'Salt and Eating Out: How salty is your food?'

As part of National Salt Awareness Week, on the 4 th February 2009 a lunchtime reception was held at the House of Commons to discuss salt and foods eaten outside the home. There were 125 guests including representatives from retailers, food manufacturers, caterers, non-government organisations, MPs and Peers, Department of Health, Food Standards Agency, media and other stakeholders.

Presentations

Mary Creagh, MP for Wakefield , Denby Dale and Kirkburton and sponsor of the event introduced the speakers:
Professor Graham MacGregor, Chairman of CASH
Dr Will Cavendish, Director of Health and Well-Being, Department of Health
Dame Deirdre Hutton, Chair, Food Standards Agency
Anton Edelmann, Chef

Mary Creagh, MP

Mary Creagh thanked everyone for attending the Annual Salt Awareness Week Reception and introduced the speakers starting with:

Professor Graham MacGregor, Chairman of CASH

Professor MacGregor thanked Mary Creagh for sponsoring the 10 th Salt Awareness Week Reception. He also thanked the speakers; Dame Deirdre Hutton, Anton Edelmann and Dr Will Cavendish, stepping in for Dawn Primarolo, MP at the last minute. Particular thanks were extended to the financial sponsors who make the event possible: The British Heart Foundation, Food Standards Agency, Asda, Autograph food service, Avenence Elior, Lo-Salt, Marks & Spencer's, McCain, Pepsico, Sainsbury's, Sodexo, The Co-operative Group and Waitrose.

Professor MacGregor then welcomed the winners of the CASH trainee chef award, Bruce McFarlane, lecturer from Hastings College and Sarah Everidge, student at Weymouth College , who answered a CASH questionnaire about trainee chefs' opinions on the issue of salt, and its use in cooking.

Professor MacGregor went on to outline why the issue of salt intake is so important, explaining that salt is the major factor in increasing blood pressure, which in turn is the major cause of stroke, heart attack and heart failure which together remain the biggest cause of death and disability in the UK.

Professor MacGregor went on to say that we are at a tremendous disadvantage when 80% of the salt consumed is hidden in foods, reducing the public's right to have a say in the amount of salt in a meal, as this makes it very difficult for people to reduce their salt intake. From a public health point of view, however, if the food industry can make gradual reductions of salt over time, this will slowly reduce the salt intake of the whole population. That is what is happening in the UK , and salt intake has fallen in the past four years, in adults and children alike, without a change in the foods they are eating. From a public health perspective it is fantastic because we are able to affect a dangerous thing in our diet without having to ask people to change the foods they are buying.

Professor MacGregor extended congratulations to the food industry for the reductions they have made, pointing out that the majority of foods looked at in the CASH surveys have had a reduction of approx 20-30% in the last 4 years which is a major achievement. However, Professor MacGregor went on to say that although this is a major achievement, it is not enough, as the 6g target is not being met with these reductions. Therefore it is vital that the Food Standards Agency resets more challenging salt targets and that the food industry gets onboard so that the 6g target can be achieved by 2012. This will achieve a major reduction in strokes, heart attacks, heart failure, unnecessary death and suffering. Professor MacGregor went on to say that we are setting an example to the rest of the world, as here in the UK we are leading the way in salt reduction programmes, therefore all of the companies involved should be very proud.

Professor MacGregor proceeded with an explanation that a major area that has been missed out so far is foods eaten outside of the home. With the diffuse nature of this industry, and the large numbers of people involved, this has been difficult. However, it is an area that both CASH and the Food Standards Agency will be focussing on over the next two years, including restaurants, pubs canteens, fast food and take-away outlets.

Professor MacGregor then referred the audience to the recent survey work carried out by CASH along with David Pickering and Sue Harvey from Trading Standards, looking at the salt content of popular dishes purchased from a selection of mainstream UK restaurant chains, the results of which were alarming. The worst examples were a single course containing 8g salt, and a three course meal containing 15g salt. Even the lowest meals tested were around 3g salt, which is half the recommended maximum adult intake, and far more than half for most children. Professor MacGregor pointed out that this is a huge amount of salt in foods, which could be easily reduced, by 20% immediately, as this would not be detectable by the general population. Then in a year's time a further 20% reduction could be made, achieving the 40% reduction target – Just as the food manufacturers and retailers are working towards.

Professor MacGregor concluded by asking Dame Deirdre Hutton and the Food Standards Agency to set salt reduction targets for meals eaten outside of the home, in order to bring them in line with the targets that the supermarkets have been working towards with their ready prepared meals over the past 4 years. Also in line with the New York City pilot, Professor MacGregor urged the Food Standards Agency to push for full nutrition labelling for restaurant meals, rather than just calories so that the public can make informed menu choices. Professor Macgregor then urged everyone to ask for less salt when eating out; after all, would a waiter add sugar to coffee without asking? Why not ask them for a meal with no added salt?

