Healthy Nutrition Guidelines for LA County

LA County Department of Public Health

Overview

The Healthy Food Procurement Initiative in Los Angeles County is a PSE Change intervention designed to improve the quality of food purchased and offered in food service contracts through the implementation of nutrition standards. In 2011, the County of Los Angeles (“County”) Board of Supervisors adopted Healthy Food Promotion in Los Angeles County Food Service Contracts, a motion aimed at County departmental food procurement policies and practices as they relate to nutrition. The motion established a process for the County’s Department of Public Health (DPH) to develop nutrition standards and/or healthy food procurement practices in new and renewing Requests for Proposals (RFP) for food service and vending contracts across County departments.

Target Behavior: Healthy Eating

Intervention Type: PSE Change

Intervention Reach and Adoption

The adoption of the Board motion sought to reach a broad audience with almost ten million people living in Los Angeles County. As of 2020, approximately 50% of the population in the county was Hispanic or Latino, 26% non-Hispanic white, 14% Asian, and 8% Black1. The percent of foreign-born residents in this jurisdiction was nearly 32%1. Additionally about 17% of county residents lived below the federal poverty line. Approximately 15% of children age 10-17 were obese (BMI >95th percentile) and approximately 40% of adults were overweight (body mass index [BMI] between 25 and 29.9), and another 24% were obese (BMI >30).2,3

As an institutional policy, the procurement motion specifically targets 100,000 + County employees; patrons who purchase food and beverages at County venues, and populations whose meals are provided by County of Los Angeles food venues and programs. The County distributes meals to youth, seniors, patients, and incarcerated individuals; populations who are at greater risk for developing nutrition-related chronic diseases and those who are economically disadvantaged. DPH estimated that motions would impact the nutritional quality of approximately 37 million meals offered/sold in various County operated settings per year.

[1] California Health Interview Survey. CHIS 2020. Los Angeles, CA: UCLA Center for Health and Policy Research, Los Angeles, CA. Retrieved February 2, 2022. 

[2] Obesity Rates for Youth Ages 10 to 17. Oct. 2021. State of Childhood Obesity. Retrieved February 2, 2022. 

[3] Key Indicators of Health by Service Planning Area. January 2017. Los Angeles County Department of Public Health. Retrieved February 2, 2022. 

Setting: Community, Retail, Worksite

Target Audience: Preschool (<5 years old), Elementary School, Middle School, High School, Pregnant/Breastfeeding Women, Parents/Mothers/Fathers, Adults , Older Adults

Race/Ethnicity: All

Intervention Components

The Healthy Food Procurement Initiative includes the following components:

  • Institutional policy should include evidence-based nutrition standards, as well as other healthy food procurement strategies that promote selection/consumption of healthy foods and beverages.
  • Institutional policy should designate an organization or formal group to coordinate implementation of new nutrition standards and other promotion strategies.
  • The coordinating organization should consult with stakeholders whom the institutional policy will impact, such as food service vendors and department leadership in charge of food service contracts. This step must precede policy implementation.
  • The coordinating organization should have adequate resources to oversee institutional policy implementation, including sufficient resources to offer ongoing technical assistance and evaluation.
  • An organization or formal group should be authorized to evaluate and monitor the institutional policy or system change. In Los Angeles County, the coordinating organization (Los Angeles County Department of Public Health) also serves as the entity that evaluates and monitors policy implementation.

Intervention Materials

The materials supporting this institutional policy have been carefully developed by the County of Los Angeles Department of Public Health, Division of Chronic Disease and Injury Prevention. They are meant to serve as example documents, not exact guidelines for successful intervention/policy replication. Provide credit to the LA County Department of Public Health when reproducing materials in the original, or adapted, form:

  • Model policy– Healthy Food Promotion in LA County Food Service Contracts
  • “Creating Healthy Food Environments” policy brief
  • Nutrition Standards – Nutrition Standards for Prepared Foods, Snacks, and Beverages (2021) revision to Los Angeles County’s current nutrition standards
  • Board motion 3.115 County of Los Angeles Vending Machine Nutrition Policy, the most recently adopted vending machine nutrition policy
  • Case study on the vending machine program
  • Policy brief on working with public and private hospitals
  • Eat Your Best Promotional and technical assistance resources including signage posters, implementation guides, and a and cookbook to promote plant-forward menus

 

Intervention Costs

Materials available at no cost.

Designated staffing for implementation and evaluation is needed to sustain the intervention. 

