Healthy Eating Research Nutrition Guidelines For The .
Healthy Eating ResearchNutrition Guidelines for theCharitable Food SystemMarch 2020Healthy Eating Research A National Program of the Robert Wood Johnson FoundationHealthy EatingResearch
Healthy Eating ResearchHealthy Eating Research Nutrition Guidelinesfor the Charitable Food SystemMarch 2020Healthy Eating Research Nutrition Guidelines for the Charitable Food System March 20201
Expert Panel Co-ChairsExpert Panel MembersHilary Seligman, MD, MASAssociate Professor of Medicine and of Epidemiologyand BiostatisticsDirector, Food Policy, Health and Hunger Program,Center for Vulnerable PopulationsUniversity of California, San FranciscoGerry Brisson, MAPresident and CEO of Gleaners Community Food Bankof Southeast MichiganMarlene Schwartz, PhDDirector, Rudd Center for Obesity & Food PolicyProfessor, Human Development and Family SciencesUniversity of ConnecticutPanel ConvenersMary Story, PhD, RDDirector, Healthy Eating ResearchProfessor, Global Health and Family Medicineand Community HealthDuke Global Health InstituteDuke UniversityMegan Lott, MPH, RDNDeputy Director, Healthy Eating ResearchDuke Global Health InstituteDuke UniversityPanel SupportRonli Levi, MPH, RDResearch Analyst, Center for Vulnerable PopulationsUniversity of California, San FranciscoKirsten Arm, MPH, RDNResearch Analyst, Healthy Eating ResearchDuke Global Health InstituteLauren Dawson, MPHCommunications Associate, Healthy Eating ResearchUniversity of Minnesota School of Public HealthEmily Welker Duffy, MPH, RDSenior Research Associate, Healthy Eating ResearchDuke Global Health InstituteElizabeth Campbell, MA, RDNSenior Director, Legislative and Government Affairs,Academy of Nutrition and DieteticsGayle Carlson, MAEDCEO, Montana Food Bank NetworkCaitlin Caspi, ScDAssistant Professor, Department of Family Medicineand Community HealthUniversity of MinnesotaMarla FeldmanSenior Program Director, MAZON: A Jewish Responseto HungerTracy Fox, MPH, RDPresident, Food, Nutrition and Policy Consultants, LLCKaren Hanner, MMVice President, Manufacturing Product Sourcing,Feeding AmericaAmy Headings, PhD, RD, LDDirector of Research and Nutrition, Mid-Ohio Food BankKatie Martin, PhDExecutive Director, Foodshare’s Institute for Hunger Research& SolutionsAmi McReynolds, MBA, MSChief Equity and Programs Officer, Feeding AmericaMary Pat Raimondi Bertacchi, MD, RDNChristina Roberto, PhDMitchell J. Blutt and Margo Krody Blutt PresidentialAssistant Professor of Health PolicyPerelman School of Medicine, University of PennsylvaniaNancy Roman, MAPresident and CEO, Partnership for a Healthier AmericaJenna Seymour, PhDSenior Policy Advisor, Division of Nutrition, Physical Activityand ObesityNational Center for Chronic Disease Prevention andHealth PromotionCenters for Disease Control and Prevention2 Healthy Eating Research Nutrition Guidelines for the Charitable Food System March 2020
External ReviewersSuggested CitationMargo Wootan, DsCVice President for Nutrition,Center for Science in the Public InterestSchwartz M, Levi R, Lott M, Arm K, Seligman H. HealthyEating Research Nutrition Guidelines for the CharitableFood System. Durham, NC: Healthy Eating Research; 2020.Available at http://healthyeatingresearch.orgFeeding America Nutritious Food Revisioning Task Force:Alissa BarnesRoadrunner Food Bank, Albuquerque, NMBrandon BartleyHoosier Hills Food Bank, Bloomington, INStephanie Berno, MS, RD, LDHouston Food Bank, Houston, TXJessica Hager, AMFeeding America, Chicago, ILLaura Held, MSFoodlink, Rochester, NYAcknowledgmentsThe expert panel was supported by Healthy Eating Research,a national program of the Robert Wood Johnson Foundation.We would like to express our gratitude and appreciation toour panel co-chairs (Hilary Seligman, MD, MAS and MarleneSchwartz, PhD), lead research analyst (Ronli Levi, MPH,RD), and each of the expert panel members. Finally, we wouldalso like to thank the Robert Wood Johnson Foundation forguidance and counsel throughout the expert panel process.Michelle Hesse, PhD, RDBlue Ridge Area Food Bank, Verona, VACourtney Kennedy, MSGood Shepherd Food Bank, Auburn, MEKatie Martin, PhDFoodshare’s Institute for Hunger Research & Solutions,Bloomfield, CTJohn NiemanGleaners Food Bank of Indiana, Indianapolis, INAdeana Osika, RDN, LDAll Faiths Food Bank, Sarasota, FLLauren Rhoades, MS, MBA, RDNFood Bank for Larimer County, Fort Collins, CODanice Tatosian, CDNFeeding Westchester, Elmsford, NYJeremy ArnoldFeeding America, Washington, D.C.Jennifer MarierFeeding America, Chicago, ILJunior MartinezFeeding America, Chicago, ILHealthy Eating Research Nutrition Guidelines for the Charitable Food System March 20203
Table of ContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Food Insecurity in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Charitable Food System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Box 1: Charitable Food System Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Nutrition, Food Insecurity, and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Charitable Food System Responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Existing Ranking Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Importance of Common Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Key Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Box 2: Key Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Approach to Developing the Panel Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Box 3: Total Sugar vs. Added Sugar and Changes in the Nutrition Facts Label . