Eating for Health: a Diet Action Plan for Scotland

7.1 The number of meals eaten outside the home rose substantially between 1984 and 1993. This trend is continuing as witnessed, for example, by the rapid growth of both lunchtime takeaway fast food outlets and new more formal restaurants. More than a quarter of our total energy intake is now being derived from food eaten outside the home. Thus, eating out plays an important and increasing part in people's eating habits and, in consequence, caterers, at all levels of catering provision, are in a position to influence both consumer awareness of healthy choices and, more importantly, the actual provision of healthy foods to consumers.

7.2 In the last 10 years, the quality of food provided by caterers in Scotland has improved and become more varied and adventurous. But there is still a need for major change to improve the nutritional content by reducing the levels of fat, salt, and sugar in the foods provided; and by increasing the use of fruit and vegetables and complex carbohydrates (rice, pastas, cereals and bread). One simple way to achieve this would be for caterers to provide a variety of vegetables, or salad, as part of the main course and included within the price of the meal. In circumstances where meals are subsidised, vegetables, in addition to potatoes, and fruit should comprise part of every meal and consideration could also be given by caterers to the introduction of price weighting policies which favour healthy foods. But, worryingly, nutrition does not feature high in caterers' food priorities. Nor does it appear that the consumer is any more concerned: nutritional value featured 16th out of 17 items in a recent survey by one major "fastfood" outlet of attributes important to customers when selecting informal eating out venues. "Tasty" food tops the list. In general, therefore, consumers are clearly not yet demanding more nutritious options when eating out.

7.3 Ideally it should be possible to look to caterers to stimulate customers' interest in, and demand for, more healthy foods and to catering establishments to provide consumers with healthy choices. But the Group believes that, currently, achievement of that objective is constrained by the fact that less than 1% of cooks and caterers in Scotland have been provided with anything other than a rudimentary understanding of nutritional principles. Even catering colleges and hotel training courses offer only limited nutritional teaching and almost no practical guidance on how to change the traditional approach to the use and presentation of vegetables or the use of spices and herbs in preference to fat, salt and sugar.

7.4 The Group concluded, therefore, that as a priority, catering staff need to be better informed about nutritional requirements. They, in turn, could apply that knowledge to the development of improved and new recipes and menus. To that end, all further and higher education institutions offering courses in hotel and catering management should consider including nutrition and dietary education in their curricula.

7.5 The fast food sector, in particular, has great potential to influence healthy eating, especially among the young. The popularity of fast food outlets as venues both for snacks and more substantial meals presents real opportunities for promoting and developing healthy eating habits among their clientele. Some initiatives have already been taken. For example, some fast food chains have introduced healthy options such as full-grain cereals, salads and grilled chicken sandwiches. The Group welcomes these initiatives but considers there is scope, without lessening popular appeal, for much wider availability of healthy foods and urges the fast food sector to take steps to broaden the range and choice of nutritionally beneficial foods. The incremental reduction in the fat content of standard products should be examined. The increasing popularity of the fast food sector will inevitably lead to a rise rather than a fall in fat consumption unless fast food producers themselves take substantive action. This is a major challenge, which will need to be met by novel approaches; and in this context the Group welcomed the production, under the auspices of the National Task Force Programme, of an information leaflet for fast food providers on healthy eating. Meanwhile dietary information leaflets, routinely available in only a few fast-food outlets at present, could begin the process of sensitising fast food consumers to the need for dietary change.

7.6 It is recommended, therefore, that all catering staff should have a basic level of training in diet and nutrition, similar to the requirement on them in relation to food hygiene. Such training should be validated externally and should be linked to, or be part of, the Scottish Vocational Qualification (SVQ) for the catering sector. The Group considers that its introduction should be examined by the Hotel and Catering Training Company, the industry lead body with a responsibility for the development and maintenance of occupational standards within the catering sector, in collaboration with the Scottish Vocational Educational Council.

7.7 In addition, it will be important to the maintenance of healthy eating standards in catering establishments that caterers have available to them a nutritional reference. To that end, the Group concluded that nutritional guidelines should be provided to all catering establishments. These should be commissioned by The Scottish Office Department of Health and should be based primarily on the proposed national Model Nutritional Guidelines for Catering Specifications for the Public Sector in Scotland (see Annex to Section 6). They should be focused according to the category of restaurant, ie formal restaurant, snack bar, takeaway etc. They should cover not only nutritional data but also advice on the provision of balanced healthy meals, as opposed to individual foods and dishes, and on the promotion and presentation of healthy food choices.

7.8 A low cost (or free) nutritional advisory service is needed, which caterers could approach both for advice and nutritional analysis of food recipes. This would enable them to develop meals which are not only attractive but nutritionally sound. The Scottish Office should provide the necessary funds to meet the cost of a pilot scheme.

