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Grummon AH, Lee CJY, D'Angelo Campos A, Whitesell C, Brewer NT, Lazard AJ, Greenfield TK, Hall MG. Health harms that discourage alcohol consumption: A randomized experiment of warning messages. Addict Behav 2024; 159:108135. [PMID: 39191066 DOI: 10.1016/j.addbeh.2024.108135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/30/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Health warnings about alcohol consumption could inform consumers and discourage alcohol consumption, but little is known about what topics these warnings should address. We sought to identify promising topics for alcohol warnings. METHODS In January 2024, we recruited a convenience sample of 2,522 US adults ages ≥ 21 years. In an online within-subjects experiment, participants viewed messages about 6 topics (5 warning topics selected from a pool of 16 topics [e.g., liver disease, liver cancer] and 1 control topic [i.e., recycling or reselling products]) shown in random order. For each topic, participants viewed and rated 2 statements about that topic on perceived message effectiveness (primary outcome) and reactance (secondary outcome). RESULTS The 16 warning topics elicited higher perceived message effectiveness than the control topic (ps < 0.001). Among the warning topics, liver disease, most cancer types, dementia or mental decline, and hypertension elicited the highest perceived message effectiveness, while breast cancer, sleep, and drinking guidelines elicited the lowest. Fourteen of the 16 warning topics (all except for fetal harms and impaired driving) elicited more reactance than the control topic (ps < 0.001). Warning topics that elicited high perceived message effectiveness generally elicited high reactance, except for messages about liver disease and liver cancer, which elicited high perceived message effectiveness but only moderate reactance. DISCUSSION Warning messages about a variety of topics hold promise for discouraging alcohol consumption. Messages about liver disease, most cancer types, dementia or mental decline, and hypertension are perceived as especially effective; however, none of these topics are included in the current US alcohol warning.
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Affiliation(s)
- Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.
| | - Cristina J Y Lee
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Aline D'Angelo Campos
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Callie Whitesell
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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2
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Rigutto-Farebrother J, Zimmermann MB. Salt Reduction and Iodine Fortification Policies Are Compatible: Perspectives for Public Health Advocacy. Nutrients 2024; 16:2517. [PMID: 39125397 PMCID: PMC11314281 DOI: 10.3390/nu16152517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Cardiovascular diseases account for almost 18 million deaths annually, the most of all non-communicable diseases. The reduction of dietary salt consumption is a modifiable risk factor. The WHO recommends a daily sodium intake of <2000 mg but average consumption exceeds this in many countries globally. Strategies proposed to aid effective salt reduction policy include product reformulation, front of pack labelling, behavioural change campaigns and establishing a low-sodium-supportive environment. Yet, salt for household and processed food use is, in countries wholly or partially adopting a universal salt iodisation policy, the principal vehicle for population-wide iodine fortification. With salt reduction policies in place, there is concern that iodine deficiency disorders may re-emerge. Recognising the urgency to tackle the rising prevalence of NCDs yet not risk the re-emergence and detrimental effect of inadequate iodine intakes, this review lays out the feasibility of integrating both salt reduction and salt iodine fortification strategies. Reducing the burden of health risks associated with an excessive sodium intake or inadequate iodine through population-tailored, cost-effective strategies involving salt is both feasible and achievable, and represents an opportunity to improve outcomes in public health.
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Affiliation(s)
- Jessica Rigutto-Farebrother
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
- Laboratory of Nutrition and Metabolic Epigenetics, Institute of Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
| | - Michael B. Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
- MRC Human Immunology Unit, MRC Wetherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
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3
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Kelly B, Ng SH, Carrad A, Pettigrew S. The Potential Effectiveness of Front-of-Pack Nutrition Labeling for Improving Population Diets. Annu Rev Nutr 2024; 44:405-440. [PMID: 38857543 DOI: 10.1146/annurev-nutr-011224-030917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Nutrition labeling on the front of food packages can support more healthful purchase decisions and encourage favorable reformulation. This systematic literature review applied Cochrane methods to synthesize and appraise the evidence on the effectiveness of front-of-pack labeling (FOPL) on diet-related outcomes and food reformulation to inform policy recommendations. The search was conducted on 11 academic and gray literature databases, from inception to July 2022. Evidence was synthesized using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), vote counting, and meta-analyses, where appropriate. Overall, 221 articles were included in the review. The randomized controlled trial evidence suggested that, compared with when no FOPL was present, FOPL likely improved consumer understanding of the nutritional quality/content of foods (moderate certainty of evidence), and the healthfulness of food choices (moderate certainty) and purchases (moderate certainty). Interpretive FOPL had a greater effect on these outcomes compared with noninterpretive systems (moderate certainty). There was inconsistency in the best-performing interpretive FOPL system.
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Affiliation(s)
- Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia;
| | - See Hoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia;
| | - Amy Carrad
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia;
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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4
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Thomas AM, Mathew MG, Cherian J. Healthier eating through legislation and social media advocacy. Br Dent J 2024; 237:239. [PMID: 39179804 DOI: 10.1038/s41415-024-7797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 08/26/2024]
Affiliation(s)
- A M Thomas
- Christian Dental College, Ludhiana, India.
| | - M G Mathew
- Christian Dental College, Ludhiana, India.
| | - J Cherian
- Christian Dental College, Ludhiana, India.
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5
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Brant LCC, Miranda JJ, Carrillo-Larco RM, Flood D, Irazola V, Ribeiro ALP. Epidemiology of cardiometabolic health in Latin America and strategies to address disparities. Nat Rev Cardiol 2024:10.1038/s41569-024-01058-2. [PMID: 39054376 DOI: 10.1038/s41569-024-01058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/27/2024]
Abstract
In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.
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Affiliation(s)
- Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vilma Irazola
- Center of Excellence for Cardiovascular Health, Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Antonio Luiz P Ribeiro
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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6
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Melo G. Fruitful changes? Exploring household fruit purchase decisions following comprehensive food policy regulations in Chile. Appetite 2024; 198:107354. [PMID: 38642723 DOI: 10.1016/j.appet.2024.107354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024]
Abstract
Changes in unprocessed healthy food purchases associated with the implementation of comprehensive food policy remain understudied. This study analyzes whether, following the announcement, modification, and implementation of Chile's Food Labeling and Advertising law targeting highly processed food (occurring in 2012, 2015, and 2016, respectively), households improved their fruit purchase decisions: purchase participation (i.e., buying likelihood) and purchase quantity. Expenditure data from a representative sample of Chilean households were employed, covering two consecutive survey waves conducted in 2011/2012 and 2016/2017. After controlling for socioeconomic factors (e.g., prices and income), results indicate that only purchase participation increased, providing weak support for positive spillover effects of a comprehensive food policy on fruit purchases. Subsample analyses reveal that this increase was driven by college-educated, childless, and low-income households and was stronger for sweeter and more convenient fruits. Considering that households in Chile do not meet health recommendations for daily fruit intake, additional policy efforts targeting healthy, unprocessed food consumption could be considered.
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Affiliation(s)
- Grace Melo
- Department of Agricultural Economics, Texas A&M University, USA.
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7
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Contreras-Manzano A, White CM, Nieto C, Quevedo KL, Vargas-Meza J, Hammond D, Thrasher JF, Barquera S, Jáuregui A. Self-reported decreases in the purchases of selected unhealthy foods resulting from the implementation of warning labels in Mexican youth and adult population. Int J Behav Nutr Phys Act 2024; 21:64. [PMID: 38877496 PMCID: PMC11177525 DOI: 10.1186/s12966-024-01609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/23/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Front-of-package nutritional warning labels (WLs) are designed to facilitate identification and selection of healthier food choices. We assessed self-reported changes in purchasing different types of unhealthy foods due to WLs in Mexico and the association between the self-reported reductions in purchases of sugary beverages and intake of water and sugar-sweetened beverages. METHODS Data came from 14 to 17 year old youth (n = 1,696) and adults ≥ 18 (n = 7,775) who participated in the Mexican arm of the 2020-2021 International Food Policy Study, an annual repeat cross-sectional online survey. Participants self-reported whether the WLs had influenced them to purchase less of each of nine unhealthy food categories due to WLs. Among adults, a 23-item Beverage Frequency Questionnaire was used derive past 7-day intake of water and sugary beverages analyzed to determine the relationship between self-reported reductions in purchasing sugary drinks due to the WLs. Multilevel mixed-effects logistic regression models were fitted to estimate the percentage of participants who self-reported reducing purchases within each food group, and overall. Sociodemographic characteristics associated with this reduction were investigated as well. RESULTS Overall, 44.8% of adults and 38.7% of youth reported buying less of unhealthy food categories due to the implementation of WL, with the largest proportion reporting decreased purchases of cola, regular and diet soda. A greater impact of WLs on the reported purchase of unhealthy foods was observed among the following socio-demographic characteristics: females, individuals who self-identified as indigenous, those who were overweight, individuals with lower educational levels, those with higher nutrition knowledge, households with children, and those with a significant role in household food purchases. In addition, adults who reported higher water intake and lower consumption of sugary beverages were more likely to report reduced purchases of sugary drinks due to the WLs. Adults who reported greater water intake and lower sugary beverages intake were significantly more likely to report buying fewer sugary drinks due to the WLs. CONCLUSION Our findings suggest that implementation of WLs has reduced perceived purchases of unhealthy foods in Mexico. These results underscore the potential positive impact of the labeling policy particularly in subpopulations with lower levels of education and among indigenous adults.
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Affiliation(s)
- Alejandra Contreras-Manzano
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
- National Council for Humanities, Science and Technology, Mexico City, Mexico
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Claudia Nieto
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Kathia L Quevedo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Jorge Vargas-Meza
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
- El Poder del Consumidor A.C., Mexico City, Mexico
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.
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8
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Neufeld LM, Nordhagen S, Leroy JL, Aberman NL, Barnett I, Djimeu Wouabe E, Webb Girard A, Gonzalez W, Levin CE, Mbuya MN, Nakasone E, Nyhus Dhillon C, Prescott D, Smith M, Tschirley D. Food Systems Interventions for Nutrition: Lessons from 6 Program Evaluations in Africa and South Asia. J Nutr 2024; 154:1727-1738. [PMID: 38582386 DOI: 10.1016/j.tjnut.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/08/2024] Open
Abstract
Although there is growing global momentum behind food systems strategies to improve planetary and human health-including nutrition-there is limited evidence of what types of food systems interventions work. Evaluating these types of interventions is challenging due to their complex and dynamic nature and lack of fit with standard evaluation methods. In this article, we draw on a portfolio of 6 evaluations of food systems interventions in Africa and South Asia that were intended to improve nutrition. We identify key methodological challenges and formulate recommendations to improve the quality of such studies. We highlight 5 challenges: a lack of evidence base to justify the intervention, the dynamic and multifaceted nature of the interventions, addressing attribution, collecting or accessing accurate and timely data, and defining and measuring appropriate outcomes. In addition to more specific guidance, we identify 6 cross-cutting recommendations, including a need to use multiple and diverse methods and flexible designs. We also note that these evaluation challenges present opportunities to develop new methods and highlight several specific needs in this space.
