Healthy Chelsea Coalition

1. Healthy Chelsea Coalition Chelsea Board of Health Partners in a process to pass and successfully implement a trans fat free regulation in Chelsea, Massachusetts

2. Obesity and Heart Disease Risk for Chelsea Residents

3. Percentage of Obese Adults, 2008* • Chelsea & Revere Data, 2008, % advised to lose weight in past year • Data Source: BRFSS

4. Overweight or Obese Children in Grades 1, 4, 7, 10, 2008-2009 Source: Massachusetts Department of Public Health, 2010; Chelsea Public Schools, 2010

5. Mortality: Overall & Chronic DiseaseHigher than State for Heart Disease, Stroke and Diabetes2005*, 2006** Vital Records *2005 Data Source: Partners Community Benefits Report **2006 Data Source: MassCHIP CHNA Health Status Indicators Report for Chelsea

6. Trans fatty acids (Trans fats) Why did the Board of Health propose a regulation focused on trans fats?

7. Dietary Behaviors Increased frequency of meals eaten away from home -- National Center for Chronic Disease and Health Promotion, Division of Nutrition, Physical Activity, and Obesity

8. Types of Fat “Good”Fats Monounsaturated (olive, peanut & canola oil; avocados, most nuts) Polyunsaturated (vegetable oils – corn, sunflower, soy, cottonseed) Omega 3 Fatty Acids (fatty cold water fish like salmon; flaxseeds, flax oil, walnuts) “Bad”Fats Saturated Fats (animal products – red meat, poultry, butter, whole milk; tropical oils – coconut, palm) Trans Fats (partially hydrogenated vegetable oils commonly used for frying & baked good and – margarine, shortenings) Reprinted with permission by Boston Public Health Commission

9. Chemical hydrogenation process transforms liquid vegetable oil into a semi-solid state. Alteration of chemical structure creates trans fatty acids (trans fat) Making Artificial Trans Fats Partially Hydrogenated Vegetable Oil Vegetable Oil + Hydrogen = Reprinted with permission by Boston Public Health Commission

10. Trans Fat = Clogged Arteries = Heart attacks and strokes In 2007 the Harvard School of Public Health released a study stating that people with elevated trans fat levels are three times more likely to contract coronary heart disease.

11. Dietary Sources of Trans Fats 79% Artificial Trans Fat from partially hydrogenated vegetable oil 21% Natural trans fat from animal products (meat and dairy) Reprinted with permission by Boston Public Health Commission

12. Health Effects of Trans Fats Raise LDL (“bad”) cholesterol (as do saturated fats) Decrease HDL (“good”) cholesterol (unlike saturated fats) Increase ratio of total cholesterol to HDL cholesterol Increase blood levels of triglycerides and other physiological effects that relate to increased risk of coronary heart disease (CHD) Promote systemic inflammatory responses “Because the presence of inflammation is an independent risk factor for atherosclerosis, sudden death from cardiac causes, diabetes, and heart failure, the inflammatory effects of trans fats may account in part for their effect on cardiovascular health.” (Mozaffarian et al. Trans Fatty Acids and Cardiovascular Disease, NEJM: 2006; 354:1601-13)

13. Impact on Coronary Heart Disease (CHD) 100 80 60 40 20 0 -20 -40 Trans % Change in CHD Sat 1%E 2%E 3%E 4%E 5%E Mono Poly (Hu et al. Dietary fat intake and the risk of coronary heart disease in women. NEJM; 337(21):1491-9.1997) Reprinted with permission by Boston Public Health Commission

14. Impact on Diabetes Data from Nurses Health Study showed a positive association between trans fat consumption and risk of diabetes 2 in women. Estimate that replacing just 2% of energy from trans fats with polyunsaturated fats is associated with a 40% lower risk of diabetes. (Salmeron et al. Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr. 2001, 73:1019-26) Reprinted with permission by Boston Public Health Commission

15. Impact on Breast Cancer In 2008 the American Journal of Epidemiology released a study stating that women with elevated trans fat levels are twice as likely to develop breast cancer.

