Live Life Well @ Health User Guide

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Healthier Food and Drink Choices • User Guide

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Live Life Well @ HealthHealthier Food and Drink Choices for Staff and Visitors in NSW Health Facilities

User Guide

NSW DEPARTMENT OF HEALTH

73 Miller Street

NORTH SYDNEY NSW 2060

Tel. (02) 9391 9000

Fax. (02) 9391 9101

TTY. (02) 9391 9900

www.health.nsw.gov.au

This work is copyright. It may be reproduced in whole or in part for study

training purposes subject to the inclusion of an acknowledgement of the source.

It may not be reproduced for commercial usage or sale. Reproduction for

purposes other than those indicated above requires written permission from

the NSW Department of Health.

© NSW Department of Health 2010. Centre for Health Advancement.

SHPN (CHA) 090098

ISBN 978-1-74187-351-1

For further copies of this document please contact:

Resource Distribution Unit

Locked Mail Bag 5003

Galdesville, NSW 2111

Tel. (02) 9879 0443

Fax. (02) 9879 0994

Further copies of this document can be downloaded from the NSW Health website www.health.nsw.gov.au

May 2010

Acknowledgement

The NSW Department of Health gratefully acknowledges adaptation of elements of Queensland Health’s A Better Choice: Healthy Food and Drink Supply Strategy (2007).

What you’ll get from this guide 5

Live Life Well @ Health 8

What is Live Life Well @ Health aiming to achieve? 8

What facilities and food outlets are applicable? 8

Why is Live Life Well @ Health needed? 9

Guiding Principles for Live Life Well @ Health 9

Requirements of Live Live Life Well @ Health 10

Healthier eating 11

The Australian Dietary Guidelines 12

The Australian Guide to Healthy Eating 14

The traffi c light approach 15

The GREEN category – Best Choices 15

The AMBER category – Select Carefully 17

The RED category – Limit 18

The nutrition standard 20

The nutrition standard for Live Life Well @ Health 20

Nutrient criteria to identify RED foods and drinks 20

The marketing standards 24

Marketing standards for Live Life Well @ Health 25

Marketing based on the 4 P’s 25

contents

Applying Live Life Well @ Health 27

Interpreting nutrition information panels 28

Example of applying Live Life Well @ Health: A snack and drink machine 32

Accessing healthier product offerings 33

Contracts, leases and tenders 34

How to assess your food outlet 34

The improvement checklist 35

Voluntary support through healthy fundraising 37

Useful information 38

Useful websites 39

Useful publications 40

Glossary 41

References 43

Appendix: Ready reckoner of ‘applicable foods’ 44commonly sold in NSW Health facilities

contentscont.

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What you’ll get from this guide

This ‘User Guide’ is designed for those who are involved in putting the policy directive Live Life Well @ Health: Healthier Food and Drink Choices for Staff and Visitors (PD2009_081) in to practice. Food service managers/personnel, retailers and caterers operating within NSW Health, as well as contract managers, will fi nd it particularly useful.

The User Guide explains the Live Life Well @ Health Nutrition and Marketing Standards and provides practical information on how to apply them. A ready reckoner is included to help simplify the task of classifying healthier and less healthy foods.

The User Guide is not intended to be read from start to fi nish. Select the sections that are most relevant to your work and experience. You may wish to check your progress against pertinent sections of the Implementation Checklist.

The User Guide can be downloaded from the NSW Health website: www.health.nsw.gov.au

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✓ Some nutritional value

✗ But with extra fat, sugar or salt

✗ Extra kilojoules

✓ Most nutritious

✓ Low in fat, sugar and salt

✓ Low in kilojoules (calories)

✗ Least nutritious✗ High in kilojoules

Live Life Well @ HealthWhat is Live Life Well @ Health aiming to achieve?

What facilities and food outlets are applicable?

Why is Live Life Well @ Health needed?

Guiding Principles for Live Life Well @ Health

Requirements of Live Life Well @ Health

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Live Life Well @ Health

What is Live Life Well @ Health aiming to achieve?

Live Life Well @ Health aims to make healthier choices easier choices by improving the nutritional quality of foods and drinks which are available and promoted to staff and visitors in NSW Health facilities.

Broadly, the expected outcomes of Live Life Well @ Health are:

• increased range, number, availability and promotion of healthier food and drink choices • decreased availability and promotion of less healthy foods and drinks.

‘Applicable foods’ in Live Life Well @ Health are:

• single serves of pre-packaged, commercial, ready-to-eat foods and drinks, including snack items, heated single food items and mixed meals

• all confectionary including pick ‘n’ mix confectionary • products packaged for display • fresh fruit • all sandwiches (including rolls, foccacia, wraps etc) • all salads.

What facilities and food outlets are applicable?

Live Life Well @ Health is applicable to all facilities managed by NSW Health including hospitals, community health centres or clinics, rehabilitation centres and offi ce buildings.

Live Life Well @ Health applies to all situations where ‘applicable foods’ are made available to staff and the general public in all NSW Health facilities including:

• cafeterias, canteens and cafes • kiosks and coffee carts • vending machines • catering provided at functions, meetings or special events eg internal meetings,

meetings with external partners, workshops and conferences, including those conducted by external agencies

• Leased premises that sell food or drinks eg newsagents, chemists, and other retail outlets.


As a result of Live Life Well @ Health it is expected that by December, 2011 at least 80 per cent of ‘applicable foods’ offered to staff and visitors through any NSW Health food outlet will be healthier choices.

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Live Life Well @ Health does not apply to: • in-patients for whom nutrition is frequently part of their clinical management. This means

that the policy excludes meals and snacks served to in-patients by the health facility. It also excludes any food and drink products supplied to in-patients through ward trolleys managed by volunteers as a patient service

• ‘applicable foods’ that staff or visitors bring from home eg birthday cake • food prepared in a health facility for outside client groups such as Meals on Wheels

clients or nursing home residents, as there will usually be existing specifi cations for such meals

• events, prizes and fundraising activities, including outlets and vending machines contracted by a hospital auxiliary

• foods prepared or cooked on-site in a health facility, except for salads and sandwiches.

Why is Live Life Well @ Health needed?

The relationship between diet and health is irrefutable. Good nutrition is essential for the normal growth and development of infants and children, physical and mental health throughout life, resistance to infection and protection against chronic disease.1

Poor nutrition is an important risk factor for a number of preventable diseases, including cardiovascular disease, type 2 diabetes, stroke and some cancers. Diets high in saturated fat, sugar and salt and low in plant foods are associated with high blood pressure, elevated blood cholesterol, overweight and obesity.1 As is the case for Australia in general, NSW is facing an obesity epidemic affecting more than half of adults and almost one in four children. 2, 3

One-third of the Australian food dollar is now spent on foods sourced outside the home.4 Such foods often contain high levels of fat, sugar and salt. It is important that people can make healthier choices when buying from food outlets outside the home.

Live Life Well @ Health provides a framework to improve the availability and promotion of healthier foods and drinks across all NSW Health facilities, making healthy choices easier choices for staff and visitors. This approach is in keeping with directions provided by the World Health Organisation.5, 6

Live Life Well @ Health is needed because NSW Health:

• has a responsibility for leading the promotion of healthier lifestyles in NSW7 8

• has an important role in modelling healthy eating to staff and visitors • has a responsibility to provide staff with healthier food and drink choices.

Guiding Principles of Live Life Well @ Health

When applying Live Life Well @ Health, facilities should be guided by the following principles:

• It is important to provide consistent messages about healthy eating in line with the Dietary Guidelines for Australian Adults, the Dietary Guidelines for Children and Adolescents and the Australian Guide to Healthy Eating. 1, 9, 10

• The approach is primarily concerned with increasing access to healthy food choices. Less healthy food choices will be restricted, but not banned.

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Requirements for Live Life Well @ Health

There are four main requirements for the implementation of Live Life Well @ Health in NSW Health facilities. These are:

1. provision of ‘applicable foods’ to staff and visitors in line with the nutrition standard (see page 19)

2. provision of ‘applicable foods’ to staff and visitors in line with the marketing standards (see page 23)

3. incorporation of the requirements of Live Life Well @ Health in to all tenders and contracts that relate to the supply of ’applicable foods’ to staff and visitors in NSW Health facilities

4. provision of healthier ‘applicable food’ choices to staff at all times (including after hours, on weekends and public holidays) in line with the nutrition and marketing standards.

