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Verney AMJ, Busch‐Hallen JF, Walters DD, Rowe SN, Kurzawa ZA, Arabi M. Multiple micronutrient supplementation cost-benefit tool for informing maternal nutrition policy and investment decisions. Matern Child Nutr 2023; 19:e13523. [PMID: 37378454 PMCID: PMC10483938 DOI: 10.1111/mcn.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 06/29/2023]
Abstract
Antenatal multiple micronutrient supplementation (MMS) is an intervention that can help reach three of the six global nutrition targets, either directly or indirectly: a reduction in low birth weight, stunting, and anaemia in women of reproductive age. To support global guideline development and national decision-making on investments into maternal nutrition, Nutrition International developed a modelling tool called the MMS cost-benefit tool to help users understand whether antenatal MMS is better value for money than iron and folic acid supplementation (IFAS) during pregnancy. The MMS cost-benefit tool can generate estimates on the potential health impact, budget impact, economic value, cost-effectiveness and benefit-cost ratio of investing in MMS compared to IFAS in LMICs. In the 33 countries with data included in the tool, the MMS cost-benefit tool shows that transitioning is expected to generate substantial health benefits in terms of morbidity and mortality averted and can be very cost-effective in multiple scenarios for these countries. The cost per DALY averted averages at US$ 23.61 and benefit-cost ratio ranges from US$ 41-US$ 1304: $1.0, which suggest MMS is good value for money compared with IFAS. With its user-friendly design, open access availability, and online data-driven analytics, the MMS cost-benefit tool can be a powerful resource for governments and nutrition partners seeking timely and evidence-based analyses to inform policy-decision and investments towards the scale-up of MMS for pregnant women globally.
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Zhu S, Mitsinikos C, Poirier L, Igusa T, Gittelsohn J. Development of a System Dynamics Model to Guide Retail Food Store Policies in Baltimore City. Nutrients 2021; 13:nu13093055. [PMID: 34578934 PMCID: PMC8465929 DOI: 10.3390/nu13093055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 12/29/2022] Open
Abstract
Policy interventions to improve food access and address the obesity epidemic among disadvantaged populations are becoming more common throughout the United States. In Baltimore MD, corner stores are a frequently used source of food for low-income populations, but these stores often do not provide a range of affordable healthy foods. This research study aimed to assist city policy makers as they considered implementing a Staple Food Ordinance (SFO) that would require small stores to provide a range and depth of stock of healthy foods. A System Dynamics (SD) model was built to simulate the complex Baltimore food environment and produce optimal values for key decision variables in SFO planning. A web-based application was created for users to access this model to optimize future SFOs, and to test out different options. Four versions of potential SFOs were simulated using this application and the advantages and drawbacks of each SFO are discussed based on the simulation results. These simulations show that a well-designed SFO has the potential to reduce staple food costs, increase corner store profits, reduce food waste, and expand the market for heathy staple foods.
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Affiliation(s)
- Siyao Zhu
- Department of Civil and Systems Engineering, Johns Hopkins Whiting School of Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA; (C.M.); (T.I.)
- Correspondence: ; Tel.: +1-517-775-9441
| | - Cassandra Mitsinikos
- Department of Civil and Systems Engineering, Johns Hopkins Whiting School of Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA; (C.M.); (T.I.)
| | - Lisa Poirier
- Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (L.P.); (J.G.)
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Takeru Igusa
- Department of Civil and Systems Engineering, Johns Hopkins Whiting School of Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA; (C.M.); (T.I.)
- Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (L.P.); (J.G.)
| | - Joel Gittelsohn
- Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (L.P.); (J.G.)
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Cooper SL, Butcher LM, Scagnelli SD, Lo J, Ryan MM, Devine A, O’Sullivan TA. Australian Consumers Are Willing to Pay for the Health Star Rating Front-of-Pack Nutrition Label. Nutrients 2020; 12:E3876. [PMID: 33352995 PMCID: PMC7765932 DOI: 10.3390/nu12123876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022] Open
Abstract
The Australia and New Zealand Ministerial Forum on Food Regulation has supported the recommendations set out in the 2019 Health Star Rating System Five Year Review Report. Specifically, the forum supported, in principle, Recommendation 9, to mandate the Health Star Rating if clear uptake targets were not achieved while the system is voluntary. Given that mandatory labelling is being considered, it is important to investigate how much consumers value the Health Star Rating in order to understand potential consumer uptake and inform industry. The aim of this study was to assess consumers' valuation of the Health Star Rating system by analysing their willingness to pay for a packaged food product with the Health Star Rating label, utilising a double-bounded dichotomous choice contingent valuation approach. The results indicate that almost two-thirds of Australian household grocery shoppers were willing to pay more for a product with the Health Star Rating, on average up to an additional 3.7% of the price of the product. However, public health nutrition benefits associated with consumers' willingness to pay more for products with the Health Star Rating is currently limited by the lack of guarantee of the systems' accuracy. Given consumer support, a well validated and comprehensive Health Star Rating labelling system can potentially improve health outcomes, cost effectiveness and reduce environmental impacts.
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Affiliation(s)
- Sheri L. Cooper
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Southern Cross Drive, Bilinga, QLD 4225, Australia
| | - Lucy M. Butcher
- School of Health and Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia; (L.M.B.); (A.D.); (T.A.O.)
- Foodbank WA, 23 Abbott Road, Perth Airport, WA 6105, Australia
| | - Simone D. Scagnelli
- School of Business and Law, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia; (S.D.S.); (M.M.R.)
| | - Johnny Lo
- School of Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia;
| | - Maria M. Ryan
- School of Business and Law, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia; (S.D.S.); (M.M.R.)
| | - Amanda Devine
- School of Health and Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia; (L.M.B.); (A.D.); (T.A.O.)
| | - Therese A. O’Sullivan
- School of Health and Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia; (L.M.B.); (A.D.); (T.A.O.)
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Serra-Majem L, Tomaino L, Dernini S, Berry EM, Lairon D, Ngo de la Cruz J, Bach-Faig A, Donini LM, Medina FX, Belahsen R, Piscopo S, Capone R, Aranceta-Bartrina J, La Vecchia C, Trichopoulou A. Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns. Int J Environ Res Public Health 2020; 17:E8758. [PMID: 33255721 PMCID: PMC7728084 DOI: 10.3390/ijerph17238758] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets. OBJECTIVE To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns. METHODS We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it. CONCLUSIONS The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.
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Affiliation(s)
- Lluís Serra-Majem
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, and Complejo Hospitalario Universitario Insular—Materno Infantil (CHUIMI), Canarian Health Service, 35016 Las Palmas de Gran Canaria, Spain; (L.T.); (J.A.-B.)
- International Foundation of Mediterranean Diet, Nutrition Research Foundation, Barcelona Science Park, 08028 Barcelona, Spain; (S.D.); (E.M.B.); (J.N.d.l.C.)
- CIBEROBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Laura Tomaino
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, and Complejo Hospitalario Universitario Insular—Materno Infantil (CHUIMI), Canarian Health Service, 35016 Las Palmas de Gran Canaria, Spain; (L.T.); (J.A.-B.)
- Department of Clinical Medicine and Community Health (DISCCO), Università degli Studi di Milano, 20122 Milan, Italy;
| | - Sandro Dernini
- International Foundation of Mediterranean Diet, Nutrition Research Foundation, Barcelona Science Park, 08028 Barcelona, Spain; (S.D.); (E.M.B.); (J.N.d.l.C.)
- Forum on Mediterranean Food Cultures, 00148 Rome, Italy
| | - Elliot M. Berry
- International Foundation of Mediterranean Diet, Nutrition Research Foundation, Barcelona Science Park, 08028 Barcelona, Spain; (S.D.); (E.M.B.); (J.N.d.l.C.)
- Braun School of Public Health, Hebrew University Hadassah Medical School, 91120 Jerusalem, Israel
| | - Denis Lairon
- Human Nutrition, Aix Marseille University, INSERM, INRA, C2VN, 13005 Marseille, France;
| | - Joy Ngo de la Cruz
- International Foundation of Mediterranean Diet, Nutrition Research Foundation, Barcelona Science Park, 08028 Barcelona, Spain; (S.D.); (E.M.B.); (J.N.d.l.C.)
| | - Anna Bach-Faig
- FoodLab Research Group (2017SGR 83), Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain; (A.B.-F.); (F.-X.M.)
- Food and Nutrition Area, Barcelona Official College of Pharmacists, 08009 Barcelona, Spain
| | - Lorenzo M. Donini
- Department of Experimental Medicine, Sapienza University, 00136 Rome, Italy;
| | - Francesc-Xavier Medina
- FoodLab Research Group (2017SGR 83), Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain; (A.B.-F.); (F.-X.M.)
| | - Rekia Belahsen
- Training and Research Unit on Nutrition & Food Sciences, Biotechnology, Biochemistry & Nutrition Laboratory, Chouaib Doukkali University, El Jadida 24000, Morocco;
| | - Suzanne Piscopo
- Department of Health, Physical Education and Consumer Studies, Faculty of Education, University of Malta, MSD2080 Msida, Malta;
| | - Roberto Capone
- International Center for Advanced Mediterranean Agronomic Studies (CIHEAM), 70010 Valenzano (Bari), Italy;
| | - Javier Aranceta-Bartrina
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, and Complejo Hospitalario Universitario Insular—Materno Infantil (CHUIMI), Canarian Health Service, 35016 Las Palmas de Gran Canaria, Spain; (L.T.); (J.A.-B.)
- CIBEROBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Food Sciences and Physiology, University of Navarra, 31008 Pamplona, Spain
| | - Carlo La Vecchia
- Department of Clinical Medicine and Community Health (DISCCO), Università degli Studi di Milano, 20122 Milan, Italy;
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Segovia J, Orellana M, Sarmiento JP, Carchi D. The effects of taxing sugar-sweetened beverages in Ecuador: An analysis across different income and consumption groups. PLoS One 2020; 15:e0240546. [PMID: 33048990 PMCID: PMC7553359 DOI: 10.1371/journal.pone.0240546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
To analyze the effects of taxing sugar-sweetened beverages (SSBs) in Ecuador, this study estimates a Quadratic Almost Ideal Demand System model using data from the 2011–2012 National Survey of Income and Expenditure for Urban and Rural Households. We derive own- and cross-price elasticities by income quintiles and consumption deciles for five beverages, including two types of sugary drink: (i) milk, (ii) soft drinks, (iii) water, (iv) other sugary drinks, and (v) coffee and tea. Overall, results show that a 20% increase in the price of SSBs will decrease the consumption of soft drinks and other sugary drinks by 27% and 22%, respectively. Heterogeneous consumer behavior is revealed across income and consumption groups, as well as policy-relevant complementarity and substitution patterns. Policy impacts are simulated by considering an 18 cents per liter tax, implemented in Ecuador, and an ad-valorem 20% tax on the price. Estimated tax revenues and weight loss are larger for the latter. From a health perspective, high-income and heavy consumer households would benefit the most from this policy. Our study supports an evidence-based debate on how to correctly design and monitor food policy.
