the food service industry's requirement for prudent diet foods

PREVENTIVE MEDICINE 2,387-396 (1973)

The Food Service Industry’s Requirement

for Prudent Diet Foods’

CLIFFORD J. ROBERTSON

Cape Cod Community College, West Barnstable, Massachusetts 02688

The newly promulgated Nutritional Guidelines teamed up with the equally newly promulgated Fat Labeling Regulations; along with the Policy State- ment on “Diet and Coronary Heart Disease” issued jointly by the Council on Foods and Nutrition of the American Medical Association and the Food and Nutrition Board of the National Research Council-National Academy of Sci- ence spelling out the “Prudent Diet” and its need can be translated into easing the plight of the millions included in that heretofore nutritionally disadvantaged group known as the “cardiac-concerned” by making it easier for one to identify and select prudent diet foods on and from the supermarket shelf. Indeed, this is manifestly the name of the game here today-until now, that is.

However, when a cardiac-concerned individual is exposed to institutional fare where the choice normally is very limited indeed or addresses a restaurant menu, he is at the mercy diet-wise of the policy of the house, with no way of telling what the foods are made from or how they are made, excepting, perhaps, in a general way, that to his conditioned manner of thinking, fish, poultry and veal, and, in general, Oriental food, are to be preferred over beef, pork, and lamb. Perhaps the day is not far off when the FDA will take the lead of other countries such as West Germany where food additives used must be listed on the menu and require that merchandise sold in food service es- tablishments must have a pertinent statement of ingredients on the label, which is, of course, the menu. When one considers that about one-third the daily nutritional intake of the average American issues from some segment or combination thereof of the food service industry, it becomes manifest that for maximum effectiveness of dietary control of coronary heart disease on the part of the cardiac-concerned, the food service industry has both a need and responsibility to offer prudent diet foods to its customers. Of course, it is realized that many of the cardiac-deeply-concerned avoid “eating out” as much as possible because of their uncertainty as to what they are and can be served, but this alters only in degree the main thesis, that the food service industry serves the average American, cardiac-concerned or not, with a highly significant portion of his nutritional requirements.

1 Presented at the Joint American Health Foundation-Institute of Food Technologists’ Sym- posium held in Miami Beach, Florida on June 13, 1973.

387 Copyright @ 1973 by Academic Press, Inc. All rights of reproduction in any form reserved.

388 CLIFFORD J. ROBERTSON

The Food Service Industry is a widely diverse entity, for it is comprised of any commercial endeavor which serves food “for hire,” either directly, as in a restaurant, or indirectly, as in an airplane or hospital, each perhaps with a different twist of goals and needs. It might be helpful at this point to classify the industry into what is perhaps an oversimplification, but for the present purposes, adequate to identify their differing positions which affect their approach to the problem of serving prudent diet foods.

The distinction, then, is made between what is known as “Institutional” Food Service and “Restaurant” Food Service, where often the twain shall meet.

The Institutional Branch can be subdivided into several categories, among which are:

1. School Lunch 2. Hospital 3. School and College 4. Industrial (in plant feeding) 5. Correctional Institution 6. Airlines 7. Military

This branch of the industry is characterized by what has come to be known as a “captive” clientele where with very limited choice the clientele takes or leaves what the house has prepared for it. In recent years, however, it may be noted that the military have been climbing out of this predicament and are in the process of being or have been in some instances already upgraded more to a “restaurant” status.

The Restaurant Branch, on the other hand, is characterized by a freedom of choice on the part of its clientele where in order to woo the customer the restaurateur must offer a (1) wider selection of items on the menu, (2) good food, (3) good service, (4) fair prices, and (5) more or less attractive decor. Restau- rants again are divided generally into four categories, depending upon how the relative emphasis is placed on their above five-point offering.

First, there is the genuine “gourmet” restaurant of which there are only a relative handful in the whole country where the emphasis is on supreme food, service, and decor, (known as haut cuisine) with prices to match. As a matter of fact, their number are slowly and inexorably dwindling because at the prices they must get to continue serving in their accustomed manner, they are becoming priced out of business. A recent example of such a casualty is Le Pavillon in New York. This category of restaurant will never cater to any but the cardiac-unconcerned, so is just worthy of mention in passing.

The second is the “Personality” restaurant of which there are myriads. They are characterized by good food, good service, good menu selection and white tablecloth setting with an attractive decor, identifying with their image or personality. The price is not low, but must be competitive. Good examples of this type of restaurant are Anthony’s Pier 4, Boston, Charlie’s Cafe Excep- tionale in Minneapolis, Antoine’s in New Orleans, Ernie’s in San Francisco.

