1
|
Serrano-Fuentes N, Rogers A, Portillo MC. Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity. PLoS One 2024; 19:e0302927. [PMID: 38718062 PMCID: PMC11078422 DOI: 10.1371/journal.pone.0302927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/13/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Reversing the upward trajectory of obesity requires responding by including the multiple influences on weight control. Research has focused on individual behaviours, overlooking the environments where individuals spend their lives and shape lifestyles. Thus, there is a need for lay understandings of the impact of environments as a cause and solution to obesity. This research aimed to understand the influence of environments on the adoption of health practices in adults with obesity and to identify lay strategies with which to address environmental barriers to behaviour change. METHODS Nineteen adults with a history of obesity living in the United Kingdom were interviewed through video conferencing between May 2020 and March 2021. Semi-structured interviews and socio-demographic questionnaires were used, and data analysed through hermeneutic phenomenology informed reflexive thematic analysis. RESULTS Three main themes were created: living with convenience and normalcy: the increased accessibility of unhealthy food, people interacting with digital media for positive practice change, and the need to prioritise prevention in schools, the National Health Service and the food industry. CONCLUSIONS The food environment was the major barrier, while interactions with social media was the most important opportunity to adopt healthy practices. The National Health Service was considered an obesogenic environment, something relevant since it has been traditionally recognised as an obesity management system. The perceptions from individuals with a history of obesity provide new suggestions on the influence of previously overlooked environments to design more adequate and effective interventions and policies that consider, more than in the past, the environments where people spend their lives.
Collapse
Affiliation(s)
- Nestor Serrano-Fuentes
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne Rogers
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Mari Carmen Portillo
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
2
|
Erfani K, Grabowski A, Parker G, Garrity A, Peterson KE, Lee JM, Nanda U. Point of Decision Design to Address Adolescent Overweight and Obesity. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:182-194. [PMID: 36946329 PMCID: PMC11042780 DOI: 10.1177/19375867231153365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVES This study aims to utilize the point of decision design framework to understand how, where, and why adolescents and families make decisions about diet and physical activity and to explore how modifications to the environment can help to promote healthier choices and reduce obesity. BACKGROUND Child and adolescent obesity is a critical public health problem. As environmental factors are a primary contributor, understanding the role of design in our surrounding environment highlights an important area of interdisciplinary study. Design strategies have been used successfully to increase stair use and reduce sedentary behavior and can be used to further promote healthier diet and activity choices among adolescents and families. METHODS We leveraged the human-centered design-thinking process through (1) qualitative interviews and survey instruments, (2) persona and prompt development, and (3) a design workshop with multidisciplinary stakeholders. RESULTS Five personas were developed from the qualitative data and used in a design-thinking workshop. During the workshop, participants generated 12 influential factors and nine points of decision which were used to generate 33 solutions spanning the design continuum (from information and policy design to the design of urban, architectural, and interior environments) aimed at improving nutrition and physical activity among adolescents. Additionally, a tool kit was prototyped, which includes interview guides, a persona framework, and a workshop facilitation guide. CONCLUSIONS Our novel process led to the generation of design solutions that can be implemented to expand and improve upon existing interventions for childhood obesity and create environments that encourage positive health outcomes.
Collapse
Affiliation(s)
- Kimia Erfani
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
| | - Aria Grabowski
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Grant Parker
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Endocrinology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen E. Peterson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Endocrinology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Upali Nanda
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Pineda E, Barbosa Cunha D, Taghavi Azar Sharabiani M, Millett C. Association of the retail food environment, BMI, dietary patterns, and socioeconomic position in urban areas of Mexico. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001069. [PMID: 36962971 PMCID: PMC10022358 DOI: 10.1371/journal.pgph.0001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023]
Abstract
The retail food environment is a key modifiable driver of food choice and the risk of non-communicable diseases (NCDs). This study aimed to assess the relationship between the density of food retailers, body mass index (BMI), dietary patterns, and socioeconomic position in Mexico. Cross-sectional dietary data, BMI and socioeconomic characteristics of adult participants came from the nationally representative 2012 National Health and Nutrition Survey in Mexico. Geographical and food outlet data were obtained from official statistics. Densities of food outlets per census tract area (CTA) were calculated. Dietary patterns were determined using exploratory factor analysis and principal component analysis. The association of food environment variables, socioeconomic position, BMI, and dietary patterns was assessed using two-level multilevel linear regression models. Three dietary patterns were identified-the healthy, the unhealthy and the carbohydrates-and-drinks dietary pattern. Lower availability of fruit and vegetable stores was associated with an unhealthier dietary pattern whilst a higher restaurant density was associated with a carbohydrates-and-drinks pattern. A graded and inverse association was observed for fruit and vegetable store density and socioeconomic position (SEP)-lower-income populations had a reduced availability of fruit and vegetable stores, compared with higher-income populations. A higher density of convenience stores was associated with a higher BMI when adjusting for unhealthy dietary patterns. Upper-income households were more likely to consume healthy dietary patterns and middle-upper-income households were less likely to consume unhealthy dietary patterns when exposed to high densities of fruit and vegetable stores. When exposed to a high concentration of convenience stores, lower and upper-lower-income households were more likely to consume unhealthy dietary patterns. Food environment and sociodemographic conditions within neighbourhoods may affect dietary behaviours. Food environment interventions and policies which improve access to healthy foods and restrict access to unhealthy foods may facilitate healthier diets and contribute to the prevention of NCDs.