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Affiliation(s)
- Joselin Segovia
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca, Azuay, Ecuador
- * E-mail:
| | - Mercy Orellana
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca, Azuay, Ecuador
| | - Juan Pablo Sarmiento
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca, Azuay, Ecuador
| | - Darwin Carchi
- Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca, Azuay, Ecuador
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Lauk J, Nurk E, Robertson A, Parlesak A. Culturally Optimised Nutritionally Adequate Food Baskets for Dietary Guidelines for Minimum Wage Estonian Families. Nutrients 2020; 12:nu12092613. [PMID: 32867197 PMCID: PMC7551125 DOI: 10.3390/nu12092613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022] Open
Abstract
Although low socioeconomic groups have the highest risk of noncommunicable diseases in Estonia, national dietary guidelines and nutrition recommendations do not consider affordability. This study aims to help develop nutritionally adequate, health-promoting, and culturally acceptable dietary guidelines at an affordable price. Three food baskets (FBs) were optimised using linear programming to meet recommended nutrient intakes (RNIs), or Estonian dietary guidelines, or both. In total, 6255 prices of 422 foods were collected. The Estonian National Dietary Survey (ENDS) provided a proxy for cultural acceptability. Food baskets for a family of four, earning minimum wage, contain between 73 and 96 foods and cost between 10.66 and 10.92 EUR per day. The nutritionally adequate FB that does not follow Estonian dietary guidelines deviates the least (26% on average) from ENDS but contains twice the sugar, sweets, and savoury snacks recommended. The health-promoting FB (40% deviation) contains a limited amount of sugar, sweets, and savoury snacks. However, values for vitamin D, iodine, iron, and folate are low compared with RNIs, as is calcium for women of reproductive age. When both the RNIs and dietary guidelines are enforced, the average deviation (73%) and cost (10.92 EUR) are highest. The composition of these FBs can help guide the development of dietary guidelines for low income families in Estonia.
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Affiliation(s)
- Janne Lauk
- Clinical Research Centre, Department of Clinical Sciences, Faculty of Medicine, Lund University, Jan Waldenströms gata 35, 214 28 Malmö, Sweden;
- Global Nutrition and Health, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark;
| | - Eha Nurk
- Department of Nutrition Research, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia;
| | - Aileen Robertson
- Global Nutrition and Health, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark;
| | - Alexandr Parlesak
- Global Nutrition and Health, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark;
- Correspondence:
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Murphy MM, Schmier JK. Cardiovascular Healthcare Cost Savings Associated with Increased Whole Grains Consumption among Adults in the United States. Nutrients 2020; 12:nu12082323. [PMID: 32756452 PMCID: PMC7469007 DOI: 10.3390/nu12082323] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/07/2023] Open
Abstract
Little is known about the potential health economic impact of increasing the proportion of total grains consumed as whole grains to align with Dietary Guidelines for Americans (DGA) recommendations. Health economic analysis estimating difference in costs developed using (1) relative risk (RR) estimates between whole grains consumption and outcomes of cardiovascular disease (CVD) and a selected component (coronary heart disease, CHD); (2) estimates of total and whole grains consumption among US adults; and (3) annual direct and indirect medical costs associated with CVD. Using reported RR estimates and assuming a linear relationship, risk reductions per serving of whole grains were calculated and cost savings were estimated from proportional reductions by health outcome. With a 4% reduction in CVD incidence per serving and a daily increase of 2.24 oz-eq of whole grains, one-year direct medical cost savings were estimated at US$21.9 billion (B) (range, US$5.5B to US$38.4B). With this same increase in whole grains and a 5% reduction in CHD incidence per serving, one-year direct medical cost savings were estimated at US$14.0B (US$8.4B to US$22.4B). A modest increase in whole grains of 0.25 oz-eq per day was associated with one-year CVD-related savings of $2.4B (US$0.6B to US$4.3B) and CHD-related savings of US$1.6B (US$0.9B to US$2.5B). Increasing whole grains consumption among US adults to align more closely with DGA recommendations has the potential for substantial healthcare cost savings.
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Affiliation(s)
- Mary M. Murphy
- Exponent, Inc., Center for Chemical Regulation and Food Safety, Washington, DC 20036, USA
- Correspondence: ; Tel.: +1-202-772-4953
| | - Jordana K. Schmier
- Pharmerit—An Open Health Company, Real-World Evidence and Data Analytics Center of Excellence, Bethesda, MD 20814, USA;
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Hirvonen K, Bai Y, Headey D, Masters WA. Affordability of the EAT-Lancet reference diet: a global analysis. Lancet Glob Health 2020; 8:e59-e66. [PMID: 31708415 PMCID: PMC7024996 DOI: 10.1016/s2214-109x(19)30447-4] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/21/2019] [Accepted: 10/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The EAT-Lancet Commission drew on all available nutritional and environmental evidence to construct the first global benchmark diet capable of sustaining health and protecting the planet, but it did not assess dietary affordability. We used food price and household income data to estimate affordability of EAT-Lancet benchmark diets, as a first step to guiding interventions to improve diets around the world. METHODS We obtained retail prices from 2011 for 744 foods in 159 countries, collected under the International Comparison Program. We used these data to identify the most affordable foods to meet EAT-Lancet targets. We compared total diet cost per day to each country's mean per capita household income, calculated the proportion of people for whom the most affordable EAT-Lancet diet exceeds total income, and also measured affordability relative to a least-cost diet that meets essential nutrient requirements. FINDINGS The most affordable EAT-Lancet diets cost a global median of US$2·84 per day (IQR 2·41-3·16) in 2011, of which the largest share was the cost of fruits and vegetables (31·2%), followed by legumes and nuts (18·7%), meat, eggs, and fish (15·2%), and dairy (13·2%). This diet costs a small fraction of average incomes in high-income countries but is not affordable for the world's poor. We estimated that the cost of an EAT-Lancet diet exceeded household per capita income for at least 1·58 billion people. The EAT-Lancet diet is also more expensive than the minimum cost of nutrient adequacy, on average, by a mean factor of 1·60 (IQR 1·41-1·78). INTERPRETATION Current diets differ greatly from EAT-Lancet targets. Improving diets is affordable in many countries but for many people would require some combination of higher income, nutritional assistance, and lower prices. Data and analysis for the cost of healthier foods are needed to inform both local interventions and systemic changes. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kalle Hirvonen
- Development Strategy and Governance Division, International Food Policy Research Institute, Bole Sub-City, Addis Ababa, Ethiopia
| | - Yan Bai
- Friedman School of Nutrition, Tufts University, Boston, MA, USA
| | - Derek Headey
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington DC, USA
| | - William A Masters
- Friedman School of Nutrition, Tufts University, Boston, MA, USA; Department of Economics, Tufts University, Boston, MA, USA.
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Faksová K, Brázdová ZD, Robertson A, Parlesak A. Nutritionally adequate food baskets optimised for cultural acceptability as basis for dietary guidelines for low-income Czech families. Nutr J 2019; 18:84. [PMID: 31810479 PMCID: PMC6898948 DOI: 10.1186/s12937-019-0510-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/03/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Czech nutrition recommendations prioritize health aspects without considering affordability. Low socio-economic groups have the highest risk of nutrition-related noncommunicable diseases and cost has been identified as an obstacle to achieve a healthy diet, making the implementation of affordability into dietary guidelines necessary. The aim of this study was to develop a food basket (FB) for a low income Czech family of four that is nutritionally adequate, health-promoting and culturally acceptable at an affordable price. METHODS Linear programming optimisation was used to ascertain that the FB covered the recommended nutrient intakes from the Czech Nutrition Society and from the World Health Organization (WHO). Cost of the FB was calculated on the basis of more than 3900 prices of 330 foods. Within a given cost constraint, all FBs were optimized for the highest possible similarity to the reported food group intake according to the most recent Czech National Food Consumption survey, which was used as a proxy for cultural acceptability. RESULTS The optimised FB affordable at a daily food budget for a Czech family on minimum wage (CZK 177, ~ € 6.8) contained 76 foods and had an average relative deviation of 10% per food category from reported intake. The main deviations were: 72% less sweets and confectionery; 66% less salt; 52% less meat; 50% less milk products; 8% less potatoes; and 484% more milk; 69% more oils and fats; 20% more cereals; and 6% more vegetables. CONCLUSIONS The optimised FB can help to guide the development of food-based dietary guidelines for low income households in Czech Republic.
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Affiliation(s)
- Kristyna Faksová
- Faculty of Health, Global Nutrition and Health, Institute for Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Zuzana Derflerová Brázdová
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Aileen Robertson
- Faculty of Health, Global Nutrition and Health, Institute for Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Alexandr Parlesak
- Faculty of Health, Global Nutrition and Health, Institute for Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
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Kim DD, Wilde PE, Michaud DS, Liu J, Lizewski L, Onopa J, Mozaffarian D, Zhang FF, Wong JB. Cost Effectiveness of Nutrition Policies on Processed Meat: Implications for Cancer Burden in the U.S. Am J Prev Med 2019; 57:e143-e152. [PMID: 31564600 PMCID: PMC6803059 DOI: 10.1016/j.amepre.2019.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Processed meats are associated with increased risk of colorectal and stomach cancers, but health and economic impacts of policies to discourage processed meats are not well established. This paper aims to evaluate the cost effectiveness of implementing tax and warning labels on processed meats. METHODS A probabilistic cohort-state transition model was developed in 2018, including lifetime and short-term horizons, healthcare, and societal perspectives, and 3% discount rates for costs and health outcomes. The model simulated 32 subgroups by age, gender, and race/ethnicity from the U.S. adult population and integrated nationally representative 2011-2014 data on processed meat consumption, with etiologic effects of processed meat consumption on cancer incidence, medical and indirect societal costs, and policy costs. RESULTS Over a lifetime, the 10% excise tax would prevent 77,000 cases of colorectal cancer (95% uncertainty interval=56,800, 107,000) and 12,500 cases of stomach cancer (95% uncertainty interval=6,880, 23,900), add 593,000 quality-adjusted life years (95% uncertainty interval=419,000, 827,000), and generate net savings of $2.7 billion from a societal perspective, including $1.1 billion healthcare costs saved. The warning label policy would avert 85,400 cases of colorectal cancer (95% uncertainty interval=56,600, 141,000) and 15,000 cases of stomach cancer (95% uncertainty interval=6,860, 34,500), and add 660,000 quality-adjusted life years (95% uncertainty interval=418,000, 1,070,000), with net savings of $4.5 billion from a societal perspective, including $1.3 billion healthcare costs saved. In subgroup analyses, greater health and economic benefits accrued to (1) younger subpopulations, (2) subpopulations with greater cancer risk, and (3) those with higher baseline processed meat consumption. CONCLUSIONS The model shows that implementing tax or warning labels on processed meats would be a cost-saving strategy with substantial health and economic benefits. The findings should encourage policy makers to consider nutrition-related policies to reduce cancer burden.
