HSE Policy on Calorie Posting

Document

reference number

Date Status Responsible

H&WCP01 June 2015 Document developed

HSE National Expert Group

on Healthy Vending & Calorie Posting

Aug 2015 Document approved

National Director Health

& Wellbeing

Sept 2015 Document

approved

HSE Leadership

Team

1st Review June 2016 Document

revised

HSE Healthy

Eating & Active Living National

Implementation Group

2nd Review June 2018

Document revised

HSE Healthy Eating & Active

Living National Implementation

Group

2

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

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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

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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.

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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 encourage other

organisations to follow suit

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

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• 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)

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3.2 Legislation/Other Related Policies • Healthy Ireland in the Health Services National Implementation Plan 2015-2017

• 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.

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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

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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

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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.

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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 Monitoring

• 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 Revision and Audit

• Initial review will take place June 2016 and every two years thereafter or as warranted by the Expert Group.

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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-improved-health-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

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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

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10.0 Appendices

Appendix I Members of the National Expert Group on Vending and Calorie Posting Appendix II Inpatient menus

Appendix III Peer Review of Policy Appendix IV Key Stakeholders Review of Policy

Appendix V Signature Sheet Appendix VI Examples of calorie posting Appendix VII Communication and available supports

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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.

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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 63-

84% 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

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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. Adrienne.Lynam@hse.ie

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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. Adrienne.Lynam@hse.ie

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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. Adrienne.Lynam@hse.ie

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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

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Appendix VI Examples of calorie posting

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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