Vending Machines and Health Systems

Controversies and Concerns

Diane Dooley MD

12/08/09 2

Obesity is on the rise

15

32.2

43.8 45.3

0

10

20

30

40

50

% Overweight/Obese

1971

2-4 years

5-11 years

12-19 years

Percent overweight and obese Contra Costa County children 2 – 19 years

Pediatric Nutrition Surveillance

2008

15

40.135.1

46.3

0

10

20

30

40

50

% Overweight/Obese

1971

White

Black

HispanicContra Costa children ages 5-8 by ethnicity

Pediatric Nutrition Surveillance

2008

Health Disparity Emerges

Vending machines in hospitals

7% of all US vending machines in hospitals and nursing homes

California laws do not regulate nutritional content

Profit pressures correlate with quality Beverage vending agreements vs. food vending agreements

Vending machines at CCRMC

Patient access machines located in Richmond, Pittsburg Health Centers, CCRMC cafeteria

Unknown profit No contract County provides electricity,

space, disposal of waste, associated cleaning costs

Vending machines standards

• County Healthy Vending policy passed 2004

50% “Healthy” drinks, snacks

Public health audit 2007- 20% compliance

Best selling items: Cheetos, Doritos, Lays Classics, soda, candy

Vending Machine survey

• “Smart Choices” are marked by green star• Most survey participants did not notice the

smart choices posters on the machines• ½ of Spanish speakers thought green stars

meant item was cheaper• Majority had purchased items from the machines in the last few visits

Pittsburg Health Center

“They are often eating chips in am clinic visits”

“They are often eating chips in am clinic visits”

WIC Survey:-Cookies, chips and sweetened drinks are commonly brought to WIC

Pittsburg Health Center

43.7 of Fifth graders are overweight

Pittsburg Unified School

District 5th graders

Healthy Kids Survey2006

Pittsburg Unified School

District 5th graders

Healthy Kids Survey2006

Obesity Efforts Pittsburg Health Center

• 80% of providers report counseling almost all patients to avoid sweetened drinks

• Soda Free Summer campaign• Prenatal Sweet Success program• Diabetes registry• Pediatric Obesity QIP• FIT resident grant• NEW Kids program

Obesity Efforts Pittsburg Health Center

• WIC social marketing campaigns

• Have Fun and Be Healthy• Have Fun and Be Active• Healthy Drinks

New food package introduced October 2009:More breastfeeding supportLess juiceMore fruits and vegetables

New food package introduced October 2009:More breastfeeding supportLess juiceMore fruits and vegetables

12/08/09 12

Soda – Should we sell it?

Increases likelihood of being overweight or obese

Density of fast food restaurants and convenience stores correlates with obesity and diabetes

Highest consumption among children from low income families, Latino

12/08/09 13

Soda – Should we sell it?

Concord 44.2

Richmond 46.1

San Francisco 36.9

Bakersfield 60.1

• 49% of California children consume one or more sweetened soda daily

• Childhood consumption increasing annually

• Soda, fruit juice and sweetened beverages provide an average of 270 extra kcal/day (10-15% total)

Percent of Children and Adolescents 2-17 years drinking one or more sodas per day

12/08/09 14

Health impacts for children

Dental caries associated with frequent consumption of sugary foods

Higher rates of fractures, osteoporosis

Highest risk groups: low income, Latino, African -American, uninsured

Snacks

170 Calories/11 grams fat/serving

170 Calories/11 grams fat/serving

120 calories/ 20 ounce bottle

120 calories/ 20 ounce bottle 280 calories/

14 grams fat/serving

280 calories/ 14 grams fat/serving

Sweetened Drinks survey

100% of health professionals surveyed felt sweetened drinks were a problem

Most providers discuss the harmful effects of sugar and sippy cups

Inadequate time, parental disinterest and easy access to junk food limit counseling effectiveness

Culturally appropriate tools and vending machine restrictions would assist providers in addressing this issue

Counseling Patients

Barriers Top Five: Parental disinterest/overwhelm in setting limits for

children Parental disinterest/overwhelm in promoting

health Lack of adequate time to counsel Lack of culturally relevant, up to date educational

materials/counseling tools Awareness that families may not have the

resources to buy healthy drinks

Food Marketing to Children

“Constant assault of marketing these drinks to kids makes me a voice in the wilderness”“Constant assault of marketing these drinks to kids makes me a voice in the wilderness”

A study of McDonald’s restaurants in Children’s Hospitals showed correlation with increased fast food purchasing by parents and a more positive perception of the healthiness of McDonald’s food.

“..food and beverage marketing influences the preferences and purchase requests of children”-IOM

“..food and beverage marketing influences the preferences and purchase requests of children”-IOM

• Department of pediatrics worked with Public Health and CCRMC dietary department in 2008 to develop 100% Healthy vending policy

• Based upon SB 965, SB 12 School standards• Passed by MEC as part of the pediatric

obesity quality improvement initiative October 2008

• Implemented by CCRMC cafeteria vending machines October 2009

100% Healthy Vending Policy

“A supportive environment helps individuals make positive behavioral changes and models the importance of healthy lifestyle choices for patients and families”

“A supportive environment helps individuals make positive behavioral changes and models the importance of healthy lifestyle choices for patients and families”

Nutritional Environment

• Food environment may influence health and nutritional choices

• Formula and the perinatal unit, • Cigarettes and smoking at health centers

Make the healthy choice the easy choice

Conclusion

Vending machines in clinics provide convenient foods to patients and profit to the health system.

Providers in the clinic are actively educating patients about the hazards of soda and unhealthy snacks but feel undermined by the presence of machines in the lobby selling junk food

Our health system should move towards a 100% healthy vending policy in all patient access machines and model a healthy nutritional environment our patients