Food, Beverage & Procurement StandardS

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Food, Beverage &procurementStandardsfor P hiladelphia Hospitalsa lt hyFoodHos p i ts GodaloHe

As a hospital food service provider, you know thatGood Food Is good health care.The Good Food, Healthy Hospitals initiative is helping Philadelphia hospitals increase their offeringsof nutritious, locally sourced foods, and recognizing Good Food leaders. These Food, Beverage andProcurement Standards are designed to help your institution set and achieve goals, and get therecognition you deserve.good food can improve our health,environment, and regional economy.Good Food not only provides us with adequatenutrition, but also promotes public health whileimproving environmental and economic sustainability.One of this initiative’s guiding principles is that GoodFood should be simple, and making healthy choicesshould be easy. Ensuring access to fresh, unrefined,locally sourced food in hospitals demonstrates ahealth system’s commitment to preventive care.Among the ten largest U.S. cities, Philadelphia hassome of the highest rates of poverty and diet-relatedchronic diseases, including hypertension, type-2diabetes, and heart disease.  Research shows thatimproving dietary intake can lower chronic diseaserisk, particularly among at-risk populations. Forexample, reducing excessive sodium intake from theaverage 3400mg/day to the recommended 2300mg/day can lower high blood pressure, and risk for heartdisease and stroke.The procurement of sustainably produced farmproducts supports personal, community, andenvironmental health by reducing non-therapeuticantibiotics, pesticides, and other toxic chemicals in ourfood system.Additionally, purchasing regionally sourced productssupports local farmers, improves the local economy,increases food security through the preservation ofarable land, and reduces the distance food travels.Many conventionally raised and harvested productstravel an average of 1,500 miles from farm to market.Philadelphia hospitalscan lead the way.Philadelphia hospitals have a unique opportunityto improve community health and wellness. Everyday, these hospitals prepare thousands of mealsreaching our most vulnerable populations that oftenlack access to fresh, nutritious food. Their size andcommunity presence provide them institutionalleverage to impact procurement standards andinfluence suppliers to provide more foods thatpromote human health, a thriving regional economy,and a healthy environment.Our region’s farmers already grow foods that supportthese values, but access to the broader Philadelphiafood system is not yet fully integrated.Good Food, Healthy Hospitalsgives Philadelphia hospitals andfamilies the chance to say yes tolocal, sustainable, whole foodsbased meals.

what is “good food?”We believe Good Food not only provides us withadequate nutrition, but also promotes publichealth while improving environmental andeconomic sustainability.Bikeridelondon for Shutterstock.comThe Good Food, Healthy Hospitals initiative strives toconnect farming families with Philadelphia families,while advancing the City’s public health.The documents provided are to be used as a guidewherein each participating hospital may developpriority areas of individual food service operations.The standards are set up as goals to reach while alsorecognizing current accomplishments.Measuring and recognizing successThe following Good Food standards provide a tool formeasurement and a basis for recognizing achievementwithin the hospital food environment.By implementing these voluntary standards,Philadelphia hospitals and healthcare systems will:We’re here to help!Our team is available to provide technical assistance,including conducting nutritional analysis, advising onmenu planning, and assisting with product selection andvendor engagement, to help hospitals meet these goals.Improve the health of Philadelphians, includingnutritionally vulnerable populations such as thechronically ill, youth and seniors;We can also provide educational marketing materials foryour use, such as nutrition facts and farmer profiles.Lessen the economic burden of healthcare costsassociated with type-2 diabetes, cardiovasculardisease, other diet-related illness; andFinally, we can help promote your progress andaccomplishments through our established recognitionsystem. Contact us for assistance:Serve as a model for other large institutions,employers, and programs.Catherine Bartoli: catherine.bartoli@phila.govShelley Chamberlain: shelley@thecommonmarket.org

