Consumer research for development of educational messages for the MyPyramid Food Guidance System

Whose Plate Is It? Awareness of MyPlate Among US Adults Over Time Since Implementation

BACKGROUND

MyPlate is a tool designed to educate the general US population on how to eat in alignment with the Dietary Guidelines for Americans; yet, there is a lack of data on who has heard of MyPlate over time.

OBJECTIVE

The objective of this analysis was to examine the prevalence of awareness of MyPlate within the US population and if awareness changes differentially over time.

DESIGN

This study was a serial, cross-sectional survey.

PARTICIPANTS/SETTING

Three survey waves of data (2013-2018) were used from the National Health and Nutrition Examination Survey of adults aged 20 years or older (n = 17,023).

MAIN OUTCOME MEASURES

Percentage of the US adult population who had heard of MyPlate was measured and stratified by sex, age, citizenship status, education, household food security status, income, receipt of Supplemental Nutrition Assistance Program (SNAP) benefits, and receipt of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits.

STATISTICAL ANALYSES PERFORMED

Global Wald tests were used to assess whether prevalence of awareness of MyPlate differed by sociodemographic characteristics. Tests of homogeneity using likelihood ratio tests of nested logistic regression models were used to assess whether differences in awareness of MyPlate by various sociodemographic characteristics changed over time from 2013 to 2018.

RESULTS

Twenty percent (19.5%) (n = 875) of the analytic sample of participants aged 20 years and older had heard of MyPlate in 2013-2014, 24.5% (n = 1,020) in 2015-2016, and 24.6% (n = 1,086) in 2017-2018. Awareness of MyPlate changed differentially over time (P value < .1) from 2013 to 2018 by income, household food security status, and receipt of SNAP benefits, with slower increases in awareness for households with lowest income over time, narrowing of differences in awareness by household food security status over time, and persistent differences in awareness by receipt of SNAP benefits over time.

CONCLUSIONS

These results highlight the current low awareness of MyPlate, disparities in awareness of MyPlate immediately after implementation by sociodemographic characteristics, and increases in awareness over time at differential rates within levels of income, food security status, and ever receipt of SNAP benefits. Given that the Dietary Guidelines for Americans 2025-2030 are currently in development, new strategies should be considered to disseminate tools that translate the updated Dietary Guidelines in such a way that reach the general population equitably upon implementation within the United States.

From harmful nutrients to ultra-processed foods: exploring shifts in 'foods to limit' terminology used in national food-based dietary guidelines

OBJECTIVE

The choice of terms used to describe 'foods to limit' (FTL) in food-based dietary guidelines (FBDG) can impact public understanding, policy translation and research applicability. The choice of terms in FBDG has been influenced by available science, values, beliefs and historical events. This study aimed to analyse the terms used and definitions given to FTL in FBDG around the world, including changes over time and regional differences.

DESIGN

A review of terms used to describe FTL and their definitions in all current and past FBDG for adults was conducted, using a search strategy informed by the FAO FBDG website. Data from 148 guidelines (96 countries) were extracted into a pre-defined table and terms were organised by the categories 'nutrient-based', 'food examples' or 'processing-related'.

SETTING

National FBDG from all world regions.

PARTICIPANTS

None.

RESULTS

Nutrient-based terms (e.g. high-fat foods) were the most frequently used type of term in both current and past dietary guidelines (91 %, 85 %, respectively). However, food examples (e.g. cakes) and processing-related terms (e.g. ultra-processed foods) have increased in use over the past 20 years and are now often used in conjunction with nutrient-based terms. Regional differences were only observed for processing-related terms.

CONCLUSION

Diverse, and often poorly defined, terms are used to describe FTL in FBDG. Policymakers should ensure that FTL terms have clear definitions and can be integrated with other disciplines and understood by consumers. This may facilitate the inclusion of the most contemporary and potentially impactful terminology in nutrition research and policies.

The feasibility of implementing food-based dietary guidelines and food graphics in Ethiopia

This study aimed to test the acceptability, cultural appropriateness, consumers' understanding, and practicality of the Ethiopian food-based dietary guideline's messages, tips, and food graphics. A qualitative study design was applied with focus group discussions and key informant interviews. Four different participant groups were included: 40 consumers, 15 high-level nutrition experts, 30 frontline community health extension workers (HEWs), and 15 agriculture extension workers (AEWs) to incorporate different stakeholder perspectives. Data collection was conducted using 7 focus group discussions (FGDs) and 30 key informant interviews (KIIs). Collected data were coded and analyzed using QSR International NVivo V.11 software. Most of the study participants were highly interested in implementing the dietary guidelines once these guidelines are officially released. Based on the participants' views, most of the messages align with the current nutrition education materials implemented in the country except the messages about physical activity and alcohol intake. However, participants suggested defining technical terms such as ultra-processing, whole grain, safe and balanced diet in simpler terms for a better understanding. Practicality, affordability, availability, and access to the market were the major barriers reported for adherence to the guidelines. To be more inclusive of cultural and religious beliefs, findings show that the guideline should address fasting and traditional cooking methods. In conclusion, the dietary guidelines were well received by most stakeholders. They are thought to be feasible once feedback on wording, affordability, availability, and access is considered in the messages, tips, and graphic designs.

