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Luick M, Bianchi F, Bain F, Bandy L, Doshi P, Hilliard D, Leung J, Mottershaw A, Stuijfzand B, Whitwell-Mak J, Jebb SA, Harper H, Pechey R. Do calorie labels change energy purchased in a simulated online food delivery platform? A multi-arm randomised controlled trial. Int J Behav Nutr Phys Act 2024; 21:103. [PMID: 39289766 PMCID: PMC11406871 DOI: 10.1186/s12966-024-01638-y] [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: 12/13/2023] [Accepted: 08/01/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND As rates of obesity and overweight continue to increase in the UK, calorie labels have been introduced on menus as a policy option to provide information to consumers on the energy content of foods and to enable informed choices. This study tested whether the addition of calorie labels to items in a simulated food delivery platform may reduce the energy content of items selected. METHODS UK adults (n = 8,780) who used food delivery platforms were asked to use the simulated platform as they would in real life to order a meal for themselves. Participants were randomly allocated to a control condition (no calorie labels) or to one of seven intervention groups: (1) large size calorie labels adjacent to the price (LP), (2) large size label adjacent to the product name (LN), (3) small label adjacent to price (SP), (4) small label adjacent to product name (SN), (5) LP with a calorie label switch-off filter (LP + Off), (6) LP with a switch-on filter (LP + On), or, (7) LP with a summary label of the total basket energy content (LP + Sum). Regression analysis assessed the impact of calorie labels on energy content of foods selected compared to the control condition. RESULTS The mean energy selected in the control condition was 1408 kcal (95%CI: 93, 2719). There was a statistically significant reduction in mean energy selected in five of the seven intervention trial arms (LN labels (-60 kcal, 95%CI: -111, -6), SN (-73, 95%CI: -125, -19), LP + Off (-110, 95%CI: -161, -57), LP + On (-109, 95%CI: -159, -57), LP + Sum (-85 kcal, 95%CI: -137, -30). There was no evidence the other two conditions (LP (-33, 95%CI: -88, 24) and SP (-52, 95%CI: -105, 2)) differed from control. There was no evidence of an effect of any intervention when the analysis was restricted to participants who were overweight or obese. CONCLUSION Adding calorie labels to food items in a simulated online food delivery platform reduced the energy content of foods selected in five out of seven labelling scenarios. This study provides useful information to inform the implementation of these labels in a food delivery platform context.
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Affiliation(s)
- Madison Luick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | | | - Lauren Bandy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | | | | | | | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hugo Harper
- Behavioural Insights Team, London, UK
- Nesta, London, UK
| | - Rachel Pechey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Ares G, Turra S, Bonilla L, Costa M, Verdier S, Brunet G, Alcaire F, Curutchet MR, Vidal L. WEIRD and non-consensual food deserts and swamps: A scoping review of operational definitions. Health Place 2024; 89:103315. [PMID: 39013213 DOI: 10.1016/j.healthplace.2024.103315] [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] [Received: 03/18/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
The aim of the present study was to critically analyze operational definitions of food deserts and food swamps included in empirical studies published in peer-reviewed journals. A scoping review was conducted following the recommendations of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. A search of the scientific literature was performed on August 2023 to identify empirical studies including operational definitions of food deserts and/or food swamps in three databases: Scopus, PubMed, and Scielo. A total of 932 scientific articles were identified in the three databases, from which 157 articles, published between 2002 and 2023, were included in the review. The included studies were mainly conducted in WEIRD (Western, Educated, Industrilaized, Rich and Democractic) countries. They presented a total of 107 operational definitions of food deserts and 30 operational definitions of food swamps. Large heterogeneity in the operational definitions of food deserts and food swamps was found. Published studies differed in all the elements of the operational definitions analyzed in the present work. Results stress the need for standardization and the development of more objective and multivariate continuous measures of physical food accessibility that reflect the complexity of modern food environments globally. A series of recommendations to advance food environment research are derived.
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Affiliation(s)
- Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Uruguay.
| | - Sergio Turra
- Escuela de Nutrición, Universidad de la República, Av. Ricaldoni S/N, CP 11600, Montevideo, Uruguay
| | - Luciana Bonilla
- Instituto Nacional de Alimentación, Ministerio de Desarrollo Social, Piedras 165, CP 11000, Montevideo, Uruguay
| | - María Costa
- Instituto Nacional de Alimentación, Ministerio de Desarrollo Social, Piedras 165, CP 11000, Montevideo, Uruguay
| | - Sofía Verdier
- Instituto Nacional de Alimentación, Ministerio de Desarrollo Social, Piedras 165, CP 11000, Montevideo, Uruguay
| | - Gerónimo Brunet
- Espacio Interdisciplinario, Universidad de la República, José Enrique Rodó 1843, CP 11200, Montevideo, Uruguay
| | - Florencia Alcaire
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Uruguay
| | - María Rosa Curutchet
- Instituto Nacional de Alimentación, Ministerio de Desarrollo Social, Piedras 165, CP 11000, Montevideo, Uruguay
| | - Leticia Vidal
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Uruguay
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Moore HJ, O'Malley CL, Lloyd S, Eskandari F, Rose K, Butler M, Townshend TG, Brown H, Clarkson D, Lake AA. Measuring the association between the opening of a new multi-national restaurant with young people's eating behaviours. Appetite 2024; 203:107651. [PMID: 39216823 DOI: 10.1016/j.appet.2024.107651] [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: 03/07/2024] [Revised: 08/02/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024]
Abstract
Out-of-home eating (takeaway, take-out and fast-foods) is associated with intakes of higher energy and fat, and lower intakes of micronutrients, and is associated with excess weight gain. In 2017, a unique opportunity arose to measure the association between the opening of a new multi-national fast-food restaurant (McDonald's) and consumption of fast-food on young people aged 11-16. This study uses a repeated cross-sectional design to explore group level change over time with respect to out-of-home eating behaviours of young people. Two secondary schools in Redcar and Cleveland agreed to participate and facilitated the completion of a questionnaire on their pupils eating behaviours at three timepoints a) prior to the new restaurant opening, b) three months post-opening and c) nine months post opening. Reported frequency of visits to McDonald's showed a statistically significant increase in visits between 3 and 9 months of the restaurant opening. This research asks and explores the question of whether the introduction of a new multi-national fast-food restaurant influences eating habits of young people attending schools near the new outlet.
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Affiliation(s)
- Helen J Moore
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.
| | - Claire L O'Malley
- Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK; Centre for Public Health Research, School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Scott Lloyd
- Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK; Public Health South Tees, Middlesbrough, UK
| | - Fatemeh Eskandari
- Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK; Centre for Public Health Research, School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Kelly Rose
- Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK; Durham County Council, UK
| | - Mark Butler
- Centre for Public Health Research, School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Tim G Townshend
- Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK; School of Architecture, Planning & Landscape, Newcastle University, Newcastle Upon Tyne, UK
| | - Heather Brown
- Division of Health Research, Lancaster University, UK
| | | | - Amelia A Lake
- Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK; Centre for Public Health Research, School of Health & Life Sciences, Teesside University, Middlesbrough, UK
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4
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Wopereis TM, de Vet E, Rongen FC, Poelman MP. Food availability, perceived food environment and social norm perceptions of healthy and vegetarian food consumption at a public music festival in the Netherlands: a cross-sectional study. BMJ Nutr Prev Health 2024; 7:166-173. [PMID: 38966116 PMCID: PMC11221294 DOI: 10.1136/bmjnph-2023-000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/16/2024] [Indexed: 07/06/2024] Open
Abstract
Objective To gain insight into the food availability, the perceived food environment, and social norm perceptions in favour of healthy and vegetarian food consumption at a festival. Design Two cross-sectional substudies were conducted to audit food and beverages at the festival, and to measure visitors' perceptions of the festival food environment (accessibility, affordability, availability, diversity, quality) and their social norms perceptions via a mobile survey. Setting Public music festival, the Netherlands. Sample 75 food stands and 153 adult festival visitors. Results 75 food stands offered 627 food and beverage items, of which 92.4% were not supportive of a healthy diet. Of all food items, 46.6% were vegetarian (including 20% fries). Participants especially perceived the festival food environment as unsupportive of healthy choices. They also had weak descriptive and injunctive social norm perceptions in favour of healthy and vegetarian food consumption. However, they had stronger descriptive (t(152)=-5.5; p<0.001) and injunctive norm perceptions (t(152)=-4.5; p<0.001) of vegetarian food consumption (mean descriptive social norm perception=2.42; SD=0.82; mean injunctive social norm perception=3.14; SD=0.78), than healthy food consumption (mean descriptive social norm perception=2.10; SD=0.76; mean injunctive social norm perception=2.93; SD=0.78). Participants had stronger injunctive than descriptive social norm perceptions of healthy (t(152)=-12.4; p<0.001) and vegetarian (t(152)=-11.3; p<0.001) food consumption. Participants' perceived food environment and their perception of social norms were positively correlated. Conclusion The festival's food environment appears unsupportive of healthy and vegetarian food consumption. The limited availability of healthy and vegetarian food coincided with weak social norm perceptions encouraging their consumption, particularly descriptive norms that arise from observing others. The food environment may stand in the way of developing descriptive norms for the consumption of healthy and vegetarian food, as people can only see others consume food that is available. Implementation of public event policies could support healthier, more sustainable festivals.
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Affiliation(s)
- Tamika M Wopereis
- Consumption and Healthy Lifestyles Chair Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles Chair Group, Wageningen University & Research, Wageningen, The Netherlands
- Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, The Netherlands
| | - Frédérique C Rongen
- Consumption and Healthy Lifestyles Chair Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Maartje P Poelman
- Consumption and Healthy Lifestyles Chair Group, Wageningen University & Research, Wageningen, The Netherlands
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Polden M, Jones A, Essman M, Adams J, Bishop T, Burgoine T, Donohue A, Sharp S, White M, Smith R, Robinson E. Point-of-choice kilocalorie labelling practices in large, out-of-home food businesses: a preobservational versus post observational study of labelling practices following implementation of The Calorie Labelling (Out of Home Sector) (England) Regulations 2021. BMJ Open 2024; 14:e080405. [PMID: 38604637 PMCID: PMC11015320 DOI: 10.1136/bmjopen-2023-080405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES On 6 April 2022, the UK government implemented mandatory kilocalorie (kcal) labelling regulations for food and drink products sold in the out-of-home food sector (OHFS) in England. Previous assessments of kcal labelling practices in the UK OHFS found a low prevalence of voluntary implementation and poor compliance with labelling recommendations. This study aimed to examine changes in labelling practices preimplementation versus post implementation of mandatory labelling regulations in 2022. METHODS In August-December 2021 (preimplementation) and August-November 2022 (post implementation), large OHFS businesses (250 or more employees) subject to labelling regulations were visited. At two time points, a researcher visited the same 117 food outlets (belonging to 90 unique businesses) across four local authorities in England. Outlets were rated for compliance with government regulations for whether kcal labelling was provided at any or all point of choice, provided for all eligible food and drink items, provided per portion for sharing items, if labelling was clear and legible and if kcal reference information was displayed. RESULTS There was a significant increase (21% preimplementation vs 80% post implementation, OR=40.98 (95% CI 8.08 to 207.74), p<0.001) in the proportion of outlets providing any kcal labelling at point-of-choice post implementation. Only 15% of outlets met all labelling compliance criteria post implementation, with a minority of outlets not presenting labelling in a clear (33%) or legible (29%) way. CONCLUSION The number of large businesses in the OHFS providing kcal labelling increased following the implementation of mandatory labelling regulations. However, around one-fifth of eligible outlets sampled were not providing kcal labelling 4-8 months after the regulations came into force, and the majority of businesses only partially complied with government guidance. More effective enforcement may be required to further improve kcal labelling practices in the OHFS in England. PREREGISTRATION Study protocol and analysis strategy preregistered on Open Science Framework (https://osf.io/pfnm6/).
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Affiliation(s)
- Megan Polden
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Lancaster University, Lancaster, UK
| | | | - Michael Essman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tom Bishop
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Stephen Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Richard Smith
- Institute of Health Research, University of Exeter Medical School, Exeter, Devon, UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK
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6
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Libuy N, Church D, Ploubidis G, Fitzsimons E. Fast food proximity and weight gain in childhood and adolescence: Evidence from Great Britain. HEALTH ECONOMICS 2024; 33:449-465. [PMID: 37971895 PMCID: PMC10952272 DOI: 10.1002/hec.4770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023]
Abstract
We study the relationship between proximity to fast food restaurants and weight gain from late childhood to early adolescence. We use the Millennium Cohort Study, a UK-wide nationally representative longitudinal study, linked with granular geocoded food outlet data to measure the presence of fast food outlets around children's homes and schools from ages 7 to 14. We find that proximity to fast food outlets is associated with increased weight (body mass index, overweight, obese, body fat, weight), but only among those with maternal education below degree level. Within this sample, those with lower levels of emotional regulation are at heightened risk of weight gain.
