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What is the Winner’s Circle Healthy Dining Program^SM?

What are the nutrition criteria that meals, foods and beverages must meet to qualify under Winner’s Circle?

Who can use the Winner’s Circle Program?

Who were the key partners, experts, and organizations that helped develop the program? 

How does Winner’s Circle identify and promote healthy options?

Why was Winner’s Circle developed?

When and where was Winner’s Circle launched?

How was Winner’s Circle evaluated?

What were the results?

Is the Winner’s Circle Program still operating? 

What is the Healthy Food in Hospitals Program (Red Apple Program)?
 

Citations
 

What is the Winner’s Circle Healthy Dining Program^SM?

The Winner's Circle Dining Program^SM is a menu labeling and social marketing initiative developed by NC Prevention Partners (NCPP) that promotes healthy food in dining establishments. The goal of the program is to enable consumers to easily indentify and select healthy options when eating away from home by using one consistent logo: a purple star and gold fork.  The program uses science-based nutrition criteria to identify healthy dining options on menus, and also provides resources, ideas and tools for food establishments to offer healthier menu options. 

Winner’s Circle Program Goals:

• To make it easier for consumers to select healthy items when they are dining out 
   
• To give consumers consistent, sound and easily recognizable nutrition guidance in participating restaurants by displaying the Winner’s Circle logo on menus, doors, menu inserts, brochures and table tents directing  them to the healthy food choices available
   
• To increase consumer demand for healthy restaurant items with marketing tools and local promotions

What are the nutrition criteria that meals, foods and beverages must meet to qualify under Winner’s Circle?

The Winner's Circle nutrition criteria are based on the most current evidence in nutrition science and support the Dietary Guidelines for Americans. Therefore, the criteria identify foods and beverages that are appropriate for the majority of the population.   Foods that promote optimal health--such as fruits, vegetables, grains, beans and low-fat dairy--while limiting total fat and sodium, are promoted. The criteria are consistent with recommendations from the following organizations:

• American Heart Association
• American Cancer Society
• USDA’s Dietary Guidelines for Americans and Food Guide Pyramid
• Healthy People 2000 and 2010
• American Diabetes Association
• Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure
• National Heart Lung and Blood Institute
• National Institutes of Health

Click here to see the Nutrition Criteria used in the Winner's Circle Healthy Dining Program.
 

Who can use the Winner’s Circle Program?

Any establishment that sells food and beverages to consumers is eligible to use this program. This includes:

• Restaurants
• Workplace cafeterias
• Churches
• Schools
• Grocery store deli
• Convenience stores
• Malls
• Vending machines
• Summer camps
• Ball parks, sports arenas

Who were the key partners, experts, and organizations that helped develop the program? 

Winner’s Circle was developed by NCPP with guidance from the following National Scientific Advisory Board:

• Kathy Kolasa, Ph.D., RD, LDN, Professor & Section Head, Nutrition Services and Education, Dept of Family Medicine, The Brody School of Medicine at ECU
• Joanne Lee, MPH, RD Project Officer Active Living by Design
• Elizabeth Davenport, MPH, RD, International Food Information Council
• Becky Mullis, Ph.D, RD, LD, Professor and Head, Dept of Foods and Nutrition, The University of Georgia
• Jennifer Anderson, PhD, RD Colorado State University, Department of FSHN
• Suzanne Murphy Cancer Research Center of Hawaii
• Jan Dodds, PhD, RD, Professor, Department of Nutrition, UNC School of Public Health
• Alice Ammerman, PhD, RD, Associate Professor, Department of Nutrition, UNC Gillings School of Global Public Health
• Diane Beth, MS, RD, LDN, 5 A Day Coordinator/ Lead Chronic Disease Nutritionist, NCDHH
• Jennifer Seymour, liaison to CDC, Epidemiologist, Division of Nutrition and Physical Activity, S- Div. Of Public Health
• Sheila Cohn, R.D., L.D., Manager, Nutrition Policy, Health and Safety Regulatory Affairs, National Restaurant Association
• Marcia Smith,  PhD, Past President, Am. School Food Service Assoc.
• Barbara Rimer, Department of Health Behavior and Health Education, UNC School of Public Health
• Wendy L. Johnson-Taylor, Ph.D., MPH, R.D., Public Health Nutrition and Health Policy Advisor, Division of Nutrition Research Coordination, National Institutes of Health
• Karen Stanley, RD, LDN, NC Division of Public Health, Physical Activity and Nutrition Branch
• Doris Sargent, MS, RD, LDN, NC Division of Public Health, Nutrition Services Branch
• Elizabeth Zimmerman, MPH, RD, Worksite Wellness Coordinator, Physical Activity and Nutrition Branch, NC Division of Public Health, NC DHHS
• Gwyn Roberson, Child Nutrition Director, Scotland School District, North Carolina Public Schools