Differences in Awareness of Chinese Dietary Guidelines Among Urban and Rural Residents: A Cross-Sectional Survey in Southwest China

Objectives: This study aimed to compare the awareness of Chinese dietary guidelines (CDGs, 2016) between rural and urban areas in Southwest China and identify the factors that affect CDGs (2016) awareness. Methods: This cross-sectional survey included 8,320 individuals aged 18-75 years from Chongqing, Sichuan, Guizhou, and Yunnan, China. Convenience sampling method was adopted to select the survey subjects and face-to-face surveys in each region were conducted to collect data. Descriptive statistics and generalized linear model were used to evaluate differences in awareness of CDGs among urban and rural residents and its influencing factors. Results: Overall CDGs awareness was low in urban and rural areas, although the awareness rate was higher in the former than in the latter (29.1% vs. 19.9%, respectively). Region, education level, Body Mass Index (BMI), gender, income, and age are the influencing factors of CDGs awareness. Urban participants were likely to acquire relevant knowledge from social media, books/magazines, family/friends, and experts. However, rural participants were likely to acquire relevant knowledge from food sales staff (p < 0.05). Conclusion: Rural residents are less aware of CDGs than their urban counterparts in Southwest China. Future dietary education should adopt different strategies for different populations, with considerable focus on rural residents.

Consumer perception of food variety in the UK: an exploratory mixed-methods analysis

BACKGROUND

'Food variety' is a key term that is frequently used in dietary guidelines around the world. Consuming a variety of foods - be it within a meal, across meals, or as part of the whole diet - is one factor that has been shown to increase food intake. However, little is known about consumer understanding of variety, and this may be a potential barrier to the success of dietary guidelines in today's 'obesogenic' environment. This research sought to explore 1) consumer recognition of different forms of variety, and 2) consumer definitions of variety.

METHODS

In an online study (N = 240), participants were asked to discuss a range of photographs depicting different forms of variety, and to directly define the term 'food variety'. They were unaware of the research aim.

RESULTS

Using a mixed methods approach, directed content analysis of these data showed that individuals referenced multiple forms of variety in the presence of food photographs. However, when asked to define variety, participants tended to only discuss variety in the context of the whole diet.

CONCLUSIONS

These findings emphasise a need to educate consumers about variety to encourage adherence to dietary guidelines and help consumers better manage their own food intake.

Developing and refining behaviour-change messages based on the Brazilian dietary guidelines: use of a sequential, mixed-methods approach

Background

Dietary Guidelines are an important tool for population health promotion efforts. However, current surveillance data suggest that only a small minority of the population meet the 2014 Brazilian Dietary Guidelines (BDG) recommendations. Translating recommendations into practice may not be immediately clear and behavior-change messages guiding the behaviors that need to be changed and identifying substitute practices to meet a specific recommendation, are required. This study details the methods undertaken to develop and refine messages supporting the adoption of healthy dietary choices and behaviors in adults, as outlined in the BDG.

Methods

A sequential, five-step, mixed-methods approach, determined a priori, was followed for designing and refining messages. These included: (1) content extraction; (2) audience analysis; (3) input from an expert review panel; (4) message development and message refinement; and a (5) test of content validity.

Results

The content extraction process led to the identification of 63 excerpts from the BDG, organized into themes. The audience analysis highlighted barriers to healthy eating that included lack of time (to eat, to cook), difficulty in accessing healthy food, the convenience and the ubiquitous marketing of ultra-processed foods. Twenty of the 63 DG excerpts reviewed by the expert panel were identified as being a priority for message development and total of 111 messages were developed. Messages were short, structured to be one-sided, conveyed the most important information at the beginning (anticlimactic), used simple language and were explicit in the information they relayed. They were positive and gain-framed and used an empathetic, solution- or substitution-based tone and were presented in the active voice. The messages focused on goals and skill development, behavior regulation, incentivized positive practices as time and/or cost saving. Content validity testing helped further messages and reduced the number of messages from 111 to 40.

Conclusions

This study provides the blue-print for the phase-wise development of messages that synthesize the key recommendations of the food-based BDG and communicate the adoption of behaviors and goals that are consistent with it’s message. It details methods which could be adapted and replicated for message development in other contexts.

A systematic review of recall errors associated with portion size estimation aids in children

To reduce errors in portion size estimation, a number of aids have been developed and tested. This systematic review synthesizes what is known about error associated with use of different portion size estimation aids (PSEAs) within self-reported dietary recall studies in children (aged ≤18 years). Eight electronic databases were searched using relevant keywords. From 8184 records identified and screened, 327 full texts were retrieved, with 10 records representing 9 studies meeting inclusion criteria. Studies using proxy reporting were excluded. Thirteen PSEAs were identified. To facilitate comparisons between different types of aids they were categorized into 'physical 2-dimensional (2D)', 'digital 2D' and '3-dimensional' PSEAs. Seven were physical 2D (e.g. food atlas), two were digital 2D (i.e. computer-based), and four were 3D (e.g. modelling clay, household items). Comparisons of PSEAs within studies found the smallest estimation errors for digital 2D and largest for 3D aids. Errors in relation to food type were varied, with portions of amorphous foods overestimated in multiple studies. No effects for recall interval time or sex were identified. One study reported a significant improvement in estimation error with increasing age. Across studies, large variations in study design and reporting of estimation error hindered the synthesis of evidence regarding the influence of different types of PSEAs on accuracy. While a definitive conclusion about the most accurate PSEA could not be drawn, a check-list to guide future PSEA development and testing has been proposed in the current review. This will assist comparability with future studies of PSEAs for children facilitate development of more accurate PSEAs in the future.

