The Wellness Challenge

There once was a time when, for foodservice operators, managing a “wellness” program consisted of providing a few healthy dining choices for those customers who were doing more than just talking health. That is no longer the case. Not only have customers in general become more concerned with their health, issues such as an increase in food allergies, a marked rise in celiac disease and gluten intolerance and the prevalence of eating disorders—particularly on college campuses—have raised the bar for operators regarding what they need to do to offer programs that meet the needs of as many patrons as possible.

This month, FoodService Director asked three dietitians to share their views on how wellness programs have changed and what operators need to do to make them work in today’s environment.  

Know Your Audience

According to Rachel Begun, R.D., a consulting dietitian and a current spokeswoman for the Academy of Nutrition and Dietetics, the biggest challenge of creating a successful wellness program is not having a clear definition of what wellness is in the context of the type of program the operator is managing and the facility’s customer base.

“[Non-commercial] foodservice operators are usually serving a pretty diverse population, and eating healthy means different things to different people,” says Begun, who has worked on a consulting basis for Flik Independent School Dining, a division of Compass Group North America. “For some people that means focusing on calorie intake. For some people it might mean focusing on making sustainable choices. Others are focusing on fat and carb intake. So choosing which messages to target, I think, is one of the hardest aspects of implementing a wellness program, and that’s why it’s important for operators to really have a pulse on food and nutrition trends as well as the needs and desires of their customers.”

Related:Online Exclusive: Resources Abound to Solve Wellness Challenge

Complicating the issue somewhat is the fact that, for some customers, wellness and sustainability are linked.

“Some people see wellness and sustainability as two different silos, and others see them as more of an interrelated phenomenon,” she suggests. “That makes it all the more important to get some kind of understanding of what wellness means to your particular customers.”

How that occurs is up to individual operators, whether it is by surveying customers, holding a meeting of the minds with the foodservice management team or a combination of the two, so long as the end result is an understanding of what you need to accomplish.

“The next step is figuring out what your message is going to be and how are you going to communicate that message,” Begun adds. “The old thinking was if people are just given nutrition knowledge then they will automatically make good decisions and behaviors based on that knowledge. We know that is not necessarily the case. We know that people make food choices based on emotions, on feelings, on the way they were raised and on their values, so I think it’s important you first focus on the message.

Different messages are going to resonate with different people. A school audience where 90% participate in after-school sports needs the message that certain choices will help them perform better in their soccer game or their ballet lesson. If you have a group that is very sustainability focused your message should be that you’re bringing in locally grown food, that you help to contribute to the local economy or you’re helping to reduce the impact on the environment.”

Food allergies: Begun sees two major nutritional challenges facing foodservice operators in all non-commercial segments. One is consumers’ attitudes toward dieting, and the other is the increasing number of people either being diagnosed with or believing they have a food allergy or an intolerance of gluten. For both, Begun advocates having chefs and dietitians working in tandem on recipe testing and menu development.

“It’s estimated today that 12 million Americans have food allergies of one type or another; one in every 13 children under the age of 18 has a food allergy,” she notes. “Some people have multiple food allergies, which makes it really difficult for them to get safe food outside of the home.

“Then you have all those with celiac disease and gluten sensitivity. One in 100 people—3 million Americans—has celiac disease and one in six people has gluten sensitivity. That equates to almost 20 million Americans.

“We really don’t understand what gluten sensitivity means yet. We just know that some people have adverse effects to eating gluten that are different from [symptoms of] celiac disease.”

Research and communication: In terms of diet issues, Begun suggests that operators and chefs do their homework to make sure they understand the pros and cons of all the various types of diets being promoted.

“Operators need to look at trends to make sure they’re not fly-by-night trends that you’re going to jump on for the short term,” she says. “Is there scientific evidence that what you’re promoting in the dining room is actually helping and promoting the health of consumers? That’s where it’s really important for chefs and dietitians to work together on the foodservice team, because the chefs are coming from a culinary perspective and the dietitians are coming from a nutrition perspective, so they have the knowledge to know what the evidence is.

