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UWHC,UWMF,

Policies,Administrative,UW Health Administrative,Culinary Services

UW Health Nutrition and Sustainability Standards (3.00)

UW Health Nutrition and Sustainability Standards (3.00) - Policies, Administrative, UW Health Administrative, Culinary Services

3.00

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Administrative (Non-Clinical) Policy
This administrative policy applies to the operations and staff of the University of Wisconsin Hospitals and
Clinics Authority as integrated effective July 1, 2015, including the legacy operations and staff of UWHC
and UWMF.
Policy Title: UW Health Nutrition and Sustainability Standards
Policy Number: 3.00
Effective Date: January 1, 2016
Chapter: Culinary Services
Version: Original
I. PURPOSE

To support the mission and vision of UW Health as the national leader in healthcare, and to advance the
well-being of the people of Wisconsin and beyond, food and beverage items sold throughout the
organization will meet specific nutrition and sustainability standards. Areas of inclusion are retail,
vending, catering and patient meal services.

II. DEFINITIONS

The We Are Health Committee is a multi-disciplinary group who guide, implement, monitor and manage
the nutrition standards and sustainable food purchasing guidelines for UW Health developed by evidence-
based research and current best practices.
The Healthy Food and Beverage Process Assessment is a tool used to monitor the food and beverage
environment for: 1) product, 2) preparation, 3) portion size, 4) placement, 5) pricing, 6) promotion, and 7)
purchasing practices. (Table 1).
My Smart Choice guidelines developed by UW Health centered on evidence-based research, and are
outlined in Table 2.
Sugar sweetened beverages (SSB) include any beverage with an added sweetener. These include, but are
not limited to, energy drinks, sports drinks, fruit drinks, regular soda, sweetened milk and milk
alternatives, sweetened tea and sweetened coffee drinks.
Sustainable means the impact of production, distribution, and the overall supply chain has on consumers
and the environments overall health. This includes:
A. Antibiotic and hormone free
B. Pesticide and chemical free
C. Source identified and local as outlined in Table 3
D. Third party certification/labels and/or USDA approved claims (disclosure and then relevance) as
outlined in Table 4
E. Vendor business practices including, but not limited to: protection of farm worker health and
welfare, ecologically and environmentally sustainable practices (recycling, energy and waste
practices), etc.

III. POLICY
A. The Healthy Food and Beverage Process Assessment will be completed on a quarterly basis by a
designee of the We Are Health Committee to ensure:
1. At least 60% of the food and beverage items offered will meet the criteria outlined in the
Healthy Food and Beverage Process Assessment.

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2. At least 60% of the beverages offered will not contain non-nutritive sweeteners (NNS)
such as aspartame and sucralose and no SSB will be sold.
3. All fountain beverages will be available in 12-16 fl. ounce portions.
4. 100% fruit or vegetable juice and fruit and vegetable smoothie beverages will be limited
to 4-8 fl. ounce portions, as available.
B. A purchasing assessment will be completed on a quarterly basis by a designee of the We Are
Health Committee and/or Culinary and Clinical Nutrition Service to ensure:
1. At least 20% of the food purchases will meet the requirements for: 1) sustainable
purchasing; and/or 2) local purchasing.
2. At least three (3) of the five (5) supplemental education and promotion activities will take
place on a regular occurring basis:
a. hospital CSA (Community Supported Agriculture)
b. onsite Farmers Market
c. cooking demonstrations
d. local food product tastings
e. local, sustainable producer and vendor sourcing promotion
f. community education
g. hospital gardens or farms
C. All food and beverage items prepared by Culinary Services will have a Nutrition Facts, ingredient
and allergen label on the food item, or be available upon request using the manufacturers’
information and/or CBORD®.
D. At least 60% of the food items offered in retail, catering and patient meal services will meet the
My Smart Choice guidelines.
E. A food waste assessment will be completed on a weekly basis with adjustments as needed.
1. Donations will be made to a local food pantry system or a farmer if possible, and/or the
food waste will be composted. Efforts will be taken to use some “waste” in other
productive means (e.g. vegetable ends can be used in stock production).
F. New food and beverage selections will be monitored and reviewed by the We Are Health
committee members to ensure options available to customers meet the criteria outlined.