Food portion sizes, obesity, and related metabolic complications in children and adolescents

Introduction

The purpose of this narrative review is to provide evidence for the impact of food portion sizes on the development of obesity in children and adolescents. Strategies are needed on portion size estimation and on the relationship of portion size with certain health problems such as obesity, insulin resistance, and emotional eating in all age groups, in order to provide information for parents, teachers, and health professionals aiming to promote healthy eating. A wide range of controlled laboratory studies have found that portion size (PS) had the strongest effect on the amount of food consumed. The effect of PS on total energy intake has been already observed with different types of foods and beverages, especially with energy-dense foods. The influence of large PS was persistent and happened regardless of demographic characteristics such as age, gender, income level, or body mass index. Although a direct causal link between PS and obesity remains controversial, some health and dietetics organizations recommend to moderate PS, especially for energy-dense foods. Research studies in both laboratory and free-living contexts are needed to determine the causal link between increased PS, obesity, and related metabolic complications in children and adolescents.

Evaluating MyPlate After 8 Years: A Perspective

MyPlate is the current educational icon that supports communication of US Dietary Guidelines for Americans to the public. Since its inception in 2011, there has been a paucity of research documenting consumer awareness of the icon and its effectiveness for improving Americans' diets. This perspective presents the extent to which MyPlate has been represented in the nutrition education literature and discusses current evaluation and utilization needs. The authors argue that more rigorous, theory-based evaluation of MyPlate, as both a standalone icon and part of educational interventions, is needed to advance communication and adoption of the Dietary Guidelines for Americans.

Considerations for Evaluation of Fruit and Vegetable Intake in Low-Literate Spanish-Speaking Participants in USDA Food and Nutrition Education Programs

Rates of obesity and associated chronic disease are high in Hispanics in the United States. Nutrition education interventions promoting dietary change in underserved populations have been shown to have positive effects on behaviors such as fruit and vegetable (FV) intake, thereby reducing the chronic disease burden. Evaluation tools in the Spanish language to assess the dietary behavior changes made in response to the intervention are important in determining the success of such efforts. Currently, there are no Spanish-language tools focused exclusively on FV intake and behaviors that include features to enhance readability for use in low-literacy participants of US Department of Agriculture (USDA) food assistance and education programs. There is a need for such tools to determine the degree to which programs are able to promote behavior change. In designing these tools, researchers should take into account potential issues that may arise when administered. For example, respondents may have difficulty estimating consumption for mixed dishes and vegetables added to food. To address such issues, researchers should employ strategies to assist respondents to understand what constitutes FV and appropriately identify amount consumed. Addition of images to tools or development of accompanying instruction guides may be helpful. Once developed and tested, such scales may be used with Spanish-speaking participants of USDA food assistance and education programs aimed at improving FV behaviors and ultimately, intake.

Challenges following a personalised diet adhering to dietary guidelines in a sample of Australian university students

BACKGROUND

Food-based dietary guidelines are designed to support populations to adopt a healthy diet. University students studying nutrition related courses are typically en-route to professional roles that involve advocating a healthy diet.

AIM

The present study compared the dietary intake of university students enrolled in a foundation nutrition course against the Australian Dietary Guidelines (ADGs) and Nutrient Reference Values (NRVs), and explored students' experiences of following a 3-day self-determined diet plan adhering to the ADGs/NRVs.

METHODS

Students (n = 115) initially collected, and subsequently analysed a 3-day prospective diet record to determine food group/nutrient intake. Individuals then modified their diet to comply with recommendations (ADGs/NRVs) and attempted to implement the diet plan. Challenges associated with meeting the ADGs/NRVs were described in an online survey form.

RESULTS

Baseline food group and nutrient intakes deviated from the guidelines, with 'lean meats & alternatives' the only group consumed in recommended quantities. Students demonstrated the capacity to plan a modified personal diet adhering to the ADGs food group recommendations. However, when following this, several key challenges to dietary adherence were identified. Challenges were categorised as personal/behavioural factors (e.g. the quantity/type of food) and societal factors (e.g. time, cost, social factors).

CONCLUSION

Overall, this study highlights challenges influencing adherence to dietary guidelines in a sample of undergraduate university students. Understanding these factors may help tailor advice to facilitate improved dietary patterns in this population group.

Big hearts, small hands: a focus group study exploring parental food portion behaviours

BACKGROUND

The development of healthy food portion sizes among families is deemed critical to childhood weight management; yet little is known about the interacting factors influencing parents' portion control behaviours. This study aimed to use two synergistic theoretical models of behaviour: the COM-B model (Capability, Opportunity, Motivation - Behaviour) and Theoretical Domains Framework (TDF) to identify a broad spectrum of theoretically derived influences on parents' portion control behaviours including examination of affective and habitual influences often excluded from prevailing theories of behaviour change.

METHODS

Six focus groups exploring family weight management comprised of one with caseworkers (n = 4), four with parents of overweight children (n = 14) and one with parents of healthy weight children (n = 8). A thematic analysis was performed across the dataset where the TDF/COM-B were used as coding frameworks.

RESULTS

To achieve the target behaviour, the behavioural analysis revealed the need for eliciting change in all three COM-B domains and nine associated TDF domains. Findings suggest parents' internal processes such as their emotional responses, habits and beliefs, along with social influences from partners and grandparents, and environmental influences relating to items such as household objects, interact to influence portion size behaviours within the home environment.

CONCLUSION

This is the first study underpinned by COM-B/TDF frameworks applied to childhood weight management and provides new targets for intervention development and the opportunity for future research to explore the mediating and moderating effects of these variables on one another.