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Affiliation(s)
- David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
| | - Parke E Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Junxiu Liu
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Lauren Lizewski
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Jennifer Onopa
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts
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11
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Long MW, Polacsek M, Bruno P, Giles CM, Ward ZJ, Cradock AL, Gortmaker SL. Cost-Effectiveness Analysis and Stakeholder Evaluation of 2 Obesity Prevention Policies in Maine, US. J Nutr Educ Behav 2019; 51:1177-1187. [PMID: 31402290 DOI: 10.1016/j.jneb.2019.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the potential cost-effectiveness of and stakeholder perspectives on a sugar-sweetened beverage (SSB) excise tax and a Supplemental Nutrition Assistance Program (SNAP) policy that would not allow SSB purchases in Maine, US. DESIGN A cost-effectiveness simulation model combined with stakeholder interviews. SETTING Maine, US. PARTICIPANTS Microsimulation of the Maine population in 2015 and interviews with stakeholders (n = 14). Study conducted from 2013 to 2017. MAIN OUTCOME MEASURES Health care cost savings, net costs, and quality-adjusted life-years (QALYs) from 2017 to 2027. Stakeholder positions on policies. Retail SSB cost and implementation cost data were collected. ANALYSIS Childhood Obesity Intervention Cost-Effectiveness Study project microsimulation model with uncertainty analysis to estimate cost-effectiveness. Thematic stakeholder interview coding. RESULTS Over 10 years, the SSB and SNAP policies were projected to reduce health care costs by $78.3 million (95% uncertainty interval [UI], $31.7 million-$185 million) and $15.3 million (95% UI, $8.32 million-$23.9 million), respectively. The SSB and SNAP policies were projected to save 3,560 QALYs (95% UI, 1,447-8,361) and 749 QALYs (95% UI, 415-1,168), respectively. Stakeholders were more supportive of SSB taxes than the SNAP policy because of equity concerns associated with the SNAP policy. CONCLUSIONS AND IMPLICATIONS Cost-effectiveness analysis provided evidence of potential health improvement and cost savings to state-level stakeholders weighing broader implementation considerations.
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Affiliation(s)
- Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
| | - Michele Polacsek
- Department of Public Health, College of Health Professions, University of New England, Portland, ME
| | - Pamela Bruno
- Department of Public Health, College of Health Professions, University of New England, Portland, ME
| | - Catherine M Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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12
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Eustachio Colombo P, Patterson E, Schäfer Elinder L, Lindroos AK, Sonesson U, Darmon N, Parlesak A. Optimizing School Food Supply: Integrating Environmental, Health, Economic, and Cultural Dimensions of Diet Sustainability with Linear Programming. Int J Environ Res Public Health 2019; 16:ijerph16173019. [PMID: 31438517 PMCID: PMC6747157 DOI: 10.3390/ijerph16173019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
There is great potential for reducing greenhouse gas emissions (GHGE) from public-sector meals. This paper aimed to develop a strategy for reducing GHGE in the Swedish school food supply while ensuring nutritional adequacy, affordability, and cultural acceptability. Amounts, prices and GHGE-values for all foods and drinks supplied to three schools over one year were gathered. The amounts were optimized by linear programming. Four nutritionally adequate models were developed: Model 1 minimized GHGE while constraining the relative deviation (RD) from the observed food supply, Model 2 minimized total RD while imposing stepwise GHGE reductions, Model 3 additionally constrained RD for individual foods to an upper and lower limit, and Model 4 further controlled how pair-wise ratios of 15 food groups could deviate. Models 1 and 2 reduced GHGE by up to 95% but omitted entire food categories or increased the supply of some individual foods by more than 800% and were deemed unfeasible. Model 3 reduced GHGE by up to 60%, excluded no foods, avoided high RDs of individual foods, but resulted in large changes in food-group ratios. Model 4 limited the changes in food-group ratios but resulted in a higher number of foods deviating from the observed supply and limited the potential of reducing GHGE in one school to 20%. Cost was reduced in almost all solutions. An omnivorous, nutritionally adequate, and affordable school food supply with considerably lower GHGE is achievable with moderate changes to the observed food supply; i.e., with Models 3 and 4. Trade-offs will always have to be made between achieving GHGE reductions and preserving similarity to the current supply.
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Affiliation(s)
| | - Emma Patterson
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Social Medicine, Stockholm County Council, 112 21 Stockholm, Sweden
| | - Liselotte Schäfer Elinder
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden.
- Centre for Epidemiology and Social Medicine, Stockholm County Council, 112 21 Stockholm, Sweden.
| | - Anna Karin Lindroos
- The National Food Agency, Uppsala, Sweden and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg University, 405 30 Gothenburg, Sweden
| | - Ulf Sonesson
- RISE Research Institutes of Sweden, 420 29 Gothenburg, Sweden
| | - Nicole Darmon
- MOISA, INRA, Univ Montpellier, CIHEAM-IAMM, CIRAD, Montpellier SupAgro, 34060 Montpellier, France
| | - Alexandr Parlesak
- Global Nutrition and Health, University College Copenhagen, 2200 Copenhagen, Denmark
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13
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Champeny M, Hou K, Diop EI, Sy Gueye NY, Pries AM, Zehner E, Badham J, Huffman SL. Prevalence, duration, and content of television advertisements for breast milk substitutes and commercially produced complementary foods in Phnom Penh, Cambodia and Dakar, Senegal. Matern Child Nutr 2019; 15 Suppl 4:e12781. [PMID: 31225708 PMCID: PMC6617818 DOI: 10.1111/mcn.12781] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/07/2018] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Abstract
Promotion of breast milk substitutes (BMS) and inappropriate marketing of commercially produced complementary foods (CPCF), including through television, can negatively influence infant and young child feeding. The World Health Organization International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly (WHA) resolutions prohibit such advertising and require manufacturers and distributors to comply with its provisions; however, such regulations at national level may vary. Advertisements require Ministry of Health approval in Cambodia but are not regulated in Senegal. Television stations were monitored for 13 months in Phnom Penh and for 3 months in Dakar to assess advertisements for BMS and CPCF. Ten television channels (out of 16) in Phnom Penh and four (out of 20) in Dakar aired advertisements for BMS. Three and five channels, respectively, aired advertisements for CPCF. All BMS advertised in Phnom Penh were for children over 1 year of age. BMS products for children 6+ months of age and 1+ years of age were advertised in Dakar. Average air time for BMS advertisements was 189.5 min per month in Phnom Penh and 29.7 min in Dakar. Air time for CPCF advertisements averaged 3.2 min per month and 13.6 min, respectively. Fewer than half of BMS advertisements and three quarters of CPCF advertisements explicitly stated an age of use for products. Nutrition and health claims were common across BMS advertisements. This study illustrates the need to adopt, regulate, monitor, and enforce legislation prohibiting BMS promotion, as well as to implement regulations to prevent inappropriate promotion of CPCF.
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Affiliation(s)
| | - Kroeun Hou
- Helen Keller InternationalNew YorkNew YorkUSA
| | | | | | - Alissa M. Pries
- Helen Keller InternationalNew YorkNew YorkUSA
- London School of Hygiene and Tropical MedicineLondonUK
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14
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Companies agree to sustainable food policies. Vet Rec 2019; 184:571. [PMID: 31072982 DOI: 10.1136/vr.l2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Buckton CH, Fergie G, Leifeld P, Hilton S. A discourse network analysis of UK newspaper coverage of the "sugar tax" debate before and after the announcement of the Soft Drinks Industry Levy. BMC Public Health 2019; 19:490. [PMID: 31046718 PMCID: PMC6498658 DOI: 10.1186/s12889-019-6799-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/11/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND On 6th April 2018, the UK Government introduced the Soft Drinks Industry Levy (SDIL) as a mechanism designed to address increasing prevalence of obesity and associated ill health by reducing sugar consumption. Given that the successful introduction of upstream food and nutrition policies is a highly political enterprise involving multiple interested parties, understanding the complex network of stakeholders seeking to influence such policy decisions is imperative. METHODS Media content analysis was used to build a dataset of relevant newspaper articles, which were analysed to identify stakeholder agreement or disagreement with defined concept statements. We used discourse network analysis to produce visual representations of the network of stakeholders and coalitions evident in the debate as it was presented in UK newspapers, in the lead up to and following the announcement of the Soft Drinks Industry Levy in the UK, from May 2015 to November 2016. RESULTS Coding identified 3883 statements made by 214 individuals from 176 organisations, relating to 47 concepts. Network visualisations revealed a complex network of stakeholders with clear sceptical and supportive coalitions. Industry stakeholders appeared less united in the network than anticipated, particularly before the SDIL announcement. Some key industry actors appeared in the supportive coalition, possibly due to the use of corporate social responsibility rhetoric. Jamie Oliver appeared as a dominant stakeholder, firmly embedded with public health advocates. CONCLUSION This study highlights the complexity of the network of stakeholders involved in the public debate on food policies such as sugar tax and the SDIL. Polarisation of stakeholders arose from differences in ideology, focus on a specific policy and statements about the weight of evidence. Vocal celebrity policy entrepreneurs may be instrumental in gaining public and policy makers' support for future upstream regulation to promote population health, to facilitate alignment around a clear ideology.
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Affiliation(s)
- Christina H. Buckton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
| | - Gillian Fergie
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
| | - Philip Leifeld
- Department of Government, University of Essex, Colchester Campus, Colchester, CO4 3SQ UK
- School of Social and Political Sciences, University of Glasgow, University Avenue, Glasgow, G12 8QQ UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
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16
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Affiliation(s)
- Riaz Bhunnoo
- Global Food Security Programme, Biotechnology and Biological Sciences Research Council, Polaris House, North Star Avenue, Swindon SN2 1UH, UK.
