Food prices are associated with dietary quality, fast food consumption, and body mass index among U.S. children and adolescents

The relationship between price and nutritional balance for young adults in the menus of Japanese restaurants

Background

Eating habits are a contributing factor to obesity. Higher-priced menu items have better nutritional quality/balance, as the relationship between the price of food per serving and nutritional quality/balance has been reported. However, previous studies on the nutritional content of restaurant menu items did not focus on the relationship between the nutritional balance of menu items and prices. Therefore, this study aimed to investigate this relationship.

Methods

The nutritional balance score (NBS) was defined and calculated according to each nutritional criterion of men and women aged 18-29 years, covering more than 2,000 menu items in 26 Japanese restaurant chains. Furthermore, NBS distribution by gender and restaurant brand, and the relationship between the menu item's NBS and price were assessed.

Results

The results showed that the average NBS of the analyzed menu items differed between the criteria for men and women, with the menu items assessed based on men's criterion being more nutritionally balanced on average. The compositions of the top 10 menu items differed between men and women, and most were set menus or rice bowl menus, which were offered by fast-food restaurants. The relationship between price and NBS in most fast-food and casual restaurants was expressed as a concave function. The maximum NBS based on the criteria for men and women were 64.9 and 64.1, with prices of 639.9 and 530.3 yen, respectively.

Discussion

NBS score increased with price to a certain level before decreasing, suggesting that the price at which NBS was the highest differed between men and women. The results of this study could contribute to the development of a methodology for healthy eating out practices, with a focus on price.

Stages of change and self-efficacy are related to consumption of food markers among Brazilian adolescents and young adults

Objective

This study aimed at analyzing the association between stages of change, consumption of food markers, and self-efficacy in the adoption of healthy eating practices, adjusted by nutritional knowledge, among Brazilian adolescents and young adults.

Methods

A cross-sectional analysis was conducted with 347 individuals from schools in the Federal District, Brazil. They completed a self-administered questionnaire covering: consumption of food markers, stage of change, self-efficacy in the adoption of healthy eating practices, and nutritional knowledge. Adjusted logistic regression was conducted.

Results

Participants in pre-contemplation (OR = 0.22), contemplation (OR = 0.19), decision (OR = 0.13) and action (OR = 0.40) stages have less chance to have healthy eating than those in maintenance, including fruits and vegetables [pre-contemplation (OR = 0.23), contemplation (OR = 0.19), and decision (OR = 0.09)]. Adolescents and young adults in pre-contemplation (OR = 0.29) and contemplation (OR = 0.37) had lower chances of having low consumption of sugar-sweetened beverages compared to those in maintenance (p < 0.05). Adolescents and young adults in pre-contemplation (OR = 0.38) and contemplation (OR = 0.36) were less likely to have high self-efficacy scores than those in maintenance (p < 0.05). Higher score of self-efficacy was associated with a lower chance of having a high consumption of sugar-sweetened beverages (OR = 1.02; p = 0.032).

Conclusion

Regardless of nutritional knowledge, individuals in the earlier stages of change are less likely to have an adequate consumption of healthy foods markers, including fruits and vegetables, and low sugar-sweetened beverages consumption. They are also less likely to have high self-efficacy scores than those in maintenance. Nutritional interventions to focus on enhancing self-efficacy among adolescents and young adults in earlier stages of change to improve dietary habits.

Fast-Food Consumption, Dietary Quality, and Dietary Intake of Adolescents in Saudi Arabia

High fast-food consumption is a common public-health concern among adolescents, due to its link to a number of non-communicable diseases. Frequent consumption of fast food may also affect diets of individuals; however, research addressing this issue is lacking in Saudi Arabia. We aimed to investigate the association between fast-food consumption, dietary quality, and dietary intake of adolescents in Saudi Arabia. This is a cross-sectional study of 617 healthy adolescents aged 11-18 years, who were recruited randomly from 16 middle- and high-schools located in Jeddah and Madinah, Saudi Arabia. Sociodemographic data were collected from parents. Dietary data, including the frequency of fast-food consumption, dietary quality (assessed using the short-form food frequency questionnaire), and dietary intake (assessed using multiple 24 h diet recalls from a subsample), were collected from the adolescents. Approximately one-third of adolescents (28.5%) reported frequent fast-food consumption (>two times a week). Results showed that a higher proportion of male adolescents frequently consumed fast-food, compared with female adolescents (32.8% vs. 24.8%, p = 0.039). Adolescents with the highest monthly family-income (≥SAR 21,000 ) reported a significantly higher frequency of fast-food consumption compared with families with a lower monthly income (p = 0.009). Frequency of fast-food consumption predicted lower dietary-quality in adolescents (Beta (B) = -0.27 [95% confidence interval (CI): -0.35 to -0.18]) and higher carbohydrate and free-sugar intake (B = 6.93 [95% CI: 0.78 to 13.1], and B = 3.93 [95% CI: 1.48 to 6.38], respectively). In conclusion, nutrition-intervention programs aiming to limit fast-food consumption and enhance the dietary quality of adolescents in Saudi Arabia, are warranted.

Applications of environmental DNA (eDNA) in agricultural systems: Current uses, limitations and future prospects

Global food production, food supply chains and food security are increasingly stressed by human population growth and loss of arable land, becoming more vulnerable to anthropogenic and environmental perturbations. Numerous mutualistic and antagonistic species are interconnected with the cultivation of crops and livestock and these can be challenging to identify on the large scales of food production systems. Accurate identifications to capture this diversity and rapid scalable monitoring are necessary to identify emerging threats (i.e. pests and pathogens), inform on ecosystem health (i.e. soil and pollinator diversity), and provide evidence for new management practices (i.e. fertiliser and pesticide applications). Increasingly, environmental DNA (eDNA) is providing rapid and accurate classifications for specific organisms and entire species assemblages in substrates ranging from soil to air. Here, we aim to discuss how eDNA is being used for monitoring of agricultural ecosystems, what current limitations exist, and how these could be managed to expand applications into the future. In a systematic review we identify that eDNA-based monitoring in food production systems accounts for only 4 % of all eDNA studies. We found that the majority of these eDNA studies target soil and plant substrates (60 %), predominantly to identify microbes and insects (60 %) and are biased towards Europe (42 %). While eDNA-based monitoring studies are uncommon in many of the world's food production systems, the trend is most pronounced in emerging economies often where food security is most at risk. We suggest that the biggest limitations to eDNA for agriculture are false negatives resulting from DNA degradation and assay biases, as well as incomplete databases and the interpretation of abundance data. These require in silico, in vitro, and in vivo approaches to carefully design, test and apply eDNA monitoring for reliable and accurate taxonomic identifications. We explore future opportunities for eDNA research which could further develop this useful tool for food production system monitoring in both emerging and developed economies, hopefully improving monitoring, and ultimately food security.

