RETHINKING HEALTHY EATING

IN THE WORKPLACE
A Toolkit for Employers

Ellen Curitti MSc RD

Public Health Nutritionist
Region of Waterloo Public Health
Copyright Acknowledgment

Written permission is required if any adaptations or changes are made to this resource. No part of this
resource may be used or reproduced for commercial purposes or to generate monetary profits. Copies of this
resource, in its entirety, may be created for non-commercial use provided the source is fully acknowledged

© Region of Waterloo Public Health, 2011

PART I

RETHINKING HEALTHY EATING

IN THE WORKPLACE
The Cost of Doing Nothing: The Business Case
 Table of Contents
PART I - THE COST OF DOING NOTHING: THE BUSINESS CASE
1.0 THE BUSINESS CASE 7
Introduction
Workplaces are often looking for ways to
improve the health and quality of life for their
employees. It is not uncommon for healthy
eating to be listed as a top choice on
employee interest surveys.
The rationale for this business case is to
provide evidence to workplaces on the
importance of creating a supportive healthy
eating environment.
A supportive healthy eating environment is
much more than simply making healthy
choices available to employees. In a truly
supportive environment, the onus is not placed
on employees to consistently resist an
unhealthy food environment in order to
maintain good health. Instead, a supportive
environment provides surroundings and
conditions that foster good health and
support healthy eating.
Before planning your workplace healthy
eating strategy, review:
PART I – ‘THE COST OF DOING NOTHING:
THE BUSINESS CASE’
Provides information for workplaces in
Waterloo Region about the
benefits of creating a
Healthy
comprehensive workplace healthy eating
strategy.
Outlines the current costs of unhealthy
eating for workplaces.
PART II – ‘EXAMINING THE EVIDENCE:
ADDRESSING THE LIMITATIONS OF CURRENT
INTERVENTIONS’
Presents an overview of the current
evidence on the barriers individuals face
when trying to maintain healthy eating
behaviours.
PART III – ‘MAKING THE SHIFT:
COMPREHENSIVE STRATEGIES TO PROMOTE
HEALTHY EATING’
Guides workplaces in planning,
implementing and evaluating evidence-
based comprehensive healthy eating
strategies.
This resource can be downloaded from:
http://www.projecthealth.ca under ‘Project
Health Resources’.
For more information or to schedule a
consultation, please call: 519-883-2287 or
visit: http://www.projecthealth.ca
 Business Case
What is Healthy Eating?
Healthy eating refers to following the Most Canadians are not active enough (85%
recommendations in Canada’s Food Guide, of Canadians are sedentary) to allow for
which describes the type and amount of food regular consumption of foods listed as
people need to eat to support good health.1 “Foods to Limit” on Canada’s Food Guide.2,3
Consuming these foods on a regular basis
Following the recommendations in Canada’s
either means that nutritious foods are
Food Guide will help your employees get
displaced from the diet or that individuals are
enough vitamins, minerals and other
eating too many foods high in calories, salt,
nutrients, as well as reduce the risk of
sugar or fat, which can contribute to the
developing nutrition-related chronic disease.1
development of chronic disease.
Canada’s Food Guide recommends the
Canada’s Food Guide also recommends
average number of servings from each Food
drinking water regularly to meet hydration
Group that Canadians should try to eat each
needs. Additional water is needed during hot
day.1 All Canadians are encouraged to
weather or when employees are physically
consume more vegetables, fruits and whole
active.1 Some very active individuals may
grains while limiting or avoiding foods with
require more calories and should eat extra
high levels of added fat (especially trans
servings of food from the four Food Groups.1
fats), sugar and salt.1

Tools: CANADA’S FOOD GUIDE

Visit the Health Canada website for tools that will help your employees follow Canada’s
Food Guide http://healthcanada.gc.ca/foodguide.

Project Health – Rethinking Healthy Eating: The Business Case 7

 Business Case

Who is at Risk for Nutrition Related Chronic Disease?

Virtually all Canadians require significant improvements to their dietary intakes.

Less than 1% of Canadians follow a diet
consistent with Canada’s Food Guide.2 The
table below shows the percentage of
working aged Canadians classified as
having a ‘poor’ diet or a diet that ‘needs
improvement’.2 In each age category, more
men than women were found to have diets
classified as ‘poor’.2
Overall, Canadians’ diets scored a 58.8 on
the Healthy Eating Index with 50 being the
cut off for ‘poor diet’ and above 80 being the
cut off for ‘good diet’.2 This indicates that the
average Canadian diet is much closer to the
‘poor’ diet category than to the ‘good’ diet
category.2

Table 1: Average score on Canadian adaptation of the Healthy Eating Index2

Age Gender Poor Diet Diet Needs Improvement Average Score
Men 28.9% 71.1% 54.0
19 to 30
Women 20.0% 80.0% 56.9
Men 22.4% 77.5% 56.4
31 to 50
Women 13.0% 86.4% 60.2
Men 19.2% 80.5% 57.7
51 to 70
Women 10.4% 88.9% 61.3

Project Health – Rethinking Healthy Eating: The Business Case 8

 Business Case

Nutrition Related Chronic Disease in Waterloo Region

Several of the most prevalent chronic
diseases in Waterloo Region are related to
poor diet quality including high blood
pressure (affecting 15% of the population),
diabetes (4%), and heart disease (3%).4
Other common conditions such as back
problems (18%), arthritis (13%), and asthma
(9%) can be associated with weight status.4
In 2008, the prevalence of overweight and
obesity among adults 18 and over in
Waterloo Region was 55.5%, up from 49.5 in
2005, and this upward trend is expected to
continue.5-7 Table 2 shows that in 2007/2008
men were more likely to be overweight or
obese than women.7 Over 75% of men in the
50-64 age group are overweight or obese.5
These percentages are based on self-
reported weight and height. It is common for
individuals to under-report weight and over-
report height.8,9 In Canada, the discrepancy
between measured and self-reported height
and weight may be as high as 8%.8

Table 2: Self-reported Overweight and Obesity in Waterloo Region by Age and

Gender – 2007/20087
Age Group Men Women
18-34 47.5 % 32.4 %
35-49 67.8 % 43.7 %
50-64 76.8 % 59.7 %
65+ 65.9 % 57.2 %

Personal Costs Related to Chronic Disease

Individuals often carry a significant personal
financial burden when they develop chronic
disease. For example, obese men are faced
with approximately $2646 and women with
$4879 of additional expenses per year due
to medical expenses and wage losses (i.e.,
disability, sick leave, decreased productivity,
and insurance costs).10 Increased personal
financial burdens can make it more difficult
for individuals to follow through with health
care recommendations, making financially
disadvantaged individuals even more at risk
for health problems related to chronic
disease.11

Project Health – Rethinking Healthy Eating: The Business Case 9

 Business Case

The Business Case for Healthy Eating

Healthy Eating: A Health and Safety Issue
Healthy eating is associated with a lower risk The presence of chronic disease can also
of developing chronic diseases such as cause sleep disruptions, or can otherwise
obesity, type 2 diabetes, certain types of affect alertness which increases the risk of
cancer, heart disease, and osteoporosis.1,2 having traffic collisions for employees who
In addition, healthy eating can contribute to drive to work or as part of their
the overall health and vitality of employees.1 occupation.13,16 This also has implications for
employees who operate machinery.
Most employed Canadian adults spend at
least 60% of their waking hours at work.12 Employees who have the benefit of optimal
This makes the workplace an ideal setting to health are more likely to be at work and
promote healthy eating. Workplace perform well.17 They are also more likely to
environments that support healthy eating remain with an employer who values their
may be particularly effective to reach health.18 Employers should consider the
worksite populations typically resistant to resources spent to improve the productivity
health education since employees do not and health of employees similar to how they
have to actively choose to participate.13-15 An would consider investments in workplace
example of this is reducing employee facilities.18-20 After all, investing in healthy
exposure to foods designated as “Foods to eating helps to protect the vitality of a
Limit” by Canada’s Food Guide.1 workplace’s greatest assets, its employees!
Historically, workplaces have taken
responsibility for removing environmental
safety hazards in the workplace, while the
onus has been on employees to be
responsible for maintaining a healthy diet.13
However, the workplace food environment
and the demands of work may negatively
impact eating and physical activity
behaviours, which may lead to employees
developing nutrition related chronic
diseases.12,13
In some cases the presence of chronic
diseases such as obesity can reduce the
availability or effectiveness of personal
equipment, making affected individuals more
at risk of experiencing a workplace injury.13

Project Health – Rethinking Healthy Eating: The Business Case 10

 Business Case

Employer Costs Related to Chronic Disease

The presence of chronic diseases among
employees creates a burden on workplaces
in terms of depleting human resources and
increasing financial losses related to
increased medical expenses,
pharmaceutical costs, higher rates of injury,
disability and workers compensation,
increased absenteeism, decreased
productivity, higher insurance costs, higher
rates of employee turnover and early
retirement.13,14,21-34
When individuals have a chronic medical
condition they often have mental health
issues such as depression that either
preceded the condition or has occurred as a
result of having a chronic disease.35,36 As a
result, mental health issues related to the
development of chronic disease may also
increase workplace costs.34
Absenteeism
In 2009, the average Canadian employee
missed approximately 6.6 days of work, up
from 5.7 days in 2008. These missed days
cost employers an average of 2.6% of
payroll expenses.37
The presence of nutrition related chronic
disease can have a profound impact on
absenteeism rates. For example, compared
to normal weight employees the estimated
number of workdays missed for overweight
employees is not necessarily higher, while
studies have shown that obese workers miss
significantly more work time compared to
normal weight workers, (1 to 10 additional
days per employee per year).14,22,38,39,40

Project Health - Healthy Eating Business Case for Employers 11

 Business Case

Compared to individuals without chronic
disease
individuals with diabetes miss an
additional 1.9 to 6.4 days per year;34,41-43
women with osteoporosis miss an
additional 12.7 days of work;43
individuals with cancer miss an additional
2.8 to 26.7 days of work;34,42,43
individuals with cardiovascular disease
miss an additional 6.8 to 32.7 days; and
34,42,43
individuals with hypertension miss 0.9 to
4.2 additional days of work.34, 42
Productivity
Productivity losses due to employees going
to work despite being sick, stressed or
distracted have been shown to cost
employers more than health costs,
absenteeism and disability combined.44 In
some cases losses due to productivity were
two to three times higher than costs related
to medical and pharmacy and medical
costs.45,46 For chronic health conditions,
costs related to decreased productivity make
up the major component of the workplace
costs for chronic disease.33,34,41,42,45-47
One study found that 61% of overall losses
related to chronic health conditions were due
to losses in productivity.34 Another employer
found that lost productivity made up 6.8% of
total labour costs.33
Prescription Drug Costs
Prescription drugs represent 60% to 70% of
workplace health expenditures in Canada.48
In 2007, prescription drugs cost $665 per
employee, more than double the costs in
2000.49
Much of this cost increase is due to
conditions related to unhealthy eating habits.
In 2009, four of the top ten prescription
drugs dispensed in Canada were for high
blood pressure, cardiovascular disease, high
cholesterol, and type 2 diabetes.50
Overall Costs
Overall workplace financial losses related to
chronic disease range from as low as a few
hundred dollars33,34,51,52 to several thousand
dollars per affected employee per year, (i.e.,
combined costs of $3000 to $15000 higher
than employees without chronic health
conditions).31,34,41,43
A supportive healthy eating environment
may prevent employees from developing
chronic diseases and may also assist
individuals who have chronic diseases to
manage their conditions, both of which will
help to contain health-related workplace
expenditures.

Workplace Example: Scotiabank

In 2001, none of the top 10 drugs covered by Scotiabank’s drug plan were related to
unhealthy eating. By 2007, three of the top 10 prescription drugs were for medical
conditions related to unhealthy eating. To address this growing problem Scotiabank
has created a supportive environment by implementing healthier menus, setting
nutritional guidelines for foods served at work functions and providing nutritional
counselling for employees.53

Project Health – Rethinking Healthy Eating: The Business Case 12


Promoting Healthy Eating in the Workplace
The goal of your healthy eating initiative
should be to help your employees to follow
Canada’s Food Guide, which translates the
science of nutrition and health into a healthy
eating pattern.1
By following Canada’s Food Guide,
employees will be able to meet their nutrient
needs and reduce their risk of developing
nutrition related chronic diseases.
Additionally, creating a supportive healthy
eating environment may also help individuals
who have developed chronic diseases to
manage their conditions. In addition to
providing awareness raising, educational
Project Health - Healthy Eating Business Case for Employers
Business Case
and skill building activities in the workplace
dietary improvements can be achieved by:
Offering more dark green and orange
vegetables, fruit and whole grains.2
Reducing the sodium, sugar and trans fat
content in available foods.1
Limiting “Foods to Limit” as classified by
Canada’s Food Guide in the workplace.2
Specifically limiting soft drinks, sweet
baked goods, deep fried foods, frozen
and pre-prepared meals, side dishes, and
frozen pizza, salad dressing, potato
chips, salty snacks, and french fries.54
13
 Business Case
What about personal ‘choice’?
Often the argument against limiting certain
foods that that “people need to have
choices”, this feeling is especially strong
when it comes to food. However, is it an
individual’s personal right to have less
healthy food available to them in the
workplace?
Workplaces should not feel obligated to offer
“Foods to Limit” to their employees.
Employees always have the right to pack
preferred foods in their lunch bag or to
purchase foods from other locations.
Therefore, by not offering some choices you
will not violate anyone’s personal rights to
choose what they eat.
People by nature are not fond of changes,
especially imposed changes.55 As a result,
when making any changes in the workplace,
it should be expected that there will be some
opposition. It is also possible that the
individuals who are most opposed to
changes are in the minority. By using
workplace committees and conducting
needs assessments you can involve
stakeholders in decision-making and give all
employees an equal opportunity to identify
their personal preferences and priorities.
Studies on choices show that people most
often make day-to-day choices that serve a
purpose such as providing energy or
Project Health – Rethinking Healthy Eating: The Business Case
nutrition, (e.g. what to have for lunch at
work).56-58 This may mean that people accept
having choices in the workplace limited to
more nutritious foods.
However, when people have expectations of
fun, excitement or reward attached to food
occasions, they tend to desire and expect
more indulgent food choices.56-58 When
offered indulgent choices, people often look
for reasons to justify making a more
indulgent choice (e.g. “It was a hard day at
work today”, or “I’m going to the gym
later”).58
Many people struggle to make healthy
choices when offered tempting foods.56,59-62
These people will benefit the most from
interventions that reduce exposure to
tempting foods.
In studies that used focus groups to ask
employees what changes should be made to
work environments, it has been individuals in
management positions that are most
reluctant to limit the types of foods offered to
employees.61,63 Some employees may also
be initially resistant to the idea of not being
offered “Foods to Limit”, however, in time
they will probably adjust to changes as long
as they have a reasonable amount of
healthy choices that are tasty, appealing and
reasonably priced.57,64
14
 Business Case

Return on Investment (ROI)

Many studies have been conducted on
promoting healthy eating in the workplace;
however, most studies use a unique
approach to encourage healthy eating.
Interventions have included health-related
print materials, emails and websites; healthy
eating challenges; incentives; group or one-
on-one education; point-of-purchase
messages; health screening and referrals;
and environmental support strategies such
as offering healthier options in cafeterias and
vending machines.
Very few, if any, studies have examined the
effects of implementing a healthy eating
policy in the workplace.
The return on investment (ROI) for
workplace healthy eating interventions has
varied: ranging from substantial losses,65 to
no ROI,51,66 to savings of $1.17 to $6.00 per
dollar spent.67 In comparison, studies on
workplace weight-loss interventions have
estimated savings of $0.85 to $4.87 per
kilogram of weight lost.51,68,69

Success Story: WORKPLACE HEART HEALTH INTERVENTION

This intervention included onsite health education, referrals for smoking cessation,
stress management, cholesterol, hypertension, diabetes and treatment for drug and
alcohol addiction. Memberships in fitness clubs were given along with awards for
milestones in behaviour change. In addition, a group competition was held with awards
for best outcome.
For each dollar invested, the employer saved $6.00 in health care expenses.69

Project Health – Rethinking Healthy Eating: The Business Case 15

 Business Case
Considerations:
Although some studies have shown a
positive ROI, none have investigated long
term effects. It is not clear if ROI is ongoing
over several years or if the interventions
have a diminishing effectiveness over time.
Also, it may be difficult to effectively evaluate
ROI data. For example, absenteeism may be
influenced by several variables; not solely
Project Health – Rethinking Healthy Eating: The Business Case
related to sickness, such as job satisfaction
or work/life conflicts, making it a less than
perfect measure of the effectiveness of
healthy eating interventions.45 Therefore, it is
important to evaluate several aspects of your
healthy eating initiative in order to determine
its effectiveness.
16
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Healthy Eating Toolkit for Workplaces
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61. Devine CM, Nelson JA, Chin N, Dozier A, Fernandez
ID. "Pizza is cheaper than salad": Assessing workers' views
for an environmental food intervention. Obesity (Silver
Spring). 2007;15 Suppl 1:57S-68S.
62. Wilcox K, Vallen B, Block L, Fitzsimons GJ. Vicarious
goal fulfillment: When the mere presence of a healthy
option leads to an ironically indulgent decision. Journal of
Consumer Research. 2009;36:380-393.
63. Gates D, Brehm B, Hutton S, Singler M, Poeppelman
A. Changing the work environment to promote wellness: A
focus group study. AAOHN J. 2006;54:515-520.
64. Stice E, Yokum S, Blum K, Bohon C. Weight gain is
associated with reduced striatal response to palatable food.
J Neurosci. 2010;30:13105-13109.
65. Meenan RT, Vogt TM, Williams AE, Stevens VJ,
Albright CL, Nigg C. Economic evaluation of a worksite
obesity prevention and intervention trial among hotel
workers in Hawaii. J Occup Environ Med. 2010;52 Suppl
1:S8-13.
66. Finkelstein EA, Linnan LA, Tate DF, Leese PJ. A
longitudinal study on the relationship between weight loss,
medical expenditures, and absenteeism among overweight
employees in the WAY to health study. J Occup Environ
Med. 2009;51:1367-1373.
67. Anderson LM, Quinn TA, Glanz K, et al. The
effectiveness of worksite nutrition and physical activity
interventions for controlling employee overweight and
obesity: A systematic review. Am J Prev Med.
2009;37:340-357.
68. Baker KM, Goetzel RZ, Pei X, et al. Using a return-on-
investment estimation model to evaluate outcomes from an
obesity management worksite health promotion program. J
Occup Environ Med. 2008;50:981-990.
69. Milani RV, Lavie CJ. Impact of worksite wellness
intervention on cardiac risk factors and one-year health care
costs. Am J Cardiol. 2009;104:1389-1392.
18
PART II

RETHINKING HEALTHY EATING

IN THE WORKPLACE
Examining the Evidence:
Addressing the Limitations of Current Interventions
 Table of Contents
PART II - EXAMINING THE EVIDENCE:
ADDRESSING THE LIMITATIONS OF CURRENT INTERVENTIONS

2.0 ENERGY BALANCE 23

3.0 MAKING CHANGES 31
4.0 BARRIERS TO HEALTHY EATING 37
5.0 CONCLUSION 60
Introduction
Is it time for change?
Despite education efforts to promote healthy eating,
eating habits do not seem to be improving. There is
also evidence that current methods to promote
healthy eating and healthy weights may be doing
some harm (e.g. lowering self-esteem, creating
weight bias, increasing disordered eating).
Good decisions are based on good information.
Before taking action to promote healthy eating in your
workplace, consider the information in this resource.
PART II - EXAMINING THE EVIDENCE: ADDRESSING
THE LIMITATIONS OF CURRENT INTERVENTIONS:
Makes the case that healthy eating is not just an
individual issue.
Highlights the current barriers to healthy eating in
a workplace context.
The previous section PART I – ‘THE COST OF DOING
NOTHING: THE BUSINESS CASE’
Outlined the current costs of unhealthy eating for
workplaces.
The next section: PART III – ‘MAKING THE SHIFT:
COMPREHENSIVE STRATEGIES TO PROMOTE
HEALTHY EATING’
Guides workplaces in planning, implementing
and evaluating evidence-based comprehensive
healthy eating strategies.

Energy Balance
Energy balance for adults means that the
number of calories eaten equals the number
of calories that are used by the body. In this
state, weight maintenance will occur. Weight
maintenance is defined as having a weight
that does not increase or decrease by more
than 5% over time.1
The population-wide increase in weight is
caused by a combination of environmental
and lifestyle factors that make it easy for
people to eat more calories than their bodies
can use. However, genetic factors can
determine whether a person will become
obese meaning that some individuals are
more susceptible than others to becoming
obese when exposed to excess calories in
the food environment.2
It is often assumed that the damage caused
by unhealthy eating can be “undone” by
being physically active. However, the reality
is that there is no substitute for healthy
eating, especially in the case of weight
control.
Energy Balance
Using common catch phrases such as “all
foods fit”, and “everything in moderation”
may cause individuals to become
complacent when faced with unhealthy
choices. However, it only takes a small
number of extra calories each day to cause
a significant weight problem.
How much is too much?
A Canadian study, found that obese men
and women ate an average of only 200
calories more per day than non-obese
individuals.3 Consuming as few as 50 to
150 extra calories per day can cause an
individual to become obese.4-6
Therefore, even small increases in caloric
intake can have significant negative
implications for the overall health of
employees. Consequently, the types and
amounts of food available to people in their
work environments should be carefully
considered.

Food For Thought: A TINY INDULGENCE

Consuming an extra 100 calories per day, can result in a 4.5 kg (10 lb) weight gain in one
year.7 This is the amount of calories in: 1 cup of soda, 10 jelly beans, 5 chocolate
covered almonds, half of a donut, or one quarter of a muffin.8

The bottom line: Even a small daily “treat” can have negative long-term effects on
weight.

Project Health – Rethinking Healthy Eating: Examining the Evidence 23

 Energy Balance

What Role Does Calorie Intake Play in Energy Balance?

It is estimated that 60% to 100% of obesity
among Canadians is related to excess
calorie consumption.9 There were up to 530
more calories available for each Canadian to
consume in 2002 than there were in 1985.9
Three food items account for more than half
of this increase: salad oils, wheat flour, and
soft drinks.7
The extra calories in our diets are most often
found in sweet baked goods, convenience
foods (deep fried foods, frozen and pre-
prepared meals, side dishes, and frozen
pizza), salad dressing, potato chips, salty
snacks, and french fries.7
The portion sizes that we typically eat are
also much larger than the recommended
portion sizes in Canada’s Food Guide,
leading to higher calorie intake overall, even
for foods considered to be “healthy”.10

Food For Thought: HOW MUCH EXERCISE?

In order to burn off an extra 530 calories per day, a person would have to walk at a
moderate pace for two hours per day, seven days per week.11 This is significantly more
time than is required to meet the current physical activity guidelines.

The bottom line: People need daily physical activity to help maintain their health and
weight, however, calorie intakes overall need to be decreased to reduce weight.

Project Health – Rethinking Healthy Eating: Examining the Evidence 24

 Energy Balance

Physical Activity and Energy Balance

The Role of Physical Activity in Weight Loss
Moderate-intensity physical activity (defined
as walking 150 minutes per week at a 6.4
kilometer (4 mile) per hour pace), can help
to maintain weight. However, this amount of
physical activity is not enough to cause
weight loss (defined as losing more than
5% of body weight).1
It requires a significant increase in physical
activity in order for weight loss to occur (up
to 80 minutes of moderate intensity
physical activity per day), well above the
amount needed to maintain good health.1,7

The Importance of Physical Activity

Physical activity can help to prevent falls as
well as chronic diseases such as
osteoporosis, cardiovascular disease,
certain types of cancer, and diabetes.1,12,13
Participating in regular physical activity can
also have a significant positive effect on
waist circumference, even when there is no
substantial weight loss involved.14
Canada’s new Physical Activity Guidelines,
launched in January 2011, recommend
adults (18 to 64 years of age) accumulate
at least 150 minutes of moderate-to-
vigorous intensity aerobic physical activity
per week in bouts of 10 minutes or more.
Adults should also perform strengthening
activities (for muscles and bones) at least
two days per week. In addition, more
physical activity provides even greater
health benefits.15

Tools: PROMOTING PHYSICAL ACTIVITY IN YOUR WORKPLACE

For more information on physical activity, see the toolkit: “Active Employees, Active
Workplaces: Promoting & Supporting Physical Activity at Work” at
http://www.projecthealth.ca under ‘Project Health Resources’.

Project Health – Rethinking Healthy Eating: Examining the Evidence 25

 Energy Balance

Dispelling the Myth:

Labour-Related Physical Activity
The rapid weight gain that has occurred in
North America in the past 30 years is often
attributed to the reduction in labour-related
physical activity.9 Current research suggests
reduced labour-related physical activity is not
the main reason for population weight gain.7,9
The decline in labour-related physical activity
occurred mostly between 1950 and 1970.9 This
reduction in physical activity would only
account for a three pound weight gain across
the population (or 26 calories per day).9

Food For Thought: PHYSICAL ACTIVITY GUIDELINES AND WEIGHT LOSS

If a sedentary individual started walking 30 minutes per day at a moderate intensity,
five days a week for one month, (with energy intake held constant), this person could
expect to lose 0.5 kg (1 lb).16
The bottom line: Physical activity is an important part of a healthy lifestyle, however,
physical activity alone is not an effective weight loss strategy.

Project Health – Rethinking Healthy Eating: Examining the Evidence 26

 Energy Balance

Leisure-Time Physical Activity What About Resistance Training?

Over 50% of Canadians report that they are The muscles in our body burn more calories
physically active; however, only 15% of than fat tissue. However, even a big
Canadians are active enough to meet increase in muscle mass of 4.5 kilograms
current physical activity guidelines.17 (10 pounds) would only burn an extra 45
calories per day.18 That’s the equivalent of
Leisure-time physical activity is related to
less than two coffee creamers.8
healthy weight maintenance. Canadian
men with a healthy weight (BMI 18.5-24.9 Studies of the effects of resistance training
kg/m2) perform an average of 35 minutes of on body weight typically show a weight loss
moderate-to -vigorous physical activity per of less than 1 kg (2.2 pounds) overall.1
day, while overweight and obese men
performed 26 and 19 minutes respectively.
Similarly, women with a healthy weight
perform 25 minutes of moderate to
vigorous physical activity per day, while
overweight and obese women performed
only 20 and 13 minutes respectively.17

Success Stories: THE NATIONAL WEIGHT CONTROL REGISTRY

The National Weight Control Registry is a roster of people who have successfully
maintained a 10% weight loss. In addition to significantly reducing their energy intake,
these individuals walk an average of 45 kilometres per week.19

Project Health – Rethinking Healthy Eating: Examining the Evidence 27

 Energy Balance

Limitations of Physical Activity in Energy Balance

Compensation

As physical activity levels go up, people do This is thought to be due to an energy

not necessarily lose as much weight as they
expect.14
compensation effect where physical activity
causes increased energy intake.14,20 In fact,
large increases in physical activity may
reduce leptin in the blood (a hormone that
sends signals to your brain that you are full).
As a result of lower leptin, people experience
more hunger and tend to seek out food
based rewards.20 This is one reason why
people do not lose as much weight as they
may expect, when they become physically
active.14,20
Compensatory Intentions

Individuals who are trying to control their

eating behaviours often think of a coping
strategy to prevent themselves from feeling
guilty while indulging in a tempting food.21
For example, promising yourself to go for a
run after eating a cookie. However, people
who use this strategy usually fail to perform
the compensatory behaviour, leading to
weight gain.21 There is also a tendency to
underestimate the number of calories that
have been consumed and overestimate the
number of calories that can be burned during
physical activity.21

Food for Thought: PHYSICAL ACTIVITY AND WEIGHT LOSS

Physical activity has a multitude of health benefits. However, the calories that are used
during physical activity are a small fraction of the calorie deficit that is needed to cause
weight loss.7,14
The bottom line: Individuals who are trying to lose weight are unlikely to be successful
if they do not simultaneously reduce energy intake.1

Project Health – Rethinking Healthy Eating: Examining the Evidence 28


Energy Balance References
1. Physical Activity Guidelines Advisory Committee. G.4
Energy balance. In: Physical Activity Guidelines Advisory
Committee Report, 2008. Washington, DC: U.S. Department
of Health and Human Services; 2008:G40-i-G4-37.
2. Loos RJ. Recent progress in the genetics of common
obesity. Br J Clin Pharmacol. 2009;68:811-829.
3. Langlois K, Garriguet D, Findlay L. Diet composition and
obesity among Canadian adults. Statistics Canada. Cat. No.
82-003-XPE.
4. Cohen D, Farley TA. Eating as an automatic behavior. Prev
Chronic Dis. 2008;5:A23.
5. Hill JO, Peters JC, Wyatt HR. Using the energy gap to
address obesity: A commentary. J Am Diet Assoc.
2009;109:1848-1853.
6. Hill JO, Peters JC, Catenacci VA, Wyatt HR. International
strategies to address obesity. Obes Rev. 2008;9:41-47.
7. Slater J, Green CG, Sevenhuysen G, Edginton B, O'Neil J,
Heasman M. The growing Canadian energy gap: More the
can than the couch? Public Health Nutr. 2009;12:2216-2224.
8. Health Canada. Nutrient value of some common foods.
Ottawa, Ontario: Published by authority of the Minister of
Health.; 2008.
9. Bleich S, Cutler D, Murray C, Adams A. Why is the
developed world obese? Annu Rev Public Health.
2008;29:273-295.
10. Health Canada. Eating Well with Canada's Food Guide: A
Resource for Educators and Communicators. Ottawa: Health
Canada; 2007.
11. Swinburn B, Sacks G, Ravussin E. Increased food energy
supply is more than sufficient to explain the US epidemic of
obesity. Am J Clin Nutr. 2009;90:1453-1456.
12. Kesaniemi A, Riddoch CJ, Reeder B, Blair SN, Sorensen
TI. Advancing the future of physical activity guidelines in
Project Health – Rethinking Healthy Eating: Examining the Evidence
Energy Balance
Canada: An independent expert panel interpretation of the
evidence. Int J Behav Nutr Phys Act. 2010;7:41.
13. Warburton DE, Charlesworth S, Ivey A, Nettlefold L,
Bredin SS. A systematic review of the evidence for Canada's
physical activity guidelines for adults. Int J Behav Nutr Phys
Act. 2010;7:39.
14. Church TS, Martin CK, Thompson AM, Earnest CP,
Mikus CR, Blair SN. Changes in weight, waist circumference
and compensatory responses with different doses of exercise
among sedentary, overweight postmenopausal women. PLoS
One. 2009;4:e4515.
15. Canadian Society for Exercise Physiology. Canadian
Physical Activity Guidelines.
http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-
adults-ENG.pdf. Accessed 24/01/2011.
16. Hainer V, Toplak H, Mitrakou A. Treatment modalities of
obesity: What fits whom? Diabetes Care. 2008;31 Suppl
2:S269-77.
17. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J,
Trembley MS. Physical activity of Canadian adults:
Accelerometer results from the 2007 to 2009 Canadian Health
Measures Survey. Statistic Canada. Cat. No. 82-003-X
18. Wolfe RR. The underappreciated role of muscle in health
and disease. Am J Clin Nutr. 2006;84:475-482.
19. Anderson JW, Konz EC, Frederich RC, Wood CL. Long-
term weight-loss maintenance: A meta-analysis of US studies.
Am J Clin Nutr. 2001;74:579-584.
20. Turner JE, Markovitch D, Betts JA, Thompson D.
Nonprescribed physical activity energy expenditure is
maintained with structured exercise and implicates a
compensatory increase in energy intake. Am J Clin Nutr.
2010;92:1009-1016.
21. Kronick I, Knauper B. Temptations elicit compensatory
intentions. Appetite. 2010;54:398-401.
29
 Making Changes
Can People Change?
Canadians say that nutrition is an important The average amount of maintained weight
factor in their food choices; however, this is loss in randomized clinical control trials is
not reflected in their actual food choices.1 only 1.0 to 6.8 kg (2.2 to 15 pounds) after 5
Eating habits have been getting worse over years.7,11-14
the years, despite efforts and campaigns
Similarly, workplace based trials report a
aimed at helping people to make healthy
sustained weight loss of only about 1 kg (2.8
choices.2
pounds) one year after the intervention.15
We often think of eating as a personal
choice which can be influenced by education
and individual counselling. Nutrition
education can improve nutrition knowledge;
however, it does not necessarily influence
food choice behaviour.3-6
Hundreds of weight loss intervention
programs have been studied to find the best
way to help people lose weight. Many of
these interventions include a variety of
physical activity and healthy eating
education sessions, behavioural and
cognitive techniques to motivate behaviour
change, as well as professional counselling
from doctors, dietitians, and physical activity
specialists. Unfortunately, none of these
approaches have resulted in significant long-
term weight loss. People lose weight initially
but they usually regain some, if not all, of the
weight within one year.7,8 Only 5 to 20% of
individuals who lose weight, are successful
in maintaining their weight loss.8-11

Project Health – Rethinking Healthy Eating: Examining the Evidence 31

 Making Changes
Is Education Effective?
In general, awareness-raising efforts to
promote healthy eating and behaviour
change have been fairly ineffective. Below,
three examples highlight the disappointing
outcomes of some traditional awareness-
raising strategies.
Example 1:
A group of obese women were recruited for
a study in which dietary education was not
provided. The women lost an average of 10
kg (22 lbs) because they were required to
follow a controlled diet as part of the study.
The weights of the participants were
recorded for the next four years. The weights
of these participants were compared to
participants of 16 previous studies on the
effectiveness of behaviour modification
treatments for obesity using education
interventions.
The pattern of weight regain in the non-
education group had a similar trajectory to
participants who had been part of the
intervention studies that included dietary
education. These results indicate that being
part of a treatment group for weight loss was
not effective for maintaining weight loss;
participants in the 16 education interventions
Project Health – Rethinking Healthy Eating: Examining the Evidence
gained weight at the same rate as the group
that had no education for weight control.16
Example 2:
A media blitz was disseminated in a
community on the dangers of trans fats. Part
of the strategy was to provide education on
how to avoid trans fats. Initially, sales of
items containing trans fats decreased, but
sales started increasing again only one week
after the media campaign was complete.17
Comparable results were seen in New York
City after a similar media campaign. Despite
launching a widespread educational
campaign for food suppliers, supermarkets,
restaurants, and consumers, trans fat use
remained unchanged.18
Example 3:
A study was conducted with people who had
been recently diagnosed with a nutrition-
related cancer. The control group was
provided with awareness-raising materials,
dietary guidelines, newsletters and an
invitation to participate in cooking classes.
Despite the fact that this group of people had
a recent cancer diagnosis and were
expected to be motivated to change (as
cancer recurrence might be prevented with
dietary improvements), education failed to
prompt any of these individuals to make
improvements in their eating habits.19
32
 Making Changes

What about other weight loss methods?