Collapse
Affiliation(s)
- Elisa Pineda
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, South Kensington Campus, London, United Kingdom
- Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Diana Barbosa Cunha
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Christopher Millett
- Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| |
Collapse
|
4
|
Diaz-Beltran M, Almanza B, Byrd K, Behnke C, Nelson D. Fast-Food Optimal Defaults Reduce Calories Ordered, as Well as Dietary Autonomy: A Scenario-Based Experiment. J Acad Nutr Diet 2023; 123:65-76.e2. [PMID: 35710043 DOI: 10.1016/j.jand.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Low-calorie menu items as optimal defaults may encourage healthier choices when people eat out. Limited research has studied default effects from the restauranteurs' perspective, as well as the public health perspective. OBJECTIVE To examine the effects of optimal defaults on calories ordered, dietary autonomy, and visit intention in the context of a fast-food drive-through. DESIGN Between-subjects randomized scenario-based experiment. PARTICIPANTS/SETTING In all, 377 adults who lived in the United States were recruited through a crowdsourcing platform in July 2020. INTERVENTION Participants were asked to visualize ordering a combo meal in a fast-food drive-through. They were randomly assigned to order from 1 of 3 menu boards: (1) menu items available for combos by customer choice, (2) combos that included traditional high-calorie default items, or (3) combos that included low-calorie optimal defaults. MAIN OUTCOME MEASURES Differences in calories ordered among groups, dietary autonomy, and restaurant visit intention. ANALYSIS Statistical tests included multiple regression, Kruskal-Wallis, χ2, and 1-way analysis of variance. Covariates such as education and sex were tested in regression models as potential confounders. RESULTS Compared with the choice combo meals, optimal combo meals reduced calories ordered by consumers (-337 kcal, standard error = 19, P < .001), while traditional combos increased them (+132 kcal, standard error = 20, P < .001). No significant difference was found in visit intention. Dietary autonomy was affected by the optimal defaults (P = .025), even in participants with high health concern. Conversely, the traditional combo's effect on dietary autonomy was moderated by health concern (B = -0.26, P = .023), with only individuals with very high levels of health concern perceiving less autonomy. CONCLUSIONS Optimal defaults provided a robust reduction in calories ordered but had implications for dietary autonomy.
Collapse
Affiliation(s)
- Monica Diaz-Beltran
- Nutrition and Biochemistry Department, Pontificia Universidad Javeriana, Bogota, Colombia.
| | - Barbara Almanza
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Karen Byrd
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Carl Behnke
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Douglas Nelson
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| |
Collapse
|
5
|
Ramesh G, Belardo D, Gulati M, Ostfeld RJ, Michos ED. Agricultural policy and societal factors influence patients' ability to follow a healthy diet. Am J Prev Cardiol 2021; 8:100285. [PMID: 34816143 PMCID: PMC8593558 DOI: 10.1016/j.ajpc.2021.100285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022] Open
Abstract
Cardiovascular and cardiometabolic diseases are largely preventable, and are propagated by a poor diet. Poor diet may be due to a lack of supply and access to healthy foods, agricultural subsidies, and marketing. Improving national dietary intake starts with enhancing dietary guidelines, enacting legislative changes to optimize agricultural subsidies and food advertising, and incentivizing a plant-forward diet.
Collapse
Affiliation(s)
- Gautam Ramesh
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, AZ, USA
| | - Robert J Ostfeld
- Division of Cardiology, Montefiore Health System, Bronx, NY, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Schubert E, Rosenblatt D, Eliby D, Kashima Y, Hogendoorn H, Bode S. Decoding explicit and implicit representations of health and taste attributes of foods in the human brain. Neuropsychologia 2021; 162:108045. [PMID: 34610343 DOI: 10.1016/j.neuropsychologia.2021.108045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
Obesity has become a significant problem word-wide and is strongly linked to poor food choices. Even in healthy individuals, taste perceptions often drive dietary decisions more strongly than healthiness. This study tested whether health and taste representations can be directly decoded from brain activity, both when explicitly considered, and when implicitly processed for decision-making. We used multivariate support vector regression for event-related potentials (as measured by the electroencephalogram) to estimate a regression model predicting ratings of tastiness and healthiness for each participant, based on their neural activity occurring in the first second of food cue processing. In Experiment 1, 37 healthy participants viewed images of various foods and explicitly rated their tastiness and healthiness. In Experiment 2, 89 healthy participants completed a similar rating task, followed by an additional experimental phase, in which they indicated their desire to consume snack foods with no explicit instruction to consider tastiness or healthiness. In Experiment 1 both attributes could be decoded, with taste information being available earlier than health. In Experiment 2, both dimensions were also decodable, and their significant decoding preceded the decoding of decisions (i.e., desire to consume the food). However, in Experiment 2, health representations were decodable earlier than taste representations. These results suggest that health information is activated in the brain during the early stages of dietary decisions, which is promising for designing obesity interventions aimed at quickly activating health awareness.
Collapse
Affiliation(s)
- Elektra Schubert
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Daniel Rosenblatt
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Djamila Eliby
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Yoshihisa Kashima
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Hinze Hogendoorn
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Stefan Bode
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
| |
Collapse
|
7
|
Gómez-Donoso C, Sacks G, Vanderlee L, Hammond D, White CM, Nieto C, Bes-Rastrollo M, Cameron AJ. Public support for healthy supermarket initiatives focused on product placement: a multi-country cross-sectional analysis of the 2018 International Food Policy Study. Int J Behav Nutr Phys Act 2021; 18:78. [PMID: 34127002 PMCID: PMC8201822 DOI: 10.1186/s12966-021-01149-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food retail environments have an influential role in shaping purchasing behavior and could contribute to improving dietary patterns at a population level. However, little is known about the level of public support for different types of initiatives to encourage healthy food choices in supermarkets, and whether this varies across countries or context. The current study aimed to explore the level of support for three potential supermarket initiatives focused on product placement across five countries, and factors that may influence this support. METHODS A total of 22,264 adults from Australia, Canada, Mexico, the United Kingdom and the United States (US) provided information on support for three supermarket initiatives related to product placement (targeting product positioning: 'checkouts with only healthy products', 'fewer end-of-aisle displays containing unhealthy foods or soft drinks' or availability: 'more shelf space for fresh and healthier foods') as part of the online 2018 International Food Policy Study. The proportion of respondents that supported each initiative was assessed across countries, and multivariable logistic regression analyses were conducted to evaluate the influence of sociodemographic factors on support. RESULTS The initiative that received the highest support was 'more shelf space for fresh and healthier foods': 72.0% [95% CI 71.3-72.7], whereas 'checkouts with only healthy products' received the lowest support: 48.6% [95% CI 47.8-49.4]. The level of support differed between countries (p < 0.001 for all initiatives), with the US generally showing the lowest support and Mexico the highest. Noteworthy, in the overall sample, there was not much opposition to any of the initiatives (2.5-14.2%), whereas there was a large proportion of neutral responses (25.5-37.2%). Respondents who were older, female, highly educated, and those who reported having more nutrition knowledge tended to be more supportive, with several differences between countries and initiatives. CONCLUSIONS Most people in the assessed five countries showed a generally high level of support for three placement initiatives in supermarkets to encourage healthy food choices. Support varied by type of initiative (i.e., product positioning or availability) and was influenced by several factors related to country context and sociodemographic characteristics. This evidence could prompt and guide retailers and policy makers to take stronger action to promote healthy food choices in stores.
