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Cassano S, Jia A, Gibson AA, Partridge SR, Chan V, Farrell P, Phongsavan P, Allman-Farinelli M, Jia SS. Benchmarking online food delivery applications against menu labelling laws: a cross-sectional observational analysis. Public Health Nutr 2024; 27:e101. [PMID: 38557393 PMCID: PMC11036439 DOI: 10.1017/s1368980024000673] [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: 04/14/2023] [Revised: 12/01/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE It is unknown how well menu labelling schemes that enforce the display of kilojoule (kJ) labelling at point-of-sale have been implemented on online food delivery (OFD) services in Australia. This study aimed to examine the prevalence of kJ labelling on the online menus of large food outlets with more than twenty locations in the state or fifty locations nationally. A secondary aim was to evaluate the nutritional quality of menu items on OFD from mid-sized outlets that have fewer locations than what is specified in the current scheme. DESIGN Cross-sectional analysis. Prevalence of kJ labelling by large food outlets on OFD from August to September 2022 was examined. Proportion of discretionary ('junk food') items on menus from mid-sized outlets was assessed. SETTING Forty-three unique large food outlets on company (e.g. MyMacca's) and third party OFD (Uber Eats, Menulog, Deliveroo) within Sydney, Australia. Ninety-two mid-sized food outlets were analysed. PARTICIPANTS N/A. RESULTS On company OFD apps, 35 % (7/23) had complete kJ labelling for each menu item. In comparison, only 4·8 % (2/42), 5·3 % (2/38) and 3·6 % (1/28) of large outlets on Uber Eats, Menulog and Deliveroo had complete kJ labelling at all locations, respectively. Over three-quarters, 76·3 % (345/452) of menu items from mid-sized outlets were classified as discretionary. CONCLUSIONS Kilojoule labelling was absent or incomplete on a high proportion of online menus. Mid-sized outlets have abundant discretionary choices and yet escape criteria for mandatory menu labelling laws. Our findings show the need to further monitor the implementation of nutrition policies on OFD.
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Affiliation(s)
- Sophia Cassano
- The University of Sydney, Sydney Nursing School, Faculty of
Medicine and Health, Sydney, NSW2006, Australia
| | - Anna Jia
- The University of Sydney, Sydney Nursing School, Faculty of
Medicine and Health, Sydney, NSW2006, Australia
| | - Alice A Gibson
- The University of Sydney, Menzies Centre for Policy and
Economics, School of Public Health, Faculty of Medicine and Health, Sydney,
NSW2006, Australia
- The University of Sydney, Charles Perkins Centre,
Sydney, NSW2006, Australia
| | - Stephanie R Partridge
- The University of Sydney, Charles Perkins Centre,
Sydney, NSW2006, Australia
- The University of Sydney, Engagement and Co-Design Research Hub,
School of Health Sciences, Faculty of Medicine and Health, Sydney,
NSW2006, Australia
| | - Virginia Chan
- The University of Sydney, Sydney Nursing School, Faculty of
Medicine and Health, Sydney, NSW2006, Australia
| | - Penny Farrell
- The University of Sydney, Menzies Centre for Policy and
Economics, School of Public Health, Faculty of Medicine and Health, Sydney,
NSW2006, Australia
| | - Philayrath Phongsavan
- The University of Sydney, Charles Perkins Centre,
Sydney, NSW2006, Australia
- The University of Sydney, Prevention Research Collaboration,
Sydney School of Public Health, Faculty of Medicine and Health, Sydney,
NSW2006, Australia
| | - Margaret Allman-Farinelli
- The University of Sydney, Sydney Nursing School, Faculty of
Medicine and Health, Sydney, NSW2006, Australia
- The University of Sydney, Charles Perkins Centre,
Sydney, NSW2006, Australia
| | - Si Si Jia
- The University of Sydney, Charles Perkins Centre,
Sydney, NSW2006, Australia
- The University of Sydney, Engagement and Co-Design Research Hub,
School of Health Sciences, Faculty of Medicine and Health, Sydney,
NSW2006, Australia
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Wakui N, Matsuoka R, Ichikawa K, Togawa C, Okami A, Kawakubo S, Kagi H, Watanabe M, Tsubota Y, Yamamura M, Machida Y. Investigation of the 1-week effect of traffic light nutrition labeling on diet selection among Japanese university students: a randomized controlled trial. BMC Public Health 2024; 24:381. [PMID: 38317163 PMCID: PMC10840142 DOI: 10.1186/s12889-024-17815-4] [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: 07/31/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The method of displaying nutrition information labels on the front of food packaging (FOP: Front of Pack) has been implemented worldwide to prevent lifestyle-related diseases. This study aimed to investigate whether the use of the UK's Traffic Light Food (TLF) label, known as the FOP label, influences the dietary choices of Japanese youth and promotes healthy dietary choices. METHODS Diet selection was performed for one week each during the baseline and intervention periods. During the intervention period, TLF labels were displayed on meal images of the intervention group. Participants chose what they would like to have for dinner of the day from 15 images. Each meal was scored based on the color of the nutrition label, and a comparison between groups was made to determine whether TLF labeling influenced meal selection for dinner. The psychological stress caused by the presence or absence of nutrition labels and nutritional components when choosing meals was also evaluated. RESULTS A total of 69 participants were randomly assigned to two groups. Dietary choice scores indicated that the TLF-labeled group made significantly healthier dietary choices than the unlabeled group. Additionally, the TLF-labeled group showed a significant increase in the percentage of people conscious of nutritional components when choosing meals. Furthermore, a significant increase in the number of people conscious of protein, a nutritional ingredient not indicated on the TLF label, was observed. During the test period, no difference in psychological stress caused by the presence and absence of the TLF labels was observed. CONCLUSIONS The use of TLF labels also encouraged healthy dietary choices among Japanese university students. The use of FOP nutrition labels should be considered in Japan to prevent lifestyle-related diseases through healthy dietary choices. TRIAL REGISTRATION UMIN Clinical Trials Registry Number: UMIN000047268. Registered March 23, 2022.
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Affiliation(s)
- Nobuyuki Wakui
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan.
| | - Raini Matsuoka
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
| | - Kotoha Ichikawa
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
| | - Chikako Togawa
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
| | - Aika Okami
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
| | - Shoko Kawakubo
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
| | - Hinako Kagi
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
| | - Mai Watanabe
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
| | - Yuika Tsubota
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
| | - Miho Yamamura
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
| | - Yoshiaki Machida
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, 142-8501, Tokyo, Japan
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3
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Fogolari N, Souza AD, Bernardo GL, Uggioni PL, Oliveira RC, Rodrigues VM, Proença RPC, Fernandes AC. Qualitative menu labelling in university restaurants and its influence on food choices: A systematic review and synthesis without meta-analysis. NUTR BULL 2023; 48:160-178. [PMID: 37161615 DOI: 10.1111/nbu.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 05/11/2023]
Abstract
Qualitative menu labelling can be defined as descriptive or non-numerical interpretive labels (e.g. traffic light labelling, healthy food symbols, messages or ingredient lists). Qualitative information seems to have a positive influence on consumers' food choices, particularly in institutional food service establishments, such as in universities. The aim of this systematic review was to assess the influence of different formats of qualitative menu labelling on food choices in university restaurants. This systematic review was guided by the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis Without Meta-Analysis (SWiM) and conducted vote counting of studies based on the direction of effect. Studies were retrieved from Cochrane Library, Scopus, MEDLINE, LILACS, SciELO and Web of Science databases and reference lists of selected articles. Experimental and quasi-experimental studies were included. Two independent researchers searched and extracted the data and assessed the methodological quality using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. From the initial search (460 records), four papers were selected, plus one paper identified in a previous study and a further six from an update search, totalling 11 included studies, reporting 14 different interventions (n = 499 174). Types of interventions included the use of symbols and the inclusion of traffic light labelling. Outcomes of interest were food choice, expressed as mean, median or percent healthy food choices or purchases. Qualitative menu labels increased healthy food choices and/or purchase behaviour, with 10 of 12 interventions favouring the intervention (83%; 95%CI 55-95%; p = 0.0386). Most of the studies favouring the intervention used healthy food symbols for healthier foods or food components, alone or in association with another intervention and were of moderate and weak quality. These findings may serve as a basis for the implementation of nutrition information policies in university restaurants.
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Affiliation(s)
- Natalia Fogolari
- Department of Nutrition and the Nutrition in Foodservice Research Centre (NUPPRE) of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Aretusa D Souza
- Department of Nutrition and the Nutrition in Foodservice Research Centre (NUPPRE) of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Greyce L Bernardo
- Department of Nutrition, NUPPRE, and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Paula L Uggioni
- Department of Nutrition, NUPPRE, and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Renata C Oliveira
- NUPPRE and the Catholic University Centre of Santa Catarina, Joinville, Santa Catarina, Brazil
| | - Vanessa M Rodrigues
- NUPPRE and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Rossana P C Proença
- Department of Nutrition, NUPPRE, and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ana C Fernandes
- Department of Nutrition, NUPPRE, and the Nutrition Postgraduate Program of the Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Robinson E, Polden M, Langfield T, Clarke K, Calvert L, Colombet Z, O'Flaherty M, Marty L, Tapper K, Jones A. Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2023; 20:10. [PMID: 36747247 PMCID: PMC9903416 DOI: 10.1186/s12966-023-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP). METHODS Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups. RESULTS Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041]. CONCLUSIONS Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required. REVIEW REGISTRATION Registered on PROSPERO (CRD42022312532) and OSF ( https://doi.org/10.17605/OSF.IO/W7RDB ).