Evidence Summary

The County of Los Angeles has 37 departments and over 100,000 employees. An internal assessment found that fifteen out of the 37 departments procure (sell, serve, and/or distribute) food. The healthy food procurement initiative is a very large undertaking and the creators outlined short (1-3 year), intermediate (3-5 year) and long-term (6+ year) outcomes. At this time, the short-term and intermediate outcomes have been assessed.

The initial assessment involved an extensive survey of the settings (e.g., cafeterias, vending machines, and concessions), practices (current nutrition standards, dietary accommodations), and challenges anticipated by each County department. Since 2011, DPH has partnered with 7 County departments including the Probation Department, Department of Public Works, Department of Health Services, Department of Children and Family Services, Department of Parks and Recreation, Department of Beaches and Harbors, and the Chief Executive Office. DPH provided technical assistance to each department, conducted site visits and menu reviews, recommended and integrated DPH nutrition standards in County contract solicitation and operational processes, and established a monitoring and compliance system.

An adapted version of the validated Nutrition Environment Measures Survey for Vending Machines (NEMS-V) tool and an internally developed environmental scan tool for cafeterias were used to collect baseline and follow-up data on the food and beverage options offered in vending machines and cafeterias at select facility locations. To date, we have collected baseline data on food and beverages that are offered in 45 County hospitals and multiple worksite cafeterias.

Vendor quarterly revenue, product sales records, and nutritional information of vending machine snacks and beverages were collected to examine the level of adherence and impact of 100% healthy vending policy at a large urban agency in Los Angeles County. A key finding was that policy adherence increased for snacks and beverages sold in County vending machines at the start and 23 months after implementing the policy; from ~32% to ~61% for snacks and ~50% to ~98% for beverages. However, average snack and beverage revenues appeared to decrease during the sampled period for snacks and beverages by ~37% and ~34%, respectively. DPH also conducted an environmental scan sub-assessment, and found a 32% price increases for vended snacks and beverages occurred shortly after the implementation of the policy. To some extent, this may explain the decreases in snack and beverage revenue.

DPH plans to continue technical assistance through the dissemination of healthy food procurement toolkits, and promotion of model procurement guidelines for a variety of venues and institutions. The DPH evaluation team has published several articles pertaining to healthy food procurement work and has several manuscripts in development that document the challenges and successes of creating healthier food environments. Contribution to this evidence base provides valuable information for informing similar efforts in other sectors (e.g., cities, private companies, community-based organizations with food services).

[4] Wickramasekaran et al. (2018). Evaluating the Potential Health and Revenue Outcomes of a 100% Healthy Vending Machine Nutrition Policy at a Large Agency in Los Angeles County, 2013-2015. Journal of Public Health Management and Practice, 24(3), 215-224 DOI: 10.1097/PHH.0000000000000702 

Classification: Practice-tested

Evaluation Indicators

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

Readiness and Capacity – Short Term (ST) Changes – Medium Term (MT) Effectiveness and Maintenance – Long Term (LT) Population Results (R)
Individual
Environmental Settings MT5 LT5
Sectors of Influence MT7

Evaluation Materials

Center TRT developed an evaluation logic model and evaluation plan for a policy modeled after the Healthy Food Promotion in Los Angeles County Food Service Contracts institutional policy. The policy aims to increase access and availability of healthy foods and beverages in county departments and programs by including nutrition standards and healthy food promotion practices into food service contract requests for proposals. The logic model is intended to guide the evaluation process (as opposed to the planning process); the evaluation plan focuses on the implementation and effectiveness of an approach similar to LA County’s. The evaluation plan addresses the reach, adoption, extent of implementation, and effectiveness of a policy modeled after the LA County policy. The evaluation is a pre-post design with no comparison group. This evaluation plan provides guidance on evaluation questions and types and sources of data for both process and outcome evaluation. If you are interested in answering evaluation questions not listed in the evaluation plan, please refer to the list of additional evaluation questions here. We suggest a variety of data collection tools throughout the evaluation plan. 

  • Salad Bar Toolkit

 

Additional Information

Website: Additional information on the intervention can be found on the Center TRT website: http://www.centertrt.org/?p=intervention&id=1184&section=1. The LA County Department of Public Health website is http://www.choosehealthla.com/.

Contact Person(s):
Michelle Wood, MPP
Program Manager, Food Policy Initiatives
Division of Chronic Disease and Injury Prevention
Los Angeles County Department of Public Health
3530 Wilshire Blvd., 8th Floor
Los Angeles, CA 90010
Phone: (213) 351-7809
Email: mwood@ph.lacounty.gov