Focus on Restaurants Engagement to Strengthen Health (FRESH)

FRESH stands for Focus on Restaurant Engagement to Strengthen Health. It is a study funded by the National Institutes of Health aimed at improving the diets of customers who purchase food and beverages at independently owned restaurants. The priority areas for FRESH are predominantly low-income urban neighborhoods in Baltimore and the Washington DC metropolitan area.

FRESH is a 5-year project that is funded by the National Institutes of Health through 2027.

The FRESH intervention has officially begun!
We are actively partnering with local restaurants in the DC and Baltimore areas, working closely with restaurant owners, staff, and community members to implement healthier menu options and cooking practices. This collaborative approach ensures the intervention is community-driven and sustainable.

The FRESH study’s primary outcome is to increase participants’ overall diet quality by 5 points on the Healthy Eating Index (HEI) scale through improved access to healthier food and beverage options at participating restaurants.

Beyond our primary outcome of improving diet quality by 5 HEI points, our comprehensive
approach involves:

Our focus is on improving access to healthier foods and beverages in independently owned restaurants, particularly aiming for a 5-point increase in customer HEI scores. We will measure changes in restaurant sales and examine how the project affects regular customers, as well as the restaurant staff and owners. To accurately assess dietary improvements, we are using dietary recalls and the Veggiemeter®, a validated tool that measures skin carotenoid levels as an objective biomarker of fruit and vegetable consumption.

Over 5 years, FRESH will collaborate with 24 restaurants to increase access to and promotion of healthful foods. We will engage with community members and organizations in Metro DC and Baltimore to maximize the impact of our project. We aim to ensure sustainability and community support. To facilitate this, we created Community Advisory Boards (CABs), which include:

• Residents and neighborhood association members of the eligible study site neighborhoods
• Owners of restaurants in eligible neighborhoods
• Non-Governmental Organizations working in health and well-being
• Representatives at the city and county levels

The FRESH study team will gather information to help create a simulation model to use in various urban settings, aiming to promote healthier menu options in independently owned restaurants. This model will act like a map to illustrate how different components of a system interconnect and influence one another.

The Quality of Menu Offerings in Independently Owned Restaurants in Baltimore, Maryland: Results from Mixed-Methods Formative Research for the FRESH Trial

Read the full publication on MDPI ↗

Publication Overview:
This formative research study involved interviews with 14 Baltimore restaurant owners and analysis of menu offerings to inform the design of the FRESH intervention. The study found that healthy options were severely limited, with only 17.5% of food items and 27.6% of beverages classified as healthy across the restaurants studied. While restaurant owners were open to some changes, such as using healthier cooking fats, they showed reluctance toward reducing sugar and salt or adopting non-frying cooking methods. These insights were instrumental in shaping the FRESH intervention to ensure that proposed menu changes can be feasible to implement.

Design of the Focus on Restaurant Engagement to Strengthen Health (FRESH) study: Leveraging systems science to work with independently-owned restaurants to increase access to and promotion of healthful foods.

Read more about the study on Frontiers ↗

Publication Overview:
This FRESH study is a multisite cluster randomized controlled trial designed to address the complex challenge of improving dietary quality in racial and ethnic minority communities with lower incomes, where independently owned restaurants are a primary source of prepared food. The intervention employs systems science approaches and consists of 3 phases: restaurant engagement, low-sugar beverages, and healthy meals. This intervention will be implemented over 12 months across 24 intervention restaurants and 24 comparison restaurants in Baltimore and the Washington DC metropolitan area.

Please visit the FRESH Instagram page to learn more about what is happening in restaurants and the communities where FRESH works!