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Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Megan Polden
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Tess Langfield
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Katie Clarke
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Lara Calvert
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Zoé Colombet
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lucile Marty
- Centre Des Sciences Du Goût Et de L'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - Katy Tapper
- Department of Psychology, City, University of London, London, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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Wakui N, Matsuoka R, Togawa C, Ichikawa K, Kagi H, Watanabe M, Ikarashi N, Yamamura M, Shirozu S, Machida Y. Effectiveness of Displaying Traffic Light Food Labels on the Front of Food Packages in Japanese University Students: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1806. [PMID: 36767176 PMCID: PMC9914024 DOI: 10.3390/ijerph20031806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Nutrition labeling on the front of food packages has been implemented worldwide to help improve public health awareness. In this randomized double-blind controlled trial, we used a Google Forms questionnaire to evaluate the effectiveness of nutrition labeling on food packages in university students. The questionnaire, ultimately completed by 247 students, included 15 dietary images from which they were asked to choose what they wanted to eat for breakfast, lunch, and dinner the following day. For the interventional (traffic light food [TLF]) group only, TLF labels were displayed on dietary images. This group had a significantly higher proportion of people conscious of healthy eating during all meals than the control group, and the effect of TLF labeling on choosing meals was the highest for lunch. In addition to the indicated nutritional components, the TLF group had a significantly higher proportion of people who were conscious of the ones of protein and dietary fiber that were not indicated on the label. The use of TLF labels resulted in an increase in the proportion of people choosing a healthy diet as well as being conscious of their nutritional components. Therefore, the use of TLF labels may help promote healthy dietary choices in Japan.
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Affiliation(s)
- Nobuyuki Wakui
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Raini Matsuoka
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Chikako Togawa
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Kotoha Ichikawa
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Hinako Kagi
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Mai Watanabe
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Nobutomo Ikarashi
- Department of Biomolecular Pharmacology, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Miho Yamamura
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Shunsuke Shirozu
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Yoshiaki Machida
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
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Kirkpatrick KM, Kleinberger CA, Moylan EM, Bukhari AS, Deuster PA. Nutrition Program Fidelity Assessment tool: a framework for optimising implementation in military dining facilities. Public Health Nutr 2023; 26:219-228. [PMID: 36226363 PMCID: PMC11077443 DOI: 10.1017/s1368980022001896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/24/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim was to develop, refine and assess the usefulness of the Go for Green® (G4G) 2.0 Program Fidelity Assessment (PFA) tool. G4G 2.0 is a Department of Defense programme designed to optimise access, availability and knowledge of high-performance nutritious foods in military dining facilities (DFAC). DESIGN During a multi-site study to evaluate G4G 2.0 on meal quality and diner satisfaction, subject matter experts developed and refined a PFA tool based on eight programme requirements (PR). They identified tasks critical to programme success and corresponding benchmarks, then proposed expansion of several PR and developed a scoring system to assess adherence. Three PFA were conducted (Site 1, Site 2A and Site B). SETTING Two DFAC in the USA implementing the G4G 2.0 programme. PARTICIPANTS Military DFAC participating in a G4G 2.0 evaluation study. RESULTS After G4G 2.0 implementation, Site 1 conducted a PFA and met benchmarks for eight of fifteen sections. At Site 2, a PFA was conducted after G4G 2.0 implementation (Site 2A) and one 3 months later (Site 2B) with twelve of fifteen and ten of fifteen sections meeting benchmarks, respectively. CONCLUSION Research highlights the need to maximise implementation quality to ensure interventions are effective, achievable and efficient. Using a PFA tool to objectively assess nutrition interventions can inform programme fidelity, successes and opportunities for improvement. Results identify key areas that require additional training and resources to optimise access to nutrient-dense foods that support nutritional fitness. This feedback is critical for assessing potential programme impact on Service Members.
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Affiliation(s)
- Katie M Kirkpatrick
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720B Rockledge Drive, Suite 605, Rockville, MD20817, USA
| | - Carolyn A Kleinberger
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720B Rockledge Drive, Suite 605, Rockville, MD20817, USA
| | - Elizabeth M Moylan
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720B Rockledge Drive, Suite 605, Rockville, MD20817, USA
| | - Asma S Bukhari
- Military Nutrition Division of the US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
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Cameron AJ, Oostenbach LH, Dean S, Robinson E, White CM, Vanderlee L, Hammond D, Sacks G. Consumption Frequency and Purchase Locations of Foods Prepared Outside the Home in Australia: 2018 International Food Policy Study. J Nutr 2022; 152:76S-84S. [PMID: 35274693 PMCID: PMC9188859 DOI: 10.1093/jn/nxab437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/17/2021] [Accepted: 01/17/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Foods prepared outside the home (e.g., fast-food chains, restaurants) represent increasing proportions of diets worldwide, and have been associated with higher energy intakes and BMIs. To improve the healthiness of population diets, it is important to understand patterns of consumption of these foods, and whether related policy measures are effective. OBJECTIVES This study aimed to identify the frequency and sources of consumption of foods prepared outside the home in Australia, and to understand the impact of nutrition information in restaurants on related food choices. METHODS Data were from a web-based survey (the International Food Policy Study) completed in 2018 by Australian adults aged ≥18 years (n = 4103). The number of meals prepared outside the home, their purchase locations, and the extent to which nutrition information was noticed and influenced purchasing decisions were each analyzed by sociodemographic characteristics and BMI, with linear models also adjusted for sex, age group, education, ethnicity, and BMI. RESULTS An average of 2.73 (95% CI, 2.61-2.86) meals per week were prepared outside the home, with higher frequencies among men, younger ages, and more highly educated participants. A wide variety of sources for these foods was observed, with fast-food outlets being most common. Around one-quarter of all foods prepared outside the home were delivered. A small percentage (14.9%; 95% CI, 13.3%-16.7%) of participants reported noticing nutrition information, but among those who did, around half reported that it influenced their behavior. CONCLUSIONS Foods prepared outside the home are commonly purchased in Australia, particularly by young adults, from a variety of outlet types. While current menu energy labeling regulations may provide some population health benefit, a broader policy focus on foods prepared outside the home is needed as part of efforts to improve population diets.
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Affiliation(s)
- Adrian J Cameron
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Laura H Oostenbach
- Institute for Physical Activity and Nutrition Research (IPAN), Deakin University, Geelong, Australia
| | - Sarah Dean
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Ella Robinson
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Gary Sacks
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
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Giazitzi K, Chrysanthakopoulou V, Boskou G. A Hypothetical Tavern Menu for the Evaluation of Calorie Selection through Menu Labelling. Foods 2022; 11:foods11111624. [PMID: 35681374 PMCID: PMC9180666 DOI: 10.3390/foods11111624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
The purpose of the present study is to evaluate calories selection according to the type of menu labelling applied on a hypothetical Greek tavern menu. Three questionnaires were designed and each one included a hypothetical menu of Greek tavern food. Menu A did not include any nutritional information, Menu B included calorie posting and Menu C had the “NB” mark next to dishes that were Nutritionally Balanced choices. A total of 437 participants were recruited in the study. The mean calories selection was significantly lower on Menu B (1874 Kcal) and C (1787.7 Kcal) compared to Menu A (2157.3 Kcal). The overweight and obese participants ordered significantly fewer calories on Menu B (−504 Kcal and −404 Kcal) and C (−451.3 Kcal and −393 Kcal) than on the Menu A. Menu labelling should be assessed in real-life settings in Greece. It could be a policy for the prevention and control of obesity in European countries.
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Kleinberger CA, Bukhari AS, Kirkpatrick KM, Moylan EM, Billington JL, Armstrong NJ, Cole RE, Deuster PA. Go for Green® Nutrition Program: Translating Evidence Into Practice. Mil Med 2022; 188:1046-1053. [PMID: 37191636 DOI: 10.1093/milmed/usab503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Introduction
Go for Green® (G4G) is an evidence-based, multi-component nutrition program for military dining facilities (DFAC) to improve nutritional fitness among Service Members. The program evolved from supporting “fueling” during initial Army training into a robust intervention across all U.S. Military branches. The current G4G program consists of eight program requirements to optimize the nutrition environment, including traffic light labeling, nutritious menus, choice architecture, food promotion, marketing, and staff training. The evolution of the G4G program, development of standardized program requirements, and lessons learned are described.
Materials and Methods
The latest scientific evidence, best practices in health promotion and nutrition education, results and data from G4G implementation in the military community support the current version of G4G. Feedback and observations from program developers, military branch foodservice headquarters, installation leadership, and local G4G DFAC teams provided insight into implementation challenges, successes, facilitators, and barriers.
Results
The G4G program has evolved and expanded from its initial inception over 10 years ago to its current version. Research studies, nutrition science, and feedback from military community stakeholders have informed programmatic changes and improvements.
Conclusions
G4G 2.0 is a robust, innovative, multi-component, performance nutrition program with clear program element requirements. Value was added to elevate the G4G program by setting program requirements, expanding program components, and establishing a centralized resource hub. Performance nutrition initiatives in local military DFAC for dining facilities, such as G4G 2.0, has great potential to impact the health and well-being of Service Members.