Depicted serving size: cereal packaging pictures exaggerate serving sizes and promote overserving

Background

Extensive work has focused on the effects of nutrition label information on consumer behavior on the one hand, and on the effects of packaging graphics on the other hand. However, little work has examined how serving suggestion depictions - graphics relating to serving size - influence the quantity consumers serve themselves. The current work examines the prevalence of exaggerated serving size depictions on product packaging (study 1) and its effects on food serving in the context of cereal (study 2).

Methods

Study 1 was an observational field survey of cereal packaging. Study 2 was a mixed experimental cross-sectional design conducted at a U.S. university, with 51 student participants. Study 1 coded 158 US breakfast cereals and compared the serving sizes depicted on the front of the box with the suggested serving size stated on the nutrition facts panel. Study 2 measured the amount of cereal poured from exaggerated or accurate serving size depictions. Study 1 compared average servings via t-tests. Study 2 used a mixed model with cereal type as the repeated measure and a compound symmetry covariance matrix.

Results

Study 1 demonstrated that portion size depictions on the front of 158 cereal boxes were 64.7% larger (221 vs. 134 calories) than the recommended portions on nutrition facts panels of those cereals. Study 2 showed that boxes that depicted exaggerated serving sizes led people to pour 17.8% more cereal compared to pouring from modified boxes that depicted a single-size portion of cereal matching suggested serving size. This was 42% over the suggested serving size.

Conclusions

Biases in depicted serving size depicted on cereal packaging are prevalent in the marketplace. Such biases may lead to overserving, which may consequently lead to overeating. Companies should depict the recommended serving sizes, or otherwise indicate that the depicted portion represents an exaggerated serving size.

Dietary guidance for pulses: the challenge and opportunity to be part of both the vegetable and protein food groups

Pulses are a dry, edible variety of beans, peas, and lentils that have been consumed for 10,000 years. Pulses are rich in plant-based protein and fiber, as well as micronutrients such as iron and potassium. The satiating effect of both fiber and protein assists in managing weight and combating obesity. The high fiber content and low glycemic index of pulses aid people with diabetes in maintaining blood glucose and insulin levels. Pulse consumption may improve serum lipid levels to reduce the risk of cardiovascular disease. Pulses developed as a member of both the protein and vegetable food groups as a result of its high content of plant-based protein and dietary fiber. The last two revisions of the Dietary Guidelines saw the transformation from the MyPyramid "meat and beans group" to the MyPlate "protein foods group," a nutrient name rather than a food source. Research suggests that consumers better identify with food source examples rather than nutrient names. The 2015 Dietary Guidelines also came with a new area: sustainable diets. Encouraging the consumption of sustainable food sources, like pulses, is imperative to ensuring a secure, healthy food supply for the U.S. population over time and for future generations.

Defining "Protein" Foods

Changing the name of the "protein foods" group on the US Department of Agriculture's visual food guide, MyPlate, back to the "meat & beans" group would provide important clarification regarding US Department of Agriculture recommendations for a balanced diet. Previous iterations of the food guide named the protein group after its constituent foods (ie, the "meat & beans" group on the 2005 MyPyramid), and the reasons for renaming the entire group with MyPlate are unclear. The exclusion of dairy foods from the "protein foods" group of the 2010 MyPlate illustrates the shortcomings of this group's name. Dairy foods contain high-quality, affordable protein and constitute a significant portion of the protein intake among the US population but are not listed as "protein foods" on MyPlate. Dairy products and other high-calcium foods do have their own section of MyPlate; however, having this separate group does not mitigate the disingenuousness of having a "protein group" that excludes an important protein source. In addition, because consumers tend to understand food-based terms better than nutrient-based terms, a change to "meat & beans" group would also provide clarification for consumers and for educators regarding the content and role of this group.

An evaluation of portion size estimation aids: precision, ease of use and likelihood of future use

OBJECTIVE

The present study aimed to evaluate the precision, ease of use and likelihood of future use of portion size estimation aids (PSEA).

DESIGN

A range of PSEA were used to estimate the serving sizes of a range of commonly eaten foods and rated for ease of use and likelihood of future usage.

SETTING

For each food, participants selected their preferred PSEA from a range of options including: quantities and measures; reference objects; measuring; and indicators on food packets. These PSEA were used to serve out various foods (e.g. liquid, amorphous, and composite dishes). Ease of use and likelihood of future use were noted. The foods were weighed to determine the precision of each PSEA.

SUBJECTS

Males and females aged 18-64 years (n 120).

RESULTS

The quantities and measures were the most precise PSEA (lowest range of weights for estimated portion sizes). However, participants preferred household measures (e.g. 200 ml disposable cup) - deemed easy to use (median rating of 5), likely to use again in future (all scored either 4 or 5 on a scale from 1='not very likely' to 5='very likely to use again') and precise (narrow range of weights for estimated portion sizes). The majority indicated they would most likely use the PSEA preparing a meal (94 %), particularly dinner (86 %) in the home (89 %; all P<0·001) for amorphous grain foods.

CONCLUSIONS

Household measures may be precise, easy to use and acceptable aids for estimating the appropriate portion size of amorphous grain foods.

Usage and Understanding of Serving Size Information on Food Labels in the United States

Purpose.

To investigate consumer understanding and usage of serving size (SS) information on Nutrition Facts (NF) labels.

Design.

We analyzed three data sources: (1) U.S. Food and Drug Administration (FDA) Health and Diet Survey (HDS) 1994 (n = 1945), 1995 (n = 1001), and 2008 (n = 2584); (2) National Health and Nutrition Examination Survey (NHANES) 2005–2006 and 2007–2008 (n = 10,750); and (3) 2011 FDA Nutrition Facts Label Experimental Study (NFLES) (n = 9493). Data from FDA are cross-sectional and we focused on usage and meaning of SS.

