Strategies to Reduce Sodium Intake in the United States (2010) / Chapter Skim
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6 The Food Environment: Key to Formulating Strategies for Change in Sodium Intake
6 The Food Environment: Key to Formulating Strategies for Change in Sodium Intake
Pages 153-212
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From page 153... ...
. The food environment framework reflects an interaction of multiple components: manufacturers, retailers, restaurant/foodservice operations, consumers, regulation/policy, and communication/advertising (Glanz et al., 2005)
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From page 154... ...
This section provides an overview of food manufacturing and retailing in the United States, information on how food products are developed, and examples of efforts taken by the food industry to reduce sodium intake and the levels of sodium in the foods it produces. Characteristics of the Processed Food Industry Processed food represents one of the largest sectors of the U.S.
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From page 155... ...
The top food manufacturers in the United States are multinationals that create and sell a variety of products under numerous national brand names. National brands are typically those that are well known and advertised, and most have strong customer loyalty.5 In addition to large multinationals, thousands of small- and mediumsized companies make products that are sold nationally or regionally.
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From page 156... ...
, but the dominance of such products varies greatly by food category. Although still less prevalent than brand name products, private label products are an important component of the processed food supply, especially given their current rate of growth, which is higher than that of national brand name products (Martinez, 2007)
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Characteristics of the Food Retailing Industry Food retailers are increasingly important in the food environment, not only because of their longstanding role as key distributors for and promoters of processed foods, but also because their increasing concentration and data-gathering technologies have given them the ability to influence the types of products developed by manufacturers. Over the past decade, the food retail sector has seen dramatic changes driven by the growth of nontraditional food retailers such as big box supercenters (Martinez, 2007)
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Slotting fees are one-time payments made by food processors to retailers in exchange for placement of new products on store shelves (FTC, 2003)
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To create new products, the largest processed food manufacturers have 8 Available online: http://walmartstores.com/Sustainability/9125.aspx (accessed October 12, 2009)
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All sizes of food manufacturers are relying more on ingredient suppliers, external contract developers, and consultants to be part of the product development process (Beckley et al., 2007; Thomas, 2007)
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Questions asked 9 Available online: http://www.uga.edu/nchfp/business/starting_business.html#ceslinks and http://www.ces.ncsu.edu/index.php? page=foodsafetyprocessing (accessed October 15, 2009)
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Reproduced with permission of Taylor and Francis Group LLC from "New food product development: From concept to marketplace," 2nd Figure 6-2 edition; permission conveyed through Copyright Clearance Center, Inc.
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THE FOOD ENVIRONMENT BOX 6-1 Sources of Product Ideas Internal Sources • Business and marketing teams • Research and development teams • Sales personnel • Packaging teams • Regulatory affairs departments External Sources • Competitors • Suppliers • Consumers • Retailers SOURCES: Straus, 2009; Topp, 2007. include the following (Heyhoe, 2002; Moskowitz et al., 2009; Straus, 2009)
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. Knowledge of food science, engineering, chemistry, microbiology, and packaging is used to create prototypes that can meet the product concept within the constraints of modern food processing and without exceeding the intended cost of the product.
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From page 165... ...
In addition, companies test products to ensure that the reformulated product is considered by consumers to be of equal or better quality than the original version so as not to lose market share, according to a participant in the public information-gathering workshop held by the committee (March 30, 2009)
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From page 166... ...
. Challenges to Introducing New or Reformulated Products with Reduced Sodium There are a number of challenges to reducing the sodium content of processed foods.
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New product development with lower sodium at baseline, however, may be less costly than reformulating existing products with established consumer taste expectations. The Industry's Efforts to Reduce Sodium in Foods The processed food and retailing industries have taken steps toward encouraging reductions in sodium intake.
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From page 168... ...
It is notable that the industry has used two different approaches to reduce the sodium content of the American food supply through reformulating existing products. The first approach is to make changes in the sodium content of products in order for those products to qualify for sodium content claims and then to market these items to consumers interested in reduced-sodium products.
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From page 169... ...
There has been a slight rebound in the number of products with sodium content claims in recent years, which may be a result of increased attention to sodium intake and/or more recent food science innovations that have made further reductions possible. With renewed attention to salt and sodium reduction around the world, food manufacturers have created sodium reduction initiatives in recent years.
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From page 170... ...
and reducing the sodium content of existing Healthy Request soup lines from 480 to 410 mg per serving.b ConAgra reduced the annual sodium usage in its products by 2.8 million pounds over a period of several years, ending in 2007.c More recently, ConAgra announced plans to cut its overall sodium use by 20 percent by 2015, by reducing sodium in more than 160 products.d General Mills instituted a sodium reduction plan across all of its business categories and has silently reduced the sodium levels in Progresso, Hamburger Helper, and Cheerios products (Wiemer, 2009) , and has six reduced-sodium soups with 450–480 mg sodium per serving.e In its 2010 Corporate Social Responsibility Report, General Mills pledged to further reduce sodium in more than 600 of its products by 20 percent, on average, by 2015.