ContentsFood & Beverage purchasing standard5Standard for Food and Beverages Served in Patient Meals10Standard for Food and Beverages Served in Cafeterias,CafÉs, and On-Site Restaurants14Standard for Food and Beverages Served in Catering17Standard for vending19Appendices1. Terminology & Definitions222. Healthy Beverage Identification System243. Snack Vending Sample Planogram254. Beverage Vending Sample Planogram265. Seasonal Availability of Local Vegetables and Fruit28Recognizing achievement30Note All percentages listed are a percentage of the total annual purchase of the specific food category. Standards such as “vegetables and fruit are local” and “unprocessed fresh or frozen seafood is a firstpreference” are intentionally written without suggesting a quantity or volume at this time. Hospitals areencouraged to track their purchases in order to meet purchasing benchmarks, which are quantitative. Seepurchasing benchmarks that follow.Good Food, Healthy HospitalSGood Food, Healthy Hospitals is a four-year initiative to transform Philadelphia’shospital food environment and bring healthier options to employees, patients,and visitors every day. This work is made possible by funding from the Centersfor Disease Control and Prevention and Get Healthy Philly, an initiative of thePhiladelphia Department of Public Health.

Nicolas A Tonnelligood food is local foodDid you know? The Delaware Valley is hometo more than 100 farms that use sustainablemethods to reduce or eliminate chemical pesticides andfertilizers. These practices help protect our waterways,improve soil quality, and even help fight global warming.1Food & Beveragepurchasing standardThese food and beverage purchasing guidelines incorporate most of food service, includingpatient meals, the cafeteria, cafés, catering and on-site restaurants. The purchasing benchmarksoutline purchasing goals for healthy foods and beverages. Purchased food guidelines ensurethat healthier food options such as vegetables and fruits, whole grains, and lean proteins area regular part of individual’s diets so that those who only eat a few items of each meal arestill eating healthy options. Purchased beverage guidelines ensure that individuals are beingencouraged to select beverages that support health and hydration. Purchased snack guidelinesensure that the healthiest and healthier options are available.There are 60 total guidelines in this Standard. To achieve recognition, hospitals mustimplement the following:All Foods: at least 1 of the 4 guidelinesFood Groups: at least 22 of the 35 guidelinesOther Foods: at least 6 of the 9 guidelinesSnacks & Beverages: at least 7 of the 12 guidelines5

TIP: Choose whole grains (oats, brownor wild rice, quinoa, buckwheat, and more)instead of refined grains (white flour,white rice).Grain-Based FoodsWhole GrainsInclude whole, dry grains to cookfrom scratch.Processed Whole GrainsVegetables and FruitA wide variety (“a rainbow”) of brightly colored,seasonally available vegetables and fruit.Fresh vegetables and fruit are first preference(whole or pre-cut); frozen are secondpreference; canned, processed or preprepared are third preference.All canned/frozen vegetables and fruit have 290mg sodium per serving.All canned and frozen fruit is packaged in100% water or unsweetened juice, withoutadded sweeteners or preservatives (no syrup).Products made using vegetable basedproteins (e.g. veggie burgers) contain 290mg sodium per serving.Vegetables and fruit are local and/orsustainable.Minimum 50% of grain-based items arewhole grain where they are offered or are partof a dish such as breads for sandwiches andwraps, rice dishes, pasta meals, and soups.All sliced sandwich bread contains 180mgsodium per serving, is whole grain, andcontains 2g fiber per serving.All other grains/starches (pasta, buns, hoagierolls, dinner rolls, tortillas, wraps, burritoand taco shells, muffins, bagels, waffles,pancakes) contain 290mg sodium perserving.Cereal (hot or cold) contains 215mg sodiumper serving, 10g sugar per serving, 2gfiber per serving.1, 2GrainsGrains are local and/or sustainably grown.procurement resourcesWe can provide resources to help you source andpromote fresh, healthy, sustainable foods.Contact:Catherine Bartoli: catherine.bartoli@phila.gov; orShelley Chamberlain: shelley@thecommonmarket.org.6The Common Market

