The Healthy 15

From farmers’ markets to educational sessions with dietitians and labeling better-for-you options, creating a comprehensive wellness program encompasses a whole host of tactics. This month we showcase 15 operations that are at the forefront of creating a healthy foodservice environment for both their employees and guests. These 15 operations were selected from nominations across all market segments. 

Carilion Clinic, Roanoke, Va.

For many healthcare institutions, promoting health and wellness doesn’t occur only within the boundaries of the hospital campus. For them, there is almost a moral mandate to work within the community at large to try to foster the health of anyone who might fall under their sphere of influence.

Few health systems are doing this better than Carilion Clinic. According to Becky Ellis, senior director of dining and nutrition services, after partnering with local health and human services organizations on a community health needs assessment, the health system came up with four short-term goals—only one of which can be satisfied totally within the walls of Carilion’s hospitals.

That goal, to increase the offering of healthy foods provided by the department, began in December 2012 with an aggressive rethinking of what the hospitals will sell and how they would be marketed.

Outside the hospitals, a farmers’ market and farm share program were established at Carilion Roanoke Memorial Hospital for employees and local residents. The Carilion Clinic Farmer’s Table and the farm share program were begun in 2012. Ellis says that, combined, the two programs grossed $21,594 in 2012 and $77,876 in 2013, a growth rate of more than 250%.

Carilion also came up with a plan to grow the Supplemental Nutrition Assistance Program’s Double Value program. To boost the program, which effectively doubles the buying power of food stamps used to purchase healthy local foods at the city’s farmers’ market and community markets established by the Local Environmental Agriculture Project (LEAP), Carilion donated a total of $15,000, which LEAP is using to develop a comprehensive data tracking system to plot additional health outcome data on people who have used the Double Value program.

Carilion also has doubled the number of sites at which it runs its Happy Healthy Cooks (HHC) initiative, from four to eight. HHC is a 20-week program in which volunteers teach children as young as four about healthy foods and proper nutrition—including learning to prepare healthy plant-based recipes.

Avera Heart Hospital, Sioux Falls, S.D.

Long before most hospitals fully embraced the idea of healthful dining, Joanne Shearer believed that it should be a hospital’s mission to promote health and wellness in its foodservice program.

So when 52-bed Avera Heart Hospital was built 10 years ago, Shearer, the now-retired food and nutrition services director, created A La Heart Café to be a trendsetter among hospital foodservice venues.

“Joanne’s dream was to have one healthy food culture for the entire organization,” says Mary Beth Russell, R.D., who replaced Shearer as director about two years ago. “She wanted to use a Mediterranean-type influence in the cooking process and how we taught our classes so we could benefit heart patients. So that is how she designed our menu.”

According to Russell, Shearer demonstrated her resolve even before the café opened. “This hospital was a copycat of several the organization had built around the country, so the kitchen was very standard,” Russell says. “Everybody got the same equipment. The first thing she did, when the equipment arrived, was she refused to let them put in a fryer of any kind. I think what she bought instead was a tilt skillet so we could do sautéing. So there are no fried foods in our hospital.”

The menu changes twice a year, and before each changeover staff will gather to review the menu to come up with several new items to keep the menus fresh. Russell notes that, in an effort to control sodium levels, all soups are made fresh in house. Overall, between 70% and 80% of the menu items are made from scratch.

“We also post nutritional data for all of our entrées, which is probably our best marketing tool,” she says. “It actually brings people in. We have some surrounding facilities and people will walk over here for lunch because of our healthy culture and our nutrition information.”

Ironically, if there is one negative to the program, Russell adds, it would be the department’s emphasis on reducing salt. “Patient satisfaction, when it comes to taste, is lower than we would like it,” she says. “The No. 1 complaint is that we use too little salt. We try to overcome that by using different spices and seasonings, but the flavors aren’t always what patients expect.”

Still, the foodservice program is generally well received. Russell says she has noticed it particularly because she moved from the patient education side to foodservice. “The cool thing about it is we have nurses and doctors, and all of our staff, having firsthand experience eating the same kinds of foods we’re encouraging our patients to eat,” she says. “It really helps with education to have the support of the staff.”