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17
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Pell D, Penney T, Hammond D, Vanderlee L, White M, Adams J. Support for, and perceived effectiveness of, the UK soft drinks industry levy among UK adults: cross-sectional analysis of the International Food Policy Study. BMJ Open 2019; 9:e026698. [PMID: 30827952 PMCID: PMC6429875 DOI: 10.1136/bmjopen-2018-026698] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To answer four questions: What are attitudes, knowledge and social norms around sugar-sweetened beverages (SSBs)? What are current levels of trust in messages on SSBs? What is current support for, and perceived effectiveness of, the UK soft drinks industry levy (SDIL)? What is the association between attitudes, knowledge, social norms, trust, SSB consumption and sociodemographic factors; and support for, and perceived effectiveness of, the SDIL? DESIGN Cross-sectional online survey. SETTING UK. PARTICIPANTS UK respondents to the 2017 International Food Policy Study aged 18-64 years who provided information on all variables of interest (n=3104). OUTCOME MEASURES Self-reported perceived effectiveness of, and support for, the SDIL. RESULTS Most participants supported the SDIL (70%), believed it would be effective (71%), had a positive attitude to SSBs (62%), had knowledge of the link between SSBs and obesity (90%), and trusted messages from health experts (61%), but not those from the food and beverage industry (73%). Nearly half (46%) had negative social norms about drinking SSBs. In adjusted models, older age, non-consumption of SSBs, social norms to not drinks SSBs, knowledge of the link between SSBs and obesity and trust in health expert messages were associated with greater support for the SDIL, whereas having dependent children and trusting messages from the food and beverage industry were associated with less support. In adjusted models, older age was associated with lower perceived effectiveness of the SDIL, whereas social norms to not drink SSBs, negative attitudes to SSBs and trusting messages from health experts and the food and beverage industry were associated with greater perceived effectiveness. CONCLUSIONS There was strong support for the SDIL and belief that it would be effective. Those with more 'public health' orientated norms and trust were generally more likely to support the SDIL or believe that it would be effective.
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Affiliation(s)
- David Pell
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tarra Penney
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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18
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Jetter KM, Adkins J, Cortez S, Hopper GK, Shively V, Styne DM. Yes We Can: Eating Healthy on a Limited Budget. J Nutr Educ Behav 2019; 51:268-276. [PMID: 30851840 PMCID: PMC6601616 DOI: 10.1016/j.jneb.2018.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study determined how people who live in low-income households can consume an affordable, nutritious diet. DESIGN A community-based participatory research (CBPR) project was completed that developed and priced 2 weeks of healthy menus that met US Department of Agriculture Dietary Guidelines for Americans. Prices were collected from a market basket survey of 13 stores in the city of Chico during October, 2010. Initial menu development began in 2011-2012. Menus were reviewed in 2017 and reflect current guidelines. SETTING Chico, CA. MAIN OUTCOME MEASURES Macro dietary objectives including the caloric content and servings of fat, sugar, whole grains, and fruits and vegetables. The cost of purchasing the market basket of goods for a family of 4 that achieved those objectives was determined. RESULTS The 2 weeks of menus all met dietary objectives on average. The daily cost varied from $19 to $31 when food was purchased from a bulk supermarket, with an average daily cost of $25. Average monthly cost was $756 in 2010 dollars, or $838 in 2015 dollars. CONCLUSIONS AND IMPLICATIONS People living in low-income households can afford to eat healthily. Using CBPR principles, daily targets, and technical support, public health partners can partner with community members for member-defined solutions that are affordable and meet dietary guidelines. Access to stores that sell low-price bulk items is important to being able to afford a healthy diet.
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Affiliation(s)
- Karen M Jetter
- Agricultural Issues Center, University of California, Davis, CA.
| | | | - Susie Cortez
- Mechoopda Indian Tribe of Chico Rancheria, Chico, CA
| | | | - Vicki Shively
- Community Health, Northern Valley Indian Health, Inc, Willows, CA
| | - Dennis M Styne
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, CA
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Carrillo-Álvarez E, Penne T, Boeckx H, Storms B, Goedemé T. Food Reference Budgets as a Potential Policy Tool to Address Food Insecurity: Lessons Learned from a Pilot Study in 26 European Countries. Int J Environ Res Public Health 2018; 16:E32. [PMID: 30586848 PMCID: PMC6338967 DOI: 10.3390/ijerph16010032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/08/2018] [Accepted: 12/14/2018] [Indexed: 01/15/2023]
Abstract
The aim of this article is to present the development of cross-country comparable food reference budgets in 26 European countries, and to discuss their usefulness as an addition to food-based dietary guidelines (FBDG) for tackling food insecurity in low-income groups. Reference budgets are illustrative priced baskets containing the minimum goods and services necessary for well-described types of families to have an adequate social participation. This study was conducted starting from national FBDG, which were translated into monthly food baskets. Next, these baskets were validated in terms of their acceptability and feasibility through focus group discussions, and finally they were priced. Along the paper, we show how that food reference budgets hold interesting contributions to the promotion of healthy eating and prevention of food insecurity in low-income contexts in at least four ways: (1) they show how a healthy diet can be achieved with limited economic resources, (2) they bring closer to the citizen a detailed example of how to put FBDG recommendations into practice, (3) they ensure that food security is achieved in an integral way, by comprising the biological but also psychological and social functions of food, and (4) providing routes for further (comparative) research into food insecurity.
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Affiliation(s)
- Elena Carrillo-Álvarez
- Blanquerna School of Health Sciences-Universitat Ramon Llull-Global Research on Wellbeing-GRoW Research group, Padilla, 08025 Barcelona, Spain.
| | - Tess Penne
- Research Foundation-Flanders, Herman Deleeck Centre for Social Policy-University of Antwerp, 2000 Antwerp, Belgium.
| | | | - Bérénice Storms
- Herman Deleeck Centre for Social Policy-University of Antwerp, 2000 Antwerp, Belgium.
| | - Tim Goedemé
- Institute for New Economic Thinking at the Oxford Martin School and Department of Social Policy and Intervention, University of Oxford, Oxford OX2 6ED, UK.
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20
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Lee A, Lewis M. Testing the Price of Healthy and Current Diets in Remote Aboriginal Communities to Improve Food Security: Development of the Aboriginal and Torres Strait Islander Healthy Diets ASAP (Australian Standardised Affordability and Pricing) Methods. Int J Environ Res Public Health 2018; 15:ijerph15122912. [PMID: 30572646 PMCID: PMC6313302 DOI: 10.3390/ijerph15122912] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Abstract
Aboriginal and Torres Strait Islander peoples suffer higher rates of food insecurity and diet-related disease than other Australians. However, assessment of food insecurity in specific population groups is sub-optimal, as in many developed countries. This study tailors the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to be more relevant to Indigenous groups in assessing one important component of food security. The resultant Aboriginal and Torres Strait Islander Healthy Diets ASAP methods were used to assess the price, price differential, and affordability of healthy (recommended) and current (unhealthy) diets in five remote Aboriginal communities. The results show that the tailored approach is more sensitive than the original protocol in revealing the high degree of food insecurity in these communities, where the current diet costs nearly 50% of disposable household income compared to the international benchmark of 30%. Sixty-two percent of the current food budget appears to be spent on discretionary foods and drinks. Aided by community store pricing policies, healthy (recommended) diets are around 20% more affordable than current diets in these communities, but at 38.7% of disposable household income still unaffordable for most households. Further studies in urban communities, and on other socioeconomic, political and commercial determinants of food security in Aboriginal and Torres Strait Islander communities appear warranted. The development of the tailored method provides an example of how national tools can be adapted to better inform policy actions to improve food security and help reduce rates of diet-related chronic disease more equitably in developed countries.
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Affiliation(s)
- Amanda Lee
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland 4006, Australia.
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo 2007, New South Wales, Australia.
| | - Meron Lewis
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland 4006, Australia.
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21
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Ferguson M, O'Dea K, Altman J, Moodie M, Brimblecombe J. Health-Promoting Food Pricing Policies and Decision-Making in Very Remote Aboriginal and Torres Strait Islander Community Stores in Australia. Int J Environ Res Public Health 2018; 15:ijerph15122908. [PMID: 30572601 PMCID: PMC6313585 DOI: 10.3390/ijerph15122908] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022]
Abstract
Aboriginal and Torres Strait Islander people living in remote communities in Australia experience a disproportionate burden of diet-related chronic disease. This occurs in an environment where the cost of store-purchased food is high and cash incomes are low, factors that affect both food insecurity and health outcomes. Aboriginal and Torres Strait Islander storeowners and the retailers who work with them implement local policies with the aim of improving food affordability and health outcomes. This paper describes health-promoting food pricing policies, their alignment with evidence, and the decision-making processes entailed in their development in community stores across very remote Australia. Semi-structured interviews were conducted with a purposive sample of retailers and health professionals identified through the snowball method, September 2015 to October 2016. Data were complemented through review of documents describing food pricing policies. A content analysis of the types and design of policies was undertaken, while the decision-making process was considered through a deductive, thematic analysis. Fifteen retailers and 32 health professionals providing services to stores participated. Subsidies and subsidy/price increase combinations dominated. Magnitude of price changes ranged from 5% to 25% on fruit, vegetables, bottled water, artificially sweetened and sugar sweetened carbonated beverages, and broadly used 'healthy/essential' and 'unhealthy' food classifications. Feasibility and sustainability were considered during policy development. Greater consideration of acceptability, importance, effectiveness and unintended consequences of policies guided by evidence were deemed important, as were increased involvement of Aboriginal and Torres Strait Islander storeowners and nutritionists in policy development. A range of locally developed health-promoting food pricing policies exist and partially align with research-evidence. The decision-making processes identified offer an opportunity to incorporate evidence, based on consideration of the local context.
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Affiliation(s)
- Megan Ferguson
- School of Public Health, The University of Queensland, Brisbane 4072, Australia.
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Darwin 0811, Australia.
| | - Kerin O'Dea
- Division of Health Sciences, University of South Australia, Adelaide 5001, Australia. Kerin.O'
| | - Jon Altman
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood 3125, Australia.
| | - Marjory Moodie
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong 3220, Australia.
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Darwin 0811, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3168, Australia.