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Affiliation(s)
- Carolyn A Kleinberger
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD 20817, USA
| | - Asma S Bukhari
- US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Katie M Kirkpatrick
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD 20817, USA
| | - Elizabeth M Moylan
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD 20817, USA
| | | | | | - Renee E Cole
- US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- US Military-Baylor University Graduate Program in Nutrition, Medical Center of Excellence Joint Base San Antonio-Fort Sam Houston, San Antonio, TX 78234, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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10
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Menu labeling influence on purchase behaviors: Applying the theory of planned behavior and health consciousness. Appetite 2022; 172:105967. [DOI: 10.1016/j.appet.2022.105967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/06/2022] [Accepted: 02/04/2022] [Indexed: 11/18/2022]
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11
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Starke AD, Willemsen MC, Trattner C. Nudging Healthy Choices in Food Search Through Visual Attractiveness. Front Artif Intell 2021; 4:621743. [PMID: 33969288 PMCID: PMC8102049 DOI: 10.3389/frai.2021.621743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/12/2021] [Indexed: 11/24/2022] Open
Abstract
Recipe websites are becoming increasingly popular to support people in their home cooking. However, most of these websites prioritize popular recipes, which tend to be unhealthy. Drawing upon research on visual biases and nudges, this paper investigates whether healthy food choices can be supported in food search by depicting attractive images alongside recipes, as well as by re-ranking search results on health. After modelling the visual attractiveness of recipe images, we asked 239 users to search for specific online recipes and to select those they liked the most. Our analyses revealed that users tended to choose a healthier recipe if a visually attractive image was depicted alongside it, as well as if it was listed at the top of a list of search results. Even though less popular recipes were promoted this way, it did not come at the cost of a user’s level of satisfaction.
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Affiliation(s)
- Alain D Starke
- Marketing and Consumer Behaviour Group, Wageningen University and Research, Wageningen, Netherlands.,Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | - Martijn C Willemsen
- Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands.,Recommender Lab, Jheronimus Academy of Data Science, 's-Hertogenbosch, Netherlands
| | - Christoph Trattner
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
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12
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Abstract
OBJECTIVE Online meal ordering services are increasing in popularity in Australia and globally. Meals ordered online for home delivery are typically less healthy than home-made meals, potentially contributing to weight gain. The aim of the present study was to identify the types of consumers who are most likely to engage in online meal ordering. DESIGN A cross-sectional survey including items relating to demographic and lifestyle factors was disseminated via a web panel provider. SETTING Australia. PARTICIPANTS A total of 2010 Australian adults aged 18+ years. RESULTS More than a quarter of respondents (28 %) engaged in online meal ordering at least once in the previous month. Younger respondents, those with a higher BMI, and those with higher education and income levels were more likely to have done so. Consuming higher levels of sugary drinks and fast-food restaurant patronage were significantly associated with ordering meals online for home delivery. CONCLUSIONS The outcomes of this study suggest that the use of online meal ordering services is becoming a common practice in Australia, and it is therefore important to implement evidence-based strategies and policies to encourage individuals to make healthy food choices when using these services.
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Bosselman R, Choi HM, Lee KS, Kim E, Cha J, Jeong JY, Jo M, Ham S. Customers' perception of the attributes of different formats of menu labeling: a comparison between Korea and the U.S. Nutr Res Pract 2020; 14:286-297. [PMID: 32528635 PMCID: PMC7263896 DOI: 10.4162/nrp.2020.14.3.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study compared the perception of customers from Korea and the U.S. on the attributes of different formats of menu labeling The specific objectives were 1) to compare the customers' perceived usefulness, ease-of-understanding, clarity, and attractiveness of different formats of menu labeling between Korea and the U.S.; and 2) to compare the customers' use intention to different formats of menu labeling between Korea and the U.S. SUBJECTS/METHODS A survey was conducted in Korea and the U.S. The participants were allocated randomly to view 1 of the 7 restaurant menus that varied according to the following types of menu labeling formats: (type 1) kcal format, (type 2) traffic-light format, (type 3) percent daily intake (%DI) format, (type 4) kcal + traffic-light format, (type 5) kcal + %DI format, (type 6) traffic-light + %DI format, and (type 7) kcal + traffic-light + %DI format. A total of 279 Koreans and 347 Americans were entered in the analysis. An independent t-test and 1-way analysis of variance were performed. RESULTS Koreans rated type 4 format (kcal + traffic light) the highest for usefulness and attractiveness. In contrast, Americans rated type 7 (kcal + traffic light + %DI) the highest for usefulness, ease-of-understanding, attractiveness, and clarity. Significant differences were found in the customers' perceived attributes to menu labeling between Korea and the U.S. Americans perceived higher for all the 4 attributes of menu labeling than Koreans. CONCLUSIONS The study is unique in identifying the differences in the attributes of different formats of menu labeling between Korea and the U.S. Americans rated the most complicated type of menu labeling as the highest perception for the attributes, and showed a higher use intention of menu labeling than Koreans. This study contributes to academia and industry for practicing menu labeling in different countries using different formats.
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Affiliation(s)
- Robert Bosselman
- Department of Apparel, Events & Hospitality Management, College of Human Sciences, Iowa State University, Ames, IA 50011, USA
| | - Hyung-Min Choi
- International Center for Hospitality Research & Development, Dedman School of Hospitality, Florida State University, Tallahassee, FL 32306, USA
| | - Keum Sil Lee
- Department of Tourism Management, Jangan University, Hwaseong 18331, Korea
| | - Eojina Kim
- Department of Hospitality & Tourism Management, Pamplin College of Business, Virginia Tech, Blacksburg, VA 24061, USA
| | - Jaebin Cha
- Department of Health & Medical Administration, Kyungmin University, Uijeongbu 11618, Korea
| | - Jin-Yi Jeong
- Department of Food & Nutrition, Institute of Symbiotic Life-TECH, College of Human Ecology, Yonsei University, Seoul 03722, Korea
| | - Mina Jo
- Division of Hotel & Tourism, College of Economics & Business Administration, The University of Suwon, Hwaseong 18323, Korea
| | - Sunny Ham
- Department of Food & Nutrition, Institute of Symbiotic Life-TECH, College of Human Ecology, Yonsei University, Seoul 03722, Korea
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14
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Testing the efficacy of and parents' preferences for nutrition labels on children's menus from a full-service chain restaurant: results of an online experiment. Public Health Nutr 2020; 23:1820-1831. [PMID: 32308190 DOI: 10.1017/s1368980019004488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Test the efficacy and perceived effectiveness of nutrition labels on children's menus from a full-service chain restaurant in an online study. DESIGN Using a between-groups experiment, parents were randomised to view children's menus displaying one of five children's nutrition labelling conditions: (i) No Nutrition Information (control); (ii) Calories Only; (iii) Calories + Contextual Statement (CS); (iv) Calories, Sodium + CS; or (v) Calories and Sodium in Traffic Lights + CS. Parents hypothetically ordered up to one entrée, side, beverage and dessert for their child, then rated and ranked all five labelling conditions on the level of perceived effectiveness. SETTING Online survey. PARTICIPANTS 998 parents with a 3-12 year old child. RESULTS Parents exposed to menus displaying 'Calories, Sodium + CS' selected significantly fewer calories 'overall' (entrées + side + dessert + beverage) compared to parents exposed to the control condition (-53·1 calories, P < 0·05). Parents selected 'entrees' with significantly fewer calories and lower sodium when exposed to menus with 'Calories + CS' (-24·3 calories, P < 0·05); 'Calories, Sodium + CS' (-25·4 calories, -56·1 mg sodium, P < 0·05 for both); and 'Calories and Sodium in Traffic Lights + CS' (-29·1 calories, -58·6 mg sodium, P < 0·05 for both). Parents exposed to menus with 'Calories, Sodium + CS' and 'Calories and Sodium in Traffic Lights + CS' were more likely to notice and understand nutrition information compared to other nuntrition labelling conditions. Parents perceived the menu with 'Calories and Sodium in Traffic Lights + CS' as most effective (P < 0·05). CONCLUSIONS Menus disclosing calories, sodium and a contextual statement increased the proportion of parents who noticed and understood nutrition information, and resulted in parents selecting lower calorie and sodium entrées for their children in the hypothetical purchase task.
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15
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Vermote M, Nys J, Versele V, D'Hondt E, Deforche B, Clarys P, Deliens T. The effect of nudges aligned with the renewed Flemish Food Triangle on the purchase of fresh fruits: An on-campus restaurant experiment. Appetite 2019; 144:104479. [PMID: 31585133 DOI: 10.1016/j.appet.2019.104479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study examined the effect of nudges, inspired by the recently renewed Flemish Food Triangle, on fruit sales in a Belgian on-campus university restaurant. METHODS In this mixed-method real-life experiment, nudges were added weekly over a period of four consecutive weeks: placement of (1) Food Triangle posters in the restaurant, (2) 'green heart' icons above the fruit stands, and (3) substitution and (4) social norm messages at the fruit stands. During baseline (no intervention) and all intervention weeks, dessert sales were registered. Short interviews were used to ask customers about their perceptions regarding the intervention. Follow-up measurements (7 and 30 weeks later) evaluated the longer-term effectiveness, while all nudges remained in place. Dessert sales were analyzed separately for both sexes, students and staff categories (based on academic degree). RESULTS Compared to baseline, the combination of the Food Triangle and the green heart intervention materials in week 2 resulted in significant increases in fruit consumption across almost all subgroups. The other intervention materials used in the current study had rather limited effects in the short term. After 7 weeks of follow-up, significant fruit sale increases were established for all subgroups compared to baseline. At 30 weeks follow-up, the effect for staff B (Bachelor's degree) disappeared. The majority of the respondents (66.4%) had noticed at least one of the nudges, while only 3.4% indicated to have adjusted their dessert choice as a result of the nudges. CONCLUSIONS The combination of nudges was effective in the long term and increased fruit purchase in nearly all subgroups. Short interviews show that a more active approach may be needed to increase effect sizes.