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Fruits and Vegetables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Table 1: Nutrition Guidelines for Ranking Charitable Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Grains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Protein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Dairy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Non-Dairy Alternatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Beverages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Mixed Dishes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Processed and Packaged Snacks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Desserts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Condiments and Cooking Staples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Miscellaneous Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Table 2: General Rankings of Food Products According to Panel Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Comparing Products across Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Alignment with Other Nutrition Ranking Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Appendix: Alignment with other guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Healthy Eating Research Nutrition Guidelines for the Charitable Food System March 2020
IntroductionBox 1: Charitable Food System DefinitionsFood Insecurity in the United StatesFood insecurity is defined by the U.S. Department ofAgriculture (USDA) as the lack of consistent access to enoughfood for an active, healthy life.1 In 2018, approximately 1 in9 U.S. households experienced food insecurity.2 While hungerand food security are related, they are also distinct. Hungerrefers to a personal, physical sensation of discomfort, whilefood insecurity refers to a lack of available financial resourcesfor food at the household level.3 People living in food insecurehouseholds face a number of barriers to eating healthythat make them vulnerable to diet-related chronic diseases,including obesity, diabetes, hypertension, and heart disease.4In recent years, strategies to address food insecurity havefocused on interventions that simultaneously support foodaccess and health.5Charitable Food SystemFederal food programs like the Supplemental Nutrition AssistanceProgram (SNAP) and the Special Supplemental Nutrition Programfor Women, Infants, and Children (WIC) are the first line ofdefense against food insecurity in the United States. However,these benefits are often not sufficient to meet all of the foodneeds of people living in food insecure households. For SNAPrecipients, the average benefit amount is 1.40 per personper meal—an amount which may not be adequate to meethousehold food needs.6 The charitable food system—a networkof food banks, food pantries, and meal programs—fills this gapby distributing billions of pounds of food annually (Box 1).Feeding America is a national member organization thatincludes approximately 200 food banks across the United States.This food bank network distributes food through approximately60,000 hunger relief agencies to serve an estimated 46.5 millionlow-income individuals each year.7Food banks typically receive food (or money for foodpurchases) through multiple channels, including individualdonors, food drives, growers, manufacturers, distributors,and retailers. The federal government also provides food andadministrative funds to the charitable food system throughprograms such as The Emergency Food Assistance Programand Commodity Supplemental Food Program. Some statesprovide similar funding through programs such as California’sCalFood program and the Massachusetts Emergency FoodAssistance Program. Food purchasing provides food bankswith greater flexibility than food donations to alter foods intheir inventory.Meal program: A program implemented by acommunity organization to provide eligible clients(often seniors, adults with disabilities, and low-incomeindividuals) with no- or low-cost meals. Many foodbanks also operate summer meal programs to close thegap during the summer months when school is out.Food bank: An organization responsible for sourcing,warehousing, and distributing food to communityagencies such as food pantries. Food banks alsoengage in other strategies to systematically addressfood insecurity, including policy advocacy and referralsto federal nutrition programs.Agency: A community organization that distributesfood directly to clients. The majority host food pantries,but some host meal programs. Many agenciesare located in faith-based settings and communitycenters. Other settings include residential programs,congregate meal sites, and schools.Food pantry: A site where groceries are distributedto individuals at no cost. Food pantries may also becalled food shelves.Food donor: Growers, manufacturers, distributers,retailers, and individuals who provide food fordistribution to low-income households by food banksor agencies. The USDA also contracts with food banksto distribute food through programs such as TheEmergency Food Assistance Program (TEFAP) andCommodity Supplemental Food Program (CSFP).Clients: Individuals and families who receive foodfrom a food pantry.Food from the food bank is supplied to partner agencies, suchas food pantries and meal programs. Groceries from foodpantries and meals from meal programs are then provideddirectly to clients. Pantries and meal programs typically sourcefood from their local food bank as well as their own fooddonors and direct purchases.Although the charitable food system was originally conceptualizedas a way to provide temporary assistance to low-income familiesin acute need, for a variety of complex reasons, today’s charitablefood system plays a critical role in supporting the ongoing foodneeds of many chronically food insecure households.7,8 Thus,more people are exposed to the charitable food system, and forlonger periods of time, than in past decades.Healthy Eating Research Nutrition Guidelines for the Charitable Food System March 20205
