Healthy Eating Research:
Building Evidence to Prevent Childhood
Obesity
Minimum Stocking Levels and
Marketing Strategies
of Healthful Foods for Small
Retail Food Stores
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Presenters
Melissa Laska
Jennifer Pelletier
Associate Professor,
Epidemiology &
Community Health
University of Minnesota
School of Public Health
PhD Candidate and
Research Assistant
University of Minnesota
School of Public Health
Tracy Fox
President
Food, Nutrition & Policy
Consultants, LLC
Across the U.S., there are notable disparities
in the healthfulness of foods and beverages
found in retail settings.
Small food stores tend to lack
a wide array of healthy, staple
foods.
Introduction
Limited access to stores that
carry healthful food may
contribute – at least in part –
to disparities in diet and
health.
Addressing the Problem
Strategies for addressing limited access to
stores that stock and sell healthy, staple
foods and beverages include:
• Attracting new grocery stores or supermarkets
to an underserved community.
• Improving the healthfulness of products sold
by existing food retailers in a given community.
Small Food Stores
Small stores face challenges in
stocking and selling healthy food.
• “Healthy corner store” programming has
shown some success in addressing
challenges.
• Policy action has been used to support
healthy corner store work and to institute
healthy stocking standards for retailers.
Key Challenge
Lack of consistency
in standards across
these programs and
policies.
Aims of this report
Identify basic and preferred minimum stocking
levels for healthful foods and beverages in
small retail food stores.
Identify marketing strategies small stores
should use to enhance sales of healthy foods
and beverages.
Expert Panel Leadership
Panel Conveners:
Panel Chair:
Mary Story, PhD, RD
Director, Healthy Eating Research
Professor, Global Health and Community and Family
Medicine
Associate Director of Education and Training
Duke Global Health Institute
Melissa N. Laska, PhD, RD
Associate Professor, Epidemiology & Community Health
Co-Director, Obesity Prevention Center
Senior Program Advisor, Healthy Eating Research
University of Minnesota School of Public Health
Panel Support:
Megan Lott, MPH, RDN
Senior Associate of Policy and Research, Healthy
Eating Research
Duke Global Health Institute
Jennifer E. Pelletier, MPH
PhD Candidate and Research Assistant
University of Minnesota School of Public Health
Lesley Schmidt Sindberg, MPH
Senior Research Coordinator, Healthy Eating Research
University of Minnesota School of Public Health
Expert Panel Members
Guadalupe X. Ayala, PhD, MPH
San Diego State University
Paul Nojaim
Nojaim Brothers Supermarket
Brian Elbel, PhD, MPH
New York University School of Medicine and
Wagner Graduate School of Public Service
Collin R. Payne, PhD
New Mexico State University
Christine Fry, MPP
ChangeLab Solutions
Joel Gittelsohn, PhD
Johns Hopkins Bloomberg School of Public Health
Steve Gortmaker, PhD
Harvard T.H. Chan School of Public Health
Allison Karpyn, PhD
University of Delaware
Fred A. Katz, MBA, MSDE
Johns Hopkins University Carey Business School
Stephanie Jilcott Pitts, PhD
East Carolina University
Julie Ralston Aoki, JD
Public Health Law Center
Tracy Fox, MPH, RD
Food, Nutrition & Policy Consultants, LLC
Bill McKinney
The Food Trust
Scope
Small retail food stores
• Have retail floor space dedicated to foods/ beverages
• Have no more than 3 cash registers that may be
used for food/beverage transactions
• Includes: dollar stores, retail pharmacies, stores
accepting WIC or SNAP
• Excludes: home goods stores, electronics stores,
office supply stores
Methodology
Sources reviewed
• 2015 Dietary Guidelines for Americans
• Peer-reviewed research
• National recommendations and guidelines
• Existing retailer requirements in local, state, and
federal policies and programs
• e.g. WIC retailer requirements, Healthy Corner
Store Certification Programs
Overview
1. Minimum Stocking Levels of Healthful
Foods/Beverages (Table 1)
• Fruits and Vegetables
• Dairy and Fortified Soy Beverages
