HSE Policy on Calorie Posting
Document
reference
number
H&WCP01
Date
Status
Responsible
June 2015
Document
developed
Aug 2015
Document
approved
Sept 2015
Document
approved
Document
revised
HSE
National
Expert
Group
on
Healthy
Vending
&
Calorie Posting
National
Director Health
& Wellbeing
HSE Leadership
Team
HSE
Healthy
Eating & Active
Living National
Implementation
Group
1st Review
June 2016
2nd Review
June 2018
Document
revised
HSE
Healthy
Eating & Active
Living National
Implementation
Group
Table of Contents
1.0
Policy Statement......................................................................3
2.0
Purpose ..................................................................................3
3.0
Scope.....................................................................................6
4.0
Roles and Responsibilities .........................................................7
5.0
Procedure ...............................................................................9
6.0
Implementation ..................................................................... 11
7.0
Monitoring ........................................................................... 11
8.0
Revision and Audit ……………………………………………………………………….…12
9.0
References……………………………………………………………………………………….12
10.0
Appendices……………………………………………………………………………………… 14
Appendix 1
Members of the National Expert Group on Vending and
Calorie Posting
Appendix II
In-patient menus
Appendix III
Peer Review of Policy
Appendix IV
Key Stakeholder Review of Policy, Reviewer Statement
Appendix V
Signature Sheet
Appendix VI
Example of calorie posting
Appendix VII
Communication and available supports
2
1.0 Policy Statement
The Health Service Executive (HSE) is committed to maintaining and promoting
the health of the whole population as part of its implementation of Healthy
Ireland: A Framework for Improved Health and Wellbeing 2013-2025. The
development and implementation of a calorie posting policy across HSE facilities is
an important initiative in this regard.
The adoption of a Calorie Posting Policy reflects the commitments outlined in
Healthy Ireland in the Health Services National Implementation Plan 2015-2017,
referenced under key national policy priority programmes including the HSE
Healthy Eating and Active Living Programme and HSE Staff Health and Wellbeing
Programme. These national programmes align with priorities stated in the HSE’s
Corporate Plan 2015-2017. The first goal in the Corporate Plan states that the
HSE will promote health and wellbeing as part of everything we do so that people
will be healthier. Calorie posting will increase consumer awareness of the calorie
content of the foods and drinks on offer at HSE facilities and help people make
more informed and healthier choices. The fifth goal in the Corporate Plan states
that the HSE will engage, develop and value our workforce to deliver the best
possible care and services to the people who depend on them. Calorie posting is
one action to support our staff to make healthier choices, to keep them healthy
and well, thus creating positive role models for colleagues, family, friends and
service users alike.
The policy applies to all in-house catering and contracted catering and vending
services throughout the HSE. The Policy does not apply to in-patient menus.
2.0 Purpose
Goal 4 of Healthy Ireland: A Framework for Improved Health and Wellbeing 2013–
2025 is to:
“Create an environment where every individual and sector of society can play
their part in achieving a healthy Ireland”.
The introduction of calorie posting is health promoting and contributes to
improving nutrition and healthier diet. Diet has a critical role to play in the
prevention of obesity and chronic diseases including heart disease, diabetes and
certain cancers.
In Ireland, the proportion of adults and children who are not maintaining a
healthy body weight is increasing. The prevalence of obesity in 18-64 year old
adults has increased significantly since 1990 from 8% to 26% in men and from
13% to 21% in women. Four out of five adults over the age of 50 years (TILDA,
2014) and three out of five adults 18-64 years (NANS, 2011) are overweight or
3
obese. Studies reveal that as a population we are becoming obese at an earlier
age. Between 1990 and 2007, there has been a 6% increase in overweight and
obesity in 13-17 year old Irish boys (IUNA, 2007). Alarmingly, one in every four
children aged three, seven and nine-year in Ireland is either overweight or obese
(COSI, 2008, 2010).
