods, feature meat in smaller portions lessfrequently, and focus innovation on the menu value proposition.

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Fruit and Vegetable Consumption and Production:

More than 90 percent of American farmland is planted with

commodities such as corn and soybeans, rather than the

fruits and vegetables that need to be more central to our diets.

The average American eats just 1.6 servings of whole fruits

and 1.4 servings of whole vegetables, less than half of whats

recommended: enough to ll half our plates. Chefs should

not feel constrained to exclusively support local growersin

some cases, produce grown farther away can have a lower

environmental impactbut they should work with well-

managed farms and distributors to incorporate more produce

into seasonal menus.

Fish, Seafood, and Oceans: Overshing is rampant in the

vast majority of the worlds sheries. But pushing sh from

the plate is not the answer. Chefs must expand choices

beyond the usual shrimp, salmon, tuna, and white shes in

favor of a wider variety of sh from responsibly managed wild

sheries and aquaculture facilities and use their inuence to

persuade diners to try new species that reect what the ocean

ecosystem can sustainably provide.

Climate Change: More intense and frequent weather

swings will bring unprecedented challenges to the farming

community and, as a result, the foodservice industry. Chefs

must work to source ingredients from farmers who use

sustainable practices, as well as prioritize low-carbon foods

on their menus. Chefs also must work to reduce their own

environmental impact, as foodservice facilities have the

highest energy intensity per square foot among commercial

buildings in the United States.

Supply Chain Transparency and Resiliency:The

efcient global food chain has successfully kept food cheap

in the United States, but signs of strain are beginning to

show. Severe weather and consumer panics over deadly

bacterial outbreaks and mislabeled meat and seafood have

cost millions of dollars and shaken, perhaps irrevocably,

consumers faith in the system. Foodservice operators mustembrace technology, such as mobile data collection, to ensure

a safe and steady supply of food.

Finally, Menus of Change provides comprehensive guidance

for menu design that supports the triple bottom line. The

Principles of Healthy, Sustainable Menus outlined here

feature essential culinary strategies tied to sourcing, avor

insight, portion size, calorie quality, and more that are needed

to increase the likelihood of success of new business models.

Together, they point to a clear path to a new, more sustainable

future for the culinary and foodservice sector.

state of

the plateHow are we doing? Sometimes its hard to tell. The Menus of

Change dashboard on the next page provides a snapshot of

the foodservice industrys recent progress to improve nutrition,

sustainability, and protability. Its scores on critical issues that

affect the foodservice industry will be updated annually to

show where progress is being made. It also creates a set ofstandards, which are designed to be used by businesses to

judge their own efforts on sustainability.

dashboard sCore Key:The scores assigned to each issue indicates progress or lack

thereof in the food industry and/or culinary profession over the

last 12 to 18 months, as follows:

1: sIgnIICant deClIne or regress

2: gettIng better, but ar roMwhere It needs to be

3. no sIgnIICant progress

4. good progress, wIth rooM or More

5. sIgnIICant progress

MethodologyThe scores were developed based on the expert opinions of the Menusof Change Scientic and Technical Advisory Council, who considered

new research ndings and trend data as well as innovations and change

in business practices and policies, and were reviewed by members of theSustainable Business Leadership Council to ensure they reected new

industry initiatives and practices.

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4MENU

SOFCH

ANGE

SCOREISSUE JUSTIFICATION

D

ASHBO

ARD

Modest improvements towards healthier diets include a large reduction in the intake of

trans fats, a small reduction in sugar-sweetened beverages, and increase in whole fruits

and whole grains.

Red-meat production and consumption in the United States is falling for the first time.

Menu innovation is a contributor to progress.

Foodservice companies understand the importance of change, but implementation

remains slow, and consumers remain unsure of how to make smart choices.

The prevalence of food insecurity nationally has risen over the last decade and remains

stagnant. The food industry should do more among the sectors very large workforce.

Modest but insufficient progress to date on food waste reduction and increased

plant-centric menu innovation, but global supply chains remain brittle.

Innovative programs are starting to link healthcare and healthy eating. But the

connection is far from universal and more education is required.

Awareness is growing and important innovations are underway, but most meat still

comes from industrial farms where conditions are not aligned with consumer ethics.

Increased sales of locally grown foods demonstrate progress, but the U.S. food system

must dramatically change to meet population-wide health and sustainability imperatives

and support consumer aspirations for more local and regional flavors.

Consumers remain confused by basic definitions of healthy and sustainable.

Consumers need to understand that choosing better ingredients is only a partial

solution, along with changes to what and how much to eat.

Chefs are very engaged in the movement for sustainability. But there needs to be addi-

tional focus on portion size, nutrition, and public health.

Supply chains remain opaque with serious consequences, including a growing consumer

suspicion that some foods are not safe.

There is much experimentation, but dynamics that propel active capital investments are

still new and evolving.

Food companies have made improvements in defining and disclosing sustainability

challenges and opportunities. Investors still see significant risk, particularly with regard

to resource constraints.

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O

UR

VISIO

NNUTRITIOUS AND

HEALTHY

OUR VISIONENVIRONMENTALLYSUSTAINABLE

DELICIOUSCULINARY AND

CULTURAL APPEAL

SOCIALLY RESPONSIBLE

AND ETHICAL

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O

UR

VISIO

N

INTEGRATED GUIDANCE FORBUSINESS AND CULINARY LEADERS

THE FUTURE OF FOOD

HEALTHY, SUSTAINABLEAND DELICIOUS

BUSINESS MODELSAND STRATEGIES

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GPS: A MODEL FOR CHANGE

RISK &OPPORTUNITY

ANALYSIS

SUCCESSFULCHANGE

CURRENT BUSINESSSTRATEGIES AND

MENUS

COST ANDECONOMIC TRENDS

PUBLIC HEALTH &

NUTRITIONSCIENCE ISSUES

AND IMPERATIVES

ENVIRONMENTALSCIENCE ISSUES

AND IMPERATIVES

INTEGRATION OFPUBLIC HEALTH &ENVIRONMENTAL

FINDINGS,TRENDS AND

DRIVERS

VALUES, ETHICSAND CONSUMER

PREFERENCES

SHAPINGCONSUMER

PREFERENCES /LEADING

THE MARKET

CULINARYINSIGHTS

BUSINESSINSIGHTS

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III. green shoots:delICIous sIgns oChange

The reduction in trans fats probably has beenthe main factor responsible for a reductionin bad cholesterol and an increase in goodcholesterol in U.S. children and adults.

the ood Industry Is In a perIod o reMarKableInnovatIon. taKIng the long vIew, soMe o Itslast Major InnovatIons were IMpleMentIng the barCode and walKIng up to a Counter to plaCe anorder. More reCently, the Industrys oCus has beenpaCKagIng, wIth bloCKbuster produCts lIKe lunChablesor go-gurt.

But now, driven by concerns about health, sustainability, resource scarcity, and growingconsumer interest in where food comes from, the food industry is devising products and

services to satisfy consumer demands to protect public health and the planet. Today products,companies, and concepts exist that would have been impossible to imagine even a decade ago.

According to the research rm Technomic, 50 percent of consumers say they want to seehealthier dishes in restaurants. Fast-casual concepts like Native Foods Caf and Veggie Grillare answering that call. Both are 100 percent vegan and offer plenty of fruits and vegetablesas well as soy proteins, such as seitan and tempeh, which they use for meatball subs andchipotle barbecueitems with plenty of crossover appeal. Launched in Palm Springs in 1994,Native Foods Caf now has 14 locations, while Veggie Grill doubled its number of restaurants in2012, from eight to 16 and plans to double its size again over the next year. Larger chains likeThe Cheesecake Factory, Red Robin Gourmet Burgers, and Burger King also are innovating inresponse to consumer eating habits and rising prices, and adding burgers made from poultry,sh, and plants.

