Diet and Disease
• Three NCDs account for almost 60% of all
registered death in Hong Kong *:
– Cancer (32.4%)
– Heart diseases (15.2%)
– Cerebrovascular diseases (8.9%)
• Unhealthy dietary habits
– increase the risk of chronic illnesses
– cause overweight and obesity
* 2006 data
Self-reported BMI in Adults
2005
2006
60
54.2
50.3
50
Ov er all
Male
Female
50.3
45.6
46
40.2
Percentage
40
27.1
30
20
18.820.4
16.8
14 15.2 13.1
13.312.4
31
16.317.6
9.1 9.2
4.5 5.6
10
23.4
19.7
0
< 18.5
18.522.9
23.024.9
25.0 or
m or e
< 18.5
18.5- 22.9 23.0- 24.9
25 or
m or e
< 18.5
18.522.9
23.024.9
25 or
m or e
Overweight
+ Obese
2005
2006
27.1
32.0
35.9
51.4
36.0
41.0
Data source: Behavioral Risk Factor Surveillance System
Childhood Obesity
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
97/98
Boys
98/99
99/00
Girls
* Data Source: DH Student Health Service
00/01
01/02
Total
02/03
03/04
04/05
05/06
06/07
• 1997/98 16.4%
• 2005/06 19.4%
• 2006/07 20.3%
EatSmart Campaigns
@ Restaurants
@ Schools
Strategies
Supportive environment
Publicity and communication
Education and empowerment
Research and evaluation
Strengthen Community Actions
Build partnerships
Strategies
Supportive environment
Publicity and communication
Education and empowerment
Research and evaluation
Strengthen Community Action
Build partnerships
Community Dietetic Service
database
Community Dietetic Service
database
Community Dietetic Service Database
Today Session
Update EatSmart@school
Introduce EatSmart@restaurant
Q&A
Update of
‘EatSmart@school.hk’
Campaign
Department of Health
Aim
To improve eating habit of
primary school students
In 2006/07 academic year…
Strategies
 Alliance building
 Publicity and advocacy
 Creating supportive environment
 Education and empowerment
 Research and evaluation
Target groups
School personnel
Students
Lunch
Suppliers
Parents
Department of Health
EMB
DC &
FEHD
CHEHP
Media
Healthy
Cities
HKNA
FOOD
HKCC
HKASO
BUSINESS
PTA
HSC
SCHOOLS
Policy - - - $ - - Environment - - Skills
Healthy food choices
Inc consumption of healthier food in schools
Family & carers
Inc consumption of healthier food at home
Inc Physical Activity
Dec obesity among children population
Health determinants
Improved health outcome (CHD, DM, HT, stroke,
cancer)
Steering Committee, Task
Force and Working Groups
Alliance Building Ceremony
Publicity and advocacy
 39 briefings (dietitians, school
administrators, parents, caterers, District
Councilors)
 Media activities
 11 press conference
 13 press release
 94 media interview
 TV ads/road shows
 >200 visits to schools and caterers
 School based events
Supportive environment
 Making healthier choices easier in schools




Nutritional guidelines on school lunch (Apr 06)
Nutritional guidelines on school snack (Jun 06)
A guide book to lunch suppliers (Aug 06)
Revision of EDB guidelines (May 07)
Education materials
 Dedicated thematic website
 Web-based teaching kits
 Pamphlets to parents
www.eatsmart.gov.hk
> 50% 10 schools
took part
Students
 Strengthen curriculum
 Peer Educators
collaborated with
Scouts and Brownies
 Fruit Day 2007
230,000 students took part in
Fruit Day 2007
E-card Competition
Slogan
Competition
Eat more vegetables , eat more fruits.
Drink more water , feel so good.
Healthy life with healthy food.
。
利口不利腹，零食少接觸，
蔬果加五穀，健康又滿足
School ‘NutriAgent’ Project
(SNAP) targeting school
personnel and parents
Healthy Lunch
Cooking
Competition
Nutritional workshop for chef
In 2007/08 academic year…
Way forward
 Advocate healthy eating policy in
schools
 Strengthen educational efforts
 Enhance collaboration with caterers
 Sustain community interest and
demand for healthy food choices
Lunch Guidelines Revision
Aim
To ensure the content of the
guidelines is relevant and
sound from public health,
dietetic, supplier and
practical points of view
Major Amendments
Amendment 1
 Clarification of 321 message
Grains & cereals, vegetables and meat should be
in the ratio of 3 ： 2 ： 1 by volume
Amendment 2:
Encouraged Food Items
Old version
 Whole grains
 Reduced fat dairy
products or other
calcium-rich food
items
New version
 Whole grains or
grains and cereals
with added
vegetable
Lunch suppliers should include the
following food category in AT LEAST ONE
menu choice on ALL school days
Amendment 3
Strongly Discouraged Food Items
Food belongs to this category are
strongly in ALL menu choices in order
to help reduce consumption of total fat
(especially saturated fat and artificial
trans fat), salt and sugar by students.