For all foodsELIMINATE Trans FatAll products have “0 grams” trans fat and no partially hydrogenated oils in ingredient list.LOWER SodiumAll products have 480mg sodium per serving, unless otherwise noted.INCREASE Whole, Unrefined Foods, Beverages and Ingredients50% of all foods and beverages are whole and unrefined or are made with 100% whole,unrefined food ingredients (annual expenditure; measure dollars).INCREASE Local and/or Sustainable FoodsIncrease local and/or sustainable food purchases by 20% of total food purchases overbaseline year OR achieve 15% local and/or sustainable food purchases of total foodpurchases (measure dollars).Beans, Legumes, Nuts & SeedsWhole, dry beans and legumes cooked fromscratch are first preference.Canned beans and legumes contain 290mgsodium per servingAll nuts, seeds, nut/seed butters contain 230mg sodium per serving.All nut/seed butters contain 4g sugarper serving.Nuts and seeds (unsalted) are added tomenus as optional ingredients.Beans, legumes, nuts and seeds are localand/or sustainable.MeatDecrease the amount of meat purchased by20% from baseline (meat beef, poultry,pork, and lunchmeat; measure lbs.)OR provide documentation that this reductionhas already been achieved.Unprocessed fresh or frozen meat is firstpreference.All beef, pork, and poultry is lean, i.e.contains 10% fat per serving.All deli/luncheon and other ready-to-eatmeats have 480mg per 2oz serving.All canned/frozen poultry contains 290mgsodium per serving.Meat is local and/or sustainable.1 In children’s hospitals/pediatric menus, cereal 6 grams sugar per serving2 Cereals that contain dried cranberries, dates, and/or raisins are exempt from the sugar standard due to the limited availability of this product typethat meets the sugar standard. Cereals must still meet fiber and sodium standards. Recommend phasing out high sugar cereals over time.7

SeafoodUnprocessed fresh or frozen seafood is firstpreference.All frozen/canned seafood (e.g., salmon, tuna)has 290mg sodium per serving.Seafood is sustainable and least toxic.EggsEggs are local and/or sustainable.Other FoodsSoupsPurchase ingredients to make soupsfrom scratch using whole, unrefinedfood ingredients as first preference overpurchasing soup base.All soups contain 480mg sodium per8oz serving.Oils, condiments and saucesDairyOlive oil and non-GMO canola oil are firstpreferences.All milk is 1% or non-fat, except children 2years old are served whole milk.Salad dressings contain 290mg sodiumper serving.All milk is unsweetened.Use low-fat mayonnaise.All yogurt is non-fat or low-fat.Use reduced sodium soy sauce, low-sodiumketchup & low-calorie salad dressings (perFDA definitions3).All yogurt contains no added sweeteners or 20g sugar/6oz.All prepared cheese products contain 230mg sodium per serving.Reduce or eliminate prepared cheeseproducts.Dairy is local and/or sustainable (includingrBGH free).SweetenersLimit food purchases containing added sugars(e.g. cakes, muffins, cookies, ice creams,puddings). Purchase to meet criteria 200calories and 18g sugar per serving.Fruit and whole, unrefined sweeteners arelocal and/or sustainable.Deep Fried FoodsNo purchase of food products that areprepared by deep frying; this includesbreaded, pre-fried products.3 FDA definitions for low-fat, reduced sodium, and low sodium can be found here: /ucm064911.htm.8

