The European FOOD -Fighting Obesity through Offer and Demand- programme was created as a project in 2009 thanks to the co-funding of the European Commission (DG SANTE).
Edenred, as lead partner and coordinator, proposed to representatives of Public Health Authorities, Nutritionists, Research centres and Universities in six countries (Belgium, the Czech Republic, France, Italy, Spain, and Sweden) to form a Consortium of partners.
Despite the end of the EU funding in April 2011, the partners decided to take advantage of the actions and results and continued under a long-term programme, to which Belgium is taking part.
Edenred designs and develops voucher programmes for companies and public authorities. Its flagship product is the meal voucher (or Ticket Restaurant®) which has been in practice worldwide for more than 50 years and is used by more than 43 million people every day in 42 countries.
Meal vouchers can act as a launch pad for effecting a change of employee food and lifestyle habits. Furthermore, the FOOD project – which became a long-term programme - is in perfect harmony with Edenred’s stated corporate social responsibility goals, of which access to balanced nutrition is a key priority. Edenred is responsible for the coordination of the programme and for the dissemination of the information and results.
High School Lucia de Brouckère
The Information and Research Centre for Food Intolerances and Hygiene (HELdB-CIRIHA).
The CIRIHA is establishing its reputation as a centre for adverse reactions to food, food hygiene and practical nutrition. It conducts research in the fields of treating food and cardiovascular diseases. The centre’s objective is to offer advice to the medical, paramedical and economic forums and the general public in the form of consultancy services, information and training.
Federal Public Service (FPS) Health, Food Chain Safety and Environment
The FPS was set up in 2001. Its mission is to develop a transparent, dynamic and scientifically-founded policy in order to secure, now and in the future, a high-quality health, a healthy nutrition and a better environment, in co-operation with relevant partners.
Belgian National Food and Health Plan (PNNS)
The PNNS is a multidisciplinary project that aims to enhance better eating habits and increase physical activity in the general population. It allows all actors to participate in taskforces according to subject: consumer organisations, the food industry, the distribution sector, universities, etc. This results in an exciting mix of actions ranging from communication and information to improving the food offer, conducting vital research and offering tools to health professionals to tackle these issues. These actions encompass a wide range of subjects such as: salt reduction, breastfeeding, malnutrition in the elderly, promoting fruit and vegetable consumption amongst others.
Nutri-Challenge - health in your company, was launched in 2008 by a nutritionist and a dietician to offer a wide range of services tailored to meet an increasing demand of people aware of the thin link between food and health: food analysis – workshops – info booth – cooking workshops – group or individual coaching – conferences. They provide scientifically-based nutritional information in such a way that it can be understood by a wide audience. Nutri-Challenge delivers projects in a creative and well-organised way to bring successful results and communicate the final message.
Step 1 : Research and knowledge
Inventory of existing results
During the project phase (2009-2011) and before the creation of the tools and the launch of communication campaigns, the Consortium took several actions to understand what had been done so far in health promotion at the workplace and to determine the needs of both target groups, employees and restaurants.
A detailed inventory of existing programmes related to nutritional interventions was first conducted. This review of existing programmes was carried out in order to understand the initiatives already carried on in the various countries regarding interventions to promote healthy eating through a work setting. The core of the review focused on initiatives targeting balanced food in restaurants and those targeting employees in a company setting.
70 programmes matched the review criteria in the 6 countries and were entered into the study.
Below are the 6 programmes and interventions that were identified in Belgium for employees and included in the FOOD inventory under the project phase (2009-2011).
This programme was launched in 2004. It targeted AXA employees and aimed at improving their health in the workplace. The programme followed “Hazard analysis and critical control points” (HACCP) guidelines and was accessible to the employees via the company intranet, offering them nutritional advice.
Launched in 2008, the aim of this programme was to help companies promote cardiovascular health and wellbeing in the workplace. Companies that paid to participate in the programme were able to choose from a wide package that included printed material, conferences, workshops, teambuilding activities etc.
