Preventing weight gain with calorie-labeling

The Effect of Retail Food Environment Interventions on Dietary Behavior in Postsecondary Education Settings: A Systematic Review and Meta-analysis

BACKGROUND

Postsecondary education institutions, where hundreds of millions of people work and study globally, are a key setting for retail food environment interventions.

OBJECTIVE

We aimed to synthesize the evidence for the effectiveness of retail food environment interventions in improving the healthiness of dietary behavior of students and staff in postsecondary education settings.

METHODS

Academic databases were searched for randomized controlled trials (RCTs) and quasi-experimental studies published until August 2023. Studies were eligible if they assessed the impact of a retail food environment intervention on healthiness of dietary behavior (purchases or consumption) in students or staff in postsecondary education settings and targeted one of the following food environment elements: placement, price, product, or promotion. Business-related outcomes (total sales, profit, or revenue) were included as secondary outcomes. Findings were synthesized in narrative form, organized by retail food environment element. Where comparable dietary outcome data were available from ≥10 interventions, findings were pooled using random effects meta-analysis.

RESULTS

Of 10,126 studies initially identified, 55 (76% quasi-experimental) were included, describing 71 separate interventions (n = 49 single-element and n = 22 multi-element). Two-thirds (n = 47, 66%) of interventions (n = 32 single-element and n = 15 multi-element) demonstrated significant improvements in dietary behavior. Single-element interventions targeting placement (n = 1) and price (n = 3) improved dietary behavior. Most (n = 9/10, 90%) interventions targeting product availability or convenience (product element) improved dietary behavior, while n = 19/35 (54%) targeting promotion did. Pooled findings from 12 interventions reporting changes in energy content demonstrated a significant decrease in purchased or consumed energy (-7.9%; 95% confidence interval: -10.3%, -5.6%). Almost all interventions (n = 11/12, 92%) that evaluated the impact on business-related outcomes found either a significant increase or no change following the intervention.

CONCLUSIONS

We established encouraging evidence supporting the role of retail food environment interventions in postsecondary education settings to support healthy dietary behaviors of students and staff.

REGISTRY

PROSPERO (International Prospective Register of Systematic Reviews, URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295836; registration number CRD42022295836).

Impact of Health, Environmental, and Animal Welfare Messages Discouraging Red Meat Consumption: An Online Randomized Experiment

BACKGROUND

Reducing red meat consumption is a key strategy for curbing diet-related chronic diseases and mitigating environmental harms from livestock farming. Messaging interventions aiming to reduce red meat consumption have focused on communicating the animal welfare, health, or environmental harms of red meat. Despite the popularity of these 3 approaches, it remains unknown which is most effective, as limited studies have compared them side by side.

OBJECTIVE

Our aim was to evaluate responses to red-meat-reduction messages describing animal welfare, health, or environmental harms.

DESIGN

This was an online randomized experiment.

PARTICIPANTS

In August 2021, a convenience sample of US adults was recruited via an online panel to complete a survey (n = 2,773 nonvegetarians and vegans were included in primary analyses).

INTERVENTION

Participants were randomly assigned to view 1 of the 4 following messages: control (neutral, non-red meat message), animal welfare, health, or environmental red-meat-reduction messages.

MAIN OUTCOME MEASURES

After viewing their assigned message, participants ordered hypothetical meals from 2 restaurants (1 full service and 1 quick service) and rated message reactions, perceptions, and intentions.

STATISTICAL ANALYSES PERFORMED

Logistic and linear regressions were performed.

RESULTS

Compared with the control message, exposure to the health and environmental red-meat-reduction messages reduced red meat selection from the full-service restaurant by 6.0 and 8.8 percentage points, respectively (P = .02 and P < .001, respectively), while the animal welfare message did not (reduction of 3.3 percentage points, P = .20). None of the red-meat-reduction messages affected red meat selection from the quick-service restaurant. All 3 red-meat-reduction messages elicited beneficial effects on key predictors of behavior change, including emotions and thinking about harms.

