The evidence that obesity is among the risk factors for several diet-related conditions and diseases such as dislipidaemia, diabetes, hypertension, CVD and cancer is convincing(Reference Whitlock, Lewington and Sherliker1, 2). The causes of overweight and obesity are, however, complex and multi-factorial(Reference Darnton-Hill, Nishida and James3). Addressing them effectively requires concerted action and effort by various stakeholders, i.e. policy makers at local, national and international levels; caterers; food industry; consumer organisations and health professionals(Reference Daar, Singer and Persad4, 5). Public–private partnerships could potentially be useful(Reference McDonnel, Bryant and Harris6–8), but some scepticism regarding their effectiveness was expressed(Reference Nestle9).
Eating out has gained importance in the diet of Europeans(Reference Orfanos, Naska and Trichopoulou10) and has been positively associated with weight gain(Reference Bes-Rastrollo, Basterra-Gortari and Sanchez-Villegas11, Reference Pereira, Kartashov and Ebbeling12). Over 35 % of Belgians consume over 25 % or more of their energy intake when eating outside the home(Reference Vandevijvere, Lachat and Kolsteren13). Adults in the UK consume 21 % of their meals outside the home, corresponding to 27 % of their daily energy intake(Reference Kearney, Hulshof and Gibney14). A sample of Irish adults showed that approximately two meal occasions took place at work and another two in places other than the home and this on a daily basis(Reference O’Dwyer, McCarthy and Burke15). In a Spanish study, more than half of the participants ate out once weekly and 27 % reportedly ate out on two or more eating-out occasions per week(Reference Bes-Rastrollo, Basterra-Gortari and Sanchez-Villegas11). The catering sector is therefore an important stakeholder in the provision of nutrition policies in Europe(Reference Lachat, Roberfroid and Huybregts16). It is uniquely placed to be involved in the implementation of effective strategies aiming to promote healthier eating out.
Stakeholder mobilisation, however, is not a panacea and relies on joint thinking from the planning and conceptualisation stage of policy measures onwards(Reference Lang and Rayner17). In 2006, a multidisciplinary forum was organised in the USA to formulate recommendations to improve the nutritional aspects of eating out. The outcome of the discussions underlines the necessity for a better understanding of consumers’ behaviour, increased availability of low-energy foods and the provision of information on healthier choices to consumers when eating out(18). The PorGrow (Policy options for responding to the growing challenge of obesity) project is an example of a European initiative to map stakeholder views and perceptions aiming to build a broad consensus in order to tackle obesity(Reference Millstone and Lobstein19). The project proposes policy options and describes how acceptable they are for various stakeholders, thus providing guidance for policy makers to respond to the obesity epidemic(Reference Hubel20). The EU-supported ‘Food-Pro-fit’ project was launched in 2006 to provide assistance to the food service and catering sector, featuring an online tool designed to help caterers to control and reduce the amount of fat, salt and sugar in their produce(Reference Colom21, Reference Colom22). In addition, the FOOD (Fighting Obesity through Offer and Demand) project is a recent public–private partnership consortium that focuses on restaurants and catering companies and aims to develop and test tailor-made tools to enhance healthy offer and demand(23). At a national level, an activity worth mentioning is the collaboration between the UK Food Standards Agency and the catering and restaurant businesses to provide a range of healthy options when eating out(24).
Documenting the views of stakeholders is important for effective action as it promotes cooperation and assists policy makers when drawing up relevant strategies(Reference Hubel20). In this context, the present paper presents the results of a SWOT analysis evaluating the strengths, weaknesses, opportunities and threats for a number of strategies for promoting healthier eating out in Europe. The SWOT analysis is a popular instrument used to outline a framework for action. It has been used before in connection with health-related policy research(Reference Mannan25, Reference Sharma and Deepak26) and with strategic decision-making exercises(Reference Kahveci and Meads27, Reference Dyson28).