It was launched in 2007 by a dietician and a journalist. Targeted at employees, it aims to promote healthy nutrition for improved performance on the workplace through training combined with communication tools for the employees.
It was launched by the non-for profit organisation VIGEZ (Vlaams Instituut voor Gezondheidspromotie vzw - the Flemish Health Administration) in 2003 and took place in Flanders and Brussels. The programme targeted both employers and employees and aimed to improve employee health by encouraging behaviour change. Companies had to pay in order to participate and the programme was open to a variety of companies in the north of Belgium. The programme offered a large scope of interventions and evaluation to be done every three years.
It was launched by the insurance company Partenamut in 2008 targeting restaurants and its 460,000-member network. The free programme aimed to promote healthy nutrition by encouraging restaurants to create healthy menus supervised by dieticians and physicians. Participants earned ‘healthy’ points that could later be exchanged as a ‘buy one get one free’ meal in the restaurant for special menus created and supervised by a dietician.
It was created in 2001 by Emmanuel Verstraeten in Brussels and opened in New York in 2008. The restaurants offer a menu complying with SPE standards (a nutritional charter called Sanitas Per Escam, which means ‘Health Through Food’ developed by chefs and nutritionists), offering a unique restaurant experience that combines seasonality, local production and specific cooking techniques.
There was a growing concern in companies regarding the health of their employees that could have resulted in indirect costs due to loss of labour. This was for them an incentive to participate in the various programmes offered. In the case of Belgium all but one of the programmes were initiated by private companies with only two free programmes included in this review. Positively, scientists backed up the interventions yet only half included high levels of communications to their users. Only three of the programmes were offered across the whole country.
The review of the existing programmes included in the inventory enabled the partners to draw several common conclusions:
- There was a general lack of evaluation of most programmes
- The projects were not well promoted
- Target audiences were mostly passive
- Low presence of professionals
- Unsuitable tools were created as a result of wrong assessment of the target audience’s
- Lack of visibility and clarity of the tools created
Quantitative and qualitative surveys
First questionnaires for employees and restaurants (2009)
Following the review of existing programmes and based on the main findings, a survey was launched, with two questionnaires: one aimed at restaurants and the other at employees. The survey was conducted in each of the participating countries through Edenred’s network, designed by the CIRIHA and the Institute Paul Bocuse and later analysed by the Research Centre of the Institut Paul Bocuse, in France.
At least 52,000 employees and 5,000 restaurants were targeted by the questionnaires in the six participating countries. A total of 4,529 employees and 399 restaurants responded to the questionnaires, a response rate above the 5% that was anticipated.
555 Belgian employees responded to the first questionnaire; two thirds of them were female workers.
Most employees that were familiar with a programme promoting balanced food (59.5%), reported being informed through a food industry campaign. 80% of those unfamiliar with one would have liked to receive more information on the subject.
The meaning of balanced nutrition for Belgian employees was almost equally either ‘various food in a moderate amount in a nice environment’ or ‘eating pleasant food while at the same time protecting your health’. This indicates that pleasure, environment and diversity are positively associated with balanced food. Also in Belgium, the most respondents out of the six countries linked balanced food with food low or free of fat,salt and sugar. This result can indicate that balanced nutrition is also associated with dieting, a result that can portray a negative image to this type of food.
Around 40% of employees reported being overweight or obese as it can be seen in the following graph. Fewer respondents reported being obese compared with national statistics.
Figure 1: Breakdown of employee reported weight
Belgium has the smallest number (12.2%) of employees out of the six countries reporting having their lunch in restaurant. Nearly 90% of employees preferred to have home cooked food or food brought into the office. The majority (70.5%) have their lunch in the office in a common room and 17.3% have their lunch at home.
Those eating out preferred to have their lunch in a bakery or sandwich bar or a fast food restaurant. No employees responded to eating in a restaurant!