Chelsea Senior Living, New Jersey, New York, Pennsylvania

Almost all of the residents at Chelsea Senior Living spent their lives preparing and eating home-cooked meals. So it follows that they would expect the same type of fresh, wholesome fare upon moving into an assisted living community. That’s one of the reasons why this year the 16-facility organization adopted a new mandate to make all of its food from scratch.

Cooking from scratch allows directors to control exactly what goes into residents’ meals, which helps limit fat and salt content. With the exception of low-sodium chicken or beef bases, Chelsea kitchens are entirely salt free. But that doesn’t mean chefs sacrifice flavor: Fresh salads, such as Summer Citrus Salad with chicken, Mandarin oranges and lime marinade, are served daily. Dinner offerings include sole baked in parchment paper with fresh herbs, red potatoes and sugar snap peas, or herb-crusted roast beef with garlic mashed potatoes and sautéed escarole. Every meal within each four-week cycle menu is reviewed by a dietitian, and menus are required to feature at least one heart-healthy option at breakfast, lunch and dinner, says Mike Nodine, food service director at Chelsea’s Warren, N.J., location.

But exposure to healthy foods in the dining room is only the beginning. On Wellness Wednesdays residents can participate in themed presentations and learn how they can take control of their health through smart diet choices. “When we focused on vision, we talked about foods with that orange color that are high in vitamin A,” says Priscilla Rackliff, food service director at the Tinton Falls, N.J., location. There’s also a commitment to natural, food-based alternatives as a first resort for wellness issues. For example, yogurt is a common remedy for stomach trouble.

El Monte City School District, California

There are only four schools in the entire country that have received the Alliance for a Healthier Generation’s (AHG) gold standard, the highest honor given by the organization. Three of those are in El Monte City School District.

The success of El Monte’s wellness program is driven by the heart of its stakeholders. The program isn’t merely focusing its efforts inside the schools. It’s reaching out to build a community that puts wellness first. After assembling a team that includes key stakeholders from various departments (foodservice, PE, the city’s parks and recreation department, for example) the team set about ways to help reduce the percentage—38%, at present—of the community’s children who are overweight or obese.

“We’re trying to create a culture of wellness within El Monte,” says Robert Lewis, Ph.D., director of nutrition services. “We also sit on the board of the city’s wellness program and they sit on ours, so we can write these policies together so kids aren’t confused. So if unhealthy snacks are bad in school they are bad on city property too.”

Some of the wellness initiatives the foodservice department focuses on include no competitive foods, promotion of non-food fundraising and educational programs. The district has wellness teachers whose sole job is to teach nutrition and healthy eating to students. Those wellness teachers meet with Lewis’ dietitian to receive materials to use when going into classrooms.

Other programs started by the wellness committee that span multiple departments include:

Unidine at Griffin Hospital, Derby, Conn.

When it comes to promoting health and wellness, Chris Garrand, general manager for Unidine Corp. at 163-bed Griffin Hospital has an easy time of it. Not only does Unidine, based in Boston, consider itself a healthy foodservice company, Griffin Hospital positions itself the same way.

“The hospital is very wellness driven,” Garrand explains. “They are self-insured and they really promote and provide incentives to employees to live a healthy lifestyle.”

Garrand uses Unidine’s OHSOGOOD wellness program, which provides a wide variety of healthy dining options, to augment the various classes and programs the hospital offers its staff. The five stations in the hospital’s dining space, as well as the grab-and-go area, all offer whole-grain and vegetarian options. OHSOGOOD items are plentiful and marked with a special logo at the point of sale to make them easier to find.

“We have a made-to-order salad station manned by a chef,” he notes. “All of our proteins are roasted in house. Our pizza station offers both whole-wheat and regular crusts. We do housemade whipped fruits; we will purée a fruit, such as mango, add a little gelatin and apple and blend it into a light dessert that has a lot of nutrients. Also, throughout the hospital, there are no sugar-sweetened beverages sold.”