Managers of NSW Health facilities are to ensure that:

• Live Life Well @ Health is brought to the attention of key personnel who have a role in policy implementation

• an action plan is developed for delivering the mandatory requirements and which engages key personnel and volunteers

• staff and visitors are informed about local implementation of the policy.


Healthier EatingThe Australian Dietary Guidelines

The Australian Guide to Healthy Eating

The traffi c light approach

The GREEN category – Best Choices

The AMBER category – Select Carefully

The RED category – Limit

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Healthier Eating

Healthier Eating

Live Life Well @ Health is consistent with the Dietary Guidelines for Australian Adults1, Dietary Guidelines for Children and Adolescents in Australia10 and the Australian Guide to Healthy Eating9. These resources are the basis for the Live Life Well @ Health traffi c light system which will help you to categorise foods as healthier or less healthy choices.

The Australian Dietary Guidelines

The Dietary Guidelines for Australian Adults and the Dietary Guidelines for Children and Adolescents in Australia were developed by the National Health and Medical Research Council (NHMRC) to support healthy eating patterns. They are based on scientifi c evidence available about the nutrients and foods that adults and children need for good health. The individual guidelines are not listed in order of importance and should be considered as a package, rather than in isolation. (NOTE: A revision of the Australian dietary guidelines is expected to be released in 2010 as a result of the ongoing review processes undertaken by the NHMRC).

The Dietary Guidelines for Australian Adults

Enjoy a wide variety of nutritious foods

• Eat plenty of vegetables, legumes and fruits• Eat plenty of cereals, (including breads, rice, pasta and noodles), preferably

wholegrain• Include lean meat, fi sh, poultry and/or alternatives• Include milks, yoghurt, cheese and/or alternatives. Reduced fat varieties should

be chosen, where possible• Drink plenty of water.

and care should be taken to:

• Limit saturated fat and moderate total fat intake• Choose foods low in salt• Limit your alcohol intake if you choose to drink• Consume only moderate amounts of sugars and foods containing added sugars.

Prevent weight gain: be physically active and eat according to your energy needs

Care for your food: prepare and store it safely

Encourage and support breastfeeding

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The Dietary Guidelines for Children and Adolescents in Australia

Encourage and support breastfeeding

Children and adolescents need suffi cient nutritious foods to grow and develop normally

• Growth should be checked regularly for young children• Physical activity is important for all children and adolescents.

Enjoy a wide variety of nutritious foods

Children and adolescents should be encouraged to:

• Eat plenty of vegetables, legumes and fruits• Eat plenty of cereals, (including breads, rice, pasta and noodles), preferably

wholegrain• Include lean meat, fi sh, poultry and/or alternatives• Include milks, yoghurt, cheese and/or alternatives. Reduced fat milk is not suitable for

young children under 2 years old, but reduced fat varieties should be encouraged for older children and adolescents

• Choose water as a drink.

and care should be taken to:

• Limit saturated fat and moderate total fat intake. Low fat diets are not suitable for infants

• Choose foods low in salt• Consume only moderate amounts of sugars and foods containing added sugars.

Care for your child’s food: prepare and store it safely

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Healthier Eating

The Australian Guide to Healthy Eating

The Australian Guide to Healthy Eating provides information about the amounts and types of foods needed each day from the fi ve basic food groups, and are consistent with the Australian dietary guidelines.

The basic fi ve food groups

While the Australian Dietary Guidelines (2003) provide the general framework for sound nutrition, the Australian Guide to Healthy Eating provides more specifi c advice regarding the number of serves needed from each of the basic fi ve food groups for different age and gender groups.

The Australian Guide to Healthy Eating uses a plate model, divided in to different sized segments, to indicate the proportions of food from each of the fi ve food groups that should be eaten for good health. Foods are grouped where they share a similar range of nutrients. About two-thirds of the foods we eat should come from two major food groups – the breads, cereals, rice, pasta and noodles group and the vegetables and legumes group.

Source: The Australian Guide to Healthy Eating, copyright Commonwealth of Australia 1998, reproduced by permission of the Australian Government Department of Health and Ageing.

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Extra foods

Some foods do not fi t in to the fi ve food groups because they are not good sources of essential nutrients and are high in energy (kilojoules). They are regarded as ‘extra’ foods and include biscuits, cakes, desserts, pastries, soft drinks, high fat snack items such as crisps, pies, pasties, sausage rolls and other takeaways, lollies and chocolates. Most of these foods are high in fat (particularly saturated fat), and/or salt and/or added sugar. For these reasons it is recommended that their intake is limited, and that they are eaten only occasionally or in small amounts.

The Traffi c Light Approach

There are hundreds of different food products which are available to staff and visitors in NSW Health facilities, and many new products are being introduced every year. A traffi c light approach is being used to simplify the task of categorising foods in line with the national dietary guidelines. This means that under Live Life Well @ Health ‘applicable foods’ are classifi ed in to three colour categories according to their nutritional value: GREEN, AMBER and RED.

GREEN – Best choices

Actively promote and encourage these foods and drinks. These foods should dominate the menu or display. Encourage staff and visitors to choose GREEN products everyday.

AMBER – Select carefully

Do not let these foods and drinks dominate the menu or display. Avoid large serve sizes. Encourage staff and visitors to choose AMBER products sometimes only.

RED – Limit

Limit the availability of these products to no more than 20 per cent of the ‘applicable foods’ offered. Use the smallest available serve size of foods. Limit drinks to 375ml. Encourage staff and visitors to choose RED products rarely.

The GREEN category – Best choices

Foods and drinks from the GREEN category are the best choices because in general they:

• are nutritious • are low in saturated fat, sugar and salt • help to avoid an intake of excess energy (kilojoules).

In broad terms, foods in the GREEN category include breads, wholegrain cereals, rice, pasta, noodles; vegetables and legumes; fruit; reduced-fat milk, yoghurt and cheese; lean meats, fi sh, poultry, eggs; and, water. These products are easy to assess because they are automatically in the GREEN category.

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Healthier Eating

Even within the GREEN category healthier choices can be made. For example, wholegrain breads provide more nutritional value than refi ned varieties because they incorporate all of the natural grain and are higher in fi bre.

Water should always be readily available, free of charge to staff and visitors in NSW Health facilities. Tap water is the preferred drink but commercial water may be sold by food outlets.

The table below shows examples of foods that fi t in to the GREEN category. For more information on better choices within the GREEN category refer to the Ready Reckoner of ‘applicable foods’ commonly sold in NSW Health Facilities on pages 41 – 47.

The GREEN category

Food type Examples

Breads All breads including multigrain, wholemeal, rye, hi-fi bre, white breads or rolls. Examples include burritos, English muffi ns, focaccia, lavash, Lebanese, pita, raisin or fruit breads, tortillas and Turkish breads. Some plain corn and rice cakes or crispbreads. Pikelets, hot cross buns and small scones.

Breakfast cereals Wholegrain breakfast cereals that are high in fi bre and lower in salt and added sugar. Examples include wheat biscuits, cereal fl akes with a variety of grains, bran, un-toasted muesli or porridge.

Other grain foods Plain rice, pasta, unfl avoured noodles, polenta, cous cous, buckwheat.

Fruit All fresh, frozen, canned and dried fruit. Includes avocado.

Vegetables All fresh, frozen, canned and dried vegetables. Char grilled vegetables drained of oil.

Legumes All forms of dried and prepared beans (pulses) and peas. Examples include baked beans, red kidney beans, soy beans, mung beans, lentils, chick-peas, split peas, bean curd and tofu.

Dairy products Plain or fl avoured reduced fat varieties of milk, yoghurt, cheese and custard.

Dairy Alternatives Plain or fl avoured reduced fat soy varieties of milk, yoghurt, cheese and custard. Choose products fortifi ed with calcium.

