Health news Health & Medical News Healthier vending machines not just for schools

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Healthier vending machines not just for schools

Ed Fischer's twice-daily Cokes used to come in 20-ounce bottles until City Hall went on a health kick and restocked the sugar-sweetened beverages in its vending machines as 12-ounce cans.

"It's a little less. It's fine," Fischer said the other day, pocketing a Snickers bar. "From a rational point of view, I know I shouldn't be doing this."

Some workers now go across the street for their bottles of soda. But for those like Fischer who grudgingly accept the city's messing with their vending machines, that simple difference in container size could add up to 10 or 15 pounds a year.
Just a few years after sodas started disappearing from schools, a growing number of cities, states, hospitals, businesses, and even park systems are turning their attention to the nutrition that they offer employees and visitors, particularly through vending.

Boston's approach is simple and severe: The mayor announced a ban on the sale of all sugar-sweetened beverages on city properties.

Delaware state parks are applying more carrot than stick: Most machines now dispense two bottles of water for the price of one; soda prices are unchanged.

Philadelphia's effort is more comprehensive than most, at least on beverages. Besides limiting the size of regular sodas, it is placing them in lower-selling spots in the machines (as is Delaware) and pricing them higher than bottled water (though not as starkly as Delaware). At least 65 percent of the choices are required to be water, 100 percent fruit juice, or diet sodas and teas. Machines "wrapped" with advertising must promote water, and total calories in every item have to be prominently listed.
In combination, the moves change the environment in which food purchases are made, said Gary D. Foster, director of Temple University's Center for Obesity Research and Education.

"Government often tells people what they should do: 'Eat more of this, drink less of this,' " said Foster, who was not involved with the vending initiative. "But we don't help people with the how. What this policy effectively does is make the decision to eat healthier easier."

Nearly 40 machines have been converted since February. Most of the rest - 225 are covered by the city's main vending contract in municipal buildings, recreation centers, and elsewhere - are planned to change by year's end.

It is too early to measure reaction, but no drop-off significant enough to make adjustments has shown up, said Kyle Gish, district manager for Vendlink/Canteen, the city's vendor. While there is a big push for healthier foods everywhere, he said he knew of no other contracts that were going as far as the city has in his district, which covers area counties in Pennsylvania and New Jersey.

After talking with businesses that have tried healthy-vending campaigns and working closely with its vendor, the city settled on a series of changes rather than a Boston-type ban in order to avoid people "just blowing off the machines and going out to buy the unhealthy things," said Donald F. Schwarz, deputy mayor for health and opportunity. "What you'd like to do is encourage people over time to make healthier choices."

He said the city targeted liquids because, unlike even the worst solid snack foods, their "hollow calories" fail to signal the body that it is getting full and also because of growing evidence that the high-fructose corn syrup in soft drinks may be more harmful than other sugars.

Limiting beverage sizes to 12 ounces essentially turns back the clock nearly two decades, when larger plastic bottles were introduced in machines. The city would like to go back even further, to 71/2 ounce sizes.

Rates of obesity and the chronic medical conditions that are linked to it have been rising sharply nationwide since the 1970s. They are particularly high in Philadelphia, where 32 percent of adults are obese, the 2010 Southeastern Pennsylvania Household Health Survey reported - six percentage points higher than any surrounding county.

Among poor and African American city residents, rates approached 40 percent - nearly twice that of whites in the wealthiest suburbs.

"I think addressing vending is important. There is no one thing that is causing obesity or heart disease, so there are going to have to be multiple policies," said Margo G. Wootan, nutrition policy director for the Center for Science in the Public Interest, a Washington advocacy group.

Research in behavioral economics shows that changes such as those being made in Philadelphia influence eating habits, Wootan said, by creating a "default" option. "Just by putting the healthy choices at eye level and putting the unhealthy choices lower down, more people will make healthy choices."

The city is making similar changes in low-income neighborhoods' food environments. The broader campaign (, funded with a federal grant, includes introducing mobile carts that sell fresh fruits and vegetables, stocking more produce in corner stores, and distributing coupons that add $2 redeemable only for fruits and vegetables for every $5 in food stamps spent at participating farmers' markets.

The food industry has aggressively fought attempts by cities and states to legislate bigger changes in the food-purchasing environment, such as taxing sugary sodas by the ounce (it is winning so far) and mandatory listing of calories in restaurants (it eventually supported uniform rules in the federal health-care overhaul, which includes labels in vending machines).

Vending companies are trying to be seen as part of the solution to the country's weight problem. The National Automatic Merchandising Association in 2007 introduced a program that lists 400 snack foods that meet specified fat and sugar guidelines and advises vendors on how to work with customers to promote them. More than 1,200 organizations, including the state of Tennessee, have signed on.

Getting it right can be tricky, said Jackie Clark, spokeswoman for the industry group. Hospital employees have different tastes than construction workers. Changing too much will simply send people elsewhere. Marketing is essential to update lingering memories of healthy foods that do not taste good.

"There is plenty of yummy stuff out there," Clark said. With the right balance and promotion, she said, the "Fit Pick" industry program "increased sales because people who thought, 'There's nothing in the vending machine for me' started going to it."

The Compass Group of food-service companies, the corporate parent of Philadelphia's vendor, offers a similar program. Green "Balanced Choices" stickers appear on snacks in city machines that contain no more than 250 calories, 10 percent saturated fat, 35 percent total fat (zero trans fat) and 350 milligrams of sodium.

The city has not yet considered its own snack-food standards to complement the beverage policy. But it is working with the College of Physicians of Philadelphia to build healthy-eating programs, including vending, at 10 large employers around the city. None has gone so far as to limit sodas to 12 ounces.

The Cleveland Clinic, which started much of the healthy-food-for-employees movement in 2007 - the same year it stopped hiring smokers - has gone much further. Its vending machines have been emptied of all sugar-sweetened beverages, and snacks that are high in sugar (candy) or saturated fat (chocolate), or fried (potato chips).

Revenue from the 500 to 700 machines on 14 campuses plummeted for about six months but "it has all leveled back out, behaviors have changed, and people seem really pleased," said Bill Barum, a former chef for King Hussein and Queen Noor of Jordan and at the old Locust Club in Philadelphia before becoming senior director for hospitality operations at the clinics.

In fact, he said, finances were a key reason behind the changes - healthier employees reduce insurance costs.

Long-term savings did not drive Philadelphia's campaign and short-term losses were impossible to predict, said Schwarz, the deputy mayor, who is also health commissioner. (The vending contract earned the city $283,673 in commissions on beverage machines last year.)

Schwarz said he was surprised at how many people thanked him for the downsized cans. But he knows plenty of others are not happy.

Arika Samuel is one.

"I want my bottles back!" said the outreach coordinator for Councilwoman Jannie L. Blackwell in City Hall.

Samuel relies on a 20-ounce Pepsi for her afternoon energy boost, and now goes out at lunchtime two or three days a week specifically to buy one.

That may not be what the city wants, but she actually gets slightly more exercise doing so.

Source: Health News , By Don Sapatkin "Inquirer Staff Writer"

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