Cross-national investigation of the drivers of obesity: Re-assessment of past findings and avenues for the future

The visual analogue scale as a child-friendly measure of the unhealthy = tasty intuition

Worldwide, obesity is a growing concern. The implicit belief that healthiness and tastiness in food are inversely related (the Unhealthy = Tasty Intuition or UTI) decreases healthy food consumption and increases the risk of obesity. Since also childhood obesity has increased at an alarming rate and a large component of adult obesity is established during childhood, questions about children's own food beliefs and preferences are important. However, methods currently used to assess the UTI are either unvalidated Likert scales or implicit measures that are time intensive and too complex to be used for children. Two studies presented here offer an alternative measurement - the simple visual analogue scale. The findings show that this measure is more effective in predicting dietary quality in adults and the frequency of healthy food consumption in children compared to more traditional measures. This simple and effective tool could be used by academics and health practitioners alike to better understand children's food beliefs at an early age, which is a critical step when addressing the increasing obesity problem.

Evaluation of Dietary and Alcohol Drinking Patterns in Patients with Excess Body Weight in a Spanish Cohort: Impact on Cardiometabolic Risk Factors

Unhealthy dietary habits and sedentarism coexist with a rising incidence of excess weight and associated comorbidities. We aimed to analyze the dietary and drinking patterns of patients with excess weight, their main characteristics, plausible gender differences and impact on cardiometabolic risk factors, with a particular focus on the potential contribution of beer consumption. Data from 200 consecutive volunteers (38 ± 12 years; 72% females) living with overweight or class I obesity attending the obesity unit to lose weight were studied. Food frequency questionnaires and 24 h recalls were used. Reduced-rank regression (RRR) analysis was applied to identify dietary patterns (DPs). Anthropometry, total and visceral fat, indirect calorimetry, physical activity level, comorbidities and circulating cardiometabolic risk factors were assessed. Study participants showed high waist circumference, adiposity, insulin resistance, dyslipidemia, pro-inflammatory adipokines and low anti-inflammatory factors like adiponectin and interleukin-4. A low-fiber, high-fat, energy-dense DP was observed. BMI showed a statistically significant (p < 0.05) correlation with energy density (r = 0.80) as well as percentage of energy derived from fat (r = 0.61). Excess weight was associated with a DP low in vegetables, legumes and whole grains at the same time as being high in sweets, sugar-sweetened beverages, fat spreads, and processed meats. RRR analysis identified a DP characterized by high energy density and saturated fat exhibiting negative loadings (>-0.30) for green leafy vegetables, legumes, and fruits at the same time as showing positive factor loadings (>0.30) for processed foods, fat spreads, sugar-sweetened beverages, and sweets. Interestingly, for both women and men, wine represented globally the main source of total alcohol intake (p < 0.05) as compared to beer and distillates. Beer consumption cannot be blamed as the main culprit of excess weight. Capturing the DP provides more clinically relevant and useful information. The focus on consumption of single nutrients does not resemble real-world intake behaviors.

Overweight and obesity in adulthood, sociodemographic factors, lifestyle, and the early burden of noncommunicable diseases among Americans: NHANES 2007-2018

OBJECTIVES

To evaluate the association between nutritional status in early adulthood and the burden of noncommunicable diseases (NCDs); To evaluate the influence of sociodemographic factors and lifestyle on the outcomes of BMI kg/m2  ≤24.9, ≥25.0, and ≥30.0; to estimate the population attributable fraction (PAF) to BMI elevated at 25 years old in the burden of NCDs in American adults.

METHODS

We used data from 15 721 American adults participating in the National Health and Nutrition Examination Survey from 2007 to 2018. The Hazard Ratio (HR), Incidence Rate Ratio (IRR), and 95% confidence intervals (CI) were estimated in the proportional risk regression models of Cox (entire population) and Poisson (restricted to non-patients), respectively. The proportionality of the risk between the burden of NCDs and BMI at 25 years old was drawn by the Kaplan-Meier curve, and the PAF was calculated. All analyses were adjusted taking into account the sample weights.

RESULTS

Health disparities (sex, age, race/ethnicity, education, poverty index, and education level), and lifestyle (physical activity, smoking, and alcohol consumption) influenced the current nutritional status. Cumulative survival in overweight and obese groups decreased considerably over time (p < .0001). Being overweight and obese in adulthood may increase the risk of early NCDs (HR: 1.68, 95% CI: 1.54-1.84 and HR: 2.87, 95% CI: 2.56-3.21, respectively). About 22.72% (95% CI: 19.99-25.36, p < .001) of the burden NCDs could have been avoided if overweight at age 25 had been prevented.

CONCLUSIONS

Monitoring weight change from young adulthood can provide a sensitive and useful clinical measure for early detection of adverse trends in NCDs risk.

The unhealthy-tasty intuition in dining out situations: the role of health inferences and taste expectations

Introduction

Increasing obesity rates around the globe have challenged policymakers to find strategies to prompt healthier eating habits. While unhealthy eating takes place in many different contexts, dining out is a context where individuals often choose an unhealthy option despite the availability of healthier alternatives. One possible explanation for this behavior is the unhealthy-tasty intuition, which refers to the belief that unhealthy food is tastier than healthy food. Nevertheless, many policymakers and restaurant managers follow the - in this context - counterintuitive approach of using health claims to nudge people towards more healthy eating choices or habits.

Methods

The current research employs an online experiment with 137 participants and investigates how health claims and sensory claims impact on the purchase intention of healthy options for desserts. Furthermore, it explores how health inferences and taste expectations mediate the intention to purchase.