Lean meat, fi sh, poultry, eggs and alternatives

Lean chicken, turkey, beef, pork, lamb and veal with fat and skin removed. All fresh and plain frozen fi sh. Canned fi sh such as tuna, salmon, sardines (drained of oil or canned in spring water with no added salt). Eggs.

Nuts and seeds All plain, unsalted, un-roasted nuts and seeds. All nut and seed pastes with no added sugar, salt or fat. (Check local policy of the health facility for provision of nuts.)

Drinks Water. Unfl avoured mineral water and soda water. Reduced fat milk/soy milk (plain or fl avoured).

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The AMBER category – Select carefully

AMBER foods are mainly processed foods and drinks which should be selected carefully because in general they:

• have some nutritional value, but less than GREEN products • can, in large serve sizes, contribute to excess kilojoules • have added saturated fat, sugar or salt.

Choosing AMBER foods and drinks carefully means:

• reducing the number of AMBER foods and drink offerings • reading food labels to compare and choose healthier choices • providing smaller serve sizes where possible.

Types of foods and drinks that fi t in AMBER

AMBER products include:

Full fat dairy products (plain and fl avoured), yoghurt, custard, cheese; diet drinks and fruit juice, sandwiches made with high saturated fat ingredients such as butter, mayonnaise and processed meats, as well salads added oil-based dressing.

Some types of ‘applicable foods’ may be classifi ed as either AMBER or RED depending on their nutrient content. These types of foods include:

• sugar-sweetened drinks • ice blocks and ice confections • savoury snack foods and biscuits • cakes, muffi ns and sweet pastries • snack food bars and sweet biscuits • ice creams and dairy desserts • hot single food items such as savoury pastries, oven-baked potato products crumbed or

coated meats • frozen/ready-to-eat meals.

In these cases the nutrient content of the product will need to be assessed against ‘Nutrient criteria to identify RED foods and drinks’ specifi ed on pages 20 – 21 to determine whether it is an AMBER or a RED choice.

Using product information from the Nutrition Information Panel, assess such items against the tables on pages 20 – 21. If a product contains less than or equal amounts of the nutrients specifi ed by the criteria it will be classifi ed as an AMBER choice. If a product has higher amounts than any nutrient criteria it is considered a RED choice. For more information on how to read and compare food labels, refer to pages 25 – 28.

The Ready Reckoner of ‘applicable foods’ commonly sold in NSW Health Facilities on pages 41– 47 may assist you in making a quick assessment.

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Healthier Eating

Artifi cially-sweetened, ‘diet’, ‘sugar-free’ or ‘low-joule’ drinks

The acids present in soft drinks, including sugar free or artifi cially sweetened varieties, have been associated with the gradual erosion of enamel from teeth causing sensitivity and loss of the tooth’s natural shape.12 If these drinks are consumed on a regular basis, the risk of tooth erosion increases considerably. Artifi cially sweetened drinks are therefore classifi ed in the AMBER category. Try to keep to a 375ml serve.

Don’t let AMBER foods and drinks dominate

Foods and drinks in the AMBER category can offer convenience. However these products should not dominate the choices available at the expense of GREEN options. A display with mostly AMBER options will be too heavily balanced towards higher kilojoule product lines of lesser nutritional value.

Avoid large serve sizes – provide moderate serve sizes

There is a general trend towards serving or packaging foods and drinks in bigger serving sizes. For instance, some meat pies are 25 per cent larger today than they were several years ago. Eating foods and drinks in larger serve sizes makes it easier to consume excess energy (kilojoules). Provide smaller serve sizes instead. For example, try to keep full fat milks and juices to a 375ml serve.

The RED category – Limit

Most foods and drinks that make up the RED category are based on the ‘extra’ foods as defi ned by the Australian Guide to Healthy Eating. ‘Nutrient criteria to identify RED foods and drinks’ are provided to help determine whether a food or drink fi ts in to the RED category.

Foods and drinks from this category are not an essential part of a balanced diet. It is recommended that these foods and drinks are only eaten occasionally and in small amounts because they generally:

• lack nutritional value • are high in saturated fat, sugar or salt • contribute excess energy (kilojoules).

The table below provides a broad description of the types of foods and drinks that are generally placed in the RED category.

Where drinks in the RED category are offered, they must not exceed a 375ml serve.

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Types of foods and beverages that fi t in to the RED category

The RED categoryFood type Examples

Sugar-sweetened drinks Soft drinks, fruit drinks, energy drinks, sports drinks and fl avoured mineral waters

Confectionery or lollies All types

Savoury snacks Crisps, potato chips and other similar products

Ice-creams Chocolate-coated and premium ice-creams

Cakes, muffi ns, sweet tarts, pies, pastries and slices

Croissants, donuts, cream-fi lled buns or cakes and sweet pastries. Medium to large serves of cakes and muffi ns

Hot savoury items Most pies, pastries, sausage rolls, or quiche

Some types of products may fall in to either the RED or AMBER categories depending on their nutrient content. Compare the nutrition information label of products against the ‘Nutrient criteria to identify RED foods and drinks’ on pages 20 – 21.

The nutrition standard for Live Life Well @ Health

Nutrient criteria to identify RED foods and drinks

The Nutrition Standard

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The Nutrition Standard for Live Life Well @ Health

The Nutrition Standard for Live Life Well @ Health is:

’Applicable foods’ include single serves of pre-packaged, commercial, ready-to-eat foods and drinks; pick ‘n’ mix confectionary; products packaged for display; fresh fruit; all sandwiches (including rolls, foccacia, wraps etc); and all salads.

The Nutrition Standard is:

• applicable to each separate outlet and each separate vending machine in any NSW Health facility.

• a minimum standard. NSW Health facilities may choose to supply a lower percentage of RED products as considered appropriate eg for professional seminars or staff meetings.

A target of at least 50 per cent GREEN ‘applicable’ foods (and so, no more than 30 per cent AMBER) is not mandatory, but strongly encouraged. Such targets will take time to achieve as healthier options need to be sourced, trialled and phased in.

Nutrient criteria to identify RED foods and drinks

The following tables on pages 20 – 21 list the set of nutrient criteria to defi ne whether an ‘applicable’ food or drink falls in to the RED category. There are three main groupings of food and drink that are assessed:

• snacks and sugar-sweetened drinks (Table 1) • hot single food items (Table 2) • commercial, frozen/ready-to-eat mixed meals (Table 3).

Within each table there are a number of product categories.

Assessing a product against the criteria

Use the RED food and drink criteria tables on the following pages along with the product’s nutrition information panel to determine if a food or drink fi ts in to the RED category. If a product exceeds any one of the nutrient criteria for the product category then it is considered to be in the RED category.

Of the ‘applicable foods’ available to staff and visitors, the proportion of RED product lines should not exceed 20 per cent.

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For example, if a crumbed meat patty contains more than 1000kJ energy per 100 grams, even though it has less saturated fat and less sodium than the criteria specifi ed in Table 2, it is still considered to be in the RED category.

Foods and drinks are assessed ‘per 100 grams’ or ‘per serve’ as sold. For example, drinks and snack foods (Table 1) are assessed on a per serve basis for ease of use. Hot single foods (Table 2) are assessed per 100 grams due to the wide variation in serve sizes within this category. Commercial, frozen/ready-to-eat mixed meals are assessed ‘per 100 grams’ and ‘per serve as sold’. There are examples on pages 25 – 28 which show how to use the Nutrition Information Panel to assess products against the nutrient criteria.

Table 1: Snacks and Sugar-sweetened drinks

(assess per serve as sold)

CATEGORY NUTRIENT CRITERIA

FOOD1 OR DRINK Energy (kJ)

per serve

Saturated Fat (g)

per serve

Sodium (mg)

per serve

Sugar-sweetened drinks: Cordials, energy drinks, fl avoured mineral water, iced tea, soft drinks, sports drinks/waters, sweetened waters, fruit juice less than 99% juice, ice blocks, ice confections 2, 3, 4

more than 300kJ

more than100mg

Savoury snack foods and biscuits 5

more than 600kJ

more than 3g more than 200mg

Cakes, muffi ns and sweet pastries

more than 900kJ

more than 3g

Snack food bars, muesli bars, sweet biscuits and fruit bars and leathers (less than 90% dried fruit)

more than 600kJ

more than 3g

Ice creams, milk- or soy-based ice confection and premium dairy desserts 6

more than 600 kJ

more than 3g

1 – Confectionary items are classifi ed as RED. These foods have minimal nutritional value. Sugar free gum, cough lozenges, sugar free lollies and antacids are exempt as they have special uses.