Medications What does this mean?
People usually lose about 5 kg (11 lbs) when It has been suggested that if the current rate
prescribed medication to induce weight of weight gain continues, everyone living in
loss.20 However, most weight loss drugs are the U.S. will be overweight or obese by the
not approved for more than one to two years year 2050.24 After years of conducting
of use and individuals will most likely regain hundreds of weight loss interventions without
weight once the treatment has stopped.11,21 seeing substantial long-term weight loss,
health promoters should question whether
Bariatric Surgery
people really can lose weight and keep it off.
Bariatric surgery (i.e., gastric bypass or Evidence on the ability of people to lose
gastric banding) is a treatment available for weight in the current environment suggests
people with a BMI of 40 kg/m2 or more, or a that only a small proportion of individuals will
BMI of 35 kg/m2 with weight-related health be able to do so, while the vast majority will
problems.21 continue to gain weight.
Surgery reduces the amount of food that the This is the rationale for creating a supportive
stomach can hold, thereby promoting weight healthy eating environment in the workplace,
loss. Initially, bariatric surgery recipients lose which can help to prevent weight gain and
large amounts of weight. However, it is support individual efforts to maintain a
unclear if weight loss is maintained long- healthy weight.
term. One systematic review reported that
weight loss was about 28-76 kg (62-167 lb)
in the second year after surgery, but the net
weight loss was only 20 kg (44 lb) eight
years after surgery.11 Another study showed
that only 43% of people had successful
weight loss results (i.e., no complications
and sustained weight loss of more than 25%
of their excess weight) when assessed
seven years after bariatric surgery.22
Many people who have bariatric surgery do
not return to a “healthy” weight.
Nevertheless, even a modest amount of
weight loss can result in improvements in
health conditions such as diabetes and high
blood pressure.23

Project Health – Rethinking Healthy Eating: Examining the Evidence 33

 Making Changes
Why Do People Resist Change?
Workplaces often report that employee
resistance is one of the major barriers to
making changes in the workplace.
Unfortunately, people are often opposed to
changes in the food environment because
weight is considered to be a personal
responsibility.
Lack of willpower is a common explanation
for failing to maintain a healthy diet.4
However, food and eating decisions involve
a very complex mix of social, psychological,
physiological, and environmental factors,
most of which affect us without our
conscious awareness.
Awareness-raising efforts are often directed
at individual behaviour change. As a result,
most people attribute obesity to individual
lifestyle factors and are resistant to
interventions and policies meant to address
the unhealthy food available in the
environment. Typically, such initiatives are
perceived as “taking away choices.”25
However, an environment with an increased
availability of inexpensive (or free),
convenient, calorie-dense foods is most
likely the reason for continued weight gain in
the population.4
Weight Bias
The bias that weight is easily modifiable and
weight loss is a matter of personal effort and
self-control is shared by the media,
Project Health – Rethinking Healthy Eating: Examining the Evidence
regulatory agencies, consumer groups, and
health practitioners.6,26,27 As a result, people
who are overweight or obese are
stigmatized, ridiculed, and discriminated
against in our society, which lowers the
quality of life for overweight and obese
individuals.27-30
In the workplace, overweight and obese
workers can face disadvantages in wages,
hiring, promotions, and job termination
because of their weight status.27-29,33-37
Negative attitudes toward overweight
individuals are accepted and sometimes
encouraged. It is even common in popular
media to ridicule overweight characters.34
Children as young as three years old
express that they would rather not have an
overweight child as their friend, showing that
this widespread cultural value is embedded
at an early age.35
In addition, it is not uncommon for
overweight and obese individuals to describe
other overweight individuals as stupid,
unmotivated and lazy.33,34 People struggling
with their weight often internalize this weight
bias and believe that they simply lack the
motivation and willpower to overcome their
weight problem. When overweight people try
and fail to lose weight, they reinforce these
stereotypes to themselves and others.34
34
 Making Changes

Unfortunately, individuals who experience

weight stigma are more likely to engage in
binge eating, maladaptive eating behaviours
and low levels of physical activity.33
Therefore, the stigma due to weight bias
may actually contribute to the risk of
becoming obese.31 Individuals facing weight
stigma are also at a higher risk of low self-
esteem, depression and suicide.33
Weight bias may be the result of another
bias known as the ‘just world’ bias – which
implies that people "get what they deserve"
and that “there is a reason for
everything.”33,35 In a ‘just world’, hard work
results in success, meaning that any failure
is likely the fault of the individual.35 As a
result, we rely on education and individual
behaviour change initiatives to help
individuals lose weight. We expect that this
is sufficient to address the obesity epidemic,
while disregarding the need to change the
external factors that influence eating
behaviours and weight status.35

Reducing Weight Bias

Unfortunately, when people are educated on
lifestyle aspects of weight gain alone (i.e.,
individual responsibility for diet and
exercise), they tend to display higher rates of
weight bias.25 However, education on
environmental, genetic, and social influences
on weight status decreases the belief that
obesity is solely an individual issue and
increases support for initiatives addressing
supportive environments and policy
development.36-39

Project Health – Rethinking Healthy Eating: Examining the Evidence 35

Making Changes References
1. Hamelin AM, Lamontagne C, Ouellet D, Pouliot N,
O'Brien HT. Healthful eating: Beyond food, a global
concept. Can J Diet Pract Res. 2010;71:98.
2. Slater J, Green CG, Sevenhuysen G, Edginton B, O'Neil
J, Heasman M. The growing Canadian energy gap: More
the can than the couch? Public Health Nutr. 2009;12:2216-
2224.
3. Chandon P, Wansink B. The biasing health halos of fast-
food restaurant health claims: Lower calorie estimates and
higher side-dish consumption intentions. Journal of
Consumer Research. 2007;34:301-314.
4. Cohen D, Farley TA. Eating as an automatic behavior.
Prev Chronic Dis. 2008;5:A23.
5. Seymour JD, Yaroch AL, Serdula M, Blanck HM, Khan
LK. Impact of nutrition environmental interventions on
point-of-purchase behavior in adults: A review. Prev Med.
2004;39 Suppl 2:S108-36.
6. Wansink B, Huckabee M. De-marketing obesity.
California Management Review. 2005;47:1-13.
7. Curioni CC, Lourenco PM. Long-term weight loss after
diet and exercise: A systematic review. Int J Obes (Lond).
2005;29:1168-1174.
8. Sharma AM, Padwal R. Obesity is a sign - over-eating is
a symptom: An aetiological framework for the assessment
and management of obesity. Obes Rev. 2010;11:362-370.
9. Wansink B, Jusy DR, Payne CR. Mindless eating and
healthy heuristics for the irrational. American Economic
Review. 2009;99:165-169.
10. Ness-Abramof R, Apovian CM. Diet modification for
treatment and prevention of obesity. Endocrine. 2006;29:5-
9.
11. Douketis JD, Macie C, Thabane L, Williamson DF.
Systematic review of long-term weight loss studies in obese
adults: Clinical significance and applicability to clinical
practice. Int J Obes (Lond). 2005;29:1153-1167.
12. Lombard CB, Deeks AA, Teede HJ. A systematic
review of interventions aimed at the prevention of weight
gain in adults. Public Health Nutr. 2009;12:2236-2246.
13. Wu T, Gao X, Chen M, van Dam RM. Long-term
effectiveness of diet-plus-exercise interventions vs. diet-
only interventions for weight loss: A meta-analysis. Obes
Rev. 2009;10:313-323.
14. Anderson JW, Konz EC, Frederich RC, Wood CL.
Long-term weight-loss maintenance: A meta-analysis of
US studies. Am J Clin Nutr. 2001;74:579-584.
15. Anderson LM, Quinn TA, Glanz K, et al. The
effectiveness of worksite nutrition and physical activity
interventions for controlling employee overweight and
obesity: A systematic review. Am J Prev Med.
2009;37:340-357.
16. Lowe MR, Timko CA. Dieting: Really harmful, merely
ineffective or actually helpful? Br J Nutr. 2004;92 Suppl
1:S19-22.
17. Niederdeppe J, Frosch DL. News coverage and sales of
products with trans fat: Effects before and after changes in
federal labeling policy. Am J Prev Med. 2009;36:395-401.
18. Angell SY, Silver LD, Goldstein GP et al. Cholesterol
control beyond the clinic: New York City’s trans fat
restriction. Ann Int Med. 2009;151:129-134.
19. Chapman K. Can people make healthy changes to their
diet and maintain them in the long term? A review of the
evidence. Appetite. 2010;54:433-441.
20. Rucker D, Padwal R, Li SK, Curioni C, Lau DC. Long
term pharmacotherapy for obesity and overweight: Updated
meta-analysis. BMJ. 2007;335:1194-1199.
Project Health – Rethinking Healthy Eating: Examining the Evidence
21. Fisher BL, Schauer P. Medical and surgical options in
the treatment of severe obesity. Am J Surg. 2002;184:9S-
16S.
22. Suter M, Calmes JM, Paroz A, Giusti V. A 10-year
experience with laparoscopic gastric banding for morbid
obesity: High long-term complication and failure rates.
Obes Surg. 2006;16:829-835.
23. O'Brien PE. Bariatric surgery: Mechanisms, indications
and outcomes. J Gastroenterol Hepatol. 2010;25:1358-
1365.
24. Wang Y, Beydoun MA, Liang L, Caballero B,
Kumanyika SK. Will all Americans become overweight or
obese? Estimating the progression and cost of the US
obesity epidemic. Obesity (Silver Spring). 2008;16:2323-
2330.
25. Tillotson JE. America's obesity: Conflicting public
policies, industrial economic development, and unintended
human consequences. Annu Rev Nutr. 2004;24:617-643.
26. Brownell KD, Kersh R, Ludwig DS, et al. Personal
responsibility and obesity: A constructive approach to a
controversial issue. Health Aff (Millwood). 2010;29:379-
387.
27. Puhl RM, Heuer CA. The stigma of obesity: A review
and update. Obesity (Silver Spring). 2009;17:941-964.
28. Judge TA, Cable DM. When it comes to pay, do the
thin win? The effect of weight on pay for men and women.
J Appl Psychol. 2010
29. Schulte PA, Wagner GR, Ostry A, et al. Work, obesity,
and occupational safety and health. Am J Public Health.
2007;97:428-436.
30. MacLean L, Edwards N, Garrard M, Sims-Jones N,
Clinton K, Ashley L. Obesity, stigma and public health
planning. Health Promot Int. 2009;24:88-93.
31. Klarenbach S, Padwal R, Chuck A, Jacobs P.
Population-based analysis of obesity and workforce
participation. Obesity (Silver Spring). 2006;14:920-927.
32. Dor A, Ferguson C, Langwith C, Tan E. A heavy
burden: The individual costs of being overweight and obese
in the United States. Washington: The George Washington
University School of Public Health and Health services
Department of Health Policy.; 2010.
33. Puhl RM, Heuer CA. Public opinion about laws to
prohibit weight discrimination in the United States. Obesity
(Silver Spring). 2011;19:74-82.
34. Wang SS, Brownell KD, Wadden TA. The influence of
the stigma of obesity on overweight individuals. Int J Obes
Relat Metab Disord. 2004;28:1333-1337.
35. Puhl RM, Brownell KD. Psychosocial origins of
obesity stigma: Toward changing a powerful and pervasive
bias. Obes Rev. 2003;4:213-227.
36. O'Brien KS, Puhl RM, Latner JD, Mir AS, Hunter JA.
Reducing anti-fat prejudice in preservice health students: A
randomized trial. Obesity (Silver Spring). 2010;18:2138-
2144.
37. Harris JL, Bargh JA, Brownell KD. Priming effects of
television food advertising on eating behavior. Health
Psychol. 2009;28:404-413.
38. Alvaro C, Jackson LA, Kirk S, et al. Moving
governmental policies beyond a focus on individual
lifestyle: Some insights from complexity and critical
theories. Health Promot Int. 2010
39. Barry CL, Brescoll VL, Brownell KD, Schlesinger M.
Obesity metaphors: How beliefs about the causes of obesity
affect support for public policy. Milbank Q. 2009;87:7-47.
36
 Barriers to Healthy Eating
How the Environment Impacts Individual Choice
“Obesity has been described as a mismatch between human physiology and the
environment in which we live.”1

Food Availability Taste and Price

There were up to 530 more calories
available for each Canadian to consume in
2002 than there were in 1985.2 This increase
in available calories is directly correlated with
the rising obesity rate, making increased
energy intake the most likely reason that
people have gained weight.2
Taste is the most important factor influencing
food choice, followed by food cost.3-10
Studies show that price modifications are
more effective than educational health
messages to motivate people to purchase
healthier foods.7,11

Is “pizza cheaper than salad”12 in your workplace?

Project Health – Rethinking Healthy Eating: Examining the Evidence 37

 Barriers to Healthy Eating

Portion Sizes
Portion size appears to be a major factor for
how much food people consume; as the
amount of food served suggests that it is an
appropriate amount to eat.10,12-15 In fact, the
‘French paradox’ appears to be nothing
more than smaller portion sizes.16
Meals eaten away from home typically
encourage people to eat too many calories
because of high calorie density and large
portion sizes.4,7,17-20 One study showed that
when eating out, people purchased meals
that contained an average of 827 calories
per meal.17
In addition, on days that people eat fast
food, they consume about 205 more calories
than they do on days they do not eat fast
food.21
People often underestimate the calories in
food, especially for unhealthy items.21 In one
study, participants underestimated the
caloric content of meals by more than 600
calories.22
Trends in larger portion sizes make it difficult
for individuals to resist eating foods that are
high in calories, fat, sugar and salt especially
when not at home.

Over the past few decades the largest increases in portion sizes have occurred in fast
foods such as hamburgers (18% larger), cheeseburgers (24% larger), french fries (57%
larger), and sweetened beverages (62% larger).23

Project Health – Rethinking Healthy Eating: Examining the Evidence 38

 Barriers to Healthy Eating

Educating people about the effects of portion

size seems to have little to no effect on their
food consumption.24 In an experiment, a
group of university graduate students were
educated on the effects of portion sizes on
food consumption. Six weeks later these
students were invited to a party where they
knew they would be part of a study. The
students were divided into two groups, with
each group receiving different sized bowls.
The students were allowed to consume as
many snacks as they wanted. The group
with the larger bowls served themselves
55% more food compared to the group with
smaller bowls. When the students were
informed of this effect, the typical response
was “maybe that happens to other people,
but not to me”.25

Food For Thought: PORTION SIZE

People who are served larger portion sizes consume more food but do not report
greater feelings of fullness. This is true even when it involves food that tastes bad. In
one study, people were given stale 14-day old popcorn in boxes twice the normal size.
Even though they complained about the taste, the participants who were given the
larger boxes of stale popcorn ate 34% more popcorn than participants given stale
popcorn in normal sized boxes.13
The bottom line: Larger portion sizes cause people to eat more

Project Health – Rethinking Healthy Eating: Examining the Evidence 39

 Barriers to Healthy Eating

Television, Media and Advertising

The nutrient content of the majority of
advertised foods goes against nutrition
education and guidelines and may
encourage the development of chronic
disease.26 The pattern of nutrition imbalance
found in advertised food mimics the pattern
of imbalance in the common North American
diet, leading researchers to believe that
television commercials have a direct impact
on what consumers eat. Approximately 85%
of foods advertised in Canada are for foods
designated as “Foods to Limit” by Canada’s
Food Guide.27
Among children, there is an association
between watching commercial television and
obesity. However, when children watched
other forms of media that did not contain
food commercials, there was no association
with obesity. These results suggest that it is
the commercials themselves that stimulate
unhealthy food consumption and weight
in any advertisements they watched.31
gain.28
Women who habitually diet and monitor their
Social modelling theory predicts that we will weight and men in general may be
mimic the behaviours of other people. This especially prone to increased eating when
effect was shown when people watched soft exposed to advertising food cues.31 Food
drinks commercials and then subsequently commercials may act as a stimulus that can
drank more pop.29 Similar effects have also trigger a desire to eat, even when the viewer
been shown after people are shown fast is not hungry.31
food commercials.30
Other forms of advertising such as brand
Advertised foods do not have to be present logos may also act as food cues, which can
in order to have an effect. Adults shown food also subsequently affect food consumption
commercials ate more food overall even patterns.31
though the food they ate was not presented

Project Health – Rethinking Healthy Eating: Examining the Evidence 40

 Barriers to Healthy Eating

Convenience
“Effort is not required to continue eating when food is present; effort is required to
refrain from eating when food is present.”12

Many studies have examined the
relationship between the food environment
and weight. A high ratio of fast food
restaurants and convenience stores in a
neighbourhood is associated with increased
weight.32-35
The availability of poor nutritional choices
has a profound impact on what people eat.36
For example, many stores sell unhealthy
‘snack’ foods placed near the cash register.36
The mere presence of convenient ready-to-
eat foods increases the likelihood that
people will consume them, leading to higher
overall energy intakes.36
Therefore, the impact of vending machines,
food in common areas and foods placed at
influential locations such as near cash
registers in cafeteria lines should be
carefully considered.

Food For Thought: THE LAW OF LEAST EFFORT

In one study, secretaries who had chocolates placed on their desk ate twice as many as
secretaries that had chocolates placed only six feet away.37

The bottom line: As effort goes up, food consumption goes down.

Project Health – Rethinking Healthy Eating: Examining the Evidence 41

 Barriers to Healthy Eating

Time Pressures
Forty-one per cent of Canadians say that Common barriers to making family meals
their life is so hectic that they find it hard to include: being a single parent, working an
include healthier foods in their diets.38 The inflexible job, and working a schedule that
feeling that there is not enough time in the interferes with family time such as evening
day to do everything has been implicated in and night shifts.39
the decline of family meals and the
People are more likely to cook meals at
increased consumption of convenience and
home if they have cooking skills and flexible
fast foods.39,40 When asked, people admitted
or reduced work schedules (i.e., they can be
making ‘quick’ foods because they did not
home in the afternoon).39,40
have the time or energy to cook, despite
knowing that it was not ‘good’ for them.39

Project Health – Rethinking Healthy Eating: Examining the Evidence 42

 Barriers to Healthy Eating

Point-of-Purchase Nutrition Information

Most individuals underestimate the calorie
content of food. Providing nutrition labels
gives consumers an opportunity to improve
nutritional intakes.3,17,41-43
However, nutrition information has to be
readily available at the point-of-purchase, as
only 0.1% of people look for nutrition
information before making their purchase.
Websites, pamphlets, and tray liners are not
an effective format to promote behaviour
change.20
In order to prevent indulgence at a later point
in the day, it is also important that nutrition
information be provided along with an
average estimate of how many calories
people need for the day.44,45 For example,
“this menu item has 500 calories; the
average person needs 2000 calories a day.”
Consumers welcome information in the form
of nutrition labels and logos.46 However,
providing nutrition information is not always
an effective way to improve dietary
intakes.4,14,47-49
Most Canadians report being interested in
nutrition, however, 61% think that there are
so many different things to consider when
buying foods, (e.g., fat, trans fat, sugar,
calories, fibre, locally produced, organic,
etc.), that it is impossible for an ordinary
person to figure out what to eat.38
Consumers report that nutrition logos
assigned to products that meet specific
nutrition criteria influence their food
choices.50 However, studies on this type of
labelling fail to show substantial positive
effects on actual food choice when logos are
placed on healthier food items.51
To complicate matters, nutrition labels are
not always accurate. One study analyzed
foods in a lab found that the calorie content
of packaged food was an average of 18%
higher than what was stated on the label.52
Therefore, providing nutrition information is
probably not effective as a stand-alone
intervention but may be useful as part of a
comprehensive strategy.14

Is it Healthy?
It is difficult for the average person to tell if a food item is healthy.

For example, one very healthy sounding Raisin Bran Muffin has:53

360 calories (almost 20% of average daily needs)

10 grams of fat (15% of average daily needs)
790 mg sodium (over 50% of daily recommendation)
6 grams of fibre (considered a very high source of fibre)
37 grams of sugar (100% of daily recommendation)54

Project Health – Rethinking Healthy Eating: Examining the Evidence 43

 Barriers to Healthy Eating
Stress
A stressful work environment where workers
experience high demand, low job control,
and low social support can negatively
influence eating behaviours, and often leads
to skipping meals, eating at workstations,
extra snacking, and a preference for calorie
dense foods.12,55,56 In this type of work
environment, health problems are more
likely to occur.12,57,58
Increasing BMI has been associated with
work related psychological factors such as
Project Health – Rethinking Healthy Eating: Examining the Evidence
fatigue, tension, anxiety, and depression.58-60
It is likely that some workers use food as a
way to cope with job strain, which
contributes to the development of
obesity.58,61,62
“It’s like a quick pat on the
shoulder or something like that.
You’ve kept up with your day;
you’ve done a great job, here have
a cookie”.12
- Manufacturing Worker
44
 Barriers to Healthy Eating

Social Norms and Cues

Eating food with other people can create a
sense of belonging, and social norms can
dictate individual behaviours.22,63 Therefore,
individual employee behaviour can be
influenced by the health-related norms and
values of other co-workers.57,66
Having other people present while eating
can influence both the amount and types of
food people eat. Eating with others,
especially familiar people, can extend eating
occasions and suppress self-monitoring.15
Individuals use social cues to decide what to
eat and how much to eat without attracting
negative judgment from others.19,64 It has
been shown that individuals will eat more
when eating companions eat more and vice
versa.65 This effect can be profound, with
one researcher finding that meal size almost
doubled when subjects ate with seven or
more people.15
Work related activities that revolve around
eating and drinking can promote excess
caloric intake. Such activities include
workplace celebrations, fundraisers, social
events, and entertaining clients.34

Food For Thought: SOCIAL INFLUENCE

In one study, two different bowls of crackers were provided to participants. Subjects
unknowingly copied another person’s behaviour by eating whichever type of cracker
the other person ate.13

The bottom line: Eating behaviours are unknowingly influenced by others.

Project Health – Rethinking Healthy Eating: Examining the Evidence 45

 Barriers to Healthy Eating

Holidays The increased stress, caloric intake and

lower physical activity levels that occur
“Corporate break rooms need
during the holiday season significantly
not become repositories for
contribute to the weight status of
unused Halloween candy and
employees.68
holiday leftovers.” 66
Most people gain between 0.62 to 0.70 kg
(1.4 to 1.5 pounds) per year.69,70 Half of this
weight is gained between the Thanksgiving
and Christmas holidays and is not lost in the
summer months as commonly believed.68,71

The holidays are a time when cultural and

social influences combine to create high risk
environments conducive to weight gain.68
Factors such as eating with others, longer
meal times, easy access to food, and large
portion sizes increase overall calorie
intake.68 In addition, holiday celebrations are The cumulative effects of holiday weight gain
likely to include alcoholic beverages, which are likely to contribute to an increase in body
contribute a significant amount of calories. weight.70,71 Overweight and obese people
seem to be especially prone to holiday
weight gain.68,71

Project Health – Rethinking Healthy Eating: Examining the Evidence 46


Implications for Workplaces
Many of the environmental factors that
influence food choice are outside the control
of individual employees. This highlights the
necessity for creating a supportive healthy
eating environment in the workplace. There
are many strategies and policies that
workplaces can implement to help improve
employee’s eating habits.
Project Health – Rethinking Healthy Eating: Examining the Evidence
Barriers to Healthy Eating
Refer to the section ‘Part III - Making the
Shift: Comprehensive Strategies to Promote
Healthy Eating’ for strategies to improve the
food environment in your workplace. This
resource is available for download at:
http://www.projecthealth.ca under ‘Project
Health Resources’.
47
 Barriers to Healthy Eating
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49
 Barriers to Healthy Eating

Common Psychological Biases That Influence

Health Behaviours
The human mind is extremely complex and influences food choices without
conscious awareness. These psychological biases can prevent people from making
consistent healthy food choices.

Cognitive Bias
A cognitive bias occurs when the brain Because of this bias, people do not realize
allows judgments and decisions to be made that their diet requires improvement. As a
based on personal experience, likes, dislikes result, they fail to take action.
and cultural experiences without supporting
Tailored feedback from health professionals
evidence. Several cognitive biases exist that
seems to be the most appropriate method to
apply to how people think about health.
address this bias. However, research shows
that some people receiving negative tailored
Optimistic Bias
feedback are even less likely than others to
From a nutrition perspective, optimistic bias take action on a health issue.2
causes people to underestimate the
consequences of their food intakes. People
usually rate their nutrition-related risk to be
lower compared to others.1,2 As a result of
this bias, people accept the messages in
health promotion campaigns but believe
them to be more applicable to others than to
themselves.
Optimistic bias was evident in the report:
Recommendations of the Sodium Working
Group.
“Public opinion research has shown
that Canadians are aware of sodium
as a health issue, but perceive it as
everybody else’s problem. Very few
understand what a healthy amount
of sodium is, and most continue to
have high dietary intakes.” 3

Project Health – Rethinking Healthy Eating: Examining the Evidence 50


Status Quo Bias
“When in doubt, do nothing!”
People seem to prefer having things stay the
same.4
Part of the status quo bias is a tendency to
feel worse about poor outcomes of changes
they made compared to poor outcomes that
resulted from not making a change.5
Brand loyalty is an example of status quo
bias. Once people are relatively happy with a
product, they will not seek out alternatives,
even if superior products become available.4
The status quo bias might help to explain
why it is so hard to make changes as an
individual. It also might help to explain why
people tend to resist imposed changes.
Project Health – Rethinking Healthy Eating: Examining the Evidence
Barriers to Healthy Eating
Restraint Bias
“I’ll buy this bag of cookies and
just have one…”
There is a tendency to overestimate one’s
ability to resist impulsive behaviours, which
causes people to expose themselves to
temptation.6
The assumption that individuals “should be
able to” control themselves could explain
acceptance of food temptations in the
workplace environment. Unfortunately,
people are tempted and eventually succumb
to behaviours that result in poor health
outcomes. A common example is bringing in
high-calorie “treats” to share with for co-
workers, ultimately contributing to weight
gain.
51
 Barriers to Healthy Eating
Hyperbolic Discounting
“The time to begin most
things is ten years ago."
~Mignon McLaughlin
People seem to be aware of the risks related
to eating unhealthy foods but seem to
“forget” about long-term health goals when
they make food decisions.7
Hyperbolic discounting is the preference for
immediate payoffs compared to future gains.
For example, eating a tasty brownie now
verses enjoying good health in the future.
This bias is also evident in the form of other
human traits such as procrastination,
overspending and failure to save for
retirement.8
‘Sin taxes’ such as those placed on tobacco
or alcohol products have been used in the
past to decrease this bias, as there is an
immediate negative consequence to making
an unhealthy decision.7
Project Health – Rethinking Healthy Eating: Examining the Evidence
Third Person Bias
“…that might fool someone
else, but it won’t fool me…”
The third person bias is the tendency to
believe that others are more influenced by
media messages than oneself.9
However, simply seeing a logo or watching a
food commercial might create a desire to
eat!10
The billions of dollars that are spent
advertising food products should suggest
that they are an effective way to increase
sales. Especially since the pattern of
nutritional imbalance found in the common
American diet mimics the pattern of
imbalance in advertised foods.11
52

The “Halo” Effect
“These chips have no trans fat,
so I can eat as many as I want…”
How a particular food is marketed can
influence whether or not one chooses to
eat it and how much of it is consumed. A
halo effect occurs when one judges a
food be ‘healthy’ because one
component of it is perceived as healthy.
People tend to underestimate the caloric
content of foods served at restaurants
that market themselves as ‘healthy’. As a
result, they often order higher calorie
side dishes, which contributes to higher
overall caloric intakes.12
Similarly, when snack foods are
marketed as ‘healthy’ many people
assume that these foods either taste bad
or can be consumed in limitless
amounts.13-15
Just mentioning certain ingredients or
attributes can create positive or negative
biases about the perceived taste of food.
In one study, the mere mention of soy
made people evaluate a product as
“grainy” and “tasteless” compared to
those who tasted the same product with
no mention of soy. Suggesting that the
product contained soy made people
believe that they tasted it, even though
the product did not contain any soy.13
Food product names also have a huge
effect on whether people choose to eat
them. Descriptive names tend to
increase taste ratings and overall sales.
Project Health – Rethinking Healthy Eating: Examining the Evidence
Barriers to Healthy Eating
They also make people think that they
contain more calories and are more
satisfying than menu items with plain
names.12 For example, “Traditional
Cajun Red Beans with Rice” verses “Red
Beans with Rice”. 13
Implications for Workplaces
The psychological factors that influence food
related behaviours occur outside the
conscious awareness of individuals.
Educating people about these psychological
influences does little to change the individual
perception of health and lifestyle behaviours,
as people continue to believe that the
messages are more applicable to others
than themselves.
It is important for health promoters to be
aware of these psychological influences and
accept them as part of the human condition,
rather than having an expectation that
people ‘should’ behave differently.
The most important strategy to counter these
psychological biases is to ensure that the
workplace food environment is structured in
such a way that healthy eating is ‘just
another part’ of the average workday. For
strategies to implement supportive healthy
eating environments in workplaces, please
to the section ‘Part III - Making the Shift:
Comprehensive Strategies to Promote
Healthy Eating’. This resource is available
for download at: http://www.projecthealth.ca
under ‘Project Health Resources’.
53
 Barriers to Healthy Eating
Psychological Bias References
1. Shepherd R, Shepherd R. Resistance to changes in diet.
Proc Nutr Soc. 2002;61:267-272.
2. Raats MM, Sparks P. Unrealistic optimism about diet-
related risks: Implications for interventions. Proc Nutr Soc.
1995;54:737-745.
3. Sodium Working Group. Sodium reduction strategy for
Canada, recommendations of the Sodium Working Group.
2010.
4. Samuelson W, Zeckhauser R. Status quo bias in decision
making. Journal of Risk and Uncertainty. 1988;1:7-59.
5. Fleming SM, Thomas CL, Dolan RJ. Overcoming status
quo bias in the human brain. Proc Natl Acad Sci U S A.
2010;107:6005-6009.
6. Nordgren LF, van Harreveld F, van der Pligt J. The
restraint bias: How the illusion of self-restraint promotes
impulsive behavior. Psychol Sci. 2009;20:1523-1528.
7. Scharff RL. Obesity and hyperbolic discounting:
Evidence and implications. J Consum Policy. 2009;32:3-
21.
8. Angeletos G, Laibson D, Repetto A, Tobacman J,
Weinberg S. The hyperbolic consumption model:
Calibration, simulation, and empirical evaluation. Journal
of Economic Perspectives. 2001;15:47-68.
Project Health – Rethinking Healthy Eating: Examining the Evidence
9. Sun Y, Pan Z, Shen L. Understanding the third-person
perception: Evidence from a meta-analysis. Journal of
Communication.;58:280-300.
10. Harris JL, Bargh JA, Brownell KD. Priming effects of
television food advertising on eating behavior. Health
Psychol. 2009;28:404-413.
11. Mink M, Evans A, Moore CG, Calderon KS, Deger S.
Nutritional imbalance endorsed by televised food
advertisements. J Am Diet Assoc. 2010;110:904-910.
12. Chandon P, Wansink B. The biasing health halos of
fast-food restaurant health claims: Lower calorie estimates
and higher side-dish consumption intentions. Journal of
Consumer Research. 2007;34:301-314.
13. Wansink B, van Ittersum K, Painter JE. How
descriptive food names bias sensory perceptions in
restaurants. Food Quality and Preference. 2005;16:393-
400.
14. Wansink B, Huckabee M. De-marketing obesity.
California Management Review. 2005;47:1-13.
15. Howlett E, Burton AS, Bates K, Huggins K. Coming to
a restaurant near you? Potential customer responses to
nutrition information disclosure on menus. Journal of
Consumer Research. 2009;36:494-503.
54
 Barriers to Healthy Eating

Physiological Barriers to Healthy Eating

Will Power, Self-Control, and
Personal Responsibility
Self-control is required help people follow a
healthy diet. But what is will power?
up just enough blood glucose to make it
difficult to complete a secondary act of self-
control. 3
Implications for Workplaces

The Self-Control Theory 1. Employees will likely perform better

when they are well nourished (i.e.,
Researchers have been investigating the
skipping meals will lead to a drop in
ability of subjects to exert self-control under
blood glucose that impair one’s ability to
different conditions. There are a wide variety
concentrate).
of behaviours that are expected of
employees during any given workday that 2. Tempting employees with unhealthy
require the use of self-control (e.g., paying foods when self-control is at its lowest
attention during meetings).3 What is (e.g., right before lunch), or when they
interesting is that self-control seems to have are trying to concentrate (e.g., during a
a limited energy source.3 meeting) makes it very difficult for them
to consistently eat a healthy diet.6
How Will Power Works
The self control theory may also help to
Researchers believe that will power is
explain some other food related
controlled by the brain. Even though the
phenomenon such as the “What the Hell”,7,8
brain only makes up 2% of body mass, it
and “Token Salad” effects9 as well as other
uses 20% of the body’s energy.3 Each time
justification type behaviours described on
participants in studies engage in an effort of
the following page.10
self-control, there is a small but measurable
drop in blood glucose.4,5 It appears that
exerting self-control causes the brain to use

Food for Thought: SELF-CONTROL INFLUENCES HEALTH BEHAVIOURS

Even if employees resist temptation initially, research shows that individuals who are
trying to maintain a healthy diet usually have a breakdown in self-control later in the
day.3,4 One study even showed that smokers were more likely to smoke after being
required to resist eating cookies.11
The bottom line: Unhealthy food temptations may impact other health behaviours as
well.11

Project Health – Rethinking Healthy Eating: Examining the Evidence 55

 Barriers to Healthy Eating

“What The Hell?”7,8 increase in the sale of the least healthy

menu items.9,13
“I’ve already blown my diet; I
might as well keep going” The self-control theory may explain why
people seek out nutrition education, request
The “What The Hell” effect is a reaction that
healthy eating programs, demand healthy
dieters have, often causing them to abandon
foods on menus and then fail to actually
their diets especially in situations where
make healthy ‘choices’. The very thing that
dieters have less control over food choices
people need to exercise self-control when
or feel deprived. Once dieters give in and
faced with eating decisions is depleted when
break their diet, they feel that the day is lost.
they are hungry (i.e., blood glucose), causing
This results in giving into further temptation
them to make more indulgent ‘choices’ when
and eating more of whatever food is
they are available.
available.7,8
Justification
The Token Salad
“It was a tough day at the office,
“I’ll have the burger and fries”
we should go out tonight…”
The majority of consumers are health
People working towards a goal that requires
conscious, however, the food industry
high-personal effort, (e.g., completing a
reports that consumers say they want more
major presentation at work) feel that they
salads offered, but when they are added to
can indulge after meeting that goal.9,10,12
the menu, salad sales do not increase.9,13 In
fact, when healthy items are added to the
menu, some food providers notice an

Food For Thought: INDULGENT DISTRACTIONS

A group of participants had to resist eating a plate of cookies while completing a
challenging mental task. They gave up after only 8 minutes. The group that was
allowed to eat the cookies lasted 19 minutes, while another group that did not have any
food provided to them lasted 21 minutes.6
The bottom line: The availability of tempting foods when employees are trying to work
can be mentally distracting and counterproductive.3,13,14

Project Health – Rethinking Healthy Eating: Examining the Evidence 56

 Barriers to Healthy Eating
Physiological Barriers References
1. Krebs-Smith SM, Reedy J, Bosire C. Healthfulness of
the U.S. food supply: Little improvement despite decades
of dietary guidance. Am J Prev Med. 2010;38:472-477.
2. Hill JO. Can a small-changes approach help address the
obesity epidemic? A report of the Joint Task Force of the
American Society for Nutrition Institute of Food
Technologists, and International Food Information Council.
Am J Clin Nutr. 2009;89:477-484.
3. Gailliot MT, Baumeister RF. The physiology of
willpower: Linking blood glucose to self-control. Pers Soc
Psychol Rev. 2007;11:303-327.
4. Gailliot MT, Baumeister RF, DeWall CN, et al. Self-
control relies on glucose as a limited energy source:
Willpower is more than a metaphor. J Pers Soc Psychol.
2007;92:325-336.
5. Miller HC, Pattison KF, DeWall CN, Rayburn-Reeves R,
Zentall TR. Self-control without a "self"?: Common self-
control processes in humans and dogs. Psychol Sci.
2010;21:534-538.
6. Cohen D, Farley TA. Eating as an automatic behavior.
Prev Chronic Dis. 2008;5:A23.
7. Canadian Obesity Network. False hopes and
overwhelming urges. Conduit. 2009;Winter.
Project Health – Rethinking Healthy Eating: Examining the Evidence
8. Polivy J, Herman CP, Deo R. Getting a bigger slice of
the pie. Effects on eating and emotion in restrained and
unrestrained eaters. Appetite. 2010;55:426-430.
9. Wilcox K, Vallen B, Block L, Fitzsimons GJ. Vicarious
goal fulfillment: When the mere presence of a healthy
option leads to an ironically indulgent decision. Journal of
Consumer Research. 2009;36:380-393.
10. Sela A, Berger J, Liu W. Variety, vice, and virtue: How
assortment size influences option choice. Journal of
Consumer Research. 2009;35:941-951.
11. Shmueli D, Prochaska JJ. Resisting tempting foods and
smoking behavior: Implications from a self-control theory
perspective. Health Psychol. 2009;28:300-306.
12. Chandon P, Wansink B. The biasing health halos of
fast-food restaurant health claims: Lower calorie estimates
and higher side-dish consumption intentions. Journal of
Consumer Research. 2007;34:301-314.
13. Keohane J. Fat profits: On the services of fast food
chains. Portfolio.com. 2008 Accessed 3/10/2009.
14. Muraven M, Baumeister RF. Self-regulation and
depletion of limited resources: Does self-control resemble a
muscle? Psychol Bull. 2000;126:247-259.
57
 Barriers to Healthy Eating

Is Eating an Addiction?
“A loss of control over food intake” fits the “I just need something sweet.”
description of classic substance abuse
The involvement of the dopamine reward
disorders.1 As with drug abuse, people
system may explain the desire to eat
continue to ‘use’ despite knowing about the
something (e.g., dessert), even when no
negative effects on their bodies, feeling the
longer hungry (e.g., after a big meal).
negative physical consequences of use,
(e.g., pain or chronic disease), and The addictive process is likely a key reason
experiencing feelings of isolation due to the that the majority of individuals have not been
stigma of being overweight or obese.1 able to control their intake of refined grains,
fats, and sugars. However, unlike other
Obesity and Addiction addictive substances, foods containing
Just as poppies and coca beans are refined grains, fat and sugar are heavily
relatively harmless in their natural form, once advertised, inexpensive and difficult to avoid.
components are extracted, refined and
concentrated, they become potent drugs
such as cocaine and opium. Sugars and fats
are also found in nature in small
concentrations and like drugs, are not
addictive, until processed.1
Researchers have found that eating refined
grains (i.e., white flour), sugars, and fats
commonly found in processed food,
stimulate the dopamine system in the brain
similar to the reward pathway for drugs of
abuse.1-5
Obese individuals have fewer dopamine
receptors than lean people, (comparable for
drug users compared to non-users).6 Eating
foods that contain refined grains, fats and
sugars causes the loss of dopamine
receptors.7 The result of having fewer
dopamine receptors is that more substance
(i.e., food) is required to feel satisfied.2 This
promotes overeating and a preference for
processed, high-fat, high-sugar foods, which
increases the risk of developing obesity.