CONCLUSIONS

Red-meat-reduction messages, especially those describing health or environmental harms, hold promise for reducing red meat selection in some types of restaurants. Additional interventions may be needed to discourage red meat selection across a wider variety of restaurants, for example, by making salient which menu items contain red meat.

How Does the University Food Environment Impact Student Dietary Behaviors? A Systematic Review

The food environment has been implicated in creating an obesogenic generation; and while previous research has focused on population-wide initiatives, the university population resides in a research gap. To explore detailed components of the university food environment and what shaped dietary behaviors, we retrieved literature from the following databases: ScienceDirect, Scopus, PubMed, Medline, and EMBASE. Eleven studies were identified for qualitative content analysis and study quality assessment identified most of the studies as of good quality (n 8) and some as of fair quality (n 3). The certainty of evidence remained at a low level for all (n 11) studies due to the cross-sectional, observational nature of studies. Three major themes emerged: (1) food environment, (2) student perceptions (SPs), and (3) dietary outcome (DO). In a university food environment, the taste of food was paramount for the food choices of students, followed by the availability of food and the price of food. When university students perceive and choose foods and beverages, they sometimes regard unhealthy foods and beverages as healthy options. The diet quality of university students is more susceptible to living arrangements and socioeconomic status, but higher salt, fat, and added sugar consumption generally resulted in poorer quality of diet on campus. Future research could use novel methods to explore a wider range and deeper level of students' dietary behavior determinants in university food environments.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42021283562.

Analysing Credibility of UK Social Media Influencers' Weight-Management Blogs: A Pilot Study

Social media influencers (SMI) are individuals with large follower engagement, who can shape the thoughts and dietary behaviours of their audience. Concerns exist surrounding the spread of dietary misinformation by SMI, which may impact negatively on public health, yet no standards currently exist to assess the credibility of their information. This study aimed to evaluate the credibility of key SMI weight management (WM) blogs (n = 9), piloting a pre-prepared credibility checklist. SMI were included if they had a blue-tick verification on ≥2 social media (SM) and an active WM blog. A sample of blog posts were systematically evaluated against thirteen credibility indicators under four themes: ‘transparency’, ‘use of other resources’, ‘trustworthiness and adherence to nutritional criteria’ and ‘bias’. Indicators were yes/no questions to determine an overall credibility percentage for each SMI. The ten most recent meal recipes from each blog were evaluated against Public Health England’s (PHE) calorie targets and the UK ‘traffic light’ food labelling scheme to assess nutritional quality. Percentages ranged from 23–85%, the highest gained by a Registered Nutritionist. SMI blogs may not be credible as WM resources. Given the popularity and impact of SM in the context of overweight, obesity and WM, this study may inform the methodological approach for future research.

College campuses' influence on student weight and related behaviours: A review of observational and intervention research

Research indicates that most college students are not meeting dietary and physical activity guidelines, and the average student gains an estimated 1.6-3.0 kg during 4 years of study. College administrations are well-positioned to influence student weight-related health behaviours by ensuring that campus environments/policies promote health. However, to date, campus health interventions have largely addressed individual and interpersonal factors rather than environmental/policy-level changes. Using an ecological perspective, this narrative review synthesizes the literature on campus environmental/policy-level factors (e.g., food availability, physical activity requirements) associated with student diet, physical activity and weight, as well as campus interventions to address these factors. Web of Science and PubMed databases were searched between December 2018 and November 2019. Results indicate that campus food environments may contribute to overconsumption and weight gain, and the number of campuses requiring students to participate in physical activity courses is in decline. Eight examples of environmental/policy-level campus interventions are presented: nutrition labels in dining halls, campus-wide healthy choice marketing campaigns, restricted payment methods for à la cart dining, trayless dining, health-themed residence halls, peer health education programmes, active classroom spaces and physical activity course requirements. Implications for research and health promotion programmes/policies in the field of college health are discussed.

Does labelling of healthy foods on menus using symbols promote better choices at the point-of-purchase?

