A review of recipes provided on the Healthy Start website

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1 A review of recipes provided on the Healthy Start website Georgia Machell and Caroline Donovan March 2013 novafir

2 First Steps Nutrition Trust March 2013 ISBN This report was written by Georgia Machell and Caroline Donovan. First Steps Nutrition Trust 112 Queens Road London SW19 8LS E: Registered charity number: A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 1

3 Contents Summary 3 1 The Healthy Start scheme 4 2 Recipes on the Healthy Start website 5 3 Practical testing of a selection of Healthy Start recipes 15 4 Conclusion 23 5 Recommendations 23 2 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

4 Summary The Healthy Start scheme provides vouchers to young and low-income pregnant women and those with children up to the age of 4 years. The vouchers can be used to buy, or to contribute to the purchase of, fresh cows milk, fresh or frozen plain fruit and vegetables, and infant formula. The Healthy Start website ( provides information to beneficiaries and to health professionals about the Healthy Start scheme and includes recipes which aim to provide ideas for using milk, fruit and vegetables for easy and quick meals. Healthy Start is a UK-wide scheme but the website is managed by the Department of Health. The recipes are one of the key sources of practical support for those in receipt of Healthy Start vouchers and are likely to be used not just by beneficiaries visiting the website but also by health care practitioners and others who support young and low-income pregnant women and families with children under the age of 4 years. This review summarises the recipes available on the Healthy Start website in February 2013, considers how they were presented and explained, and how they related to the purchase of items as part of Healthy Start. Also, a selection of recipes was tested to consider their practicality and to see whether the outcome matched information given on the website. The recipes on the Healthy Start website in February 2013 did not appear to have been adequately tested, did not provide sufficient information to support beneficiaries, and in some cases were not fit for purpose. The following issues emerged from this review: The quality of the recipes was poor in places. Language used to describe measures of ingredients was not consistent and the methods given were often vague and confusing. There was no clear information on whether recipes were a complete meal or part of a meal, and no indication of how recipes might be used to meet the needs of different family members. There was no information on how much it would cost to make each recipe, and recipes did not seem to take account of the fact that the target audience are in low-income households. Some of the recipes appeared to require a considerable amount of equipment and heat energy. Some of the tested recipes did not work in practice, meaning that the ingredients did not always go together well, resulting in food that was unpleasant in texture and/or taste. The photos that accompanied the recipes on the Healthy Start website did not always reflect the recipe ingredients. The portion size data given for some recipes were inaccurate. As these recipes are currently the primary resource for supporting the use of Healthy Start vouchers, it is recommended all recipes should be double-tested and thoroughly edited and that consideration is given to providing complete information on how much it costs to make each recipe, how the recipes relate to Healthy Start voucher use, and how they can meet the needs of all family members. A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 3

5 1 The Healthy Start scheme Healthy Start is the welfare food scheme for young (aged under 18 years) and low-income pregnant mothers and families with children up to the age of four. It is designed to reduce health inequalities and empower expectant mothers and families with young children to make long-term healthy changes to their diet. The scheme is described as a nutritional safety net. 1 Eligible beneficiaries are signed up to the scheme by registered health professionals (midwives, health visitors, GPs and nurses) from 10 weeks of pregnancy, and every four weeks beneficiaries receive four food vouchers worth 3.10 each that can be spent on fresh or plain (unsweetened) frozen fruits and vegetables, liquid cows milk, and infant formula. As well as food vouchers, beneficiaries receive a coupon every 8 weeks that can be exchanged for free maternal and infant vitamins. Table 1 outlines the benefits available as part of the Healthy Start scheme. Table 1. Healthy Start benefits food vouchers and vitamin supplements (February 2013) Beneficiary Food vouchers Vitamin supplements Expectant mother One voucher ( 3.10) per week Infant 0 6 months Two vouchers ( 6.20) per week Infant 6 months 1 year Two vouchers ( 6.20) per week Child 1-4 years One voucher ( 3.10) per week Free Healthy Start women s vitamin tablets that contain folic acid, vitamin D and vitamin C. In certain circumstances free vitamin supplements may be provided to infants under 6 months old who are entitled to Healthy Start vouchers, if healthcare professionals consider that their vitamin stores are likely to be low and that the supplements would benefit them. Free Healthy Start children s vitamin drops that contain vitamin A, vitamin D and vitamin C are advised daily for all breastfed babies over 6 months of age and for formula-fed babies receiving less than 500ml of formula per day. Free Healthy Start children s vitamin drops that contain vitamin A, vitamin D and vitamin C are advised daily for all 1-4 year olds. The food voucher aspect of the Healthy Start scheme was designed to enable families to choose and buy foods that add nutritional value to their diets at crucial points in the life cycle. It is acknowledged that beneficiaries require some practical support and advice to get the most out of their vouchers. The Department of Health offers a range of leaflets which provide some information and which can be ordered for distribution by health care professionals. It also offers information, on the Healthy Start website, for both beneficiaries and health care professionals. The main source of information on healthy eating and practical use of the foods that can be bought with the vouchers is on the website, and general information is provided on healthy eating in pregnancy, introducing solid foods, milk and fruit and vegetables. The Recipes section is one of the six key headings on the Healthy Start home page. 1 Department of Health, [ accessed February A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

