History and Goals of the Keystone Forum:

On March 12, 2004, as part of the Department of Health and Human Services' efforts to reduce obesity in America, the Food and Drug Administration published a report providing short- and long-term recommendations that, if implemented, could help reduce the country's overweight and obesity rate and help consumers lead healthier lives through better nutrition. The Calories Count report noted that the problem of overweight and obesity has no single cause and is the result of multiple factors acting together over time. One of the many recommendations made was that FDA work through a facilitator to provide a forum for stakeholders to seek consensus-based solutions to specific aspects of the obesity problem in the United States, with a particular focus on foods consumed away from home. Although not the only contributing factor to obesity warranting attention, increases in the percentage of food consumed outside the home and the growing percent of calories consumed in away-from-home foods, combined with the general lack of easily accessible nutrition information for these foods, provides reason for evaluating means to reduce their impact on obesity. The Keystone Forum on Away-From-Home Foods and the subsequent report are the culmination of that recommendation.

Beginning in 2004, the Keystone Center, a non-profit public policy and dispute resolution organization developed, assembled and facilitated a series of meetings with representatives from industry, government agencies, civic-sector organizations, and academia. The specific purpose of the Forum was to consider what can be done, given what is currently known, to support consumers' ability to manage calorie intake with respect to preventing undue weight gain and obesity, within the scope of away-from-home foods. To accomplish this goal, forum participants addressed three primary issues: 1) understanding and influencing consumer behavior with regard to away-from-home foods; 2) increasing the availability of lower-calorie products, menu items, and meals at establishments that provide away-from-home foods; and 3) providing consumers with nutrition information regarding away-from-home foods. Their recommendations are contained in the "Keystone Forum on Away-From-Home Foods: Opportunities for Preventing Weight Gain and Obesity" report, which hopefully will be useful to foodservice operators and their suppliers, policymakers, public health and medical professionals, culinary professionals, patient and consumer advocates and research scientists.

Summary Keystone Forum Recommendations:

The report's recommendations are divided into three sections, corresponding to the Forum's primary areas of discussion.

Understanding and Influencing Consumer Behavior

1. Shift the emphasis of marketing. The marketing of lower-calorie and less-calorie-dense foods should increase, accompanied by a reduction in marketing that highlights higher-calorie (or calorie-dense) foods or encourages large portions.
2. Update marketing standards. Industry, government, health and nutrition experts, consumer representatives, and other stakeholders should work together to review and update standards for marketing away-from-home foods to children.
3. Promote low-calorie-dense dietary patterns. Strengthen and/or create education and promotion programs regarding away-from-home foods which promote the consumption of fruits, vegetables, no- and low-fat milk and milk products, whole grains, and foods low in saturated fats and trans-fatty acids, as recommended by the 2005 Dietary Guidelines for Americans.
4. Promote enhanced "lifestyle education" programs. Use a combination of social marketing campaigns and consumer education programs to provide "healthy lifestyle" education to help individuals eat more healthfully in today's food environment. Existing campaigns and programs could be enhanced or, as necessary, new ones could be created.
5. Review the effectiveness of existing programs. The U.S. Department of Health and Human Services and the USDA should, in partnership together, coordinate a comprehensive survey and analysis of existing government-sponsored education and social marketing campaigns related to managing weight gain and reducing obesity in the context of away-from-home foods.
6. Improve government access to data on consumer behavior and attitudes. Federal agencies should act immediately to increase the access of government researchers and policymakers to syndicated commercial databases. Key agencies should establish recurring line items in their respective budgets, thereby ensuring continual and timely access to the needed commercial data sets.
7. Ensure public availability of information. A means must be developed for continually improving the publicly available knowledge base regarding consumer interests, attitudes, and behaviors regarding away-from-home foods.

Increasing the Availability of Lower-Calorie Products, Menu Items, and Meals

1. Promote the wider inclusion in foodservice of less-calorie-dense menu items and calorie-sparing cooking techniques that are widely accepted by consumers and that take into account constraints on operators.
2. Foodservice providers should develop and promote portion-size, plate composition, and menu-pairing options that help consumers in their efforts to manage their energy intake.
3. Foodservice providers should develop, make available, and promote beverage options that help consumers to reduce calorie intake.
4. Industry and academia should conduct-collaboratively, if possible-research on the topics and questions listed in Chapter 3 [of the report]. In addition, a specific scientific survey should be conducted about the experiences of operators and restaurateurs in developing menu items that could aid in weight management.

Providing Consumers with Nutrition Information

1. Away-from-home food establishments should provide consumers with calorie information in a standard format that is easily accessible and easy to use.
2. Research by multiple sectors should be conducted on how consumers use nutrition information for away-from-home foods; how this information affects their calorie intake at that venue; how and why nutrition information affects operators' decisions, costs, and revenues; and unanticipated consequences.