OBJECTIVE

Take-away foods account for a significant proportion of dietary intake among young adults (18-35 years). Young adults want nutrition information at the point-of-purchase (POP); however, it is either unavailable, perceived as ineffective or difficult to use. The present study examined whether symbols on university food outlet menus identifying healthier options would increase their sales and consumer's awareness of these symbols, purchasing factors and barriers to eating healthy foods.

DESIGN

Repeated-measures, comparison group, quasi-experimental study.

SETTING

Two carefully matched university food outlets were analysed to determine the targeted items. Tick symbols ✓ were placed next to the targeted items in the experimental outlet. No changes were made at the comparison outlet. Customers were surveyed at the experimental outlet. Food sales were collected for 4 weeks from both outlets at baseline and during the intervention. Food sales were also collected from the experimental outlet 10 weeks later.

PARTICIPANTS

Food outlet patrons.

RESULTS

Significant increases in food sales were observed during observation 3 compared with observation 1 (P = 0·0004) and observation 2 (P = 0·0002). Sixty-eight per cent of respondents noticed the symbols, and of that, 30 % reported being influenced. Taste was the most common purchasing factor, and people were less likely to select taste as a factor if they were influenced by the symbols (P = 0·04).

CONCLUSIONS

Identifying healthier options with a symbol at the POP increased sales over time. Several purchasing factors (price, taste and healthy food availability) need to be addressed to improve the food selection of young adults.

Evaluation of the impact of calorie labeling on McDonald's restaurant menus: a natural experiment

Background

The long-term effect of calorie labeling on fast-food purchases is unclear. McDonald’s voluntarily labeled its menus with calories in 2012, providing an opportunity to evaluate this initiative on purchases.

Methods

From 2010 to 2014, we collected receipts from and administered questionnaires to 2971 adults, 2164 adolescents, and 447 parents/guardians of school-age children during repeated visits to 82 restaurants, including McDonald’s and five control chains that did not label menus over the study period in four New England cities. In 2018, we analyzed the data by using difference-in-differences analyses to estimate associations of calorie labeling with calories purchased (actual and estimated) and predicted probability of noticing calorie information on menus.

Results

Calorie labeling at McDonald’s was not associated with changes in calories purchased in adults (change = − 19 cal pre- vs. post-labeling at McDonald’s compared to control chains, 95% CI: − 112, 75), adolescents (change = − 49 cal, 95% CI: − 136, 38), or children (change = 13 cal, 95% CI: − 108, 135). Calorie labeling generally increased the predicted probability of noticing calorie information, but did not improve estimation of calories purchased.

Conclusions

Calorie labeling at McDonald’s was not associated with changes in calories purchased in adults, adolescents, or children. Although participants were more likely to notice calories on menus post-labeling, there was no improvement in ability to accurately estimate calories purchased.

Improving Cardiovascular Health through Nudging Healthier Food Choices: A Systematic Review

Obesity and metabolic syndrome are considered major public health problems, and their negative impact on cardiovascular disease (CVD) and diabetes mellitus type 2 (DM2) is profound. Targeting modifiable risk factors such as dietary habits is therefore of great importance. Many of today’s health challenges with overweight and obesity may have behavioral roots, and traditional methods such as regulations and campaigns are often insufficient to improve dietary choices. Nudging or choice architecture might be a viable tool to influence people’s everyday choices and behaviors to better outcomes. This paper reviews the current state of the rapidly expanding number of experimental field studies that investigate the effects/associations of nudging on healthy food choices. A systematic literature search was conducted in PubMed, where 142 citations were identified. Based on selection criteria, six randomized controlled trials and 15 non-randomized controlled trials were ultimately included. The results of this systematic review show that many of the studies included traffic-light labeling, which may be a promising strategy. The reviewed findings, however, also highlight the challenges that confront experimental studies examining the impact of nudging on diet.

"Doing a good thing for myself": a qualitative study of young adults' strategies for reducing takeaway food consumption

BACKGROUND

Increasingly the population is eating meals and snacks prepared outside the home, especially younger adults. Takeaway foods can be energy-dense, high in saturated fat and sodium, and deleterious to health. Extending studies examining the barriers to healthy eating, this paper explores strategies employed by young adults who report reducing consumption of unhealthy takeaway foods.