A recent WHO report (2015) projects that Ireland is on course to be the most
obese country in Europe by 2030 with 89% of Irish males and 85% of Irish
women projected to be overweight with obesity projections of 48% and 57%
respectively. This is unsustainable at every level – personal, societal, financial
and for the health system.
Solving the obesity epidemic requires a comprehensive, integrated approach.
However, evidence shows that one of the key contributors to these adverse trends
is the obesogenic environment in which we live which can make the unhealthy
option (high fat, high salt, high sugar foods) the easier option leading to the
consumption, in the home, the workplace and when eating out, of excess calories
from highly processed food.
The HSE is one of the largest employers in Ireland employing over 100,000 staff.
It is also one of the largest purchasers of food products. Our staff, services and
the environment and culture within which we work and deliver services has a
major influence on the health and wellbeing of both staff and service users alike.
Outside of the family unit, the HSE is the main custodian of the health of our
population.
This policy seeks to leverage our scale and influence to make the healthier choice
the easier choice for the thousands of staff, service users and visitors who use our
catering services every day. This policy provides for the HSE to support the
health and wellbeing of staff and service users alike while acting as an exemplar
across the public service.
The purpose of this policy is to promote awareness of healthier food and drink
choices amongst HSE staff and the public using and visiting HSE healthcare
facilities, by highlighting the calorie content of food and drinks provided in HSE
facilities.
4
This policy will:
•
create a supportive environment, including health education for
patients/service users and staff to adopt healthy eating habits
•
encourage increased uptake of healthy food and beverage options at
HSE premises
•
ensure that the organisation reflects best practice in relation to
healthy weight management
•
support other initiatives in relation to the broader healthy eating and
active living programme
•
serve as an exemplar of good practice and
organisations to follow suit
encourage other
2.1. Background
The HSE is involved in numerous partnerships to address the increasing trend
towards weight gain in our society. Those partnerships include staff within the
HSE, external partners, the Department of Health and other government
departments. The HSE Healthy Ireland Implementation Plan 2015-2017 has
identified improving staff health and wellbeing and reducing the burden of chronic
disease as two strategic priority areas. Implementing calorie posting is a positive
first step as part of this work.
This policy forms part of the broader healthy eating programme within the HSE. It
supports a wide ranging programme of initiatives in relation to food and nutrition
in HSE settings which includes:
•
HSE Healthy Vending Policy with a five year National Contract for Vending
awarded early in 2015 www.hse.ie/healthyvending
•
Development of a national cross divisional/structural governance
framework for HSE Healthy Eating and Active Living Programme
•
Posting of allergenic ingredients in line with legislation introduced in
December 2014
•
Development of a food and nutrition policy and implementation plan for
hospitals
•
Supporting the implementation of the Safe Better Healthcare Standards in
all settings and ensuring the implementation of relevant nutrition and
hydration standards including HIQA auditing of nutrition and hydration
across settings
5
•
Quality Improvement Programme for nutrition and hydration across
services
The policy supports the Department of Health’s National Healthy Eating
Guidelines. Key developments by the Department of Health (DOH) include:
1. Committing to introducing legislation to make calorie posting mandatory in
Irish catering establishments. By introducing this policy, prior to national
legislation being introduced in 2016, the HSE will serve as an exemplar of
good practice for other organisations whilst also looking to improve the
health and wellbeing of HSE staff and service users.
2. Establishment in co-operation with other partners, including the HSE, a
national steering group to develop an Obesity Policy and Action Plan for
Ireland 2015-2025.
3. Committing to introducing legislation for healthy workplaces in the public
sector
The Irish Heart Foundation through their Happy Heart at Work Award has revised
its standards to incorporate calorie posting as part of their Silver and Gold Awards
commencing January 2016.
3.0 Scope
This policy applies to all food and beverage outlets on HSE premises i.e. staff
canteens, staff and visitor restaurants, coffee shops, mobile shop trolleys and
vending machines.