Collapse
Affiliation(s)
- Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood VIC, Geelong, 3125, Australia
| | - Lana Vanderlee
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels, École de nutrition, Université Laval, Québec, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Claudia Nieto
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood VIC, Geelong, 3125, Australia.
| |
Collapse
|
8
|
Visual attention towards food during unplanned purchases - A pilot study using mobile eye tracking technology. PLoS One 2021; 16:e0247755. [PMID: 33661946 PMCID: PMC7932502 DOI: 10.1371/journal.pone.0247755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/14/2021] [Indexed: 11/19/2022] Open
Abstract
This pilot study aims to investigate the relationships between consumers' weight status, energy density of food and visual attention towards food during unplanned purchase behavior in a real-world environment. After more than a decade of intensive experimental eye tracking research on food perception, this pilot study attempts to link experimental and field research in this area. Shopping trips of participants with different weight status were recorded with mobile eye tracking devices and their unplanned purchase behavior was identified and analyzed. Different eye movement measurements for initial orientation and maintained attention were analyzed. Differences in visual attention caused by energy density of food were found. There was a tendency across all participants to look at low energy density food longer and more often.
Collapse
|
9
|
Signs of Warning: Do Health Warning Messages on Sweets Affect the Neural Prefrontal Cortex Activity? Nutrients 2020; 12:nu12123903. [PMID: 33371197 PMCID: PMC7765959 DOI: 10.3390/nu12123903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/13/2020] [Accepted: 12/18/2020] [Indexed: 12/01/2022] Open
Abstract
In the global attempt to combat rising obesity rates, the introduction of health warning messages on food products is discussed as one possible approach. However, the perception of graphical health warning messages in the food context and the possible impact that they may have, in particular at the neuronal level, have hardly been studied. Therefore, the aim of this explorative study was to examine consumers’ reactions (measured as neuronal activity and subjective reporting) of two different types of graphical health warning messages on sweets compared to sweets without warning messages. One type used the red road traffic stop sign as graphical information (“Stop”), while the other one used shocking pictures (“Shock”), an approach similar to the images on cigarette packages. The neural response of 78 participants was examined with the neuroimaging technique functional near-infrared spectroscopy (fNIRS). Different hemodynamic responses in the orbitofrontal cortex (OFC), the frontopolar cortex (FOC), and the dorsolateral prefrontal cortex (dlPFC) were observed, regions which are associated with reward evaluation, social behavior consequences, and self-control. Further, the health warning messages were actively and emotionally remembered by the participants. These findings point to an interesting health information strategy, which should be explored and discussed further.
Collapse
|
10
|
Density of outdoor food and beverage advertising around gathering place for children and adolescent in East Java, Indonesia. Public Health Nutr 2020; 24:1066-1078. [PMID: 33261696 DOI: 10.1017/s1368980020004917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To survey outdoor food and beverage advertisements ('F&B adverts') for products that may be a risk factor for obesity, diabetes and CVD located in the vicinity of gathering places for children and adolescents. DESIGN We recorded the GPS coordinates of all F&B adverts visible from the streets at distances of 0-100, 100-300 and 300-500 m from facilities often used by children and adolescents. Those for unhealthy foods and beverages were identified. The density (number per square kilometre) of such advertisements was calculated and evaluated using hotspot analysis. SETTING The sub-districts Mulyorejo and Sukolilo in Surabaya city and the sub-districts Banyuwangi and Giri in Banyuwangi District, Indonesia. PARTICIPANTS None. RESULTS The proportion of all outdoor advertisements that were F&B adverts was slightly higher in Banyuwangi than in Surabaya. Of the 570 F&B adverts recorded in Banyuwangi, 227 (39·8 %) and 273 (47·9 %) were for unhealthy foods and beverages, respectively. Of 960 F&B adverts in Surabaya, 271 (28·2 %) and 445 (46·3 %) were for unhealthy foods and beverages. In both regions, F&B advert density increased near gathering places for children and adolescents; all recreational areas had at least one set of advertisements for unhealthy beverages and food at 100-300 and 300-500 m. Both regions had one hotspot with significantly high numbers of unhealthy advertisements; Banyuwangi had one cold spot with a significantly low number of healthy advertisements. CONCLUSION Regulations to control advertisements for unhealthy foods and beverages in areas frequented by children and adolescents are urgently needed.
Collapse
|
11
|
Hecht AA, Perez CL, Polascek M, Thorndike AN, Franckle RL, Moran AJ. Influence of Food and Beverage Companies on Retailer Marketing Strategies and Consumer Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7381. [PMID: 33050424 PMCID: PMC7600709 DOI: 10.3390/ijerph17207381] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 01/20/2023]
Abstract
The retail food environment plays an important role in shaping dietary habits that contribute to obesity and other chronic diseases. Food and beverage manufacturers use trade promotion-incentives paid to retailers-to influence how products are placed, priced, and promoted in stores. This review aims to: (1) catalogue trade promotion practices that manufacturers use to influence retailer marketing strategies, and (2) describe how these retailer marketing strategies affect consumer purchasing behavior and attitudes. Researchers searched five databases, Academic Search Ultimate, Business Source Ultimate, PsycINFO, PubMed, and Web of Science, to identify literature from industry and academic sources published in English through November 2019. Twenty articles describing manufacturer trade promotion practices were synthesized and provided insight into four types of trade promotion practices: category management, slotting allowances, price discounts, and cooperative advertising. Fifty-four articles describing the impact of retailer marketing on consumers were synthesized and graded for quality of evidence. While comparison across studies is challenging, findings suggest that retailer marketing strategies, such as price promotions and prominent placement, lead to increased sales. Results can guide efforts by policymakers, public health practitioners, and food retailers to design retail environments that improve healthy eating while maintaining retailer financial interests. Additional research should measure the impact of retailer marketing strategies on consumer diet quality and retailer outcomes (e.g., return-on-investment).