Bittersweet: How prices of sugar-rich foods contribute to the diet-related disease epidemic in Mexico

I provide new evidence on how price changes of nutritionally similar foods, such as those rich in sugar or fats, change obesity and diet-related diseases in the context of Mexico between 1996-2010. I merge a bar-code level price dataset with product-specific nutritional composition to two datasets with health outcomes: state-level administrative and nationally representative individual-level panel data. Exploiting within-city variation in prices using fixed effects models, I show that decreased prices of sugar-rich foods increase obesity, type 2 diabetes, and hypertension prevalence; yet the prices of foods rich in other nutrients do not. Health responses to price changes are the largest for those abdominally obese or at the highest risk for chronic disease. The association between prices of sugary foods and chronic disease is meaningful: I estimate that in Mexico, price reductions of sugary foods explain roughly 15 percent of the rise in obesity and diabetes during the 15-year study period.

The Supply of Calories, Proteins, and Fats in Low-Income Countries: A Four-Decade Retrospective Study

Over the past decades, both the quantity and quality of food supply for millions of people have improved substantially in the course of economic growth across the developing world. However, the number of undernourished people has resumed growth in the 2010s amid food supply disruptions, economic slowdowns, and protectionist restrictions to agricultural trade. Having been common to most nations, these challenges to the food security status of the population still vary depending on the level of economic development and national income of individual countries. In order to explore the long-run determinants of food supply transformations, this study employs five-stage multiple regression analysis to identify the strengths and directions of effects of agricultural production parameters, income level, price indices, food trade, and currency exchange on supply of calories, proteins, and fats across 11 groups of agricultural products in 1980-2018. To address the diversity of effects across developing nations, the study includes 99 countries of Asia, Europe, Latin America, the Middle East, and Africa categorized as low-income, lower-middle-income, and upper-middle-income economies. It is found that in low-income countries, food supply parameters are more strongly affected by production factors compared to economic and trade variables. The effect of economic factors on the food supply of higher-value food products, such as meat and dairy products, fruit, and vegetables, increases with the rise in the level of income, but it stays marginal for staples in all three groups of countries. The influence of trade factors on food supply is stronger compared to production and economic parameters in import-dependent economies irrelevant of the gross national income per capita. The approach presented in this paper contributes to the research on how food supply patterns and their determinants evolve in the course of economic transformations in low-income countries.

The Relationships Between Parental Stress, Home Food Environment, and Child Diet Patterns in Families of Preschool Children

PURPOSE

Home food environment, including home food availability and parental food preparation practices, plays a significant role in child diet patterns. Recent evidence suggests that parental psychological stress is related to parental food preparation practices; however, there is limited information about the relationship between parental psychological stress and home food availability. The purpose of the study is to examine the relationships between parental stress, home food availability, child diet patterns, and body mass index (BMI) in families with young children.

DESIGN

A secondary data analysis from a mixed-methods design study.

SETTING

The parent study was conducted in both local and online communities using a web-based survey.

PARTICIPANTS

Participants were 256 parents of children aged 2 to 5 years (53.4% white; 41.5% of overweight or obese children).

MEASURES

Parents completed well-validated self-report questionnaires.

ANALYSIS

We used latent structural equation modeling using Bayesian analysis.

RESULTS

There was a negative relationship between parents' general stress and healthy food availability at home (β* = -.20, P < .001 for fruits; β* = -.23, P < .001 for vegetables; and β* = -.24, P < .001 for healthy beverage) and a positive relationship between parenting stress and healthy snack and healthy beverage availability (β = .13, P = .03; β = .14, P = .02, respectively). There was no relationship between parental stress and unhealthy food availability at home while unhealthy food availability was significantly associated with child's unhealthy eating pattern (β* = .86, P < .01 for unhealthy snack; β* = .51, P < .01 for unhealthy beverage). There was no moderating effect of children's health insurance on the relationships between parental stress and home food availability. Furthermore, child diet patterns were not associated with child BMI.

CONCLUSION

Parental psychological stress is a potentially important intervention target point for improving home food environment and child diet patterns.

Association between the price of ultra-processed foods and obesity in Brazil

BACKGROUND AND AIMS

To estimate the relationship between the price of ultra-processed foods and prevalence of obesity in Brazil and examine whether the relationship differed according to socioeconomic status.

METHODS AND RESULTS

Data from the national Household Budget Survey from 2008/09 (n = 55 570 households, divided in 550 strata) were used. Weight and height of all individuals were used. Weight was measured by using portable electronic scales (maximum capacity of 150 kg). Height (or length) was measured using portable stadiometers (maximum capacity: 200 cm long) or infant anthropometers (maximum capacity: 105 cm long). Multivariate regression models (log-log) were used to estimate price elasticity. An inverse association was found between the price of ultra-processed foods (per kg) and the prevalence of overweight (Body mass index (BMI) ≥25 kg/m²) and obesity (BMI ≥30 kg/m²) in Brazil. The price elasticity for ultra-processed foods was -0.33 (95% CI: -0.46; -0.20) for overweight and -0.59 (95% CI: -0.83; -0.36) for obesity. This indicated that a 1.00% increase in the price of ultra-processed foods would lead to a decrease in the prevalence of overweight and obesity of 0.33% and 0.59%, respectively. For the lower income group, the price elasticity for price of ultra-processed foods was -0.34 (95% CI: -0.50; -0.18) for overweight and -0.63 (95% CI: -0.91; -0.36) for obesity.

CONCLUSION

The price of ultra-processed foods was inversely associated with the prevalence of overweight and obesity in Brazil, mainly in the lowest socioeconomic status population. Therefore, the taxation of ultra-processed foods emerges as a prominent tool in the control of obesity.

The price of ultra-processed foods and beverages and adult body weight: Evidence from U.S. veterans

The consumption of ultra-processed foods in the U.S. and globally has increased and is associated with lower diet quality, higher energy intake, higher body weight, and poorer health outcomes. This study drew on individual-level data on measured height and weight from U.S. Department of Veterans Affairs medical records for adults aged 20 to 64 from 2009 through 2014 linked to food and beverage price data from the Council for Community and Economic Research to examine the association between the price of ultra-processed foods and beverages and adult body mass index (BMI). We estimated geographic fixed effects models to control for unobserved heterogeneity of prices. We estimated separate models for men and women and we assessed differences in price sensitivity across subpopulations by socioeconomic status (SES). The results showed that a one-dollar increase in the price of ultra-processed foods and beverages was associated with 0.08 lower BMI units for men (p ≤ 0.05) (price elasticity of BMI of -0.01) and 0.14 lower BMI units for women (p ≤ 0.10) (price elasticity of BMI of -0.02). Higher prices of ultra-processed foods and beverages were associated with lower BMI among low-SES men (price elasticity of BMI of -0.02) and low-SES women (price elasticity of BMI of -0.07) but no statistically significant associations were found for middle- or high-SES men or women. Robustness checks based on the estimation of an individual-level fixed effects model found a consistent but smaller association between the price of ultra-processed foods and beverages and BMI among women (price elasticity of BMI of -0.01) with a relatively larger association for low-SES women (price elasticity of BMI of -0.04) but revealed no association for men highlighting the importance of accounting for individual-level unobserved heterogeneity.

