France
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 France is taking part.
Partners
Edenred
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.
Research Centre of the Institute Paul Bocuse
The Institute Paul Bocuse is a management school specialising in hospitality, restaurateur and culinary arts. It has opened in 2008 a Research Centre in order to give back food its real identity and to build a new vision of nutrition. In partnership with the Centre de Recherche en Nutrition Humaine (CRNH) and several universities, the Institute Paul Bocuse and its associates combine their strengths in a multidisciplinary approach engaging with issues around: nutrition, culinary arts, sensory evaluation, sociology, psychology, linguistic, arts de la table, design, marketing, consumer behaviour, economy, etc. The core activity of the Research Centre is the study of nutrition and eating behaviours where three themes gained importance: taste / pleasure, health / wellbeing and economy.
The Research Centre of the Institute Paul Bocuse was a FOOD member during the project phase.
Methodology
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 conducted 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.
It was launched by Auchan in 2006 and was free to use. Targeting its employees, the programme provided access to information about healthy food and products sold in supermarkets, certified by a private Agency using nutritional information.
It was launched by the insurer AXA in 2006 for an unlimited period and was free to use. Promoting a healthy lifestyle, the programme targeted AXA’s 15,000 employees. Communication was performed via email to employees who also received personalised coaching by dieticians and doctors. Weaknesses identified were the lack of clear objectives and interaction on the employee side and an inadequate match between tools and objectives.
It was launched by the company E. Leclerc in 2008 for a two-year period and was free to use. Targeting the general public, this programme offered consumers information on healthy food. Originally, the software created a selection of balanced meals based on the users’ preferences. The references were unclear however with some inaccuracies in the programme itself.
It was launched by Kraft foods in 2006 and was free to use. The programme targeted the company’s employees educating them about healthy lifestyles.
It was a coaching tool launched by Protéines in 2002 to companies wishing to communicate healthy messages to their employees. The programme offered engaging and visual content to its paid users.
It was another programme offered by Protéines to companies interested in educational programmes for their employees. Backed up by professionals, the programme was innovative yet only computer based and therefore rather rigid.
Launched by Unilever and targeting the general public, advice was sent weekly by email during four weeks to customers interested in balanced food. The programme only promoted Unilever products by an unidentified source of experts and also made no reference to physical activity.
It launched a programme targeting its customers aiming to prove that fast food can be healthy. The intervention provided customers with plenty of information based on PNNS recommendations and was available on the internet.
Summary
In summary, quite a few interventions and programmes were included in the inventory from France. Unlike Italy where most of the programmes were offered by public bodies, here in France (apart from the PNNS) all were offered by private companies, several of them from the food industry. Apart from three programmes, all were free to use. The cost was not specified in all but one programme. Half of the programmes had evaluation planned with two of these evaluating the programme itself. A general lack of addressing the subject of physical activity was noticed, as was the absence of a glossary or references to books on the subject.
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 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
1,959 employees responded to the questionnaire from France, the biggest response (nearly three time the average response) out of the six countries (Belgium, the Czech Republic, France, Italy, Spain, Sweden) From this initial survey, some important results emerged that helped to shape the first set of tools and messages.
The following graph analyses the overall weight of employees. Only around a third claim to be overweight or obese, lower than the OECD estimate. This may be a result of the survey demographics, which was composed of 74.2% women with more than half of the respondents under 35 years of age.
Figure 1: Breakdown of employee reported weight
The largest number of employees out of the six countries claimed to have knowledge of a national programme dealing with balanced food (74%). The two popular definitions for balanced food chosen were eating: ‘various foods in moderate amount, in a nice environment’ and ‘eating pleasant food while at the same time protecting your health’.
79% of respondents claimed to have a lunch break daily and the most respondents out of the six countries claimed to never have a break (6.7%). Out of those who have a lunch break, 32.1% eat out, 26.6% go home during lunch and the majority (41.3%) have food brought from home. The main reason for not eating out for those who would have time to do so and do not bring their own food is restaurant food being too high in calories (19.5%).
Figure 2: Breakdown of lunch places frequented by French employees:
The employees eating out tend to choose a restaurant close to their workplace (55.5%) and which is cheap (50.2%). In line with the results from the other six countries, French employees choose what to eat when eating out depending on what they want at that moment (65.7%). Price again was the next most important determinant (36.7%).