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This category will be slow in catering to the needs of the cardiac-concerned, for there are many among them who fancy themselves as catering to gourmets or near gourmets only.

The third category is known as the “Old Reliable,” featuring a fair menu selection, fair food and service, neat and clean surroundings, and a modest price. Good examples are Howard Johnson’s and Hot Shoppes, Fairfield Kitchens. This type restaurant is fastly moving to be dominated by chains, and only when the policy of the chain is so motivated, will this category cater to the cardiac-concerned. This means a successful selling job from the inside will affect many restaurants at once.

The fourth and last category is the “Filling Station” concept, the fast-food operation, with very limited menu, where the emphasis is on speed and price. An example, of course, is McDonald’s. These also are chain-dominated. Here again, catering to the cardiac-concerned will come only when the chain management is so motivated and can be done reasonably within its price and systems framework.

When it comes right down to extending the prudent diet to the food service industry, short of government regulation, it comes down to the attitude and understanding on the part of the management of the food service establishment itself large or small. Inasmuch as the inclusion of specially selected items on the menus will be necessary, special preparation and isolation of these dishes in the kitchen will be required, and the fact that the food service operator to begin with is no doubt ignorant on the subject, therefore most impatient of and unbelieving in the goal of prudent diet, let alone of what it may do to his food and labor costs, any thoughts of a spontaneous stampede to the cause is unrealistic. As an example, quoted from a talk given before a local group of members of the Institute of Food Technologists by the Director of one of America’s leading schools of the culinary arts is “

. . . in the relation of nutrition to gastronomy, and it will probably shock you, I am not greatly interested in nutrition.” This reflects the philosophy under which literally hundreds of potential food service executives have been and are being released onto the American food service scene each year.

The following I quote from the director of advertising of a very large fast- food operation in response to a letter to its President objecting to a television commercial extolling the nutritional praises for children of its French-fried potatoes (fried incidentally in highly saturated beef tallow, information not included, of course, in the commercial), and pointing out to the company that insofar as frying fat goes, they do have an option as to what kind of fat in which to fry. “The principal goal of the company and its licensees. . . is to provide wholesome, nutritional food at (company) prices for all those who wish to pa- tronize our stores. In our judgment as well as the judgment of the financial community and consuming public, we are meeting that goal. We can only as- sume that those adults who purchase our food products for themselves or for their minor children have made a conscious and rational decision to do SO and have weighed in their own minds the potential health risk to be incurred from the consumption of fried foods.”


The writer might be charitable in regarding both these situations as isolated instances were it not for the fact that in his fairly wide experience, they typify the attitude of food service directors at large, who seem to take it for granted that the choice is between good food or prudent diet foods, not good foods and equally good foods for the cardiac-concerned. The word diet scares them into believing that they will be serving “medicine” foods, and they fear jeopardizing their establishment’s image for good food. Indeed, your scribe’s vigorous efforts in the course of the past 5 years to imbue his food service students with an updated approach to nutrition for the benefit of their fu- ture customers, including the prudent diet concept, have often met with rebuff from student and colleague alike.

The changeover to prudent diet foods stands a better chance of emerging first in the institutional branch where the food service directors in general seem to be in better touch with nutritional developments and better able to control its food production than in the restaurant area. A policy change when it comes in this field stands a pretty good chance of being a widespread one where by the stroke of the pen prudent-diet foods can constitute a wide spec- trum of the institutional offering, particularly if the price factor is favorable. Incidentally, a food service director who has himself been the victim of a coronary is the easiest one in the world to convince to change his fare to the prudent diet. In the writer’s experience, this changeover has so been made in a limited fashion several times in the past, particularly in large company exec- utive dining rooms.

The spearhead of the main advance of prudent diet foods for the institution can very well be felt first in hospital food service where hospitals now regularly feature six different diets, namely:

1. Pediatrics 2. Low sodium 3. Low fat 4. Calculated (calories) diet 5. Bland 6. Regular

There are several good-sized food service contractors who now collectively run a large segment of the hospital food service, contractors who have it down to a system not only to furnish these special diets, but to offer a choice to the patient from a menu presented on the previous day. There are also many hospitals that, because of the complications involved in offering these restricted diets and choices through their own food service department, buy the special diet items frozen from outside suppliers of which, consequently, there are several that have sprung up in this area such as Idylewild Farms with their “Nutritional Care” line and Armour with their “Hospital Fare,” items whose pertinent analysis has been laboratory certified for the purpose, and cornpa- nies whose major endeavor in the food service industry has been to furnish both the institutional and the restaurant trade with a wide variety of frozen, prepared entrees, many of which can be considered quite epicurean.

