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Jones A, Gough T, Robinson E. Two online randomised controlled trials examining effects of alcohol calorie labelling on hypothetical ordering of calories from alcohol and food. Appetite 2024; 200:107548. [PMID: 38876150 DOI: 10.1016/j.appet.2024.107548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Providing calorie information for alcoholic beverages is a potential public-health intervention which may serve to reduce alcohol use but also prevalence of overweight/obesity. Equivocal evidence has been found for the effectiveness of alcohol calorie information at reducing drinking intentions as well as purchasing and consumption. However, the extent at which calorie information 'on-trade' will impact consumer behaviour for both alcohol and food consumption has not been investigated. AIMS (1) To examine the presence of alcohol calorie labelling for hypothetical purchasing of alcohol and food in typical UK restaurant scenarios. (2) To determine the characteristics of individuals who will be likely to choose to view alcohol calorie labels. METHODS Two online randomised control trials using a hypothetical menu selection. In experiment one (N = 325) participants were randomised to the presence or absence of alcohol calorie labels. In experiment two (N = 1081) individuals were randomised to alcohol calorie labels absent or the choice to view alcohol calorie labels. The primary outcome for each study was calories ordered from alcoholic beverages. RESULTS There was no evidence that the presence of alcohol calorie information on restaurant menus impacted the number of calories ordered from alcoholic beverages or from food and soft drinks. Younger individuals and individuals who exhibit greater motives for good health were more likely to choose to view alcohol calorie labels. CONCLUSIONS In two online, hypothetical experiments there is no evidence for alcohol calorie labelling impacting consumer decisions to order alcohol or food. Given the choice, a self-selecting group of individuals who are more motivated by health concerns will view alcohol calorie labels, and in turn may be less likely to order alcohol.
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Affiliation(s)
- Andrew Jones
- Psychology, Liverpool John Moores University, Liverpool UK.
| | - Thomas Gough
- Department of Psychology, University of Liverpool, Liverpool UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool UK
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2
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Liddiard E, Hamshaw RJT. Body dissatisfaction and beyond: Investigating attitudes towards calorie labels on UK food menus. Appetite 2024; 199:107418. [PMID: 38754766 DOI: 10.1016/j.appet.2024.107418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
In 2022 the British government made calorie labels on menus a legal requirement to encourage healthier food choices while dining out. Yet, little research has explored perceptions of calorie labels on menus in the United Kingdom or tested whether there may be groups of people vulnerable to potential negative effects of calorie labels, such as those with body dissatisfaction. This between-subjects, convergent mixed-methods study addressed these enquiries. Participants were 562 adults who completed an online survey where hypothetical food orders were made from a menu. The study found that participants who viewed a menu with calorie labels ordered fewer calories. Quantitative results did not find that participants with higher levels of body dissatisfaction were at significantly greater odds of using calorie labels to order fewer calories. However, our qualitative (thematic) analysis revealed that experiences of calorie labels could be shaped by body image concerns. Themes further drew on how calorie labels were empowering, but there were also concerns about their oversimplicity. Findings are discussed in relation to implications for future calorie labelling policies. Given the inconsistent findings amongst the limited amount of literature investigating the role of body dissatisfaction in how calorie labels are used, future research is crucial. In the meantime, as a cautionary measure, clinicians involved in supporting individuals with body or food-related concerns should be aware of the challenges their clients may experience in facing calorie labels on menus when dining out.
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Affiliation(s)
- Emma Liddiard
- Department of Psychology, University of Bath, Bath, UK
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3
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Hockin-Boyers H, Jamie K, Pope S. Intuitive tracking: Blending competing approaches to exercise and eating. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 39084317 DOI: 10.1111/1467-9566.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024]
Abstract
Under the conditions of neo-liberal individual responsibilisation, self-tracking has become the predominant model of health management. More recently, though, intuition-based approaches to exercise and eating are also gaining traction. These two approaches are often located in opposition. While self-tracking uses datafication and calculability to structure health decisions, intuitive approaches encourage abandonment of rules and restrictions around exercise and food in favour of corporeal self-awareness and attunement to sensation. Although navigating these competing approaches is a common experience for all populations, the tensions between them are felt particularly acutely by people with complex health histories, such as eating disorders (EDs). In this article, we draw on mixed-methods longitudinal data, analysed using phenomenological analysis, to propose a novel framework - 'intuitive tracking'-which moves beyond understandings of self-tracking as the antithesis of intuitive engagement with exercise and health. Drawing on longitudinal interviews and photo elicitation with 19 women who are in recovery from EDs and using weightlifting as a tool to support their recovery, we demonstrate how attentiveness to bodily and emotional cues is successfully combined with an emphasis on monitoring health behaviours to support wellbeing. We conclude that theoretical understandings of self-tracking can and should make space for intuition-led decision-making.
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Affiliation(s)
| | | | - Stacey Pope
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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Salvia MG, Mattie H, Tran A. Noticing and Responding to Calorie Labels on Restaurant Menus: Patterns in Sexual-Minority Men. Am J Prev Med 2024; 66:269-278. [PMID: 37813173 DOI: 10.1016/j.amepre.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION A calorie-labeling policy for restaurant menus was implemented in 2018. Whether and how sexual-minority men use this information has not been evaluated. METHODS The Men's Body Project, a 2020 cross-sectional survey study of 504 cisgender sexual-minority men (mean age=35.8±10.4 years, 71.0% White, 5.6% Asian, 14.3% Black, 9.1% another/multiple race identities) assessed respondents' awareness of calorie labels on restaurant menus and subsequent responses. Additional questions were asked about weight-change goals, body image, disordered eating behaviors, and muscle-enhancing supplement use. Analyses in 2022-2023 used multivariate logistic regression to assess the associations between noticing calories and weight- and muscularity-oriented behaviors and, among those who noticed calorie labels, whether participants reported using this information to order more or fewer calories. RESULTS Approximately half of the participants reported noticing calorie labels. Those who did were more likely to report engaging in disordered eating behaviors (OR=2.03). Among participants who noticed menu labels, ordering fewer calories was the most frequent response, whereas 25% reported not changing the caloric content of their order. Many participants (21%) reported ordering both more and fewer calories, and this heterogeneous ordering pattern was associated with both disordered eating (OR=4.70) and muscle-enhancing behaviors (OR=9.42) compared with that among participants who did not report behaviors. Reporting weight-control efforts was associated with ordering fewer calories than participants not doing anything to change their weight (OR=2.53). CONCLUSIONS Most participants noticed calorie labels on menus, and many reported subsequently ordering fewer calories. Disordered eating and muscle-enhancing behaviors were associated with behavior changes in response to calorie information.