3.1
•
•
Exemptions
It should be recognised that this policy reflects an expected standard,
governed by best practice, in relation to calorie posting. However there
may be occasions when it is acceptable to deviate from the policy. For
example, it is acceptable that restaurants/canteens do not display calorie
content on once-off dishes or “dish of the day” if that dish is produced and
served less than once a month.
This HSE Calorie Posting Policy does not cover the posting of calories on
inpatient menus as individual diets are part of a therapeutic clinical
intervention. (See Appendix II)
6
3.2 Legislation/Other Related Policies
• Healthy Ireland in the Health Services National Implementation Plan 20152017
• HSE Corporate Plan 2015-2015: Building a high quality health service for a
healthier Ireland
• HSE Healthy Vending Policy 2014 www.hse.ie/healthyvending
• HSE National Contract for Vending 2015-2020
• HSE Waste Management Policy 2011
• Provision of Food Information to the Consumer Regulation (FIR) 1169/2011
governing the posting of 14 specific allergens in pre packaged and loose
food
• HSE Financial Regulations version 4, 20th December 2013
• EU Directive 2004/18/Ec (procurement policy for public bodies)
• Green Procurement Guidance for the Public Sector EPA 2014
• Food Harvest 2020
• Green Healthcare programme www.greenhealthcare.ie
4.0 Roles and Responsibilities for Implementation
4.1
Responsibilities of Senior Management
Director General
The Director General of the Health Services is responsible for ensuring compliance
with the HSE Calorie Posting Policy. The delegated authority for co-ordinating and
monitoring implementation of this policy are the National Directors, Chief Officers
of the Community Healthcare Organisations and Chief Executive Officers of the
Hospital Groups.
National Directors (NDs), Chief Officers (COs) of Community Healthcare
Organisations (CHOs) and Chief Executive Officers (CEOs) of Hospital
Groups (HGs)
NDs, COs and CEOs are responsible for overseeing the development, provision
and communication of resources and supports locally to assist the implementation
of this policy, in conjunction with appropriate personnel.
They should:
• Endorse and support local implementation of the policy and ensure
compliance through agreed monitoring process
• Ensure this policy is brought to the attention of all staff
• Align appropriate resources to support the implementation of this policy
• Include actions aligned to this policy in CHO, HG, Hospital, service healthy
Ireland implementation plans
• Report to the Health and Wellbeing Division on implementation as outlined
under the Healthy Ireland in the Health Services Implementation Plan
2015–2017 and annual Operational Plans
• Link with HSE Food Sourcing Procurement Group re implementation.
7
A calorie posting implementation group with a designated lead should be
established by the relevant senior manager at local level to guide and support the
implementation, monitoring and review of the Calorie Posting Policy. This work
could be included within the remit of existing local nutrition steering group or as
part of the local Healthy Ireland implementation team.
4.2
•
•
•
•
•
•
•
•
Responsibilities of Facilities and Catering Management
Catering Managers
Ensure that all food and drink provided on HSE premises is calorie posted
using a recognised evidenced based tool such as but not exclusive to FSAI
Menucal www.fsai.ie
or a nutritional analysis package e.g. WISP
www.tinuvielsoftware.co.uk/wisp4.htm , Nutritix www.nutritics.com which
may be available through local nutrition and dietetics service
Support, implement and ensure compliance with the policy
Ensure that staff and visitors are made aware of the introduction and
relevance of calorie posting
Develop a monitoring system to enable research into changes in purchasing
behaviour
Participate with any training initiatives needed to implement the policy
HSE Catering Management will bring the policy and the availability of both
commercial and free programmes to determine calorific content to the
attention of suppliers and potential contractors.
Facilities Managers
Bring the policy and the availability of examples of both commercial (e.g.
WISP www.tinuvielsoftware.co.uk/wisp4.htm, Nutritix www.nutritics.com)
and free (MenuCal) programmes to determine calorific content to the
attention of suppliers and potential contractors
Ensure compliance with the policy in non HSE delivered services i.e.
contracted services.