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Affiliation(s)
- Nicolás Libuy
- Centre for Longitudinal Studies, Social Research Institute, UCLLondonUK
| | - David Church
- Centre for Longitudinal Studies, Social Research Institute, UCLLondonUK
| | - George Ploubidis
- Centre for Longitudinal Studies, Social Research Institute, UCLLondonUK
| | - Emla Fitzsimons
- Centre for Longitudinal Studies, Social Research Institute, UCLLondonUK
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7
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Tarro L, Mandracchia F, Queral J, Besora-Moreno M, Vilanova N, Valls RM, Pedret A, Solà R, Llauradó E. Impact of an Intervention on Healthy Offerings and Allergenic Food Management in Restaurants: A Parallel Randomized Controlled Study. Nutrients 2023; 15:4869. [PMID: 38068728 PMCID: PMC10708017 DOI: 10.3390/nu15234869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
The consumption of out-of-home meals is increasing. This study is aimed at assessing the effect of an intervention on healthy offerings and the management of food allergies and intolerances. Ten (control group) and eight restaurants (intervention group) were randomized in a 12-month parallel controlled trial. The outcomes were changes regarding adherence to the Mediterranean diet (AMed) and gluten management (SMAP) criteria, the traffic light rating category, nutrients, and gluten- and allergen-free content of dishes. After 12 months, and compared with baseline, there was an improvement of ≥25% in four items of the AMed criteria in the intervention group, whereas an increase in the offer of dairy desserts without added sugar, and a decrease in the first course offerings of vegetables and/or legumes were observed in the control group (p < 0.05). Also, after 12 months, there was an improvement of ≥50% in four SMAP criteria (p < 0.05) and in the mean average of all SMAP criteria (p = 0.021) compared with baseline in the intervention group, in which intra- and inter-group improvements for desserts in traffic light ratings, nutrients, and allergens were observed (p < 0.05). Therefore, the intervention showed beneficial effects, improving the quality of menus toward the Mediterranean diet pattern and gluten and food allergy/intolerance management.
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Affiliation(s)
- Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (L.T.); (F.M.); (J.Q.); (M.B.-M.); (N.V.); (R.M.V.); (A.P.)
| | - Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (L.T.); (F.M.); (J.Q.); (M.B.-M.); (N.V.); (R.M.V.); (A.P.)
| | - Judit Queral
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (L.T.); (F.M.); (J.Q.); (M.B.-M.); (N.V.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (IISPV), 43204 Reus-Tarragona, Spain
| | - Maria Besora-Moreno
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (L.T.); (F.M.); (J.Q.); (M.B.-M.); (N.V.); (R.M.V.); (A.P.)
| | - Nerea Vilanova
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (L.T.); (F.M.); (J.Q.); (M.B.-M.); (N.V.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (IISPV), 43204 Reus-Tarragona, Spain
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (L.T.); (F.M.); (J.Q.); (M.B.-M.); (N.V.); (R.M.V.); (A.P.)
| | - Anna Pedret
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (L.T.); (F.M.); (J.Q.); (M.B.-M.); (N.V.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (IISPV), 43204 Reus-Tarragona, Spain
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (L.T.); (F.M.); (J.Q.); (M.B.-M.); (N.V.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (IISPV), 43204 Reus-Tarragona, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (L.T.); (F.M.); (J.Q.); (M.B.-M.); (N.V.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (IISPV), 43204 Reus-Tarragona, Spain
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Polden M, Robinson E, Jones A. Assessing public perception and awareness of UK mandatory calorie labeling in the out-of-home sector: Using Twitter and Google trends data. Obes Sci Pract 2023; 9:459-467. [PMID: 37810520 PMCID: PMC10551121 DOI: 10.1002/osp4.674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/01/2023] [Accepted: 04/10/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives In 2021 the UK government announced a new obesity policy requiring large out-of-home food outlets to provide mandatory in-store calorie labeling on food and drink items. Public acceptability and engagement with obesity policies could influence the level of impact on wider public health particularly with population-level policies such as calorie labeling. This study aimed to examine public responses and awareness of the policy using social media (Twitter) comments and Google trends data. Methods This study examined responses to social media posts on Twitter (tweets) from the UK Department of Health and Social Care detailing the policy, implementation date and post-implementation information about the policy's enforcement. The sentiments of the tweets were coded and the number of likes and replies extracted. This study utilized google trends to examine public awareness of the policy by extracting weekly relative search volume for relevant phrases such as "calorie labeling." Results From the 276 replies/quote-tweet extracted, the majority expressed a negative sentiment toward the policy (N = 197/71.4%). There were fewer tweets expressing a positive sentiment (N = 25/8.7%) and a neutral/no sentiment (N = 54/19.6%). There was no difference in the number of "likes" or retweets between tweets expressing positive or negative sentiments. Five themes were identified expressing negative sentiments (most common being negative impacts on eating disorders). Google trends data revealed increased searches for "calorie labels/labeling" during the week of the policy enforcement compared to previous weeks in the last 5 years but no significant differences in searches for specific menu calorie labeling. Conclusions This analysis revealed negative sentiment toward and increased searching of calorie labeling information during the announcement and implementation of the 2021 mandatory calorie labeling policy in England. A greater understanding of public responses to calorie labeling policies may help tailor future policies and public communication strategies.
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Affiliation(s)
- Megan Polden
- Department of Primary Care and Mental HealthUniversity of LiverpoolLiverpoolUK
| | - Eric Robinson
- Department of PsychologyUniversity of LiverpoolLiverpoolUK
| | - Andrew Jones
- School of PsychologyLiverpool John Moores UniversityLiverpoolUK
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9
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Finlay A, Boyland E, Jones A, Witkam R, Robinson E. The impact of calorie labelling and proportional pricing on out of home food orders: a randomised controlled trial study using a virtual food and drink delivery app. Int J Behav Nutr Phys Act 2023; 20:112. [PMID: 37726788 PMCID: PMC10508026 DOI: 10.1186/s12966-023-01513-2] [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: 04/24/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Mandatory calorie labelling in the out-of-home food sector was introduced in England in 2022, and menu pricing strategies that ensure cost is equivalent to portion size (proportional pricing) have been proposed as a policy to reduce obesity. Food delivery app-based platforms now contribute significantly to diet, and evidence suggests that those at a socioeconomic disadvantage may have greater exposure to unhealthy options on these platforms. However, public health policies to improve nutritional quality of food ordered from food delivery apps has received limited examination. OBJECTIVE This experimental study assessed the impact of calorie labelling and proportional pricing on item and meal size selection, calories ordered, and money spent when selecting food and drinks from three outlet types on a virtual delivery app. METHODS UK adult participants (N = 1126, 49% female), stratified by gender and education level completed an online study where they ordered items from three branded food and beverage outlets (coffee shop, sandwich outlet, fast food outlet) using a virtual delivery app. Participants were presented food and beverage options with vs. without calorie labels and with value (larger portions are proportionally cheaper) vs. proportional pricing. RESULTS Calorie labelling did not influence portion size selection for any outlets, but significantly reduced calories ordered from the coffee shop (-18.95kcals, 95% CI -33.07 to -4.84) and fast food outlet (-54.19kcals, 95% CI -86.04 to -22.33). Proportional pricing reduced the likelihood of choosing a larger beverage from the coffee shop (OR = 0.58, 95% CI 0.45 to 0.75), but was associated with increased calories ordered from the fast food outlet (51.25kcals, 95% CI 19.59 to 82.90). No consistent interactions were observed with participant characteristics, suggesting that effects of calorie labelling and pricing on outcomes were similar across sociodemographic groups. CONCLUSIONS Calorie labelling on food delivery platforms may effectively reduce calories ordered. Proportional pricing may be useful in prompting consumers to select smaller portion sizes, although further research in real-world settings will now be valuable.
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Affiliation(s)
- Amy Finlay
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK.
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Andrew Jones
- Department of Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Rozemarijn Witkam
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
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Porter A, Langford R, Summerbell C, Tinner L, Kipping R. A qualitative exploration of food portion size practices and awareness of food portion size guidance in first-time parents of one- to two-year-olds living in the UK. BMC Public Health 2023; 23:1779. [PMID: 37704981 PMCID: PMC10500748 DOI: 10.1186/s12889-023-16647-y] [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: 12/09/2022] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Food portion size guidance resources aimed at parents of young children in the UK are freely available from a number of credible sources. However, little is known about whether parents are aware of, and use, any of these resources to guide their food portioning practices. OBJECTIVES We aimed to explore the food portion size practices used by first-time parents living in the UK when feeding their one- to two-year-old child, and their awareness of and views on six food portion size guidance resources. METHODS Participants were recruited via parent Facebook groups and online parent forums. Online 1-1 semi-structured interviews were conducted, during which parents were shown images of six food portion size guidance resources to facilitate discussion. Data was analysed in NVivo 11 using a Reflexive Thematic Analysis approach. RESULTS Of the 27 participants, most were women (n = 25), white (n = 18), and educated to first degree level or higher (n = 24). First-time parents mostly relied on their own judgement and "instinct" to portion foods, based on their learned experience of how much their child ate on a day-to-day basis. This experience was used alongside physical indicators of food portion size, such as the size of children's dishware and food packaging. Most participants were unaware of any of the six food portion size guidance resources we showed them; only four had read any of the resources. Parents suggested they had previously sought advice about weaning from a range of sources (e.g. online, friends, community groups) but would be unlikely to seek out specific food portion size guidance. Parents suggested recommendations on food portion size should acknowledge and highlight parents' perception that "every child is different". CONCLUSIONS Existing food portion size guidance resources for parents of young children in the UK are ineffective as they have poor reach and impact. We suggest parents should be involved in developing novel strategies to promote age-appropriate consumption and healthy weight gain in young children.
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Affiliation(s)
- Alice Porter
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- School for Public Health Research, NIHR, London, UK.
| | - Rebecca Langford
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carolyn Summerbell
- School for Public Health Research, NIHR, London, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Laura Tinner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruth Kipping
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School for Public Health Research, NIHR, London, UK
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11
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Hetz K, Weerasinghe N, Rippin H, Wickramasinghe K, Zhiteneva O, Usman MA, Politis C, Galea G. The Development and Potential of a Digital out of Home Food Environment Monitoring Platform. Nutrients 2023; 15:3887. [PMID: 37764671 PMCID: PMC10536807 DOI: 10.3390/nu15183887] [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: 08/04/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The rapidly growing field of digital meal delivery platforms has transformed the out of home (OOH) food environment, presenting both opportunities and challenges for public health. This paper introduces the development and potential of a novel digital platform designed for monitoring the OOH food environment. Drawing on publicly available data from meal delivery applications, this platform provides valuable insights into the landscape of digital food offerings, such as the most common restaurants per region, average caloric content per meal type, and energy value per monetary unit. This research addresses the current void in regulations for this digital environment, particularly around food labeling and provision of nutrition information. Even though the platform has significantly improved our understanding of the digital food ecosystem, it highlights gaps, primarily due to the lack of publicly available individual data and inconsistencies in provided information. Despite these challenges, the proposed digital platform holds considerable promise for better understanding the digital food environment, supporting healthier food choices, and informing future policy interventions aimed at regulating the online food environment. This research advocates for mandatory regulations in the digital food sector to ensure comprehensive, comparable, and transparent nutrition information and equality in access to nutritious foods.