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Affiliation(s)
- Marie Vermote
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Jana Nys
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Vickà Versele
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Eva D'Hondt
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Benedicte Deforche
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium; Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Peter Clarys
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Tom Deliens
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
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16
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Zerbini C, Luceri B, Marchetti A, Di Dio C. Shaping consumption propensity through the emotional response evoked by nutritional labels: Evidence from an fMRI study. Food Res Int 2019; 125:108547. [PMID: 31554096 DOI: 10.1016/j.foodres.2019.108547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/19/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
The study aims to investigate a) the ability of nutritional labels in pictorial and textual form to guide consumption choices applying the dual-coding theory; b) the effectiveness of a new type of pictorial label (i.e. the body label) that appeals to the self-congruence theory and to positive emotional response. The research hypotheses were tested trough a 2x4x2 fMRI experimental design with 2 levels of product version (regular vs light), 4 levels of label type (text vs traffic light vs star rating vs body) and 2 levels of group of people (normal weight vs overweight). The body light label generates more brain activation in areas involved in the reward circuit compared to the body regular one, and compared to all the other types of labels for both versions, only in the overweight subject group. Furthermore, the star rating label has the worst performance in orienting healthy food choices as it requires more cognitive effort. The results are of interest to policy maker's strategies and to out-of-store and in-store communication strategies with the aim to contract the excessive body-weight phenomenon.
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Affiliation(s)
- Cristina Zerbini
- Department of Economics and Management, University of Parma, Parma, Italy.
| | - Beatrice Luceri
- Department of Economics and Management, University of Parma, Parma, Italy
| | - Antonella Marchetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Cinzia Di Dio
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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17
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What makes people leave LESS food? Testing effects of smaller portions and information in a behavioral model. Appetite 2019; 139:127-144. [DOI: 10.1016/j.appet.2019.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/26/2018] [Accepted: 03/23/2019] [Indexed: 11/19/2022]
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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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19
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Dana LM, Chapman K, Talati Z, Kelly B, Dixon H, Miller C, Pettigrew S. Consumers' Views on the Importance of Specific Front-of-Pack Nutrition Information: A Latent Profile Analysis. Nutrients 2019; 11:nu11051158. [PMID: 31126149 PMCID: PMC6566345 DOI: 10.3390/nu11051158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 01/03/2023] Open
Abstract
Nutrition labelling can influence consumers’ assessments of food healthiness and their food choices. However, there is a lack of consensus about the optimal type and amount of nutrition information to provide on food packages. This study analysed consumers’ preferences for front-of-pack information relating to energy and various nutrients (sugar, saturated fat, sodium, fibre, carbohydrate, and protein). The aim was to identify discrete preference segments within the Australian market where the current Health Star Rating front-of-pack labelling system can be displayed with different levels of nutrition information. Adults (n = 1558) completed a survey assessing socio-demographics, self-reported nutrition knowledge, diet healthiness, special dietary requirements, and perceived importance of the provision of energy and nutrient information on the front of food packs. Latent profile analysis identified five consumer segments within the sample that ranged from groups exhibiting high levels of interest in various forms of nutrition information to one with very low interest and one with divergent scores according to whether nutrients were perceived as positive or negative for health. The results indicate that different forms of front-of-pack labelling featuring varying degrees of information about energy and specific nutrients are likely to be of interest and use to different market segments.
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Affiliation(s)
| | - Kathy Chapman
- School of Life and Environment Sciences, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
- School of Medicine & Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Zenobia Talati
- School of Psychology, Curtin University, Kent St, Bentley, WA 6102, Australia.
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
| | - Helen Dixon
- School of Psychology, Curtin University, Kent St, Bentley, WA 6102, Australia.
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC 3004, Australia.
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne VIC 3010, Australia.
| | - Caroline Miller
- Population Health Research Group, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia.
- School of Public Health, University of Adelaide, Adelaide, SA 5000, Australia.
| | - Simone Pettigrew
- School of Psychology, Curtin University, Kent St, Bentley, WA 6102, Australia.
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20
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Niven P, Morley B, Dixon H, Martin J, Jones A, Petersen K, Wakefield M. Effects of health star labelling on the healthiness of adults' fast food meal selections: An experimental study. Appetite 2019; 136:146-153. [PMID: 30684644 DOI: 10.1016/j.appet.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/09/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
The addition of Health Star Rating (HSR) labelling to menus at fast food outlets is feasible, however how this would impact consumer menu selection remains unclear. The aim of this study was to test whether the addition of HSR labelling to kilojoule (kJ) labelling on menus at fast food outlets would prompt consumers to select healthier meals. Using a between-subjects experimental design, 1007 adults aged 18-49 were allocated to one of four menu labelling conditions: (i) no labelling; (ii) kilojoule labelling; (iii) HSR labelling; and (iv) kilojoule + HSR labelling. Respondents were presented with their assigned menu online and instructed to select an evening meal as they would at a fast food restaurant. The main analyses tested differences by menu labelling condition in the total mean kilojoule content and Nutrient Profiling Score (NPS) of respondents' evening meal selections using one-way ANOVA. The mean kilojoule content of meals did not differ significantly by menu labelling condition. However, respondents in the kilojoule + HSR labelling condition selected healthier meals (lower mean NPS) than those who viewed menu boards with kilojoule labelling only (M = 2.88 cf. M = 3.78, p = 0.046). In addition, in a post hoc per-protocol analysis of respondents who reported using menu labelling to assist their meal selection, respondents shown kilojoule + HSR menu labelling selected meals with a significantly lower kilojoule content compared to those shown HSR labelling only (4751 kJ cf. 5745 kJ, p = 0.038). Findings provide evidence that adding HSRs to kilojoule labelling on menu boards at fast food outlets has the potential to assist adults to make healthier evening meal selections.
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Affiliation(s)
- Philippa Niven
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.
| | - Jane Martin
- Obesity Policy Coalition, Melbourne, Victoria, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Kristina Petersen
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia; The Pennsylvania State University, Department of Nutritional Sciences, University Park, PA, USA
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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21
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Using insights from behavioral economics to nudge individuals towards healthier choices when eating out: A restaurant experiment. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2018.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Conceptual understanding and quantity inferences: a new framework for examining consumer understanding of food energy. Public Health Nutr 2018; 21:3168-3177. [PMID: 30132428 DOI: 10.1017/s1368980018002021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The study examined two components of consumer understanding of food energy information: understanding the concept of energy and its quantity. Using this new framework, we investigated whether activity-equivalent labels facilitated interpretations of food energy compared with calorie labels and whether an image format would strengthen this facilitative effect compared with text. DESIGN We assessed the effect of energy representation and format in a 2 (activity v. calories)×2 (image v. text) between-subjects design. Conceptual understanding of energy was measured in terms of level of understanding and personal engagement. Quantitative understanding was measured in terms of participants' estimations of a food's contribution to their recommended daily intake and perceptions of energy values as precise or single-bound interval estimates. SETTING The experiment was conducted online through Qualtrics. SUBJECTS Eight hundred and twelve participants (55 % female, age range 18-74 years) were recruited through a national survey panel in the UK. RESULTS Participants were twice more likely to have a stronger conceptual understanding of energy and four times more likely to personally engage with activity labels v. calorie labels. Participants did not differ across labels in their estimations of energy quantities; however, they inferred quantities to mean exactly the stated number of calories, but at least the stated activity duration. There were no added benefits in presenting an image over the text format. CONCLUSIONS Activity labels can facilitate conceptual understanding of energy, but may be subject to quantitative misinterpretations. Nutrition communication should consider what people infer from quantities represented on labels.
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23
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Extrinsic and intrinsic food product attributes in consumer and sensory research: literature review and quantification of the findings. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11301-018-0146-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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24
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Adding sodium information to casual dining restaurant menus: Beneficial or detrimental for consumers? Appetite 2018; 125:474-485. [DOI: 10.1016/j.appet.2018.02.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/27/2018] [Accepted: 02/23/2018] [Indexed: 11/18/2022]
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25
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Lee K, Lee Y. Parents' meal choices for their children at fast food and family restaurants with different menu labeling presentations. Nutr Res Pract 2018; 12:243-250. [PMID: 29854330 PMCID: PMC5974070 DOI: 10.4162/nrp.2018.12.3.243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study examined the effect of nutrition labeling formats on parents' food choices for their children at different restaurant types. SUBJECTS/METHODS An online survey was conducted with 1,980 parents of children aged 3-12 years. Participants were randomly assigned to fast food or family restaurant scenarios, and one of four menu stimuli conditions: no labeling, low-calorie symbol (symbol), numeric value (numeric), and both low-calorie symbol and numeric value (symbol + numeric). Participants selected menu items for their children. Menu choices and total calories were compared by nutrition labeling formats in each type of the restaurant. RESULTS Low-calorie item selections were scored and a two-way analysis of variance (ANOVA) was conducted for an interaction effect between restaurant and labeling type. In the fast food restaurant group, parents presented with low-calorie symbols selected the lowest calorie items more often than those not presented with the format. Parents in the symbol + numeric condition selected significantly fewer calories (653 kcal) than those in the no labeling (677 kcal) or numeric conditions (674 kcal) (P = 0.006). In the family restaurant group, no significant difference were observed among different labeling conditions. A significant interaction between restaurant and labeling type on low-calorie selection score (F = 6.03, P < 0.01) suggests that the effect of nutrition labeling format interplays with restaurant type to jointly affect parents' food choices for their children. CONCLUSIONS The provision of easily interpretable nutritional information format at fast food restaurants may encourage healthier food choices of parents for their children; however, the effects were negligible at family restaurants.
