Healthier menus without restrictive legislation

The recent New York City law restricting portion sizes of sugary beverages offered in restaurants has stirred much controversy among policy makers, scientists, the media and consumers. Opponents support the freedom of choice in selecting beverage portions and contend there is insufficient evidence that legislation will change behavior or body weight. Proponents contend that something should be done to reduce the ever-expanding receptacles in which sugar-laden beverages are served and cite research showing the size of a serving dish is associated with the amount consumed.

The debate has also waged on publicly among behavioral science powerhouses in The Atlantic, for example. Dr. Kelly Brownell, founder of the Yale Rudd Center of Food Policy and Obesity argues that research showing that increasing portion size is linked to greater consumption makes a case for legislation; while Drs. David Just and Brian Wansink, the latter of whom who produced some of the data demonstrating portion size predicts consumption,  have taken a more cautious view, fearing a prohibition-like backlash that could lead to increased desirability of the banned substance or possibly an increase in consumption of unlegislated but equally as harmful foods. More recently the debate about government regulation of soda has moved to a scientific stage in the New England Journal of Medicine, with Drs. David Just and Brian Wansink reprising their cautious stance on the one side, and Dr. Thomas Farley on the other side, pointing out that gads of legislation requiring the food industry to protect health already exists, so regulating soda availability hardly represents a new trend.

As the debate about whether to legislate or not continues, we should explore additional strategies that could effectively change the food environment in restaurants. Three medical students at the University of Massachusetts Medical School have devised a collaborative approach to changing the food landscape in restaurants and it is transforming the city of Worcester, Massachusetts, the second largest city in New England with about 181,631 residents. In 2010, Mitch Li, Adam Chin, and Matt DeWolf hatched the idea of developing a healthy restaurant certification program in which restaurants receive local accolades, membership into a local business network, and a healthy “status” by making healthy menu choices more plentiful and easier for the consumer to make.

The program called WooFood, a 501(c)3 nonprofit organization, is making rapid progress in transforming the food landscape in Worcester, MA. To date, 11 restaurants have become WooFood certified and over 20 others are soon to be certified. The WooFood model borrows strategies from the field of behavioral economics to improve restaurant menus. WooFood certification does not simply require restaurants to make healthy options more available, healthy options must also be easy to identify on the menu, easy to order, and appealing. Criteria address portion sizes, fruit and vegetables, whole grains, fats, sugary beverages, and healthy dessert choices. In terms of sugary beverages, WooFood criteria ask restaurants to not list sugary beverages on menus. Restaurants are also required to offer and highlight two beverages (other than water) that contain <3.6% sugar by weight. Sodas may still be offered, but only healthy choices will appear on menus. Interestingly, the majority of establishments have enthusiastically adopted these measures and report no customer resistance.

In the year since the first official restaurant certification, restaurants are now approaching WooFood to become certified, notably the DCU Center, the major sports arena in the area. The benefits to joining for businesses are plenty. WooFood is officially endorsed by the Worcester District Medical Society, thus certified restaurants also enjoy this endorsement. Certified restaurants are listed on the WooFood website along with professional photos of their certified dishes. Restaurants are also promoted via social media outlets. WooFood has also created a local business network by engaging other local businesses to provide free or discounted services to certified restaurants.

In addition to interest from restaurant owners and local businesses, the academic community has taken notice of the concept. Efforts are underway to evaluate the effectiveness of WooFood on consumer behavior, and professors from 3 local colleges have partnered with WooFood to create internships for their marketing students. The creative leveraging of community resources and the rapid spread of WooFood illustrates the potential of this model to be adapted in other communities.

Most importantly, WooFood demonstrates that a pro-business approach to creating a healthier food landscape in restaurants is possible. Because WooFood is funded by grants and donations and supported with the help of volunteers and interns, the major challenges going forward will be financial sustainability, scalability, and dissemination, all integral parts of their mission. While the national spotlight has been focused on legislation, other approaches to changing the food landscape are happening in our communities and require our attention if they are to have a chance to grow, become disseminated, and ultimately have broad impact.

Sherry Pagoto is Associate Professor of Medicine, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School. She blogs at Shrink and can be reached on Twitter @DrSherryPagoto.

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