Setting.

United States.

Subjects.

Adults (18+ years).

Measures.

Both HDS and NHANES addressed how often participants used SS information and HDS also asked how SS is determined. Both NHANES and NFLES contained similar questions on the meaning of SS but NFLES also included an open-ended response option.

Analysis.

We included both quantitative and qualitative measures. Questions were analyzed by demographic variables and body mass index with frequencies, cross-tabulations, and χ2 statistics reported.

Results.

HDS showed that the percentage of consumers who used SS information often or sometimes increased from 54% in 1994 to 64% in 2008. NHANES and NFLES data indicated that a majority of respondents had misinterpreted the meaning of SS. Women and obese individuals were more likely to use SS often or sometimes, but were also more likely to misinterpret the meaning of SS. A small subsample of NFLES participants expressed a distrust of the SS information.

Conclusion.

There is a widespread misunderstanding about SS, suggesting the need for clearer NF labels or enhanced education efforts.

Communicating science-based recommendations with memorable and actionable guidelines

For many domains of basic and applied science, a key set of scientific facts is well established and there is a need for public action in light of those facts. However, individual citizens do not consistently follow science-based recommendations, even when they accept the veracity of the advice. To address this challenge, science communicators need to develop a guideline that individuals can commit to memory easily and act on straightforwardly at moments of decision. We draw on research from psychology to discuss several characteristics that will enhance a guideline's memorability and actionability and illustrate using a case study from the US Department of Agriculture's communications based on nutrition science. We conclude by discussing the importance of careful research to test whether any given guideline is memorable and actionable by the intended target audience.

Reference serving sizes for the Brazilian population: An analysis of processed food labels

OBJECTIVE: To compare serving sizes reported on processed food labels with reference serving sizes according to nutrition labeling legislation and the "Food Guide for the Brazilian Population". METHODS: This cross-sectional study analyzed the labels of 2,072 processed foods in a supermarket of Florianópolis, Santa Caratina, Brazil. The foods were classified according to the Brazilian food labeling legislation. Central tendency and variability values were calculated for the serving sizes and energy values reported on the labels, as well as the ratio between the reported and reference energy value. The Spearman correlation test was performed between the reference serving size and the reference energy density, and also between the reference serving size and energy density of each study food. RESULTS: Nutrition labeling and the Food Guide presented reference servings with different sizes and energy values. The serving sizes reported on the labels did not follow either of the references and presented heterogeneous values, with a maximum range of 55-240 g among ready and semi-ready pre-prepared dishes. The reported energy values were between 0.1 times smaller and 2.4 times larger than the reference values. The reference serving sizes presented a highly inverse correlation with the reference energy density (Spearman coefficient= 0.9) and a very low inverse correlation with the energy density of the foods analyzed (Spearman coefficient= 0.2). CONCLUSION: This study showed the need for standardizing reference serving size information for the Brazilian population as well as reviewing nutrition labeling legislation in order to standardize the serving sizes reported on labels and to update the reference energy density used to calculate serving sizes.

Underestimating a serving size may lead to increased food consumption when using Canada’s Food Guide

It is unclear whether Canadians accurately estimate serving sizes and the number of servings in their diet as intended by Canada’s Food Guide (CFG). The objective of this study was to determine if participants can accurately quantify the size of 1 serving and the number of servings consumed per day. White, Black, South Asian, and East Asian adults (n = 145) estimated the quantity of food that constituted 1 CFG serving, and used CFG to estimate the number of servings that they consumed from their 24-h dietary recall. Participants estimated 1 serving size of vegetables and fruit (+43%) and grains (+55%) to be larger than CFG serving sizes (p ≤ 0.05); meat alternatives (–33%) and cheese (–31%) to be smaller than a CFG serving size (p ≤ 0.05); and chicken, carrots, and milk servings accurately (p > 0.05). Serving size estimates were positively correlated with the amount of food participants regularly consumed at 1 meal (p < 0.001). From their food records, all ethnicities estimated that they consumed fewer servings of vegetables and fruit (–15%), grains (–28%), and meat and alternatives (–14%) than they actually consumed, and more servings of milk and alternatives (+26%, p ≤ 0.05) than they actually consumed. Consequently, 68% of participants believed they needed to increase consumption by greater than 200 kcal to meet CFG recommendations. In conclusion, estimating serving sizes to be larger than what is defined by CFG may inadvertently lead to estimating that fewer servings were consumed and overeating if Canadians follow CFG recommendations without guidance. Thus, revision to CFG or greater public education regarding the dietary guidelines is warranted.

Effectiveness and efficiency of different shapes of food guides

OBJECTIVE

To compare the influence of a food guide's shape on its effectiveness and efficiency to convey nutritional information.

METHODS

A between-subjects experiment was conducted by manipulating the graph's shape (circle, pyramid, or rainbow). Nutrition tasks were used to assess the effectiveness and eye-movement data (number/duration of fixations) to examine the efficiency of the formats. The data were quantitatively analyzed (chi-square, ANOVA).

RESULTS

There were no overall differences between the formats regarding effectiveness and efficiency. However, there were differences between the formats in effectiveness regarding 3 of the 5 nutrition tasks (χ(2)s ≥ 7.044, Ps < .05). Furthermore, viewers' attention was drawn to different parts of the graph, depending on the format.

CONCLUSIONS AND IMPLICATIONS

The results suggest that choosing different formats for practical nutrition communication does not play a major role in effectiveness or efficiency of this communication. However, different parts of the graph are more salient in various food guide formats.