The dining room is open from 6:30 a.m. to 6:30 p.m. To help third-shift staff maintain their healthy diets, Garrand’s team sends wraps, salads and fresh fruit to the nursing units in the evening, and the vending machines that the hospital stocks are filled with healthy items.

Garrand adds that the patient menu mirrors what can be found on the retail side, and for that reason the patient menu actually controls the retail menu. “We do restaurant-style dining, where orders are taken with an iPad and sent down to the kitchen,” he explains. “We don’t want to show them a lot of choices [on the menu] if they can only order three things because of their diets. So we really try to reverse engineer the menu to fit into most patients’ diet parameters.”

In addition to the menu offerings, the department will provide monthly lunch and learns that often include cooking demos.

“I believe that we have a moral obligation to offer healthy foods. It doesn’t have to be the only option, but it has to be an option. Here, we are looked at as the healthy food company to promote that message,” Garrand says.

Colorado Springs District 11

Good food. That’s the foundation of the wellness program at Colorado Springs School District 11.

In 2006, when the district’s foodservice department went self-op, Rick Hughes, director of food and nutrition services, created the Good Food Project, which set standards for the foods that could be served in schools. Those standards include: no growth hormones, antibiotics, added sugars, trans fats, artificial preservatives or dyes; whole or natural foods that are environmentally friendly with minimal packaging; and whole grains and fresh fruits and vegetables. It took nearly five years to cleanse the menus of items that didn’t fit the Good Food standards.

“We publicize those standards to the community. We want people to know that’s what guides us and that’s what we’re accountable for and that we’re not just going to throw something into our menus that goes against that,” Hughes says.

A large part of the Good Food Project is cooking from scratch as much as possible. Pizza dough and roasted chicken are now made in house. The move to scratch required the hiring of an executive chef, Brian Axworthy, who has revamped the production process to include four central production hubs: a bakery, cold prep and two entrée locations.

The district also is growing produce in a school garden, which is then used in school meals. The garden now has 120 beds and grows 30,000 pounds of organically grown produce each year.

Recognizing the importance of guaranteeing that no child goes hungry, Hughes’ team started breakfast in the classroom programs in 15 schools. Hughes also lobbied, along with other Colorado directors, to get a law passed in the state legislature that requires the bill for reduced-priced meals to be picked up by the state, meaning those students now receive meals free of cost.

North Carolina State University, Raleigh, N.C.

The Freshman 15? Not if you’re a student at North Carolina State University. A multifaceted program rooted in the nutrition-focused menu development process paves an easy-to-follow path for diners wanting to make healthful choices at the dining table and beyond.

Central to the health and wellness programs at NC State is menu development. Streamlined management software for menu planning, purchasing, nutrition analysis, allergen marking, product labeling and information display take out the guesswork for the 18 on-staff chefs, resulting in accurate recipe testing, nutritional data collection and reporting, accurate ingredient cost data and menu management. Some of the established nutritional criteria include:

Parkhurst Dining at Highmark, Pittsburgh, Camp Hill, Pa., and Delaware

Parkhurst Dining has put health and wellness at the forefront within the three corporate office locations of its client Highmark. During a 10-year period, Parkhurst has evolved the offerings at Highmark’s request, gradually implementing healthier options. “Gradual change was well received by our guests,” the company’s nomination states. “If our approach is too strong and too radical, employees feel like they are being forced to eat healthy and they will likely go somewhere else. If our approach is too soft or lacks commitment, the end result will be little or no change.”

Today, several initiatives focused on the overall health and well-being of Highmark employees combine to deliver fresh, flavorful options across all Highmark dining operations, including:

In addition, healthy ingredients are the basis for menu development, including incorporation of global flavors and seasonings. The Chef’s Table program (see March 2014 issue) brings preparation of healthy dishes in front of the customer through chef demonstrations and recipe sharing. Catering menus also have been revamped to include only items deemed to be healthy. 

