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NSW Food Forum 2014 – Creating healthy food environments | NSW HEALTH |

CREATING HEALTHY FOOD ENVIRONMENTS

Report from the NSW Food Forum 2014

11 March 2014

Executive summary

The NSW Food Forum 2014 was hosted jointly by the NSW Ministry of Health, the Heart Foundation and the NSW Premier’s Council for Active Living. About 250 participants from community, industry, NGOs, academia, NSW Health and other government agencies met to discuss key NSW and national initiatives that support healthy food environments and identify gaps and opportunities for future action.

This report provides a summary of the Forum proceedings. Discussions centred on food reformulation, consumer information, the retail and food service environments and local councils. There was consensus around the need to adopt multiple strategies to create healthy food environments, both top down and bottom up, as well as to have good cooperation between all levels of government, industry, the health sector, academia and NGOs.

Regarding future directions, the general consensus around opportunities was that consumers can be assisted in making healthy food choices through the provision of information about the nutritional quality of the foods they buy. Retail and food service environments can also help to make healthier choices easier, and to reward consumers for making them. Some of the future opportunities identified by consumers were:

• The food industry's role in reformulating foods to contain fewer kilojoules and less salt, saturated fat and sugar is encouraged. However there is also potential to increase the pace of reformulation through the Food and Health Dialogue as well as acting on portion size and consumer messaging

• The Heart Foundation’s Healthier Oils Initiative has the potential to improve the quality of the diet but would need to broaden its reach beyond the 11% of councils that have taken it up

• The NSW menu labelling at fast food outlets initiative is an important platform to be supported and all sectors can work together to increase awareness and understanding of kilojoules. This initiative should consider expanding to address salt and saturated fat in the near future

• Retailers can have a role in providing healthier options at the premium sites in their stores, including the check-outs, end-of-aisle displays and island bins, as well as incentives for healthier shopping

• Cross-sector support for the Health Star Rating front-of-pack labelling system is encouraged. This system has the potential to make it easier for consumers to make healthy food choices

• Councils can continue their work on food and health by sharing best practice and utilising the local government’s Integrated Planning and Reporting Framework.

A literature review and further stakeholder discussions are planned which will explore options to create a healthier food environment.

NSW FOOD

FORUM 2014

20% Community

6% Other Government

16% NGOs

19% Academia

11% Industry

28% NSW Health

| NSW HEALTH | NSW Food Forum 2014 – Creating healthy food environments NSW Food Forum 2014 – Creating healthy food environments | NSW HEALTH |

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NSW MINISTRY OF HEALTH

73 Miller Street

NORTH SYDNEY NSW 2060

Tel. (02) 9391 9000

Fax. (02) 9391 9101

TTY. (02) 9391 9900

www.health.nsw.gov.au

This work is copyright. It may be reproduced in

whole or in part for study or training purposes

subject to the inclusion of an acknowledgement of

the source. It may not be reproduced for commercial

usage or sale. Reproduction for purposes other than

those indicated above requires written permission

from the NSW Ministry of Health.

© NSW Ministry of Health 2014

SHPN: (CPH) 140267

ISBN: 978-1-74187-057-2

Further copies of this document can be

downloaded from the NSW Health website

www.health.nsw.gov.au

2014

Breakdown of Forum Attendees

Contents

Introduction 7

Reformulation 8

Consumer information 12

Retail environment 14

Local councils 15

The need for multiple strategies 16

Future direction 17

Next steps 17

About the NSW Food Forum 18


4

Introduction

Obesity is rapidly becoming the major health burden for NSW, as for the rest of Australia. The latest data shows that in NSW, 51.5% of adults and 22.8% of children were overweight or obese in 2013 and 2010 respectively.

The NSW Healthy Eating and Active Living Strategy 2013-2018 provides a whole of government framework to promote and support healthy eating and active living in NSW and to reduce the impact of lifestyle-related chronic disease.

The Strategy aims to encourage and support the community to make healthy lifestyle changes at a personal level, and to create an environment that supports healthy living through improvements in the food supply, healthier built environments and transport solutions. The Strategy aims to ensure that everyone has opportunities to be healthy through the delivery of evidence-based and relevant policies and programs. One of its four key strategic directions is to encourage environments to support healthy eating and active living.