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None of these companies canvassed, however, offer to the hospital a “high polyunsaturated’ (or prudent) diet per se simply because there has apparently been, up to the present, no specific demand from the hospital for this type of diet. In checking with one of the larger hospital contractors, the answer to this becomes obvious. There is currently a rapidly increasing demand in the hospital for such a “high polyunsaturated” diet, but the kitchen, according to earlier practice when the demand was very light, achieves this goal by em- bellishing or dressing up its low-fat items with polyunsaturated margarine, or oil whenever feasible. If this demand for “high poly” diets increases over the current 50% of all “low fat” trays now served, it is quite possible that the demand will then become explicit for the polyunsaturated diet with its own identity, which can open up a whole new avenue for the industry and extend over into the participating and inquiring restaurant trade.

An early overt advance in institutional offering of prudent diet foods may well be the airline category, some of which even now in their effort to woo the travelling executives make the boast of offering special diet foods upon prior request.

In a study entitled “An Institutional Approach to the Dietary Regulation of Blood Cholesterol in Adolescent Males,” in which the interrelationship of diet and level of blood cholesterol of adolescent males was tested and manip- ulated, authored by Cynthia Ford, Robert B. McGandy, and Fredrick J. Stare, Vol. 1, No. 3 Preventive Medicine, it was demonstrated that the blood cholesterol level of the subjects studied could be lowered significantly and main- tained on a low level by following a dietary regimen dominated by the following seven factors:

1. The use of a low-fat milk with extra skim milk solids 2. Replacement of butter with a highly polyunsaturated margarine 3. Use of polyunsaturated oils and shortenings in baked goods and for

frying 4. Use of low cholesterol or cholesterol-free egg products whenever pos-

sible, particularly in baking 5. Fewer eggs and more cereals 6. Use of a low-fat ice cream or an ice cream made with a polyunsaturated

fat 7. Use of fish, veal, poultry, and carefully trimmed beef with some

frequency

For any who would be interested in the source of foods used in this cholesterol-lowering diet, listed below are some of the acknowledgements published for help given in the preparation of this study.

Fisher Cheese Co., Wapakoneta, OH (corn oil-filled cheese) General Mills Chemicals, Inc., Minneapolis, MI (cholesterol-free egg mix Heinz USA, Pittsburgh, PA (prepared puddings) Lever Brothers, Edgewater, NJ (specially prepared margarine) Mitchell Foods, Fredonia, NY (polyunsaturated soybean oil nondairy

creamer)


Oscar Mayer & Co., Madison, WI (specially prepared safflower oil-filled frankfurters and bologna, low-fat meats)

Pet, Inc., St. Louis, MO (frozen waffles) Procter & Gamble Co., Cincinnati, OH (vegetable fats and oils) Roberts Dairy Co., Omaha, NE (egg product) Worthington Foods, Worthington, OH (imitation bacon bits)

The problem of introducing prudent-diet foods into the restaurant itself can be prefaced by quoting from a syndicated column appearing on March 14th in the Boston Globe “Eating Out is a Problem for the Dieter” by Dr. Jean Mayer of the Harvard Department of Nutrition. The question is raised by a young man in his thirties who says “Recently I learned that my blood cholesterol (level) was very high. Through a new program of exercise and diet high in polyunsaturates I’ve managed to reduce my cholesterol count considerably. My problems arise in eating out. So many items on the restaurant menu are taboo that there is no choice. Do you have any suggestions?’

Dr. Mayer answered by pointing out some of the more obvious (to us-not to him) suggestions to confine his choice wherever possible to oriental dishes, poultry, fish and veal and to many foods low in saturated fats.