Analysis of Motivational Climate, Emotional Intelligence, and Healthy Habits in Physical Education Teachers of the Future Using Structural Equations

This study developed a Structural Equation Model (SEM) in order to identify the associations between motivational climate, emotional intelligence, adherence to the Mediterranean Diet (MD), Physical Activity (PA), and some health indicators in a sample of future teachers. A non-experimental and cross-sectional study was carried in 775 university students (22.22 ± 3.76), using as main scales the Perceived Motivational Climate in Sport Questionnaire (PMCSQ-2), Emotional Intelligence Inventory adapted for the sport context, Physical Activity Questionnaire for Adolescents (PAQ-A), Mediterranean Diet Quality Index (KIDMED), 20 meter Shuttle Run Test (20mSRT), and percentage of lean and fat mass as calculated by the Tanita TBF300®® (Tanita-Corporation, Tokyo, Japan) electronic scale. The results showed a positive association between emotional intelligence and task climate, whereas the relationship with an ego climate was low. Ego-oriented climate was positively related to MD and high levels of PA. Emotional intelligence was directly related to higher levels of PA and the level of adherence to MD. PA was negatively associated with fat mass and positively with lean mass and VO2MAX. Task-oriented motivational climate showed a positive relation with the emotional intelligence of young people. Ego-oriented motivational climates were related to higher rates of physical-sport engagement and better diet quality.

Efficacy of population-wide diabetes and obesity prevention programs: An overview of systematic reviews on proximal, intermediate, and distal outcomes and a meta-analysis of impact on BMI

We conducted an overview of systematic reviews and a meta-analysis of the impact on body mass index (BMI) of primary studies of population-wide obesity and diabetes prevention programs, in order to evaluate their efficacy. We searched eight databases for reviews of population-level programs reporting effect on diet, physical activity, BMI, or prevalence of obesity/overweight or type 2 diabetes mellitus (T2DM). Meta-analysis of primary studies within reviews reporting effect on BMI. Interventions were categorized using ANGELO framework and quality assessment using AMSTAR. Fifty-three systematic reviews were included. Primary studies were largely natural experiments or cross-sectional studies of national data. Increased price of sugar-sweetened beverages (SSBs) and fast food, decreased price of fruit and vegetables, food labelling, and grocery store interventions were associated with positive effects on diet. Park and playground renovations and point-of-choice prompts to increase stair use were associated with positive effects on physical activity. Increased price of SSBs, menu labelling, grocery store interventions, and multicomponent interventions were associated with small reductions in BMI. There was insufficient evidence of impact of any interventions on the prevalence of overweight, obesity, or T2DM. We have identified a promising suite of population-wide actions to improve diet, increase physical activity, and reduce BMI. Impact on subsequent incidence of T2DM remains speculative.

Effects of Contextual Economic Factors on Childhood Obesity

OBJECTIVES

To examine the association between changes in contextual economic factors on childhood obesity in the US.

METHODS

We combined data from 2003, 2007, and 2011/2012 National Surveys of Children's Health for 129,781 children aged 10-17 with 27 state-level variables capturing general economic conditions, labor supply, and the monetary or time costs of calorie intake, physical activity, and cigarette smoking. We employed regression models controlling for demographic factors and state and year fixed effects. We also examined heterogeneity in economic effects by household income.

RESULTS

Obesity risk increased with workforce proportion in blue-collar occupations, urban sprawl, female labor force participation, and number of convenience stores but declined with median household income, smoking ban in restaurants, and full service restaurants per capita. Most effects were specific to low income households, except for density of supercenters/warehouse clubs which was significantly associated with higher overweight/obesity risk only in higher income households.

CONCLUSIONS FOR PRACTICE

Changes in state-level economic factors related to labor supply and monetary or time cost of calorie intake may affect childhood obesity especially for children in low-income households. Policymakers should consider these effects when designing programs aimed at reducing childhood obesity.

Is an Iranian Health Promoting School status associated with improving school food environment and snacking behaviors in adolescents?

The Iranian Health Promoting Schools (IHPS) program was first piloted and then formally established in Iran in 2011 as a framework to promote healthy environment and behaviors such as proper dietary practice among adolescents. This study examined the role of IHPS in improving the school food environment and snacking behaviors among adolescents. In this cross-sectional study, 1320 eighth grade students from 40 middle schools with IHPS and non-IHPS program were selected using a proportional stratified random sampling method. A modified 55-item qualitative Food Frequency Questionnaire was used to assess the frequency of consumption of healthy and unhealthy snacks in the studied adolescents. Mixed effect negative binomial regression models were used to analyze the data. The association was also adjusted for individual variables, including gender, socio-economic status, pocket money, family structure and nutritional knowledge level. No significant difference was observed between the average of healthy and unhealthy snack items in IHPS and non-IHPS schools (p > 0.05). On the basis of adjusted analysis, being from/in IHPS was not associated with weekly frequency consumption of unhealthy [prevalence rate ratio (PRR) = 0.99; 95% CI: 0.85-1.16] and healthy (PRR = 1.08; 95% CI: 0.96-1.2) snacks among the adolescents. There was no difference regarding school food environment and snacking behaviors in IHPS and non-IHPS schools. This might indicate that there has been a weakness in institutionalizing the comprehensive concepts of the HPS approach in the studied schools. Addressing the proper understanding of HPS approach and the need for development of HPS through matching and adaptability with health promotion actions to reach defined standards, is necessary.

Unhealthy Lifestyle and Nutritional Habits Are Risk Factors for Cardiovascular Diseases Regardless of Professed Religion in University Students

To date, few studies have evaluated the possible association between religion and nutritional habits, lifestyle and cardiovascular risk in the university population. This study identified differences in the eating habits of Christian and Muslim university students and determined a possible association between the impact of religion on their lifestyles and the parameters related to cardiovascular risk. A cross-sectional study was performed with a sample population of 257 students (22.4 ± 4.76 year) at the campus of the University of Granada in Melilla (Spain). An anthropometric evaluation and a dietary assessment were performed. Blood pressure was also measured. There was a higher prevalence of overweight (29.1%) among Christian university students. The prevalence of pre-hypertension was similar between Christians and Muslims (48.3%) but was higher among Christian males (74.5%). Christian students presented higher levels of visceral fat. Students of both religions ingested carbohydrates, saturated fatty acids and total cholesterol, proteins, sodium and alcohol in excess. Significant positive correlations were found between food energy, sweets, snacks, soft drinks and body mass index (BMI) in both sexes and between the consumption of sausages-fatty meats and the systolic blood pressure (SBP) and body adiposity index (BAI) variables. Muslim students were less likely to consume alcohol (odds ratio [OR] = 7.88, 95% confidence interval [CI] = 4.27, 14.54). Christian and Muslim students presented improvable lifestyles and intake patterns. The high intake of saturated fatty acids, total cholesterol, sodium and alcohol in Christian students could lead to the early development of cardiovascular disease.

Longitudinal change in the diet's monetary value is associated with its change in quality and micronutrient adequacy among urban adults

Background

Reducing diet costs may lead to the selection of energy-dense foods, such as refined grains or foods high in added sugars and/or fats, which can lower overall dietary quality. We examined the longitudinal association between the monetary value of the diet (MVD) and the overall dietary quality across sex, race and income groups.

