Is there a consumer backlash against the diet and health message?

Investigating the efficacy and feasibility of using a whole-of-diet approach to lower circulating levels of C-reactive protein in postmenopausal women: a mixed methods pilot study

OBJECTIVE

Chronic inflammation is associated with obesity and is an underlying pathophysiology for cardiovascular disease (CVD) development in postmenopausal women. This study aims to determine feasibility and efficacy of an anti-inflammatory dietary intervention to lower levels of C-reactive protein in weight stable postmenopausal women with abdominal obesity.

METHODS

This mixed-methods pilot study used a single arm pre-post design. Thirteen women followed a 4-week anti-inflammatory, dietary intervention, optimizing consumption of healthy fats, low glycemic index wholegrains, and dietary antioxidants. Quantitative outcomes included change in inflammatory and metabolic markers. Focus groups were undertaken and thematically analyzed to explore participants lived experience of following the diet.

RESULTS

There was no significant change in plasma high-sensitivity C-reactive, protein. Despite discouraging weight loss, median (Q1-Q3) body weight decreased by -0.7 (-1.3 to 0 kg, P = 0.02). This was accompanied by reductions in plasma insulin (0.90 [-0.05 to 2.20] mmol/L), Homeostatic Model Assessment of Insulin Resistance (0.29 [-0.03 to 0.59]), and low-density lipoprotein:high-density lipoprotein ratio (0.18 [-0.01 to 0.40]) ( P ≤ 0.023 for all). Thematic analysis revealed that postmenopausal women have a desire to improve meaningful markers of health status that do not focus on weight. Women were highly engaged with learning about emerging and innovative nutrition topics, favoring a detailed and comprehensive nutrition education style that challenged their proficient health literacy and cooking skills.

CONCLUSIONS

Weight-neutral dietary interventions targeting inflammation can improve metabolic markers and may be a viable strategy for CVD risk reduction in postmenopausal women. To determine effects on inflammatory status, a fully powered and longer-term randomized controlled trial is required.

Prevalence and Potential Consequences of Exposure to Conflicting Information about Mammography: Results from Nationally-Representative Survey of U.S. Adults

As scientific evidence evolves and clinical guidelines change, a certain amount of conflicting health information in the news media is to be expected. However, research is needed to better understand the public's level of exposure to conflicting health information and the possible consequences of such exposure. This study quantifies levels of public exposure to one paradigmatic case: conflicting information about breast cancer screening for women in their 40s. Using a nationally-representative survey of U.S. adults aged 18-59 in 2016, we implemented four distinct types of measures of exposure to conflicting mammography information: an ecological measure based on keyword counts of local news closed-captioning, an inferred exposure measure based on a series of knowledge questions, a thought-listing exercise where respondents described their perceptions of mammography without prompting, and an explicit measure of self-assessed exposure to conflict. We examined the relationship between these exposure measures and four outcomes: confusion about mammography, backlash toward mammography recommendations, and confusion and backlash about health information more generally. We found moderate amounts of exposure to conflicting information about mammography, more among women than men. Exposure to conflicting information - across multiple measures - was associated with more confusion about mammography, more mammography-related backlash, and general health information backlash, but not general confusion about health information. These observational findings corroborate experimental-based findings that suggest potentially undesirable effects of exposure to conflicting health information. More research is needed to better understand how to mitigate these possible outcomes, in the context of a media landscape that proliferates exposure to multiple scientific perspectives.

Is Coffee the Cause or the Cure? Conflicting Nutrition Messages in Two Decades of Online New York Times' Nutrition News Coverage

Two-thirds of US adults report hearing news stories about diet and health relationships daily or a few times a week. These stories have often been labeled as conflicting. While public opinion suggests conflicting nutrition messages are widespread, there has been limited empirical research to support this belief. This study examined the prevalence of conflicting information in online New York Times' news articles discussing published nutrition research between 1996-2016. It also examined the contextual differences that existed between conflicting studies. The final sample included 375 news articles discussing 416 diet and health relationships (228 distinct relationships). The most popular dietary items discussed were alcoholic beverages (n = 51), vitamin D (n = 26), and B vitamins (n = 23). Over the 20-year study period, 12.7% of the 228 diet and health relationships had conflicting reports. Just under three-fourths of the conflicting reports involved changes in study design, 79% involved changes in study population, and 31% involved changes in industry funding. Conflicting nutrition messages can have negative cognitive and behavioral consequences for individuals. To help effectively address conflicting nutrition news coverage, a multi-pronged approach involving journalists, researchers, and news audiences is needed.

Evidence-Based Lifestyle Guidelines and Self-Management Strategies Utilized by Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder, affecting 13% of reproductive-aged women. While lifestyle management is the first-line treatment for improving complications, women experience challenges with implementation. This cross-sectional study aims to identify the types and sources of dietary and physical activity (PA) interventions implemented by women with PCOS and understand how they use self-management strategies to support lifestyle change. An online questionnaire was disseminated via a consumer-based PCOS website (May 2015-2016). Women (n = 1167) were aged 18-45 years and primarily born within the United States (70%). A quarter or less of women (diet 25%, PA 14%) sought lifestyle advice from health professionals (medical clinicians or dietitians) compared to over half (diet 59%, PA 67%) using alternative sources, namely from online platforms. While only 33% and 16% of women reported following formal dietary or PA guidelines, respectively, 57% had implemented a 'special diet' to manage their condition, many of which were inconsistent with evidence-based practice in PCOS. Participants also displayed a low level of engagement with important self-management behaviors, including goal setting and positive self-talk. These findings suggest that online information may promote inaccurate and ineffective lifestyle advice and emphasize the need to increase engagement with qualified health professionals.