Several organizations partnered with NCPP to develop and deliver the program including:

• Cardiovascular Health, Physical Activity and Nutrition, and Women and Children’s Health Programs of the NC Division of Public Health
•  NC Department of Public Instruction
• Local NC health agencies
• WAY to Health Research Initiative

How does Winner’s Circle identify and promote healthy options?

The Winner’s Circle Icon
Healthy menu items are labeled with the Winner’s Circle icon seen below.  Restaurants, businesses and community food settings are offered a variety of labeling strategies to identify the healthy items.

This Winner's Circle Munch Box meets the nutrition criteria for a full meal	Winners Circle also identifies healthy items sold individually

Promotional Materials and Strategies
Participating venues use the Winner’s Circle logo on their doors, cash registers and other visible locations (i.e. posters, flyers, etc.).  Schools use the logo on bulletin boards, staff T shirts, aprons, etc. While the Winner’s Circle logo was the primary way to identify healthy items, many consumers requested seeing more nutrition information about foods labeled as Winner’s Circle items. As a result, numerous Winner’s Circle restaurants chose to post calories or other nutrients.  Many restaurants also chose to provide the full nutrition analysis in a brochure, tray liner or table tent.

Communities promote Winner’s Circle establishments through television public service announcements (PSAs), newspaper ads, and promotional billboards.

Why was Winner’s Circle developed?
Winner’s Circle was developed in response to the obesity epidemic and research that showed Americans are increasingly eating their meals away from home.  Healthy People 2010 noted that since the late 1970s, there has been a 30 percent increase in meals consumed outside the home.  Between 1994 and 1996, on any given day, 57 percent of meals were consumed at restaurants, fast food outlets, school cafeterias and vending machines.  An analysis conducted in 1995 found that foods eaten away from home generally had higher total fat, saturated fat and cholesterol levels.  Furthermore, research indicates that people are getting an increasing number of calories from away from home meals and snacks.  


When and where was Winner’s Circle launched?
Winner’s Circle was first piloted in two North Carolina counties in 1999 as a partnership between NC Prevention Partners and the NC Heart Disease and Stroke Prevention Branch, NC Division of Public Health.  The successful pilot led to an expansion of the program to other North Carolina communities in 2000 and to schools in 2001. By 2004, 65 counties in the state had been trained, including more than 50 health departments and 65 school districts.  NCPP’s public health partnerships expanded to include the Physical Activity and Nutrition Branch (PAN).  The PAN Branch provided health promotion funding to local health departments to implement community interventions including the Winner’s Circle.  

NCPP was provided funds from the Women and Children’s Section at NCDPH to extend Winner’s Circle to schools.  Initially, NC Prevention Partners piloted the program in three NC Local Education Agencies (LEAs) during the 2001-2002 school year. The success of those pilots led to recruitment and training of additional LEAs during the 2002 – 2003 school year.  By 2005, 81 of 115 total LEAs, representing over 1600 schools in NC were participating in the NC Winner’s Circle in Schools program.  In addition to labeling healthier foods, many schools discontinued the use of fryers in their cafeterias during this time, and other systems changes for healthier foods.  

Public health state funds for Winner’s Circle were unavailable after 2005. NCPP continued to receive requests from local communities for technical assistance and support. In response, NCPP hosted one last Winner’s Circle training in 2006 for interested communities. While NCPP does not currently track county activity related to menu labeling, we do receive calls and emails periodically from local agencies who continue to use the tools to label menus locally.