“The best thing to do is consider food and nutrition together,” Begun adds. “I know it sounds very basic, like, ‘of course, who wouldn’t do that,’ but I believe that for a very long time we did think of them as two different silos. I think that foodservice operators who are really standing out and making waves from a wellness perspective are those who are incorporating the two into the same silo and treating it as one dialogue. That goes back to having your chefs and dietitians work together.”

Assuming that you’ve got a handle on what your customers’ needs are and how best to meet them, the battle comes down to getting the message out. Begun is a fan of using social media to communicate with customers for two reasons.

“First of all, social media platforms are very visual,” she notes. “The sharing of photos on Facebook or Pinterest, for example, is a great way to show that healthy foods can be very appetizing.

“Second, I think people like talking about food issues. Communicating nutrition is not a one-way street. It’s a two-way dialogue. It’s a great opportunity for operators to share their knowledge of culinary trends and it’s a great chance to get feedback from customers. Companies used to spend millions of dollars to get focus group feedback. Now, they don’t have to spend a dime. All they have to do is contribute on social media.”  

Information Overload

Theresa Laurenz, R.D., dietitian for Dining Services at Northwestern University, in Evanston, Ill., says she has seen a disturbing increase in unhealthy eating habits, particularly eating disorders, on campus. Most troubling is a rise in male anorexia.

“There has been a substantial increase in the number of male students with eating disorders, particularly anorexia,” says Laurenz. “What we don’t know is whether [the increase] is more because people are now feeling comfortable coming out and we’re just recognizing it, or if it truly is an increase. But, whichever, it’s still alarming because anorexia has always been considered this white female issue. Now we’re learning that it’s definitely across all cultures, males and females.”

Laurenz suggests two related reasons for an overall increase in unhealthful eating behaviors. One is an information overload regarding what is proper nutrition, and the related reason is parents, teachers and other authority figures communicating the message of nutrition to an extreme.

“There definitely is a lot of conflicting information out there,” she says. “Even within the nutrition and dietetic community and the healthcare community there are opposing opinions, which are difficult to sift through; research isn’t perfect. The biggest thing I think I’ve noticed is that kids are hearing from so many people what to eat and when to eat that they aren’t relying on their own internal cues. I think it’s really interesting how difficult it is for people to listen to their hunger cues and eat when they’re hungry and eat foods that are going to nourish them and make them feel full because they want to feel nourished. Instead, they rely on all the outside marketing and believe, ‘if I eat this way I’m going to be healthy,’ whether that’s really healthy or not.”

Laurenz is quick to point out that this isn’t true of all students. However, for students who are susceptible to suggestion or who have a poor self-image, the barrage of information may be too much.

“Parents and teachers, especially gym teachers, who are trying to teach our kids about how to be healthy and what the best things to eat are communicating the message about the bad foods, the things they shouldn’t be eating, and that they shouldn’t be overeating and they shouldn’t be having this food or that food,” she explains.

“When they grow up and they do go off on their own, now they have their own choices and they focus on the negative versus just on the positive. And the people who really pay attention to the nutrition facts we have around campus are usually the ones who are on the spectrum for disordered eating. Those people who are really counting calories or using those calorie apps are choosing calorie counts that are not appropriate for them. Most of them do not need to lose weight; they are already in a healthy weight range or body fat range and some of them are even below their healthy body fat range. This is just another number for them to become obsessed about and another way to judge themselves.”

Posting nutritionals: In that regard, Laurenz says that foodservice departments can sometimes unwittingly contribute to the obsession with diet by providing easy access to nutrition information.

“I wonder whether it’s really good for us to have these nutrition facts out there,” she says. “Is this really the focus we need to have, or should we just give them wholesome, nutritious food and help them to understand the message, ‘eat when you’re hungry and don’t eat when you’re not hungry?’