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Affiliation(s)
- Kathrin Hetz
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Special Initiative on NCDs and Innovation, 2100 Copenhagen, Denmark
| | - Nuwan Weerasinghe
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Special Initiative on NCDs and Innovation, 2100 Copenhagen, Denmark
- Faculty of Science, Engineering and Computing, Kingston University London, Kingston upon Thames, London KT1 2EE, UK
| | - Holly Rippin
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Special Initiative on NCDs and Innovation, 2100 Copenhagen, Denmark
| | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Special Initiative on NCDs and Innovation, 2100 Copenhagen, Denmark
| | - Olga Zhiteneva
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Special Initiative on NCDs and Innovation, 2100 Copenhagen, Denmark
| | - Muhammad Arslan Usman
- Faculty of Science, Engineering and Computing, Kingston University London, Kingston upon Thames, London KT1 2EE, UK
| | - Christos Politis
- Faculty of Science, Engineering and Computing, Kingston University London, Kingston upon Thames, London KT1 2EE, UK
| | - Gauden Galea
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Special Initiative on NCDs and Innovation, 2100 Copenhagen, Denmark
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12
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Fong M, Scott S, Albani V, Brown H. The Impact of COVID-19 Restrictions and Changes to Takeaway Regulations in England on Consumers' Intake and Methods of Accessing Out-of-Home Foods: A Longitudinal, Mixed-Methods Study. Nutrients 2023; 15:3636. [PMID: 37630827 PMCID: PMC10459227 DOI: 10.3390/nu15163636] [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: 06/07/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND COVID-19 restrictions significantly impacted the operations of fast food and full-service retailers. Full-service retailers were permitted to operate as takeaway outlets without needing to seek formal changes in planning permissions. We conducted a study to determine consumers' intake and modes of accessing foods from fast food and full-service retailers during various COVID-19 restrictions and changes to takeaway/delivery regulations, as well as their experiences. METHODS We conducted a longitudinal, mixed-methods study comprising three surveys, which examined the intake frequency and modes of accessing retailers, and two rounds of qualitative focus groups, which explored their related experiences. The data were collected at three timepoints (T) from May 2021-March 2022. The participants were adults living in Northern England (n = 701 at T1); a sub-sample participated in the focus groups (n = 22). The intake data were presented descriptively; an ordered logit regression explored the factors associated with the intake frequency. The focus group data were analysed using a framework analysis. RESULTS The mean weekly intake frequency from fast food retailers at T1, T2, and T3 was 0.96 (SD 1.05), 1.08 (SD 1.16), and 1.06 times (SD 1.12), respectively. For full-service retailers, this was 0.36 (SD 0.69), 0.75 (1.06), and 0.71 (SD 0.99) times, respectively. Food access issues (OR (SE): T1 = 1.65 (0.40), T2 = 2.60 (0.66), T = 2.1 (0.62)) and obesity (T1 = 1.61 (0.31), T2 = 2.21 (0.46), T3 = 1.85 (0.42)) were positively associated with intake from fast food, but not full-service retailers. Delivery services were commonly used to access fast food (30-34% participants), but not full-service retailers (6-10% participants). As COVID-19 restrictions eased, participants were eager to socialise on-premises at full-service retailers. CONCLUSIONS Takeaway/delivery services were seldom used to access full-service retailers, but the use of delivery services to access fast food was high. Policymakers must recognise delivery services as a growing part of the food environment, and the challenges they pose to planning policies for obesity prevention.
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Affiliation(s)
- Mackenzie Fong
- National Institute for Health and Care Research Applied Research Collaboration (North East and North Cumbria), Newcastle-upon-Tyne NE3 3XT, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - Steph Scott
- National Institute for Health and Care Research Applied Research Collaboration (North East and North Cumbria), Newcastle-upon-Tyne NE3 3XT, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - Viviana Albani
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - Heather Brown
- Division Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4AT, UK
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13
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Pepper T, Hart KH, Hodgkins CE. Tackling (Childhood) Obesity through a Voluntary Food Reformulation Policy: A Repeated Cross-Sectional Study Investigating Nutritional Changes in the Out-of-Home Sector. Nutrients 2023; 15:3149. [PMID: 37513567 PMCID: PMC10384819 DOI: 10.3390/nu15143149] [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: 06/26/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The Childhood Obesity Plan aimed to reduce sugar and energy in foods through a voluntary sugar-reduction programme. Our primary objective was to determine whether this implementation strategy had been successful, focusing on the out-of-home sector. We used a repeated cross-sectional design to evaluate nutritional changes in desserts served by leading chain restaurants. We extracted nutrition information from online menus in autumn/winter 2020, for comparison with baseline (2017) and interim (2018) values extracted from third-party datasets. We assessed compliance with the 20% sugar-reduction target and category-specific energy targets by product category and for pooled desserts. Overall, sugar/portion and energy/portion decreased by 11% and 4%, respectively. Policy targets were achieved in one of five categories (ice-cream: -38% sugar, p < 0.001; -30% energy, p < 0.001). Secondary outcomes were analysed for subgroups with the necessary data. Few chains significantly reduced sugar and/or energy across their dessert range. Energy/portion was positively associated with portion weight and sugar/portion but not with sugar/100 g. More than half of adults' desserts contained excessive sugar and/or saturated fat compared with dietary guidelines. Children's desserts less frequently exceeded guidelines. These results demonstrate that voluntary measures can drive substantial change when technical, commercial, and operational barriers can be overcome.
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Affiliation(s)
- Tammy Pepper
- Department of Nutritional Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Kathryn H Hart
- Department of Nutritional Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Charo E Hodgkins
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
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14
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Polden M, Jones A, Adams J, Bishop T, Burgoine T, Essman M, Sharp SJ, Smith R, White M, Robinson E. Kilocalorie labelling in the out-of-home sector: an observational study of business practices and consumer behaviour prior to implementation of the mandatory calorie labelling policy in England, 2022. BMC Public Health 2023; 23:1088. [PMID: 37280640 PMCID: PMC10242589 DOI: 10.1186/s12889-023-16033-8] [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: 02/17/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Regulations mandating kilocalorie (kcal) labelling for large businesses in the out-of-home food sector (OHFS) came into force on 6th April 2022 as a policy to reduce obesity in England. To provide indicators of potential reach and impact, kcal labelling practices were studied in the OHFS, and customer purchasing and consumption behaviours prior to implementation of the mandatory kcal labelling policy in England. METHODS From August-December 2021, large OHFS businesses subject to the kcal labelling regulations were visited prior to regulations coming into force on 6th April 2022. 3308 customers were recruited from 330 outlets and collected survey information on the number of kcal purchased and consumed by customers, customers' knowledge of the kcal content of their purchases, and customers noticing and use of kcal labelling. In a subset of 117 outlets, data was collected on nine recommended kcal labelling practices. RESULTS The average number of kcals purchased (1013 kcal, SD = 632 kcal) was high with 69% of purchases exceeding the recommendation of a maximum of 600 kcal per meal. Participants underestimated the energy content of their purchased meals by on average 253 kcal (SD = 644 kcals). In outlets providing kcal labelling in which customer survey data was collected, a minority of customers reported noticing (21%) or using (20%) kcal labelling. Out of the 117 outlets assessed for kcal labelling practices, 24 (21%) provided any in-store kcal labelling. None of the outlets met all nine aspects of recommended labelling practices. CONCLUSIONS Prior to implementation of 2022 kcal labelling policy, the majority of sampled OHFS large business outlets in England did not provide kcal labelling. Few customers noticed or used the labels and on average customers purchased and consumed substantially more energy than recommended in public health guidelines. The findings suggest that reliance on voluntary action for kcal labelling implementation failed to produce widespread, consistent, and adequate kcal labelling practices.
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Affiliation(s)
- Megan Polden
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK.
| | | | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tom Bishop
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Michael Essman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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15
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Bianchi F, Luick M, Bandy L, Bone J, Kelly S, Farrington J, Leung J, Mottershow A, Murar F, Jebb SA, Harper H, Pechey R. The impact of altering restaurant and menu option position on food selected from an experimental food delivery platform: a randomised controlled trial. Int J Behav Nutr Phys Act 2023; 20:60. [PMID: 37208720 PMCID: PMC10197857 DOI: 10.1186/s12966-023-01456-8] [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: 11/28/2022] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Overconsumption is one of the most serious public health challenges in the UK and has been linked to increased consumption of food ordered through delivery platforms. This study tested whether repositioning foods and/or restaurant options in a simulated food delivery platform could help to reduce the energy content of users' shopping basket. METHODS UK adult food delivery platform users (N = 9,003) selected a meal in a simulated platform. Participants were randomly allocated to a control condition (choices listed randomly) or to one of four intervention groups, (1) food options listed in ascending order of energy content, (2) restaurant options listed in ascending order of average energy content per main meal, (3) interventions 1 and 2 combined (4) interventions 1 and 2 combined, but food and restaurant options repositioned based on a kcal/price index to display options lower in energy but higher in price at the top. Gamma regressions assessed the impact of interventions on total energy content of baskets at checkout. RESULTS The energy content of participants' baskets in the control condition was 1382 kcals. All interventions significantly reduced energy content of baskets: Compared to control, repositioning both foods and restaurants purely based on energy content of options resulted in the greatest effect (-209kcal; 95%CIs: -248,-168), followed by repositioning restaurants (-161kcal; 95%CIs: -201,-121), repositioning restaurants and foods based on a kcal/price index (-117kcals; 95%CI: -158,-74) and repositioning foods based on energy content (-88kcals; 95%CI: -130,-45). All interventions reduced the basket price compared to the control, except for the intervention repositioning restaurants and foods based on a kcal/price index, which increased the basket price. CONCLUSIONS This proof-of-concept study suggests repositioning lower-energy options more prominently may encourage lower energy food choices in online delivery platforms and can be implemented in a sustainable business model.
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Affiliation(s)
| | - Madison Luick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Lauren Bandy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Stefan Kelly
- Behavioural Insights Team, London, UK
- Nesta, London, UK
| | | | | | | | | | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hugo Harper
- Behavioural Insights Team, London, UK
- Nesta, London, UK
| | - Rachel Pechey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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16
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Keeble M, Adams J, Burgoine T. Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis. JMIR Public Health Surveill 2023; 9:e41822. [PMID: 36848236 PMCID: PMC10131934 DOI: 10.2196/41822] [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: 08/10/2022] [Revised: 02/08/2023] [Accepted: 02/23/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Food prepared out of home is typically energy-dense and nutrient-poor. Online food delivery services have become a popular way to purchase such food. The number of accessible food outlets through these services can influence how frequently they are used. Anecdotally, food outlet access through online food delivery services increased in England between 2020 and 2022, in the context of the COVID-19 pandemic. However, the extent to which this access changed is poorly understood. OBJECTIVE We aimed to investigate monthly changes in online access to food prepared out of home in England in the context of the first 2 years of the COVID-19 pandemic compared with November 2019 and the extent to which any changes were associated with deprivation. METHODS In November 2019 and monthly between June 2020 and March 2022, we used automated data collection to construct a data set containing information about all food outlets in England registered to accept orders through the leading online food delivery service. Across postcode districts, we identified the number and percentage of food outlets registered to accept orders and the number that was accessible. We used generalized estimating equations (adjusted for population density, the number of food outlets in the physical food environment, and rural/urban classification) to investigate the change in outcomes compared with prepandemic levels (November 2019). We stratified analyses by deprivation quintile (Q). RESULTS Across England, the summed number of food outlets registered to accept orders online increased from 29,232 in November 2019 to 49,752 in March 2022. Across postcode districts, the median percentage of food outlets registered to accept orders online increased from 14.3 (IQR 3.8-26.0) in November 2019 to 24.0 (IQR 6.2-43.5) in March 2022. The median number of food outlets accessible online decreased from 63.5 (IQR 16.0-156.0) in November 2019 to 57.0 (IQR 11.0-163.0) in March 2022. However, we observed variation by deprivation. In March 2022, the median number of outlets accessible online was 175.0 (IQR 104.0-292.0) in the most deprived areas (Q5) compared with 27.0 (IQR 8.5-60.5) in the least deprived (Q1). In adjusted analyses, we estimated that the number of outlets accessible online in the most deprived areas was 10% higher in March 2022 compared with November 2019 (incidence rate ratios: 1.10, 95% CI 1.07-1.13). In the least deprived areas, we estimated a 19% decrease (incidence rate ratios: 0.81, 95% CI 0.79-0.83). CONCLUSIONS The number of food outlets accessible online increased only in the most deprived areas in England. Future research might attempt to understand the extent to which changes in online food access were associated with changes in online food delivery service use and the possible implications on diet quality and health.
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Affiliation(s)
- Matthew Keeble
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Thomas Burgoine
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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17
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Robinson E, Boyland E, Evans R, Finlay A, Halsall L, Humphreys G, Langfield T, McFarland‐Lesser I, Patel Z, Jones A. Energy labelling of alcoholic drinks: An important or inconsequential obesity policy? Obes Sci Pract 2023; 9:75-86. [PMID: 37034571 PMCID: PMC10073822 DOI: 10.1002/osp4.638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/28/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behavior are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behavior, suggest alcohol energy labelling may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity.