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Affiliation(s)
- Meg G Salvia
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
| | - Heather Mattie
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Alvin Tran
- Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, Connecticut
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5
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Frances T, O'Neill K, Newman K. 'An extra fight I didn't ask for': A qualitative survey exploring the impact of calories on menus for people with experience of eating disorders. Br J Health Psychol 2024; 29:20-36. [PMID: 37518837 DOI: 10.1111/bjhp.12685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES The UK government made it mandatory for large restaurants and cafes in England to display calorie labels on menus. Existing evidence identifies minimal potential for benefit, but significant potential for harm to those with eating disorders. To date, only one published study has directly explored the impact of this legislation on those with eating disorders. This study explores the impact of calorie labelling on menus on adults with experience of eating disorders in England. DESIGN A qualitative online survey was designed and distributed, and 399 adults with current or past experience/s of eating disorders completed the survey. METHODS Reflexive thematic analysis was used, informed by a critical realist approach. RESULTS Six themes were developed: (1) impacts on relationships, (2) exclusion and increased isolation, (3) restricted freedom, (4) dis/embodiment, (5) anger and frustration at the perpetuation of diet culture and (6) we are all responsible for ourselves. Most participants felt calorie labels on menus is detrimental to their eating disorder and/or recovery. People are navigating multiple opposing cultural narratives around health, bodies and eating disorder recovery that can put additional barriers in place to developing a relationship with food and body that they would like. CONCLUSIONS Calorie labelling on menus is likely to adversely impact those with eating disorders. Menus with calories should be available separately but should not be the first or only one provided. People with experience of eating disorders should be directly involved in the development of public health legislation and policy that is likely to affect them.
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Affiliation(s)
| | - Kel O'Neill
- Independent Counselling and Psychotherapy Practice, UK
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6
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Dupuis R, Block JP, Barrett JL, Long MW, Petimar J, Ward ZJ, Kenney EL, Musicus AA, Cannuscio CC, Williams DR, Bleich SN, Gortmaker SL. Cost Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S. Am J Prev Med 2024; 66:128-137. [PMID: 37586572 PMCID: PMC10840662 DOI: 10.1016/j.amepre.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Calorie labeling of standard menu items has been implemented at large restaurant chains across the U.S. since 2018. The objective of this study was to evaluate the cost effectiveness of calorie labeling at large U.S. fast-food chains. METHODS This study evaluated the national implementation of calorie labeling at large fast-food chains from a modified societal perspective and projected its cost effectiveness over a 10-year period (2018-2027) using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model. Using evidence from over 67 million fast-food restaurant transactions between 2015 and 2019, the impact of calorie labeling on calorie consumption and obesity incidence was projected. Benefits were estimated across all racial, ethnic, and income groups. Analyses were performed in 2022. RESULTS Calorie labeling is estimated to be cost saving; prevent 550,000 cases of obesity in 2027 alone (95% uncertainty interval=518,000; 586,000), including 41,500 (95% uncertainty interval=33,700; 50,800) cases of childhood obesity; and save $22.60 in healthcare costs for every $1 spent by society in implementation costs. Calorie labeling is also projected to prevent cases of obesity across all racial and ethnic groups (range between 126 and 185 cases per 100,000 people) and all income groups (range between 152 and 186 cases per 100,000 people). CONCLUSIONS Calorie labeling at large fast-food chains is estimated to be a cost-saving intervention to improve long-term population health. Calorie labeling is a low-cost intervention that is already implemented across the U.S. in large chain restaurants.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Jason P Block
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Jessica L Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Joshua Petimar
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erica L Kenney
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aviva A Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Duffy F, Peebles I, Maloney E, Robertson MDA, Sharpe H. Individuals with restrictive eating disorders' experience of the introduction of calories on menus in England: An interpretative phenomenological analysis study. EUROPEAN EATING DISORDERS REVIEW 2023; 31:802-812. [PMID: 37406031 DOI: 10.1002/erv.3007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/05/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE In April 2022 the Calorie Labelling (Out of Home) Regulations came into effect in England where cafés, restaurants, and takeaways with over 250 employees were required to provide calorie labelling on menus. Concerns have been raised regarding the potential negative impact this could have on individuals with eating disorders (EDs), yet this has not been explored using qualitative methodology. METHOD Eleven participants with a current or previously diagnosed restrictive ED were interviewed in September 2022. Interpretative Phenomenological Analysis (IPA) was used to explore their experience of the introduction of calories on menus. RESULTS Using IPA we established six themes and seven subordinate themes. These included the introduction of calories on menus as an 'attack' on individuals with EDs; the prominent visual display of calories as an attentional pull; normalising of calories counting; the impact on behaviour; and associated strategies for managing. CONCLUSION This contributes to research surrounding the implications for public health policies on individuals with EDs, especially their ability to reinforce and amplify disordered thoughts and behaviours, and the need for greater consideration of how to minimise impact and potential harm of large public health campaigns.
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Affiliation(s)
- Fiona Duffy
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Edinburgh, Scotland
| | - Imogen Peebles
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Edinburgh, Scotland
| | - Ellen Maloney
- School of Philosophy, Psychology and Language, University of Edinburgh, Edinburgh, Scotland
| | | | - Helen Sharpe
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland
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Putra IGNE, Polden M, Wareing L, Robinson E. Acceptability and perceived harm of calorie labeling and other obesity policies: A cross-sectional survey study of UK adults with eating disorders and other mental health conditions. Int J Eat Disord 2023; 56:2049-2061. [PMID: 37507841 PMCID: PMC10947290 DOI: 10.1002/eat.24031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We assessed perceptions of recently proposed UK obesity policies (mandatory calorie labeling, banning of advertisements of unhealthy food and drinks online and before 9 pm on TV, and banning "buy one get one free" deals for unhealthy food and drinks) in people with an eating disorder (ED) and other mental health conditions. METHOD A total of 1273 participants with a self-reported lifetime mental health condition (N = 583 with an ED) completed an online survey in September-November 2022. Multinomial logistic regression was used to examine support for and potential adverse effects of policies in participants with and without an ED. A qualitative analysis of the potential effects of the policy on current ED symptoms was also conducted to better understand how and why policies may be damaging or beneficial. RESULTS Participants with an ED had a lower level of support for the implementation of the calorie labeling policy compared to those without an ED (43% vs. 58%). Half of the participants with an ED (55%) reported that labeling may worsen their ED symptoms. Qualitative data indicated perceived potential harm (e.g., a gateway to relapse, negative effects on mood) and perceived benefits (e.g., feeling informed and reassured) of calorie labeling in participants with an ED. No differences in support or perceived harms of the other two policies were observed between participants with versus without an ED. DISCUSSION Future studies are warranted to explore the potential effects of calorie labeling and how to mitigate negative impacts on people with an ED. PUBLIC SIGNIFICANCE This research is the first to assess the perceptions of UK obesity-related policies in people with an ED and other mental health conditions. Participants with an ED (vs. without) were more likely to disagree with the government implementing the calorie labeling policy. These findings highlight the potentially harmful effects of calorie labeling in people with an ED and the need for future research to understand how to mitigate negative impacts.