Project Health – Rethinking Healthy Eating: Examining the Evidence 58

 Barriers to Healthy Eating

Eating is an Addiction References

1. Ifland JR, Preuss HG, Marcus MT, et al. Refined food
addiction: A classic substance use disorder. Med
Hypotheses. 2009;72:518-526.
2. Mahapatra A. Overeating, obesity and dopamine
receptors. ACS Chemical Neuroscience. 2010;1:396-397.
3. Lutter M, Nestler EJ. Homeostatic and hedonic signals
interact in the regulation of food intake. J Nutr.
2009;139:629-632.
4. Avena NM, Rada P, Hoebel BG. Sugar and fat bingeing
have notable differences in addictive-like behavior. J Nutr.
2009;139:623-628.
5. Zheng H, Lenard NR, Shin AC, Berthoud HR. Appetite
control and energy balance regulation in the modern world:
Reward-driven brain overrides repletion signals. Int J Obes
(Lond). 2009;33 Suppl 2:S8-13.
6. Volkow ND, Wise RA. How can drug addiction help us
understand obesity? Nat Neurosci. 2005;8:555-560.
7. Stice E, Yokum S, Blum K, Bohon C. Weight gain is
associated with reduced striatal response to palatable food.
J Neurosci. 2010;30:13105-13109.

Project Health – Rethinking Healthy Eating: Examining the Evidence 59

Conclusion
The current food environment offers multiple
opportunities for employees to engage in
unhealthy eating behaviour. The default
choice in most situations is an unhealthy
choice, which must be resisted, if one wants
to maintain good health.
The common belief that individuals are
responsible for their own eating behaviour is
challenged by the evidence that individuals
are highly influenced by portion size, pricing,
advertising and convenience. They can only
resist the food environment for so long
before giving into temptation. Humans may
not psychologically be able to identify that
unhealthy eating poses a risk to their own
personal health and may not be
physiologically equipped to manage multiple
requirements for self-control. Finally, the
brain possesses a reward pathway that
creates a strong desire to eat unhealthy food
containing high amounts of fat, sugar, and
refined flour, which has nothing to do with a
need for calories.
It is not realistic to offer unhealthy choices
and expect employees to consistently follow
a healthy diet. Individuals must make
choices for themselves, but the environment
significantly influences the content of the
choices people make.1 Ensure that the
environment in your workplace makes
healthier choices the easiest choices and
minimizes the burden on employees to resist
unhealthy choices.
There are many initiatives and strategies
that workplaces can implement to create a
supportive healthy eating environment. Refer
to the section ‘Part III - Making the Shift:
Comprehensive Strategies to Promote
Healthy Eating’ for strategies to improve the
food environment in your workplace. This
resource is available for download at:
http://www.projecthealth.ca under ‘Project
Health Resources’.

Conclusion References
1. Brownell,KD, Kersh,R, Ludwig,RC, Post,RC, Puhl,RM,
Schwartz,MB, Willet,W. Personal responsibility and
obesity: a constructive approach to a controversial issue.
Health Affairs. 2010;29(3):378-386.

Project Health – Rethinking Healthy Eating: Examining the Evidence 60

PART III

MAKING THE SHIFT

Comprehensive Strategies to Promote Healthy Eating
 Table of Contents
PART III
INTRODUCTION
CURRENT EVIDENCE 67
OVERVIEW OF COMPREHENSIVE WORKPLACE HEALTH PROMOTION 68

6.0 GETTING STARTED: PLANNING A COMPREHENSIVE HEALTHY EATING STRATEGY FOR

WORKPLACES 69
STEP 1 – OBTAIN MANAGEMENT SUPPORT 71
STEP 2 – ESTABLISH A WELLNESS COMMITTEE 72
STEP 3A – ASSESS WORKPLACE HEALTH NEEDS AND INTERESTS 76
STEP 3B – ASSEMBLE A HEALTHY EATING SUBCOMMITTEE 79
STEP 4 – DEVELOP A WELLNESS PLAN 80
STEP 5 – DEVELOP THE EVALUATION PLAN 85
STEP 6 – CHECK-IN WITH MANAGEMENT 87
STEP 7 – IMPLEMENT THE PLAN 88
STEP 8 –EVALUATE AND UPDATE THE STRATEGY 90

7.0 STRATEGIES TO PROMOTE HEALTHY EATING IN THE WORKPLACE 93

7.1 AWARENESS RAISING 97

BULLETIN BOARDS AND POSTERS 98
DISPLAYS AND HEALTH FAIRS 98
EATRIGHT ONTARIO 98
EMAILS, NEWSLETTERS AND OTHER EMPLOYEE COMMUNICATIONS 99
EVENTS 100
HEALTH SCREENING AND HEALTH RISK ASSESSMENTS 100
LUNCH AND LEARNS 101
MOBILE HEALTH TECHNOLOGY 101
PAMPHLETS 102
POINT-OF-DECISION NUTRITION INFORMATION 103
PROMOTING LOCAL FOOD OPPORTUNITIES 104
VIDEOS 104
 7.2 SKILL BUILDING 107
LUNCH AND LEARNS 108
HEALTH FAIRS 108
SMART PHONE APPLICATIONS 108
KNOWLEDGE SKILLS 108
PLANNING SKILLS 109
MEAL PREPARATION AND COOKING SKILLS 110
GARDENING SKILLS 111
CHALLENGES AND CONTESTS 112
HEALTH PROMOTION PROGRAMS 113

7.3 SUPPORTIVE ENVIRONMENTS 117

ACCESS TO REGISTERED DIETITIANS 119
CAFETERIAS 121
CELEBRATIONS 135
COMMON AREAS 139
FACILITIES 143
MEETINGS AND EVENTS 145
ORGANIZATIONAL CULTURE 153
PEER SUPPORT GROUPS 159
PROMOTING LOCAL FOOD 163
VENDING MACHINES 173
WORKPLACE GARDENS 179

7.4 POLICY DEVELOPMENT 185

8.0 SPECIAL CONSIDERATIONS 195

9.0 COMMUNITY INVOLVEMENT 213

10.0 APPENDIX A: NUTRITION CRITERIA

PART III – ‘MAKING THE SHIFT: COMPREHENSIVE The presence of chronic diseases has substantial
STRATEGIES TO PROMOTE HEALTHY EATING’ negative financial implications for workplaces. For
more background information on the business case
This is the third part of a toolkit designed to give
for promoting healthy eating in the workplace visit the
employers and health intermediaries the tools to
Project Health website http://www.projecthealth.ca to
create a comprehensive healthy eating strategy in
download a copy of:
their workplace.
PART I – ‘THE COST OF DOING NOTHING: THE
Current eating habits place employees at risk for
BUSINESS CASE’.
developing nutrition-related chronic diseases. Despite
efforts and campaigns aimed at helping people to The food environment influences the eating habits of
make healthy choices, eating habits have been employees. Most healthy eating interventions are
getting worse over the years.1 This is most likely due focused on changing individual eating habits without
to changes in the food environment, including making improvements to the food environment. For
increased portion sizes as well as widespread more background information on the limitations of
availability and promotion of less healthy foods current healthy eating promotion strategies visit the
described as “Foods to Limit” by Canada’s Food Project Health website http://www.projecthealth.ca to
Guide (e.g., cakes, pastries, candies, chocolate, download a copy of:
cookies, granola bars, ice cream, doughnuts, muffins, PART II – ‘EXAMINING THE EVIDENCE: ADDRESSING
french fries, potato chips, salty snacks, and THE LIMITATIONS OF CURRENT INTERVENTIONS’
sweetened hot and cold beverages).1-12
Many people struggle to make healthy choices when
offered tempting foods.3,13-16 Consequently, the types
and amounts of food available to people in their work
environments should be carefully considered. A
supportive healthy eating environment can be created
in the workplace by promoting healthy food and by
improving the nutritional quality of foods available to
employees in cafeterias, vending machines,
meetings, events, and food left in common areas
(e.g., candy bowls on desks and leftover food placed
in the work area). Workplaces should also think
about, celebrating, fundraising and rewarding
employees without using food.

Workplaces have multiple opportunities to improve

employee eating habits, ranging from interventions
that improve individual knowledge about healthy
eating, to changing the food environment by
implementing supportive environments and policies
that ensure that employees are offered and sold
healthy foods in the workplace.
 Introduction
Introduction
This guide will provide steps to implement a comprehensive healthy eating
strategy in workplaces. To begin the process of planning a healthy eating
strategy, it is important that all key stakeholders in the organization support the
concept. Key stakeholders may include: senior management, unions and
employee associations, employees, occupational health, health and safety
representatives, human resources and benefits, communications and food
service providers.

Current Evidence
The current literature suggests that
environmental interventions are helpful when
encouraging healthier eating habits among
employees.17-20 However, the majority of
research on the promotion of healthy eating
in workplaces consists of healthy eating
education and environmental supports such
as point-of-decision information (e.g.,
stickers identifying healthier choices and
nutrition information such fat content,
calories, etc.), promotional materials,
preferential pricing for healthier choices,
increased availability of healthier choices
and targeted food placement (e.g., food
items placed at eye-level or at the cash
register).21,22 These studies show a small
impact from these types of environmental
strategies.21,22
It is possible that the limited impact that
these strategies have is due to the fact that
individuals still have to make the healthier
choice, while less healthy choices remain
widely available.
french fries, potato chips, salty snacks, and
sweetened hot and cold beverages).2
The literature is limited in terms of the
effectiveness of decreasing exposure of
“Foods to Limit”. However, we do know that
the food environment has changed
drastically in the past few decades. This has
increased the number of calories available
per person in the food supply, mostly from
“Foods to Limit”.1,8-12,23
Studies of neighbourhoods show that poor
quality food environments are associated
with low quality diets.24-26
It has also been established that any cues
associated with food or eating (e.g.,
watching others eat, watching food
commercials, having food available in close
proximity, etc.) has the potential to motivate
individuals to eat.4,27-29 Food cues encourage
people to eat without being aware, making it
difficult for individuals to resist eating when
food cues are present.4,27

Canada’s Food Guide recommends that
people limit foods and beverages high in
calories, fat, sugar or salt. (e.g., cakes,
pastries, candies, chocolate, cookies,
granola bars, ice cream, doughnuts, muffins,
From a harm reduction standpoint, it makes
sense to limit food cues in the workplace,
especially for “Foods to Limit”, as they have
the potential to cause harm by promoting the
development of nutrition-related chronic
disease.27,28,30

Project Health - Comprehensive Strategies to Promote Healthy Eating 67

Overview of Comprehensive
Workplace Health Promotion
There are three critical areas in
organizations that influence employee health
and health behaviours.
Occupational Voluntary
Health Health
& Safety Practices
Organizational
Culture/Change
Occupational Health and Safety
The first area, traditional health and safety
initiatives, protect employees from physical
harm or exposure to harmful substances
with the goal of reducing work related injury,
illness and disability.
Voluntary Health Practices
The second area is voluntary health
practices (e.g., promotion of smoke-free
living, physical activity, healthy eating, etc.).
Workplace health promotion strategies often
focus on changing voluntary health practices
of individuals by running educational and
skill building programs. The programs are
often targeted at individual behaviour;
however, they are less likely to be effective
compared to strategies that also target
organizational factors that have an impact on
personal health practices. For example,
individuals may use food to cope with job
stress, which then contributes to the
development of nutrition-related health
problems.16,31-37
Project Health - Healthy Eating Toolkit for Workplaces
Organizational Health
When planning workplace health promotion
efforts it is important to make improvements
in the organizational culture either before or
in conjunction with voluntary health
promotion activities.
A supportive organizational culture means
the workplace promotes physical and mental
health and well-being. There are many areas
that workplaces can target to improve the
health outcomes of employees such as
enhancing social support, ensuring a job
effort-reward balance, and improving job
control, work structure, communication
strategies, organizational change processes
and management style.38
In a supportive workplace culture,
employees have adequate job training, a
sense of fairness and respect on the job,
work-life balance, some control over how
their work is completed and are rewarded
adequately for their efforts. In an ideal
workplace, efforts are made to manage and
prevent workplace conflict and help is
available to assist employees in times of
distress.38
A negative organizational culture can limit
the effectiveness of workplace health
promotion efforts. Address any issues
related to organizational culture that affect
employee health to enhance the
effectiveness of your comprehensive healthy
eating strategy.
See the Organizational Culture section on
page 153 for suggestions on improving
organizational culture to support your
wellness efforts.
68
GETTING STARTED
Planning a Comprehensive Healthy Eating Strategy for
Workplaces
This section has been adapted from The Health Communication Unit
publication, “The Eight Steps to Developing a Health Promotion Policy” available
from: http://www.thcu.ca/resource_db/pubs/489887946.pdf
Elements of an Effective Comprehensive Healthy Eating
Strategy
There is no single correct approach to implement a comprehensive workplace
healthy eating strategy. The workplace health promotion literature suggests
that there are eight elements that help to make workplace health promotion
strategies successful. This section outlines these elements, which in practice
may not always occur in the order presented.

Step 1 – Obtain Management Support

To create a healthy workplace, it is important
that everyone in the organization is working
towards a common goal. The most important
part of any organizational change is
management support.39,40
Obtaining senior management support is
essential to generate resources such as
employee time and financial support
required to initiate and maintain successful
wellness programs.41 Additionally, senior
managers must be prepared to see the
process through to the end.40 Without this
commitment, the chances of success are
significantly reduced.
All levels of the organization need to be
engaged in the wellness approach to make
the strategy a success.42 If some members
of the organization are not supportive of a
healthy eating strategy, you may need to do
some work to create buy-in.
Creating Buy-in
Decision-makers will need to know why a
healthy eating strategy is important.43
Put together a business case for your
organization and align the business case
with current organization priorities, missions
and values.42
Include any relevant information from
previous employee interest surveys that
indicates healthy eating is a priority for
employees.

The Role of Management in Increasing Employee Acceptance

It is possible that employees may be
somewhat resistant to some aspects of your
healthy eating strategy.
When senior management’s commitment
and involvement is visible, employees are
more likely to commit to and participate in
creating a healthy workplace.
Managers play a critical role in
organizational change; therefore, the
approach of management representatives is
important.
An effective manager is sensitive to
employee needs, trustworthy, walks the talk,
treats others with respect, and
communicates well with employees.40,44
It will be important for management
representatives to talk to those who are most
resistant to changes. Listening to concerns
and being compassionate about other’s
feelings, opinions and fears can help to
increase employee acceptance of
changes.39,40

Project Health – Comprehensive Strategies to Promote Healthy Eating 71

Step 2 – Establish a Wellness Committee
A committee approach is helpful to
exchange ideas between employees, service
providers, wellness staff and management.41
Successful workplace health initiatives often
indicate that program acceptance was
achieved using a committee approach.21,45-48
Involve all relevant stakeholders, so that
committee decisions will consider different
perspectives.
A wellness committee is responsible for
conducting health needs and interest
assessments, organizing awareness raising
and skill building activities, planning
supportive environment interventions,
assisting with the implementation of
activities, drafting policies for management
approval, and evaluating outcomes.
Engaging Employees
There are a number of ways to involve
employees in the decision making process
ranging from consultation to direct
involvement in decision making.40,44
For example, employees can be consulted
about services they would like through
surveys, suggestion boxes, and focus
groups.
Project Health - Comprehensive Strategies to Promote Healthy Eating
Employees should have a greater role in the
decision making process if it is felt that there
may be some resistance to changes.39
Individuals who are most likely to be
resistant to changes should be involved in
the process, so that concerns can be heard
and addressed. This also gives employees
time to prepare for the changes.42 Ensure
that employee involvement happens early
and often in the process.40,42,49
It is important to outline to employee
stakeholders what decisions they will be able
to influence. For example, management may
have already made the decision that there
will be changes (e.g., “we will be making
changes to the workplace food environment
to make sure that there is an emphasis on
healthy food, whenever food is offered or
sold to employees"). In this case, the
wellness committee might be asked to make
a decision such as: what changes will be
made, how the changes are made, where to
start the process and how long the process
should take.
Organizing the Committee
Develop a Terms of Reference for the wellness committee.
A Terms of Reference is a document that defines what the wellness committee is responsible for
and what types of decisions it can make. It should specify the roles and responsibilities of
committee members and outline how decisions are made.
Figure 1 - Sample Terms of Reference

“Committee name”
Terms of Reference

Purpose of the committee

The purpose of the “committee name” is to develop, implement, evaluate and sustain a
comprehensive health promotion strategy in the workplace. The intent is to make the healthy
choices the easy choices and ensure that workplace practices are consistent with the healthy living
messages promoted in the workplace. The “committee name” will be responsible for leading the
process to create a comprehensive health promotion strategy in our workplace. For example, the
committee will:
Develop the terms of reference
Complete a healthy eating needs and interest assessment
Set priorities for action
Develop a plan to address identified areas of concern
Carry out the duties outlined in the plan
Manage resources (time, budget)
Evaluate initiatives
Communicate with workplace employees and managers about the committee activities

Membership

The Committee will consist of “number of members” members and will include representatives
from: management, unions/employee associations, employees, health and safety staff, etc.
Roles and Responsibilities
Chair

The Chair of the “committee name” will be determined by (e.g., rotating through all members,
designated chair each year, etc.) The Chair will be responsible for: calling for agenda items and
drafting the agenda for meetings; ensuring quorum is achieved; and guiding committee members
to work toward a common goal.

Project Health - Comprehensive Strategies to Promote Healthy Eating 73

Recorder

Decide how the recorder will be chosen (e.g., volunteer at each meeting, rotating recorder,
designated recorder etc.). The recorder will take minutes of each meeting and give to the chair for
distribution within “number of days” days of the meeting.

Members

Members of the “committee name” will:

Attend meetings
Conduct discussions in a professional manner (e.g., constructively dealing with conflict)
Complete tasks as assigned

Decision-making

When making decisions, the “name of committee” will strive for consensus.
If consensus cannot be achieved after a reasonable length of time, decisions will be made by (e.g.,
majority vote, designated decision-maker such as a senior manager, etc.).

Meetings

Meetings will be held on the “designated day” of each month or at the call of the Chair. There will
be a minimum of “number of” meetings per year.
A quorum of fifty percent plus one must be met in order to proceed with the meeting.

Workplace Examples: WELLNESS COMMITTEE TERMS OF REFERENCE

Hamilton Wentworth District School Board
http://www.hwdsb.on.ca/staff/hr/case/pdfs/terms_ref.pdf

Provincial Health Services Authority

http://www.phsa.ca/NR/rdonlyres/3DDA4DE0-6725-4842-AAF0-
BD88CB61CFF7/0/FoodPolicyAL_300November2010.pdf (page 7)
Tees, Esk and Wear Valleys NHS Foundation Trust
http://www.tewv.nhs.uk/Global/Strategies/STRAT-0020-
v1%20Health%20and%20Wellbeing%20Strategy.pdf (page 11)
York Region (Sample)
http://www.york.ca/NR/rdonlyres/jlt37gvt33zifb2hvztjlcmff45ytqqqpo2e2jxn2qcjl66yav4o
vkbljjcm342gcmqpgfmqyya5peisd3glud4gcb/WW_Terms_of_Reference.pdf

Project Health - Comprehensive Strategies to Promote Healthy Eating 74

Agenda and Minutes
Have an agenda for each meeting using a standard format, to guide everyone on what will be
accomplished in the meetings.
Keep minutes to record the committee discussions and post the minutes, so that all employees can
see what the committee is discussing and planning.

Figure 2 – Minutes Template

Name of Committee: ______________________________________
Meeting date _____________________________________________
Participants: _____________________________________________
Regrets: _________________________________________________
Chair: _____________________ Recorder: ____________________

Agenda Item Discussion Decisions Action (who will

Points complete the action
and when will it occur)
1.0 Welcome and
Introductions
2.0 Review and Additions
to Agenda
3.0 Review of Minutes of
Previous Meeting
4.0 Business Arising from
the Minutes
5.0 New Business

Date, time and location of next meeting: _____________________

Project Health - Comprehensive Strategies to Promote Healthy Eating 75

Step 3A – Assess Workplace Health Needs
Understanding the needs and interests of
employees is an essential part of developing
a comprehensive workplace health program.
Before proceeding with a healthy eating
initiative, conduct a general health needs
and interest assessment to determine the
health priorities of your employees and
managers. The results of the health needs
and interest assessment are critical to
determine readiness for change and will
guide decisions in subsequent phases of the
workplace wellness program.
Methods for assessing employee needs and
interests include having informal
discussions, suggestion boxes, focus
groups, and surveys. Examine other sources
of information such as absenteeism,
productivity, disability claims, and benefit
costs to identify if healthy eating is an issue
for your workplace.
It is possible that your employees have
health concerns that are not related to
healthy eating or that the timing is not right
for a healthy eating initiative in your
workplace. Sometimes workplaces are ready
to make changes in one area (e.g., tobacco
cessation) without being equally ready to
make changes in other areas, such as
changing the workplace food environment.50
If this is the case, you may want to focus
your wellness efforts on other health
promotion areas and revisit healthy eating as
a priority later on.
Tools: CONDUCTING HEALTH NEEDS AND INTEREST ASSESSMENTS
To conduct a comprehensive general health needs assessment. Visit
http://www.projecthealth.ca/understanding-workplace-health/assessment/survey-tools
Project Health - Comprehensive Strategies to Promote Healthy Eating
What are employees interested in?
This information can be helpful in planning
awareness raising and skill building activities
and may also help to create buy-in for
supportive environment and policy
development initiatives.
Are there barriers to healthy eating
in the workplace?
Often people have good knowledge about
healthy eating but find it difficult to follow
through. Identify factors in your workplace
that act as promoters or barriers to healthy
eating.
Asking the right questions
The answers your employees will give
depend on how the questions are asked. For
example, employees may indicate that they
would like healthy eating lunch and learns
because that is they type of health promotion
activity that is most familiar to them.
However, if you were to ask why employees
wanted education, you may find that
employees are having difficulty managing
their weight or a chronic health condition,
issues that require a comprehensive
strategy, rather than a simple education
approach.
To avoid frustration, think about how you will
use the information before adding questions
to surveys and only ask employees if they
want services that you will be able to
provide.
76
Needs Assessment Questions for Healthy Eating
Review these sample questions and use them as a guide when you develop needs assessment
questions for your workplace. Please note that this is not an exhaustive list of questions but a
sample to get you started.

Figure 3 – Needs Assessment Questions

Identifying Barriers to Healthy Eating

 What challenges do you face in following a healthy diet? (Open-ended)

Workplace Related Barriers to Healthy Eating

 Not enough time during the work day to eat / too busy to take a break
 Not enough healthy options at work
 Healthy options are too expensive
 Healthy options are not tasty
 Healthy options are not appealing
 Healthy options are not convenient
 Not sure which options are healthy
 Work related stress makes it hard for me to follow a healthy diet
 Food being offered/shared in common areas is not healthy
 Fundraisers conducted in the workplace offer tempting food
 Options in workplace vending machines are not healthy
 Food that is served during meetings/events is not healthy
 My job requires me to entertain clients which makes it hard to follow a healthy diet
 What changes can we make to the workplace to help you eat healthier? (Open-ended)

Barriers to Healthy Eating at Home

 Healthy food is too expensive
 Stress related to home/personal issues makes it hard for me to follow a healthy diet
 Have trouble resisting tempting food at home
 Lack of support from family members
 Lack of support from friends
 Not enough time to shop for groceries
 Not enough time to cook/prepare healthy meals
 I am not sure how to prepare healthy meals
 I am not sure how to follow a healthy diet
 I find nutrition/food labels difficult to understand

Project Health - Comprehensive Strategies to Promote Healthy Eating 77

 Employee Interest Questions
I am interested in:
 Learning how to choose healthier food options
 Improving my cooking skills
 Weight management
 Participating in a workplace garden
 Learning about gardening at home
 Buying produce from a cooperative agriculture program
 Attending a farmers market
 Having an on-site farmers market
 Learning more about (open-ended)
 Having these activities at work (open-ended)

Interest in Health Risk Assessments (HRAs)

I would like to have a health screening for the following:
 Cholesterol
 Triglycerides
 Blood pressure
 Blood glucose (blood sugar)
 Body Mass Index
 Waist Circumference

Tools: PROJECT HEALTH CAN HELP!

Project Health staff are available to help you build your business case, create buy-in
among staff and decision-makers, participate in events, offer educational materials,
develop action plans and assist in implementing and evaluating initiatives. Contact us
at 519-883-2287 or visit http://www.projecthealth.ca

Project Health - Comprehensive Strategies to Promote Healthy Eating 78

Step 3B – Assemble a Healthy Eating Subcommittee
Once you establish that healthy eating is a
priority area for your workplace through your
health needs and interest assessment (step
3A), you may want to consider creating a
healthy eating sub-committee. This ensures
that your wellness committee has
representatives from all perspectives
involved in promoting healthy eating in the
workplace.
Develop a terms of reference for the healthy
eating sub-committee and follow the same
process for setting meeting agendas and
minutes.
Who to involve
Consider involving representatives from:
 Management/supervisors
 Health and safety committee members
 Wellness committee members
 Human resources
 Employees
 Unions and employee associations
 Food services personnel
 Purchasing department
 Fundraising committee

Ensure that enough time is allotted for  Social committee

everyone to participate (e.g., four hours per  Training and development staff
month to attend meetings and participate in  Marketing and communications staff
activities).  Benefits staff
If a workplace has food service providers  Health champions
(e.g., cafeterias, cafes, etc.) it is important  Other relevant workplace stakeholders
that they be involved in committee
discussions regarding potential food service
changes.
Once the priorities for action have been
established, the food service provider will be
responsible for the implementation of the
changes.

Tip: HEALTHY EATING CHAMPIONS

Invite ‘healthy eating champions’ to be a part of your committee. A healthy eating
champion is an employee that is passionate and dedicated to healthy eating who can
communicate information to co-workers, listen effectively and seek feedback from
their peers.49 Having champions on your committee will help to create excitement and
buy-in among staff about healthy eating initiatives.

Project Health - Comprehensive Strategies to Promote Healthy Eating 79

Step 4 – Develop an Action Plan
The committee responsible for developing When prioritizing action areas consider:
the healthy eating strategy should review the
The ease of implementing solutions,
information collected during the needs and
such as “quick wins” that may motivate
interest assessment then prioritize areas to
and encourage continued progress
work on and put together a high level plan.
The possibility of making a difference,
The plan should:
(e.g., existence of effective solutions),
Make program recommendations employer readiness to change,
likelihood of success and other issues
Clarify the high level goals of the
related to workplace policies or politics
program
The costs that will be incurred if no
Identify required resources
action is taken
Establish a timeline for implementation
The subjective opinions and preferences
Plans should address, or at least of workplace stakeholders, including
acknowledge, issues related to how managers, employees and their
occupational health and safety, voluntary representatives51
health practices and organizational culture
You may want to target some activities
are influencing the priority areas for your
to certain groups of employees or
comprehensive healthy eating strategy.
include spouses to reinforce healthy
When developing the plan, use the behaviours at home as well as work52
information collected from the situation
assessment to prioritize the workplace
actions to address areas of concern.

Workplace Example: CAPITAL HEALTH - HEALTHY EATING STRATEGY

In 2011, Capital Health developed a healthy eating strategy to work toward a goal of
providing 100% healthy choices in their restaurants, vending, retail and catering
operations. This logic model shows the corporate healthy eating goals, objectives,
areas of intervention, communication plan and awareness raising, skill building,
environmental supports and policy components of the strategy.
http://www.cdha.nshealth.ca/system/files/sites/92/documents/capital-health-healthy-
eating-strategy.pdf

Project Health - Comprehensive Strategies to Promote Healthy Eating 80

Putting Your Healthy Eating Plan Together Using a Comprehensive
Approach

A comprehensive approach to wellness programming includes all four key health

promotion approaches.

Awareness Raising Supportive Environment

Awareness raising activities provide
information to employees about the benefits
of making healthy eating choices. Examples
of awareness raising activities include
providing information about healthy eating in
pamphlets, company newsletters, articles on
the company intranet, and healthy eating
information posted on bulletin boards.
Skill Building
Skill building activities give employees an
opportunity to learn skills that will help them
to change healthy eating behaviours.
Examples include education sessions where
employees learn food skills such as
vegetable, fruit and herb gardening, healthy
cooking techniques, nutrition label reading
and menu planning.
A supportive environment means that the
workplace contains sustainable ongoing
activities that make it easier for employees
to make healthy eating choices. This
includes reducing barriers in the workplace
environment that make it difficult for
employees to follow a healthy diet.
Policy Development
Workplace policies provide clear definitions
of expected employee behaviour and
mandate the roles and responsibilities of
employees and managers to ensure
supports are in place to help individuals
make healthy choices. For example, a
workplace may choose to have a policy that
fruit and vegetable options must be provided
whenever food is served in workplace
meetings.

Project Health - Comprehensive Strategies to Promote Healthy Eating 81

Creating Goals and Objectives
By setting out goals and objectives you can An objective should be written in a way that
track the process of your strategy to allows it to be evaluated. Use SMART
determine if you have been successful in objectives that are:
your efforts.
Specific
Goals are statements of broad, long-term
Measurable
accomplishments expected from the
program. Attainable

Each goal should have one or more Realistic

objectives to accomplish the goal. An Timely
objective is a statement that describes what
the project is trying to achieve.

Tip: EXAMPLE GOALS AND OBJECTIVES FOR FOOD SERVED IN MEETINGS

Goal: To create a workplace environment that supports healthy eating.
Objectives:
Specific: What do you want to do?
Example: Create a policy that ensures healthy food is served.
Measurable: How much and how often will it be done?
Example: In every meeting where food is served.
Attainable: How will it be done?
Example: Employees will order food using set nutrition criteria.
Realistic: Will employees be able to follow the policy?
Example: Employees will use a standard catering form.
Timely: When will it be done?
Example: The policy will take effect July1, 2012.

Objective Summary:
Our workplace will create a policy that ensures healthy food is served whenever food is
offered in meetings. Employees will order food using a standard catering form, which
will be based on a set nutrition criteria. The policy will take effect July 1, 2012.

Project Health - Comprehensive Strategies to Promote Healthy Eating 82

Establish a Timeline
Prioritize your action items. Start small and
work towards bigger initiatives.43
Establish a timeline for each part of the
strategy. Plan out what needs to be done
and when it needs to be completed.
Ensure your timeline is realistic and gives a
reasonable time for activities to be
completed.43 If you anticipate a great deal of
resistance, proceed slowly with changes.44
Program timing
Determine the best time of the year to offer
programs. Some initiatives may need to be
scheduled monthly or quarterly, while others
less often.52 Activities should be scheduled
at times that are convenient for
participants.52 For example, offering activities
before and after work to meet the needs of
shift workers.52 Participation in events may
be increased if employees are able to attend
during work time.
Establish a Budget
Consider the resources that will be needed
to complete the plan such as staff time, and
financial resources for incentives, printed,
materials, food costs, etc.
Integration
Ensure that planned initiatives are integrated
into the overall organization’s goals and
priorities so that it is an everyday part of the
organization, rather than an extra
responsibility.42,51 Try to incorporate a ‘health
and wellness lens’ into decision-making
processes so that any new workplace
decisions are assessed for their impact on
employee health.51
Project Health - Comprehensive Strategies to Promote Healthy Eating
Examine how existing policies and
procedures influence eating habits. For
example a performance management
system that rewards high output, regardless
of how the results are achieved, may
encourage unhealthy behaviours to get the
work done.51
Promotion and Communication
Create a communication plan to inform
employees about planned activities.44 If your
workplace contains different types of
employees (e.g., office workers and drivers),
identify the most effective way to
communicate with each group.
Plan to give employees clear and consistent
details about the healthy eating strategy.
Employees will need information on how,
when, and where changes will occur. They
will also need to know who will be doing the
work.
Consider developing a logo or branding your
health initiatives to make it easily
recognizable to employees.
When making changes to foods offered and
sold to employees, ensure employees know
that they always have the option to bring
their own food to work with them.
Education
Plan an educational component to your
strategy. Employees will require education
on the environmental, genetic and social
influences on eating habits as well as the
limitations of current dietary interventions.
Without education, employees may feel that
healthy eating is solely a personal
responsibility and resist changes to the
workplace food environment.53-55
83
Figure 4 – Workplace Healthy Eating Action Plan Worksheet
After completing your workplace nutrition needs and interest assessment, reflect on the areas that were identified and make a plan to address each area.
Highlight three areas where your workplace is doing well with regard to implementing healthy eating policies and practices:
1. __________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________

3. __________________________________________________________________________________________________________________

List three priority areas where workplace healthy eating practices need improvement:
1. __________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________
3. __________________________________________________________________________________________________________________

Once your priority areas have been determined, create a plan to improve each area. Start small, even tackling one area will make a difference. Make sure you
include activities from all four comprehensive health promotion areas: awareness raising, skill building, supportive environments and policy.
Goal: ________________________________________________________________________________________________
Strategies
Target Evaluation Person Resources
Objective Awareness Skill Supportive Policy Timeline
Audience Method Responsible Needed
Raising Building Environment Development
Step 5 – Develop the Evaluation Plan
Monitoring and evaluating your workplace
wellness initiatives is a very important step in
your wellness programming cycle. This
information will help you identify your
successes, and enable you to modify your
future wellness strategies.52 Programs and
initiatives should be evaluated on the goals
and objectives set during the planning
process.52
In addition to evaluating each initiative, it is
important to evaluate the healthy workplace
program’s overall success after three to five
years, or after a significant change such as
new management.51
Figure 5 – Types of Success Indicators
Formative Indicators
(These indicators identify if interventions will
meet the needs of employees)27
 Appeal of incentives – Do employees like
the incentives offered? Do the incentives
motivate staff to participate?
 Usability of information or interventions –
Is the information targeted, relevant and
easily understood by employees?
Project Health - Comprehensive Strategies to Promote Healthy Eating
Consider tracking process indicators as well
as short-term outcome measures that will
indicate if your program has been successful.
Long-term successes in the promotion of
healthy eating can be somewhat challenging
to measure and problems related to unhealthy
eating may take decades to appear.
There are different levels of evaluation and
each offers different types of evaluation
information. These include formative, process
and outcome evaluations.
When evaluating health promotion activities
there are several types of success indicators
that are commonly used: formative, process,
short-term and long-term outcome indicators.
Process Indicators
(These indicators identify what works and
does not work in your workplace)
 Ensure that the committee had
representation from all stakeholder groups
 Determine how the programs and
initiatives were implemented (e.g.,
designated people were able to carry out
their assigned activities)
 Track participation rates, uptake of health
risk assessments and use of employee
assistance programs (EAP)
 Ask employees how satisfied they are
with initiatives
 Track costs to determine if programs and
initiatives were accomplished according to
the budget
85
Outcome Indicators
(These example indicators show whether the program met its objectives)
Short-Term Indicators
 Uptake of current healthy food and drink
options in the cafeteria, catering or
vending operations
 Group statistics of employee physical
assessments including BMI, waist
circumference, blood pressure, and blood
glucose screening
 Intentions of behaviour change and/or
personal goal setting among employees37
 Increased knowledge52
 Self-reported behaviour change52
 Positive changes in workplace culture52
Long-term Outcome Indicators41,52
 Absenteeism rates
 Presenteeism rates (productivity losses)
 Self-reported job satisfaction and
employee morale
 Employee turnover
 Disability claims
 WSIB claims
 Prescription drug benefits costs
 Changes in risk factors (aggregate HRA
data such as blood pressure, cholesterol
etc.)