2005 was also the year Winner’s Circle became a national program when it was adopted for use by the Washington State Health Department. NCPP provided training and technical assistance to public health partners in Washington on how to implement the program across their state.
 

How was Winner’s Circle evaluated?

A variety of evaluation strategies were used to determine the impact of Winner’s Circle in communities and schools. On a regular basis, local Winner’s Circle teams turned in reporting forms to NCPP that included survey information on where consumers dine out, a listing of their qualified menu items, a log of media hits and local promotional efforts, and in some cases, sales data that reflected changes in sales before and after program implementation. In addition, phone and email contact was maintained with all participating counties in order to collect process evaluation data and qualitative feedback. Program evaluation data was also collected each year to reveal the level of success with implementing the program, raising awareness through community promotional efforts, and increasing opportunities for healthy eating away from home.

During the 2005-2006 school year, the NC Division of Public Health led an intensive evaluation of the NC Winner’s Circle in Schools program. The evaluation was designed and conducted by a team of representatives from interested program partners and stakeholders. Funding was provided by the US Centers for Disease Control and Prevention through North Carolina’s Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases.
 
What were the results of Winner’s Circle evaluations?

Process Measures
The following chart summarizes data collected about the Winner’s Circle Program from the pilot phase through 2004:
 

Schools Data
A robust evaluation of Winner’s Circle in schools was conducted in 2005 by the NC Division of Public Health. In addition to focus group interviews with parents, students, and teachers, child nutrition staff members were surveyed about the Winner’s Circle in schools program. The evaluation targeted 81 participating LEAs , engaging both child nutrition directors and supervisors at the district level and cafeteria managers at the school level. The survey response rate for child nutrition directors was 64% and for cafeteria managers, 49%. Results from the surveys included the following:

• Most participating Local Education Agencies (LEAs) have implemented Winner’s Circle (WC) in all or nearly all schools in the LEA (75 – 100% of elementary, middle, and high schools).
• Among responding Cafeteria Managers at all school levels (elementary, middle, and high school), the two most common daily services offered through the WC program were (1) labeling WC serving line side items and (2) offering fresh fruit and vegetables and labeling them as WC.
• Whether or not schools post daily WC meals varies significantly by school level (elementary, middle, high school), with 63% of elementary managers posting a daily WC meal compared to 37% of high school managers.
• 56% of Cafeteria Managers do not label all WC items offered in the cafeteria with the WC logo
• 78% of Cafeteria Managers reported that labeling meals/items for WC takes 10 minutes or less per day for their staff.
• 80% of Directors/Supervisors consider program participation to be “very easy” or “somewhat easy.”
• Among Directors/Supervisors, 84% did not report a change in the financial status of the Child Nutrition Program for the Local Education Agency as a result of WC. About 2% reported that the program’s financial status had improved as a result of WC. About 14% reported that the program’s financial status had worsened as a result of WC.
• Among Cafeteria Managers, 77% did not report a change in cafeteria revenue due to WC. About 10% reported that revenue had increased due to WC. About 13% reported that revenue had decreased due to WC.
• About 90% of Directors/Supervisors reported that the WC program has helped increase the number of available healthy pre-packaged a la carte foods and beverages.
• 87% of responding Directors/Supervisors reported that students eat/drink healthier with the WC program in place, especially elementary students. They attributed this more to a change in the cafeteria environment than to a deliberate behavior change by the students.
• 73% of Cafeteria Managers reported that students eat/drink healthier because of WC, especially elementary students.
   

