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Queensland Health

A Better Choice Drinks Classification Guide

2A Better Choice Drinks Classification Guide

A Better Choice Drinks Classification Guide

Published by the State of Queensland (Queensland Health), October 2019

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Contents

About the Drinks Classification Guide 1

Scope and mandatory requirements of the directive 1Table 1: Healthier drinks classifications—GREEN 2Table 2: Healthier drinks classifications—AMBER 3Table 3: Unhealthy drinks classifications—RED 4

Additional information 6Fermented or brewed soft drinks 7Table 4: Fermented or brewed soft drinks (post-fermentation) 7

Figure 1: Example compliant drinks display fridge or vending machine ten shelves 7

Appendix 1: Definitions of terms 8

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Scope and mandatory requirements of the DirectiveThe Directive applies to all Hospital and Health Services. It does not apply to in-patient, residential and aged-care meals; or to drinks that patients, staff and visitors bring from outside the facility for their own personal consumption.

The directive requires that Hospital and Health Services shall ensure:

• There is no sale, provision, promotion and advertising of unhealthy drinks, classified as RED Drinks (refer to Table 3), at any outlet or through catering and fundraising activities. This includes drinks with added sugar, cream, ice-cream, sorbet, gelato or confectionary; and larger serving sizes of juices, flavoured milks, milk-based drinks, hot drinks, and artificially sweetened drinks.

• Any drinks for sale, provided, promoted and advertised at any outlet or through catering and fundraising activities must be healthier drinks.

• Artificially sweetened drinks do not comprise more than 20 per cent of drinks displayed for sale at any outlet.

• Free drinking water is readily available, promoted and accessible in healthcare facilities, wherever drinks are sold or provided.

• Water is promoted as the drink of choice for sale at any outlet.

• Alcoholic drinks are restricted in supply, or not supplied at all.

• Monitoring of compliance of these requirements is undertaken at least annually, as at 1 December, and reported to the Department of Health by 31 December each year.

The Drinks Classification Guide

Healthier drinks:GREEN or AMBER

Unhealthy drinks: RED

This Drinks Classification Guide has been developed to support implementation of the drinks available in accordance with the A Better Choice strategy. Using a traffic light classification system, drinks are categorised as:

For Hospital and Health Services, this Guide supports implementation requirements in accordance with the Health Service Directive—Healthier Drinks at Healthcare Facilities (the Directive), which ensures that any drinks sold, provided, promoted and advertised at their facilities are only healthier drinks.

This guide is also applicable for use by the Department of Health to support the sale, provision, promotion and advertising of only healthier drinks.

Definitions of terms are included at Appendix 1 (refer to pages 8–9).

• Healthier drinks: GREEN, AMBER • Unhealthy drinks: RED.


Table 1: Healthier drinks classifications—GREEN

GREEN drinks should comprise at least 50% of drinks displayed and can be promoted and advertised.

Water

• Plain water: any serving size• Bottled unsweetened water — still, sparkling, mineral and flavoured: any serving size

Plain milk

• Reduced-fat (<2.6% fat): any serving size• Full-cream: serving size up to 500mL

Flavoured milk

• Reduced-fat milk (<2.6% fat): serving size up to 375mL

Milk-based drinks include milkshakes, milk and fruit smoothies

• Made with reduced fat milk (<2.6% fat), no added cream, ice-cream, sorbet, gelato or confectionery.

• Up to 20mL of syrup flavouring may be added. Recommended option is sugar-free syrup: serving size up to 375mL

Plant-based milk alternatives (e.g. soy, rice and almond)

• Plain, fortified with at least 100mg of added calcium per 100mL: any serving size

• Flavoured, fortified with at least 100mg added calcium per 100mL: serving size up to 375mL

Hot drinks

• Made with water (e.g. tea, long black, espresso)

• Made with milk (e.g. flat white, latte)

» Reduced fat milk (<2.6% fat) is the recommended option

» No added syrup, cream or confectionery

» Offer sweeteners as an alternative to sugar

» Offer de-caffeinated varieties

Serving size up to 500mL




Drinks with added intense artificial or natural sweeteners should not comprise more than 20% of total drinks displayed. AMBER drinks should not be promoted or advertised.