Table 1. Healthy Food Environment Assessment Tool

Product

Fruits
ξ All packaged fruit is 100% water or unsweetened juice with no added sweeteners
ξ In each retail outlet, a variety of at least three whole or sliced fruits are offered daily
Vegetables
ξ Offer at least one raw, salad-type vegetable daily
ξ Offer at least one steamed, baked, or grilled no-starchy vegetable daily, prepared without solid
fats
ξ Offer at least one prepared vegetable option with ≤140 milligram sodium as served
ξ All vegetable offerings contain ≤230 milligram sodium
ξ Mixed dishes where vegetable is the main ingredient contain ≤480 milligram sodium

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ξ A variety of seasonally and locally grown vegetables are available
Cereals and Grains
ξ 100% whole grain option is offered as the standard choice for rice, grains and pasta
ξ At least one cereal with ≤140 milligram sodium per serving is offered
ξ All cereal, bread, and plain pasta offerings contain ≤230 milligram sodium per serving

ξ Sixty percent of breakfast cereals will contain at least 3 grams of fiber and ≤8 grams of sugar per
serving
Dairy, Yogurt, Cheese, Milk or Milk Alternative
ξ 1% or fat-free milk or milk alternatives are offered
ξ Low-fat (2% or less) or fat-free cottage cheese items is offered
ξ 2%, 1%, or fat-free yogurt is offered (no full fat)
ξ Processed cheeses contain ≤230 milligram sodium per serving
ξ Whole milk is available upon request. Signage placed near the dairy section indicating its
availability
ξ Yogurt with no added sweeteners and/or yogurt with reduced sugar is offered Flavored nonfat
and low-fat yogurt will contain no more than 30 grams of total sugars per 8-ounce serving*
Protein Foods
ξ Lean meat, poultry, fish, or low-fat vegetarian entrée choices are available
ξ Canned or frozen tuna, seafood, and salmon contains <290 milligram sodium per serving, and
canned meat <480 milligram sodium per serving with the goal of offering low mercury fish
ξ A daily vegetarian entrée is available at each station
Grill
ξ No deep-fried foods served
ξ All single-item menu options are ≤500 calories
Snack Foods
ξ Snack options in ≤250 calorie portions are available at all retail outlets
Children’s Menu
ξ All menu choices are ≤500 calories
ξ All meals include a fruit and/or vegetable
ξ The standard choice for all meals includes low fat milk, milk alternative or water
Desserts
ξ Desserts have ≤30% calories from fat and/or <2 grams of saturated fat and zero grams of trans fat
ξ One sugar-free option is available

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Combination Meals
ξ Where value meal combinations are offered, fruit or a non-fried, non-starchy vegetable is the
optional side
Beverages
ξ Fruit or vegetable juice is100% juice (with no added sweetener). As available, limit to a 4-8 oz.
serving.
ξ Vegetable juices will contain ≤230 milligram sodium per 8 oz. serving
ξ 1% or fat-free milk and milk alternatives are offered. Flavored nonfat and low-fat milk contain
no more than 22 grams of total sugars per 8-ounce portion.
ξ 60% of available beverage choices will not contain added sugar or a non-nutritive sweetener.
40% of beverages will contain less than 120 calories per 8 ounces.
ξ No sugared sodas offered
ξ Filtered water stations are readily accessible
Vending Machines
ξ No items will contain trans-fat as defined by FDA
*In addition to meeting the requirement listed above, 60% of all packaged food or beverage
choices will meet the green and yellow criteria and 40% of choices will meet the red criteria (see
appendix).
Preparation
Saturated fat
ξ Eliminate trans-fat
ξ Use vegetable oil or olive oil for food preparations
ξ Limit butter and/or exchange for a lower saturated fat oil (when possible)
Portion Size
Beverages
Water and unflavored low fat milk is allowed in any size container
Entrees
ξ Half or reduced-size portions are available at competitive prices
ξ Portion-sensible serving sizes are available in all food venues
Children’s Menu
ξ Age-appropriate portions are served for all menu items
Placement
Healthy Food/Beverage Choices
ξ Food and beverage choices that meet the My Smart Choice nutrition guidelines are prominently
displayed
ξ No salt dispensers are in plain view (i.e., cafeteria tables)