METHODS

Young adults aged 18 to 35 years in paid employment were recruited to participate in eight semi-structured focus groups. In response to initial findings, recruitment for the final four groups refocused on participants who either wanted, were in the process of, or had changed their takeaway food habits. Focus group recordings were transcribed verbatim and coded by two researchers for recurrent themes using an inductive method.

RESULTS

Forty-eight participants with a mean BMI of 23.4 kg/m² and mean age of 25 years took part, of which 34 were female, and 27 were born outside Australia. Four broad strategies emerged: altering cognitions about consumption/reduction of takeaway food; practical changes to behaviours; finding external support; and, reconfiguring social events. In detail, participants cognitively recast takeaway food consumption as negative (expensive and unhealthy) and reducing consumption of such foods or consuming healthy alternatives as a (positive) self-care action. Setting goals and making personal rules around consumption, and consciously making practical changes, such as planning for food shopping, were other strategies. Externally derived support including supportive food environments and friends and family passively reduced exposure to unhealthy takeaway food. Finally, some participants actively created social environments supportive of healthy choices.

CONCLUSIONS

Our participants reported strategies they believed led to them successfully reduce their takeaway food consumption by matching the attractions (e.g., convenience) and countering apparent disincentives for reducing consumption (e.g., losing a reward) of takeaway food. They reported eschewing more short-term rewards and costs, to prioritise their health, believing that avoiding these foods would benefit them personally and financially. The identified strategies are consistent with documented techniques for successful behaviour change and corresponded to all levels in the social-ecological model from intrapersonal factors to public policy. The findings could underpin health promotion strategies to support this at-risk group.

The Healthfulness of Entrées and Students' Purchases in a University Campus Dining Environment

The purpose of this study is to determine the availability of “more healthful” (MH) versus “less healthful” (LH) entrée items in the campus dining and if students’ purchases are reflective of what is offered. This is an observational study in which purchases of the available entrée items in the campus dining at South Dakota State University in one academic year were collected and categorized as either MH or LH according to the American Heart Association guidelines. Chi-square tests were used to determine the differences between the proportion of purchased MH and LH versus those available. Odds ratio estimates with 95% confidence limits were used to determine the associations between the demographics and MH and LH purchases. Of the total entrée items available, 15.0% were MH and 85.0% were LH. In the fall, 8.0% of purchases were MH and 92.0% purchases were LH as compared to 8.9% MH and 91.1% LH in the spring. Whites were less likely than non-whites to purchase a MH entrée. Females were two times more likely to choose MH entrées than males. The campus dining offerings and students’ purchases of entrees were primarily LH. Work with campus dining providers to create profitable, yet healthful, dining entrees is needed to improve the healthfulness of offerings.

A Systematic Review of Calorie Labeling and Modified Calorie Labeling Interventions: Impact on Consumer and Restaurant Behavior

OBJECTIVE

Evidence on the effects of restaurant calorie labeling on consumer and restaurant behavior is mixed. This paper examined: (1) consumer responses to calorie information alone or compared to modified calorie information and (2) changes in restaurant offerings following or in advance of menu labeling implementation.

METHODS

Searches were conducted in PubMed, Web of Science, Policy File, and PAIS International to identify restaurant calorie labeling studies through October 1, 2016, that measured calories ordered, consumed, or available for purchase on restaurant menus. The reference lists of calorie labeling articles were also searched.

RESULTS

Fifty-three studies were included: 18 in real-world restaurants, 9 in cafeterias, and 21 in laboratory or simulation settings. Five examined restaurant offerings.

CONCLUSIONS

Because of a lack of well-powered studies with strong designs, the degree to which menu labeling encourages lower-calorie purchases and whether that translates to a healthier population are unclear. Although there is limited evidence that menu labeling affects calories purchased at fast-food restaurants, some evidence demonstrates that it lowers calories purchased at certain types of restaurants and in cafeteria settings. The limited data on modified calorie labels find that such labels can encourage lower-calorie purchases but may not differ in effects relative to calorie labels alone.