Collapse
Affiliation(s)
- Amelie A. Hecht
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (C.L.P.); (A.J.M.)
| | - Crystal L. Perez
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (C.L.P.); (A.J.M.)
| | - Michele Polascek
- Westbrook College of Health Professions, University of New England, Portland, ME 04103, USA;
| | - Anne N. Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA;
| | - Rebecca L. Franckle
- Program in Global Public Health and the Common Good, Department of Biology, Boston College, Chestnut Hill, MA 02467, USA;
| | - Alyssa J. Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (C.L.P.); (A.J.M.)
| |
Collapse
|
12
|
Availability and placement of healthy and discretionary food in Australian supermarkets by chain and level of socio-economic disadvantage. Public Health Nutr 2020; 24:203-214. [PMID: 32792022 DOI: 10.1017/s1368980020002505] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The current study aimed to investigate availability and placement of healthy and discretionary (less healthy) food in supermarkets in Victoria, Australia, and examine variation by supermarket chain and area-level socio-economic disadvantage. DESIGN Cross-sectional supermarket audit. Measures included: (i) proportion of shelf space (in square metres) allocated to selected healthy and discretionary food and beverages; (ii) proportion of end-of-aisle, checkout and island bin displays containing discretionary food and beverages and (iii) proportion of space within end-of-aisle, checkout and island bin displays devoted to discretionary food and beverages. SETTING Metropolitan areas of Melbourne and Geelong, Australia. Assessment: June-July 2019. PARTICIPANTS Random sample of 104 stores, with equal numbers from each supermarket group (Coles, Woolworths, Aldi and Independent stores) within strata of area-level socio-economic position. RESULTS Proportion of shelf space devoted to selected discretionary foods was greater for Independent stores (72·7 %) compared with Woolworths (65·7 %), Coles (64·8 %) and Aldi (63·2 %) (all P < 0·001). Proportion of shelf space devoted to selected discretionary food for all Coles, Woolworths and Aldi stores was 9·7 % higher in the most compared with the least disadvantaged areas (P = 0·002). Across all stores, 90 % of staff-assisted checkout displays and 50 % of end-of-aisle displays included discretionary food. Aldi was less likely to feature discretionary food in end-of-aisle and checkout displays compared with other supermarket groups. CONCLUSIONS Extensive marketing of discretionary food in all Australian supermarket chains was observed, which is likely to strongly influence purchasing patterns and population diets. Findings should be used to inform private and public sector policies to reduce marketing of discretionary food in supermarkets.
Collapse
|
13
|
Ethical Considerations for Food and Beverage Warnings. Physiol Behav 2020; 222:112930. [PMID: 32434747 DOI: 10.1016/j.physbeh.2020.112930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/16/2020] [Indexed: 02/08/2023]
Abstract
Several countries have implemented warnings on unhealthy foods and beverages, with similar policies under consideration in the U.S. and around the world. Research demonstrating food warnings' effectiveness is emerging, but limited scholarship has evaluated the ethics of food warning policies. Using a public health ethics framework for evaluating obesity prevention policies, we assessed the ethical strengths and weaknesses of food warnings along multiple dimensions: 1) Health behaviors and physical health, 2) Psychosocial well-being, 3) Social and cultural values, 4) Informed choice, 5) Equality, 6) Attributions of responsibility, 7) Liberty, and 8) Privacy. Our analysis identifies both ethical strengths and weaknesses of food warnings, including that: 1) warnings are likely to generate important benefits including increased consumer understanding and informed choice, healthier purchases, and potential reductions in obesity prevalence; 2) warnings evoke negative emotional reactions, but these reactions are an important mechanism through which food warnings encourage healthier behaviors and promote informed choice; 3) warnings appear unlikely to have ethically unacceptable effects on social and cultural values, attributions of responsibility, liberty, or privacy. Current research suggests we continue to pursue food warnings as a policy option for improving public health while simultaneously conducting additional research on the ethics of these policies. Future research is especially needed to clarify warnings' effects on stigma and to characterize the balance and distribution of costs of and benefits from implementing warning policies.
Collapse
|
14
|
Meal deals, combos and bundling: the impact on the nutrition composition of children's meals in restaurants. Public Health Nutr 2020; 23:2253-2255. [PMID: 32349856 DOI: 10.1017/s1368980019005160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increased consumption of food outside the home means that the nutritional content of meals served in restaurants now makes a significant contribution to overall diet. Children's menus in restaurants, usually aimed at those aged 10 years and younger, are frequently high in energy, fat, salt, sugar and lack variety. The food and drink on children's menus are often bundled together as a combo or meal deal that may be convenient to order and sometimes, but not always, cheaper. Bundling has the potential to add additional foods that may not have been selected individually thus increasing the amount ordered and consumed. Substituting some meal deal items for healthier options has the potential to make it easier to eat well when eating outside the home and improve dietary intakes. However, the impact of such measures on child health has yet to be fully explored.
Collapse
|
15
|
Lee IP, Walker RM. Does source credibility matter for point-of-decision prompts? A quasi-experimental field study to increase stair use. PLoS One 2019; 14:e0225520. [PMID: 31751401 PMCID: PMC6872137 DOI: 10.1371/journal.pone.0225520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022] Open
Abstract
A quasi-experimental field study was undertaken to examine whether the source credibility of point-of-decision (POD) prompts would affect their effectiveness in increasing stair use. POD prompts attributed either to a more credible source, a less credible source, or nothing were randomly installed in three student halls of residence at a public university in Hong Kong (plus a control). The stair and elevator use of residents were recorded by view-from-top surveillance cameras and counted using motion-detection software, resulting in 14,189 observations. The findings show that all the POD prompts can yield, as hypothesized, a significant positive effect on stair use. The relative increase in stair use was 2.49% on average. However, contrary to our second hypothesis, the POD prompt attributed to the more credible source was not the most effective intervention. The implications of these findings are discussed in conclusion.