Others are looking to the sea for innovative food sources. ngel Len, chef-owner of Aponiente

in Cadiz, Spain, uses plankton to add umami to meat-free dishes like risotto, which hemakes without butter or cream. For packaged foods, California company Solazyme RoquetteNutritionals has unveiled a commercial algal protein, which it grows in dark, commercial vatsthrough a process called heterotrophic fermentation. The result is a sustainable, vegan, non-allergenic substance made up of 50 percent protein, 20 percent dietary bers, and 10 percenthealthy lipids, plus micronutrients and minerals. Aurora Algae is also racing to commercialize analgal protein. It is building a commercial plant i n Western Australia where, via photosynthesis, itwill grow a strain that feeds on nothing but sunlight and waste carbon dioxide.

Growing at a rapid clip is Revolution Foods, a p ioneer in bringing real foodno high fructosecorn syrup, no additives, preservatives, or hormonesto school lunches. Kristin Richmond andKirsten Tobey conceived the company when they were students at the Haas School of Businessat the University of California at Berkeley. They launched their rst pilot program in 2006,replacing greasy rectangular pizza with meals like roasted chicken with yams, beans, and alocally grown peach. Today, Revolution Foods serves one million meals a week in more than 850

schools for prices only slightly higher than what it costs to serve typical school lunch fare.

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Where possible, Revolution Foods sources locallyand sustainablyand no wonder. Locally sourcedand environmentally responsible foods took threeof the top ve spots on the National Restaurant

Associations 2013 Whats Hot list. Chipotle

pioneered local and sustainable sourcing at scale;upstart chains like LYFE Kitchen and True FoodKitchen are following its lead, as are big companieslike Dardens Seasons 52 restaurants.

SweetGreen, a salad-and-frozen-yogurt concept thatbegan in Washington, D.C. and has expandedup the East Coast, sources 20 percent to 45 percentof its ingredients locally, depending on the time ofyear. Its new line of cold-pressed juices, dubbedSweetpress, includes one called Seasonal, a bl endof watermelon juice, coconut water, lime, and mint.Food companies and chefs increasingly turn tointriguing avor combinations to attract consumers.

Foodpairing, a Belgian company that is helpingcutting-edge chefs like Heston Blumenthal and DavidKinch come up with tempting avor matches, has

developed software around ingredient combinations.For example, if a chef types in cucumber, theprogram shows an interactive visualization ofcombinations that can pair well with that vegetable,such as mango, barramundi, pita chips, olive oil, andborage. It offers the potential to develop p lates thatuse less meat, with positive results for the planet anddiners health. For a similar service, larger restaurantgroups and food manufacturers can turn to FoodGenius. The Chicago-based startup mines industrydata to help companies gure out what to make, how

to package it, market it, and how much they can charge.

Almost as important as what goes on the plate iswhat gets thrown away. Companies are sproutingaround the country to pick up and process kitchengrease into biofueland they are paying restaurantsfor the privilege. Firms such as EnviRelation and

EcoMovement are hauling away food scraps forcomposting.

No longer forgotten are the workers who produce ourfood. The Coalition of Immokalee Workers, a groupthat represents Florida tomato pickers, has grabbedheadlines for making deals with companies includingChipotle, Taco Bell, Burger King, and McDonalds.Less well known are efforts like those of the EquitableFood Initiative, comprised of major food buyers suchas Costco, growers, and farmworker groups. Thegroup is currently drafting standards for workingconditions, pesticide use, and food safety, which willbe used to certify growers and their food.

Taken together, this new set of 21st century valuesand economic incentives have created a restaurantand foodservice industry as dynamic as any in history.

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Iv: nutrItIon, health,sustaInabIlIty,and ood ethICs:

sCIenCe and polICyhIghlIghtsthe ollowIng serIes o essays suMMarIzes theCoMplexIty o nutrItIon and envIronMental sCIenCeto provIde Clear guIdanCe or CulInary proessIonalswho hope to oer healthy and sustaInable ChoICes.thIs seCtIon also looKs at natIonal eConoMIC trends

that suggest new ways the ood Industry CanposItIvely IMpaCt publIC health.

dIet and health:reCent trendsOver the last several decades, researchers have exhaustively studied the relationships betweenwhat we eat and our health, in particular diseases such as cardiovascular disease, cancer, andtotal mortality. This has included experiments in animals; controlled feeding studies in humanslasting for several weeks among a few dozen subjects; large epidemiologic studies with several

decades of followup, and a limited number of randomized trials in humans. While some of thesestudies have been enlightening, the resulting tens of thousands of publications have, perhapsironically, made it incredibly complicated for the average eater to read, interpret, and synthesizethis vast body of knowledge into useful guidelines. And so another wave of papers werepublished to review the literature and develop conclusions. But many of them also had limitationsas a result of gaps in the scientic literature, which remains a work in progress, the limited

perspectives of some of the committees, and sometime conicts of interest.

One of the most inuential review processes has been the U.S. Dietary Guidelines, which is

intended to provide guidance to individuals, institutions, and federal policies related to food.Mandated by Congress, the United States Department of Agriculture updates it s guidelines every

ve years. It also created the Healthy Eating Index (HEI), a scoring system that can be used to

rate the diets of individuals or the menus of foodservice operations based on adherence to itsguidelines. In 1995, however, researchers at the Harvard School of Public Health were concernedthat the U.S. guidelines were inconsistent with the best available scientic evidence.

More than 90 percent of American farmlandis planted with commodities such as corn andsoybeans, rather than the fruits and vegetablesthat need to be more central to our diets.

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They decided to use data on dietary intakes reportedby over 100,000 men and women to determinewhether those who adhered most closely to thefederal guidelines had lower risks of cardiovasculardisease, cancer, and other major chronic diseases,compared to those who adhered less well. Althoughthis would seem to be a minimal criterion for dietaryguidelines, this was the rst time any guidelines

had been evaluated this way. Disappointingly, afteraccounting for tobacco use, physical activity, andother factors, there was little relation between

adherence to the Dietary Guidelines and the risk ofmajor chronic disease. Thus, these investigatorsdeveloped an alternative Healthy Eating Index (aHEI)

based on the best available published literature,taking into account ndings from short-term studies

in humans of the effect of different diets on bloodcholesterol fractions and other risk factors andalso long-term prospective epidemiologic ndings.

Emphasis was given to ndings that were supported

by both types of evidence.

Using the same populations in which the HEI

had been evaluated, the Harvard investigatorsdocumented that better adherence to its own

alternative index did predict lower risk of majorchronic disease. This nding was conrmed in other

large populations. During subsequent ve-year

updates, the U.S. Dietary Guidelines have evolved to

be closer to Harvards alternative index. But becausescientic evidence has continued to accumulate,

the Harvard group updated its guidelines as theAlternative Healthy Eating Index 2010 (AHEI 2010),

and has recently published an analysis examiningboth the USDA HEI 2005, the most recently

available, and the AHEI 2010 in relation to risk ofmajor chronic diseases. As expected, the scoreswere strongly correlated. Now adherence to bothpredicted better health outcomes, although the AHEI

2010 did so somewhat more strongly.

For the Menus of Change process we haveelected to use the elements of the AlternativeHealthy Eating Index 2010 as the primary focusfor evaluating healthfulness of diets. These haveconsiderable overlap with the USDAs criteria but

tend to be more intuitive, and also most directlysupported by evidence. (For example for political

reasons the USDA refers to added sugar and the

AHEI refers to soda and other sugar-sweetenedbeverages; the USDA refers to solid fat and the

AHEI refers to red meat and dair y fat). As noted,

the AHEI 2010 was a stronger predictor of health

outcomes when all elements were combined.