“In addition, a lot of times the information is not accurate because you have to follow a recipe exactly in order for it to be correct,” Laurenz adds. “If you have a food change-up such as a product switch, it’s no longer going to be accurate. And if you don’t have people weighing out every ounce of ingredients and really using measuring cups it won’t be correct. If I see a cook who doesn’t at least have some kind of a scale next to him while he’s cooking, he’s not following that recipe. I know he’s not.”

Laurenz says that during one-on-one counseling with students, her primary goal is to teach them that wellness isn’t simply about eating right.

“I really try to get them to describe what their life is like, to find out what things have been created in their life to prevent them from having a balance,” she says. “One fact people don’t consider is that many students are lacking in sleep. Researchers have shown that when you lack sleep, your cortisol levels increase. Your hunger levels increase. Your satiety levels decrease and you become more insulin-resistant, which increases your chance of having Type 2 diabetes.”

To that, she adds, when you add the stressful environment of a college campus, students will seek ways to alleviate the stress, and food may be the temporary fix.

“Most people, when they get right down to it, know what they should be having as far as food,” Laurenz suggests. “They know that they should have those fruits and vegetables and those whole grains and good proteins, and they should be eating at regular intervals throughout the day and that they shouldn’t starve themselves or skip meals. Those aren’t complicated, but what is complicated usually is creating an environment in which they can make good choices. I do that on a one-to-one basis, but I do feel that our dining halls can also create that environment to help people create great choices.”

Dining behaviors: To accomplish that, Laurenz recommends the advice of Brian Wansink, a Cornell University professor and researcher who studies diners’ behaviors. One of Wansink’s theories is that, in a cafeteria environment, people tend to select the first foods they see, especially if they are particularly hungry.

“This is something that we are talking about for next year. Even our Sargent Dining Hall, one of the six dining halls at Northwestern, the first two stations you see are the grill with the french fries and the pizza station,” she notes. “We’ve talked about making changes to that setup; maybe a nice little appetizer station that has some carrots or celery sticks or bell peppers or snap peas or whatever vegetables cut up so that when they students in they say, ‘oh, here’s ranch dressing and carrot sticks. I’m going to grab that.’ And they fill up their plate with that stuff and then they go to an entrée station, where maybe there’s some great roasted vegetables there that they also put on their plate. Now they have a much more balanced plate than a plate full of french fries when they first walk in.”

Laurenz adds that, in her opinion, going trayless may have reduced food waste, but it hasn’t necessarily helped promote healthier dining. Students are hesitant to give up desserts and, with only two hands to carry food, dessert often takes the place of a healthier menu item, she says.

Laurenz’s other advice? Making vegetables and healthy food items more exciting. “I know it’s been a standard for a long time to have plain steamed vegetables represent the healthy option, but you know people want flavors with their vegetables,” she explains. “They want them to be exciting. They want them to be mixed in with other great things. And they want the names of these dishes to be exciting. So if you just have broccoli as a side, why not call it ‘broccoli bites’ and cut them up into little bite-size pieces that are easy to manage, rather than big broccoli stalks?

“So pick different ways of preparing those vegetables and making them exciting. And then advertise them. You know, ‘here are the top five things that these vegetables do for you.’ Also, if you do have the opportunity, do cooking demonstrations; they always pull over people. Instead of demos where you focus on the meat, focus on the vegetables that people tend to skip over.”  

Accentuate the Positive

Gina Guiducci, R.D., dietitian for Dining Services at Brown University in Providence, R.I., likes the word “wellness.” Her philosophy about wellness is taken from the positive attitude the word suggests.

“Wellness is a great word because it begins with ‘well,’ so it’s more about prevention than treatment, and that’s a good thing because a lot of health messaging tends to be so negative, as in, ‘This is your problem and this is what you need to do to fix it.’ I like to focus on the positives.”

For that reason, Guiducci isn’t a fan of wellness programs that are built around what customers shouldn’t be doing.

