Menu Planning: Calories and Portion Sizes

Updated: January 2019

Overview: The certified dietary manager (CDM) has a critical role in providing safe, appealing, & appropriate food to their customers. With today’s consumer demands, combined with emerging health care needs, this is a vitally important skill for the CDM. The CDM has a key role in developing, analyzing, and implementing their facility’s menu, along with training and evaluating their staff in proper production and service of the menu. The Menu can be viewed as the Foundation of the Department. The menu is an outline of food items that are offered by the foodservice department. Regardless of whether you offer a cycle menu, a set menu, a selective menu, or a room-service menu, it is still a list of food items from which calories and portion sizes can be determined.

Supplemental Material: Access the Gap Analysis Tool to supplement your practices.

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Standard 1

The certified dietary manager (CDM) shall implement a menu & production schedule to serve nourishing, safe, culturally & clinically appropriate food to their customers. Customers may be considered patients, clients, members of the public, or employees.

Criteria

Implement & Evaluate

1.1 The menu will include a variety of food items from day to day.

Resources:
✓ Software from vendor
✓ Standardized Menus as written or purchased and approved by RDN

1.2 The menu will honor individuals’ personal preferences, religious customs, cultural practices and diet choice.

Resources:
✓ Food acceptance surveys/Menu Score Cards
✓ Plate Waste Studies
✓ Resident Counsel Feedback
✓ Sales Data
✓ Input from customers
✓ Input from employees
✓ Assessments and CMS guidelines for LTC

1.3 The menu will consist of meals that comply with specialized diet orders according to the facilities approved diet manual.

✓ The facility diet manual should be reviewed and approved by the Administration and/or Registered Dietitian (RDN) yearly.

1.4 The menu will include local and seasonal foods and will be updated on a regular basis to incorporate these options.

1.5 The menu will include a variety of preparation methods, colors, textures and flavors.

Is there a variety of?
✓ Color
✓ Shape
✓ Texture
✓ Seasoning
✓ Flavor
✓ Consistency

Also note:
✓ Plate Coverage
✓ Food Group Balance

1.6 The general menu should meet governmental standards such as MyPlate or Dietary Guidelines for Americans.

✓ CDM prepares a written procedure to determine menu item costs using either the Contribution Margin or Cost Percent method

1.7 The menu is written so that staff can prepare and serve the food with available resources and equipment.

1.8 The menu will be meet the clinical needs according to the physician diet order.

✓ Liberalize diet orders as requested by customer or to improve nutritional care.
✓ Document all diet changes in the medical record.

1.9 The menu will be written for the type of customer the foodservice operation serves.

The following are resources available, however this list is not all-inclusive. The CDM, in partnership with their RDN, will utilize resources that apply to their facility and customers.

LTC/SNF/Acute Care

Dysphagia

National Dysphagia Diet
Academy of Nutrition & Dietetics Nutrition Care Manual
Download

Diabetes

Diabetes Meal Plans and a Healthy Diet
Download

Meal Plan Diabetes 2,000 Calories
Download

Renal/Kidney Disease

Kidney Disease Stages 1-4
Download

School Foodservice

School Nutrition
Download

Nutrition Standards School Meals
Download

Special Diet Checklist for Schools
Download

Corrections

Federal Regulations
Download

1.10 Appropriate staff of the dietary department will be trained on proper substitutions of the menu if items are missing or run out.

Competency Training:
✓ CDM trains staff on menu substitutions and documentation
✓ CDM documents competency training/in-service attendance and competency skill testing evaluation
✓ CDM keeps records in the department
✓ Honor food substitution requests by customers

1.11 Appropriate staff of the dietary department will be trained & evaluated on proper food preparation techniques, service, and presentation.

Competency Training:
✓ CDM trains staff on all culinary aspects of their position
✓ CDM documents competency training/in-service attendance and competency skill testing evaluation
✓ CDM keeps records in the department

Standard 2

The certified dietary manager (CDM) shall have calorie and macronutrient composition for menu items available on record and available for customers as requested. The CDM shall have processes and/or software to analyze menu items or utilize menu programs that include this function.

Criteria

Implement & Evaluate

2.1 The CDM works with the Registered Dietitian Nutritionist (RDN) to implement processes or software to analyze menu items for calories and macronutrient (carbohydrate, protein, fat) composition.

Resources:
✓ Menu Planning Software from vendors
✓ USDA Dietary Reference Intakes (DRIs) (www.nap.edu/catalog/dri/)

2.2 The CDM has caloric and macronutrient composition available for consumer review.

✓ Menu analyzation documents
✓ Menus with calories or macros posted

2.3 Therapeutic menus are approved by the RDN.

✓ Signature of RDN on menus annually or more often as menu cycle changes

2.4 The regular/general diet menu should provide calories according to the approved facility policy.

✓ Menu with nutrient data (including calories and all or some micro and macro nutrients)
✓ Example language in policy: The General Diet will provide 1,800-2,200 calories, 65-80 grams of protein, 60-72 grams of fat, and 250-300 grams of carbohydrate daily, not including snacks.

2.5 All staff that serves food items are trained and evaluated on proper serving sizes for all meals.

Competency Training:
✓ CDM trains staff on serving sizes and service tools
✓ CDM documents competency training/in-service attendance and competency skill testing evaluation
✓ CDM keeps records in the department

Documents:
✓ Production Schedules
✓ In-service records and certificates
✓ Test Trays/Meal Audits

Tools:
✓ Proper Serving Utensils
✓ Charts or Graphs: serving scoops and spoons

2.6 Menus have options for small, regular and large portion sizes.

✓ Diet order should reflect small or large portions and reason for change
✓ Charts comparing small, regular and large portion sizes for all food groups (example: cooked vegetables ¼ cup small serving, ½ cup regular serving, ¾ cup large serving)



References:

Molt, Mary. Food For Fifty. 14th Edition. Pearson, 2018.

Legvold, Dee, and Salisbury, Kristi. Foodservice Management by Design. Association of Nutrition & Foodservice Professionals, 2nd Edition, 2018.

Kristin Klinefelter, MS, RDN, LD has been in the dietetics field for 20 years, working in a variety of consulting and education capacities. She has been working with the University of North Dakota's Nutrition and Foodservice Training Program for ten years and served on the Certifying Board for Dietary Managers (CBDM) for six years.


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