The main reasons given for not eating out in a restaurant was preference for home cooked food (53.9%) followed by 31.4% claiming to not having time to go out.
Figure 2: Breakdown of lunch places frequented by Belgian employees:
The main determinant in choosing a lunch place for Belgian employees was the proximity to the workplace. Affordability and quick service were the next important factors. What they wanted at the present time was the main factor in choosing what to eat.
51 Belgian restaurants responded to the questionnaire. The majority were restaurants offering a special lunch menu and most often a ‘dish of the day’.
Figure 3: Respondents’ restaurant classification:
About half of restaurant owners claimed to be familiar with a programme regarding balanced nutrition (49%) with the majority informed by television. Just over half of those respondents claimed to actually know who was promoting the programme.
38.5% of the respondents who were familiar with such a programme have applied its recommendations in the restaurant, mainly by increasing the amount of vegetables offered and offering dishes lower in fat, salt and sugar. Three quarters of those who haven’t applied the recommendations have not done so due to lack of demand from their customers. Lack of time was the reason given by the other 25%.
More than 80% of restaurant owners claimed to have some knowledge of balanced food, similar to the average of the other countries but Spain, as is evident from the following graph. 5.9% of respondents (second highest percentage after the Czech Republic), were not interested at all in issues of balanced food.
Figure 4: Restaurant owners’ knowledge about balanced food
The most respondents out of the six countries reported in Belgium to be using local produce in their restaurants (91.8%), with the main benefit to the restaurant being the price and quality of the food.
Nearly 65% of restaurateurs (the fewest out of the six countries but still a high percentage), saw no obstacles in promoting balanced nutrition in their restaurants. The main issues raised being time and no perceived demand from customers.
The results from Belgium indicate that the employees surveyed preferred having home cooked food at lunchtime. The small numbers that go out to lunch mostly chose establishments offering a quick meal. Therefore, lack of time that was mentioned by a third of the respondents could be one of the reasons for this phenomenon.
A very large percentage of Belgian restaurateurs reported to be using local produce in their cooking. More of them need to be encouraged to promote other aspects of balanced food in their restaurants. Offering balanced nutrition would become important to restaurants only following demand from their customers.
These results indicate that the Belgian partners need to encourage employees to frequent local restaurants and to demand healthy balanced food to encourage restaurants to make changes to the food they offer.
Restaurants’ qualitative survey
In parallel with the quantitative survey, a qualitative restaurant study was conducted in 2009 in twelve countries (Belgium, Brazil, the Czech Republic, France, Germany, Greece, India, Italy, Morocco, Poland, Spain, United Kingdom) and five restaurants were chosen and interviewed in each country.
The aims of the survey were to understand how and why chefs cook the way they do, and what could trigger a change in attitude. The next stage was to try and convince restaurants that cooking healthily has many benefits with no additional costs.
Several restaurants were surveyed in Belgium and therefore varied also in their attitudes toward procurement and cooking.
The restaurants that offered quality food were also the ones using healthier cooking modes and better quality ingredients. All but one restaurant displayed interest in healthy food yet, for some the price of such food would be a barrier to changing supplies. Most restaurant owners have noticed increased demand from customers for healthy food and to them only this would provide an incentive to make changes to the way they cook, which is in line with the results from the quantitative questionnaire. So far none of the restaurants have made changes to the food they offer following such demand.
Some restaurateurs were interested in training and mentioned health education from a young age to be a necessity.
Step 2 : Recommendations
Following a consolidation of the results from the first survey of 2009 and the inventory, experts outlined a set of recommendations targeted at restaurants and employees.
The purpose of these recommendations was to offer tangible and practical advice to help both target groups adopt healthier nutritional habits.
Despite the intention of some partners to have only common European recommendations, each country decided to adapt the recommendations to its local cultural habits. Following further consultation on national level, the partners accepted six common European recommendations to employees and one to the restaurants.