Anti-Inflammatory Diets in Fertility: An Evidence Review

Infertility is a global health concern affecting 48 million couples and 186 million individuals worldwide. Infertility creates a significant economic and social burden for couples who wish to conceive and has been associated with suboptimal lifestyle factors, including poor diet and physical inactivity. Modifying preconception nutrition to better adhere with Food-Based Dietary Guidelines (FBDGs) is a non-invasive and potentially effective means for improving fertility outcomes. While several dietary patterns have been associated with fertility outcomes, the mechanistic links between diet and infertility remain unclear. A key mechanism outlined in the literature relates to the adverse effects of inflammation on fertility, potentially contributing to irregular menstrual cyclicity, implantation failure, and other negative reproductive sequelae. Therefore, dietary interventions which act to reduce inflammation may improve fertility outcomes. This review consistently shows that adherence to anti-inflammatory diets such as the Mediterranean diet (specifically, increased intake of monounsaturated and n-3 polyunsaturated fatty acids, flavonoids, and reduced intake of red and processed meat) improves fertility, assisted reproductive technology (ART) success, and sperm quality in men. Therefore, integration of anti-inflammatory dietary patterns as low-risk adjunctive fertility treatments may improve fertility partially or fully and reduce the need for prolonged or intensive pharmacological or surgical interventions.

The Impact of Information Presentation and Cognitive Dissonance on Processing Systematic Review Summaries: A Randomized Controlled Trial on Bicycle Helmet Legislation

Background: Summaries of systematic reviews are a reference method for the dissemination of research evidence on the effectiveness of public health interventions beyond the scientific community. Motivated reasoning and cognitive dissonance may interfere with readers' ability to process the information included in such summaries. Methods: We conducted a web experiment on a panel of university-educated North Americans (N = 259) using a systematic review of the effectiveness of bicycle helmet legislation as a test case. The outcome variables were the perceived tentativeness of review findings and attitude toward bicycle helmet legislation. We manipulated two types of uncertainty: (i) deficient uncertainty (inclusion vs. non-inclusion of information on limitations of the studies included in the review) and (ii) consensus uncertainty (consensual findings showing legislation effectiveness vs. no evidence of effectiveness). We also examined whether reported expertise in helmet legislation and the frequency of wearing a helmet while cycling interact with the experimental factors. Results: None of the experimental manipulations had a main effect on the perceived tentativeness. The presentation of consensual efficacy findings had a positive main effect on the attitude toward the legislation. Self-reported expertise had a significant main effect on the perceived tentativeness, and exposing participants with reported expertise to results showing a lack of evidence of efficacy increased their favorable attitude toward the legislation. Participants' helmet use was positively associated with their attitude toward the legislation (but not with perceived tentativeness). Helmet use did not interact with the experimental manipulations. Conclusions: Motivated reasoning and cognitive dissonance influence a reader's ability to process information contained in a systematic review summary.

Healthy or not? The impact of conflicting health-related information on attentional resources

Despite its ubiquity, little is known about the impact of exposure to conflicting health information on cognitive efficiency. We hypothesized that it would reduce attentional capacity, as evidenced by (1) increased response errors during the Attention Network Test (ANT), (2) decreased efficiency of each ANT system (alerting, orienting, execute control), and (3) increased self-reported workload, (4) nutritional confusion and (5) nutritional backlash. A sample of 184 online participants were assigned randomly to read an article containing either congruent or conflicting health information. Subsequently, they completed the ANT and self-report measures of workload, nutritional confusion, and backlash at nutritional recommendations and research. Participants in the conflicting health information condition made more errors, had overall slower reaction times, and reported greater workload, nutritional confusion, and backlash. No differences were found for individual ANT systems. These findings suggest that exposure to conflicting health information can degrade attentional mechanisms responsible for accurate and prompt responding to incoming information.

Revisiting nutrition backlash: Psychometric properties and discriminant validity of the nutrition backlash scale

OBJECTIVES

Nutrition backlash is a disposition defined by negative feelings about dietary recommendations. Past research has measured nutrition backlash using the nutrition backlash scale (NBS) and found that it is negatively related to the consumption of fruits and vegetables. The aim of this study was to examine several aspects of the NBS, including factor structure, discriminant validity, and relationship to demographic characteristics and health behaviors.

METHODS

Adults were recruited to participate in two studies. Study 1 (N = 480) included measures of nutritional backlash, information overload, worry, fatalism, and nutrition-related behaviors. Study 2 (N = 399) was a follow-up that examined the factor structure of the NBS in a separate sample.

RESULTS

In study 1, a six-item version of the NBS was found to be a good fit for the data and discriminant from overload, worry, and fatalism. NBS was higher for those with less education, non-white participants, and men. Individuals with higher backlash were less likely to look at nutritional labels and to use sunscreen. Study 2 confirmed the factor structure from study 1.