Notably, the elements of the AHEI 2010 closelyresemble those of the traditional Mediterraneandiet, which has been associated with lower risks ofmany adverse health outcomes. In many respects,the Mediterranean diet serves as a gold standard.But understanding of the key elements allows itsprinciples to be incorporated in diets of many avors

and nationalities.

dIvergenCe o sCIenCe roMConventIonal belIes

Conventional wisdom is often awed, and the widelyheld beliefs about healthful eating are no excepti on.The Harvard Alternate Healthy Eating Index ratesdiets based on science with which some may not befamiliar. Several topics in particular merit explanationbecause of their divergence from commonly heldbeliefs:

1. Low fat is not an appropriate diet goal.

Low-fat diets were all the rage in the 1980s and1990s. But new, strong evidence has shown that it is

the type of fat in t he diet, rather than the percentageof total fat, that is linked to heart disease. Moreover,low-fat diets are not effective for long-term weightcontrol. Specically, the AHEI recommends thattrans fats from partially hydrogenated vegetable oilsbe avoided, and unsaturated fats f rom vegetableoils should be used to replace saturated fat whenpossible. Saturated fat itself is similar to mostcarbohydrates in its relation to heart disease, andreplacing it with carbohydrates has no benet andcan be harmful if those carbohydrates are rened

starch or sugar.

2. Lean cuts of red meat are not the answer.

Reducing saturated fat is not benecial ifreplaced by carbohydrates, but replacement withunsaturated fats will have multiple health benets.Therefore, simply reducing the fat content of redmeat likely will have minimal benets because thisis often replaced by calories for rened starchesand sugar. Moreover, other evidence suggests thathigher intake of red meat, irrespective of its totalfat content, increases risks of heart disease anddiabetes if compared to poultry, sh, eggs, nuts,

or legumes. Environmental assessments lead tosimilar conclusions about protein choices: Selectingbetter types of red meat or eating nose to tail arenot the best choices because red meats have anoutsized impact on the land, water, and climatecompared to poultry, sh, and plant-based proteins.

Table 1 illustrates the greenhouse-gas emissionsassociated with several common proteinsources and is a good indicator of environmentalimpact including energy and chemical use, soilmanagement, and mechanical irrigation. Both publichealth and the environment will improve if restaurantsdecrease the amount of red meat on menus andreplace them with alternative protein sources.

3. Contamination and environmental risks

should not deter consumption of seafood. A

recent report that sh, specically farmed salmon,had been contaminated by industrial chemicalstriggered a widespread scare that led many peopleto reduce their consumption of sh. But there was

no evidence that the amounts of the chemicalsfound were enough to cause human disease.

Some species of sh, such as tilesh and tuna, docontain mercury, mainly from natural sources, andthese sh should not be consumed by pregnant orlactating women. However, the risk derived f romtheoretical calculations is vastly outweighed by thebenets of eating seafood. It is extremely importantthat pregnant women do not avoid sh in generalbecause a generous intake of Omega-3 fatty acidsis needed for neurological development of thefetus. Reports about overshing and damagingaquaculture practices also have put some people offseafood. But the worries generally concern a handfulof popular commercial species such as tuna, cod,salmon, and shrimp. Eating a wider variety of shspecies, both wild and farmed, is a simple measurethat would go a long way towards maintaining ahealthy diet and addressing environmental concerns.

5

10

15

20

39.2

13.6

14.1

27.0

10.4

9.6

5.4

13.512.1

11.9

6.9

4.8

2.0

2.82.0

0.9

0.81.0

1.9

3.85.8

4.84.5

7.0

2.9

2.23.1

3.8

2.4

2.3

1.6

4.7

3.4

LAMB

BEEF

CHEE

SE

PORK

SALM

ON

CHICKEN

EGGS

TOFU

DRYBE

ANS

MILK

LENTIL

S

Estimated GHGEmissions/KG ofProduct

Table 1

Estimated GHGEmissions/1000

Calories of Product

Estimated GHG

Emissions/100gProtein of Product

Table 1 Greenhouse Gas Emissions for Select Protein SourcesBased on data from Clean Metrics / Environmental Working Group, Meat Eaters Guide, Methodology, 2011. Estimates of GHG production for total lifecycle,from farm to table. These are estimates of typical or average GHG production, and this can vary substantially for each type of protein source depending ondetails of production methods. Note: The GHG production is best expressed per calorie or protein, rather than per kilogram, because some foods, such asmilk, are mainly water.

*Calorie Reference: USDA National Nutrient Database for Standard Reference, Release 25: Energy (kcal) Content of Selected Foods per Common Measures,https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25a208.pdf

**Protein Reference: USDA National Nutrient Database for Standard Reference, Release 25: Energy (kcal) Content of Selected Foods per Common Measures,https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25a203.pdf

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Vegetables:Vegetable consumption has beenassociated with lower risk of cardiovascular disease,in part because vegetables are a major source ofpotassium, which reduces blood pressure, but othercomponents may also contribute to this lower risk.

The relation with vegetable consumption and cancerrisk is much weaker than previously believed, butsome modest benet is likely for specic forms ofcancer. Potatoes (including baked, mashed, andfrench fries) are not included as a vegetable becausethey are a major source of starch and have not beenassociated with lower risk of chronic disease inepidemiologic studies and also are associated withincreased risk of diabetes.

Whole Fruits: Fruit consumption has beenassociated with lower risk of cardiovascular diseaseand some cancers. The AHEI included only wholefruit in our denition, as fruit juice is not associatedwith lower risk of cardiovascular disease or cancer

and may increase risk of diabetes.

Whole Grains: Greater consumption of wholegrains is associated with lower risk of cardiovasculardisease, diabetes, and possibly colorectal cancer.Conversely, rened grains are not associated withlower risk, and may increase risk of diabetes,coronary heart disease, and other chronic diseases.In calculating whole-grain intake, the AHEI usesgrams of whole grains, which accounts for thevariability of the percent of whole grains in a range ofwhole grain products.

Nuts and Legumes: Nuts, legumes, and vegetableprotein (e.g., tofu) are important sources of

protein and contain important constituents suchas unsaturated fat, ber, copper, magnesium,plant sterols, and other nutrients. Nuts and othervegetable proteins have been associated with lowerrisk of cardiovascular disease, especially when usedas a substitute for other protein sources, such asred meat. Nuts are also associated with lower ri sk ofdiabetes and weight gain.

Fish (EPA + DHA): One or more servings of shper week, specically species high in long-chain(n-3) fatty acids EPA + DHA, is strongly protectiveagainst fatal cardiac arrhythmias and sudden cardiacdeath. This also may lower the incidence of other

cardiovascular diseases.

Polyunsaturated Fat: Replacing saturated fatswith polyunsaturated fats leads to positive changesin blood cholesterol fractions, is associated with alower risk of coronary heart disease, and may lowerrisk of Type 2 diabetes. In contrast, a low-fat diet has

had no benecial effects on cardiovascular-disease

risk factors, lipid prole or blood p ressure, and

did not reduce the risk of cardiovascular disease,breast cancer, colon cancer, or total mortality.Monounsaturated fats also have benecial effects on

blood lipids. In practice, replacing saturated fats withpolyunsaturated and monounsaturated fats meansusing liquid vegetable oils instead of butter, lard, orpartially hydrogenated fats wherever possible.

Trans Fats:Trans-isomers of fatty acids, formedby partial hydrogenation of vegetable oils toproduce margarines and vegetable shortening, areassociated with higher risk of coronary heart diseaseand diabetes. Fortunately, use of these has beengreatly reduced. The AHEI recommends that partiallyhydrogenated fats be avoided completely.