Nutrition Facts Panel use is associated with diet quality and dietary patterns among Latinos with type 2 diabetes

OBJECTIVE

The study aims were to (i) identify determinants of Nutrition Facts Panel (NFP) use and (ii) describe the association between NFP use and dietary intake among Latinos with type 2 diabetes.

DESIGN

Baseline cross-sectional data from a clinical trial were used to assess the association between NFP use and dietary intake. Diet was measured using two methods: (i) a diet quality score (the Healthy Eating Index-2010) derived from a single 24 h recall and (ii) dietary pattern (exploratory factor analyses) from an FFQ. Multivariable logistic and non-parametric quantile regressions were conducted, as appropriate. Settings Hartford County, Connecticut, USA.

SUBJECTS

Latino adults (n 203), ≥21 years of age, with diagnosed type 2 diabetes, glycosylated Hb≥7 %, and without medical conditions limiting physical activity.

RESULTS

Participants' education level, diabetes-related knowledge and English speaking were positively associated with NFP use. At the higher percentiles of diet quality score, NFP use was significantly associated with higher diet quality. Similarly, NFP users were more likely to consume a 'healthy' dietary pattern (P=0·003) and less likely to consume a 'fried snack' pattern (P=0·048) compared with NFP non-users.

CONCLUSIONS

The association between reported NFP use and diet quality was positive and significantly stronger among participants who reported consuming a healthier diet. While NFP use was associated with a healthier dietary pattern, not using NFP was associated with a less-healthy, fried snack pattern. Longitudinal studies are needed to understand whether improving NFP use could be an effective intervention to improve diet quality among Latinos with type 2 diabetes.

Nutrition label use is associated with lower longer-term diabetes risk in US adults

Background: Regular nutrition label use may have important long-term health implications. To our knowledge, the role of nutrition label use in protecting against the development of chronic diseases was unexplored prospectively before this study.Objective: We tested the association between nutrition label use and risk of a future diabetes diagnosis in a multiethnic US cohort.Design: Data from the ongoing National Longitudinal Survey of Youth-1979 (NLSY79) were analyzed. From 2002 (baseline) to 5 follow-up time points (2004-2012), 7150 diabetes-free, multiethnic young adults were prospectively followed for a diagnosis of incident diabetes. Nutrition label use, diabetes diagnosis, time to diabetes diagnosis, and all covariates were self-reported.Results: Between January 2002 and September 2013, 430 participants (6.0%) were diagnosed with diabetes. A weighted, multivariable, extended Cox regression was conducted, which suggested that in nutrition label users, the HR of diabetes diagnosis risk decreased significantly with time (P-nutrition label use × time interaction < 0.05) compared with risk in nutrition label nonusers.Conclusions: There is an association between nutrition label use and diabetes risk in the longer term. However, additional longitudinal research with a robust dietary intake assessment is needed to test this hypothesis.

A Cross-Sectional Study of the Relationship between Nutrition Label Use and Food Selection, Servings, and Consumption in a University Dining Setting

BACKGROUND

Nutrition labels at the point of purchase are recommended to improve food choice, yet food choice does not always translate into food consumption. It is important to understand the relationship between label use, food selection, servings, and consumption. Previous research, which has relied on self-reported intake or inferred label use or intake based on sales data, has not adequately answered this question.

OBJECTIVE

To combine survey and meal photographic data to compare food selection, servings, and consumption between label users and nonusers.

DESIGN

Diners were surveyed in two cross-sectional waves during the fall 2014 semester. Food selections were recorded, and pre- and postmeal photographs were taken of diners' plate. Photographs were coded to identify the selection, servings, and consumption of MyPlate food categories.

PARTICIPANTS/SETTING

Convenience sample of 1,069 diners (39% women, 53% freshman) in two university dining halls. Students had to be older than age 18 years and just beginning their meal to participate.

MAIN OUTCOME MEASURES

Selection, servings, and consumption of MyPlate food categories for label users and nonusers.

STATISTICAL ANALYSES PERFORMED

Differences in food selection were tested via χ² tests, and differences in adjusted least squares means for servings and consumption were tested via t tests.