4.3 Responsibilities of frontline catering staff
• Be familiar with and comply with the policy
• Support the local implementation plan
• Have the knowledge to assist customers to choose a lower calorie option if
requested.
4.4 Responsibilities of Dietitians
• Local nutrition and dietetic services (in acute hospitals, residential units,
CHO sites) will support catering staff and advise on implementing the
policy. Additional caution is needed in catering facilities where in-patient
food is provided as well as other food for staff and visitors from the one
kitchen. Standardising menus may change the nutritional content of foods
and may change the therapeutic diets being implemented. Facilities must
consult with the Dietetics Department or the local Community Dietitian to
ensure that all changes are accounted for within prescribed menus.
4.5
Responsibilities of Health Promotion and Improvement Staff
8
Health Promotion and Improvement staff will support local services in the
implementation of the policy as part of the Healthy Ireland implementation
plans in hospitals and CHOs.
4.6
•
•
•
•
•
•
Responsibilities of HSE Procurement / Office of Government
Procurement (OGP)
Note: The procurement categories of Food and Catering Services now fall
under the OGP from a tender prospective.
Use sustainable procurement criteria as outlined in GPP guidelines in
food related contracts
Bring the policy and the availability of examples of both commercial and
free programmes to determine calorie content to the attention of suppliers
and potential contractors (MenuCal www.fsai.ie, WISP
www.tinuvielsoftware.co.uk/wisp4.htm, Nutritix www.nutritics.com)
Be familiar with the policy and ensure where possible that procurement
contracts take into account the need, in some instances to purchase
smaller pack sizes and/or smaller portions when calorie posting and
developing standardised recipes
In conjunction with budget holders ensure compliance with the HSE
National Vending Contract
Ensure external contractors are notified and existing contracts are revised
accordingly
Ensure that all new contracts or contracts due for renewal with external
catering providers include the implementation of this policy.
4.7
•
Responsibilities of external contractors
All food and beverage contractors operating on HSE campus grounds must
comply with this policy.
5.0
Procedure
The following conditions must be adhered to in implementing calorie posting in all
HSE facilities:
•
•
•
•
Calorie posting is in place for all food and drink items on sale
Calorie information is displayed clearly at the ’point of choice’ for the
consumer
Calorie information is displayed per standard portion or per meal
Information on how many calories an average person needs in a day is
prominently displayed to help consumers better understand calorie
information
9
Where and how to post calories
Calories must be posted on the menu board, printed menu, chalk board or display
tag, anywhere food and drink offerings are described and the prices are displayed.
Calorie information at the ‘point of choice’ must be as clearly presented as the
price. If there is more than one ‘point of choice’ in a food outlet, calories must be
posted at each point.
Typical ‘point of choice’ locations include:
•
•
•
•
•
•
•
Printed menus
Menu boards
Chalk boards
Shelf edging
Counter display tags
Table centres
Flyer-style menus
Clearly and prominently displaying calorie information is achieved by:
•
•
•
Positioning the calorie information beside the price of the food or drink item.
Ensuring the font and format of the calorie information is similar to the name
and price of the menu item
If using colour, ensure clear differentiation and legibility. Up to 10% of all
males are Red-Green colour blind so avoid use of these colours. See sample at
Appendix VI.
Information on the accuracy of the calorie information provided should be
highlighted at the ‘point of choice’. Statements such as ‘The calorie
information provided is calculated using average figures and based on a
typical serving size’ or ‘We ensure that the calorie information provided is
as accurate as possible. However, we may occasionally substitute
ingredients and this may slightly alter the calorie value displayed’ can be
used.
Information on recommended daily calorie intake should also be provided. This
will help consumers make sense of calories on menus in the context of their
overall daily eating habits.
