Advice related to diets and nutrition seems to be confusing to many people. One day, the latest scientific news may tell us one thing only to be contradicted the following day by the results of yet another study. To avoid such confusion, it is a good idea to consider more stable perspectives that come from trusted sources of nutrition information. One such source is the Dietary Guidelines for Americans (1) that come from the United States Department of Agriculture (USDA) and the Department of Health and Human Services. This source offers advice that considers that nutrition and physical activity needs are not the same for everyone and that our food and beverage choices, along with our physical activity, should be priorities because they directly relate to how we feel and function (see “Resources” section for additional information). As a cross-cutting message that applies to the entire workforce, worksite health promotion messaging related to eating a healthy diet may be as simple as: “focus on fruits, vegetables, whole grains, and low-fat dairy products, include protein, and avoid saturated fats, sodium, and added sugars.”
Of course, healthy nutrition is a bit more complex than this because it also relates to the unique considerations that apply to individuals. Such considerations include physical activity patterns, body mass index or body composition, medical care issues related to chronic conditions, and a person’s caloric requirements for a healthy weight.
In the workplace, what can an employer do to support its workforce given the challenges related to healthy eating and following a diet that is nutritious and maintains energy requirement throughout the day? Clearly, energy requirements for an office worker may be drastically different than those of a construction worker. Yet, despite the difference in caloric needs, both diets should be healthful. It is the purpose of this brief commentary to provide suggestions and considerations for healthful nutrition at the workplace.
RECOMMENDATIONS FOR HEALTHY EATING PATTERNS FOR ADULTS
The Dietary Guidelines for Americans provide the main source of science-based information for proper nutrition. Considering the context of the workplace, recommendations for workers to follow don’t always need to be about weight loss. In fact, a general focus on increasing certain types of foods and limiting others is an appropriate message to send. For example, the following foods are not consumed often enough, and a relative increase in their consumption is good advice:
- A variety of vegetables from all the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
- Fruits, especially whole fruits
- Grains, at least half of which are whole grains
- Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
- A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
A healthy eating pattern also limits:
- Saturated fats and trans fats, added sugars, and sodium
One effective health education tool is the ChooseMyPlate resource from the USDA available at ChooseMyPlate.gov (see Figure). This educational resource illustrates the five food groups that are the building blocks for a healthy diet, including fruits, grains, vegetables, protein, and dairy.
Note: Available at: https://www.choosemyplate.gov/
Another evidence-based resource is ChooseYourFish.org, a web site designed to provide information about the benefits of eating fish. This web site, which was developed by HealthPartners Institute in partnership with the Minnesota Department of Health, provides specific guidance for pregnant women about what types of fish to consider and what types of benefits this provides for both the mother and the baby (see the “Resources” section for additional information).
Specific Foods—Fruits and Vegetables
The Produce for Better Health Foundation (2) provides a rich Web site including a section focused on fruits and vegetables (see the “Resources” section for additional information). Their Top 10 Reasons to Eat More Fruits and Vegetables include:
- Color and texture
- Low in calories
- May reduce disease risk
- Vitamins and minerals
- Quick, natural snack
- Fun to eat
- …and they are delicious!
This type of advice almost is designed for a worksite health promotion fruits and vegetables campaign!
An example of the types of topics a healthy eating program could focus on is provided in the sidebar. Healthy eating and active living, alone or in combination, can elevate mood, manage and sustain high energy throughout the day, provide opportunities for coworkers to enjoy time with each other, reduce stress, build self-esteem, and reduce risk of heart disease and cancer.
Sidebar: Healthy Eating Suggestions to Include in a Workplace Program
- Suggest for people to eat at least one dark-green and one orange vegetable each day.
- Pick real vegetables and fruit instead of juice.
- Choose lots of whole grain options each day.
- Drink fat-free/skim or low-fat milk.
- Include protein options besides meat, e.g., beans, lentils, or tofu.
- Eat at least two servings of fish each week.
- Select lean meat and alternatives prepared with little or no added fat or salt.
- Be physically active every day.
- Satisfy your thirst with water.
- Provide ideas for healthy snack options that include lots of variety so people can experiment and try new foods, such as:
- ○ Raw vegetables like baby carrots or celery
- ○ Fresh fruit such as apples
- ○ Dried fruit / canned fruit
- ○ Nuts
- ○ Peanut butter
- ○ Low salt pretzels
- ○ Whole grain crackers
- ○ Low-fat yoghurt
- ○ Canned fish
- ○ Granola bars
- ○ Rice cakes
- ○ Whole-grain cereal
- ○ Cottage cheese
- ○ Low-fat cheese
- ○ Bagel bits
- ○ Bran muffins
- ○ Milk
- ○ Juice box
FACTORS FOR PROGRAM DEVELOPMENT
As a worksite health promotion professional, when you are working on designing and implementing a healthy eating initiative, not only would you look for bona fide resources for employees, you also should consider factors that are related to the design of a successful program. The following factors are important to keep in mind:
- Consider the adult population in general and workers specifically as the main audience.