6 2 Recipes on the Healthy Start website In February 2013 there were 28 recipes available on the Recipes page of the Healthy Start website No source is given on the website for these recipes. Figure 1 illustrates how the recipes are presented on the Healthy Start website. Figure 1. Healthy Start Recipes page 2.1 Review of recipes available on the Healthy Start website Table 2 summarises the recipes that were signposted at in February The introduction to the recipes states: There are lots of delicious things you can make with the milk, fruit and veg you buy with your Healthy Start vouchers. Why not try something new today? We have pulled together some easy and quick recipes and will put new recipes up all the time so don t forget to come back and look again. Remember if you can t find the fresh fruit and veg you need for a recipe why not try frozen? A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 5

7 The website in February 2013 contained 5 Milk recipes, 1 Egg recipe, 2 Fruit recipes, 12 Vegetable recipes, and 8 Introducing solid foods recipes. 2.2 Missing recipe information Five of the recipes that were on the website did not provide any further information other than the picture. Despite the fact that eggs cannot be purchased with Healthy Start vouchers, there is an Eggs recipes section. The one egg recipe in this section, for a Simple omelette has a photo of the Hearty macaroni and cheese recipe from the Milk recipes section. When one clicks on the Simple omelette recipe title to view the complete recipe, an error message is returned. Recipes are also unavailable for Fruity milkshake, Hearty macaroni and cheese, Simple Greek salad and Healthy fried rice. 2.3 Inconsistent portion size information The recipes did not provide information for a consistent number of per recipe, varying between 1-6 adult and 2-10 weaning. None of the recipes had details of portion sizes for children, although many suggested that they were recipes for the whole family. The Pasta ratatouille bake, for example, was described as: A lovely pasta bake that the whole family will love, with herbs, delicious vegetables and a cheesy topping. However, the recipe provided information for 4 adult portion sizes only. 2.4 Inconsistent information on recipes and meals Portion sizes were given for some but not all recipes. The portion sizes sometimes included just the recipe item but sometimes also included a starchy food accompaniment (e.g. pasta or rice). The Fish pie recipe included broccoli as an accompaniment and the broccoli appeared to be included in the total portion size, but other recipes did not include a vegetable accompaniment. There was no consistent pattern in portion size or in the relationship between the photo shown of the meal and the recipe given. In some cases, it was unclear whether meals were main meals, light meals or accompaniments. For example, the Vegetable couscous recipe claimed: Couscous is really quick to make just pour on boiling water, leave it for a few minutes to soak the water up, and then add whatever vegetables and flavourings you like. It s ideal as a filling lunch or as a side dish with grilled fish. Here s a recipe to get you started. The recipe states that it serves six adults, but it is unclear whether it is designed to make enough for six people as a side dish or a main dish. There is no consistency in suggested energy content and meal type. For example, the Spanish omelette recipe (which is suggested to provide 339kcal) is described as: A Spanish classic: have it with a salad for a delicious light lunch. 6 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