Red and Processed Meat: Consumption of redmeat and processed meat is associated with greaterrisk of coronary heart disease, especially whensubstituted for nuts, poultry, or sh. Red meat and/

or processed meat are also associated with higherrisk of stroke, diabetes, and colorectal and othercancers, and total mortality. The greater risks ofcardiovascular disease are mediated in part by thehigher amounts of saturated fat and cholesterol in redmeat, but other factors are also likely to play a role.

Sugar-Sweetened Beverages: Intake of sugar-sweetened beverages, including soda and fruitdrinks, is associated with increased risk of weightgain and obesity, cardiovascular disease, diabetes,and gout. The AHEI included intake of fruit juice inthis category, given the positive association withrisk of diabetes, and lack of benecial effects on

cardiovascular disease or cancer, as has been seenfor whole fruits.

Sodium: High sodium intake increases bloodpressure, and salt-preserved foods are associatedwith greater risk of stomach cancer, cardiovasculardisease, and total mortality. Further, sodium-reduceddiets signicantly lowered the risks of high blood

pressure and cardiovascular disease in clinical trials.Reductions in sodium intake to 2,300 milligrams perday as recommended by the USDA would prevent a

large number of new cases of cardiovascular disease.

dIetary aCtors not InCludedas IndICators

1) Alcoholic Beverages: Strong evidence indicatesthat moderate consumption of alcoholic beveragesreduces risk of heart disease and diabetes. However,even at these moderate levels, risk of breast cancer

is increased, and alcohol consumption increasesrisk of trafc injuries and abuse. Because of thesecompeting risks and benets, which depend in part

on age and family history of alcohol dependence,this topic was deemed too complex to be useful asan indicator of diet quality for an overall population.

2) Coffee and Tea:The health effects of thesebeverages have been studied extensively, and theyare safe and good alternatives for sugar-sweetenedbeverages. Some health benets have been seen for

coffee, especially a reduction in risk of diabetes. Butbecause coffee intake is often limited by side effectsof caffeine, and tea seems to be neutral with respect

to health, they were not included as indicators.

3) Milk, Cheese, and Other Dairy Products: Milkhas been widely promoted as essential for adequatecalcium intake and bone health. However, the basisfor the calcium requirements in the United States

is dubiousthey are much higher than the WorldHealth Organizations denition of adequate intake

and recent studies do not show any reduction inbone fractures with high dairy consumption. Also,high consumption of dairy products puts largeamounts of saturated fat into the food supply. Forthese reasons, greater consumption has not beenincluded as an indication of higher dietary quality.

Although there is not sufcient reason to promote

higher consumption of dairy products in generalfor health reasons, moderate consumption ofone or two servings a day can add variety andavor to diets and may contribute to diet quality,

depending on the other aspects of a personsdiet. Consumption of cheese has been increasingdramatically over the last several decades in theUnited States, becoming almost de rigueur in salads

and sandwiches. This provides large amountsof sodium along with less healthy fats and manycalories. Smaller amounts of cheese and use ofalternative ways to add avor and variety to these

foods would be desirable. Recent data suggestthat consumption of yogurt may be associatedwith reduced weight gain, and this deserves furtherinvestigation. Of particular concern are the largeamounts of sugar added to milk and many yogurts.Minimizing added sugar and using the natural avor

of yogurt to advantage should be a goal.

IndICators o dIetary qualItyThe elements of the AHEI 2010 are described below, each with a brief scientic rationale. The scientic literature on each of these is large, and a more extensive discussion of these topics is beyond

the scope of this report. The indicators are discussed in more detail and with additional references on the Harvard School of Public Health website, Nutrition Source (www.nutritionsource.org).

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25

27

29

31

33

35

37

39

41

43

45

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

Figure 1: Total dietary quality score measured by the AHEI-2010 among participants aged 20 yearsor older with different genders by NHANES study period.

Figure 1Alternative HealthyEating Index (AHEI)

AHEI without trans-fatcomponent

TotalDie

taryqualityscore

Figure 2

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

2

3

1

4

5

6

DietaryQualityScore 7

8

9

10

11

Figure 2: Dietary quality scores for each AHEI-2010 component among participants aged 20 years or older by NHANESstudy period.

Vegetables Fruit Nuts andLegumes

Red/ProcessedMeat

Trans-FatSugar-SweetenedBeverages andFruit Juice

WholeGrains

Figure 3

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

500.0

1000.0

1500.0

2000.0

2500.0

3000.0

TotalEnergyIntake(k

cal/day)

Figure 3: Energy intake among study population by NHANES study period for adultsage 20 years and older

All Male Female

Figure 4

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

All Male Female

BodyMassIndex(Kg

/M2)

27.40

27.60

27.20

27.80

28.00

28.20

28.40

28.60

28.80

30.00

30.20

Figure 4: Age-adjusted body mass index among participants aged 20 years and older withdifferent genders by NHANES study period.

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tIMe trends In Key dIetaryIndICators

In an effort to judge whether American diets arebecoming more healthful for this report, investigatorsfrom the Harvard School of Public Health appliedthe standards established in the Alter native HealthyEating Index to national survey data for the United

States. Each variable is scored from 0 to 10, with10 being the healthiest. Thus, for polyunsaturatedfat, whole fruits, vegetables, whole grains, nuts,and legumes, a higher score means higher intake.For trans fat, sugar-sweetened beverages and fruitjuice, red and processed meat, and sodium, a higherscore means lower intake. The total score is the sumof the individual elements; 100 would be perfect.

For this report, we used data for persons 20 yearsof age and older from 1999 through 2010, the latestavailable data from the U.S. National Health and

Nutrition Examination Survey (NHANES), which

is a representative national sample of the U.S.

population. Complex foods, such as a soup or stew,were dissected so the individual components were

included as red meat, vegetables, etc. Intake oftrans fat is not available from the NHANES, so datafrom the late 1990s and 2010 were used to estimatethe national trend.

Figure 1 shows that the average AHEI-2010 dietquality score increased slowly but steadily for bothmen and women, from an average of 37.6 in 1999and 2000 to 44.4 in 2009 and 2010, an increaseof 6.7 points. However, half of the increase in theoverall score was due to the large reduction in transfat intake; if this is excluded, the average scoreincreased by 3.3 points over the same time period.

Figure 2 illustrates that dietary scores improved

most for trans fat (decreased intake), followedby whole fruit (increased intake) and sugar-

sweetened beverages and fruit juice (decreased

intake). In the most recent years whole-grain

intake also increased. Red-meat consumption hasnot changed appreciably, following a small decline(increase in score) from 1999 to 2000 and 2001

to 2002. Intakes of nuts and legumes haveincreased slightly, but other dietary scores have notchanged appreciably, including intake of sodium.

The reduction in trans fat intake probably has beenthe main factor responsible for a reduction in LDL

(bad) cholesterol and an increase in HDL (good)cholesterol in both U.S. children and adults during

this same period.

Although not included in the AHEI-2010 diet-qualityscore, total caloric intake is of interest becauseof its relation with obesity and weight gain. Asseen in Figure 3, total energy intake among adultsdecreased slightly during the same time period,on average by approximately 100 calories per day.However, as shown in Figure 4, Body Mass Index(BMI), a measure of weight adjusted for height,

increased over this period; a plateauing may haveoccurred during the last four years. The failure to

see a decline in BMI despite the small reductionin reported caloric intake might be due to a subtledrift in dietary assessment methods, a reduction inphysical activity, or an increase in watching televisionor other highly inactive past times.

Although the overall improvement in diet quality isencouraging, the scores remain poor, and roomfor vast improvements remain. For example, theaverage daily servings of whole fruits and vegetableswere 1.6 and 1.4, respectively versus 2.1 servings ofsugar-sweetened beverages and fruit juice.