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Ejlerskov KT, Sharp SJ, Stead M, Adamson AJ, White M, Adams J. Supermarket policies on less-healthy food at checkouts: Natural experimental evaluation using interrupted time series analyses of purchases. PLoS Med 2018; 15:e1002712. [PMID: 30562349 PMCID: PMC6298641 DOI: 10.1371/journal.pmed.1002712] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In response to public concerns and campaigns, some United Kingdom supermarkets have implemented policies to reduce less-healthy food at checkouts. We explored the effects of these policies on purchases of less-healthy foods commonly displayed at checkouts. METHODS AND FINDINGS We used a natural experimental design and two data sources providing complementary and unique information. We analysed data on purchases of small packages of common, less-healthy, checkout foods (sugary confectionary, chocolate, and potato crisps) from 2013 to 2017 from nine UK supermarkets (Aldi, Asda, Co-op, Lidl, M&S, Morrisons, Sainsbury's, Tesco, and Waitrose). Six supermarkets implemented a checkout food policy between 2013 and 2017 and were considered intervention stores; the remainder were comparators. Firstly, we studied the longitudinal association between implementation of checkout policies and purchases taken home. We used data from a large (n ≈ 30,000) household purchase panel of food brought home to conduct controlled interrupted time series analyses of purchases of less-healthy common checkout foods from 12 months before to 12 months after implementation. We conducted separate analyses for each intervention supermarket, using others as comparators. We synthesised results across supermarkets using random effects meta-analyses. Implementation of a checkout food policy was associated with an immediate reduction in four-weekly purchases of common checkout foods of 157,000 (72,700-242,800) packages per percentage market share-equivalent to a 17.3% reduction. This decrease was sustained at 1 year with 185,100 (121,700-248,500) fewer packages purchased per 4 weeks per percentage market share-equivalent to a 15.5% reduction. The immediate, but not sustained, effect was robust to sensitivity analysis. Secondly, we studied the cross-sectional association between checkout food policies and purchases eaten without being taken home. We used data from a smaller (n ≈ 7,500) individual purchase panel of food bought and eaten 'on the go'. We conducted cross-sectional analyses comparing purchases of common checkout foods in 2016-2017 from supermarkets with and without checkout food policies. There were 76.4% (95% confidence interval 48.6%-89.1%) fewer annual purchases of less-healthy common checkout foods from supermarkets with versus without checkout food policies. The main limitations of the study are that we do not know where in the store purchases were selected and cannot determine the effect of changes in purchases on consumption. Other interventions may also have been responsible for the results seen. CONCLUSIONS There is a potential impact of checkout food polices on purchases. Voluntary supermarket-led activities may have public health benefits.
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Affiliation(s)
- Katrine T. Ejlerskov
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Stephen J. Sharp
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Martine Stead
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Ashley J. Adamson
- Institute of Health & Society and the Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Bergallo P, Castagnari V, Fernández A, Mejía R. Regulatory initiatives to reduce sugar-sweetened beverages (SSBs) in Latin America. PLoS One 2018; 13:e0205694. [PMID: 30339667 PMCID: PMC6195269 DOI: 10.1371/journal.pone.0205694] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background and objectives Latin American (LA) countries have begun to adopt a variety of regulations targeting sugar-sweetened beverages (SSBs) for public health reasons. Our objective was to characterize the regulatory strategies designed to reduce SSB consumption over the last decade, and assess the available evidence on their enforcement and impact. Methods We searched legal and public health databases for public and private SSBs regulations in 14 LA countries and then conducted a systematic review of the available literature. We tracked comparative variations in the type of body issuing the regulations, their scope, and binding status. We present data following a 5-category framework we named NUTRE that classifies SSBs regulations as: (1) restrictions to SSB availability in schools (N), (2) taxes and other economic incentives to discourage consumption (U), (3) restrictions on advertising and marketing (T), (4) regulations on government procurement and subsidies (R), and (5) product labeling rules (E). Results Since 2006, 14 LA countries have adopted at least 39 public and private SSB regulatory initiatives across the NUTRE framework. Comprehensive efforts have only been approved by Chile, México and Ecuador, while the rest have comparatively few initiatives. 28 out of the 39 regulatory initiatives were passed by legislative and executive bodies; 11 initiatives represent self-regulatory undertakings by the beverage industries. An 86% (24/28) of public sector regulations are binding; 56% (22/39) contain explicit monitoring or evaluation methods; and 62% (24/39) provide for sanctions. Moreover, 23 regulations specify the body in charge of monitoring the new rules and standards. Conclusions LA countries are targeting SSB consumption through a variety of mechanisms, particularly via restrictions to availability in schools and through taxes. Interdisciplinary evidence comparing alternative regulatory strategies is scarce, and few studies offer data on impact and implementation challenges. More evidence and further comparative assessments are needed to support future decision-making.
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Affiliation(s)
- Paola Bergallo
- Law Department, Universidad Torcuato Di Tella, Ciudad Autónoma de Buenos Aires, Argentina
- * E-mail:
| | - Valentina Castagnari
- Law Department, Universidad Torcuato Di Tella, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alicia Fernández
- University of California San Francisco, San Francisco, California, United States of America
| | - Raúl Mejía
- Centro de Estudios de Estado y Sociedad, Ciudad Autónoma de Buenos Aires, Argentina
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Carroll GJ, Buccini GS, Pérez-Escamilla R. Perspective: What Will It Cost to Scale-up Breastfeeding Programs? A Comparison of Current Global Costing Methodologies. Adv Nutr 2018; 9:572-580. [PMID: 30060074 PMCID: PMC6140429 DOI: 10.1093/advances/nmy041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Breastfeeding is one of the most feasible and cost-effective maternal-child health interventions. Currently, global investments needed to achieve the WHO global nutrition target for exclusive breastfeeding (EBF) do not meet the recommended standards for economic investment and implementation of policies supporting mothers to breastfeed. Estimating implementation costs of high-quality, high-impact programs based on each country's enabling environment and specific context is essential for developing and prioritizing recommendations that can drive the successful scaling-up of breastfeeding programs globally. We provide a detailed comparison (strengths, limitations, and gaps) of the 2 most recent global cost analysis frameworks used to estimate financial needs for scaling-up breastfeeding interventions from World Breastfeeding Costing Initiative (WBCi) and the World Bank. Our comparison found that the World Bank presents the more advanced costing methodology for scaling-up breastfeeding programs. However, there is a need to adapt and improve this costing framework to guide individual countries based on key contextual factors that consider the complexity of health systems.
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Affiliation(s)
- Grace J Carroll
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT
| | - Gabriela S Buccini
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT
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Huang Y, Pomeranz J, Wilde P, Capewell S, Gaziano T, O'Flaherty M, Kersh R, Whitsel L, Mozaffarian D, Micha R. Adoption and Design of Emerging Dietary Policies to Improve Cardiometabolic Health in the US. Curr Atheroscler Rep 2018; 20:25. [PMID: 29654423 PMCID: PMC6248872 DOI: 10.1007/s11883-018-0726-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains-food prices, reformulation, marketing, labeling, and government food assistance programs-appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the US and key elements crucial to define in designing such policies are not well established. We created an inventory of recent US dietary policy cases aiming to improve cardiometabolic health and assessed the extent of their proposal and adoption at federal, state, local, and tribal levels; and categorized and characterized the key elements in their policy design. RECENT FINDINGS Recent federal dietary policies adopted to improve cardiometabolic health include reformulation (trans-fat elimination), marketing (mass-media campaigns to increase fruits and vegetables), labeling (Nutrition Facts Panel updates, menu calorie labeling), and food assistance programs (financial incentives for fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant and Children (WIC) program). Federal voluntary guidelines have been proposed for sodium reformulation and food marketing to children. Recent state proposals included sugar-sweetened beverage (SSB) taxes, marketing restrictions, and SNAP restrictions, but few were enacted. Local efforts varied significantly, with certain localities consistently leading in the proposal or adoption of relevant policies. Across all jurisdictions, most commonly selected dietary targets included fruits and vegetables, SSBs, trans-fat, added sugar, sodium, and calories; other healthy (e.g., nuts) or unhealthy (e.g., processed meats) factors were largely not addressed. Key policy elements to define in designing these policies included those common across domains (e.g., level of government, target population, dietary target, dietary definition, implementation mechanism), and domain-specific (e.g., media channels for food marketing domain) or policy-specific (e.g., earmarking for taxes) elements. Characteristics of certain elements were similarly defined (e.g., fruit and vegetable definition, warning language used in SSB warning labels), while others varied across cases within a policy (e.g., tax base for SSB taxes). Several key elements were not always sufficiently characterized in government documents, and dietary target selections and definitions did not consistently align with the evidence-base. These findings highlight recent action on dietary policies to improve cardiometabolic health in the US; and key elements necessary to design such policies.
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Affiliation(s)
- Yue Huang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Jennifer Pomeranz
- College of Global Public Health, New York University, New York, NY, USA
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Tom Gaziano
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Rogan Kersh
- Wake Forest University, Winston-Salem, NC, USA
| | | | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
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Pearson-Stuttard J, Kypridemos C, Collins B, Mozaffarian D, Huang Y, Bandosz P, Capewell S, Whitsel L, Wilde P, O’Flaherty M, Micha R. Estimating the health and economic effects of the proposed US Food and Drug Administration voluntary sodium reformulation: Microsimulation cost-effectiveness analysis. PLoS Med 2018; 15:e1002551. [PMID: 29634725 PMCID: PMC5892867 DOI: 10.1371/journal.pmed.1002551] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/09/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sodium consumption is a modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD). The US Food and Drug Administration (FDA) has proposed voluntary sodium reduction goals targeting processed and commercially prepared foods. We aimed to quantify the potential health and economic impact of this policy. METHODS AND FINDINGS We used a microsimulation approach of a close-to-reality synthetic population (US IMPACT Food Policy Model) to estimate CVD deaths and cases prevented or postponed, quality-adjusted life years (QALYs), and cost-effectiveness from 2017 to 2036 of 3 scenarios: (1) optimal, 100% compliance with 10-year reformulation targets; (2) modest, 50% compliance with 10-year reformulation targets; and (3) pessimistic, 100% compliance with 2-year reformulation targets, but with no further progress. We used the National Health and Nutrition Examination Survey and high-quality meta-analyses to inform model inputs. Costs included government costs to administer and monitor the policy, industry reformulation costs, and CVD-related healthcare, productivity, and informal care costs. Between 2017 and 2036, the optimal reformulation scenario achieving the FDA sodium reduction targets could prevent approximately 450,000 CVD cases (95% uncertainty interval: 240,000 to 740,000), gain approximately 2.1 million discounted QALYs (1.7 million to 2.4 million), and produce discounted cost savings (health savings minus policy costs) of approximately $41 billion ($14 billion to $81 billion). In the modest and pessimistic scenarios, health gains would be 1.1 million and 0.7 million QALYS, with savings of $19 billion and $12 billion, respectively. All the scenarios were estimated with more than 80% probability to be cost-effective (incremental cost/QALY < $100,000) by 2021 and to become cost-saving by 2031. Limitations include evaluating only diseases mediated through BP, while decreasing sodium consumption could have beneficial effects upon other health burdens such as gastric cancer. Further, the effect estimates in the model are based on interventional and prospective observational studies. They are therefore subject to biases and confounding that may have influenced also our model estimates. CONCLUSIONS Implementing and achieving the FDA sodium reformulation targets could generate substantial health gains and net cost savings.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Yue Huang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdansk, Poland
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Laurie Whitsel
- American Heart Association, Washington, District of Columbia, United States of America
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
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Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, Peñalvo JL, Mozaffarian D. Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis. PLoS One 2018; 13:e0194555. [PMID: 29596440 PMCID: PMC5875768 DOI: 10.1371/journal.pone.0194555] [Citation(s) in RCA: 222] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/06/2018] [Indexed: 01/10/2023] Open
Abstract
Background School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. Objective To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. Methods We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children’s dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg’s and Egger’s test evaluated potential publication bias. Results From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. Conclusions Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.
