Americans are spending more of their food budgets and getting more of their calories from meals prepared away from home — especially ready-to-eat fare from fast food outlets, chain restaurants, and convenience stores. These kinds of meals tend to be heavier in calories, fat, sugar, and sodium and lighter in healthy nutrients. But if restaurants are part of the problem, they can also be part of the solution and that’s what Choose Health LA Restaurants is all about. It’s a new partnership between the Department of Public Health’s (Public Health) Choose Health LA initiative, and 700 restaurant locations across Los Angeles County aimed at offering the public healthier food in smaller portions.
What’s the Problem?
According to the U.S. Department of Agriculture, Americans now get nearly a third of our calories — 32 percent — from meals prepared outside the home, up from about from about 18 percent in 1977.1 The percentage of our food budgets devoted to restaurant and take-out food has jumped to 43 percent in 2012 from 26 percent in 1970.2 Foods pre- pared outside the home are typically higher in calories, sodium, fat, and sugar and lower in dietary fiber than meals cooked at home. Portion sizes have also increased in recent decades, and larger portion sizes are associated with overeating.
In Los Angeles County, almost one-quarter of adults and nearly as many children are obese, increasing their risk of developing Type 2 diabetes.3
Diet-related health conditions don’t just take a toll on individuals and their families, they increase healthcare costs for a range of preventable diseases, lead to lost productivity, and increase absenteeism from work and school.
Restaurants play an active role in forming the eating behaviors of children. Among children aged 6 to 18, away-from-home foods are most likely to come from fast food outlets, restaurants, and schools.1 According to an evaluation of kids’ meals from over 40 chain restaurants, children consume about 25 percent of their daily calories from restaurants and more than 90 percent of restaurant chains fail to meet industry standards in providing healthy options in children’s meals.4 Kids’ menus tend to be dominated by chicken nuggets, burgers, French fries, and often include sugary drinks. Offering a wider range of nutritious menu options gives children the chance to eat healthier food during a pivotal time for growth and development while also enabling restaurants to be seen as healthy places.
Why it Matters
More than 75 percent of Americans say they’re making an effort to consume smaller portions and make healthier choices.1 That gives restaurants the chance to play an active role supporting healthy eating behaviors and reducing preventable chronic diseases such as diabetes that may be linked to consumption of unhealthy foods and beverages.
“Even in some of the larger restaurant chains, everyone has a story about a health issue —from their mom, their sister, themselves or even some of their regular customers over the years,” said Christine Montes, a policy analyst with the Department of Public Health. “Restaurants really are incredible partners and there’s so much opportunity in working with restaurant operators to impact health.”
What We’re Doing
The Choose Health LA restaurant program began as a way to promote healthy eating and support local businesses. It is based on the recognition that restaurants can play an important role in promoting healthy food.
The first step was to reach out to restaurants and learn about their needs. Department staff members conducted in-depth key informant interviews and met with representatives from over 100 restaurants. They were careful to listen and learn to what was important to restaurant operators. Although many restaurant operators expressed concern about declining revenues and worried that customers wouldn’t want healthier food options, they were open to reducing portion sizes. Not surprisingly, restaurant managers were concerned about interventions or regulations that would negatively affect their financial bottom line.
Staff members also took to the streets to get input from community members, including mothers with young children, to find out more about what they liked to eat. They also connected with county residents through a collaborative partnership with community-based organizations, public health nurses, and other community leaders who served as liaisons between the department and the community. “Having relationships with commu- nity liaisons has been key in building links to the community,” said Montes. “Our staff isn’t big enough to have an impact on a one-on-one basis, so we asked: ‘who can we work with that will multiply our message for us?’ We call these connections our ‘multipliers.’”
Once they felt they understood the perceptions and attitudes of community members and restaurant operators, staff members launched an effort to address restaurant operators’ concerns and help them join the program. It was set up as a voluntary partnership, which proved essential to gaining support and participation from restaurant owners and managers. “Neutral reception felt positive,” says Montes. “Having the restaurant industry say ‘Okay, we’ll think about this,’ was very important as we prepared to launch the program.”
Public Health aims to provide a ‘win’ for participating restaurants while boosting the health of patrons. Restaurants receive technical assistance to implement menu changes and free promotional materials to increase the visibility of the healthier foods they offer. Decals posted in the windows identify participating restaurants. Educational materials are available for customers. At the program launch, advertisements in Metro subway and train stations and on buses encouraged riders to patronize participating restaurants and direct them to Internet listings, including an interactive map of locations.
Since its launch in 2013, the program has been working to recruit restaurants to join the partnership. Seventeen brands representing more than 700 restaurant locations across the county—from Subway® Restaurants to small chains to ‘mom and pop’ restaurants — have joined and are now offering healthier menus and smaller portion size options. Many smaller restaurants and taquerias are offering mini-versions of their top-selling meals, reducing strain on the kitchen while helping maintain customer loyalty. Peggy Gonzalez, manager of Maria’s Italian Kitchen, said she and her staff got excited as they planned ways to encourage healthier eating among children.
“We decided that all entrees get a vegetable,” Gonzales says.
“We went beyond the guidelines to make sure health was a big part of the menu. Now sodas do not come with children’s meals. Customers have to pay for them, whereas water and milk come with the meal.”
Maria’s Italian Kitchen rolled out a new kids’ menu offering healthier main dishes and a variety of vegetable side dishes included in the price. “Just recently, we started making ‘Veggie Dippers’ one of the vegetable options. It has olives for eyes, cucumbers to make the head and celery as the body. It makes vegetables more exciting for kids,” said Peggy Gonzalez, Manager of Maria’s Italian Kitchen.
Public Health is building on the momentum by expanding restaurant recruitment efforts and streamlining application materials and procedures. Staff members continue to provide personalized assistance to help interested restaurants complete the application process. In addition, staff will be evaluating the impact of the program to share their experiences and help guide other efforts. Staff members described restaurant operators’ perspectives on the restaurant program in a paper published in the electronic journal Preventing Chronic Disease. A second paper that examines the program’s impact on menu options at participating restaurants is now in the works.
Public Health’s Choose Health LA initiative is helping residents make healthy choices when they dine out. It’s also demonstrating that business can play an important role in improving the health of residents by making manageable modifications to their menus — and their business model — that encourage health-conscious customers to return.
Christine Montes, MPH
Los Angeles County Department of Public Health Division of Chronic Disease and Injury Prevention Choose Health LA Restaurants Program
- U.S. Department of Agriculture, Economic Research Service. Nutritional Quality of Food Prepared at Home and Away From Home, 1977-2012 (2013).
- U.S. Department of Agriculture, Economic Research Service. Food Expenditures, 1970-2012 (2013).
- Los Angeles County Department of Public Health, Obesity and Related Mortality in Los Angeles County: A Cities and Communities Health Report (2011).
- Center for Science in the Public Interest, Kids Meals: Obesity on the Menu (2013).