Methods and findings

Longitudinal data from 1,466 adult urban participants from Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used. Healthy Eating Index–2010 (HEI–2010) and Mean Adequacy Ratio (MAR) were computed and a national food price database was used to estimate MVD. Multiple linear regression analyses were conducted linking annual rates of change (Δ) in MVD to ΔHEI-2010 and ΔMAR, stratifying by sex, race and income groups. Among key findings, ΔHEI-2010 was comparable across socio-demographic groups, while ΔMAR was higher among women and individuals above poverty. Adjusting for key covariates, ΔMVD was positively associated with both ΔHEI-2010 and ΔMAR, and with a consistently stronger association among individuals above poverty, specifically for the total proteins and empty calories components of HEI-2010 and several nutrient adequacy ratios (NARs: vitamins C, E, B-6 and Zinc). ΔMVD-ΔMAR association was stronger in women, mainly influenced by ΔMVD’s positive associations with B-vitamins, copper, calcium, magnesium and phosphorus NARs. ΔMVD-Δvitamin D NAR’s positive relationship was stronger among Whites, while ΔMVD-Δvitamin B-12 NAR’s association was stronger among African-Americans.

Conclusions

In sum, a potential increase in MVD may have a stronger impact on dietary quality among urban adult women and above-poverty individuals.

A comparison of the nutritional content of processed foods available on the French market, according to the type of brand, and potential impact on nutrient intakes-An Oqali study

The French Observatory of Food Quality (Oqali) aims to collect all nutrition data provided on processed food labels, at the level of brand products, in order to monitor reformulation and nutrition labeling changes over time. This work aimed to make a cross-sectional comparison of the nutrition content of processed foods on the French market, according to their type of brand (national brands, retailer brands, entry-level retailer brands, hard discount, and specialized retailer brands), and to study the potential impact of the differences observed on simulated nutrient intakes. A total of 16,453 branded processed foodstuffs were considered, collected between 2008 and 2011 and divided into 24 food sectors. Labeled nutrition values were compared between types of brands by family of products. Nutrition values were matched with consumption data from the French Individual and National Study on Food Consumption (INCA 2) (Afssa, 2006-2007) to determine whether the nutrition differences underlined were magnified or diminished when crossing them with consumption data. Only isolated differences in nutrient contents between types of brands could be highlighted. In the case of a theoretical and exclusive consumption of processed foodstuffs from one specific type of brand, protein intakes from first-price products (entry-level retailer brands and hard discount) appeared to be significantly lower than the ones from national or retailer brand products. The absence of systematic differences in the nutrition contents of processed foods from various types of brands is an encouraging result when considering social inequalities and nutrition. As protein intakes in France are currently above recommended levels (Afssa, 2007), consumption of first-price foodstuffs does not imply any risk of deficiency for French consumers.

Americans' Perceptions about Fast Food and How They Associate with Its Consumption and Obesity Risk

We aimed to systematically examine Americans' perceptions of fast food (FF) and how these perceptions might affect fast food consumption (FFC) and obesity risk. We searched PubMed and Google for studies published in English until February 17, 2017 that reported on Americans' perceptions (defined as their beliefs, attitudes, and knowledge) regarding FF as well as those on their associations with FFC and obesity risk. Thirteen articles met inclusion criteria. Limited research has been conducted on these topics, and most studies were based on convenience samples. A 2013 nationally representative phone survey of about 2000 subjects showed that one-fifth of Americans thought FF was good for health, whereas two-thirds considered FF not good. Even over two-thirds of weekly FF consumers (47% of the total population) thought FF not good. Americans seem to have limited knowledge of calories in FF. Negative and positive FF perceptions were associated with FFC. Those who consumed less FF seemed more likely to view FF negatively. When Americans valued the convenience and taste of FF and preferred FF restaurants with kid's menus and play areas, they were likely to purchase more FF. Available research indicates neither perceived availability of FF nor Geographical Information System (GIS)-based FF presence in the neighborhood has significant associations with weekly FFC. No studies examined potential links between FF perceptions and obesity risk. Americans' perceptions of FF and how they might associate with FFC and obesity risk are understudied. Considerable variation was observed in Americans' perceptions and FFC.

Effect of an Intervention Program Based on Active Video Games and Motor Games on Health Indicators in University Students: A Pilot Study

(1) Background: High levels of physical inactivity caused by sedentary digital screen leisure constitute one of the main causes of the high levels of obesity observed in today&rsquo;s society; (2) Methods: The present study aims to analyse the effect of a 12-week intervention program based on the application of active video games and motor games on health status indicators, problematic use of video games, and resilience capacity in university students. Besides, the content blocks of the Physical Education (PE) field are worked on through these devices, revealing their potential as an Information and Communications Technology (ICT) resource. A longitudinal study with a pre-experimental design with pretest⁻posttest measurements in a single group (n = 47) was performed, using as main instruments a Tanita TBF300&reg; bioimpedance scale, the 20mSRT test for maximum oxygen consumption (VO²_max), the Adherence to a Mediterranean Diet Test (KIDMED), the Questionnaire for Experiences Related to Video games (QERV) and the Connor-Davidson Resilience Scale (CD-RISC); (3) Results: The main results were a discrete improvement in the percentage of fat mass and VO²_max, representing a small effect size in both cases. The quality of the diet followed and the confidence and tolerance for adversity as a resilience factor were also improved, representing a medium size effect for this last variable; (4) Conclusions: Despite the limitations of this study as it does not have a control group, the main conclusions are that active video games and motor games can be a motivational resource to follow an active lifestyle, helping to improve health status indicators in young adults.

Diets Rich in Fruits and Vegetables Are Associated with Lower Cardiovascular Disease Risk in Adolescents

Obesity and cardiovascular disease (CVD) risk are public health concerns in adolescents, yet few studies have examined the association of their diet to CVD risk factors. This study investigated associations between diet, body mass index (BMI), waist circumference (WC), blood pressure (BP), and blood lipids in 163 16-17 year olds. Diet recall data were converted into Healthy Eating Index-2010 (HEI) to assess diet quality. Differences in diet between groups with normal or obese BMI, normal or hypertensive BP, and normal or altered lipids were determined. Associations between diet and BMI, WC, BP, and lipids, controlling for race, gender, and socioeconomic status, were examined. Mean HEI was 49.2 (±12.0), with no differences observed between groups. HEI was not associated with any CVD risk. Sweetened beverage consumption was higher in obese adolescents, and positively related to total cholesterol (TC). Fruit intake was negatively related to BMI and diastolic BP. Total vegetable intake was negatively related to systolic BP. Greens and beans were negatively related to TC and LDL. Whole grains were negatively related to HDL. This research suggests a cardioprotective effect of diets rich in fruits and vegetables, as well as low in sweetened beverages in adolescents.

Exploring perceptions and beliefs about the cost of fruit and vegetables and whether they are barriers to higher consumption

BACKGROUND

Fruit and vegetable (F&V) consumption is below recommendations, and cost may be a barrier to meeting recommendations. Limited evidence exists on individual perceptions about the cost, actual spending and consumption of F&V. This study investigated perceptions and beliefs about cost of F&V and whether this is a barrier to higher consumption.

METHODS

An online survey of Australian adults (n = 2474) measured F&V consumption; expenditure on F&V and food; and perceived barriers to consumption. Multivariable logistic regression examined associations between participants' responses about cost of F&V and demographic factors, and with actual consumption and expenditure on F&V.