In addition to employee education and training, marketing has played an important role in this new, healthy approach. Within the servery, easy-to-read nutrition signage guides healthy choices, healthy options are listed first on digital marketing boards and Healthy Interruption Points featuring nutritious snack options are strategically placed throughout the café to divert unhealthy impulse purchases. 

Overlook Medical Center, Summit, N.J.

At Overlook Medical Center, the foodservice team is focusing on making the healthy choice the easy choice through education and rewarding better-for-you choices.

One of the biggest motivators is the Summit Fit Club, which rewards customers for making healthier food choices. Each customer who participates in the program receives a Fit Club card to keep track of his/her points. Every menu item in the cafeteria is labeled with Fit Points, which range from one to three, with three being the healthiest. When customers participating in the program check out, they swipe their Fit Club card to earn points and after 200 points they earn a $5 meal voucher and other gifts, which are shown on their printed receipt.

The Summit Fit Club isn’t the only way that the foodservice department is promoting healthy options. Learning what a proper portion size actually is and eating only that amount can be a challenge. Overlook offers a “right-size portion” program. If customers select the smaller portion of a special, they get a lower price.

While working to enhance healthy dining options, the staff has made a commitment to reduce animal proteins on menus by 20%, has added more healthy items to vending machines and the retail manager has developed, designed and built a nutritional kiosk, which also prints menus and nutritionals for back-of-the-house foodservice staff.

Rex Healthcare, Raleigh, N.C.

Could you imagine going to work and being rewarded for eating a healthy breakfast? It might sound too good to be true, but that’s exactly what happens at Rex Healthcare. When the hospital adopted an employee healthcare plan that rewarded staff members for healthy lifestyle choices (and penalized them for unhealthy ones), Director of Culinary and Nutrition Services Jim McGrody was inspired to develop the Vitality Bowl, a whole-grain breakfast porridge. Now, for every eight times employees purchase the fiber-packed breakfast—made with red rice, kamut, farro, wheat berries, dried mango, and cinnamon topped with housemade granola, berries and peaches—they earn points that can be put toward keeping their healthcare costs low.

But that’s just a taste of the healthy initiatives that earned Rex Healthcare a Gold Apple Award from Prevention Partners, a North Carolina nonprofit focusing on leading health issues. Recently, the 660-bed complex launched Be, Nourish, Learn, Move, a healthy branded concept that offers a unique take on good-for-you meals, plus nutrition and lifestyle education. A major part of the menu overhaul involved ditching the deep-fat fryer in favor of baked and grilled fare. “We’re a major bariatric and stroke center. It seemed hypocritical to serve food that contributes to those problems,” McGrody says.

Instead of burgers or chicken strips, Rex serves entrées such as Spice Island Grilled Tilapia, Cod Provençal and Grilled Flank Steak Sandwich. Gone are the usual french fry or onion ring sides, which have been replaced by grilled zucchini, kale salad with citrus dressing, beet salad and baked potato wedges tossed in gourmet flavor blends like Thai chili and dill pickle. During the warmer months, the kitchen also will put out specials showcasing vegetables from the courtyard garden, including an heirloom tomato salad. And thanks to a color-coded labeling system, it’s easy for guests to know exactly how many calories and fat grams are in any given menu item. 

The patient menu got a makeover, too. In addition to scrapping fried foods, McGrody focused on creating delicious low-fat, low-sodium versions of dishes people already know and love. Regular tuna salad got a Mediterranean update with Kalamata olives, capers and fresh herbs served on fresh greens with a toasted cumin seed vinaigrette. Caesar salad is tossed with a silken tofu-based dressing that patients adore just as much as the original.

Guckenheimer at SanDisk, Milpitas, Calif.

The move to a new office location in February 2013 provided the opportunity to offer its 2,000 employees new, healthier dining options at SanDisk headquarters. In partnership with its foodservice provider, Guckenheimer, the team set out to overhaul the menu in order to remove less healthy items, add healthier ones and put the brakes on free doughnut Fridays to instead provide free muffins and whole-wheat bagels. “There were people who didn’t like that,” explains Karla Lacey, Guckenheimer’s chief marketing officer, of the doughnut deletion. “And so [SanDisk was willing] to really have conviction at a very senior level that being healthy and really walking the walk and not just talking about it was really important. It really takes a company that’s committed up and down.”