2004 NC BRFSS Data
Winner’s Circle was also evaluated using three questions that were added to the 2004 NC Behavioral Risk Factor Surveillance System (BRFSS) survey. The questions targeted individual awareness and use of the Winner’s Circle Program by individuals in their community. The questions and response rates are summarized here:

1. Are you aware of the Winner’s Circle Healthy Dining Program as identified with a purple star and fork logo in restaurants, schools, convenience markets, worksite, vending machines and other places that you eat away from home?
N = 14,494
Yes: 1,844 (12.8%)
No: 12,650 (87.2%)

2. If yes, how did you hear of the Winner’s Circle Healthy Eating Program? 
N = 1,688
Restaurant - 34.6%
Worksite - 7.3%
School  -  6.2%
Television -  19.4%
 Other - 32.5%

3. Have you used the Winner’s Circle purple star and fork logo to choose a healthy meal or item when eating away from home?  
N = 1,814
Yes:  36.2%
No :  63.8%
 
(Because these questions were not included in subsequent surveys, trend data for Winner’s Circle awareness and use are not available.)
 

Qualitative data

Beaufort Community College: Roberson’s Vending implemented the Winner’s Circle Healthy Dining Program SM in January 2004 at Beaufort Community College Campus (BCCC) in Washington, North Carolina. The program targeted the snack foods available in vending machines throughout the campus as well as the food served in the cafeteria. All items were analyzed to determine if they qualified under the Winner’s Circle guidelines.  If they did meet the nutritional criteria, they were labeled with the Winner’s Circle purple star and fork logo.  New menu and vending items were added that met the Winner’s Circle criteria, and each of these qualified items was promoted as being a healthy option.  The program saw a huge amount of success (particular amongst employees), and there were even many requests for healthy catering at employee events.

Is the Winner’s Circle Program still operating? 
While the Winner’s Circle Healthy Dining Program^SM; is no longer an active program of NCPP, the lessons learned from developing the program have played a significant role in driving the next generation of healthy food environments. Building on the success of Winner’s Circle, NCPP launched two related initiatives in 2008 – the Healthy Food in Hospitals Program and WorkHealthy America^SM. Both of these programs include menu labeling components and are garnering national attention. As for Winner’s Circle,  NCPP does not currently track county activity related to menu labeling, but does receive calls periodically from local agencies who indicate they continue to use Winner’s Circle  tools to label menus locally.

What is NCPP’s Healthy Food in Hospitals Program (Red Apple Program)?

With support from The Duke Endowment, and in partnership with the NC Hospital Association, NCPP launched the Healthy Food Environment project (known as the Red Apple Project) in 2007, as part of NCPP’s Healthy NC Hospital Initiative.  This three-year initiative was aimed at establishing healthy food environments in hospitals across North Carolina. In order to earn a Red Apple Award, the hospital must increase access to healthy food, use pricing to promote healthy options, use marketing and nutrition labeling to identify good choices, and provide education and benefits to all staff and visitors throughout the campus.

The Winner’s Circle nutrition criteria were used as the basis for the Healthy Food Environment nutrition standard. Foods meeting these criteria are promoted as healthy in cafeterias, vending machines, catering menus, gift shops, and other campus venues.  Many hospitals promote these foods using their own branded wellness logo.  In some cases, hospitals that do not have their own wellness logo have used the Winner’s Circle or the Red Apple icon.

As of December 2010, 84 of North Carolina’s 127 acute care hospitals have achieved Red Apple status. Click here to see a current map of North Carolina Red Apple Hospitals.

UNC’s Center for Health Promotion and Disease Prevention has included a case study of the pricing element of this healthy food environment model on the Center of Excellence for Training and Research Translation website as a practice-tested intervention. Click here to view the case study.

The Division of Nutrition, Physical Activity and Obesity (DNPAO)of the Center for Disease Control and Prevention (CDC) has become interested in this initiative, and has asked NCPP to advise on a national advisory committee to consider how to create a national movement for healthy hospitals.  Additionally, in October 2010 NCPP began a contract with the DNPAO, in partnership with UNC’s Center for Health Promotion and Disease Prevention, to create sentinel surveillance indicators for employee-health promotion within hospitals in the areas of tobacco-free policies, cessation systems, healthy food, physical activity and supportive breastfeeding environments.   This contract will build on NCPP’s WorkHealthy America^SM, an online assessment and training and technical assistance product.  The WorkHealthy America^SM nutrition module will guide organizations to establish an evidence-based healthy food environment including menu labeling. Click here for more information.
 

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