During the project phase, the partners used the guidelines from the Belgian PNNS (National Food and Health Plan) and information about the dietary habits of the Belgian population (from a 2004 survey) to form the recommendations. Dietary recommendations were created to try and correct unhealthy food habits. The aim of the recommendations was to offer simple, concrete and easy to understand and apply guidelines that cover most areas of healthy nutrition.
The recommendations to both groups compiled by the Belgian partners aimed to target unhealthy eating habits and to encourage a healthier balanced diet. There was an attempt to reduce the use of animal fat in the preparation modes and food offered, to use vegetable fats, leaner meats, fish and grains rich in protein. Employees were urged to make changes to some of their unhealthy habits that were typical to local culture and to participate in more physical activities.
The recommendations to the employees have slightly changed in 2014.
- 1) I eat at least 5 portions of fruit and vegetables a day:
- If possible, choose locally grown seasonal produce
- One portion = +- 80g = +- one fistful
- 2) I eat starchy food in every meal:
- Eat a variety of grains: whole rice, pasta, bulgur, quinoa, corn and semolina wheat. Prefer healthy cooking methods.
- 3) I taste the food before adding salt:
- Do not add salt to the cooking water
- Flavour the food with other condiments such as herbs or spices
- 4) On certain days I can do without meat:
- Replace meat with other proteins such as: quorn, tofu, fish, eggs etc. Choose white and lean meats
- 5) I eat fish once or twice a week:
- Eat fatty fish such as: salmon, sardines, anchovy, mackerel etc., prepared using healthy cooking methods.
- 6) I drink 1.5 litre of water a day, corresponding to approximately 8-10 glasses of water:
- Limit tea and coffee consumption to one or two cups a day, preferably with no sugar in it
- Limit the consumption of alcohol and soft drinks
- 7) I lower the use of fat and prefer the use of vegetable oils:
- Prefer using vegetable oils such as olive oil or groundnut oil for cooking and rapeseed, sunflower, chestnut, sesame and soya oils for cold preparation
- Avoid sauces made of butter or cream and prefer milk, light cream and yogurt alternatives
- 8) I eat two dairy products a day preferably low in fat:
- Choose milk, soft white cheese and yoghurt based desserts. Other cheeses should be eaten in moderation.
- Substitute dairy products with protein rich soya ones.
- 9) I have treats on special occasions:
- Alcohol - such as wine and beer – soft drinks, biscuits, cakes and sweets should be consumed in moderation.
- 10) I prefer cooking methods such as steaming, roasting, or frying in a non-stick pan:
- Avoid deep-fried foods as much as possible and other fatty foods
And…I exercise for at least 30 minutes each day!
Recommendations to the employees (2014)
- 1 – Taste the food before adding salt.
- 2 – Lower the use of fat and preferably use vegetal oils.
- 3 – Eat at least 5 portions of fruit/vegetables per day.
- 4 – Choose types of cooking that do not add too much fat (steaming, roast, grill, etc.).
- 5 – I drink 1.5 litres of water a day.
- 6 – I eat starchy foods for each meal.
- 7 – I can do without meat some days.
- 8 – I eat fish once to twice a week.
- 9 – I eat 2 dairy products a day, low-fat is even better.
- 10 – I move for at least 30 minutes a day.
Recommendations to the restaurants (2009)
The Belgian partners wished to avoid alienating the restaurants by being too restrictive. They preferred to engage with the restaurants rather than create rules. They decided the recommendations should therefore be short, easy, and practical to implement and verify.
Nine recommendations were formed to complement the recommendations targeted at employees and added to the common European recommendation.
- 1 – Favour cooking methods such as steam, oven, or grill.
- 2 – I propose vegetables as accompaniment and fruit as dessert.
- 3 – I put whole bread on the table.
- 4 – I do not put salt on the table.
- 5 – I offer poultry or white meat dishes.
- 6 – I offer fish on my menu.
- 7 – I offer tap water on demand.
- 8 – I replace butter with olive oil to accompany the bread.