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Affiliation(s)
| | - Megan Polden
- Department of Primary Care and Mental Health, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
- NIHR Applied Research Collaboration North West CoastLiverpoolUK
| | | | - Eric Robinson
- Department of Psychology, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
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9
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Santos BM, Haynos AF. Difficulties with positive emotion regulation in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023; 31:520-528. [PMID: 36854860 PMCID: PMC10239315 DOI: 10.1002/erv.2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 03/02/2023]
Abstract
Individuals with anorexia nervosa (AN) have well-documented difficulties regulating negative emotions, but less is known about positive emotion regulation in this population. To address this gap, we compared responses on the Difficulties in Emotion Regulation Scale-Positive questionnaire and the traditional DERS questionnaire (measuring negative affect dysregulation) between females with AN (n = 30) and demographically-matched controls without an eating disorder history (NC; n = 30) and examined relations between positive emotion regulation and clinical symptoms. Results indicated that individuals with AN demonstrated greater difficulty regulating negative (p < 0.001, d = 2.75) and positive (p < 0.001, d = 1.08) emotions compared to NC participants. Specifically, the AN group reported heightened positive emotion nonacceptance (p = 0.004, d = 0.78) and impulsivity (p = 0.003, d = 0.81). Greater positive emotion nonacceptance was associated with higher anxiety (p = 0.015) and depression (p = 0.022) among individuals with AN. Unexpectedly, more positive emotion impulsivity was associated with less restrictive eating in AN (p < 0.001). Findings were largely maintained even after controlling for negative emotion dysregulation and psychotropic medication use. The results suggest that reducing shame related to positive emotions could improve mood in AN; alternatively, relinquishing control when experiencing positive emotion could reduce restriction. More research is warranted on positive emotion regulation as a treatment target for AN.
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Affiliation(s)
- Bolade M. Santos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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Robinson E, Boyland E, Christiansen P, Haynos AF, Jones A, Masic U, Robertson D, Tapper K, Marty L. Is the effect of menu energy labelling on consumer behaviour equitable? A pooled analysis of twelve randomized control experiments. Appetite 2023; 182:106451. [PMID: 36610541 PMCID: PMC10082393 DOI: 10.1016/j.appet.2023.106451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/18/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023]
Abstract
Menu energy labelling has been implemented as a public health policy to promote healthier dietary choices and reduce obesity. However, it is unclear whether the influence energy labelling has on consumer behaviour differs based on individuals' demographics or characteristics and may therefore produce inequalities in diet. Data were analysed from 12 randomized control trials (N = 8508) evaluating the effect of food and drink energy labelling (vs. labelling absent) on total energy content of food and drink selections (predominantly hypothetical) in European and US adults. Analyses examined the moderating effects of participant age, sex, ethnicity/race, education, household income, body mass index, dieting status, food choice motives and current hunger on total energy content of selections. Energy labelling was associated with a small reduction (f2 = 0.004, -50 kcal, p < 0.001) in total energy selected compared to the absence of energy labelling. Participants who were female, younger, white, university educated, of a higher income status, dieting, motivated by health and weight control when making food choices, and less hungry, tended to select menu items of lower energy content. However, there was no evidence that the effect of energy labelling on the amount of energy selected was moderated by any of the participants' demographics or characteristics. Energy labelling was associated with a small reduction in energy content of food selections and this effect was similar across a range of participants' demographics and characteristics. These preliminary findings suggest that energy labelling policies may not widen existing inequalities in diet.
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Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | | | - Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Una Masic
- Gender Identity Development Service, Tavistock and Portman NHS Trust, London, UK
| | - Deirdre Robertson
- Behavioural Research Unit, Economic and Social Research Institute, Ireland & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Katy Tapper
- Department of Psychology, City, University of London, UK
| | - Lucile Marty
- Centre des Sciences Du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000, Dijon, France
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Penzavecchia C, Todisco P, Muzzioli L, Poli A, Marangoni F, Poggiogalle E, Giusti AM, Lenzi A, Pinto A, Donini LM. The influence of front-of-pack nutritional labels on eating and purchasing behaviors: a narrative review of the literature. Eat Weight Disord 2022; 27:3037-3051. [PMID: 36369593 PMCID: PMC9803757 DOI: 10.1007/s40519-022-01507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Front-of-Pack Nutritional Labels are considered a useful tool to help consumers orient themselves in their food choices and direct their behavior toward a healthier diet. FOPNL development and use are part of a framework that includes cognitive, biological, hedonic and cultural aspects, able to affect consumers' eating and purchasing behavior. AIM Given the complexity of the matter, the aim of this narrative review is to analyze the combination of different factors that drive food choices and eating behaviors and to highlight some aspects that are not fully studied. METHODS The authors conducted the research using a top-down approach at first, followed by a bottom-up approach; starting with general considerations about the purchasing process, gradually narrowing the discussion to a specific sub-population, and finally extending the discussion back to more general reasonings about the direction to adopt in future, or at least to evaluate, for effective communication. RESULTS Biases and attitudes toward food products were found to regularly interfere with buying behavior patterns, making it impossible to standardize an average consumer. This reflects in current research, increasing the complexity of the topic. All determinants influencing food choices are often assessed individually rather than in a synergistic and multidimensional context, while the purchasing scenario is characterized by multiple stimuli to which the consumer is subjected. FOPNLs' impact on perceived healthiness has been studied in different conditions, but some population subgroups have not been sufficiently represented. In particular, the effect of FOPNLs on consumers suffering from eating disorders is understudied and needs further attention. Furthermore, some approaches can be compared to "negative nutrition" or "loss-framed communication", putting nutrients out of context, emphasizing losses more than gains and risking promoting negative feelings in consumers. CONCLUSION Due to the heterogeneity of studies, evidence on what works best in driving people to adopt lasting lifestyle changes is still mixed. Science communicators and policymakers should consider the possibility that a multi-component approach incorporating nutrition information and education may be a key strategy to promote consumers' self-consciousness and to support them in their cognitive efforts toward a healthy and sustainable diet. LEVEL OF EVIDENCE Level V, narrative review.