7.9 The Model Nutritional Guidelines for Catering Specifications for the Public Sector in Scotland will have relevance to various other large scale catering provisions within the public service. There is a clear need for improved dietary practice within the Scottish Prison Service and the other public services as well. The Scottish Prison Service is particularly well placed to influence diet. Unlike most other institutions, the Service provides the total food intake of substantial numbers of mainly young men for long periods of time. Most prisoners are drawn from that section of the population with the least healthy eating habits and the highest rate of coronary heart disease in middle age. The Action Group recommends that the public services should review their existing specifications in the light of the Model Nutritional Guidelines.

7.10 In considering further incentives to encourage caterers to be more sensitive to the need for healthy eating, the Group reviewed the healthy eating award schemes currently operating elsewhere in the UK and in Sweden, Australia and Canada. These are administered variously by Government interests, Health Boards, voluntary organisations or local authorities. They apply either to retailers or caterers or both and involve the display of a symbol or use of a specific logo on menus or foods which meet certain pre-determined nutritional criteria related to fat, salt, sugar and fibre and healthy choice menus. In some instances, provision of smoke-free areas and standards of food hygiene are included. The schemes enjoy varied levels of success but it is clear that all raise awareness, both within the catering and retail industries and amongst the public, of the value of healthy eating. They also provide an effective mechanism to give, in simple terms, complex messages to consumers about healthy eating.

7.11 The Health Education Board for Scotland is examining this area. Several local initiatives run by Health Boards are in operation in Scotland. These include the Better Hearted Award in Forth Valley, Look Lively Eat Wisely in Inverness, Eat to the Beat in Grampian, a Heart Beat Award in Ayrshire and Arran and a Healthy Choice Award in Tayside. In addition, some supermarkets operate their own healthy eating awards using, inter alia, healthy eating logos to identify products suitable as part of a healthy diet.

7.12 The Group is particularly attracted to an award scheme because of its potential to increase contact and improve communication between caterers, retailers, health professionals and consumers. The Group concluded, therefore, that a National Healthy Eating Award Scheme should be encouraged and that its introduction should be explored by the Scottish Consumer Council together with the Health Education Board for Scotland.

7.13 Careful consideration of the scope and the practical implications of the Scheme will be necessary but the criteria governing the Scheme will obviously need to be based on the Scottish dietary targets and requirements of the proposed nutritional guidelines. The Award might be graded to reflect achievement of individual aspects of healthy eating. Alternatively, and this is the Action Group's preference, it could be made in recognition of a catering establishment's delivery of healthy food choices in relation to entire menus. Consideration will have to be given also to the criteria governing local award initiatives such as those described in paragraph 7.11 to ensure that these are consistent with those of the proposed national Scheme. And monitoring arrangements will have to be put in place to evaluate the Scheme's impact.

7.14 It will be vital for the Scheme to be well publicised and for its promotional materials to explain to consumers how it operates so that the healthy eating messages are received clearly. It is also essential that the Scheme is administered by a body which is generally well known and respected by consumers: otherwise it will have little credibility.

7.15 The Group welcomes the initiatives being taken by the Scottish Tourist Board to promote higher quality and nutritionally appropriate menus in catering outlets and restaurants throughout Scotland. The Board will wish to consider appropriate mechanisms through which nutritional expertise and advice can be provided to caterers.

7.16 Catering establishments should also be encouraged to contribute to the promotion of the desired increase in breastfeeding rates by providing appropriate facilities for nursing mothers.

Action Points

Catering establishments should work progressively towards providing a variety of vegetables and/or a side salad as part of the main course of every meal. The cost should be included in the price of the meal.
All further and higher education institutions offering courses in hotel and catering management should consider including nutrition and dietary education in their curricula.
The fast food sector should broaden the range and choice of nutritionally beneficial foods which it offers to consumers. The feasibility of an incremental reduction in the fat content of standard products should be examined urgently.
All catering staff should have a basic level of training in nutrition and diet. The training should be validated externally and be linked to or be part of the Scottish Vocational Qualification for the catering sector. Its introduction should be considered by the Hotel and Catering Training Company in collaboration with the Scottish Vocational Education Council.
The Scottish Office Department of Health should commission the preparation of nutritional guidelines, based` on the Model Nutritional Guidelines for Catering Specifications for the Public Sector in Scotland annexed to Section 6 of the Action Plan. The guidelines should be provided to all catering staff.
A low cost (or free) nutritional advisory service which caterers could approach for advice and nutritional analysis of food recipes should be piloted. The Scottish Office should fund the cost of a pilot scheme.
The Scottish Office should ensure that the catering services of the Scottish Prison Service and other public services in Scotland reflect the guidance in the Model Nutritional Guidelines for Catering Specifications for the Public Sector in Scotland.
The introduction of a national Healthy Eating Award Scheme should be explored by the Scottish Consumer Council in partnership with the Health Education Board for Scotland.
The Scottish Tourist Board should consider ways of incorporating nutritional advice within its campaign to raise catering standards throughout Scotland.