Methods
The present study was carried out in order to identify and assess actions through which the catering sector could be engaged in strategies for healthier eating out in Europe. The data for the present study were collected within the framework of the HECTOR project on ‘Eating Out: Habits, Determinants and Recommendations for Consumers and the European Catering Sector’. Among others, the HECTOR project aims to come up with strategies and measures that will enhance the nutritional profile of meals as offered by catering enterprises as well as increase the acceptance of and demand for healthier foods by European consumers. The HECTOR consortium features participants from sixteen European countries as well as those from various international organisations(29).
During a 2 d workshop in May 2008, thirty-eight project participants took part in a collaborative process to identify actions needed for the effective involvement of the catering sector in strategies for healthier eating out in Europe. Project participants from the University of Athens Medical School and Ghent University acted as facilitators. The outline of the workshop is presented in Fig. 1. In short, participants initially received background information on current knowledge regarding food services in Europe, the psychological and social aspects of eating out and consumers’ attitudes and behaviour when eating out. The presentations were prepared by working groups prior to the workshop. The presentations set the scene for the discussions and provided state-of-the-art data on eating out in Europe. The workshop’s objective, its organisation and anticipated outcomes were explained to the participants. They were subsequently split into three working groups with specific thematic priorities as defined in the project’s protocol: to enhance the supply of health-promoting products by the catering sector (group 1); to improve consumers’ awareness on optimal food choices (group 2); and to increase consumers’ demand for healthy foods when eating out (group 3). The facilitators organised the allocation to working groups a priori and due care was given to striking a balance between representatives of the private and public sectors in all groups. The composition of each working group is shown in Table 1. The group included: (i) representatives of catering enterprises located in five European countries (Belgium, Croatia, Greece, Poland and Portugal), including large meal providers of institutions (hospitals, schools, universities and prisons) as well as small restaurant owners; (ii) representatives of three large multinational companies acting as food service operators and fast-food providers; (iii) governmental officials who cooperate in food legislative processes; (iv) academics involved in advisory committees; (v) independent experts on the basis of knowledge of their country’s situation; (vi) members of national consumer associations; and (vii) representatives of international bodies, such as FAO and WHO.
Fig. 1 Outline of a 2 d workshop to identify actions needed for the effective involvement of the catering sector in strategies for healthy eating out in Europe – the HECTOR project entitled ‘Eating Out: Habits, Determinants, and Recommendations for Consumers and the European Catering Sector’
Table 1 Composition of the working groups – the HECTOR projectFootnote *
* The HECTOR project entitled ‘Eating Out: Habits, Determinants, and Recommendations for Consumers and the European Catering Sector’.
† Public sector: academics, representatives from consumer organisations and international non-governmental organisations; governmental officials and representatives from national nutrition institutes.
‡ Private sector: food service operators and fast-food providers (multinational), food service operators, large caterers (nationally) and institutional meal providers and small restaurants.
Each group performed a SWOT analysis to identify the issues that might show effectiveness in prompting participation of the catering sector in strategies for healthier eating out. During the analysis, the groups worked in separate rooms and discussion was coordinated by a facilitator. The participants were not allowed to change groups during the workshop. Only one individual, i.e. the workshop coordinator, regularly attended the various groups to get assurance that the discussions would indeed lead to achieving the objectives. Each group appointed a rapporteur to present the group’s conclusions to the plenary and summarise discussions and final conclusions in a short narrative report. Group discussions lasted for 3 h, with regular breaks to inform the plenary of intermediate conclusions and ensure coherence of the output from all working groups. The rapporteur summarised the group work in the plenary and group members were given the opportunity to add comments and/or clarifications. As part of the overall workshop organisation, it was decided not to record the discussions or comments made by the participants to allow them to interact more freely and on a personal basis.
For the purpose of the project, eating out was defined to include meals, beverages and snacks consumed at places other than the home. Each group’s facilitator explained that ‘optimal diets’ or ‘healthy eating’ were to be understood as dietary choices that comply best with international nutrition recommendations and that the terms ‘caterers’ or ‘catering sector’ referred to all food services that supply prepared meals or prepared foods that are part of a meal. At first, each working group listed strategies and policy measures that would be relevant to their group’s thematic priority. Following this, the members deliberated on the main internal (strengths and weaknesses) and external factors (opportunities and threats) enhancing or slowing the involvement of the catering sector in each of the previously identified strategies. Subsequently, the key actions needed to address weaknesses and threats were listed and those that were common among the different strategies were identified. Based on this common list, participants from the catering enterprises discussed those actions that were most important. The final list of actions was presented and discussed in the plenary. To avoid overlap, we tabulated similar strategies of the working groups and did not present the output of each working group separately.