- 9 – I offer a dairy product as dessert.
- 10 – I replace aperitive biscuits by olives, salad or dried fruits.
Criteria to respect in order to be part of the FOOD restaurants’ network
Following the creation of the FOOD recommendations for restaurants, a network of restaurants respecting a certain number of recommendations was created.
In Belgium, restaurants have to respect the criteria below in order to be part of the FOOD network (since 2014):
- vegetables are proposed in most of the dishes and/or are available as a side dish
- an alternative to greasy carbohydrates is proposed (rise, potatoes or pasta instead of fries, rosti, croquettes)
At least 2 criteria of the 3 following criteria:
- Un repas végétarien est proposé au menu
- Les plats sont proposés en portions de tailles différentes
- Des fruits et des produits laitiers sont proposés en dessert
To see the map of the entire network of FOOD restaurants, click here:
Step 3 : Communication strategy
The road show (2009)
The communication campaign officially started in October 2009 with a ‘road show’ in the six participating countries. A double-decker bus customised with the FOOD colours drove through the main city of each of the six countries of the project phase. The journey started in Paris and then continued on to Brussels, Stockholm, Prague, and Milan ending in Madrid. These one-day stops enabled the partners to showcase the first tools created and to explain the project objectives and actions.
The FOOD bus stopped in Brussels for two days, on October the 7th and 8th, 2009.
In the heart of the European district, located in a popular square, the employees and restaurant owners were invited to:
- take with them the national guides with the 10 recommendations
- taste healthy dishes following culinary demonstrations
- have a question and answer session with nutritionists
- try on a 10kg vest, aiming at demonstrating the impact of weight excess
Many groups participated to FOOD seminars given by Nutri-Challenge.
Along the project and programme phase, several communication tools targeting both target groups were created:
Step 4 : Evaluation
Second questionnaires for employees and restaurants (2010)
A second survey was conducted in 2010 to try and evaluate the first stage of the project and the success of the tools. At this point the project had achieved many of its targets. Nutritional recommendations had been formed in each country for both the restaurants and the employees and communication tools were created in each country and across the whole project. More than 100 communication initiatives were introduced and implemented in the 28 months duration of the project. Especially popular was the website,visited more than 66,600 times between February 2009 and May 2011.
It was estimated that, after 28 months, around four million employees and 195,000 restaurants had been reached by the messages of the project.
The evaluators pointed out to several difficulties encountered regarding the survey questionnaires, in particular the fact that the questionnaires ended up being very long due to need to assess several types of national interventions, possibly resulting in fewer responses.
Outcomes and impacts on a European level were analysed by the Centre of Research of the Institut Paul Bocuse.
The questionnaires have reached a minimum of 52,000 employees. It is hard to say in which way the project had impacted on employees’ choice of balanced food as the general objective was to sensitise and provide this target group with the information needed to help them make healthier choices. Nevertheless, an important result from the 2010 survey was that 59% of employees were in favour of eating healthily at lunchtime meaning that this continues to be an important target group.
From the restaurant perspective, at least 5,000 establishments were reached via the questionnaires. Very positively, after a few months, more than 1,760 restaurants joined the FOOD restaurant network following national recommendations despite the fact that the interventions targeted at the restaurant staff took place quite late in the project. This short time frame could also offer an explanation to the second survey’s pretty low awareness results from restaurants (only 10% of respondents were familiar with the project’s objectives), yet the results indicated that 51% of them saw the value in serving healthy meal.
Therefore, continued support from programmes such as FOOD is needed to further increase the demand for this kind of food/meals by the customers and to increase the number of restaurants offering it.
On top of the many actions and tools created and implemented and the creation of the FOOD restaurant network a further achievement of the project is the creation of a successful partnership between the public and private sectors.
Employee questionnaire results
Over a quarter of all questionnaire respondents out of the six countries were Belgian (1615 respondents, almost four times the response rate from the previous round in 2009), the biggest response rate from any of the six countries (Belgium, the Czech Republic, France, Italy, Spain, Sweden).