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From page 171... ...
The company reports that the approach will be stepwise and include periodic reassessment of goals.j Unilever created a worldwide Nutrition Enhancement Program to reduce levels of sodium and other nutrients of concern. Thus far, the program has removed 9,100 tons of salt from products around the world, and there are plans to reduce sodium in 22,000 products.k According to a representative at the committee's public information-gathering session, reductions have included 25 percent in Knorr Side Dishes and over 40 percent (of silent reductions)
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From page 172... ...
Health and sodium content information is intended to educate consumers and provide them with tools they can use to help them reduce their sodium intake. However, as described in Chapter 2, such knowledge and tools like the Nutrition Facts panel have remained insufficient in reducing sodium content levels to those recommended by the Dietary Guidelines for Americans.
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From page 173... ...
As a result, FDA recently announced steps to address the use of front-of-package and shelf label claims concerning the nutritional quality of a food.28 It is clear that food manufacturers and retailers have taken some steps to help the American public reduce sodium intake; however, such efforts have been limited. Not all companies have dedicated resources to this concern, and the intensity of sodium reduction efforts appears to have fluctuated over time.
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Box 6-3 lists restaurant/foodservice operations as classified by the National Restaurant Association.31 Definitions of each of these restaurant/foodservice categories are provided in the glossary (Appendix A)
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on the basis of sales, are shown in Table 6-6, with the top companies reflecting fast food operations. According to USDA estimates, full-service and fast food restaurants account for more than 77 percent of away-from-home food sales.32 Commercial operations are open to the public such as fast food and fine dining restaurants.
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From page 176... ...
A company or individual may own multiple independent restaurants, but because each location operates with a different menu or concept for the dining experience, these restaurants are still considered independent establishments. In contrast, chain restaurants are a group of restaurants that have the same name and marketing strategy, and menu items that are generally standardized across locations (Walker, 2009)
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. New menu items can be created from scratch or from completely or partially prepared processed foods.
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stated that in some cases, these items may be identical to processed foods sold to the public by retailers, but in other cases, these products are specially designed to meet the needs of restaurant/foodservice operations. For large chains, menu and menu item development are more complex.
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. While redesigning menus and menu items to lower calories or include more fruits and vegetables may have the added benefit of reducing sodium content, this may not be the case for all items.
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and may lack the skills to reduce sodium using a variety of preparation techniques or alternative flavor strategies. Education may be useful at all levels of restaurant/foodservice operations to raise awareness of these issues.
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The Industry's Efforts to Reduce Sodium in Foods The abovementioned challenges are obstacles to reducing sodium in menu items and are likely reasons why the committee was unable to find much evidence that reducing sodium in foods has been a major initiative of the restaurant/foodservice industry in the past. This is not to say that individual restaurant/foodservice companies have not made efforts to lower sodium across their menus or to provide lower-sodium options.
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From page 182... ...
and the Reduced Sodium icon (servings must have 25 percent less sodium than the original version) .f In order to use the icon system, chefs and managers must complete a 10-hour web-based nutrition program and answer test questions with 100 percent accuracy, and chefs must complete a day-long, hands-on training that includes reduced-sodium production techniques, which they then teach to others in their units.g ConAgra announced in January 2008 that it would offer all of its Chef Boyardee food service products with lower sodium content.
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From page 183... ...
This may be due to a lack of consumer pressure on restaurant/foodservice companies in past initiatives to reduce the sodium content of foods, in part because of the relatively limited nutritional information readily available to the public in these venues, and it may also be closely tied to the notion that it is a special occasion to consume meals at restaurants. Sodium reduction has been perceived by the industry as less
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From page 184... ...
It is notable that sodium intake has been a concern for some federal programs, and, as described below, limited efforts have been taken to reduce sodium in some programs. National School Lunch Program and School Breakfast Program Operating under the aegis of the Food and Nutrition Service of USDA, the National School Lunch Program and the School Breakfast Program provide meals for the nation's children.
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Nutrition Services Incentive Program Department of Regular feeding of troops Defense Fresh Fruit and Vegetable Program Defense Supply Center Philadelphia's Subsistence Directorate (link between the Armed Forces and the food industry, provides subsistence for military personnel and federal agencies worldwide) Department of Justice Subsistence program purchases food for prisons (Bureau of Prisons)
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From page 186... ...
To help schools reduce the sodium content of meals, they are offered lower-sodium foods through the USDA's Commodity Distribution Program. In the past, the Commodity Distribution Program's Commodity Improvement Council conducted a review to identify potential reductions in fat, sodium, and/or sugar levels of products.
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. SNAP has only a few limitations on items that can be purchased using its benefits, such as food products that contain alcohol or tobacco, vitamins and supplements, and foods sold hot at the point of sale are not eligible.46 Recently, there has been more interest in encouraging more healthful food purchases using SNAP funds, and it has been recognized that the size of SNAP offers an impressive opportunity to promote dietary change.