Amendment 4
Strongly Discouraged Food Items
Old version
 Desserts or
beverages with more
than 10 grams or 2
teaspoonfuls of
added sugar in each
serving.
New version
 Desserts with
added sugar or
beverages in
“Snacks to Choose
Less” category *
* “Snacks to Choose Less” in Nutritional Guidelines on Snacks for Primary
School Students
Amendment 5
Healthy Lunch Box Checklist
Other Amendments
 Clarifications of the original concepts
or guidelines
 Further elaborations with examples
Schools





Set healthy eating policy
Join SNAP
Select the right lunch supplier (19.12)
Carry out school lunch and snack surveillance
4.17 Fruit Day 2008
Principal Summit
Parents
 Join SNAP 07/08
 Strengthen parental education effort
 Territory-wide publicity exercise
 HEAT Program
 Letters to parents
Students
 Strengthen curriculum
 ‘Healthy Eating
Ambassador’ Program
collaborated with
Scouts and Brownies
 417 Fruit Day
Lunch Suppliers
 Set up regular working group
 Equip chef with skills to make healthy lunch
 Build a database of suppliers and healthy snack
 Suggest protocols for selection of lunch
suppliers
We need your help…
 Public education
 Problem-solving skills
 A “nutrition-sensible” environment
 Watch out for “health demotive” practices!
Thank you
‘EatSmart@restaurant.hk’
Campaign
Baseline Study in early 2007
• To examine people’s dinning out habits
• To solicit people’s view on healthy eating
promotion in restaurants
Dinning out for 5x/wk +
100
90
Per cent age
80
70
60
52
50
40
32
30
52
20
11
10
11
0
Br eakf ast
Lunch
Dinner
Source: BRFSS, DH, 2005
Comments on Dishes
100
84
70
60
60
50
53
40
40
27
30
20
10
ui
t
es
fr
ss
le
le
ss
ve
to
o
ge
ta
sw
bl
ee
t
lty
sa
to
o
ea
sy
0
gr
Per cent age
90
80
Source: Baseline Survey for ESR Campaign, DH, 2007
Asking for More Healthy Choices
95
92
100
93
90
80
Per cent age
93
89
70
60
50
40
30
20
10
ll
O
ve
ra
>
65
yr
s
rs
4y
-6
35
4y
-3
18
12
-1
7y
rs
Age
rs
0
Source: Baseline Survey for ESR Campaign 2007, DH
Task Force and Working Group
Content
• Principles
• Criteria to become an EatSmart Restaurant
(ESR)
• Experience of the Pilot Project
• Final Launch of the Campaign
• Role of Dietitians / Nutritionists
Principles
Supportive Environment to Healthy Eating
Point of Purchase Information
Availability
Accessibility
Point of Purchase Information
• Provide information when food is being chosen
or purchased
 Availability and Accessibility
• Larger variety and quantity
• The lack of healthier choice is one of the
key barriers to the adoption of healthy
eating habits*
* Source: Qualitative study on dietary and exercise practices of
people of Hong Kong, Department of Health, 2004
An ESR….