RESULTS

Cost was identified as a barrier for 29% of people not meeting recommended fruit servings and for 14% of people not meeting recommendations for vegetables. Cost was a more common barrier for those on lower incomes (fruit aOR 1.89; 95% CI 1.20-2.98 and vegetables aOR 2.94; 95% CI 1.97-4.39) and less common for older participants (fruit aOR 0.33; 95% CI 0.17-0.62 and vegetables aOR 0.31; 95% CI 0.18-0.52). There was no association between the perceived barriers and actual F&V spending. Twenty percent of participants said F&V were not affordable; 39% said cost made it difficult to buy F&V, and for 23% the cost of F&V meant they bought less than desired.

CONCLUSIONS

A minority reported F&V were not affordable where they shopped and that cost was a barrier to higher consumption. However, it is apparent that young adults and those on low incomes eat less than they would like because of cost. Strategies that remove financial impediments to consumption are indicated for these population sub-groups.

Dietary quality of the US child and adolescent population: trends from 1999 to 2012 and associations with the use of federal nutrition assistance programs

BACKGROUND

The state of the economy, changes in federal food assistance programs, and policies related to nutrition and the food supply in the United States may influence dietary quality in children and adolescents.

OBJECTIVE

We investigated dietary quality trends from 1999 to 2012 in the US child and adolescent population and their associations with socioeconomic status and participation in federal food assistance programs.

DESIGN

In this study, a nationally representative sample of 38,487 children and adolescents, aged 2-18 y, in the NHANES from 1999 to 2012 were included. Dietary information was collected with the use of a 24-h dietary recall. Dietary quality was measured with the use of the Healthy Eating Index 2010 (HEI-2010).

RESULTS

The mean HEI-2010 increased significantly from 42.5 (95% CI: 41.2, 43.8) to 50.9 (95% CI: 50.0, 51.8) from 1999 to 2012 (P-linear trend < 0.001). The reduction in empty calorie intake contributed to greater than one-third of this improvement in the total HEI-2010. We also observed significant increases in 9 other HEI-2010 component scores. However, the HEI-2010 component score for sodium decreased significantly, which reflected an increase in sodium consumption. We calculated the covariate-adjusted mean HEI-2010 score in subgroups that were defined by sociodemographic status and participation in nutrition assistance program at each NHANES cycle. Non-Hispanic black children and adolescents had a consistently lower HEI-2010 than that of other groups across all NHANES cycles. We observed a trend toward a lower HEI-2010 in Supplemental Nutrition Assistance Program (SNAP) participants than in nonparticipants after the 2003-2004 cycle. We also observed a lower HEI-2010 in participants in the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) than in nonparticipants. In general, participants in the Special Supplemental Nutrition Program for Women, Infants, and Children appeared to have a higher HEI-2010 than that of nonparticipants.

CONCLUSIONS

Although HEI-2010 scores in children and adolescents improved steadily, the overall dietary quality remained poor. Participants in the SNAP and participants in the National School Lunch Program, School Breakfast Program, or both have lower dietary quality than do nonparticipants. Future policy interventions are needed to continue improvement in dietary quality and to address disparities.

Can policy ameliorate socioeconomic inequities in obesity and obesity-related behaviours? A systematic review of the impact of universal policies on adults and children

This systematic review examined the impact of universal policies on socioeconomic inequities in obesity, dietary and physical activity behaviours among adults and children. PRISMA-Equity guidelines were followed. Database searches spanned from 2004 to August 2015. Eligible studies assessed the impact of universal policies on anthropometric, dietary or physical activity-related outcomes in adults or children according to socioeconomic position. Thirty-six studies were included. Policies were classified as agentic, agento-structural or structural, and their impact on inequities was rated as positive, neutral, negative or mixed according to the dominant associations observed. Most policies had neutral impacts on obesity-related inequities regardless of whether they were agentic (60% neutral), agento-structural (68% neutral) or structural (67% neutral). The proportion of positive impacts was similar across policy types (10% agentic, 18% agento-structural and 11% structural), with some differences for negative impacts (30% agentic, 14% agento-structural and 22% structural). The majority of associations remained neutral when stratified by participant population, implementation level and socioeconomic position measures and by anthropometric and behavioural outcomes. Fiscal measures had consistently neutral or positive impacts on inequities. Findings suggest an important role for policy in addressing obesity in an equitable manner and strengthen the case for implementing a broad complement of policies spanning the agency-structure continuum.

Are the price patterns of cardioprotective vs. unhealthy foods the same? A report from Iran

BACKGROUND

Although several studies have assessed the price of different food groups in developed countries, there is scarce evidence regarding developing countries. Also, there is no report regarding the price of cardioprotective compared with unhealthy foods. The aim of this study was to determine the trend of food cost across different food groups (cardioprotective vs. unhealthy) and to assess the association between food cost and nutritional quality of foods in Iran.

METHODS

A list of foods consumed frequently by Iranian population was provided. Nutritional quality of foods was assessed by energy density and nutrient rich foods (NRF) index. Food groups were defined according to the US Department of Agriculture (USDA) MyPlate food groups. The price of food groups was reported as kcal/price and price/serving.

RESULTS

Although a positive association between different types of nutrient rich foods, nutrient content of foods and food price was observed, there was an inverse relationship between food price and energy density. The kcal/price of "oils" was less than "whole grains" and "refined grains". "Sugar, sweets and beverages" and "beans and legumes" food groups had equal kcal/price media. Among healthy foods for cardiovascular system, nuts had the highest price/serving. On the other hand, among unhealthy foods for cardiovascular system, processed meat had the highest price/serving. The price/serving of healthy oils was similar to saturated and trans fatty acids rich oils. Also, the price/serving of low-fat (healthy) vs. high fat (unhealthy) dairy was not different. Similar finding was observed for white meat vs. red meat.

CONCLUSION

Our findings revealed that the pattern of food price in Iran is different from developed countries. Also, we found that Iranians can consume a cardioprotective diet without any economic pressure.

Does food vendor density mediate the association between neighborhood deprivation and BMI?: a G-computation mediation analysis

BACKGROUND

In previous research, neighborhood deprivation was positively associated with body mass index (BMI) among adults with diabetes. We assessed whether the association between neighborhood deprivation and BMI is attributable, in part, to geographic variation in the availability of healthful and unhealthful food vendors.

METHODS

Subjects were 16,634 participants of the Diabetes Study of Northern California, a multiethnic cohort of adults living with diabetes. Neighborhood deprivation and healthful (supermarket and produce) and unhealthful (fast food outlets and convenience stores) food vendor kernel density were calculated at each participant's residential block centroid. We estimated the total effect, controlled direct effect, natural direct effect, and natural indirect effect of neighborhood deprivation on BMI. Mediation effects were estimated using G-computation, a maximum likelihood substitution estimator of the G-formula that allows for complex data relations such as multiple mediators and sequential causal pathways.

RESULTS

We estimated that if neighborhood deprivation was reduced from the most deprived to the least deprived quartile, average BMI would change by -0.73 units (95% confidence interval: -1.05, -0.32); however, we did not detect evidence of mediation by food vendor density. In contrast to previous findings, a simulated reduction in neighborhood deprivation from the most deprived to the least deprived quartile was associated with dramatic declines in both healthful and unhealthful food vendor density.

CONCLUSIONS

Availability of food vendors, both healthful and unhealthful, did not appear to explain the association between neighborhood deprivation and BMI in this population of adults with diabetes.