 Positive sustained environmental changes

and/or healthy eating policy
implementation
 Cafeteria and/or vending sales

Tip: EVALUATION EXAMPLE

If the previous policy example were evaluated (food policy for meetings), tracking these
indicators can help to determine if the goal and objectives were met.
Do employees understand how to complete the new catering form? Formative
Was policy implemented on the target date? Process
Were employees and managers who order food trained by the target date? Process
Have managers had to remind employees to follow the policy? Process
Are the employees who order food following the policy? Outcome
Does data show that catering orders show that healthier food is being ordered?
Outcome
If the policy is not being followed, what is the reason? Process
How satisfied are employees with the food offered in meetings? Process
Have there been any changes to food expenditures/budget? Outcome

Project Health - Comprehensive Strategies to Promote Healthy Eating 86

Step 6 – Check-in with Management
Ongoing communication with management is
important throughout the entire process. This
step is essential to guarantee support and
approval for funding or human resources. It’s
also needed for a commitment to their role in
the communication of the plan, role modelling
and to ensure leadership presence.
Once the plan has been drafted, organize a
final check-in with management before
proceeding. Present the drafted plan to
managers and any organized labour groups
for approval. Include goals, objectives and
planned activities, as well as plans for
communication and evaluation.

Project Health - Comprehensive Strategies to Promote Healthy Eating 19

Step 7 – Implement the Plan
Now that your plan has been approved, it is Incentives
time to implement your strategies. Don’t
Incentives can build motivation by offering
forget to incorporate the evaluation process
rewards for healthy behaviours. Incentives
into each activity. Here are some other tips
also create interest in participating. When
to help make your strategy a success!
you provide incentives, the company sends
Launch your initiative! the message that it is committed to
employee health.52
Once your healthy eating strategy is ready to
implement, it is important that management Other Considerations52
representatives (e.g., CEO, President,
Ask employees what types of rewards
Director, union leader, etc.) communicate
motivate them
with employees.52
Make sure every participant who
Communication may need to occur several
achieves a goal receives some
times in order to ensure that everyone who
recognition
is affected is informed of when changes will
occur and how changes will affect them. Use incentives to promote your worksite
wellness program through logos and
Use internal communication strategies such
branding
as email, posters, pay-stub attachments,
internal websites and word-of-mouth to Avoid rewards for biometric changes
spread the word! (i.e., pounds lost, cholesterol
improvements)
Launch the event with activities such as:
Avoid offering incentives for the “best” or
 Giveaways
the “most.” This tends to discourage
 Contests and competitions participation by those who are likely to
get the most benefit from joining
 Free health assessments with
personalized feedback Avoid incentives that are not in keeping
with health messaging. For example, gift
 Loyalty cards as an incentive for
certificates for tanning are not consistent
selecting healthier options
with sun safety recommendations; gift
 Food tasting table certificates for restaurants are not
 Information on what employees can do consistent with healthy eating messages
at home (e.g., packing lunches, family
meals)56
 Vouchers for Maximum Nutritional Value
foods in the cafeteria (See Appendix A
for a description of food categories)

Project Health - Comprehensive Strategies to Promote Healthy Eating 88

Ideas for Incentives
Merchandise that promotes your
company (e.g., cups, pens, day timers,
etc.)
Apparel, or reusable grocery bags that
promote your wellness messaging or
your wellness branding
Pedometers (higher end) – walking or
bicycle
Gift cards for local farmers markets,
movie tickets, local attractions, travel,
books, malls, music store, movie
rentals, downloadable music or books,
drug stores, or hardware stores, etc.
Booklet of passes to recreational
facilities (e.g., swim passes, gym
passes, skating, bowling, etc.)
Useful household items such as
magazine subscriptions, beach towels,
cooler bags or backpacks, gardening
tools, etc.
Eco-friendly items such as solar-
powered cell chargers, crank
flashlight/radios, rain barrels, or
biodegradable bags
Event tickets for music or sport events
Paid time off (e.g., Friday afternoon)
A draw for one big item (e.g., active
gaming console, electronic devices such
as e-readers, MP3 players, mobile
devices, cameras, or DVDs with a
physical activity focus, trips and
vacations, spa packages)
Step 8 – Evaluate and Update the Strategy
Once your program has been implemented, The committee should present the report to
start collecting the data from your management and other key stakeholders
evaluations. Review the information that you along with suggested recommendations.51
collected during the evaluation and use it to This can help to gain further commitment
plan next steps. Complete another needs from your workplace decision-makers.
assessment to determine if needs are met or
if new needs have arisen. Celebrate Your Successes!
The healthy eating committee should use Don’t forget to celebrate your successes!
this information to create a report that
Even if things didn’t work out as you
identifies: if goals and objectives were met,
expected them to, your wellness committee
indicator results, implications of results, any
has gained insight into what worked and
issues that hindered the process and most
what didn’t which will help you move forward
importantly, recommendations for program
in future programming! Share your
improvements. This will help you decided
successes with all employees in your
what changes or improvements need to be
workplace to create energy, enthusiasm and
made and will help you determine what
momentum for your strategy
activities should continue and/or expand
upon.

Project Health - Comprehensive Strategies to Promote Healthy Eating

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27. Cohen DA. Neurophysiological pathways to
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28. Rothman AJ, Sheeran P, Wood W. Reflective and
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dietary change. Annals of Behavioral Medicine.
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29. Levitsky DA, Pacanowski CR. Free will and the
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30. Brownell KD, Kersh R, Ludwig DS, et al. Personal
responsibility and obesity: A constructive approach to a
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31. Shain M, Kramer DM. Health promotion in the
workplace: Framing the concept; reviewing the
evidence. Occup Environ Med. 2004;61:643-8, 585.
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obesity, and occupational safety and health. Am J
Public Health. 2007;97:428-436.
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working conditions explain differences in eating
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34. Nishitani N, Sakakibara H, Akiyama I. Eating
behaviour related to obesity and job stress in male
Japanese workers. Nutrition. 2009;25:45-50.
35. Fernandez ID, Su H, Winters PC, Liang H.
Association of workplace chronic and acute stressors
with employee weight status: Data from worksites in
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36. Kouvonen A, Kivimaki M, Virtanen M, et al.
Effort-reward imbalance at work and the co-occurrence
of lifestyle risk factors: Cross-sectional survey in a
sample of 36,127 public sector employees. BMC Public
Health. 2006;6:24.
37. Berset M, Semmer NK, Elfering A, Jacobshagen N,
Meier LL. Does stress at work make you gain weight?
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38. Canadian Mental Health Association.
Comprehensive Workplace Health Promotion –
Affecting Mental Health in Workplace. Available at:
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health-promotion-affecting-mental-health-in-the-
workplace.
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Psychologist-Manager Journal. 2008;11:211-219.
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Thorsen AV, Trolle E. Factors influencing participation
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Kling WC. A pilot study of an online workplace
nutrition program: The value of participant input in
program development. J Nutr Educ Behav.
2008;40:160-167.
47. Hersey J, Williams-Piehota P, Sparling PB, et al.
Promising practices in promotion of healthy weight at
small and medium sized U.S. worksites. Prev Chronic
Dis. 2008;5:1-11.
48. Kruger J, Yore MM, Bauer DR, Kohl HW. Selected
barriers and incentives for worksite health promotion
services and policies. . Am J Health Promot.
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involving employees in change at Allstate Insurance.
Organizational Development Journal. 2007;25:27-31.
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organization theory to understand the determinants of
effective implementation of worksite health promotion
programs. Health Educ Res. 2009;24:292-305.
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and practitioners. 2010.
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Building a healthy worksite: A guide to lower health
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Healthy people = healthy profits. 2009.
92
 Strategies
STRATEGIES
To Promote Healthy Eating in the Workplace

Awareness
raising

Skill
Policy building
development

Supportive
environment
Healthy Eating Strategies at a Glance
In order to make the greatest impact on the wellness of your employees and company, all four of the
following approaches need to be considered in your wellness planning efforts.

Definitions of Success
Each section contains “definitions of success” that represent the gold standard of what a workplace
would achieve in each topic area to be successful. Initially, workplaces may choose their own goals and
strive towards achieving the “definitions of success”.

Awareness Raising
Awareness raising activities provide information to employees about the benefits of making healthy
choices.
 Bulletin Boards and Posters
 Displays and Health Fairs*
 EatRight Ontario
 Emails, Newsletters and Other Employee Communications
 Events*
 Health Screening and Health Risk Assessments*
 Lunch and Learns*
 Mobile Health Technology*
 Pamphlets
 Point-of-Decision Nutrition Information
 Promoting Local Food Opportunities
 Videos

*These activities may be considered skill building if a hands-on learning component is added (e.g.,
label reading, menu planning, cooking skills, self-monitoring, etc.)

Skill Building
Skill building activities help to educate employees and develop the necessary skills to support a healthy
choice.

 Lunch and Learns

 Health Fairs
 Smart Phone Applications
 Knowledge Skills
 Planning Skills
 Meal Preparation and Cooking Skills
 Gardening Skills
 Challenges and Contests
 Health Promotion Programs

Project Health – Comprehensive Strategies to Promote Healthy Eating 94

Supportive Environment
Strengthen and enhance employees’ healthy practices. These activities make it easier for employees to
make healthy choices

 Access to Registered Dietitians

 Cafeterias
 Celebrations
 Common Areas
 Facilities
 Meetings and Events
 Organizational Culture
 Peer Support Groups
 Promoting Local Food
 Vending Machines
 Workplace Gardens

Policy Development
Policies enhance and sustain healthy practices by clarifying roles and expectations between employers and
employees.

Policies can be implemented to strengthen workplace support for healthy eating in any of the areas
that have been covered in this toolkit including:
 Awareness Raising
 Skill Building
 Supportive Environments
 Organizational Culture

Special Considerations
This section addresses considerations for some specific employee populations that are hard to reach with
traditional health promotion strategies, or that have specific needs related to healthy eating.

Community Involvement
Workplaces often work with other organizations to benefit the community. This section offers suggestions
on how to incorporate community involvement into your comprehensive healthy eating strategy.

Did You Know: WATERLOO REGION’S HEALTHY WORKPLACE AWARDS

The Waterloo Region Healthy Workplace Awards program recognizes and celebrates workplaces in
Waterloo Region who demonstrate a strong commitment to improved health for their employees.
Workplaces that implement a healthy eating strategy that includes all four health promotion strategies
may be eligible for a Waterloo Region Healthy Workplace Award. For more information on the health
workplace awards see: http://projecthealth.ca/healthy-workplace-awards-program

Project Health – Comprehensive Strategies to Promote Healthy Eating 95

 Awareness Raising
Awareness Raising
Awareness raising activities increase employees' general knowledge about a
health topic to help them make healthy food choices. It is the first step in
supporting employees to improve their eating habits. When used as part of a
comprehensive workplace strategy, awareness raising can help employees
understand what changes will need to be made and why changes are needed. As
part of awareness raising, be sure to include information about how the
environment affects individual health behaviours.
There are many ways to create awareness about healthy eating. These activities
do not need to be expensive or time consuming. Try adding recipes, humour,
statistics, trivia, weekly health tips, quotes and simple messages into healthy
eating education activities.1

Definitions of Success
 Nutrition information and/or educational opportunities are provided to employees
on an ongoing basis, using a variety of activities.
Bulletin Boards and Posters
Create a bulletin board in a high traffic area where you
can post information and posters on various nutrition
topics.
For a listing of posters available for loan, visit:
http://www.projecthealth.ca/menu-services/posters

Displays and Health Fairs

Displays

Similar to bulletin boards, displays can create interest around healthy eating, especially when they
include interactive components.
Healthy eating displays are available for loan. To view the displays, visit:
http://www.projecthealth.ca/menu-services/displays/healthy-eating-displays
Health Fairs
Invite Project Health staff to attend your workplace health fair to give employees an opportunity to
ask questions and learn about healthy eating. Health fairs that offer education, information and
pamphlets are considered to be awareness raising opportunities.
For more information or to book a health fair, contact Project Health
http://www.projecthealth.ca/menu-services/health-fairs
When health fair displays provide information only, they are considered to be awareness
raising activities. However, skill building can also be incorporated into health fair displays (e.g.,
label reading, self-monitoring, etc.)

EatRight Ontario
Many people have questions about nutrition and health. EatRight Ontario provides a free
Registered Dietitian consultation service to all Ontario residents.
EatRight Ontario can be accessed by visiting http://www.eatrightontario.ca or by calling toll
free 1-877-510-5102. Telephone services are available Monday through Friday between 9:00
am to 5:00 pm. Over 100 languages are available
Order EatRight Ontario promotional materials from the Service Ontario website
https://www.publications.serviceontario.ca/ecom and search for “EatRight” in the “Quick
Publications Search” box at the top

Project Health – Comprehensive Strategies to Promote Healthy Eating 98

Emails, Newsletters and Other Employee Communications
Emails

Email messages have the potential to reach large numbers of people and can provide immediate
feedback to participants.2,3 They are suitable for employees who have easy access to the internet
with their own personal email addresses.3

Emails may help increase the effectiveness of other strategies (e.g., directing employees to new
articles on healthy eating on a website, etc.).3,4 However, the effect sizes are usually small, so
emails should be used as part of a comprehensive healthy eating strategy, rather than a stand-
alone technique.2-5
Tips:
Keep an archive of previous email messages so employees can go back to relevant topics3
Consider increasing the frequency of email messages to intensify impact (e.g. one per week)5
Track the number of emails viewed (e.g., request “read” receipts), or number of “hits” on the
website2,3
Keep emails in a user-friendly format and accessible to individuals with limited computer skills3
Include thought provoking messages (e.g., examples of how to improve eating habits)5,6
Determine topics of interest of employees and tailor health messages accordingly3,6,7
Invite employee’s family members to subscribe to email and newsletters, as the individual who
is most responsible for household food shopping and preparation may be a family member of
the employee6
Newsletters (print or electronic)

Newsletter articles and inserts can serve many purposes (e.g., enhance support among workers,
provide information/education, promote activities or special events, and help support a corporate
culture that encourages healthy eating).
EatRight Ontario offers a newsletter service. Employees and health promoters can sign up at:
http://www.eatrightontario.ca/en/NewsletterSignUp.aspx

Use information provided by EatRight Ontario for newsletter content in newsletters. (Ensure
that you acknowledge EatRight Ontario as the source). http://www.eatrightontario.ca
Identify any employees who will not be reached by a newsletter and explore other options to
reach them
Other Employee Communications

Other ways to communicate information with staff include:

Simple messages on pay cheque stubs or pay cheque inserts
“Pop-up” messaging when employees use the company intranet

Project Health – Comprehensive Strategies to Promote Healthy Eating 99

Events
Plan a workplace event to celebrate health promotion occasions such as Nutrition Month® in March
or Healthy Workplace Month in October. Be sure to plan events well in advance to make sure that
you have enough time to organize activities and promote the event to staff members.
Include posters, handouts, promotional cafeteria specials or free samples of healthy items,
quizzes, contests or lunch and learns to celebrate your event.
Visit http://www.dietitians.ca for more information on Nutrition Month® and
http://www.healthyworkplacemonth.ca for Healthy Workplace Month

Health Screening and Health Risk Assessments

Many employees appreciate the opportunity to be screened for health
conditions while at work. This can be especially important for populations
that do not have regular contact with a physician. Health Risk Assessments
(HRAs) are a recommended strategy for workplaces when they
include a health education component.8
When HRAs provide information only, they are considered
to be awareness raising only. However, skill building
activities can also be incorporated into HRAs (e.g., setting
goals, creating action plans, etc.).
Conduct on-site blood glucose, blood pressure, waist
circumference and cholesterol screening
Ensure that feedback is given in a confidential manner
Refer individuals to see other medical professionals for
follow-up when appropriate

Tools: PLANNING FOR HEALTH SCREENING

WELCOA
See the resource “Choosing the Health Risk Assessment That's Right For You” for
information on hiring a health screening provider.
http://www.absoluteadvantage.org/uploads/files/Choosing_HRA.pdf
Centers for Disease Control and Prevention
Checklist for Planning Employee Health Risk Appraisal Implementation
http://www.cdc.gov/nccdphp/dnpao/hwi/downloads/HRA_checklist.pdf

Project Health – Comprehensive Strategies to Promote Healthy Eating 100

Lunch and Learns
Educate your employees about healthy eating over the lunch hour.

See the Project Health website for Lunch and Learn updates (minimum 10 employees in
attendance, call 519-883-2287 for booking): http://www.projecthealth.ca/menu-services/lunch-
and-learns

When lunch and learns provide information only, they are considered to be awareness raising
activities, however, skill building can also be incorporated into lunch and learn sessions (e.g.,
label reading, setting goals, self-monitoring, etc.)

Mobile Health Technology

Mobile Health (mHealth) involves the use of mobile phone technology to promote health, prevent
disease and provide health care. Such technology includes, but is not limited to, text messaging
and smartphone applications.9
Text Messages

Text messaging is the least advanced, but most widely adopted and least expensive of mHealth
technologies.9 According to the Canadian Wireless Telecommunication Association, Canadians
send 199 million text messages per day.10 However, the use of text messaging varies by age,
culture and other demographic factors.
The use of text messaging for preventive health behaviour change is relatively new. There is
established research evidence of the effectiveness of text messaging in clinical management of
existing health conditions; however the research on its use in healthy individuals is still in its first
generation. However, early evidence is showing that, at least in the short term, this type of
messaging may have a positive effect on sustaining positive health behaviours.9,11,12
Effectiveness of text messaging may be enhanced by tailoring messages to individuals. Tailoring
could involve:11,12
including employee name or nickname in the message
incorporating individual goals into messages
allowing participants to write the messages they will receive
allowing participants to specify days and times when they would like to receive the
messages
basing messages on a health behaviour change theory (e.g., stages of change) that takes
into the account an individual’s current state of readiness for making changes to eating
habits

Project Health – Comprehensive Strategies to Promote Healthy Eating 101

Smart Phone Applications

Hundreds of smartphone apps (applications) are available to help individuals monitor physical
activity, weight and food intake.13 Some smartphone apps also offer information about the food
allergen content of food items.
Although users give smartphone apps high ratings for satisfaction the effectiveness of these
applications to help individuals improve their dietary intake has yet to be established.13 In addition,
there are some concerns about the accuracy of the information provided by smartphone apps.13
Smartphone apps that can be used to set goals or build skills such as keeping a food journal are
considered to be skill building activities.
Typically the calorie and allergen information provided by these apps is derived from the
United States Department of Agriculture, Nutrient Database of Foods and is more indicative of
foods offered the United States.13 Therefore, if seeking out food related smartphone apps use
apps that are based on the Canadian Nutrient File database to be more reflective of foods
available in Canada.
Smartphone apps should not be used in place of advice from
health professionals

Pamphlets
Make educational materials available to employees in an accessible area.

Several healthy eating pamphlets are available from Project Health at:
http://www.projecthealth.ca/menu-services/pamphlets. Additional nutrition pamphlets can be
found at: http://www.region.waterloo.on.ca/nutrition

Dietitians of Canada produces several educational nutrition pamphlets available at:

http://www.dietitians.ca/Your-Health/Nutrition-A-Z.aspx

Project Health – Comprehensive Strategies to Promote Healthy Eating 102

Point-of-Decision Nutrition Information
Point-of-decision nutrition information means that nutrition information is available to individuals at
the moment that they are making a food decision.
There are three general types of point-of purchase information strategies:
1. Nutrition Labels
The Nutrition Facts Panel available on packaged food in Canada. These labels describe the
nutritional content of food items. Sometimes this type of nutrition information is also made available
to consumers in other formats such as websites, pamphlets, tray liners and posters.
2. Point-of-Purchase Messaging
Point-of-purchase messaging includes prompts or tips to encourage people to make healthier
choices (e.g., “grab a salad!”). Point-of-purchase messaging can be attached to walls, shelves,
refrigerators, and serving areas in the form of posters, glass clings, floor clings, table tents and
displays.
3. Nutrition Symbols
Nutrition symbols are sometimes used to identify healthier choices, such as the logo used in the
Heart and Stroke Health Check™ program that identifies products that meet a specified nutrition
criterion. Many food companies have designed their own nutrition symbols (e.g., Presidents
Choice® Blue menu, PepsiCo® Smart Choices, etc.) and some workplaces design their own
stickers or logos to show items that meet nutritional criteria selected by the workplace.
Effectiveness of Point-of-Decision Nutrition Information
Consumers report using nutrition information when making food decisions and studies show that
consumers who use nutrition labelling tend to reduce their caloric intake.14-21
However, providing point-of-decision nutrition information may not always be effective at motivating
people to make healthier choices. Research shows mixed results on the effectiveness of point-of-
decision nutrition information. Several studies indicate that providing nutrition information at the
point-of-decision had a positive effect on food purchases,14,18-20,22 while others report little or no
effect.23-26

The Bottom Line

Point-of-decision nutrition information may have a small effect when used as part of a
comprehensive healthy eating program, involving education and environmental changes. However,
point-of purchase nutrition information is not likely to be effective as a stand-alone intervention.26

Project Health – Comprehensive Strategies to Promote Healthy Eating 103

Using Point-of-decision making nutrition information

Nutrition information must be made available at the moment that food decisions are being
made in order to be effective. Put nutrition information directly on products or on menu boards
rather than in pamphlets or on websites14
Provide skill building opportunities to help employees learn how to use and interpret nutrition
information. For example, labelling caloric content is only useful if employees understand how
many calories they need each day23,27,28
When using nutrition symbols ensure that the nutritional parameters consider the overall
nutritional quality of food items rather than just a few nutrients. For example, some nutrition
symbols may be liberal (allowing high amounts of some nutrients that should be limited such
as sodium) or based on only a few nutritional parameters (such as low-fat, or high fiber) while
failing to address other nutrients that may negatively impact health (such as sodium, or added
sugar)
Use information in conjunction with positive
changes to the nutritional content of foods
offered. Otherwise, using point-of-decision
information strategies without improving the
nutritional quality of the food, can leave
employees feeling as though it is much too
difficult to actually consume a healthy diet29

Promoting Local Food Opportunities

Make educational materials about local foods available to employees.
Place Buy-Local Buy-Fresh maps in an accessible area,
http://www.foodlink.ca/index.php?p=blbf_map_locations
Place a link to the Foodlink Waterloo Region website on your intranet, http://www.foodlink.ca
Post opportunities for employees to participate in local food related events:
http://www.wrfoodsystem.ca/events

Videos
Videos can be used by health promoters to educate others about healthy eating.

For a listing of healthy eating videos available from Project Health, visit:
http://www.projecthealth.ca/menu-services/menu-services/books-and-publications

Project Health – Comprehensive Strategies to Promote Healthy Eating 104

Awareness Raising References
1. Gates D, Brehm B, Hutton S, Singler M, Poeppelman
A. Changing the work environment to promote
wellness: A focus group study. AAOHN J.
2006;54:515-520.
2. Norman GJ, Zabinski MF, Adams MA, Rosenberg
DE, Yaroch AL, Atienza AA. A review of eHealth
interventions for physical activity and dietary behavior
change. Am J Prev Med. 2007;33:336-345.
3. Plotnikoff RC, McCargar LJ, Wilson PM, Loucaides
CA. Efficacy of an E-mail intervention for the
promotion of physical activity and nutrition behavior in
the workplace context. Am J Health Promot.
2005;19:422-429.
4. Woodall WG, Buller DB, Saba L, et al. Effect of
emailed messages on return use of a nutrition education
website and subsequent changes in dietary behavior. J
Med Internet Res. 2007;9:e27.
5. Plotnikoff RC, Pickering MA, McCargar LJ,
Loucaides CA, Hugo K. Six-month follow-up and
participant use and satisfaction of an electronic mail
intervention promoting physical activity and nutrition.
Am J Health Promot. 2010;24:255-259.
6. Block G, Block T, Wakimoto P, Block CH.
Demonstration of an E-mailed worksite nutrition
intervention program. Prev Chronic Dis. 2004;1:A06.
7. Cousineau T, Houle B, Bromberg J, Fernandez KC,
Kling WC. A pilot study of an online workplace
nutrition program: The value of participant input in
program development. J Nutr Educ Behav.
2008;40:160-167.
8. Task Force on Community Preventive Services. A
recommendation to improve employee weight status
through worksite health promotion programs targeting
nutrition, physical activity, or both. Am J Prev Med.
2009;37:358-359.
9. Cole-Lewis H, Kershaw T. Text messaging as a tool
for behavior change in disease prevention and
management. Epidemiol Rev. 2010;32:56-69.
10. Canadian Wireless Telecommunications
Association. Facts & figures. 2011;2012.
11. Fjeldsoe BS, Marshall AL, Miller YD. Behavior
change interventions delivered by mobile telephone
short-message service. Am J Prev Med. 2009;36:165-
173.
12. Gerber BS, Stolley MR, Thompson AL, Sharp LK,
Fitzgibbon ML. Mobile phone text messaging to
promote healthy behaviors and weight loss
maintenance: A feasibility study. Health Informatics J.
2009;15:17-25.
13. Gan KO, Allman-Farinelli M. A scientific audit of
smartphone applications for the management of obesity.
Aust N Z J Public Health. 2011;35:293-294.
14. Bassett MT, Dumanovsky T, Huang C, et al.
Purchasing behavior and calorie information at fast-
food chains in New York City, 2007. Am J Public
Health. 2008;98:1457-1459.
15. French SA. Pricing effects on food choices. J Nutr.
2003;133:841S-843S.
16. Burton S, Creyer EH, Kees J, Huggins K. Attacking
the obesity epidemic: The potential health benefits of
providing nutrition information in restaurants. Am J
Public Health. 2006;96:1669-1675.
Project Health – Comprehensive Strategies to Promote Healthy Eating
17. Kimathi AN, Gregoire MB, Dowling RA, Stone
MK. A healthful options food station can improve
satisfaction and generate gross profit in a worksite
cafeteria. J Am Diet Assoc. 2009;109:914-917.
18. Post RE, Mainous AG,3rd, Diaz VA, Matheson
EM, Everett CJ. Use of the nutrition facts label in
chronic disease management: Results from the national
health and nutrition examination survey. J Am Diet
Assoc. 2010;110:628-632.
19. Roberto CA, Larsen PD, Agnew H, Baik J,
Brownell KD. Evaluating the impact of menu labeling
on food choices and intake. Am J Public Health.
2010;100:312-318.
20. Temple JL, Johnson K, Recupero K, Suders H.
Nutrition labels decrease energy intake in adults
consuming lunch in the laboratory. J Am Diet Assoc.
2010;110:1094-1097.
21. Howlett E, Burton AS, Bates K, Huggins K.
Coming to a restaurant near you? potential customer
responses to nutrition information disclosure on menus.
Journal of Consumer Research. 2009;36:494-503.
22. Ellis S, Glanville NT. Trans fat information on food
labels: Consumer use and interpretation. Can J Diet
Pract Res. 2010;71:6-10.
23. Harnack LJ, French SA, Oakes JM, Story MT,
Jeffery RW, Rydell SA. Effects of calorie labeling and
value size pricing on fast food meal choices: Results
from an experimental trial. Int J Behav Nutr Phys Act.
2008;5:63.
24. Vyth EL, Steenhuis IH, Heymans MW, Roodenburg
AJ, Brug J, Seidell JC. Influence of placement of a
nutrition logo on cafeteria menu items on lunchtime
food choices at Dutch work sites. J Am Diet Assoc.
2011;111:131-136.
25. Elbel B, Kersh R, Brescoll VL, Dixon LB. Calorie
labeling and food choices: A first look at the effects on
low-income people in New York City. Health Aff
(Millwood). 2009;28:w1110-21.
26. Swartz JJ, Brxton D, Viera AJ. Calorie menu
labeling on quick-service restaurant menus: An updated
systematic review of the literature. International
Journal of Behavioral Nutrition and Physical Activity.
2011;8
27. Piron J, Smith LV, Simon P, Cummings PL, Kuo T.
Knowledge, attitudes and potential response to menu
labelling in an urban public health clinic population.
Public Health Nutr. 2010;13:550-555.
28. Krukowski RA, Harvey-Berino J, Kolodinsky J,
Narsana RT, Desisto TP. Consumers may not use or
understand calorie labeling in restaurants. J Am Diet
Assoc. 2006;106:917-920.
29. Engbers LH, van Poppel MN, Chin A Paw M, van
Mechelen W. The effects of a controlled worksite
environmental intervention on determinants of dietary
behavior and self-reported fruit, vegetable and fat
intake. BMC Public Health. 2006;6:253.
105
 Skill Building
Skill Building
Food skills are all the skills individuals need to provide good food for their
household, make healthy choices and prepare meals that are safe, nutritious
and culturally acceptable.1 Skill building activities give employees a chance to
master skills that will help them to choose and prepare healthy food.

Definitions of Success
 Skill building opportunities are provided to employees on a regular basis. Skill
building refers to activities that include a hands-on component such as workplace
challenges, meal planning, label reading, shopping, budgeting, meal preparation,
and gardening. Some skill building activities can occur in the workplace; however,
it may be easier in some instances to locate an agency that can provide skill
building education for your employees (e.g., community college, community
centre, local market, private company, etc.).
Lunch and Learns
When lunch and learns contain a skill building component such as label reading, setting goals,
self-monitoring, they can be counted as skill building activities.
See the Project Health website for Lunch and Learn updates. Be sure to request a skill
building component when booking your lunch and learn (minimum 10 employees in
attendance, call 519-883-2287 for booking).: http://www.projecthealth.ca/menu-
services/lunch-and-learns

Health Fairs
When health fair displays contain skill building components (e.g., label reading, self-monitoring,
etc.) they can be counted as skill building opportunities
For more information or to book a health fair contact Project Health
http://www.projecthealth.ca/menu-services/health-fairs

Smart Phone Applications (Apps)

Smartphone apps that can be used to set goals or build skills such as keeping a food journal are
considered to be skill building activities. See the smartphone apps section on page 102 for more
information.

Knowledge Skills
Knowledge skills include utilizing nutrition information,
reading food labels, practicing food safety, and
incorporating/substituting ingredients.
Reading Nutrition Labels
Introduce short interventions held at workstations
that teach employees one basic healthy eating
skill, such as learning how to find sodium or
sugar on nutrition labels.
Include a label reading education session into
healthy eating lunch and learns.
Planning Skills
Planning Skills include planning meals for the week, creating shopping lists, food budgeting, and
coordinating food preparation.
Meal Planning
The Canada’s Food Guide website offers educational tools that describe appropriate
portion sizes, allow individuals to create personal Food Guides, as well as providing tips for
planning meals, shopping, reading food labels, snacking and eating out. http://www.hc-
sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

EatRight Ontario offers a menu planner, recipes and other food skill resources
http://www.eatrightontario.ca
Food Budgeting
The Eat Well For Less resource gives information on healthy eating on a
budget.
http://chd.region.waterloo.on.ca/en/healthyLivingHealthProtection/resources/Ea
tWellForLess.pdf

Project Health – Comprehensive Strategies to Promote Healthy Eating – Skill Building 110
Meal Preparation and Cooking Skills
These skills include thinking creatively about using leftovers and adjusting
recipes, mechanical techniques such as chopping, mixing and cooking and
using senses such as sight, taste, smell, texture and temperature to make food
visually appealing, appetizing and enjoyable.
Individuals with cooking skills are more likely to make healthy food choices.
Men and individuals living alone generally report less skill with food and
cooking, and rely more on ready-made meals and convenience foods which
may be less nutritious.2
Offer employees opportunities to develop their interest and confidence in cooking. Look for
courses offered in colleges, community centres, farmers’ markets or other local venues.
Provide workers with healthy recipes. Many reputable websites offer free recipes including
EatRight Ontario http://www.eatrightontario.ca and Dietitians of Canada
http://www.dietitians.ca

Offer healthy cookbooks (such as the titles offered through Dietitians of Canada) to workers,
to borrow, purchase or for use as rewards, incentives or prizes http://www.dietitians.ca
Recipe Analyzer is a tool available from Dietitians of Canada that analyzes recipes for
nutrition content. Individuals may find this tool helpful to assess their favorite recipes for
nutrient content: http://www.dietitians.ca/Your-Health/Assess-Yourself/Recipe-Analyzer.aspx
Educate employees about food safety techniques. This can include food safety techniques
for packing a lunch, cooking on the barbeque, picnics, general food safety in the kitchen and
more. Health Canada offers an interactive website on safe food handling: http://www.hc-
sc.gc.ca/fn-an/securit/kitchen-cuisine/index-eng.php or The Canadian Partnership for
Consumer Food Safety Education http://www.canfightbac.org/en/

Project Health – Comprehensive Strategies to Promote Healthy Eating – Skill Building 110
Gardening Skills
People who garden at home consume vegetables and fruit more often, leading
to higher nutritional quality diets.3 Gardening also has other benefits such as
providing opportunities to be physically active, reducing the effects of stress
and lowering the risk of developing cardiovascular disease and depression.4
Offer employees and their families opportunities to learn gardening skills. Look for courses
offered in colleges, community centres, farmers markets or other local venues or sponsor a
course in your workplace.
Use vegetable and fruit plants, flowers, herbs, bulbs and gardening supplies as prizes during
challenges and competitions.

