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1. Vending Machines and
Health Systems
Controversies and Concerns
XXX

2. 12/08/09 2
Obesity is on the rise
15
32.2
43.8 45.3
0
10
20
30
40
50
% Overweight/Obese
1971
2-4 years
5-11 years
12-19 years
Percent overweight and obese Contra
Costa County children 2 – 19 years
Pediatric Nutrition
Surveillance
2008

3. 15
40.1
35.1
46.3
0
10
20
30
40
50
%Overweight/Obese
1971
White
Black
Hispanic
children ages
5-8 by
ethnicity
Pediatric Nutrition
Surveillance
2008
Health Disparity Emerges

4. Vending machines in hospitals
 7% of all US vending machines in hospitals
and nursing homes
 California laws do not regulate nutritional
content
 Profit pressures correlate
with quality
 Beverage vending
agreements vs. food
vending agreements

5. Vending machines at CCRMC
 Patient access machines located in
Richmond, XX Health Centers, CCRMC
cafeteria
 Unknown profit
 No contract
 County provides electricity,
space, disposal of waste,
associated cleaning costs

6. Vending machines standards
• County Healthy
Vending policy passed
2004
 50% “Healthy”
drinks, snacks
 Public health audit
2007- 20% compliance
 Best selling items:
Cheetos, Doritos, Lays
Classics, soda, candy

7. XX Health Center
“They are often
eating chips in
am clinic visits”
XX Survey:
-Cookies, chips
and sweetened
drinks are
commonly
brought to XX

8. XX Health Center
 43.7 of Fifth graders are overweight
XX Unified
School District
5th graders
Healthy Kids
Survey
2006

9. Obesity Efforts
XX Health Center
•80% of providers report
counseling almost all patients
to avoid sweetened drinks
•Soda Free Summer campaign
•Prenatal Sweet Success program
•Diabetes registry
•Pediatric Obesity QIP
•FIT resident grant
•NEW Kids program

10. Obesity Efforts
XX Health Center
•XX social marketing
campaigns
• Have Fun and Be Healthy
• Have Fun and Be Active
• Healthy Drinks
New food package introduced
October 2009:
More breastfeeding support
Less juice
More fruits and vegetables

11. 12/08/09 11
Soda – Should we sell it?
 Increases likelihood of being
overweight or obese
 Density of fast food
restaurants and convenience
stores correlates with obesity
and diabetes
 Highest consumption among
children from low income
families, Latino

12. 12/08/09 12
Soda – Should we sell it?
Concord 44.2
Richmond 46.1
San Francisco 36.9
Bakersfield 60.1
•49% of California children
consume one or more
sweetened soda daily
•Childhood consumption
increasing annually
•Soda, fruit juice and
sweetened beverages
provide an average of 270
extra kcal/day (10-15% total)
Percent of Children and Adolescents 2-17
years drinking one or more sodas per day

13. 12/08/09 13
Health impacts for children
 Dental caries associated
with frequent consumption
of sugary foods
 Higher rates of fractures,
osteoporosis
 Highest risk groups: low
income, Latino, African -
American, uninsured

14. Sweetened Drinks survey
 100% of health professionals surveyed felt
sweetened drinks were a problem
 Most providers discuss the harmful effects of sugar
and sippy cups
 Inadequate time, parental disinterest and easy
access to junk food limit counseling effectiveness
 Culturally appropriate tools and
vending machine restrictions would
assist providers in addressing this
issue

15. Counseling Patients
Barriers
Top Five:
 Parental disinterest/overwhelm in setting limits for
children
 Parental disinterest/overwhelm in promoting
health
 Lack of adequate time to counsel
 Lack of culturally relevant, up to date educational
materials/counseling tools
 Awareness that families may not have the
resources to buy healthy drinks

16. • Department of pediatrics worked with Public
Health and CCRMC dietary department in
2008 to develop 100% Healthy vending policy
• Based upon SB 965, SB 12 School standards
• Passed by MEC as part of the pediatric
obesity quality improvement initiative
October 2008
• Implemented by CCRMC cafeteria vending
machines October 2009
100% Healthy Vending Policy
“A supportive environment helps individuals make positive
behavioral changes and models the importance of healthy
lifestyle choices for patients and families”

17. Nutritional Environment
• Food environment may influence health and
nutritional choices
• Formula and the perinatal unit,
• Cigarettes and smoking at health centers
Make the healthy choice the easy
choice

18. Conclusion
 Vending machines in clinics provide convenient
foods to patients and profit to the health system.
 Providers in the clinic are actively educating
patients about the hazards of soda and unhealthy
snacks but feel undermined by the presence of
machines in the lobby selling junk food
 Our health system should move towards a 100%
healthy vending policy in all patient access
machines and model a healthy nutritional
environment our patients