Strategic nutrition: a vision for the twenty-first century

It is now widely accepted that poor nutrition plays a major role in the epidemic of various diseases, including obesity, type 2 diabetes and CVD. There has also been much research regarding the role of related factors such as advertising and food prices. Many intervention studies have been carried out where attempts have been made to persuade people to modify their behaviour, such as by making dietary changes, in order to enhance health (health promotion). There has also been much debate on the potential of government policy as a tool for achieving these goals. Various proposals have been made, such as a tax on sugary drinks, the redirection of food subsidies and how the salt content of food can be reduced. However, the great majority of previous papers have considered only single aspects of the topics discussed here. The present paper reviews strategies for improving public health, both health promotion interventions and the use of government policy approaches. Topics discussed include providing advice for the general population and the design of food guides and food labels. This leads to the conclusion that we need an overall strategy that integrates this diverse body of information and formulates a comprehensive action plan. I propose the term 'strategic nutrition'. The implementation of this plan opens up a path to a major advance in public health.

Monetary Value of Diet Is Associated with Dietary Quality and Nutrient Adequacy among Urban Adults, Differentially by Sex, Race and Poverty Status

OBJECTIVE

The association between monetary value of the diet (MVD, $/day) with dietary quality was examined using a large sample of urban US adults, differentially by socio-demographic factors.

METHODS

This was a cross-sectional study of 2,111 participants, aged 30-64y, using data from the Healthy Aging in Neighborhoods of Diversity across the Life Span Study. Dietary quality indices included Healthy Eating Index-2010 (HEI-2010) and Mean Adequacy Ratio (MAR), (two 24-hr recalls). A national food price database was used to estimate MVD. Multiple linear/logistic regression analyses were conducted stratifying separately by sex, race and poverty status.

RESULTS

Women had significantly higher HEI-2010 scores than men (43.35 vs 41.57 out of 100, respectively), whereas MAR scores were higher for men (76.8 vs 69.9, out of 100), reflecting energy intake gender differentials. Importantly, a $3/day higher MVD (IQR: $3.70/d (Q1) to $6.62/d (Q4)) was associated with a 4.98±0.35 higher total HEI-2010 and a 3.88±0.37 higher MAR score, after energy-adjustment and control for key confounders. For HEI-2010 and MAR, stronger associations were observed among participants above poverty and among women, whilethe MVD vs. HEI-2010 association was additionally stronger among Whites. Sex and poverty status differentials were observed for many MAR and some HEI-2010 components.

CONCLUSIONS

Despite positive associations between measures of dietary quality and MVD, particularly above poverty and among women, approaching compliance with the Dietary Guidelines (80 or more for HEI-2010) requires a substantially higher MVD. Thus, nutrition education may further improve people's decision-making regarding food venues and dietary choices.

Food Price Spikes Are Associated with Increased Malnutrition among Children in Andhra Pradesh, India

BACKGROUND

Global food prices have risen sharply since 2007. The impact of food price spikes on the risk of malnutrition in children is not well understood.

OBJECTIVE

We investigated the associations between food price spikes and childhood malnutrition in Andhra Pradesh, one of India's largest states, with >85 million people. Because wasting (thinness) indicates in most cases a recent and severe process of weight loss that is often associated with acute food shortage, we tested the hypothesis that the escalating prices of rice, legumes, eggs, and other staples of Indian diets significantly increased the risk of wasting (weight-for-height z scores) in children.

METHODS

We studied periods before (2006) and directly after (2009) India's food price spikes with the use of the Young Lives longitudinal cohort of 1918 children in Andhra Pradesh linked to food price data from the National Sample Survey Office. Two-stage least squares instrumental variable models assessed the relation of food price changes to food consumption and wasting prevalence (weight-for-height z scores).

RESULTS

Before the 2007 food price spike, wasting prevalence fell from 19.4% in 2002 to 18.8% in 2006. Coinciding with India's escalating food prices, wasting increased significantly to 28.0% in 2009. These increases were concentrated among low- (χ(2): 21.6, P < 0.001) and middle- (χ(2): 25.9, P < 0.001) income groups, but not among high-income groups (χ(2): 3.08, P = 0.079). Each 10.0 rupee ($0.170) increase in the price of rice/kg was associated with a drop in child-level rice consumption of 73.0 g/d (β: -7.30; 95% CI: -10.5, -3.90). Correspondingly, lower rice consumption was significantly associated with lower weight-for-height z scores (i.e., wasting) by 0.005 (95% CI: 0.001, 0.008), as seen with most other food categories.

CONCLUSION

Rising food prices were associated with an increased risk of malnutrition among children in India. Policies to help ensure the affordability of food in the context of economic growth are likely critical for promoting children's nutrition.

Food environments and childhood weight status: effects of neighborhood median income

BACKGROUND

A key aspect of any intervention to improve obesity is to better understand the environment in which decisions are being made related to health behaviors, including the food environment.

METHODS

Our aim was to examine the extent to which proximity to six types of food establishments is associated with BMI z-score and explore potential effect modification of this relationship. We used geographical information software to determine proximity from 49,770 pediatric patients' residences to six types of food establishments. BMI z-score obtained from the electronic health record was the primary outcome.

RESULTS

In multivariable analyses, living in closest proximity to large (β, -0.09 units; 95% confidence interval [CI], -0.13, -0.05) and small supermarkets (-0.08 units; 95% CI, -0.11, -0.04) was associated with lower BMI z-score; living in closest proximity to fast food (0.09 units; 95% CI, 0.03, 0.15) and full-service restaurants (0.07 units; 95% CI, 0.01, 0.14) was associated with a higher BMI z-score versus those living farthest away. Neighborhood median income was an effect modifier of the relationships of convenience stores and full-service restaurants with BMI z-score. In both cases, closest proximity to these establishments had more of an adverse effect on BMI z-score in lower-income neighborhoods.

CONCLUSIONS

Living closer to supermarkets and farther from fast food and full-service restaurants was associated with lower BMI z-score. Neighborhood median income was an effect modifier; convenience stores and full-service restaurants had a stronger adverse effect on BMI z-score in lower-income neighborhoods.

Healthy food subsidies and unhealthy food taxation: A systematic review of the evidence

The Global Burden of Disease Study and related studies report unhealthy diet is the leading risk for death and disability globally. Given the evidence associating diet and non-communicable diseases (NCDs), international and national health bodies including the World Health Organization and United Nations have called for population health interventions to improve diet as a means to target NCDs. One of the proposed interventions is to ensure healthy foods/beverages are more accessible to purchasers and unhealthy ones less accessible via fiscal policy, namely taxation and subsidies. The objective of this systematic review was to evaluate the evidence base to assess the effect of healthy food/beverage subsidies and unhealthy food/beverage taxation. A comprehensive review was conducted by searching PubMed, Medline, and Google Scholar for peer-reviewed publications and seventy-eight studies were identified for inclusion in this review. This review was performed in keeping with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Although moderate in quality, there was consistent evidence that taxation and subsidy intervention influenced dietary behaviors. The quality, level and strength of evidence along with identified gaps in research support the need for further policies and ongoing evaluation of population-wide food/beverage subsidies and taxation. To maximize success and effect, this review suggests that food taxes and subsidies should be a minimum of 10 to 15% and preferably used in tandem. Implementation of population-wide polices for taxation and subsides with ongoing evaluation of intended and unintended effects are supported by this review.