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ξ Only My Smart Choice items are placed near point of sale (i.e. cash registers)
ξ There is access to free water
Pricing
ξ Healthier options are promoted by pricing lower or at a competitive price to the less healthy
alternatives
Promotion

Nutrition Labeling
ξ All items prepared by Culinary Services are clearly include ingredient, nutrition and allergy
information
ξ My Smart Choice criteria guide food and beverage selections offered in all food venues. Sixty
percent of food and/or beverage items at all locations will meet these criteria.
ξ Only healthy items are being promoted. No unhealthy items will receive promotion or
marketing.
Sustainability Practices
ξ Waste reduction, recycling and composting programs are promoted
ξ Promotions or incentives are offered for the use of reusable beverage containers
ξ Filtered, free water is available and promoted instead of bottled water
ξ Food and beverage purchases are ecologically sound, economically viable and socially
responsible

*Institute of Medicine Nutrition Standards for Foods in
Schoolshttp://www.cdc.gov/heatlhyyouth/nutrition/pdf/compfoodbooklet.pdf
Purchasing Practices

Seasonal produce
ξ Fruits and vegetables will be purchased from local farmers or farm co-operatives
ξ Environmentally friendly cleaning products will be used, when available
Environmental Impact
ξ Pest management practices and environmentally-friendly pest control alternatives are utilized
ξ Single-service items (e.g. flatware, plates and bowls) are compostable and made from bio-based
materials

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Table 2. UW Health’s My Smart Choice Guidelines
My Smart Choice Criteria
Entrée
Calories ≤ 450 calories
Saturated Fat ≤ 5 grams
Sodium < 600 milligrams
Vegetable Side
Calories ≤ 100 calories
Saturated Fat ≤ 1 gram
Sodium < 230 milligrams
Starch Side or Soup
Calories ≤ 150 calories
Saturated Fat ≤ 2 grams
Desserts
Calories ≤ 120 calories
Saturated Fat ≤ 2 grams
Added Sugar ≤ 7 grams
Snacks
Calories ≤ 250 calories
Saturated Fat ≤ 2 grams
Added Sugar ≤ 7 grams
Combination Meal
Calories ≤ 500 calories
Saturated Fat ≤ 6 grams
Sodium < 600 milligrams
Beverages per 8 ounces
Calories ≤ 120 calories
Saturated Fat ≤ 2 grams
Added Sugar ≤ 0 grams
Sodium < 230 milligrams

Table 3. UW Health’s Definitions of Source, Local and Sustainable with Priority Order for Tiered
Purchasing Strategy
Priority Order Definition
Local Tier 1:
County-Wide
Items grown or produced in Dane Countya
Local Tier 2:
State Wide
Items grown or produced in the state of Wisconsin or 150 mile radius of Madison,
WIb
Regional Item grown in the surrounding state radius of 600 miles of Madison, WI
National Products grown and produced demonstrating responsible safety, environmental,
conservation, sustainable business practices, verified by 3rd party certifications,
agencies or transparent operational practices, subject to review
International Products grown and produced demonstrating responsible safety, environmental,
conservation, sustainable business practices, verified by 3rd party certifications,
agencies or transparent operational practices, subject to review
Sustainable An item that meets all standard product and vendor considerations and at least one of
the items outlined in Definitions (A) Item 6, a-e
Local An item that meets Guidelines described under local Tier 1 or 2
Sustainable &
Local
An item that meets all standard product and vendor considerations, outlined in
Procedures Item 3 and described under local Tier 1 or 2
a. An item is considered produced in Wisconsin when at least 50% of the products
ingredients, production, or processing activities are from/in Wisconsin. This is the
definition used by the Something Special from Wisconsin program administered by the
Department of Agriculture.
b. The Healthier Hospital Initiative (HHI) defines local, state-wide as items grown or
produced in the state of WI or 250-mile radius of Madison, WI.