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Affiliation(s)
- Kiwon Lee
- Hospitality Management, College of Education, Health and Human Services, Kent State University, Kent, OH 44242, USA
| | - Youngmi Lee
- Department of Food and Nutrition, Myongji University, 116, Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 17058, Korea
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Abstract
OBJECTIVE The present research aimed to investigate the impact of the physical activity calorie equivalent (PACE) front-of-pack label on consumption, prospective consumption and liking of familiar and unfamiliar discretionary snack foods. DESIGN In a within-subject randomised design, participants tasted and rated liking (9-point hedonic scale) and prospective consumption (9-point category scale) of four different snack foods with four different labels (i.e. blank, fake, PACE, PACE doubled) and four control snack foods. The twenty snack foods were presented during two 45 min sessions (i.e. ten snack foods per session) which were separated by one week. The amount participants sampled of each snack food was measured. SETTING The study was conducted in the Centre for Advanced Sensory Sciences laboratory at Deakin University, Australia. SUBJECTS The participants were 153 university students (126 females, twenty-seven males, mean age 24·3 (sd 4·9) years) currently enrolled in an undergraduate nutrition degree at Deakin University. RESULTS When the PACE label was present on familiar snack foods, participants sampled 9·9 % (22·8 (sem 1·4) v. 25·3 (sem 1·5) g, P=0·03) less than when such label was not present. This was in line with a decreased prospective snack food consumption of 9·1 % (3·0 (sem 0·2) v. 3·3 (sem 0·2) servings, P=0·03). Such pattern was not seen in unfamiliar snacks. CONCLUSIONS The PACE label appears to be a promising way to decrease familiar discretionary snack food consumption in young, health-minded participants.
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Bleich SN, Economos CD, Spiker ML, Vercammen K, VanEpps EM, Block JP, Elbel B, Story M, Roberto CA. A Systematic Review of Calorie Labeling and Modified Calorie Labeling Interventions: Impact on Consumer and Restaurant Behavior. Obesity (Silver Spring) 2017; 25:2018-2044. [PMID: 29045080 PMCID: PMC5752125 DOI: 10.1002/oby.21940] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health
| | | | - Marie L. Spiker
- Department of International Health, John Hopkins Bloomberg School of Public Health
| | - Kelsey Vercammen
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health
| | | | - Jason P. Block
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine and Wagner School of Public Service
| | - Mary Story
- Duke Global Health Institute, Duke University
| | - Christina A. Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania
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Cantu-Jungles TM, McCormack LA, Slaven JE, Slebodnik M, Eicher-Miller HA. A Meta-Analysis to Determine the Impact of Restaurant Menu Labeling on Calories and Nutrients (Ordered or Consumed) in U.S. Adults. Nutrients 2017; 9:E1088. [PMID: 28973989 PMCID: PMC5691705 DOI: 10.3390/nu9101088] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 11/16/2022] Open
Abstract
A systematic review and meta-analysis determined the effect of restaurant menu labeling on calories and nutrients chosen in laboratory and away-from-home settings in U.S. adults. Cochrane-based criteria adherent, peer-reviewed study designs conducted and published in the English language from 1950 to 2014 were collected in 2015, analyzed in 2016, and used to evaluate the effect of nutrition labeling on calories and nutrients ordered or consumed. Before and after menu labeling outcomes were used to determine weighted mean differences in calories, saturated fat, total fat, carbohydrate, and sodium ordered/consumed which were pooled across studies using random effects modeling. Stratified analysis for laboratory and away-from-home settings were also completed. Menu labeling resulted in no significant change in reported calories ordered/consumed in studies with full criteria adherence, nor the 14 studies analyzed with ≤1 unmet criteria, nor for change in total ordered carbohydrate, fat, and saturated fat (three studies) or ordered or consumed sodium (four studies). A significant reduction of 115.2 calories ordered/consumed in laboratory settings was determined when analyses were stratified by study setting. Menu labeling away-from-home did not result in change in quantity or quality, specifically for carbohydrates, total fat, saturated fat, or sodium, of calories consumed among U.S. adults.
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Affiliation(s)
| | - Lacey A McCormack
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD 57007, USA.
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Maribeth Slebodnik
- Arizona Health Sciences Library, University of Arizona, Tucson, AZ 85724, USA.
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Fernandes AC, Oliveira RC, Proença RPC, Curioni CC, Rodrigues VM, Fiates GMR. Influence of menu labeling on food choices in real-life settings: a systematic review. Nutr Rev 2017; 74:534-48. [PMID: 27358442 DOI: 10.1093/nutrit/nuw013] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
CONTEXT Evidence that menu labeling influences food choices in real-life settings is lacking. Reviews usually focus on calorie counts without addressing broader issues related to healthy eating. OBJECTIVE This systematic review assessed the influence of diverse menu-labeling formats on food choices in real-life settings. DATA SOURCES Several databases were searched: Cochrane Library, Scopus, MEDLINE, Web of Science, Food Science and Technology Abstracts, Biological Abstracts, CAB Abstracts, EconLit, SciELO, and LILACS. STUDY SELECTION Articles reporting experiments, quasi-experiments, and observational studies using control or preintervention groups were selected blindly by two reviewers. DATA EXTRACTION Data was extracted using a standard form. Analyses differentiated between foodservice types. The quality of the 38 included studies was assessed blindly by two reviewers. DATA ANALYSIS The results were mixed, but a partial influence of menu labeling on food choices was more frequent than an overall influence or no influence. Menu labeling was more effective in cafeterias than in restaurants. Qualitative information, such as healthy-food symbols and traffic-light labeling, was most effective in promoting healthy eating. In general, the studies were of moderate quality and did not use control groups. CONCLUSIONS Calorie labeling in menus is not effective to promote healthier food choices. Further research in real-life settings with control groups should test diverse qualitative information in menu labeling.
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Affiliation(s)
- Ana C Fernandes
- A.C. Fernandes, R.C. Oliveira, R.P.C. Proença, V.M. Rodrigues, and G.M.R. Fiates are with the Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição), Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições - NUPPRE), Federal University of Santa Catarina (Universidade Federal de Santa Catarina - UFSC), Florianópolis, Santa Catarina, Brazil. C.C. Curioni is with the Department of Social Nutrition, Institute of Nutrition, University of the State of Rio de Janeiro (Universidade do Estado do Rio de Janeiro - UERJ), Rio de Janeiro, Brazil
| | - Renata C Oliveira
- A.C. Fernandes, R.C. Oliveira, R.P.C. Proença, V.M. Rodrigues, and G.M.R. Fiates are with the Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição), Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições - NUPPRE), Federal University of Santa Catarina (Universidade Federal de Santa Catarina - UFSC), Florianópolis, Santa Catarina, Brazil. C.C. Curioni is with the Department of Social Nutrition, Institute of Nutrition, University of the State of Rio de Janeiro (Universidade do Estado do Rio de Janeiro - UERJ), Rio de Janeiro, Brazil
| | - Rossana P C Proença
- A.C. Fernandes, R.C. Oliveira, R.P.C. Proença, V.M. Rodrigues, and G.M.R. Fiates are with the Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição), Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições - NUPPRE), Federal University of Santa Catarina (Universidade Federal de Santa Catarina - UFSC), Florianópolis, Santa Catarina, Brazil. C.C. Curioni is with the Department of Social Nutrition, Institute of Nutrition, University of the State of Rio de Janeiro (Universidade do Estado do Rio de Janeiro - UERJ), Rio de Janeiro, Brazil.