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Affiliation(s)
- Lynnette M Neufeld
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations (FAO), Rome, Italy.
| | - Stella Nordhagen
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Jef L Leroy
- Nutrition, Diets and Health Unit, International Food Policy Research Institute, Washington, DC, United States
| | - Noora-Lisa Aberman
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Inka Barnett
- Institute of Development Studies (IDS), University of Sussex, Brighton, United Kingdom
| | - Eric Djimeu Wouabe
- Evaluation and Adaptive Learning, Results for Development (R4D), Washington, DC, United States
| | - Amy Webb Girard
- Nutrition and Health Sciences Program, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Wendy Gonzalez
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Carol E Levin
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Mduduzi Nn Mbuya
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Eduardo Nakasone
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, MI, United States
| | - Christina Nyhus Dhillon
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | - David Tschirley
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, MI, United States
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Ivaturi A, Do LG, Giles L, Devenish G, Scott JA, Ha DH, Golley R, Bell LK, Moynihan PJ. Sources and determinants of free sugars intake by 5-year-old Australian children in the SMILE cohort. MATERNAL & CHILD NUTRITION 2024:e13671. [PMID: 38804267 DOI: 10.1111/mcn.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/02/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
Reducing free sugars intake is important for the prevention of dental caries and obesity in children. The study aimed to determine the amount and sources of free sugars known to contribute to dental caries, and identify sociodemographic determinants of intake by children aged 5 years in Australia. Cross-sectional analysis of dietary data from a cohort study, collected using a customized food frequency questionnaire were used to calculate free sugars intake as grams/day and percentage contribution to Estimated Energy Requirement (EER). The percent contribution of food sources to free sugars intake was derived. Sociodemographic determinants of achieving intakes within WHO thresholds (i.e., <5% and <10% Energy were explored with multinomial logistic regression. Complete data were available for 641 children (347 boys, 294 girls). Median (IQR) free sugars intake (g/day) was 31.6 (21.3-47.6) in boys and 28.1 (19.6-47.9) in girls. The median (IQR) percentage contribution to EER was 7.9 (5.4-12.7); 21% and 42% of children had intakes <5% EER and between 5% and <10%, respectively. The main sources of free sugars were: (1) Cakes, Biscuits and Cereal Bars; (2) Sweetened Milk Products (predominantly yoghurts) and (3) Desserts. Maternal university education, single-parent household, and maternal place of birth being Australia or New Zealand were associated with free sugars intake <5% EER. In conclusion, less than a quarter of 5-year-old children in the SMILE cohort achieved the WHO recommendations to limit free sugars to <5% EER. Strategies to lower free sugars intake could target priority populations such migrants, populations with lower levels of education or health literacy and identify areas for intervention in the wider food environments that children are exposed to.
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Affiliation(s)
- Anupama Ivaturi
- Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Loc Giang Do
- School of Dentistry, University of Queensland, Herston, Queensland, Australia
| | - Lynne Giles
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Gemma Devenish
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jane A Scott
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Diep H Ha
- School of Dentistry, University of Queensland, Herston, Queensland, Australia
| | - Rebecca Golley
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Lucy K Bell
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Paula J Moynihan
- Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Palu A, Santos JA, Silatolu AM, Deo A, Bell C, Waqa G, Webster J, McKenzie BL. Energy, nutrient and overall healthiness of processed packaged foods in Fiji, a comparison between 2018 and 2020. BMC Public Health 2024; 24:1383. [PMID: 38783234 PMCID: PMC11112809 DOI: 10.1186/s12889-024-18787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
In Fiji, packaged foods are becoming increasingly available. However, it is unknown if nutrition composition of these foods has changed. This study aims to assess changes in energy, nutrient content and healthiness of packaged foods by comparing data from five major supermarkets in Fiji in 2018 and 2020. Foods were categorised into 14 groups; nutrient composition information was extracted and healthiness assessed using Health Star Rating (HSR). Descriptive statistics and a separate matched products analysis was conducted summarising differences in nutrient content and HSR. There was limited evidence of change in the nutrient content of included products however, there was a small reduction in mean saturated fat in the snack food category (-1.0 g/100 g, 95% CI -1.6 to -0.4 g/100 g). The proportion of products considered healthy based on HSR, increased in the convenience foods category (28.4%, 95% CI 8.3 to 48.5) and decreased in non-alcoholic beverages (-35.2%, 95% CI -43.6 to -26.9). The mean HSR score increased in the fruit and vegetables category (0.1 (95% CI 0.1, 0.2)) and decreased for non-alcoholic beverages (-1.1 (-1.3, -0.9)) and the sauces, dressings, spreads, and dips category (-0.3 (-0.3, -0.2)). Strengthened monitoring of the food supply is needed to improve the healthiness of foods available.
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Affiliation(s)
- Aliyah Palu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia
| | - Ana Moala Silatolu
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, Fiji National University, Tamavua Campus, Suva, Fiji
| | | | - Colin Bell
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gade Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, Fiji National University, Tamavua Campus, Suva, Fiji
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia
| | - Briar L McKenzie
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia
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11
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Bradbury KE, Mackay S. Ultra-processed foods linked to higher mortality. BMJ 2024; 385:q793. [PMID: 38719491 DOI: 10.1136/bmj.q793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Affiliation(s)
- Kathryn E Bradbury
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland 1023, New Zealand
- Centre for Translational Health Research (TRANSFORM), Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland 1023, New Zealand
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12
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Minaker LM, Menko P, Olona D. Development and testing of two tools to assess point-of-sale food and beverage marketing to children in restaurants. Public Health Nutr 2024; 27:e128. [PMID: 38705591 PMCID: PMC11112432 DOI: 10.1017/s1368980024000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To describe the development and testing of two assessment tools designed to assess exterior (including drive-thru) and interior food and beverage marketing in restaurants with a focus on marketing to children and teens. DESIGN A scoping review on restaurant marketing to children was undertaken, followed by expert and government consultations to produce a draft assessment tool. The draft tool was mounted online and further refined into two separate tools: the Canadian Marketing Assessment Tool for Restaurants (CMAT-R) and the CMAT-Photo Coding Tool (CMAT-PCT). The tools were tested to assess inter-rater reliability using Cohen's Kappa and per cent agreement for dichotomous variables, and intra-class correlation coefficients (ICCs) for continuous or rank-order variables. SETTING Waterloo, Ontario, Canada. PARTICIPANTS Restaurants of all types were assessed using the CMAT-R (n 57), and thirty randomly selected photos were coded using the CMAT-PCT. RESULTS The CMAT-R collected data on general promotions and restaurant features, drive-thru features, the children's menu and the dollar/value menu. The CMAT-PCT collected data on advertisement features, features considered appealing to children and teens, and characters. The inter-rater reliability of the CMAT-R tool was strong (mean per cent agreement was 92·4 %, mean Cohen's κ = 0·82 for all dichotomous variables and mean ICC = 0·961 for continuous/count variables). The mean per cent agreement for the CMAT-PCT across items was 97·3 %, and mean Cohen's κ across items was 0·91, indicating very strong inter-rater reliability. CONCLUSIONS The tools assess restaurant food and beverage marketing. Both showed high inter-rater reliability and can be adapted to better suit other contexts.
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Affiliation(s)
- Leia M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Patrycia Menko
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - David Olona
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Gibson LA, Stephens-Shields AJ, Hua SV, Orr JA, Lawman HG, Bleich SN, Volpp KG, Bleakley A, Thorndike AN, Roberto CA. Comparison of Sales From Vending Machines With 4 Different Food and Beverage Messages: A Randomized Trial. JAMA Netw Open 2024; 7:e249438. [PMID: 38717775 PMCID: PMC11079689 DOI: 10.1001/jamanetworkopen.2024.9438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/27/2024] [Indexed: 05/12/2024] Open
Abstract
Importance Point-of-sale food messaging can encourage healthier purchases, but no studies have directly compared multiple interventions in the field. Objective To examine which of 4 food and beverage messages would increase healthier vending machine purchases. Design, Setting, and Participants This randomized trial assessed 13 months (February 1, 2019, to February 29, 2020) of vending sales data from 267 machines and 1065 customer purchase assessments from vending machines on government property in Philadelphia, Pennsylvania. Data analysis was performed from March 5, 2020, to November 8, 2022. Interventions Study interventions were 4 food and beverage messaging systems: (1) beverage tax posters encouraging healthy choices because of the Philadelphia tax on sweetened drinks; (2) green labels for healthy products; (3) traffic light labels: green (healthy), yellow (moderately healthy), or red (unhealthy); or (4) physical activity equivalent labels (minutes of activity to metabolize product calories). Main Outcomes and Measures Sales data were analyzed separately for beverages and snacks. The main outcomes analyzed at the transaction level were calories sold and the health status (using traffic light criteria) of each item sold. Additional outcomes were analyzed at the monthly machine level: total units sold, calories sold, and units of each health status sold. The customer purchase assessment outcome was calories purchased per vending trip. Results Monthly sales data came from 150 beverage and 117 snack vending machines, whereas 1065 customers (558 [52%] male) contributed purchase assessment data. Traffic light labels led to a 30% decrease in the mean monthly number of unhealthy beverages sold (mean ratio [MR], 0.70; 95% CI, 0.55-0.88) compared with beverage tax posters. Physical activity labels led to a 34% (MR, 0.66; 95% CI, 0.51-0.87) reduction in the number of unhealthy beverages sold at the machine level and 35% (MR, 0.65; 95% CI, 0.50-0.86) reduction in mean calories sold. Traffic light labels also led to a 30-calorie reduction (b = -30.46; 95% CI, -49.36 to -11.56) per customer trip in the customer purchase analyses compared to physical activity labels. There were very few significant differences for snack machines. Conclusions and Relevance In this 13-month randomized trial of 267 vending machines, the traffic light and physical activity labels encouraged healthier beverage purchases, but no change in snack sales, compared with a beverage tax poster. Corporations and governments should consider such labeling approaches to promote healthier beverage choices. Trial Registration ClinicalTrials.gov Identifier: NCT06260176.
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Affiliation(s)
- Laura A. Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
| | - Alisa J. Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sophia V. Hua
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
| | - Jennifer A. Orr
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
| | - Hannah G. Lawman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
- Now with Novo Nordisk Inc, Plainsboro Township, New Jersey
| | - Sara N. Bleich
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
- Department of Health Care Management, University of Pennsylvania Wharton School, Philadelphia
| | - Amy Bleakley
- Department of Communication, University of Delaware, Newark
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
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Miller C, Ettridge K, Pettigrew S, Wittert G, Coveney J, Wakefield M, Roder D, Durkin S, Martin J, Kay E, Dono J. Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency. Public Health 2024; 230:138-148. [PMID: 38547760 DOI: 10.1016/j.puhe.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption. DESIGN AND METHODS A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE. RESULTS PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low. CONCLUSIONS Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.