Results and discussion

Findings from the online experiment confirm that health claims prompt positive health inferences, while also stimulating unfavorable taste expectations, resulting in a lower intention to purchase. Surprisingly, we found no effect of a sensory claim on taste expectations. The findings of our experiment contradict the unhealthy-tasty intuition by revealing a significant positive correlation between taste expectations and health inferences. While both health inferences and taste expectations impact positively on purchasing intentions for the health-claim condition, the indirect effect of taste expectations was stronger than the indirect effect of health inferences.

"Unhealthy = Tasty": How Does It Affect Consumers' (Un)Healthy Food Expectations?

Consumers having a strong unhealthy = tasty (UT) belief are less likely to choose healthy food even though they recognize its health benefits, because they assume healthy food to be unpalatable. The aim of this study was to profile consumers according to their UT belief and specify the strength of the belief among a demographically representative consumer group. The other aim was to investigate the effect of UT belief on expectations of two food products representing either an unhealthy or a healthy image. A total of 1537 consumers participated in the online survey. The scale-based (1-7) mean for UT belief was 3.27 and related positively to male gender and food pleasure orientation and negatively to general health interest. The results indicate that a strong UT belief correlates with positive expectations of unhealthy food and with negative expectations of healthy food. UT belief seemed to increase expected food-associated guilt, but other strong food-related attitudes (health interest with unhealthy food and pleasure orientation with healthy food) reduced this effect. In practice, understanding the relationship between UT belief and personal factors and attitudes, and the importance of this belief to food expectations can assist in finding the tools to encourage consumers towards healthier food choices.

Cultural Influences on the Regulation of Energy Intake and Obesity: A Qualitative Study Comparing Food Customs and Attitudes to Eating in Adults from France and the United States

(1) Background: The influence of food culture on eating behavior and obesity risk is poorly understood. (2) Methods: In this qualitative study, 25 adults in France with or without overweight/obesity participated in semi-structured interviews (n = 10) or focus groups (n = 15) to examine attitudes to food consumption and external pressures that influence eating behavior and weight management. Results were compared to an equivalent study conducted in the United States, thereby contrasting two countries with markedly different rates of obesity. Emerging key themes in the French data were identified through coding using a reflexive approach. (3) Results: The main themes identified were: (1) influence of commensality, social interactions, and pleasure from eating on eating behavior, (2) having a balanced and holistic approach to nutrition, (3) the role of environmental concerns in food consumption, (4) relationship with "natural" products (idealized) and food processing (demonized), (5) perceptions of weight status and management. Stress and difficulties in hunger cue discernment were viewed as important obstacles to weight management in both countries. External pressures were described as a major factor that explicitly influences food consumption in the U.S., while there was an implicit influence of external pressures through eating-related social interactions in France. In France, products considered "natural" where idealized and juxtaposed against processed and "industrial" products, whereas this was not a salient aspect in the U.S. (4) Conclusions: This first comparative qualitative study assessing aspects of food culture and eating behaviors across countries identifies both common and divergent attitudes to food and eating behavior. Further studies are needed to inform the development of effective behavioral interventions to address obesity in different populations.

The unhealthy = tasty belief is associated with BMI through reduced consumption of vegetables: A cross-national and mediational analysis

Obesity is one of the greatest public health challenges of modern times and its prevalence is increasing worldwide. With food so abundant in developed countries, many people face a conflict between desires for short-term taste and the goal of long-term health, multiple times a day. Recent research suggests that consumers often resolve these conflicts based on their lay beliefs about the healthiness and tastiness of food. Consequently, such lay beliefs can play critical roles not just in food choice but also weight gain. In this research, we show, across six countries and through mediation analysis, that adults who believe that tasty food is unhealthy (the Unhealthy = Tasty Intuition, or "UTI"; Raghunathan, Naylor, & Hoyer 2006) are less likely to consume healthy food, and thereby have a higher body mass index (BMI). In Study 1, we conducted a cross-sectional survey in five countries (Australia, Germany, Hong Kong, India, and the UK), and found that greater strength of belief in UTI was associated with higher BMI, and this relationship was mediated by lower consumption of fruits and vegetables. The observed patterns largely converged across the sampled Western and Asian-Pacific countries. In Study 2, we teased apart the mediating role of vegetable versus fruit consumption and also addressed the issue of reversed causality by predicting BMI with a measure of UTI belief taken 30 months previously. We found that vegetable consumption, but not fruit consumption, mediated the association between UTI belief and BMI. Our findings contribute to the literature by showing how lay beliefs about food can have pervasive and long-lasting effects on dietary practices and health worldwide. Implications for public policy and health practitioners are discussed.

Healthy Advertising Coming to Its Senses: The Effectiveness of Sensory Appeals in Healthy Food Advertising

With increasing obesity rates and the daily overload of unhealthy food appeals, an important objective for advertising today is to promote healthy food consumption. According to previous research, sensory food advertisements referring to multiple senses—a combination of visual (sight), tactile (touch) and olfactory (smell) cues—evoke more positive sensory thoughts and, therefore, higher taste perceptions than advertisements referring to a single sense (e.g., only taste cues). However, this research only focused on sensory advertising for unhealthy food. The current research investigates how sensory advertising can promote healthy food. While multiple-sense ads for unhealthy food were shown to be more effective than single-sense ads, we find that, for healthy food, single-sense ads increase taste perceptions and advertising effectiveness compared to multiple-sense ads. In two laboratory experiments, we show a different underlying process for this effect—that is, single-sense ads evoke fewer negative thoughts than multiple-sense ads, which mediates the effect of single-sense versus multiple-sense ads on taste perceptions and advertising effectiveness. Moreover, we show that these effects occur not only for verbal ads but, importantly, also for visual ads, which are omnipresent today. This article closes with implications for theory and suggestions for food marketers, ad executives, and public policy.