• Provides EatSmart Dishes of “More Fruit &
Vegetables” and “3 Less”
• Indicates the EatSmart Dishes clearly
More Fruit and Vegetables
means that either fruit and vegetables are the sole
ingredients of the dish
or they occupy at least twice as much the amount of
meat present in the dish
3 Less
means that the dish has less fat or oil, salt and
sugar, meeting the “3 Less” requirement
Definition of 3 “Less”
Definition of 3 Less
Example: Fats & Oils / Salad Dressing / Spread
Suggestions
 Use healthy vegetable
oil
 Use low- or reducedfat salad dressing
 Use spread which is
reduced-fat and
without added sugar
Examples of
healthier ingredients
Examples of less
healthy ingredients
Corn oil, olive oil,
canola oil, reducedfat peanut butter,
jam without added
sugar
Butter, lard, coconut
oil, margarine
containing trans fat,
salad dressing, jam
with added sugar
Definition of 3 Less
Example: Grains and Cereals
Suggestions
Use
grains
and
cereals which is low in
fat and without added
sugar
Examples of
healthier ingredients
Examples of less
healthy ingredients
White bread,
whole wheat
bread, white rice,
red rice, egg
noodles, spaghetti,
rice vermicelli,
Chinese noodles
Croissant, pastry,
“cocktail bun”,
“pineapple bun”,
bun with lotus
seed paste, stirfried rice and
noodles, fried
instant noodles, EFu noodles
Definition of 3 Less
Example: Seasonings
Suggestions
Examples of
healthier ingredients
Examples of less
healthy ingredients
Use natural
ingredients to replace
seasonings or sauce
which are high in salt
or fat
Garlic, ginger,
spring onion,
onion, lemon or
lime juice, vinegar,
parsley
Shrimp paste,
fermented
soybean curd,
salted black bean,
chicken powder.
MSG, ready-touse sauces (e.g.
black pepper
sauce, curry,
satay), oyster
sauce
Definition of 3 Less
Example: Food Preparation / Cooking Methods / Mode of Serving
Suggestions
Replace frying with
blanching to prepare
meat
Blanch canned
vegetables to reduce
sodium content
Use low-fat cooking
methods
Examples of
healthier cooking
Boiling, steaming,
grilling, baking,
stewing, stir-frying
or pan-frying with
small amount of oil
Examples of less
healthy cooking
Deep-frying
(including the
frying process of
meat prior to
cooking),
Pour salad
dressing or
condiments over
the dishes
Checklist for the “3 Less” Dishes
• Use as the final Ax
• “3 Less” dishes must
pass all the 12 criteria
in the checklist!!!
店內宣傳產品 Restaurant Interventions
Door decal
Door decal
Table tent
Menu
Certificate
Table tent
vegetables occupy at least
twice as much the amount of
meat present in the dish
Pilot Study
Healthier dishes offered on any day in
August 2007: 685 dishes
Pre-intervention: 243 dishes
Data from 50 outlets
Sales in EatSmart Restaurants
Sales
94.5% of restaurant staff perceived more
customers choosing Healthier Dishes
62% of restaurants reported increased
sales in healthier dishes
98.0% of restaurant staff thinks it is viable
to promote healthy eating in restaurant
settings
Customers’ feedback
Customers
• >95% are satisfied with the healthier dishes
• 85.8% said the campaign attracted them to
choose the EatSmart Dishes
• 98.8% supported restaurants providing the
healthier dishes
• 75.2% would patronize this restaurant again for
the healthier dishes
Awareness and Ordering pattern
500 Customers
Awareness of the Pilot Project
 237
 263
Ordered Healthier Dish




114
123
27
236
48.1%
4.7 times more likely to order
10.3%
Staff
• Welcomed the campaign
• Difficulties encountered
•
•
Matching ingredients
Knowing the customers’ want
Benefits to ESR
1. Brings business
2. Exclusive use of the EatSmart Decal
3. Free use of “More Fruit and Vegetables”
and “3 Less” logos
4. Identification as customer-centric business
operators
Benefits to ESR
5. Free promotion materials
6. Listed on the EatSmart Website for maximum
exposure
7. ES Campaign promotional activities and
collaborative programmes.
8. Training, resources and professional support
Posters,
API,
pamphlets
www.eatsmart.gov.hk
7.30 Press Event in an EatSmart Restaurant
3000
2500
2000
Chinese version
1500
English version
1000
500
Sunday
Sunday
Sunday
0
20- 21 22 23 24 25 26 27 28 29 30 31 1- 2 3 4 5
JulAug720 Kick off ceremony
730 Lunch at新皇朝觀
景
Hit rate of CHEU web
Media monitoring
Entry requirement
• Licensed food premise
• Compulsory attendance in a 2-hour nutrition training
session
• Submission of 5 healthy recipes
• Provide clear point-of-purchase information
• Committed to healthy eating promotion and incentive
programme
Time Table
Dec 2007
Mar 2008
Recruitment
Training
Territory-wide launch
– Kick-off ceremony
– Launch of the ESR website
– Serial of promotion activities
Roles of Dietitians / Nutritionists
• As a patron
• Recommend to your family members,
friends and also clients
• Provide dietetic service to the ESRs
• Recipe development
• Recipe vetting
• Promotion strategies