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Affiliation(s)
- Claudia Penzavecchia
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Vicenza, Italy
| | - Luca Muzzioli
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Andrea Poli
- NFI-Nutrition Foundation of Italy, Milan, Italy
| | | | - Eleonora Poggiogalle
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Anna Maria Giusti
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Andrea Lenzi
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Alessandro Pinto
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Lorenzo Maria Donini
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy.
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12
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Robinson E, Boyland E, Evans R, Finlay A, Halsall L, Humphreys G, Langfield T, McFarland‐Lesser I, Patel Z, Jones A. Energy labelling of alcoholic drinks: An important or inconsequential obesity policy? Obes Sci Pract 2022; 9:75-86. [PMID: 37034571 PMCID: PMC10073822 DOI: 10.1002/osp4.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/28/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behavior are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behavior, suggest alcohol energy labelling may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity.
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Affiliation(s)
- Eric Robinson
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Emma Boyland
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Rebecca Evans
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Amy Finlay
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Lauren Halsall
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Gabrielle Humphreys
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Tess Langfield
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - India McFarland‐Lesser
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Zina Patel
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Andrew Jones
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
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Raffoul A, Gibbons B, Boluk K, Neiterman E, Hammond D, Kirkpatrick SI. "Maybe a little bit of guilt isn't so bad for the overall health of an individual": a mixed-methods exploration of young adults' experiences with calorie labelling. BMC Public Health 2022; 22:938. [PMID: 35538462 PMCID: PMC9092873 DOI: 10.1186/s12889-022-13364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Menu labelling, and more specifically calorie labelling, has been posited as an intervention to improve nutrition literacy and the healthfulness of consumers’ food purchases. However, there is some concern calorie labelling may unintentionally trigger or exacerbate disordered eating among vulnerable persons. The purpose of this research was to explore young adults’ experiences with labelling, with a focus on its implications for their relationships with food. Methods Individual semi-structured interviews were conducted with participants from a campus-based menu labelling study. Interview data were inductively coded using thematic analysis and supported by survey data assessing disordered eating, body esteem, and related constructs. Results The sample consisted of 13 participants (10 women, 3 men), most of whom perceived themselves as “about the right weight” (62%). Four key themes included: (1) participants’ support of and skepticism about labelling interventions, (2) the identification of knowledge and autonomy as mechanisms of labelling interventions, (3) the role of the individual’s and others’ relationships with food in experiences with labelling, and (4) disordered eating and dieting as lenses that shape experiences with interventions. Participants’ perceptions of and experiences with calorie labels were shaped by gender, body esteem, and disordered eating risk. Conclusions The results provide insight into the complexity of young adults’ interactions with labelling interventions and context for future research exploring the unintended consequences of public health nutrition interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13364-w.
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Affiliation(s)
- Amanda Raffoul
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada. .,Present address: Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.
| | - Brooke Gibbons
- Department of Recreation and Leisure Studies, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Karla Boluk
- Department of Recreation and Leisure Studies, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Elena Neiterman
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Sharon I Kirkpatrick
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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Fuster M, Abreu-Runkle R, Handley MA, Rose D, Rodriguez MA, Dimond EG, Elbel B, Huang TTK. Promoting healthy eating in Latin American restaurants: a qualitative survey of views held by owners and staff. BMC Public Health 2022; 22:843. [PMID: 35477376 PMCID: PMC9043880 DOI: 10.1186/s12889-022-13294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Restaurants, particularly independently-owned ones that serve immigrant communities, are important community institutions in the promotion of dietary health. Yet, these restaurants remain under-researched, preventing meaningful collaborations with the public health sector for healthier community food environments. This research aimed to examine levels of acceptability of healthy eating promotion strategies (HEPS) in independently-owned Latin American restaurants (LARs) and identify resource needs for implementing HEPS in LARs. Methods We completed semi-structured, online discussions with LAR owners and staff (n = 20), predominantly from New York City (NYC), to examine current engagement, acceptability, potential barriers, and resource needs for the implementation of HEPS. Verbatim transcripts were analyzed independently by two coders using Dedoose, applying sentiment weighting to denote levels of acceptability for identified HEPS (1 = low, 2 = medium/neutral, 3 = high). Content analysis was used to examine factors associated with HEPS levels of acceptability and resource needs, including the influence of the Coronavirus pandemic (COVID-19). Results The most acceptable HEPS was menu highlights of healthier items (mean rating = 2.8), followed by promotion of healthier items (mean rating = 2.7), increasing healthy offerings (mean rating = 2.6), nutrition information on the menu (mean rating = 2.3), and reduced portions (mean rating = 1.7). Acceptability was associated with factors related to perceived demand, revenue, and logistical constraints. COVID-19 had a mixed influence on HEPS engagement and acceptability. Identified resource needs to engage in HEPS included nutrition knowledge, additional expertise (e.g., design, social media, culinary skills), and assistance with food suppliers and other restaurant operational logistics. Respondents also identified potential policy incentives. Conclusions LARs can positively influence eating behaviors but doing so requires balancing public health goals and business profitability. LARs also faced various constraints that require different levels of assistance and resources, underscoring the need for innovative engagement approaches, including incentives, to promote these changes.