The NSW Food Forum 2014, held on 11 March, was organised in partnership with the NSW Ministry of Health, the Heart Foundation and the NSW Premier’s Council for Active Living. Broadly, its aim was to encourage a healthy food environment to make healthy food choices the easy choices. A healthy food environment is characterised by the wide availability and promotion of healthy foods, beverages and meals that are also affordably priced.1 Specifically, its aims were:

• To showcase and discuss key NSW and national initiatives that support and/or promote healthy food environments

• To identify gaps and opportunities to guide future NSW action to promote healthy food environments.

About 250 participants from community (20%), industry (11%), NGOs (16%), academia (19%), NSW Health (28%) and other government (6%), keenly debated a broad range of relevant issues. This report summarises the day’s proceedings.

Discussions centred on the areas of:

• Reformulation

• Consumer information

• The retail environment

• Local councils

• The need for multiple strategies.

1 Swinburn B et al 2013 INFORMAS: Overview and

Key Principles, Obesity Reviews 14 (1), 1-12


7

Reformulation

Reformulation was one of the most commonly addressed issues of the day. Lowering the salt and saturated fat content of processed foods was seen as an essential component of any efforts to create a healthy food environment.

Central to food reformulation is the Commonwealth Government’s Food and Health Dialogue, a voluntary, collaborative forum between government, industry and public health groups to take action on reformulation, portion sizing and consumer messaging. It was established in 2009.

Kathy Dennis of the Commonwealth Department of Health said to date the Dialogue had reached agreement on targets for reformulation of breads, breakfast cereals, processed meats, simmer sauces, soups, savoury pies, savoury crackers, cheeses and potato, corn and extruded snacks. Most of these agreements were to reduce salt.

Julie-Anne Mitchell of the Heart Foundation NSW spoke of the Tick in Food Service program, which operated in the area of quick service restaurants between 2006 and 2011. She highlighted that market failure resulted in the initiative closing after five years, but the experience informed future developments such as mandatory kilojoule labelling in quick service restaurants in NSW in 2011. The program was started because, by 2005 an estimated 3-4 million Australians were visiting fast food chains or independent outlets on a daily basis.2 The aim of the Tick in Food Service program was to provide a small range of healthier food options in every major fast food outlet, but the concept never took off. 'While the initiative was underpinned by strong evidence, public and professional support for such an innovative approach to public health nutrition remained low,' she said.

Barbara Eden of the Heart Foundation NSW described the Foundation’s Healthier Oils Initiative, which was developed in response to the knowledge that Australians are eating twice as much saturated fat as recommended. It focuses on small-medium sized food outlets, where in 2007 about 70% of meals eaten-out-of-home were consumed.3

It uses a three-pronged approach working with local councils, educating food outlets and increasing consumer awareness. Seventeen councils (11%) are currently working with this initiative and the food outlets that have swapped to healthier oils are acting as ambassadors for the program within their local government area.

Dr Geoffrey Annison of the Australian Food and Grocery Council said its members support

Dr Bruce Neal emphasised that we need to move beyond measures that rely on individuals making the right choice – we need a healthier food supply, not just the odd healthier choice within it

reformulation through the Healthier Australia Commitment4 in an effort to reduce the intake of sodium, saturated fat and energy from our foods.

Nilani Sritharan of Cereal Partners Worldwide said food companies were actively looking for ways to reformulate and innovate to deliver more nutritious products. But it was technically difficult, she said, and cited the example of Vitabrits. If you add more salt, the briquettes become bricks and cannot be broken. Too little and they do not hold together.

She also said manufacturers had to work within the bounds of consumer taste. If they stopped making Milo cereal and replaced it with pure oats, consumers would switch to another cereal to suit their tastes. ‘It’s about transitioning the consumer over time,’ she said. The challenge is to bring a healthy product to market at a price consumers can afford, and to make these products tasty so as to maintain sales.

IN 2005 AN ESTIMATED 3-4 MILLION AUSTRALIANS WERE VISITING FAST FOOD CHAINS OR INDEPENDENT

OUTLETS ON A DAILY BASIS

3-4 MILLION

2 Based on BIS Shrapnel. 2006. Fast Food in Australia 2006-2008

3 BIS Shrapnel. 2007. Foodservice in Australia 2007

4 www.togethercounts.com.au/

healthier-australia-commitment/

Media personality Adam Spencer led the discussions at the NSW Food Forum


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added sugars, and portion size, and is working to eliminate artificial colours and flavours from its own brands.