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Affiliation(s)
- Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
- * E-mail:
| | - Dimitra Karageorgou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Ioanna Bakogianni
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Eirini Trichia
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Laurie P. Whitsel
- Policy Research, American Heart Association, Dallas, TX, United States of America
| | - Mary Story
- Global Health Institute and Community and Family Medicine, Duke University, Durham, NC, United States of America
| | - Jose L. Peñalvo
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
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28
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Houghton F, Houghton S. Ireland's new sugar tax: a step in the right direction. N Z Med J 2018; 131:97-98. [PMID: 29470479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Frank Houghton
- Director HEALR Research Group, Limerick Institute of Technology, Limerick, Ireland
| | - Sharon Houghton
- Lecturer, Department of Psychology, University of Limerick, Limerick, Ireland
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Abstract
The Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) is the federal government's largest form of food assistance, and a frequent focus of political and scholarly debate. Previous discourse in the public health community and recent proposals in state legislatures have suggested limiting the use of SNAP benefits on unhealthy food items, such as sugar-sweetened beverages (SSBs). This paper identifies two possible underlying motivations for item restriction, health and morals, and analyzes the level of empirical support for claims about the current state of the program, as well as expectations about how item restriction would change participant outcomes. It also assesses how item restriction would reduce individual agency of low-income individuals, and identifies mechanisms by which this may adversely affect program participants. Finally, this paper offers alternative policies to promote healthier purchasing and eating among SNAP participants that can be pursued without reducing individual agency. Health advocates and officials must more fully weigh the attendant risks of implementing SNAP item restrictions, including the reduction of individual agency of a vulnerable population.
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Affiliation(s)
- Benjamin W Chrisinger
- Stanford Prevention Research Center, Stanford University School of Medicine, 1070 Arastradero Road, Suite 300, Palo Alto, CA 94304, USA.
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30
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Shekar M, Kakietek J, D’Alimonte MR, Rogers HE, Eberwein JD, Akuoku JK, Pereira A, Soe-Lin S, Hecht R. Reaching the global target to reduce stunting: an investment framework. Health Policy Plan 2017; 32:657-668. [PMID: 28453717 PMCID: PMC5406759 DOI: 10.1093/heapol/czw184] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2016] [Indexed: 11/26/2022] Open
Abstract
Childhood stunting, being short for one's age, has life-long consequences for health, human capital and economic growth. Being stunted in early childhood is associated with slower cognitive development, reduced schooling attainment and adult incomes decreased by 5-53%. The World Health Assembly has endorsed global nutrition targets including one to reduce the number of stunted children under five by 40% by 2025. The target has been included in the Sustainable Development Goals (SDG target 2.2). This paper estimates the cost of achieving this target and develops scenarios for generating the necessary financing. We focus on a key intervention package for stunting (KIPS) with strong evidence of effectiveness. Annual scale-up costs for the period of 2016-25 were estimated for a sample of 37 high burden countries and extrapolated to all low and middle income countries. The Lives Saved Tool was used to model the impact of the scale-up on stunting prevalence. We analysed data on KIPS budget allocations and expenditure by governments, donors and households to derive a global baseline financing estimate. We modelled two financing scenarios, a 'business as usual', which extends the current trends in domestic and international financing for nutrition through 2025, and another that proposes increases in financing from all sources under a set of burden-sharing rules. The 10-year financial need to scale up KIPS is US$49.5 billion. Under 'business as usual', this financial need is not met and the global stunting target is not reached. To reach the target, current financing will have to increase from US$2.6 billion to US$7.4 billion a year on average. Reaching the stunting target is feasible but will require large coordinated investments in KIPS and a supportive enabling environment. The example of HIV scale-up over 2001-11 is instructive in identifying the factors that could drive such a global response to childhood stunting.
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Affiliation(s)
- Meera Shekar
- Health, Nutrition and Population Global Practice, World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | - Jakub Kakietek
- Health, Nutrition and Population Global Practice, World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | - Mary R D’Alimonte
- Results for Development, 1111 19th Street NW, Washington, DC 20036, USA
| | - Hilary E Rogers
- Results for Development, 1111 19th Street NW, Washington, DC 20036, USA
| | - Julia Dayton Eberwein
- Health, Nutrition and Population Global Practice, World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | - Jon Kweku Akuoku
- Health, Nutrition and Population Global Practice, World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | - Audrey Pereira
- Health, Nutrition and Population Global Practice, World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | - Shan Soe-Lin
- Results for Development, 1111 19th Street NW, Washington, DC 20036, USA
| | - Robert Hecht
- Results for Development, 1111 19th Street NW, Washington, DC 20036, USA
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31
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Harding M, Lovenheim M. The effect of prices on nutrition: Comparing the impact of product- and nutrient-specific taxes. J Health Econ 2017; 53:53-71. [PMID: 28288356 DOI: 10.1016/j.jhealeco.2017.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 02/12/2017] [Accepted: 02/15/2017] [Indexed: 05/09/2023]
Abstract
This paper provides an analysis of the role of prices in determining food purchases and nutrition using very detailed transaction-level observations for a large, nationally-representative sample of US consumers over the period 2002-2007. Using product-specific nutritional information, we develop a new method of partitioning the product space into relevant nutritional clusters that define a set of nutritionally-bundled goods, which parsimoniously characterize consumer choice sets. We then estimate a large utility-derived demand system over this joint product-nutrient space that allows us to calculate price and expenditure elasticities. Using our structural demand estimates, we simulate the role of product taxes on soda, sugar-sweetened beverages, packaged meals, and snacks, and nutrient taxes on fat, salt, and sugar. We find that a 20% nutrient tax has a significantly larger impact on nutrition than an equivalent product tax, due to the fact that these are broader-based taxes. However, the costs of these taxes in terms of consumer utility are only about 70 cents per household per day. A sugar tax in particular is a powerful tool to induce healthier nutritive bundles among consumers.
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Affiliation(s)
- Matthew Harding
- Department of Economics, University of California - Irvine, 3207 Social Science Plaza B, Irvine, CA 92697, United States; Department of Statistics, University of California - Irvine, 3207 Social Science Plaza B, Irvine, CA 92697, United States.
| | - Michael Lovenheim
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, 102 Martha Van Rensselaer Hall, Ithaca, NY 14853, United States; NBER, United States.
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Schwartz MB, Just DR, Chriqui JF, Ammerman AS. Appetite self-regulation: Environmental and policy influences on eating behaviors. Obesity (Silver Spring) 2017; 25 Suppl 1:S26-S38. [PMID: 28229539 DOI: 10.1002/oby.21770] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Appetite regulation is influenced by the environment, and the environment is shaped by food-related policies. This review summarizes the environment and policy research portion of an NIH Workshop (Bethesda, MD, 2015) titled "Self-Regulation of Appetite-It's Complicated." METHODS In this paper, we begin by making the case for why policy is an important tool in efforts to improve nutrition, and we introduce an ecological framework that illustrates the multiple layers that influence what people eat. We describe the state of the science on how policies influence behavior in several key areas: the federal food programs, schools, child care, food and beverage pricing, marketing to youth, behavioral economics, and changing defaults. Next, we propose novel approaches for multidisciplinary prevention and intervention strategies to promote breastfeeding, and examine interactions between psychology and the environment. RESULTS Policy and environmental change are the most distal influences on individual-level appetite regulation, yet these strategies can reach many people at once by changing the environment in which food choices are made. We note the need for more research to understand compensatory behavior, reactance, and how to effectively change social norms. CONCLUSIONS To move forward, we need a more sophisticated understanding of how individual psychological and biological factors interact with the environment and policy influences.
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Affiliation(s)
- Marlene B Schwartz
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - David R Just
- Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York, USA
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, and Center for Health Promotion and Disease Prevention, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
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Webb M, Fahimi S, Singh GM, Khatibzadeh S, Micha R, Powles J, Mozaffarian D. Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations. BMJ 2017; 356:i6699. [PMID: 28073749 PMCID: PMC5225236 DOI: 10.1136/bmj.i6699] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide. DESIGN Global modeling study. SETTING 183 countries. POPULATION Full adult population in each country. INTERVENTION A "soft regulation" national policy that combines targeted industry agreements, government monitoring, and public education to reduce population sodium intake, modeled on the recent successful UK program. To account for heterogeneity in efficacy across countries, a range of scenarios were evaluated, including 10%, 30%, 0.5 g/day, and 1.5 g/day sodium reductions achieved over 10 years. We characterized global sodium intakes, blood pressure levels, effects of sodium on blood pressure and of blood pressure on cardiovascular disease, and cardiovascular disease rates in 2010, each by age and sex, in 183 countries. Country specific costs of a sodium reduction policy were estimated using the World Health Organization Noncommunicable Disease Costing Tool. Country specific impacts on mortality and disability adjusted life years (DALYs) were modeled using comparative risk assessment. We only evaluated program costs, without incorporating potential healthcare savings from prevented events, to provide conservative estimates of cost effectiveness MAIN OUTCOME MEASURE: Cost effectiveness ratio, evaluated as purchasing power parity adjusted international dollars (equivalent to the country specific purchasing power of US$) per DALY saved over 10 years. RESULTS Worldwide, a 10% reduction in sodium consumption over 10 years within each country was projected to avert approximately 5.8 million DALYs/year related to cardiovascular diseases, at a population weighted mean cost of I$1.13 per capita over the 10 year intervention. The population weighted mean cost effectiveness ratio was approximately I$204/DALY. Across nine world regions, estimated cost effectiveness of sodium reduction was best in South Asia (I$116/DALY); across the world's 30 most populous countries, best in Uzbekistan (I$26.08/DALY) and Myanmar (I$33.30/DALY). Cost effectiveness was lowest in Australia/New Zealand (I$880/DALY, or 0.02×gross domestic product (GDP) per capita), although still substantially better than standard thresholds for cost effective (<3.0×GDP per capita) or highly cost effective (<1.0×GDP per capita) interventions. Most (96.0%) of the world's adult population lived in countries in which this intervention had a cost effectiveness ratio <0.1×GDP per capita, and 99.6% in countries with a cost effectiveness ratio <1.0×GDP per capita. CONCLUSION A government "soft regulation" strategy combining targeted industry agreements and public education to reduce dietary sodium is projected to be highly cost effective worldwide, even without accounting for potential healthcare savings.