Women ate just one serving of whole grains, whilemen ate 1.3 servings. Sodium intake remainedat approximately 3,400 milligrams per day.

It is also noteworthy that the NHANES data thatthe Harvard School of Public Health analyzedshows improvement in diet through 2010 anddoes not include the effects of many public-healthpromotion campaigns and changes in foodserviceoperations since that time designed to increaseour consumption of fresh fruits and vegetables andwhole grains while reducing our intake of red meat.From the White House Garden to Meatless Monday,improving dietary quality has become a part of the

national conversation that hopefully will lead to morerapid improvements.

sCore: 4Modest improvements towards healthier dietsinclude a large reduction in the intake of trans fats,a small reduction in sugar-sweetened beverages,

and increase in whole fruits and whole grains.

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proteInConsuMptIonandproduCtIonOver the past several decades, meat p roductionand consumption have soared worldwide. Globalproduction rose to 297 million tons in 2011, morethan ve times as much as in the 1950s, and

average meat consumption per capita was 174pounds in industrialized countries and 70 poundsin developing countries. Worryingly, the developingworld is catching up: Over the last decade, meatproduction has increased nearly 26 percent inAsia, 28 percent in Africa, and 32 percent in South

America. Since 1995, developing countries haveseen per-capita meat consumption grow 25 percentversus 2 percent in industrialized countries, a

15-percent increase overall.

The global increase in meat pro duction has sev ereenvironmental impacts, as the livestock industrycontributes to problems of land degradation,climate change, air pollution, water shortageand water pollution, and a loss of biodiversity.

The reason is simple: Intensive animal agriculturerelies on turning plants into animal feed and takesseveral pounds of plant-based feed to produce asingle pound of meat. This concentrates all of theimpacts of farming soybeans, corn, wheat, sorghum,and other pulses and grains into a much smalleramount of food for people. Put another way, ittakes about 39 acres of farmland to produce 1,000kilograms of ground beef for hamburgers and onlythree-quarters of an acre to grow 1,000 kilograms

of potatoes to serve along with them. It takes one-sixteenth of an acre to produce 1,000 kilograms ofcarrot sticks, the healthier choice.

For foodservice operators, this also concentrates theprice and cost volatility. These grains used for feedwill become harder to produce in a world with greaterswings in weather and a restricted water supply.

The consumption of meat also has substantialimpacts on human health. Diets that includesubstantial amounts of red meat and productsmade from these meats, including lean red meat but

especially such items as bacon, hot dogs, sausage,salami, and bologna, increase risk of diabetes, heartdisease, and some cancers. In addition, higherconsumption of red meat, especially processedred meat, increases risk of premature death.

It is estimated that nearly 10 percent of deathscould be prevented if all American adults cut theircurrent red meat consumption to less than onehalf a serving of red meat per day (approximately

one-and-a-half ounces). Substituting one serving of

red meat per day with foods including sh, poultry,

nuts, legumes, low-fat dairy, and whole grains candecrease risk of premature death by 7 percent to 19percent, as well as reducing the risk of diabetes andheart disease.

The mix of health and price concerns (driven in

part by persistent droughts) as well as a growing

awareness of meat productions environmentalimpact has signicantly affected consumption in the

United States, where trends are headed in a very

different direction than most of the world. Between2011 and 2014, U.S. beef consumption is expected

to decline by more than 12 percent. Over the pastdecade, beef production has dropped almost everyyear including three of the largest drops in the past35 years. Chefs can claim at least some signicant

responsibility as the use of chicken breast, a lean

protein, doubled between 2009 and 2012 and therehas been a 22 percent rise in vegetarian menu items.The foodservice industry also has changed the menufor everyday dining as it has embraced campaignslike Meatless Monday and challenges to make half ofeach plate fruits and vegetables.

reCoMMendatIons:Chefs and the foodservice industry should continueto help shape our food habits to favor healthy andsustainable proteins, especially plant-based proteins,but also poultry and sh, while looking for ways

to use red meats in small portions. This approachalso can help foodservice operators better managecosts as climate and other factors make farmingand livestock production less predictable. Chefs alsohave a responsibility to create a new aspirationalvision for dining throughout the worldone that

builds appeal and excitement around plant-basedfoodsas other countries experience risingafuence and look to embrace the Western eating

habits that chefs have helped to foster.

sCore: 4Red meat production and consumption in the United

States is falling for the rst time. Menu innovation is acontributor to progress.

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Ish, seaood,and oCeansOvershing is rampant in the vast majority of the

worlds sheries. Global seafood production totals

about 154 million metric tons, or $217.5 billion, butthat is only part of the story. Illegal, underreported,and unregulated shing accounts for an additional

$10 billion to $23 billion. According to the United

Nations Food and Agriculture Organization (UN

FAO), 80 percent of the worlds sh stocks are fully

exploited, over-exploited, or depleted. And yet,demand for seafood is expected to triple within thenext few decades.

Today, foodservice and restaurants focus theirmenu offerings on a small number of species, whichexacerbates issues related to human health and thehealth of the oceans. More than half of the seafoodconsumed in the United States is shrimp, canned

tuna, and salmon. Just 10 species make up 90percent of the seafood we eat.

Some of the popular sh served are still good

choices for foodservice. Alaskan pollock, forexample, is certied by the Marine Stewardship

Council. In 2013, McDonalds announced it wouldpurchase only Alaskan pollock for its Filet-O-Fishand Fish McBites.

But the overall, intense shing to harvest ever-

increasing amounts of just a handful of speciesalong with produce feed for aquaculture operationshas caused great harm to the oceans ecosystem.Indiscriminate use of bottom trawls can destroylong-lived coral reef habitats. Long-lining, a methodin which thousands of hooks are strung out acrossmiles of line, can trap large numbers of turtles, sharks,marine mammals, and seabirds. The relentless pursuitof popular sh disrupts marine food chains by leaving

some predators without their traditional prey. The

pressure to provide the most popular species has ledto many instances of fraud in supply chains. Finally,the practice of discarding non-targeted species, calledbycatch, is wasteful. According to the UN FAO, nearly

30 percent of sh caught are thrown back dead and

bring no benet to the human diet or economy.

Aquaculture, which now produces about as muchseafood as the wild catch, can relieve some pressureson sheries, but it is not always practiced in ecologically

sound ways. Farmed sh can escape and intermix with

native species, while site selection of some farmingoperations has led to pollution. And some farmedshsalmon and other carnivorous speciesare

reliant upon inputs of antibiotics and large amountsof feed sh. In 2010, 15 million metric tons of wild

seafood was reduced to make sh meal and sh oil.

Sustainable aquaculture models do exist,however. For example, pangasius (a species of

river catfish) requires minimal fish-based feed and

can withstand very high cage densities.

Barramundi produces high levels of Omega-3s,even when fed a mostly vegetarian diet, and hasthe sweet avor and meaty texture that chefs love.Species that are low on the food chain, such asmussels, clams, and oysters, can be farmed in waysthat help to improve the health of ecosystem and tokeep traditional marine food production areas activeand protable.

Some seafood can have harmful levels ofaccumulated environmental toxins such as PCBs,

dioxins, and methyl-mercury. While exposure to thesetoxins should be limited, especially by pregnant andnursing mothers, the benets of increased Omega-3intake make seafood a good choice when selectinganimal proteins. Many options exist for high-omegaand low-toxin seafood. Generally it is best to mitigaterisk by eating a diverse variety of seafood.

reCoMMendatIons:About two-thirds of seafood consumed in theUnited States is eaten in restaurants. This offersthe foodservice industry a unique responsibility andopportunity to ensure the health of the oceans.