Dr Bruce Neal of the George Institute for Global Health said reformulation is essential. ‘It reduces the need for any individual to make the healthy choice every single time,’ he said. Dr Geoffrey Annison said the food industry has been reformulating for years, and the pace should increase now that standards for health claims are in place.

Opportunities

Kathy Dennis said that with respect to the Food and Health Dialogue, there are opportunities to increase the pace of reform, to include more nutrients in reformulation agreements and to increase the amount of work around portion sizing and consumer messaging.

Julie-Anne Mitchell said there is the opportunity to supercharge public education on kilojoules and to reduce confusion with calories. Other opportunities included developing strategies to reduce salt and saturated fat as part of NSW quick service restaurants and menu labelling legislation and leveraging the Heart Foundation's experience of working with industry to drive the reformulation agenda. A focus on training of work force chefs, cooks and hospitality staff to increase their awareness of health issues and healthy food preparation practices was also discussed.

Barbara Eden saw opportunities for those food outlets that have swapped to healthier oils to be recognised and rewarded for their efforts to encourage other food outlets to swap to healthier oils.

Nilani Sritharan saw the opportunity to translate the Dietary Guidelines into consistent messages that are practical and applicable at a meal and product level, so as to guide consumers at meal times and provide portion guidance that works at a product level.

Vanessa Hattersley said having more nutrition professionals working in industry is an important way of improving the nutritional profile of foods.

The panel discussion covered a range of other issues. Should we aim for silent reformulation, as is the approach of the Food and Health Dialogue, or should we promote reformulation changes, so industry can use health claims as a marketing advantage? Is it better to try to improve health through a food-based approach or a nutrient-based approach? Could portion control and standardising of serving sizes be included in reformulation? The planned foray of the Food and Health Dialogue into the food service sector, to encourage this sector to use healthier ingredients, is keenly anticipated.

Vanessa Hattersley, Nutrition Manager for Coles Supermarkets, said that in addition to their internal nutrition targets, they have already achieved a number of Food and Health Dialogue targets across their private label portfolio, and are on track to meet the remainder.

Her counterpart in Woolworths, Stevie Wring, said Woolworths is also encouraging product reformulation to reduce sodium, saturated fat,


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Consumer information

Dr Lisa Szabo of the NSW Food Authority said the kilojoule menu labelling initiative at fast food and snack outlets in NSW is a highly successful initiative, with 90 per cent of affected chains implementing the labelling legislation on day one (1 February 2012), and with good compliance. Both implementation and compliance had the benefits of nationally agreed principles, which gave chains the confidence to roll out the NSW requirements nationally.

Research showed that with the legislation and education campaign, there was a significant increase in consumer knowledge of the 8700kJ figure and a 15% (519kJ) decrease in the median kJ value of a meal purchased.4

Nur Rahman of Gloria Jean’s Coffees said the NSW Food Authority was very supportive throughout the process of kilojoule menu labelling. However, there were still costs incurred, and he would like to see a Regulatory Impact Statement before any new regulations were introduced. He also said he would like to see greater education for consumers, and more co-operation between government and industry. He warned that when Gloria Jean’s had offered healthy and less healthy choices, the less healthy choice had been more popular.

Dr Kevin Buckett of the South Australian Department of Health described the Health Star Rating front of pack labelling system, which was based on the nutrient profiling scoring criterion health claims model. It uses star ratings, which are familiar from being used for movies, whitegoods and other consumer goods.

Dr Bruce Neal said that almost everybody in Australia ate a sub-optimal diet, and noted that food-related risk such as high fasting blood glucose levels and a high body mass index are becoming more significant causes of death and illness globally with time, rather than less.

However, apps like FoodSwitch, despite their success, are not the answer. The information in FoodSwitch should be on the packaging, he said.

‘We need to move beyond measures that rely on individuals making the right choice, we need a healthier food supply, not just the odd healthier choice within it,’ Dr Neal said.

The consensus was that having nutrition information widely available and easily accessible can help consumers make healthier food and beverage choices.

Nur Rahman supported greater education for consumers, and more co-operation between government and industry.

Opportunities

One opportunity is to build on the success of the kilojoule menu labelling to include salt and saturated fat. While there was consensus that this would benefit consumers, it is seen as difficult to do without making menu boards too crowded to be understood. Other ways to include salt and saturated fat would need to be considered.