• Whole Grain-Rich Staple Products
• Meat/Protein
• Beverages
Qualifying Standards (Table 2)
Overview
Two Levels of Minimum Stocking
• Basic
• Preferred
2. Marketing Strategies for Food Retailers
• Apply to basic & preferred
• May also apply to larger stores
Fruits and Vegetables
Basic
Varieties
• ≥4 FRUITS
• ≥2 Fresh
• ≥6 VEGETABLES
• ≥4 Fresh
• ≥1 Dark green or
red/orange
Fruits and Vegetables
Basic
Varieties
Single kind of
product,
regardless of
form, processing,
or package size
• ≥4 FRUITS
• ≥2 Fresh
• ≥6 VEGETABLES
• ≥4 Fresh
• ≥1 Dark green or
red/orange
Fruits and Vegetables
Basic
Varieties
• ≥4 FRUITS
• ≥2 Fresh
• ≥6 VEGETABLES
• ≥4 Fresh
• ≥1 Dark green or
red/orange
Pounds*
≥30
*No more than 50% from a single variety
Fruits and Vegetables
Basic
Preferred
Varieties
• ≥4 FRUITS
• ≥6 FRUITS
• ≥2 Fresh
• ≥3 Fresh
• ≥6 VEGETABLES
• ≥8 VEGETABLES
• ≥4 Fresh
• ≥4 Fresh
• ≥1 Dark green or
• ≥2 Dark green or
red/orange
red/orange
Pounds*
≥30
*No more than 50% from a single variety
Fruits and Vegetables
Basic
Preferred
Varieties
• ≥4 FRUITS
• ≥6 FRUITS
• ≥2 Fresh
• ≥3 Fresh
• ≥6 VEGETABLES
• ≥8 VEGETABLES
• ≥4 Fresh
• ≥4 Fresh
• ≥1 Dark green or
• ≥2 Dark green or
red/orange
red/orange
Pounds*
≥30
≥45
*No more than 50% from a single variety
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)
Fresh, frozen, or canned
Non-expired, non-spoiled
Canned/frozen fruit packed in water, 100% juice, extra light or light syrup
Canned/frozen vegetables with no added ingredients and no more than 240 mg sodium
Excludes fruit or vegetable juice, garlic, herbs, condiments, ginger root, lemons, and limes
Dairy and Fortified Soy Beverages
Basic
Milk/Fortified Soy
Beverage
• ≥5 gallons
• ≥1 variety
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)
Milk: skim (0% fat), low-fat (1%), in half gallon package or larger
Fortified soy beverage: original or plain, fortified with calcium and vitamins A and D, in half gallon package
or larger
Yogurt with no more than 23 g total sugar/6 oz serving. No frozen yogurt or yogurt with mix-in ingredients.
Cheese that is low-fat, part-skim, or fat free. Excludes processed cheese products and cheese packaged
with other foods
Dairy and Fortified Soy Beverages
Basic
Milk/Fortified Soy
Beverage
• ≥5 gallons
• ≥1 variety
Yogurt
• ≥32 ounces
• ≥ 1 variety
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)
Milk: skim (0% fat), low-fat (1%), in half gallon package or larger
Fortified soy beverage: original or plain, fortified with calcium and vitamins A and D, in half gallon package
or larger
Yogurt with no more than 23 g total sugar/6 oz serving. No frozen yogurt or yogurt with mix-in ingredients.
Cheese that is low-fat, part-skim, or fat free. Excludes processed cheese products and cheese packaged
with other foods
Dairy and Fortified Soy Beverages
Basic
Milk/Fortified Soy
Beverage
• ≥5 gallons
• ≥1 variety
Yogurt
• ≥32 ounces
• ≥ 1 variety
Cheese*
• ≥2 pounds
• ≥1 variety
*Only if cheese is stocked
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)
Milk: skim (0% fat), low-fat (1%), in half gallon package or larger
Fortified soy beverage: original or plain, fortified with calcium and vitamins A and D, in half gallon package
or larger
Yogurt with no more than 23 g total sugar/6 oz serving. No frozen yogurt or yogurt with mix-in ingredients.
Cheese that is low-fat, part-skim, or fat free. Excludes processed cheese products and cheese packaged
with other foods
Dairy and Fortified Soy Beverages
Basic
Preferred
Milk/Fortified Soy
Beverage
• ≥5 gallons
• ≥1 variety
• ≥10 gallons
• ≥ 2 varieties
Yogurt
• ≥32 ounces
• ≥ 1 variety
• ≥64 ounces
• ≥ 2 varieties
Cheese*
• ≥2 pounds
• ≥1 variety
• ≥4 pounds
• ≥2 varieties
*Only if cheese is stocked
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)
Milk: skim (0% fat), low-fat (1%), in half gallon package or larger
Fortified soy beverage: original or plain, fortified with calcium and vitamins A and D, in half gallon package
or larger
Yogurt with no more than 23 g total sugar/6 oz serving. No frozen yogurt or yogurt with mix-in ingredients.