Do we provide meaningful guidance for healthful eating? An investigation into consumers' interpretation of frequency consumption terms

OBJECTIVE

To investigate consumers' understanding of terms commonly used to provide guidance about frequency and quantity of food consumption.

METHODS

A survey of 405 shoppers explored how frequently consumers thought food labeled with the terms "eat often," "eat moderately," "eat occasionally," "a sometimes food," and "an extra food" should be eaten. In a separate phase, 30 grocery buyers responded to open-ended questions about their interpretation of these terms.

RESULTS

Responses indicated significant differences in meaning between the terms. However, the specific interpretation of each term varied considerably across respondents. The qualitative research found the terms to be highly subjective, and there was a high degree of uncertainty about the meaning of the term "an extra food" in particular.

CONCLUSIONS AND IMPLICATIONS

Food frequency and descriptive terms currently used do not provide meaningful or consistent nutritional guidance. There is a need for simple, unambiguous terminology.

Serving size guidance for consumers: is it effective?

Larger portion sizes (PS) may be inciting over-eating and contributing to obesity rates. Currently, there is a paucity of data on the effectiveness of serving size (SS) guidance. The aims of the present review are to evaluate SS guidance; the understanding, usability and acceptability of such guidance, its impact on consumers and potential barriers to its uptake. A sample of worldwide SS guidance schemes (n 87) were identified using targeted and untargeted searches, overall these were found to communicate various inconsistent and often conflicting messages about PS selection. The available data suggest that consumers have difficulty in understanding terms such as 'portion size' and 'serving size', as these tend to be used interchangeably. In addition, discrepancies between recommended SS and those present on food labels add to the confusion. Consumers generally understand and visualise SS best when expressed in terms of household measures rather than actual weights. Only a limited number of studies have examined the direct impact of SS guidance on consumer behaviour with equivocal results. Although consumers recognise that guidance on selecting SS would be helpful, they are often unwilling to act on such guidance. The challenge of achieving consumer adherence to SS guidance is formidable due to several barriers including chronic exposure to larger PS, distorted consumption norms and perceptions, the habit of 'cleaning one's plate' and language barriers for ethnic minorities. In conclusion, the impact of SS guidance on consumers merits further investigation to ensure that future guidance resonates with consumers by being more understandable, usable and acceptable.

Consumer response to healthy eating, physical activity and weight-related recommendations: a systematic review

Strong evidence linking poor diet and lack of physical activity to risk of obesity and related chronic disease has supported the development and promotion of guidelines to improve population health. Still, obesity continues to escalate as a major health concern, and so the impact of weight-related guidelines on behaviour is unclear. The aim of this review was to examine consumer response to weight-related guidelines. A systematic literature search was performed using Medline, PsycInfo, ProQuest Central and additional searches using Google and reference lists. Of the 1,765 articles identified, 46 relevant titles were included. Most studies examined attitudes towards content, source, tailoring and comprehension of dietary guidelines. Many respondents reported that guidelines were confusing, and that simple, clear, specific, realistic, and in some cases, tailored guidelines are required. Recognition of guidelines did not signify understanding nor did perceived credibility of a source guarantee utilization of guidelines. There was a lack of studies assessing: the impact of guidelines on behaviour; responses to physical activity guidelines; responses among males and studies undertaken in developing countries. Further research is needed, in particular regarding responses to physical activity guidelines and guidelines in different populations. Communication professionals should assist health professionals in the development of accurate and effective weight-related guidelines.

Evaluating MyPlate: an expanded framework using traditional and nontraditional metrics for assessing health communication campaigns

MyPlate, the icon and multimodal communication plan developed for the 2010 Dietary Guidelines for Americans (DGA), provides an opportunity to consider new approaches to evaluating the effectiveness of communication initiatives. A review of indicators used in assessments for previous DGA communication initiatives finds gaps in accounting for important intermediate and long-term outcomes. This evaluation framework for the MyPlate Communications Initiative builds on well-known and underused models and theories to propose a wide breadth of observations, outputs, and outcomes that can contribute to a fuller assessment of effectiveness. Two areas are suggested to focus evaluation efforts in order to advance understanding of the effectiveness of the MyPlate Communications Initiative: understanding the extent to which messages and products from the initiative are associated with positive changes in social norms toward the desired behaviors, and strategies to increase the effectiveness of communications about DGA in vulnerable populations.

Initial development and testing of a questionnaire of parental self-efficacy for enacting healthy lifestyles in their children

PURPOSE

The purpose of this study was to develop and test a questionnaire to assess parental self-efficacy for enacting healthy diet and physical activity behaviors in their 6- to 11-year-old children.

DESIGN AND METHODS

A 35-item questionnaire was developed and tested with 146 U.S. parents.

RESULTS

Participant responses resulted in a 34-item questionnaire with two subscales (dietary behaviors and physical activity behaviors), which were valid and reliable in the study sample.

PRACTICE IMPLICATIONS

This new measure will serve as a tool for the assessment of parental self-efficacy for enacting healthy lifestyles in their children 6-11 years old.

School foodservice personnel's struggle with using labels to identify whole-grain foods

OBJECTIVE

To describe how school foodservice personnel use current labeling methods to identify whole-grain products and the influence on purchasing for school meals.

METHODS

Focus groups explored labeling methods to identify whole-grain products and barriers to incorporating whole-grain foods in school meals. Qualitative analysis procedures and the constant comparative method were used to analyze data.