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Affiliation(s)
- Melissa Fuster
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Rosa Abreu-Runkle
- Department of Hospitality Management, School of Professional Studies, New York City College of Technology, City University of New York, New York, NY, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - Donald Rose
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Michelle A Rodriguez
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Emily G Dimond
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.,Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Terry T K Huang
- Department of Community Health and Social Sciences and Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
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15
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16
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Hall MG, Grummon AH, Higgins ICA, Lazard AJ, Prestemon CE, Avendaño-Galdamez MI, Taillie LS. The impact of pictorial health warnings on purchases of sugary drinks for children: A randomized controlled trial. PLoS Med 2022; 19:e1003885. [PMID: 35104297 PMCID: PMC8806063 DOI: 10.1371/journal.pmed.1003885] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/08/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pictorial warnings on tobacco products are promising for motivating behavior change, but few studies have examined pictorial warnings for sugary drinks, especially in naturalistic environments. This study aimed to examine the impact of pictorial warnings on parents' purchases of sugary drinks for their children in a naturalistic store laboratory. METHODS AND FINDINGS Parents of children ages 2 to 12 (n = 325, 25% identifying as Black, 20% Hispanic) completed a shopping task in a naturalistic store laboratory in North Carolina. Participants were randomly assigned to a pictorial warnings arm (sugary drinks displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (sugary drinks displayed a barcode label). Parents selected 1 beverage and 1 snack for their child, as well as 1 household good; one of these items was selected for them to purchase and take home. The primary outcome was whether parents purchased a sugary drink for their child. Secondary outcomes included reactions to the trial labels, attitudes toward sugary drinks, and intentions to serve their child sugary drinks. Pictorial warnings led to a 17-percentage point reduction in purchases of sugary drinks (95% CI for reduction: 7% to 27%), with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm (p = 0.002). The impact of pictorial warnings on purchases did not differ by any of the 13 participant characteristics examined (e.g., race/ethnicity, income, education, and age of child). Pictorial warnings also led to lower calories (kcal), purchased from sugary drinks (82 kcal in the control arm versus 52 kcal in the pictorial warnings arm, p = 0.003). Moreover, pictorial warnings led to lower intentions to serve sugary drinks to their child, feeling more in control of healthy eating decisions, greater thinking about the harms of sugary drinks, stronger negative emotional reactions, greater anticipated social interactions, lower perceived healthfulness of sugary drinks for their child, and greater injunctive norms to limit sugary drinks for their child (all p < 0.05). There was no evidence of difference between trial arms on noticing of the labels, appeal of sugary drinks, perceived amount of added sugar in sugary drinks, risk perceptions, or perceived tastiness of sugary drinks (all p > 0.05). CONCLUSIONS Pictorial warnings reduced parents' purchases of sugary drinks for their children in this naturalistic trial. Warnings on sugary drinks are a promising policy approach to reduce sugary drink purchasing in the US. TRIAL REGISTRATION The trial design, measures, power calculation, and analytic plan were registered before data collection at www.clinicaltrials.gov NCT04223687.
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Affiliation(s)
- Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Isabella C. A. Higgins
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Allison J. Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carmen E. Prestemon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mirian I. Avendaño-Galdamez
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Negowetti N, Ambwani S, Karr S, Rodgers RF, Austin SB. Digging up the dirt on "clean" dietary labels: Public health considerations and opportunities for increased Federal oversight. Int J Eat Disord 2022; 55:39-48. [PMID: 34312898 DOI: 10.1002/eat.23585] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND "Clean" dietary labels are often viewed by consumers as referencing products that are minimally processed, without additives, preservatives, artificial colors, or ingredients, but may also be interpreted as vegan, gluten-free, dairy-free, "real," or "natural." Although the "clean" diet trend continues to grow in popularity, there is a lack of consensus regarding the definition and use of this terminology with a corresponding lack of regulation for such labels in the United States. METHOD This multidisciplinary scoping review examines the public health implications of the "clean" label trend and the legal and policy landscape for regulation. We report on findings from case law and legal research generated through the Westlaw database and from the U.S. Food and Drug Administration (FDA) enforcement actions and website documents to discuss options for federal- and state-level intervention to mitigate harm. RESULTS One feasible avenue for change is for the FDA to provide industry guidance, disseminate public statements to debunk myths, and enforce labeling statutes to police deceptive "clean" labeling claims. We also suggest consumer-protection litigation and state-level litigation via attorneys general as alternative actions to combat the abundant misinformation associated with "clean" diets and labels. DISCUSSION Although the FDA has taken some enforcement actions, these efforts are insufficient given the proliferation of "clean" label products in the marketplace and the potential for adverse impacts on public health including increased risk for disordered eating. The current unregulated, undefined landscape for "clean" dietary labels thus requires urgent action by federal authorities and state attorneys general.
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Affiliation(s)
- Nicole Negowetti
- Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Harvard Law School, Cambridge, Massachusetts, USA
| | - Suman Ambwani
- Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Psychology, Dickinson College, Carlisle, Pennsylvania, USA
| | - Stefani Karr
- Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel F Rodgers
- Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - S Bryn Austin
- Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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18
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Al-Otaibi H, Al-Sandal T, Elkatr HO. Is Calorie Labeling on Menus Related to Weight Disturbances among Females in Saudi Arabia? J Nutr Metab 2021; 2021:4041451. [PMID: 34513089 PMCID: PMC8433015 DOI: 10.1155/2021/4041451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
Calorie labeling is a recent initiative from the Saudi Food and Drug Authority (SFDA) aimed to reduce the prevalence of noncommunicable diseases (NCDs) by influencing people to make healthier food choices when they eat out and can also help people with weight disturbances to be more aware of their calorie intake. The present study aimed to investigate the association between the use of calorie labeling on restaurant menus, calorie intake, weight concern, body weight perception, and weight-control behaviors among young women. A quasi-experimental study was conducted among female students at a university restaurant. Participants were assigned to two groups: food menus with (experimental group) and without (control group) calorie labeling. The logistic regression model assessed the predictors of using calorie information separately for the experimental and control groups. Calorie labeling had a significant effect on reducing calorie consumption in the experimental group by 59 calories compared to the control group. The higher weight concern in the control group (OR = 0.410; 95% CI 0.230-0.730; P ≤ 0.002) was a predictor for using calorie information. The experimental group had higher weight concern (OR = 1.530; 95% CI 1.107-2.115; P ≤ 0.01) and body weight perception (OR = 4.230; 95% CI 1.084-6.517; P ≤ 0.038) and lower calorie intake (OR = 1.005; 95% CI 1.001-6.517; P ≤ 0.008) predictors for using calorie information. Weight-control behaviors did not significantly predict the use of calorie information in the groups. Calorie labeling might increase the weight disturbances among young females. More investigation is needed across various populations to gain a better understanding of calorie labeling as an effective food choice among people who are vulnerable to weight disturbances or already have weight disorders.
