As folks dig into Chinese fare to celebrate the Lunar New Year, they might be surprised to hear that they’re getting an extra helping of sodium. Popular main dishes such as General Tso’s Chicken can contain as much as 2,325 mg of sodium in one serving, 25 mg more than the amount FDA recommends eating in an entire day.
In 2012, a group of Philadelphia health advocates noted that their city has more than 400 Chinese take-out-only restaurants—more than all the city’s fast food joints combined. They formed the Philadelphia Healthy Chinese Take-out Initiative, with the goal of reducing the amount of sodium in Chinese take-out by 10 to 15 percent.
Overconsumption of sodium is a nationwide problem. The average American eats nearly 3,500 milligrams of a day, or 52 percent more than the FDA recommends. The recommendation is even lower for people with hypertension, for African Americans, and for middle-aged and older adults.
The Philadelphia initiative targeted low-income neighborhoods where predominantly people of color reside and Chinese take-out is commonly eaten. “In Philly, we have such high rates of hypertension, particularly among African Americans and Hispanics,” says Jennifer Aquilante of the Philadelphia Department of Public Health (PDPH). Sodium is known to raise human blood pressure and half of the city’s African Americans and nearly a third of its Hispanics suffer from hypertension (or high blood pressure), which can lead to heart disease, heart failure, stroke, and kidney problems.
Launched in 2010 by the PDPH—with funding from the U.S. Centers for Disease Control and Prevention—Get Healthy Philly also promotes healthy foods, smoke-free environments, and works to reduce youth smoking rates.
For the initiative, staff from the PDPH Get Healthy Philly program, Temple University’s Center for Asian Health, the Asian Community Health Coalition, and the Greater Philadelphia Chinese Restaurant Association worked with 300 Chinese takeout restaurants. Not only did they target table salt, the most obvious source of sodium in our diets, but they also turned an eye toward processed foods, canned sauces, and prepared mixes.
First, they asked restaurant owners two important questions: Did they realize that too much sodium contributed to health problems? And, second, were they willing to make changes? Most of the restaurant owners answered yes, and requested help in preparing and marketing lower-sodium meals. Get Healthy Philly brought in Professor Shirley Cheng of New York’s Culinary Institute of America, to conduct classes and provide recipes for lower-sodium Chinese cooking.
Professor Cheng gave chefs from over 200 restaurants free cooking training in late 2012 and early 2013. She recommended included using ginger, garlic, scallions, and lemon to add flavor instead of table salt, and also using lower sodium ingredients and modifying recipes. In one example, Cheng recommended a modified sauce recipe for shrimp and broccoli that reduced the sodium from 2,400 mg to 1,300 mg. Her chicken lo mein sauce reduced sodium from 2,500 mg per order to 1,600 mg.
Restaurant owners received a certificate of participation, a door decal, a toolkit, posters about sodium, and recipes for the most popular menu items.
“Chinese food in general is high in sodium because of the sauces,” Aquilante says. “We ask them to use about half as much sauce as they normally do.” In addition to using less sauce, the Get Healthy Philly program also asked the restaurants to give out soy sauce packets only when asked.
Tongshe Lu, owner of Great Taste Chinese Food, completed his training in 2012. “It’s a great program for Chinese take out restaurants,” he says.
To measure the program’s progress, Temple University Professor Grace X. Ma conducted compliance checks at six, 16, and 24 months post training. She found that the sodium content in the three most popular dishes dropped consistently: 13 percent in General Tso’s chicken, 30 percent in chicken lo mein, and 34 percent in shrimp and broccoli.
“I’ve reduced half [the] sodium after the training,” says restaurant owner Tianxing Chen. “It helps to make everybody healthy in the community.”
How did the customers respond to the change? Get Healthy Philly surveyed over 300 customers from nine restaurants after the shift. When asked if they would order the dishes they’d eaten again, 91-97 percent of the customers said yes.
However, initiatives like this one in Philly show that sodium is an acquired taste, so over time people can adapt to less sodium in their food. “We know from research that a 20 percent reduction in sodium isn’t that noticeable,” says Aquilante.
Partnerships between the Chinese and African American communities have been key to making the Philadelphia Healthy Chinese Take-out Initiative possible. In 2015, PDPH began a new outreach program with 80 pastors from African American churches. The pastors learned about the Chinese take-out program and other health issues. In turn, the pastors have begun educating their congregations.
Two years after training, 185 Chinese take-out-only restaurants were still participating in the program.
The success in Philadelphia is serving as a model for other cities looking to improve their residents’ health. In 2015 the Advocate Heart Institute and the Chicago Department of Public Health worked with four Chicago restaurants that serve South Asian fare to reduce sodium levels in their food.
“Several other cities have inquired about our program and replicated it in their own way,” says Aquilante. “Since our initiative is so comprehensive, I think cities can pull out pieces that they want to focus on.”