RESULTS

A greater proportion of nutrition label users selected fruits, vegetables, and beans and fewer selected potatoes compared with nonusers. In addition, fewer label users selected fried foods and foods with added sugars (all P values <0.05). Label users served themselves and consumed more vegetables and fewer potatoes and refined grains compared with nonusers (all P values <0.05).

CONCLUSIONS

Our results suggest label users behave differently compared with nonusers. Based on the meals observed, these differences appear more qualitative in nature (selecting different foods) than quantitative (selecting more or less food).

Nutrition facts panel use is associated with higher diet quality and lower glycated hemoglobin concentrations in US adults with undiagnosed prediabetes

BACKGROUND

The majority of US consumers use the nutrition facts panel (NFP) or health claims for food selections. Although previous studies have consistently reported positive impacts of NFP use on dietary intake, evidence regarding the effect of the use of health claims, either alone or in combination with the NFP, on diet quality and health outcomes is scarce.

OBJECTIVES

Our primary objective was to test for associations of the use of food labels (the NFP or health claims) with overall diet quality in individuals with prediabetes. In addition, we examined the association between food label use and glycated hemoglobin (HbA1c) concentrations.

DESIGN

We conducted a weighted linear regression, which was appropriate for a complex sampling survey, with the use of cross-sectional data from 2654 US adults with undiagnosed prediabetes who participated in the 2005-2010 NHANES cycles. The following 4 categories of food label (NFP or health claims) use were identified: 1) both labels, 2) health claims only, 3) neither label, and 4) the NFP only. Healthy Eating Index-2010 score, which we used to assess diet quality, was calculated from two 24-h recalls. Blood samples for analyzing HbA1c concentrations (glycemic control) were collected in the mobile examination center.

RESULTS

The overall diet quality scores for the use of both labels [b: -2.76 (95% CI: -5.04, -0.48); P = 0.019], of health claims only [b: -3.46 (-6.64, -0.28); P = 0.033], and of neither label [b: -4.01 (-5.75, -2.28); P < 0.001] were lower than those of NFP-only users. Moreover, HbA1c concentrations of users of both labels [b: 0.09% (95% CI: 0.03%, 0.16%); P = 0.008] and health claims only [b: 0.13% (95% CI: 0.02%, 0.25%); P = 0.021] were higher than those of NFP-only users.

CONCLUSIONS

In participants with undiagnosed prediabetes, the use of health claims alone, of both labels, or of neither label (compared with the use of the NFP only) was associated with poorer diet quality. In addition, users of neither label and users of both labels had poorer glycemic control. Further studies are needed to understand why the use of health claims may not be health promoting in this high-risk population.

Dietary contribution of foods and beverages sold within a university campus and its effect on diet quality of young adults

OBJECTIVE

Tertiary education institutions have been linked with excessive weight in young adults. However, few data are available on the effect of foods from the university food environment on the diet quality of young adults. The aim of this study was to describe the association of a number of foods and beverages consumed at university food outlets with the diet quality of young adults.

METHODS

This was a cross-sectional survey in which the 103 university student participants, aged 19 to 24 y, contributed 5 d of dietary data. A purposely designed, validated smartphone application was used to collect the data. Diet quality was assessed by adherence to the 2013 dietary guidelines for food groups and nutrients, and the validated Healthy Eating Index for Australians (HEIFA-2013) was applied. Individual HEIFA-2013 scores were compared with the frequency of food purchase and consumption from university outlets to assess a dose-response effect of the food environment. Comparisons by tertiles of diet quality for body mass index, waist circumference, and takeaway food consumption (university and other) were computed using a one-way analysis of variance and post hoc Tukey test.

RESULTS

There was a statistically significant difference between the number of university foods and beverages consumed in 5 d and the HEIFA-2013 scores: More on-campus purchases resulted in a poor-quality diet (P = 0.001). As the HEIFA-2013 tertile scores increased, there was a significant decrease in the number of university campus and other takeaway foods consumed; body mass index and waist circumference showed a decrease in trend.