2 – ‘Sugar-sweetened’ drinks and ices applies to soft drinks, fl avoured mineral waters, fl avoured waters, sports waters, sports drinks, energy drinks, fruit drinks, slushees, ice confection, ice blocks, and cordials. Different sources of sugar are used by manufacturers to sweeten drinks and ices including sucrose (commonly called sugar), fructose, glucose, fruit juice, and fruit juice concentrate. Drinks and ices sweetened with any of these ingredients should be assessed against the RED drink criteria. A product that claims on the label that it contains ‘no added sugar’ may still be sweetened with a fruit juice concentrate.

3 – Plain unfl avoured waters, plain and fl avoured milks and milk alternatives do not need to be assessed against the RED food and drink criteria tables.

4 – RED drinks may be included as part of the 20% limit described in the Nutrition Standard. However, RED drink offerings should be limited to a 375ml serve.

5 – When a packet of commercial biscuits is used, a serve is equivalent to 2 medium-sized biscuits.

6 – Premium dairy desserts include items such as cheesecake, panna cotta, tiramisu, crème brulee or mousse.

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Table 2: Hot single food items 1

(assess per 100g)


FOOD Energy (kJ)per 100g

Saturated Fat (g)per 100g

Sodium (mg)per 100g

Savoury pastries (eg pies, sausage rolls, quiche, savoury croissants), pizza, oven baked potato products, dim sims, spring rolls, hot noodle cups

more than1000kJ

more than 5g

more than 400mg

Crumbed and coated foods (eg patties, chicken products) frankfurts, sausages

more than 1000 kJ

more than 5g

more than 700mg

1 – Oven-baked potato products include wedges, chips, gems, hash browns, scallops.

Table 3: Commercial, frozen/ready-to-eat mixed meals

(assess per 100g and per serve as sold)


FOOD Energy (kJ)per serve

Saturated Fat (g)per 100g

Sodium (mg)per 100g

Pasta and lasagne, curries, roast dinners, stir fried dinners, fried rice 1

more than2500kJ

more than 4g

more than 400mg

1 – Adapted in line with the Queensland Health. A Better Choice-Healthy Food and Drink Supply Strategy (2007)

The Marketing StandardsMarketing standards for Live Life Well @ Health

Marketing based on the 4 P’s

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Marketing Standards

Marketing Standards

Marketing standards for Live Life Well @ Health

Marketing standards for Live Life Well @ Health are designed to promote the healthier food and drink choices. In general, this means that: • GREEN products are most actively promoted, and most prominently displayed, as they

are the best choices. • AMBER products may be promoted. However, they should not dominate the menu or

displays. Large serve sizes should be avoided. • RED products must not be promoted or prominently displayed.

The Marketing Standards for Live Life Well @ Health are: • point of sale identifi cation and marketing of healthier choices • placement of healthier options to optimise their visibility • price parity of healthier and less healthy options • no ‘combos’ (eg snack plus a drink) of any products sold except where they are classifi ed

as GREEN or AMBER products • no supply or sale of merchandise promoting RED products • no advertising of any RED food or drinks • stocking of RED products in the smallest size available.

Marketing based on the 4 Ps

In applying the marketing standards, it may be helpful to consider the ‘4 Ps’ of marketing. The 4Ps stand for Product; Placement; Promotion; and Price. Examples of how the 4Ps of marketing should be applied in Live Life Well @ Health are outlined below:

Product • Provide a range of appealing healthier food and drink options. These include foods and

drinks from the GREEN and AMBER categories. Aim for GREEN products to comprise 50 per cent of the product lines on offer.

• Include GREEN choices across all product lines and stock. • Presentation is an important factor. Colour, fl avour, texture and temperature are the key

considerations in the successful presentation of ‘applicable foods’ such as salads and sandwiches.

• Stock RED products in the smallest size available and limit the serve size of RED drinks to 375ml. Limit the size of AMBER products where possible.

Placement • Place healthier options in positions to optimise their promotion. For example: o Place GREEN foods and drinks in a prime position, such as at eye-level on shelves,

benches and fridges. AMBER products are then placed at the next best position(s). o Display GREEN foods and drinks prominently. o Place GREEN and AMBER foods and drinks in high traffi c areas. o Establish sections or areas for each category within display cabinets or fridges and

shelves.

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• RED foods and drinks should not be displayed in excessive quantities or in prominent areas such as:

o beside cash registers o at reception desks or counters in waiting areas o at the entrance or exit of an outlet o placed at eye-level on-top or within cabinets, fridges, shelves or free-standing

displays.

Promotion • Identify healthier choices at point of sale where possible. For example, establish a

colour-coding system on menu or display such as a GREEN, AMBER or RED spot. • The promotion and advertising of RED foods and drinks is not permitted in NSW Health

facilities. This includes: o advertising on cabinets, fridges, vending machines or menu boards (a menu listing

of products on sale by brand name is acceptable) o meal or point-of-sale promotions including RED products (eg two-for-one) o any promotional materials or merchandise featuring RED foods or drinks. • Use Live Life Well @ Health resources to promote the overall approach. Providing clear,

easy-to-understand information will help staff and visitors make an informed choice.

Price • Provide price parity of healthier and less healthy alternatives where possible ie the

healthier option does not cost more than, and ideally less than, the standard item eg low fat milk does not cost more than the equivalent full fat milk product.

• Do not offer super-sizing or ‘combos’ (eg snack plus a drink) which use RED products.

Interpreting nutrition information panels

Example of applying Live Life Well @ Health: A snack and drink machine

Accessing healthier product offerings

Contracts, leases and tenders

How to assess your food outlet

The improvement checklist

Voluntary support through healthy fundraising

Applying Live Life Well @ Health

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Interpreting nutrition information panels

Food labels – how to read them

Information on food labels can be confusing. However, if used correctly, food labels can be a useful source of information about a product. Manufacturers are required to include Nutrition Information Panels (NIPs) on food labels under the Food Standards Code.1 NIPs can be used to help work out whether or not a product fi ts in to the RED or AMBER category. Ingredient lists may also help assess products.

What is on a label?

There is a lot of information on food labels. The focus here is on the NIP. The nutrients are displayed in a standard format, providing quantity per serve and quantity per 100g (or 100ml if liquid) of the food or drink.

Reading Nutrition Information Panels

NIPs provide information on the amount of energy (kilojoules), protein, total fat, saturated fat, carbohydrate, sugars and sodium (salt), as well as any other nutrient about which a claim is made (eg fi bre, iron, calcium). Information is required to be provided ‘per 100g’ and ‘per serve’.

IMPORTANT NOTE: In Live Life Well @ Health the term ‘serve size’ refers to the serve ‘as sold’. In some instances this may be different from the serve size specifi ed on the label by the manufacturer. Always check the serve size of the food product using the serve size ‘as sold’.

Comparing a food or drink item against the criteria

When making a decision about the suitability of a product the Nutrition Information Panel (NIP) on the package needs to be compared to the RED food and drink criteria tables on pages 20 – 21.

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Example A: Crumbed Chicken Fillet Patty

Nutrition Information Panel for crumbed chicken fi llet patty

Servings per package: 60

Average serving size: 120g

QUANTITY PER SERVE

QUANTITY PER 100g

ENERGY 1176kJ 980kJ

PROTEIN 17.4g 14.5g

FAT - Total- Saturated

15.8g4.1g

13.2g3.4g

CARBOHYDRATE- Sugars

18.3g0.2g

15.3g0.2g

SODIUM 734mg 612mg

STEP 1

Identify the correct assessment table. This food belongs in the group Hot single food items – crumbed & coated foods and should be assessed against the relevant RED criteria in Table 2. See the crumbed food criteria reproduced below for convenience.