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Affiliation(s)
- Eric Robinson
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Emma Boyland
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Rebecca Evans
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Amy Finlay
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Lauren Halsall
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Gabrielle Humphreys
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Tess Langfield
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | | | - Zina Patel
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
| | - Andrew Jones
- Department of PsychologyEleanor Rathbone BuildingUniversity of LiverpoolLiverpoolUK
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18
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Potvin Kent M, Soares Guimaraes J, Pritchard M, Remedios L, Pauzé E, L'Abbé M, Mulligan C, Vergeer L, Weippert M. Differences in child and adolescent exposure to unhealthy food and beverage advertising on television in a self-regulatory environment. BMC Public Health 2023; 23:555. [PMID: 36959572 PMCID: PMC10037770 DOI: 10.1186/s12889-023-15027-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 01/11/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Food and beverage promotion is a contributor to children's dietary behaviours, and ultimately, downstream health consequences. Broadcast television remains an important source of such advertising. The objective of this study was to examine and compare children and adolescent's exposure to food advertising on television in Canada over an entire year in a self-regulatory environment. METHODS Television advertising data for 57 selected food and beverage categories were licensed from Numerator for 36 stations in Toronto, for 2019. The estimated average number of advertisements viewed by children aged 2-11 and adolescents aged 12-17 was determined overall, by food category, and by marketing technique. The healthfulness of advertisements was also assessed using Health Canada's Nutrient Profile Model. RESULTS Overall in 2019, children viewed 2234.4 food ads/person/yr while adolescents viewed 1631.7 ads, exposure for both groups stemmed primarily from stations with general appeal, and both age groups were exposed to a range of powerful marketing techniques. Exposure to advertising for restaurants, snacks, breakfast food and candy and chocolate was high among both age groups and the healthfulness of most advertised products was considered poor. Adolescents were exposed to 36.4% more food products classified as unhealthy, had higher exposure to all marketing techniques examined, and were exposed to substantially more child-related marketing techniques compared to children. CONCLUSION Children and adolescents were heavily exposed to food advertisements on television in 2019. Despite current self-regulatory policies, children's exposure to unhealthy food and beverages remains high. Differences in exposure to food advertisements by food category and healthfulness may suggest that adolescents are being disproportionately targeted by food companies as a result of self-regulatory marketing restrictions.
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Affiliation(s)
- Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Julia Soares Guimaraes
- School of Interdisciplinary Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Meghan Pritchard
- School of Interdisciplinary Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Lauren Remedios
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Elise Pauzé
- School of Interdisciplinary Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Mary L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Christine Mulligan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Laura Vergeer
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Madyson Weippert
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
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Downsizing food: a systematic review and meta-analysis examining the effect of reducing served food portion sizes on daily energy intake and body weight. Br J Nutr 2023; 129:888-903. [PMID: 35387692 PMCID: PMC9975786 DOI: 10.1017/s0007114522000903] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Portion sizes of many foods have increased over time. However, the size of effect that reducing food portion sizes has on daily energy intake and body weight is less clear. We used a systematic review methodology to identify eligible articles that used an experimental design to manipulate portion size served to human participants and measured energy intake for a minimum of 1 d. Searches were conducted in September 2020 and again in October 2021. Fourteen eligible studies contributing eighty-five effects were included in the primary meta-analysis. There was a moderate-to-large reduction in daily energy intake when comparing smaller v. larger portions (Standardised Mean Difference (SMD) = -0·709 (95 % CI: -0·956, -0·461), approximately 235 kcal (983·24 kJ)). Larger reductions to portion size resulted in larger decreases in daily energy intake. There was evidence of a curvilinear relationship between portion size and daily energy intake; reductions to daily energy intake were markedly smaller when reducing portion size from very large portions. In a subset of studies that measured body weight (four studies contributing five comparisons), being served smaller v. larger portions was associated with less weight gain (0·58 kg). Reducing food portion sizes may be an effective population-level strategy to prevent weight gain.
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20
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Kalbus A, Ballatore A, Cornelsen L, Greener R, Cummins S. Associations between area deprivation and changes in the digital food environment during the COVID-19 pandemic: Longitudinal analysis of three online food delivery platforms. Health Place 2023; 80:102976. [PMID: 36758447 PMCID: PMC9899780 DOI: 10.1016/j.healthplace.2023.102976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/09/2023]
Abstract
Online food delivery services facilitate access to unhealthy foods and have proliferated during the COVID-19 pandemic. This study explores associations between neighbourhood deprivation and exposure to online food delivery services and changes in exposure by deprivation during the first year of the pandemic. Data on food outlets delivering to 661 postcode districts in London and the North of England in 2020 and 2021 were collected from three online delivery platforms. The association between area deprivation and overall exposure to online food delivery services was moderated by region, with evidence of a positive relationship between count of outlets and deprivation in the North of England, and a negative relationship in London. There was no association between area deprivation and growth of online food delivery services. Associations between neighbourhood deprivation and exposure to the digital food environment vary geographically. Consequently, policies aimed at the digital food environment need to be tailored to the local context.
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Affiliation(s)
- Alexandra Kalbus
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, United Kingdom.
| | - Andrea Ballatore
- Department of Digital Humanities, King's College London, Strand, London, WC2R 2LS, United Kingdom
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, United Kingdom
| | - Robert Greener
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, United Kingdom
| | - Steven Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, United Kingdom
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Robinson E, Polden M, Langfield T, Clarke K, Calvert L, Colombet Z, O'Flaherty M, Marty L, Tapper K, Jones A. Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2023; 20:10. [PMID: 36747247 PMCID: PMC9903416 DOI: 10.1186/s12966-023-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP). METHODS Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups. RESULTS Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041]. CONCLUSIONS Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required. REVIEW REGISTRATION Registered on PROSPERO (CRD42022312532) and OSF ( https://doi.org/10.17605/OSF.IO/W7RDB ).
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Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Megan Polden
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Tess Langfield
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Katie Clarke
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Lara Calvert
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Zoé Colombet
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lucile Marty
- Centre Des Sciences Du Goût Et de L'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - Katy Tapper
- Department of Psychology, City, University of London, London, UK
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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22
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Kalbus A, Cornelsen L, Ballatore A, Cummins S. Associations between the food environment and food and drink purchasing using large-scale commercial purchasing data: a cross-sectional study. BMC Public Health 2023; 23:72. [PMID: 36627591 PMCID: PMC9831883 DOI: 10.1186/s12889-022-14537-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/03/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evidence for an association between the local food environment, diet and diet-related disease is mixed, particularly in the UK. One reason may be the use of more distal outcomes such as weight status and cardiovascular disease, rather than more proximal outcomes such as food purchasing. This study explores associations between food environment exposures and food and drink purchasing for at-home and out-of-home (OOH) consumption. METHODS We used item-level food and drink purchase data for London and the North of England, UK, drawn from the 2019 Kantar Fast Moving Consumer Goods panel to assess associations between food environment exposures and household-level take-home grocery (n=2,118) and individual-level out-of-home (n=447) food and drink purchasing. Density, proximity and relative composition measures were created for both supermarkets and OOH outlets (restaurants and takeaways) using a 1 km network buffer around the population-weighted centroid of households' home postcode districts. Associations between food environment exposure measures and frequency of take-home food and drink purchasing, total take-home calories, calories from fruits and vegetables, high fat, salt and sugar products, and ultra-processed foods (UPF), volume of take-home alcoholic beverages, and frequency of OOH purchasing were modelled using negative binomial regression adjusted for area deprivation, population density, and individual and household socio-economic characteristics. RESULTS There was some evidence for an inverse association between distance to OOH food outlets and calories purchased from ultra-processed foods (UPF), with a 500 m increase in distance to the nearest OOH outlet associated with a 1.1% reduction in calories from UPF (IR=0.989, 95%CI 0.982-0.997, p=0.040). There was some evidence for region-specific effects relating to purchased volumes of alcohol. However, there was no evidence for an overall association between food environment exposures and take-home and OOH food and drink purchasing. CONCLUSIONS Despite some evidence for exposure to OOH outlets and UPF purchases, this study finds limited evidence for the impact of the food environment on household food and drink purchasing. Nonetheless, region-specific effects regarding alcohol purchasing indicate the importance of geographical context for research and policy.
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Affiliation(s)
- Alexandra Kalbus
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrea Ballatore
- Department of Digital Humanities, King's College London, London, UK
| | - Steven Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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23
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Reynolds JP, Ventsel M, Hobson A, Pilling MA, Pechey R, Jebb SA, Hollands GJ, Marteau TM. Evaluation of physical activity calorie equivalent (PACE) labels' impact on energy purchased in cafeterias: A stepped-wedge randomised controlled trial. PLoS Med 2022; 19:e1004116. [PMID: 36346795 PMCID: PMC9642872 DOI: 10.1371/journal.pmed.1004116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent meta-analysis suggested that using physical activity calorie equivalent (PACE) labels results in people selecting and consuming less energy. However, the meta-analysis included only 1 study in a naturalistic setting, conducted in 4 convenience stores. We therefore aimed to estimate the effect of PACE labels on energy purchased in worksite cafeterias in the context of a randomised study design. METHODS AND FINDINGS A stepped-wedge randomised controlled trial (RCT) was conducted to investigate the effect of PACE labels (which include kcal content and minutes of walking required to expend the energy content of the labelled food) on energy purchased. The setting was 10 worksite cafeterias in England, which were randomised to the order in which they introduced PACE labels on selected food and drinks following a baseline period. There were approximately 19,000 workers employed at the sites, 72% male, with an average age of 40. The study ran for 12 weeks (06 April 2021 to 28 June 2021) with over 250,000 transactions recorded on electronic tills. The primary outcome was total energy (kcal) purchased from intervention items per day. The secondary outcomes were: energy purchased from non-intervention items per day, total energy purchased per day, and revenue. Regression models showed no evidence of an overall effect on energy purchased from intervention items, -1,934 kcals per site per day (95% CI -5,131 to 1,262), p = 0.236, during the intervention relative to baseline, equivalent to -5 kcals per transaction (95% CI -14 to 4). There was also no evidence for an effect on energy purchased from non-intervention items, -5 kcals per site per day (95% CI -513 to 504), p = 0.986, equivalent to 0 kcals per transaction (95% CI -1 to 1), and no clear evidence for total energy purchased -2,899 kcals per site (95% CI -5,810 to 11), p = 0.051, equivalent to -8 kcals per transaction (95% CI -16 to 0). Study limitations include using energy purchased and not energy consumed as the primary outcome and access only to transaction-level sales, rather than individual-level data. CONCLUSION Overall, the evidence was consistent with PACE labels not changing energy purchased in worksite cafeterias. There was considerable variation in effects between cafeterias, suggesting important unmeasured moderators. TRIAL REGISTRATION The study was prospectively registered on ISRCTN (date: 30.03.21; ISRCTN31315776).
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Affiliation(s)
- James P. Reynolds
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- School of Psychology, Aston University, Birmingham, United Kingdom
- * E-mail: (JPR); (TMM)
| | - Minna Ventsel
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Alice Hobson
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark A. Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Pechey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- EPPI-Centre, UCL Social Research Institute, University College London, London, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom
- * E-mail: (JPR); (TMM)
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24
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Huang Y, Burgoine T, Essman M, Theis DRZ, Bishop TRP, Adams J. Monitoring the Nutrient Composition of Food Prepared Out-of-Home in the United Kingdom: Database Development and Case Study. JMIR Public Health Surveill 2022; 8:e39033. [PMID: 36074559 PMCID: PMC9501650 DOI: 10.2196/39033] [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: 05/05/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hand transcribing nutrient composition data from websites requires extensive human resources and is prone to error. As a result, there are limited nutrient composition data on food prepared out of the home in the United Kingdom. Such data are crucial for understanding and monitoring the out-of-home food environment, which aids policy making. Automated data collection from publicly available sources offers a potential low-resource solution to address this gap. OBJECTIVE In this paper, we describe the first UK longitudinal nutritional database of food prepared out of the home, MenuTracker. As large chains will be required to display calorie information on their UK menus from April 2022, we also aimed to identify which chains reported their nutritional information online in November 2021. In a case study to demonstrate the utility of MenuTracker, we estimated the proportions of menu items exceeding recommended energy and nutrient intake (eg, >600 kcal per meal). METHODS We have collated nutrient composition data of menu items sold by large chain restaurants quarterly since March 2021. Large chains were defined as those with 250 employees or more (those covered by the new calorie labeling policy) or belonging to the top 100 restaurants based on sales volume. We developed scripts in Python to automate the data collection process from business websites. Various techniques were used to harvest web data and extract data from nutritional tables in PDF format. RESULTS Automated Python programs reduced approximately 85% of manual work, totaling 500 hours saved for each wave of data collection. As of January 2022, MenuTracker has 76,405 records from 88 large out-of-home food chains at 4 different time points (ie, March, June, September, and December) in 2021. In constructing the database, we found that one-quarter (24.5%, 256/1043) of large chains, which are likely to be subject to the United Kingdom's calorie menu labeling regulations, provided their nutritional information online in November 2021. Across these chains, 24.7% (16,391/66,295) of menu items exceeded the UK government's recommendation of a maximum of 600 kcal for a single meal. Comparable figures were 46.4% (29,411/63,416) for saturated fat, 34.7% (21,964/63,388) for total fat, 17.6% (11,260/64,051) for carbohydrates, 17.8% (11,434/64,059) for sugar, and 35.2% (22,588/64,086) for salt. Furthermore, 0.7% to 7.1% of the menu items exceeded the maximum daily recommended intake for these nutrients. CONCLUSIONS MenuTracker is a valuable resource that harnesses the power of data science techniques to use publicly available data online. Researchers, policy makers, and consumers can use MenuTracker to understand and assess foods available from out-of-home food outlets. The methods used in development are available online and can be used to establish similar databases elsewhere.