snacks and BeveragesSee Dairy Category above for standardson fluid milk.Increase Green Light4 beverage purchasesby 20% of total beverage purchases overbaseline yearOR achieve 65% Yellow Light5 beveragepurchases of total beverage purchases foruse throughout the hospital (patient meals,cafeteria, café, catering and vending; includespromotion of tap water over bottled waterwhere possible; measure dollars).“Green Light” Beverages6Healthiest Snack8Whole, unrefined food and/or foodingredients.No or low sodium and no artificial additives.Snack is local and/or sustainable.Healthier Snack9Sixty-five percent of snacks purchased meetthe following criteria (collectively counts asone nutrition guideline): 250 calories per package, excluding nutsand seeds. 7 grams total fat per serving, excludingsnacks containing nuts and/or seeds. 1 gram saturated fat per serving. 230mg sodium per serving. 18g sugar per serving, except for snackscontaining only fresh fruits or vegetables,dried fruits or vegetables, or packagedfruit packed in its own juice or water mayexceed 18 grams of sugar per serving. “0 grams” trans fat and no partiallyhydrogenated oils in ingredient list. Is not gum, candy, or non-baked chips.Water is a first preference.Milk substitutes are available, such as nutand soy milks.Coffee and tea, where offered, isunsweetened.Beverages are local and/or sustainable.“Yellow Light” Beverages7All beverages have 40 calories per containeror serving (except 100% juice and milk).All juice is 100% vegetable or fruit juice.Vegetable juice contains 230mg sodiumper serving.4 Green Light beverages: include water and other beverages listed in the “Green” beverage category in Appendix 2.5 Yellow Light beverages: include beverages listed in the “Green” and “Yellow” beverage categories in Appendix 2.6 Beverages listed in the “Green” beverage category in Appendix 2.7 Beverages listed in the “Yellow” beverage categories in Appendix 2.8 The complete definition of a healthiest snack is a whole, unrefined food or food that contains 100% whole, unrefined food ingredients, e.g. vegetables,fruit, nuts, seeds, whole grains, dairy, eggs, seafood, and meat. A healthiest snack is also fresh, dehydrated, processed or prepared in a manner thatmaintains its natural state; contains no or low sodium and no artificial additives; and is ideally local and/or sustainable food or food ingredients.9 This is the complete definition of a healthier snack.9

istock.com2standard for FOOD & BEVERAGESSERVED iN patient mealsThe patient meal standards listed below are to be used for the regular patient population that isnot prescribed a specific therapeutic diet. These guidelines address how food is being preparedand promoted, the sodium and sugar content of foods, the variety of vegetables, fruit and otherwhole, unrefined foods and ingredients that are made available to patients. Guidelines areprovided for specific food categories, beverages, snacks, food preparation and presentation, andnutrition standards for adult patients on a regular diet and for pediatric menus.There are 16 guidelines in this category. To achieve recognition, hospitals mustimplement at least 10 of the 16 guidelines.10

Food & Beverage guidelinesVegetables and FruitBeveragesOffer a minimum of 5 servings of differentbrightly colored vegetables and fruit per day.Tap water is available at all patient meals.Offer a minimum of 2 servings of differentbrightly colored vegetables and fruit at lunchand dinner.Offer daily at least one raw, salad-typevegetable and at least one steamed, baked, orgrilled vegetable at lunch and dinner.All juices must be 100% vegetable or fruitjuice; fruit juice is limited to 4oz serving;vegetable juice contains 230mg sodiumper serving.Only Green and Yellow Light beverages areoffered on the patient menu.preparation &presentation guidelinesSandwiches, Salads,Soups, & EntrÉesWhole, unrefined foods and ingredients are afirst preference.No deep frying is used to prepare patientmeals.Minimum 50% of grain-based items arewhole grain where they are offered or are partof a dish such as breads for sandwiches andwraps, rice dishes, pasta meals, and soups.e.g. if both a pasta dish and rice dish areoffered, offer brown rice and/or whole grainpasta as an option.Use juices from scratch cooking in graviesand sauces to flavor menu items, e.g. fromcooking soup stock, vegetables, mushrooms,seafood, and meat.Where appropriate, encourage the selection ofthe healthiest offerings on the patient menu.Where appropriate, mark key indicators todefine healthy menu items, e.g. cooked fromscratch, vegetarian/vegan options, whole grainitems, local and/or sustainable foods.Soups contain 480mg sodium per8oz serving.Offer a minimum of one vegetarianentrée daily.good food is NutritiousAccording to the Union of ConcernedScientists, increasing our consumptionof fruits and vegetables could savemore than 100,000 lives and 17billion in health care costs from heartdisease each year.Nico Nelson11