Collapse
Affiliation(s)
- Ivan P. Lee
- Center for Experimental and Behavioral Public Administration, School of Public Affairs and Administration, Rutgers University–Newark, Newark, New Jersey, United States of America
- * E-mail:
| | - Richard M. Walker
- Chan Hon-pun Professor in Behavioural and Policy Sciences, Laboratory for Public Management and Policy, Department of Public Policy, City University of Hong Kong, Hong Kong, China
| |
Collapse
|
16
|
Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 9:CD012573. [PMID: 31482606 PMCID: PMC6953356 DOI: 10.1002/14651858.cd012573.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
Collapse
Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | | |
Collapse
|
17
|
Almiron-Roig E, Forde CG, Hollands GJ, Vargas MÁ, Brunstrom JM. A review of evidence supporting current strategies, challenges, and opportunities to reduce portion sizes. Nutr Rev 2019; 78:91-114. [DOI: 10.1093/nutrit/nuz047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Although there is considerable evidence for the portion-size effect and its potential impact on health, much of this has not been successfully applied to help consumers reduce portion sizes. The objective of this review is to provide an update on the strength of evidence supporting strategies with potential to reduce portion sizes across individuals and eating contexts. Three levels of action are considered: food-level strategies (targeting commercial snack and meal portion sizes, packaging, food labels, tableware, and food sensory properties), individual-level strategies (targeting eating rate and bite size, portion norms, plate-cleaning tendencies, and cognitive processes), and population approaches (targeting the physical, social, and economic environment and health policy). Food- and individual-level strategies are associated with small to moderate effects; however, in isolation, none seem to have sufficient impact on food intake to reverse the portion-size effect and its consequences. Wider changes to the portion-size environment will be necessary to support individual- and food-level strategies leading to portion control.
Collapse
Affiliation(s)
- Eva Almiron-Roig
- E. Almiron-Roig and M. Ángeles Vargas are with the Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- E. Almiron-Roig is with the Navarra Institute for Health Research (IdiSNa), Pamplona, Spain
| | - Ciaran G Forde
- C.G. Forde is with the Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Singapore
| | - Gareth J Hollands
- G.J. Hollands is with the Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - M Ángeles Vargas
- E. Almiron-Roig and M. Ángeles Vargas are with the Centre for Nutrition Research, University of Navarra, Pamplona, Spain
| | - Jeffrey M Brunstrom
- J.M. Brunstrom is with the Nutrition and Behaviour Unit, School of Psychological Science, and the National Institute for Health Research, Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
18
|
Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 8:CD012573. [PMID: 31452193 PMCID: PMC6710643 DOI: 10.1002/14651858.cd012573.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
Collapse
Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| |
Collapse
|
19
|
Young M, Coppinger T, Reeves S. The Nutritional Value of Children's Menus in Chain Restaurants in the United Kingdom and Ireland. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:817-825. [PMID: 31126724 DOI: 10.1016/j.jneb.2019.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Obesity in the United Kingdom and the Republic of Ireland is rising, as is the frequency of eating out in restaurants. The aim of this study was to investigate the nutritional quality of children's menus in restaurants. DESIGN Cross-sectional review of menus aimed at children from 20 popular chain restaurants in the United Kingdom and Ireland. MAIN OUTCOME MEASURES Total energy, fat, saturated fat, and salt were collected from every food item on the menu in each restaurant. All potential meal combinations were created. A total of 39,266 meals were analysed. ANALYSIS Meals were compared with UK nutritional guidelines. Meals from fast food and full-service restaurants and main meals and meal deals were compared. RESULTS The average meal for younger children (aged 2-5 years) contained 609 ±117 kcal, and for older children (6-12 years) 653 ± 136 kcal compared with guidelines of 364 and 550 kcal, respectively. A total of 68% of younger children's and 55% of older children's meals contained more total fat than recommended and more than 4 times the amount of saturated fat. Fast food restaurant meals contained less energy, fat, and salt than did full-service restaurants, and meal deals were less likely to meet dietary guidelines than were main meals alone. CONCLUSION AND IMPLICATIONS Eating in chain restaurants, in particular meal deals, does not contribute positively to the diet of children in the United Kingdom and Ireland.
Collapse
Affiliation(s)
- Michelle Young
- Department of Life Sciences, University of Roehampton, London, United Kingdom
| | - Tara Coppinger
- Department of Sport Leisure and Childhood Studies, Cork Institute of Technology, Cork, Ireland
| | - Sue Reeves
- Department of Life Sciences, University of Roehampton, London, United Kingdom.
| |
Collapse
|
20
|
Consumers' opinions on warning labels on food packages: A qualitative study in Brazil. PLoS One 2019; 14:e0218813. [PMID: 31242235 PMCID: PMC6594644 DOI: 10.1371/journal.pone.0218813] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/10/2019] [Indexed: 01/03/2023] Open
Abstract
This study aimed to assess consumers’ uses of and opinions on the current Brazilian food label and their reaction to the introduction of a front-of-package warning label. We conducted 12 focus groups among a diverse sample of adult consumers, to broadly assess: (1) uses of and perceptions about the current food label, and (2) opinions about implementing a front-of-package warning label to guide food purchases. Data was analyzed with a triangulation of researchers using an exploratory content analysis, which allowed codes to emerge from the data. The frequency of codes across focus groups was compared by gender and socioeconomic status to explore differences by these sociodemographic factors. Codes were divided into six main themes: (1) “Reasons for using food labels”; (2) “Barriers to using food labels”; (3) “Requirements for a new label”; (4) “Perceived influence on consumption behaviors”; (5) “Perceived influence on child behaviors”; and (6) “Perceptions of the food manufacturers using of warning labels”. Participants used food labels to check nutrient content and ingredient information but the format of these labels and the technicality of the content displayed often made the information inaccessible, particularly for those with low socioeconomic status. Most participants were supportive of the display of front-of-package warning labels on products and considered them useful to inform purchases. Women believed that they and their children would reduce the consumption of foods with front-of-package warning labels, while men reported more polarity in their intentions. For men and their children, front-of-package warning labels would result in either stopping food intake entirely or continued consumption without changes to the amount. The study results highlight the potential of front-of-package warning labels to support healthier behaviors in both consumers and their children.