In addition to making detailed nutrition information available, the team has reduced portion sizes and added the lunch option of a fruit add-on at no charge. Color Matters, a stoplight labeling system created by Guckenheimer, helps guide customers to healthier options. With the renewed focus on health, today more than 80% of the items available in the café carry green or yellow labels.

“The employees love the fact that they are being offered choices,” says Ravi Naik, senior vice president and chief information officer for SanDisk. “And the fact that each choice comes with the necessary information about the ingredients, the calories, fat content, fiber content, etc., allows the employees to make educated decisions.”

“One of the things that I think is important is that [SanDisk] is not just concerned about weight,” Lacey explains. “They want people to eat well and be productive and live well.” Recognizing the importance of eating a healthy breakfast, SanDisk began offering free oatmeal every day, complete with a toppings bar with dried fruit, nuts and brown sugar. At the previous location, less than two gallons of oatmeal would be sold on a “good day,” according to Lacey. But the offering has been such a hit with employees that now 50 gallons of oatmeal are served each day.

The success of getting employees on board with the new dining program is also due in part to SanDisk’s financial support. By changing the subsidy breakdown to pay more for green-labeled items and less for yellow and red, the company has encouraged café guests to choose healthier options not just for their bodies but for their wallets, too.

UCSF Medical Center, San Francisco

The goal of the Smart Choice, Smart U program at this 850-bed healthcare complex is two-fold: encourage customers to choose more healthy foods and lead them to make lifestyle changes that will improve their overall health.

The first step was to create healthy menus, which the foodservice department did in 2009 as part of its multimillion-dollar renovation of the retail program. But the key to the success of the program, according to Director of Nutrition & Food Services Dan Henroid, has been providing customers with the knowledge to make the proper choices.

“We are not aware of any other foodservice operator that provides nutritional information in as many places as we do,” he says. Prepurchase, customers can gather data from traditional and digital signage, the department’s website, package labels on to-go items and even from “The Book,” a ring-bound volume in the Moffitt Café that contains information on all the café’s menu items. After the sale is complete, customers can see the nutritionals of the foods they’ve bought on their “smart receipts.” These receipts also contain health messages and even discount coupons for healthy foods and beverages.

As an adjunct to the program, Henroid has adopted the Healthy Beverage Initiative from the Boston Public Health Commission. This program uses color coding to identify beverages by level of healthfulness: green and yellow tabs for healthier drinks and red for sugary beverages.

The department has rearranged the fountain machines, segregating the “red” drinks from the rest and even graphically demonstrating the amount of sugar in various size drinks (see photo at left). It also has increased the price on unhealthy beverages and lowered the price on better-for-you drinks.

University of Georgia, Athens

The menu at the University of Georgia is big. Every day there are more than 300 items on the docket, but before an item can make it to the serving line it must meet a strict nutrition standard checklist that was created by the foodservice team. Here are a few of the guidelines that menu items must meet:

Beyond making the menu healthier, the university has a registered dietitian who educates students on nutrition principles and how to incorporate them into their daily lives. The dietitian is available for additional education purposes, including providing presentations upon request. Students may also take part in an eight-week Eating Smart Course where they can dig deeper into learning how to incorporate wellness into their busy routines. The dietitian is also available for private counseling sessions to discuss weight management, body fat percentage, exercise, food allergies and other health-related topics—for free.

One of the most unusual things that the university dining staff created is the menu labeling system. The menu symbols identify foods with specific nutritional guidelines, such as vegan, meatless, less than 30% of total calories from fat and Bon-i-fied Good (items the team deem healthiest). This system provides students and faculty with the information they need to make healthier choices every time they dine.