Distribute resources about vegetable and fruit freezing, which are available from Project
Health. http://projecthealth.ca/project-health-topics/healthy-eating
Offer workshops on food preservation techniques such as freezing and canning to help
individuals learn how to extend the local, seasonal harvest.

Project Health – Comprehensive Strategies to Promote Healthy Eating – Skill Building 111
Challenges and Contests
Challenges and contests can be a great way to encourage behaviour change by allowing
employees to try a new behaviour. Here are some considerations to make before implementing a
healthy eating challenge in your workplace.
Try This!
 Hold contests and challenges for at least two months to encourage employees to form new
habits.5

 Instead of weight loss, promote positive behaviour changes, such as eating more fruit and
vegetables, increasing fibre intake, and reducing sodium or sugar intakes
 Educate employees about healthy living and offer skill building sessions as part of the
challenge/contest (e.g., cooking challenges)
 Give healthy living incentives (e.g., pedometers, Frisbees, gardening tools, sunscreen, hats,
reusable water bottles, reusable shopping bags, grocery lists, cooking utensils, or healthy
cookbooks) either as one grand prize or in increments (e.g., passport system that includes
attending education sessions and participating in challenges). An incremental award system
may help to motivate people to participate in all of the challenge activities.
 Launch the challenge with an activity or event
 Have FUN!
Are there any concerns?
The popularity of television shows such as “The Biggest Loser®” have inspired similar weight
loss challenges in workplaces. The television show contestants have medical supervision,
personal trainers, and nutrition consultants. These individuals are able to focus on weight
loss without the distractions and stresses of daily life. Employees do not have these supports
during workplace weight challenges and therefore, the weight loss achieved on these shows
is somewhat unrealistic for employees

A weight loss challenge may have unintended side effects on employees attempting to lose
weight, such as using unhealthy practices like fasting, skipping meals, using weight loss
supplements or following nutritionally unbalanced nutrition plans

Weight challenges may result in lower self-esteem for some individuals, especially if the
focus is on superficial results such as weight and appearance rather than positive health
outcomes and the adoption of healthy behaviours

Project Health – Comprehensive Strategies to Promote Healthy Eating – Skill Building 112
Health Promotion Programs
Health promotion programs promote knowledge and skills that help
participants follow a healthy diet. Health promotion programs are typically
time limited (e.g., 14 week program). Health promotion programs in general,
have been successful at promoting short-term positive changes in dietary
intake.6
If health promotion programs are offered on an ongoing basis (e.g., weekly),
they are considered to be supportive environment similar to peer support
programs. See page 159 for more details.

Essential Elements for Health Promotion Programs

If your workplace decides to implement a healthy eating promotion program, look for
programs that contain these elements. This will increase the chances that your program
will be effective.

1. Time
Offering paid time to attend health promotion programs can significantly increase employee
participation rates.7

2. Structured Programs
Use programs that incorporate foods skills such as meal planning, food preparation techniques,
label reading, and budgeting. Structured programs with scheduled sessions that include skills
development have better results than self-directed or education-only programs.8

3. Tailored Programs
Ensure the program is tailored for the needs of your employee group.9,10

4. Integration
Link the health promotion program with other related programs (e.g., health screening and health
risk assessments, occupational health and safety initiatives).9

5. Goal Setting
Have employees set personal goals that are SMART (Specific, Measurable, Attainable, Realistic
and Timely) (e.g., “I will bring a healthy lunch to work at least three days per week”).6,11-14

6. Self-monitoring
Encourage employees to monitor their food intake using paper or electronic tools (e.g., food
diaries).13,15-17

Project Health – Comprehensive Strategies to Promote Healthy Eating – Skill Building 113
7. Rewards and Incentives
Offer rewards or competitions to motivate employees to stick to their goals.7,18 Even reverse
financial rewards have been shown to help motivate people (e.g., contracts where people deposit
their own money and get it back when they meet their personal goal).18,19 However, incentives are
only useful for as long as they are in effect.6,19
For a listing of incentive ideas see page 89.

8. Program Intensity
Plan for several personal contacts. Programs tend to have more success with a higher number of
contacts over a longer period of time (i.e., at least two months).5,13,16,18,20

9. Individual versus Group Approach

Use individual or group approaches as both formats have proven effective.13
10. Communication Strategy
Determine the most effective way to communicate with your employees (e.g., face-to-face,
telephone, print materials, email, or internet). Research suggests that programs that incorporate
face-to-face contact at least once per month are most effective.18 Some web-based applications
can be used for conducting assessments, providing information, and tracking progress.21
However, individuals that are familiar with technology are more inclined to use it to keep
records.22,23
Incorporate tailored feedback, as it is more effective than general information.9,13,18,20 Ensure
feedback is timely and is provided in a confidential manner.9

11. Social Support

Include family members to increase program effectiveness.6,24 This may be especially important in
the case of healthy eating, as the employee may not be responsible for the majority of household
food shopping and preparation.
People who are supported by friends, family and colleagues are more successful at behaviour
change than those who try to do it alone.9,13,25,26

12. Program Leaders

When using programs that have been developed by health professionals, both health
professionals and/or lay leaders can be effective program leaders.13,27

13. Multi-Component Interventions

Incorporate several health behaviours into your program (e.g., healthy eating and physical
activity) as these tend to be more effective.13

Project Health – Comprehensive Strategies to Promote Healthy Eating – Skill Building 114
Skill Building References
1. Vanderkooy P. Food skills of waterloo region adults.
Region of Waterloo Public Health; 2010.
2. van der Horst K, Brunner TA, Siegrist M. Ready-
meal consumption: Associations with weight status and
cooking skills. Public Health Nutr. 2011;14:239-245.
3. Nanney MS, Johnson S, Elliott M, Haire-Joshu D.
Frequency of eating homegrown produce is associated
with higher intake among parents and their preschool-
aged children in rural Missouri. J Am Diet Assoc.
2007;107:577-584.
4. Van Den Berg AE, Custers MHG. Gardening
promotes neuroendocrine and affective restoration from
stress. Journal of health Psychology. 2011;16:3-11.
5. Lally P, Van Jaarsveld CHM, Potts HWW, Wardle J.
How habits are formed: Modelling habit formation in
the real world. Eur J Soc Psychol. 2010;40:998-1009.
6. Archer WR, Batan MC, Buchanan LR, et al.
Promising practices for the prevention and control of
obesity in the worksite. Am J Health Promot.
2011;25:e12-26.
7. Linnan LA, Sorensen G, Colditz G, Klar DN,
Emmons KM. Using theory to understand the multiple
determinants of low participation in worksite health
promotion programs. Health Educ Behav. 2001;28:591-
607.
8. Heshka S, Anderson JW, Atkinson RL, et al. Weight
loss with self-help compared with a structured
commercial program: A randomized trial. JAMA.
2003;289:1792-1798.
9. Sparling PB. Worksite health promotion: Principles,
resources, and challenges. Prev Chronic Dis.
2010;7:A25.
10. Janer G, Sala M, Kogevinas M. Health promotion
trials at worksites and risk factors for cancer. Scand J
Work Environ Health. 2002;28:141-157.
11. World Health Organization. Healthy workplaces: A
model for action for employers, workers, policy-makers
and practitioners. 2010.
12. Steyn NP, Parker W, Lambert EV, Mchiza Z.
Nutrition interventions in the workplace: Evidence of
best practice. South African Journal of Clinical
Nutrition. 2009;22:111-117.
13. Greaves CJ, Sheppard KE, Abraham C, et al.
Systematic review of reviews of intervention
components associated with increased effectiveness in
dietary and physical activity interventions. BMC Public
Health. 2011;11:119.
14. World Health Organization, World Economic
Forum. Preventing noncommunicable diseases in the
workplace through diet and physical activity:
WHO/World Economic Forum Report of a Joint Event.
2008.
Project Health – Comprehensive Strategies to Promote Healthy Eating – Skill Building
15. Burke LE, Wang J, Sevick MA. Self-monitoring in
weight loss: A systematic review of the literature. J Am
Diet Assoc. 2011;111:92-102.
16. Burke LE, Steenkiste A, Music E, Styn MA. A
descriptive study of past experiences with weight-loss
treatment. JADA. 2008;108:640-647.
17. Wing RR, Crane MM, Thomas JG, Kumar R,
Weinberg B. Improving weight loss outcomes of
community interventions by incorporating behavioral
strategies. Am J Public Health. 2010;100:2513-2519.
18. Benedict MA, Arterburn D. Worksite-based weight
loss programs: A systematic review of recent literature.
Am J Health Promot. 2008;22:408-416.
19. Levy RL, Finch EA, Crowell MD, Talley NJ,
Jeffery RW. Behavioral intervention for the treatment
of obesity: Strategies and effectiveness data. Am J
Gastroenterol. 2007;102:2314-2321.
20. Eakin EG, Lawler SP, Vandelanotte C, Owen N.
Telephone interventions for physical activity and
dietary behavior change: A systematic review. Am J
Prev Med. 2007;32:419-434.
21. Norman GJ, Zabinski MF, Adams MA, Rosenberg
DE, Yaroch AL, Atienza AA. A review of eHealth
interventions for physical activity and dietary behavior
change. Am J Prev Med. 2007;33:336-345.
22. Maruyama C, Kimura M, Okumura H, Hayashi K,
Arao T. Effect of a worksite-based intervention
program on metabolic parameters in middle-aged male
white-collar workers: A randomized controlled trial.
Prev Med. 2010;51:11-17.
23. Morgan PJ, Collins CE, Plotnikoff RC, et al.
Efficacy of a workplace-based weight loss program for
overweight male shift workers: The workplace POWER
(preventing obesity without eating like a rabbit)
randomized controlled trial. Prev Med. 2011;52:317-
325.
24. Quintiliani L, Poulsen S, Sorensen G. Healthy
eating strategies in the workplace. International
Journal of Workplace Health Management.
2010;3:182-196.
25. Rigsby A, Gropper DM, Gropper SS. Success of
women in a worksite weight loss program: Does being
part of a group help? Eat Behav. 2009;10:128-130.
26. Shay LE. A concept analysis: Adherence and
weight loss. Nurs Forum. 2008;43:42-52.
27. Boyko J, McRae L, Robeson P. Worksite nutrition
and physical activity interventions for controlling
employee overweight and obesity: Evidence and
implications for public health Hamilton, ON: McMaster
University.: health-evidence.ca; 2010.
115
 Supportive Environments
Supportive Environments
A supportive environment includes ongoing, sustainable activities that make it
easier to make healthy choices and participate in healthy behaviours. In a
supportive environment, employees do not have to actively resist an
environment full of less healthy choices in order to follow a healthy lifestyle.

Definitions of Success
 See each individual section under supportive environment for a list of
applicable success indicators

Project Health – Comprehensive Strategies for Promoting Healthy Eating 53

Environmental interventions place less responsibility on individuals and do not require employees
to self-select into programs – a major barrier in reaching many employees. Workplaces can make
an impact on eating behaviours by improving the environmental factors that influence eating in the
workplace.
This section outlines the steps to creating a supportive healthy eating environment in your
workplace. Example strategies include:
 Improving the nutritional quality of food offered in cafeterias, cafes, vending machines,
workplaces stores, during meetings and celebrations
 Encouraging managers and employees to avoid using food as a reward or for fundraising
purposes
 Creating on-site farmers’ market or workplace garden
 Offering nutritional counseling benefits or services for employees who have nutrition related
health conditions
 Sourcing food from local and sustainable food producers
 Ensuring that food offered to employees has been handled in a safe manner
 Providing adequate time and space to eat and facilities to allow employees to store and
prepare their own food
 Fostering a supportive workplace culture to minimize stress and encourage positive employee
interactions
 Access to Registered Dietitians
Access to Registered Dietitians
Workplaces can offer several services that can help individuals eat healthier.
These include services provided by a Registered Dietitian on-site, through an
employee assistance program (EAP) or through health benefits

Definitions of Success
 High-risk employees have access to the services of a Registered Dietitian through
health benefits, on-site services or through EAP programs

Registered Dietitian Services

Dietitians offer services such as nutrition assessments, diet modification and counselling to help
individuals achieve nutrition goals.1 Currently, there is good evidence that intensive dietitian
counselling for adults with certain conditions can improve nutrition related risks, especially when
combined with physical activity.1,2 However, nutrition counselling is not as effective at promoting
healthy eating among healthy adults without identified nutrition risks.1

Nutrition therapy provided by Registered Dietitians has been proven to improve health risks for the
following conditions:1
high cholesterol (i.e., LDL, total cholesterol)

high blood pressure

diabetes management
pre-diabetes (high blood glucose)
kidney disease
weight management
Counselling services provided by Registered Dietitians in Canada are not covered by all employee
health benefit packages and employee assistance programs. Workplaces may want to consider the
addition of dietitian consulting services to workplace health benefits for high-risk employees.
Current evidence suggests that dietitian interventions may improve health outcomes and be
delivered at a reasonable cost. Many studies do not cover cost-effectiveness and therefore there is
limited evidence for long-term economic benefits.1

Tools: REGISTERED DIETITIANS

Registered Dietitians are regulated health professionals uniquely trained to counsel
individuals on diet, food and nutrition.1 For a list of Registered Dietitians in Waterloo
Region see: http://projecthealth.ca/files/RegisteredDietitians.pdf

Project Health - Comprehensive Strategies to Promote Healthy Eating 119

Healthy Eating Interventions References
1. Royall D. A systematic review of the effectiveness of
nutrition counselling interventions by dietitians in
outpatient and in workplace settings. Dietitians of
Canada; 2009.
2. Anderson LM, Quinn TA, Glanz K, et al. The
effectiveness of worksite nutrition and physical activity
interventions for controlling employee overweight and
obesity: A systematic review. Am J Prev Med.
2009;37:340-357.
 Cafeterias
Cafeterias
Many working adults find it difficult to make time for healthy eating. The workplace
cafeteria is an excellent place to promote healthy eating habits by ensuring the food
provided to employees is nutritious.

There are several environmental factors that influence employee food choices such as
the availability of healthy and less healthy choices, the taste and price of available
foods, portion sizes, marketing and advertising, and the convenience of available
options. Often attempts to promote healthier items are unsuccessful because only one
aspect is addressed such as making healthier foods available without considering
placement, pricing, promotion, convenience or taste. Ideally, all of these aspects will be
addressed to promote healthy eating in your workplace.

Definitions of Success
 At least 80 per cent of foods come from the “Maximum Nutritional Value”
and “Sell/Offer Most” categories*
 Foods from the “Sell/Offer Less” categories are limited to 20 per cent or less*
 Foods from the “Not Recommended” category are not offered*
 Meals include three of the four Food Groups from Canada’s Food Guide**
 Price, placement and promotion and used to market healthier foods

 Foods and beverages offered are culturally acceptable

 Eating area is clean and pleasant with adequate seating
 Local and/or organic food is used whenever possible
 Food service employees have food safety training
 Food service operations are as energy efficient as possible
*See the Nutrition Standards in Appendix A for a description of food categories.
**Please visit http://healthcanada.gc.ca/foodguide for a copy of Canada’s Food Guide
1.0 Needs Assessment
A cafeteria needs assessment can take many forms, including surveys or focus groups with
employees to identify their needs and interests. The assessment should also include information
from cafeteria managers and personnel about the operations of the cafeteria and suggestions they
have for improvements.

Assess the current cafeteria operations and identify both positive and negative aspects of the
service in terms of promoting healthy eating.
Identify training needs, as skills vary widely among food service personnel (e.g., training on food
preparation techniques, food presentation, marketing and customer service).
For more information on assessing needs in your workplace see page 76 in the ‘Getting Started’
section.

2.0 Evaluation Indicators

Tracking indicators will help to determine if there have been positive changes in the promotion of
healthy foods in the cafeteria. Identify relevant indicators in your cafeteria and monitor them before,
during and after your interventions.
Some possible indicators include:
The percentage of food that is available for sale from the “Maximum Nutritional Value”,
“Sell/Offer Most”, “Sell/Offer Less” and “Not Recommended” categories
Cafeteria sales (e.g., sales of healthy meal specials, salads etc. at the point of purchase
through cash register sales or number of portions sold.)
If meals include three of the four Food Groups from Canada’s Food Guide
Healthier foods are promoted, priced competitively, and placed in convenient locations
If foods and beverages offered are acceptable to various cultures in the workplace

The number of food service employees that have food safety training
Food safety reports from Public Health Inspectors
Monitoring to ensure employees have a clean, pleasant eating area

The percentage of local and/or organic foods that are purchased for the cafeteria
The environmental impacts of food service operations (e.g., waste reduction, energy use)
Employee satisfaction with cafeteria food services (e.g., taste, price, quality, convenience)

Note barriers, challenges and successes in the implementation process

Any other relevant indicators

Project Health – Comprehensive Strategies to Promote Healthy Eating 122

3.0 Creating a Healthy Cafeteria
3.1 Improve the Nutritional Content of Available Foods
Ensure meals meet Canada’s Food Guide recommendations
Most meals do not follow current Canada’s Food Guide recommendations. In order to promote
healthy eating habits, the food offered in the cafeteria should meet Canada’s Food Guide
recommendations. This can be achieved using the Nutrition Standards in Appendix A. Using a
nutrition standard ensures that foods offered in the cafeteria are: part of Canada’s Food Guide,
higher in nutrients such as vitamins, minerals and fibre, and contain little or no added fat, sugar or
salt.
Workplaces should aim to serve the majority of foods from the “Maximum Nutritional Value” and
“Sell/Offer Most” categories (e.g., 80 per cent of foods offered should come from these categories),
with an emphasis on “Maximum Nutritional Value” foods. Foods from the “Sell/Offer Less” category
should be limited (e.g., to 20 per cent or less). Additionally, workplaces should avoid offering foods
from the “Not Recommended” category.
Assess the foods available in the cafeteria using the Nutrition Standards in Appendix A (use this
information as your baseline data). Then, work with your food service provider to make changes to
the nutritional content of foods offered to employees. The changes can be implemented all at once
or phased in over time.

Success Stories: IMPROVING NUTRITIONAL QUALITY

“Chevron’s food service vendor has a “stealth health” philosophy: it uses quality
ingredients and few highly processed foods to offer menu items that delight rather
than require sacrifice. Instead of seeing a daily “healthy entrée,” employees choose
from an array of appetizing healthful options, such as meatloaf made with whole grains
and low-sodium soups made from scratch.”1
An intervention at a truck stop had positive effects on driver’s food habits by providing
training for food service workers on healthy food preparation techniques.2 As an added
bonus, the food service operator actually saved money using lower-fat cooking
methods.2

Project Health – Comprehensive Strategies to Promote Healthy Eating 123

Ways to help employees meet Canada’s Food Guide recommendations
Plan cafeteria meals so they contain three of the four Food Groups from Canada’s Food
Guide. Ensure that half of the plate is from the Vegetables and Fruit Food Group, one
quarter of the plate is from the Grain Products Food Group and one quarter of the plate is
from the Meat and Alternatives Food Group
Add more vegetables (chopped or pureed) to casseroles, pasta dishes, mixed recipes and
sandwich fillings.3 Serve all specials or meals with salads, raw or cooked vegetables or
whole or canned unsweetened fruit as sides.4 Add vegetable or fruit garnishes to
sandwiches such as grated carrots or slices of fresh fruit3
Reformulate existing food products (i.e., reduce the amount of added fat, salt or sugar
used or add more vegetables to the recipe)5-7 Reduce or remove energy dense ingredients
used in recipes such as cheese, cream, butter, margarine, oils, mayonnaise, salad
dressings, higher fat meats, and sugar. Substitute some high fat ingredients such as beef
with low energy-density ingredients such as mushrooms (e.g., casseroles, stews, chilli,
and pizza)3,7,8 Mix onion, celery, oats and other vegetables in ground meat dishes (e.g.,
meatballs, meatloaf)3
Use low fat cooking methods such as grilling, baking, stir-frying, microwaving, steaming,
roasting, sautéing, toasting and barbequing
Look for the healthiest ingredients. For example, use low-fat mayonnaise in recipes or
low-salt canned products, sauces, breads, etc.
Serve sauces, dressings and gravies in small portions, on the side
Offer smaller servings of grain products such as thin crust on pizzas, small pitas, tortillas,
wraps and breads
Remove less healthy drinks, desserts and sides and replace them with healthier tasty
options (e.g., fruit salads for dessert instead of cake or baked goods)
Sell sliced fruit or vegetables– such as slices of melon or carrot sticks in convenient snack
sizes (e.g. 100 g)3
Serve vegetarian meals more often (e.g., once or twice a week). Get inspiration from
ethnic cuisine (e.g., Asian dishes) that typically focus on vegetables3

Success Story: IMPROVING NUTRITIONAL QUALITY

Railroad operator, Union Pacific Corp, made a request to their cafeteria operator to cut
the fat and calories on every menu item by 10%.9

Project Health – Comprehensive Strategies for Promoting Healthy Eating 124124

3.2 Taste
Taste can be highly subjective and in some cases, labeling a food as ‘healthy’ causes assumptions
of poor taste (e.g., low-fat, light, or foods that mention they contain ‘healthy’ ingredients such as
soy).5, 10-13
When working with populations that are less health oriented, focus on other positive and
enjoyable features of healthy foods such as freshness or locally grown foods
Use appealing descriptive terms in food names, for example, “rich”, “spicy”, “home made”,
“chunky” or “traditional”12

The more often a food is tasted the more it is liked.10 If at first the employees do not like
the new food items, keep trying, as they may eventually be accepted, especially if they
are coupled with well-liked food items
Try offering free samples when introducing new foods in the cafeteria

3.3 Price
Consumers tend to purchase items that they consider to be reasonably priced. Therefore, healthy
foods must be priced competitively (i.e. the same or less than other options).5,10,13-22
Consider increasing the price of less healthy items (if they are available), to subsidize the
price of healthier items such as vegetables and fruit

Success stories: WORKPLACE CAFETERIA PRICING STRATEGIES

Between 7-10% of corporate cafeterias run by food service company Sodexho, use
pricing strategies to encourage healthy eating. These include increasing the price of
fatty foods and using the extra money to subsidize the cost of healthy sandwiches, cut
fruit and salads.9
L.L Bean increased the price of burgers and lowered the price for salads. As a result,
fruit and salad sales doubled while french fry and burger sales fell by half.9
Humana Inc. subsidizes the sale of healthy items so they can be offered at a discount to
employees. When the subsidy was introduced, sales increased by 19 per cent,
completely offsetting the cost of the subsidy.23

Project Health – Comprehensive Strategies to Promote Healthy Eating 125

3.3 Promotion
Marketing can be used to influence employee food choices by offering incentives to eat healthier
foods or by using visual prompts that can nudge employees towards making healthier choices.
Avoid promoting less healthy items, (e.g., “Sell/Offer Less” or “Not Recommended”) such
as “buy 10, get one free muffin”. Instead, use this type of promotion to encourage the
consumption of healthier items
Remove advertisements for foods from the “Sell/Offer Less” or “Not Recommended”
categories

Use point-of-decision prompts such as logos, nutrition labels and messaging (e.g.,
posters, glass-clings, tent cards, etc.) to highlight healthier choices in the cafeteria. See
page 103 for more information on point-of-decision prompts

3.4 Placement
Healthy foods must be as convenient as other choices to encourage consumption.5,14,22,24
Examine the traffic flow of the cafeteria, to ensure that healthy items are the most
convenient to purchase and that they do not take more time and effort to obtain
Typically less healthy foods such as food from the “Not Recommended” category are
placed at the register, which is considered to be an influential location. Replace these with
healthier options. Sales of healthier items can also be increased by placing them at eye
level25
Most consumers will make selections that are visible on the menu, rather than asking for
alternatives.26 Ensure that the healthiest options are highly visible on the menu. Consider
not offering other options on the menu board
Consider making the healthier versions the default options for food, especially if
consumers have the option of asking for a variation if they desire. For example, make pre-
made sandwiches on whole grain bread instead of white. Employees always have the
option of making a special request for white bread instead

Offer employees a salad or steamed vegetables with their entrée and avoid prompting to
make less healthy choices

Project Health – Comprehensive Strategies for Promoting Healthy Eating 126

Healthy Dinner Program
Many working adults find it difficult to manage time constraints related to work making convenient
access to healthy options especially important.27 Forty-one percent of Canadians feel that their life
is so hectic that they find it hard to include healthy food options on a daily basis.28
As a result of time constraints, many people rely on convenience foods (e.g., pre-packaged and
frozen meals) and foods purchased away from home (e.g., fast food, take-out, and restaurant
meals) instead of preparing meals for themselves.27 Other factors such as lack of food skills and
living in a single person household also increase the use of convenience foods and foods eaten
away from home.28-30
Eating foods prepared outside the home have been shown to be lower in nutritional quality
compared to foods prepared at home.31-33 Eating dinner away from home just once per week, has
been related to significantly higher biomarkers for cardiovascular disease as well as an increased
risk for becoming overweight or obese.33
Therefore, some employees may benefit from a healthy meal take-away dinner program.30 A
healthy dinner program allows employees to pre-order dinner from the cafeteria for pick up on their
way home. Meals should meet the criteria for “Maximum Nutritional Value” or “Sell/Offer Most.”
One study examined the effects of a workplace hot meal take-away program and showed that
vegetable and fruit intakes were higher on days that workers ate meals prepared by this service.34
A meal take-away program can also provide extra revenue for your food service operator.

Success Story: MORSELS CAFÉ IN CAMBRIDGE ONTARIO

Morsels Café offers a Dinner Home program, where office workers can take home a
nutritious meal for four. Each day the café offers a take-home dinner consisting of a
meat and starch, while customers have a choice of vegetable or salad to have with their
meal. The portion sizes are based on Canada’s Food Guide and healthy ingredients are
used in each recipe.

Project Health – Comprehensive Strategies to Promote Healthy Eating 127

3.5 Portion Size
Food is being consumed away from home more often, which is associated with increased portion
sizes, leading to an increase in total energy intake.6,10,35-40 People served larger portions eat more
food, as the amount served is an indicator that it is an appropriate amount to consume.25,37,38,41
Food service establishments can positively influence consumer health by serving appropriate
portion sizes.38,42-44
Strategies to Reduce Portion Sizes
Align portion sizes to those recommended in Canada’s Food Guide

If foods categorized as “Sell/Offer Less” or “Not Recommended” are available in your

cafeteria, ensure that the portion sizes are as small as possible
Allow individuals to purchase half-portion sizes on request and price these accordingly (i.e.,
it should cost half as much)
Consumers tend to avoid extremes (i.e. if small, medium and large are offered, most people
choose the medium size).41 Avoid removing the smallest size if it does not sell well (i.e., 250
ml or 8 oz) otherwise it may prompt people to choose even larger portion sizes
Assess the size of serving dishes, glasses and take out containers used in the cafeteria, as
people tend to use these items as consumption guidelines.25 Use smaller dishes and
containers in the cafeteria to reduce portion sizes (i.e., rather than giving smaller portions in
large containers, which may result in customers feeling deprived). For example, serving
plates should be no larger than 23 cm (nine inches) in diameter

Project Health – Comprehensive Strategies for Promoting Healthy Eating 108

3.6 Culturally Appropriate Foods
Waterloo Region is culturally diverse with almost 25 per cent of the population coming from other
countries.45
Individuals from other countries or those who practice certain religions may have special dietary
needs. Workplaces should be considerate of the diverse needs of the workplace population and
make sure that employees have access to foods that are conducive to traditional eating patterns.
Add extra choices when food is offered to employees (e.g., offering soy milk in addition to
cow’s milk or offering vegetarian options). Workplaces may also wish to serve some
ethnic cuisines to increase the variety of foods offered in the cafeteria
Make ingredient lists available upon request
Assess if employees have any special dietary needs during the needs assessment
process. For more information see page 76 of the ‘Getting Started’ section

3.7 Purchasing Local and Organic Foods

Locally produced foods are not necessarily farmed using organic farming methods. You
may want to use both local and organic criteria for food purchasing at your facility
Explore with your food service providers if it is possible to supply a specified percentage
of locally sourced and/or organic food for use in cafeterias, caterings and events

You may not be able to replace all of your current food purchases with local/organic
foods. However, you can augment the foods that you currently purchase with local and/or
organic products
Consider the capacity of current food services staff to process fresh foods. For example if
potatoes currently come peeled and chopped, extra staff time will be needed to use fresh
unprocessed foods
Buy fresh local produce when in season. This may also require some careful menu
planning to ensure that ingredients correspond to seasonal availability. Other items such
as meat, eggs and milk may be purchased locally year round

3.8 Pleasant Eating Area

Provide a clean, quite, bright space that is away from the workspace

Ensure there is adequate seating and a clean surface to place food to allow for
comfortable dining
Avoid conducting business meetings and events in the eating area during meal times to
allow employees to relax during their lunch break
Provide adequate waste, recycling and organics bins and ensure these are kept clean

Project Health – Comprehensive Strategies to Promote Healthy Eating 129

3.9 Preventing Foodborne illness
Foodborne illnesses are caused by ingesting bacteria, viruses, or other parasitic organisms in
contaminated food or water. It is estimated that there are between 11 million and 13 million cases
of food related illness in Canada every year.46
Employers should ensure that food offered to employees is handled appropriately to reduce the
incidence of food bourne illness.

Ways to Reduce the Incidence of Foodborne Illness in Cafeterias

Hand Washing

Educate all food service workers on proper hand washing techniques

Make sure that food service employees have access to proper hand washing facilities and that
sinks are in a convenient location to encourage use
Put up hand washing signs in food service areas to prompt employees to wash their hands

Food Safety Training

Provide food safety training for food service staff. Food service operators with at least one full-
time staff completing food safety training, tend to have better food safety inspection scores
compared to operators with no certified staff members.47 Food safety training is offered at
Conestoga College: http://www.conestogac.on.ca

Management Responsibilities

Monitor employees to make sure they are washing their hands appropriately and using safe
food handling techniques
Encourage employees to stay home when they are sick to prevent the transmission of illness
to customers and other employees. Individuals with symptoms such as vomiting, diarrhea,
fever, or sore throat should not have contact with any food or food preparation areas, as they
may spread illnesses48
Set up a daily schedule for cleaning equipment, appliances and surfaces and regularly
checking equipment such as refrigerators, freezers and dishwashers to make sure they are
functioning properly

Tools: FOOD SAFETY

For more information on food safety visit:
http://chd.region.waterloo.on.ca/en/healthyLivingHealthProtection/foodsafetyinspectionr
esults.asp

Project Health – Comprehensive Strategies for Promoting Healthy Eating 130

3.10 Environmentally Friendly Approaches to Food Services
Any reduction in energy use or food waste is a positive step to becoming
environmentally friendly. Here are some suggestions to help your cafeteria to “go
green”:

Equipment and Facilities

Whenever possible purchase Energy Star® appliances.49 These will also give off less heat
which may also reduce air conditioning costs49
Use energy efficient light bulbs where applicable and turn off lights when they are not needed49
Turn off equipment when it is not in use49
Use full loads in oven and dishwashers whenever possible49
Ensure equipment is routinely maintained to keep it running properly49

Waste Management
Look for concentrated products that require less packaging49
Use reusable plates, cups, glasses and cutlery instead of disposables
Divide waste into organics, recyclables, and waste
Request that suppliers offer products that have less packaging49
Buy in bulk when possible to reduce packaging or use reusable bins to transport items (e.g.,
milk crates)49

Non-food Products
Use less toxic cleaners and soaps when available. Look for products that are biodegradable49
Reduce the amount of paper used by reducing printing or using double sided printing49 If this is
not possible use recycled paper products49

Food Products
Purchase products that are grown, locally – to reduce transportation, and grown sustainably or
organically to reduce pesticide use and to protect the environment49
Use seasonal menus to incorporate produce that is available locally49
Reduce the frequency of offering animal-based protein foods and offer smaller portion sizes.
This is not only advantageous from a nutritional perspective, but reduces greenhouse gas
emissions.49 For example, it requires 40 kcal of fossil fuel based energy to produce 1 kcal of
beef, 14 kcal to produce 1 kcal of pork and 10 kcal to produce 1 kcal of poultry.49 However, it
only requires 2.2 kcal of energy to produce 1 kcal of plant proteins.49 Offer more vegetarian,
poultry, pork and fish choices and reduce beef choices overall to reduce carbon emissions49
Use fish products that are environmentally sustainable.49 For more information see the
resource: A guide to eating fish for women, children and families:
http://chd.region.waterloo.on.ca/en/healthyLivingHealthProtection/resources/FishBooklet.pdf

Project Health – Comprehensive Strategies to Promote Healthy Eating 131

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 Celebrations
Celebrations
Often celebrations are a time to share food with friends, family and colleagues.
Celebrations can be an important part acknowledging workplace successes and
important life milestones. In this section you will find some suggestions to
incorporate healthy eating into workplace celebrations.

Definitions of Success
 Workplace celebrations emphasize foods from the “Maximum Nutritional Value”
and “Sell/Offer Most” categories*
 Foods from the “Not Recommended” category are limited, or excluded from
celebrations. Celebrations that include foods from the “Not Recommended”
category are limited to a few occasions throughout the year (e.g., once per
month)*
 Celebrations incorporate non-food activities
*See the Nutrition Standards in Appendix A for a description of food categories.
1.0 Needs Assessment
Take a look at current workplace celebration activities. Note how often they occur and what types
of foods are being served during celebrations. Determine if celebrations support your healthy
eating strategy and consider improvements to current activities.
Ask employees if they are willing to make changes to current celebration events to make them
healthier and what supports would be helpful to them. This will help you determine employee
needs and interests. It will also help to create employee and management support for changes
your committee may recommend.

2.0 Evaluation Indicators

Possible indicators include tracking:
How frequently do workplace celebrations occur?
What types of celebrations are occurring that involve food?
How often do celebrations/events occur without food?
If food is served, are healthy foods available? Are less healthy foods available?
How much food is served?
What do employees expect during celebrations?

3.0 Creating Healthier Celebrations

Food Served During Celebrations

Emphasize foods from the “Maximum Nutritional Value” and “Sell/Offer Most” categories during
celebrations. Try to limit the number of occasions foods from the “Not Recommended” category are
offered (e.g., once per month).
Consider the amount of food that is typically offered during celebrations. If portion sizes are large,
serve smaller amounts. Also try to scale down the number of items offered to one or two items if
celebrations occur outside of traditional meal times (i.e., they are snacks).

Frequency of Celebrations
If workplace celebrations occur frequently, and foods in the “Not Recommended” category are
commonly offered, this practice may begin to compromise diet quality. Consider reducing the
frequency of celebrations. For example,

Instead of celebrating each individual staff members’ birthday, you may wish to have quarterly
celebrations (e.g., Spring birthday celebrations that occur from April to June)
Ask staff if it is important to them to celebrate birthdays at work, or if they feel that personal
celebrations will suffice

Project Health – Comprehensive Strategies to Promote Healthy Eating 136

Celebrating Without Food

Employees may appreciate non-food related celebrations; ask if there are other types of rewards or
celebratory activities that could take place to mark occasions without food.
Have a staff bulletin board where notices and pictures can be attached
Acknowledge milestones with non-food items such as cards, flowers, group gifts, etc.

Have fun theme days incorporating costumes or fun activities (e.g., golf putting contest,
karaoke etc.), physical activity events (e.g., an afternoon of beach volley-ball or golf)
Take a group break together to enjoy a walk, afternoon tea, etc.

Organize an afternoon retreat (e.g., bowling, attending a movie, volunteering for a

community cause during the holidays, etc.

The Bottom Line

There are many ways for workplaces to celebrate. Be creative and engage staff in finding
alternative options to food based celebrations.