- Redesign eating opportunities to make the healthy choice the easy choice.
- Use simple messages to address important dietary risk factors or issues.
- Make sure the advice provided is possible for workers to act on, consistent over time, and informed by credible sources.
- Whenever possible, rely on health professionals (e.g., dietitians or nutritionists) to provide specific guidance for dietary information related to diseases such as diabetes or cardiovascular disease.
- Ensure that guidance and information provided is actionable by aligning it with the programs, services, and foods available at the workplace.
- Align messages and programming aspects with the culture of the company.
- Connect the program with community-based resources.
INTERVENTION PROGRAMS AND POLICIES
Various types of approaches may be considered in creating interventions or programs for the workplace. We present four ideas here that include suggestions about what individuals can do, as well as what the company can do, to change the environmental conditions.
One area of focus should be the provision of accurate information and building awareness of what it means to eat healthy. This is important in itself but unlikely to be sufficient for people to change their eating behavior. Often, access to web-based resources is central to this option, and messages presented using texting or email are an important aspect of this intervention tactic.
Behavior Change Programs
Another individual-level programming option is to provide behavior change programs that will allow people to learn new ways to improve their dietary habits. Such programs include nutrition education and programming aspects such as health assessments or screening, self-instruction, and group education/classes. Furthermore, they tend to be organized around topics such as weight management or reduction of cardiovascular disease or other chronic conditions.
Obviously, healthful dietary choices also are influenced by the environment in which workers find themselves. For example, if the corporate cafeteria doesn’t provide healthy food options and doesn’t make the healthy choice the easy choice, it is unlikely that workers will consume them often enough. So, for example, a company can decide to make available point-of-service nutrition information/labeling that informs workers about their food options. Another option is to make available healthy options in the cafeteria and vending machines.
Often, large companies outsource their food services and many, including small- and medium-sized companies, make vending options available at the workplace that follow healthy catering policies. Examples of these types of policies and guidelines include the healthy vending toolkit created by the King County Public Health Department (see “Resources” section).
HOW TO MEASURE IMPACT
It is important to include an approach to the evaluation of the healthy eating program because this will allow for justification of continued allocation of resources as well as a chance to feed results back to the participants. For this purpose, indicators of changes participants have made because of the program would be ideal. Furthermore, being able to see a shift in the entire population also would be impactful. Available data may come from existing questions embedded in a health assessment but also may be complemented by short surveys as part of the healthy eating program itself. Don’t forget that if people purchase their foods at the corporate cafeteria, it may be possible to work with the food vendor to capture receipts and find out the type of purchases that were made during specific timeframes, thereby enabling the capture of a newly established pattern of food choices brought about by the intervention program.
An example of such a project was the price change initiated by HealthPartners for its employees at the corporate cafeteria during the month of March 2012 (3). The price of salad bar purchases was reduced by 50% during the month, and monthly sales data were analyzed for February through June. This information was complemented by a survey to employees. Salad bar sales more than tripled during the price reduction period and returned to baseline afterward. Employees reported that the high price of purchasing a salad relative to other choices available to them was a significant barrier to choosing to eat a salad. As a result, it may be concluded that policies that make salads competitive in price to other choices in cafeterias may significantly increase healthful food consumption.
Eating healthy and well is important not only for health but also for maintaining the energy needed to perform at work. It is in the interest of companies to ensure that healthy food options are available to employees. It may be difficult to keep track of everything related to eating well, but keeping things simple for people and relying on trusted, evidence-informed sources is a good strategy when it comes to designing and implementing a worksite health promotion program focused on healthy eating.
RESOURCES TO CONSIDER
1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans
. 8th edition. December 2015. Available at https://health.gov/dietaryguidelines/2015/guidelines/
2. The Produce for Better Health Foundation. Available at http://www.pbhfoundation.org/pub_sec
3. Kottke TE, Pronk NP, Katz AS, Tillema JO, Flottemesch TJ. The effect of price reduction on salad bar purchases at a corporate cafeteria. Prev Chronic Dis
. 2013;10:E25. doi: http://dx.doi.org/10.5888/pcd10.120214