FOOD OR DRINK Energy (kilojoules) per 100g

Saturated fat (g) per 100g

Sodium (mg) per 100g

Crumbed and coated foods, frankfurts, and sausages

more than 1000kJ

more than 5g

more than 700mg

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STEP 2

Hot foods are also assessed per 100g, use the per 100g column on the (NIP).

• per 100g

i) Look at the per 100g column in the NIP for ALL these nutrients:

• Energy (kilojoules) • Saturated fat • Sodium

ii) Compare the NIP using per 100g column with the RED criteria. Highlighted text shows the nutrients of interest for the RED category.

If any one of the nutrient criteria is exceeded, the food is classifi ed in the RED category.

980 kilojoules per 100g is less than the nutrient criteria for energy (fi ts into AMBER category)

3.4g saturated fat per 100g is less than the nutrient criteria for saturated fat content (fi ts

into AMBER category)

612mg sodium per100g is less than the nutrient

criteria for sodium content (fi ts into AMBER category)


FOOD OR DRINK Energy (kilojoules) per 100g

Saturated fat (g) per 100g

Sodium (mg) per 100g

Crumbed and coated foods, frankfurts and sausages

more than 1000kJ

more than 5g

more than 700mg

This crumbed chicken fi llet patty is in the AMBER food category. This means it should be selected carefully in consideration of the overall menu or display, healthier alternatives and serve size.

Nutrition Information Panel for crumbed chicken fi llet patty



QUANTITY PER SERVE

QUANTITY PER 100g

ENERGY 1176kJ 980kJ

PROTEIN 17.4g 14.5g


15.8g4.1g

13.2g3.4g


18.3g0.2g

15.3g0.2g

SODIUM 734mg 612mg

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Example B: Chocolate-coated ice-cream

STEP 1

Identify the correct assessment table. This food belongs in the groupIce-creams, milk- or soy- based ice confection and premium dairy desserts and should be assessed against the RED criteria in Table 1 (page 20).

STEP 2

Ice-creams, milk- or soy- based ice confection and premium dairy desserts are assessed per serve. • per serve

i) Look at the ‘Quantity per serve’ column for these nutrients: • Energy (kilojoules) • Saturated fat

Remember if any one nutrient is greater than the criteria in Table 1 the food is classifi ed in the RED category.

700 kilojoules per serve exceeds the nutrient criteria (fi ts into RED

category)

8.7g saturated fat per serve exceeds the

nutrient criteria (fi ts into RED category)


FOOD OR DRINK Energy (kilojoules) per serve

Saturated Fat (g) per serve

Ice creams, milk- or soy-based ice confection and premium dairy desserts

600kJ 3g

For this serving size, this chocolate coated ice-cream is in the RED category.

Nutrition Information Panel for a chocolate-coated ice cream



QUANTITY PER SERVE

QUANTITY PER 100g

ENERGY 700kJ 1273kJ

PROTEIN 1.2g 2.2g


10.5g8.7g

19.1g15.8g


17.2g15.7g

31.3g28.5g

SODIUM 36mg 65mg

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Example of applying Live Life Well @ Health: A snack and drink machine

The example below illustrates how you could apply Live Life Well @ Health standards to a mixed snack and drink vending machine.

STEP 1: Assess the current situation

Using the Ready Reckoner of ‘applicable foods’ commonly sold in NSW Health Facilities (pages 41 – 47) determine the whether a snack or drink fi ts in to the GREEN, AMBER or RED category. See Figure1(a).

Figure 1(a). Snack and drink machine before applying Live Life Well @ Health standards

Bulky itemse.g crisps.

Bulky items Bulky items Bulky items Bulky items

Choc Choc Choc Snack Lollies Lollies Lollies Snack Snack Snack

Drink Drink Drink Drink Fruit drink

Fruit drink

Fruit drink

Drink Drink Drink

Soft drink

Soft drink

Soft drink

Diet drink

Diet drink

Drink Iced tea

Iced tea

Sports drink

Sports drink

Water Water Water Water 99% juice

99% juice

99% juice

Fruit drink

Drink Drink

STEP 2: Assess the proportion of GREEN, AMBER or RED products.

To work out the overall proportion of products from each colour category, determine the total number of slots in the machine. In the example of Figure 1 (a) there are 45 slots of varying size. You also need to count the number of slots containing GREEN, AMBER or RED products.

Then determine the proportion of products from each colour category. For example, the 4 GREEN products in the example in Figure 1 (a) represent 9 per cent of the products displayed ie 4/45 x 100 = 9 per cent. The proportions of GREEN, AMBER or RED products are summarised in Figure 1 (b).

Figure 1(b): Proportions of GREEN, AMBER or RED products.

Total Slots = 45 4 GREEN 12 AMBER 29 RED

Proportion displayed 9% 27% 64%

This machine in Figure 1(a) does not comply with Live Life Well @ Health standards because the 20 per cent limit on RED products is exceeded and RED products are prominently displayed.

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STEP 3: Make the change to a Live Life Well @ Health snack and drinks machine: Limit red offerings to 20 per cent.

Rearrange offerings so that healthier choices are prominently displayed. Over time, increase the proportion of GREEN choices.

Figure 2 (a): Proportion of snack and drinks machine after Live Life Well @ Health standards are applied

Bulky snack items

Bulky snack items

Bulky snack items Bulky snack items

Bulky snack items

Snack Snack Snack Snack Snack Snack Snack Snack Snack Snack

99% juice

99% juice

Water Water Water Water Water Water Diet drink

Diet drink

99% juice

99% juice

Diet drink

Plain full fat milk

Flav. reduced fat milk

Flav. reduced fat milk

Flav. full fat milk

Flav. full fat milk

Diet iced tea

Iced tea

Soft drink

Soft drink

Fruit drink

*Drink Drink Drink Drink *Drink Sports drink

Sports drink

* Maximum serve size of RED drinks is 375ml (mandatory limit). Suggested maximum serve size for 99% juice, full fat milk and diet drinks is 375ml (non mandatory limit).

STEP 4. Check the overall proportion of GREEN, AMBER and RED drinks

Figure 2 (b). Proportions of GREEN, AMBER or RED products in the modifi ed snack and drink machine.

Total Slots = 45 14 GREEN 22 AMBER 9 RED

Proportion displayed 31% 49% 20%

This machine now complies with the recommendations from Live Life Well @ Health. RED products have been reduced to 20 per cent of the options. GREEN and AMBER options are displayed most prominently in the central and eye-level slots.

Accessing Healthier food offerings

A useful on-line search tool is available at www.healthyfoodproducts.com.au

Using this tool you can search for new GREEN and AMBER product alternatives suitable for your health facility. You can also obtain the details you need to purchase these products.

The tool allows you to search by category, company and key word.

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Contracts, Leases and Tenders

The requirements of the Live Life Well @ Health should be incorporated in to all relevant contracts, leases and tenders ie those that relate to the provision of ’applicable foods’ to staff and visitors in NSW Health facilities.

Tenders for all new contracts must identify the Live Life Well @ Health policy. Such tenders should also specify that the tenderer needs to nominate how they will comply with the Nutrition and Marketing Standards. Ability to demonstrate how these standards will be carried out should be a selection criterion.

All new contracts, as well as extensions or renewals of existing contracts, need to incorporate the Nutrition and Marketing Standards of the Policy Directive.

All new contracts, as well as extensions or renewals of existing contracts, should provide a clause which notes that NSW Health may amend the Live Life Well @ Health policy directive from time to time and that suppliers will be required to take all reasonable steps to adjust their offering to comply with such amendments.

Where there are existing binding contracts for the supply of food and drinks which do not comply with Live Life Well @ Health, the contractors need to be informed about the Policy requirements and encouraged to comply on a goodwill basis. The contractor should be advised that when the contract expires, the requirements of Live Life Well @ Health will be incorporated in the selection criteria for subsequent tenders and contracts.

In some instances it may be possible to negotiate an extended term of tenancy in a lease in exchange for immediate compliance.

How to assess your food outlet

Live Life Well @ Health requires that less healthy ‘applicable’ foods are limited to 20 per cent in NSW Health food outlets and vending machines.

In food outlets which have a small range of products for sale, it is appropriate to calculate the proportion of RED foods as a percentage of all ‘applicable’ food and drink offerings.