This information must be clear and easily seen by the consumer before their
choice is made. This information must be the same in all food outlets/service
areas. A pictorial of a man, woman and child beside their recommended daily
calorie needs will highlight the information and assist with literacy difficulties.
10
For example:
RECOMMENDED DAILY CALORIE INTAKE
MEN NEED APPROX. 2,500 CALORIES A DAY
WOMEN NEED APPROX. 2,000 CALORIES A DAY
CHILDREN NEED APPROX. 1,800 CALORIES A DAYB
6.0
Implementation
This Policy is a significant step forward in providing information on the calorie
content of food and drink served on HSE premises. The policy will take effect
upon implementation of the Calorie Posting Policy within a particular site or across
a particular setting. The implementation of this policy is led by the Chief
Executive Officer of the Hospital Group/Chief Officer of the Community Healthcare
Organisations with support from Health and Wellbeing, Health Promotion and
Improvement.
This policy is mandated until it is superseded by national
legislation.
Evidence shows that the impact of calorie posting for behaviour change is much
more
effective
when
implementation
incorporates
a
comprehensive
communication plan.
A suite of communication materials is available at
www.hse.ie/heal.ie to support effective implementation of this policy.
The National Co-ordinator for the policy is the National Health Promoting Health
Services Co-ordinator, Health Promotion and Improvement Tel: 01 8976112.
7.0
•
•
•
•
Implementation of calorie posting will be mandatory for including in the CHO
and Hospital Group Plans and monitoring will form part of the monitoring
process for the implementation of these plans which will include inclusion and
reporting on progress as part of their Operational Plans
A national audit will be undertaken to assess impact of calorie posting on staff
food choices, economic, social, health and environmental metrics
A collective report is required by the Expert Group on Vending and Calorie
Posting in December 2015 for each Hospital Group outlining progress. The
Expert Group will collate this information for the National Director of the Health
and Wellbeing Division. Thereafter ongoing monitoring to be mainstreamed
into existing/new reporting mechanisms of both Hospital Groups and CHOs
Ongoing monitoring will be built into the terms of all catering contracts.
8.0
•
Monitoring
Revision and Audit
Initial review will take place June 2016 and every two years thereafter or as
warranted by the Expert Group.
11
References
Brug, J. (2008). Determinants of healthy eating: motivation, abilities and
environmental opportunities. Family practice, 25(suppl 1), i50-i55.
Dumanovsky, T., Huang, C. Y., Nonas, C. A., Matte, T. D., Bassett, M. T., & Silver,
L. D. (2011). Cross sectional customer surveys. BMJ, 343.
A recent CDC report suggests that Menu Labelling in 2014 is used by nearly 60%
of respondents in 17 states – CDC MMWR report July 2014
Bollinger, B., Leslie, P., & Sorensen, A. (2010). Calorie posting in chain
restaurants (No. w15648). National Bureau of Economic Research.
Calories on menus in Ireland – Report on a national public consultation.
http://www.fsai.ie/WorkArea/DownloadAsset.aspx?id=11419
Dept of Health & Children (Dublin) April 2009 Food and Nutrition Care in Hospitals
(Guidelines for preventing Under-Nutrition in Acute Hospitals) (Dublin 2009)
http://www.lenus.ie/hse/handle/10147/85517
DoH&C 2013
Healthy Ireland Framework for improved health and wellbeing
2013 – 2025 (Dublin 2013)
http://health.gov.ie/blog/publications/healthy-ireland-a-framework-for-improvedhealth-and-wellbeing-2013-2025/
FSAI 2013
Menucal Calorie Calculator
http://www.fsai.ie/food_businesses/menucal.html
Swartz et al. Calorie menu labeling on quick-service restaurant menus: an
undated systematic review of the literature. International Journal of Behavioral
Nutrition and Physical Activity 2011, 8:135
http://www.ijbnpa.org/content/8/1/135
Seunghee Wie & Kathryn Giebler (2014) College Students’ Perceptions and
Behaviors Toward Calorie Counts on Menu Journal of Foodservice Business
Research, 17:1, 56-65, http://dx.doi.org/10.1080/15378020.2014.886910
12
Review of the available evidence/analysis
As part of developing this document the following similar policies and projects
were reviewed and key findings outlined below:
1. A health protection approach is one that creates environmental opportunities
for healthful behaviour and protects against un-healthful behaviour
Source: Brug, J. (2008). Determinants of healthy eating: motivation, abilities and
environmental opportunities. Family practice, 25(suppl 1), i50-i55.