The foodservice industry should expand choices

beyond the usual shrimp, salmon, tuna, and whiteshes in favor of a wider variety of sh and seafoodfrom well-managed wild sheries and aquaculturefacilities. Smaller sh and seafood that are lower onthe food chain, such as mollusks and sardines, aregood options, as are herring, anchoveta, mackerel,and a host of farmed species such as tilapia, swai,pangasius, and barramundi. But shifting our focusto only these new species is not the answer.

That will simply cause more overshing, but of

different species. Chefs can use their inuence

to persuade diners to try new sh and seafood.

This, in turn, will allow shermen to focus on what

ecosystem can sustainably provide.

Foodservice and culinary professionals also mustdemand traceability for the seafood they receive.Studies by Oceana, a leading ocean advocacyorganization, reveal that in many major metropolitanareas, seafood is fraudulently mislabeled more than

30 percent of the time. Without transparency andtraceability, any effort at responsible purchasing iseasily undermined.

Finally, restaurants and foodservice operations musttrain staff to communicate the importance of theseissues and to explain changes to menus. The NewEngland Aquarium, Monterey Bay Aquarium, andother groups such as Chefs Collaborative all provideeducation and training tools.

sCore: 2Foodservice companies understand the importanceof change, but implementation remains slow, andconsumers remain unsure of how to make smart choices.

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oodInseCurItyIn 2011, an estimated 17.9 million, or one in six, U.S.

households were food insecure, meaning that theyhad difculty, at some time during the year providing

enough food for everyone in their household. Almostseven million of these households were forced to skip

meals or reduce their food intake by cutting backon food portions. In severe cases, both adults andchildren went hungry. Half a century after the nationsWar on Poverty, hunger is still a reality in America.

At greatest risk for food insecurity are householdswith children; Black, non-Hispanic, and Hispanichouseholds; and households with incomes below185 percent of the poverty level, or $23,550 for

a family of four. Ironically, many foodservice andagricultural workers are among those who struggleto feed themselves and their families. A 2012 studyconducted by the Food Chain Workers Alliance foundthat food-industry workers face higher levels of food

insecurity than the rest of the U.S. workforce and useSupplemental Nutrition Assistant Program (SNAP)

benets, formally known as food stamps, at double

the rate of individuals working in other industries.

Despite the innocuous sounding label, foodinsecurity is a dire condition and has been linked toinadequate intake of important nutrients, behavioraland psychosocial dysfunction, cognitive decits,

and health problems including obesity. The majorityof food-insecure households meet their food needsby relying on government assistance programs;reducing the quality, variety, or desirability of theirdiet; and visiting emergency food pantries.

Government programs are a bulwark against hunger.

But more is needed to effectively addressandeliminatefood insecurity, especially in low-incomeneighborhoods, which tend to have less access tostores that sell nutritious foods than higher-income,white neighborhoods. Studies also have foundthat restaurants in low-income neighborhoodsoffer their customers fewer healthy menu optionsthan restaurants in high-income neighborhoods.Programs such as Share Our Strengths CookingMatters, which teach families how to stretch theirfood dollar and cook nutritious meals, are an effortto address these problems. Such programs have thepotential to increase access to healthy foods throughincreased demand.

reCoMMendatIons:There are multiple ways culinary professionals andfood business owners and operators can play animportant role in tackling food insecurity. Culinaryprofessionals can share their food skills andknowledge through programs that teach cookingand budgeting skills to low-income families. Givendisparities in access to healthy menu choices inrestaurants, culinary professionals should offercompetitively priced healthy items and food-preparation options. As employers to 20 million

people, food-industry owners and operators alsoshould look for ways to provide livable wages andadopt employment practices that enhance foodworkers well being. They should encourage theirsuppliers to do the same, and communicate to theircustomers why that is part of an all-encompassingstrategy toward reducing food insecurity.

sCore: 3The prevalence of food insecurity nationally has risenover the last decade and remains stagnant. Thefood industry should do more to help protect andempower the sectors workforce.

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ClIMateChangeThe specter of increasing weather volatility and achanging climate are all around us. From the meltingof polar ice caps to extreme events like SuperstormSandy, changing weather patterns in the United

States and internationally have become hard to

ignore: 2012 was the hottest year on record since1895 and insured weather-related losses reached $44

billion in 2011, topped only by 2005 when HurricanesKatrina, Rita, and Wilma hit the Gulf Coast.

The worlds food supply, rooted as it is in agriculturalsystems and natural cycles, will be in the bulls-eye ofa changing climate. While these dynamics may seemfar from the plate, they are likely to have increasingimpact on the culinary and foodservice industriesin the years ahead. Recent analyses paint a starkpicture for the U.S. agricultural system including

the prospects of an increasing number of severeweather events; changes in rainfall patterns, with

increased risk of ooding and drought; and alteredrate of plant growth and crop ripening that mayaffect yields and waste rates, among others.

These dynamics are of growing concern amongfood-industry leaders. For instance, a 2012 surveyof 350 executives from leading North Americanfood and agribusiness companies found that 68

percent said weather extremes and volatility will bethe single biggest factor affecting North Americanfood and agribusiness in 2013. That concern faroutweighed the next two closest factorsconsumerdemand (13 percent) and policy and regulation (10

percent).

A 2012 analysis by the Institute for Agriculture andTrade Policy in conjunction with Compass GroupUSA/Foodbuy substantiated such concerns.

Fruit and vegetable distributors reported increasingweather anomalies in recent years, such as early andlate freezes and heavy rains during the dry seasonin tropical zones. They also saw increasing pricevolatility, in part due to extreme weather events, andthe need for additional backup sources of supplyboth within and outside the United States.

More intense and frequent weather swings willbring unprecedented challenges to the farmingcommunity, and as a result to the foodservice

industry. More family farms are likely to be lostas repeated weather crises overwhelm farmersnancial reserves. A dearth of public and private

crop insurance for fruit, vegetable, and diversied

farm operations leaves many such farmers especiallyvulnerable and without the safety net that isprovided to producers of corn, soybeans, and othercommodities.

But the industry is also a major contributor to thegreenhouse gases that lead to climate change.Foodservice facilities have the highest energyintensity per square foot among commercialbuildings in the United States. And although beef

consumption has fallen, widely used foods likebeef and dairy have particularly high emissions perpound. Jointly, that accounts for nearly half of thegreenhouse gases attributable to different categoriesof food.

Whats more, up to 40 percent of food grownin the United States today goes to waste, even

though much of it is edible. Consumer preferencesfor cosmetically perfect fruits and vegetables andcommon contracting practices with growers, forinstance, contribute to over-planting, farm elds that

are left unharvested, and high cull rates on the farm.Wasted food contains enormous embedded carbonin its production, transportation, and processing.When dumped in a landll, it also gives off signicant

amounts of methane, a particularly powerfulgreenhouse gas.

reCoMMendatIons:Foodservice and culinary professionals can playa key role both in reducing greenhouse-gasemissions and supporting practices that willhelp our food and agricultural systems adaptto a changing future. These include purchasingfrom farmers who use agricultural practices thatbuild soil fertility, conserve water, and reducereliance on petrochemical-based inputs; reducingenergy and water use in f oodservice facilities;eliminating excess packaging; incorporating

practices that reduce food waste by customers;buying from food sources that offer lower-carbon transportation and shorter periods ofrefrigeration in transit; and composting organicmaterial. In designing menus, foodservice andculinary professionals should prioritize low-carbonfoods such as exitarian and Meatless Monday

offerings to reduce the consumption of meat anddairya move that also advances health andwellness objectives while containing food costs.Adopti ng metri cs to i dentif y high-impact changestrategies and track progress is also essentialfor procurement, menu design practices, energyand water use, food waste, packaging, and otheractions that impact greenhouse-gas emissionsand resource conservation.

sCore: 2Modest but insufcient progress to date on food

waste reduction and increased plant-centric menuinnovation, but global supply chains remain brittle.

