The home food environment of overweight gatekeepers in the Netherlands

Home availability of ultraprocessed foods in families who prepare meals at home

ABSTRACT Objective This study characterized the degree of processing of the food items available at home and the routine of shopping for food in families with children and/or teenagers and whose meals are usually prepared at home. Methods Mixed methods (interview, questionnaires, and food inventory). Interview’s transcripts were submitted to thematic analysis and the foods identified in the inventory were classified according to the degree of processing and analyzed for their availability and access in the home food environment. Results Results revealed the high availability of ultra-processed foods; that the supermarket was the main source of food acquisition; and that purchasing food is part of an organized routine where time and control of expenses are the most valued aspects. Conclusion Actions which focus on planning and executing the acquisition of unprocessed and minimally processed foods are needed to promote greater availability and increased intake of such foods, so that the composition of homemade meals may be in line with what is recommended by the national dietary guidelines.

The Food Environment of Primary School Learners in a Low-to-Middle-Income Area in Cape Town, South Africa

Rapid changes in food environments, where less nutritious foods have become cheaper and more accessible, have led to the double burden of malnutrition (DBM). The role food environments have played in shaping the DBM has attained global interest. There is a paucity of food environment research in low-to-middle-income countries. We conducted a case study of the food environments of school aged learners. A primary school in Cape Town was recruited. A multi-method design was used: a home food and eating behaviours questionnaire completed by 102 household respondents and four questions completed by 152 learners; learner participatory photography; a semi-structured school principal interview; a tuckshop inventory; observation of three-day tuckshop purchases. Foods that were commonly present in households: refined carbohydrates, fats/oils, chicken, processed meats, vegetables, fruit, legumes, snacks/drinks. Two thirds of households had rules about unhealthy drinks/snacks, ate supper together and in front of the TV, ate a home cooked meal five–seven times/week and ate breakfast together under two times/week. Vegetables were eaten under two times/week in 45% of households. A majority of learners (84%) took a lunchbox to school. Twenty-five learners photographed their food environment and 15 participated in semi-structured interviews. Six themes emerged: where to buy; what is available in the home; meal composition; family dynamics; peer engagement; food preparation. Items bought at informal food outlets included snacks, drinks and grocery staples. The principal interview revealed the establishment of a healthy school food environment, including a vegetable garden, although unhealthy snacks were sold at the tuckshop. Key dimensions of the food environment that require further investigation in disadvantaged urban and informal settlement areas include the home availability of unhealthy foods, eating behaviours in households and healthfulness of foods sold by informal food outlets.

Snacks and The City: Unexpected Low Sales of an Easy-Access, Tasty, and Healthy Snack at an Urban Snacking Hotspot

: While many people declare an intention to eat and snack more healthily, a large body of research has found that these intentions often do not translate into actual behavior. This failure to fulfil intentions is regularly attributed to the obesogenic environment, on which basis it is assumed that changing the food environment may lead to more healthy snacking behavior. To test this premise in real life practice, the present research project investigated whether making a healthy snack easy-to-access in an urban environment characterized by unhealthy snacking would support people in their intentions of purchasing more healthy snacks. The urban snack project consisted of three phases. In Phase 1, a hotspot location for unhealthy snacking was determined by using a Global Positioning System to track people's snacking locations anda survey to verify the location . In Phase 2, an attractive snack was developed that met consumers' criteria of what constituted a healthy and tasty snack, together with corresponding branding that also included a small food truck from which to sell the newly developed snacks. In Phase 3, the snack was sold from the food truck located at the previously determined unhealthy snacking hotspot. We counted the number of snacks sold and canvassed people's opinions about the snack and its branding, finding that in spite of people's appreciation for the snack, the food truck, and the branding, actual sales of the snack were very low. In the Discussion, we name predominant eating and purchasing habits as possible reasons for these low sales. Future research could focus on placing the healthy snack directly beside people's habitual snack purchase location to ensure that the new choice gets better recognized. Overall, the findings suggest that merely placing healthy snacks more prominently in people's food environment is not sufficient to lead people to snack more healthily.

A qualitative study exploring the dietary gatekeeper's food literacy and barriers to healthy eating in the home environment

ISSUE ADDRESSED

Food literacy has been recognised as a collection of interrelated food skills and knowledge to support healthy dietary outcomes. In the home environment, the dietary gatekeeper is the individual most responsible for food preparation, and therefore, has a significant influence on the family diet. This study explored how the dietary gatekeeper's food literacy skills are used to manage dietary barriers to facilitate healthy eating in the home environment.

METHODS

Qualitative data were collected from a sample of household dietary gatekeepers with children (n = 17). Participants were also instructed to take photographs of family meals prior to the interview and these were used as interview prompts to gain deeper insights into gatekeeper behaviour.

RESULTS

Participants reported the two most significant barriers to healthy eating in households were time pressure and fussy eating. Four strategies were identified that used gatekeepers' food literacy to manage these barriers: breaking up meal tasks; customising meals for family tastes; camouflaging healthy ingredients; and facilitating food choice autonomy. These strategies incorporated interrelated food literacy skills related to the planning, preparation, selection and eating domains.

CONCLUSION

The current findings highlight the dietary gatekeeper's food literacy as an interrelated concept and show how it is operationalised to successfully manage barriers to healthy eating experienced in the home environment. SO WHAT?: Future health promotion campaigns must offer tailored communications and interventions that provide resources and support to dietary gatekeepers to foster food literacy and counteract the influence of barriers to healthy eating.

A Process Evaluation of a Multi-Component Intervention in Dutch Dietetic Treatment to Improve Portion Control Behavior and Decrease Body Mass Index in Overweight and Obese Patients

The SMARTsize intervention embeds an evidence-based portion control intervention in regular dietetic care. This intervention was evaluated to explore (1) which patients participated, (2) the implementation process, and (3) the outcomes of the intervention. The intervention was evaluated with an observational study design including measures at baseline, and three, six, and nine months after the start of the program. Data concerning the process (participation, dose delivered, dose received, satisfaction) and the outcomes (self-efficacy, intention, portion control strategies, and Body Mass Index (BMI) were collected with forms and questionnaires filled out by dietitians and patients. Descriptive analyses, comparison analyses, and cluster analyses were performed. Patients were mainly obese, moderately to highly educated women of Dutch ethnicity. Use of the intervention components varied from 50% to 100% and satisfaction with the SMARTsize intervention was sufficient to good (grades 7.2⁻8.0). Statistically significant (p < 0.001) improvements were observed for self-efficacy (+0.5), portion control strategies (+0.7), and BMI (-2.2 kg/m²), with no significant differences between patients with or without counselling. Three clusters of patients with different levels of success were identified. To conclude, implementing an evidence-based portion control intervention in real-life dietetic practice is feasible and likely to result in weight loss.