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Affiliation(s)
- Hala Al-Otaibi
- Department of Food and Nutrition Science, College of Agricultural Science and Food, King Faisal University, Hofuf, Saudi Arabia
| | - Tahani Al-Sandal
- Department of Food and Nutrition Science, College of Agricultural Science and Food, King Faisal University, Hofuf, Saudi Arabia
| | - Haiam O. Elkatr
- Department of Food and Nutrition Science, College of Agricultural Science and Food, King Faisal University, Hofuf, Saudi Arabia
- Department of Home Economics, Faculty of Specific Education, Ain Shams University, Cairo, Egypt
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Bristow C, Allen KA, Simmonds J, Snell T, McLean L. Anti-obesity public health advertisements increase risk factors for the development of eating disorders. Health Promot Int 2021; 37:6323697. [PMID: 34279033 DOI: 10.1093/heapro/daab107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although overweight and obesity are increasing in prevalence, eating disorders such as anorexia nervosa, bulimia nervosa and binge-eating disorder are simultaneously on the rise. It is important to address the burden of disease of overweight and obesity on the population, yet there is concern that some of these efforts may be encouraging unhealthy weight control behaviours (UWCB). Using an online survey, 137 participants were exposed to four anti-obesity public health advertisements presented in random order. Weight satisfaction, shape satisfaction, desire to control weight, desire to control shape and desire to engage in UWCB were measured on a 100-point visual analogue scale. A significant effect of the experimental condition was found after exposure to Image 1 with a decrease in weight satisfaction, and increased desire to control body weight, body shape and engage in UWCB. Mean scores for UWCB also increased, on average, across all four image conditions. Public health advertisements targeting obesity risk encouraging unhealthy weight control and subsequent disordered eating behaviours. Those responsible for the implementation of such advertisements must consider very carefully the potential to cause unintended harm.
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Affiliation(s)
- Claire Bristow
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| | - Kelly-Ann Allen
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| | - Janette Simmonds
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| | - Tristan Snell
- School of Psychology, Faculty of Health, Deakin University, Melbourne Victoria, Australia
| | - Louise McLean
- Faculty of Education, Monash University, Melbourne Victoria, Australia
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20
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Musicus AA, Hua SV, Schwartz MB, Block JP, Barg FK, Economos CD, Glanz K, Krieger JW, Roberto CA. Messages Promoting Healthy Kids' Meals: An Online RCT. Am J Prev Med 2021; 60:674-683. [PMID: 33632647 PMCID: PMC8279041 DOI: 10.1016/j.amepre.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/06/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Calorie labeling is now required on all large U.S. chain restaurant menus, but its influence on consumer behavior is mixed. This study examines whether different parent-targeted messages encourage parents to order lower-calorie meals for their children in a hypothetical online setting. METHODS An online RCT was conducted with sociodemographically diverse primary caregivers of children aged 6-12 years (data collected and analyzed in 2017-2019). Participants (N=2,373) were randomized to see 1 of 4 messages: (1) nonfood control, (2) kids' meals are the right size for children, (3) doctors recommend a 600 kcal per meal limit for kids, or (4) 600 kcal per meal is a generally recommended limit for kids. Participants ordered hypothetical meals for their children and themselves and rated meal and message perceptions. RESULTS There were no significant differences between conditions in calories ordered for children at either restaurant, although all 3 food message conditions ordered fewer calories for their children than the control (full service: 27-68 fewer kcal, fast food: 18-64 fewer kcal). The general 600 kcal/meal limit message consistently performed best across outcomes, encouraging parents to order the fewest calories for their children at both restaurants (5%-7% fewer) and significantly increasing their understanding of calorie recommendations for kids' meals. It also significantly reduced fast-food calories parents ordered for themselves compared with the control (-106 kcal, p=0.042). CONCLUSIONS Although no statistically significant differences were detected, messages with specific calorie recommendations for kids led parents to order lower-calorie restaurant meals for their children, suggesting that additional real-world studies with larger sample sizes are warranted.
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Affiliation(s)
- Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Sophia V Hua
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Marlene B Schwartz
- UConn Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Frances K Barg
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christina D Economos
- Division of Nutrition Interventions, Communication, and Behavior Change, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Karen Glanz
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James W Krieger
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; School of Medicine, University of Washington, Seattle, Washington
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Seward MW, Soled DR. Unintended consequences in traffic-light food labeling: A call for mixed methods in public health research. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:465-467. [PMID: 30908133 DOI: 10.1080/07448481.2019.1583238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 01/05/2019] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
Nudge theory describes how indirect suggestions and positive reinforcement can influence decision-making. We used nudge theory to implement a traffic-light labeling and choice architecture (modifying product placement) intervention at Harvard University cafeterias, but found no significant change in sales. Survey and focus group data showed that some students thought the labeling may exacerbate eating disorders, however, there is extremely limited research on potential negative consequences of labeling. One way to describe these findings is through 20th century philosopher Michel Foucault's concept of biopower. Biopower manipulates cultural norms and nudges individuals to engage in self-surveillance and self-discipline, de facto subjugating themselves to certain ways of being. Biopower may lead to the creation of an in-group and an out-group based on who can adopt the new behaviors, such as healthy eating. Those in the out-group may face additional unintended consequences, highlighting the need for mixed-methods research to better evaluate public health interventions.
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Christoph MJ, Larson N, Laska MN, Neumark-Sztainer D. Nutrition Facts Panels: Who Uses Them, What Do They Use, and How Does Use Relate to Dietary Intake? J Acad Nutr Diet 2019; 118:217-228. [PMID: 29389508 DOI: 10.1016/j.jand.2017.10.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 10/16/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Nutrition labels are a low-cost tool with the potential to encourage healthy eating habits. OBJECTIVE To investigate correlates of frequent Nutrition Facts label use, describe the types of label information most often used, and measure how label use relates to dietary intake in young adults. DESIGN Cross-sectional population-based study of young adults participating in Project Eating and Activity in Teens and Young Adults-IV. PARTICIPANTS/SETTING Surveys and food frequency questionnaires were completed during 2015-2016 by young adults (N=1,817; weighted sample=49% women) aged 25 to 36 years. MAIN OUTCOME MEASURES Nutrition Facts label use, frequency of using specific information on labels, and dietary intake. STATISTICAL ANALYSES PERFORMED Relative risks and adjusted means were used to examine how demographic, behavior, and weight-related factors were associated with Nutrition Facts panel use, and how label use related to dietary outcomes. Associations with P values <0.05 were considered statistically significant. RESULTS Approximately one-third (31.4%) of participants used Nutrition Facts labels "frequently." Use was significantly higher for women; for participants with high education and income; among those who prepared food regularly; among those who were physically active; among those with a weight status classified as overweight; and among those who were trying to lose, gain, or maintain weight. Label components used most often included sugars (74.1%), total calories (72.9%), serving size (67.9%), and the ingredient list (65.8%). Nutrition Facts label users consumed significantly more fruits, vegetables, and whole grains and fewer sugar-sweetened beverages, compared with nonusers. Nutrition Facts label users ate significantly more frequently at sit-down restaurants but less frequently at fast-food restaurants compared with nonusers. CONCLUSIONS Although Nutrition Facts label use was associated with markers of better dietary quality in a population-based sample of young adults, only one-third of participants used labels frequently. Methods to improve label use should be studied, particularly through leveraging weight- or health-related goals (eg, interest in making healthier food choices), and meeting consumer preferences concerning label content.