Finally, Professor MacGregor announced that World Action on Salt and Health ( WASH ) now has 27 countries on board, supporting Salt Awareness Week.

Dame Deirdre Hutton, Chair, Food Standards Agency

Dame Hutton thanked Mary Creagh for supporting the Salt Awareness Week event year on year, and went on to praise Professor Graham MacGregor, for the challenges he sets the Food Standards Agency and the work he carries out, then thanked him for his compliments to the Food Standards Agency. Dame Deirdre said that it was great to hear that the work of the Food Standards Agency is heralded around the world and that the UK leads by example. Where we lead today, others will follow tomorrow, she said, especially as many of the food manufacturers are global therefore this is a significant gain.

Dame Hutton went on to highlight the importance of striking a good balance, between campaigners, the food industry, consumers and government. She said she feels that we are in a position of good understanding at the moment with real levels of commitment which was illustrated by the people attending the reception. She then went on to say that it is absolutely critical that this good working relationship continues in order to achieve change.

Dame Hutton highlighted the fact that this year's Salt Awareness Week is focussed on the salt in foods eaten outside of the home, in restaurants, canteens, pubs and take-away outlets. Then she went on to highlight the success of campaigns aimed at reducing salt in shop bought foods, which deserves a pat on the back.

Dame Hutton continued by explaining that the latest research indicates that salt intake has decreased from 9.5g in 2000, to 8.6g in 2008, which sounds small but it actually represents 6000 lives per year! This just goes to show what can be achieved; however she admitted that as professor MacGregor mentioned, there is more work to do in order to reach the 6g target which leads us to target food eaten outside of the home. It's no good targeting one food sector, and not others. A level playing field is needed so that consumers' taste is adjusted to acceptable levels, both in and out of the home. Many retailers and manufacturers have made real strides in this area, and credit must be paid to those organisations. However, according to Food Standards Agency figures, some organisations have gone much further and faster than others. We know it can be done, and we know that those that have not made the changes can do more. These companies know who they are, and we hope to see a shift that will create a more level playing field in the near future, particularly in the more popular products.

Dame Hutton then highlighted that there were sponsors and retailers present at the reception that have committed to meeting the current voluntary salt reduction targets by 2010. Manufacturers like Pepsico that have reduced the salt in their Sensations range by 40 percent, and between 25-55 percent out of a range of their snacks. Also McCain who after a recent consultation said that they would be willing to work towards the proposed revised targets for 2012. The message to gain from that is that where the Agency sees companies doing well, they are more than willing to ‘name and fame' and really praise these companies, praise which can only be welcomed by consumers, therefore the seal of approval from the Food Standards Agency is well worth having.

Dame Hutton went on to explain that we are eating out more than ever before, therefore attentions are now turning to the eating out and catering industry. Not just focussing on posh restaurant meals, as 1 in 6 meals are now eaten outside of the home according to last year's ‘Food Matters' report. Therefore in the last 18 months the Food Standards Agency have extended their partnership work to include restaurants and catering businesses. Autograph, Avenance and Sodexo are among the sponsors for this event, all of which were among the first to make public salt reduction commitments for all of their workplace contracts. This work has progressed, so that commitments have been secured from the UK 's largest quick-service restaurants; McDonalds, Burger King, KFC, Wimpy, Nando's and Subway. In the near future similar commitments are going to be published from major pub chains, coffee shops, sandwich outlets and family restaurants. This all goes to show that the industry is beginning to take salt reduction seriously.

Dame Hutton then looked forward, stating that partnership working is critical to continue to under-pin the work that the Food Standards Agency and the Department of Health have carried out. And while the Agency appreciates the challenge that meeting these targets presents, they have also been encouraged by the willingness of the industry to work with them, therefore they want to encourage everyone to continue the very positive work that has been done so far, and to keep pressing forward.

Encouraged by the fact that the work carried out is being recognised beyond our shores, particularly in Brussels , where most of our food legislation comes from. Dame Hutton went on to say that the issue of salt reduction is very much on the Commission's radar, where they are looking to reduce salt in foods like bread meat, cheese and ready meals by 16% across the community. Therefore, here in the UK we are leading the field, and this is very much to the credit of Professor MacGregor and his team and indeed many in this room.

In conclusion, Dame Hutton asked that everyone remembers why we are doing this; behind the figures and the consultations, the debate and detail are real people, whose health can be improved, whose lives can be saved, better quality of life is a goal that is worthy of all our efforts in reducing salt in foods.

Dr Will Cavendish, Director of Health and Well-Being, Department of Health

Dr Will Cavendish thanked Mary Creagh for the introduction and made apologies for Dawn Primarolo who was unable to speak at the event due to illness. He then went on to say that the salt strategy has been a great success, with a 10 percent average reduction since the year 2000, therefore huge congratulations to Dame Deirdre Hutton and the Food Standards Agency for the strong leadership they have shown on this issue.