Project Health – Comprehensive Strategies to Promote Healthy Eating 137

 Common Areas
Common Areas
In many workplaces, employees bring in ‘treats’ for co-workers to share.
Leftover food from meetings and events is often placed in common areas for
people to consume. Additionally, fundraisers based on selling “Foods to Limit”
(e.g., cakes, pastries, candies, chocolate, cookies, granola bars, ice cream,
doughnuts, muffins, french fries, potato chips, salty snacks, and sweetened hot
and cold beverages) are typically placed in common areas for people to
purchase.1 Candy dishes on desks are also an example of food offered in
common areas.
“Corporate break rooms need not become repositories for unused Halloween
candy and holiday leftovers”.2

Definitions of Success
 Common areas in workspaces are free from food
 Employees have been educated on the influence of food in the environment and
have accepted the decision to reduce and/or eliminate food in common areas
1.0 Needs Assessment

To determine if this is a priority area for your workplace, ask employee about their personal barriers
to healthy eating. If employees indicate that they have difficulty resisting tempting food when
present, it may be worthwhile to address this issue.

2.0 Evaluation Indicators

You will know if efforts have been effective if there is less food left in common areas. This can be
periodically monitored throughout the year to see if behaviour changes have been maintained.

3.0 Addressing Food in Common Areas

Having the occasional less-than-healthy snack is not going to make or break the health of an
employee. However, the calorie margin for ‘treats’ is very small, with experts estimating that it only
takes 50 to 150 extra calories per day to cause an individual to become obese.3-6 This is roughly
the equivalent of one cookie, 250 ml of soda, 10 jellybeans, or 5 chocolate covered almonds.7
Therefore, daily consumption of just a few extra calories is enough to cause employees to develop
chronic health problems over time. Additionally, heart health experts are warning that consuming
even relatively small amounts of sugar may increase blood pressure and therefore consumption
should be limited to 100 to 150 kcal per day.8

Employees may enjoy having access to food in common areas or dread the thought of having to
avoid eating when tempting foods are available. However, it is possible that employees may resent
being told that they are not permitted to bring ‘treats’ to work. Many people believe that each
individual’s self-restraint is strong enough to resist temptation, and this is the premise for having
these foods available, (i.e., “the people who do not want to consume can simply make that
‘choice’”).9
However, the food that surrounds individuals is a predictor of what they will consume. Evidence
suggests that people who live in homes with many high-fat and high-sugar foods eat more of these
foods.9 Foods high in fat, sugar or white flour act in the brain a similar way to drugs of addiction
which makes them very tempting and difficult for people to resist.10-17

Food for Thought: OUT OF SIGHT

In one experiment, office workers ate 3.1 more chocolates when they were placed in
transparent jars on their desks compared to when the chocolates were in opaque jars.6
The bottom line: Seeing food causes eating.

Project Health – Comprehensive Strategies to Promote Healthy Eating 140

The presence of less healthy foods can be extremely distracting for workers, and there is evidence
that individuals have difficulty doing more than one task requiring self-control at a time.18-21 This
creates a scenario where people exposed to tempting foods in their work areas will either eat the
‘treat’ and get on with their work (potentially increasing diet related health risks) or try to resist to
maintain their health, resulting in distracted and less productive employees. One experiment
showed that people trying to do a math quiz while having to resist cookies were less than half as
productive as people who did not have to resist cookies.6 Additionally, there is evidence to suggest
that people who resist initially, eventually have a breakdown in self-control at a later point in the
day, so employees may feel deprived from resisting ‘treats’ at work and give-in later in the day
when they get home.18 Having regular access to food in the work area may also create a habit of
rewarding oneself to cope with boredom or stress in the workplace.22,23

Bringing in food to share with others may be a profoundly personal issue for some employees and
addressing this issue requires a ‘cultural shift’ within the workplace. Be considerate of employee’s
feelings and beliefs when addressing this particular concern. To diminish resistance to the
suggestion of minimizing or eliminating food in common areas, have a discussion with employees
to gauge their readiness to make changes. If employees are resistant to the idea, they may benefit
from education on how the food environment impacts individual food choices.24-26 For more
information, see the ‘Healthy Eating Business Case for Employers’ available from the Project
Health website under ‘Resources for Employers’ http://www.projecthealth.ca.
If employees are agreeable to the idea of minimizing or eliminating food in common areas, it may
be adequate to have an understanding among employees that this is the acceptable practice. In
this case, there is no responsibility for ensuring that employees stick to the agreement, however, it
may be the most acceptable solution among the employees.
Policy
If the workplace feels strongly that food in common areas is unacceptable, a policy could be
considered. For more information, see the section on policy development. Example policies are
available on page 192.
Common Areas References
1. Health Canada. Eating Well with Canada's Food
Guide: A Resource for Educators and Communicators.
Ottawa: Health Canada; 2007.
2. Heinen L, Darling H. Addressing obesity in the
workplace: The role of employers. The Milbank
Quarterly. 2009;87:101-122.
3. Hill JO, Peters JC, Catenacci VA, Wyatt HR.
International strategies to address obesity. Obes Rev.
2008;9:41-47.
4. Hill JO. Can a small-changes approach help address
the obesity epidemic? A report of the Joint Task Force
of the American Society for Nutrition Institute of Food
Technologists, and International Food Information
Council. Am J Clin Nutr. 2009;89:477-484.
5. Hill JO, Peters JC, Wyatt HR. Using the energy gap
to address obesity: A commentary. J Am Diet Assoc.
2009;109:1848-1853.
6. Cohen D, Farley TA. Eating as an automatic
behavior. Prev Chronic Dis. 2008;5:A23.
7. Health Canada. Nutrient value of some common
foods. Ottawa, Ontario: Published by authority of the
Minister of Health.; 2008.
8. Johnson RK, Appel LJ, Brands M, et al. Dietary
sugars intake and cardiovascular health: A scientific
statement from the American Heart Association.
Circulation. 2009;120:1011-1020.
9. Nordgren LF, van Harreveld F, van der Pligt J. The
restraint bias: How the illusion of self-restraint
promotes impulsive behavior. Psychol Sci.
2009;20:1523-1528.
10. Stice E, Spoor S, Ng J, Zald DH. Relation of
obesity to consummatory and anticipatory food reward.
Physiol Behav. 2009;97:551-560.
11. Stice E, Yokum S, Blum K, Bohon C. Weight gain
is associated with reduced striatal response to palatable
food. J Neurosci. 2010;30:13105-13109.
12. Liu Y, von Deneen KM, Kobeissy FH, Gold MS.
Food addiction and obesity: Evidence from bench to
bedside. J Psychoactive Drugs. 2010;42:133-145.
13. Mahapatra A. Overeating, obesity and dopamine
receptors. ACS Chemical Neuroscience. 2010;1:396-
397.
Project Health – Comprehensive Strategies to Promote Healthy Eating
14. Avena NM, Rada P, Hoebel BG. Sugar and fat
bingeing have notable differences in addictive-like
behavior. J Nutr. 2009;139:623-628.
15. Ifland JR, Preuss HG, Marcus MT, et al. Refined
food addiction: A classic substance use disorder. Med
Hypotheses. 2009;72:518-526.
16. Lutter M, Nestler EJ. Homeostatic and hedonic
signals interact in the regulation of food intake. J Nutr.
2009;139:629-632.
17. Volkow ND, Wise RA. How can drug addiction
help us understand obesity? Nat Neurosci. 2005;8:555-
560.
18. Shmueli D, Prochaska JJ. Resisting tempting foods
and smoking behavior: Implications from a self-control
theory perspective. Health Psychol. 2009;28:300-306.
19. Gailliot MT, Baumeister RF, DeWall CN, et al.
Self-control relies on glucose as a limited energy
source: Willpower is more than a metaphor. J Pers Soc
Psychol. 2007;92:325-336.
20. Gailliot MT, Baumeister RF. The physiology of
willpower: Linking blood glucose to self-control. Pers
Soc Psychol Rev. 2007;11:303-327.
21. Muraven M, Baumeister RF. Self-regulation and
depletion of limited resources: Does self-control
resemble a muscle? Psychol Bull. 2000;126:247-259.
22. Devine CM, Nelson JA, Chin N, Dozier A,
Fernandez ID. "Pizza is cheaper than salad": Assessing
workers' views for an environmental food intervention.
Obesity (Silver Spring). 2007;15 Suppl 1:57S-68S.
23. Macht M. How emotions affect eating: A five-way
model. Appetite. 2008;50:1-11.
24. O'Brien KS, Puhl RM, Latner JD, Mir AS, Hunter
JA. Reducing anti-fat prejudice in preservice health
students: A randomized trial. Obesity (Silver Spring).
2010;18:2138-2144.
25. Alvaro C, Jackson LA, Kirk S, et al. Moving
governmental policies beyond a focus on individual
lifestyle: Some insights from complexity and critical
theories. Health Promot Int. 2010
26. Barry CL, Brescoll VL, Brownell KD, Schlesinger
M. Obesity metaphors: How beliefs about the causes of
obesity affect support for public policy. Milbank Q.
2009;87:7-47.
142
 Facilities
Facilities
The physical set up of your workplace can influence employee eating habits. Employees
who bring their own lunches tend to eat healthier diets than individuals who purchase
food away from home.1

Definitions of Success
 Employees have access to a clean, attractive eating area
 There is enough space for employees to sit and enjoy their lunch
 Employees have access to a kitchenette where they can store and heat food

1.0 Needs Assessment

During your needs assessment, determine if there are any barriers to healthy eating that occur as a
result of the physical set-up of the workplace. For example, do employees need a refrigerator to
store lunches? Does the building electrical system prevent the use of toasters, kettles, etc.? Do
employees have a clean, attractive area to eat that is away from their desks?

2.0 Evaluation Indicators

Some possible indicators include:

Ask employees what they like and don’t like about current workplace facilities
Record process indicators about what worked, what didn’t and lessons learned

3.0 Creating Supportive Workplace Facilities

Kitchenette
Provide a kitchenette that includes a sink so employees can rinse food and wash containers,
plates, glasses, etc. The kitchenette may also include a refrigerator to store snacks, lunches and
beverages. A microwave and/or toaster oven is also essential to facilitate employees preparing
their own lunches. Consider adding a cold water dispenser, water fountain and/or a water and ice
dispenser to promote water consumption. Adding a hot water dispenser can also provide a way for
employees to make their own hot water, coffee or tea, without the use of a kettle. Implement a
regular cleaning schedule for the kitchenette, microwave and refrigerator.

Project Health - Comprehensive Strategies to Promote Healthy Eating 143

Eating Area
An attractive eating area encourages employees to take a break from work and enjoy their meals.
To create an attractive eating area:
Provide a clean, quiet, bright space that is (ideally) away from the work space
Ensure there is adequate seating and a surface to place food in the eating area to allow
for comfortable dining
Avoid conducting business meetings and events in this area during meal times to allow
employees to relax during their lunch break
Provide enough waste, recycle and organic bins, which should be emptied daily or more
often if required
Outdoor Facilities
Consider adding an outdoor eating facility such as picnic tables for use during warmer
months. If possible, place this eating area in a shady location.
Ensure there are adequate bins for garbage, food waste and recyclables. These should
be emptied regularly and should be pest proof.

Facilities References
1. McGuire M. (2011). Todd J.E., Mancino L., Lin B-H. The Impact of Food Away from Home on Adult Diet Quality. ERR-90,
U.S. Department of Agriculture, Econ. Res. Serv., February 2010. Adv Nutr;2:442-443.

Project Health - Comprehensive Strategies to Promote Healthy Eating 144

 Meetings and Events
Meetings and Events
Workplace meetings and events offer a great opportunity to demonstrate your
commitment to employee health and well-being by incorporating healthy
eating and active living into workplace events.

Definitions of Success
 Food is not served during meetings when not required

 When offered, foods and beverages emphasize the “Maximum Nutritional Value”
foods. Foods that are “Not Recommended” are not offered to employees during
meetings*
 Special dietary needs have been accommodated
 Locally produced food is offered whenever possible
 Safe food handling techniques are used when offering food
 Employees have facilities to wash their hands before food is served
*See the Nutrition Standards in Appendix A for a description of the nutrition categories
1.0 Needs Assessment
Conduct an environmental scan to determine when and how food is ordered for meetings.
Determine what types of foods are served during meetings (i.e., how many foods of “Minimal
Nutritional Value” are offered to employees?). Are portion sizes consistent with recommendations
in Canada’s Food Guide? Are foods acceptable to various cultures in the workplace? You may also
want to determine the percentage of locally produced food that is currently served and determine if
you can increase the amount of locally produced food that you purchase for meetings and events.

Conduct focus groups with individuals who are responsible for purchasing and ordering foods for
meetings and events, to find out how it is done and if any changes can be made using a similar
process (e.g., if changes are too difficult they will not be sustained).

2.0 Evaluation Indicators

Tracking indicators before, during and after your interventions will help to determine if positive
changes have been made. Identify relevant indicators for your workplace, some possible indicators
include:

Improvements in the nutritional quality of foods served during meetings and events
Decreases in the number of occasions food is offered
The percentage of food served that is locally produced

Changes in the amount of money spent on foods for meetings and events
Ensuring that special dietary needs are being accommodated whenever possible
Doing spot checks to ensure that food is handled in a safe manner (e.g., perishable food
not left sitting out for more than two hours, tongs for serving, hand washing facilities are
available, etc.)
Any barriers, challenges and successes in the implementation process
Any other relevant indicators

Project Health – Comprehensive Strategies to Promote Healthy Eating 146

3.0 Creating Healthier Meetings
3.1 Determining When Meetings or Events Require Food
The first question to ask before planning for food at workplace events is: does this meeting or event
require food?
Often we offer food because we want people to attend or participate in workplace functions;
however, if food is offered to employees above and beyond what they normally consume in a
workday, it may contribute to excess calorie consumption.1,2 Food presented during a meeting may
also make it more difficult for employees to concentrate on work related tasks.3 It may also be
difficult for employees to follow a healthy diet if they are being offered less healthy choices during
work functions.
Consider not offering food if a meeting is occurring mid-morning or mid-afternoon. However, you
may want to serve tap water or other beverages such as coffee and tea during meetings.

Project Health – Comprehensive Strategies to Promote Healthy Eating 147

3.2 Foods to Serve
If food is appropriate to serve at your meeting, carefully consider the nutritional quality and safety
of the food that is served.
Aim to serve 80 per cent of the food options from the “Maximum Nutritional Value” and “ Sell/Offer
Most” and categories, while minimizing foods from the “Sell/Offer Less” category to 20 per cent.
Avoid serving foods from the “Not Recommended” category. (See Appendix A)
Meals should contain three of the four Food Groups from Canada’s Food Guide, while snacks
should contain two of the four Food Groups. Always offer a vegetable or fruit choice when food is
served. Also, order a vegetarian option when ordering entrees.
If you are ordering pizza for your event, order a healthier version by requesting thin, whole grain
crust, less cheese (or part-skim cheese with 20% M.F. or less), lean meat such as ham or chicken,
vegetable toppings and low sodium pizza sauce. Also order a salad or veggie sticks with low fat
dressing on the side to accompany the pizza.

Project Health – Comprehensive Strategies to Promote Healthy Eating 142

3.3 Special Dietary Needs
Give attendees at events an opportunity to specify if they have special dietary needs when they are
registering for events (e.g., medical, allergies, religious, cultural) so that their needs can be
accommodated.
Keep a list of staff food allergies or other special dietary needs so that food provided during
meetings is appropriate for all staff.
The most common food allergies include: peanuts, tree nuts (almonds, Brazil nuts, cashews,
hazelnuts, macadamia nuts, pecans, pine nuts, pistachio nuts, and walnuts), sesame seeds, milk,
eggs, fish (including shellfish and crustaceans), soy, wheat and sulphites.4
The reaction to food allergies can be serious and even fatal. If you have a staff member or
attendee with a serious food allergy, ensure that you do not serve food that contains the allergen
and that food served has not come in contact with the allergen. For more information on food
allergies see Health Canada: http://www.hc-sc.gc.ca/fn-an/securit/allerg/index-eng.php.

3.4 Food Safety

Prevent foodborne illness at your event by:
Ensuring your food service provider has a good history of compliance with food handling
requirements. Check the record of food service providers in Waterloo Region on the
Public Health webpage: http://chd.region.waterloo.on.ca/en/index.asp
Making sure food does not sit out at room temperature for longer than two hours. Prevent
foodborne illness in high risk foods such as meats, fish, poultry and eggs, salads
containing mayonnaise or meats, fish, poultry or eggs, milk and milk products, sandwich
meats, soups, chili and stews by keeping these foods at the appropriate temperature. Hot
foods should be kept at a minimum temperature of 60˚C (140˚F) (e.g., by using a chafing
dish), and cold foods should be kept at 4˚C (40˚C) (e.g., by keeping items on ice)
Handling food with utensils and providing enough utensils for each food item
Planning appropriate disposal for leftover food, plates, cutlery etc.; including garbage,
recycling and organics bins
Providing food handlers and attendees with adequate hand washing facilities
Not allowing any employees with communicable illnesses (e.g., with symptoms such as
sore throat, diarrhea or vomiting) to prepare or serve food
For more information see the Food Safety webpage from the Region of Waterloo:
http://chd.region.waterloo.on.ca/en/index.asp

Project Health – Comprehensive Strategies to Promote Healthy Eating 149

3.5 Workplace Barbeques
Here are some healthy eating ideas for the barbeque:5
Veggie Kabobs – Assemble cherry tomatoes, diced orange and green peppers,
mushrooms, and red onions on a skewer. If using wooden skewers, soak them in cold water
first for about 30 minutes to prevent them from burning. Grill these veggie kabobs for four to
five minutes on medium heat
Corn on the cob – Peel away the husks. Place the corn directly on the grill on high heat
for about 10 minutes, frequently rotating the cobs to prevent them from charring. Grill until
the corn is slightly browned and tender
Grilled fruit – Try fresh, ripe peaches, mangos, pears, nectarines, and plantains. Lightly
baste fruit slices with a non-stick vegetable spray. Place large pieces directly on the grill and
smaller pieces on skewers or a grill pan. Grill just until the fruit gets tender and the grill
marks show
Fish – Firm fleshed fish such as salmon, tilapia or halibut are great on the grill. Sprinkle
some herbs over a fish fillet, and then wrap them loosely in foil paper to create a packet or
tent. Place them directly on the grill for about ten minutes. The steam trapped in the foil
packet essentially cooks the fish and the flavour locks in. If you prefer barbequing fish
directly on the grill, place it skin-side up. The skin helps to hold the fish together
Stir-grilled veggies – This is a cross between stir-frying and grilling. Stir-fry veggies in a
grilling basket on the BBQ. Try stir-grilling shrimp and scallops too
Tofu – Buy extra firm tofu and soak it in your favourite marinade overnight. Cook on a
lightly greased grill for about four or five minutes a side, or until browned or threaded on
your veggie kabobs
Grilled Panini sandwiches – Cut Panini buns in half lengthwise, and place them face
down on the grill until toasted. Stuff the bun with grilled zucchini, eggplant, red pepper and
provolone cheese. For a meat-lovers’ version, add grilled chicken breast
Healthy barbeque information provided by EatRight Ontario http://www.eatrightontario.ca/.

Beverages
Serve water, sparkling water and small servings of 100% fruit juice (i.e. 125 to 250 ml)

Food Safety for Barbequing

Ensure that you follow safe food handling techniques while barbequing to prevent foodborne
illness. http://www.hc-sc.gc.ca/fn-an/securit/kitchen-cuisine/barbecue-eng.php

Project Health – Comprehensive Strategies to Promote Healthy Eating 150

3.6 Green meetings
Workplace meetings and events can generate a large amount of waste or use unnecessary resources. Take
steps to make your meeting more eco-friendly:

Have attendees RVSP so that you know how much food to order. This will eliminate food waste
Plan meals using portion size recommendation in Canada’s Food Guide. Ensure that meals have at least
three of the four Food Groups. Half the plate should consist of vegetables, one quarter grain products and one
quarter meat or meat alternative. Consider offering a fruit based dessert
Request that the caterer offer seasonal food that is locally produced. (Locally produced organic or sustainably
produced food is even more environmentally friendly)
Serve water, juice and coffee in jugs. Provide reusable mugs or glasses, and/or ask attendees to bring their
own mugs. If you are using a caterer, make a request for reusable dishes, trays, glasses, mugs and linens. If
this is not an option, ask for items that are recyclable or compostable such as paper plates, napkins or corn
based utensils
Ensure you have adequate bins for organics and recyclables. Mark the bins clearly so attendees know what
items go in each bin
Use bulk condiments such as salad dressing, spreads etc., instead of individual packages
Collect plastic name tags at the end of the event and reuse at other events

Minimize paper use by offering electronic versions of documents, posting the agenda in one location for
everyone to view and by conducting event registration by telephone or email

Project Health – Comprehensive Strategies to Promote Healthy Eating 93

Meetings and Event References
1. Hill JO, Peters JC, Wyatt HR. Using the energy gap to address
obesity: A commentary. J Am Diet Assoc. 2009;109:1848-1853.
2. Hill JO. Can a small-changes approach help address the obesity
epidemic? A report of the Joint Task Force of the American Society for
Nutrition, Institute of Food Technologists, and International Food
Information Council. Am J Clin Nutr. 2009;89:477-484.
Project Health – Comprehensive Strategies to Promote Healthy Eating
3. Cohen D, Farley TA. Eating as an automatic behavior. Prev Chronic
Dis. 2008;5:A23.
4. Health Canada. It's your health - food allergies. 2009.
5. EatRight Ontario. Over the Grill. Available at:
http://www.eatrightontario.ca/en/ViewDocument.aspx?id=188.
152
 Organizational Culture
Organizational Culture
A supportive workplace culture means the workplace promotes physical and
mental health. There are many areas that organizations can target to improve
the health outcomes of employees such as social support, workplace culture, job
control, effort-reward balance, work structure, communication, organizational
change processes and management style.
High levels of workplace related stress can negatively affect personal health
practices and organizational culture. A comprehensive workplace health
promotion strategy can be used to create a healthy organization.
In a supportive workplace culture employees have adequate job training, a sense
of fairness and respect on the job, work-life balance, some control over how
their work is completed and are rewarded adequately for their efforts. In an
ideal workplace, efforts are made to manage and prevent workplace conflict
and help is available to assist employees in times of distress.1
By addressing organizational culture issues that affect employee health, efforts
to promote workplace health will be more effective.

Definitions of Success
 Negative organizational factors are identified and plans are in place to make
improvements
 Employees and management have opportunities to learn skills in communication,
leadership and conflict prevention/resolution

 During organizational changes employees are kept well informed and efforts are
made to minimize employee stress
 Management staff use positive practices that promote work-life balance and ensure
reasonable workloads
 Management role model healthy behaviours
 Employees are encouraged to leave their desks/work area to eat lunch

 Employee work efforts are rewarded with non-food rewards

Project Health – Comprehensive Strategies to Promote Healthy Eating 153

1.0 Needs Assessment
Identify negative organizational cultural factors in your workplace using surveys or interviews. 2
Once problems with organizational culture are identified, you can take steps to address priority
areas

2.0 Evaluation Indicators

Monitor employee job satisfaction, and satisfaction with workplace training and communication
Monitor other workplace indicators that can reflect employee satisfaction such as turnover,
sick time, complaints, staff negativity and labour grievances

3.0 Creating a Supportive Workplace Culture

Skill Building Opportunities

Teach managers how to identify and support people who are struggling with work/life balance,
heightened work demands or problems with mental health.1 Reallocate work when necessary
to reduce workload2

Provide skill building sessions for managers, supervisors and employees in communication,
leadership, and conflict prevention and resolution.2 Staff development and training courses
aimed at developing interpersonal skills in the workplace may have additional benefits for
employees when they are outside work3

Project Health – Comprehensive Strategies to Promote Healthy Eating 154

Supportive Management Practices

Improve management practices by consulting employees about their work, negotiating

workload with employees, using two-way communication, and offering constructive feedback
to employees2,3
Keep demands on employee time and energy reasonable and provide adequate recognition
for work well done3,4
Ensure that working conditions and job demands do not negatively influence employees’
personal relationships3
Corporations could consider ways in which they can make a positive contribution to the
community in which they are located, for example through corporate community involvement3
Management should encourage employees to take their breaks and leave their work areas to
enjoy lunch
Management should role model healthy behaviours and support healthy eating strategies in
the workplace (e.g., take their lunch breaks, follow policies that support healthy eating)
Ensure managers provide clear and consistent information when organizational change
occurs3
During periods of job insecurity, resolve matters quickly to minimize the health consequences
of exposing workers to a chronic stressor. Workers should be kept well informed of any
changes to reduce rumour and anxiety and maintain job satisfaction3

Project Health – Comprehensive Strategies to Promote Healthy Eating 155

Rewarding Employees

Employees are motivated in their work when they know that they have made a difference in the
organization. Sometimes, small gestures such as a verbal acknowledgement or a hand-written
note of thanks can go a long way to show employees that their efforts are appreciated.
Occasionally, employees may also desire other forms of rewards such as a party or a tangible
reward to celebrate their achievements.

Ask employees what types of rewards motivate them. Here are some ideas for rewarding
employees for a job well done:

Give written recognition from supervisor, manager or human resources (e.g., letter of
recognition, hand-written notes, certificates of achievement, etc.)
Give verbal recognition from supervisor or manager (e.g., positive feedback, making an
announcement in team meetings, etc.)
Ask employees nominate other co-workers for awards or honourable mentions
Give special privileges (e.g., an afternoon off or flexible hours)

Provide a healthy staff lunch or dinner (e.g., chili with a whole wheat bun and a salad,
healthy pizza with salad or fruit dessert) or other perks such as “Fresh Fruit Fridays”
Provide employees with requested equipment when group targets are met

Provide opportunities to learn new skills (e.g., internal job shadow, educational activities,
or other opportunities for individual growth)
Give gift cards for malls, local stores, entertainment, sporting events, a spa day, a
massage, bookstores, downloadable music, etc.
Have employees draw from an assortment of random “prizes”
Have management complete a task for employees, such as cooking a healthy meal,
serving in the cafeteria, car wash etc.
Have an office event during a special holiday or occasion with awards given out for the
best team decoration

Make considerations about when rewards are given and make sure that there is a fair and
consistent process for rewarding employees. Give individual and team rewards when they are
warranted. Also keep in mind that rewards that are given often may eventually be expected by
employees, which begin to feel like more entitlements rather than rewards – in this case be
spontaneous and creative in your employee rewards!

Project Health – Comprehensive Strategies to Promote Healthy Eating 156

Organizational Culture References
1. Canadian Mental Health Association. Comprehensive
Workplace Health Promotion – Affecting Mental Health in
Workplace. Available at:
http://wmhp.cmhaontario.ca/comprehensive-workplace-
health-promotion-affecting-mental-health-in-the-
workplace.
2. World Health Organization. Healthy workplaces: A
model for action for employers, workers, policy-makers
and practitioners. 2010.
3. Work stress and health: The Whitehall II study. London,
England: Published by Public and Commercial Services
Union on behalf of Council of Civil Service
Unions/Cabinet Office; 2004.
4. Shain M, Kramer DM. Health promotion in the
workplace: Framing the concept; reviewing the evidence.
Occup Environ Med. 2004;61:643-8, 585.

Project Health – Comprehensive Strategies to Promote Healthy Eating 95

 Peer Support Groups
Peer Support Groups

Peer support groups allow individuals to share similar lived experiences, and
provide advice and encouragement to one another.1-4 Attending an ongoing
peer support group may help motivate employees to meet their personal
healthy eating goals.1,3,4

Workplaces can organize ongoing informal peer support groups where

employees discuss interests (e.g., healthy cooking) or personal goals (e.g.,
eating more vegetables and fruit) or their experiences living with health
conditions (e.g., diabetes, heart disease).

Alternatively, workplaces may choose to offer an organized peer support group

such as Weight Watchers© or TOPS (Taking Pounds off Sensibly), which are
focused on healthy eating with the ultimate goal of weight loss. Workplaces
may also choose to offer financial support for employees who would like to
attend an ongoing peer support group that is focused on healthy eating.

Definitions of Success
 Employees have access to an ongoing peer support program that encourages
healthy eating
Ongoing Group Weight Loss Programs
Employees may express interest in a weight loss program such as Weight Watchers© or TOPS.
However, the majority of employees could use improvements to their diet, regardless of weight
status.5 Therefore, health promotion programs that target all employees are recommended over
weight loss programs.

Why is there a demand for workplace weight loss programs?

With the increase in population weight gain, there has also been a rise in available methods for
weight loss (e.g., diet books, videos, television programs, websites and commercial weight loss
programs).6,7 Despite low success rates, most overweight individuals look for ways to lose
weight.8,9 In one sample of overweight adults, 93.5 per cent had tried to lose weight on their own
and the number of weight loss attempts ranged from four to 20 attempts.8

Considerations Before Offering a Group Weight Loss Program

Are there any benefits?

Many programs (e.g., Weight Watchers©) offer food plans that are based on a nutritionally
balanced diet6
Commercial weight loss programs are less expensive than individual counselling, but are also
less effective10

Are workplace weight loss programs effective?

Participants of worksite weight loss programs in general, tend to lose a modest amount of
weight compared to controls, i.e. 1.4 kg (3.2 lbs).11 Workplaces should consider if this outcome
is worth the expense, as there is little evidence that worksite based weight loss programs
result in a return-on–investment.12
Some programs have demonstrated effectiveness including Weight Watchers© and TOPS.10,13
These programs offer many of the elements that help people maintain healthy eating
behaviours such as a structured plan that allows for flexibility, build skills for healthy eating
(e.g., estimating portion sizes), provide leadership and peer support, include individual goal
setting and incorporate physical activity into the plan.14,15 In the case of Weight Watchers©,
there is also a financial incentive to maintain weight loss.14

Project Health - Comprehensive Strategies to Promote Healthy Eating 160

Should my workplace have an on-site group weight loss program?
Although modest weight loss (~5 per cent) can help to improve chronic disease risk factors such as
lowering cholesterol and improving blood glucose, there are some concerns about promoting
weight loss in the workplace.11,16
Weight loss is difficult to achieve and weight loss maintenance is even more difficult. Most
people who lose weight typically gain it back within the first year4,8,17,18
Individuals attempting to lose weight do not necessarily follow healthy eating patterns.19 In
addition, the focus on weight loss may have unintended consequences such as preoccupation
with food and appearance, cycles of weight loss and regain, reduced self-esteem, eating
disorders and increased feelings of guilt and depression if weight loss efforts are
unsuccessful19-21
The focus on weight loss may increase weight bias against individuals who are overweight or
obese, leading to further weight based stigma22
Traditional weight loss programs may only benefit a small portion of the workforce as they tend
to appeal to Caucasian middle-aged women, who are well educated and have good
incomes4,8,23,24
Some programs have costs which limits participation for some individuals14

The onus for behaviour change is based solely on the individual, which may be a frustrating
experience if the worksite and/or home food environment offers tempting foods25
Many people seek out quick weight loss results and therefore, program drop-out rates tend to
be high8,26

The Bottom Line

If your workplace decides to offer an ongoing weight loss program, the program should incorporate
health promotion elements that help individuals succeed in healthy behaviour changes such as:
tailored programs that give individual feedback in a timely manner, social support, and
opportunities for skill building (e.g., self-monitoring, goal setting). The program should also have
proven its effectiveness. In addition, workplace weight loss groups or group interventions
promoting healthy eating should be implemented in conjunction with positive changes to the
workplace food environment.

Project Health - Comprehensive Strategies to Promote Healthy Eating 161

Peer Support Groups References
1. Moisio R, Beruchashvili M. Questing for well-being
at weight watchers: The role of the spiritual-therapeutic
model in a support group. Journal of Consumer
Research. 2010;36:857-875.
2. Levy RL, Finch EA, Crowell MD, Talley NJ, Jeffery
RW. Behavioral intervention for the treatment of
obesity: Strategies and effectiveness data. Am J
Gastroenterol. 2007;102:2314-2321.
3. Rigsby A, Gropper DM, Gropper SS. Success of
women in a worksite weight loss program: Does being
part of a group help? Eat Behav. 2009;10:128-130.
4. Shay LE. A concept analysis: Adherence and weight
loss. Nurs Forum. 2008;43:42-52.
5. Garriguet D. Diet quality in Canada. Health Rep.
2009;20:41-52.
6. Ma Y, Pagoto SL, Griffith JA, et al. A dietary quality
comparison of popular weight-loss plans. J Am Diet
Assoc. 2007;107:1786-1791.
7. Dansinger ML, Gleason JA, Griffith JL, Selker HP,
Schaefer EJ. Comparison of the Atkins, Ornish, Weight
Watchers, and Zone diets for weight loss and heart
disease risk reduction: A randomized trial. JAMA.
2005;293:43-53.
8. Burke LE, Steenkiste A, Music E, Styn MA. A
descriptive study of past experiences with weight-loss
treatment. JADA. 2008;108:640-647.
9. Gates D, Brehm B, Hutton S, Singler M, Poeppelman
A. Changing the work environment to promote
wellness: A focus group study. AAOHN J.
2006;54:515-520.
10. Tsai AG, Wadden TA. Systematic review: An
evaluation of major commercial weight loss programs
in the United States. Ann Intern Med. 2005;142:56-66.
11. Boyko J, McRae L, Robeson P. Worksite nutrition
and physical activity interventions for controlling
employee overweight and obesity: Evidence and
implications for public health Hamilton, ON: McMaster
University.: health-evidence.ca; 2010.
12. Benedict MA, Arterburn D. Worksite-based weight
loss programs: A systematic review of recent literature.
Am J Health Promot. 2008;22:408-416.
13. Cobiac L, Vos T, Veerman L. Cost-effectiveness of
weight watchers and the Lighten Up to a Healthy
Lifestyle Program. Aust N Z J Public Health.
2010;34:240-247.
14. Lowe MR, Kral TV, Miller-Kovach K. Weight-loss
maintenance 1, 2 and 5 years after successful
completion of a weight-loss programme. Br J Nutr.
2008;99:925-930.
Project Health - Comprehensive Strategies to Promote Healthy Eating
15. Mitchell NS, Dickinson LM, Kempe A, Tsai AG.
Determining the effectiveness of Take Off Pounds
Sensibly (TOPS), a nationally available nonprofit
weight loss program. Obesity (Silver Spring).
2011;19:568-573.
16. Morgan LM, Griffin BA, Millward DJ, et al.
Comparison of the effects of four commercially
available weight-loss programmes on lipid-based
cardiovascular risk factors. Public Health Nutr.
2009;12:799-807.
17. Janer G, Sala M, Kogevinas M. Health promotion
trials at worksites and risk factors for cancer. Scand J
Work Environ Health. 2002;28:141-157.
18. Curioni CC, Lourenco PM. Long-term weight loss
after diet and exercise: A systematic review. Int J Obes
(Lond). 2005;29:1168-1174.
19. Bacon L, Aphramor L. Weight science: Evaluating
the evidence for a paradigm shift. Nutr J. 2011;10:9.
20. Urquhart CS, Mihalynuk TV. Disordered eating in
women: Implications for the obesity pandemic. Can J
Diet Pract Res. 2011;72:50.
21. Puhl RM, Heuer CA. Public opinion about laws to
prohibit weight discrimination in the United States.
Obesity (Silver Spring). 2011;19:74-82.
22. Puhl RM, Heuer CA. Obesity stigma: Important
considerations for public health. Am J Public Health.
2010;100:1019-1028.
23. Burke LE, Wang J, Sevick MA. Self-monitoring in
weight loss: A systematic review of the literature. J Am
Diet Assoc. 2011;111:92-102.
24. Wing RR, Crane MM, Thomas JG, Kumar R,
Weinberg B. Improving weight loss outcomes of
community interventions by incorporating behavioral
strategies. Am J Public Health. 2010;100:2513-2519.
25. Kwak L, Kremers SP, Visscher TL, van Baak MA,
Brug J. Behavioral and cognitive effects of a worksite-
based weight gain prevention program: The NHF-NRG
in balance-project. J Occup Environ Med.
2009;51:1437-1446.
26. Truby H, Baic S, deLooy A, et al. Randomised
controlled trial of four commercial weight loss
programmes in the UK: Initial findings from the BBC
"diet trials". BMJ. 2006;332:1309-1314.
162
 Promoting Local Food
Promoting Local Foods
Workplaces can encourage vegetable and fruit consumption by making fresh produce
available at the worksite. This can be achieved by organizing a local food project such
as a farmers’ market, offering the worksite as a community shared agriculture (CSA)
program drop-off site, and/or facilitating the sale of produce directly from farmers to
employees.
Some research shows that having the opportunity to sample and purchase local foods
at work increases the chance that employees will continue to purchase local foods
outside the workplace as well.1
Buying local foods supports local farmers, food processors and retailers, which helps to
strengthen the local economy. Buying local also helps to protect the environment by
reducing carbon emissions that result from packaging and transporting food from
distant locations.2

Definitions of Success
 Employees have increased access to vegetables and fruit at work through the
promotion of local foods (e.g., farmers’ markets, CSA programs, and direct
purchasing from farmers)
 Local food promotion project (e.g., farmers’ market, CSA program) is profitable
for the farmers
 Employees enjoy participating in the local food project
Is Local Food Organic?
Often local and organic foods are confused. Local food refers to the geographic area where food is
produced, while organic refers to the farming method used to produce food. Food is considered to
be locally grown if it is produced in Waterloo Region, or in the Province of Ontario.
Organic Food
The Canadian national standards control: which substances can be used on organic foods, how
the soil is managed, when and how processing facilities are cleaned, as well as how organic
products are separated from non-organic foods while being shipped and sold.
Organic Food and Health
Often individuals indicate that they consume organic products because they believe them to be
better for their personal health.3,4 Organic foods are not necessarily nutritionally superior to foods
grown using conventional farming methods in terms of vitamin and mineral content.5,6 An
independent study showed that on average, organic produce contains higher amounts of
antioxidants.7 However, the nutritional differences between organic and conventionally grown
produce are unlikely to produce any significant difference in health outcomes.5
Eating organically produced food may be one way to reduce exposure to pesticides.4 However; all
foods are susceptible to contamination from pollution in the environment. Therefore all fruit and
vegetables should be washed thoroughly to remove pesticides and other environmental pollutants.4
People often choose to eat organic food due to concerns of the effects conventional farming
methods have on the environment and animal welfare.3 Others choose organic food to avoid eating
genetically modified (GM) food.3 GM foods can be found as an ingredient in any food product, so
they are difficult to avoid unless the product is certified as organic.8
What is Genetically Modified Food?
A GMO is a generically modified organism, (e.g., a seed), that has had its genes (DNA) altered to
act in a way that does not happen naturally and/or contains genes from another organism.8
GMOs were developed to have certain benefits. For example, GM foods may grow well even when
sprayed with pesticides, have less disease caused by insects or viruses, resist damage due to
weather, like frost or draught, ripen slower and last longer during shipping, bruise less easily and/or
have more of a certain nutrient.8

GM foods have been grown and sold in Canada since 1994 and are regulated by Health Canada.8

Information: GENETICALLY MODIFIED FOODS

For more information on genetically modified foods visit EatRight Ontario:
http://www.eatrightontario.ca/

Project Health - Comprehensive Strategies to Promote Healthy Eating 164

1.0 Needs Assessment
Are employees interested in having increased access to vegetables and fruit at the worksite?
Ensure that employees are interested in having a local food project by asking:
 If employees prefer a farmers’ market, CSA program or direct purchasing from a local farmer
 Preferred days, and times to have a market or have food dropped off at the worksite9

 Effective methods of communication to promote the project among employees (e.g., posters,
email, intranet, word-of-mouth)9

2.0 Evaluation
Track the number of employees that participate in the local food project
Use sales data to determine if the project is profitable for the farmer(s)
Use surveys to seek feedback from participants
Check-in with vendors throughout the process to determine if any improvements are needed

3.0 Planning Your Local Food Project

The results of your needs assessment should help you determine if employees are interested in
having access to local food at the worksite. It should also indicate what format employees prefer.
For more information on planning a farmers’ market see page 166. For more information on
planning a CSA program see page 170. If employees would rather purchase food directly from the
farmer see page 171 for a listing of resources that can help you locate local farms.