16. Restaurants and other Food Service Establishments Learning from Conversations with Chelsea Restaurants

17. RESTAURANT SURVEY RESULTS TOTAL # CHELSEA RESTAURANTS = 77 77% (59 RESPONDING as of 1/1/12)

18. Background for and Implications of the Chelsea trans fat free regulation

19. “Food Service Establishments” (FSE) Any entity that serves food or beverage for consumption and is required to hold a permit from the City of Boston Inspectional Service Department (ISD). Includes: • Restaurants • Delis • Bakeries • Caterers • Mobile carts • Supermarkets • Schools • Child care centers • Senior centers Reprinted with permission by Boston Public Health Commission

20. Trans fat bans in place

21. Trans Fat Bans in Food Service Establishments Site of Ban New York City – 8 million Philadelphia – 1.5 million Montgomery County, MD – 932,000 Brookline, MA – 58,000 King County, WA – 1.8 million Nassau County, NY – 1.3 million Westchester County, NY – 949,355 Suffolk County, NY – 1.5 million Boston, MA – 600,000 Stamford, CT – 118,000 Cambridge, MA – 100,000 California – 36.5 million Albany County, NY – 298,000 Broome County, NY – 200,000 Needham, MA – 30,000 Lynn, MA – 90,000 Chelsea, MA – 40,000 Also Puerto Rico – 4 million (not included in percentage) United States Population: 301 Million 18% of US population resides in a community where trans fats are banned

22. FDA's nutrition labeling regulations Stick of Margarine Frozen Potatoes

25. Clarifying the distinction between prior trans fat regulations & Chelsea’s approach From the Boston regulation passed in March 2008 “artificial trans fat” - food or beverage that is labeled as, lists as an ingredient, contains or is prepared with vegetable shortening, margarine or any kind of partially hydrogenated vegetable oil. However, a food or beverage whose nutrition facts label or other suitable documentation lists the trans fat content of the food as less than 0.5 grams per serving shall not be deemed to contain artificial trans fat. From Chelsea’s regulation, passed December 2011 SECTION 1: DEFINITIONS (A) Artificial Trans Fat – any ingredient that is partially hydrogenated. Artificial trans fats are commonly found in vegetable oils, butter substitutes, shortening, margarine, cake mixes and frosting. SECTION II: PROHIBITION “No food service establishment, vending machine, or mobile food vendor shall store, prepare, distribute, hold for service, or serve any food or beverage containing artificial fat in the City of Chelsea.

26. Role of Trans Fat in Foods Frying oil: Doesn’t break down as quickly French fries, chicken nuggets, donuts, taco shells, chips Baking: Texture and longevity of baked goods harder to achieve with liquid oils cakes, crackers, pastries, cookies, pies Spreads Margarine is a common butter alternative Longer shelf life than other fats Pre-mixed foods: pancake mix, hot chocolate, salad dressing However…”Trans fatty acids are not essential and provide no known benefit to human health” * (*Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. National Academies Press, 2005) Reprinted with permission by Boston Public Health Commission

27. Industrial Suppliers have responded “You asked for Zero-Grams Trans Fat (ZGTF) products that meet your highest quality standards. We listened. Simplot ZGTF products deliver the same flavor, texture, crispness and stability as traditional products -- thanks to our exclusive, specially formulated oil blend, Nutri Blanch™. Only Simplot has it. So now there’s a healthier alternative we can all feel good about!” “With a complete line of “zero trans” products, recipes and merchandising resources, Ventura’s Trans Fat Free Kitchen™ makes the switch to trans fat free foods simple. Our trans fat free replacement products are generally equivalent 1:1 in recipes.  They deliver even more than great performance and great taste: namely, healthy benefits for your customers—and your business.”

28. TRANS FAT FREE OPTIONS OILS • BUNGE OIL • LODERS CROKLAAN • ACH/ADM (STRATAS) • VENTURE FOODS • CON AGRA FOODS • WESTERN PACIFIC OILS • SIGNATURE • SIMPLOT • BAKING / BAKERY • ABEL AND SCHAFER • ACH FOOD COMPANIES • BAKE’NJOY • BESTBRANDS • BOSTON GORMET CHEFS • DAWN FOODS • MIMAC • PENNANT FOODS • PIDY GOURMET • PURATOS

29. Next Steps 2012 and 2013

30. Supporting Compliance & Enforcement Technical assistance to restaurants and other food service establishments Make the connections with new distributors as needed Hands-on training for inspectors, creation of checklists and tracking materials

31. Healthy Restaurant Campaign • Use the conversation about trans fats as a jumping off point to focus on increasing the availability and visibility of healthy menu options “Healthy Restaurant certificates are popping up all over the county. When you see one, you know the restaurant – from fast food to fine dining – has a clean and safe environment and offers healthy menu choices. Check out the list of healthy restaurants or look at a map to find the closest healthy restaurant to you. ” http://healthyhowardmd.org/healthy-howard/healthy-restaurants