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République Tchèque

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 the Czech Republic is taking part.

Partners

Edenred

https://www.edenred.cz

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.

STOB (Stop Obesity)

http://www.stob.cz/cs/home

STOB is part of the non-for profit non-governmental civic association, the Hravě žij zdravě o. s. (Healthy Living the Easy Way). The project STOB (Stop Obesity) helps people lose weight sensibly. It aims to promote a healthy lifestyle and prevent obesity in children and adults.
The objective of STOB is to create a systemised platform focusing on the care for overweight or obese children and adults, and includes both experts and laypersons. The civic association’s further activities include organising weight reduction courses founded on cognitive/behavioural psychotherapy all over the Czech Republic.

Methodology

Step 1 : Research and knowledge

Inventory of existing results

During the project phase (2009-2011), the consortium took several actions before the creation of the tools and the launch of communication campaigns to understand what has been done so far in this area 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 was on initiatives targeting balanced food in restaurants and those targeting employees in a company setting.
70 programmes matched the review criteria and were integrated into the study.

Below are the programmes and interventions that were identified in the Czech Republic and included in the FOOD inventory under the project phase (2009-2011).

It was launched by Metal Alliance in 1999, for an unlimited duration and consisted in actions at the workplace offered free of charge. The aim of the intervention was to decrease employment sickness and to improve companies’ responsibility and involvement in creating healthy workplaces. This was done by targeting companies and encouraging them to increase their involvement through internal communication.
The programme was aimed only at companies signed up for insurance with Metal alliance providing means to improve customers’ health thus increasing company profit. The main weakness identified was that employees were not actively involved.

This programme was launched in 2002 and offered free of charge. Its objective was to encourage companies to care about their employees’ health, targeting employees and employers, and to improve companies’ responsibility and involvement in health and safety in the workplace. Self-evaluation was to be conducted by the companies using a questionnaire with reports of the evaluation to be made every three years.
The main message was to increase companies’ involvement through high levels of communication for employees and companies. The programme created stimulation for companies to try and change their employees’ health behaviour.
The project integrated all the parameters for health, safety and wellbeing of employees, and did not concentrate solely on food but also on safety and healthy lifestyle. Also here the employees did not take an active part in the project.

It was a free programme promoting healthy nutrition launched by Skoda Auto in 2006 and scheduled to run for 3 years or more.
The programme’s objectives were to decrease employees’ sickness and long-term disease. The main message was to improve healthy habits by offering more alternative healthy foods. This was done through providing information to all employees on the intranet – such as useful tools to check personal BMI status. Evaluation was performed through employees giving information about their energy intake and meal composition. Here as well, employees were not actively involved.

It was a free programme launched by SZU in 1999 for an unlimited period. The programme’s objectives were supporting and stimulating the company to take responsibility for its employees’ health to influence behaviour change (on a management level) ; improving company responsibility and involvement in employee health and safety in the workplace, through internal communication. This programme was government supported and included other aspects of healthy lifestyle. Its weakness was that employees did not play an active part in the programme.

It was launched by STOB in 2008 and was free to participate in. It aimed to support the public in its attempt to make lifestyle changes regarding food and physical activity. It was open to the general public and to employees. The programme aimed to help its participants to lose weight and improve their healthy eating habits to increase their wellbeing. This was done through the use of an interactive internet application that runned for around four weeks and also included a training programme.
The programme used cognitive behavioural methods to change personal habits. It was highly interactive and required self-study and personal involvement. It also required commitment from its users as it only runned for a limited period.

Summary

All the interventions that were reviewed were free to use. This is an advantage on the one hand as it may encourage more people to participate but on the other hand can result in a low commitment level.
Out of the five programmes, four were company based. In these cases, healthy employees create a healthier workforce, which is beneficial to the company. This demonstrates that companies are developing an interest in the wellbeing of their employees indicating that the time is right to develop such interventions.
One of the weaknesses found in the majority of the programmes was that employees were not actively engaged in them. Another was that none of the programmes had strict monitoring and evaluation criteria and their cost was also impossible to calculate.

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 weren’t 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 Institute 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.

Employees

300 employees responded to the questionnaire. The target response was 5%, which was not reached in this case. Nonetheless, some important results emerged from this initial questionnaire that helped to shape the first set of tools and messages.
The following graph analyses the overall weight of employees. This self-reported response fits with the national statistics previously mentioned in the percentage of overweight adult population.

Figure 6 : Breakdown of employee reported weight :

The percentage of employees who have a lunch break during the working day is shown in the following graph. The Czech Republic has the lowest percentage of employees having lunch every working day (53.2%). Only a small minority though never have a lunch break clearly making the majority a suitable target group.