The real answer to this question, however, is going to come when the food service operator, be it a privately owned or chain-owned restaurant of any type, hears from enough of these cardiac-concerned individuals and realizes that in addition to offering a real service, there could be “gold in them thar hills.” This decision to cater to the needs of the cardiac-concerned could first be approached by instituting on the menu a “Cardiac-Concerned Corner,” by listing a choice of perhaps two or three or more dishes and/or full meals prepared according to the prudent diet. The food service operator could have a right to realize that for the special care involved he could charge a modest premium, even though in a great many cases it could entail the substitution of a lower cost for a higher cost fat. He could also withhold salt from some items recommending instead “salting to requirement.” He would also soon find out that in practice this would not necessarily mean lowering the acceptability level of his product and result perhaps eventually in having the item appear in the same fashion on his regular menu, which he could asterisk as prudent diet items. He could also very well enjoy a greater increase in business than anticipated, not only from the attracted cardiac-concerned customer himself but from others who may accompany him to the restaurant to partake of “regular” fare. In describing this comer on the menu it might be well for the restau- ranteur to point out to cover himself in the legal aspect that this selection of items in no way represents a therapeutic diet such as prescribed by a doctor, but a good honest effort to ease the dietary plight of the cardiac-concerned.

There has been considerable television publicity lately over what are called “diet” restaurants springing up in the Los Angeles area. An enquiry into this subject with the Restaurant Association of Southern California revealed that such restaurants, featuring chiefly health, natural, organic, soul, and low- calorie food have been coming (and going) for quite some time, none of which

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had the solid status even of belonging to the Restaurant Association, and cer- tainly none sophisticated enough to offer a bona-fide prudent diet.

The food service operator will soon find out that the implementation of such a cardiac-concerned comer is perhaps not so difficult as anticipated. Dr. Jean Mayer writes in another syndicated column in the April 22nd issue of the Boston Globe with the self-explanatory title “Low Cholesterol Diet? Edit Cookbook, Change Buying Habits.” Although this article was intended prin- cipally to help the homemaker, it can apply equally to the restaurateur reaching for the trade of the cardiac-concerned. He points out four steps to achieve this end, namely:

1. Decrease the total fat in the recipe. This means buying leaner meats, trimming visible fat before cooking, and skimming fat carefully after cooking.

2. Increase the percentage of polyunsaturated oils by using corn, cot- tonseed, soybean, or safflower oil products in place of butter and other fats. Use margarine which lists a polyunsaturated oil wherever applicable, particularly as a spread. (In most places this is legal provided its service is posted on menu or wall and the product is properly identified,)

3. Use fish and poultry as often as meat. 4. Limit the eggs to two a week.

To the restaurateur this means cutting down his saturated fats to a min- imum and substituting therefor a polyunsaturated fat product for which he need but go to his fat supplier for advice and product. There are many fat and oil products on the market for such purposes, as Tables I and II, each listing products of a well-known company, will reveal.

Although all these fat products are not of direct concern to the interested food service manager, they can serve to demonstrate to him that there may be products such as baked goods, coffee whiteners, potato products, and whipped toppings now on the market conforming to the prudent diet of which

TABLE I PRUDENT-DIET-QUALIFYING COMMERCIAL FATS AND/OR OILS FROM COMPANY “A”

Analysis

Product name

Nutex Nectar Frymax Sterling Oil Prep

P.G.-7N

Application

Cakes Filled milk products Deep-fat frying Salad dressings Wherever butter is used in preparing foods Breads, buns, and baking

Percenr” poly Percenr sat.

34 24 30 21 36 19 38 14 34 20

29 27

‘1 Based upon weight of total fat.


TABLE II PKUDENT-DIET-QUALIFYING COMMERCIAL FATS AND/OR OILS FROM COMPANY “R"

Application Product name

(tailored system)

Analysis

Percent” poly” Percent” sat.

Filled milk products Frozen coffee whitener Fluid whipped topping Mellorine Sour dressing Spray-dried coffee

whitener Cakes Pastry Bread Nut roasting and deep

fat frying

Poly plus M 31 27 Poly plus w 30 27 Poly plus T 31 24 Poly plus D 32 26 Poly plus A 31 26

Poly plus P 29 24 Fluid Flex 54 22 Poly Puff 41 26 B-4 33 23

Durkex 25 28 14

o Based upon weight of total fat. * Calculated on basis of cis-cis-methylene-interrupted fatty acids.

he can avail himself for his clientele by shopping around. Or, if not now avail- able, perhaps he can, by making his needs known, help create the successful demand for such products in his area.

In addition to the above, other companies have products and formulas avail- able. One well-known oil supplier in particular has a booklet listing 36 Formulas for Hospital and Institutional use that employ a polyunsaturated oil.