When an outlet has a large number of food and drink offerings of many types, it is suggested to group, assess and report on products using the following groupings:

• savoury hot meal options• savoury cold meal options (including salads and sandwiches/bread rolls etc)• savoury/sweet snack foods (including confectionary) and desserts • cold drinks.

Where these groupings are applied, there should be no more that 20 per cent RED product lines in any of the groupings.

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Improvement Checklist

In addition to reviewing the types of foods and drinks offered for sale, successful implementation of Live Life Well @ Health requires attention to other management and promotional factors. The checklist below sets out a number of these factors. This checklist may be used by the responsible managers/committee of the health facility to monitor progress towards Live Life Well @ Health.

Key factor for success Met Areas needing improvement

Mechanism for coordination

A mechanism is identifi ed to engage key personnel in local implementation of Live Life Well @ Health eg an existing group(s), network, new structure.

An action plan with priorities, assigned responsibilities and timelines is developed.

Vending machines

A maximum of 20% ‘applicable’ foods offered are RED product lines.

GREEN foods and drinks are stocked and displayed prominently.

GREEN foods and drinks are always available.

Vending machines do not advertise RED products.

Contractors or personnel restocking the machines are well informed about the requirements of Live Life Well @ Health.

The requirements of Live Life Well @ Health are incorporated in vending contracts.

Other food outlets

Personnel are well informed about Live Life Well @ Health.

Reliable, regular access to healthier food and drink products by customers.

Live Life Well @ Health requirements are incorporated in leases or contracts for retailers/contractors who sell food/drinks in the health facility.

A maximum of 20% ‘applicable foods’ offered are RED product lines.

Personnel have a clear understanding of their role in implementing Live Life Well @ Health.

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Marketing and Promotion

Live Life Well @ Health promotional resources are used.

Promote ‘applicable foods’ in the GREEN category.

Identify healthier choices at point of sale.

Healthier options are placed to optimise their promotion.

RED foods/drinks are not prominently displayed.

RED foods and drinks are not advertised or promoted.

Stock RED foods in the smallest size available.

RED drinks do not exceed 375ml.

The healthier options do not cost more than the standard option where possible.

Establish sections for each category eg in display cabinets, fridges.

No ‘combos’ (eg snack plus a drink) of any products sold except where they are classifi ed as GREEN or AMBER products.

Catering supplied at functions and meetings

A maximum of 20% ‘applicable foods’ provided are RED choices.

Staff or companies preparing or organising catering are informed about Live Life Well @ Health catering requirements.

Fundraising

Fundraisers are aware of the Live Life Well @ Health and encouraged to support the policy on a voluntary basis.

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Voluntary Support through Healthy Fundraising

Fundraising activities which are designed to raise money to support charities or patient services in NSW Health facilities are exempt from complying with Live Life Well @ Health. However, fundraisers are encouraged to support the aim and objectives of Live Life Well @ Health on a voluntary basis.

Ideally staff and visitors receive consistent nutrition messages throughout a health facility. For example, a visitor cannot distinguish between a vending machine run by the health service and a machine run by fundraisers!

For the purposes of Live Life Well @ Health the term ‘fundraising’ concerns activities undertaken within NSW Health facilities which are designed to raise money to support client/patient services or charities/service clubs. Examples include a hospital auxiliary shop and a service club stall.

Activities of staff social clubs for the benefi t of members are bound by the requirements of Live Life Well @ Health. Such activities are not considered to be ‘fundraising’ in the context of Live Life Well @ Health.

Ideas for fundraising activities with an emphasis on health and fun include:

• healthier food options such as seasonal fruit drives or dried fruits • healthy food cookbooks • physical activity events such as fun runs or ride-to-work day • healthy raffl es and healthy barbecues (ask a local butcher about obtaining healthier sausages) • physical activity events - walk-a-thons, fun runs, bike-a-thons, round robin sporting

competitions (eg touch football, soccer or netball) • Leisure, culture and the arts - local cinemas run preview screenings of new movies (and

a percentage of the profi t comes back to the facility), produce a recipe book, offer travel vouchers or host an art show

• Social events - gala dinner, charity ball, auction or trivia night • Second hand sale: Garage or car-boot sale, book fair, ‘white elephant’ stall • Non-food fundraisers - spring fl ower/bulb drives, books or CDs, home wares, gardening

tools, calendars or cards, toothbrushes and sunscreen.

For more ideas on healthy fundraising refer to:

Fruitful fundraising

This is a comprehensive guide with food and non-food fundraising ideas. Features include ways to promote physical activity; event and special day ideas; healthy fundraising policy information; evaluation and other useful resources. A CD-ROM is available on request via (03) 6222 7222 or via email: [email protected].

Fundraising Directory 2008

This guide contains information on events, non-food and some healthier fundraising suppliers available at www.fundraisingdirectory.com.au

Fundraising Ideas for Healthy Kids available at www.nutritionaustralia.org

A range of informative healthy fundraising fact sheets can be found on the Healthy Kids Association website: www.schoolcanteens.org.au

Useful InformationUseful websites

Useful publications

Glossary

References

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Useful Information

Useful Websites

Cancer Council NSWwww.cancercouncil.com.au

Commonwealth Department of Health and Ageingwww.healthyactive.gov.au/internet/healthyactive/publishing.nsf/Content/eating

Food Standards Australia and New Zealandwww.foodstandards.gov.au

Get Healthy Information and Coaching Servicewww.gethealthynsw.com.au

Go for 2&5 fruit and vegetable campaignwww.gofor2and5.com.au

Healthy Food Products on-line search toolwww.healthyfoodproducts.com.au

Healthy kids Associationwww.schoolcanteens.org.au

Live Life Wellwww.livelifewell.nsw.gov.au

Measure Up Campaignwww.measureup.gov.au

National Health and Medical Research Councilwww.nhmrc.gov.au/publications/synopses/dietsyn.htm

NSW Healthwww.health.nsw.gov.au

Nutrition Australiawww.nutritionaustralia.com.au

The Heart Foundationwww.heartfoundation.com.au

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Useful Publications

Australian Guide to Healthy Eating

To obtain copies of the booklet and poster contact the Commonwealth Department of Health and Ageing on 1800 020 103 extension 8654 (free call) or email [email protected]

Food for Health – Dietary Guidelines for Australian Adults

To obtain copies of the booklet, pamphlet and poster produced by the National Health and Medical Research Council contact National Mail and Marketing on 1800 020 103 ext 8654 (free call) or email [email protected]

Food for Health – Dietary Guidelines for Children and Adolescents in Australia

To obtain copies of the booklet, pamphlet and poster produced by the National Health and Medical Research Council contact National Mail and Marketing on 1800 020 103 ext 8654 (free call) or email [email protected]

Live Life Well @ Health support materials (user guide, poster, ‘table talker’ and fundraising pamphlet). Phone: Order free copies phone: 9879 0443 or see on www.health.nsw.gov.au

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Useful Information

Glossary

‘Applicable foods’

Applicable foods in Live Life Well @ Health include single serves of commercial, ready-to-eat foods and drinks; pick ‘n’ mix confectionary; products packaged for display; fresh fruit; all sandwiches (including rolls, foccacia, wraps etc) and all salads.

Catering for staff functions

This refers to catering for activities in the health facility which have been arranged for staff purposes eg internal staff meetings, meetings with external partners, workshops, conferences, planning days, social events, workforce development activities, professional development by an external organisation (eg pharmaceutical company) and lectures.

Coffee carts

A large mobile cart, retailing hot beverages prepared at the point of service. Beverages are predominantly coffee and tea-based. Often non-beverage food items are available for purchase.

Foods and drinks prepared on-site

This includes foods and drinks that involve cooking or preparation of foods/ingredients within a health facility for sale/provision to staff and visitors.

Food and drink outlets

Any situation where food and/or drinks are offered to staff and visitors in a NSW Health facility.

Fundraising

For the purposes of Live Life Well @ Health, ‘fundraising’ concerns activities undertaken within NSW Health facilities which are designed to raise money to support patient services or community charities/service clubs. Examples include a hospital auxiliary shop and stalls for a service club. Funds raised for a staff social club are not considered to be ‘fundraising’.