| | - Cintia C Curioni
- A.C. Fernandes, R.C. Oliveira, R.P.C. Proença, V.M. Rodrigues, and G.M.R. Fiates are with the Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição), Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições - NUPPRE), Federal University of Santa Catarina (Universidade Federal de Santa Catarina - UFSC), Florianópolis, Santa Catarina, Brazil. C.C. Curioni is with the Department of Social Nutrition, Institute of Nutrition, University of the State of Rio de Janeiro (Universidade do Estado do Rio de Janeiro - UERJ), Rio de Janeiro, Brazil
| | - Vanessa M Rodrigues
- A.C. Fernandes, R.C. Oliveira, R.P.C. Proença, V.M. Rodrigues, and G.M.R. Fiates are with the Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição), Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições - NUPPRE), Federal University of Santa Catarina (Universidade Federal de Santa Catarina - UFSC), Florianópolis, Santa Catarina, Brazil. C.C. Curioni is with the Department of Social Nutrition, Institute of Nutrition, University of the State of Rio de Janeiro (Universidade do Estado do Rio de Janeiro - UERJ), Rio de Janeiro, Brazil
| | - Giovanna M R Fiates
- A.C. Fernandes, R.C. Oliveira, R.P.C. Proença, V.M. Rodrigues, and G.M.R. Fiates are with the Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição), Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições - NUPPRE), Federal University of Santa Catarina (Universidade Federal de Santa Catarina - UFSC), Florianópolis, Santa Catarina, Brazil. C.C. Curioni is with the Department of Social Nutrition, Institute of Nutrition, University of the State of Rio de Janeiro (Universidade do Estado do Rio de Janeiro - UERJ), Rio de Janeiro, Brazil
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OLIVEIRA RCD, FERNANDES AC, PROENÇA RPDC, HARTWELL H, RODRIGUES VM, FIATES GMR. Preferences for menu labelling formats of young adults in Brazil and in the United Kingdom. REV NUTR 2017. [DOI: 10.1590/1678-98652017000300005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective This pilot study was aimed at exploring preferences of young adults in two different contexts on restaurant menu labelling formats. Methods Five focus groups were conducted with 36 participants, two focus groups with 11 participants in Brazil and three focus groups with 25 in the United Kingdom. Themes originating from the content analysis of the transcriptions were organised around four possible menu labelling formats: 1) numerical information on calories; 2) numerical information on calories and nutrients; 3) traffic light system plus Guideline Daily Amounts; 4) food information with ingredients list plus highlighted symbols. Results In both countries, participants preferred the ingredients list plus symbols format, considered more comprehensive and useful to make an informed food choice. Organic food and vegetarian symbols were the ones considered most important to appear on restaurant menu labels with ingredients list. However, most participants in Brazil and in the United Kingdom rejected the information restricted to calories and calories plus nutrients formats, saying that these would not influence their own choices. Conclusion This is the first multicultural qualitative study exploring preferences of people living in different countries with different eating habits, but where menu labelling is voluntary. Results evidenced similarities in participants’ likes and dislikes for menu labelling formats in these two different contexts. Discussions showed participants in both countries prefer qualitative information than numerical information, suggesting that ingredients list and symbols provide information that people want to see on the menu.
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Haynos AF, Roberto CA. The effects of restaurant menu calorie labeling on hypothetical meal choices of females with disordered eating. Int J Eat Disord 2017; 50:275-283. [PMID: 28130796 PMCID: PMC5378635 DOI: 10.1002/eat.22675] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/15/2016] [Accepted: 12/29/2016] [Indexed: 11/09/2022]
Abstract
Concerns have been raised that obesity public policy measures may have harmful effects on individuals with eating disorders. However, little research has investigated this topic. We examined the impact of a popular obesity public policy, menu calorie labeling, on hypothetical food choices of women with disordered eating. Seven hundred sixteen adult females completed an online survey in which they were randomly assigned to receive a restaurant menu with or without calorie information listed. Participants selected foods representative of a meal they would choose to consume and answered questions on restaurant ordering and menu labeling. Participants completed the Eating Disorder Examination Questionnaire (Fairburn & Beglin, ) to assess global eating pathology. Diagnoses of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) were also derived from this measure. Generalized linear modeling examined the impact of menu label condition, disordered eating, and the menu label by disordered eating interaction on hypothetical food selection and related variables. When disordered eating was examined continuously, menu labeling did not differentially affect food selections of those with elevated disordered eating (p = .45). However, when examined by eating disorder diagnosis, participants with AN or BN ordered significantly fewer (p < .001) and participants with BED ordered significantly more (p = .001) calories in the menu label versus no label condition. Menu labeling may decrease the calories ordered among individuals with AN or BN and increase calories ordered among individuals with BED.
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Affiliation(s)
- Ann F. Haynos
- University of Minnesota Medical Center, Minneapolis, MN
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Roy R, Beattie-Bowers J, Ang SM, Colagiuri S, Allman-Farinelli M. The Effect of Energy Labelling on Menus and a Social Marketing Campaign on Food-Purchasing Behaviours of University Students. BMC Public Health 2016; 16:727. [PMID: 27496103 PMCID: PMC4974729 DOI: 10.1186/s12889-016-3426-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Rajshri Roy
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Level 4, E40, D17, Sydney, NSW, Australia.
| | - Jack Beattie-Bowers
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Level 4, E40, D17, Sydney, NSW, Australia
| | - Siew Min Ang
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Level 4, E40, D17, Sydney, NSW, Australia
| | | | - Margaret Allman-Farinelli
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Level 4, E40, D17, Sydney, NSW, Australia
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Shah M, Bouza B, Adams-Huet B, Jaffery M, Esposito P, Dart L. Effect of calorie or exercise labels on menus on calories and macronutrients ordered and calories from specific foods in Hispanic participants: a randomized study. J Investig Med 2016; 64:1261-1268. [PMID: 27402619 DOI: 10.1136/jim-2016-000227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 11/04/2022]
Abstract
The effect of menu labels on food choices is unknown in Hispanics. This study evaluated the impact of menu labels on calories and macronutrients ordered in Hispanics. 372 Hispanics (18-65 years) were randomly assigned to menus with no labels (NL) (n=127), rank-ordered calorie labels plus a statement on energy needs per meal (CL) (n=123), or rank-ordered exercise labels showing minutes of brisk walking necessary to burn the food calories (EL) (n=122). The menus had identical food choices. Participants were instructed to select foods from the assigned menu as if having lunch in a fast food restaurant. One-way analysis of variance found no difference in calories ordered (median (25th and 75th centiles)) by menu condition (NL: 785.0 (465.0, 1010.0) kcal; CL: 790.0 (510.0, 1020.0) kcal; EL: 752.5 (520.0, 1033.8) kcal; p=0.75). Calories from specific foods and macronutrient intake were not different by menu condition. Menu label use was 26.8% in the CL and 25.4% in the EL condition. Calories ordered were not different between those who used and those who did not use the labels. Regression analysis showed that perception of being overweight (p=0.02), selecting foods based on health value (p<0.0001), and meeting exercise guidelines (p<0.0001) were associated with fewer calories ordered. Logistic regression showed that selecting foods based on health value (p=0.01) was associated with higher food label use. Menu labels did not affect food choices in Hispanic participants. Future studies should determine if nutrition, exercise, and weight perception counseling prior to menu labels intervention would result in better food choices. TRIAL REGISTRATION NUMBER NCT02804503; post-results.
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Affiliation(s)
- Meena Shah
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
| | - Brooke Bouza
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
| | - Beverley Adams-Huet
- Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Manall Jaffery
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
| | - Phil Esposito
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
| | - Lyn Dart
- Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas, USA
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Reale S, Flint SW. The Impact of Menu Label Design on Visual Attention, Food Choice and Recognition: An Eye Tracking Study. J SENS STUD 2016. [DOI: 10.1111/joss.12216] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sophie Reale
- School of Health and Related Research; University of Sheffield; Regent Court, Sheffield, S1 4DA United Kingdom
| | - Stuart William Flint
- Academy of Sport and Physical Activity; Sheffield Hallam University; United Kingdom
- Centre for Sport and Exercise Science; Sheffield Hallam University; United Kingdom
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Abstract
Extensive research into the impact of nutrition labelling across Europe has shown that many consumers can effectively use a nutrition label to rank a food for healthiness. The present paper considers observational and laboratory evidence which has examined the impact of nutrition labelling (on food packaging and at point of purchase) on dietary behaviour. In addition, the potential counterproductive effects of foods bearing 'healthy' nutrition labels are examined. The observational evidence provides a useful insight into the key characteristics of nutrition label use. Those most likely to engage with nutrition labels are more likely to have a diet related disease and/or be on a weight loss diet and have a good overall diet quality. Experimental evidence, while limited, suggests that serving size information may be overlooked by consumers. In fact, there may be a tendency among consumers to overeat foods that are perceived to be healthier. The findings from the present paper suggest that if nutrition labelling is to be considered a strategy to facilitate consumers in managing their energy intake, it must coincide with salient, consistent and simple serving size information on the front of food packages and at the point of purchase. There is a clear need for more experimental research using robust methodologies, to examine the impact of nutrition information on dietary intake. In the meantime, there should be greater attention given to portion size within national dietary guidance.
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The impact of menu energy labelling across socioeconomic groups: A systematic review. Appetite 2016; 99:59-75. [DOI: 10.1016/j.appet.2015.12.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/14/2015] [Accepted: 12/19/2015] [Indexed: 11/22/2022]
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Haws KL, Liu PJ. Half-size me? How calorie and price information influence ordering on restaurant menus with both half and full entrée portion sizes. Appetite 2016; 97:127-37. [DOI: 10.1016/j.appet.2015.11.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
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Menu labelling is effective in reducing energy ordered and consumed: a systematic review and meta-analysis of recent studies. Public Health Nutr 2015; 19:2106-21. [DOI: 10.1017/s1368980015003468] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveMenu 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.DesignThe 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.ResultsThe 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).ConclusionsThe review supports that menu labelling can effectively reduce energy ordered and consumed in the away-from-home food environment.