Cheese that is low-fat, part-skim, or fat free. Excludes processed cheese products and cheese packaged
with other foods
Whole Grain-Rich Staple Products
Basic
Whole Grain-Rich
Staple Products*
• ≥5 pounds
• ≥2 varieties
*Excluding cereal
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)
Varieties of staple products include but are not limited to whole grain bread, brown rice, whole wheat or
whole corn tortillas, quinoa, and barley.
Whole grain is the first ingredient
Excludes whole grain-rich snacks and sweets
Whole grain-rich cereal must have no more than 21.2 g total sugar per 100 g, or no more than 6 g per 1
dry ounce and be in packages of at least 11 ounces
Whole Grain-Rich Staple Products
Basic
Whole Grain-Rich
Staple Products*
• ≥5 pounds
• ≥2 varieties
Whole Grain-Rich
Cereal
• ≥4 containers
• ≥3 varieties
*Excluding cereal
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)
Varieties of staple products include but are not limited to whole grain bread, brown rice, whole wheat or
whole corn tortillas, quinoa, and barley.
Whole grain is the first ingredient
Excludes whole grain-rich snacks and sweets
Whole grain-rich cereal must have no more than 21.2 g total sugar per 100 g, or no more than 6 g per 1
dry ounce and be in packages of at least 11 ounces
Whole Grain-Rich Staple Products
Basic
Preferred
Whole Grain-Rich
Staple Products*
• ≥5 pounds
• ≥2 varieties
• ≥10 pounds
• ≥ 2 varieties
Whole Grain-Rich
Cereal
• ≥4 containers
• ≥3 varieties
• ≥12 containers
• ≥ 4 varieties
*Excluding cereal
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)
Varieties of staple products include but are not limited to whole grain bread, brown rice, whole wheat or
whole corn tortillas, quinoa, and barley.
Whole grain is the first ingredient
Excludes whole grain-rich snacks and sweets
Whole grain-rich cereal must have no more than 21.2 g total sugar per 100 g, or no more than 6 g per 1
dry ounce and be in packages of at least 11 ounces
Meat/Protein
Basic
Varieties
Meat products
Poultry
Fish
Eggs
Dried or canned beans
Dried split peas
Black-eyed peas
Lentils
Soybean products (including tofu)
Nuts
Nut butter
•
≥4 total varieties
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):
Cuts of meat or deli meat that are labeled by USDA as lean or extra lean.
Qualifying products must be plain and packages with no oils, sauces, or other food products.
All products in this category must be low sodium (no more than 360 mg per serving).
Nuts must have no added sugar and nut butter must be packaged with no other food products.
Meat/Protein
Basic
Varieties
Meat products
Poultry
Fish
Eggs
Dried or canned beans
Dried split peas
Black-eyed peas
Lentils
Soybean products (including tofu)
Nuts
Nut butter
•
≥4 total varieties
• ≥1 lean or
extra lean red
meat*
*Only if red meat is stocked
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):
Cuts of meat or deli meat that are labeled by USDA as lean or extra lean.
Qualifying products must be plain and packages with no oils, sauces, or other food products.
All products in this category must be low sodium (no more than 360 mg per serving).
Nuts must have no added sugar and nut butter must be packaged with no other food products.
Meat/Protein
Varieties
Meat products
Poultry
Fish
Eggs
Dried or canned beans
Dried split peas
Black-eyed peas
Lentils
Soybean products (including tofu)
Nuts
Nut butter
Basic
Preferred
•
•
≥4 total varieties
• ≥1 lean or
extra lean red
meat*
≥8 total varieties
• ≥1 lean or extra
lean red meat*
*Only if red meat is stocked
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):
Cuts of meat or deli meat that are labeled by USDA as lean or extra lean.
Qualifying products must be plain and packages with no oils, sauces, or other food products.
All products in this category must be low sodium (no more than 360 mg per serving).
Nuts must have no added sugar and nut butter must be packaged with no other food products.