Nutrition GuidelinesDaily values for adult patients on a regular diet(collectively counts as one guideline):Calories2,000 caloriesSodium 2,300mg10Added Sugar100-150 calories(or 10% total calories) 11Saturated Fat 10% of total caloriesFiber 28 gramsProtein10-35% of total caloriesCarbohydrate45-65% of total caloriesPotassium4,700mgCalcium1,000mgIron 8mg (18mg F; 8mg M)Recommendations for adults ages 1950 years. Based on USDA’s 2015 DietaryGuidelines for Americans: http://www.cnpp.usda.gov/DietaryGuidelines & American HeartAssociation Recommendations forAdded Sugar.Nutrition Guidelinesfor Pediatric MenusHospitals serving patients under 19 yearsold shall follow the Institute of Medicine,Food and Nutrition Board’s DietaryReference Intakes (DRI) for appropriateage groups.12good food issustainably grownThe Centers for Disease Control andPrevention envision a food system thatprovides healthy, sustainable choices,minimizes environmental impacts, andserves as a model for the broader publichealth community.Choosing local, healthy, environmentallyresponsible food helps promote personalhealth as well as the overall health ofthe community.The best indicators of the sustainabilityof a product are third partycertifications or USDA/FDA approvedlabel claims, since they are based onclear and meaningful standards.When possible, food and beverageproducts should carry one or more thirdparty certification or USDA/FDA labelclaims for sustainability.In the case of local farmers that don’thave certifications or label claims,foods and beverages will be consideredsustainable under these procurementstandards if appropriate documentationis provided to substantiate thatsustainable food production methodshave been used.Have questions about sustainable foodqualifications or sources? Get in touchwith us, we are here to help.10 Hospitals can meet the sodium standards gradually bydeveloping a plan and fully implement by September 2018.11 Per American Heart Association’s recommendations for addedsugars: yEating/Nutrition/Sugar-101 UCM 306024 Article.jsp#5 discretionary calories and added sugars.12 Institute of Medicine, Food and Nutrition Board’s DietaryReference Intakes (DRI): https://ods.od.nih.gov/HealthInformation/Dietary Reference Intakes.aspx.12Clockwise from top left: Dairy goats at theKirchenburg Family Farm, in the DelawareValley; organic arugula and radishes; locallygrown hydroponic basil; low spray apples.

The Common MarketWoodley WonderworksEric Ray13

DoranJessica ReederSTANDARD FOR FOOD & BEVERAGESSERVED iN CAFETERiAS,CAFÉS, & ON-SiTE RESTAURANTSThe guidelines for foods and beverages served listed below are to be used for cafeterias, cafés,and for on-site restaurants located in hospitals that sell food to staff, visitors and patients.These guidelines address how food is being prepared, made available and promoted. Themeal, beverage and snack serving guidelines also ensure that people eating meals have ahealthy, balanced diet and people eating snacks have healthy options available. The guidelinesinclude food categories; healthy meal options; food content and preparation; productplacement, pricing and promotion; and nutrition information.There are 30 guidelines in this category. To achieve recognition, hospitals mustimplement at least 19 of the 30 guidelines.14

