Better Bites: Implementation and Outcomes of a Campuswide Healthy Food Program

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Better Bites Implementation and Outcomes of a
Campus-wide Healthy Food Program

• Jannette Berkley-Patton, PhD
• Ann D. Chapman, MS, RD
• Robert R. Basow, BS, MBA
• Melissa G. Smith, MS, CHES

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Contextual Background

• ADA guidelines for balanced eating
• 2 cups of fruit and 2 ½ cups of vegetables per
  day
• 6-ounce equivalents of whole grains per day
• 3 cups of fat-free, low-fat milk, and/or cheese
  equivalent per day.
• 2005 National College Health Assessment
• Among students, 43 of men overweight to obese
  and 31 of women
• Only 28.5 of students consume 3-4 servings of
  fruits and vegetables per day and less than 6
  consume 5 or more servings
• College students begin to experience weight gain
  in freshman year.
• Many university residence halls have
  all-you-can-eat dining halls.
• Supermarket studies have demonstrated the
  effectiveness of social and point marketing
  (posters, food labels) on food selection
  behaviors.

American College Health Association. American
College Health Association - National College
Health Assessment (ACHA-NCHA) Web Summary.
Updated April 2006. Available at
http//www.acha.org/projects_programs/ncha_sampled
ata.cfm. 2006.
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KU Contextual Background

• 29,000 students on Lawrence campus
• 2006 KU National College Health Assessment
  (N1,266 students)
• Only 30 consume 3 or more servings of fruits and
  vegetables
• Only 50 exercise 3 or more days per week
  vigorously for at least 20 min.
• 31 are overweight to obese

• Newer campus Union dining facility (Underground)
• Changes/renovations in residence hall cafeterias
  
• Changes in KU Dining Services personnel/organizat
  ional structure

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Overview of Better Bites Program

• H.O.M.E.B.A.S.E. (Healthy Options for Movement
  and Exercise, Body Acceptance, and Savvy Eating)
• Goals
• Offer students, faculty, and staff healthier
  alternatives in campus dining venues and vending
  machines
• Advocate for healthier food options on campus
• Involve faculty, staff, and students in the
  implementation and maintenance process
• The multidisciplinary H.O.M.E.B.A.S.E.
  partnership includes
• Student Health Services -KU Dining Services
• Strategic Campaigns Class
• Student Recreation Center
• Community Health and Education Department
• Human Resources
• Interested students, staff, and faculty
• Vending machine supplier

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Better Bites Implementation

• In 2002, in response to KU Dining Services desire
  to offer healthier food options, H.O.M.E.B.A.S.E.
  launched Fresh and Hearty in campus dining
  facilities.
• Items were identified from the list of vending
  items and hot-food items in dining halls that met
  the AHA guidelines for fat, calories, and sugar,
  and for hot-food items, used flavorful herbs and
  spices (baked chicken, stir fry).
• The SHS dietitian reviewed residence dining hall
  menus and met with staff to discuss the new
  program
• Dining hall staff provided input on how to attach
  logo to the food service lines
• In 2002, the vending machine supplier attended
  H.O.M.E.B.A.S.E. meetings, and agreed to affix
  Better Bites logos to suitable vending items
• In 2003, Better Bites was launched in vending
  machines
• Strategic campaigns class began providing
  evaluation and recommendations for Better Bites
• Funding for the programs was generated for SHS,
  participating residence halls, and KU Food
  Services
• By 2004, the Fresh Hearty program was renamed
  to Better Bites, which is has been the
  campus-wide name of the program since that time
• Better Bites was selected as a premiere campus
  initiative by the American Association of
  Colleges and Universities Sumer Symposium in
  Washington D.C.
• In 2004, the Better Bites program expanded to
  include Grab Go items in Campus Dining
  facilities and KU Dining Services broadly
  incorporated Better Bites into its convenience
  stores, new eating facilities, marketing plan,
  and menus

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Implementation of Better Bites

• All campus Union dining facilities (3)
• All campus residence hall dining centers (4)
• All campus Hawk Shop convenience stores (6)
• All campus vending machines

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Better Bites Marketing

• Brochures to prospective students during Summer
  Orientation
• Brochures and cups in new students rooms prior to
  check-in at the start of Fall semester
• Posters in dining halls
• Postings on Food Service website and alongside
  menu items
• Better Bites Man at entry to dining facilities
  with brochures
• Better Bites logo on food service lines
  identifying qualifying foods
• Signs in vending machines
• Table tents
• Better Bites punch cards to receive free food
• Media coverage
• Campus sidewalk chalking

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Better Bites Marketing

• Sidewalk Chalking

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Case Study 1 Focus Groups Semi-structured
Interviews

• Study conducted by senior-level Strategic
  Campaigns class
• Goal of focus groups and interviews
• To assess student, faculty, and staff opinions on
  healthy foods and the Fresh Hearty and Better
  Bites programs
• In Fall 2003, two focus held with freshmen living
  in residence halls groups

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Case Study 1Student Focus Group Findings

• Most students recognized the Fresh Hearty
  logo
• Students did not understand the meaning of Fresh
  Hearty
• Use one name -- Better Bites -- for all healthy
  food programs
• Students eat what sounds good instead of what is
  healthy
• Few had seen the Better Bites logos in vending
  machines and were unaware of meaning
• Females were more likely than males to want to
  learn more about making healthy choices

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Case Study 1Faculty and Staff Interview Findings