Beverages
Basic
Plain water
•
≥384 ounces (24 bottles
of size 16 oz)
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):
Low-calorie beverages have no more than 40 calories per 8 ounce serving
Vegetable juice with no more than 140 mg sodium per servings
Family size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
Beverages
Basic
Plain water
•
≥384 ounces (24 bottles
of size 16 oz)
Fountain beverages*
•
•
•
Plain water available
≥1 low-calorie beverage
≥1 container size 12
ounces or smaller
*Only if fountain beverages
are sold
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):
Low-calorie beverages have no more than 40 calories per 8 ounce serving
Vegetable juice with no more than 140 mg sodium per servings
Family size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
Beverages
Basic
Plain water
•
≥384 ounces (24 bottles
of size 16 oz)
Fountain beverages*
•
•
•
Plain water available
≥1 low-calorie beverage
≥1 container size 12
ounces or smaller
•
≥6 family-sized
containers OR
≥24 individual-sized
bottles (8 ounces)
*Only if fountain beverages
are sold
100% Fruit or Vegetable
Juice*
•
*Only if juice or juice-flavored
beverages are stocked
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):
Low-calorie beverages have no more than 40 calories per 8 ounce serving
Vegetable juice with no more than 140 mg sodium per servings
Family size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
Beverages
Basic
Preferred
Plain water
•
≥384 ounces (24 bottles
of size 16 oz)
•
≥384 ounces (24 bottles of
size 16 oz)
Fountain beverages*
•
•
•
Plain water available
≥1 low-calorie beverage
≥1 container size 12
ounces or smaller
•
•
•
Plain water available
≥2 low-calorie beverages
≥2 container sizes 12
ounces or smaller
No container sizes larger
than 16 ounces
*Only if fountain beverages
are sold
•
100% Fruit or Vegetable
Juice*
•
•
*Only if juice or juice-flavored
beverages are stocked
≥6 family-sized
containers OR
≥24 individual-sized
bottles (8 ounces)
•
•
≥12 family-sized containers
OR
≥48 individual-sized bottles
(8 ounces)
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):
Low-calorie beverages have no more than 40 calories per 8 ounce serving
Vegetable juice with no more than 140 mg sodium per servings
Family size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
Beverages
Basic
Preferred
Plain water
•
≥384 ounces (24 bottles
of size 16 oz)
•
≥384 ounces (24 bottles of
size 16 oz)
Fountain beverages*
•
•
•
Plain water available
≥1 low-calorie beverage
≥1 container size 12
ounces or smaller
•
•
•
Plain water available
≥2 low-calorie beverages
≥2 container sizes 12
ounces or smaller
No container sizes larger
than 16 ounces
*Only if fountain beverages
are sold
•
100% Fruit or Vegetable
Juice*
•
•
*Only if juice or juice-flavored
beverages are stocked
Access to dispensed,
potable water
≥6 family-sized
containers OR
≥24 individual-sized
bottles (8 ounces)
•
•
•
≥12 family-sized containers
OR
≥48 individual-sized bottles
(8 ounces)
Must be provided free of
charge
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):
Low-calorie beverages have no more than 40 calories per 8 ounce serving
Vegetable juice with no more than 140 mg sodium per servings
Family size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
Marketing Strategies
Marketing Strategies
Category
Description
Placement
Physical location of products in store
Marketing Strategies
Category
Description
Placement
Physical location of products in store
Price
Relative and absolute prices of
products
Marketing Strategies
Category
Description
Placement
Physical location of products in store
Price
Relative and absolute prices of
products
Promotion
Deals, advertisements, signage
Marketing Strategies: Placement
Category
Strategies
Placement
Place healthier foods/beverages in multiple
prominent locations throughout the store
• Eye level
• End caps
• Grab & go displays near entrance/checkout
Marketing Strategies: Placement
Category
Strategies
Placement
Place healthier foods/beverages in multiple
prominent locations throughout the store
• Eye level
• End caps
• Grab & go displays near entrance/checkout
Stock only healthier foods/beverages/non-food items
in some or all checkout areas
-ORIncrease the proportion of healthier
foods/beverages/non-food items in all checkout areas
Marketing Strategies: Placement
Category
Strategies
Placement
Place healthier foods/beverages in multiple
prominent locations throughout the store
• Eye level
• End caps
• Grab & go displays near entrance/checkout
Stock only healthier foods/beverages/non-food items
in some or all checkout areas
-ORIncrease the proportion of healthier
foods/beverages/non-food items in all checkout areas
Cross-merchandize healthier foods/beverages by