CONCLUSIONS

Efforts to improve the diet quality of young adults attending university may benefit from approaches to improve the campus food environment.

The Effect of Energy Labelling on Menus and a Social Marketing Campaign on Food-Purchasing Behaviours of University Students

Background

This study assessed the impact of kilojoule (kJ) labelling alone or accompanied by a social marketing campaign on food sales and selection of less energy-dense meals by young adults from a university food outlet.

Methods

There were two kJ labelling intervention phases each of five weeks: (1) kJ labelling alone (2) kJ labels with marketing materials (“8700 kJ campaign”). Food sales of labelled items were tracked during each intervention and five weeks after. Food sales during interventions were also compared with historical sales of foods in the same 10-week period in the previous year. A sub sample of young adults (n = 713; aged 19–24) were surveyed during both the interventions to assess awareness, influence, sentiment and anticipated future impact of kJ labels and the social marketing campaign respectively.

Results

There were no differences in sales between the kJ labelling with social marketing and the 5-weeks of labelling before and after. The percentage sale of chicken Caesar burger (3580 kJ, P = 0.01), steak and chips (4000 kJ, P = 0.02) and the grill burger (5500 kJ, P = 0.00) were lower in the year with menu labelling and social marketing campaign. Only 30 % students were initially aware of the kJ labels on the menu but 75 % of students were accepting of kJ labelling, after they were made aware. Respondents viewing the marketing campaign elements and then using kJ values on the menu selected meals with a lower mean energy content; constituting a reduction of 978 kJ (p < 0.01) even though the majority claimed that the 8700 kJ campaign would not impact their food choices.

Conclusions

Point-of-purchase energy labelling may be an effective method to encourage better food choices when eating out among young adults. However, further efforts to increase awareness and provide education about energy requirements to prevent weight gain will be needed.

Eating tasty foods to cope, enhance reward, socialize or conform: What other psychological characteristics describe each of these motives?

Psychological characteristics associated with eating motives of the Palatable Eating Motives Scale (PEMS) were identified in 192 undergraduates. Coping was characterized by greater BMI, emotion-triggered eating, and eating concern and also by binge-eating and perceived stress reactivity in females. Reward Enhancement was characterized by greater BMI, anxiety- and depression-eating in females and by anger/frustration-eating in males. Conformity was strongly characterized by binge-eating and by failure-based stress and all eating disorder traits in females and by anger/frustration- and anxiety-eating in males. The sex-divergent patterns of these traits across PEMS motives highlight the heterogeneity of hedonic eating. The traits may also be maintaining the motives, hence adresseing them should improve treatments for obesity, binge-eating, and foster healthier coping, reward, and psychosocial interactions.

Menu labelling is effective in reducing energy ordered and consumed: a systematic review and meta-analysis of recent studies

Objective

Menu labelling is a practical tool to inform consumers of the energy content of menu items and help consumers make informed decisions in the eating-out environment, and the volume of studies published recently regarding its effects is expanding, both quantitatively and geographically. The aim of the present review and meta-analysis is to consider the most recent evidence which assesses the effect of menu labelling regarding changes in energy consumed, ordered or selected in both real-world and experimental settings.

Design

The review included fifteen peer-reviewed, full-text articles published between 2012 and 2014. Pertinent methodological information was extracted from each of the included studies and a quality assessment scheme was applied to classify the studies, after which systematic across-study comparisons were conducted. A meta-analysis was conducted including twelve of the fifteen studies, and stratified according to type of research setting and outcome: energy consumed, ordered or selected.

Results

The rating yielded studies categorized by study quality: good (n 3), fair (n 9) and weak (n 3). Overall nine studies showed statistically significant reductions in energy consumed, ordered or selected. Three articles reported no effect of menu labelling. The meta-analysis showed statistically significant effects of menu labelling: overall energy consumed was reduced by a mean of 419·5 kJ (100·2 kcal) and energy ordered in real-world settings decreased by a mean of 325·7 kJ (77·8 kcal).

Conclusions

The review supports that menu labelling can effectively reduce energy ordered and consumed in the away-from-home food environment.