8 On the other hand, Mixed vegetable and lentil curry which is suggested to provide 309kcal, is suggested as a main meal: Why not try this warm, hearty dish on a chilly autumn night? 2.5 Portion size calculations A brief inspection of some of the recipes suggests potential errors in some portion-size calculations. For example, the ingredients listed for Vegetable couscous would make a dish weighing about 900g (if standard portion size data for the ingredients are used). When divided into six, this would not give the 205g portion size suggested but 150g. Practical testing of some of the recipes was undertaken to consider this issue further. 2.6 Introducing solid foods recipe information incomplete The recipes that are designed for weaning do not indicate what ages they are appropriate for. The Introducing solid foods section of the Healthy Start website has a link to an NHS Choices webpage on weaning. However, when clicked on, the page no longer exists. Therefore, there is little guidance to accompany the recipes designed for weaning and no information to support continued breastfeeding as complementary foods are introduced. 2.7 Lack of clarity over which recipe ingredients can be bought with Healthy Start vouchers The recipes did not indicate which food items could be bought with a Healthy Start voucher, and it was not clear if recipes had been designed to maximise voucher use even if this was not the most cost-effective option. For example, some recipes that would traditionally be made with canned tomatoes (e.g. Vegetable spag Bol, or Vegetable chilli) had fresh tomatoes in the recipe despite the increased cost), and this may be because only fresh tomatoes can be bought with Healthy Start vouchers. The Baked rice pudding recipe lists prunes and apricots in the ingredients but does not specify if these are dried fruits, but it also suggests trying apricots, apples or plums, but does not provide alternative weights for fresh and dried options. Dried fruit cannot be bought with Healthy Start vouchers and the photo does not show rice pudding with fruit as suggested by the recipe. The Salmon fish cakes had fresh tomato in the ingredients despite these not being traditionally found in fish cakes. 2.8 Recipes did not appear to consider the cost of ingredients or cooking, or ease of preparation and equipment needed, which might be relevant for low-income families A number of recipes involved oven-cooking, which is the most expensive cooking method and for some recipes, such as Rice pudding and Baked pears with yoghurt, a much simpler method could have been suggested. The amount of equipment needed for some recipes was considerable. Furthermore, there was no indication of the cost of the recipe, cost per portion or Healthy Start voucher spend required. A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 7

9 2.9 Recipes were poorly edited We found a number of typographical errors in some of the recipes. For example, in the Winter vegetable stovies recipe it says to thinkly cut the vegetables. Also, in some recipes some of the listed ingredients were not mentioned in the method. For example, tomatoes and natural yoghurt were included in the ingredients for the Salmon fish cakes, but were not mentioned in the method. 8 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

10 Table 2. Recipes on the Healthy Start website (February 2013) Name Category Recipe available Number of Portion size suggested Is this a complete meal? Does photo reflect recipe ingredients? What in the recipe can be bought with Healthy Start food vouchers? Banana velvet Milk Yes 2 adults 223g No Yes Banana, skimmed milk Baked rice pudding Milk Yes 2 adults 286g Pudding No. There is no fruit included in the photo. Fish pie Milk Yes 4 adults 458g Yes. Broccoli is included in the recipe and ize weight Fruity milkshake Hearty macaroni and cheese Simple omelette Milk No n/a n/a n/a No recipe ingredients given. Milk No n/a n/a n/a No recipe ingredients given. Egg No n/a n/a n/a No. The photo is of Hearty macaroni and cheese. Yes Skimmed milk. Fresh apricots, apples and plums suggested as alternative to dried fruit in recipe. Potato, milk. (Suggests broccoli on the side.) Equipment needed Blender, measuring jug, freezer (for ice) Oven, measuring jug, knife, chopping board, ovenproof dish Oven, vegetable peeler, scales, measuring jug, chopping board, cheese grater, saucepan, mixing bowl, ovenproof dish Method of cooking and preparation time Blender and chilled in freezer. time 5 minutes. Bake in the oven. time 1 hour 5 minutes. Boil the potatoes and make sauce on the hob. Bake for 30 minutes in oven. time 1 hour 30 minutes. Recipe cost/ portion cost * 42p/ 21p 70p/ 35p 6.83/ 1.71 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a * Costings for each recipe were based on the exact amount of ingredients used in each recipe. Portion costs were based on the portion information that accompanied each recipe. Costs were based on loose fruits and vegetables and supermarket value-brand items.