Flavoured and mineral water

• Bottled water—still, sparkling, mineral and flavoured; with added intense artificial or natural sweeteners: serving size up to 600mL

Plain milk

• Full-cream: serving size more than 500mL

Flavoured milk

• Reduced-fat (<2.6% fat): serving size more than 375mL and up to 500mL

• Full-cream: up to 375mL


• No added cream, ice-cream, sorbet, gelato or confectionery;

» Made with reduced-fat milk: serving size more than 375mL and up to 500mL » Made with full-cream milk: serving size up to 375mL

• Up to 20mL of syrup flavouring or 1 level tablespoon of powder flavouring may be added. Recommended option is sugar-free syrup.


• Flavoured, fortified with at least 100mg of added calcium per 100mL: serving size more than 375mL and up to 500mL

Hot drinks made with milk (e.g. coffee, mocha, chai, hot chocolate)

• Reduced fat milk is recommended. Without added cream or confectionery.

• Up to 20mL of syrup flavouring may be added. Preferred option is sugar-free syrup. • Serving size up to 500mL

Juice

• Fruit and vegetable juices, and combined fruit and vegetable juices, unsweetened, 99–100% juice (includes frozen and carbonated varieties): serving size up to 300mL

Drinks with added sweeteners e.g. cordial, iced tea, energy and sports drinks (does not include flavoured milks)

• With added intense artificial or natural sweeteners: serving size up to 600mL

Formulated supplementary beverages

• For example, breakfast drinks: serving size up to 300mL

Table 2: Healthier drinks classifications—AMBER




RED drinks contain added sugar, cream, ice-cream, sorbet, gelato and/or confectionary; and include larger serving sizes of juices, flavoured milks, milk-based drinks, hot drinks and drinks with added sweeteners.

RED drinks must not be promoted or advertised.

Soft drink and carbonated drinks with added sugar

• Includes bottled, canned, post-mix and frozen varieties: any serving size

Drinks with added sweeteners (does not include flavoured milks*)

• Includes intense artificial or natural sweeteners: serving size more than 600mL*Note: the exclusion of milk-based drinks from this category is due to their overall nutrient profile, when

compared with other drink types that are not milk-based

Cordials and iced tea

• With added sugar, (includes post-mix and frozen varieties): any serving size• With added intense artificial or natural sweeteners: serving size more than 600mL

Energy and sports drinks

• With added sugar: any serving size• With added intense artificial or natural sweeteners: serving size more than 600mL

Flavoured and mineral water

• With added sugar: any serving size• With added intense artificial or natural sweeteners: serving size more than 600mL

Juice

• Fruit juices, vegetable juices and combined fruit and vegetable juices; unsweetened that contain 99–100% juice: serving size more than 300mL

Fruit drinks that contain less than 99% juice:

• Includes bottled, canned, post-mix and frozen varieties: any serving size

Flavoured milk

• Reduced-fat milk (<2.6% fat): serving size more than 500mL• Full-cream milk: serving size more than 375mL

Table 3: Unhealthy drinks classifications—RED




RED drinks contain added sugar, cream, ice-cream, sorbet, gelato and/or confectionary; and include larger serving sizes of juices, flavoured milks, milk-based drinks, hot drinks and drinks with added sweeteners.

RED drinks must not be promoted or advertised.