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Affiliation(s)
- Michael Webb
- Stanford University, Stanford, CA, USA, and Institute for Fiscal Studies, London, UK
| | - Saman Fahimi
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Gitanjali M Singh
- Tufts Friedman School of Nutrition Science & Policy, 150 Harrison Ave, Boston, MA 02111, USA
| | | | - Renata Micha
- Tufts Friedman School of Nutrition Science & Policy, 150 Harrison Ave, Boston, MA 02111, USA
| | - John Powles
- Cambridge Institute of Public Health, Cambridge, UK
| | - Dariush Mozaffarian
- Tufts Friedman School of Nutrition Science & Policy, 150 Harrison Ave, Boston, MA 02111, USA
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Affiliation(s)
- Pavan Sukhdev
- GIST India, and former study leader of The Economics of Ecosystems and Biodiversity (TEEB)
| | - Peter May
- Federal Rural University of Rio de Janeiro, Brazil, a past president of the International Society for Ecological Economics, and a member of the Project Steering Committee for TEEBAgriFood
| | - Alexander Müller
- Food and Agriculture Organization of the United Nations, study leader of the TEEBAgriFood Project, and managing director of TMG - Töpfer, Müller, Gassner, a sustainability think tank
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Greer AE, Cross-Denny B, McCabe M, Castrogivanni B. Giving Economically Disadvantaged, Minority Food Pantry Patrons' a Voice: Implications for Equitable Access to Sufficient, Nutritious Food. Fam Community Health 2016; 39:199-206. [PMID: 27214675 DOI: 10.1097/fch.0000000000000105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study provides economically disadvantaged, minority food pantry patrons (hereafter, patrons) a meaning-ful voice by examining their experiences trying to obtain sufficient, nutritious food. Five focus groups were conducted using a semistructured discussion guide. Atlast.ti software was used to manage and analyze the data. Patrons reported that pantry staff who preserved their dignity by showing compassion were highly valued. Stigma and shame associated with pantry use were major concerns. Patrons suggested environmental and policy changes to improve their food acquisition experiences. These findings suggest that multilevel interventions addressing food access, food distribution policies, and patron-staff interactions are warranted.
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Affiliation(s)
- Anna E Greer
- Departments of Physical Therapy & Human Movement Science (Dr Greer and Ms Castrogivanni) and Social Work (Dr Cross-Denny), Sacred Heart University, Fairfield, Connecticut; and Council of Churches of Greater Bridgeport, Bridgeport, Connecticut (Ms McCabe)
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Darmon N, Lacroix A, Muller L, Ruffieux B. Food Price Policies May Improve Diet but Increase Socioeconomic Inequalities in Nutrition. World Rev Nutr Diet 2016; 115:36-45. [PMID: 27197830 DOI: 10.1159/000442069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Unhealthy eating is more prevalent among women and people with a low socioeconomic status. Policies that affect the price of food have been proposed to improve diet quality. The study's objective was to compare the impact of food price policies on the nutritional quality of food baskets chosen by low-income and medium-income women. Experimental economics was used to simulate a fruit and vegetable subsidy and a mixed policy subsidizing healthy products and taxing unhealthy ones. Food classification was based on the Score of Nutritional Adequacy of Individual Foods, Score of Nutrients to Be Limited nutrient profiling system. Low-income (n = 95) and medium-income (n = 33) women selected a daily food basket first at current prices and then at policy prices. Energy density (ED) and the mean adequacy ratio (MAR) were used as nutritional quality indicators. At baseline, low-income women selected less healthy baskets than medium-income women (less fruit and vegetables, more unhealthy products, higher ED, lower MAR). Both policies improved nutritional quality (fruit and vegetable quantities increased, ED decreased, the MAR increased), but the magnitude of the improvement was often lower among low-income women. For instance, ED decreased by 5.3% with the fruit and vegetable subsidy and by 7.3% with the mixed subsidy, whereas decreases of 13.2 and 12.6%, respectively, were recorded for the medium-income group. Finally, both policies improved dietary quality, but they increased socioeconomic inequalities in nutrition.
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Chang Y, Carithers T, Leeke S, Chin F. Geographic Disparity in Funding for School Nutrition Environments: Evidence from Mississippi Schools. J Sch Health 2016; 86:121-128. [PMID: 26762823 DOI: 10.1111/josh.12361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 05/16/2015] [Accepted: 06/18/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Despite the federal initiatives on equitable provision of school nutrition programs, geographic disparity in childhood obesity persists. It may be partly because built-in school nutrition environments rely on each school's efficient use of existing operational funds or its ability to obtain expanded financial support. This study explores how funding acquisition by schools is determined by local community characteristics and how it relates to healthy school meal offerings. METHODS Information about food preparation technology and funding in 811 schools in Mississippi was obtained by in-depth phone interviews of district child nutrition directors and school foodservice managers, which was matched to socioeconomic indicators of schools and communities. Probit models were estimated. RESULTS About 56% of schools in the sample received some funds toward combination oven/steamers in the last few years. Small schools, schools in non-metro counties, and those in low-income minority areas were significantly less likely to be funded. Obtainment of funds was associated with a 45 percentage-point reduction in the probability of serving fried foods. CONCLUSIONS Funds obtained by schools for advanced food preparation technology contributes to creation of healthier nutrition environments for children. However, fund availability is associated with community characteristics, possibly contributing to geographic disparity of child health.
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Affiliation(s)
- Yunhee Chang
- Nutrition & Hospitality Management, University of Mississippi, P. O. Box 1848, University, MS 38677.
| | - Teresa Carithers
- Nutrition & Hospitality Management, University of Mississippi, P. O. Box 1848, University, MS 38677.
| | - Shannon Leeke
- Nutrition & Hospitality Management, University of Mississippi, P. O. Box 1848, University, MS 38677.
| | - Felicia Chin
- Nutrition & Hospitality Management, University of Mississippi, P. O. Box 1848, University, MS 38677.
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Allais O, Etilé F, Lecocq S. Mandatory labels, taxes and market forces: An empirical evaluation of fat policies. J Health Econ 2015; 43:27-44. [PMID: 26164818 DOI: 10.1016/j.jhealeco.2015.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 06/04/2023]
Abstract
The public-health community views mandatory Front-of-Pack (FOP) nutrition labels and nutritional taxes as promising tools to control the growth of food-related chronic diseases. This paper uses household scanner data to propose an ex-ante evaluation and comparison of these two policy options for the fromage blanc and dessert yogurt market. In most markets, labelling is voluntary and firms display fat labels only on the FOP of low-fat products to target consumers who do not want to eat fat. We here separately identify consumer preferences for fat and for FOP fat labels by exploiting an exogenous difference in legal labelling requirements between these two product categories. Estimates of demand curves are combined with a supply model of oligopolistic price competition to simulate policies. We find that a feasible ad valorem fat tax dominates a mandatory FOP-label policy from an economic perspective, but both are equally effective in reducing average fat purchases.
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Affiliation(s)
- Olivier Allais
- INRA, UR1303 ALISS, F-94205 Ivry-sur-Seine Cedex, France.
| | - Fabrice Etilé
- INRA, UR1303 ALISS, F-94205 Ivry-sur-Seine Cedex, France; Paris School of Economics, F-75600 Paris, France.
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Irz X, Leroy P, Réquillart V, Soler LG. Economic assessment of nutritional recommendations. J Health Econ 2015; 39:188-210. [PMID: 25443618 DOI: 10.1016/j.jhealeco.2014.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/21/2014] [Accepted: 09/10/2014] [Indexed: 06/04/2023]
Abstract
The effect of consumers' compliance with nutritional recommendations is uncertain because of potentially complex substitutions. To lift this uncertainty, we adapt a model of consumer behaviour under rationing to the case of linear nutritional constraints. Dietary adjustments are derived from information on consumer preferences, consumption levels, and nutritional contents of foods. A calibration exercise simulates, for different income groups, how the French diet would respond to various nutrition recommendations, and those behavioural adjustments are translated into health outcomes through the DIETRON epidemiological model. This allows for the ex-ante comparison of the efficiency, equity and health effects of ten nutritional recommendations. Although most recommendations impose significant taste costs on consumers, they are highly cost-effective, with the recommendations targeting salt, saturated fat, and fruits and vegetables (F&V) ranking highest in terms of efficiency. Most recommendations are also economically progressive, with the exception of that targeting F&V.
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Affiliation(s)
- Xavier Irz
- MTT Agrifood Research Finland, Economic Research Unit, Latokartanonkaari 9, 00790 Helsinki, Finland.
| | - Pascal Leroy
- INRA ALISS UR 1303, 65 Boulevard de Brandebourg, 94205 Ivry-sur-Seine, France
| | - Vincent Réquillart
- Toulouse School of Economics (GREMAQ - INRA and IDEI), Université Toulouse 1 - Capitole, Manufacture des Tabacs, 21 Allée de Brienne, 31000 Toulouse, France
| | - Louis-Georges Soler
- INRA ALISS UR 1303, 65 Boulevard de Brandebourg, 94205 Ivry-sur-Seine, France
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Abstract
Two years after their implementation, new school-nutrition standards are at risk. In response to complaints about food waste and difficulties in meeting certain goals, among other issues, lawmakers have proposed granting schools waivers if they are losing revenue.
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Affiliation(s)
- Jennifer A Woo Baidal
- From the Department of Pediatrics, Boston Children's Hospital (J.A.W.B.), the Department of Pediatrics, MassGeneral Hospital for Children (J.A.W.B., E.M.T.), and the Department of Nutrition, Harvard School of Public Health (E.M.T.) - all in Boston
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Jeong M, Gilmore JS, Bleakley A, Jordan A. Local news media framing of obesity in the context of a sugar-sweetened beverage reduction media campaign. J Nutr Educ Behav 2014; 46:583-8. [PMID: 24878152 DOI: 10.1016/j.jneb.2014.04.294] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 03/26/2014] [Accepted: 04/04/2014] [Indexed: 05/09/2023]
Abstract
OBJECTIVE This study examined local news media's framing of obesity preceding and surrounding the Philadelphia sugar-sweetened beverage reduction media campaign. METHODS Using key search terms pertaining to obesity and sugary beverages, the authors searched the LexisNexis database and gathered local news stories (n = 167) that were aired or published between October, 2010 and March, 2011. They conducted a content analysis, coding for framing-related outcome measures (underlying factors, action steps, and contextual agents). RESULTS Overall, the news media employed individual-level framing in the majority of stories when discussing obesity, both before and after the campaign launch. After the campaign launched, however, stories were significantly more likely to mention systemic-level contextual agents such as food companies (P = .008), beverage companies (P = .03), and champions or advocates (P = .001). CONCLUSIONS AND IMPLICATIONS The researchers observed a shift in the local news media discourse toward more thematic framing of obesity, and suggest that public health officials consider the potential impact of news media frames on garnering public support for future policy implementations.