11 Name Category Recipe available Number of Apple crumble Fruit Yes 6 (adults not specified) Summer fruit salad Vegetable couscous Winter vegetable stovies Portion size suggested Is this a complete meal? Does photo reflect recipe ingredients? What in the recipe can be bought with Healthy Start food vouchers? Equipment needed 179g Pudding Yes Apple, orange Sieve, peeler, knife, chopping board, scales, oven, mixing bowl, ovenproof dish Fruit Yes 2 adults 294g Pudding Kiwi, grapes and orange are not shown. Vegetable Yes 6 adults 206g Not a complete meal. No meat or meat alternative food group element. Vegetable Yes 2 adults 463g Not a complete meal. No meat or meat alternative food group element. Photo does not show sweetcorn. The frozen vegetables in the recipe are not shown the picture. The potatoes in the photo appear to have been baked or grilled. Banana, apple, orange, strawberries, grapes, kiwi Peppers, onion, sweetcorn, cherry tomatoes Mixed frozen vegetables, potato, parsnip, carrot, turnip, onion Knife, fridge to chill Kettle (to boil water), scales, knife, bowl Scales, peeler, knife, freezer, chopping board, saucepan, measuring jug Method of cooking and preparation time Bake in the oven for 30 minutes. time 45 minutes. Chill in fridge if necessary. Total preparation time 15 minutes. No cooking required. time 30 minutes. Boil and simmer on hob. time 1 hour 10 minutes. Recipe cost/ portion cost 2.87/ 48p 1.56/ 78p 1.85/ 46p 1.53/ 77p 10 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

12 Name Category Recipe available Mixed vegetable and lentil curry Number of Portion size suggested Is this a complete meal? Vegetable Yes 2 adults 505g Photo shows curry with rice but recipe is for curry only. Does photo reflect recipe ingredients? Yes What in the recipe can be bought with Healthy Start food vouchers? Garlic, onion, carrot, potato, cauliflower, courgette, mushrooms Equipment needed Saucepan, knife, peeler Method of cooking and preparation time Simmer on hob. time 55 minutes. Recipe cost/ portion cost 2.37/ 1.19 Vegetable chilli Vegetable spag Bol Spanish omelette Vegetable Yes 2 adults 627g Recipe is for chilli and rice. Vegetable Yes 2 adults 537g Recipe is for spaghetti and sauce. No meat alternative in recipe. The photo does not show rice. The parsley garnish is not listed in the ingredients. Yes Onion, garlic, tomatoes, red pepper, mushrooms, mixed vegetables Onion, mixed frozen vegetables, garlic, tomato, red pepper, mushroom, carrot, courgette Vegetable Yes 1 adult 398g Yes Yes Potato, onion, red/green pepper, garlic, frozen peas, tomato 2 saucepans, knife, chopping board, scales Knife, chopping board, peeler, 2 saucepans Peeler, knife, saucepan, scales, frying pan Boil, then simmer for 20 minutes Boil rice. time 50 minutes. Simmer for 20 minutes. time 45 minutes. Boil potatoes. Fry omelette. Grill top. Total preparation time 45 minutes. 2.08/ 54p 2.98/ / 1.38 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 11

13 Name Category Recipe available Parsnip and cauliflower layer bake Number of Portion size suggested Is this a complete meal? Does photo reflect recipe ingredients? Vegetable Yes 4 adults 230g Yes No. This looks like a photo of cauliflower cheese. What in the recipe can be bought with Healthy Start food vouchers? Carrot, parsnip, leek, cauliflower Equipment needed Saucepan, steamer, oven, knife, ovenproof dish Method of cooking and preparation time Boil vegetables for 10 minutes. Bake in oven for 30 minutes. time 55 minutes. Recipe cost/ portion cost 4.69/ 1.17 Salmon fish cakes Vegetable Yes 4 adults 89g (Photo shows two fish cakes for this portion size.) No. Salad shown in photo is not included in recipe. Yes Potato, tomatoes, parsley Scales, oven, 2 bowls, can-opener, knife, chopping board, cheese-grater, baking tray Bake in oven for 20 minutes. time 45 minutes / 72p Pasta ratatouille bake Cauliflower cheese with pasta Vegetable Yes 4 adults 386g Yes Yes Onion, garlic, fresh oregano, fresh basil, tomato, courgette, broad beans Vegetable No n/a n/a n/a No recipe given. 2 saucepans, oven, scales, cheese grater, ovenproof dish, knife Boil the pasta. Simmer sauce for 20 minutes. Bake dish for minutes. time 1 hour 15 minutes. 3.67/ 92p n/a n/a n/a n/a Simple Greek salad Vegetable No n/a n/a n/a No recipe given. n/a n/a n/a n/a 12 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