• Milk-based drinks made with reduced-fat milk (<2.6% fat) as the main ingredient: serving size more than 500mL

• Milk-based drinks made with full-cream milk as the main ingredient: serving size more than 375mL

• Milk-based drinks with:

» More than 20mL of syrup flavouring or 1 level tablespoon of powder flavouring

» Added sugar, cream, ice-cream, sorbet, gelato or confectionary

Any serving size


• Flavoured, with at least 100mg added calcium per 100mL: serving size more than 500mL• Plain or flavoured, with less than 100mg of added calcium per 100mL: any serving size

Formulated supplementary beverages

• For example: breakfast drinks: serving size more than 300mL

Hot drinks made with milk (e.g. coffee, mocha, chai, hot chocolate)

• With added cream, ice-cream or confectionary

• More than 20mL of syrup flavouring or 1 level tablespoon of powder flavouring Any serving size

Other drinks

• Any caffeine-containing drinks are not recommended for children.

RED drinks include but are not limited to this table.


Additional information

1 Health Protection Branch, Prevention Division, Department of Health

Fermented or brewed soft drinks

Fermented or brewed soft drinks are an expanding market in Australia. Under the Australia New Zealand Food Standards Code (the Code) Standard 2.6.2-2:

A brewed soft drink means a food that:

A. is the product prepared by a fermentation processfrom water with sugar and one or more of:

I. fruit extractives or infusionsII. vegetable extractives or infusions

B. contains no more than 1.15 percent alcohol by volume.

Alcohol is a by-product of fermentation. A review of international literature and consultations have raised concerns about the potential for these beverages to explode or contain excess or undeclared alcohol and as a result, fail to comply with the Code. This raises a safety concern and potential risk for pregnant women and children, and potential risk of driving under the influence of alcohol.

For more information, refer to the Fermented food fact sheet

Due to the safety aspects associated with fermented soft drinks, it is recommended that Hospital and Health Services do not stock/supply these types of drinks.1 Should Hospital and Health Services supply fermented or brewed drinks for sale, the nutrition classification under A Better Choice is outlined in Table 4:

Table 4: Fermented or brewed soft drinks (post-fermentation)

AMBER drinks

• Less than one gram of sugar as per NutritionInformation Panel, with or without addedintense artificial or natural sweeteners:serving size up to 600mL

RED drinks

• Less than one gram of sugar as per NutritionInformation Panel, with or without addedintense artificial or natural sweeteners:serving size more than 600mL

• More than one gram of sugar remaining (post-fermentation) as per Nutrition InformationPanel: any serving size


https://www.publications.qld.gov.au/dataset/food-labelling/resource/887868ff-a16e-42be-b434-47d793dc79b8

Figure 1: Example compliant drinks display fridge or vending machine ten shelves

The minimum proportion of total drinks displayed is 50 per cent GREEN. Facilities are encouraged to display a greater proportion of GREEN drinks.

Water should be displayed at eye-level

AMBER drinks with added intense arti�cial or natural sweeteners should make up no more than 20 per cent of the total drinks displayed.

Flavoured milk reduced-fat Formulated supplementary beverage Flavoured milk full-cream 500mL 300mL 375mL

99–100% fruit juice 99–100% fruit juice 99–100% vegetable juice300mL 300mL 300mL

No sugar sports drink No sugar iced tea No sugar energy drink added sweetener, 600mL added sweetener, 500mL added sweetener, 250mL

Diet so� drink Diet so� drink Diet so� drink600mL 600mL 600mL

Unflavoured milk Unflavoured milk Unflavoured milk reduced-fat, 500mL reduced-fat, 500mL full-cream, 500mL

Flavoured milk Flavoured milk Flavoured milk reduced-fat, 375mL reduced-fat, 375mL reduced-fat, 375mL

Flavoured plant-based milk Flavoured plant-based milk Flavoured plant-based milkwith calcium, 375mL with calcium, 375mL with calcium, 375mL

Plain water, still, 600mL Plain water, still, 600mL Plain water, still, 600mL

Plain water, still, 600mL Plain water, still, 600mL Plain water, still, 600mL Flavoured water, still Flavoured water, sparkling Plain water, sparkling 600mL 600mL 600mL


Appendix 1: Definitions of terms

Terms Definition / Explanation / Details

Added sugar Includes addition of sucrose (commonly called sugar), fructose, glucose, honey, fruit juice concentrate, fruit sugar syrup and deionised fruit juice.