CONCLUSIONS

A six-item version of the NBS was found to be reliable, discriminant from related measures, higher in underserved groups (less-educated, non-white, and male participants), and related to nutrition label use.

Inflaming Public Interest: A Qualitative Study of Adult Learners' Perceptions on Nutrition and Inflammation

Research suggests national dietary guidelines are losing public resonance, with consumers actively seeking alternate nutrition advice from unregulated online platforms that often propagate misinformation. Improved diet quality can beneficially affect inflammation, and with science relating to nutrition and inflammation also appealing to consumers, this emerging topic provides an opportunity to consider how novel engagement strategies can be used to increase public support of expert-generated advice. This study aimed to qualitatively explore MOOC learners' perceptions and experiences of following diets believed to help manage inflammation. Data were collected from an evidence-based nutrition-focused Massive Open Online Course (MOOC), which included a unit titled Foods and Inflammation. The Framework method was used to analyze 12,622 learner comments, taken from the MOOC's online discussion forum and questionnaire. Learners identified avoidance of core food groups, such as dairy and grains, as key in managing inflammation. Dietary advice came mainly from the internet, and health professionals reportedly lacked an appreciation of the learners' underlying nutrition knowledge, providing oversimplified advice that did not satisfy their scientific curiosity. To help build consumer trust and increase engagement, health professionals need to consider innovative education strategies that utilize novel topics such as nutrition and inflammation, in a safe and accurate manner.

Confusion and nutritional backlash from news media exposure to contradictory information about carbohydrates and dietary fats

OBJECTIVE

To test the effect of news media exposure to contradictory information about carbohydrates and dietary fats on levels of confusion, nutritional backlash and dietary intentions.

DESIGN

We conducted an online survey experiment between 11 and 28 February 2018, randomizing participants to one of six experimental conditions. Two 'contradictory information' conditions asked participants to read one news article on the risks of a low-carbohydrate diet and one article on the risks of a low-fat diet. Two 'convergent information' conditions asked participants to read two articles with similar information on the risks of one of these two diets. A fifth 'established health recommendations' control condition asked participants to read two articles on the harms of smoking and sun exposure. A sixth 'no information' condition served as a second control group. We used general linear models to test hypotheses on the effects of exposure on confusion, nutritional backlash and dietary intentions.

SETTING

USA.

PARTICIPANTS

Adults (n 901) registered with Amazon's Mechanical Turk (M-Turk).

RESULTS

Exposure to contradictory information about carbohydrates and dietary fats increased confusion and nutritional backlash compared with exposure to established health recommendations for non-dietary behaviours and a no-exposure control. Exposure to contradictory information also increased confusion compared with exposure to consistent nutrition information regarding carbohydrates and dietary fats.

CONCLUSIONS

Contradictory nutrition information in the news media can negatively affect consumers' attitudes, beliefs and behavioural intentions. Dietary debates that play out in the media may adversely influence both short-term dietary decisions and future efforts to communicate about unrelated nutrition issues.

Desigualdades sociais no perfil de consumo de alimentos da população brasileira: Pesquisa Nacional de Saúde, 2013

RESUMO: Introdução: É amplamente reconhecido que elevada concentração de renda prevalece no Brasil e que a posição socioeconômica dos segmentos sociais exerce influência nas condições de vida e saúde, incluindo a qualidade da alimentação. Objetivo: Medir a magnitude das desigualdades sociais no perfil da qualidade alimentar da população brasileira. Método: Analisaram-se dados da amostra de 60.202 adultos da Pesquisa Nacional de Saúde de 2013. Foram estimadas as prevalências de indicadores de qualidade alimentar segundo sexo, raça/cor, renda, escolaridade e posse de plano de saúde. Razões de prevalência foram estimadas por meio de regressão múltipla de Poisson. Resultados: Maior prevalência de consumo de alimentos saudáveis foi verificada no sexo feminino, entre os brancos e no grupo de melhor nível socioeconômico. Entretanto,para alguns alimentos considerados não saudáveis, como doces, sanduíches, salgados e pizzas, também foi observada maior prevalência nos segmentos sociais mais favorecidos, nas mulheres e nos brancos, expressando a concomitância de escolhas alimentares saudáveis e não saudáveis. Desigualdade de maior magnitude foi observada quanto à comparação do consumo de leite desnatado e semidesnatado segundo renda (razão de prevalência - RP=4,48). Conclusão: Além de expressiva desigualdade social no perfil alimentar dos brasileiros, foram detectados perfis mistos, incluindo alimentos saudáveis e não saudáveis, sinalizando a necessidade de monitoramento e de intervenções de promoção de alimentação saudável que levem em conta as desigualdades sociais e as contradições no consumo alimentar.

Habit formation intervention to prevent obesity in low-income preschoolers and their mothers: A randomized controlled trial protocol

BACKGROUND

Low-income and racial/ethnic minority mothers and their young children are at increased risk for obesity. Lack of access to evidence-based obesity prevention and treatment services further contributes to these disparities.