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Affiliation(s)
- C Miller
- School of Public Health, The University of Adelaide, Adelaide, Australia; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - K Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
| | - S Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - G Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - J Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - D Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - S Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Martin
- Food for Health Alliance, Cancer Council Victoria, Melbourne, Australia
| | - E Kay
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; College of Education Psychology and Social Work, Flinders University, Adelaide, Australia
| | - J Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
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15
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Basto-Abreu A, Carnalla M, Reyes-Sánchez F, Reyes-García A, Haby MM, Junquera-Badilla I, Sartoris-Ayala L, Rivera JA, Popkin BM, Barrientos-Gutiérrez T. Predicted impact of banning nonessential, energy-dense food and beverages in schools in Mexico: A microsimulation study. PLoS Med 2024; 21:e1004394. [PMID: 38728236 PMCID: PMC11086919 DOI: 10.1371/journal.pmed.1004394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Childhood obesity is a growing concern worldwide. School-based interventions have been proposed as effective means to improve nutritional knowledge and prevent obesity. In 2023, Mexico approved a reform to the General Education Law to strengthen the ban of sales and advertising of nonessential energy-dense food and beverages (NEDFBs) in schools and surroundings. We aimed to predict the expected one-year change in total caloric intake and obesity prevalence by introducing the ban of NEDFBs sales in schools, among school-aged children and adolescents (6 to 17 years old) in Mexico. METHODS AND FINDINGS We used age-specific equations to predict baseline fat-free mass (FFM) and fat mass (FM) and then estimated total energy intake (TEI) per day. The TEI after the intervention was estimated under 4 scenarios: (1) using national data to inform the intervention effect; (2) varying law compliance; (3) using meta-analytic data to inform the intervention effect size on calories; and (4) using national data to inform the intervention effect by sex and socioeconomic status (SES). We used Hall's microsimulation model to estimate the potential impact on body weight and obesity prevalence of children and adolescents 1 year after implementing the intervention in Mexican schools. We found that children could reduce their daily energy intake by 33 kcal/day/person (uncertainty interval, UI, [25, 42] kcal/day/person), reducing on average 0.8 kg/person (UI [0.6, 1.0] kg/person) and 1.5 percentage points (pp) in obesity (UI [1.1, 1.9] pp) 1 year after implementing the law. We showed that compliance will be key to the success of this intervention: considering a 50% compliance the intervention effect could reduce 0.4 kg/person (UI [0.3, 0.5] kg/person). Our sensitivity analysis showed that the ban could reduce body weight by 1.3 kg/person (UI [0.8, 1.8] kg/person) and up to 5.4 kg/person (UI [3.4, 7.5] kg/person) in the best-case scenario. Study limitations include assuming that obesity and the contribution of NEDFBs consumed at school remain constant over time, assuming full compliance, and not considering the potential effect of banning NEDFBs in stores near schools. CONCLUSIONS Even in the most conservative scenario, banning sales of NEDFBs in schools is expected to significantly reduce obesity, but achieving high compliance will be key to its success. WHY WAS THIS STUDY DONE? - School-based interventions have been recognized as effective means to improve nutritional knowledge and prevent obesity-related diseases.- In December 2023, the Chamber of Representatives of Mexico approved an amendment that strengthens and updates the General Education Law (Article 75) and nutritional guidelines to ban the sales and advertising of nonessential energy-dense food and beverages (NEDFBs) in schools. WHAT DID THE RESEARCHERS DO AND FIND? - We used age-specific equations to predict baseline fat-free mass (FFM) and fat mass (FM) and total energy intake (TEI) per day.- We used microsimulation modeling to predict body weight and obesity prevalence of children and adolescents 1 year after implementing the intervention in Mexican schools.- Our modeling study suggests that an important impact on obesity prevalence can be expected if the law is implemented and enforced as intended. WHAT DO THESE FINDINGS MEAN? - If successful, this law could serve as an example beyond Mexico on how to achieve changes in body weight through school food regulation.- An important limitation of our main scenario is that we assumed full compliance of schools with the law, yet lower compliance will reduce its impact. We also did not consider historical trends on obesity or NEDFBs consumed in schools during our 1 year simulation, and we considered only the ban impact inside schools, excluding effects near and outside schools.
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Affiliation(s)
- Ana Basto-Abreu
- National Institute of Public Health, Center for Population Health Research, Mexico
| | - Martha Carnalla
- National Institute of Public Health, Center for Population Health Research, Mexico
| | | | - Alan Reyes-García
- National Institute of Public Health, Center for Population Health Research, Mexico
| | - Michelle M. Haby
- Division of Biological and Health Sciences, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Mexico
| | | | | | - Juan A. Rivera
- National Institute of Public Health, Center for Population Health Research, Mexico
| | - Barry M. Popkin
- Department of Nutrition, Gillings School of Global Public Health, and the Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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16
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Jorquera C, Droppelmann G, Pridal P, Faúndez J, Feijoo F. Chilean Market Protein Shakes Composition. Nutrients 2024; 16:1129. [PMID: 38674821 PMCID: PMC11055153 DOI: 10.3390/nu16081129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Understanding the nutritional content of protein supplements is crucial for optimal nutritional planning among athletes and other people. Distribution of macronutrients and aminograms in the main products available in the national Chilean market remains unknown. A descriptive cross-sectional study was conducted to identify the main protein supplements available in the Chilean market. Information on macronutrients and aminograms from the nutritional labels of each product was extracted. The analysis considered the content per portion and per 100 g. Cluster analysis models and graphical representations were explored. Eighty protein shakes were assessed in the Santiago de Chile market. The median protein dosage was 32 g (range from 25 to 52), and the median energy value stood at 390 kcal (range from 312 to 514). The median protein content per 100 g of product was found to be 75 g (range from 42.5 to 97.2). The combined median concentration of amino acids was 4749.75 mg. Among these, the essential amino acid L-Tryptophan exhibited the lowest concentration at 1591.50 mg, while the conditional amino acid L-Glutamine had the highest median concentration at 17,336 mg. There was a significant prevalence of animal-derived products, placing specific emphasis on protein supplements that feature elevated levels of the amino acids L-Glutamine and L-Leucine.
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Affiliation(s)
- Carlos Jorquera
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago 8580745, Chile; (C.J.); (P.P.)
| | - Guillermo Droppelmann
- Clínica MEDS, Santiago 7550000, Chile
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Paula Pridal
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago 8580745, Chile; (C.J.); (P.P.)
| | - Javier Faúndez
- Club Social y Deportivo Unión Española, Santiago, Chile;
| | - Felipe Feijoo
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340025, Chile;
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17
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Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A Narrative Review of Public Health Interventions for Childhood Obesity. Curr Obes Rep 2024; 13:87-97. [PMID: 38172483 DOI: 10.1007/s13679-023-00550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB). RECENT FINDINGS Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
| | - Erica Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, USA
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, Mass General for Children, The Greater Boston Food Bank, Boston, USA
| | - Ellen McMahon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Lauren Kruse
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, USA
| | - Emma K Edmondson
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
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18
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Ferreira SRG, Macotela Y, Velloso LA, Mori MA. Determinants of obesity in Latin America. Nat Metab 2024; 6:409-432. [PMID: 38438626 DOI: 10.1038/s42255-024-00977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/04/2024] [Indexed: 03/06/2024]
Abstract
Obesity rates are increasing almost everywhere in the world, although the pace and timing for this increase differ when populations from developed and developing countries are compared. The sharp and more recent increase in obesity rates in many Latin American countries is an example of that and results from regional characteristics that emerge from interactions between multiple factors. Aware of the complexity of enumerating these factors, we highlight eight main determinants (the physical environment, food exposure, economic and political interest, social inequity, limited access to scientific knowledge, culture, contextual behaviour and genetics) and discuss how they impact obesity rates in Latin American countries. We propose that initiatives aimed at understanding obesity and hampering obesity growth in Latin America should involve multidisciplinary, global approaches that consider these determinants to build more effective public policy and strategies, accounting for regional differences and disease complexity at the individual and systemic levels.
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Affiliation(s)
| | - Yazmín Macotela
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, UNAM Campus-Juriquilla, Querétaro, Mexico
| | - Licio A Velloso
- Obesity and Comorbidities Research Center, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
| | - Marcelo A Mori
- Institute of Biology, Universidade Estadual de Campinas, Campinas, Brazil.
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19
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Kikuta C, Borges CA, Duran AC. Monitoring health and nutrition claims on food labels in Brazil. Front Nutr 2024; 11:1308110. [PMID: 38385015 PMCID: PMC10879323 DOI: 10.3389/fnut.2024.1308110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction The monitoring of nutrition and health claims on food and beverage labels has been proposed by international and national organizations because it can collaborate with the development of public policies to regulate food labeling and marketing strategies. One way of carrying out this monitoring is by using data collected by private companies. Objective To compare information on nutrition and health claims available in a commercial database of a private company that monitors the launch of new foods and beverages in Brazilian food retailers with information on those same claims manually coded by trained research assistants. Methods This is a cross-sectional observational study using a data sample of newly launched food and beverages available at a commercial database from 2018 to 2021. We compared the information on health and nutrition claims available on the commercial dataset with reliable information on the same nutrition and health claims manually coded by trained research assistants using a tested taxonomy to classify such claims. We used Gwet's Kappa AC1 with 95% CI and percentage agreement to compare both data sources and calculated sensitivity and specificity of the compared data. Results A total of 6,722 foods and beverages were analyzed. Mintel-GNPD presented 36.28% (n = 2,439) of nutrition claims, while in the trained researchers' coding, it was 33.73% (n = 2,267). We found a prevalence of 5.4% (n = 362) for health claims in Mintel-GNPD and 10.8% (n = 723) in the researchers' coding. All subcategories of nutrition and health claims showed high agreement (Kappa >0.81). Health claims presented kappa = 0.89 with 33.7% sensitivity and 98.0% specificity while nutrition claims showed kappa = 0.86 with 92.9% sensitivity and 92.5% specificity. Conclusion Nutrition and health claims showed high agreement, with great results in nutrition claims, indicating that Mintel-GPND is suitable for monitoring such claims on food and beverage packaging in Brazil. Additionally, our findings show a high prevalence of nutrition and health claims on food packages launched in the Brazilian food retail, highlighting the need to monitor these to develop public policies to regulate food marketing on packaging in Brazil.
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Affiliation(s)
- Carolina Kikuta
- Graduate Program in Public Health, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Camila Aparecida Borges
- Center for Epidemiological Studies in Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Ana Clara Duran
- Center for Epidemiological Studies in Nutrition and Health, University of São Paulo, São Paulo, Brazil
- Center for Food Studies and Research, University of Campinas, Campinas, Brazil
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Bassi S, Bahl D, Gopal S, Sethi V, Backholer K, Gavaravarapu SM, Babu GR, Ghosh-Jerath S, Bhatia N, Aneja K, Kataria I, Mishra P, De Wagt A, Arora M. Are advertising policies affirmative in restricting the marketing of foods high in fat, salt and sugar (HFSS) in India?: evidence from SWOT Analysis. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 21:100315. [PMID: 38361596 PMCID: PMC10866952 DOI: 10.1016/j.lansea.2023.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 02/17/2024]
Abstract
The regulatory Indian environment for advertising high fat, salt, and sugar (HFSS) foods and non-alcoholic beverages, on various media was reviewed. Identified national-level policies were categorised as mandatory or self-regulatory based on legal content. For each mandatory regulation, Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was undertaken to determine how existing policies could be strengthened to safeguard children from unhealthy food advertisements. Thirteen policies (nine mandatory; four self-regulatory) relevant to advertising in India were identified. Of the nine mandatory policies, Guidelines for Prevention of Misleading Advertisements and Endorsements for Misleading Advertisements, 2022, is the only policy that restricts HFSS food advertisements to children across all media. There are key shortfalls, including limited scope of 'child-targeted' advertisements and lack of criteria to define HFSS foods. A robust regulatory framework is needed to protect children from HFSS food marketing, not just what is 'directed' at them, with clear evidence-based food classification criteria.