Alcoholic drinks Alcoholic drinks are not essential to provide the nutrients the body needs and increase risk of alcohol-related accidents, injuries, diseases and death. They should only be consumed sometimes, in small amounts, or not at all. Avoiding alcohol is the safest option for pregnant or breastfeeding women. Alcoholic drinks should be restricted in supply or not supplied at all. In addition:

• any mixers added to alcohol should not be RED drinks

• all events where alcohol is being served and/or involving external stakeholders must be approved in writing by the Health Service Chief Executive or delegate

• where Queensland Health facilities are licensed to provide alcohol to staff, visitors and/or the general public at functions, meetings or events, alcoholic drinks should not be provided in excessive quantities and should be served in accordance with the Code of Practice for the responsible service, supply and promotion of liquor

• alternatives to alcoholic drinks should be used as gifts or fundraising prizes.

Artificially sweetened drinks

Includes any drinks (except milk-based drinks) which have added non-nutritive sweeteners from artificial or natural sources. Some examples include (but not limited to):

• artificial sweeteners—acesulphame potassium, aspartame, cyclamate, saccharin, and sucralose

• natural sweeteners—stevia, erythritol, and allulose.

Catering Includes the provision of drinks at meetings, events, workshops, training, and any other functions.

Drink of choice Water is the drink of choice and should be:

• always available

• placed on prominent shelves and/or at eye level

• prominently advertised or promoted where drinks are sold or provided

• the default option when different drink choices are available in promotional offers and meal deals.

Free drinking water Free drinking water is to be made available at healthcare facilities that have a water risk management plan in place.

A water risk management plan describes how a facility, prescribed under Chapter 2A of the Public Health Act 2005, will prevent or minimise the risks to health associated with the water supply of the facility.


Terms Definition / Explanation / Details

Healthcare facility A geographic site where one or more healthcare services are located on Hospital and Health Services land, including but not limited to:

• hospitals

• community health centres

• primary health care centres

• laboratories

• office buildings operated by Hospital and Health Services.

Healthier drinks Includes drinks with no added sugar and/or with important nutritional value or contains added sugar and has some nutritional value when consumed in smaller amounts. Some examples are:

• Water (still, sparkling, flavoured)

• 99% fruit and vegetables juices (check serving size)

• Plain milk

• Flavoured milks (check serving size)

• Plant-based milk alternatives (check serving size)

• Hot drinks (check serving size).

Artificially sweetened drinks can provide a useful alternative to those that are high in sugar, however these drinks should not comprise more than 20% of drinks displayed for sale at any outlet.

In-patient, residential and aged-care meals

These meals are specifically designed to ensure clinical needs are met and to prevent malnutrition, particularly for long-stay patients. They must comply with the Queensland Health Nutrition Standards for Meals and Menus and the Aged Care Quality Standards.

Implementation of the Directive is encouraged in residential and mental health units, where clinically appropriate.

Outlets Any point of sale for drinks, including but not limited to:

• Retail—restaurants, cafes, cafeterias, kiosks, staff canteens, convenience stores, newsagents, post offices, florists, gift stores and pharmacies

• Vending machines

• Other—coffee carts, tea trolleys, staff social clubs and private selling within the workplace.

Promotion and advertising

Product placement in prominent areas, static display of marketing materials, special meal-deal promotion, digital marketing, or master-branding (i.e. use of any visible promotional or advertising materials showing unhealthy drinks, including billboards, digital or static display panels, store umbrellas, flags, straw holders, counter signs, and drink fridges or vending machine decals).

Sold or provided Any drinks which are sold through outlets or provided to staff or visitors as part of catering or through private selling within the workplace.

Unhealthy drinks Unhealthy drinks are classified as RED. These drinks are nutrient-poor and lack nutritional value, can be energy dense, and can contribute to excess energy intake (kilojoules). When frequently consumed unhealthy drinks can increase the risk of unhealthy weight and dental decay.


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