National dietary guidelines for Australians

The National Health and Medical Council (NHMRC)’s Dietary Guidelines for Australian Adults and Dietary Guidelines for Children and Adolescents in Australia are based on the best available scientifi c evidence and provide information for health professionals and the general population about healthy food and drink choices. These documents are currently under review by the NHMRC. Revised dietary guidelines are expected to be published in 2011.

NSW Health

NSW Health refers to all services in the NSW public health system including Area Health Services, the Children’s Hospital at Westmead, Justice Health, Ambulance Services of NSW, the Clinical Excellence Commission and Health Support Services.

NSW Health facilities

A NSW Health facility refers to any building, including the grounds of the building, which is managed by NSW Health eg the building and campus of hospitals, community health centres or clinics, rehabilitation centres and offi ces.

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Packaged food and drinks

A package is currently defi ned in Standard 1.1.1 of the Australian and New Zealand Food Standards Code as any container or wrapper in or by which food intended for sale is wholly or partly encased, covered, enclosed, contained or packaged and, in the case of food carried or sold or intended to be carried and sold in more than one package, includes every such package, but does not include: (a) bulk cargo containers; or (b) pallet overwraps; or (c) crates and packages which do not obscure labels on the food; or (d) transportation vehicles.

Product lines

A product line refers to a single variety and single size (usually branded) of a food or drink type which is being offered to NSW Health staff and visitors. For example, provision of Brand X diet cola, Brand Y diet cola, Brand X lemonade, and Brand Y regular cola (375ml) and Brand Y regular cola (300ml) would amount to fi ve different product lines of soft drinks. Each different fl avour of a product is a separate product line. For example a Brand XX chocolate paddle pop and Brand XX strawberry paddle pop would amount to two separate product lines.

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Useful Information

References

1. National Health and Medical Research Council. Food for Health - Dietary Guidelines for Australian Adults. Commonwealth of Australia: Canberra. 2003.

2. Centre for Epidemiology and Research. 2008 Summary Report on Adult Health from the New South Wales Population Health Survey. NSW Department of Health: Sydney. 2009.

3. NSW Centre for Overweight and Obesity. NSW Schools Physical Activity and Nutrition Survey (SPANS) (2004): Full report. NSW Department of Health: Sydney. 2006.

4. Stanton, R. Nutrition problems in an obesogenic environment. Medical Journal of Australia, vol. 184(2): 76-79. 2006.

5. World Health Organisation. Health promotion in Hospitals: Evidence and Quality management. World Health Organisation: Geneva. 2005.

6. World Health Organisation. Health promotion in Hospitals Project. World Health Organisation: Geneva. 2005.

7. NSW Premier’s Department. State Plan: Investing in a Better Future. NSW Government: Sydney. 2009.

8. NSW Department of Health. State Health Plan: A New Direction for NSW: Towards 2010. NSW Government: Sydney. 2007.

9. Commonwealth Department of Health and Family Services. The Australian Guide to Healthy Eating. Commonwealth of Australia: Canberra. 1998.

10. National Health and Medical Research Council. Food for Health – Dietary Guidelines for Children and Adolescents in Australia. Commonwealth of Australia: Canberra. 2003.

11. National Health and Medical Research Council. Australian Guidelines to reduce Health risks from drinking Alcohol, Commonwealth of Australia, Canberra. 2009.

12. Dental Practice Education Research Unit. Erosion – Detecting and managing dental erosion. The University of Adelaide. [Online] Available at: http://www.arcpoh.adelaide.edu.au/dperu/special/erosion/ErosionA3.pdf (diet drinks). 2006.

13. Food Standards Australia New Zealand. Australia New Zealand Foods Standard Code, Food Standards Australia New Zealand, Canberra. 2006.

Ready Reckoner

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Ready Reckoner

APPENDIX 1: READY RECKONER FOR ‘APPLICABLE FOODS‘ COMMONLY SOLD IN NSW HEALTH FACILITIES

See the index below to help you fi nd your way around the Ready Reckoner.

How to use the Ready Reckoner Hot single food items Page 49

Biscuits – sweet Page 47 Ice creams Page 49

Breads Page 47 Ice blocks Page 49

Breakfast cereals Page 47 Nuts Page 49

Buns, scones, pikelets Page 47 Salads Page 50

Cakes, muffi ns, sweet pastries etc

Page 47 Savoury snack foods and biscuits

Page 50

Confectionary Page 47 Snack food bars Page 50

Dairy products and alternatives Page 47 Soups Page 50

Commercial, frozen/ready to eat mixed meals

Page 48 Spreads and sauces Page 51

Drinks Page 48 Sushi and rice paper rolls Page 51

Fruit, vegetables and legumes Page 49

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HOW TO USE THE READY RECKONER

Purpose

The purpose of this chart is to help you determine whether an ‘applicable food’ is classifi ed as RED as opposed to AMBER/GREEN. Once ‘applicable foods’ are classifi ed according to the correct colour category, you will be able to assess whether your food outlet/vending machine complies with the Nutrition Standard for Live Life Well @ Health.

‘Applicable foods’ include single serves of: pre-packaged, commercial, ready-to-eat foods and drinks; pick ‘n’ mix confectionary; products packaged for display; all sandwiches (including rolls, focaccia, wraps etc), all salads; and fresh fruit. Food and drinks prepared or cooked on-site, other than salads and sandwiches, are not applicable. A serve refers to a serve as sold.

What are RED, AMBER and GREEN foods?

■ RED products should be limited to no more than 20 per cent of ‘applicable foods’ for sale in an outlet (including a vending machine). This is because they lack nutritional value, are high in saturated fat, sugar and/or salt and can contribute excess energy (kilojoules).

■ AMBER products are mainly processed food and drinks. They have some nutritional value but have moderate levels of saturated fat, sugar and/or salt and, in large serves, can contribute to excess energy (kilojoules).

■ GREEN products are the best choices and should be encouraged. They are nutritious foods, contain less saturated fat, added sugar and/salt and help to avoid excess energy (kilojoules).

How to classify a product in to the right colour category:

1. Choose the appropriate ‘product category’ for the product. See Column 1.

2. Identify the ‘likely colours’ for the product category in Column 2. Also, check the comments in Column 4. This information may be enough to help you decide the suitable colour category for the product.

3. If the ‘likely colours’ are BOTH ■ and ■, check the label information against the RED criteria in Column 3 to work out the best fi t.

• If the product exceeds any of the RED nutrient criteria then it is classifi ed as RED. That is, if the product you are considering has more than the number specifi ed for energy OR saturated fat OR sodium, it is a RED food.

• If the product does NOT exceed any of the RED criteria it will be classifi ed as AMBER.

See the search product tool at www.healthyfoodproducts.com.au for examples of AMBER and GREEN products. Choose GREEN products where possible.

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READY RECKONER: READY RECKONER FOR ‘APPLICABLE FOODS’ COMMONLY SOLD IN NSW HEALTH FACILITIES

PRODUCT CATEGORY LIKELY COLOUR(S) RED CRITERIAserve size is

serve ‘as sold’

COMMENTS

Food or Drink GREEN AMBER RED RED Nutrient

Criteria

BREADS AND GRAIN PRODUCTS

Energy More than 600kJ per serve

Chocolate biscuits and biscuits with cream fi llings are RED.Some small - medium sized sweet biscuits may be AMBER. Some manufacturers have developed lower fat biscuits. Encourage high fi bre varieties. Check against the RED criteria.

Biscuits: sweet(See savoury biscuits in ‘savoury snack foods’)

■ ■ Saturated fat

More than 3g per serve

Breads ■ All breads are GREEN. They include fl atbreads, rolls, focaccia, Turkish, English muffi ns, crumpets, bagels, fruit bread, crispbreads.

Breakfast cereals ■ ■ GREEN cereals are wholegrain or whole wheat cereals and natural (not toasted) muesli. Refi ned cereals and toasted muesli are likely to be AMBER. Provide a low fat milk option.

Buns, scones, pikelets and similar

■ ■ Pikelets and plain/fruit scones or buns are healthier alternatives to fancy cakes. Smaller items, without icing, confectionary or chocolate, are likely to be GREEN. Lightly iced fi nger buns fi t the AMBER category.