Over half of respondents spotted nutritional information in the restaurants they eat in, yet this information was not easily found (78.6%) and not always clear (63.5%). Having nutritional information is useful thought 70.1% of respondents and triggers positive eating habits (74%). 58% of respondents would have liked an icon indicating the balanced meal and 42% wish to know the calorific value of their chosen dish.
Restaurants
Again in France, the most responses to the questionnaire were received with 91 restaurants participating; just over half of them independently run. A special lunch ‘formula’ was offered by half of the restaurants surveyed.
Figure 3: Respondents’ restaurant classification:
Similar to the response by the employees, restaurant owners were aware of the existence of a programme on balanced nutrition (62.8%). Most respondents thought these programmes were government run; yet 72.5% did not know the name of the programme. These results indicate that despite the fact that such programmes are becoming popular and restaurateurs are more aware of them, they do not always leave a strong or lasting impression on this target audience.
Respondents who were aware of a nutritional programme tended to also follow its recommendations such as reducing salt, fat and sugar in preparing their dishes and offering more fruit and vegetables. The minority not following any recommendations (37.2%) blamed it on lack of time and budget. Another reason given by 45.5% of respondents for not following recommendations was lack of demand by customers. This answer slightly contradicts the fact that over half of employees surveyed claimed to choose their restaurant based on its menus and nutritional information offered.
Figure 4: Restaurant owners’ knowledge about balanced food
Restaurant owners were willing to participate in improving their customers’ health. None of the respondents, as evident from the previous graph, were uninterested in balanced food. Out of the 28.2% of respondents who saw obstacles to promoting balanced food, budget and time were perceived to be the main barriers. Those interested in improving their knowledge would mainly prefer training (50%) and wished to be contacted by email.
The response from France was the biggest for both sectors that also claimed to have knowledge and interest in the issues relating to balanced food. A third of French employees eat in a restaurant at lunchtime with the rest preferring homemade food. The choice of restaurant was most often based on proximity to the workplace and price. Working directly with the restaurants and providing employees with a list of restaurants close to their workplace offering balanced food and signposting the healthy meal option (despite its complicated implementation) could help them eat better and make healthier choices in the future.
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.
The five participating restaurants varied in type and in attitude toward healthy cooking. Apart from one traditional restaurant that was not interested in healthy food or making changes to its cooking despite noticing a change in people’s eating habits, all other were very much in favour.
Following on from the demand from their clients, the restaurant owners found healthy cooking an important subject and not just a passing trend. Very positively, they use seasonal fresh produce and do not perceive it to be more expensive. Emphasis was given to producing healthier dishes that are both tasty and high quality. They were all interested in training to help make balanced dishes that are not time consuming.
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 – employees and restaurants - 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.
In France
Six principles form the basis for balanced nutrition according to the French recommendations in order to achieve a good balance between the nutritional needs of the body and the food consumed.
- Diversity – eating foods from the different food groups while varying menus and cooking methods
- Rhythm – eating three to four meals daily to include breakfast paying attention to seasonality
- Adaptivity – matching the quantity eaten to levels of hunger, amount of physical activity and one’s lifestyle
- Conviviality – paying attention to the environment in order to enjoy one’s meal
- Quality – choosing ‘good’ products and preferring cooking methods that preserve the taste and nutritional value of the food
- Pleasure – taking time to enjoy the meal while paying attention to the senses involved
Recommendations to the employees
FOOD France has chosen to follow the principles of the Plan National Nutrition Santé (PNNS) and dietary guidelines. This has resulted in the need to make changes to the initial employee recommendations and adjust them to apply for a whole day and to add a recommendation specifically regarding physical activity (the only country together with Belgium in which this is part of the recommendations):
- 1 – Taste the food before adding salt and/or other condiments.
- 2 – Lower the use of fat and preferably use vegetal oils.
- 3 – As a dessert, choose a fresh fruit based option.
- 4 – Choose types of cooking that do not add too much fat (steaming, roast, grill, etc.)
- 5 – Choose water to accompany your lunch.
- 6 – Eat raw fruit or vegetable with your meal.
- 7 – Eat a dairy product with your meal and favour those which are low in sugar, low in fat and low in additives.
- 8 – Why not choose fish for this dish? (The consumption of fish is recommended at least twice a week).