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Affiliation(s)
| | | | | | - Vani Sethi
- UNICEF, Regional Office for South Asia, Kathmandu, Nepal
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | | | - Giridhara R. Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | | | | | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
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21
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Mota BEF, de Alcântara IC, de Souza PM, Souza GGL, Mais LA, Menezes CC, David IA. Commentary: Editorial: Strengthening food labeling policies in Brazil. Front Nutr 2023; 10:1331250. [PMID: 38144427 PMCID: PMC10739461 DOI: 10.3389/fnut.2023.1331250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Bruna Eugênia Ferreira Mota
- Laboratory of Psychophysiology, Institute of Exact and Biological Sciences, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Iasmim Cristiane de Alcântara
- Laboratory of Psychophysiology, Institute of Exact and Biological Sciences, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Perciliany Martins de Souza
- Laboratory of Psychophysiology, Institute of Exact and Biological Sciences, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Gabriela Guerra Leal Souza
- Laboratory of Psychophysiology, Institute of Exact and Biological Sciences, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Laís Amaral Mais
- Healthy and Sustainable Diets Program, Brazilian Institute for Consumer Defense (IDEC), São Paulo, Brazil
| | - Camila Carvalho Menezes
- Department of Food, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Isabel Antunes David
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal University Fluminense, Niterói, Brazil
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22
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Jones A, Shahid M, Morelli G, Howes K, Riesenberg D, Sievert K, Pettigrew S, Sacks G. Chocolate unicorns and smiling teddy biscuits: analysis of the use of child-directed marketing on the packages of Australian foods. Public Health Nutr 2023; 26:3291-3302. [PMID: 37962247 PMCID: PMC10755390 DOI: 10.1017/s136898002300215x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The use of food packaging as a vehicle for marketing to children is under investigated. Our objective was to determine the prevalence and types of child-directed promotional techniques used on food packaging in Australia. DESIGN Based on existing literature and regulations, we developed a framework to classify on-pack child-directed promotional techniques involving the use of characters and other elements that appeal to children. We analysed the packaging of all products in eight food categories available for sale from supermarkets in 2019 and recorded the use of child-directed promotions on pack. We assessed the number and proportion of products displaying child-directed promotional techniques overall and assessed the healthiness of products using child-directed promotions against four indicators of healthiness to provide summary data overall and for the manufacturers who most frequently employed child-targeted strategies. SETTING Data were collected from the FoodSwitch database in Sydney, Australia. RESULTS 901/8006 (11·3 %) products displayed one or more child-directed on-pack element. Most frequent was on foods for infants and young children (n 315), confectionery (n 283), snack foods (n 172) and dairy (n 168). Personified characters were the most commonly used element (n 512). Products using child-directed promotional techniques scored poorly on all four indicators of healthiness: mean health star rating 2·34 (out of 5); 81 % ultra-processed and 6·1 % and 4·5 % products eligible to market to children under Western Pacific and Mexican nutrient profiling schemes, respectively. CONCLUSIONS Australian children are targeted by promotional techniques on the packaging of unhealthy food products. Stronger regulation of these techniques is warranted to protect children's health.
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Affiliation(s)
- Alexandra Jones
- The George Institute for Global Health, University of New South Wales, UNSW, Sydney, Australia
| | - Maria Shahid
- The George Institute for Global Health, University of New South Wales, UNSW, Sydney, Australia
| | - Georgia Morelli
- The George Institute for Global Health, University of New South Wales, UNSW, Sydney, Australia
| | - Kylie Howes
- The George Institute for Global Health, University of New South Wales, UNSW, Sydney, Australia
| | - Devorah Riesenberg
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Katherine Sievert
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, UNSW, Sydney, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Contreras-Manzano A, White CM, Nieto C, Quevedo KL, Vargas-Meza J, Hammond D, Thrasher JF, Barquera S, Jáuregui A. Self-reported decreases in the purchases of selected unhealthy foods resulting from the implementation of warning labels in Mexican youth and adult population. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.22.23298843. [PMID: 38045333 PMCID: PMC10690347 DOI: 10.1101/2023.11.22.23298843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Front-of-package nutritional warning labels (WLs) are designed to facilitate identification and selection of healthier food choices. We assessed self-reported changes in purchasing different types of unhealthy foods due to WLs in Mexico and the association between the self-reported reductions in purchases of sugary beverages and intake of water and sugar-sweetened beverages. Methods Data came from 14-17 year old youth (n=1,696) and adults ≥18 (n=7,775) who participated in the Mexican arm of the 2020-2021 International Food Policy Study, an annual repeat cross-sectional online survey. Participants self-reported whether the WLs had influenced them to purchase less of each of ten unhealthy food categories due to WLs. Among adults, a 23-item Beverage Frequency Questionnaire was used derive past 7-day intake of water and sugary beverages analyzed to determine the relationship between self-reported reductions in purchasing sugary drinks due to the WLs. Multilevel mixed-effects logistic regression models were fitted to estimate the percentage of participants who self-reported reducing purchases within each food group, and overall. Sociodemographic characteristics associated with this reduction were investigated as well. Results Overall, 44.8% of adults and 38.7% of youth reported buying less of unhealthy food categories due to the implementation of WL, with the largest proportion reporting decreased purchases of cola, regular and diet soda. A greater impact of WLs on the reported purchase of unhealthy foods was observed among the following socio-demographic characteristics: females, individuals who self-identified as indigenous, those who were overweight, individuals with lower educational levels, those with higher nutrition knowledge, households with children, and those with a significant role in household food purchases. In addition, adults who reported higher water intake and lower consumption of sugary beverages were more likely to report reduced purchases of sugary drinks due to the WLs. Adults who reported greater water intake and lower sugary beverages intake were significantly more likely to report buying fewer sugary drinks due to the WLs. Conclusion Our findings suggest that implementation of WLs has reduced purchases of unhealthy foods in Mexico. These results underscore the positive impact of the labeling policy particularly in subpopulations with lower levels of education and among indigenous adults.
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Wood B, Robinson E, Baker P, Paraje G, Mialon M, van Tulleken C, Sacks G. What is the purpose of ultra-processed food? An exploratory analysis of the financialisation of ultra-processed food corporations and implications for public health. Global Health 2023; 19:85. [PMID: 37957671 PMCID: PMC10644600 DOI: 10.1186/s12992-023-00990-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND In recent decades there has been a global rise in consumption of ultra-processed foods (UPFs) to the detriment of population health and the environment. Large corporations that have focused heavily on low-cost manufacturing and extensive marketing of UPFs to maximise profits have driven this dietary transition. The same corporations claim to serve the interests of multiple 'stakeholders', and that they are contributing to sustainable development. This paper aimed to test these claims by examining the degree to which UPF corporations have become 'financialised', focusing on the extent to which they have prioritised the financial interests of their shareholders relative to other actors, as well as the role that various types of investors have played in influencing their governance. Findings were used to inform discussion on policy responses to improve the healthiness of population diets. METHODS We adopted an exploratory research design using multiple methods. We conducted quantitative analysis of the financial data of U.S. listed food and agricultural corporations between 1962 and 2021, share ownership data of a selection of UPF corporations, and proxy voting data of a selection of investors between 2012 and 2022. We also conducted targeted narrative reviews using structured and branching searches of academic and grey literature. RESULTS Since the 1980s, corporations that depend heavily on manufacturing and marketing UPFs to generate profits have been increasingly transferring money to their shareholders relative to their total revenue, and at a level considerably higher than other food and agricultural sectors. In recent years, large hedge fund managers have had a substantial influence on the governance of major UPF corporations in their pursuit of maximising short-term returns. In comparison, shareholders seeking to take steps to improve population diets have had limited influence, in part because large asset managers mostly oppose public health-related shareholder proposals. CONCLUSIONS The operationalisation of 'shareholder primacy' by major UPF corporations has driven inequity and undermines their claims that they are creating 'value' for diverse actors. Measures that protect population diets and food systems from the extractive forces of financialisation are likely needed as part of efforts to improve the healthiness of population diets.
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Affiliation(s)
- Benjamin Wood
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Ella Robinson
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Guillermo Paraje
- Business School, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Mélissa Mialon
- Trinity Business School, Trinity College, Dublin, Ireland
| | | | - Gary Sacks
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
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Alcaire F, Machín L, Curutchet MR, Giménez A, Ares G. Parent Experiences With Warning Labels After Policy Implementation in Uruguay. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:823-832. [PMID: 37804264 DOI: 10.1016/j.jneb.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To explore the perception and experiences of parents of children and adolescents during the first year of the mandatory implementation of nutritional warning labels in Uruguay. DESIGN Qualitative research based on semistructured interviews. SETTING Montevideo, Uruguay. PARTICIPANTS Twenty-eight parents of children and adolescents. PHENOMENON OF INTEREST Perception of and experiences with warning labels, a front-of-pack nutrition labeling scheme that has become increasingly popular in Latin America. ANALYSIS Content analysis of the transcripts based on a deductive-inductive approach. RESULTS Interview transcripts evidenced high awareness, acceptance, and understanding of warning labels among parents of children and adolescents. Most participants reported considering warnings for decision making and changing their purchase decisions because of their implementation, particularly when choosing foods for their children. They reported their children were aware of and understood warnings but did not tend to take them into account when choosing foods. CONCLUSIONS AND IMPLICATIONS Results from the present work contribute to the growing body of literature showing the effectiveness of warning labels. Lack of interest or perceived benefits and structural barriers emerged as key motives for not using the warnings when making purchasing decisions, suggesting the need to develop additional strategies to increase policy effectiveness.
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Affiliation(s)
- Florencia Alcaire
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Canelones, Uruguay
| | - Leandro Machín
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
| | | | - Ana Giménez
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Canelones, Uruguay
| | - Gastón Ares
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Canelones, Uruguay; Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay.
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Lutter CK. Improvement of the Brazilian nutritional scenario despite the persistence of social inequalities. CAD SAUDE PUBLICA 2023; 39:e00136323. [PMID: 37878869 PMCID: PMC10599223 DOI: 10.1590/0102-311xen136323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 10/27/2023] Open
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Hilton S, Vaczy C, Buckton C, Patterson C, Smith MJ. Expert views on high fat, salt and sugar food marketing policies to tackle obesity and improve dietary behaviours in the UK: a qualitative study. BMC Public Health 2023; 23:1951. [PMID: 37814236 PMCID: PMC10561510 DOI: 10.1186/s12889-023-16821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 09/22/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND There has been a lack of progress in reducing obesity in the United Kingdom (UK) despite Government strategies released over the last 30 years. These strategies, including the most recent publication from July 2020, have focused on childhood obesity and high fat, sugar and/or salt (HFSS) marketing restrictions, particularly broadcast advertising. In this study, we aimed to examine a range of expert views on the potential impact and the relative importance of such policies. METHODS Semi-structured interviews were conducted with 42 experts in policy (n = 19), industry (n = 10), and advocacy (n = 13) with an interest in obesity. The UK Government's 2020 obesity strategy was used as a prompt to guide discussion on policy options. Qualitative thematic analysis was employed to answer the three research questions and themes were inductively coded within each research question. Data were also cross compared using matrix coding and a form of framework analysis to examine the views expressed by the different types of stakeholders. RESULTS Reactions to the July 2020 proposal were mixed among policy and advocacy stakeholders, while commercial stakeholders expressed disappointment. A main theme emerging in all groups was frustration with the policy process and wishing to see more clarity regarding restrictions and their implementation. There was an overall lack of trust that the government would carry out their proposed plan and agreement that a more comprehensive, multi-sector approach aimed at the underlying drivers of obesity would be most effective, with some stakeholders indicating that some of the proposed policies could make a difference if implemented robustly. On the theme of promoting healthier options, some stakeholders suggested lowering the prices of 'healthy' products and making them more accessible to combat regressivity. There was a potentially surprising level of agreement between policy/advocacy stakeholders and commercial stakeholders, although commercial stakeholders were more likely to advocate for collaboration between government and industry as well as voluntary industry measures. CONCLUSION While HFSS marketing restrictions have a role to play and send a strong signal - provided they are implemented comprehensively - investment in these policies needs to be part of wider efforts to tackle the underlying drivers of obesity.