Figure 7 : Percentage of employees having lunch daily :

More than 90% Czech employees eat lunch in a restaurant (94.8%) :

Figure 8 : Breakdown of lunch places frequented by Czech employees :

The following questions were taken from the questionnaires and show the attitude of the Czech respondents :
During working day, I choose a restaurant or a cafeteria because : ‘It is close to my workplace’ (67%), ‘It offers a big quantity of food’ (47%).
The majority of employees are looking for convenience and value for money when choosing where to have their lunch break. Nutrition was the least chosen answer with unfortunately only 11.5% of respondents motivated by the nutritional quality of the food.
At lunchtime, I decide what I am going to eat according to : ‘What I want at the present time’ (78.9%). Convenience was again the main determinant of choice. The least chosen answer was : ‘The waiter’s advice’ (3.6%), which leads us to assume that customers prefer to make their own food choices.
What do you think is the meaning of ‘balanced nutrition’ ? ‘Various types of food in moderate amounts eaten in a nice environment’ (88.7%).
Regarding nutritional advice in a restaurant I would like to have : ‘An indication of the total energy value’ (47.7%), ‘a symbol pointing balanced dishes’ (47.3%).
More than in any of the other countries surveyed, in the Czech Republic 9.7% of respondents were not interested in nutritional information. The majority of employees declared that a list of restaurants close to their company, which offer balanced food, completed by nutritional information sent by email would be the best way to alert them to a nutritional programme. Employees are therefore interested in being contacted directly and receiving guidance.
‘For me, the best way to be sensitised about a nutritional programme would be’ : In the workplace - a list of restaurants close to my company (65%). At the restaurant or cafeteria - Placemats on the table (46.4%). These results have led to the development of the restaurant network and some of the project’s tools.

Restaurants

41 restaurants responded to the questionnaire. Despite the small number of results, some conclusions regarding this sector were made that lead to recommendations toward restaurants and formed the base of the communication effort.
56% of respondents claimed not to be aware of the existence of nutritional programmes. This result leads to the need to educate the restaurateurs about the existence of such programmes and their possible implementations in the restaurants.
The main reasons given for not making changes to the food on offer were budget (46.2%) and time (33.3%). Also, 63.4% of the respondents do not use local products in their cooking. However, a majority of respondents would like to learn more about balanced food.

50% of restaurant owners would like to have received training and practical work and be informed about balanced nutrition. This has led to the creation of individual workshops to restaurants in the Czech Republic that was piloted in 45 restaurants.

Restaurant qualitative survey

In parallel with the quantitative survey, a qualitative restaurant study has been conducted in 2009. This survey was conducted in twelve countries (Belgium, Brazil, the Czech Republic, France, Germany, Greece, India, Italy, Morocco, Poland, Spain, United Kingdom) and five restaurants were chosen 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.

Five restaurants were chosen in the Czech Republic and their owners were interviewed regarding their attitudes toward healthy cooking. Several common themes emerged from these even though the restaurants chosen were varied in the type of food they offer and their clientele. The main issue that emerged was that eating healthy balanced food is not part of the Czech culture. This means that restaurant owners do not pay much attention to their cooking methods, for example the amount of fat used in preparing the dishes. Restaurateurs were also not aware of any existing national health schemes. Seasonality depended on the restaurant type and products were bought locally or abroad depending on price and demand for quality from the clients.
Nevertheless, restaurant owners have noticed an increase in the demand for healthy food and all but one of the restaurateurs interviewed had a positive approach toward healthy cooking and were interested in training that would explain how to cook healthily without spending more money.

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.

The recommendations that were adopted in the Czech Republic related to the food on offer, which is culturally specific to the country. It also depended on local eating habits and the relationship with healthy food, aiming to tackle increasing rates of overweight and obesity. The partners incorporated the nutritional recommendations created by the Health Ministry of the Czech Republic.

Recommendations to the employees

The purpose of the recommendations was to provide employees with simple and easy to use guidelines to assist them in choosing food during the working day. One of the basic nutrition rules to be related was the importance of eating three main meals during the day. The maximum energy content of these is to be 20% energy intake during breakfast, 35% during lunch and 30% during dinner. Morning and afternoon snacks are to provide no more than 5-10% of the daily energy intake with approximately three-hour intervals between meals.
Employees are to use these as guidelines to improve their health and to modify their eating habits not only during the working day.

  • Taste the food before adding salt and/or try other condiments.
  • Lower the use of fat and preferably use vegetal oils.
  • Eat at least 5 portions of fruit/vegetables per day.
  • As a dessert, choose a fresh fruit based option and sometimes as an alternative, a dairy product.
  • Choose types of cooking that do not add too much fat (steaming, roast, grill, etc.).
  • Choose water to accompany your lunch .
  • It is necessary and very important to choose and maintain a regular diet : Three meals are recommended per day. Maximum energy intake should be at lunch, though breakfast should be regarded as an important part of daily meals. Dinner is the third meal of the day. Morning and afternoon snacks should represent only a small proportion of daily energy intake, therefore, choose vegetables or fruit. It is recommended to leave 3 hour intervals between each meal.
  • Keep in mind that breakfast is the most important meal of the day, and increases well-being and is a good start to every day.
  • Hunger between main meals should be suppressed by fruit or vegetables.

