Furthering nutrition equity through innovative and empathetic collaborations with the restaurant sector

Examples from Latin American restaurants

Datos Bibliográficos

ID22074440
AutoresMelissa Fuster (0000-0001-6357-9986, Tulane University, autor de correspondencia)
Año2023
Volumen11
Páginas1058859-1058859
Fecha de publicación2023-02-02
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaFrontiers in Public Health (JOURNAL)
Identificadores de la revistaISSN: 2296-2565 • E-ISSN: 2296-2565
EditorialFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2023.1058859
PMID36817908
OpenAlexW4319014652
IdiomaEN
Citas recibidas1
Referencias citadas28

Dietary factors are one of the leading causes of preventable death and disability (1). Successful dietary interventions to address this problem can only be successful when food environments support healthy food choices (2,3). This realization has driven increased interventions and regulation of the retail food environment, which, while mostly focused on markets and outlets for at-home food consumption, has started to target restaurants as sites for regulation (4,5). The focus on restaurants responds to shifts in consumption patterns, where an increased proportion of our food spending has been shifting to foods away from home. Recent data from 2021 shows that the consumption of foods prepared away from home accounts for 55% of food spending among American households, with restaurant meals occurring at least weekly for two-thirds of adults in the United States (6,7).Research addressing foods away from home has highlighted the unhealthful aspect of restaurant offerings through associations between foods purchased at fast foods and increased intakes of saturated fat and sodium (8)(9)(10). Public health initiatives and policies to improve food choices at restaurants have included efforts to restrict choice (ex. trans-fat ban law) or guide choice through pricing schemes, point of sale promotion of healthy options, and providing nutrition information, among others (11). Most of these efforts have targeted chain-based, fast-food restaurants. Emerging research in small, non-chain restaurants demonstrates interventions can be successful at increasing the consumption of healthier options, through point-of-purchase promotion of healthy dishes and increasing the availability of healthier options (12). To fully benefit from the potential of these collaborations, we need a shift in the public health and nutrition fields on how we view and approach restaurants, from places of unhealthy eating to places for creating dietary change. A true partnership with restaurants has the potential to enhance social opportunities for healthier eating, contending against social norms and perceptions where healthier choices are viewed as restrictive, bland, or plainly not enjoyable. These perceptions are an important, yet overlooked barrier, to healthy eating behaviors. Diners prioritize taste and indulgence when dining out and the use of healthy designations actually dissuades customers from ordering these items (13). Labeling food as healthy decreases perceived satiety and influence the perception that healthy items are less filling (14,15).Restaurants are an important part of community food environments, affecting local food availability and access (3,16). Restaurants can serve as vehicles to spread culinary innovations by exposing clients to new ingredients and modes of preparations, with the potential to change perceptions and social norms around eating and cookingchanges that can have a ripple effect on foods eaten at home (17,18). The culinary sector is increasingly involved in initiatives to motivate healthful eating practices as demonstrated in the "Menus for Change" report produced by the Culinary Institutes of America, which guides how to provide healthier and more sustainable meals (19). Other examples are found among an increasing number of restaurants, such as Alice Waters' Chez Panisse restaurant, Chef Dan Barber's sustainable approach to cuisine, and Chef Jamie Oliver's attention to healthy meals for school children (20,21). These chefs are promoting menu innovations to bring environmental consciousness to their customers, addressing fashion, health, environmental sustainability, and deliciousness as convergent rather than contradictory values.While these new trends bend towards more healthy and environmentally sustainable offerings, these innovations have largely failed to trickle down to restaurants serving communities experiencing the largest burden of disease from diet-related conditions, as in the case of Hispanic/Latin communities. Latin American restaurants are an increasingly important sector. According to the National Restaurant Association, 80% of consumers eat at a restaurant serving ethnic cuisine at least once a month (22). Within these, there are over 120,000 LARs in the United States, most of which are independently owned. Mexican restaurants alone make up 8% of all US restaurants (23, 24).Cuisines in Latin America and the Caribbean are undergoing a transformation where local restaurants are playing a role in creating new, desirable perceptions of their localities and cuisines, bringing locally grown foods to consumers. Research has mostly documented these transitions in México and Perú (25,26), but similar trends