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Affiliation(s)
- Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK
| | - Caroline Vaczy
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK.
| | - Christina Buckton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK
| | - Chris Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK
| | - Marissa J Smith
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Square, Glasgow, G3 7HR, UK
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Gearhardt AN, Bueno NB, DiFeliceantonio AG, Roberto CA, Jiménez-Murcia S, Fernandez-Aranda F. Social, clinical, and policy implications of ultra-processed food addiction. BMJ 2023; 383:e075354. [PMID: 37813420 PMCID: PMC10561019 DOI: 10.1136/bmj-2023-075354] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Ashley N Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nassib B Bueno
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Brazil
| | - Alexandra G DiFeliceantonio
- Fralin Biomedical Research Institute at VTC, Department of Human, Nutrition Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Susana Jiménez-Murcia
- Department of Clinical Psychology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernandez-Aranda
- Department of Clinical Psychology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos III, Barcelona, Spain
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Crosbie E, Otero Alvarez MG, Cao M, Vejar Renteria LS, Rodriguez E, Larrañaga Flota A, Carriedo A. Implementing front-of-pack nutrition warning labels in Mexico: important lessons for low- and middle-income countries. Public Health Nutr 2023; 26:2149-2161. [PMID: 37519233 PMCID: PMC10564596 DOI: 10.1017/s1368980023001441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 06/13/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To analyse the implementation of front-of-pack nutrition labelling (FOPNL) in Mexico. DESIGN Review of publicly accessible documents, including legislative websites, news sources, and government, intergovernmental, and advocacy reports. Usage of the policy cycle model to analyse the implementation and evaluation stages of Mexico's General Health Law, amended with FOPNL (2019-2022). RESULTS In October 2019, the government published a draft modification of the Norma Oficial Mexicana (Official Mexican Standard) to regulate and enforce a new FOPNL warning label system. A 60-d public consultation period followed (October-December 2019), and the regulation was published in March 2020 and implementation began in October 2020. An analysis of nine key provisions of the Standard revealed that the food and beverage industry and its allies weakened some original provisions including health claims, warnings for added sweeteners and display areas. On the other hand, local and international public health groups maintained key regulations including the ban on cartoon character advertisements, standardised portions and nutrient criteria following international best practices. Early implementation appears to have high compliance and helped contribute to reformulating unhealthy products. Continued barriers to implementation include industry efforts to create double fronts and market their cartoon characters on social media and through digitalised marketing. CONCLUSION Early success in implementing the new FOPNL system in Mexico was the result of an inclusive and participatory regulatory process dedicated to maintaining public health advances, local and international health advocacy support, and continued monitoring. Other countries proposing and enacting FOPNL should learn from the Mexican experience to maintain scientifically proven best practices, counter industry barriers and minimise delays in implementation.
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Affiliation(s)
- Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, NV89557, USA
- Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA
| | | | - Michelle Cao
- School of Public Health, University of Nevada Reno, Reno, NV89557, USA
| | | | | | | | - Angela Carriedo
- Department of Health, University of Bath, Bath, UK
- World Public Health Nutrition Association, London, UK
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Varela P, De Rosso S, Ferreira Moura A, Galler M, Philippe K, Pickard A, Rageliene T, Sick J, van Nee R, Almli VL, Ares G, Grønhøj A, Spinelli S, van Kleef E. Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system. Nutr Res Rev 2023:1-21. [PMID: 37746804 DOI: 10.1017/s0954422423000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.
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Affiliation(s)
| | - Sofia De Rosso
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France
| | | | | | - Kaat Philippe
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France
| | | | | | - Julia Sick
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Florence, Italy
| | - Roselinde van Nee
- Wageningen University, Marketing & Consumer Behaviour Group, Wageningen, The Netherlands
| | | | - Gastón Ares
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | | | - Sara Spinelli
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Florence, Italy
| | - Ellen van Kleef
- Wageningen University, Marketing & Consumer Behaviour Group, Wageningen, The Netherlands
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Taillie LS, Bercholz M, Prestemon CE, Higgins ICA, Grummon AH, Hall MG, Jaacks LM. Impact of taxes and warning labels on red meat purchases among US consumers: A randomized controlled trial. PLoS Med 2023; 20:e1004284. [PMID: 37721952 PMCID: PMC10545115 DOI: 10.1371/journal.pmed.1004284] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/02/2023] [Accepted: 08/22/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Policies to reduce red meat intake are important for mitigating climate change and improving public health. We tested the impact of taxes and warning labels on red meat purchases in the United States. The main study question was, will taxes and warning labels reduce red meat purchases? METHODS AND FINDINGS We recruited 3,518 US adults to participate in a shopping task in a naturalistic online grocery store from October 18, 2021 to October 28, 2021. Participants were randomized to one of 4 conditions: control (no tax or warning labels, n = 887), warning labels (health and environmental warning labels appeared next to products containing red meat, n = 891), tax (products containing red meat were subject to a 30% price increase, n = 874), or combined warning labels + tax (n = 866). We used fractional probit and Poisson regression models to assess the co-primary outcomes, percent, and count of red meat purchases, and linear regression to assess the secondary outcomes of nutrients purchased. Most participants identified as women, consumed red meat 2 or more times per week, and reported doing all of their household's grocery shopping. The warning, tax, and combined conditions led to lower percent of red meat-containing items purchased, with 39% (95% confidence interval (CI) [38%, 40%]) of control participants' purchases containing red meat, compared to 36% (95% CI [35%, 37%], p = 0.001) of warning participants, 34% (95% CI [33%, 35%], p < 0.001) of tax participants, and 31% (95% CI [30%, 32%], p < 0.001) of combined participants. A similar pattern was observed for count of red meat items. Compared to the control, the combined condition reduced calories purchased (-312.0 kcals, 95% CI [-590.3 kcals, -33.6 kcals], p = 0.027), while the tax (-10.4 g, 95% CI [-18.2 g, -2.5 g], p = 0.01) and combined (-12.8 g, 95% CI [-20.7 g, -4.9 g], p = 0.001) conditions reduced saturated fat purchases; no condition affected sodium purchases. Warning labels decreased the perceived healthfulness and environmental sustainability of red meat, while taxes increased perceived cost. The main limitations were that the study differed in sociodemographic characteristics from the US population, and only about 30% to 40% of the US population shops for groceries online. CONCLUSIONS Warning labels and taxes reduced red meat purchases in a naturalistic online grocery store. Trial Registration: http://www.clinicaltrials.gov/ NCT04716010.
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Affiliation(s)
- Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Maxime Bercholz
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Carmen E. Prestemon
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Isabella C. A. Higgins
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Anna H. Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Marissa G. Hall
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Lindsay M. Jaacks
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
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Roberto CA. An inconvenient truth: Difficult problems rarely have easy solutions. Behav Brain Sci 2023; 46:e173. [PMID: 37646295 DOI: 10.1017/s0140525x23000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Individual-level interventions are often interesting and easy to implement, but are unfortunately ill-equipped to solve most major global problems (e.g., climate change, financial insecurity, unhealthy eating). Resources spent developing, pursuing, and touting relatively ineffective i-frame interventions draw resources away from the development and implementation of more effective s-frame solutions. Behavioral scientists who want to develop solutions to the world's biggest problems should focus their efforts on s-frame solutions.
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Affiliation(s)
- Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA. ; https://peachlab.org/
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de Faria NC, Andrade GMDP, Ruas CM, Claro RM, Braga LVM, Nilson EAF, Anastácio LR. Impact of implementation of front-of-package nutrition labeling on sugary beverage consumption and consequently on the prevalence of excess body weight and obesity and related direct costs in Brazil: An estimate through a modeling study. PLoS One 2023; 18:e0289340. [PMID: 37566577 PMCID: PMC10420370 DOI: 10.1371/journal.pone.0289340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
RATIONALE Intake of sugary beverages has been associated with obesity and chronic non-communicable diseases, thereby increasing the direct health costs related to these diseases. Front-of-package nutrition labeling (FoPNL) aims to help consumers understand food composition, thereby improving food choices and preventing the development of such diseases. OBJECTIVE To estimate, over five years, the impact of implementing FoPNL in Brazil on the prevalence of excess body weight and obesity in adults who consume sugary beverages and the direct costs related to such problems. METHODS A simulation study to performed to estimate the effect of FoPNL implementation on the prevalence of excess body weight and obesity. The VIGITEL research database (2019), published in the 2020 report, was used in this study (the final sample consisted of 12,471 data points representing 14,380,032 Brazilians). The scenarios were considered: base (trend in sugary beverage intake); 1 (base scenario associated with the changes in energy content of the purchased beverages observed after the first phase of the Chilean labeling law (-9.9%); and 2 (scenario 1 associated with reformulation of beverages, total energy reduction of -1.6%). Changes in body weight were estimated using the simulation model of Hall et al. (2011) over five years. A linear trend in the prevalence of obesity and excess body weight in the Brazilian population was considered. The impact of the prevalence of obesity and excess body weight on body mass index was estimated. In addition, the direct health costs related to obesity were estimated. RESULTS Energy consumption from sugary beverages after FoPNL implementation is expected to be reduced by approximately 28 kcal/day (95% CI, -30 to -27) considering scenario 1. In scenarios 1 and 2, without FoPNL, the prevalence of obesity and excess body weight over five years was estimated to be 25.3% and 25.2%, and 64.4% and 64.2%, respectively. By extrapolating the results to the entire Brazilian population, it was observed that the implementation of FoPNL may reduce the prevalence of obesity by -0.32 percentage points and -0.35 percentage points (scenario 1 and 2, respectively) and excess body weight by -0.42 percentage points and -0.48 percentage points (scenarios 1 and 2, respectively) in five years. It is estimated that after five years of implementation, it will be possible to save approximately US$ 5,5 millions (95% CI 4,7 to 8,8) in scenario 1, reaching approximately US$ 6,1 millions (95% CI 5,3 to 9,8) in scenario 2. CONCLUSION The results of this modeling study indicate that FoPNL may reduce prevalence of excess body weight and obesity, representing strategic public policies for obesity prevention.
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Affiliation(s)
- Natália Cristina de Faria
- Post-Graduate Program in Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Cristina Mariano Ruas
- Department of Social Pharmacy, Faculty of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Rafael Moreira Claro
- Department of Nutrition, School of Nursing, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Centre for Epidemiological Research in Nutrition and Health (NUPENS), University of Sao Paulo, Sao Paulo, Brazil
| | - Luíza Vargas Mascarenhas Braga
- Post-Graduate Program in Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Eduardo Augusto Fernandes Nilson
- Centre for Epidemiological Research in Nutrition and Health (NUPENS), University of Sao Paulo, Sao Paulo, Brazil
- Oswaldo Cruz Foundation (Fiocruz) Brasília, Brasilia, Brazil
| | - Lucilene Rezende Anastácio
- Post-Graduate Program in Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Flexner N, Ahmed M, Mulligan C, Bernstein JT, Christoforou AK, Lee JJ, Khandpur N, L’Abbe MR. The estimated dietary and health impact of implementing the recently approved 'high in' front-of-package nutrition symbol in Canada: a food substitution scenario modeling study. Front Nutr 2023; 10:1158498. [PMID: 37614744 PMCID: PMC10443708 DOI: 10.3389/fnut.2023.1158498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
Background Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy food environments and to help consumers make healthier food choices. Consumer surveys report that after implementation of mandatory 'high in' FOPL symbols between 30 and 70% of consumers choose or were willing to choose products with fewer 'high in' symbols. Health Canada has recently published FOPL regulations that will require prepackaged food and beverages that meet or exceed thresholds for sodium, total sugars, or saturated fat to display a 'high in' FOPL nutrition symbol. Objectives The aims were to estimate the potential (1) dietary impact of substituting foods with similar foods that would display at least one less 'high in' symbol, and (2) the number of diet-related noncommunicable disease (NCD) deaths that could be averted or delayed due to estimated dietary changes. Methods Baseline and counterfactual intakes of sodium, total sugars, saturated fats, and energy were estimated among Canadian adults (n = 11,992) using both available days of 24 h-recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS). Similar foods to those reported in CCHS that would display at least one less 'high in' symbol (n = 239) were identified using a Canadian branded food composition database. Based on current FOPL consumer research, identified foods were substituted for 30, 50, and 70% of randomly selected CCHS-Nutrition adult participants and for all adult participants. Potential health impacts were estimated using the Preventable Risk Integrated ModEl. Results Mean dietary reductions of between 73 and 259 mg/day of sodium, 2.0 and 6.9 g/day of total sugars, 0.2 and 0.5 g/day of saturated fats, and 14 and 46 kcal/day of energy were estimated. Between 2,148 (95% UI 1,913-2,386) and 7,047 (95% UI 6,249-7,886) of deaths due to diet-related NCDs, primarily from cardiovascular diseases (70%), could potentially be averted or delayed if Canadians choose products with fewer 'high in' symbols. Conclusion Results suggest that FOPL could significantly reduce sodium and total sugar intakes among Canadian adults, the consequences of which could avert or delay an important number of diet-related NCD deaths. These findings provide relevant data to support the importance of the impending FOPL regulations.