Recommendations to the restaurants

Eight recommendations in total were agreed on in the Czech Republic. Recommendations 2-7 are specific to local cultural habits. Together these form the guidelines to the Czech restaurants. The emphasis to the restaurateurs and chefs was on cooking the traditionally heavy Czech food in a more balanced form. The recommendations were based on the traditional daily menus and followed these principles :

  • Favour cooking methods such as steam, oven, or grill.
  • Offer dishes in 2 sizes.
  • In our country, accompaniments are excessive compared with other countries – a lot of carbohydrates
    • Serve less meat but more vegetables ; and serve fewer accompaniments = 1 quarter of the plate
    • Modify the nutritional ratios of helpings – more vegetables, less accompaniments – with both made-to-order and typical Czech meals = half vegetables, quarter accompaniments and quarter meat.
  • Offer a range of smaller portions
    • Soup is specific to the Czech Republic, for example a thick goulash soup served with a roll and followed by the main course, is too rich in calories
    • Serve smaller helpings of soup without any bread, unless the soup itself is the main dish.
  • Increase range of vegetable salads, especially with olive or rapeseed oil added.
  • Reduce the content of trans fatty acids in edible fats and in products utilising edible oils by preferring olive-oil or rapeseed oil - cold pressed.
  • Expand the choice of beans, peas and other pulses in Winter.
  • Use less fat and salt + Use iodine salt.

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 the Czech Republic, restaurants have to apply 5 out of the 8 recommendations in order to be part of the FOOD restaurants network.

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.

Many journalists and visitors came and took part in the activities.
The Chef Martin Sindelar of the famous restaurant “Le Pavillon” offered many culinary demonstrations : appetizers, healthy sandwiches, fruit preparations, banana cake and more.
An exhibition was organized by STOB, the Czech partner in which Iva Malkova compared traditional foods prepared in a calorie rich versus lean methods of cooking and answered many questions. Many people were amazed to discover that industrial beverages could contain almost 44 pieces of sugar !
Comedians offered a show where they explained in a humoristic way what a balanced diet is and the comparisons between typical dishes prepared in different ways.
Finally, visitors were invited to measure their blood cholesterol and check their eating habits.

Communication tools

Along the project and programme phase, several communication tools targeting both target groups were created :

See the Communication tools for employees

See the Communication tools for restaurants

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 that was 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

In the Czech Republic, 873 employees responded to the questionnaire (14.1% of the total sample, compared with only 7% in 2009). The respondents were 80% female (more than the average in the other countries), with 27.9% of them over the age of 50 (the proportion is significantly higher than expected).
Regarding diet, Czech respondents perceived their diet is unhealthy more frequently than in other countries. Only 6% of respondents (58 people) admitted to eating 5 portions of fruit and vegetables 6-7 times a week. The majority (214 respondents or 25%) only have 5 portions once or twice a week.
50% of employees were still unaware of national programmes that promote healthy eating but nevertheless would have liked to receive more information on the subject.
64% of respondents reported having a lunch break every day with only 5% never having lunch during the day. 83% of those who have a lunch break have it in a restaurant. This continues to indicate that the Czech employees are good targets for this project.
A majority (around 60%) of employees responded that a balanced meal is never on display when they eat out in a restaurant. Fruit is not an option for dessert claim the majority (a third of respondents) and neither are there alternatives to biscuits as starters (46%). This is an indication that the FOOD recommendations in these restaurants were not adhered to. These options being available would have helped the Czech employees to make healthier choices (diffusing the ‘toxic environment’ previously mentioned).
Still 58% were not interested in seeking nutritional advice from restaurant staff and ranked staff knowledge or willingness to help with meal choice as last in the importance when choosing a restaurant. A similar trend exists in the other countries yet the percentage is the highest in the Czech Republic.

Restaurant questionnaire results

57 restaurants responded to the questionnaire (corresponding to 18% of the total sample of responses across the six countries). Out of these, 73.7% of the restaurants offered a special lunch option (deal, dish, meal or menu) with soup, main course and dessert as the popular option. The majority of customers in these restaurants were employees (our target audience).
Positively, 40% of the respondents wished to receive more information about balanced food and the FOOD project. Most restaurants would like to receive training sessions to learn about balanced food.
However, more than 40% of restaurants were convinced that their customers may think negatively about them serving balanced food. Changing the attitude of restaurant owners toward healthy food should be a priority in the Czech Republic. This should be done through demonstrating that these changes can be achieved without spending more time or money on the cooking.

Despite the short time that passed between the first and second surveys and the difficulty to determine whether there was a change in behaviour, some promising results emerge from the questionnaires. The Czech employees continue to be good candidates for the interventions as they often have lunch in a restaurant. They are also interested to learn more about healthy eating. Increased demand from the employee side would encourage the restaurants to make the necessary changes to the food they offer.

Questionnaires inspired from the 2009-2010 surveys, called the FOOD barometers, are launched every year since 2012 to monitor the evolution of the habits and opinions of both target groups –employees and restaurants - about balanced food.

Click here to consult the results for the Czech Republic

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.