The Dietitian who Guarantees "Eating Well"
  • Country – France
       
    In France, the National Food Program (French PNA), presented by the Government in September 2010, mobilized all the actors to guarantee a healthy, safe and environmentally conscious diet for all: "Eating Well this is everyone's business."
     
    The PNA is also committed to promoting the French Culinary heritage.
     
    One of the main intentions of the PNA is to facilitate access to healthy food for all, especially for those who cannot manage the content of what they eat, like the 6 million students who eat in canteens from kindergarten through high school.
     
    In this context, the General Food Directorate wished to promote a varied and balanced diet, and tailored to the needs of children in school canteens by mandating compliance with nutritional rules (meals composition, variety and frequency of meals, portion size).
     
    In 1999, the first official nutritional recommendation was published by the Standing Group for the Study of Foodstuffs Market (French GPEMDA). This very first version targeted only school meals.  In 2001 the National Education Body disseminated to school leaders, "Circular of the school" which incorporated and completed the first dietary guidelines (frequencies and portion size weights). This document talked about a balanced diet, food safety, nutrition education and taste education, as well as the inclusion of specific medical plans through an Individualized welcome Project (French PAI).

    In 2007, the Market Catering & Nutrition Study Group (French GEMRCN formerly  GPMEDA) published new recommendations which were part of the strategy of the National Nutrition and Health Program (French PNNS) on the prevention of nutrition-related diseases, including overweight and obesity.   This new version, drafted with the active participation of several dietitians, covered all the catering from early childhood through the elderly in institutions whose needs are very specific.  In 2011 these recommendations formed the basis for the law and the decree of September 30, 2011 for restaurants serving over 80 meals.    
     
    The quality and nutritional balance objectives of served meals, according to this decree are:

    • Ensuring dietary fiber and vitamins: promoting consumption of fruits and vegetables at every meal
    • Reducing fat intake and rebalancing fatty acids: reducing consumption of  processed meats, fried foods and pre-fried pastry entrĂ©es and pastries for dessert  
    • Decreasing consumption of simple carbohydrates: preferring fresh or cooked fruit, or choosing slightly sweet pastries for desserts
    • Increasing intakes of iron and trace elements: providing non chopped red meat (beef, lamb and veal) at least once a week, and organ meats.

     
    To achieve the quality and nutritional balance objectives of served meals, the decree requires the frequencies of appearance of dishes and weights with respect to the delivered ready-to-eat products.  This entails:

    • Ensuring meal structure: four or five dishes on every lunch or dinner, including a main course with vegetables, starch and a dairy product.
    • Ensuring a minimum intake of calcium with a dairy product at each meal (calcium> 100mg/portion)
    • Limiting frequency of high-fat meals (eg giving only 4 fried products on 20 meals)
    • Ensuring variety of served dishes
    • Adapting appropriate portion sizes of dishes to suit each age group of consumers.
    • Providing unrestricted water and free access to bread.
    • Not providing salt and sauces in self-service.

     
    The above objectives influence the purchase of products (salads or entrĂ©es with less than 15% fat, main course with a good protein level, dairy product with sufficient amount of calcium and limited fat, and so on)                                                                      
     
    The dietitian ensures the implementation of these recommendations in cooperation with the kitchen staff. He also trains territorial agents (cooks, service agents) who will have to implement these recommendations in the communities.    Control checks are carried out by veterinary service agents who usually check the hygiene procedures provided they have been previously trained to these new nutritional regulations. Beyond improving nutritional meals, complementary actions are carried out by dietitians to meet such expectations and student needs, for example in terms of taste education, information, etc.
     
    Conclusion                                                                                                                                   
    The Dietitian, rich in nutrition knowledge, cooking and hygiene procedures as well as catering, is a key player in Public Health for the communities.   
     
    Therese Libert, Florence Rossi, Delphine Le Gonidec                                                                              
    French Association of Nutritionist Dietitians (AFDN)  
    afdn@afdn.org
     
    References    
    www.agriculture.gouv.fr
    www.frenchfoodintheus.org/spip.php?article3038
    www.campusresponsables.com/sites/default/files/GEMRCN.pdf
    www.sante.gouv.fr/nutrition-programme-national-nutrition-sante-pnns,6198.html