There are a number of margarine companies just waiting to help him “prudent-dietize” his offerings. One of these companies, Standard Brands, and I single them out because it was from them that the recipes listed at the end of this article were obtained, has been running a series of ads, housewife- oriented to be sure, but equally applicable to the restaurateur, that illustrates what can be done. These recipes show how Chicken Kiev, broccoli, apple pie, and beef stew can be treated to make them conform to the prudent diet. In- cidentally, even bacon can be made to conform by pouring off the rendered pork fat just before the bacon is crisp, and browning and “crisping” it in a polyunsaturated oil.

To show that an excellent meal can be presented conforming to the prudent diet, the menu of a recent annual luncheon at The American College of Car- diology is offered (Fig. 1).

Most margarine companies have booklets containing literally dozens of recipes for the preparation of prudent diet foods from soup of all varieties, through a surprising variety of entrees and desserts to nuts, enough to assure that ennui can be far from the order of the day in a properly designed and presented prudent diet. A newly published book, “Eat to Your Heart’s Con- tent” by Bennet and Simon, published by White, Inc., which provides a de- tailed description of the 14-year Diet and CHD Research Study established in

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1957 by Dr. Norman Joliffe lists a wide offering of conforming prudent diet foods. The substitution of soy protein products for meats may even further the quest of the restaurateur for qualifying prudent diet dishes. For example, adequately conforming and appealing dishes such as chili, spaghetti sauce, and sloppy joes can be made from the simulated burger bits now accepted in general use for protein nutrification in the school lunch program.

The conscientious cardiac-concerned comer must play down the use of eggs, availing itself whenever necessary in the preparation of the food of the several low-cholesterol egg substitutes on the market. Organ meats and shell- fish, too, are off limits. The amount of egg yolk contained in a normal serving of mayonnaise or cooked dressing, however, is well within the recommended egg-yolk tolerance of the prudent diet.

There also exists the viable alternative for the food service operator to utilize the various low-fat frozen entrees produced by the various suppliers of this type of prepared, frozen entree mentioned earlier in connection with hospital food service, which can be embellished and dressed up in current hospital fare fashion for service to an enquiring prudent-diet seeker, particularly if


this food service establishment already utilizes a frozen, prepared entree for his normal bill of fare.

With the correct attitude and guidance, requiring manifestly a well-con- ceived and executed educational program, the food service operator can and eventually will make prudent-diet foods not only to do the nutritional job, but also to have as highly acceptable a taste standard as what is now considered normal and appealing.

In implementing such a program, the U. S. will only be catching up with progress made in this respect by other countries. I refer specifically to Sweden where the Stockholm “Institute of Rationization in Catering” headed by Per Skoder is well advanced in the implementation of a diet and exercise program to reduce cholesterol levels.

In closing, let me offer the following homespun verse and dedicate it to that perhaps intellectually disadvantaged group, the Cardiac-Unconcerned:

His doctor has made the prognosis That saturates foster thrombosis. But he’d rather expire Fulfilling desire Than eat prudent, avoiding sclerosis.

CHICKEN KIEV: Pound 8 large pieces boned chicken breasts very thin. Place l-l/Z tbsp margarine in center of each breast. Combine 4 tbsp chives, 1 tsp salt, and l/8 tsp pepper, sprinkle over margarine. Roll each breast and overlap sides so that margarine mixture is completely enclosed; the flesh will adhere. Beat 4 egg whites and 2 tbsp milk together. Roll chicken in bread crumbs, then in egg white mixture and again in bread crumbs; coat well. Refrigerate at least 20 min. Deep fry in hot (370°F) corn oil until well browned, 8-10 min. Drain well. Serve hot. Makes 8 servings.

BROCCOLI: Buy 1 bunch dark-green, firm broccoli, with no trace of yellow. Rinse well in cool water and cut off stalk bottoms and leaves. Separate into florets. If stems are thick, quarter length- wise up to florets. Stand florets up in small saucepan. Cover stems with water. Add 1 tsp salt. Bring to boil and cook about 10 min or until tender crisp. Drain well and serve topped with 2 tbsp margarine. Provides 4 servings.

APPLE PIE: Combine 2 C unsifted flour, 1 tsp salt, and 2/3 C margarine in a bowl. Add 6 tbsp ice water, mix thoroughly. Chill. Roll l/2 to fit 9-m pie pan. Put in pan. Combine 6 C sliced, fresh apples, 3/4 C sugar, l/4 C flour and 1 tsp cinnamon. Turn into pan. Dot with 2 tbsp margarine. Roll out remaining pastry. Place over apples. Seal to bottom pastry, shape edge. Cut 6 slits. Bake at 400’ F about 50 min or till done. Provides 8 servings.

the food service industry's requirement for prudent diet foods

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