METHODS

This two-arm, parallel, randomized controlled trial (RCT) tests the effectiveness of a simple obesity intervention (HABITS) delivered as part of ongoing home visitation services, compared to the existing home visitation services without obesity-related content on mothers' and children's obesity risks. HABITS focuses on habit formation and modifications of food and activity cues in the home to support habit formation. Habit formation is focused on improving five behaviors: 1) fruits/vegetables, 2) fried foods, 3) sugar-sweetened beverages, 4) physical activity and 5) self-monitoring. Participants will be 298 mothers (>50% African American; 100% low income) and their children (3-5yo at baseline) enrolled in a home visitation program in central Alabama. Home visitors will be randomly assigned to deliver the home visitation curriculum with or without HABITS as part of their weekly home visits for 9 months. Assessments of mothers (weight, waist circumference, and habit strength of targeted behaviors), children (rate of weight gain), and the food/activity household environment will be conducted at enrollment, post-intervention (9 month), and one year post-intervention follow-up.

DISCUSSION

This research is poised to have a substantial impact because the delivery modalities of current obesity efforts disproportionally restrict the reach and engagement of underserved, low-income children and their caregivers who are most at-risk for health and obesity disparities.

Does Health Information in Mass Media Help or Hurt Patients? Investigation of Potential Negative Influence of Mass Media Health Information on Patients' Beliefs and Medication Regimen Adherence

As an important public health issue, patient medication non-adherence has drawn much attention, but research on the impact of mass media as an information source on patient medication adherence has been scant. Given that mass media often provide confusing and contradicting information regarding health/medical issues, this study examined the potential negative influence of exposure to health information in mass media on patients' beliefs about their illnesses and medications, and medication adherence, in comparison with the effects of exposure to another primary medication information source, physicians. Survey data obtained from patients on blood thinner regimens revealed that the frequency of exposure to health information in mass media was negatively related to accuracy of patients' beliefs about their medication benefits and patient medication adherence. On the other hand, frequency of visits with physicians was positively associated with patients' beliefs about their medication benefits but had no significant relation to medication regimen adherence. The implications of the study findings are discussed, and methodological limitations and suggestion for future research are presented.

Communicating Uncertain Science to the Public: How Amount and Source of Uncertainty Impact Fatalism, Backlash, and Overload

Public dissemination of scientific research often focuses on the finding (e.g., nanobombs kill lung cancer) rather than the uncertainty/limitations (e.g., in mice). Adults (n = 880) participated in an experiment where they read a manipulated news report about cancer research (a) that contained either low or high uncertainty (b) that was attributed to the scientists responsible for the research (disclosure condition) or an unaffiliated scientist (dueling condition). Compared to the dueling condition, the disclosure condition triggered less prevention-focused cancer fatalism and nutritional backlash.

Reaching Low-Income Mothers to Improve Family Fruit and Vegetable Intake: Food Hero Social Marketing Campaign-Research Steps, Development and Testing

The objective of this study was to create/test a social marketing campaign to increase fruit/vegetable (FV) intake within Oregon Supplemental Nutrition Assistance Program (SNAP) eligible families. Focus groups (n = 2) and pre/post campaign phone surveys (n = 2082) were conducted in intervention counties (IC) and one control county. Participants were female (86%-100%) with 1-2 children at home. Mean FV intake/without juice was 3.1 servings/day; >50% preferred the Internet for delivery of healthy eating information. Participants reported time/financial burdens, low household FV variety and desirability of frozen/canned FV, and acceptance of positive messages. A Food Hero (FH) campaign was created/delivered daily August-October 2009 to mothers through multiple channels (e.g., grocery stores, online, educators). Results showed that the IC had better FH name recall (12%) and interpretation of intended messages (60%) vs. control (3%, 23%, respectively). Compared to controls, the IC were less likely to report healthy food preparation as time consuming or a FV rich diet expensive, and it was easier to get their family to eat fruit. Results did not vary based on county/household characteristics. The FH campaign increased FH awareness and positive FV beliefs. A longer campaign with FV assessments will increase understanding of the target audience, and allow for campaign refinement.

Trends in Natural Food Sales and Consumer Food Choices

The expansion of thinking from treating disease to increased concern with disease prevention and health maintenance is reflected in the growing market for natural foods and dietary supplements. These new products make the already complex task of food shopping even more confusing. Inexperienced consumers will require help to evaluate these new choices, creating challenges for health care providers and the food industry. This article helps readers make sense of these new products by providing a general overview of the natural foods category. Discussed are the complexities consumers face when shopping for food and related products, definitions relevant to natural foods, trends in natural foods consumption, and future trends in this area, including the impact of genetically modified foods.

The natural foods industry has been one of the shining stars of food manufacturing and retailing over the past decade as an ever-growing segment of the U.S. population seeks out organic and natural foods and nutraceuticals. The consumer motivations fueling this industry are varied and range from securing the practical benefits of a healthy diet to the psychological benefits of leading a particular lifestyle.

To support the diffusion throughout the U.S. population of this more holistic approach to health, the industry and health care professionals must help consumers make sense of the confusing array of product offerings. The newest consumers entering these markets will be less involved and committed than the pioneering consumers were, and they will have different motivations. These late adopters will look to the industry, regulators, and their health care providers to make sense of these often complex and contradictory product offerings. Consider, for example, a consumer trying to understand the differences between a natural food and a genetically modified nutraceutical, both promoting health benefits. As discussed earlier, the food shopping process is already very noisy, and the winners in natural foods will be the ones that help consumers solve their food purchasing problems. This problem will be complicated as mass retailers offer more organic and natural foods and nutraceuticals, along with their conventional products, confronting a broader cross-section of consumers further.