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Ahn JY, Park HR, Lee K, Kwon S, Kim S, Yang J, Song KH, Lee Y. The effect of providing nutritional information about fast-food restaurant menus on parents' meal choices for their children. Nutr Res Pract 2015; 9:667-72. [PMID: 26634057 PMCID: PMC4667209 DOI: 10.4162/nrp.2015.9.6.667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/OBJECTIVES To encourage healthier food choices for children in fast-food restaurants, many initiatives have been proposed. This study aimed to examine the effect of disclosing nutritional information on parents' meal choices for their children at fast-food restaurants in South Korea. SUBJECTS/METHODS An online experimental survey using a menu board was conducted with 242 parents of children aged 2-12 years who dined with them at fast-food restaurants at least once a month. Participants were classified into two groups: the low-calorie group (n = 41) who chose at least one of the lowest calorie meals in each menu category, and the high-calorie group (n = 201) who did not. The attributes including perceived empowerment, use of provided nutritional information, and perceived difficulties were compared between the two groups. RESULTS The low-calorie group perceived significantly higher empowerment with the nutritional information provided than did the high-calorie group (P = 0.020). Additionally, the low-calorie group was more interested in nutrition labeling (P < 0.001) and considered the nutritional value of menus when selecting restaurants for their children more than did the high-calorie group (P = 0.017). The low-calorie group used the nutritional information provided when choosing meals for their children significantly more than did the high-calorie group (P < 0.001), but the high-calorie group had greater difficulty using the nutritional information provided (P = 0.012). CONCLUSIONS The results suggest that improving the empowerment of parents using nutritional information could be a strategy for promoting healthier parental food choices for their children at fast-food restaurants.
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Affiliation(s)
- Jae-Young Ahn
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
| | - Hae-Ryun Park
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
| | - Kiwon Lee
- Department of Retail, Hospitality and Tourism Management, University of Tennessee, Knoxville, United States
| | - Sooyoun Kwon
- Department of Food and Nutrition, Honam University, Gwangju 506-714, Korea
| | - Soyeong Kim
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
| | - Jihye Yang
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
| | - Kyung-Hee Song
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea. ; Nutritional Education, Graduate School of Education, Myongji University, Seoul 120-728, Korea
| | - Youngmi Lee
- Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 449-728, Korea
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Cioffi CE, Levitsky DA, Pacanowski CR, Bertz F. A nudge in a healthy direction. The effect of nutrition labels on food purchasing behaviors in university dining facilities. Appetite 2015; 92:7-14. [DOI: 10.1016/j.appet.2015.04.053] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022]
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Yoong SL, Dodds P, Hure A, Clinton-Mcharg T, Skelton E, Wiggers J, Wolfenden L. Healthier options do not reduce total energy of parent intended fast food purchases for their young children: a randomised controlled trial. Nutr Diet 2015. [DOI: 10.1111/1747-0080.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sze Lin Yoong
- School of Medicine and Public Health; University of Newcastle Callaghan 2308 NSW & Hunter Medical Research Institute, New Lambton 2305 NSW; Wallsend New South Wales Australia
- Priority Research Centre for Health Behaviour (PRCHB); University of Newcastle, Callaghan NSW 2308; Wallsend New South Wales Australia
- Hunter New England Population Health; Hunter New England Local Health District 2287; Wallsend New South Wales Australia
| | - Pennie Dodds
- School of Medicine and Public Health; University of Newcastle Callaghan 2308 NSW & Hunter Medical Research Institute, New Lambton 2305 NSW; Wallsend New South Wales Australia
- Priority Research Centre for Health Behaviour (PRCHB); University of Newcastle, Callaghan NSW 2308; Wallsend New South Wales Australia
| | - Alexis Hure
- School of Medicine and Public Health; University of Newcastle Callaghan 2308 NSW & Hunter Medical Research Institute, New Lambton 2305 NSW; Wallsend New South Wales Australia
| | - Tara Clinton-Mcharg
- School of Medicine and Public Health; University of Newcastle Callaghan 2308 NSW & Hunter Medical Research Institute, New Lambton 2305 NSW; Wallsend New South Wales Australia
| | - Eliza Skelton
- School of Medicine and Public Health; University of Newcastle Callaghan 2308 NSW & Hunter Medical Research Institute, New Lambton 2305 NSW; Wallsend New South Wales Australia
| | - John Wiggers
- School of Medicine and Public Health; University of Newcastle Callaghan 2308 NSW & Hunter Medical Research Institute, New Lambton 2305 NSW; Wallsend New South Wales Australia
- Priority Research Centre for Health Behaviour (PRCHB); University of Newcastle, Callaghan NSW 2308; Wallsend New South Wales Australia
- Hunter New England Population Health; Hunter New England Local Health District 2287; Wallsend New South Wales Australia
| | - Luke Wolfenden
- School of Medicine and Public Health; University of Newcastle Callaghan 2308 NSW & Hunter Medical Research Institute, New Lambton 2305 NSW; Wallsend New South Wales Australia
- Priority Research Centre for Health Behaviour (PRCHB); University of Newcastle, Callaghan NSW 2308; Wallsend New South Wales Australia
- Hunter New England Population Health; Hunter New England Local Health District 2287; Wallsend New South Wales Australia
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James A, Adams-Huet B, Shah M. Menu Labels Displaying the Kilocalorie Content or the Exercise Equivalent: Effects on Energy Ordered and Consumed in Young Adults. Am J Health Promot 2015; 29:294-302. [DOI: 10.4278/ajhp.130522-quan-267] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Determine the effect of menu labels displaying the energy content of food items or the exercise equivalent on energy ordered and consumed at lunch and energy intake for the remainder of the day in young adults. Design. Subjects were randomized to a menu with no labels (no-labels), menu with kilocalorie labels displaying the energy content of the food items (kcal-labels), or menu with exercise labels displaying the minutes of brisk walking needed to burn the food energy (exercise-labels). Setting. The study was conducted in one dining area located in a metabolic kitchen at the Texas Christian University and another located in a residence occupied by graduate students. Subjects. Of the 300 subjects, 55.7% were female, 77.3% were college students, 88% were white, and 88% were non-Hispanic. Mean body mass index and age were 24.2 ± 4.5 kg/m2 and 21.9 ± 2.3 years, respectively. Intervention. All menus contained the same food/beverage choices. Subjects ordered and consumed foods/beverages for lunch from the menu to which they were assigned. Subjects were blinded to study purpose. Measures. Energy ordered and consumed at lunch were assessed from the weight of the food ordered and consumed, respectively, and the energy content of the same foods available on the restaurant Web site. Postlunch energy intake was assessed by food recall. Analysis. Analysis of covariance, adjusted for premeal hunger levels and gender, determined the effect of menu type on energy ordered and consumed and postlunch energy intake. Results. Significant menu effect was observed for energy ordered (p = .008) and consumed (p = .04) at lunch. The exercise-labels group ordered significantly (p = .002) less energy (adjusted mean [confidence intervals]: 763 [703, 824] kcal) at lunch, compared to the no-labels group (902 [840, 963] kcal) but not compared to the kcal-labels group (827 [766, 888] kcal). The exercise-labels group also consumed significantly (p = .01) less energy (673 [620, 725] kcal) at lunch, compared to the no-labels group (770 (717, 823) kcal) but not compared to the kcal-labels group (722 [669, 776] kcal). Energy ordered and consumed were not different between kcal-labels and no-labels groups. There was no difference in postlunch energy intake by menu type. Conclusion. The menu with exercise-labels resulted in less energy ordered and consumed and this did not lead to greater energy consumption post lunch, compared to the menu with no-labels in young adults largely made up of normal-weight, non-Hispanic white college students.
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Long MW, Tobias DK, Cradock AL, Batchelder H, Gortmaker SL. Systematic review and meta-analysis of the impact of restaurant menu calorie labeling. Am J Public Health 2015; 105:e11-24. [PMID: 25790388 PMCID: PMC4386504 DOI: 10.2105/ajph.2015.302570] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 11/04/2022]
Abstract
We conducted a systematic review and meta-analysis evaluating the relationship between menu calorie labeling and calories ordered or purchased in the PubMed, Web of Science, PolicyFile, and PAIS International databases through October 2013. Among 19 studies, menu calorie labeling was associated with a -18.13 kilocalorie reduction ordered per meal with significant heterogeneity across studies (95% confidence interval = -33.56, -2.70; P = .021; I(2) = 61.0%). However, among 6 controlled studies in restaurant settings, labeling was associated with a nonsignificant -7.63 kilocalorie reduction (95% confidence interval = -21.02, 5.76; P = .264; I(2) = 9.8%). Although current evidence does not support a significant impact on calories ordered, menu calorie labeling is a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories. These findings are limited by significant heterogeneity among nonrestaurant studies and few studies conducted in restaurant settings.
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Affiliation(s)
- Michael W Long
- Michael W. Long, Angie L. Cradock, and Steven L. Gortmaker are with Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Deirdre K. Tobias is with Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Holly Batchelder is with Tufts University Friedman School of Nutrition Science and Policy, Boston
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Using traffic light labels to improve food selection in recreation and sport facility eating environments. Appetite 2015; 91:329-35. [PMID: 25913684 DOI: 10.1016/j.appet.2015.04.057] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 02/27/2015] [Accepted: 04/16/2015] [Indexed: 11/23/2022]
Abstract
Many recreation and sports facilities have unhealthy food environments, however managers are reluctant to offer healthier foods because they perceive patrons will not purchase them. Preliminary evidence indicates that traffic light labeling (TLL) can increase purchase of healthy foods in away-from-home food retail settings. We examined the effectiveness of TLL of menus in promoting healthier food purchases by patrons of a recreation and sport facility concession, and among various sub-groups. TLL of all menu items was implemented for a 1-week period and sales were assessed for 1-week pre- and 1-week post-implementation of TLL (n = 2101 transactions). A subset of consumers completed a survey during the baseline (n = 322) and intervention (n = 313) periods. We assessed change in the proportion of patrons' purchases that were labeled with green, yellow and red lights from baseline to the TLL intervention, and association with demographic characteristics and other survey responses. Change in overall revenues was also assessed. There was an overall increase in sales of green (52.2% to 55.5%; p < 0.05) and a reduction in sales of red (30.4% to 27.2%; p < 0.05) light items from baseline to the TLL period. The effectiveness of TLL did not differ according to any of the demographic or other factors examined in the survey. Average daily revenues did not differ between the baseline and TLL periods. TLL of menus increased purchase of healthy, and reduced purchase of unhealthy foods in a publicly funded recreation and sport facility, with no loss of revenue. Policymakers should consider extending menu labeling laws to public buildings such as recreation and sports facilities to promote selection of healthier items.