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Mohr B, Dolgopolova I, Roosen J. The influence of sex and self-control on the efficacy of nudges in lowering the energy content of food during a fast food order. Appetite 2019; 141:104314. [PMID: 31181248 DOI: 10.1016/j.appet.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/15/2022]
Abstract
An experiment aimed at reducing calorie content of a food order was performed by introducing interventions at the fast food ordering screen on a tablet computer. Modifications included a virtual order assistant, a color-coded system and highlighting low-calorie choices. Participants of the study were 401 university students. Before starting an order, participants were asked to indicate their calorie goal. Our results show that the order assistant is the only intervention that leads to significantly fewer calories in the fast food order. The effect is due to women ordering fewer high-calorie dishes. Men, in contrast, are unresponsive to changes in the choice context regarding calories ordered. Results indicate that the level of self-control moderates the impact of the feature highlighting choices so that higher levels of self-control lead to lower calorie intake for both sexes. This research highlights the importance of gender and self-control for designing choice environments aimed at decreasing calorie intake.
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Affiliation(s)
- Bernhard Mohr
- Chair of Marketing and Consumer Research, TUM School of Management, Technical University of Munich, Germany
| | - Irina Dolgopolova
- Chair of Marketing and Consumer Research, TUM School of Management, Technical University of Munich, Germany.
| | - Jutta Roosen
- Chair of Marketing and Consumer Research, TUM School of Management, Technical University of Munich, Germany
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24
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McGeown L. The calorie counter-intuitive effect of restaurant menu calorie labelling. Canadian Journal of Public Health 2019; 110:816-820. [PMID: 30701412 DOI: 10.17269/s41997-019-00183-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/16/2019] [Indexed: 12/16/2022]
Abstract
As of January 1, 2017, the Healthy Menu Choices Act mandates that food service premises with 20 or more locations in Ontario must display the number of calories in every food item sold on menus. The impetus for this legislation was to enable Ontarians to become aware of the calorie content of foods and beverages consumed outside the home, and make healthier dietary choices while dining out. Though arising as an initiative to attenuate the development of obesity and current obesity rates, evidence suggests menu labelling does not significantly alter individuals' food choices. Moreover, focusing primarily on caloric content may be an ineffective, and perhaps detrimental, strategy to effect change in the obesity epidemic. Beyond the initiative's questionable utility, there has been a lack of consideration as of yet to the unintended negative implications this initiative may have on eating disorder (ED) symptomatology in the general population and those attempting to recover from an ED. The objective of the current commentary is thus to argue that in light of evidence of minimal benefit and the potential for harm, nutrition labelling on menus may be a misguided public health initiative.
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Affiliation(s)
- Laura McGeown
- Department of Psychology, Lakehead University, 955 Oliver Rd, Thunder Bay, Ontario, P7B 5E1, Canada.
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Shared Concerns and Opportunity for Joint Action in Creating a Food Environment That Supports Health. Nutrients 2018; 11:nu11010041. [PMID: 30585215 PMCID: PMC6357161 DOI: 10.3390/nu11010041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 11/21/2022] Open
Abstract
The food industry is a for-profit industry with high relevance to universal eating disorders prevention. To date, policy which targets the food industry and food environment has been underutilized in efforts to decrease the incidence of eating disorders and associated risk factors. In contrast, food policy has been extensively leveraged with the aim of reducing the incidence of obesity. While philosophical misalignments with these later efforts may have constituted an obstacle to identifying the food environment as a key target for eating disorders prevention, food policy is an area where shared interests can be found. Specifically, a shared goal of obesity and eating disorders prevention efforts is creating a food environment that supports health, while minimizing the influence of the food industry that profits from the sale of highly palatable, processed foods and “diet” foods and from increasing portions of foods served and eaten.
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Kerins C, McSharry J, Hayes C, Perry IJ, Geaney F, Kelly C. Barriers and facilitators to implementation of menu labelling interventions to support healthy food choices: a mixed methods systematic review protocol. Syst Rev 2018; 7:88. [PMID: 29935530 PMCID: PMC6015453 DOI: 10.1186/s13643-018-0752-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/05/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Menu labelling is continuing to gather public and legislative support as one of the potential environmental strategies for addressing the obesity pandemic. However, issues relating to implementation have been reported in countries where menu labelling has been introduced on a voluntary or mandatory basis. The aim of this mixed methods systematic review is to synthesise the empirical evidence on the barriers and facilitators to implementation of menu labelling interventions to support healthy food choices. METHODS This review will use the 'best fit' framework synthesis approach to synthesise qualitative, quantitative and mixed methods evidence. Peer-reviewed publications will be accessed through PubMed, EMBASE, CINAHL, PsycINFO, Web of Science and Scopus. Grey literature will be accessed through Google Scholar, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies will be undertaken. There will be no restriction on menu labelling scheme or format, publication year or language; however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. At least two independent reviewers will perform study selection, data extraction and quality appraisal; if consensus is required, another independent reviewer will be consulted. A combination of deductive coding, using the Consolidated Framework for Implementation Research as the a priori framework, and inductive analysis, using secondary thematic analysis, will be used. The overall process will assist in the construction of a new evidence-based conceptual model regarding the implementation of menu labelling interventions. The new model will be assessed for bias and a sensitivity analysis performed. DISCUSSION Given the growing consensus that a systemic, sustained portfolio of obesity prevention strategies, delivered at scale, is needed to address the obesity epidemic, greater understanding of the practical issues relating to implementation of such strategies is required. Findings from this review will be used to develop a set of best-practice guidelines to enhance the adoption, implementation and sustainability of menu labelling interventions across countries worldwide. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017083306.