placing complementary products near each other
Marketing Strategies: Price
Category
Strategies
Price
Offer at least 10% price discount in promotions for
fruits and vegetables through coupons, vouchers,
rebates, or other methods
Marketing Strategies: Price
Category
Strategies
Price
Offer at least 10% price discount in promotions for
fruits and vegetables through coupons, vouchers,
rebates, or other methods
Offer at least 10% price discount in promotions for
healthier versions of products within a product
category (e.g., whole grain-rich bread vs. white
bread)
Marketing Strategies: Price
Category
Strategies
Price
Offer at least 10% price discount in promotions for
fruits and vegetables through coupons, vouchers,
rebates, or other methods
Offer at least 10% price discount in promotions for
healthier versions of products within a product
category (e.g., whole grain-rich bread vs. white
bread)
Use proportional pricing, as opposed to value
pricing, for full-calorie fountain beverages
Marketing Strategies: Promotion
Category
Strategies
Promotion
Cross-promote healthier foods/beverages by
offering price promotions for complementary
products purchased together (e.g., through
circulars, digital media, in-store signage)
Marketing Strategies: Promotion
Category
Strategies
Promotion
Cross-promote healthier foods/beverages by
offering price promotions for complementary
products purchased together (e.g., through
circulars, digital media, in-store signage)
Use shelf tags, labels, tear off cards, and/or other
point-of-purchase signage to promote healthier
foods/beverages
Summary
Basic Level
Preferred Level
Minimum Stocking Requirements
• Fruits and Vegetables
• Dairy and Fortified Soy Beverages
• Whole Grain-Rich Staple Products
• Meat/Protein
• Beverages
Minimum Stocking Requirements
• Fruits and Vegetables
• Dairy and Fortified Soy Beverages
• Whole Grain-Rich Staple Products
• Meat/Protein
• Beverages
Summary
Basic Level
Preferred Level
Minimum Stocking Requirements
• Fruits and Vegetables
• Dairy and Fortified Soy Beverages
• Whole Grain-Rich Staple Products
• Meat/Protein
• Beverages
Minimum Stocking Requirements
• Fruits and Vegetables
• Dairy and Fortified Soy Beverages
• Whole Grain-Rich Staple Products
• Meat/Protein
• Beverages
Marketing Strategies
• Placement
• Price
• Promotion
Policy Implications
Feb. 10, 2016
Tracy Fox, MPH, RD
President, Food, Nutrition & Policy Consultants, LLC
Culver, IN
www.foodnutritionpolicy.com
@TracyFoxRD
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Policy Opportunities
•
SNAP: Enhancing Food
Retail Eligibility (proposed
rule anticipated)
•
National Commission on
Hunger Report
•
SNAP EBT Pilot and
Expansion
•
Healthy Food Financing
Initiatives
SNAP: Enhancing Retail Food Store Eligibility
Aug. 2013: FNS issued a Request for Information
on ways to “enhance retailer definitions and
requirements in a manner that improves access to
healthy food choices for SNAP participants”
FNS “considers access to a variety of healthy
foods at SNAP retailers to be fundamental to the
effectiveness of… the program”
Proposed rule expected – soon?
Freedom from Hunger: An Achievable Goal for the US
National Commission on Hunger Report
Rec. 5. Use evidence-based product placement
strategies that encourage purchase of healthy products
with SNAP benefits, and tie it to SNAP eligibility for
stores.
Action Item
The USDA should create new standards for SNAP vendor
eligibility to ensure that participating store… comply with
improved health and nutrition standards; ie.: USDA should
require SNAP retail stores (or those applying to become one) to
provide enhanced and immediately visible shelf space for
healthy foods and beverages.
https://hungercommission.rti.org
SNAP Summer EBT Pilot and Expansion
Households receiving free or reduced price school
meals got either a $60 increase in SNAP or a $30 increase
in SNAP per month over summer
Both resulted in reduced food insecurity
(more food security)
Sites that had a WIC delivery (specified
certain foods) resulted in same improvement
in food security at regular SNAP delivery
(no limits on purchases)
One concern was redemption: lower redemption with WIC
Healthy Food Financing Initiatives
Stocking recommendations could be used in
setting standards for financing of new retail
food stores in underserved communities
Subscribe to RWJF Weekly Policy Update
• Go to:
http://www.rwjf.org/en/manage-your-subscriptions.html
• Select: “Childhood Obesity Weekly Policy Update
Newsletter”
Thank You
Tracy Fox, MPH, RD
President, Food, Nutrition & Policy Consultants, LLC
Culver, IN
www.foodnutritionpolicy.com
@TracyFoxRD
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QUESTIONS?
Thank You
http://healthyeatingresearch.org
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