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Affiliation(s)
- Yuru Huang
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Thomas Burgoine
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Michael Essman
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Dolly R Z Theis
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Tom R P Bishop
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Jean Adams
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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25
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Huang Y, Burgoine T, Theis DRZ, Adams J. Differences in energy and nutrient content of menu items served by large chain restaurants in the USA and the UK in 2018. Public Health Nutr 2022; 25:1-9. [PMID: 35642073 PMCID: PMC9991847 DOI: 10.1017/s1368980022001379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/25/2022] [Accepted: 05/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the sector-wide energy and nutritional differences of both adult and children's restaurant menu items in the UK and the USA in 2018. DESIGN Cross-sectional study. SETTING Energy and nutritional information provided on restaurant websites. PARTICIPANTS Menu items (n 40 902) served by forty-two large UK chains and ninety-six large USA chains. RESULTS Mean absolute energy, fat and saturated fat values were higher in USA menu items. For example, the mean adjusted per-item differences of adult menu items between the USA and the UK were 45·6 kcal for energy and 3·2 g for fat. Comparable figures for children's menu items were 43·7 kcal and 4 g. Compared with UK menu items, USA adult menu items also had higher sugar content (3·2 g, 95 % CI (0·5, 6)), and children's menu items had higher Na content (181·1 mg, 95 % CI (108·4, 253·7)). Overall, 96·8 % of UK and 95·8 % of USA menu items exceeded recommended levels for at least one of Na, fat, saturated fat or sugars. CONCLUSIONS Menu items served by large chain restaurants had higher mean absolute levels of energy, fat and saturated fat in the USA compared with the UK. UK adult menu items were also lower in sugars compared with the USA ones and children's items lower in Na. As more than 95 % of all items were considered to have high levels of at least one nutrient of public health concern in the USA and the UK, improvements in restaurant menu items are needed in both countries.
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Affiliation(s)
- Yuru Huang
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Dolly RZ Theis
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
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26
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Gesteiro E, García-Carro A, Aparicio-Ugarriza R, González-Gross M. Eating out of Home: Influence on Nutrition, Health, and Policies: A Scoping Review. Nutrients 2022; 14:1265. [PMID: 35334920 PMCID: PMC8953831 DOI: 10.3390/nu14061265] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 12/13/2022] Open
Abstract
Eating out of home (EOH) is a common practice worldwide but research gaps have been identified. The aims of this review were (a) to find a common definition for EOH, (b) to determine the nutritional contribution of EOH, and (c) to analyze the relationship of EOH with health parameters in adults. Fifty-seven articles were finally selected. The definition of EOH was not harmonized between researchers and the comparison between studies was quite difficult. Restaurant and fast food were the terms most used, followed by chain restaurant, à la carte, sit-down restaurant, eating at table, full service, ready to eat, takeaway, buffet and buffet by weight, bar, cafes, and cafeterias, either alone or attached to at least one of the above. The profile of the main EOH participant was a highly educated, high-income, and unmarried young man. EOH was related to a body mass index (BMI) or being overweight in a different way depending on age, sex, or EOH frequency. A high rate of EOH led to poorer diet quality, characterized by higher intakes of energy, total and saturated fats, sugar, and sodium, as well as lower intakes of fiber, dairy, fruit, vegetables, and micronutrients. Regarding beverages, a higher intake of soft drinks, sugar-sweetened beverages, fruit juices, beer, and other alcohol was observed when EOH. There is a need for a methodological consensus for analyzing the impact of EOH on dietary intake and health to avoid bias. Additionally, measures and policies should be utilized to help consumers to make healthier choices when EOH is compatible with business regarding those running EOH establishments.
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Affiliation(s)
- Eva Gesteiro
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, E-28040 Madrid, Spain; (A.G.-C.); (R.A.-U.); (M.G.-G.)
| | - Alberto García-Carro
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, E-28040 Madrid, Spain; (A.G.-C.); (R.A.-U.); (M.G.-G.)
| | - Raquel Aparicio-Ugarriza
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, E-28040 Madrid, Spain; (A.G.-C.); (R.A.-U.); (M.G.-G.)
| | - Marcela González-Gross
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, E-28040 Madrid, Spain; (A.G.-C.); (R.A.-U.); (M.G.-G.)
- Institute of Health Carlos III, CIBEROBN (Physiopathology of Obesity and Nutrition, CB12/03/30038), E-28029 Madrid, Spain
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Price promotions offered by quick service restaurants in Australia: analysis from an obesity prevention perspective. Public Health Nutr 2022; 25:513-527. [PMID: 34247689 PMCID: PMC9991702 DOI: 10.1017/s1368980021002688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the price promotions offered by major quick service restaurant (QSR) chains in Australia from an obesity prevention perspective. DESIGN Cross-sectional audit of ten of the largest QSR chains in Australia. We collected information regarding temporary price promotions and 'combination deals' offered by each chain over thirteen consecutive weeks in 2019-2020. We assessed the type of promotions, the magnitude of discount, and the energy content and healthiness of items promoted (based on Victorian Government criteria). SETTING Melbourne, Australia. PARTICIPANTS Ten major QSR chains. RESULTS Temporary price promotions (n 196) and combination deals (n 537 on regular menus, n 36 on children's menus) were observed across the ten selected QSR chains. In relation to temporary price promotions, the mean magnitude of discount for main menu items (n 75) was 41·7 %. The price reductions and energy content of combination deals varied substantially the by chain, the meal size and the sides/drinks selected as part of the 'deal'. When the lowest-energy options (e.g. small chips, small sugar-free drink) were included as part of each combination deal, the mean energy content was 2935 kJ, compared to 5764 kJ when the highest-energy options (e.g. large fries, large sugar-sweetened drink) were included. Almost all available products were classified as unhealthy. CONCLUSION Price promotions are ubiquitous in major QSR chains in Australia and provide incentives to consume high levels of energy. The action to restrict price promotions on unhealthy foods and ensure lower-energy default items as part of combination deals should be included as part of efforts to improve population diets and address obesity in Australia.
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Mandracchia F, Tarro L, Llauradó E, Valls RM, Solà R. The “Healthy Meals” web app for the assessment of nutritional content and food allergens in restaurant meals: Development, evaluation and validation. Digit Health 2022; 8:20552076221081690. [PMID: 35251681 PMCID: PMC8891920 DOI: 10.1177/20552076221081690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/30/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The development and the evaluation of the Healthy Meals web app designed for professionals from different disciplines related to food, aimed to assess the nutritional and food allergen content of restaurant meals, was described. Methods App evaluation concerned: (1) usability, scored on a 7-point scale by 6 restaurateurs and 10 nutritionists through the Computer System Usability Questionnaire; (2) quality, scored on a 5-point scale by 10 nutritionists through the Mobile App Rating Scale; (3) validation, by two nutritionists through differences in entered nutrient contents. Ratings reliability was assessed by the interclass correlation coefficient. Results Users agreed with the web app usability (mean 5.6/7 points, SD 0.9), with moderate reliability among ratings (interclass correlation coefficient = 0.57; 95% CI, 0.18 to 0.82). The web app showed good objective quality (mean 4.0/5 points, SD 0.4), with excellent reliability among nutritionists (interclass correlation coefficient = 0.91; 95% CI, 0.85 to 0.96). For web app validation, no significant differences were observed between the two nutritionists’ data, with excellent reliability (interclass correlation coefficient = 0.98; 95% CI, 0.97 to 0.99). App data entry was identified as a point to improve. Conclusions The Healthy Meals web app designed for professionals related to food, such as restaurateurs, demonstrated to be usable, of good quality and valid for dishes nutritional assessment and food allergen identification. Points to improve were identified, while app effectiveness should be tested in trials.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Spain
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | - Rosa M. Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Spain
- Hospital Universitari Sant Joan de Reus, Spain
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29
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Porter A, Toumpakari Z, Kipping R, Summerbell C, Johnson L. Where and when are portion sizes larger in young children? An analysis of eating occasion size among 1·5-5-year-olds in the UK National Diet and Nutrition Survey (2008-2017). Public Health Nutr 2021; 25:1-12. [PMID: 34955105 PMCID: PMC9991682 DOI: 10.1017/s1368980021005024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify eating occasion-level and individual-level factors associated with the consumption of larger portions in young children and estimate their relative importance. DESIGN Cross-sectional. SETTING Data from parent-reported 4-d food diaries in the UK National Diet and Nutrition Survey (2008-2017) were analysed. Multilevel models explored variation in eating occasion size (kJ) within (n 48 419 occasions) and between children (n 1962) for all eating occasions. Eating contexts: location, eating companion, watching TV, and sitting at a table and individual characteristics: age, gender, ethnicity and parental socio-economic status were explored as potential correlates of eating occasion size. PARTICIPANTS Children aged 1·5-5 years. RESULTS Median eating occasion size was 657 kJ (IQR 356, 1117). Eating occasion size variation was primarily attributed (90 %) to differences between eating occasions. Most (73 %) eating occasions were consumed at home. In adjusted models, eating occasions in eateries were 377 kJ larger than at home. Eating occasions sitting at a table, v. not, were 197 kJ larger. Eating in childcare, with additional family members and friends, and whilst watching TV were other eating contexts associated with slightly larger eating occasion sizes. CONCLUSIONS Eating contexts that vary from one eating occasion to another are more important than demographic characteristics that vary between children in explaining variation in consumed portion sizes in young children. Strategies to promote consumption of age-appropriate portion sizes in young children should be developed, especially in the home environment, in eating contexts such as sitting at the table, eating with others and watching TV.
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Affiliation(s)
- Alice Porter
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 2BN, UK
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 2BN, UK
| | - Ruth Kipping
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
- Fuse, NIHR Centre for Translational Research in Public Health, London, UK
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 2BN, UK
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Bishop TR, von Hinke S, Hollingsworth B, Lake AA, Brown H, Burgoine T. Automatic classification of takeaway food outlet cuisine type using machine (deep) learning. MACHINE LEARNING WITH APPLICATIONS 2021; 6:None. [PMID: 34977839 PMCID: PMC8700226 DOI: 10.1016/j.mlwa.2021.100106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Researchers have not disaggregated neighbourhood exposure to takeaway ('fast-') food outlets by cuisine type sold, which would otherwise permit examination of differential impacts on diet, obesity and related disease. This is partly due to the substantial resource challenge of manual classification of unclassified takeaway outlets at scale. We describe the development of a new model to automatically classify takeaway food outlets, by 10 major cuisine types, based on business name alone. MATERIAL AND METHODS We used machine (deep) learning, and specifically a Long Short Term Memory variant of a Recurrent Neural Network, to develop a predictive model trained on labelled outlets (n = 14,145), from an online takeaway food ordering platform. We validated the accuracy of predictions on unseen labelled outlets (n = 4,000) from the same source. RESULTS Although accuracy of prediction varied by cuisine type, overall the model (or 'classifier') made a correct prediction approximately three out of four times. We demonstrated the potential of the classifier to public health researchers and for surveillance to support decision-making, through using it to characterise nearly 55,000 takeaway food outlets in England by cuisine type, for the first time. CONCLUSIONS Although imperfect, we successfully developed a model to classify takeaway food outlets, by 10 major cuisine types, from business name alone, using innovative data science methods. We have made the model available for use elsewhere by others, including in other contexts and to characterise other types of food outlets, and for further development.