- 9 – Choose wholegrain bread.
And move at least 30 minutes a day!
Recommendations to the restaurants
The Institute Paul Bocuse formed the ten recommendations to the restaurants following the French PNNS guidelines.
- 1 – Favour cooking methods such as steam, oven, or grill.
- 2 – Offer dishes in 2 sizes .
- 3 – I offer at least one starter with salads (raw vegetables and/or fruit).
- 4 – I offer at least one dish with fish or vegetal proteins.
- 5 – I offer vegetables and starchy food as accompaniment of all the dishes.
- 6 – I offer at least one dessert with fresh fruit.
- 7 – As appetisers, I offer olives, dry fruit, raw vegetables instead of peanuts and salty biscuits.
- 8 – I offer seasoning for salads which are made with low-fat cottage cheese, lemon juice and herbs.
- 9 – I offer whole bread.
- 10 – I offer automatically tap water to my clients.
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 France, restaurants have to apply 6 out of the 12 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.
In Paris, a fruit and vegetable garden specially installed in front of the bus, appealed to Parisian employees, restaurant managers and passers-by tempting them to come in and find out more about healthy eating.
Despite the rain, many showed interest in the food issue, and came into the bus to take part in the activities offered: measurement of weight and Body Mass Index, comparisons of the nutritional value of various products, healthy food tasting and more.
Amongst other activities, visitors and journalists had the opportunity to try a 10kg vest, aiming at demonstrating the impact of excess weight on the body: a lasting experience for those who tried!
Communication tools
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 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
1,483 employees responded to the second questionnaire. This was a satisfactory response rate despite being lower than the 2009 one. 61% of employees reported a normal weight, the largest group out of the countries responding. Around 70% of them claimed to eat healthily or rather healthily.
The most respondents out of the six countries claimed to be familiar with a programme promoting healthy food, the majority of them familiar with the PNNS (National Health Nutrition Plan) through a food industry campaign.
Almost 70% of respondents consider nutritional recommendations in their eating habits. 20% have been following recommendations, 25% have made changes in the past year and 25% more were about to make such changes. These results indicate a positive trend in people’s behaviour toward issues relating to nutrition and balanced diet.
Less employees than in the 2009 questionnaire claim to never eat lunch during the working day (2%). 91% have a lunch break often or every working day. Three quarters of those eat at least in one type of restaurant. The main reasons given for not eating in a restaurant remain as in 2009: lack of time and preferring to bring food from home. For those eating out, speed of service and proximity to the workplace were now the main determinants in choosing a restaurant. A varied offer of meals and price were the next most important criteria.
Regarding balanced diet, ‘diversified food in moderate quantity and in a nice environment’ together with ‘good food that at the same time protects my health’ were the main definitions chosen as in 2009. The results point out to diversity, quantity, quality and environment being the most relevant to respondents regarding balanced food.
Restaurant questionnaire results
44 restaurants have responded to the second questionnaire. This low response rate can imply that the use of the internet as means of communication with restaurants is not perfectly adequate. Direct contact through phone calls or face-to-face meetings may be necessary in order to reach further restaurants. Furthermore, time constraints were often a reason for owners not to answer the questionnaire.
The majority of restaurants responding to the questionnaire were independently run (73%) and were heterogeneous in size and clientele. 82% of these restaurants offer a special lunch menu, most often a starter, main and dessert.
15% of restaurant owners believed their staff had sufficient knowledge about nutrition with 65% admitting they were in need of further knowledge. The main reason for these restaurants to not implement nutritional recommendations was budget.
Unlike in the case of the employees, where more and more were considering issues of nutrition in their eating habits, restaurants were still not making nutrition a priority. This was evident from the results, where only 27% of restaurants had made changes following the recommendations and over 40% had not considered the subject or were not interested. The short time period of implementation can be a one of the causes.
The results from the second survey indicate yet again that there is a growing interest amongst the French employees in issues concerning nutrition. The majority of employees were familiar with a national programme promoting healthy eating, mostly the PNNS, making the latter a good programme to partner with. More employees claimed to have a lunch break and when eating out a varied menu was one of several factors when choosing a restaurant. It is important to feed this information back to restaurants to get them motivated to follow nutritional recommendations. New methods of contacting restaurants should be considered.
The FOOD barometers (since 2012)
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.
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.