Dr Will Cavendish then went on to say that it is a great example of industry, government, campaigning organisations, independent experts and organisations like CASH that work together to get a result. At the Department of Health they are seeking to build coalitions for better health, to help tackle major issues like alcohol and obesity, therefore the example of salt really stands out as something than can be learned from. The global attention shows that the UK is best in class and is a tribute to the people in this room that are responsible.

Dr Will Cavendish continued by stating that government is committed to the goal of 6 grams, which will save tens of thousands of lives each year, contributing to a significant improvement in public health. He then went on to reassure everyone concerned that they will receive very strong ministerial backing when seeking to continue.

Dr Will Cavendish then went on to speak about ‘Change for Life' and the coalition of grass roots activists, local government, major corporations, government and the Food Standards Agency, all combining together to tackle obesity. He confirmed that a lot has been learned from the salt campaign, therefore the work that has gone on so far is extremely important. , He then went on to reiterate the message that reaching the 6 gram goal is of great importance and will gain ministerial backing.

Anton Edelmann, Chef

Anton Edelmann started by outlining the fact that salt is a flavour enhancer and that the main problem faced, both in the home and the professional kitchen is the fact that people overdo it with salt. A little is good and too much is bad. Cheap ingredients can lack flavour therefore added salt can enhance the flavour, but will result in a dish that is not very good for you. However the way around this is to tease out flavours in other ways such as adding oils, herbs and spices.

Anton went on to add that he feels the main way to tackle this is to aim the salt reduction message both at people cooking at home as well as where chefs are educated. Currently there is nothing in the way of education to budding new chefs, therefore colleges need to start teaching about the issues surrounding salt. Anton went on to say that the quality of the food can be an issue, where low quality foods have more salt added, and that fresh foods are best. You get what you pay for.

The second issue he mentioned was about encouraging the public to ask chefs not to add salt; he then went on to say that in his restaurant salt cellars have been taken away from the tables, making diners ask if they require it. Staff in his restaurant tell him that salt is rarely asked for. Anton concluded by congratulating the industry for the changes that have already been made, and then went on to highlight the importance of salt education in school.

Question and Answer session

Q1) Question from Bruce McFarlane, Hastings College
What are the government going to do to help encourage students to reduce the amount of salt used in their cooking?

A1) Dr Will Cavendish, Department of Health
Admitted that this is not something that the Department of Health have looked at and that they will take this message away and discuss with colleagues

A1) Mary Creagh, MP
Also stated that the government have recently been discussing the curriculum in FE colleges, therefore this could be something she can raise with her colleagues

A1) Professor Graham MacGregor, Chaiman, Consensus Action on Salt and Health
Went on to add that it really must be up to the individual colleges to add this serious matter of food and health into their own curriculum, rather than waiting years for direction from the government or Department of Health. The issue is of great importance and that he would be happy to help devise some educational materials along with Mr Bruce McFarlane for his students in order that it can be integrated into the course ready for the new intake of students.

Q2) Professor Sever, Cash Member, Imperial College
Referred to a point previously made by Professor MacGregor about the link between salt intake and the increased consumption of sugary drinks, indication that some food and beverage companies may be resistant to making the salt reduction changes. Do any food manufacturers want to comment?

A1) Professor Graham MacGregor, Chaiman, Consensus Action on Salt and Health
Highlighted the research carried out, which showed an indirect link between salt and obesity. He then went on to state that Pepsico are leading the field in reducing salt in their snacks, even though they have both food and drink brands

A2) Dame Deirdre Hutton, Chair Food Standards Agency
Illustrates the complexity of the issue, and the importance of integrated work with the Department of Health

Q3) Juliette Kellow, Freelance Nutrition Writer
Is this a sourcing issue? Are the foods ordered from outside UK higher in salt?

A3) Professor Graham MacGregor, Chaiman, Consensus Action on Salt and Health
Highlighted this as an issue, but placed the responsibility of sourcing healthy ingredients with the food industry (the largest industry in the UK )

Q4) Question from the audience
Is the target of 6 grams going far enough?

A4) Dame Deirdre Hutton, Chair, Food Standards Agency
Lets get down to 6 grams then ask that question!

Comment) Ian Wasson, Chairman, Local Authority Caterers Association (LACA)
Emphasising the work that has gone on in schools to ensure they are getting a reduced salt, healthy balanced meal.

Comment) Mary Creagh, MP
Asking that this work reaches further to include under 5 centres as well.

Comment) Sarah Jane Staines, The Academy of Culinary Arts
Emphasising the point that Anton made about the importance of education about salt and sugar from 5yrs upwards. Then went on to highlight a new campaign they are involved in called FEAST.

Comment) Jackie Schneider, Children's Food Campaign Coordinator, Sustain
Highlighted the importance of parental responsibility when packing a school lunch as many children are consuming very unhealthy products that are very high in salt. Also urging the Department of Health to give strong guidance to schools about education on salt and health.