Another opportunity is to consider portion sizes, which have increased over time. They have been driven in part by the economics of providing better value in a larger serving, but what else has led to the change? What contribution has increased portion size made to the increase in obesity? And what opportunities could arise from using the portion sizes as described in the Australian Dietary Guidelines?

And finally, is it possible for industry to standardise portion sizes for foods, as they have done for beverages?

It was generally accepted that there are opportunities to:

• Work together across all sectors to increase public understanding of kilojoules

• Use the Health Star Rating system to provide food manufacturers and retailers with a market advantage, and consumers with the ability to choose healthier foods.

There is also the opportunity to better understand the relationship between marketing (including advertising, labelling, the retail environment and more) and consumer demand. To what extent does one lead the other?

4 Fast Choices Evaluation Report. NSW Food

Authority 2013. http://www.foodauthority.nsw.gov.

au/science/evaluating-what-we-do/fastchoices/

0.0g0.0g 000mg0000kJ 0.0g

PER PACK

SAT FAT SUGARS SODIUM NUTRIENTENERGY

LOW0% DI* HIGHLOW HIGH

0.0g0.0g 000mg0000kJ

PER PACK

SAT FAT SUGARS SODIUMENERGY

LOWLOWLOW0% DI*

0.0g0.0g 000mg0000kJ

PER 100g

SAT FAT SUGARS SODIUMENERGY

LOWLOWLOW0% DI*

0000kJ

PER PACK

ENERGY

0% DI*

0000kJ

PER PACK

ENERGY

0% DI*

0000kJ

PER 100g

ENERGY

0% DI*

0000kJ

PER PACK

ENERGY

0% DI*

0000kJ

PER PACK

ENERGY

0% DI*

0000kJ

PER 100g

ENERGY

0% DI*

OPTION 1

Use these Star Ratings to replace the stars above. The one to use will be indicated on the pack copy

OPTION 2 OPTION 3 OPTION 4 OPTION 5

0.0g0.0g 000mg0000kJ 0.0g

PER 100g

SAT FAT SUGARS SODIUM NUTRIENTENERGY

LOW0% DI* HIGHLOW HIGH

Health Star Rating front-of-pack labelling system


12 13

Retail environment Local councils

Dr Lukar Thornton of Deakin University spoke of his research which examined the placement within stores of different types of food at supermarkets. This research showed that the prime positions in supermarkets – check-outs, end-of-aisle displays and island bins – overwhelmingly contained snack foods and soft drinks. For example, only 14% of stores did not have snack foods or soft drinks at 100% of their checkouts.5

Dr Danny Wiggins explained the government had three main ways of acting to improve health – through direct action, through regulation and through persuasion, including education and advocacy. He acknowledged councils' current healthy food related activities, resourcing issues and differing priorities.

Other research from his group showed that supermarkets in disadvantaged areas had a greater length of shelf space dedicated to snack food and soft drink items than those in more affluent areas. Also, supermarkets in the more disadvantaged areas had a lower ratio of fruit and vegetables to snack foods and soft drink than those in the more affluent areas.

'Changes need to be made to the placement and promotion of unhealthy snack items and soft drinks in supermarkets', he said, and gave LaManna in Melbourne as an example of one supermarket which has implemented such changes.

Dr Danny Wiggins stressed the importance of the Integrated Planning and Reporting (IP&R) Framework to local council strategy development, and advised that opportunities existed to further leverage food related council activities and resourcing via the IP&R process. He encouraged all participants to pursue councils' IP&R ongoing reviews and advised that the NSW Premier’s Council for Active Living has developed tools to help councils integrate healthy eating and active living into IP&R responses.

Vanessa John of Wollongong City Council gave an example through the Illawarra Regional Food Strategy. She said councils were excellent at disseminating information but were short on resources and struggled to assign people to particular issues.

Opportunities

Dr Danny Wiggins noted that opportunities existed to use town planning legislation to restrict outdoor advertising content in certain locations, but that these had not been tested. Evidence would have to be gathered on the impact of outdoor advertising on consumption, as any such questions may need to be assessed by the Land and Environment Court.

Opportunities

Further research will examine whether these differences contribute to impulse purchases and to the poorer health of disadvantaged groups.