Food & Beverage guidelinesVegetables and FruitDessertsOffer local and/or sustainable fruits andvegetables (See Appendix 4 foravailability chart).At least 50% of all desserts have no morethan 200 calories per serving and 18g sugarper serving.Offer minimum of 4 different brightly coloredvegetable choices at lunch and dinner,e.g. leafy green salads, steamed, sautéed orroasted vegetables, and/or raw vegetables.BEVERAGESOffer minimum of 4 different brightly coloredfresh fruit choices at each meal, e.g. wholefruit, cut fruit, fresh fruit salad.Offer daily at least one raw, salad-typevegetable and at least one steamed, baked, orgrilled vegetable at lunch and dinner.Tap water is available at all meals (includesinfused water).Limit serving size of sugar sweetenedbeverages to maximum of 16 ounces (appliesto bottles and fountain drinks).Offer minimum of 3 Green and/or Yellow lightbeverage options at fountain machines.Sandwiches, Salads,Soups, and EntrÉesRotate specially featured salad bar itemsusing whole, unrefined foods and ingredients.(See Appendix 4 for availability chart).Minimum 50% of grain-based items arewhole grain where they are offered or are partof a dish such as breads for sandwiches andwraps, rice dishes, pasta meals, and soups.Examples: If both a pasta dish and rice dishare offered on the hot bar, offer brown riceand/or whole grain pasta as an option.Provide nutrition information for beverages atthe point of choice including but not limitedto name of beverage, container size andcalories per container.Use “Green,” “Yellow,” “Red” beverage“traffic light” labeling or similar system toindicate healthier beverages (Appendix 2).Offer minimum of 65% Green and/or Yellowlight beverages.Offer minimum of one non-cream based soupat each meal where soup is offered.Soups contain 480mg sodium per8oz serving.Offer minimum of one vegetarian optionentrée daily.15

PRESENTATION & SERVICE GUIDELINESHealthy Meal OptionsOffer minimum of 1 entrée and/or side ateach food station or a total of 8 entrees and/orsides that fit the following criteria:Contain entrees with no more than 500calories, 600mg sodium, 0g trans fat, 10%calories from saturated fat.Contain sides with no more than 250 calories,360mg sodium, 0g trans fat, 10% caloriesfrom saturated fat.Food Content & PreparationEliminate the use of deep fryers.Reduce number of pre-fried products.Reduce number of fried products on menu.All products have “0 grams” trans fat and nopartially hydrogenated oils in ingredient list.Product Placement, Price, and PromotionFood and beverage promotions are limited tohealthy options. This includes meal combosand “specials of the day.”Only items that fit criteria for healthierofferings (standards for healthiest andhealthier snacks and Green and Yellow lightbeverages) are placed within 5 feet of point ofpurchase (cash register).Green and yellow light beverages andhealthiest or healthier snacks are placed inpositions with the highest selling potential.Sugar sweetened beverages and other snacksare placed in positions with the lowest sellingpotential.Encourage selection of the healthiest andhealthier offerings at the point of choice. Thismay be done via nutrition labeling or specificsignage that indicates a healthy option.The price per ounce of healthy offerings doesnot exceed the price of other menu options,e.g. Water is not be more expensive than sodapackaged in the same sized bottle.Local and sustainable foods and beveragesare indicated on menus, menu boards, and/or other signage by way of source identification(Indicating supplier and location).NUTRITION INFORMATIONNutrition information for entrée and side itemsis provided at the point of choice including butnot limited to serving size, calories, total fat (g),sodium (mg), carbohydrate (g), protein (g),and fiber (g) content for each item.16

Chiots RunSTANDARD FOR FOOD & BEVERAGESSERVED iN CATERiNGThe Catering Standard is for meetings and special events held on or off the hospital campus.There are 17 guidelines in this category. To achieve recognition, hospitals mustimplement at least 11 of the 17 guidelines.Food & Beverage guidelinesFoods ServedNo deep frying may be used to prepare foods.Serve at least one fresh vegetable option at alllunch and dinner meals and one fresh fruit atall meals.If serving sweets/desserts, offer in smallerportions. Or serve fruit as dessert.Offer local and/or sustainable foods.Minimum 50% of grain based items are wholegrain where they are offered or are part ofa dish such as sandwiches and wraps, ricedishes, pasta meals, and soups.Snacks must meet standards for thehealthiest or healthier snacks.13Offer low sodium options as a default choice.Offer minimum of one vegetarian option onthe menu.13 Healthiest and Healthier snacks: see criteria on page 9.17