Perhaps the greatest challenge facing the stakeholders in this arena is the evolution of genetically modified foods. By definition, these foods are certainly not organic and probably not natural, yet may offer health benefits. To date, the introduction of genetically modified foods has been difficult because consumers have not been properly educated about these new technologies. The industry must pay more attention to conducting reliable studies of these products and then communicating the results.

Surviving “Risk Factor Frenzy”: The Perils of Incorrectly Applying Epidemiological Research in Health Education and Promotion

In health education and promotion, “risk factors” for disease gathered from epidemiological research form the basis from which the majority of recommendations to individuals for lifestyle change are made. Unfortunately, many health practitioners are unaware that this type of research was never intended to be applied to individuals. The result is ongoing public confusion and anxiety concerning health recommendations and a loss of credibility for health professionals. This article: 1) briefly reviews the most commonly encountered limitations inherent in epidemiological research; 2) explores the problems and potential negative consequences of incorrectly applying epidemiological research in health education and promotion; and 3) makes recommendations to help health practitioners more skillfully interpret and incorporate into their work findings from epidemiological research.

Impact of Perceived Healthiness of Food on Food Choices and Intake

Healthy eating is an important determinant of health, but adherence to dietary guidelines remains a public health concern. Identifying factors that impact dietary habits is therefore important to facilitate healthy eating. One widely used strategy to help consumers make healthier food choices is nutrition information, such as labeling and claims. Despite the intention of these strategies to improve decision making, they can also be misunderstood or misinterpreted by consumers. The aim of this review is to explore food perceptions by examining how cognitive factors influence perceived healthiness of food, and the impact of perceived healthiness of food on food choices and intake. Overall findings of this review suggest that cognitive factors, such as type of food and branding, significantly contribute to judgmental bias and have an impact on perceived healthiness while not consistently or systematically influencing choice and intake.

Everyday life classification practices and technologies

Purpose

– Through the application of domain-analytic principles, the purpose of this paper is to explore how participants’ understandings of healthy eating are related to their grouping and classification of foods.

Design/methodology/approach

– In total, 30 food-interested people were asked to (1) sort a series of 56 statements about food, health, and eating on a scale from “most disagree” to “most agree”; (2)complete an open card sort of 50 foods; and (3) classify these 50 foods on a scale from “most unhealthy” to “most healthy”. Exercises (1) and (3) involved Q-methodology, which groups people who share similar understandings of a phenomenon.

Findings

– Participants’ understandings of healthy eating – revealed by the first Q-methodology exercise – were related to shared food priorities, values, and beliefs; these understandings were indirectly connected with food identities, which was not expected. This suggests that lay domain knowledge is difficult to capture and must involve other methodologies than those currently employed in domain-analytic research.

Research limitations/implications

– Although a small sample of food-interested people were recruited, the purpose of this study was not to make generalized claims about perspectives on healthy eating, but to explore how domain knowledge is related to everyday organizational processes.

Originality/value

– To “classify” in Library and Information Science (LIS) usually involves an engagement with formally established classification systems. In this paper the author suggests an alternative path for LIS scholars: the investigation of everyday life classification practices. Such an approach has value beyond the idiosyncratic, as the author discusses how these practices can inform LIS researchers’ strategies for augmenting the messages provided by static classification technologies.

Examining the media portrayal of obesity through the lens of the Common Sense Model of Illness Representations

This study examined the Irish media discourse on obesity by employing the Common Sense Model of Illness Representations. A media sample of 368 transcripts was compiled from newspaper articles (n = 346), radio discussions (n = 5), and online news articles (n = 17) on overweight and obesity from the years 2005, 2007, and 2009. Using the Common Sense Model and framing theory to guide the investigation, a thematic analysis was conducted on the media sample. Analysis revealed that the behavioral dimensions of diet and activity levels were the most commonly cited causes of and interventions in obesity. The advertising industry was blamed for obesity, and there were calls for increased government action to tackle the issue. Physical illness and psychological consequences of obesity were prevalent in the sample, and analysis revealed that the economy, regardless of its state, was blamed for obesity. These results are discussed in terms of expectations of audience understandings of the issue and the implications of these dominant portrayals and framings on public support for interventions. The article also outlines the value of a qualitative analytical framework that combines the Common Sense Model and framing theory in the investigation of illness narratives.

Adverse outcomes associated with media exposure to contradictory nutrition messages

There is increasing concern that the media present conflicting health information on topics including cancer screening and nutrition. Although scholars have speculated that exposure to this information leads to increased public confusion, less trust in health recommendations, and less engagement in health behaviors, there is a lack of empirical research that directly addresses the role of media exposure to conflicting information. Using data from the Annenberg National Health Communication Survey, this study finds that exposure to conflicting information on the health benefits and risks of, for example, wine, fish, and coffee consumption is associated with confusion about what foods are best to eat and the belief that nutrition scientists keep changing their minds. There is evidence that these beliefs, in turn, may lead people to doubt nutrition and health recommendations more generally-including those that are not rife with contradictory information (e.g., fruit/vegetable consumption, exercise). The implications of these findings for healthy eating campaigns and interventions are discussed.

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.