Collapse
|
21
|
Cornelsen L, Berger N, Cummins S, Smith RD. Socio-economic patterning of expenditures on 'out-of-home' food and non-alcoholic beverages by product and place of purchase in Britain. Soc Sci Med 2019; 235:112361. [PMID: 31262504 DOI: 10.1016/j.socscimed.2019.112361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/16/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
While most food is consumed at home, food eaten out-of-home plays an important role in diets and it has been associated with higher energy intake and higher body weight. Beyond prepared meals, there is limited understanding of what foods people buy out-of-home and where they buy them from. This study analyses out-of-home food purchases by food groups and food outlet types, and estimates socio-economic differences in these expenditure patterns. We used a nationally representative product-level dataset of expenditures (n=2,734,987) on foods and non-alcoholic beverages for out-of-home consumption for 9,704 respondents in Great Britain (June 2015-December 2017). Population weighted estimates of per capita weekly expenditures and shares of expenditure were derived for four outlet types and eight food groups. We used linear multi-level modelling to determine differences in expenditure patterns by socio-economic status (SES) characterised via occupational social grade. Out-of-home purchases make up 25-39% of total food and beverage expenditures. Mid- and high-SES respondents spent nearly twice as much (£17.76 and £15.11 weekly), compared to low-SES respondents (£9.69) for out-ofhome food consumption. A third of expenditures across SES (36-37%) were spent in venues other than restaurants or fast-food and takeaway outlets. Meals accounted for 60% of expenditures, but a third was spent on beverages (10-12% non-alcoholic cold beverages, 17-18% hot beverages) and 9-10% on snacks. Mid- and low-SES respondents had a greater share of expenditure in takeaway and fast-food outlets, supermarkets and convenience stores, and on cold non-alcoholic beverages. Overall, low-SES respondents spent less on out-of-home foods but the share of this expenditure across different foods or outlets varied less. While restaurants, fast-food and takeaway outlets were a major source of out-of-home purchases, a significant proportion was spent in other outlets. Policies targeting out-of-home consumption should therefore consider the full range of foods as well as the diversity of places where they are sold.
Collapse
Affiliation(s)
- Laura Cornelsen
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
| | - Nicolas Berger
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Steven Cummins
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Richard D Smith
- College of Medicine and Health, University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| |
Collapse
|
22
|
Daniels SR, Pratt CA, Hollister EB, Labarthe D, Cohen DA, Walker JR, Beech BM, Balagopal PB, Beebe DW, Gillman MW, Goodrich JM, Jaquish C, Kit B, Miller AL, Olds D, Oken E, Rajakumar K, Sherwood NE, Spruijt-Metz D, Steinberger J, Suglia SF, Teitelbaum SL, Urbina EM, Van Horn L, Ward D, Young ME. Promoting Cardiovascular Health in Early Childhood and Transitions in Childhood through Adolescence: A Workshop Report. J Pediatr 2019; 209:240-251.e1. [PMID: 30904171 DOI: 10.1016/j.jpeds.2019.01.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/08/2019] [Accepted: 01/23/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Charlotte A Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD.
| | - Emily B Hollister
- Department of Information Technology & Analytics, Diversigen, Inc, Houston, TX
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
| | | | - Jenelle R Walker
- Center for Translation Research and Implementation Science, NHLBI, Bethesda, MD
| | - Bettina M Beech
- Department of Pediatrics and Family Medicine, University of Mississippi Medical Centre, Jackson, MS
| | - P Babu Balagopal
- Nemours Children's Clinic, Mayo Clinic College of Medicine, Rochester, MN
| | - Dean W Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Matthew W Gillman
- Office of the Director, National Institutes of Health (NIH), Bethesda, MD
| | - Jaclyn M Goodrich
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Cashell Jaquish
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, MD
| | - Brian Kit
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, MD
| | - Alison L Miller
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - David Olds
- Prevention Research Center for Family and Child Health, University of Colorado, Denver, CO
| | - Emily Oken
- Department of Population Medicine, Harvard Pilgrim Health Care Inc, Wellesley, MA
| | - Kumaravel Rajakumar
- Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nancy E Sherwood
- School of Public Health, University of Minnesota, Minneapolis, MN
| | - Donna Spruijt-Metz
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles, CA
| | | | - Shakira F Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Susan L Teitelbaum
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, University, Chicago, IL
| | - Dianne Ward
- Department of Nutrition, University of North Carolina, Chapel Hill, NC
| | | |
Collapse
|
23
|
Impact of reducing portion sizes in worksite cafeterias: a stepped wedge randomised controlled pilot trial. Int J Behav Nutr Phys Act 2018; 15:78. [PMID: 30115084 PMCID: PMC6097301 DOI: 10.1186/s12966-018-0705-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing the portion sizes of foods available in restaurants and cafeterias is one promising approach to reducing energy intake, but there is little evidence of its impact from randomised studies in field settings. This study aims to i. examine the feasibility and acceptability, and ii. estimate the impact on energy purchased, of reducing portion sizes in worksite cafeterias. METHODS Nine worksites in England were recruited to reduce by at least 10% the portion sizes of foods available in their cafeterias from targeted categories (main meals, sides, desserts, cakes). In a stepped wedge randomised controlled pilot trial, each site was randomised to a date of implementation, staggered fortnightly, following a baseline period of four weeks. Impact on energy purchased was analysed using generalised linear mixed modelling. We also assessed feasibility, acceptability, and fidelity of intervention implementation. RESULTS Data from six of the nine randomised sites were analysed, with three sites excluded for not providing sufficient data and/or not implementing the intervention. The extent to which the intervention was implemented varied by site, with between 6 and 49% of products altered within targeted categories. Feedback following the intervention suggested it was broadly acceptable to customers and cafeteria staff. For the primary outcome of daily energy (kcal) purchased from intervention categories, there was no statistically significant change when data from all six sites were pooled: percentage change - 8.9% (95% CI: -16.7, - 0.4; p = 0.081). Each of these six sites showed reductions in energy purchased, ranging from - 15.6 to - 0.3%, which were borderline statistically significant at two sites (respective percentage changes (95% CIs): - 15.6% (- 26.7, - 2.8); - 14.0% (- 25.0, - 1.2)). Secondary outcome data are suggestive of a compensatory increase in energy purchased from food categories not targeted by the intervention, with no overall effect observed on energy purchased across all categories. CONCLUSIONS The results of this pilot trial suggest that reducing portion sizes could be effective in reducing energy purchased and consumed from targeted food categories, and merits investigation in a larger trial. Future studies will need to address factors that prevented optimal implementation including site dropout and application across a limited range of products. TRIAL REGISTRATION ( ISRCTN52923504 ). Registered on 20th September 2016.