Cakes, muffi ns, sweet pastries etc

■ ■ Energy More than 900kJ per serve

Fancy cakes, large muffi ns, friands, donuts and pastries fall in to the RED category. Check smaller sized scrolls, lower fat muffi ns / un-iced cakes or banana bread against the RED criteria.

Saturated fat


CONFECTIONARY

Lollies: boiled, jellies, jubes, liquorice, yoghurt-coated, fruit juice lollies or jellies, ‘natural confectionery’, sugar coated nuts, chocolate, carob, nougat.

■

All types of confectionary are classifi ed as RED. This includes dried fruit coated with chocolate/confectionary.

Sugar free gum, cough lozenges, sugar free lollies and antacids are exempt as they have special uses.

DAIRY PRODUCTS & ALTERNATIVES

Cheese, custard, fromage frais, plain or fl avoured yoghurt, plain or fl avoured soy yoghurts which are enriched with calcium.

Also see ‘Drinks’ for milk drinks and soy alternatives.

■ ■

Reduced- and low-fat forms including cottage and ricotta cheese (whether plain or fl avoured) fi t in to the GREEN category.

Full fat forms fi t in to the AMBER category.

Reduced fat forms are encouraged (except for young children under the age of 2 years who need full fat milk products).



serve ‘as sold’

COMMENTS


Criteria

DRINKS The mandatory maximum serve of a RED drink is 375ml. It is suggested (ie non mandatory) that selected AMBER drinks such as juices, full fat milks/soy alternatives and diet drinks are limited to a 375ml serve.

Sugar-sweetened drinks: cordials, energy drinks, fl avoured mineral water, iced tea, soft drinks, sports drinks/ waters, sweetened waters, fruit drinks less than 99% juice

■ ■ Energy

Sodium

More than 300kJ per serve

More than 100mg per serve

Most of these drinks will be RED as they are high in kilojoules and are poor nutrition value. Check against the RED criteria. The mandatory maximum serve size for RED drinks is 375ml.

Diet drinks (artifi cially sweetened)

■ Preferred drinks for children are water, reduced fat milks (full fat milk for young children under 2 years). The suggested (ie not mandatory) maximum serve of a diet drink is 375ml.

Fruit juice (at least 99 %) ■ The suggested (not mandatory) maximum serve of fruit juice is 375ml.

Milk, soy drinks, (plain/fl avoured)

■ ■ Reduced fat forms are GREEN. Full Fat forms are AMBER. 375ml is the suggested (ie not mandatory) maximum serve size for full fat milks and full fat soy drinks (plain or fl avoured). Children under 2 years of age need full fat milks. Reduced fat milks are encouraged for older children.

Water, unsweetened ■ Tap water is the preferred drink. Commercial bottled water, soda water and unfl avoured mineral water are acceptable alternatives. The serve size is unlimited.

Tea and coffee and hot chocolate

NA NA NA Tea and coffee vending machines are exempt from colour classifi cation but should provide a reduced fat milk option.

COMMERCIAL, FROZEN or READY-TO-EAT MIXED MEALS

Frozen commercial mixed meals can be useful for providing staff with access to meals after hours. Some health facilities supply commercial frozen meals through vending machines.

Check against the RED criteria. Meals which pass the RED criteria, and also contain more than 3g fi bre per serve, are classifi ed as GREEN.

eg Pasta, lasagne, curries, roast dinners, stir fried dinners, fried rice

■ ■ ■ Energy

Saturated fat

Sodium


More than 4g per 100g

More than 400mg per 100g

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serve ‘as sold’

COMMENTS


Criteria

FRUIT, VEGETABLES AND LEGUMES

See Juices in ‘Drinks’See ‘Hot single food items’ for baked potatoes.

■ All forms fi t in to the GREEN category: Fresh, frozen, canned and dried.

Fruit leathers less than 90% fruit should be assessed as snack food bars.

HOT SINGLE FOOD ITEMS (Commercial)

Savoury pastries (eg pies, sausage rolls, quiche, croissants), pizza, quiches, oven-baked potato products, dim sims, spring rolls, hot noodle cups.

■ ■ Energy

Saturated fat

Sodium

More than 1000kJ per 100g

More than 5g per100g

More than 400mg per 100g

A number of companies make reduced fat options.

Check against the RED criteria.

Foods items which are simply reheated are applicable. Those which require cooking eg frying, are not applicable to Live Life Well @ Health.

ICE CREAMS, milk based ice confections and indulgent dairy desserts (not yoghurts)

Some low fat ice confections, ice cream products and yoghurt-based ices fall in to the AMBER category.

Check against the RED criteria.

Premium and chocolate-coated ice creams. Standard, reduced and low fat ice creams. Milk-based ice confections.

Dairy desserts

■ ■

■

Energy

Saturated fat



ICE BLOCKS, water or fruit-based ice confections

■ ■ Energy

Sodium



Some frozen juices fi t in to the AMBER category.

If less than 90% juice, assess against the RED criteria

NUTS

Check the policy of the health facility for the provision of nut products.

■ ■ ■ GREEN choices include unsalted nuts, mixtures of fruit, nuts and seeds (uncoated, no added salt), peanut butter without no added salt/no added sugar.

Salted nuts are in the AMBER category.

Nuts coated with confectionary or chocolate are in the RED category.



serve ‘as sold’

COMMENTS


Criteria

SALADS

A salad is a cold savoury dish which includes a mixture of vegetables, mainly raw and sliced.

Examples: coleslaw, garden salad, potato salad, mixed bean, pasta salad, rice salad, tabouleh.

■ ■ ■

GREEN salads do NOT contain:– fatty/salty processed meats.

Suitable alternatives include lean meats, skinless chicken, salmon, drained tuna, egg, beans eg soy beans

– full fat cheese. Reduced fat cheese is a good alternative

– added salad dressing. Dressing may be offered separately for discretionary use.

AMBER salads contain one-two of the following ingredients. RED salads contain three or more of the following ingredients:– fatty/salty processed meats eg

chicken roll, corned beef, Devon, ham, salami, sausage

– full fat cheese– added oily dressing eg mayonnaise.

Dressing may be offered separately for discretionary use.

The best dressings are based on polyunsaturated or monounsaturated oils in combination with liquids such as vinegar and lemon juice. No-oil dressings and reduced-oil dressings are suitable but are higher in salt.

SAVOURY SNACK FOODS AND BISCUITS

Popcorn, plain

Flavoured popcorn, crisps, chips and similar. Savoury biscuits, crackers, cheese and dip packs

■ ■

■ ■

Energy

Saturated fat

Sodium




Most commercial forms of pop corn will be AMBER due to added salt and fat. Air-popped popcorn without additives is in the GREEN category.

A number of companies have formulated healthier AMBER options in snack food and savoury biscuit lines. Check against the RED criteria.

SNACK FOOD BARS

Breakfast bars, muesli bars, cereal based bars, fruit bars and leathers (<90% dried fruit)

■ ■

Energy

Saturated fat



Fruit is a healthy alternative to confectionary. AMBER snack bars provide another alternative. Fruit leathers <90% fruit should be assessed against the RED criteria for snack food bars.

SOUPS (commercial single serves)

■ ■ GREEN soups are based on vegetables/lentils or other legumes/barley and/or lean unprocessed meats where they have:

Less than 1.0g of saturated fat per 100g and less than 250mg of sodium per 100g1.

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serve ‘as sold’

COMMENTS


Criteria

SPREADS AND SAUCES

See peanut butter under ‘Nuts’.

■ ■

AMBER choices include, jam, honey, unsaturated and polyunsaturated fat spreads/margarines yeast extracts. RED choices include butter and dairy blends.

SUSHI AND RICE PAPER ROLLS

■ ■ Sushi, sashimi and rice paper rolls are classifi ed in the GREEN category when condiments are optional and served separately. If high salt condiments eg soy sauce, are added they are classifi ed as AMBER.

1 Criteria adapted from the Healthy Kids School Canteen Association Nutrient Criteria (2005)

SHPN

(C

HA

) 09

0098

Live Life Well @ Health User Guide

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