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On today’s menu:
Lana Vanderlee & David HammondCPHA Annual MeetingMay 28, 2014
Evaluation of a
menu labelling
initiative in
hospital
cafeterias in
Ottawa, Canada.
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1. Mancino et al. Separating what we eat from where: Measuring the effect of food away from home on diet quality. Food Policy 2009;34(6):557-562. 2. Pereira MA et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. The Lancet 2005;365(9453):36-42. 3. French SA, Harnack L, Jeffery RW. Fast food restaurant use among women in the Pound of Prevention study: dietary, behavioral and demographic
correlates. International Journal of Obesity & Related Metabolic Disorders 2000;24(10).4. Industry Canada Office of Consumer Affairs. Chapter 9 – Consumer Spending. https://www.ic.gc.ca/eic/site/oca-bc.nsf/eng/ca02117.html#a95.
Food consumed away from homehas poor nutritional value1
Increased consumption of fast food associated with becoming overweight or obese.2,3
One quarter of the Canadian food dollar is spent on food away from home.4
Background
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Menu labelling is currently mandatory in several US jurisdictions
United States will implement menu labelling federally in 2014 – via Patient Protection and Affordable Care Act
Canada has no mandatory menu labelling– Informed Dining voluntary program in BC – Government of Ontario announced Healthy Eating
Decisions Made Easy Act
Background
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Evidence for menu labelling is mixed
Reviews suggest little impact at a population level5,6,7
• Some impact upon population subgroups• Impact varies upon settings
Little literature examining menu labeling in a Canadian context
Background
5. Kiszko KM, Martinez OD, Abrams C, Elbel B. The influence of calorie labeling on food orders and consumption: a review of the literature. J Comm Health. DOI 10.1007/s10900-014-9876-06. Swartz JJ, Braxton D, Viera AJ. Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature. Int J Beh Nutr Phys Act. 2011, 8:1357. Harnack LJ, French SA. Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: a review of the literature. Int J Beh Nutr Phys Act. 2008, 5:51
The Ottawa Hospital Menu Labelling Program
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Developed by Nutrition and Foodservices team with support from clinical nutrition team and external experts.
Identified an opportunity to implement a new menu labelling program with digital menu boards during renovations at the Civic hospital
Intervention components 5 digital menu boards with nutritional values for
calories, sodium, saturated fat and total fat.
7 Information provided for most food items
Civic Cafeteria Jan 2011
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Intervention components
Health logo for items that meet the developed nutritional standards.
Educational campaign at the entrance to the seating area.
Removal of deep fryers and increase in healthier options.
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Civic General DifferencePaninis 408 625 +217Entrée 435 553 +118Grill 447 536 +89Salad Bar 494 568 +74Sandwiches 470 519 +49Soups 120 120 0Pizzas 402 400 -2Breakfast 332 277 -55
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Jan/2011– Food selection across sites (kcal)
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General Cafeteria Jan 2011
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General Cafeteria Sept 2012
Advertisements on menu boards Sept 2012
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20 seconds of ads, 20 seconds of nutrition information
CivicDisplays
January
Study timeline
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August/September
Wave 1
GeneralDisplaysSeptember
November/December
Wave 2
2011 2012
Wave 1 Wave 2
Civic x xGeneral 0 x
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2, 085 exit interviews– Wave 1 n=1,003– Wave 2 n=1,082
10 minute intercept survey• Food ordered in the cafeteria• Noticing and use of menu labelling
Methods
Nutritional analysis of food ordered and consumed
Nutrition information obtained from The Ottawa Hospital Nutrition Services (using C-Bord)
Several estimations made:• Items from the salad bar• Items lacking adequate description
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Methods
Analysis
3 primary outcomes• Noticing nutrition information• Using nutrition information• Nutrient consumption
Regression models used to test differences• Wave• Site
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Analysis
Socio-demographics • age, gender, ethnicity, income, education, BMI
Consumer and behavioural demographics • consumer type, frequency of visiting the
cafeteria, use of nutrition labels when shopping for food, frequency of eating out, self-reported general health, and dieting behaviour in the previous year
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Results
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Sample description
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Civic GeneralWave 1
n=497Wave 2
n=511Wave 1
n=506Wave 2
n=571
Mean age (yrs) 44.9 47.1 44.9 45.3
55+ yrs 26% 31% 28% 31%
‘White’ * 76% 82% 74% 78%
Female 59% 61% 61% 60%
High income* 49% 43% 38% 41%
Staff* 58% 55% 53% 51%
Overweight/obese
53% 56% 49% 50%
General Civic
Did you notice any nutrition information anywhere in the cafeteria?
36%
80%
54%63%
W1 W2W1 W2
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Significant change in noticing nutrition information between sites over time X2= 61.2, p<0.001
Wave 2 Noticing
cc c
30% 33%27% 32%
11%
27%14%
20%
Did the nutrition information influence what you selected for your meal?Overall sample
n=2,085Among those who noticed
n=1,210
General Civic General CivicW1 W2 W1 W2 W1 W2 W1 W2
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There was a significant change in use of nutrition information between sites over time X2=11.5 , p=0.001
c
Wave 2 Use
cc
General CivicW1 W2 W1 W2
Calories consumed
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There was a significant change in calorie consumption between sites over time X2= 5.7, p=0.017
Wave 2 Nutrient Consumption
610 kcal
482 kcal
598 kcal533 kcal
c
General CivicW1 W2 W1 W2
Saturated Fat consumed
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Wave 2 Nutrient Consumption
General CivicW1 W2 W1 W2
Total fat consumed
7.3 g4.9 g6.7 g 5.5 g
25.1 g
15.5 g
23.1 g18.6 g
General CivicW1 W2 W1 W2
Sodium consumed
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Wave 2 Nutrient Consumption
c
1395 mg
1074 mg1244 mg
1171 mg
CivicW1 W2
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Calorie consumption lower among those who reported using nutritional labelling p=0.009
500 kcal573 kcal
Used labelling
Didn’t use labelling
Wave 1 & 2
Use of nutrition information more common among:Those who are not of ‘White’ ethnicity p<0.001
Those who usually or always use nutrition information when shopping for food p<0.001
Those with improved general health p=0.027
Hospital staff compared to patients p=0.003
Socio-demographic correlates
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Support for menu labelling
3%Maybe
2%No
…in Ottawa Hospital cafeterias
95%Yes
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4%Maybe
5%No
91%Yes
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Support for menu labelling
…in all fast-food and other chain restaurants
Preferred menu labels
71% want calories
55% want fat
48% want sodium
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Conclusions
Indicates a positive impact of menu labelling
Importance of noticing information
Magnitude of impact
Nutrition content and product reformulation
Few socio-demographic differences 31
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Additional support provided by:
Acknowledgements
Funding for the project provided by:
Stipend support to Lana Vanderlee funded by the CIHR Training Grant in Population Intervention for Chronic Disease Prevention: A Pan-Canadian Program (Grant #53893)
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Questions?
Lana Vanderlee PhD candidate
School of Public Health and Health Systems
University of Waterloo
Email: [email protected]
Tel: 519-888-4567 ext. 31066