Collapse
|
24
|
Warkentin S, Mais LA, Latorre MDRDDO, Carnell S, Taddei JADAC. Parents Matter: Associations of Parental BMI and Feeding Behaviors With Child BMI in Brazilian Preschool and School-Aged Children. Front Nutr 2018; 5:69. [PMID: 30148134 PMCID: PMC6096004 DOI: 10.3389/fnut.2018.00069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/19/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Brazil is undergoing nutritional transition and rates of obesity in preschool and school-aged children are increasing. Excess weight in the first years of life could predict excess weight in adulthood, making it essential to study risk factors in this population. Objective: Our goal was to investigate associations of parent feeding behaviors, as well as more distal familial influences including family SES and maternal and paternal weight, with BMI z-score in preschool and school-aged children in a Brazilian sample. Methods: Cross-sectional study. Data were collected in 14 Brazilian private schools. Parents of children aged 2–8 years (n = 1,071) completed a questionnaire assessing parent feeding behaviors, as well as sociodemographic and anthropometric information. Hierarchical linear regression models were fitted to investigate relationships between parent and child characteristics and child BMI z-score in preschool (2–5 years, n = 397) and school-aged (6–8 years, n = 618) children. Results: Final models indicated that higher maternal BMI and “restriction for weight control” were associated with higher child BMI z-score in both age groups (excessive weight, i.e., BMI ≥ +1 z-score, in preschoolers and school-aged children: 24.4 and 35.9%, respectively). In preschoolers only, “healthy eating guidance” and “pressure” were associated with lower child BMI z-score. For school-aged children, male sex, higher father BMI, and “restriction for health” were associated with higher child BMI z-score. Conclusions: Parent feeding behaviors and parent weight, as well as child sex, are associated with child BMI z-score, with evidence for differential relationships in preschool and school-aged children. Optimal obesity prevention and treatment strategies may differ by child age.
Collapse
Affiliation(s)
- Sarah Warkentin
- Discipline of Nutrology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Laís A Mais
- Discipline of Nutrology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | | | - Susan Carnell
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | |
Collapse
|
25
|
Mamiya H, Moodie EEM, Buckeridge DL. A novel application of point-of-sales grocery transaction data to enhance community nutrition monitoring. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2017:1253-1261. [PMID: 29854194 PMCID: PMC5977589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Unhealthy eating is the most important preventable cause of global death and disability. Effective development and evaluation of preventive initiatives and the identification of disparities in dietary patterns require surveillance of nutrition at a community level. However, nutrition monitoring currently relies on dietary surveys, which cannot efficiently assess food selection at high spatial resolution. However, marketing companies continuously collect and centralize digital grocery transaction data from a geographically representative sample of chain retail food outlets through scanner technologies. We used these data to develop a model to predict store-level sales of carbonated soft drinks, which was applied to all chain food outlets in Montreal, Canada. The resulting map of purchase patterns provides a foundation for developing novel, high-resolution nutrition indicators that reflect dietary preferences at a community level. These detailed nutrition portraits will allow health agencies to tailor healthy eating interventions and promotion programs precisely to meet specific community needs.
Collapse
Affiliation(s)
- Hiroshi Mamiya
- Surveillance Lab, McGill Clinical and Health Informatics, McGill University 1140 Avenue Pine, Montreal, Quebec, Canada, H1A1A3
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University 1020 Avenue Pine, Montreal, Quebec, Canada, H3A1A2
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University 1020 Avenue Pine, Montreal, Quebec, Canada, H3A1A2
| | - David L Buckeridge
- Surveillance Lab, McGill Clinical and Health Informatics, McGill University 1140 Avenue Pine, Montreal, Quebec, Canada, H1A1A3
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University 1020 Avenue Pine, Montreal, Quebec, Canada, H3A1A2
| |
Collapse
|
26
|
Rosenblatt DH, Summerell P, Ng A, Dixon H, Murawski C, Wakefield M, Bode S. Food product health warnings promote dietary self-control through reductions in neural signals indexing food cue reactivity. NEUROIMAGE-CLINICAL 2018; 18:702-712. [PMID: 29564209 PMCID: PMC5859581 DOI: 10.1016/j.nicl.2018.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/12/2018] [Accepted: 03/06/2018] [Indexed: 11/10/2022]
Abstract
Modern societies are replete with palatable food cues. A growing body of evidence suggests that food cue exposure activates conditioned appetitive physiological and psychological responses that may override current metabolic needs and existing eating goals, such as the desire to maintain a healthy diet. This conditioned response results in unhealthy dietary choices and is a contributing factor in the current obesity epidemic. Prime based obesity prevention measures such as health warnings at point-of-sale or on product packaging may have the potential to counteract the influence of the obesogenic environment at the crucial moment when people make food purchasing or consumption decisions. Existing research into the efficacy of these intervention strategies has predominantly employed self-report and population level measures, and little evidence exists to support the contention that these measures counteract food cue reactivity at the time of decision making. Using a dietary self-control priming paradigm, we demonstrated that brief exposure to food product health warnings enhanced dietary self-control. Further, we analysed electroencephalographic correlates of selective attention and food cue evoked craving (N1, P3, LPP) to show that health warning exposure reduced the automatic appetitive response towards palatable food cues. These findings contribute to existing evidence that exogenous information can successfully prime latent goals, and substantiate the notion that food product health warnings may provide a new avenue through which to curb excessive energy intake and reduce rising obesity rates. Food product health warnings successfully promote dietary self-control. ERP components P3 and LPP sensitive to food characteristics and health warnings LPP amplitudes also directly predict dietary self-control. Health warnings useful to reduce appetitive food responses in obesity prevention
Collapse
Affiliation(s)
- Daniel H Rosenblatt
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia; Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | - Patrick Summerell
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Alyssa Ng
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | - Carsten Murawski
- Department of Finance, The University of Melbourne, Victoria, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | - Stefan Bode
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia; Department of Psychology, University of Cologne, Germany.
| |
Collapse
|
27
|
Goryakin Y, Monsivais P, Suhrcke M. Soft drink prices, sales, body mass index and diabetes: Evidence from a panel of low-, middle- and high-income countries. FOOD POLICY 2017; 73:88-94. [PMID: 29276333 PMCID: PMC5727680 DOI: 10.1016/j.foodpol.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 09/16/2017] [Accepted: 09/23/2017] [Indexed: 06/02/2023]
Abstract
We take advantage of four different cross-country datasets containing data on 78 countries for the period 1999-2014, in order to assess the relationship of carbonated soft drinks' sales, as well as their prices, with body mass index (BMI), overweight, obesity and diabetes. Using an ecological study design and multivariate regression longitudinal estimation approaches, we find that carbonated soft drink sales were significantly positively related to BMI, overweight and obesity - but only in the low and lower-middle income countries. This finding was robust to a number of sensitivity and falsification checks. In this sub-sample, an increase in per capita soft drink sales by 1 litre per year was related to an increase of BMI by about 0.009 kg/m2 (p < 0.1).. This is a small effect, implying that halving annual consumption per capita in this group of countries would result in a drop of BMI by only about 0.03 kg/m2. Although soft drink prices were negatively related to weight-related outcomes in the sample of higher middle income and high income countries, this finding was not robust to falsification checks. The results thus suggest that sales restrictions to steer consumers away from soft drinks could indeed have a beneficial health effects in poorer countries, although the effect magnitude appears to be very small. However, given potential limitations of using ecological research design, results from individual level studies would be required to further ascertain the role of soft drink sales and prices in obesity and diabetes.