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Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christine Mulligan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jodi T. Bernstein
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anthea K. Christoforou
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neha Khandpur
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- Center for Epidemiological Research in Nutrition and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Mary R. L’Abbe
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Alfraidi A, Alafif N, Alsukait R. The Impact of Mandatory Food-Marketing Regulations on Purchase and Exposure: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1277. [PMID: 37628276 PMCID: PMC10453145 DOI: 10.3390/children10081277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Abstract
(1) Background: Several governments have enforced a series of actions to improve the local food environment and reduce obesity-related diseases in the population by implementing statutory regulations to reduce or ban the marketing of products that are considered unhealthy based on nutrient profile systems or them being high in fat, sugar, and salt (HFSS); (2) Objective: This narrative review is aiming to provide a comprehensive exploration of the available evidence on the impact of identified mandatory regulations restricting food marketing, including advertisements and packages on the exposure and purchase of HFSS food products, to help justify the need for these regulations; (3) Methods: Articles were retrieved by searching electronic databases, including EBSCO Education, PubMed, Scopus, Web of Science, and Google Scholar from 2012 up to December 2022; (4) Results: A total of 12 articles were included in this review. Almost all mandatory food-marketing regulations have evidence in favor of reducing HFSS food purchases and exposure; (5) Conclusions: Protecting children and adolescents from food and beverage marketing through mandatory regulations is a crucial step toward tackling global childhood and adolescent obesity and securing a healthier environment for future generations.
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Affiliation(s)
- Alanoud Alfraidi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (N.A.); (R.A.)
- Department of Clinical Dietitian, Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia
| | - Nora Alafif
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (N.A.); (R.A.)
| | - Reem Alsukait
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (N.A.); (R.A.)
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Paraje G, Montes de Oca D, Corvalán C, Popkin BM. Evolution of food and beverage prices after the front-of-package labelling regulations in Chile. BMJ Glob Health 2023; 8:e011312. [PMID: 37400119 DOI: 10.1136/bmjgh-2022-011312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/24/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION This study assesses the impact on prices of the 2016 Chilean comprehensive food policy package, centred around front-of-package warning labels for food and beverages high in saturated fats, sugars, calories and/or salt, on food and beverage prices, labelled or not. METHODS Data from Kantar WorldPanel Chile, from January 2014 to December 2017, were used. The methodology implemented was interrupted time series analyses with a control group on Laspeyres Price Indices on labelled food and beverage products. RESULTS After the regulations were implemented, prices among different categories of products (eg, high-in; reformulated but still high-in; reformulated and not high-in; not high-in) did not change with regulations relative to the control group. Specific price indices (relative to the control group) for households from different socioeconomic strata remained unchanged. CONCLUSIONS Even where reformulation was extensive, we found no evidence that it was associated with price changes, at least during Chile's first year and a half of regulation implementation.
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Affiliation(s)
| | - Daniela Montes de Oca
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago de Chile, Chile
| | - Camila Corvalán
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago de Chile, Chile
| | - Barry M Popkin
- Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Furman-Assaf S, Accos-Carmel M, Kolobov T, Blaychfeld-Magnazi M, Endevelt R, Tamir O. Attitudes and perceived knowledge of health professionals on the food labelling reform in Israel. Public Health Nutr 2023; 26:1513-1521. [PMID: 36919667 PMCID: PMC10346017 DOI: 10.1017/s1368980023000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To assess the attitudes and perceived knowledge of health professionals regarding the food product judgemental-labelling reform that began in January 2020 in Israel. DESIGN Cross-sectional survey. SETTINGS An online survey among health professionals working in the Israeli health system. PARTICIPANTS 456 participants (118 physicians, 207 nurses, 131 nutritionists). RESULTS Most respondents (89·9 %) were women, 36 % had over 20 years of professional experience. All nutritionists, 96·6 % of physicians and 94·7 % of nurses reported hearing about the reform, and most (88·9 % of nurses, 76·3 % of physicians and 75·6 % of nutritionists) claimed supporting the reform to a great or very great extent. Most respondents believe they should discuss issues related to healthy eating with their patients (91·8 % of nurses, 94·9 % of physicians and all nutritionists), but only about half (47·5 % of physicians and 57·0 % of nurses) reported that they have sufficient knowledge in this field, particularly about food labelling. Almost two-thirds of nutritionists (60·3 %) reported instructing patients to change their food intake according to labelling v. 40·1 % and 34·7 % of nurses and physicians, respectively. Only some respondents felt that they could influence their patients' nutrition habits. Most participants believe that additional regulatory measures should also be used to promote healthy nutrition. CONCLUSIONS There is a gap between the desire of physicians and nurses to provide nutritional guidance to the public and their actual knowledge about the labels' meaning as well as their competencies in providing nutrition counselling. When formulating a reform, policymakers should provide clear guidelines about the expectations of implementing it in therapeutic practice.
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Affiliation(s)
- Sharon Furman-Assaf
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel
| | - Moran Accos-Carmel
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel
| | - Tatyana Kolobov
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel
| | - Moran Blaychfeld-Magnazi
- Ministry of Health, Jerusalem, Israel
- Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Ronit Endevelt
- Ministry of Health, Jerusalem, Israel
- Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Orly Tamir
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel
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Sing F, Mackay S, Cinà M, Swinburn B. The utilisation of legal instruments by United Nations actors to restrict the exposure of children to unhealthy food and beverage marketing: a qualitative content analysis of UN instruments. Global Health 2023; 19:45. [PMID: 37391743 DOI: 10.1186/s12992-023-00939-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 05/26/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION United Nations (UN) agencies are influential global health actors that can introduce legal instruments to call on Member States to act on pressing issues. This paper examines the deployment and strength of global health law instruments used by UN actors to call on Member States to restrict the exposure of children to unhealthy food and beverage marketing. METHODS Global health law instruments were identified from a review of four UN agencies that have a mandate over children's exposure to marketing of unhealthy food and beverage products namely: the World Health Organization (WHO); the Food and Agriculture Organization (FAO); the United Nations General Assembly (UNGA) and the UN Office of the High Commissioner for Human Rights (OHCHR). Data on marketing restrictions were extracted and coded and descriptive qualitative content analysis was used to assess the strength of the instruments. RESULTS A wide range of instruments have been used by the four agencies: seven by the WHO; two by the FAO; three by the UNGA; and eight by the UN human rights infrastructure. The UN human rights instruments used strong, consistent language and called for government regulations to be enacted in a directive manner. In contrast, the language calling for action by the WHO, FAO and UNGA was weaker, inconsistent, did not get stronger over time and varied according to the type of instrument used. CONCLUSION This study suggests that a child rights-based approach to restricting unhealthy food and beverage marketing to children would be supported by strong human rights legal instruments and would allow for more directive recommendations to Member States than is currently provided by WHO, FAO and UNGA. Strengthening the directives in the instruments to clarify Member States' obligations using both WHO and child rights mandates would increase the utility of global health law and UN actors' influence.
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Affiliation(s)
- Fiona Sing
- School of Population Health, University of Auckland, Auckland, 1023, New Zealand.
| | - Sally Mackay
- School of Population Health, University of Auckland, Auckland, 1023, New Zealand
| | - Margherita Cinà
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, US
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, 1023, New Zealand
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Machín L, Alcaire F, Antúnez L, Giménez A, Curutchet MR, Ares G. Use of nutritional warning labels at the point of purchase: An exploratory study using self-reported measures and eye-tracking. Appetite 2023:106634. [PMID: 37356578 DOI: 10.1016/j.appet.2023.106634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
Nutritional warning labels are gaining relevance in the region of the Americas as a policy tool to reduce information asymmetry and encourage healthier food choices. However, empirical evidence about consumer experiences with warning labels after implementation is still scarce. In this context, the aim of the present work was to explore the use of nutritional warning labels after policy implementation in Uruguay, using a combination of eye-tracking and self-reported data. The study was conducted in three supermarkets, in two regional capitals, 19 months after the entry into force of the policy. A total of 224 participants were intercepted while entering the facilities of the supermarket and asked to wear a mobile eye-tracker while making their food purchases. Then, they were asked a series of questions about their awareness and use of warning labels. Although participants reported high awareness and understanding of the labels, active search and use at the point of purchase was low. Only 6% of the consumers declared having actively searched for the warning labels and 7% fixated their gaze on the labels. The majority of the participants (72%) who declared having seen the warnings on a product, purchased it anyway. However, 56% declared having changed their food choice decisions as a consequence of the implementation of the policy. Participants' accounts about reasons for (not) taking into account the warning labels provide relevant insights for the development of strategies to encourage citizens to increase policy effectiveness and encourage healthier food choices.
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Affiliation(s)
- Leandro Machín
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Uruguay
| | - Florencia Alcaire
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay
| | - Lucía Antúnez
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay
| | - Ana Giménez
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay
| | | | - Gastón Ares
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Uruguay; Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay.
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Pemjean I, Mediano F, Ferrer P, Garmendia ML, Corvalán C. Food access, domestic environments, and dietary quality of low-middle income Chilean children during the COVID-19 pandemic. Front Public Health 2023; 11:1164357. [PMID: 37408742 PMCID: PMC10319070 DOI: 10.3389/fpubh.2023.1164357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Food access is associated with dietary quality; however, people living in similar physical environments can have different food access profiles. Domestic environments may also influence how food access relates to dietary quality. We studied food access profiles of 999 low-middle income Chilean families with children during the COVID-19 lockdown and how these profiles relate to dietary quality; secondarily, we also explore the role of the domestic environment in this relationship. Materials and methods Participants of two longitudinal studies conducted in the southeast of Santiago, Chile, answered online surveys at the beginning and end of the COVID-19 pandemic lockdown. Food access profiles were developed by a latent class analysis considering food outlets and government food transfers. Children's dietary quality was estimated by self-reported compliance with the Chilean Dietary Guidelines of Americans (DGA) and daily ultra-processed food (UPF) consumption. Logistic and linear regressions were used to assess the association between food access profiles and dietary quality. Domestic environment data (i.e., the sex of the person who buys food and cooks, meal frequency, cooking skills, etc.) were incorporated in the models to assess their influence on the relationship between food access and dietary quality. Results We have categorized three food access profiles: Classic (70.2%), Multiple (17.9%), and Supermarket-Restaurant (11.9%). Households led by women are concentrated in the Multiple profile, while families from higher income or education levels are focused on the Supermarket-Restaurant profile. On average, children presented poor dietary quality, with a high daily UPF consumption (median = 4.4; IQR: 3) and low compliance with national DGA recommendations (median = 1.2; IQR: 2). Except for the fish recommendation (OR = 1.77, 95% CI:1.00-3.12; p: 0.048 for the Supermarket-Restaurant profile), the food access profiles were poorly associated with children's dietary quality. However, further analyses showed that domestic environment variables related to routine and time use influenced the association between food access profiles and dietary quality. Conclusion In a sample of low-middle income Chilean families, we identified three different food access profiles that presented a socioeconomic gradient; however, these profiles did not significantly explain children's dietary quality. Studies diving deeper into household dynamics might give us some clues on intra-household behaviors and roles that could be influencing how food access relates to dietary quality.