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Affiliation(s)
- Claire Kerins
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, University Road, Galway, Ireland
| | - Jennifer McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland
| | - Catherine Hayes
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin Russell Centre, Tallaght Cross, Dublin 24, Ireland
| | - Ivan J. Perry
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Fiona Geaney
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Colette Kelly
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, University Road, Galway, Ireland
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Seward MW, Block JP, Chatterjee A. Student experiences with traffic-light labels at college cafeterias: a mixed methods study. Obes Sci Pract 2018; 4:159-177. [PMID: 29670754 PMCID: PMC5893474 DOI: 10.1002/osp4.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 01/09/2018] [Accepted: 01/21/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To assess student perceptions of traffic‐light labels (TLLs) in college cafeterias. Design Cross‐sectional, mixed‐methods study. Setting One northeastern US college. Participants A total of 1,294 survey respondents; 57 focus group participants. Interventions Seven‐week traffic‐light labelling (green = ‘nutrient‐rich’, yellow = ‘less nutrient‐rich’, red = ‘more nutrient‐rich choice in green or yellow’) intervention at two college cafeterias. Main Outcome Measure(s) Perceptions of TLLs and food labelling; disordered eating behaviours. Analysis Performed χ2 analyses to test for differences between pre‐intervention and postintervention responses, and between postintervention subgroups stratified by site, gender, weight status and varsity athlete status. Qualitative analysis based on the immersion‐crystallization method. Results In postintervention surveys, 60% found TLLs helpful, and 57% used them a few times a week. When asked whether TLLs increased risk of developing eating disorders, 16% of participants said they did and 47% said TLLs might exacerbate existing eating disorders. In focus groups, some students thought the red ‘colour seemed jarring’, but the vast majority agreed ‘the more nutrition information available, the better’. Conclusions and Implications Students generally supported TLLs, but future college‐based interventions should address eating disorder concerns. Labels that incorporate nutrition information and education, and avoid negative messaging or judgment of what students eat, may be more acceptable.
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Affiliation(s)
- M W Seward
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston USA
| | - J P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston USA
| | - A Chatterjee
- Division of Global Health Equity Brigham and Women's Hospital, Harvard Medical School Boston USA
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Christoph MJ, Loth KA, Eisenberg ME, Haynos AF, Larson N, Neumark-Sztainer D. Nutrition Facts Use in Relation to Eating Behaviors and Healthy and Unhealthy Weight Control Behaviors. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:267-274.e1. [PMID: 29276019 PMCID: PMC5845784 DOI: 10.1016/j.jneb.2017.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Investigate the relationship between use of Nutrition Facts labels on packaged foods and weight-related behaviors. DESIGN Cross-sectional survey in 2015-2016. PARTICIPANTS Young adult respondents (n = 1,817; 57% women; average age 31.0 ± 1.6 years) to the Project Eating and Activity in Teens and Young Adults-IV survey, the fourth wave of a longitudinal cohort study. VARIABLES MEASURED Use of Nutrition Facts labels on packaged foods; healthy, unhealthy, and extreme weight control behaviors; intuitive eating; binge eating. ANALYSIS Linear and logistic regression models were adjusted for age, ethnicity/race, education, income, and weight status. RESULTS In women, greater Nutrition Facts use was associated with a 23% and 10% greater likelihood of engaging in healthy and unhealthy weight control behaviors, respectively, and a 17% greater chance of engaging in binge eating. In men, greater label use was associated with a 27% and 17% greater likelihood of engaging in healthy and unhealthy weight control behaviors, respectively, and a lower level of intuitive eating. CONCLUSIONS AND IMPLICATIONS Professionals advising patients and clients on weight management may consider possible gender differences in response to weight loss and management guidance. Since label use was related to engagement in some unhealthy behaviors in addition to healthy behaviors, it is important to consider how individuals may use labels, particularly those at risk for, or engaging in, disordered eating behaviors. Future research investigating potential relationships between Nutrition Facts use, intuitive eating, and binge eating is needed.
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Affiliation(s)
- Mary J Christoph
- Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, MN.
| | - Katie A Loth
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Marla E Eisenberg
- Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Ann F Haynos
- Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Nicole Larson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Larson N, Haynos AF, Roberto CA, Loth KA, Neumark-Sztainer D. Calorie Labels on the Restaurant Menu: Is the Use of Weight-Control Behaviors Related to Ordering Decisions? J Acad Nutr Diet 2018; 118:399-408. [PMID: 29325890 DOI: 10.1016/j.jand.2017.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/09/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is emerging evidence that calorie information on restaurant menus does not similarly influence the ordering decisions of all population groups and may have unintended consequences for individuals who struggle with disordered eating or other weight-related concerns. OBJECTIVE This study describes demographic patterns in the use of calorie information on restaurant menus and investigates relationships between using this information to limit calorie intake and measures of restaurant visit frequency and weight-related concerns and behavior. DESIGN/PARTICIPANTS There were 788 men and 1042 women (mean age=31.0±1.6 years) who participated in the fourth wave of the Project EAT study. Participants were initially recruited from Minneapolis-St Paul, MN, schools and completed EAT-IV surveys online or by mail from 2015 to 2016. MAIN OUTCOME MEASURES Participants self-reported weight-related concerns, restaurant eating, intuitive eating, dieting, healthy (eg, exercise) and unhealthy (eg, use of laxatives) weight-control behaviors, and binge eating. STATISTICAL ANALYSES PERFORMED Descriptive statistics and linear and logistic regression models accounting for demographics and weight status. RESULTS Approximately half of participants (52.7%) reported they had noticed calorie information while purchasing a meal or snack in a restaurant within the previous month. Among individuals who noticed calorie information, 38.2% reported they did not use it in deciding what to order. The most common use of calorie information was to avoid high-calorie menu items (50.1%) or to decide on a smaller portion (20.2%). Using menu labels to limit calories was related to binge eating among women and was associated with more weight-related concerns, dieting, and unhealthy weight-control behaviors among both women and men. CONCLUSIONS Nutrition educators and other health care professionals should talk with clients who struggle with disordered eating or weight-related concerns to learn about their use of calorie information at restaurants, address any potential unintended consequences, and promote healthy uses of calorie information.
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