14 Name Category Recipe available Healthy fried rice Apple and pear pudding Cream of carrot mash Number of Portion size suggested Is this a complete meal? Does photo reflect recipe ingredients? Vegetable No n/a n/a n/a No photo available for this recipe. Introducing solid foods Introducing solid foods Yes 5 Yes 6 What in the recipe can be bought with Healthy Start food vouchers? Equipment needed Method of cooking and preparation time Recipe cost/ portion cost n/a n/a n/a n/a n/a n/a Yes Apple, pear Peeler, knife, pan, implement for mashing n/a n/a Yes Carrot, potato, milk Peeler, knife, saucepan, measuring jug, fork or potato masher Boil/simmer. time 30 minutes. Boil. time 25 minutes. 93p/ 19p 66p/ 11p Baked pears with yoghurt Introducing solid foods Yes 4 n/a n/a No. Photo shows raw pears. Pear Scales, oven, peeler, knife, ovenproof dish Bake in oven for 10 minutes. time 20 minutes. 1.08/ 27p Baked bananas with custard Introducing solid foods Yes 2 n/a n/a No. There is no custard in the photo. Banana, milk Oven, measuring jug, knife, ovenproof dish, tin foil Bake in oven for minutes. time 25 minutes. 52p/26p Broccoli, cauliflower and potato mash Introducing solid foods Yes 6 n/a n/a Yes Potato, broccoli, cauliflower, milk Peeler, knife, saucepan, implement for mashing Boil. time 35 minutes. 72p/12p Carrot and apple mash Introducing solid foods Yes 4 n/a n/a Yes Carrot, apple, milk Peeler, knife, tablespoon, saucepan, implement for mashing Boil. time 20 minutes. 45p/11p A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 13

15 Name Category Recipe available Number of Portion size suggested Is this a complete meal? Does photo reflect recipe ingredients? What in the recipe can be bought with Healthy Start food vouchers? Equipment needed Method of cooking and preparation time Recipe cost/ portion cost Sweet potato and cauliflower mash Introducing solid foods Yes 10 n/a n/a Yes Sweet potato, cauliflower, milk Measuring jug, peeler, knife, saucepan, implement for mashing Boil. time 20 minutes. 1.13/11p Turnip, potato and cauliflower mash Introducing solid foods Yes 5 n/a n/a Yes Potato, turnip, cauliflower, milk Peeler, knife, saucepan, implement for mashing Boil. time 35 minutes. 63p/13p 14 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

16 3 Practical testing of a selection of Healthy Start recipes The following recipes were selected for practical testing as they represented a range of dishes from the different categories. Banana velvet 2 Apple crumble 3 Winter vegetable stovies 4 Parsnip and cauliflower layer bake 5 Salmon fish cakes 6 Baked pears with yoghurt 7 We followed each recipe exactly and then used the following questions to guide the review: Were the ingredients in the recipe appropriately explained? Was the method in the recipe clear? How much kitchen equipment was required to make the recipe? Were cooking times realistic? What quantity did the recipe make and how did portion sizes compare with those given? How much did it cost to make the recipe? How much of the total cost of each recipe was covered by Healthy Start vouchers? Was the finished product appealing in look, taste and texture? Costings for each recipe were based on the exact amount of ingredients used in each recipe. Portion costs were based on the portion information that accompanied each recipe. Costs were based on loose fruits and vegetables and supermarket value-brand items. A summary of the findings is given in Table