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Affiliation(s)
- Tom R.P. Bishop
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Stephanie von Hinke
- School of Economics, University of Bristol, Bristol BS8 1TU, UK
- Erasmus School of Economics, Erasmus University Rotterdam, Netherlands
| | | | - Amelia A. Lake
- School of Health and Life Sciences, Centre for Public Health Research, Teesside University, Middlesbrough TS1 3BX, UK
- Fuse – Centre for Translational Research in Public Health, Newcastle NE1 4LP, UK
| | - Heather Brown
- Fuse – Centre for Translational Research in Public Health, Newcastle NE1 4LP, UK
- Population Health Sciences Institute, Newcastle University, NE1 4LP, UK
| | - Thomas Burgoine
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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Trends in energy and nutrient content of menu items served by large UK chain restaurants from 2018 to 2020: an observational study. BMJ Open 2021. [PMCID: PMC8718418 DOI: 10.1136/bmjopen-2021-054804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The objective of this study was to evaluate the change in energy and nutrient content of menu items sold in large UK chain restaurants (eg, fast food, full service) from 2018 to 2020. Design Observational study. Setting Energy and nutritional information of menu items served by 29 large UK chain restaurants that consistently provided this information online in all three years. Data were collected in 2018 (March–April), 2019 (April) and 2020 (October–November) from restaurant websites. Primary and secondary outcome measures The per-item energy and nutrient (saturated fat, sugar and salt) changes in all items available on menus (‘all menu items’) and recurring items that were consistently available on menus in all three years (‘core menu items’), overall and in 12 different food categories. Results Our study included 7770, 9213 and 6928 menu items served by 29 large UK chain restaurants in 2018, 2019 and 2020, respectively. Our results showed that sugar content declined from 2018 to 2020 among all menu items (per-item: −0.43 g/year, 95% CI −0.66 to –0.21). This reduction in sugar was evident in beverages, sandwiches and desserts. Among core menu items (N=1855), sugar content reduced significantly from 2018 to 2020 (per-item: −0.31 g/year, 95% CI −0.45 to –0.17), especially in beverages. Energy, salt and saturated fat content in menu items remained constant overall, in both all menu items and core menu items. Fewer food categories had significant changes in energy, sugar, salt and saturated fat content among core menu items than among all menu items. Conclusions From 2018 to 2020, sugar content declined in restaurant menu items, which may reflect a response to the sugar reduction strategy and the effects of the soft drinks industry levy. In contrast, there was little change in other nutrients. Future policies addressing the overall nutritional quality of restaurant foods, rather than single nutrients, may help the restaurant sector move towards offering healthier foods.
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Robinson E, Foote G, Smith J, Higgs S, Jones A. Interoception and obesity: a systematic review and meta-analysis of the relationship between interoception and BMI. Int J Obes (Lond) 2021; 45:2515-2526. [PMID: 34480102 PMCID: PMC8606313 DOI: 10.1038/s41366-021-00950-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Interoception refers to the processes by which we sense, interpret and integrate signals originating from within the body. Deficits in interoception have been linked to higher BMI and may contribute to weight gain. However, there have been conflicting findings and it is not clear how higher BMI is associated with different facets of interoception, such as interoceptive accuracy (the ability to detect internal signals) and sensibility (the tendency to attend to internal signals). METHODS We conducted a systematic review and meta-analysis of studies that measured interoception and BMI. We examined relationships between interoception and BMI in children and adults separately and as a function of interoceptive facet and measure. In sensitivity analyses, we tested for evidence of publication bias and whether the results were consistent when studies with a high risk of bias were excluded. RESULTS A total of 87 articles were eligible for inclusion. In adults (121 effects, 10,425 participants), there was cross-sectional evidence of higher BMI being associated with overall deficits in interoception (r = -0.054, 95% CI: -0.084 to -0.025) and this was consistent across sensitivity analyses. There was no statistically significant evidence of moderation by interoceptive facet or measure, although there was some variability in effect size estimates based on interoceptive facet and measures. A smaller meta-analysis limited to studies that compared participants with normal weight vs. overweight/obesity indicated poorer interoception in participants with overweight/obesity (SMD = -0.39, 95% CI -0.60 to -0.18). CONCLUSIONS In cross-sectional studies, deficits in interoception are associated with higher BMI. However, it remains unclear whether deficits in interoception contribute to or are a consequence of weight gain and obesity.
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Affiliation(s)
- Eric Robinson
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.
| | - Georgia Foote
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Jemma Smith
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Andrew Jones
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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Kerins C, Kelly C, Reardon CM, Houghton C, Toomey E, Hayes CB, Geaney F, Perry IJ, McSharry J, McHugh S. Factors Influencing Fidelity to a Calorie Posting Policy in Public Hospitals: A Mixed Methods Study. Front Public Health 2021; 9:707668. [PMID: 34485232 PMCID: PMC8414889 DOI: 10.3389/fpubh.2021.707668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Labelling menus with nutrition information has increasingly become an important obesity policy option. While much research to-date has focused on determining its effectiveness, few studies report the extent to which menu labelling is implemented as designed. The aim of this study was to explore factors influencing fidelity to a calorie posting policy in Irish acute public hospitals. Methods: A mixed methods sequential explanatory study design was employed, with a nested case study for the qualitative component. Quantitative data on implementation fidelity at hospitals were analysed first and informed case sampling in the follow-on qualitative phase. Maximum variation sampling was used to select four hospitals with high and low levels of implementation and variation in terms of geographic location, hospital size, complexity of care provided and hospital type. Data were collected using structured observations, unstructured non-participant observations and in-depth semi-structured interviews. The Consolidated Framework for Implementation Research guided qualitative data collection and analysis. Using framework analysis, factors influencing implementation were identified. A triangulation protocol was used to integrate fidelity findings from multiple sources. Data on influencing factors and fidelity were then combined using joint displays for within and cross-case analysis. Results: Quantitative fidelity data showed seven hospitals were categorised as low implementers and 28 hospitals were high implementers of the policy. Across the four hospitals selected as cases, qualitative analysis revealed factors influencing implementation and fidelity were multiple, and operated independently and in combination. Factors were related to the internal hospital environment (e.g., leadership support, access to knowledge and information, perceived importance of calorie posting implementation), external hospital environment (e.g., national policy, monitoring), features of the calorie posting policy (e.g., availability of supporting materials), and the implementation process (e.g., engaging relevant stakeholders). Integrated analysis of fidelity indicated a pattern of partial adherence to the calorie posting policy across the four hospitals. Across all hospitals, there was a consistent pattern of low adherence to calorie posting across all menu items on sale, low adherence to calorie information displayed per standard portion or per meal, low adherence to standardised recipes/portions, and inaccurate calorie information. Conclusion: Efforts to maximise fidelity require multi-level, multi-component strategies in order to reduce or mitigate barriers and to leverage facilitators. Future research should examine the relative importance of calorie posting determinants and the association between implementation strategies and shifts in fidelity to intervention core components.
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Affiliation(s)
- Claire Kerins
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Colette Kelly
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Caitlin M Reardon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Elaine Toomey
- Faculty of Education and Health Sciences, School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Catherine B Hayes
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fiona Geaney
- School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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Increasing availability of lower energy meals vs. energy labelling in virtual full-service restaurants: two randomized controlled trials in participants of higher and lower socioeconomic position. BMC Public Health 2021; 21:975. [PMID: 34034699 PMCID: PMC8147368 DOI: 10.1186/s12889-021-11007-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are a range of interventions designed to promote healthier food choices in full-service restaurants. However, it is unclear how these interventions affect dietary choices in people of lower and higher socioeconomic position (SEP). Methods A total of 2091 US participants recruited online completed Study 1 (n = 1001) and Study 2 (n = 1090). Recruitment was stratified by participant highest education level, resulting in higher SEP and lower SEP groups. In a between-subjects design, participants made hypothetical food choices (main dish, plus optional sides and desserts) from six restaurants menus in the absence vs. presence of menu energy labelling and from menus with baseline (10%) vs. increased availability (50%) of lower energy main dishes. Data were collected and analysed in 2019. Two studies were conducted in order to examine replicability and generalisability of findings across different restaurant menu types. Results Across both studies, increasing the availability of lower energy main menu options decreased the average energy content of the ordered main dish (− 129 kcal, 95% CI [− 139; − 119]) and total energy ordered (− 117 kcal, 95% CI [− 138; − 95]) in both higher and lower SEP participants. Energy labelling significantly reduced the energy content of ordered main dishes in higher SEP participants (− 41 kcal, 95% CI [− 54; − 29]), but not lower SEP participants (− 5 kcal, 95% CI [− 22; 11]). However, energy labelling reduced total energy ordered (− 83 kcal, 95% CI [− 105; − 60]) irrespective of SEP. Conclusions In two virtual experiments, increasing the availability of lower energy restaurant main menu options impacted on main menu dish choice and decreased total energy ordered irrespective of SEP. Energy labelling had a less pronounced effect on total energy ordered and had a larger impact on the energy content of main menu dish choice in higher as opposed to lower SEP participants. Trial registration Clinicaltrials.gov NCT04336540 retrospectively registered (7 April, 2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11007-0.
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Yau A, Adams J, Boyland EJ, Burgoine T, Cornelsen L, de Vocht F, Egan M, Er V, Lake AA, Lock K, Mytton O, Petticrew M, Thompson C, White M, Cummins S. Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data. BMJ Open 2021; 11:e048139. [PMID: 33827849 PMCID: PMC8031692 DOI: 10.1136/bmjopen-2020-048139] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To explore sociodemographic differences in exposure to advertising for foods and drinks high in fat, salt and sugar (HFSS) and whether exposure is associated with body mass index (BMI). DESIGN Cross-sectional survey. SETTING UK. PARTICIPANTS 1552 adults recruited to the Kantar Fast Moving Consumer Goods panel for London and the North of England. OUTCOME MEASURES Self-reported advertising exposure stratified by product/service advertised (processed HFSS foods; sugary drinks; sugary cereals; sweet snacks; fast food or digital food delivery services) and advertising setting (traditional; digital; recreational; functional or transport); BMI and sociodemographic characteristics. RESULTS Overall, 84.7% of participants reported exposure to HFSS advertising in the past 7 days. Participants in the middle (vs high) socioeconomic group had higher odds of overall self-reported exposure (OR 1.48; 95% CI 1.06 to 2.07). Participants in the low (vs high) socioeconomic group had higher odds of reporting exposure to advertising for three of five product categories (ORs ranging from 1.41 to 1.67), advertising for digital food delivery services (OR 1.47; 95% CI 1.05 to 2.05), traditional advertising (OR 1.44; 95% CI 1.00 to 2.08) and digital advertising (OR 1.50; 95% CI 1.06 to 2.14). Younger adults (18-34 years vs ≥65 years) had higher odds of reporting exposure to advertising for digital food delivery services (OR 2.08; 95% CI 1.20 to 3.59), digital advertising (OR 3.93; 95% CI 2.18 to 7.08) and advertising across transport networks (OR 1.96; 95% CI 1.11 to 3.48). Exposure to advertising for digital food delivery services (OR 1.40; 95% CI 1.05 to 1.88), digital advertising (OR 1.80; 95% CI 1.33 to 2.44) and advertising in recreational environments (OR 1.46; 95% CI 1.02 to 2.09) was associated with increased odds of obesity. CONCLUSIONS Exposure to less healthy product advertising was prevalent, with adults in lower socioeconomic groups and younger adults more likely to report exposure. Broader restrictions may be needed to reduce sociodemographic differences in exposure to less healthy product advertising.
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Affiliation(s)
- Amy Yau
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jean Adams
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Emma J Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Thomas Burgoine
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Laura Cornelsen
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Frank de Vocht
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Applied Research Collaboration West, Bristol, UK
| | - Matt Egan
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Vanessa Er
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Amelia A Lake
- Centre for Public Health Research, Teesside University, Middlesbrough, UK
- Centre for Translational Research in Public Health (Fuse), Newcastle upon Tyne, UK
| | - Karen Lock
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Mytton
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Mark Petticrew
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Claire Thompson
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Martin White
- Centre for Diet & Activity Research, University of Cambridge, Cambridge, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
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Jia P, Yang H, Cao X, Yuan C, Xiao Q, Yang S, Wang Y. Association between access to full-service restaurants and childhood obesity. Obes Rev 2021; 22 Suppl 1:e13076. [PMID: 32618058 PMCID: PMC7988535 DOI: 10.1111/obr.13076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022]
Abstract
The lack of access to full-service restaurants (FSRs) is generally thought to be a risk factor for childhood obesity, as it could discourage healthful eating-out behaviours while increasing the exposure to unhealthful food venues as "compensatory" options. However, the association between FSR access and childhood obesity has not been comprehensively reviewed previously. A literature search was conducted on PubMed and Web of Science for articles published before 1 January 2019 that examined the association between FSR access and weight-related behaviours and outcomes among children and adolescents. Eighteen studies conducted in three countries were identified, published from 2006 to 2018 with a median sample size of 2352 (ranging from 323 to 529 367). Findings were mixed among these 18 studies that reported on the association between access to FSRs and weight-related outcomes. Our meta-analyses showed that there were no significant associations of FSR access with the level of body mass index (BMI) and the BMI z-score among children. Also, there was no apparent evidence on the association between FSR access and the risk of overweight/obesity. Our results need to be interpreted with caution, considering the menu quality of FSRs and heterogeneity of eligible studies in this meta-analysis. Well-designed epidemiologic studies are warranted to further elaborate on the potential association between FSR access and children's weight status.