Students and faculty members aren’t the only ones who benefit from the foodservice programs. Many foodservice programs have used UGA Food Services as a resource, including the U.S Olympic Team’s nutrition research assistant, the U.S. Navy and five major universities. 

WVU Healthcare, Morgantown, W.Va.

Cynthia Gay, retail manager for the Health Sciences Center Cafeteria at WVU Healthcare, in Morgantown, W.Va., says her facility is known as “The Healthy Café.” She has a lot of evidence to back up the claim. “Since 2004, we’ve posted nutrition labels at the point of service for every menu item,” Gay explains. “The menu is public and the nutrition labels also can be viewed online by clicking each menu item.”

Most items are prepared from scratch using healthy ingredients. The emphasis on an already healthful menu comes in the form of a daily lunch special that has less than 500 calories and 600 milligrams of sodium, and a breakfast feature that tops out at 400 calories and averages 20 grams of “high-quality” protein.

Not only are many healthy ingredients used in the kitchen, a good portion of them are sourced locally, Gay adds.

“We have a 40-item soup and salad bar with many colorful vegetables, most of which we wash and cut on premise. We frequently offer a grain salad in the deli using barley, quinoa, bulgur, spelt and more. Our two daily soups are housemade, with the exception of tomato soup. Most of the bean products we serve are made using dried beans to keep the sodium low. We even cook our own garbanzo beans for falafel.”

Gay emphasizes that although healthy items are heavily marketed, the cafeteria still offers a variety of choices. But it seems that customers are getting the message. “The use of 100% whole-wheat bread in the deli and for toast far surpass the sale of white bread products,” she says. “And our housemade grain muffins served at breakfast and lunch far outsell doughnuts.”

Not only are the muffins grain rich, they also are small in size and low in fat and sodium, Gay notes, and most desserts have less than 12 grams of added sugar per serving.   

Finally, the department tries to take its healthy message to the community. “We exhibit at health fairs and the farmers’ market, and this year I am doing one healthy cooking demo per month,” Gay says.

Restaurant Associates at World Bank, Washington, D.C.

At a location with the name the World Bank, it’s imperative for the foodservice team, which is managed by Restaurant Associates, to take a global perspective when creating a wellness program.

“What’s fascinating for an American to be here is to [see] how different cultures view health,” says Sabrina Capannola, senior project manager at World Bank. “There are certain cultures that look at different things as healthy, and what I as an American don’t view as healthy, someone from India may, so that’s been a challenge for Restaurant Associates that they’ve really stepped up to and done a fabulous job with.”

Vital to the program’s success is a robust vegetarian offering necessary to satisfy the needs of customers. “I think one of the unique challenges of working at the World Bank is the need for vegetarian food—a vegetarian offering every single day, at every station,” explains Andrew Lisi, vice president of operations for Restaurant Associates at the account. “More so than more American-type [work] sites, there is a religious component to [eating vegetarian] for a lot of folks internationally, so we’re proud to meet those goals."

The team also has achieved wellness success through a combination of established Restaurant Associates programs, including Whole Sum, in which meals with 600 calories and 600 milligrams of sodium or less are labeled, and programs created in partnership with World Bank, such as a Steamed Seafood Chef’s Table, initially offered as a special event and now presented on most Fridays throughout the year, and a 350-calorie breakfast menu, which began as a promotion to increase daypart sales and is now a daily staple.

“A lot of the [wellness] promotions that we’ve tried here have stuck, really showing us that our customers and our client really want this, and we just keep moving forward on it,” Lisi explains. “You can try a wellness initiative and it doesn’t work and then you go back to serving hamburgers, but we’re lucky to have dialogue with our staff, with our customers and our client to get these things to work long term."

A recent addition to World Bank wellness initiatives is a multifaceted program called Passport to Wellness. Program initiatives include a monthly focus on a new country and its wellness practices, nutrition awareness programs in conjunction with monthly national observances and Chef Billy’s Picks, in which meal options lower in fat, calories and sodium carry a seal of approval from Restaurant Associates Director of Wellness Chef Billy Strynkowski.