Relative food prices and obesity in US Metropolitan areas: 1976-2001

This study investigates the impact of food price on obesity, by exploring the co-occurrence of obesity growth with relative food price reduction between 1976 and 2001. Analyses control for female labor participation and metropolitan outlet densities that might affect body weight. Both the first-difference and fixed effects approaches provide consistent evidence suggesting that relative food prices have substantial impacts on obesity and such impacts were more pronounced among the low-educated. These findings imply that relative food price reductions during the time period could plausibly explain about 18% of the increase in obesity among the U.S. adults in metropolitan areas.

Food Away from Home and Childhood Obesity

Childhood obesity is associated with a number of serious health risks that can persist into adulthood. While trends in food away from home and fast-food consumption have paralleled trends in childhood obesity, it is important to identify whether this is a causal relationship. This paper reviews recent literature in this area to summarize if there is a consensus in research findings. We group the literature into two areas - consumption of and access to food away from home (FAFH). While no consensus findings have been reached in either area, the evidence of an association between FAFH consumption and childhood obesity has gained strength. Further, there is evidence that FAFH meals add calories to children's diets. The literature on the role of FAFH access and childhood obesity has continued producing mixed results.

Food prices and obesity: a review

In response to rising rates of obesity in the United States due in part to excess food consumption, researchers and policy makers have argued that levying food taxes on obesity-promoting foods, perhaps combined with subsidies on healthier options, would be an effective tool to stem the obesity epidemic. The extent to which overall energy intake or weight outcomes will improve as a result of these policies is ultimately an empirical question. This review examines the link between food or beverage price changes and energy intake or weight outcomes among U.S. consumers. Current evidence indicates that, by themselves, targeted food taxes and subsidies as considered to date are unlikely to have a major effect on individual weight or obesity prevalence. While research suggests that the effects are modest, food taxes and subsidies may play an important role in a multifaceted approach to reducing obesity incidence.

Environmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting

PURPOSE

To investigate how a pilot environmental intervention changed food sales patterns in carryout restaurants.

DESIGN

Quasi-experimental.

SETTING

Low-income neighborhoods of Baltimore, Maryland.

SUBJECTS

Seven carryouts (three intervention, four comparison).

INTERVENTION

Phase 1, menu board revision and healthy menu labeling; phase 2, increase of healthy sides and beverages; and phase 3, promotion of cheaper and healthier combination meals.

MEASURES

Weekly handwritten menu orders collected to assess changes in the proportion of units sold and revenue of healthy items (entrée, sides and beverages, and combined).

ANALYSIS

Logistic and Poisson regression models with generalized estimating equations.

RESULTS

In the intervention group, odds for healthy entrée units and odds for healthy side and beverage units sold significantly increased in phases 2 and 3; odds for healthy entrée revenue significantly increased in phase 1 (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.26), phase 2 (OR 1.32, 95% CI 1.25-1.41), and phase 3 (OR 1.39, 95% CI 1.14-1.70); and odds for healthy side and beverage revenues increased significantly in phase 2 (OR 1.62, 95% CI 1.33-1.97) and phase 3 (OR 2.73, 95% CI 2.15-3.47) compared to baseline. Total revenue in the intervention group was significantly higher in all phases than in the comparison group (p < .05).

CONCLUSION

Environmental intervention changes such as menu revision, menu labeling, improved healthy food selection, and competitive pricing can increase availability and sales of healthy items in carryouts.

Improving perceptions of healthy food affordability: results from a pilot intervention

Background

Despite strong empirical support for the association between perceived food affordability and dietary intake amongst families with a lower socioeconomic position (SEP), there is limited evidence of the most effective strategies for promoting more positive perceptions of healthy food affordability among this group. This paper reports findings from a pilot intervention that aimed to improve perceptions of healthy food affordability amongst mothers.

Findings

Participants were 66 mothers who were the parents of children recruited from primary schools located in socioeconomically disadvantaged suburbs. Intervention group participants viewed a slideshow focussed on healthy snack food affordability that illustrated cheaper healthier alternatives to common snack foods as well as food budgeting tips and price comparison education. A mixed between-within ANCOVA was conducted to examine group differences in perceived affordability of healthy food across three time points. Results revealed no difference in perceived affordability of healthy food between the two groups at baseline whereas at post-intervention and follow-up, mothers in the intervention group perceived healthy food as more affordable than the control group.

Conclusions

Focussing on education-based interventions to improve perceptions of healthy food affordability may be a promising approach that complements existing nutrition promotion strategies.

Sociodemographic differences in fast food price sensitivity

IMPORTANCE

Fiscal food policies (eg, taxation) are increasingly proposed to improve population-level health, but their impact on health disparities is unknown.

OBJECTIVE

To estimate subgroup-specific effects of fast food price changes on fast food consumption and cardiometabolic outcomes.

DESIGN, SETTING, AND PARTICIPANTS

Twenty-year follow-up (5 examinations) in a biracial US prospective cohort: Coronary Artery Risk Development in Young Adults (CARDIA) (1985/1986-2005/2006, baseline N = 5115). Participants were aged 18 to 30 years at baseline; design indicated equal recruitment by race (black vs white), educational attainment, age, and sex. Community-level price data from the Council for Community and Economic Research were temporally and geographically linked to study participants' home address at each examination.

MAIN OUTCOMES AND MEASURES

Participant-reported number of fast food eating occasions per week, body mass index (BMI), and homeostasis model assessment insulin resistance (HOMA-IR) from fasting glucose and insulin concentrations. Covariates included individual-level and community-level social and demographic factors.

RESULTS

In repeated measures regression analysis, multivariable-adjusted associations between fast food price and consumption were nonlinear (quadratic, P < .001), with significant inverse estimated effects on consumption at higher prices; estimates varied according to race (interaction P = .04), income (P = .07), and education (P = .03). At the 10th percentile of price ($1.25/serving), blacks and whites had mean fast food consumption frequency of 2.20 (95% CI, 2.07-2.33) and 1.55 (1.45-1.65) times/wk, respectively, whereas at the 90th percentile of price ($1.53/serving), respective mean consumption estimates were 1.86 (1.75-1.97) and 1.50 (1.41-1.59) times/wk. We observed differential price effects on HOMA-IR (inverse for lower educational status only [interaction P = .005] and at middle income only [interaction P = .02]) and BMI (inverse for blacks, less education, and middle income; positive for whites, more education, and high income [all interaction P < .001]).

CONCLUSIONS AND RELEVANCE

We found greater fast food price sensitivity on fast food consumption and insulin resistance among sociodemographic groups that have a disproportionate burden of chronic disease. Our findings have implications for fiscal policy, particularly with respect to possible effects of fast food taxes among populations with diet-related health disparities.

Choosing healthier foods in recreational sports settings: a mixed methods investigation of the impact of nudging and an economic incentive

BACKGROUND

Nudging is an approach to environmental change that alters social and physical environments to shift behaviors in positive, self-interested directions. Evidence indicates that eating is largely an automatic behavior governed by environmental cues, suggesting that it might be possible to nudge healthier dietary behaviors. This study assessed the comparative and additive efficacy of two nudges and an economic incentive in supporting healthy food purchases by patrons at a recreational swimming pool.