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healthyood versushealthCarespendIngIn 1960, the total annual U.S. expenditures for food

were estimated at $74 billion. This was roughly threetimes as much as the total expenditures that sameyear of $27 billion for healthcare.

Fast forward to 2010 when Americans spent$1.25 trillion on food and more than $2.5 trillion onhealthcare, a ratio of one to two. These soberingstatistics document a 17-fold increase in foodexpenditures over the past half a century ascompared with a 92-fold increase in healthcareexpenditures over the same period of time.

These trends in health-related expenditures areconsidered unsustainable, as are the increasingrates of obesity, diabetes, and other diet- andlifestyle-related medical conditions.

One reason for this shift may be the decreasingamount of time Americans spend cooking todayas compared with the time spent decades ago.Between 1965 and 1995, the amount of timeAmericans spent cooking decreased by 50 percentin the United States, across all demographic

groups. Interestingly, though this could be morecircumstantial than causative, each 30 minutes ofreduced cooking time has been associated withan increase in Body Mass Index of 0.5. It is alsonotable, though not conclusive, that countries whereindividuals spend more time preparing their foodshave lower rates of obesity. For example, Italian andFrench adults spend about 19 more minutes per daycooking than Americans and have far lower rates ofobesity. By contrast, adults in the United Kingdom

spend almost exactly the same amount of timecooking as Americans and have comparable ratesof obesity.

Despite such trends, it is rare for medical andculinary and food industry experts to sharenotes, skills, questions, and ideas as to how thecommunitieseach responsible for trillions ofdollars of the U.S. economymight partner to

diminish rates of obesity, diabetes, and other diet-related health problems. But over the last severalyears, some interesting pilot programs have seensuccess. Cooking Matters, a program sponsoredby anti-hunger organization Share Our Strength,taught 89,000 low-income people in 40 states how

to shop smart and cook healthy food on a budget.The non-prot Wholesome Wave launched a Veggie

Prescription program that allows doctors to givemoney to families struggling with diet-related diseaseto buy fresh fruits and vegetables at local farmersmarkets. Kaiser Permanente runs 50 farmersmarkets at its hospitals. These p rograms are excitingbut they need to be ubiquitous. Integration of healthcare and culinary care will be realized only whenthere is a teaching kitchen in every doctors ofce

and hospital.

reCoMMendatIons:Thought leaders representing the medical, publichealth, food industry, business, agricultural, andentrepreneurial communities should meet regularly toexplore novel transdisciplinary strategies to combatobesity and other obesity-related diseases. Theyshould work together, and combine their powerfulinuences on society, to teach families to cook and

to develop other strategies to promote healthy,affordable, and delicious food.

sCore: 2Innovative programs are starting to link healthcareand healthy eating. But the connection is far fromuniversal and more education is required.

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Currently, over 90 perCent o aMerICan arMlandIs planted not wIth the ruIts and vegetables thatConsuMers want and need, but wIth CoMModItIes.

the CulInary InstItute oaMerICas healthy Menusr&d CollaboratIve: worKIngtogether to expand healthyMenu optIons

The Culinary Institute of America (CIA) has long been

committed to bringing innovative, compelling healthymenu R&D solutions to the foodservice industry,including through its groundbreaking Worlds ofHealthy Flavors leadership retreat (ciaprochef.com/

wohf), held each January in collaboration with the

Harvard School of Public Health (HSPH). Launched

in 2004, Worlds of Healthy Flavors brings togetherleaders in nutrition science with leaders in volumefoodservice (including culinary, nutrition, and

marketing executives) to discuss and debate the

best ways to expand the number of and consumerdemand for healthy menu options in the United

States.

In an effort to advance its support of healthy menuR&D, the CIA formed the Healthy Menus R&DCollaborative in January 2010. The multiyear initiativeis focused on accelerating the development of highlytargeted, sector-specic, practical solutions that

signicantly contribute towards expanding healthy

menu choices within the foodservice industry.

The Collaborative has three co-chairs, fromCompass Group, North America; Dunkin Brands,Inc.; and Uno Chicago Grill. Members include

representatives from Aramark, Au Bon Pain,Bertuccis, Black Angus, Brinker, Darden, Google,Harvard University Dining, HMS Host, IHOP,

McDonalds, Panera, Ruby Tuesday, Sodexo,Subway, Whataburger, and Yale University Dining

Services. Members collaborate during the annualmember meetings held in January and June as wellas through working groups that conduct online andconference-call meetings throughout the year.

The members have been working in two areasover the past three years: increasing the use of

fruits and vegetables and decreasing the amountsof sodium on their menus. Progress in both areashas been impressive. Member companies reportan average 18-percent reduction in sodium levels

and an average 24-percent increase in produceusage across their menus between 2010 and2012. Members will be focusing next on improvingcarbohydrate quality, including addressing the stickyissue of sugar-sweetened beverages.

For more information, please visit:www.CIAHealthyMenus.org

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v: deMographICsand ConsuMerpreerenCes:

Issues, trends, andChangIng appetItessustaInabIlIty Is the buzzword o the new MIllennIuM.but what does It Mean to ConsuMers? and how shouldCulInary and oodservICe proessIonals deIne and usethe terM to reaCh and grow theIr target MarKets?

According to the consumer research company The Hartman Group, 89 percent of U.S. consumers saythey are in some way engaged in sustainable living, which might mean anything from participating in abasic recycling program to cycling to work to buying local food and other products. Some make animalwelfare a priority: A 2010 survey by Context Marketing found that 69 percent of consumers will paymore for ethically produced foods and 91 percent include animal welfare in that criteria. Others seekout local foods at farmers markets, grocery stores, and the restaurants they patronize. Hartmans 2010Marketing Sustainability report found that 74 percent of consumers said that use of local and seasonalfoods is important in choosing a restaurant as i t suggests support for the local community, and aninterest in reducing transportation costs, the health and well being of its guests, and high-quality products.

When talking about sustainability, marketers usually emphasize foods environmental, social, andeconomic impacts. But as Hartman points out, it is important for marketers to make the connectionfor consumers of how sustainable choices impact their l ives directly. A snack might keep them healthy;a meal in a local restaurant might support jobs in the local community or raise money for a local PTA.Literal denitions of sustainability are losing prominence, says Laurie Demeritt, the chief executive and

president of The Hartman Group. Some personal benet must be served before larger sustainable

concerns are considered by consumers.

Foodservice and restaurants are well positioned to become models of sustainability, especiallywhen compared to traditional food and consumer packaged-good manufacturers, retailers, andvast corporate entities. Already, they have led the charge for local sourcing. The positive consumerresponse has made them more aware and open to incorporating sustainable practices into theirbusiness models.

This section provides insights and advice on how culinary professionals and foodservice businessescan navigate the tricky subjects of animal welfare and farm-to-table ingredients. It also surveysconicting consumer attitudes and suggests ways that the sector, and chefs i n particular, can

encourage healthy choices.

89 c u.s. cm i

m i i ii, micii i ic cci m cci k i c .

- The Hartman Group

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anIMalwelareFifty years ago, the country and the planet had fewerpeople who ate less meat in smaller portions. Thedemand for meat, dairy, and eggs could be metby an agricultural system built of small farms andranches practicing traditional animal husbandry with

cows grazing on open ranges, pigs rooting throughunderbrush and wallowing in mud, and chickensscratching through pastures for grubs and bugs.Times have changeddramatically.