Project Health - Comprehensive Strategies to Promote Healthy Eating 165

Farmers’ Markets
Workplaces can organize on-site farmers’ markets or make arrangements to attend an existing
local farmers’ market at a nearby location.
As an added bonus, people who use farmers’ markets enjoy the experience of interacting with
farmers and other market patrons and often report an increased sense of community.4,10

Farmers’ Markets at Large Workplaces

It may be feasible for large workplaces with several hundred employees to hold an onsite farmers’
market.11 Farmers’ markets are usually held once weekly from late spring until the early fall (due to
local produce availability).Typically 300 attendees are required to make the venture financially
worthwhile for the organizers and vendors.11

Small and Medium Sized Workplaces

Smaller workplaces may not have enough employees to enable the operation of a farmers’ market.
In this case, workplaces may choose to make a farmers’ market into a community event or partner
with another worksite (to increase sales).

Workplaces can make arrangements to attend markets that are already operating close to their
worksite. Several farmers’ markets and neighbourhood markets operate within the Region of
Waterloo. Workplaces can arrange an ‘employee walk’ or other forms of transportation to visit local
farmers’ markets.12

Alternatively, workplaces can make arrangements with local farmers to pre-order produce. For
example, circulating an order sheet to purchase specific items when they are available for harvest
and having the farmer drop them off at the worksite a few days later.

Tools: FARMERS’ MARKETS IN WATERLOO REGION

Foodlink Waterloo Region
Foodlink Waterloo Region may be a helpful resource to find local food vendors for your
own farmers’ market: Alternatively, this website can locate an existing market that is
operating within walking distance of your workplace.
http://www.foodlink.ca.
Neighbourhood Markets
Visit the Neighbourhood Markets webpage on the Region of Waterloo website to see
locations and operating hours of neighbourhood markets within Waterloo Region.
http://chd.region.waterloo.on.ca/en/clinicsClassesFairs/neighbourhoodmarkets.asp

Project Health – Comprehensive Strategies to Promote Healthy Eating 166

3.1 Planning the Farmers’ Market

Planning Committee Considerations

Municipal Zoning and By-laws

Ensure that your market location complies with local zoning and by-laws. Each municipality in
Waterloo Region has different provisions for farmers’ markets. Check with your municipality to
determine if your workplace is eligible to have an on-site farmers market. Your workplace may
be required to obtain a vendors permit to run an outdoor farmers’ market. If an outdoor market
is not possible, workplaces with cafeteria facilities may be able to hold an indoor market.
Market Location

Pick a location for the market close to your worksite. Ideally the market should occur in a
highly visible location such as a main entrance. Try to avoid locations that may be dusty, such
as gravel parking lots
Vendors should have enough room to unload their trucks9,11
If you invite members of the community, encourage walking and cycling. Also ensure adequate
parking is available.11 Make sure the market is accessible for people of all abilities11
Financial Considerations

Establish a budget for your market including financial resources for tents, chairs, tables, hand
washing facilities, staff time, promotional materials (flyers posters, etc.)
Staff or Volunteer Resources

Staff or volunteer time will be required to plan, develop and implement aspects of the farmers’
market. On market days, staff will be needed to assist with the market

Success Story: UNIVERITY OF WATERLOO FARMERS’ MARKET

University of Waterloo has been operating a Farm Market since 2006, which features
100% local produce, baked goods, honeys and preserves. The onsite market allows
students, staff and faculty and community members to purchase fresh nutritious foods
without leaving campus, reducing their ecological foot print.
Student volunteers operate the not-for-profit market while UW Food Services
purchases and transports the shipment to campus, sourced mainly from the Elmira
Produce Auction Cooperative. In addition, the market also promotes a "Bring Your Own
Bag" program for the market. http://www.foodservices.uwaterloo.ca/uwfarm_market/

Project Health – Comprehensive Strategies to Promote Healthy Eating 167

Vendor Selection Process

Complete a vendor selection process. Determine how many vendors you will need. Ensure
that vendor selection process complies with company policies and regulations for vendor
selection.9 Also ensure that the vendor selection process is transparent and accessible for all
local food producers (e.g., some producers may have difficulty with paperwork or require
assistance completing this aspect of the process). Make a decision about whether your market
will have the farmer(s) on site or whether food resellers (i.e., food retailers who have not grown
the food themselves) are invited to apply.
Decide whether you want to feature local food at your farmers’ market or whether you are
willing to accept produce from all over (i.e., imports)
Design a contractual agreement with the vendor.9 Ensure you have a plan as part of the
contract for what to do with produce that is not sold at the market (e.g., unsold produce will be
used in the cafeteria or donated to a local food bank or homeless shelter). The food producer
should not be expected to remove food that was not sold as part of the market1
Legal considerations

Make sure your insurance policy covers an onsite market. Alternatively, market insurance can
be supplied by the vendor. The vendor contract should include details about who is supplying
the insurance (i.e., the workplace or the vendor)
Check to make sure your liability insurance covers any volunteer working for the market
Nutrition Considerations

Ensure that all items that are offered for sale comply with healthy eating standards (i.e.,
emphasize foods from the “Maximum Nutritional Value” and “Sell/Offer Most” categories. Limit
foods from the “Sell/Offer Less” category to 20 per cent (or less) of foods available for sale.
Avoid offering foods from the “Not Recommended” category). See Appendix A for Nutrition
Standards
Facilities

Plan ahead to make sure you have enough trash receptacles, recycling and organics bins for
vendors and attendees. Decide ahead of time if your workplace or the vendors are responsible
for clean-up after the market

If markets are recurring, designate a place to store equipment and supplies for the market11

Project Health – Comprehensive Strategies to Promote Healthy Eating 168

Communications

Communications personnel will be needed to develop promotional items and to

create and implement a marketing plan for the market (e.g., intranet, flyers,
posters, emails).11 If the farmers’ market is ongoing throughout the season,
information on the farmers’ market should be sent to employees on a weekly basis
If you would like to invite members of the community, also consider
strategies to inform them (e.g., newspaper, local event bulletin boards,
online event calendars, local community associations etc.)11
Implementation

Display the name and price of each item clearly9

Invite participants to submit recipes that can be made with items sold at the farmers’ market11
Add excitement to your market by offering a door prize or by holding a contest or challenge.
Provide food demonstrations and sampling opportunities
Consider a “bring your own bag” policy
If funds are available, purchase market vouchers and provide them to employees at various
recognition events or use as incentives. You may also want to hand out vouchers to entice
employees to the grand opening of your farmers’ market

Tools: FARMERS’ MARKET EXAMPLES

Kaiser Permanente Thriving Markets Initiative
http://www.pps.org/projects/kaiser-permanente-thriving-markets-initiative/
Kaiser Permanente Farmers’ Market Resource Guide
http://www.eatbettermovemore.org/sa/enact/healthcare/documents/healthcare.farmers.t
ools.KPFarmersMarketResource4.pdf
Duke Farmers’ Market
http://www.hr.duke.edu/benefits/wellness/farmers/index.php

Project Health – Comprehensive Strategies to Promote Healthy Eating 169

Community Shared Agriculture Programs (CSAs)
3.2 Planning a CSA Program
CSA programs allow consumers to directly share in the local harvest. People purchase a ‘share’ in
the crops at the beginning of the season and then receive regular deliveries of farm products, most
often produce, throughout the harvest season. The cost, delivery schedule, delivery locations, and
available crops are unique to each individual CSA program. Contact CSA programs in Waterloo
Region to see if you can arrange for your employees to buy shares in a CSA at the beginning of
the season and become a drop-off location.

Tools: CSA PROGRAMS IN WATERLOO REGION

Foodlink Waterloo Region
http://www.foodlink.ca
Canadian Organic Growers
http://www.cogwaterloo.ca.
Ontario CSA Farm Directory
http://csafarms.ca/farms%20counties%20S-Z.htm

Tools: Guide to CSA Delivery at State Worksites

Washington Wellness describes the process of implementing a CSA program at their
worksites
http://www.washingtonwellness.gov/downloads/documents/csa/CSA_Delivery_Guidanc
e_110120.pdf

Project Health – Comprehensive Strategies to Promote Healthy Eating 170

Purchasing Directly from Farmers
3.3 Planning a Direct Purchase Program

Start by contacting local farmers to determine if they are able to offer delivery to the worksite.
Inquire about available crops as well as pricing. Once a farmer is selected, decide on a
communication strategy to let employees know what is available. Also determine the best way to
place an order. For example, workplaces could circulate a list of available produce among their
employees and designate one staff member to put in a collective order for the next week.

Tools: LOCAL FOOD RESOURCES

100 Mile Market

The 100 Mile Market is a unique local food sourcing and distribution company that
connects local farmers with food service operators and retailers.
http://www.100milemarket.com/html/premiers.html

Canadian Organic Growers – Perth-Waterloo-Wellington

The website provides information on organic food, organic labeling as well as sources of
local organic food.
http://www.cogwaterloo.ca/
Foodlink Waterloo Region
Foodlink connects consumers to local foods in Waterloo Region. The website contains
recipes, information on seasonal availability, local food and organic products, as well as
a map to help you find local food sources.
http://www.foodlink.ca/

Local Food Plus

Local Food Plus has developed a certification standard for local and sustainable food
production including considerations for food production, labour, native habitat
preservation, animal welfare, and on-farm energy use. See the list of Ontario food
producers who have been certified by Local Food Plus
http://www.localfoodplus.ca/find-food/consumer-search#ontario

Project Health - Comprehensive Strategies to Promote Healthy Eating 171

Promoting Local Food References
1. Ross NJ, Anderson MD, Goldberg JP, Rogers BL.
Increasing purchases of locally grown produce through
worksite sales: An ecological model. Journal of
Nutrition Education. 2000;32:304-312.
2. Foodlink Waterloo Region. Foodlink Waterloo
Region. Available at: http://www.foodlink.ca. Accessed
03/09/, 2011.
3. Padel S, Foster C. Exploring the gap between
attitudes and behaviour: Understanding why consumers
buy or do not buy organic food. British Food Journal.
2005;107:606-625.
4. Cohen M. Environmental toxins and health--the
health impact of pesticides. Aust Fam Physician.
2007;36:1002-1004.
5. Dangour AD, Dodhia SK, Hayter A, Allen E, Lock
K, Uauy R. Nutritional quality of organic foods: A
systematic review. Am J Clin Nutr. 2009;90:680-685.
6. Dietitians of Canada. Are organic foods better for my
health? 2010.
Project Health - Comprehensive Strategies to Promote Healthy Eating
7. Benbrook C, Zhao,X., Yáñez,J., Davies N, Andrews
P. New evidence confirms the nutritional superiority of
plant-based organic foods. The Organics Centre; 2008.
8. EatRight Ontario. Understanding Genetically
Modified Foods. Available at:
http://www.eatrightontario.ca/en/Articles/Food-
technology/Biotechnology/Novel-foods/Understanding-
Genetically-Modified-Foods.aspx. Accessed 01/06,
2012.
9. Centers for Disease Control and Prevention. CDC
garden market example. Atlanta: Centers for Disease
Control and Prevention; 2010.
10. McCormack LA, Laska MN, Larson NI, Story M.
Review of the nutritional implications of farmers'
markets and community gardens: A call for evaluation
and research efforts. J Am Diet Assoc. 2010;110:399
11. Network for a Healthy California - Worksite
Program. Establishing a worksite farmers' market.
California Department of Public Health; 2008.
12. Centre for Health Improvement. Worksite wellness
program keeps employees healthy. 2008.
172
 Vending Machines
Vending Machines
Vending machines stocked with inexpensive, less healthy food options have the
potential to harm the health of employees over time.
The most important factors in choosing foods are taste and price.1-5 Products offered in
vending machines tend to be the least nutritious foods and beverages sold, and are the
most convenient to purchase.6,7 By offering less healthy food choices at a low price, you
may be inadvertently encouraging employees to consume less healthy foods in place of
meals or healthy snacks.4,8

Definitions of Success
 If vending machines are present, there is an emphasis on foods from the “Maximum
Nutritional Value” and “Sell/Offer Most” categories. Foods from the “Sell/Offer Less”
category are limited (e.g., stock 20 per cent or fewer products from this category).
Foods from the “Not Recommended” category are not stocked in vending machines.
See Appendix A for a description of food categories

Project Health - Comprehensive Strategies to Promote Healthy Eating 173

1.0 Needs Assessment
Assess the purpose of the vending machines in your workplace. Are they meant for employees
who work shifts, who do not have access to the workplace cafeteria? Are vending machines there
for snacking purposes? Are vending machines a source of revenue for fundraising purposes?
If the vending machine is present for financial purposes, assess the actual profits from the machine
and determine if these funds could be raised in another manner.

2.0 Evaluation Indicators

Assess current vending machine food offerings and determine what percentage of foods
comes from each category in the Nutrition Standards in Appendix A
After the implementation, audit the machine regularly to ensure that healthy options are
present as requested and that food safety protocols are being followed. Also check to
make sure that the price, placement and promotion of foods in vending machines
encourage the healthiest options
Track vending sales before and after the implementation of healthier food choices
Note barriers, challenges and successes vending machine intervention
Any other relevant indicators

3.0 Creating Healthy Vending Machines

3.1 Determining Employee Food Access Needs

Ask employees if they use the vending machine, how often they use it and the time of day that they
typically use the machines. (One study found vending machine use to be low, with 85% of
employees reporting that they infrequently or never used them.6)
Consider whether your workplace requires a snack vending machine or if staff nutrition needs can
be better met through other food service options or by providing a kitchenette with a sink, fridge,
microwave, toaster, hot water dispenser, etc. Also determine whether your workplace requires a
beverage vending machine or if staff needs can be met by providing hot and cold water dispensers,
water fountains or water and ice machines.

Project Health - Comprehensive Strategies to Promote Healthy Eating 174

3.2 Implementation Considerations
Using Nutrition Standards
Emphasize products from the “Maximum Nutritional Value” and “Sell/Offer Most” categories. Limit
items from the “Sell/Offer Less” category (e.g., stock 20 per cent or fewer products from this
category) and avoid items from the “Not Recommended” category. See Appendix A for a
description of the Nutrition Standards.
Although it is not ideal from a nutritional standpoint, the Nutrition Standards can be phased in over
time. This strategy may be helpful if there is resistance to removing less healthy options from
vending machines, as it provides some time for employees to get used to the changes. For
example, start with 50 per cent of items coming from the “Maximum Nutritional Value” and
“Sell/Offer Most” categories and work towards 80 per cent. At the same time, work on phasing out
items that fall under the “Not Recommended” category.
Consider Employee ‘Choice’

It is often argued that individuals need to have both healthy and less healthy ‘choices’. However,
people may consume food products simply because they are in the workplace environment, so
installing a vending machine may tempt employees to consume foods they might not otherwise
‘choose’.6,8,9 The presence of a vending machine is a cue that can influence people to eat less
healthy foods.10-13 In studies, the presence of vending machines was directly correlated with the
consumption of foods high in fat and sugar.8,11,14
Employers should not feel obligated to offer less than healthy snacks to their employees.
Employees always have the option of bringing their preferred snacks to work with them, and as
such, retain the right to choose what they want to eat.15
If you are making changes to existing vending machine services you may want to conduct surveys
and/or a taste test event (to allow employees to sample products) to help determine what products
should be stocked in the vending machine.
Price
Price foods from the “Maximum Nutritional Value” and “Sell/Offer Most” categories competitively
(i.e., they should be less expensive than options from the “Sell/Offer Less” category)
Placement
Ensure the healthier items are placed in the machine so that employees notice them first (e.g.,
placed at eye level).
Food Safety
Have a plan in place to ensure your machines are checked at regular intervals to remove any
expired products.
Ensure that vending machines containing perishable foods are kept at safe temperatures.

Project Health - Comprehensive Strategies to Promote Healthy Eating 175

Working with an External Vendor
If an external vendor stocks your vending machines you will need to have a meeting with your
vendor to discuss the food products that you would like to have in your machines as well as the
price, placement and promotion strategy for healthier items.16
You may include terms your written agreement with a vending company to ensure the vendor is
filling the machines according to your specifications. A written agreement with your vending
company would be considered a healthy eating policy.
For more information on healthy eating policies see page 185.

Success Story: WATERLOO WELLINGTON COMMUNITY CARE ACCESS CENTRE

The Waterloo Wellington CCAC made changes to their snack vending machine by
changing options to healthier choices. After a period of time, it was determined that
the vending machine was not well used and it was subsequently removed from the
workplace. Initially, a few employees were dissatisfied by the removal of the machine;
however, there have been no further complaints since the machine was removed.

Project Health - Comprehensive Strategies to Promote Healthy Eating 176

Vending Machine References
1. Seymour JD, Yaroch AL, Serdula M, Blanck HM,
Khan LK. Impact of nutrition environmental
interventions on point-of-purchase behavior in adults: A
review. Prev Med. 2004;39 Suppl 2:S108-36.
2. Eertmans A, Baeyens F, & Van den Bergh, O. Food
likes and their relative importance in human eating
behavior: Review and preliminary suggestions for
health promotion. . Health Education Research.
2001;16:443-456.
3. Elinder LS, Jansson M. Obesogenic environments –
aspects on measurement and indicators. Public Health
Nutr. 2008;12:307-315.
4. French SA. Pricing effects on food choices. J Nutr.
2003;133:841S-843S.
5. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz
K. Creating healthy food and eating environments:
Policy and environmental approaches. Annu Rev Public
Health. 2008;29:253-272..
6. Gorton D, Carter J, Cvjetan B, Ni Mhurchu C.
Healthier vending machines in workplaces: Both
possible and effective. N Z Med J. 2010;123:43-52.
7. Ashe M, Feldstein LM, Graff S, Kline R, Pinkas D,
Zellers L. Local venues for change: Legal strategies for
healthy environments. The Journal of Law, Medicine &
Ethics. 2007;35:138-147.
8. Lawrence S, Boyle M, Craypo L, Samuels S. The
food and beverage vending environment in health care
facilities participating in the healthy eating, active
communities program. Pediatrics. 2009;123 Suppl
5:S287-92.
Project Health - Comprehensive Strategies to Promote Healthy Eating
9. Wansink B. Environmental factors that increase the
food intake and consumption volume of unknowing
consumers. Annu Rev Nutr. 2004;24:455-479.
10. Stice E, Spoor S, Ng J, Zald DH. Relation of
obesity to consummatory and anticipatory food reward.
Physiol Behav. 2009;97:551-560.
11. Koordeman R, Anschutz DJ, van Baaren RB,
Engels RC. Exposure to soda commercials affects
sugar-sweetened soda consumption in young women.
an observational experimental study. Appetite.
2010;54:619-622.
12. Mink M, Evans A, Moore CG, Calderon KS, Deger
S. Nutritional imbalance endorsed by televised food
advertisements. J Am Diet Assoc. 2010;110:904-910.
13. Harris JL, Bargh JA, Brownell KD. Priming effects
of television food advertising on eating behavior.
Health Psychol. 2009;28:404-413.
14. Fox MK. Improving food environments in schools:
Tracking progress. J Am Diet Assoc. 2010;110:1010-
1013.
15. Brownell KD, Kersh R, Ludwig DS, et al. Personal
responsibility and obesity: A constructive approach to a
controversial issue. Health Aff (Millwood).
2010;29:379-387.
16. Gillis B, Mobley C, Stadler DD, et al. Rationale,
design and methods of the HEALTHY study nutrition
intervention component. Int J Obes (Lond). 2009;33
Suppl 4:S29-36.
177
 Workplace Gardens
Workplace Gardens
Workplace gardens create many benefits for workplaces and their employees. A
workplace garden is a common meeting place where employees can socialize
while working together to grow herbs, vegetables, and fruit. A workplace
garden can provide an environmentally friendly source of healthy local produce
for your employees, your food service operations, and can even be donated to
members of the community who experience food insecurity.
Gardeners often report eating more vegetables and fruit compared to non-
gardeners.1 Working in a garden has also been shown to decrease stress levels in
individuals and also provides employees with an opportunity to be physically
active at work.1,2 Additionally, employees learn food skills related to growing
produce.

Definitions of Success
 Staff participate in workplace gardening
 Education is provided to employees regarding safe and sustainable gardening
methods
 Employees express enjoyment in their workplace gardening experience
 Employees were able to consume (or donate) vegetables and fruit from the
workplace garden

Adapted from: Community Garden Council of Waterloo Region. Starting a Community

Garden in Waterloo Region 2007
1.0 Needs Assessment
Ensure that employees are interested in creating a workplace garden by determining if there is
interest. If so, get a group of gardening enthusiasts together and promote the garden concept and
recruit volunteers.

2.0 Evaluation Indicators

After the first year, use participant feedback to start planning for the following year. Ask participants
about their workplace garden experiences including: what worked, what needs improvement,
budget concerns etc. Keep track of what was produced and how it was used.
3.0 Implementing a Workplace Garden
Planning Process
Winter is a good time to begin planning the garden
If you do not have a gardening expert at your workplace, consider hiring someone from the
community that can get your garden started

Form a planning group and create a garden plan. A committee should be in place to organize
the garden and to conduct meetings. Decide on the best way to communicate with one
another

Make a list of what your ideal garden will look like, who it will involve and what you will need to
get started. The plan should include: budget, location of the garden, equipment and storage
needs

Tools: LOCAL INFORMATION ON STARTING A GARDEN

Community Garden Council meetings:

http://www.together4health.ca/workgroups/community-gardens/upcoming-events

Community Gardens of Waterloo Region website:

http://www.together4health.ca/workgroups/waterloo-region-community-garden-council

The Organic Backyard: A guide to applying organic farming practices to your home
or community garden
http://www.cogwaterloo.ca/documents/Organic%20Backyard_WEB.pdf

Vegetable garden tips:

http://www.together4health.ca/workgroups/community-gardens-waterloo-
region/planting-and-caring-basic-vegetable-garden

Project Health - Comprehensive Strategies to Promote Healthy Eating 180

Staff
Staff time may be required to plan, develop and implement aspects of the workplace garden
Remind staff working in the garden to use sun protection gear such as sunscreen and hats
Facilities, Legal and Health and Safety Stakeholders
Check to make sure your workplace insurance policy covers the land use for gardening
Pick a garden site. Ensure the garden site has full or partial sun for 4-8 hours per day. Make
sure road salt from snow removal will not contaminate the site. The space should be
accessible for individuals of all abilities
Determine if your proposed site is appropriate for a garden. Check the site for indications of
illegal dumping or burning of garbage. Turn the soil and check for dark patches or odours
(e.g., from chemicals or gasoline). Contact your municipality for information on the site history.
Soil testing should be considered for sites that have a questionable history or that are next to a
busy highway, rail corridor or gas station. Soil testing can be done through the University of
Guelph. In some cases, container gardening, raised bed gardening or rooftop gardening may
be more appropriate. The City of Toronto has created a resource to help make decisions about
urban gardening based on land use history:
http://www.toronto.ca/health/hphe/pdf/urban_gardening_assessment.pdf
Call before you dig! Check with representatives from hydro, phone, cable, gas, water and
sewer to avoid cutting into lines
Find a water source, water barrels are an eco-friendly way to provide water for your garden
If possible, provide a nearby source of shade
Gates and fencing, such as: wood, plastic, chain link, post and wire, or snow fence may be
required

4x4 and 6x6 timbers or other material for constructing raised beds or containers for container
gardening may be required
Consider adding a composter for lawn cuttings, leaves and some kitchen leftovers to the
workplace garden

Project Health - Comprehensive Strategies to Promote Healthy Eating 181

Materials
Once the site has been determined and a water source secured, you will need to obtain:
Seeds, seedlings, bulbs, bedding plants, or cover crop seeds
Topsoil, compost, manure, mulching materials such as shredded leaves, hay, shredded bark,
wood chips
Garden hose, spray nozzles, hose reel, rain barrel or water tank, watering cans
Insecticidal soaps and hand-held sprayers. Involve the Health and Safety committee (e.g., for
MSDS sheets)
A wheelbarrow and garden cart, tool and storage shed, locks, benches and picnic tables
Compost bins or materials to build your own composter
Sustainability
Book garden work days to dig the garden, lay out the plots and walk paths and prepare the soil
Keep a schedule of tasks that need to be performed. Divide the work evenly. Involve
gardeners in tasks like planting flowers around the garden site, clean up and harvest

Success Stories: ADDITIONAL WORKPLACE GARDEN EXAMPLES:

Workplace Gardens
http://www.farmandafryingpan.com/2010/07/workplace-gardens

Gardens at Work: 2010 Report

http://www.employergardens.com/haberman-garden/gardens-work-2010-report
Employee Gardens! (Great for keeping the workplace healthy and happy!)
http://jaticus.com/?p=37
Out of the Office
http://www.organicgardening.com/living/out-office

Grow in Your Job. 4 tips to help you start at community garden at work
http://www.organicgardening.com/learn-and-grow/grow-your-job
Vegetable Patches at Work are a Nice Perk
http://www.treehugger.com/files/2010/07/more-companies-providing-vegetable-
patches.php

Project Health - Comprehensive Strategies to Promote Healthy Eating 182

Workplace Garden References
1. McCormack LA, Laska MN, Larson NI, Story M. Review of the
nutritional implications of farmers' markets and community
gardens: A call for evaluation and research efforts. J Am Diet
Assoc. 2010;110:399-408. doi:10.1016/j.jada.2009.11.023.
2. Van Den Berg AE, Custers MHG. Gardening promotes
neuroendocrine and affective restoration from stress. Journal of
Health Psychology. 2011;16:3-11.

Project Health - Comprehensive Strategies to Promote Healthy Eating 183

 Policy Development
Policy Development
One way to influence health behaviour is through workplace health policies. A
policy is a formal written statement that helps clarify roles and expectations of
management and employees. Well written policies define acceptable and
unacceptable behaviour and clearly state the implications of not following the
policy.
A written food and nutrition policy is a way to support other elements of a
healthy workplace nutrition environment (i.e., awareness raising, skill building,
and supportive environment initiatives).
A well written policy is consistent with the values of the organization, ensures
consistency in decision-making, fosters sustainability and clarifies functions and
responsibilities.1
A policy typically includes an objective, definitions, and expectations of
management and employee behaviour. In addition, a policy is generally:
required, equitable, sustainable, incentive-based (punitive or positive), and
enforceable (where there is meaningful consequences for unsafe, unhealthy,
and/or prohibited behaviour). Policies should be made available to all employees
and managers and adherence to the policy should be monitored.

Definitions of Success
 Written policies are developed, communicated, monitored and enforced for all
applicable areas in the workplace that influence healthy eating. This includes
policies that support healthy eating initiatives such as awareness raising and skill
building activities, and supportive environment strategies including strategies that
address organizational culture. Use the previous sections in the toolkit to formulate
the focus of your policy
1.0 Needs Assessment
Before commencing with a policy, conduct a needs assessment. Determine priority areas and
focus on a policy that will have a significant impact on health behaviours.
Gather information about your organization such as anonymous group health data from the
benefits provider and employee assistance program and conduct an audit of the workplace to
determine factors that support or discourage healthy eating
Conduct an employee need assessment and/or interest survey. The results will help you
determine if your workplace is ready for change and what changes employees are willing to
accept. Consulting employees before proceeding with policy development will help to increase
employee and management support for the policy
Review current policies and procedures to determine if there is an existing healthy eating
policy
Review current policies and procedures to determine if any are having a negative impact on
eating behaviours

Ensure key stakeholders (e.g., members of the healthy eating committee, management, labour
groups, food service providers) are part of the policy development process. Your policy should
represent the needs of both the employers and employees

Assess workplace capacity to support the logistics of evaluating, enforcing and evaluating the
policy. A policy will only be effective if it is monitored and enforced. The workplace should also
have the ability to follow through with an implementation strategy to ensure management and
employees are aware of their role in following the policy
Think about the future, will anything be happening in the organization that may affect the
policy?

Project Health - Comprehensive Strategies to Promote Healthy Eating 186

2.0 Evaluation Indictors1
Use the previous sections in this toolkit to help you determine your evaluation indicators for
your policy. For example, if you are writing a healthy meetings policy, you would use the
evaluation indicators from the Meetings and Events section under Supportive Environments
Seek employee feedback after the implementation of the policy to:

Determine if the policy is being applied

Identify barriers to policy compliance. (Whenever possible address employee concerns in a
timely manner)

Project Health - Comprehensive Strategies to Promote Healthy Eating 187

3.0 Healthy Eating Policy Development

3.1 Writing a Healthy Eating Policy

Introductory Statement

A statement that introduces the concept of the policy.

Example: (Employer name) is committed to promoting a healthy lifestyle by utilizing safe food
handling practices and supporting accessibility of healthy food and beverage choices in the
workplace.

Rationale/Objective/Purpose

Concrete examples about why your workplace is implementing the policy (i.e. what is the goal of
the policy.)
Example: To ensure that healthy food choices are offered and safe food handling procedures are
followed at all workplace functions where food and beverages are served.

Scope

The definition of where your policy is applicable.

Example: The policy applies to all workplace departments and events.

Definition

The definition of what is considered “healthy” food; so that people know what types of foods they
can offer.
Example: Foods offered will meet nutrition criteria for “Maximum Nutritional Value” or “Sell/Offer
Most”.
Principles/Procedures/Requirements

How the policy will be accomplished. Select appropriate policies for your workplace that addresses
your workplace needs assessment.
Example: At least 80 per cent of foods offered or sold to employees will meet the criteria for
“Maximum Nutritional Value” or “Sell/Offer Most”. Foods categorized as “Not Recommended” will
not be offered or sold to employees in the workplace.
Guidelines/Nutrition Criteria

See the recommended nutritional criteria in Appendix A

Project Health - Comprehensive Strategies to Promote Healthy Eating 188

Responsibilities

Management:

Example: Management is responsible for being familiar with their responsibilities under the Policy.
Example: Ensuring that the Policy is posted in the workplace in a visible and accessible spot.