are also found across the region. Innovations include showcasing fruits and vegetables in a new light, appealing to the origin of the product and sensorial qualities, and highlighting healthy dishes without focusing on health. Restaurant menus are elevating fruits and vegetables to a new light, communicating the importance of fresh, local foods. We can also see the emergence of vegetable-forward dishes, where plant-based components take precedence over animal-sourced products. This is important in Latin/Hispanic diets, as the consumption of meat has been tied to socioeconomic status, given the higher quality of animal protein. In many global contexts, meat is eaten only on a special occasion, with cheaper meats, such as chicken, eaten more frequently in lower socioeconomic strata (27). Trends are changing, where menus were more varied in offerings, not focusing on beef and pork and presenting more plantforward menus, catering to an increased interest in this type of offering among higher socioeconomic strata (28). We can also find innovative ways to promote potentially healthful dishes, such as framing these within the historic context, and seeking to re-center them as part of the national culinary imaginary. This shows that chefs in Latin America are innovating local and native ingredients to produce more visually pleasing and tasteful dishes. This approach can facilitate healthier eating and better health outcomes if disseminated outside the elite markets that most of these restaurants attract. The dissemination of these practices requires a shift in thinking among public health researchers and practitioners, to view restaurants in a new light, innovating how we approach and view the sector.The Latin American Restaurants in Action (LARiA) Project has sought to connect these healthy eating promoting innovations to restaurants serving Latin/Hispanic communities in the United States. The LARiA Project is a pilot initiative funded by the National Institutes of Health. It was designed to begin changing conceptions of healthy foods, through collaborations with Latin American restaurants. The project was motivated by a recognition that community ethnic restaurants, as in the case of those serving Latin American cuisines, are crucial, yet untapped sites for healthy eating promotion interventions (11,12). These restaurants are important institutions in immigrant communities. Aside from serving as a site to reconnect with heritage cultures through cuisines, these restaurants also serve as sites for social interactions and venues for economic opportunity, while also promoting cross-cultural exchanges (18,(29)(30)(31).The project was launched in the summer of 2020, amid the COVID-19 pandemic, conducting listening sessions with owners and staff to learn about their ongoing experiences and needs, as well as their opinions and previous engagement to promote healthier choices (32,33). The participants in these sessions shared a variety of experiences, from restaurants that sought to actively create healthier dishes to those resistant to change, amid perceptions of client demand and notions of cuisine authenticity. From these sessions, we engaged two restaurants in the intensive process of co-designing tailored innovations to promote healthier choices, via the application of human-centered design (HCD), also known as design thinking. HCD required our approach to be taken constructively and experimentally, rooted in the needs and context of the end user, in this case, the restaurants and consumers, to develop bottom-up solutions with built-in buy-in (34). Following this methodology, we successfully worked with two restaurants, resulting in interventions that increased healthy offerings and promoted existing offerings using messaging that appealed to taste and the historical roots of these offerings, respectively (35,36).The LARiA Project is part of small but important efforts that seek to engage this sector (37)(38)(39). This previous work showcases best practices for engagement with the sector, including the importance of active engagement with restaurant owners, through personal, tailored approaches that incorporate members of the sector and community in the research team (39). Yet, this is contrary to the prevalent topdown regulatory approaches that impose stringent standards continue to be at odds with the economic goal of restaurants, especially small, independently-owned restaurants, where profit margins are slim and operational burdens are high. We need innovative approaches to promote healthier diets, by not only making healthy choices available and accessible but also desirable. Restaurantsthe culinary sectorcan provide a wealth of expertise in this realm. We need to find new ways to engage restaurants, seeking to facilitate change by incorporating some carrots (rewards, incentives), not just sticks (regulation). While regulation is important, alternate avenues may be considered, where change can be incentivized, particularly among independently owned, minority serving restaurants. These establishments are often embedded in communities where diet-related health inequities are prevalent, where owners and staff are also part of these communities, seeing and being affected by the same issues we seek to address (40)

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