Is there an opportunity to implement confectionery-free supermarket checkouts in NSW, as is recommended for the ACT?

Vanessa Hattersely and Stevie Wring agreed to take back suggestions from the audience to Coles and Woolworths, but also challenged the audience to help them ‘sell in’ these ideas. For example, they said, if confectionery is removed from the checkout aisle, what replacement is equally profitable?

Other possibilities raised include:

• Having healthier food made less expensive through differential taxation or some other legislative or regulatory approach

• Linking healthy food to loyalty schemes

• Encouraging the within-store promotion of fresh food in the way that packaged food is promoted.

Is there an opportunity to implement confectionery-free supermarket checkouts in NSW, as is recommended for the ACT?

Dr Danny Wiggins stressed the importance of the Integrated Planning and Reporting Framework to local council strategy development, and advised that opportunities existed to further leverage healthy food related council activities and resourcing via the Framework process.

5 Thornton et al. BMC Public Health 2012, 12:194

http://www.biomedcentral.com/1471-2458/12/194


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The need for multiple strategies Future direction

Next steps

Multiple cross-sector strategies are needed to create healthier food environments in NSW, both top down and bottom up. Food can be reformulated to contain less salt, saturated fat, and sugar, and fewer kilojoules. More information can be provided to consumers about the nutritional quality of foods and beverages. Retail and food service environments provide an opportunity to reward consumers for making healthier choices. Councils can include healthy eating initiatives into their Integrated Planning and Reporting responses and share best practice between councils.

Forum participants agreed that the following directions are worth considering:

1. The crucial role of the food industry in reformulating foods to make them healthier is encouraged and supported through the Food and Health Dialogue. However there is potential to increase the pace of reformulation and address portion size and consumer messaging.

2. The Heart Foundation’s Healthier Oils Initiative has the potential to improve the quality of the diet but would need to broaden its reach beyond the 11% of councils that have taken it up.

3. The NSW menu labelling at fast food outlets initiative is an important platform to be supported and all sectors can work together to increase awareness and understanding of kilojoules. Further consideration needs to be given to including salt and saturated fat as part of this initiative.

4. Retailers are encouraged to provide healthier options at the premium sites in their stores (including check-outs, end-of-aisle displays and island bins) and incentives for healthier shopping.

5. Cross-sector support for the Health Star Rating front-of-pack labelling system is encouraged. This system has the potential to make it easier for consumers to make healthy food choices in the supermarket.

6. Local councils have an important role to play in creating healthier food environments by incorporating food and health into their Integrated Planning and Reporting Framework responses and resourcing.

Areas discussed in the Food Forum will be further explored with stakeholders during 2014 and 2015 to determine future actions to create a healthier NSW food environment for all.

As well, efforts need to be made to target population sub-groups such as adolescents and young adults, and people living in rural and remote regions, who may have different needs.

However, while multiple strategies are needed, it is also necessary to avoid duplication. Several governments (federal and state), NGOs and the private sector appear to be working on similar areas but in isolation. An example was product reformulation being addressed by both the National Food and Health Dialogue and the Australian Food and Grocery Council's Healthier Australia Commitment. Is there room for a more co-ordinated approach between and within sectors here?

THE PROCESS

A literature review will be undertaken to inform these discussions and it will also be important to consider factors such as feasibility, acceptability and equity.


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STAKEHOLDERCONSULTATION

FOOD FORUM

LITERATUREREVIEW

OPTIONS FORACTION

About the NSW Food Forum

The NSW Food Forum was organised jointly by the NSW Ministry of Health, the Heart Foundation and the NSW Premier's Council for Active Living. Its aims were to encourage a healthy food environment to make healthy food choices, easy choices by:

• Showcasing and discussing key NSW and national initiatives that support and/or promote healthy food environments

• Identifying gaps and opportunities to guide future NSW action to promote healthy food environments.

The NSW Ministry of Health, the Heart Foundation and the NSW Premier's Council for Active Living would like to thank the speakers and participants for their valuable contribution to the Forum.

For more information, please contact:

NSW Ministry of Health Megan Cobcroft

E [email protected]

T 02 9391 9379

Heart Foundation Julie-Anne Mitchell

E [email protected]

T 02 9219 2450

NSW Premier’s Council for Active Living Peter McCue

E [email protected]

T 02 9219 2438


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