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. The Defense Logistics Agency's Defense Supply Center in Philadelphia 48 Available online: http://www.fns.usda.gov/wic/WIC-Fact-Sheet.pdf (accessed October 15, 2009)
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The degree of sodium reduction was determined by consumer testing, and changes were not incorporated unless adequate hedonic ratings could be maintained (Wollmeringer, year unknown)
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In discussions below regarding the consumer and the food environment, paradigms from related fields of study -- including economic theory and health behavior theory -- are highlighted as useful and can be applied to future work on sodium reduction targeted to consumers. But a specific analysis of reasons for the past experiences and outcomes relative to the interface between consumers and sodium intake reduction is 56 Available online: http://www.cspinet.org/new/pdf/nyc_agency_food_standards.pdf (ac cessed November 18, 2009)
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The above mentioned factors cannot be documented and are largely hypotheses, but it seems apparent that even those personally concerned about sodium were also unable to reduce intake. The food supply undoubtedly played a key role in challenging such consumers, but it is also likely that consumer skills for interpreting the sodium content of their diet may have been lacking.
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It would now be useful to carefully examine the factors that are important to motivating consumer change in the area of sodium reduction which, when coupled with the overarching effort to reduce the sodium content of the food supply, inform the activities needed to assist consumers in selecting diets more in line with overall sodium intake reduction. Understanding and working with the interface between consumers and the food environment is critical to the success of such efforts.
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and health communication campaigns -- in the context of reducing sodium in the food supply. These theoretical perspectives provide further justification for an incremental approach to sodium reduction.
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The price of foods with lower sodium content influences consumer choices and thus is also a factor affecting sodium reduction strategies. When considering consumers as part of households, changes in the way households allocate their time for food preparation have implications for sodium consumption because households are increasingly relying on processed and prepared foods from grocery stores and foods from restaurants and other foodservice operations.
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, but they have not specifically addressed salt taste, a potentially positive attribute, or sodium content, a potentially negative attribute, in the analyses. Although specific values associated with salt taste and sodium content are not available in the literature, consumer theory suggests some considerations.
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. Data from 2004 indicate that cost is not just a concern for those with a low income; nearly 40 percent of shoppers with household incomes between $50,000 and $75,000 cite cost as a major barrier to a more healthful diet (Food Marketing Institute, 2005)
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As households have changed their allocation of time away from food preparation, the food environment has changed in response. Correspondingly, changes in the food environment have likely also facilitated changes in the way households allocate their time by reducing the time required to prepare foods and increasing the availability and ease of access to prepared foods and restaurant and other foodservice foods.
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The resulting implication is that changes in the food environment will be essential to allow individuals to purchase and consume lower-sodium foods. Applying Health Behavior Theory to Sodium Intake Reduction Behavioral theories provide guidance about the determinants of a given health behavior -- in this case, reducing salt intake.
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Use of Health Communication Campaigns As noted previously in this report, prior health communication strategies have not been successful in their attempts to influence consumer salt intake, but they have made some progress in increasing awareness. In the context of recommended changes of sodium levels in the food supply, however, a coordinated effort to communicate the risks of sodium and in
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In the case of sodium intake, however, the committee recognizes that reduction does not rely exclusively on consumer actions, and reductions of sodium in the food supply may be the greatest contributor to overall reduction of sodium intake. Accordingly, the objectives for a health communication campaign may include increasing consumers' knowledge of the impact of sodium on health outcomes and the benefits of sodium intake reductions for all groups; building support for government actions to reduce sodium in the food supply; and building skills to make food choices in line with reductions in sodium intake.
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population feels that action to reduce sodium is not necessary, although results from USDA's Diet, Health and Knowledge Survey reviewed in Chapter 2 indicate that the levels of sodium intake appears to be comparable regardless of personal perceptions of need for change. A health communication campaign in the context of reductions of sodium in the food supply may additionally have positive impacts on self-efficacy; consumers may feel more confident in their ability to reduce sodium intake with increased availability of good-tasting, lower-sodium food options.
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. Thus, it is unlikely that the average consumer will be able to successfully reduce sodium intake without changes to other components of the food environment.
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. However, sodium presents some unique challenges that were not encountered in these earlier policy issues, making effective moni toring and surveillance systems even more critical for implementing sodium reduction strategies.
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Presented at the Institute of Medicine Committee on Strategies to Reduce Sodium Intake's Public Information-Gathering Workshop, March 30, Washington, DC.
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2006. Retreat examines realistic ways to provide healthful menu items.
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2009. Identifying strategies to reduce sodium intake in the U.S.
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Presented at the Institute of Medicine Com mittee on Strategies to Reduce Sodium Intake's Public Information-Gathering Workshop, March 30, Washington, DC. Hayden, K
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Presented at the Institute of Medicine Com mittee on Strategies to Reduce Sodium Intake's Public Information-Gathering Workshop, March 30, 2009, Washington, DC. Kimmerling, G
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:26-35. National Restaurant Association.
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1995. National School Lunch Program and School Break fast Program: School Meals Initiative for healthy children, final rule.
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2009. Reformulating food products for health: Context and key issues for moing forward in Europe.
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