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Table 4. UW Health’s Definitions for Third Party Certification, Labels and/or USDA-approved
Claims, listed by Disclosure and then Relevance
Category of Food Considerations Third Party Claims
Meat, Fish, Seafood
Poultry ● Organic: USDA or third party like MOSA
● Biodynamic: Demeter
● Sustainable: Food Alliance
● Humane: Humane Raised and Handled,
American Humane, Animal Welfare Approved,
Global Animal Partnership
Meat ● Organic: USDA or third party like MOSA
● Biodynamic: Demeter
● Sustainable: Food Alliance, AGA Grass-fed,
Rainforest Alliance
● Humane: Humane Raised and Handled,
American Humane, Animal Welfare Approved,
Global Animal Partnership
Fish & Seafood ● Sustainable: Marine Stewardship Council
Certified; Food Alliance Farmed-shellfish
Produce
Fruits and
Vegetables
● Organic: USDA or third party like MOSA
● Biodynamic: Demeter
● Sustainable: Food Alliance, Protected Harvest,
Fair Trade
Frozen Fruits & Vegetables & Frozen Misc.
See: Produce

Canned/Dry Goods
Coffee/Tea

● Sustainable: Bird Friendly, Rainforest Alliance,
Fair Trade
Grains, Beans, Nuts,
and Oils

● Organic: USDA or third party like MOSA
● Biodynamic: Demeter
● Sustainable: Food Alliance, Protected Harvest,
Fair Trade
Milk/Dairy
Milk/Dairy ξ (rBST/rBGH)
Hormone free

● Organic
● Sustainable
● Humane
Eggs ● Organic: USDA or third party like MOSA
● Biodynamic: Demeter
● Sustainable: Food Alliance
● Humane: Humane Raised and Handled,
American Humane, Animal Welfare Approved,
Global Animal Partnership
Bakery
See: Grains, Beans,
Nuts, and Oils


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IV. REFERENCES
A. Piernas C, Mendez MA, Ng SW, Gordon-Larsen P, Popkin BM. Low-calorie- and calorie-
sweetened beverages: diet quality, food intake, and purchase patterns of US household
consumers. Am J Clin Nutr. 2014 Mar;99(3):567-77.
B. Pan A, Hu FB. Effects of carbohydrates on satiety: differences between liquid and solid
food. Curr Opin Clin Nutr Metab Care. 2011;14:385-90.
C. McGuire S. Institute of Medicine. 2012. Accelerating progress in obesity prevention: solving the
weight of the nation. Washington, DC: the National Academies Press. Adv Nutr. 2012;3:708-9.
D. Pan A, Malik VS, Hao T, Willett WC, Mozaffarian D, Hu FB. Changes in water and beverage
intake and long-term weight changes: results from three prospective cohort studies. Int J Obes
(Lond). 2013.
E. Bray GA, Popkin BM. Calorie-sweetened beverages and fructose: what have we learned 10 years
later. Pediatr Obes. 2013;8:242-8.
F. Glanz K, Sallis JF, Saelens BF, Frank LD. Nutrition environment measures survey in stores
(NEMS-S). Am J Prev Med. 2007;32(4):282-289.
G. Saelens BE, Glanz K, Sallis JF, Frank LD. Nutrition environment measures study in restaurants
(NEMS-R). Am J Prev Med. 2007;32(4):273-281.
H. Iowa Department of Public Health. Nutrition environment measures survey-vending. Available at
http://www.nems-v.com/index.html. Accessed January 2015.
I. Healthy Hospital Initiative: http://www.healthierhospitals.org/
J. REAP Food Group: http://www.reapfoodgroup.org/
K. Practice Green Health: http://www.practicegreenhealth.org

V. COORDINATION

Sr. Management Sponsor: VP, Facilities and Support Services
Author: Director, Culinary & Clinical Nutrition Services
Reviewers: Manager of Retail Food Operations, Culinary Services; Executive Chef, Culinary Services;
Chair, UW Health Sustainability Committee; Director, Child Health Advocacy, American Family
Children’s Hospital; Manager, Employee Wellness Program; We Are Health Committee

Approval Committee: UW Health Administrative Policy and Procedure Committee


SIGNED BY

Ronald Sliwinski
President, University of Wisconsin Hospitals
Chief of Clinical Operations


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