Results
Table 2 summarises the strategies as identified by the working groups. The strengths, weaknesses, opportunities and threats, favourable or unfavourable, to the strategy’s implementation are listed. A number of common factors were identified and are collectively described below.
Table 2 Results of an analysis to evaluate the strengths, weaknesses, opportunities and threats (SWOT analysis) involved in strategies to enhance the supply of health-promoting products by European caterers – the HECTOR projectFootnote *
SME, small-to-medium-sized enterprises.
* The HECTOR project entitled ‘Eating Out: Habits, Determinants, and Recommendations for Consumers and the European Catering Sector’.
Strengths
The first set of strengths for the catering sector relates to its practical experience and commercial advantage in tuning into changing markets and diverse customer demands. A second inherent advantage is the ability to modify the foods offered, since caterers may (quite easily) introduce changes in their recipes to reformulate meals or foods on offer. The latter is particularly relevant to small-to-medium-sized enterprises (SME).
Opportunities
Engaging in strategies for healthy eating may present interesting business opportunities for the catering sector, since healthy eating is a current societal trend paralleled with an increased demand for traditional and local foods. The control over the composition of food offered and the flexibility to modify recipes allow caterers to adjust their businesses to provide a wider offer of healthy options as well as to market their products via this concept. Outlet facilities can also be further diversified to support initiatives in this area.
Involvement in strategies to promote healthier eating out may also add to the credibility of the sector. Internally, participation is a potential way for the catering sector to underpin its corporate and social responsibilities. It may trigger a higher sense of self-esteem in the sector and among its staff, which in the long run could provide leverage when trying to increase overall efficiency.
Effective participation in strategies promoting healthier eating out is further expected to build trust with consumers. This is particularly important as it can help attract the more health-conscious individuals. Furthermore, alignment of objectives and actions in the catering sector with governmental initiatives promoting traditional and seasonal products is expected to increase transparency and create opportunities for partnership with policy makers. The development of institutional guidelines for the catering sector with specific information awareness campaigns for customers could prove particularly helpful here.
Weaknesses
A prime weakness of the catering sector is its dependence on the supply of ingredients, in terms of quality and quantity, which are both affected by factors such as seasonality, price and market structure. The effect of these on the cost of meals offered is an additional factor to be taken into consideration. Furthermore, some strategies are difficult to implement by smaller enterprises that lack the financial means, technical capacity, know-how and/or human resources. There are a number of practical barriers for which the catering sector (and in particular the SME) is not well prepared as yet. Food labelling, for instance, raises the necessity of displaying results of nutritional analysis, or even to change menus to accommodate requirements.
A third level of weakness is the internal human resource profile of the sector. In various businesses, and particularly within SME, the staff is predominantly untrained, migrant or low skilled. In many instances, language barriers, the sector’s high turnover of staff and part-time labourers limit the possibility of adequate training and building up the retailer’s capacity to offer healthy foods.
Threats
The application of new strategies and measures may necessitate a business reorientation bringing with it the potential risk of loss of current momentum and profitability, while at the same time generating considerable additional costs (e.g. for training, changes in infrastructure, labelling) and qualifications (e.g. manager creativity, cooking skills) might be needed. The additional administrative work and investment to formulate new recipes or meals that comply with what is defined as healthy can be substantial or even off-limits for smaller caterers. In addition, the introduction of such changes will most probably require training of staff. The sector as a whole, however, has a very typical human resources profile and high staff turnover could make such investments ineffective.
Significant market changes often lead to fluctuations in supply and price. An increased supply of healthy options when eating out was identified as a force that could introduce changes in traditional business relationships and links both internally and externally. Furthermore, the current organisation and operation of the supply chain may not only cause delays in the provision of products and ingredients to create these healthy options, but also compromise sustainability of the provision of specific ingredients.