17 Table 3. Details of recipe testing Recipe Banana velvet Total cost/ portion cost 42p/ 21p Healthy Start spend Portion size given Actual portion size Clarity of method 16p 223g 223g Unclear how much ice to use. Equipment needed Blender, measuring jug, freezer (for ice). Photo accuracy Accurate General comments on taste, look and texture A very watery texture and little flavour. Apple crumble Winter vegetable stovies Parsnip and cauliflower layer bake Salmon fish cakes 2.87/ 48p 1.53/ 77p 4.69/ / 72p g 132g Yes. Sieve, peeler, knife, chopping board, scales, oven, mixing bowl, ovenproof dish g 794g Unclear how to brown the vegetables. No guidance as to oil use g 250g Recipe instructions clear. 71p 89g 193g Unclear what size tin of salmon to use. Unclear if 400g potatoes is cooked weight. Method omits tomatoes and yoghurt. Scales, peeler, knife, freezer, chopping board, saucepan, measuring jug Saucepan, steamer, oven, knife, ovenproof dish. Scales, oven, 2 bowls, can-opener, knife, chopping board, cheesegrater, baking tray. The crumble topping looked like traditional crumble. (made with butter rather than with low-fat spread) Not accurate. No frozen mixed vegetables in photo. Not accurate. Dish in photo looks like simple cauliflower cheese. Accurate Low-fat spread did not make crumble. Topping was chewy. Typo in the recipe thinkly. Recipe used pints and not metric measures. Bland taste. Tastes and textures didn t really go together. Bland taste. Fromage frais curdled. Recipe involved steaming, boiling and baking which was complicated. Tasted too fishy and slightly unpleasant.

18 Recipe Total cost/ portion cost Healthy Start spend Portion size given Actual portion size Clarity of method Equipment needed Photo accuracy General comments on taste, look and texture Baked pears with yoghurt 1.08/ 27p 69p n/a n/a as weaning dish. The pears took 40 minutes to soften in the oven and dried out. Scales, oven, peeler, knife, ovenproof dish. Not accurate. The picture was of raw pears. It would have been much simpler to poach the pears and mash them with yoghurt. A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 17

19 3.1 Portion sizes We compared the adult portion size suggested by the Healthy Start recipe with those from the recipe testing. The Salmon fish cakes recipe made larger than the 89g portion the recipe suggested. An adult portion (when the recipe was divided by 4) came out at 193g. Similarly, the Winter vegetable stovies recipe suggested that an adult portion was 463g and we measured a portion to be 794g. The variations between portion sizes in theory and in practice can be due to different raw weights of ingredients and different cooking losses and gains, and small fluctuations are to be expected. The large differences noted in some of the recipes here indicate issues with the way in which the recipes are written and how ingredient measures have been expressed. 3.2 Cost There is no guidance on the Healthy Start website on the cost of each recipe, with or without a Healthy Start voucher. We costed all the recipes suggested and found that the cost varied. Within the meals that were portioned for adults, the total cost of making up the recipes varied from 42p (Banana velvet) to 6.83 (Fish pie). The cost of portion sizes varied from 21p (Banana velvet) to 1.71 (Fish pie). The cost of weaning recipes varied from 1.13 (Sweet potato and cauliflower mash) to 45p (Carrot and apple mash). Portion costs for weaning recipes varied from 11p (Carrot and apple mash, and Sweet potato and cauliflower mash) to 27p (Baked pears with yoghurt). As it is unclear whether the recipes were complete main meals, the cost of meals using the recipes may be more expensive where additional foods are needed to create a complete meal. 3.3 Quality of recipe writing We followed recipe instructions as they were written and found that, in some recipes, there were issues with the clarity of the ingredients listed and cooking methods. There were inconsistencies in the language used in the ingredients lists and cooking methods. For example, both the term margarine and low-fat spread were used across the collection. The way in which ingredients were measured was also inconsistent. For example, in the Salmon fish cakes recipe, the ingredients include 100g chopped tomato, whereas in the Pasta ratatouille bake, 4 fresh medium tomatoes were suggested. Similarly, the Salmon fish cakes recipe included a small tin of pink salmon. However, there are various different sizes of tinned salmon and it would have been more useful to state the weight of the tin. In the Baked pear with yoghurt weaning recipe, the final instruction in the method was to put a spoonful of yoghurt on top of each pear half. For a weaning food, it

20 would be more useful to suggest mashing the pear and yoghurt together. We prepared this dish both according to the recipe and in a weaning-friendly way (see the photos in Figure 2). Figure 2. Baked pears with yoghurt prepared according to the Healthy Start recipe (left), mashed for weaning (centre) and as shown on the Healthy Start website (right). In some recipes, ingredients were listed but not mentioned in the method. For example, the Salmon fish cakes recipe included 100g chopped tomatoes and 2 tablespoons of natural yoghurt, but there were no instructions in the method for when to add these ingredients. Some recipes did not provide the desired or expected taste or texture. For example, using low-fat spread in the apple crumble recipe resulted in a crumble topping that was chewy as opposed to crumbly. Figure 3. Apple crumble prepared according to the Healthy Start recipe A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 19