METHODS

An initial pre-intervention period was followed by three successive and additive interventions that promoted sales of healthy items through: signage, taste testing, and 30% price reductions; concluding with a return to baseline conditions. Each period was 8 days in length. The primary outcome was the change in the proportion of healthy items sold in the intervention periods relative to pre- and post-intervention in the full sample, and in a subsample of patrons whose purchases were directly observed. Secondary outcomes included change in the caloric value of purchases, change in revenues and gross profits, and qualitative process observations. Data were analyzed using analysis of covariance, chi-square tests and thematic content analysis.

RESULTS

Healthy items represented 41% of sales and were significantly lower than sales of unhealthy items (p < 0.0001). In the full sample, sales of healthy items did not differ across periods, whereas in the subsample, sales of healthy items increased by 30% when a signage + taste testing intervention was implemented (p < 0.01). This increase was maintained when prices of healthy items were reduced by 30%, and when all interventions were removed. When adults were alone they purchased more healthy items compared to when children were present during food purchases (p < 0.001), however parental choices were not substantially better than choices made by children alone.

CONCLUSIONS

This study found mixed evidence for the efficacy of nudging in cueing healthier dietary behaviors. Moreover, price reductions appeared ineffectual in this setting. Our findings point to complex, context-specific patterns of effectiveness and suggest that nudging should not supplant the use of other strategies that have proven to promote healthier dietary behaviors.

A systematic review of the effectiveness of taxes on nonalcoholic beverages and high-in-fat foods as a means to prevent obesity trends

BACKGROUND

As part of the efforts to curb obesity, a new focus seems to be put on taxing foods that are perceived as being associated with obesity (eg, sugar-sweetened beverages and foods high in fat, sugar, and salt content) as a policy instrument to promote healthier diets.

OBJECTIVE

To assess the possible effects of such taxation policies by identifying and analyzing all studies which investigate the impact of price increases on consumption, caloric intake, or weight outcomes.

METHODS

Electronic data bases were searched with appropriate terms and their combinations. Thereafter, abstracts were reviewed and studies were selected based on predefined criteria. The characteristics of the selected studies and the results were extracted in a special form and consequently were reviewed and synthesized.

RESULTS

Price increase may lead to a reduction in consumption of the targeted products, but the subsequent effect on caloric intake may be much smaller. Only a limited number of the identified studies reported weight outcomes, most of which are either insignificant or very small in magnitude to make any improvement in public health.

CONCLUSION

The effectiveness of a taxation policy to curb obesity is doubtful and available evidence in most studies is not very straightforward due to the multiple complexities in consumer behavior and the underling substitution effects. There is need to investigate in-depth the potential underlying mechanisms and the relationship between price-increase policies, obesity, and public health outcomes.

Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes

Taxes and subsidies are increasingly being considered as potential policy instruments to incentivize consumers to improve their food and beverage consumption patterns and related health outcomes. This study provided a systematic review of recent U.S. studies on the price elasticity of demand for sugar-sweetened beverages (SSBs), fast food, and fruits and vegetables, as well as the direct associations of prices/taxes with body weight outcomes. Based on the recent literature, the price elasticity of demand for SSBs, fast food, fruits and vegetables was estimated to be -1.21, -0.52, -0.49 and -0.48, respectively. The studies that linked soda taxes to weight outcomes showed minimal impacts on weight; however, they were based on existing state-level sales taxes that were relatively low. Higher fast-food prices were associated with lower weight outcomes particularly among adolescents, suggesting that raising prices would potentially impact weight outcomes. Lower fruit and vegetable prices were generally found to be associated with lower body weight outcomes among both low-income children and adults, suggesting that subsidies that would reduce the cost of fruits and vegetables for lower-socioeconomic populations may be effective in reducing obesity. Pricing instruments should continue to be considered and evaluated as potential policy instruments to address public health risks.

The local food environment and diet: a systematic review

Despite growing attention to the problem of obesogenic environments, there has not been a comprehensive review evaluating the food environment-diet relationship. This study aims to evaluate this relationship in the current literature, focusing specifically on the method of exposure assessment (GIS, survey, or store audit). This study also explores 5 dimensions of "food access" (availability, accessibility, affordability, accommodation, acceptability) using a conceptual definition proposed by Penchansky and Thomas (1981). Articles were retrieved through a systematic keyword search in Web of Science and supplemented by the reference lists of included studies. Thirty-eight studies were reviewed and categorized by the exposure assessment method and the conceptual dimensions of access it captured. GIS-based measures were the most common measures, but were less consistently associated with diet than other measures. Few studies examined dimensions of affordability, accommodation, and acceptability. Because GIS-based measures on their own may not capture important non-geographic dimensions of access, a set of recommendations for future researchers is outlined.

Fast food consumption and food prices: evidence from panel data on 5th and 8th grade children

Fast food consumption is a dietary factor associated with higher prevalence of childhood obesity in the United States. The association between food prices and consumption of fast food among 5th and 8th graders was examined using individual-level random effects models utilizing consumption data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99 (ECLS-K), price data from American Chamber of Commerce Researchers Association (ACCRA), and contextual outlet density data from Dun and Bradstreet (D&B). The results found that contextual factors including the price of fast food, median household income, and fast food restaurant outlet densities were significantly associated with fast food consumption patterns among this age group. Overall, a 10% increase in the price of fast food was associated with 5.7% lower frequency of weekly fast food consumption. These results suggest that public health policy pricing instruments such as taxes may be effective in reducing consumption of energy-dense foods and possibly reducing the prevalence of overweight and obesity among US children and young adolescents.

Food portion patterns and trends among U.S. children and the relationship to total eating occasion size, 1977-2006

Food and beverage portion sizes are related to childhood obesity. We examined trends in food portion sizes and the association with total meal sizes among U.S. children. We selected children 2- to 18-y-old (n = 31,337) from 4 nationally representative surveys of food intake between 1977-1978 and 2003-2006. We assessed portion sizes (kcal and g) of selected key foods (soft/fruit drinks, salty snacks, desserts, French fries, burgers, pizzas, Mexican fast foods, and hot dogs), the total energy from eating occasions that included key foods, and portion sizes of the selected key foods by source (stores, restaurants, and fast-food locations). These foods represented over one-third of children's energy intake in 2003-2006. Portion sizes increased significantly over the 30-y period and increases in pizza were particularly pronounced in the last decade [+176 kcal (736 kJ). Energy from eating occasions including pizzas and soft drinks increased, as did the proportion of energy from these foods in an eating occasion. Hamburgers and cheeseburgers increased in portion size and eating occasion size, but the proportion of these foods in the total eating occasions did not increase. Portion sizes of other key foods increased, although the total energy from eating events that included them remained constant (e.g. Mexican fast-foods, French fries, fruit drinks) or decreased (e.g. salty snacks, desserts). Portion sizes increased across all food sources (stores, restaurants, and fast foods) for soft drinks and pizzas but only at fast-food locations for French fries. Portion sizes continue to grow for selected foods. Fast-food chains appear to be linked with less healthful portion size increases for selected foods.