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Kaiser Permanente Cafeteria Menu Labeling

Implementation

Pre-implementation

  • Ensure that stakeholders are on board from the beginning. Stakeholders will vary from worksite to worksite but may include senior administration, employee wellness committee, cafeteria managers, food preparation and food service staff, and cafeteria patrons.
  • Develop an action plan to guide the collective effort that is agreed upon by all parties; assign timelines and parties responsible for implementation.
  • Develop (obtain) cycle menus and quantified recipes for all items on the menu from cafeteria manager.  Where cafeteria food service is provided through a contract catering company, obtain recipes from company director.
  • Determine the calorie and nutrient content per portion for each of the menu items.  A registered dietitian uses standard nutrient analysis software to complete the analysis.  A quality assurance monitoring system should be in place to catch and correct anomalies.
  • Communicate with worksite employees via email, newsletters, and staff meetings about the menu labeling initiative.
  • Use established nutrition criteria or develop your own set of science-based guidelines for healthy foods. The guidelines should be applicable to all foods and beverages sold in the cafeteria.  The “Minimum Guidelines for Offerings That Meet the Healthy Picks Criteria in the Cafeteria” were used by Kaiser Permanente hospitals to classify and label foods as Healthy Picks.
  • Design menu boards and nutrient content posters. Menu boards used by KP were 8½ X 11 inch signs that included the food/beverage item name, total calories in a portion, and price.  Posters were 48 inches wide by 36 inches tall and included a list of ALL menu items along with a comprehensive nutrient analysis that included calories, fat, sodium and more. Posters were created in a manner similar to that found in fast food chain restaurants.

Implementation

  • Train all personnel who are involved in food service in the cafeteria. Training should include adherence to recipes and healthy food preparation methods; compliance with specified portion sizes when serving food; consistent and correct placement of menu boards and posters (and logos if used to designate healthier options).
  • Promote menu board labeling among employees and visitors. The promotion could include basic information on the relationship between diet/food choices and health.
  • Post menu boards at countertop level at each food station in the cafeteria (i.e. grill, entrée/side dish station, soup station, salad bar, sandwich bar, and grab-and-go station).  The information presented on the signs included the item name, calorie content, and price.  For beverages, a sign may be placed on the door of one of the beverage cold cases in a highly visible location. If a large number of beverages are offered, an average calorie value by type of beverage (e.g. diet sodas, regular sodas, sports drinks, fruit juices and smoothies, and energy drinks) and size may be posted and prices eliminated. 
  • Display nutrient content posters, similar to those found in fast food chain restaurants, in a centrally located space in the cafeteria, usually away from the point-of-decision. Posters should be large enough to be easily read.

Maintenance

  • Set up a quality assurance monitoring system to ensure that menu boards and posters are consistent with menu options and that food service staff are compliant with recipes and portion management.
  • Continue to promote the menu board labeling to patrons of the cafeteria.
  • Monitor sales of items to assess trends in food purchases.
  • Conduct follow-up assessments with employees and patrons through quarterly meetings with selected employees, online assessment, interview, and/or paper surveys to determine what they like/don’t like about the menu labeling program and refine the program based on their input.
  • Obtain quantified recipes and portion sizes for all new menu items and complete nutrient analysis; update menu boards and posters.

The Keys to Success:

  • Contracts with vendors that run multiple cafeterias or a central management group may increase adoption and reach as compared to organizing through individual cafeterias.
  • Stakeholder buy-in, including not only management but also front-line workers in the cafeteria is central to implementation.
  • Integrate calorie menu labeling with Healthy Picks or another healthy choices ‘logo’ promotion (designation) to ensure calorie information is displayed and interpreted as one consideration, among several, in selecting a nutritious diet.
  • Review cycle menus to ensure at least one lower calorie, appealing and competitively priced entrée, side dish and snack are offered each day at cafeterias.
  • For entrees high in calories, consider ways to modify the recipe or portion size to reduce the calories so that no entrée is excessively high in calories (e.g. no more than 700 calories).
  • Verify calorie values and monitor portions served to ensure accuracy of calories posted.
  • Stock smaller sizes (e.g. 12 oz) of caloric beverages such as soft drinks and juices in place of larger sizes and provide free 16 fl oz cups with ice and water for patrons buying cafeteria items.
  • Develop policies to support healthier options, such as allowing patrons to substitute fruit or a low calorie side dish in place of French fries when ordering a “combo meal.” 
  • Quality assurance post-implementation to ensure that recipes are followed and that specified portion sizes are provided by food service staff.

Barriers to Implementation:

  • Space limitations may impede implementation at some locations.
  • Nutrient analysis is time consuming! Allow enough time to obtain recipes, conduct nutrient analysis, etc. prior to implementation – enough time to verify and provide quality control.
  • Can be challenging to display menu boards consistently and accurately.
  • Push-back from food service staff, which may resist portion management and offer larger than specified portions to patrons, especially to those who ‘complain.’