• Suggested use of one name for the entire program
• Hearty may convey heavy meals
• Healthy was not a good selling tool
• Increase marketing strategies
• (e.g., table tents, displays near registers when
  students enter dining halls, bus signs)
• Changes coming in Union Food Services may provide
  opportunities for expanding a healthy eating food
  program
• Implementation issues in Unions and cafeterias
• Need for lower prices on healthy food items
• Cooks and servers need to be educated on healthy
  foods
• Plan healthier menus with food service staff
• Educate students on healthy food selection

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After Case Study 1Changes in Implementation

• The overall program was renamed to Better
  Bites.
• Signs were added to the glass of vending machines
  to describe the Better Bites program and the logo
  identifying Better Bites items.
• Marketing of the overall program was expanded and
  KU Dining Services included Grab Go items,
  such as applesauce and fruit, whole wheat bagel
  with peanut butter, and salad with grilled
  chicken and low fat dressing.
• Ongoing meetings were scheduled with residence
  halls and dining services to provide feedback and
  make improvements on implementation.

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Case Study 2Observational Study of Vending
Machines

• Issues and Concerns
• Better Bites logos placed on wrong food items in
  vending machines
• Stickers attached to food items as they dropped
• Better Bites items not regularly restocked
• Small selection of Better Bites items
• Price of Better Bites items (expensive)
• Positioning of Better Bites items

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Case Study 2Observational Study of Vending
Machines

• Assessment took place in Spring 2005
• Approximately 40 vending machines on campus
• Vending machines assessed for
• Visibility of Better Bites logo, number of items
  labeled as Better Bites, specific items marked as
  Better Bites, empty Better Bites slots
• 5 student and staff members conducted assessment
  on 29 vending machines over 4-week period.
• Vending machines and vending items maintained by
  contracted vendor.

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Case Study 2 Vending Machine Findings

• Week One
• 82 Better Bites stickers in 25 machines
• Approximately 3 Better Bites stickers per machine
• No Better Bites stickers in 4 machines
• Week Four
• 52 Better Bites stickers remaining
• 37 of stickers had disappeared
• 84 of stickers were visible, but many partially
  covered by food items
• 13 products were incorrectly labeled as Better
  Bites (e.g., Fritos, Butterfinger, Buffalo wing
  chips, Chili Cheese chips)
• 4 Better Bites items unmarked (e.g., Skittles,
  Trail mix)
• Some machines still contained the Nabisco
  Sensible Choice sticker and did not contain the
  Better Bites sign

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Vending Machine Implementation Changes

• Recommendations
• Remove all Nabisco Sensible Choice signs
• Attach Better Bites sign to machine glass
• Arrange placement of Better Bites items in
  machine so sticker would not be needed (as a
  row) uniform placement
• Restock Better Bites items more frequently to
  better assess frequency of item selection
• Rotate Better Bites items in machines more
  frequently
• Final actions
• Better Bites in vending machines pulled until
  more consistent implementation.

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Case Study 3Survey of Students Campus Eating
Behaviors and Knowledge of Better Bites

• Study conducted by KUs Strategic Campaigns class
• November 2005
• 5-minute oral survey
• 555 usable surveys
• Respondents
• Students living off campus
• Students living in residence halls or other
  campus housing
• Students commuting from outside the Douglas
  County area

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Case Study 3 Survey Findings

• Lunch is the most popular meal of the day
• 76 felt it was important to have healthy food
  choices yet they dont always prefer these
  options
• 81 said healthy eating was somewhat to very
  important to them
• 73 wanted affordable health food items
• 50 said they would pay more for healthier food
• Overall, students expressed an interest in
  healthier food choices (fruits vegetables,
  natural food, low in fat calories)
• More than half of all students surveyed
  recognized the Better Bites logo
• Significantly more underclassmen recognized
  Better Bites than upperclassmen (possibly from
  residence hall dining facilities)
• Students eating in campus dining facilities less
  frequently were more likely to recognize the
  Better Bites logo than others who ate on campus
  more frequently

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Challenges to Implementation

• Cost of healthier food items
• In vending machines, inconsistent stocking of
  Better Bites items and labeling
• Positioning of Better Bites items
• Cost of marketing and promotional items
• Competing priorities for Dining Services and
  vending company
• Transitioning Better Bites into normal
  infrastructure and processes of menu planning,
  food preparation, logo placement in food lines,
  regular promotional activities, and expansion of
  items that could be identified as Better Bites

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Discussion

• Better Bites is a healthy food program that
  continues to evolve and grow at KU.
• Better Bites is meeting a critical need in
  helping students, faculty and staff make
  healthier food selections.
• Social and food labeling marketing strategies are
  important for providing information on and
  stimulus for healthy food selection.
• Critical to the success of a campus healthy food
  program
• Ongoing collaboration with a shared mission
• Sharing of resources
• Continued evaluation and input from campus
  members
• Constant improvement
• H.O.M.E.B.A.S.E. and the Strategic Campaigns
  class continues to work with Dining Services to
  make improvements for promoting healthy eating
  and providing healthy options to do so.

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Acknowledgements

• The authors would like to thank the students in
  Bob Basows Strategic Campaigns classes for
  providing incredibly valuable and highly
  professional campaign research and development
  for the Better Bites program!
• Wed also like to thank KU Dining Services staff
  members for their work and commitment to growing
  Better Bites bigger and better every year.