“Whether you are at a college or other institution, or in a restaurant or fast-food place, wellness is all about balance, not just in terms of what customers are consuming but also in terms of what operators are offering,” she says. “There’s the population that’s asking for fried chicken and french fries and things like that and we’d like to offer them healthier options. But I think stripping customers of fried foods and things that we as dietitians know are not necessarily good for people is not doing them the justice of allowing them to make the choice for themselves. All foods can fit in a healthy eating program. If you have [fried foods] one day, it’s OK. If you’re having it every day, not so much. But if [operators] take those choices away we go back to this negative message that this food is bad for you and so if you eat it you’ll feel bad about yourself.”

Providing choice: Similarly, she believes the marketing of wellness should take the approach of putting the information out there and letting customers decide whether to take the advice.

“I like tools like YouTube where students can choose to view topics from a registered dietitian on campus or perhaps link in from social media like Twitter and Facebook. I like that because it’s giving students the choice without having it be in their face, especially when they are eating. I think one of our current challenges is choosing the right avenues and times for our health messaging.”

One of the problems with wellness programs, Guiducci believes, is that many are ill-defined.

“I don’t think a lot of people really understand what wellness means,” she says. “For dietitians, health and wellness is very food and nutrition focused, but that’s not to say that’s how everybody sees it. The best approach is to take a step back and define wellness first to understand what the scope of the program should be. You have to have a needs assessment in order to understand how you’re going to be able to relate to the population, how you’re going to target the population, how they want to receive the information, how you want to deliver it and how you want to collect the data to even see whether your goals for the program are actually being met.”

Guiducci acknowledges that the health education department at Brown administers most of the wellness communication on the campus. Such information includes elements outside of the nutritional aspects, such as the importance of sleep and stress reducers such as relaxation and meditation.

“That’s not to say that we don’t collaborate and run things by one another,” she notes. “There is a food and nutrition section of their website that I contribute to, but certainly they are the ones who are driving the all-encompassing wellness programs. Going forward what I’d like to see is us getting a little bit more involved in terms of just educating around healthful nutrition.”

Much of Guiducci’s time is spent counseling students, particularly those with food allergies and celiac disease. But she says she has seen her share of eating disorders.

“There is almost an obsession around eating healthy,” she explains. “Only organic, nothing refined. Eliminate this or that. It’s reaching a point where eating healthy has becoming almost unhealthy. The other thing we’re facing, now that there is a lot of attention around celiac disease, is that a lot of people are misunderstanding what that really means. It seems like gluten-free diets are becoming trendy because I think folks are thinking this is the next low-carb diet, when in fact it is not.”

Individualized care: Nevertheless, Guiducci is currently working hard to come up with a plan to make it easier for dining services to deal with customers who have food allergies and intolerances.

“We’re creating a plan not only for residential dining but for retail dining and catering as well because we are seeing not just students but anyone who walks on campus having inquiries about special diets.”

For students who truly are in need of a specialized program, dining services allows them to place orders directly with the kitchen for meals prepared to their needs.

“Because the numbers keep increasing we are now starting to shift into a new program that will be a supplement to the current program, which is like a pantry they can access as a fallback if they didn’t have time to call ahead and place an order. But I do see us eventually, when we’re doing our recipe testing and developing our menus, looking to do things like moving to the gluten-free version of items like soy sauce so that it’s throughout our entire system and we won’t have to worry so much about ingredients. This would allow for many more options for individuals who are intolerant of gluten.”

The main advice Guiducci says she’d offer operators who are looking to start a wellness program or revive a stagnant one is simple: “Get anyone and everyone in your department on board but also involve folks who are in benefits, psych services, health services, athletics, human resources. Keep it positive. Make wellness fun. Most times, when we talk about wellness and food and nutrition, people think it’s the most boring topic ever. Making it fun gets more people engaged and wanting to participate.”

But please, don’t try to sneak one in on your customers, she adds.

“In regard to the ‘stealth health’ approach, I know there are quite a few schools that do this and I think it is a good thing that they are integrating health. But I tend not to agree with the stealth health approach only because I feel like people should know what it is they’re eating. They should be rejoicing because they’re making these changes to their menus.”