21 The methods in some of the recipes are vague. For example, in the Winter vegetable stovie recipe, the instructions were to Brown the vegetables in a pan over a low heat. However, the only way to actually brown the vegetables would be to cook them with a teaspoon of oil in a very large frying pan. Following the method in the recipe, it was not possible to brown the vegetables and as a result the vegetable stovies were sloppy and unappealing. The Banana velvet recipe used crushed ice and the recipe instruction was to pour the blended milk and banana over crushed ice. It was unclear how much ice to use and whether it was assumed one would buy crushed ice or make it. Figure 4. Banana velvet prepared according to the Healthy Start recipe 3.4 Equipment and fuel costs We also found that some recipes required considerable fuel and time for cooking and a range of kitchen appliances and equipment. For example, the Banana velvet, although a seemingly simple and cheap recipe with only three ingredients, required a blender and a freezer. The Baked pears with yoghurt recipe used an oven to cook the pears but this recipe would have been quicker to make and more energyefficient if the pears were poached rather than baked. As no liquid was added when baking, the pears took much longer to cook than suggested. 3.5 How the food looked and tasted Using photographs alongside recipes can illustrate what the outcome of a recipe should look like. Adding a photo to a recipe is also an opportunity to demonstrate suitable portion sizes. 20 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

22 The photos on the Healthy Start website did not always reflect the recipe ingredients or outcome. For example, the photo of the Winter vegetable stovies recipe shown on the website did not include the frozen vegetables, and the dish looked different to the outcome of the recipe we prepared. (See Figure 5.) Three people tasted the outcome of each recipe made as part of this review. The two recipes with the least appealing taste were the Parsnip and cauliflower layer bake and the Salmon fish cakes. The Parsnip and cauliflower layer bake had unpleasant flavours and textures and the fromage frais and eggs used to bind the vegetables together curdled. The Salmon fish cakes had an overly fishy taste, which was not pleasant. The Banana velvet was watery and lacked flavour. Figure 5. Parsnip and cauliflower layer bake and Salmon fish cakes, as cooked for this review A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 21

23 Figure 6. Winter vegetable stovies portion size when prepared following the Healthy Start website recipe (left), and photo shown on the Healthy Start website (right) The Parsnip and cauliflower layer bake photo on the Healthy Start website resembled cauliflower cheese. Also, in the recipe there was a layer of mashed carrot and parsnip which is clearly missing from the photo that accompanies the recipe on the website. Figure 7. Parsnip and cauliflower layer bake as prepared for this review (left), and as shown on the Healthy Start website 22 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

24 4 Conclusion The current recipes on the Healthy Start website did not appear to have been adequately tested, did not provide sufficient information to support beneficiaries, and in some cases were not fit for purpose. As these recipes are currently one of the primary resources for supporting the use of Healthy Start food vouchers, making sure they work well in practice is essential. Considerable amounts of public funds are spent on leaflets and the website to support the Healthy Start scheme and the Department of Health has a duty to provide clear and accurate information. With more consideration, the Recipes section on the website could become a practical resource that takes into account that families receiving vouchers live on low incomes, and that provides clarity about how meals made can support all family members to eat well. 5 Recommendations We recommend that the Department of Health carry out an audit of the current Healthy Start recipes and consider the following: Any information given on eating well on the Healthy Start website should be in line with other information and advice on supporting eating well produced by Government and other trusted sources, and weblinks to such sources should be provided. Before publishing recipes online, each recipe should be double-tested, and consideration should be given to the relevance of the recipe, cost and cooking methods to the target group. All recipes should be for complete meals, suitable for the whole family, with appropriate and consistent portion sizes shown for different family members (e.g months, 1-4 years, 5-11 years, years and adult). Recipes should be thoroughly edited to ensure instructions are clear. Some recipes suitable for low-income families from different cultures and with different dietary requirements should also be included. First Steps Nutrition Trust is developing a collection of recipes designed to help families get the most out of their Healthy Start food vouchers. Recipes will include photos of appropriate portion sizes for different family members, and a cost guide to each recipe taking into consideration the different amounts of Healthy Start voucher different families receive. The resource is scheduled to be completed by summer A review of recipes provided on the Healthy Start website First Steps Nutrition Trust 23

25 24 A review of recipes provided on the Healthy Start website First Steps Nutrition Trust

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