Collapse
Affiliation(s)
- Yevgeniy Goryakin
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Pablo Monsivais
- UKCRC Centre for Diet and Activity Research, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Nutrition and Exercise Physiology, Elson S Floyd College of Medicine, Washington State University, Spokane, WA 99210-1495, USA
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York YO10 5DD, UK
- Luxembourg Institute for Socio-Economic Research, L-4366 Esch-sur-Alzette/Belval, Luxembourg
| |
Collapse
|
28
|
Kraak VI, Englund T, Misyak S, Serrano EL. A novel marketing mix and choice architecture framework to nudge restaurant customers toward healthy food environments to reduce obesity in the United States. Obes Rev 2017; 18:852-868. [PMID: 28560794 DOI: 10.1111/obr.12553] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 01/19/2023]
Abstract
This review identified and adapted choice architecture frameworks to develop a novel framework that restaurant owners could use to promote healthy food environments for customers who currently overconsume products high in fat, sugar and sodium that increase their risk of obesity and diet-related non-communicable diseases. This review was conducted in three steps and presented as a narrative summary to demonstrate a proof of concept. Step 1 was a systematic review of nudge or choice architecture frameworks used to categorize strategies that cue healthy behaviours in microenvironments. We searched nine electronic databases between January 2000 and December 2016 and identified 1,244 records. Inclusion criteria led to the selection of five choice architecture frameworks, of which three were adapted and combined with marketing mix principles to highlight eight strategies (i.e. place, profile, portion, pricing, promotion, healthy default picks, prompting or priming and proximity). Step 2 involved conducting a comprehensive evidence review between January 2006 and December 2016 to identify U.S. recommendations for the restaurant sector organized by strategy. Step 3 entailed developing 12 performance metrics for the eight strategies. This framework should be tested to determine its value to assist restaurant owners to promote and socially normalize healthy food environments to reduce obesity and non-communicable diseases.
Collapse
Affiliation(s)
- V I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, USA
| | - T Englund
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, USA
| | - S Misyak
- Virginia Cooperative Extension's Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - E L Serrano
- Virginia Cooperative Extension's Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| |
Collapse
|
29
|
Peeters A, Backholer K. How to influence the obesity landscape using health policies. Int J Obes (Lond) 2017; 41:835-839. [PMID: 28127043 DOI: 10.1038/ijo.2017.24] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/01/2016] [Accepted: 12/13/2016] [Indexed: 12/11/2022]
Abstract
There is widespread acceptance that a significant and sustained impact on the growing global obesity burden requires implementation of a range of health policies to influence the obesity landscape. This acceptance is underpinned by the understanding that the obesity landscape is a complex interaction between the many factors that influence an individual's dietary intake and physical activity levels. Over the past decade we have seen increasing convergence in national and international recommendations on how to best improve this obesity landscape. In the past few years this has led to a noticeable increase in the implementation of these recommended national, state and local government policies. Here, we argue that to maximise the impact of population-level policies intended to improve diet and activity environments we need to see progress in a number of key areas, namely: broadening the range of environments that can be empowered to implement policy; improving our understanding of how best to combine multiple policies and interventions; and improving our understanding of the equity impact of these policies. We also argue that a key goal moving forward should be better capture and communication of the existing activities in order to more rapidly spread the uptake of these policies globally and at scale.
Collapse
Affiliation(s)
- A Peeters
- School of Health and Social Development,Deakin University, Geelong, Victoria, Australia
| | - K Backholer
- School of Health and Social Development,Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
30
|
The effect on drink sales of removal of unhealthy drinks from display in a self-service café. Public Health Nutr 2016; 19:3142-3145. [DOI: 10.1017/s1368980016002482] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe present study assessed the impact of the retailer-led removal of unhealthy beverages from display at a self-service café within a major health service. While unhealthy beverages remained available from behind the counter upon request, this was not communicated directly to customers.DesignDrinks were categorised based on the state government nutrient profiling system, classifying drinks as ‘green’ (best choices), ‘amber’ (choose carefully) and ‘red’ (limit). Total drink sales (as number of items sold per week) in the café were measured for five weeks. All unhealthy ‘red’ beverages were removed from display (but were still available for purchase) and the sales of all beverages were measured for another six weeks.ResultsWe found that, in response to this strategy, the proportion of ‘red’ drinks sold decreased from 33 % to 10 % of total drink sales. As ‘amber’ and ‘green’ drink sales increased in response to this strategy, total retailer sales remained steady. Most consumers appeared to switch to purchasing ‘amber’ drinks rather than the healthiest option, ‘green’ drinks.ConclusionsThe removal of unhealthy beverages from display can result in consumers making healthier purchases, while not significantly affecting retailers’ sales.
Collapse
|
31
|
Abstract
Initiatives to build supermarkets in low-income areas with relatively poor access to large food retailers ("food deserts") have been implemented at all levels of government, although evaluative studies have not found these projects to improve diet or weight status for shoppers. Though known to be influential, existing evaluations have neglected in-store social dynamics and shopper behaviors. Surveys and walking interviews were used with shoppers (n = 32) at a supermarket developed through the Pennsylvania Fresh Food Financing Initiative in Philadelphia, PA. Key informant interviews with stakeholders in the supermarket's development and operations provided additional context to these shopper experiences. Data were collected in July and September 2014 and qualitatively analyzed in NVivo 10.0. Participants described how the retailer helped them adapt or cope with difficult shopping routines and how it presented a reliable high-quality option (in terms of cleanliness, orderliness, and social atmosphere) in contrast to other neighborhood retailers. Health concerns were also identified, especially among those managing chronic disease for themselves or a family member. These issues underscored multiple points of challenge required to adjust shopping and eating behavior. In-store supports that reflect these challenges are warranted to more fully address food deserts and reduce health disparities.
Collapse
|