Participants further identified a threat in the use of logos, labels and similar visual signs that could facilitate customers in identifying enterprises offering healthy options. The threat was not particularly related to the presence of a sign, but rather to the lack thereof, which could create unjustified negative perceptions. Foods, menu choices and/or caterers not displaying logos or labels for any number of reasons could be erroneously perceived as inappropriate for these healthy eating options.
The sector also risks having no control over what is defined as ‘healthy’ and may face more difficulties in adapting to important societal developments in comparison with other businesses in the food sector such as retailers. In various market segments, the catering sector (in contrast to food producers) is more closely linked to customers (particularly in the case of SME) and can therefore keep up with new trends and demands faster.
There is also the concern that in some cases, a focus on healthy eating may narrow the variety of foods offered and reduce options for customers, particularly since consumers frequently indulge in conventionally poorer healthy options when eating out. Changes or reductions in what’s on offer may also result in a downturn of visits from regular customers or even cause the omission of some traditional dishes or foods if they do not comply with the recommended nutritional criteria. A too narrow focus on healthiness may result in a loss of creativity as caterers may have to forego some degree of freedom when preparing recipes and foods.
Essential actions identified by the catering sector
Essential actions to foster participation of the catering sector in healthy eating out are documented in Table 3. In general, caterers clustered the actions in four different areas: (i) definition of healthy options; (ii) external support and capacity building; (iii) communication of the strategy to consumers and caterers; and (iv) implementation practicalities.
Table 3 Actions to foster participation of the catering sector in healthy eating out: summary of views of representatives from catering-related enterprises clustered in four areas identified in the HECTORFootnote * workshop
* The HECTOR project entitled ‘Eating Out: Habits, Determinants, and Recommendations for Consumers and the European Catering Sector’.
For caterers, guidelines should be as simple as possible and preferably based on food groups. They should be limited to a number of healthy choices and respect local culture and tradition. The introduction of changes in the type of food offered could be hampered by the lack of technical capacities and participants agreed that technical support is needed to analyse the composition of dishes, create a healthy food choice programme and train the sector’s workforce. The participating caterers further pointed out that ‘healthy choices’, as a food positioning, has limited resonance for consumers and there are numerous more appealing food-oriented positionings that could be applied to healthy food choices. The focus, for example, could be on seasonal foods, traditional options, alternative dishes, local products, etc. It was further noted that any promotional activity should be cautious and consistent across all catering-related sectors that are expected to work together, albeit in a complementary manner.
Adapting the offer of a new ‘healthy food’ objective requires time, a realistic list of priorities and a plan of action. Furthermore, it was agreed that the introduction of novel approaches need to be planned elegantly, with a gradual and slow increase in coverage and choices of healthier eating out options. This was in order to allow the catering sector sufficient time to adapt to new market realities.
Discussion
Thirty-eight participants from sixteen European countries and international organisations, representing private catering and catering-related enterprises, public officials, members of academia, consumer associations and international non-governmental organisations, took part in the analysis in order to identify and assess the strengths, opportunities, weaknesses and threats envisaged if the catering sector was to be involved in the promotional strategies for healthier eating out. It was generally acknowledged that the sector consists of a heterogeneous set of businesses that generally respond quite rapidly to the changing context of dietary habits and lifestyles. The catering sector possesses strengths that allow a direct involvement in various healthy eating out promotion strategies and can also be linked to a number of favourable circumstances. The sector’s capacity to introduce changes in the foods offered introduces the prospect of being the trendsetter for healthy eating out. Participating in working out strategies for healthier eating out presents opportunities the sector could capitalise on. An important one is penetrating new marketing options. In addition, effective participation of the catering sector in healthy eating out strategies may promote a trust with policy makers as well as provide a memorandum of understanding to avoid top-down over-regulation and stimulate proactive attitudes within the sector. The opportunity of letting businesses tune in to customer demands may be of a particularly advantage for SME. Working towards healthier eating out may also educate, empower and motivate catering staff, which would, in turn, be an important asset for the sector.
