Eat Well El Paso!: Lessons Learned From a Community-Level Restaurant Initiative to Increase Availability of Healthy Options While Celebrating Local Cuisine

Abstract

Purpose: Restaurants have the potential to improve nutrition and positively shape social norms. We describe lessons learned and recommended strategies from Eat Well El Paso! (EWEP), a local restaurant initiative. Design: Descriptive case study. Setting: EWEP partnered with local restaurants from 2012-2017 in El Paso, Texas, along the US/Mexico border. Sample: Our sampling frame included EWEP staff and managers/owners at participating restaurants, of which the majority participated (80% and 85%, respectively). Intervention: EWEP was a local restaurant initiative led by the city public health department. EWEP contracted registered dietitians to assist locally-owned restaurants to increase availability of healthy menu options. Measures: Observation, key informant interviews, and document review assessed participation, barriers, and facilitators to restaurant participation and program sustainability. Analysis: Thematic and descriptive analyses. Results: 57% of restaurants completed the full on-boarding process, but long-term retention was low (24% of completers). Restaurant managers/owners perceived value in marketing, nutritional analysis, and menu design. Barriers included scheduling, complexity of restaurant culture, fear of food inspections, restaurant turnover, competing responsibilities, and lack of dedicated funding. Conclusion: Although local context and sample size may limit generalizability, lessons learned and recommended strategies are relevant and informative for communities working to increase restaurants’ healthy menu options.

The implementation and effectiveness of outlet‐level healthy food and beverage accreditation schemes: A systematic review

“…Of the 26 identified schemes, 22 had their governance mechanism, or their overarching managing body, described 19,21,22,29–63 . Ten schemes were managed by a coalition or collective of stakeholders.…”

“…Of the 26 identified schemes, 24 were reported as offering outlets support to implement the scheme 19,21,22,29–60,62,63,66,69 . Support took multiple forms, including provision of promotional materials, retail staff training, and provision of financial support or equipment.…”

“…Of the 26 included schemes, 20 described the rationale for the criteria by which foods and beverages were classified as healthy or not healthy. Eight schemes derived their criteria from existing nutrition guidelines, such as population‐wide dietary guidelines or school nutrition guidelines 20,29,30,45–49,51–56,62 . The criteria for two schemes were developed following a review of the literature on existing accreditation schemes in similar settings to form the basis for new criteria 21,36,39 .…”

“…Scheme criteria Flexible delivery allowing retailers to select which scheme criteria they wished to meet 19,20,32,64 Eligibility criteria to join exclude some businesses 19,64 Tiered scheme with multiple levels of criteria 19,64 Short initiative timeframe 42 Feasible, culturally acceptable, and tailored delivery to businesses 19,64 Scheme not worthwhile given retailer food options 70 Some businesses only have small changes to make to meet criteria 19,64 Resource and time intensity of delivery 19,32,58,63,64,68 Incorporating pilot scheme learnings to ensure compatibility with business practices 47 Requirements for staff training and support 47,53 Low resource and space requirements 53 Retailer recruitment Convenience of applying to participate 70,72 Misunderstandings about how to qualify for the program 72 Existing scheme easy to pick up 19,64,70 Slow approval process 42 Public recognition of certification 19,58,64 Lack of retailer engagement 20,37,38,44 Scheme provides a competitive advantage 54 Fear of loss of revenue 20,62,63,…”

The Quality of Menu Offerings in Independently Owned Restaurants in Baltimore, Maryland: Results from Mixed-Methods Formative Research for the FRESH Trial

“…This approach can be paired with a grilled entrée to create a healthy meal as part of the intervention. Similarly, the integration of local and community culinary traditions with healthy eating initiatives has been successfully implemented in other restaurant interventions, such as those conducted in Latinx restaurants in El Paso, Texas [45], and in Asian and Pacific Islander restaurants in San Diego, California [46].…”