RESULTS

Participants were school foodservice personnel (n = 67) in 5 states across the United States. Limited ability and confidence were demonstrated in identifying whole-grain products from label information, statements, and claims. Participants indicated a need for a uniform labeling method such as whole-grain content to assist in ordering and purchasing. High cost and low acceptability were listed as barriers to incorporating whole-grain foods in school meals.

CONCLUSIONS AND IMPLICATIONS

Whole-grain product labeling should be improved to enhance understanding by foodservice personnel so that whole grains are included in school meals.

Food group categories of low-income African American women

OBJECTIVE

Describe lay food group categories of low-income African American women and assess the overlap of lay food groups and MyPyramid food groups.

DESIGN

A convenience sample of African American mothers from a low-income Chicago neighborhood performed a card-sorting task in which they grouped familiar food items into food groups.

SETTING

One-on-one interviews in a neighborhood community center.

PARTICIPANTS

Twenty-eight African American mothers.

MAIN OUTCOME MEASURE

A hierarchical taxonomy of food groups for each participant, represented as a matrix of distances among food items in the individual sort of each participant.

ANALYSIS

Cultural consensus analysis, hierarchical cluster analysis, and coding of food group category labels and sorting justifications.

RESULTS

Consensus analysis revealed a consistent cultural model of lay food groups among the women. Lay food groups were systematically different from MyPyramid food groups. Lay food groups were more influenced by how food items are prepared or when and how food items are eaten than are MyPyramid food group categories.

CONCLUSIONS AND IMPLICATIONS

Nutrition messages framed using lay food group categories of low-income African Americans may be more effective for that population than messages using MyPyramid food group categories.

A review of consumer awareness, understanding and use of food-based dietary guidelines

Food-based dietary guidelines (FBDG) have primarily been designed for the consumer to encourage healthy, habitual food choices, decrease chronic disease risk and improve public health. However, minimal research has been conducted to evaluate whether FBDG are utilised by the public. The present review used a framework of three concepts, awareness, understanding and use, to summarise consumer evidence related to national FBDG and food guides. Searches of nine electronic databases, reference lists and Internet grey literature elicited 939 articles. Predetermined exclusion criteria selected twenty-eight studies for review. These consisted of qualitative, quantitative and mixed study designs, non-clinical participants, related to official FBDG for the general public, and involved measures of consumer awareness, understanding or use of FBDG. The three concepts of awareness, understanding and use were often discussed interchangeably. Nevertheless, a greater amount of evidence for consumer awareness and understanding was reported than consumer use of FBDG. The twenty-eight studies varied in terms of aim, design and method. Study quality also varied with raw qualitative data, and quantitative method details were often omitted. Thus, the reliability and validity of these review findings may be limited. Further research is required to evaluate the efficacy of FBDG as a public health promotion tool. If the purpose of FBDG is to evoke consumer behaviour change, then the framework of consumer awareness, understanding and use of FBDG may be useful to categorise consumer behaviour studies and complement the dietary survey and health outcome data in the process of FBDG evaluation and revision.

'We're not told why--we're just told': qualitative reflections about the Western Australian Go for 2&5® fruit and vegetable campaign

OBJECTIVE

To explore why there is a lack of acceptance among Western Australian (WA) adults of the Go for 2&5® fruit and vegetable social marketing message to consume at least five servings of vegetables per day.

DESIGN

A series of focus group discussions comprised of homogeneous groups varied by sex and age, until saturation of themes was achieved, followed by thematic analysis.

SETTING

Part of qualitative research for the Go for 2&5® fruit and vegetable social marketing campaign in WA (2009 population: 2.2 million).

SUBJECTS

WA adults stratified by sex and age groups (18-29 and 30-55 years) drawn from the second and third quartiles of socio-economic disadvantage.

RESULTS

Familiarity with the Go for 2&5® message was excellent. Understanding of what constitutes 'two servings of fruit' was excellent and regarded by participants as highly achievable. Understanding of what constitutes 'five servings of vegetables' was suboptimal with widespread overestimation contributing to the belief that it is unrealistic. Participants did not know how the 2&5 recommendation was formulated and believed that daily consumption of two servings of fruit and five of vegetables would confer no greater health benefit than one of fruit and three of vegetables. Participants assumed that the 2&5 recommendation was 'aspirational' in the sense that it was purposely exaggerated to simply encourage greater overall consumption.

CONCLUSIONS

A convincing case needs to be presented to WA adults as to why they should consume five servings of vegetables per day. Continuing efforts to educate incorporating what constitutes a serving will assist perceptions that the recommendation is realistic.

Food intake of Kansans over 80 years of age attending congregate meal sites

As the population of the United States continues to age, it has become increasingly more important to recognize the food intake and eating habits of older adults. The objective of this study was to describe the food group intake, factors predicting food group intake, and the food choices of community-dwelling Kansans, 80 years of age and older who participate in congregate meal programs. Participants completed a short questionnaire querying demographic information, current health status, and dietary supplement use. Participants (n = 113) were then followed up via telephone to complete two 24-hour diet recalls. Data were analyzed to determine adequacy of food group intake and mean intake. Regression analyses were used to determine factors predicting intake and frequency analysis established food typically consumed. Female participants were significantly more likely to consume more fruit servings than males. Intake was low for all five of the food groups, especially dairy. Chronic health conditions and dietary supplement use were consistently predictive factors of the amount of each food group consumed.

Fruit and vegetables should be targeted separately in health promotion programmes: differences in consumption levels, barriers, knowledge and stages of readiness for change

Objective

The aim of the present study was to investigate whether fruit and vegetables should be treated as separate groups in health promotion programmes by examining consumption levels, barriers, knowledge and the association between stage of change and potential predictors of fruit and vegetable intake.

