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By JULIE MINDA

As one tactic to get at root causes of chronic illness in the communities it serves, Trinity Health is exploring how to tip the scales toward healthier food choices.

The Livonia, Mich.-based system is starting its influence campaign where it holds the most sway with consumers. It has created guidelines and protocols for ensuring the vending machines in its 94 hospitals contain snacks, beverages and entrées that are lower in calories, fat, sodium and sugar than traditional vending machine fare.

The green and purple crescents on the ring dispensers signal that a snack meets Trinity Health guidelines for healthier vending machine fare. To qualify, snacks generally must be relatively low in fat, sugar and salt and contain fewer than 250 calories per serving.

Nuts, dried fruit and zero-calorie beverages occupy vending space alongside candy bars, potato chips and sugary drinks. Under the new approach, in most Trinity Health facilities, the vending spirals dispensing healthier options are set off by their green color and tagged with a symbol. The products are offered at lower prices as compared to the potato chips and candy and other less healthy options. Placards by the vending machine explain how to recognize healthier picks.

Kristie Jacobsen, clinical nutrition manager for Trinity Health Food and Nutrition Services for the western region of Iowa, says that under Trinity Health's guidelines, it's not only items like almonds and dried fruits that are considered healthy. Single servings of baked chips, snack bars and pretzels, for instance, also may qualify.

Some of the facilities' refrigerated vending machines include salads, sandwiches, parfaits and veggie cups.

Lighten up
Trinity Health lays out the case for healthy vending in all of the communities it serves in a "Healthy Vending Toolkit." The publication points out that more than two-thirds of all adults in the U.S. are either overweight or obese. Nearly 20 percent of children are obese, according to the Centers for Disease Control and Prevention. Being obese may put people at greater risk for chronic disease, including some cancers, Type 2 diabetes, coronary heart disease and stroke, the Trinity Health publication says.

People should improve their diets to counter these problems, the toolkit booklet says, but "it is not enough to simply tell people what will make them healthy and assume they will find a way to do it. The environment around us has a profound impact on our health. And this includes the food and beverage environment." The booklet says studies have found that when workplaces make healthier food more accessible, employees improve their diets.

Its own backyard
Trinity Health began its vending machine makeover about three years ago, says Adam Wolski, Trinity Health Food and Nutrition Services senior analyst.

At the outset, each Trinity Health facility handled its own vending machine stocking, and "we didn't know what we didn't know," when it came to whether healthier options were offered, says Wolski. System leadership centralized vending machine oversight systemwide and gave Canteen the vending machine contracts for a majority of its facilities.

Trinity Health formed a committee of clinical dieticians, food service managers, clinicians and community health and wellness leaders, to develop a baseline for classifying healthier processed foods. Trinity Health and Canteen developed "plan-o-grams" that specify how items should be displayed.

Canteen monitors sales of each item by hospital. With this information, Trinity Health and its sites can increase the availability of popular items and switch out those that are unpopular.

'Join us'
Trinity Health hospitals can choose whether to have 50 percent, 70 percent or 100 percent of the total vending machine offerings in their facility be healthier items. The higher the tier, the better a hospital fares on the system's performance metric. The vending machine credit can account for as much as 20 percent of the hospitals' scores for community benefit performance.

Trinity Health hospitals make the Healthy Vending Toolkit available publicly on their websites, and they encourage their community partners to adopt the healthier food standards. In the introduction to the booklet posted on the website of Trinity Health's St. Mary's Health Care System of Athens, Ga., then-Chief Executive Don McKenna writes, "We challenge businesses, government, churches and other organizations to join us! No one needs to take this journey alone."

Happy eaters
Jacobsen acknowledges there was some trepidation among facility leaders about the changeover in vending machine stock — they anticipated some pushback from snackers. "But quite the opposite happened," Jacobsen says.

Outpatients with diabetes have remarked that having healthier options helps them avoid temptation. Jacobsen notes that in the western Iowa region, the hospitality services team, which is responsible for food service, is also implementing other healthy eating initiatives. For example, hospital cafeterias use a logo to label items with a high nutritional value. The cafeterias also produce healthy frozen meals for people to purchase and heat at home.

Satisfied customer
Kelley Sanchez is director of communications for Saint Agnes Medical Center, a Trinity Health facility in Fresno, Calif. She's been a fitness and healthy eating buff for decades. Up until recently she gave wide berth to the hospital's vending machines. But, since the hospital upgraded the food choices in the machines about a year ago to conform to the new healthy food standards, she's been a much more frequent customer.

Her favorites include pistachios, dried fruit, fig bars and reduced-fat chips. "I can still have snacky foods but now there is much more to pick from and there are more fun things to eat."

Sanchez says she's heard from colleagues that they appreciate the expanded range of healthy choices.

Sanchez says she's pleased that her facility has taken this step for the health of staff and community. "As a health care provider, we should be leading the way — walking the walk and talking the talk. It feels good to know that we're advocating for health and well-being."