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Affiliation(s)
- Michelle Jeong
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA.
| | - Joelle Sano Gilmore
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA
| | - Amy Bleakley
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA
| | - Amy Jordan
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA
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Segré A. [[The prevention of food wastage by restoring the value to food: reflections of an agroeconomist]. G Ital Med Lav Ergon 2014; 36:203-206. [PMID: 25558710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Each year, about one trillion USD worth of food sales is lost or wasted. In addition to its economic impacts, food wastage has significant societal costs that are born indirectly by taxpayers. Should damage costs associated with food wastage be accounted for, this global wastage appears much higher. In fact, the monetization of environmental costs such as the impact of greenhouse gases, land erosion, water use and pollinators loss amnounts to another trillion USD. Furthermore, a valuation of social costs, such as health effects of pesticides, loss of livelihoods and conflicts over natural resources adds another trillion USD. Noteworthy is the fact that not all food wastage reduction strategies are equal in terms of environmental efficiency and reducing food wastage must be a priority over energy recovery fromn food wastage. As a case study, the Italian National Plan for Food Waste Prevention (PINPAS) aims at reducing food wastage upstream the food chain, will be considered. PINPAS also seeks to improve recovery measures of unsold food. As indicated in the Guidelines on the preparation of food waste prevention programmes by the European Commission, PINPAS engages all stakeholders of the agri-food chain, from policy makers to civil groups aid producers. The first action will be the reintroduction of food education at school.
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Haddad L, Isenman P. Which aid spending categories have the greatest untapped potential to support the reduction of undernutrition? Some ideas on moving forward. Food Nutr Bull 2014; 35:266-76. [PMID: 25076774 DOI: 10.1177/156482651403500213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The financial resource needs for the reduction of undernutrition are significant, while the returns from reducing undernutrition are large. Yet the share of public resources allocated to the reduction of undernutrition remains disproportionately small. For overseas development assistance, the investment in nutrition-specific and nutrition-sensitive categories amounts to less than 3% of the total. What is the potential for other categories of public resource investments to reduce undernutrition, and in which sectors are these investments to be found? This paper proposes a framework for addressing this question and ventures some suggestions as to which of the categories of overseas development assistance beyond the well-known "nutrition-specific" and "nutrition-sensitive" categories are most likely to yield improvements in nutrition status if they could be redesigned with this in mind. We conclude that policy makers should look widely within the underlying and basic determinant intervention space for investments that, when changed at the margins, could result in significant improvements in nutrition.
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Kouam CE, Delisle H, Ebbing HJ, Israël AD, Salpéteur C, Aïssa MA, Ridde V. Perspectives for integration into the local health system of community-based management of acute malnutrition in children under 5 years: a qualitative study in Bangladesh. Nutr J 2014; 13:22. [PMID: 24649941 PMCID: PMC3994471 DOI: 10.1186/1475-2891-13-22] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 03/12/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Acute malnutrition is a major cause of death among under-five children in low- and middle-income countries. United Nations agencies recommend the integration of community-based management of acute malnutrition (CMAM) into the local health systems for sustainability. The objective of the study was to assess the preparedness of the health system to implement CMAM targeting children under-five years in two sub-districts of Bangladesh. METHODS The assessment was performed through direct observation of 44 health centres, individual interviews of seven policy makers, three donors, four health and nutrition implementing partners, 29 health workers, and review of secondary data. Assessment themes, derived from the WHO six Building Blocks, were nutrition governance, nutrition financing, health service delivery, human resources, equipment and supply, referral, monitoring and supervision mechanism. They were subdivided into 16 criteria. Findings were compared with CMAM operational recommendations according to WHO, Valid International and Food and Nutrition Technical Assistance guidelines. RESULTS The government of Bangladesh has developed inpatient and outpatient CMAM guidelines, and a policy offering free-of-charge health care for under-five children. Nutrition coordination was not under full government leadership. Most of funds (74%) dedicated to CMAM were provided by donors, for short-term interventions. Of the total 44 health centres assessed, 39 (88.6%) were active, among which 4 (10.2%) delivered inpatient services, 35 (89.8%) outpatient services, and 24 (61.5%) outreach services. These were regarded as opportunities to include CMAM activities. There were 48.9% vacant positions and the health workers were not trained for management of acute malnutrition. Equipment and supplies did not meet the operational recommendations for management of acute malnutrition. CONCLUSION Implementing CMAM through the health centres of both sub-districts would warrant progressive strengthening of the overall health system in the light of identified barriers. A short term strategy would consist of strengthening government coordination of nutrition interventions, exploring additional funding sources, equipping and supplying functional health centres, training health workers and actively involving community health workers to cope with health facility staff shortage. A mid-term strategy would consist of securing permanent funding for CMAM, rehabilitating non-functional health centres, attracting and retaining health workers in rural areas.
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Affiliation(s)
- Camille Eric Kouam
- TRANSNUT - (WHO Collaborating Centre on Nutrition Changes and Development), Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, Quebec H3T 1A8, Canada
| | - Hélène Delisle
- TRANSNUT - (WHO Collaborating Centre on Nutrition Changes and Development), Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, Quebec H3T 1A8, Canada
| | - Hans J Ebbing
- Nutrition & Health Service, Action Against Hunger France (ACF-France), House - 20, Rd- 117, Gulshan 2, Dhaka 1212, Bangladesh
| | - Anne Dominique Israël
- Nutrition & Health Service, Action Against Hunger France (ACF-France), 4 rue Niepce - 75662 PARIS CEDEX 14, Paris, France
| | - Cécile Salpéteur
- Nutrition & Health Service, Action Against Hunger France (ACF-France), 4 rue Niepce - 75662 PARIS CEDEX 14, Paris, France
| | - Myriam Aït Aïssa
- Nutrition & Health Service, Action Against Hunger France (ACF-France), 4 rue Niepce - 75662 PARIS CEDEX 14, Paris, France
| | - Valery Ridde
- School of Public Health, CRCHUM, Faculty of Medicine, University of Montreal, Saint-Antoine Tower, 850 Saint-Denis, 3rd Floor, Room S03-462, Montreal, Quebec H2X 0A9, Canada
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Grossman M, Tekin E, Wada R. Food prices and body fatness among youths. Econ Hum Biol 2014; 12:4-19. [PMID: 24246131 DOI: 10.1016/j.ehb.2013.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/26/2013] [Accepted: 10/22/2013] [Indexed: 06/02/2023]
Abstract
We examine the effect of food prices on clinical measures of obesity, including body mass index (BMI) and percentage body fat (PBF) measures derived from bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA), among youths ages 12 through 18 in the National Health and Nutrition Examination Survey. This is the first study to consider clinically measured levels of body composition rather than BMI to investigate the effects of food prices on obesity outcomes among youths classified by gender and race/ethnicity. Our findings suggest that increases in the real price per calorie of food for home consumption and the real price of fast-food restaurant food lead to improvements in obesity outcomes among youths. We also find that a rise in the real price of fruits and vegetables leads to increased obesity. Finally, our results indicate that measures of PBF derived from BIA and DXA are no less sensitive and in some cases more sensitive to the prices just mentioned than BMI, and serve an important role in demonstrating that rising food prices (except fruit and vegetable prices) are indeed associated with reductions in obesity rather than with reductions in body size proportions alone.
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Affiliation(s)
- Michael Grossman
- City University of New York Graduate Center, NBER, and IZA, 365 Fifth Avenue, 5th Floor, New York, NY 10016-4309, United States.
| | - Erdal Tekin
- Department of Economics, IZA, and NBER, Andrew Young School of Policy Studies, Georgia State University, P.O. Box 3992, Atlanta, GA 30302-3992, United States.
| | - Roy Wada
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608, United States.
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Vieux F, Dubois C, Allegre L, Mandon L, Ciantar L, Darmon N. Dietary standards for school catering in France: serving moderate quantities to improve dietary quality without increasing the food-related cost of meals. J Nutr Educ Behav 2013; 45:533-539. [PMID: 23796418 DOI: 10.1016/j.jneb.2013.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 02/04/2013] [Accepted: 02/10/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the impact on food-related cost of meals to fulfill the new compulsory dietary standards for primary schools in France. DESIGN A descriptive study assessed the relationship between the level of compliance with the standards of observed school meals and their food-related cost. An analytical study assessed the cost of series of meals published in professional journals, and complying or not with new dietary standards. The costs were based on prices actually paid for food used to prepare school meals. MAIN OUTCOME MEASURE Food-related cost of meals. ANALYSIS Parametric and nonparametric tests from a total of 42 and 120 series of 20 meals in the analytical and descriptive studies, respectively. RESULTS The descriptive study indicated that meeting the standards was not related to cost. The analytical study showed that fulfilling the frequency guidelines increased the cost, whereas fulfilling the portion sizes criteria decreased it. Series of meals fully respecting the standards (ie, frequency and portion sizes) cost significantly less (-0.10 €/meal) than series not fulfilling them, because the standards recommend smaller portion sizes. CONCLUSIONS AND IMPLICATIONS Introducing portion sizes rules in dietary standards for school catering may help increase dietary quality without increasing the food cost of meals.
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Affiliation(s)
- Florent Vieux
- Aix-Marseille University, Marseille, France; INSERM, National Institute of Health and Medical Research, Marseille, France; INRA, National Institute of Agricultural Research, Marseille, France
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Sturm R, Yach D. Eating better for less. To treat the obesity epidemic, why not lower prices on healthier food. Mod Healthc 2013; 43:27. [PMID: 23947103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Winkler JT. Make the healthy choice the cheaper choice. BMJ 2012; 344:e3834. [PMID: 22661727 DOI: 10.1136/bmj.e3834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Oliver T Mytton
- British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford, Oxford OX3 7LF, UK.
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Lo YT, Chang YH, Lee MS, Wahlqvist ML. Dietary diversity and food expenditure as indicators of food security in older Taiwanese. Appetite 2011; 58:180-7. [PMID: 22001748 DOI: 10.1016/j.appet.2011.09.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/18/2011] [Accepted: 09/30/2011] [Indexed: 11/18/2022]
Abstract
Food quality is a measure of food security in vulnerable groups. The elderly are often nutritionally vulnerable, but how much of this is reflected in food quality and determined by financial status is unclear. We determined whether expenditure on dietary quality challenges food security in the aged. We used the representative Elderly Nutrition and Health Survey in Taiwan during 1999-2000 (n=1783), and evaluated dietary quality by a Dietary Diversity Score (DDS, range: 0-6) based on a 24-h dietary recall. Monthly mean national food prices were used to estimate food expenditure. In general, it was found to cost more to achieve a greater DDS. The food expenditure of subjects whose DDS=6 was 2.20 times greater than the DDS ≤3 group, after controlling for covariates. Elders of lower socioeconomic status tended to choose foods which would have cost less. However, a sub-group of elders who achieve the highest DDS with limited money offer approaches to food-money management. Nutrition policy directed to food insecure groups, like the aged, could employ health promotion strategies which reduce financial barriers to healthy eating.
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Affiliation(s)
- Yuan-Ting Lo
- Graduate Institute of Life Sciences, National Defense Medical Center, Taiwan, ROC
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