RationaleNutrition, Food Insecurity, and HealthExtensive research has shown that food insecurity is a complexproblem, with many food insecure families also experiencingother challenges, such as a lack of affordable housing, lowwages, insufficient transportation, and fewer social supports.Poor nutrition has fueled a sharp rise in the prevalence ofchronic disease in the U.S.9 and people living in low-incomeneighborhoods often lack access to healthy food, which has ledto growing socioeconomic disparities in diet quality.10,11 As aresult, individuals living in households utilizing the charitablefood system are at high risk of poor nutrition and diet-relatedchronic disease, including obesity, diabetes, hypertension, andheart disease.7,12no) and others have three tiers (e.g., SWAP: green, yellow, red).Some systems use a ratio of “positive” nutrients (e.g., vitamins,minerals) to “negative” nutrients (e.g., sugar, sodium, saturatedfat) based on the Nutrient Rich Index (e.g., CHOP)17,18, whileothers focus exclusively on nutrients to limit (e.g., SWAP usessaturated fat, sodium, and sugar). There are systems that rankproducts based on nutrient values per 100 grams or 100 caloriesof product in order to standardize similar products with differentportion sizes, while others rank products based on nutrientvalues in one serving, as printed on the Nutrition Facts Label.Finally, some systems rely on food descriptions to categorize items(e.g., canned fruit in water or juice), while others set specificthresholds for nutrients (e.g., maximum of calories, grams ofsaturated fat, or milligrams of sodium).Charitable Food System ResponsesImportance of Common DefinitionsBecause the charitable food system is an important contributorto the food environment of people experiencing food insecurity,many organizations within this system have prioritizedsourcing and supplying more nutritious foods.8,13–15 This workis particularly important because many items moving throughthe charitable food system are shelf-stable, highly processedfoods that tend to be high in saturated fat, sodium, and addedsugars. Recent efforts to promote healthy choices in food banksand food pantries include the creation and adoption of formalnutrition policies; expanded nutrition education; cultivationof relationships with food donors who can donate healthierproducts; and investment in capacity to store and displayhealthier food items.Existing Ranking SystemsShifting charitable food system inventory toward healthierfoods and beverages requires making decisions regarding whatconstitutes a more nutritious food item. To this end, variousnutrition ranking systems (e.g., nutrition standards or nutritionguidelines) for the charitable food system have been developedto categorize foods based on specific ingredients or nutrientcriteria. In 2017, a national survey of nearly 200 state, regional,and local food banks foun
Nutrition, Food Insecurity, and Health Extensive research has shown that food insecurity is a complex problem, with many food insecure families also experiencing other challenges, such as a lack of affordable housing, low wages, insufficient transportation, and fewer social supports.
The Guidelines for Healthy Eating and Food Guide provide information to help people make healthy food choices. Eating in this way helps the body to stay healthy; it improves the ability to do everyday tasks, improves mental ability and overall sense of well being. A healthy eating plan provides the body with energy to function and helps prevent .
6. Detection of Eating Disorders 63 7. Diagnosis of Eating Disorders 73 8. Interventions at the Different Levels of Care in the Management of Eating Disorders 81 9. Treatment of Eating Disorders 91 10. Assessment of Eating Disorders 179 11. Prognosis of Eating Disorders 191 12. Legal Aspects Concerning Individuals with Eating Disorders in Spain 195
Set up a regular pattern of eating. Session 4: Healthy Eating . Ways to Eat Healthy. Eating less fat and fewer calories is an important part of losing weight. But that is only one important part of healthy eating. Another part of healthy eating is changing the way we eat and what we eat. Here are a few tips to help.
Pennsylvania Department of Aging Internet Nutrition Resources 1 Healthy Eating for Senior Adults Eating Well Over 50: Nutrition and Diet Tips for Healthy Eating as You Age
Healthy Recipes. Older Adults A guide to healthy eating for Good nutrition is important at any age. Eating well helps you feel your best each day. Healthy eating will help to prevent or manage heart disease, diabetes, osteoporosis and some cancers.
Nutrition. Healthy eating for vegetarian or vegan . pregnant and breastfeeding mothers . Healthy eating in pregnancy and breastfeeding . Healthy eating is important during pregnancy and breastfeeding. What you eat and rink d now can affect your health and the health of your baby for many years to come.
Nutrition Background Information: Healthy Eating for Children and Youth (page 7) Nutrition Sample Activities Mission Nutrition www.missionnutrition.ca Grade 6-8 Lesson 1 Exploring Healthy Eating, Lesson 2 Food For Energy and Nutrients Alberta Health Services School Nutrition Lesson Plans
41 Handout 5.1 Diet and Nutrition: Nutrition Activity Ideas for Preschool Children 43 Lesson 5B Diet and Nutrition: Healthy Eating (Child Care Providers and Parents) 44 Handout 5.2 Information and Strategies for Three Age Groups: Healthy Eating 45 Handout 5.3 Fact Sheet for Families: Good Nutrition and Healthy Smiles 46 Lesson 6 Injury Control .