Measuring Media Exposure to Contradictory Health Information: A Comparative Analysis of Four Potential Measures

There is increasing concern that the news media present conflicting health information on topics including cancer screening and nutrition, yet little is known about whether people notice such content. This study proposes four potential measures of media exposure to contradictory health information, using nutrition as an example (Measures I-IV). The measures varied on two dimensions: (1) content specificity, or whether specific nutrition topics and health consequences were mentioned in the question scripting, and (2) obtrusiveness, or whether "contradictory or conflicting information" was mentioned. Using data from the Annenberg National Health Communication Survey (ANHCS), we evaluated the performance of each measure against a set of validity criteria including nomological, convergent, and face validity. Overall, measure IV, which was moderately content-specific and obtrusive, performed consistently well and may prove most useful to researchers studying media effects of contradictory health information. Future directions and applications are discussed.

Antioxidants in foods: state of the science important to the food industry

Antioxidant foods and ingredients are an important component of the food industry. In the past, antioxidants were used primarily to control oxidation and retard spoilage, but today many are used because of putative health benefits. However, the traditional message that oxidative stress, which involves the production of reactive oxygen species (ROS), is the basis for chronic diseases and aging is being reexamined. Accumulating evidence suggests that ROS exert essential metabolic functions and that removal of too many ROS can upset cell signaling pathways and actually increase the risk of chronic disease. It is imperative that the food industry be aware of progress in this field to present the science relative to foods in a forthright and clear manner. This may mean reexamining the health implications of adding large amounts of antioxidants to foods.

Including limitations in news coverage of cancer research: effects of news hedging on fatalism, medical skepticism, patient trust, and backlash

Past research has demonstrated that news coverage of cancer research, and scientific research generally, rarely contains discourse-based hedging, including caveats, limitations, and uncertainties. In a multiple message experiment (k = 4 news stories, N = 1082), the authors examined whether hedging shaped the perceptions of news consumers. The results revealed that participants were significantly less fatalistic about cancer (p = .039) and marginally less prone to nutritional backlash (p = .056) after exposure to hedged articles. Participants exposed to articles mentioning a second researcher (unaffiliated with the present study) exhibited greater trust in medical professions (p = .001). The findings provide additional support for the inclusion of discourse-based hedging in cancer news coverage and suggest that news consumers will use scientific uncertainty in illness representations.

Something fishy? News media presentation of complex health issues related to fish consumption guidelines

OBJECTIVE

The news media are an important source of dietary information. Understanding news content, particularly the portrayal of risks and benefits of certain foods, is relevant for effective public health communication. Fish consumption may reduce risk for CVD and aid neonatal development, but recent work shows public confusion about the benefits of fish, challenged by the evidence of mercury and other contaminants in fish. We present an analysis of the messages about fish in US news media over 15 years, identifying trends in coverage and highlighting implications of current messaging.

DESIGN

We conducted a descriptive text analysis and coded for manifest content: locality of focus, story frame, reference to studies, inclusion of government guidelines and portrayal of uncertainty. We identified chronological patterns and analysed the data for statistically significant relationships between media source and content.

SETTING

News stories were selected from five daily newspapers and five television networks (1993-2007).

SUBJECTS

We analysed 310 health-related news stories on fish.

RESULTS

Risk messages outweighed benefit messages four to one, and health benefits only became prominent after 2002. No difference existed in coverage topic by news source. Fish consumption has increasingly become a national issue.

CONCLUSIONS

With the bulk of messages about fish consumption focused on risk, the benefits may be lost to consumers. This gap creates a need for public health to work with news media to more effectively communicate benefits and risks around fish consumption and health and to consider options for communicating tailored information where it can be more readily utilised.

I don't need anybody to tell me what I should be doing'. A discursive analysis of maternal accounts of (mis)trust of healthy eating information

Healthy eating initiatives, and messages about what one should be eating, are prolific in contemporary British society. This paper examines mothers' talk around food and feeding to determine how trust or mistrust in healthy eating information is established and rationalised. Discursive analysis of interviews with mothers (N=12, aged 25-45) isolated two prominent discursive positions that mothers established with regards to healthy eating messages. First, they legitimised an extensive mistrust of healthy eating information and messages on the grounds that they are at best, inconsistent and at worst, grossly contaminated by stakeholder bias. Second, and in contrast, they established (most) mothers as having a wholesome, privileged, and entirely sufficient instinctive knowledge about how to feed their children. However, an out-group of failing mothers, deemed to have inadequate nutritional knowledge, was also formulated. Mothers talk thus established a central dilemma whereby to accept nutritional advice compromised a good mothering identity. We argue that nutritional messages and interventions should be sensitive to this dilemma so that they facilitate, rather than threaten, a good mothering identity.

Fit for public consumption? An exploratory study of the reporting of nutrition research in UK tabloids with regard to its accuracy, and a preliminary investigation of public attitudes towards it

Objective

To explore the quality (accuracy, balance, practical context) of tabloid articles reporting on nutrition research, and public attitudes towards it.

Design

A qualitative multi-method study consisting of a systematic analysis of tabloid articles and a series of focus groups with members of the public.

Setting

Tabloid newspapers (nationwide). Focus groups were conducted at a UK university.

Subjects

All UK tabloid newspapers were collated for a full calendar month. Members of the local Women’s Institute and non-teaching staff within the University College Chester were recruited as focus group participants.