2. Evidence suggest that when consumers use calorie information (15%) they
choose lower calorie meals:
Source: Dumanovsky, T., Huang, C. Y., Nonas, C. A., Matte, T. D., Bassett, M. T.,
& Silver, L. D. (2011).
3. A recent CDC report suggests that Menu Labelling in 2014 is used by nearly
60% of respondents in 17 American states.
Source: CDC MMWR report July 2014
4. No negative impact on income was seen following the implementation of calorie
labelling in a large chain of coffee shops in America
Source: Bollinger, B., Leslie, P., & Sorensen, A. (2010). Calorie posting in chain
restaurants (No. w15648). National Bureau of Economic Research.
5. A recent opinion by Jason P Block outlines the potential benefits expected from
calorie labelling and shows that 81% of 1817 respondents supported calorie
labelling in restaurants in the US
6. Recent research by Safefood shows that Irish consumers across the whole of
Ireland strongly support calorie labelling (92%). A similar result to the 2012 FSAI
national public consultation on calorie labelling that showed that 96% of
consumers were in favour.
Source: Calories on menus in Ireland – Report on a national public consultation.
http://www.fsai.ie/WorkArea/DownloadAsset.aspx?id=11419
13
10.0
Appendices
Appendix I
Appendix
Appendix
Appendix
Appendix
Appendix
Appendix
II
III
IV
V
VI
VII
Members of the National Expert Group on Vending and
Calorie Posting
Inpatient menus
Peer Review of Policy
Key Stakeholders Review of Policy
Signature Sheet
Examples of calorie posting
Communication and available supports
14
Appendix I Members of the National Expert Group on Vending and
Calorie Posting
Ms. Adrienne Lynam, HSE National Project Manager-Obesity (Chairperson), Health
Promotion & Improvement
Ms. Rosemary Bracken, Catering Manager, Cherry Orchard Hospital
Ms. Fidelma Browne, HSE National Communications
Mr. Peter Byrne, Facilities Manager, Letterkenny General Hospital
Ms. Annette Collins, Catering Manager, Cork University Hospital replaced Mr.
Michael McCarthy, Head of Catering, Cork University Hospital
Ms. Anne Marie Crosse, HSE Eco Health and Sustainability Officer, Health
Promotion & Improvement
Ms. Fiona Cuddy, Dietitian, Portiuncula Hospital
Ms. Christine Gurnett, Senior Community Dietitian, Health Promotion &
Improvement
Ms. Laura Molloy, National Co-ordinator Health Promoting Hospitals, Health
Promotion & Improvement
Mr. Robert Notley, National Procurement Category Specialist
Ms. Margaret O Neill, National Dietetic Advisor (joined March 2015)
Health & Wellbeing
Ms. Gwen Rice, Senior Community Dietitian, Cavan-Monaghan,Primary Care
Dr. Marie Tuohy, Assistant National Oral Lead/Child Health, Primary Care
Dr. Nazih Eldin, former HSE Lead on Obesity was Chairperson until Aug 2014
Additional Input
The HSE National Expert Group on Vending and Calorie Posting wish to thank the
following for sharing their experiences and work:
•
•
•
•
Prof. Mary Flynn and Ms. Frankie Douglas FSAI for their direction and
assistance with MenuCal the online tool for determining calorie count.
The Irish Heart Foundation who has agreed to include calorie posting as part of
the standard required for attainment and recertification of the Happy Heart at
Work Silver and Gold Awards in 2016.