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Affiliation(s)
- Isabel Pemjean
- Doctoral Program in Public Health, School of Public Health, University of Chile, Santiago, Chile
| | - Fernanda Mediano
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, United States
| | - Pedro Ferrer
- Center for Research in Food Environments and Prevention of Nutrition-Related Diseases (CIAPEC), Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - María Luisa Garmendia
- Center for Research in Food Environments and Prevention of Nutrition-Related Diseases (CIAPEC), Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Camila Corvalán
- Center for Research in Food Environments and Prevention of Nutrition-Related Diseases (CIAPEC), Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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Hua SV, Collis CE, Block JP. Developing Effective Strategies for Obesity Prevention. Gastroenterol Clin North Am 2023; 52:469-482. [PMID: 37197887 DOI: 10.1016/j.gtc.2023.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Nutrition policies can work with clinical treatments to address the obesity epidemic. The United States has passed beverage taxes at the local level and calorie labeling mandates at the federal level to encourage healthier consumption. Nutritional changes to federal nutrition programs have been either implemented or suggested; evidence shows that the changes that have been implemented have resulted in improvements in diet quality and are cost-effective in decreasing the increase in obesity prevalence. A comprehensive policy agenda that addresses risk of obesity on multiple levels of the food supply will have meaningful long-term effects on obesity prevalence.
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Affiliation(s)
- Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
| | - Caroline E Collis
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA, USA
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Reyes-Sánchez F, Basto-Abreu A, Torres-Álvarez R, Carnalla-Cortés M, Reyes-García A, Swinburn B, Meza R, Rivera JA, Popkin B, Barientos-Gutiérrez T. Caloric reductions needed to achieve obesity goals in Mexico for 2030 and 2040: A modeling study. PLoS Med 2023; 20:e1004248. [PMID: 37363878 DOI: 10.1371/journal.pmed.1004248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND In Mexico, obesity prevalence among adults increased from 23% in 2000 to 36% in 2018, approximately. Mexico has not defined short- or long-term obesity goals, obscuring the level of effort required to achieve a relevant impact. We aimed to explore potential obesity goals for 2030 and 2040 in Mexico and to estimate the required caloric reductions to achieve them. METHODS AND FINDINGS We obtained anthropometric and demographic information on the Mexican adult population (age ≥20 years) from the Health and Nutrition Surveys conducted in 2000, 2006, 2012, 2016, and 2018 (n = 137,907). Each survey wave is cross-sectional, multistage, and representative of the Mexican population at the national, regional, and urban/rural levels. Obesity prevalence was projected for 2030 and 2040 by combining population projections of energy intake by socioeconomic status (SES) with a weight-change microsimulation model taking into account individual-level information on sex, age, physical activity, and initial body weight and height. If current trends continue, Mexico's obesity prevalence is expected to increase from 36% (95% CI 35% to 37%) in 2018 to 45% (uncertainty interval [UI] 41% to 48%) in 2030 and to 48% (UI 41% to 55%) in 2040. Based on expert opinion, we identified 3 obesity goals scenarios: (1) plausible (38% in 2030 and 36% in 2040); (2) intermediate (33% in 2030 and 29% in 2040); and (3) ideal based on the average prevalence of Organization for Economic Co-operation and Development countries (OECD; 19%). We estimated the caloric reductions needed to achieve the goal scenarios using the microsimulation model. Obesity was projected to increase more rapidly in the low SES (around 34% in 2018 to 48% (UI 41% to 55%) in 2040), than in the middle (around 38% to 52% (UI 45% to 56%)), or high SES group (around 36% to 45% (UI 36% to 54%)). Caloric reductions of 40 (UI 13 to 60), 75 (UI 49 to 95), and 190 (UI 163 to 215) kcal/person/day would be needed to reach the plausible, intermediate, and the ideal (OECD) average scenarios for 2030, respectively. To reach the 2040 goals, caloric reductions of 74 (UI 28 to 114), 124 (UI 78 to 169), and 209 (UI 163 to 254) kcal/person/day would be required, respectively. Study limitations include assuming a constant and sedentary physical activity level, not considering cohort-specific differences that could occur in the future, and assuming the same caloric trends under no intervention and the obesity goal scenarios. CONCLUSIONS To reach the 3 obesity goals in 2040, caloric reductions between 74 and 209 kcal/day/person would be needed in Mexico. A package of new and stronger interventions should be added to existing efforts such as food taxes and warning labels on non-nutritious food.
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Affiliation(s)
| | - Ana Basto-Abreu
- National Institute of Public Health, Population Health Research Center, Cuernavaca, Mexico
| | - Rossana Torres-Álvarez
- Department of Epidemiology, University of Michigan-Ann Arbor, Michigan, United States of America
| | - Martha Carnalla-Cortés
- National Institute of Public Health, Population Health Research Center, Cuernavaca, Mexico
| | - Alan Reyes-García
- National Institute of Public Health, Population Health Research Center, Cuernavaca, Mexico
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
- GLOBE (Global Obesity Centre), Deakin University, Melbourne, Victoria, Australia
| | - Rafael Meza
- Department of Epidemiology, University of Michigan-Ann Arbor, Michigan, United States of America
| | - Juan A Rivera
- National Institute of Public Health, Population Health Research Center, Cuernavaca, Mexico
| | - Barry Popkin
- Department of Nutrition at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Lee JJ, Ahmed M, Ng A(P, Mulligan C, Flexner N, L’Abbé MR. Nutrient intakes and top food categories contributing to intakes of energy and nutrients-of-concern consumed by Canadian adults that would require a 'high-in' front-of-pack symbol according to Canadian labelling regulations. PLoS One 2023; 18:e0285095. [PMID: 37200252 PMCID: PMC10194982 DOI: 10.1371/journal.pone.0285095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/14/2023] [Indexed: 05/20/2023] Open
Abstract
Canada recently mandated front-of-pack (FOP) labelling regulations, where foods meeting and/or exceeding recommended thresholds for nutrients-of-concern (i.e., saturated fat, sodium, and sugars) must display a 'high-in' FOP nutrition symbol. However, there is limited research on the amounts and sources of foods consumed by Canadians that would require a FOP symbol. The objective was to examine the intakes of nutrients-of-concern from foods that would display a FOP symbol and to identify the top food categories contributing to intakes for each nutrient-of-concern. Using the first day 24-hour dietary recall from the nationally representative 2015 Canadian Community Health Survey-Nutrition (CCHS), Canadian adults' intakes of nutrients-of-concern from foods that would display a FOP symbol was examined. Foods were assigned to 1 of 62 categories to identify the top food categories contributing to intakes of energy and nutrient-of-concern that would display a FOP symbol for each nutrient-of-concern. Canadian adults (n = 13,495) consumed approximately 24% of total calories from foods that would display a FOP symbol. Foods that would display a FOP symbol for exceeding thresholds for nutrients-of-concern accounted for 16% of saturated fat, 30% of sodium, 25% of total sugar, and 39% of free sugar intakes among Canadian adults. The top food category contributing intakes of each nutrient-of-concern that would display a FOP symbol were nutrient-specific: Processed meat and meat substitutes for saturated fat; Breads for sodium; and Fruit juices & drinks for total and free sugars. Our findings show that Canadian FOP labelling regulations have the potential to influence the intakes of nutrients-of-concern for Canadian adults. Using the findings as baseline data, future studies are warranted to evaluate the impact of FOP labelling regulations.
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Affiliation(s)
- Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joannah & Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
| | - Alena (Praneet) Ng
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christine Mulligan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nadia Flexner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hammond D, Acton RB, Rynard VL, White CM, Vanderlee L, Bhawra J, Reyes M, Jáuregui A, Adams J, Roberto CA, Sacks G, Thrasher JF. Awareness, use and understanding of nutrition labels among children and youth from six countries: findings from the 2019 - 2020 International Food Policy Study. Int J Behav Nutr Phys Act 2023; 20:55. [PMID: 37143053 PMCID: PMC10157591 DOI: 10.1186/s12966-023-01455-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/21/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Nutrition facts tables (NFTs) on pre-packaged foods are widely used but poorly understood by consumers. Several countries have implemented front-of-package labels (FOPLs) that provide simpler, easier to use nutrition information. In October 2020, Mexico revised its FOPL regulations to replace industry-based Guideline Daily Amount (GDA) FOPLs with 'Warning' FOPLs, which display stop signs on foods high in nutrients of concern, such as sugar and sodium. This study examined self-reported awareness, use, and understanding of NFTs and FOPLs among young people in six countries with different FOPLs, with an additional focus on changes before and after implementation of Mexico's FOPL warning policy. METHODS A 'natural experiment' was conducted using 'pre-post' national surveys in Mexico and five separate comparison countries: countries with no FOPL policy (Canada and the US), countries with voluntary FOPL policies (Traffic Lights in the UK and Health Star Ratings in Australia), and one country (Chile) with mandatory FOPL 'warnings' (like Mexico). Population-based surveys were conducted with 10 to 17-year-olds in 2019 (n = 10,823) and in 2020 (n = 11,713). Logistic regressions examined within- and between-countries changes in self-reported awareness, use, and understanding of NFTs and FOPLs. RESULTS Across countries, half to three quarters of respondents reported seeing NFTs 'often' or 'all the time', approximately one quarter reported using NFTs when deciding what to eat or buy, and one third reported NFTs were 'easy to understand', with few changes between 2019 and 2020. In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were higher than for NFTs in all countries, and compared with GDA FOPLs in Mexico (p < .001). Mandated Warning FOPLs in Mexico and Chile had substantially higher levels of awareness, use, and understanding than the voluntary Traffic Lights in the UK and Health Star Ratings in Australia (p < .001 for all). CONCLUSIONS Mandated easy-to-understand FOPLs are associated with substantially greater levels of self-reported awareness, use and understanding at the population-level compared to NFT and GDA-based labeling systems.
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Affiliation(s)
- David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Rachel B Acton
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Vicki L Rynard
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec City, QC, G1V 0A6, Canada
| | - Jasmin Bhawra
- School of Occupational and Public Health, Toronto Metropolitan University, 288 Church Street, Suite 300, ON, M5B 1Z5, Toronto, Canada
| | - Marcela Reyes
- Instituto de Nutrición Y Tecnología de los Alimentos (INTA), Universidad de Chile, Avda. El Líbano, 5524, Macul, Santiago, Chile
| | - Alejandra Jáuregui
- Center for Health and Nutrition Research, Instituto Nacional de Salud Pública, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | - Jean Adams
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge, CB2 0QA, UK
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 1121 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
- Center for Population Health Research, Instituto Nacional de Salud Pública, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
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Mediano F, Fierro C, Corvalán C, Reyes M, Correa T. Framing a New Nutrition Policy: Changes on Key Stakeholder's Discourses throughout the Implementation of the Chilean Food Labelling Law. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095700. [PMID: 37174218 PMCID: PMC10178804 DOI: 10.3390/ijerph20095700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
The global implementation of structural policies to tackle obesity has been slow, likely because of the competing interests of governments and the food industry. We used the discussion of the Chilean Food Labeling Law to identify influential stakeholders in the media and their frames during different periods of the law's implementation. This involved a content analysis of the food regulation media coverage in five key periods from 2007, when the food bill was first introduced in Congress, to 2018, when the second phase of the law was implemented (N = 1295). We found that most of the law coverage was through elite press. Half of the sources were from the food industry (26.7%) and government (26.2%), while other stakeholders, were less prevalent. Frames were mostly competing, except for cooperation with the law. The main food industry frame used during the discussion of the law was the "economic threat" (41.9%), whose prevalence decreased at the post-implementation period (13%, p < 0.01). No other relevant stakeholders changed their framing. Our results highlight that there are several aspects of public health communication, such as the type of media used, the involvement of scholars and civil society, and the framing, that could be improved to advance food environment policies.