Example: Investigating and dealing with incidents of non-compliance with the Policy.
Responsibilities
Employees:

Example: Being familiar and following through with their responsibilities under the Policy.
Training and Information

How managers and employees will learn about the policy and where they can go for reference
materials to assist in following the policy.
Example: All employees will be provided with appropriate information and instruction on the
contents of the Policy.
Evaluating and Accountability

How the organization will monitor compliance and what will happen if the policy is not followed?
Example: Departments must periodically evaluate the implementation of this Policy and be able to
demonstrate compliance.
Example: Food items that do not meet the nutrition criteria specified in this Policy, will not be
purchased with company funds.
Other Sections

Project Health - Comprehensive Strategies to Promote Healthy Eating 189

3.2 Policy Considerations to Support Healthy Eating
Facilities

Employees have access to an eating area that is away from their workspace and is clean and
attractive
Cafeterias, Cafés, Meetings and Events, Vending Machines

Employees will have access to healthy, reasonably priced, and culturally appropriate food
choices
Healthy food options (i.e., Foods categorized as “Maximum Nutritional Value” or “Sell/Offer
Most”) will be provided whenever food is offered or sold in the workplace
Healthy options (i.e., Foods categorized as “Maximum Nutritional Value” or “Sell/Offer Most”)
will be available at a price comparable to or lower than other choices in the workplace
Food from local sources will be provided whenever possible
Staff will follow safe food handling recommendations when perishable food served in
meetings, events, cafeterias, celebration events, fundraisers, and vending machines
Tap water is available to all staff during meetings, events and celebrations
The cafeteria provider will have at least one full-time staff member with a Safe Food Handler
certification

The promotion of foods categorized as “Sell/Offer Less” or “Not Recommended” is prohibited,

(e.g., advertisements, decals on vending machine, specials, posters, email notifications etc.)
Waste will be minimized by reducing the amount of packaging and disposable dishes used,
recycling and by diverting food waste to an organics program
Fundraising

Fundraising does not include the sale of foods categorized as “Not Recommended” (i.e., bake
sales, cookies, chocolate bars, muffins, etc.)
Organizational Culture

Create a positive workplace culture where all employees are treated in a fair manner with a
focus on respect and acceptance.2 Enforce a zero tolerance policy for workplace harassment,
discrimination or other anti-social behaviours3,4
Create flexible work policies to allow employees to enhance work-life balance (e.g., offer
flexible work hours, work from home options, child or elder care time, subsidies or spaces,
etc.)3-5
Provide adequate time for employees to eat on their lunch break
Provide work time to allow employees to attend awareness raising and skill building activities

Project Health - Comprehensive Strategies to Promote Healthy Eating 190

3.3 Build support for the policy6

It is important that stakeholders and decision makers understand the need to proceed with the
policy. In communications, focus messages on the links between the policy and eating a healthy
diet, use simple descriptions of solutions, and emphasize that change is warranted and desired.
Prepare to counter arguments such as: the policy will be too costly, it is not the workplace’s
responsibility to restrict individual freedoms, and that there is a non-policy solution to the problem.
For more information on making the case for policy, see Part I “The Cost of Doing Nothing the
Business Case” and Part II “Examining the Evidence: Addressing the Limitations of Current
Interventions”.
3.4 Implement the policy6

Ensure the following conditions are met before embarking on policy implementation:
The policy meets stated goals and objectives
The policy objectives are measurable and an evaluation plan is in place
Decision makers and stakeholders have approved the policy
An accurate estimate of the resources needed to implement your policy has been developed
The timeline is realistic and appropriate
The policy specifies who is responsible for what will be done and when it will be done

Make the policy accessible to all employees. Ensure the policy has been explained to all staff
through information sessions, training sessions, at staff meetings and during orientation for
new staff
Ensure that the policy implementation plan includes a communication plan so that all
individuals affected by the policy are aware of policy specifics and expected behaviour
3.5 Evaluating and Enforcement

Make plans for evaluating and enforcement of the policy

Project Health - Comprehensive Strategies to Promote Healthy Eating 191

SAMPLE POLICIES
Healthier Catering Policy (Singapore Government)
http://www.hpb.gov.sg/hpb/default.asp?pg_id=3410

Meeting and Function Nutrition Policy (Mecklenburg County, NC Healthy Weight

Task Force)
http://www.fitcitychallenge.org/Content/m1/Worksite/PDF/MeetingNutritionPolicy.pdf

Sample Canteen Certification Policy (Singapore Government)

http://www.hpb.gov.sg/hpb/default.asp?pg_id=3409

Healthy Eating Policy (Government of Nova Scotia )

http://www.gov.ns.ca/psc/v2/pdf/employeeCentre/healthyWorkplace/healthyEating/02_S
upportiveEnvironment.pdf#Page=19

Eat Smart Meet Smart Healthy Meetings Policy (Western and Northern Collaborative
for Healthy Living)
http://www.healthyalberta.com/Documents/Eat-Meet-Smart-policy.pdf

Nutrition Policy (Union River Healthy Communities)

http://healthycom.org/cms/files/sample-workplace-nutrition-policy-inc-vending.pdf

Food Donated by Employees Policy (Mecklenburg County, NC Healthy Weight Task

Force)
(http://www.fitcitychallenge.org/Content/m1/Worksite/PDF/PolicyFoodDonatedByEmploy
ees.pdf

Flexible Work Schedules (United Townships of Head, Clara and Maria)

http://townshipsofheadclaramaria.ca/Policies/ALTERNATE%20WORK%20SCHEDULE%2
0POLICY%20JUN%202008.pdf

Green Meetings (National Recycling Coalition)

http://www.fs.fed.us/sustainableoperations/greenteam-
toolkit/documents/NationalRecyclingCollolitionGreenMeetingsReference.pdf

*This is not a comprehensive list but a sample of existing policies

Project Health - Comprehensive Strategies to Promote Healthy Eating 192

Frequently Asked Questions

Are guidelines the same as policies?

Sometimes guidelines are confused with policies. For example, a guideline exists when employees
are provided with information that they may choose to use to help them make healthier lifestyle
choices, such as guidelines for “what to serve during meetings”, yet there is no explicit expectation
that the employee will follow the guidelines, or consequence if they do not follow the guidelines.
A policy is different than a guideline in that the behaviour outlined in the policy is expected and/or
required of all employees, and that it is not up to the employees’ discretion as to whether or not
they will follow the policy.

Is a commitment statement the same as a policy?

A commitment statement shows that your workplace cares about employee health. For example,
“our organization is committed to offering healthy and nutritious food choices”. Although a
commitment statement shows a positive intent, it is difficult for employees to decipher how this
statement should impact their behaviour. For example, when can employees expect to have
healthy choices and what is the definition of a healthy choice?
As a result of a formalized policy, employees who order food know that they are expected to
provide healthy options. A policy provides defines what a healthy choices is, it also defines when
healthy choices will be offered. For example, “a healthy choice is a food item that meets the criteria
for “Maximum Nutritional Value” or “Sell/Offer Most” (See Appendix A). Healthy food will be
available whenever food is offered or sold in the workplace.

Is having a policy the same as creating a supportive environment?

Supportive environments create an environment that fosters good health. Within a supportive
environment, employees feel that the organization provides them with encouragement,
opportunities, and rewards for developing or maintaining a healthy lifestyle. Sometimes supportive
environments are created in the absence of policy.

Example: Supportive environment in absence of a workplace policy

A workplace cafeteria provider decides that it will offer a healthy entrée option every day. Although
this is a positive health promotion activity, there is no formal expectation that it will continue. In this
case, the cafeteria may decide that if the healthy entrée does not sell well, they will discontinue the
item. Similarly, the cafeteria may consider a food item to be a healthy choice; however, the
workplace may disagree on the definition of a ‘healthy choice’. When a workplace has a cafeteria
policy, there is a clear definition of ‘healthy food choices’ (e.g., “Maximum Nutritional Value” or
“Sell/Offer Most”). Similarly, it would not be up to the discretion of the cafeteria to decide whether
or not to continue to offer a healthy entrée, regardless of sales performance.

Project Health - Comprehensive Strategies to Promote Healthy Eating 193

Policy References
1. NSW Department of Commerce Office of Industrial
Relations. Workplace policies and procedures. 2011.
2. Berset M, Semmer NK, Elfering A, Jacobshagen N,
Meier LL. Does stress at work make you gain weight?
A two-year longitudinal study. Scand J Work Environ
Health. 2011;37:45-53.
3. World Health Organization. Healthy workplaces: A
model for action for employers, workers, policy-makers
and practitioners. 2010.
Project Health - Comprehensive Strategies to Promote Healthy Eating
4. Work stress and health: The Whitehall II study.
London, England: Published by Public and Commercial
Services Union on behalf of Council of Civil Service
Unions/Cabinet Office; 2004.
5. Shain M, Kramer DM. Health promotion in the
workplace: Framing the concept; reviewing the
evidence. Occup Environ Med. 2004;61:643-8, 585.
6. The Health Communication Unit. The eight steps to
developing a health promotion policy.
194
 Special Considerations
Special Considerations
Certain workplace populations may be at higher risk of developing chronic
disease or may be difficult to reach with traditional health promotion strategies.
This section will address some common workplace issues that pose challenges
in supporting healthy eating. Topics include strategies for promoting healthy
eating among shift workers, drivers, targeting male populations, working
families, smokers and individuals working in hot conditions.

Definitions of Success
 Comprehensive workplace health promotion interventions are tailored to meet the
needs of unique workplace populations
Shift Workers
It is estimated that approximately 25 per cent
of workers in Canada work rotating shifts.1
Many employees enjoy shift work, while
others feel it is “just part of the job.” No
matter which category shift workers fall into,
it can be difficult for these workers to find a
work-life balance. As a result, some shift
workers may have reduced access to meals,
time constraints for food preparation, and
disrupted family mealtime activities, which
can cause a reliance on fast food or
unhealthy snacks found in vending
machines.1,2
Shift Work and Health
Shift workers have higher risks for
experiencing problems related to insomnia,
chronic fatigue, anxiety, depression, and
fertility problems. They also have higher
risks of developing chronic diseases such as
cardiovascular disease, hypertension,
diabetes, and high cholesterol.1,3-6
Up to 75 per cent of shift workers experience
appetite disturbances and gastrointestinal
symptoms such as constipation and heart
burn.1
Project Health - Comprehensive Strategies to Promote Healthy Eating
Shift work is related to weight gain,1,3,7,8
which has even become a problem among
occupations that traditionally have high
physical fitness requirement such as fire
fighting.9
The negative associations between shift
work and health could occur because shift
work interferes with the metabolic and
hormonal changes that occur as part of the
circadian rhythm.4,5 Additionally, shift
workers may not participate in health
promoting behaviours such as cooking
healthy meals, eating at home, and leisure-
time physical activity if they feel the need to
catch up on sleep.1
Although many studies have not shown any
differences between the nutritional intakes of
regular day workers compared to shift
workers, some studies show that sleep
deprived individuals consume 33 to 45 per
cent more calories per day, partially due to a
reliance on snacks and sugary food
products.1-4,7,10
196
Interventions for Shift Workers
Workers who bring foods from home
consume healthier diets.3 Provide
refrigerators and microwaves and ensure
employees have enough time to eat
If food services are offered, provide
smaller portions of foods, as eating large
quantities may cause fatigue
Provide workers with competitively priced
healthier options in vending machines and
cafeterias. Consider decreasing or
removing unhealthy items
Project Health - Comprehensive Strategies to Promote Healthy Eating
To reduce gastrointestinal discomfort,
make low-fat, high-fiber snacks available
and avoid providing spicy, high-fat, and/or
fried foods
Encourage workers to drink tap water
throughout their shift
Avoid encouraging excessive caffeine
intakes (i.e., more than 2 to 3 cups of
coffee per day) as this can interfere with
sleep once the shift is completed
Optimize scheduling practices so that
employees have enough time between
shifts to receive adequate sleep
197
Professional Drivers
Professional Drivers and Health
Personal health behaviours are commonly
influenced by occupation.10-14 Professional
drivers are often subject to a stressful work
environment due to long work hours,
irregular shifts, low job control, social
isolation, and anxiety over deadlines, traffic,
and weather conditions.10-14
Drivers are less likely to be physically active
during leisure time and less likely to eat a
healthy diet due to the limited availability of
healthy food.12,14 Many drivers are at an
increased risk of weight gain due to job
related factors.10-16 and as a result, also have
higher risks of developing of hypertension,
high cholesterol, diabetes, and sleep
apnea.10,16
Project Health – Comprehensive Strategies to Promote Healthy Eating
Fatigue and Collisions
Estimates suggest that up to 20 per cent of
all road collisions are related to fatigue.17-20
This is concerning given the high prevalence
of fatigue and sleep apnea among
professional drivers. Approximately 25 per
cent of professional drivers have sleep
apnea.10,11 Individuals with sleep apnea are
two to three times more likely to be involved
in a collision.19
Unfortunately, drivers may be unaware of
this risk, since their perceptions of daytime
sleepiness are not a reliable indicator of their
actual level of fatigue.21 In one study of
drivers, 76 per cent had sleep apnea but
none reported any symptoms.21 When
tested, almost half of these drivers (47 per
cent) showed symptoms of excessive
daytime sleepiness, putting them at high risk
for being involved in a collision.21
This has important safety implications for
professional truck drivers. In 2008, collisions
involving heavy trucks accounted for only
seven to eight per cent of all collisions but
approximately 20 per cent of all road
fatalities in Canada.22
The Bottom Line
Due to the nature of the occupation, drivers
can be difficult to reach through traditional
health promotion strategies.12 However
many drivers can be reached through
locations where they regularly stop such as
truck stops and depots.
.
198
Interventions for Drivers:
Drivers may benefit from regular health Competitions for drivers have also been
screening for blood pressure, diabetes, successful in promoting healthy eating and
and cholesterol. Consider implementing physical activity. The team competition
these programs where drivers congregate format can increase social interactions
between drivers and appeals to individuals
Encourage drivers to bring meals from
with a competitive nature12
home. This is associated with higher
vegetable and fruit intakes13
Offer fresh fruit, healthy snacks, or healthy
take away meals to drivers at stops and
depots
Ensure drivers have high levels of
supervisor support, and reduced job strain,
factors associated with a greater likelihood
that drivers will have healthier eating
habits13
Provide realistic schedules that include
time for traffic congestion, allow drivers to
adhere to speed limits, and provide time
for physical activity and adequate sleep.13
Drivers should be involved in
scheduling/management processes

Success Story: A HEALTHY EATING INTERVENTION FOR DRIVERS

One intervention provided truck drivers with educational materials and personal health
assessments at a frequented truck stop. The menu was altered to offer healthier foods.
The cooks at the truck stop were educated on healthy food preparation and wait staff
served as health promoters by offering healthier choices to drivers. Interviews with
drivers and staff showed that drivers were more inclined to choose healthier
alternatives as a result of the intervention.15 As an unplanned bonus, the healthier
cooking methods actually saved the truck stop money!

Tools: ROAD SAFETY

For information on implementing road safety initiatives for your workplace, visit the
Project Health website http://www.projecthealth.ca or call 519-883-2287

Project Health – Comprehensive Strategies to Promote Healthy Eating 199

Targeting Male Populations
Encouraging men to use health services is
considered to be one way to improve men’s
health, since there tend to be differences in
the way that men and women address health
concerns.23 Despite the fact that men are
more at risk of developing cardiovascular
disease and diabetes, they can be difficult to
engage in health strategies.24-26
“I’ll just wait to see if it fixes itself”
Men have been referred to as poor patients
who only seek medical help when their
problems become difficult to treat.23,27-31 In
fact, men tend to avoid seeking out health
services as long as they can continue in their
regular daily activities.24
Often, men avoid seeking medical services
as they do not want to waste medical
services, or to appear foolish, fussy, or weak
to their peers.24,27,30-32 Instead, men tend to
‘wait and see’ and give problems a chance
to heal themselves.24,30,31
Project Health – Comprehensive Strategies to Promote Healthy Eating
Some men commented that fussing about
health and nutrition too much is considered
to be vain, narcissistic, and feminine, while
having a disregard for their body is
considered to be ‘macho’.33
This traditional ‘macho’ stereotype of being
tough, independent, and self-reliant, may
prevent some men from seeking help,
participating in health promoting behaviours,
and eating healthy foods.27,30-32,34 However,
current role models for men are more
physically fit compared to older generations,
which may allow younger men to adopt
healthier lifestyles without feeling less
masculine.33
The concept of lifestyle ‘balance’ can be
misinterpreted as engaging in both ‘good’
and ‘bad’ behaviours (e.g., healthy eating
today to balance heavy drinking
tomorrow).33,35 This balance approach allows
men to think they can address health without
giving up the appearance of being
masculine.33
200
Men and Eating Behaviours
Men and women seem to have very different professionals to appeal to men’s sensibilities
behaviours when it comes to health and while encouraging them to eat healthier
nutrition. While women tend to be concerned foods.43 Even providing nutritional
about outward appearance and healthy information does not always have the
living, some men feel that health campaigns intended effect. In at least one study,
are intrusive and resent interference from researchers found that some males actually
others because they believe that food changed their order to a higher calorie item
selection is a personal choice.25,27,36-39 when presented with nutrition information!44
Although men are aware of nutritional
guidelines, they often show skepticism and
resistance to education.38-40 In focus groups,
many male interviewees explained that they
“feel healthy,” so they have no reason to
change current dietary habits.38,41
Quite often, men describe healthy eating as
being bland and insufficient (e.g., “rabbit
food”), and think that eating healthy food
deviates from social norms and conventional
patterns of their way of life.25,27,32,34,38 Large
portion sizes, hearty satisfying foods, red
meat, and alcohol are typically related to
masculinity, while vegetables, fruit, and
yogurts are considered to be feminine.38,39,42
It appears that men tend to make food
choices that express their gender identity,
which may make it less likely that they pick
foods that have healthy sounding names
such as “nature salad” that tend to be
associated with feminine characteristics.42
Foods named using words like “hearty”,
“chunky”, or “western” may make it more
likely that men will choose them.42
In a world where food companies market
products specifically for men that involve
“using meat as a condiment for other meats”
it is increasingly difficult for health

Project Health – Comprehensive Strategies to Promote Healthy Eating 201

Interventions for Male Populations
Traditional health promotion strategies may not impact men’s eating habits. To engage
male employees, develop a comprehensive, targeted workplace-based healthy eating
strategy! 29 45

Raising Awareness with Health Assessments

Men respond to gentle wake-up calls and will
make long-term health changes when they
can see the practical benefits of change.
Creating too much fear will cause men to
avoid dealing with symptoms or looking after
their health28
Have a health professional complete
assessments during work hours as men may
not attend programs held outside of work
hours26,46
Ensure that workplace health screenings are
“one stop shops” held in an area that is
appealing to men and where they tend to
congregate28
Health is perceived to be a ‘female’ word,
use more functional terms such as “check”
or “measure” to describe the assessment.28
One successful program in Australia used
the name “PitStop program”47
Include measurements of weight, height,
Body Mass Index, waist circumference,
blood pressure, cholesterol, blood glucose,
and carbon monoxide levels. Consider
adding dietary intake, alcohol intake, and
physical activity assessments26,48
Ask lifestyle questions first to put men at
ease before conducting medical tests.28
Weight and height measurements should be
done at the end, as this is the least favourite
part of the assessment28
Use practical information such as a red,
yellow, and green grading system to show
how close they are to recommended
parameters.28 Privacy is important, so results
should be covered with a top sheet28
Having same-day results motivates men to
participate and reduces the anxiety involved
with waiting for results28

Project Health – Comprehensive Strategies to Promote Healthy Eating 202

Educating Men (Awareness Raising and Skill Building)
Offer health information that is both
accessible and meaningful to men as they
like to have access to health information
prior to seeking help24
Men prefer clear, written instructions6
Present advice in a caring and non-
judgemental way.28 Health information
should not place all the blame on the
individual28
On-going support and advice is important
to help men who would like to achieve a
healthy lifestyle26
Approach health topics with humour and a
positive tone, as this is part of the male
experience25,26,28
Project Health – Comprehensive Strategies to Promote Healthy Eating
Discuss alcohol as part of healthy eating
and weight management education26
Plan activities where they can participate
with other male colleagues.25,26,34,45
Workplace support is important for men to
maintain a healthy lifestyle
Provide health information from health
professionals directly, with an emphasis
on reliable information.28 Be sure to
include nutrition information sessions,
healthy food samples, and food models
Teach food skills in a way that appeals to
men. These experiences need to be fun;
have a practical application and an
element of competition. In a study of
single men, there was interest in learning
how to cook, as it supports the masculine
identity of being able to “fend for oneself,”
but was also viewed as a way to impress
prospective dates25,26
Include female partners and other family
members who can help male workers
seek out health advice and provide
encouragement to participate in health
initiatives39
203
Supportive Environment and Policy
Address stress in the workplace to help
moderate eating behaviours and other risk
factors such as smoking, drinking, and
substance misuse.26,27,32,35,36 The
workplace is a place where men find their
self-esteem either enhanced or
diminished.28,31 Long commute times, job
insecurity, lack of job control, and a lack
of feeling valued are all stressors for
men.7,49-51 Men are unlikely to discuss
stress or mental health issues, which may
lead them to engage in unhealthy coping
behaviours52
Involve men in needs assessments and
program planning to see what types of
programs in which they would enjoy and
participate31,52
Bring services to men in an informal
environment where they feel
comfortable34,53-59
Competition can be an important
motivator for men to participate in health
promotion activities. Pay careful attention
to avoid causing lower self-esteem.26 Iron
Chef® anyone?
Focus on how healthy eating will improve
work performance.25,26 This is important
to a man’s identity and sense of
masculinity.60 Taking charge of one’s
health” and “seeking help in a timely
fashion” are perceived as being in line
with other masculine attributes such as
productivity, vitality, and strength25,31
Project Health - Healthy Eating Toolkit for Workplaces
Create an environment that encourages
healthy eating. This is more acceptable
than interventions that single out
individuals, rely solely on educational
strategies, or that focus on weight
loss.25,31This means that the healthy
choice is the default choice
Men are highly influenced by food cues,
meaning that they eat when food is
present or when food is advertised,
making a supportive food environment
especially important for men61
Offer free samples and pair ‘new’ healthy
foods with well-liked options. Also, new
foods may not be popular right away, so
repeated exposure to new healthier foods
may increase taste preference for these
items7,46,61-63
Highlight the pleasurable effects of eating
healthy foods when marketing healthier
foods to men (e.g., focus on taste or
freshness rather than on health claims)64
Try “nutrition stealth”. In workplaces
where men are typically resistant to
healthy eating (i.e., they assume that any
food that is healthier must taste terrible).
This involves improving the nutritional
quality of foods that are already provided.
Modify existing products by increasing
vegetable content and adding less salt,
fat, and sugar. One study found that
subjects could not tell the difference when
some of the beef in a recipe was replaced
with mushrooms36
204
Employees with Families
Workplaces can create healthy eating strategies that will benefit employees
throughout the continuum of raising a family, from pregnancy through
parenting teenagers.

Mothers Interventions for Pregnancy

Women make up almost half of the
workforce and over 75 per cent of these
women are in their childbearing years.65
Eight out of ten women will become
pregnant during their working years. Most of
these women will continue to work during
pregnancy and plan to work after their baby
is born.66
As it is recommended that children be
breastfed to 24 months of age and beyond,
some women may continue to breastfeed
after they return to work.
Supporting mothers who continue to
breastfeed demonstrates a commitment to
the health and well-being of employees
and their families. It also provides
benefits for your workplace such as
lower absenteeism and health
care costs, higher
productivity, loyalty, and
improved public
relations.
Proper nutrition plays an essential role in a
healthy pregnancy; however, eating well
before pregnancy is also important.
Workplaces can provide supports for
pregnant employees by:
Accommodate frequent breaks (e.g., for
frequent small meals), and allow flexible
work schedules (e.g., for attending
medical appointments, or for those who
experience nausea and vomiting)
Post signs in eating areas that highlight
important nutrients for pregnant women
(e.g., folate rich foods) and that caution
women about foods to avoid during
pregnancy
Offer pregnancy related
awareness raising materials and
opportunities for skill building
Interventions for New Mothers
Create a mother-friendly
workplace strategy in your
workplace

Tools: SUPPORTING NEW MOTHERS IN YOUR WORKPLACE

For more information on supporting a healthy pregnancy or creating a mother-friendly
workplace strategy, visit Project Health at: http://www.projecthealth.ca or call
519-883-2287.

Project Health – Comprehensive Strategies to Promote Healthy Eating 205

Employees with Children
Parents are the most important influence on
children’s eating habits and often express
concerns about their children’s diets.67
Common concerns include eating too much
‘junk food’, not eating enough, and ‘picky
eating’.67
Due to an increase in dual-income families,
many parents experience tensions between
work and family life. In 2001, 62 per cent of
couples with children were also in dual-
income families.68 The time pressures
related to daily life can make it difficult for
individuals to incorporate positive lifestyle
behaviours into their everyday lives, such as
healthy eating.65
Encouraging and supporting employees to
adopt healthy habits will benefit the health of
individual employees and their families,
which can have a positive effect on
absenteeism, productivity and health benefit
costs.69
Project Health – Comprehensive Strategies to Promote Healthy Eating
Interventions for Employees with
Children
Employers can assist employees and
their families to improve eating habits by
offering skill-building sessions on buying
and preparing healthy food and
participating in active living
Parents and children were more likely to
develop obesity and risk factors for
cardiovascular disease when they ate
meals away-from home (e.g., take out,
restaurants, fast-food).70 Consider
offering a healthy dinner take-home
program if your workplace has a
cafeteria. This is a way to improve
cafeteria sales as well as the health of
your employees and their families
Environmental supports such as offering
flex-time make it easier for employees to
put healthy behaviours into practice,
which may result in increased home
food preparation, family meals, and
opportunities for physical activity. These
factors have a positive emotional effect
on children and employees alike and
have the added bonus of reducing
absenteeism rates69,71
Efforts to decrease work-related stress
may also have a favorable impact on
healthy living behaviours both at work
and at home72
206
Tools: HELPING FAMILIES TO ADOPT HEALTHIER EATING HABITS
Starting in September 2011, the Ontario Ministry of Education implemented a school
food and beverage policy to ensure that healthier foods are sold to children at school. It
is important for parents to learn more about this policy (PPM 150). When considering
policies in the workplace, it may be beneficial to adopt similar policies that have already
been implemented by schools. Here are some resources for parents about the Ontario
School Food and Beverage Policy:
At-a Glance Guide to Ontario’s School Food and Beverage Policy:
http://www.eatrightontario.ca/CentralAttachments/At_A_Glance_Final.pdf
Bake It Up! Tasty treats for healthier school bake sales:
http://www.eatrightontario.ca/CentralAttachments/Bake_It_Up_final.pdf
Resources to help understand and use the new School Food and Beverage Policy:
http://www.eatrightontario.ca/en/ViewDocument.aspx?id=443
Articles and resources related to school health:
http://www.eatrightontario.ca/en/schoolHealth.aspx

Project Health – Comprehensive Strategies to Promote Healthy Eating 207

Employees Working in Hot Conditions
Outdoor workers and factory workers may
encounter hot conditions while on the job.
Under normal working conditions, men need
approximately 2.5 litres of water per day (for
sedentary workers) to 3.2 litres per day (for
moderately-active men). Women require 1.5
to 2.5 litres of water per day, for sedentary
and moderately-active women respectively.73
However, in a hot environment water needs
can increase to over six litres of water per
day, due to sweating!73
As a general rule, manual labourers should
drink between 600 ml to 1000 ml per hour in
hot weather, while sedentary workers should
consume 400 ml.74,75
Beverages provide about 80 per cent of
water needs while food provides the
remaining 20 per cent.73 Fluid needs can be
met with plain water, while regular food
consumption can replenish electrolytes and
maintain energy. However, if sweating is
excessive, or employees are not eating
regularly, workers may benefit from an
electrolyte replacement drink (e.g.,
Gatorade®, Powerade®, etc.).75
Improving ventilation and providing shade
may help workers maintain hydration.75
Providing shade will also protect outdoor
workers from harmful UV rays.
Tools: OUTDOOR WORKERS AND SHADE
For more information on sun safety and shade in the workplace visit the ‘Sun
Protection’ section of the Project Health website http://www.projecthealth.ca or call
519-883-2287
Project Health - Healthy Eating Toolkit for Workplaces
Caffeine and Hydration
There is no evidence that caffeine causes
dehydration or electrolyte imbalance.76,77
Health Canada recommends that caffeine
intake should be limited to 400 mg per day
for the general population and 300 mg per
day for women of childbearing age (about
500 ml of coffee per day).78 High intakes of
caffeine can have undesirable side effects
such as insomnia, anxiety and headaches.
There are also links between high caffeine
consumption and health problems such as
high blood pressure, osteoporosis and
negative effects on reproduction.78
Interventions for Hot Conditions:
Inform workers of hydration guidelines
Ensure cold water is available to
employees at all times as well as
drinks containing electrolytes for
employees who experience excessive
sweat losses
Provide workers with reusable drinking
containers
Provide shade and/or adequate
ventilation for employees who work in
hot conditions
Ensure employees have adequate time
for meals and snacks
208
Employees Who Smoke
While people are aware of the dangers of Interventions for Smokers
smoking, concerns about weight gain after
The U.S. Clinical Practice Guidelines for
cessation are often the reason that people
smoking cessation recommend that
decide not to quit and/or relapse.79-81
individuals focus on changing smoking
Smokers who quit normally gain two to five
behaviour alone rather than
kilograms (five to ten pounds).79,81,82
incorporating calorie restriction, at least
However, within five to seven years former
until they are confident that they will not
smokers will likely weigh the same as non-
have a smoking relapse80,81
smokers who are in the same age group.79
A supportive smoke-free environment
It is important that employees who are trying
can help individuals who are trying to
to quit smoking are supported in the
quit avoid triggers for smoking
workplace. Part of this supportive
behaviour
environment includes reducing exposure to
unhealthy foods and beverages. Additionally, a supportive healthy eating
environment can help these employees
It is likely too difficult for people to try to
focus on living smoke-free!
resist multiple temptations at one time. It
appears that self-control will eventually
break down if there are too many
temptations in the environment.80

Food for Thought: MULTIPLE TEMPTATIONS

One study showed that smokers who had to resist eating cookies were more likely to
smoke than those who had to resist vegetables.2 This even happened to individuals who
were not trying to quit.2
The bottom line: A supportive, healthy eating environment can help employees to
maintain other health behaviours such as smoke-free living.

Tools: SMOKING CESSATION IN THE WORKPLACE

Contact Project Health for assistance in supporting your smoke-free environment:
http://www.projecthealth.ca or 519-883-2287.

Project Health – Comprehensive Strategies to Promote Healthy Eating 209

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 Community Involvement
Community Involvement
Organizations have an impact on the community where they operate. Often
workplaces will make efforts to improve the well-being of the surrounding
community. For example, workplaces often participate in fundraisers and food
drives that support local organizations and charities. Participating in community
causes gives employees a sense of pride and accomplishment.

Definitions of Success
 Fundraising involves events or non-food items
 Healthy food is donated to local food banks and other charity organizations

 If food is sold for fundraising purposes, only “Maximum Nutritional Value” or

“Sell/Offer Most” foods are used*
*See Nutrition Standards in Appendix A for a description of food categories
Fundraising Strategies
Fundraisers often rely on the sale of less healthy food options. However, there are plenty of healthy
alternatives for a successful fundraiser:
Raffle or 50/50 tickets can be sold for prize draws (e.g., money, event ticket, day off etc.).
Ensure prizes support healthy living messages (e.g., avoid alcohol and candy prizes)

Sell common household items such as garbage bags, gift paper, greeting cards reusable
lunch bags, tote bags, t-shirts, hats, first aid kits, emergency preparedness kits, mugs, water
bottles, pens, stationary, or calendars with your workplace logo

Sell gardening products such as flowers, bulbs, vegetable, fruit or herb plants
Have employees donate time and items for a company garage sale or silent auction
Create a healthy eating cookbook

Hold a charity car wash or golf event

Offer employees the option of having a payroll deduction for a charity (one-time or on-going)
Have employees find sponsors for physical activity based events such as walk or run
events, rowing or dragon boat events, biking, or triathlon events (swim, bike and run)
Allow employees to make a small donation to participate in dress-down days, theme days or
costume days (e.g., Halloween). Offer tax receipts for larger financial donations

Sell tickets for a workplace talent show (e.g., music, skits, acting, dancing art, etc).
Have employees donate requested items for selected charities (e.g., mittens and hats)
Visit http://www.canadianfundraising.com/ontario.asp, or http://www.shopandsupport.ca for
more fundraising options

The Bottom Line

When organizing fundraisers ensure that your planned activities are aligned with your wellness
promotion messaging (e.g., avoid chocolate and candy, alcohol, tanning, etc.).

Project Health - Comprehensive Strategies to Promote Healthy Eating 214

Food-based Fundraising Strategies
Whenever possible try not to have food-based fundraisers. However, if you choose
food-based events to raise money, ensure that the food served meets the criteria for
“Maximum Nutritional Value” or “Sell/Offer Most”. Also, make sure that any food served
has been handled according to foods safety requirements. See Nutrition Standards in
Appendix A for a description of food categories.

Serve a healthy meal for a charity event. Have a charity barbeque (e.g., shish-ka-bobs with
corn), or a charity lunch or dinner (e.g., chilli with whole-grain bread and a salad with
vinaigrette dressing)
Healthy pizza day – serve a healthier pizza (i.e. request thin, whole grain crust, less cheese
or part-skim cheese with 20% M.F. or less), lean meat such as ham or chicken, vegetable
toppings and low sodium pizza sauce. Also order a salad or veggie sticks with low fat
dressing on the side to accompany the pizza
Sell vegetable and fruit boxes from local suppliers
Use a cheese or fruit basket as a prize
Try to avoid bake sales, as foods offered tend to fall into the “Not Recommended” category.
If you decide to have a bake sale feature recipes that use ingredients with “Maximum
Nutritional Value” or “Sell/Offer Most” category

The Bottom Line

Ensure that your fundraisers are not conflicting with your healthy eating messaging.

Project Health - Comprehensive Strategies to Promote Healthy Eating 215

Food Drive Strategies
Food banks and other local agencies in Waterloo Region aim to provide a selection of
food that is safe, healthy and culturally/personally acceptable. Food banks often receive
donations of less healthy food items. With more healthy food donations, charitable
organizations can offer a selection of healthy, nutritious foods to patrons and programs
who receive food assistance. Workplaces can assist by donating healthy non-perishable
food items by actively promoting the need for donated items that are healthier choices.

Meat and Meat Alternatives Healthy Choice Examples

Canned chick peas, kidney beans, Romano
beans, 6-bean mix, lentils
Dried green/yellow split peas, red/green
lentils, kidney or lima beans, chick peas
Peanut butter
Canned tuna, salmon, sardines, herring,
chicken, turkey (packed in water or
tomato sauce).
Sunflower seeds, peanuts, almonds, other
nuts/seeds, trail mix
Vegetables and Fruit
Canned fruit: peaches, pears, fruit cocktail
Applesauce
Dried fruit: raisins, apricots and prunes
Canned tomatoes
Pasta sauce (tomato)
Canned vegetables: beets, beans, peas,
corn
Grain Products
Oatmeal
Cold cereals
Whole grain or whole wheat pasta
Whole grain crisp breads and crackers
Whole grains for cooking and baking (e.g.
brown rice, whole grain or whole wheat
flour)
No added salt
No added salt. Must be in a manufacturer’s sealed
container
No added sugar, salt or hydrogenated oil.
Look for <200 mg of sodium per 60g serving
No added salt (e.g., <10 mg per serving). Must be
in a manufacturer’s sealed container
Packed in juice (15 g sugar per 125 ml serving)
Unsweetened (10 g sugar per 100 ml)
Must be in manufacturer’s sealed container
No added salt or very little added salt (e.g., 15 mg
sodium per 125 ml)
Choose the variety with the lowest amount of salt
and fat
No added salt or very little added salt (e.g., beets –
160 mg per 125 ml, other vegetables <50 mg
sodium per 125 ml)
No added sugar, no added salt
At least 4-6 grams fibre; ≤10 g sugar
no trans fat; low fat; no added salt or very little
added salt

Project Health - Comprehensive Strategies to Promote Healthy Eating 216

Fresh Food Donations
Some food banks and other charitable organizations accept donations of fresh fruit and vegetables.
Your workplace can contribute by:
Creating a workplace garden and donating vegetables and fruit to local agencies
Donating a plot of land to community agencies to create a community garden

Making financial or equipment donations to support existing community gardens

Your employees can also donate vegetables and fruit from their own gardens at home

COMMUNITY GARDENS IN WATERLOO REGION

For more information on community gardens in Waterloo Region, visit Community Gardens of
Waterloo Region: http://together4health.ca/workgroups/waterloo-region-community-garden-council

Success Story: TOYOTA MOTOR MANUFACTURING CANADA (TMMC)

TMMC in Cambridge is promoting healthy eating through the creation of a Charity
Vegetable Garden. Toyota's workplace garden uses a ‘natural gardening’ approach by
using only natural soils, collecting seeds for future years, and sharing gardening tips
which are passed along through the generations. Twenty volunteers from all over the
plant nurture the garden. All of the produce is donated to a local charity.

Project Health - Comprehensive Strategies to Promote Healthy Eating 217