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Bowen DJ, Barrington WE, Beresford SA. Identifying the effects of environmental and policy change interventions on healthy eating. Annu Rev Public Health 2015; 36:289-306. [PMID: 25785891 PMCID: PMC4583099 DOI: 10.1146/annurev-publhealth-032013-182516] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Obesity has been characterized as a disease. Strategies to change the incidence and prevalence of this disease include a focus on changing physical and social environments, over and above individual-level strategies, using a multilevel or systems approach. We focus our attention on evidence published between 2008 and 2013 on the effectiveness of interventions in nutrition environments, i.e., environmental interventions designed to influence the intake of healthful foods and amount of energy consumed. An overarching socioecological framework that has guided much of this research was used to characterize different types of environmental strategies. Intervention examples in each area of the framework are provided with a discussion of key findings and related conceptual and methodological issues. The emphasis in this review is on adults, but clearly this literature is only one part of the picture. Much research has been focused on child-specific interventions, including environmental interventions. Some evidence suggests effectiveness of policy-based or other types of interventions that aim to regulate or restructure environments to promote healthy dietary choices, and these strategies would apply to both children and adults. Opportunities to evaluate these policy changes in adults' social and physical environments are rare. Much of the existing research has been with children. As conceptual and methodological issues continue to be identified and resolved, we hope that future research in this domain will identify environmental strategies that can be included in intervention toolboxes to build healthy nutrition environments for both adults and children.
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Affiliation(s)
- Deborah J. Bowen
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, Washington 98195
| | - Wendy E. Barrington
- Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington 98195
| | - Shirley A.A. Beresford
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109
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Bleich SN, Barry CL, Gary-Webb TL, Herring BJ. Reducing sugar-sweetened beverage consumption by providing caloric information: how Black adolescents alter their purchases and whether the effects persist. Am J Public Health 2014; 104:2417-24. [PMID: 25322298 PMCID: PMC4232169 DOI: 10.2105/ajph.2014.302150] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We examined the ways in which adolescents altered the type and size of their purchases of sugar-sweetened beverages (SSBs), together with whether the effects persisted after removing caloric information signs in stores. METHODS We used a case-crossover design with 6 stores located in low-income Black neighborhoods in Baltimore, Maryland, from 2012 to 2013. The intervention used 1 of 4 randomly posted signs with caloric information: absolute calories, number of teaspoons of sugar, and number of minutes of running or miles of walking necessary to burn off a beverage. We collected data for 4516 purchases by Black adolescents, including both baseline and postintervention periods with no signs posted. RESULTS We found that providing caloric information significantly reduced the number of total beverage calories purchased, the likelihood of buying an SSB, and the likelihood of buying an SSB greater than 16 ounces (P < .05). After removing the signs, the quantity, volume, and number of calories from SSB purchases remained lower than baseline (P < .05). CONCLUSIONS Providing caloric information was associated with purchasing a smaller SSB, switching to a beverage with no calories, or opting to not purchase a beverage; there was a persistent effect on reducing SSB purchases after signs were removed.
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Affiliation(s)
- Sara N Bleich
- Sara N. Bleich, Colleen L. Barry, and Bradley J. Herring are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tiffany L. Gary-Webb is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and the Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY
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Kiszko KM, Martinez OD, Abrams C, Elbel B. The influence of calorie labeling on food orders and consumption: a review of the literature. J Community Health 2014; 39:1248-69. [PMID: 24760208 PMCID: PMC4209007 DOI: 10.1007/s10900-014-9876-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity is a challenging public health problem that affects millions of Americans. Increasingly policy makers are seeking environmental and policy-based solutions to combat and prevent its serious health effects. Calorie labeling mandates, including the provision in the 2010 Patient Protection and Affordable Care Act that is set to begin in 2014, have been one of the most popular and most studied approaches. This review examines 31 studies published from January 1, 2007 through July 19, 2013. It builds on Harnack and French's 2008 review and assesses the evidence on the effectiveness of calorie labeling at the point of purchase. We find that, while there are some positive results reported from studies examining the effects of calorie labeling, overall the best designed studies (real world studies, with a comparison group) show that calorie labels do not have the desired effect in reducing total calories ordered at the population level. Moving forward, researchers should consider novel, more effective ways of presenting nutrition information, while keeping a focus on particular subgroups that may be differentially affected by nutrition policies.
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Affiliation(s)
- Kamila M. Kiszko
- New York University School of Medicine, Department of Population Health, Senior Research Coordinator 550 First Avenue, VZ30 6 Floor, New York, NY 10016;
| | - Olivia D. Martinez
- New York University School of Medicine, Department of Population Health, Research Data Associate 550 First Avenue, VZ30 6 Floor, New York, NY 10016;
| | - Courtney Abrams
- New York University School of Medicine, Department of Population Health, Program Manager 550 First Avenue, VZ30 6 Floor, New York, NY 10016;
| | - Brian Elbel
- New York University School of Medicine, Department of Population Health and New York University Wagner School of Public Service, Assistant Professor 550 First Avenue, VZ30 6 floor, 626, New York, New York 10016 Phone: 212-263-4283
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‘How many calories are in my burrito?’ Improving consumers’ understanding of energy (calorie) range information. Public Health Nutr 2014; 18:15-24. [DOI: 10.1017/s1368980014000627] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveEnergy (calorie) ranges currently appear on menu boards for customized menu items and will likely appear throughout the USA when menu-labelling legislation is implemented. Consumer welfare advocates have questioned whether energy ranges enable accurate energy estimates. In four studies, we examined: (i) whether energy range information improves energy estimation accuracy; (ii) whether misestimates persist because consumers misinterpret the meaning of the energy range end points; and (iii) whether energy estimates can be made more accurate by providing explicit information about the contents of items at the end points.DesignFour studies were conducted, all randomized experiments.SettingStudy 1 took place outside a Chipotle restaurant. Studies 2 to 4 took place online.SubjectsParticipants in study 1 were customers exiting a Chipotle restaurant (n 306). Participants in studies 2 (n 205), 3 (n 290) and 4 (n 874) were from an online panel.ResultsEnergy ranges reduced energy misestimation across different menu items (studies 1–4). One cause of remaining misestimation was misinterpretation of the low end point’s meaning (study 2). Providing explicit information about the contents of menu items associated with energy range end points further reduced energy misestimation (study 3) across different menu items (study 4).ConclusionsEnergy range information improved energy estimation accuracy and defining the meaning of the end points further improved accuracy. We suggest that when restaurants present energy range information to consumers, they should explicitly define the meaning of the end points.
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Sonnenberg L, Gelsomin E, Levy DE, Riis J, Barraclough S, Thorndike AN. A traffic light food labeling intervention increases consumer awareness of health and healthy choices at the point-of-purchase. Prev Med 2013; 57:253-7. [PMID: 23859926 PMCID: PMC3913274 DOI: 10.1016/j.ypmed.2013.07.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/02/2013] [Accepted: 07/02/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We surveyed customers in a hospital cafeteria in Boston, Massachusetts before and after implementation of traffic light food labeling to determine the effect of labels on customers' awareness and purchase of healthy foods. METHODS Cafeteria items were identified as red (unhealthy), yellow (less healthy), or green (healthy). Customers were interviewed before (N=166) and after (N=223) labeling was implemented. Each respondent was linked to cash register data to determine the proportion of red, yellow, and green items purchased. Data were collected from February-April 2010. We compared responses to survey questions and mean proportion of red, yellow, and green items per transaction between customers interviewed during baseline and customers interviewed during the intervention. Survey response rate was 60%. RESULTS Comparing responses during labeling intervention to baseline, more respondents identified health/nutrition as an important factor in their purchase (61% vs. 46%, p=0.004) and reported looking at nutrition information (33% vs. 15%, p<0.001). Respondents who noticed labels during the intervention and reported that labels influenced their purchases were more likely to purchase healthier items than respondents who did not notice labels (p<0.001 for both). CONCLUSION Traffic light food labels prompted individuals to consider their health and to make healthier choices at point-of-purchase.
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Affiliation(s)
- Lillian Sonnenberg
- Massachusetts General Hospital, 165 Cambridge St., Suite 402, Boston, MA 02114, USA
| | - Emily Gelsomin
- Massachusetts General Hospital, 165 Cambridge St., Suite 402, Boston, MA 02114, USA
| | - Douglas E. Levy
- Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St., Boston, MA 02114, USA
| | - Jason Riis
- Harvard Business School, Boston, MA 02163, USA
| | | | - Anne N. Thorndike
- Harvard Medical School, General Medicine Division, Massachusetts General Hospital, 50 Staniford St., Boston, MA 02114, USA
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