Results

Twenty-nine tabloid articles were included. A standardised TAT (Tabloid Analysis Tool) was used a total of thirty-nine times (once for each research study cited). Twenty-six failed to accurately report research results, thirty-six failed to mention significant research limitations, and only five quoted a third-party expert source. Two focus groups, each with eight participants, were conducted. Attitudes expressed were largely negative, highlighting elements of confusion and scepticism. Articles were more likely to be disregarded than acted upon, although some value was attached to newspapers providing nutrition information.

Conclusions

Tabloid reporting on nutrition research is not sufficiently accurate, balanced or contextualised, and public attitudes towards the reporting are not wholly favourable. Guidance for journalists via registered dietitians and a strengthening of present links could serve to utilise this form of mass media more effectively.

Does social class predict diet quality?

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.

Engaging with healthy eating discourse(s): Ways of knowing about food and health in three ethnocultural groups in Canada

The aim of this study was to increase our understanding of how people make sense of healthy eating discourses by exploring the 'ways of knowing' about healthy eating among members of three different ethnocultural groups in Canada: African Nova Scotians, Punjabi British Columbians and Canadian-born European Nova Scotians and British Columbians. Data for this paper come from in-depth, individual interviews with 105 adults where they described their experiences, interpretations, and reasoning used in learning and deciding what to believe and/or reject about healthy eating. Between and within ethnocultural group differences in how people come to know and use practices about healthy eating were examined as they were represented through three broad healthy eating discourses: cultural/traditional, mainstream and complementary/ethical. The discourses represented different ways to interpret the food-health relationship and make sense of the evidence about healthy eating in the everyday experience. Engagement with different discourses led participants to undertake different practices upon themselves in the name of healthy eating. We suggest that each of the discourses has a significant contribution to make in a dialogue about how healthy eating, as part of health and well-being, should be conceptualized by a society.

Eating competence: definition and evidence for the Satter Eating Competence model

The evidence- and practice-based Satter Eating Competence Model (ecSatter) outlines an inclusive definition of the interrelated spectrum of eating attitudes and behaviors. The model is predicated on the utility and effectiveness of biopsychosocial processes: hunger and the drive to survive, appetite and the need for subjective reward and the biological propensity to maintain preferred and stable body weight. According to ecSatter, competent eaters have 1) positive attitudes about eating and about food, 2) food acceptance skills that support eating an ever-increasing variety of the available food, 3) internal regulation skills that allow intuitively consuming enough food to give energy and stamina and to support stable body weight, and 4) skills and resources for managing the food context and orchestrating family meals. Identifying these four constructs allows nutrition professionals to target interventions as well as trust and support the individual's own capabilities and tendency to learn and grow.

Designing media messages about health and nutrition: what strategies are most effective?

This report focuses on how to design media messages about nutrition that will persuade people to adopt healthful behaviors. The Elaboration Likelihood Model (ELM) is used as a theoretical framework to explore different information-processing modes that individuals employ in a variety of communication situations. Studies from the fields of communication and psychology are briefly reviewed, with a focus on the source and message strategies that are most likely to persuade different types of audiences to change their nutritional attitudes and behaviors.

Energy-dense diets are associated with lower diet costs: a community study of French adults

Objective:

High consumption of energy-dense foods has been linked to high energy intakes and excess weight gain. This study tested the hypothesis that high energy density of the total diet is associated with lower diet costs.

Design:

Dietary intakes of 837 French adults, aged 18–76 years, were assessed using a dietary history method. Dietary energy density (MJ kg−1) was calculated by dividing total energy by the edible weight of foods consumed. Daily diet cost (€day−1) was estimated using mean national food prices for 57 food items. The relationship between dietary energy density and diet cost at each level of energy intake was examined in a regression model, adjusted for gender and age.

Results:

The more energy-dense refined grains, sweets and fats provided energy at a lower cost than did lean meats, vegetables and fruit. Within each quintile of energy intake, diets of lower energy density (MJ kg−1) were associated with higher diet costs (€day−1).

Conclusion:

In this observational study, energy-dense diets cost less whereas energy-dilute diets cost more, adjusting for energy intakes. The finding that energy-dilute diets are associated with higher diet costs has implications for dietary guidelines and current strategies for dietary change.

Fat-Related Dietary Behaviors of Adult Puerto Ricans, with and without Diabetes, in New York City

OBJECTIVE

To assess the fat-related dietary behaviors of adult Puerto Ricans with and without diagnosed diabetes, living in New York City.

DESIGN

A random-digit-dialing telephone survey was conducted following Behavioral Risk Factor Surveillance System procedures. Dietary behavior was assessed using a brief Fat-Related Diet Habits Questionnaire, in which higher scores indicated higher fat intake.

SUBJECTS/SETTING

A total of 1,304 adult Puerto Ricans living in New York City were interviewed. Diabetes status was assessed using standard Behavioral Risk Factor Surveillance System questions.

STATISTICAL ANALYSES PERFORMED

Weighted analyses using SUDAAN software for complex surveys were done, and t tests were used to assess differences in mean fat-related dietary score by sociodemographic and health characteristics. Age-adjusted least-squared means were used to compare scores between those with and without diabetes. Linear regression was used to model characteristics associated with fat-related dietary score.