Among the weaknesses is the catering sector’s dependence on the supply of ingredients, the lack of financial means, the human resources profile and limited technical capacity with regard to determination of the nutritional composition of the food prepared. These weaknesses are particularly present in SME. At the same time, there is the threat that a focus on healthy eating options may narrow the variety of foods offered and thus may necessitate a business reorientation. In a sector with high staff turnover, such investments may be less effective. Participants further identified a threat in the use of logos, labels and similar visual signs not related to their use, but to how their lack thereof could be interpreted by customers and peers.
The needs differ according to the nature and size of the businesses. It may be potentially difficult for SME to follow and implement the nutritional criteria defining healthy foods. This is particularly important as small catering enterprises have a large share of the eating out market in Europe. According to a consumer database and data from Crest, on average 49 %, 92 %, 80 %, 60 % and 55 % of all informal eating out occasions in the UK, Italy, Spain, France and Germany, respectively – the five largest markets in Europe – are provided by SME (Visits coming from small restaurants and eating out businesses versus the established chains and larger enterprises. Data from informal eating out tracking tool; personal communication from TNS Consumer/TNS Global to C. Lachat, 2009). Contract catering, on the other hand, will face different challenges. There are important external regulatory constraints that may hamper compliance with additional rules and regulations(30). In general, over-regulation of the market was considered as potentially counterproductive. Nevertheless, legislation is expected in this area if initiatives from the private sector do not prove to be effective.
It was generally agreed that changes need to be implemented gradually, taking into account the context and specificity of different caterers. Governments need to create a supportive environment to enhance credibility of the messages and establish structures to assist caterers (particularly smaller ones) with the practical, technical and financial aspects of the different strategies.
Clearly, consumer demand is a key factor in the introduction of healthier options at catering outlets. The risk of losing customers is real and has the potential to undermine the effective participation of catering enterprises in healthy eating out initiatives. A number of strategies to enhance consumer demand for healthy options when eating out were identified in the present analysis. The need to implement simultaneously consumer-oriented awareness and an awareness campaign on changes in food supply emerged as an important element in the successful implementation of strategies to promote healthier eating out.
There are important similarities in the outcome of this workshop and the US forum on eating out(18), although the latter was conducted in the context of preventing overweight and obesity in North America. Both exercises highlighted that actions in the catering sector need to be implemented in parallel with consumer information campaigns, ideally ‘lifestyle’-oriented rather than focused singularly on food and diet. The present analysis clearly acknowledged the heterogeneity in the European eating out landscape and identified the need to incorporate cultural and locally relevant dimensions in catering. In addition, specific requirements involving SME were also listed, an element that was not particularly addressed in the recommendations of the US forum.
A strong element in the present analysis is that it was performed in the context of a research project with a heterogeneous group of participants from various sectors in several European regions. The participants had been working on eating out in Europe (on an academic level and in discussions with the catering sector) for 2 years prior to the workshop. This group reflects, as far as we know, currently the largest multidisciplinary research consortium working on eating out in Europe through informed and open discussions.
The present study is qualitative and did not aim to be representative. The methodology used did not allow for an exhaustive process of consultation with other stakeholders or representatives of the catering sector in Europe. This process provides a useful addition to the current debate on ways to promote healthy eating out in Europe (i.e. the discussions held at the EU Platform for Action on Diet, Physical Activity and Health). The present study provides a qualitative appraisal of the catering sector as a whole, but did not attempt to rank or score the issues identified. As priorities are inherently different for the various enterprises represented, any ranking would have required a larger number of participants and more specific methods to allow prioritisation by different stakeholders(Reference Stirling, Lobstein and Millstone31, Reference Stirling32). Nevertheless, participants from the catering enterprises listed the more important ones in order to address weaknesses and threats.
For the purpose of the HECTOR project, the consortium had to rely on the available dietary data on eating out in Europe. The current national food intake data in Europe estimate the contribution of eating out in Europe on the basis of the place of consumption and not the place of preparation(Reference Orfanos, Naska and Trichopoulos33). Since the discussions in the working groups used available food intake estimates on eating out, the HECTOR definition on eating out was used for the present study. We acknowledge that this definition classifies meals purchased outside the home (e.g. ready-to-use or take-away meals) and consumed at home as ‘home foods’.
