Increasing fruit and vegetable intake by changing environments, policy and pricing: restaurant-based research, strategies, and recommendations

Background. Restaurants are among the most important and promising venues for environmental, policy, and pricing initiatives to increase fruit and vegetable (F&V) intake. This article reviews restaurant-based environmental, policy and pricing strategies for increasing intake of fruits and vegetables and identifies promising strategies, research needs, and innovative opportunities for the future. Methods. The strategies, examples, and research reported here were identified through an extensive search of published journal articles, government documents, the internet, and inquiries to leaders in the field. Recommendations were expanded based on discussion by participants in the CDC/ACS-sponsored Fruit and Vegetable, Environment Policy and Pricing Workshop held in September of 2002. Results. Six separate type of restaurant-based interventions were identified: increased availability, increased access, reduced prices and coupons, catering policies, point-of-purchase (POP) information, and promotion and communication. Combination approaches have also been implemented. Evaluation data on these interventions show some significant impact on healthful diets, particularly with point-of-purchase information. However, most published reports emphasize low-fat eating, and there is a need to translate and evaluate interventions focused on increasing fruit and vegetable intake. Conclusions. Several models for changing environments, policy and pricing to increase fruit and vegetable availability, access, attractiveness and consumption in restaurants have been tested and found to have some promise. There is a need to evaluate fruit and vegetable-specific strategies; to obtain data from industry; to disseminate promising programs; and to enhance public-private partnerships and collaboration to expand on current knowledge. (C) 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.