More people now inhabit the country and the planet,and they are eating more meat, in larger portions,more frequently. About 99 percent of animals raisedfor food in the United States live in concentrated

animal feeding operations. These so-called CAFOsdo not include open range, underbrush, or pastures.Instead, they employ gestation crates, batterycages, debeaking, tail docking, runt thumping,dehorning, castration, detoeing, and maceration.

Billions of animals live and sleep in their own waste.

Animal welfare has been a victim of the quest forhigh yields and efciency. To produce more, more

cheaply, animals are packed together without theability to engage in natural behaviors, such asgrazing, rooting, or scratching for food. They arealso fed a steady diet of hormones and antibiotics,that help them to grow faster and bigger and tobe slaughtered sooner. The resulting sea of cheapprotein encourages people to eat more meat thanis healthful.

The production of animal feed has transformedforests and farmland around the world. About halfof all corn grown in the United States feeds animal,

about four times more corn than is used in allother food products for humans, and much morethan is converted for biofuels. And that feed mustbe transported to industrial animal facilities. Theproduction of soybeans to meet global demand isalso a leading contributor to the deforestation of theAmazon, surpassing cattle rearing itself.

Efforts to improve animal welfare are underwayand growing. As of 2012, nine states have passedlegislation to ban gestation crates that cagepregnant and nursing sows so tightly they cannotturn around. Some of the worlds largest foodcompaniesMcDonalds, Burger King, Sodexo,Sysco, and othersalso have announced that theywill eliminate gestation crates from their supplychains. In addition, seven states have banned cratesfor calves, three states have banned tail dockingfor cattle, and, in 2008, California became the rst

state to ban the use of battery cages to house layinghens, where the standard amount of oor space per

hen is roughly equivalent to an eight-and-a-half-by-eleven sheet of paper.

In April of 2012 the federal government issuednew guidelines for foodservice and vending atgovernment agencies that both mandated healthiermeals with more fresh fruits and vegetables, as wellas a recommendation to offer sustainably or locallyproduced eggs and meat from animals that aregrass-fed, free-range, pasture-raised, grass-nished,

and humanely raised and handled. New certications

being added to food labels now tout claims of

Certied Humane, or Certied Pasture (although theycurrently remain largely unregulated). Some of these

have been small initiatives with limited overall impact,but the trend is on the rise and therefore the fullpotential impact remains to be determined.

reCoMMendatIons:The community of foodservice and culinaryprofessionals are responsible for a large proportionof the demand for meat, dairy, and eggs and arein a position to promote profound improvements inthe welfare of the animals raised for food. For thesmall but growing segment of customers who arecommitted to animal-welfare reform, chefs shouldoffer certied products and a story about where they

source their meat. For the mass market, foodserviceand culinary professionals could redesign menus

with a greater number of meatless options andreformulate recipes to use smaller amounts of meat,dairy, and eggs. A selective and informed approachto food sourcing and supply-chain managementcan help to support and sustain producers withsuperior animal-welfare practices. Negotiations withproducers may lead some of them to transition toimproved animal welfare practices. If successful,such efforts could make food professionals a drivingforce in restoring traditional animal husbandry,supporting small farms and ranches, and improvingthe state of animal welfare in the meat, dairy, andegg sectors.

sCore: 3Awareness is growing and important innovations areunderway, but most meat still comes from industrialfarms where conditions are not aligned withconsumer ethics.

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loCal oodsand thearM-to-table

MoveMentSince the culinary community introduced farm-to-table dining into the American marketplace in the1980s, the concept has transformed the way we

eat and the way we think about food. In a few briefdecades, this culinary response to the loss of identityand avor in the global food supply chain has raised

the consciousness of consumers and changed theirdining and purchasing habits.

In recent years, the farm-to-table ethos hasevolved into todays vibrant local-foods movement,

spreading from independent restaurants to groceryand high-volume foodservice operations. Thereis a national Farm to School effort to improveschool foodservice operations. Across the country,vocal and engaged chefs have helped to boostschoolchildrens fruit and vegetable consumption.

Local foods are now rmly established in the

mainstream as one of the most signicant and

fastest-growing food concepts, and are regularlyfeatured on the National Restaurant AssociationsHot List as well as top grocery retail trends.

Though there is no one ofcial denition of local

food, studies have shown that consumersbelieve it to be superior in terms of quality and akey contributor to growing local economies andpromoting animal welfare. This perception is drivingsales of such foods, especially fruits and vegetables,which totaled almost $5 billion in 2008, the latest

gure available.

The problem is, there just isnt enough locallyproduced food to meet demand, especially amonglarge foodservice companies and organizations.The relative scarcity of local food is a result of long-time federal policies that favor industrial agriculture.Currently, over 90 percent of American farmland isplanted not with the fruits and vegetables and otherhealthy crops that consumers want or need, butwith commodities such as corn and soybeans thatare primarily used as inputs to p roduce animal feed,processed foods, and non-food products.

The shift back to sourcing from small, nearby farmsthat grow food for avor, rather than durability for

shipping, has inspired culinary creativity and createda sense of place at the table, while increasing thedining publics awareness of seasonality and howfood is grown. And, according to a host of recentstudies, it has also done much more than that.Chefs focus on buying from local farms is one of themain reasons that small farms still exist in the United

States, though most are located near cities andchefs who are interested in local supplies. The questfor authentic local avors also has increased the

diversity of crops and livestock raised on small farmsand preserved heirloom seeds and breeds.

Sourcing locally grown foods leads to many goodthings. But its not an effective climate-changestrategy. Environmental scientists and advocateshave rightly pointed out that reducing the distancefood is shipped farm to tablewhether from 1,500miles to 100 or 100 to 10will reduce energy useand emissions from trucking. But comprehensivestudies on greenhouse-gas emissions fromproducing food have shown that the majority of

them come from on-farm practices. (Livestockgenerally produces higher emissions than crops.)

Farmers decisions whether to use syntheticfertilizers, pesticides, and mechanical irrigation, aswell as how to manage soil, affect greenhouse-gasemissions more than transportation and storage.This is true even for fresh fruits and vegetables,where refrigerated transport and storage stillaccount for no more than one-quarter of emissions,compared to nearly three times as much comesfrom farming practices. Choosing the right farms,as well as increasing the share of plant-based foodson the menu, both are more effective approaches forreducing greenhouse-gas emissions from the food

system.

reCoMMendatIons:Increasing the use of local foods depends heavilyon companies commitment to redesigning menusand hiring skilled professionals who can developnew dishes based on available ingredients. Whileit might be difcult, especially in some areas of the

United States, to meet the rising demand for local

food, culinary and foodservice industry professionalscan take the rst steps by working closely with

progressive farmers and trusted intermediaries,including processors and distributors.

A number of companies already have beensuccessful in developing sourcing strategiesthat require the use of a certain percentage oflocal produce on menus (often 20 percent to 30

percent to start). The results are appealing to their

customers, who hear media messaging about localfoods and want to make that part of their ownpurchasing and dining habits without necessarilychanging the restaurants they patronize. It alsoencourages chefs to work with farmers to developseasonal menus based on what the farmers cangrow and to have farmers grow what the chefs wantto use.

sCore: 3Increased sales of locally grown foods demonstrateprogress, but the U.S. food system must

dramatically change to meet population-wide healthand sustainability imperatives and support consumeraspirations for more local and regional avors.

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ConsuMerattItudes andbehavIorsabout

healthy andsustaInableoodAmericans are aware of and care about healthyand sustainable food. A 2011 consumer survey byDatassential showed that 84 percent of consumers

believe it is increasingly important for chainrestaurants to offer menu items that are fresh, local,

organic, and natural. Another survey conductedin September 2012 by HealthFocus Internationalshowed that more than 70 percent of respondentsconsider nutrition and health an important issuewhen eating in restaurants. One-third of respondentsalways make menu

2013 cia hsph menus of change full report tas

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