BEVERAGES SERVEDWater is available at all times (includes filteredtap, infused, unsweetened).Juice must be 100% vegetable and/or fruitjuice, and limited to 10oz servings.Sugar sweetened beverages are not offeredon catering guide.If served upon request, sugar sweetenedbeverages are limited to 12oz servings.Milk served is local and rBGH free.18The Common MarketPRESENTATION & SERVICEGUIDELINESOffer reasonable portion sizes for foodsserved. See our “Know Your Servings” tipssheet for serving size suggestions.Include a vegetarian option at all meals.Include signage to indicate nutritioninformation or indicate on catering guide.Indicate source identification of local andsustainable foods.David Duran

KPG Payless for Shutterstock.comSTANDARD for VENDiNGHealthy vending guidelines offer and promote healthy choices among hospital patients, staff,and visitors. The vending standard is applied to beverages and foods contained in machinesthat sell products such as hot and cold beverages, shelf-stable snacks, frozen meals, frozendesserts, and refrigerated meals, snacks and beverages.To achieve recognition, 100% of snacks and meals offered per machine must contain 230 mgsodium and have “0 grams” trans fat and no partially hydrogenated oils in the ingredient list.In addition, at least 65% of the products in each machine must meet the definition of healthyand/or healthier beverages, snacks and meals.There are 20 guidelines in this category. To achieve recognition, hospitals mustimplement 5 guidelines for beverages and 5 guidelines for snacks.good food is part of a fair, local economyAccording to a research team from Cornell University, every additional 1 spent on localfood from food hubs results in an additional 0.75 in the local economy.19

BEVERAGESSNACKS & MEALSAt least 65% of beverages offered permachine are Green and Yellow Lightbeverages.At least 65% of snacks offered per machineare healthiest or healthier snacks.14Sugar sweetened beverages should not belarger than 12oz each.Green and Yellow Light beverages are placedin positions with the highest selling potential.Sugar sweetened beverages are placed inpositions with the lowest selling potential.Other than beverage display or placementthat conforms with the definition of Greenor Yellow Light beverages, no beverageshall be specially advertised, promoted, orfeatured on, in, or immediately surroundingany machine unless that beverage is a GreenLight beverage.Calorie information for beverages must beclearly and conspicuously labeled.The price of water must not exceed the lowestprice of any sugar-sweetened beverage.Pricing models that promote healthy choicesby establishing lower prices for the Greenand Yellow Light beverages relative tosugar-sweetened beverages are stronglyencouraged.At least one high fiber snack is offered permachine.At least one item must be unsalted or lightlysalted nuts.At least one item must be a dried or shelfstable fruit item.Healthiest or healthier snacks have no morethan 18g sugar/serving except those thatcontain only fresh fruits or vegetables, driedfruits or vegetables, or packaged fruit packedin its own juice or water, which may exceed18g sugar/serving.All snacks have “0 grams” trans fat and nopartially hydrogenated oils.At least five non-grain/potato based healthysnacks must be offered per machine.Healthiest and healthier snacks are placed inpositions with the highest selling potential.All healthiest and healthier snacks ineach machine are clearly andconspicuously labeled.good food is All around usWith so many local suppliers, choosing Good Food is not as difficult as you maythink. Pictured: Mark and Fran of Castle Valley mill, artisan bread from PhillyBread; and lettuce from Butter Valley Farm.14 Healthiest and Healthier snacks: see criteria on page 9 or in the terminology appendix on page 22.20

Other than snack display or placement thatconforms to the requirements above, nosnack shall be specially advertised, promoted,or featured on, in, or immediately surroundingany machine unless that snack is defined as ahealthiest or healthier snack.The price of the healthiest and healthiersnacks does not exceed the highest price ofother snacks.Healthy meal: a meal item includes salads,sandwiches, burritos, mac and cheese, soupsand combination packaged items such astuna salad kits. Breakfast breads and pastriesmust meet the snack standards. Each itemshould meet all of the following criteria:a. No more than 700 calories per package(

food & Beverage purchasing standard standard for food and Beverages served in patient meals standard for food and Beverages served in cafeterias, cafÉs, and on-site restaurants standard for food and Beverages served in catering standard for vending contentS 5 10 14 17 19 appendices 1. terminology & definitions 2. healthy Beverage .

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