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Affiliation(s)
- Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.,Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, The Netherlands.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Hongxi Yang
- Department of Health Service Management, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xinxi Cao
- Department of Health Service Management, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Changzheng Yuan
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,The Children's Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Xiao
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Shujuan Yang
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yaogang Wang
- Department of Health Service Management, School of Public Health, Tianjin Medical University, Tianjin, China
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Albalawi A, Hambly C, Speakman JR. The impact of the novel coronavirus movement restrictions in the United Kingdom on food outlet usage and body mass index. Obes Sci Pract 2021; 7:302-306. [PMID: 34123397 PMCID: PMC8170584 DOI: 10.1002/osp4.477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 01/05/2023] Open
Abstract
Background Many countries have implemented various levels of lockdown to mitigate the spread of the global SARS‐CoV‐2 pandemic. In the United Kingdom, the national lockdown restrictions were implemented between 26 March 2020 and 4 July 2020. These restrictions required all restaurants to close except for takeaway and delivery services. Moreover, individuals were instructed to largely stay in their homes, unless they were identified as essential workers, and to only leave home once per day for exercise. These restrictions might have an impact on energy intake and expenditure, thereby affecting their body weight. Aims The aim of this study was to investigate the impact of the movement restrictions in the United Kingdom on food outlet usage and body mass index (BMI). Materials and Methods Food outlet usage surveys were filled out for 7 consecutive days before and during the lockdown. Changes in BMI and food outlet usage before and during the lockdown were measured. A total of 206 participants were included in this study. Results The mean overall BMI prior to lockdown was 25.8 ± 5.2 kg·m2, and during the lockdown, it was 25.9 ± 5.3 kg·m2 (t= 0.19, p= 0.85). Restaurant usage fell to zero as all establishments were closed. There was a corresponding increase in the use of delivery services to 1.18 ± 0.13 times per week, compared to 0.50 ± 0.05 prior to lockdown (t= 4.44, p< 0.0001). No significant difference in the number of takeaway meals ordered was observed (0.67 ± 0.06 before the lockdown and 0.74 ± 0.12 times per week during the lockdown; t= 0.52, p = 0.60). There was no significant relationship between change in use of fast‐food restaurants and full‐service restaurants and the change in BMI, either alone or in combination (β = −0.012, p = 0.62, R2 = 0.11%). Discussion Despite the large changes in behavior, there was no overall adverse effect of the lockdown with respect to obesity levels. Conclusion Lockdown in the United Kingdom modified restaurant use but had no effect on obesity levels.
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Affiliation(s)
- Ahmad Albalawi
- School of Biological Sciences University of Aberdeen Aberdeen UK
| | - Catherine Hambly
- School of Biological Sciences University of Aberdeen Aberdeen UK
| | - John R Speakman
- School of Biological Sciences University of Aberdeen Aberdeen UK.,Center for Energy Metabolism and Reproduction Shenzhen Institutes of Advanced Technology Shenzhen China.,State Key Laboratory of Molecular Developmental Biology Institute of Genetics and Development Biology Chinese Academy of Sciences Beijing China.,Centre of Excellence in Animal Evolution and Genetics Chinese Academy of Sciences Yunnan China
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38
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Robinson E, Marty L, Jones A, White M, Smith R, Adams J. Will calorie labels for food and drink served outside the home improve public health? BMJ 2021; 372:n40. [PMID: 33472836 DOI: 10.1136/bmj.n40] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Eric Robinson
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Lucile Marty
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Andrew Jones
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Abstract
OBJECTIVE To estimate the daily dietary energy intake for me to maintain a constant body weight. How hard can it be? DESIGN Very introspective study. SETTING At home. In lockdown. (Except every Tuesday afternoon and Saturday morning, when I went for a run.) PARTICIPANTS: Me. n=1. MAIN OUTCOME MEASURES My weight, measured each day. RESULTS Sleeping, I shed about a kilogram each night (1.07 (SD 0.25) kg). Running 5 km, I shed about half a kilogram (0.57 (SD 0.15) kg). My daily equilibrium energy intake is about 10 000 kJ (10 286 (SD 201) kJ). Every kJ above (or below) 10 000 kJ adds (or subtracts) about 40 mg (35.4 (SD 3.2) mg). CONCLUSIONS Body weight data show persistent variability, even when the screws of control are tightened and tightened.
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Affiliation(s)
- R A Lewis
- School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong NSW 2522, Australia
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40
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Murphy SA, Weippert MV, Dickinson KM, Scourboutakos MJ, L'Abbé MR. Cross-Sectional Analysis of Calories and Nutrients of Concern in Canadian Chain Restaurant Menu Items in 2016. Am J Prev Med 2020; 59:e149-e159. [PMID: 32828587 DOI: 10.1016/j.amepre.2020.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/14/2020] [Accepted: 05/03/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The nutritional quality of restaurant foods in Canada is not monitored by government and limited research has evaluated the nutrient content of these foods. Given the increasing proportion of foods consumed outside the home, this study aims to assess levels of nutrients of public health concern in Canadian fast-food and sit-down restaurant menu items. METHODS Levels of calories, saturated fat, sodium, and sugar of 10,285 menu items from 90 national chain restaurants in Canada were assessed. Data were collected in 2016, extracted and analyzed between 2018 and 2020, and presented overall and by category. Levels in fast-food and sit-down restaurant establishments were compared. RESULTS Overall mean levels of saturated fat, sodium, and sugar were high. Entrées contained on average 52% of the total daily value for sodium (1,256 mg/serving) and 45% of the daily value for saturated fat (8.9 g/serving). Beverages and desserts had high levels of total sugar (mean=44 g and 32 g/serving, respectively) but tended to be low in sodium. Sit-down restaurant items had significantly (p≤0.0001) higher levels of calories, saturated fat, and sodium overall, although fast-food restaurant items had higher average sugar levels because of the higher number of beverage and dessert items. CONCLUSIONS Levels of nutrients of concern in Canadian menu items are excessive among most food categories. As the frequency of eating out in restaurants rises, government policies to promote reformulation and increase transparency of the nutritional content of these items are required to reduce their negative impact on public health.
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Affiliation(s)
- Sarah A Murphy
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madyson V Weippert
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kacie M Dickinson
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mary J Scourboutakos
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary R L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Keeble M, Adams J, Sacks G, Vanderlee L, White CM, Hammond D, Burgoine T. Use of Online Food Delivery Services to Order Food Prepared Away-From-Home and Associated Sociodemographic Characteristics: A Cross-Sectional, Multi-Country Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145190. [PMID: 32709148 PMCID: PMC7400536 DOI: 10.3390/ijerph17145190] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022]
Abstract
Online food delivery services like Just Eat and Grubhub facilitate online ordering and home delivery of food prepared away-from-home. It is poorly understood how these services are used and by whom. This study investigated the prevalence of online food delivery service use and sociodemographic characteristics of customers, in and across Australia, Canada, Mexico, the UK, and the USA. We analyzed online survey data (n = 19,378) from the International Food Policy Study, conducted in 2018. We identified respondents who reported any online food delivery service use in the past 7 days and calculated the frequency of use and number of meals ordered. We investigated whether odds of any online food delivery service use in the past 7 days differed by sociodemographic characteristics using adjusted logistic regression. Overall, 15% of respondents (n = 2929) reported online food delivery service use, with the greatest prevalence amongst respondents in Mexico (n = 839 (26%)). Online food delivery services had most frequently been used once and the median number of meals purchased through this mode of order was two. Odds of any online food delivery service use were lower per additional year of age (OR: 0.95; 95% CI: 0.94, 0.95) and greater for respondents who were male (OR: 1.50; 95% CI: 1.35, 1.66), that identified with an ethnic minority (OR: 1.57; 95% CI: 1.38, 1.78), were highly educated (OR: 1.66; 95% CI: 1.46, 1.90), or living with children (OR: 2.71; 95% CI: 2.44, 3.01). Further research is required to explore how online food delivery services may influence diet and health.
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Affiliation(s)
- Matthew Keeble
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB22 0QQ, UK; (J.A.); (T.B.)
- Correspondence: ; Tel.: +(44)1223-746870
| | - Jean Adams
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB22 0QQ, UK; (J.A.); (T.B.)
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Geelong VIC 3220, Australia;
| | - Lana Vanderlee
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada;
| | - Christine M. White
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.W.); (D.H.)
| | - David Hammond
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.W.); (D.H.)
| | - Thomas Burgoine
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB22 0QQ, UK; (J.A.); (T.B.)
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Kerins C, McHugh S, McSharry J, Reardon CM, Hayes C, Perry IJ, Geaney F, Seery S, Kelly C. Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review. Int J Behav Nutr Phys Act 2020; 17:48. [PMID: 32295647 PMCID: PMC7161210 DOI: 10.1186/s12966-020-00948-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 03/23/2020] [Indexed: 02/05/2023] Open
Abstract
Background Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. Methods Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the ‘best fit’ framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). Results Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs ‘Consumer Needs & Resources’ (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and ‘Compatibility’ with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs ‘Relative Advantage’ of menu labelling (e.g. improved business image/reputation) and ‘Consumer Needs & Resources’ (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. Conclusion This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. Trial registration Systematic review registration: PROSPERO CRD42017083306.
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Affiliation(s)
- Claire Kerins
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Sheena McHugh
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland
| | - Caitlin M Reardon
- Ann Arbor VA Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Catherine Hayes
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin Russell Centre, Tallaght Cross, Dublin 24, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Fiona Geaney
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Suzanne Seery
- National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Colette Kelly
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, University Road, Galway, Ireland
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Albalawi A, Hambly C, Speakman J. Associations of Food Outlet Densities with Obesity Measures Identify Fish and Chip Shops as a Uniquely Important Problem. Nutrients 2020; 12:nu12040890. [PMID: 32218120 PMCID: PMC7230371 DOI: 10.3390/nu12040890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/02/2022] Open
Abstract
Increases in the number of food outlets have been proposed as a key factor driving obesity. This study aimed to investigate the association between the densities of food establishments serving meals (excluding supermarkets and grocery stores), with body mass index (BMI), waist to hip ratio (WHR) and percentage of body fat among middle-aged adults in the UK. BMIs, WHR, %fat and socioeconomic factors were obtained from 456,079 individuals from the UK Biobank and averaged across 923 postcode districts (PD). The number of Fast-Food Restaurants (FFRs), Full-Service Restaurants (FSRs), delivery shops, takeaways, fish and chip shops, pubs and cafes were also obtained for each PD. We adjusted the obesity measures for deprivation level, education, employment, ethnicity, household size, household income and age. After adjustment, the density of fish and chip shops (per 1000 population) was positively associated with BMI and %fat for both sexes (males: BMI converted (exponentiated coefficient) β = 0.5, R2 = 4.14%, p < 0.0001; %fat converted β = 0.8, R2 = 3.32%, p < 0.0001; females: BMI converted β = 0.9, R2 = 5.31%, p < 0.0001; %fat converted β = 1.4 R2 = 4.65%, p < 0.0001). The densities of FFRs and delivery shops (per 1000 population) were not related to the adjusted obesity measures among males and females, except BMI in males where FFRs were significantly negatively associated. The densities (per 1000 population) of FSRs, pubs, cafes and total food outlets were all significantly inversely related to the obesity measures for both sexes. The number of fish and chip shops per 1000 individuals was significantly positively associated with obesity in middle-aged adults in the UK. A negative association between the other types of food outlet densities and the measures of obesity suggests access to such establishments is not a major driver of obesity. This is potentially because the food supplied at such establishments is not significantly less healthy than what is eaten elsewhere including at home (and may even be better). Paying attention only to fast food and/or full-service restaurants in intervention policy will likely not be effective. Policy intervention should potentially focus on the numbers of fish and chip shops and the deep-fried food served in such restaurants.
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Affiliation(s)
- Ahmad Albalawi
- School of Biological Sciences, University of Aberdeen, Tillydrone Ave, Aberdeen AB24 2TZ, UK; (A.A.); (C.H.)
| | - Catherine Hambly
- School of Biological Sciences, University of Aberdeen, Tillydrone Ave, Aberdeen AB24 2TZ, UK; (A.A.); (C.H.)
| | - John Speakman
- School of Biological Sciences, University of Aberdeen, Tillydrone Ave, Aberdeen AB24 2TZ, UK; (A.A.); (C.H.)