Conclusions
In conclusion, the study highlights a number of options that could be potentially instrumental in influencing dietary intake. It points out a number of strategic issues related to healthy eating out in Europe and highlights barriers and potential solutions to the challenges of engaging the catering sector in strategies for healthier eating out in Europe. In doing so, it complements the available scientific evidence and provides input for policy makers and caterers to pave the way for effective European nutritional strategies.
Acknowledgements
This work and the HECTOR project were supported by the European Commission, FP6 (FOOD-CT-2006-023043). A.F. works for McDonald’s Europe Ltd. H.A.M. works for Uniself, a Portuguese commercial catering company. No other conflict of interest is declared for the other authors. The HECTOR project is a consortium that comprises participants from various food producing and catering companies in Europe. The present study was conducted in the context of the HECTOR project entitled ‘Eating Out: Habits, Determinants and Recommendations for Consumers and the European Catering Sector’ funded in the FP6 framework of DG-RESEARCH in the European Commission. The authors are solely responsible for the contents of the document. The opinions expressed do not represent the opinions of the Commission and the Commission is not responsible for any use that might be made of the information included. C.L. drafted the initial version of the manuscript. C.L., A.N., A.T., P.K. designed and supervised the study. D.E., A.F. and H.A.M. contributed to the interpretation of the findings of the workshop and made substantial contributions to write-up of the manuscript. A.T. is the principal investigator of the HECTOR project. All authors revised the manuscript critically and approved the final text. The authors thank TNS Global and Crest NPD for providing us estimates on the share of SME in informal eating out occasions in Europe. Thanks are also due to Alexandra Manoli from the HECTOR Coordinating Centre for her support in the administration of the project and the workshop.
The HECTOR Consortium consists of: Aida Turrini (Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione, Italy); Rosario Tumino (Associazione Iblea per la Ricerca Epidemiologica – Organizzazione non lucrativa di utilita sociale, Italy); Sabine Rohrmann (Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany); Kurt Gedrich (Technische Universität München, Germany); Johanna Varjonen (National Consumer Research Centre, Finland); Jasna Pucarin-Cvetkovic (Andrija Stampar School of Public Health, Croatia); Katica Antonic Degac, Zrinka Laido (National Institute of Public Health, Croatia); Wlodzimierz Sekula, Maciej Oltarzewski (National Food and Nutrition Institute, Poland); Ibrahim Elmadfa (Department of Nutritional Sciences, University of Vienna, Austria); Maria Daniel Vaz de Almeida (Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Portugal); Eliza Markidou (Department of Medical and Public Health Services, Ministry of Health, Cyprus); Eiliv Lund (University of Tromsø, Norway); Maciej Ziemski (Gastropol Group Sp. z.o.o., Poland); Kyriaki Moumtzidou (Kobatsiari BROS SA, Greece); Christine Brombach (Zürcher Hochschule für angewandte Wissenschaften, Switzerland); Willem De Smet (BVBA De Appelier, Belgium); Zajkás Gábor (National Institute of Food Safety and Nutrition, Hungary); Maria Kapsokefalou (Agricultural University of Athens, Greece); Michael Knowles (Coca-Cola Services SA, Belgium); Jim Holding (Department for the Environment, Food and Rural Affairs, UK); Sonia Palmisano (il Mezzogiorno, Belgium); Antun Sostaric (LTC Zagreb d.o.o., Croatia); Vibeké Larsen (Studentsamskipnaden i Tromsø, Norway); Nadia Slimani, Heinz Freisling (International Agency for Research on Cancer, France); Celia Tsekeri (Consumer Association New INKA, Greece); Heiner Boeing (German Institute of Human Nutrition Potsdam-Rehbruecke, Germany); Ria van der Maas (Unilever Research & Development Vlaardingen BV, The Netherlands); Panagiotis Zamanis (A Tsilihristou SIA OE, Greece); Antonio Ramalho (Três Tempos, Comida Caseira ao Domicílio, Lda, Portugal); Ines Nurja (Institute of Statistics, Albania).
