Effectiveness of offering healthy labelled meals in improving the nutritional quality of lunch meals eaten in a worksite canteen

Highlights

• Provide insight into the effectiveness of a healthy labelling certification program.

• Multiple positive nutritional effects were found on employee food and nutrient intake.

• Nutritional improvements were sustained in the healthy certified canteen.

• No effect was seen with regard to food satisfaction and edible plate waste.

Abstract

Healthier meal selections at restaurants and canteens are often limited and not actively promoted. In this Danish study the effectiveness of a healthy labelling certification program in improving dietary intake and influencing edible plate waste was evaluated in a quasi-experimental study design. Employees from an intervention worksite canteen and a matched control canteen were included in the study at baseline (February 2012), after completing the certification process (end-point) and six month from end-point (follow-up) (total n = 270). In order to estimate nutrient composition of the consumed lunch meals and plate waste a validated digital photographic method was used combining estimation of food intake with food nutrient composition data. Food satisfaction was rated by participants using a questionnaire. Several significant positive nutritional effects were observed at the intervention canteen including a mean decrease in energy density in the consumed meals from 561 kJ/100 g at baseline to 368 and 407 kJ/100 g at end-point and follow-up, respectively (P < 0.001). No significant changes were seen with regard to food satisfaction and plate waste. In the control canteen no positive nutritional effects were observed. The results of the study highlight the potential of using healthy labelling certification programs as a possible driver for increasing both the availability and awareness of healthy meal choices, thereby improving dietary intake when eating out.

Introduction

Food produced and eaten outside home has consistently been associated with a high energy content as well as a relatively lower nutrient density (Kjollesdal et al., 2011, Lachat et al., 2009, Lassen et al., 2007, Wu and Sturm, 2013). It has therefore been considered that a consequence of eating food produced outside home on a frequent basis may contribute to both less healthy dietary habits and higher odds of weight gain (Bezerra et al., 2012, Kjollesdal et al., 2011). At the same time food produced and consumed away from home provides an increasing proportion of the daily food energy intake, making the restaurant and food service sector an important arena for promoting healthy dietary practices as a part of a long-term solution to combat the current obesity epidemic.

Especially worksites are seen as an important arena in which behavioural patterns such as healthy eating can be promoted. Worksites provide a natural social context where most employees eat at least one daily meal during their workday. Thus, worksites could potentially reach a large part of the adult population, including many who has not traditionally been engaged in health promotion activities (Kahn-Marshall and Gallant, 2012, Lassen et al., 2011).

In recent years the food service industry has implemented various initiatives aimed at improving the healthfulness of its servings. This includes the possibility of selecting healthy side dishes in fast food restaurants (Kirkpatrick et al., 2013), more fruit and vegetables in worksite canteens (Lassen et al., 2004, Thorsen et al., 2010), restriction of foods high in salt, fat and sugar (Geaney, Harrington, Fitzgerald, & Perry, 2011) and providing foods with low energy density (Lowe et al., 2010). Although such changes clearly represent a step in the right direction, the healthier options are often limited and focus on specific nutritional benefits, for example low fat options (Chand, Eyles, & Ni, 2012). Furthermore, many food establishments do not actively inform and encourage the selection of available healthier options (Kirkpatrick et al., 2013) and customers therefore might not be aware of the nutritional quality of their meal choices (Hoefkens, Pieniak, Van, & Verbeke, 2012).

In February 2012 the Danish Veterinary and Food Administration introduced labelling freshly prepared meals with a healthy label, in form of the Nordic Keyhole symbol, to the restaurant and canteen sector as a policy option to address this situation. Since 2009 the Keyhole symbol has been found on pre-packed food products in supermarkets in Denmark, and it is now widely recognized by Danish consumers as a sign of a healthy choice. Foods eligible to carry the healthy label must fulfill certain conditions. These conditions include criteria for the maximum amounts of fat, salt and sugars, together with the minimum amount of dietary fibre and wholegrain in 25 different food groups. Table 1 shows the criteria for the food groups comprising ready-made meals. The criteria are based on the Nordic Nutrition Recommendations, which are founded on scientific evidence (Nordic Council of Ministers, 2004). Keyhole labelling in restaurants and canteens is voluntary, but the restaurants and canteens need to go through a certification process to use the label on freshly prepared products, and at least one labelled meal must be present at the daily menu. Moreover, at least one employee at the restaurant must complete a Keyhole education course and 75% of all employees must go through a webinar (or equivalent training) to be able to communicate the healthy label to the customers (Danish Veterinary, 2013).

The objective of this study was to evaluate the governmental Keyhole certification program in a quasi-experimental study design with follow up, i.e. the effectiveness of serving healthy labelled meals to improve the nutritional quality of lunch meals eaten in a worksite canteen. A further objective was to examine the customer acceptability by measuring changes in edible plate waste, total amount of sold meals and customer food satisfaction.