- Institute of Genetics and Development Biology, Chinese Academy of Sciences, Beijing 100190, China
- Centre of Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming 650223, Yunnan, China
- Correspondence: ; Tel.: +44-(0)1224-272879
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White M, Aguirre E, Finegood DT, Holmes C, Sacks G, Smith R. What role should the commercial food system play in promoting health through better diet? BMJ 2020; 368:m545. [PMID: 32184211 PMCID: PMC7190369 DOI: 10.1136/bmj.m545] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Martin White and coauthors consider that the commercial food system has the potential to show leadership and support for dietary public health, but systemic change is needed first and this is likely to require governmental action
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Affiliation(s)
- Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, Institute of Metabolic Sciences, University of Cambridge, UK
| | - Emilie Aguirre
- University of Chicago Law School, Chicago, IL, USA
- Harvard Business School, Boston, MA, USA
| | - Diane T Finegood
- Morris J Wosk Centre for Dialogue, Simon Fraser University, Vancouver, BC, Canada
| | | | - Gary Sacks
- Global Obesity Centre, Deakin University, Burwood, VIC 3125, Australia
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
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45
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Marty L, Jones A, Robinson E. Socioeconomic position and the impact of increasing availability of lower energy meals vs. menu energy labelling on food choice: two randomized controlled trials in a virtual fast-food restaurant. Int J Behav Nutr Phys Act 2020; 17:10. [PMID: 32005255 PMCID: PMC6995045 DOI: 10.1186/s12966-020-0922-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food consumed outside of the home is often high in energy and population level interventions that reduce energy intake of people from both lower and higher socioeconomic position (SEP) are needed. There is a lack of evidence on the effectiveness and SEP equity of structural-based (e.g. increasing availability of lower energy options) and information provision (e.g. menu energy labelling) interventions on food choice. METHODS Across two online experiments, participants of lower and higher SEP made meal choices in a novel virtual fast-food restaurant. To be eligible to take part, participants were required to be UK residents, aged 18 or above, fluent in English, have access to a computer with an internet connection and have no dietary restrictions. Participants were randomized to one of four conditions in a 2 × 2 between-subjects design: menu energy labelling present vs. absent and increased availability of lower energy options (75% of menu options lower energy) vs. baseline availability (25% of menu options lower energy). Participants also completed measures of executive function and food choice motives. RESULTS The analysis of pooled data from both studies (n = 1743) showed that increasing the availability of lower energy options resulted in participants ordering meals with significantly less energy on average (- 71 kcal, p < 0.001, partial η2 = 0.024) and this effect was observed irrespective of participant SEP. Menu labelling had no significant effect on energy ordered (- 18 kcal, p = 0.116, partial η2 = 0.001) in participants from both higher and lower SEP. Furthermore, we found no evidence that executive function or food choice motives moderated the effect of increasing lower energy menu options or energy labelling on total energy ordered. CONCLUSIONS In a virtual fast-food environment, energy labelling was ineffective in reducing total energy ordered for both higher and lower SEP participants. Increasing the availability of lower energy options had an equitable effect, reducing total energy ordered in participants from higher and lower SEP. TRIAL REGISTRATION Study protocols and analysis plans were pre-registered on the Open Science Framework (https://osf.io/ajcr6/).
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Affiliation(s)
- Lucile Marty
- Department of Psychological Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Andrew Jones
- Department of Psychological Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Eric Robinson
- Department of Psychological Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
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46
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Dougkas A, Vannereux M, Giboreau A. The Impact of Herbs and Spices on Increasing the Appreciation and Intake of Low-Salt Legume-Based Meals. Nutrients 2019; 11:E2901. [PMID: 31805675 PMCID: PMC6950109 DOI: 10.3390/nu11122901] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 01/15/2023] Open
Abstract
Flavoring using blends of herbs and spices (H&S) instead of salt may be a promising approach to increase legume consumption and reduce salt content in foods. This study examines the effects of H&S on the appreciation and intake of low-salt legume-based dishes in a real ecological eating environment. Four mezzes with standard (0.8% w/w) (S) or lower (0.4% w/w) (LS) salt level and with or without H&S (LSHS, SHS) were developed. In a randomized cross-over trial, 94 participants attended four sessions, one week apart and received the four variants as a starter during lunch. Overall liking, food intake, and appetite ratings (visual analogue scale, VAS) were assessed during lunch. A follow-up study (n = 130) was performed where the four variants were evaluated, and overall liking was measured at the same session. Overall liking and taste scores of SHS were significantly higher compared with LS (p = 0.04 and p = 0.03, respectively), but there were no significant differences between LSHS and S. However, there were no differences in energy intake or in appetite ratings among the products. Overall appreciation was similar between the low-salt with H&S and the standard-salt mezze, suggesting that the addition of H&S is a feasible strategy for achieving a 50% reduction in salt content without compromising hedonic appreciation.
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Affiliation(s)
- Anestis Dougkas
- Institut Paul Bocuse Research Centre, BP 25-69130 Ecully CEDEX, France; (M.V.); (A.G.)
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Chai LK, Yoong SL, Bucher T, Collins CE, Shrewsbury VA. Children's Intake of Food from Non-Fast-Food Outlets and Child-Specific Menus: A Survey of Parents. CHILDREN-BASEL 2019; 6:children6110123. [PMID: 31683781 PMCID: PMC6915613 DOI: 10.3390/children6110123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/25/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
Eating out-of-home is associated with higher energy intakes in children. The continued high prevalence of childhood obesity requires a greater understanding of child menu options and eating out frequency to inform appropriate regulatory initiatives. The majority of studies to date have focused on menus from fast-food outlets with few focused on non-fast-food outlets. This study aimed to describe parents’ reports of their child(ren)’s (aged up to 6 years) frequency of consuming foods at non-fast-food outlets, observations of child menus at these outlets, and their purchasing behaviours and future preferences regarding these menus; and if their responses were influenced by sociodemographic characteristics. Ninety-five parents completed a 15-item cross-sectional survey. Overall, children from 54% of families consumed food from non-fast-food outlets at least monthly. Of the 87 parents who reported that their child eats at a non-fast-food restaurant, 71 had children who ordered from child menus every time (7%, n = 5), often (29%, n = 22), sometimes (42%, n = 32) or rarely (16%, n = 12), with a further 7% (n = 5) never ordering from these menus. All parents indicated that they would like to see a higher proportion of healthy child menu items than is currently offered. Parents’ responses were not influenced by sociodemographic characteristics. Parents’ views support implementation of initiatives to increase availability of healthy options on child menus at non-fast-food outlets.
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Affiliation(s)
- Li Kheng Chai
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
| | - Tamara Bucher
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- School of Environmental and Life Science, Faculty of Science, University of Newcastle, Ourimbah, New South Wales 2258, Australia.
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Vanessa A Shrewsbury
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
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Muc M, Jones A, Roberts C, Sheen F, Haynes A, Robinson E. A bit or a lot on the side? Observational study of the energy content of starters, sides and desserts in major UK restaurant chains. BMJ Open 2019; 9:e029679. [PMID: 31594875 PMCID: PMC6797243 DOI: 10.1136/bmjopen-2019-029679] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Our objective was to examine the kilocalorie (kcal) content of starters, sides and desserts served in major UK restaurant chains, comparing the kcal content of these dishes in fast-food and full-service restaurants. DESIGN Observational study. SETTING Menu and nutritional information provided online by major UK restaurant chains. METHOD During October to November 2018, we accessed websites of restaurant chains with 50 or more outlets in the UK. Menu items that constituted starters, sides or desserts were identified and their kcal content was extracted. Accompanying beverages were not included. We used multilevel modelling to examine whether mean kcal content of dishes differed in fast-food versus full-service restaurants. MAIN OUTCOME MEASURES The mean kcal content of dishes and the proportion of dishes exceeding public health recommendations for energy content in a main meal (>600 kcal). RESULTS A total of 1009 dishes (212 starters, 318 sides and 479 desserts) from 27 restaurant chains (21 full-service, 6 fast-food) were included. The mean kcal content of eligible dishes was 488.0 (SE=15.6) for starters, 397.5 (SE=14.9) for sides and 430.6 (SE=11.5) for desserts. The percentage of dishes exceeding 600 kcal was 26.4% for starters, 21.7% for sides and 20.5% for desserts. Compared with fast-food chains, desserts offered at full-service restaurants were on average more calorific and were significantly more likely to exceed 600 kcal. CONCLUSIONS The average energy content of sides, starters and desserts sold in major UK restaurants is high. One in four starters and one in five sides and desserts in UK chain restaurants exceed the recommended energy intake for an entire meal.
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Affiliation(s)
- Magdalena Muc
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Andrew Jones
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Carl Roberts
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Florence Sheen
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Ashleigh Haynes
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Eric Robinson
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Berger N, Cummins S, Smith RD, Cornelsen L. Recent trends in energy and nutrient content of take-home food and beverage purchases in Great Britain: an analysis of 225 million food and beverage purchases over 6 years. BMJ Nutr Prev Health 2019; 2:63-71. [PMID: 33235959 PMCID: PMC7664498 DOI: 10.1136/bmjnph-2019-000036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/21/2019] [Accepted: 07/06/2019] [Indexed: 11/12/2022] Open
Abstract
Introduction In recent years, there has been an increased focus on developing a coherent obesity policy in the UK, which has led to various national policy initiatives aimed at improving population diet. We sought to determine whether there have been concurrent changes in trends in the nutrient content of take-home food and beverage purchases within this policy environment. Methods We used 2012–2017 data from the UK Kantar Fast-Moving Consumer Goods (FMCG) panel, a nationally representative panel study of food and beverages bought by British households and brought into the home (n≈32 000 per year). Households used hand-held barcode scanners to report over 225 million product-level purchases of food and beverages, for which nutritional information was obtained. We estimated daily per capita purchases of energy and nutrients from 32 healthier and less healthy food groups defined using the nutrient profiling model used by the UK Department of Health. Results From 2012 to 2017, daily purchases of energy from food and beverages taken home decreased by 35.4 kcal (95% CI 25.5 to 45.2) per capita. This is explained by moderate decreases in the purchase of products with high contents in carbohydrate (−13.1 g (−14.4 to –11.8)) and sugar (−4.4 g (−5.1 to –3.7)), despite small increases in protein (1.7 g (1.4 to 2.1)) and saturated fat (0.4 g (0.2 to 0.6)). Food and beverage purchases exceeded daily reference intake values in fat (on average +6%), saturated fat (+43%), sugar (+16%) and protein (+28%) across all years. Although substitutions between individual food groups were large in energy and nutrients purchased, the heterogeneity of these patterns resulted in modest overall changes. Conclusion There have been small declines in the purchase of less healthy food products, which translated to a small reduction of total energy and sugar purchases taken home. However, the rate of change needs to be accelerated in order to substantially reduce the health risks of poor diets, suggesting that more radical policies may be needed to attain larger population effects.
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Affiliation(s)
- Nicolas Berger
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard D Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Laura Cornelsen
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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Young M, Coppinger T, Reeves S. The Nutritional Value of Children's Menus in Chain Restaurants in the United Kingdom and Ireland. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:817-825. [PMID: 31126724 DOI: 10.1016/j.jneb.2019.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Obesity in the United Kingdom and the Republic of Ireland is rising, as is the frequency of eating out in restaurants. The aim of this study was to investigate the nutritional quality of children's menus in restaurants. DESIGN Cross-sectional review of menus aimed at children from 20 popular chain restaurants in the United Kingdom and Ireland. MAIN OUTCOME MEASURES Total energy, fat, saturated fat, and salt were collected from every food item on the menu in each restaurant. All potential meal combinations were created. A total of 39,266 meals were analysed. ANALYSIS Meals were compared with UK nutritional guidelines. Meals from fast food and full-service restaurants and main meals and meal deals were compared. RESULTS The average meal for younger children (aged 2-5 years) contained 609 ±117 kcal, and for older children (6-12 years) 653 ± 136 kcal compared with guidelines of 364 and 550 kcal, respectively. A total of 68% of younger children's and 55% of older children's meals contained more total fat than recommended and more than 4 times the amount of saturated fat. Fast food restaurant meals contained less energy, fat, and salt than did full-service restaurants, and meal deals were less likely to meet dietary guidelines than were main meals alone. CONCLUSION AND IMPLICATIONS Eating in chain restaurants, in particular meal deals, does not contribute positively to the diet of children in the United Kingdom and Ireland.
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Affiliation(s)
- Michelle Young
- Department of Life Sciences, University of Roehampton, London, United Kingdom
| | - Tara Coppinger
- Department of Sport Leisure and Childhood Studies, Cork Institute of Technology, Cork, Ireland
| | - Sue Reeves
- Department of Life Sciences, University of Roehampton, London, United Kingdom.
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