Less than half of all employees surveyed (the smallest number out of all countries) reported to weighing a normal weight. 37% of the respondents (the most out of the six countries) considered themselves overweight.
The results from the second questionnaire contrasted against the results from the first questionnaire highlighting the importance of the country specific cultural setting.
The meaning of balanced food, in line with all other countries, was to the majority of employees ‘various foods in a moderate amount in a nice environment’. Fewer respondents chose the definition of ‘eating pleasant food while protecting your health at the same time’. This is a slight change to the 2009 results where both definitions were almost equally chosen.
38% of employees (compared with 59.5% in 2009) were aware of a programme promoting healthy or balanced food. 45% of those unfamiliar with one would like to have more information on the subject.
Figure 5: employee attitudes to making changes to their eating habits
In the past 12 months, 57% of employees have made or were considering making changes to the way they eat. Out of the 43% who replied to not making changes, 14% claimed to already eat according to healthy eating recommendations.
Over all, less people claimed to have a lunch break. 72% of employees reported to having a lunch break every single day compared with 77.6% in 2009. Similar to that, 6% of respondents claimed to never have a break compared with only 1.8% in 2009. Most employees who have a lunch break still either eat at home or bring food from home.
One of the reasons mentioned by the respondents for eating at home or eating homemade food was the cost of eating out. Lack of time to go out was another reason given by 42% of respondents, up from 31% in the previous questionnaire. Restaurant food being high in calories was the third most important reason.
Similar to Italian respondents, Belgian employees who eat in a restaurant at lunchtime, choose where to eat based on speed of service followed by the price of the food. An offer of varied meals and the nutritional quality of the food were the next most important factors. The choice of food at the restaurant was still determined by people’s wish at the time, even though slightly fewer respondents chose it than in 2009, while ‘what is good for me’ was chosen by 29.2% of respondents compared with 25.5% in 2009. The price was however significantly more important to respondents in 2010.
Restaurant questionnaire results
51 restaurants responded to the second questionnaire, the same number as in 2009. Nearly three quarters of the respondents were male (the most out of the six countries). 60.8% of restaurants that participated in the questionnaire offer a special lunch menu.
Restaurant owners were interested in increasing their knowledge of healthy cooking. However, they were not interested in educating their customers and neither were the employees expecting nutritional information in the restaurant.
Restaurant owners claimed to have noticed a growing interest in healthy food from their customers yet this phenomenon is not significant enough to convince them to make changes to the food they offer.
Budget remains the main obstacle to restaurants wishing to implement changes to their cooking methods. 15% of restaurant owners already believe they offer healthy food. 15% have made changes in the past year and 35% more were considering implementing changes to the food they offer. These results may indicate that initiatives targeted at restaurants are successfully creating a shift in restaurant owners’ attitude toward healthy food.
The results from the second questionnaire indicate that Belgian employees are increasingly experiencing time pressure at lunch and that affects their eating out habits. Fewer employees have a lunch break and the majority still bring food from home into the office. They are however considering the healthfulness of their diet and making changes to their eating habits. This is also a factor they take into account when choosing a restaurant to eat in.
Positively, restaurant owners have noticed that more and more people are interested in healthy food and wished to increase their knowledge about healthy cooking.
Hopefully, this increase in demand for healthy food from employees will continue to grow and once being felt, will encourage all Belgian restaurants to implement the recommendations and improve the food they offer.
Questionnaires inspired from the 2009-2010 surveys, called the FOOD barometers, are launched every year since 2012 in order to monitor the evolution of the habits and opinions of both target groups – employees and restaurants - about balanced food.
Step 5 : Adaptation and dissemination
The data collected during the evaluation allows the partners to adapt the communication strategy to employees and restaurants’ needs and expectations. This is a continuous improvement of the programme, its messages and communication tools.