Staff and management in Cherry Orchard and Letterkenny General Hospitals
who kindly volunteered to form a pilot for the introduction of calorie posting in
HSE facilities and the evaluation of the implementation of FSAI’s MenuCal
online tool for determining calorie content.
Ms. Sarah McCormack National HI Programme Lead HSE for sharing her
Masters research and experience of working with external contractors.
15
Appendix II
In-patient menus
It is widely accepted that patients admitted to hospital generally have nutritional needs
that would not be met by following National Healthy Eating guidelines (1). The length of
time a patient spends in hospital and the cost of that stay is linked to the patient’s
nutritional status (2).
The BAPEN Nutrition Screening Survey in UK & Republic of Ireland in 2010 showed us that
32% of patients were malnourished on admission to Irish hospitals (3). Previous studies
have shown that 11% of patients admitted to hospital are malnourished and between 6384% were at nutritional risk (1). To add to this, nutritional status often declines while the
patient is in hospital due to poor appetite, fasting for procedures/tests, vomiting etc. One
study showed that 29% of previously well-nourished patients showed deterioration in
nutritional status during their hospital stay (1).
The BAPEN study also showed that in care homes 32% of residents were found to be
malnourished on admission with the prevalence of malnutrition greater in residents
admitted from other care homes and from home. The mean BMI of those admitted to the
care homes was 24.3kg/m2,with 23% of residents having a BMI <20kg/m2.
In view of the high prevalence of malnutrition in Irish hospitals the Department of Health
& Children produced guidelines in 2008: ‘Food and Nutritional Care in Hospitals –
Guidelines for Preventing Under-Nutrition in Acute Hospitals’. This document states that
the standard or normal menu for acute hospitals should be energy-dense and high-protein
providing at least 40% of energy from fat. Standard portions of this menu should provide
2000kcals with larger portions available which would provide 2500kcals. For those with
poor appetite, high energy requirements and low food intake, a menu with at least 50%
energy from fat should be available. A healthy-eating menu should also be available for
those that are not malnourished or at risk of malnutrition. This menu should provide
around 35% of energy from fat. This guideline clearly states that that normal low-fat,
healthy-eating guidelines are not suitable for most patients in acute hospitals as such food
would not provide enough concentrated energy to meet their needs. Thus, as calorie
posting has being shown to discourage people choosing high calorie foods, putting calorie
contents on in-patient menus would discourage patients from taking the additional calories
they require.
In addition to the above in the case of patients with anorexia or bulimia nervosa who are
admitted to acute/ longer stay hospitals calorie counts on menus could be detrimental to
their recovery as this is something that is discouraged in this client group.
In conclusion, due to the current rates of malnutrition on admission and deteriorating
nutritional status of inpatients, combined with the need for high calorie diets while in
hospital, calorie posting on in-patient menus for ‘healthy eating purposes’ is not
appropriate and in some cases may be detrimental to the patient.
References:
1. Food and Nutritional Care in Hospitals – Guidelines for Preventing Under-Nutrition
in Acute Hospitals. Aug 2008
2. Allison SP. ‘Cost-effectiveness of nutritional support in the elderly’ Proceedings of
the Nutrition Society 1995; 693-699
3. BAPEN Nutrition Screening Survey in UK & Republic of Ireland 2010
16
Appendix III
Peer Review of Policy
Reviewer: The purpose of this statement is to ensure that a Policy
proposed for implementation in the HSE is circulated to a peer reviewer
(internal or external), in advance of approval. You are asked to sign this
form to confirm to the committee developing this Policy that you have
reviewed and agreed the content and recommend the approval of the
following Policy:
HSE Calorie Posting Policy
I acknowledge the following:
•
•
•
I have been provided with a copy of the Policy described above.
I have read the Policy document.
I agree with the Policy and recommend its approval by the
committee developing the Policy.