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Affiliation(s)
- Fernanda Mediano
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago 8960040, Chile
- Carolina Population Center, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Camila Fierro
- School of Communication, Diego Portales University, Santiago 8370109, Chile
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago 7830489, Chile
| | - Marcela Reyes
- Institute of Nutrition and Food Technology, University of Chile, Santiago 7830489, Chile
| | - Teresa Correa
- School of Communication, Diego Portales University, Santiago 8370109, Chile
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Melo G, Aguilar-Farias N, López Barrera E, Chomalí L, Moz-Christofoletti MA, Salgado JC, Swensson LJ, Caro JC. Structural responses to the obesity epidemic in Latin America: what are the next steps for food and physical activity policies? LANCET REGIONAL HEALTH. AMERICAS 2023; 21:100486. [PMID: 37096192 PMCID: PMC10122054 DOI: 10.1016/j.lana.2023.100486] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/12/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
Obesity is among the most complex public health challenges, particularly in Latin America, where obesity rates have increased faster than in any other region. Many countries have proposed or enacted comprehensive policies to promote adequate diet and physical activity under a structural framework. We summarize articles discussing the scope and impact of recently implemented obesity-related interventions in the light of a structural response framework. Overall, we find that: (1) market-based food interventions, including taxes on junk food, nutrition labelling, and marketing restrictions, decrease the consumption of targeted foods, (2) programs directly providing healthy foods are effective in reducing obesity, and (3) the construction of public areas for recreation increases the average frequency of physical activity. Although obesity-related interventions in the region have somewhat improved health behaviours, obesity prevalence remains on an upward trend. We discuss some opportunities to continue tackling the obesity epidemic in LATAM under a structural framework.
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Affiliation(s)
- Grace Melo
- Accountability, Climate, Equity, and Scholarship (ACES), Department of Agricultural Economics, Texas A&M, College Station, TX, USA
| | - Nicolas Aguilar-Farias
- Department of Physical Education, Sports and Recreation, Universidad de la Frontera, Chile
| | | | | | | | - Juan Carlos Salgado
- Center for Nutrition and Health Research, National Institute of Public Health and National Council for Science and Technology, Mexico
| | - Luana Joppert Swensson
- Policy and Legal Specialist for Sustainable Public Procurement, Food and Agriculture Organization, Italy
| | - Juan Carlos Caro
- Department of Industrial Engineering, University of Concepción, Chile
- Corresponding author. Department of Industrial Engineering, University of Concepción, Chile, Edmundo Larenas 219, Concepción, Chile.
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Bragge P, Waddell A, Kellner P, Delafosse V, Marten R, Nordström A, Demaio S. Characteristics of successful government-led interventions to support healthier populations: a starting portfolio of positive outlier examples. BMJ Glob Health 2023; 8:e011683. [PMID: 37225262 PMCID: PMC10230917 DOI: 10.1136/bmjgh-2023-011683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/03/2023] [Indexed: 05/26/2023] Open
Abstract
Despite progress on the Millennium and Sustainable Development Goals, significant public health challenges remain to address communicable and non-communicable diseases and health inequities. The Healthier Societies for Healthy Populations initiative convened by WHO's Alliance for Health Policy and Systems Research; the Government of Sweden; and the Wellcome Trust aims to address these complex challenges. One starting point is to build understanding of the characteristics of successful government-led interventions to support healthier populations. To this end, this project explored five purposefully sampled, successful public health initiatives: front-of-package warnings on food labels containing high sugar, sodium or saturated fat (Chile); healthy food initiatives (trans fats, calorie labelling, cap on beverage size; New York); the alcohol sales and transport ban during COVID-19 (South Africa); the Vision Zero road safety initiative (Sweden) and establishment of the Thai Health Promotion Foundation. For each initiative a qualitative, semistructured one-on-one interview with a key leader was conducted, supplemented by a rapid literature scan with input from an information specialist. Thematic analysis of the five interviews and 169 relevant studies across the five examples identified facilitators of success including political leadership, public education, multifaceted approaches, stable funding and planning for opposition. Barriers included industry opposition, the complex nature of public health challenges and poor interagency and multisector co-ordination. Further examples building on this global portfolio will deepen understanding of success factors or failures over time in this critical area.
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Affiliation(s)
- Peter Bragge
- Monash Sustainable Development Institute Evidence Review Service, Monash University, Clayton, Victoria, Australia
| | - Alex Waddell
- Monash Sustainable Development Institute Evidence Review Service, Monash University, Clayton, Victoria, Australia
| | - Paul Kellner
- Monash Sustainable Development Institute Evidence Review Service, Monash University, Clayton, Victoria, Australia
| | | | | | | | - Sandro Demaio
- Victorian Health Promotion Foundation, Carlton South, Victoria, Australia
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48
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Jawad A, Mulligan C, Savona N, L'Abbé MR. Qualitative analysis of front-of package labeling policy interactions between stakeholders and Health Canada. Front Public Health 2023; 11:982908. [PMID: 37089483 PMCID: PMC10115994 DOI: 10.3389/fpubh.2023.982908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Abstract
Background Front-of-package labelling regulations proposed by Health Canada in their Healthy Eating Strategy (2016) were finally passed in 2022, but remain unimplemented. This study analyzed interactions that occurred between stakeholders and government related to this policy proposal to identify key themes and policy implications. Methods A qualitative framework analysis was conducted on publicly available documents for stakeholder correspondences related to front-of-package that occurred between 2016 and 2019 in Health Canada's Meetings and Correspondence on Healthy Eating database. Five sequential steps were applied: familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation. A complex systems (i.e., a dynamic system with multiple interconnecting components) lens was incorporated in the final step to deepen the analysis. Results Hundred and seventy-three documents were included, the majority from industry stakeholders (n = 108, 62.4%). Three overarching themes were identified: industry trying to control the agenda and resist regulation; questioning the evidence supporting the policy and its impact on the agri-food industry; and dismissing the need and effectiveness of the policy. Incorporating a complex system lens found industry and non-industry stakeholders held markedly different perspectives on how cohesive the system defined by the front-of-package labelling policy was, and the policy impact on its stability. Economic and opportunity costs were the main trade-offs, and symbol misinterpretation considered an unintended consequence by industry. Finally, some stakeholders argued for wider policy scope incorporating more products, while others requested a narrower approach through exemptions. Conclusion Interactions with industry stakeholders on health food policy proposals require careful consideration, given it may suit their interests to generate delays and policy discordance. Explicitly setting out the principles of engagement and actively encouraging non-industry stakeholder representation provides a more balanced approach to policy consultation and development.
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Affiliation(s)
- Aalaa Jawad
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Christine Mulligan
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mary R. L'Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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White-Barrow V, Gomes FS, Eyre S, Ares G, Morris A, Caines D, Finlay D. Effects of front-of-package nutrition labelling systems on understanding and purchase intention in Jamaica: results from a multiarm randomised controlled trial. BMJ Open 2023; 13:e065620. [PMID: 37024255 PMCID: PMC10083749 DOI: 10.1136/bmjopen-2022-065620] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE To assess the effects of three different front-of-package labelling (FOPL) schemes on objective understanding and intention to purchase of products, in Jamaica. SETTING Supermarkets in Jamaica. PARTICIPANTS Adult supermarket shoppers in Jamaica (n=1206) aged 18 years old or older were included in the study, except for those visually impaired, or unable to give informed consent. DESIGN Multiarm parallel-group randomised trial. INTERVENTIONS Participants were randomly allocated to one of the three intervention groups or the control group. They were exposed to two-dimensional images of 12 mock-up products presented in random and balanced order. Participants assigned to the intervention groups were exposed to one FOPL scheme: black octagonal warning labels (OWL), magnifying glass high-in single icon (MGG) or traffic-light labelling (TFL). The control group was exposed to the nutrition facts up front. OUTCOME MEASURES OR for correctly understanding nutritional information (correctly selecting the least harmful option, correctly identifying sugars, sodium and/or saturated fats found to be in excess) and choosing to purchase the least harmful option (purchase intention), more often. RESULTS Compared with the control group, the odds for correctly selecting the least harmful option more often were 107% higher in the OWL group (OR 2.07, 95% CI 1.54 to 2.78; p<0.001), whereas the MGG (1.18, 95% CI 0.89 to 1.57; p=0.24) and the TFL (1.13, 95% CI 0.85 to 1.51; p=0.39) were inefficacious in improving such odds. OWL also resulted in the highest odds for correctly identifying a product with excessive amounts of sugars, sodium and/or saturated fats and for deciding to purchase the least harmful option or none of the options. CONCLUSIONS Octagonal warning labels performed best at improving the ability of adult shoppers in Jamaica to understand the nutrition information and at encouraging them to purchase the least harmful option more often.
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Affiliation(s)
- Vanessa White-Barrow
- College of Health Sciences, University of Technology Jamaica, Kingston, Saint Andrew Parish, Jamaica
| | - Fabio S Gomes
- Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington DC, District of Columbia, USA
| | - Sheerin Eyre
- College of Health Sciences, University of Technology Jamaica, Kingston, Saint Andrew Parish, Jamaica
| | - Gaston Ares
- Departamento de Ciencia y Tecnología de Alimentos, Facultad de Química, Universidad de la Republica Uruguay, Montevideo, Uruguay
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Audrey Morris
- Noncommunicable Diseases and Mental Health, Pan American Health Organization, Kingston, Jamaica
| | - Deonne Caines
- Ministry of Health & Wellness of Jamaica, Government of Jamaica, Kingston, Jamaica
| | - David Finlay
- College of Health Sciences, University of Technology Jamaica, Kingston, Saint Andrew Parish, Jamaica
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50
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Fretes G, Corvalán C, Reyes M, Taillie LS, Economos CD, Wilson NL, Cash SB. Changes in children's and adolescents' dietary intake after the implementation of Chile's law of food labeling, advertising and sales in schools: a longitudinal study. Int J Behav Nutr Phys Act 2023; 20:40. [PMID: 37016430 PMCID: PMC10074676 DOI: 10.1186/s12966-023-01445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND In June 2016, a comprehensive food policy was implemented in Chile that included front-of-package warning labels on key nutrients of concern (total sugars, added saturated fats, sodium, and calories), child-directed food advertisement bans, and school regulations. The policy was implemented in 3 phases from 2016 to 2019 and the primary objective was to improve children's food environments. This study's objective was to assess changes in child and adolescent intake of key nutrients of concern (total sugars, saturated fats, and sodium) at school after the initial implementation of Chile's Law of Food Labeling and Advertisement. METHODS Longitudinal study of 349 children from the Food Environment Chilean Cohort (FECHIC) and 294 adolescents from the Growth and Obesity Cohort Study (GOCS). Data were from single 24-hour dietary recalls collected from 2016 to 2019. Fixed-effects models stratified by school, home, and other locations compared nutrient consumption in each year to consumption at the pre-policy 2016 baseline. Nutrient intakes are expressed as percent of total energy. RESULTS Compared to 2016 (pre-policy), total sugars consumed by children at school decreased 4.5 [-8.0, -0.9] percentage points (pp) and 11.8 [-15.4, -8.3] pp in 2018 and 2019 respectively. In 2019, children's saturated fats and sodium intake at school also decreased (1.1 [-1.9, -0.2] pp and 10.3 [-18.1, -2.5] mg/100 kcal respectively). Likewise, in adolescents, total sugars and saturated fats consumed at school decreased in 2018 (5.3 [-8.4, -2.2] pp and 1.5 [-2.7, -0.3] pp respectively). However, consumption of key nutrients of concern at other locations increased after implementation of the policy. CONCLUSIONS After initial implementation of Chile's Labeling Law, intake of most key nutrients of concern significantly declined at school. However, we found evidence of compensatory behavior in out-of-school settings. Further research is needed to evaluate what other actions are needed to impact overall diets in the long term both at schools and out of school.
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Affiliation(s)
- Gabriela Fretes
- International Food Policy Research Institute (IFPRI), 1201 Eye St NW, Washington, DC USA
| | - Camila Corvalán
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Marcela Reyes
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
- Global Food Research Program, Carolina Population Center, Chapel Hill, NC USA
| | | | - Norbert L.W. Wilson
- Duke Divinity School, Sanford School of Public Policy, and World Food Policy Center, Duke University, Durham, NC USA
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
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