Effects of calorie labelling on macro- and micro-nutrients in main-meal choices made by young adults

BACKGROUND/OBJECTIVES

There is limited evidence that prominent calorie labelling on out-of-home meals helps consumers reduce calorie intakes and avoid weight gain, but no evidence on its effects on macro- and micro-nutrients. The objective of this study was to assess the impact of prominent calorie labelling on energy, macro- and micro-nutrients.

SUBJECTS/METHODS

Young adults in a catered residential setting were observed when choosing main meals over three study periods in fixed order in this observational study. Period 1: with calorie labels (20 weeks); period 2: without calorie labels (10 weeks); period 3: with calorie labels plus information on estimated energy requirements (10 weeks). Nutrient contents of meal choices were analysed from food composition tables.

RESULTS

Energy, 4 macronutrients and 19 micronutrients levels were derived from 4200 meals chosen by 120 subjects over 40 weeks. Means (s.d. or Median) for key macro- and micro-nutrients were for period 1: energy=658 (94) kcal, fat=31 (8.6) g, saturated fat=10.5 (2.7) g, B12=2.5 (1.7) μg, folate=119 (46.8) μg, vitamin C=80.0 (42) mg, Ca=278 (129) mg, Na=1230 (119) mg, Fe=22 (10) g, Se=19 (10.1) μg, I=34 (10.1) μg, period 2: energy=723 (87) kcal, fat=35 (7.6) g, saturated fat=12 (2.7) g, B12=3.4 (1.7) μg, Folate=182 (13.3) μg, vitamin C=87.0 (49.7) mg, Ca=379 (149) mg, Na=1352 (114) mg, Fe=41.6 (14) g, Se=26 (10.3) μg, I=38.0 (18.4) μg, period 3: energy=578 (109) kcal, fat=27.3 (9.1) g, saturated fat=8.5 (2.7) g, B12=2.2 (0.5) μg, Folate=90 (50.8) μg, vitamin C=75.0 (34) mg, Ca=277 (119) mg, Na=1205 (99) mg, Fe=14.5 (10.9) g, Se=15.0 (10) μg, I=32.0 (18.4) μg. All macro- and micro-nutrients, except for B1, vitamin C, vitamin E and Ca were significantly different between the three periods (P<0.001), but all mean intakes remained above recommended levels.

CONCLUSIONS

Calorie labelling resulted in reductions in calories, fat and saturated fat contents of the meals chosen, without compromising micronutrient consumptions.

Healthy Lifestyle Interventions to Combat Noncommunicable Disease—A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine

Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.

Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine

Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.

Eating tasty food to cope. Longitudinal association with BMI

The goals of this study were to determine if a change in certain motives to eat highly palatable food, as measured by the Palatable Eating Motives Scale (PEMS), could predict a change in body mass index (BMI) over time, to assess the temporal stability of these motive scores, and to test the reliability of previously reported associations between eating tasty foods to cope and BMI. BMI, demographics, and scores on the PEMS and the Binge Eating Scale were obtained from 192 college students. Test-retest analysis was performed on the PEMS motives in groups varying in three gap times between tests. Regression analyses determined what PEMS motives predicted a change in BMI over two years. The results replicated previous findings that eating palatable food for Coping motives (e.g., to forget about problems, reduce negative feelings) is associated with BMI. Test-retest correlations revealed that motive scores, while somewhat stable, can change over time. Importantly, among overweight participants, a change in Coping scores predicted a change in BMI over 2 years, such that a 1-point change in Coping predicted a 1.76 change in BMI (equivalent to a 10.5 lb. change in body weight) independent of age, sex, ethnicity, and initial binge-eating status (Cohen's f(2) effect size = 1.44). The large range in change of Coping scores suggests it is possible to decrease frequency of eating to cope by more than 1 scale point to achieve weight losses greater than 10 lbs. in young overweight adults, a group already at risk for rapid weight gain. Hence, treatments aimed specifically at reducing palatable food intake for coping reasons vs. for social, reward, or conformity reasons, should help achieve a healthier body weight and prevent obesity if this motive-type is identified prior to significant weight gain.