Design

Computer-assisted telephone interview survey of the target population.

Setting

Hunter and New England regions of New South Wales, Australia.

Subjects

A total of 1403 parents and carers of primary-school-aged children.

Results

Consumption levels and knowledge of recommended intakes and serving size were greater for fruit than for vegetables. There were some differences in the main barriers to the consumption of fruit compared with those cited for vegetables. There was little congruence between the stages of change for fruit consumption and those for vegetable consumption. For fruit, knowledge of serving size and recommended intake, perceptions of adequate consumption, changes made to family intake and educational attainment were all correlated with stage of change categorisation. For vegetables, knowledge of recommended intake, perceptions of adequate consumption and changes made to family intake were correlated with stage of change categorisation.

Conclusions

Significant differences in consumption levels, barriers, knowledge and stages of readiness for change can be shown when fruit and vegetables are treated as separate groups. Health promotion planners may need to consider interventions that focus on improving vegetable consumption in preference to fruit consumption. Messages about the recommended number of servings and serving size must be simplified and this may be achieved by targeting messages towards vegetable consumption.

Menu modeling with MyPyramid food patterns: incremental dietary changes lead to dramatic improvements in diet quality of menus

The MyPyramid food guidance system provides recommended food intake patterns for members of each sex at various age and activity levels. These food intake patterns are based on recommendations of the Dietary Guidelines for Americans 2005. Actual consumption patterns of American adults compared to MyPyramid recommendations indicate that substantial changes are needed to meet the goals of MyPyramid. One method for encouraging dietary change, known as the small steps approach, involves small, gradual changes to meet a desired endpoint. Menu modeling was used to evaluate the effects of gradual dietary changes on diet quality. Seven days of baseline menus were developed to model the intake of adult women aged 31 to 50 years. Incremental changes were made to each baseline menu to create a series of three transitional menus and a final target menu. Target menus met MyPyramid energy and nutrient intake goals. Diet quality was measured for each baseline, transitional, and target menu using the Healthy Eating Index-2005. The average Healthy Eating Index-2005 score for baseline menus compared to target menus increased by more than 50 points with incremental increases observed for each transitional menu. This analysis demonstrates that small, practical changes in food choices that bring consumers closer to meeting MyPyramid recommendations result in gradual and dramatic improvements in diet quality. Food and nutrition professionals can use menu modeling to provide concrete examples and specific guidance for making progressive changes in food selections to meet current dietary recommendations.

Consumer perceptions of fruit and vegetables serving sizes

OBJECTIVE

To assess consumer understanding of fruit and vegetable serving sizes.

DESIGN

The Western Australian Health Department launched the Go for 2&5(R) campaign to promote fruit and vegetables in March 2002. The Health & Wellbeing Surveillance System surveyed 1108 adults, aged 16 years and over, between September and November 2002 about what constituted a serving of fruit and of vegetables, their usual daily fruit and vegetables intake, and their recall of the campaign.

SETTING

The study was undertaken as a part of a public health intervention - social marketing campaign in Western Australia, which had a population of 1 927 000 in 2002.

RESULTS

Forty-two per cent of respondents knew that the fruit serving size was one piece and only 14.5 % reported the (1/2) cup vegetable serving size. The mean fruit intake was 1.8 (95 % CI 1.7, 1.8) servings/d and the mean vegetable intake was 2.8 (95 % CI 2.7, 3.0) servings/d. Vegetable intake was associated with being female (P = 0.006), increasing age (P < 0.0001), awareness of the campaign (P = 0.031) and knowledge of standard serving size (P = 0.006). Fruit consumption was associated with being female (P = 0.007). Fruit and vegetable intakes were not associated with educational attainment or household income.

CONCLUSIONS

The Go for 2&5(R) campaign uses a prescriptive message to promote increased consumption of fruit and vegetables. Respondent's knowledge of the standard of serving sizes for fruit and vegetables suggests there is value in separating fruit and vegetable recommendations in messages to encourage increased consumption.

Developing food-based dietary guidelines to promote healthy diets and lifestyles in the Eastern Caribbean

Obesity, cardiovascular diseases, and diabetes are becoming leading causes of morbidity and mortality in the Eastern Caribbean countries of St. Vincent and the Grenadines, Saint Lucia, Grenada, and Dominica. To promote healthful diets and lifestyles and encourage behavioral changes, Food-Based Dietary Guidelines (FBDG) were developed for the general population in each of these countries. This paper reports on the comprehensive process of developing the guidelines through consensus building among stakeholders, technical assessments and priority setting, and use of qualitative methods to field test messages to ensure public understanding and motivation. Nutritionists in each country received training and support from the Food and Agriculture Organization and the Pan American Health Organization's nutritionists.

MyPyramid.gov: assessment of literacy, cultural and linguistic factors in the USDA food pyramid web site

MyPyramid.gov, a major national Web site about healthful eating and physical activity, was analyzed for literacy, cultural, and linguistic factors relevant to consumers. The assessment used 4 standardized readability tests, 1 navigational test, availability of non-English content, and new criteria for cultural factors. Readability scores averaged between grade levels 8.8 and 10.8, and half the navigation criteria were met. The Web site was available in Spanish, but it had little cultural tailoring for English speakers. It is recommended that MyPyramid's readability, navigation, and cultural tailoring be improved. References are provided to help educators learn more about assessing and using Internet communication with diverse audiences.