______________________
Name
________________ ___________
Signature
Date
Please return this completed form to:
Ms. Adrienne Lynam, Chairperson National Expert Group on Vending and
Calorie Posting. [email protected]
17
Appendix IV
Key Stakeholders Review of Policy
Reviewer: The purpose of this statement is to ensure that a Policy,
proposed for implementation in the HSE is circulated to Managers of
Employees who have a stake in the Policy, in advance of approval of the
Policy. You are asked to sign this form to confirm to the committee
developing this Policy that you have seen and agree to the following
Policy.
HSE Calorie Posting Policy
I acknowledge the following:
•
•
•
I have been provided with a copy of the Policy described above.
I have read the Policy document.
I agree with the Policy and recommend its approval by the
committee developing the Policy
______________________
Name
_______________________
Signature
Date
Please return this completed form to:
Ms. Adrienne Lynam, Chairperson National Expert Group on Vending &
Calorie Posting. [email protected]
18
Appendix IV
Key Stakeholders Review of Policy
Reviewer: The purpose of this statement is to ensure that a Policy,
proposed for implementation in the HSE is circulated to Managers of
Employees who have a stake in the Policy, in advance of approval of the
Policy. You are asked to sign this form to confirm to the committee
developing this Policy that you have seen and agree to the following
Policy.
HSE Calorie Posting Policy
I acknowledge the following:
•
•
•
I have been provided with a copy of the Policy described above.
I have read the Policy document.
I agree with the Policy and recommend its approval by the
committee developing the Policy
______________________
Name
_______________________
Signature
Date
Please return this completed form to:
Ms. Adrienne Lynam, Chairperson National Expert Group on Vending &
Calorie Posting. [email protected]
19
Appendix V
Signature Sheet:
I have read, understand and agree to adhere to the attached Policy, Procedure,
Protocol or Guideline:
Print Name
Signature
Area of
Work
Date
20
Appendix VI Examples of calorie posting
21
22
Appendix VII
Communication and available supports
•
•
A communications plan has been developed to inform HSE staff and the
general public including Introduction of calorie posting to staff through email broadcasts, the
HSE Intranet and Health Matters.
Use of press releases, tender documentation and www.hse.ie to
communicate with the public as well as existing and potential
contractors.
A suite of communication materials is available on www.hse.ie
The newly designed vending machines carry the following caption “It’s all
about choice … make yours a healthy one”. This will draw the customer’s
attention to the presence of “Better Choice”/ healthier options and the calorie
posting of all products in the machine to assist them to make a more informed
product choice. To encourage the purchase of healthier options all machines
must also display the following Health Promotion information key messages in
lime green info bubbles:
1. Want a healthy snack? Choose the green option
2. Save your smile, drink water
3. Keep your snack to 150 calories
•
•
To support use of calorie posting, Nutrition information will be prominently
displayed in food service areas.
A number of support documents (Toolkit) to assist in preparing for and
introduction of calorie posting are posted on www.hse.ie These comprise:
i. A review of calorie posting in the workplace setting (including healthcare
facilities) Athlone Institute of Technology. May 2015
ii. The 10 top tips to getting started
iii. Introducing Calorie Posting: Case study report from the pilots sites in
Cherry Orchard and Letterkenny General Hospitals June 2015
iv. Introducing Calorie Posting : implementing calorie posting in Dr
Steevens' Hospital and a review of working with external contractors
May 2015
v. HSE Marketing and Communication tools
vi. Evaluation of Caloriewise: A Northern Ireland pilot of the display of
calorie information in food catering businesses (including three hospital
trusts) Oct. 2013
vii. Putting calories on menus in Ireland Draft Technical Guidance for Food
Businesses. FSAI 2012
viii. The Impact of Restaurant Calorie Labels on Food Choice: Results from a
Field Experiment. Economic Inquiry April 2014
ix. FSAI Putting calories on menus in Ireland Draft Technical Guidance For
Food Businesseswww.fsai.ie
23