RESULTS

Fat-related dietary score was lower among those with diabetes and varied by population and health characteristics. Age-adjusted scores were significantly lower for those with diabetes who were younger, less educated, obese, or physically active. In the regression model, family history, weight, and exercise interacted with diabetes status. Those with diabetes were significantly more likely to modify meat consumption practices (eg, remove skin or trim fat) to reduce fat compared with those without diabetes.

CONCLUSIONS

New York City Puerto Ricans with diabetes are somewhat more likely to engage in behaviors to reduce fat compared with those without diabetes. Targeted, culturally sensitive nutrition education and counseling emphasizing lower-fat food choices and other fat-reducing behaviors can help reduce risk and control diabetes. Education messages should be tailored to the individual's diabetes status and other health and sociodemographic characteristics.

Filling yet fattening: stereotypical beliefs about the weight gain potential and satiation of foods

To what extent are stereotypes concerning the weight-gain potential and perceived hunger satisfaction of food names not congruent with views of the nutrient profiles of those same foods? Respondents rated the same 22 food names and descriptions in terms of weight-gain potential and hunger satisfaction. Half of the 22 snacks included foods from the lower two tiers of the USDA Food Guide Pyramid (fruits, vegetables, and grains: FV&G) and the other half from the upper two tiers (meats, dairy, fats, and sweets: MDF&S). FV&G and MDF&S snack names and descriptions were paired for data analyses based on energy content. Name and description ratings for weight-gain potential were not correlated, while these ratings for hunger satisfaction were strongly correlated. For weight-gain potential, fat and fiber content predicted snack-name ratings, while energy and sugar content predicted description ratings. For perceived hunger satisfaction, protein content predicted snack name ratings while energy and fat content predicted description ratings. The MDF&S snack named in each pair was always considered a greater weight gain promoter compared to its corresponding FV&G snack named. However, the description of the FV&G snack in each pair was often judged to promote greater weight-gain than the description of its corresponding MDF&S snack. Also, MDF&S names were generally judged as more filling than FV&G foods named with similar calorie content; however, a trend in the opposite direction was evident when rating the nutrient descriptions of these same foods. Apparently, food names have acquired reputation for promoting obesity and (to a lesser extent) hunger satisfaction that are not based on their nutrient profiles.

A Nutrient Density Standard for Vegetables and Fruits: Nutrients per Calorie and Nutrients per Unit Cost

OBJECTIVES

The Dietary Guidelines for Americans 2005 recommended that consumers give priority to nutrient-dense foods, those that contain substantial amounts of key nutrients in relation to the dietary energy they provide. This study developed a scoring system to estimate the nutritional adequacy of vegetables and fruits, on a per weight, per calorie, and per unit cost basis.

DATA

We used a French national food composition database for 637 foods, including 129 vegetables and fruits. Mean national retail prices were obtained for each food.

METHODS

The nutrient adequacy score was defined as the mean of percent daily values for 16 nutrients, based on 100 g of food. The nutrient density score and the nutrient-to-price ratio were the mean of percent daily values for 16 nutrients, expressed per 100 kcal and per 1 euro of food, respectively. Relationships between energy density of vegetables and fruits, nutrient adequacy score, nutrient density score, and nutrient-to-price ratio were tested using linear regression.

RESULTS

Energy density and nutrient density score were negatively correlated, confirming the widely accepted notion that energy-dense foods tend to be nutrient-poor. As expected, fruits and vegetables had the highest nutrient density score because they were nutrient-rich in relation to their low energy content. They also had a relatively high nutrient-to-price ratio, showing that they provided nutrients at a reasonable cost when compared with other foods.

CONCLUSIONS

Foods ranked differently when nutritional adequacy was calculated per weight (nutrient adequacy score), per calorie (nutrient density score), or per unit cost (nutrient-to-price ratio). The present results showed that although fruits and vegetables are an expensive source of dietary energy, they provide key nutrients at a reasonable cost.

Obesity and Nutrition in Women Throughout Adulthood

Nutritional challenges are particularly relevant to women. Almost 62% of women are overweight; of these women, 33% are obese. The incidence of obesity is even greater in non-Hispanic Black and Mexican American women. Women who are overweight or obese experience a greater number of adverse health outcomes, including an increased incidence of cardiovascular disease and breast and colon cancer. Dietary patterns influence health outcomes, with a heart-healthy pattern having the most positive health outcomes. Health care providers should encourage women to consume a diet high in fruits and vegetables and low in total and saturated fats.

Diet and cardiovascular disease in the UK: are the messages getting across?

Cardiovascular disease (CVD) is a leading cause of premature death in the UK and a major cause of ill health and disability. Whilst death rates from CVD have been falling since the late 1970s in the UK, levels of morbidity (such as angina) do not seem to be falling and may even be rising in some age-groups, especially as the population ages. There is broad consensus that lifestyle factors, including physical activity and diet, are fundamental determinants of heart disease risk. Current recommendations to reduce cardiovascular risk include maintaining a healthy body weight, eating five or more portions of fruit and vegetables each day, reducing intake of fat (particularly saturated fatty acids), reducing salt intake and eating one portion of oily fish per week. Although some improvements have been made in recent years (e.g. a reduction in total fat intake), national studies suggest that more effective campaigns are required to increase awareness of the benefits of these dietary changes. The present paper will discuss how the dietary messages relating to CVD are best communicated to the general public and will identify some of the main barriers to their implementation.