Physical activity calorie expenditure (PACE) labels in worksite cafeterias: effects on physical activity

Sedentary behaviors and physical activity of the working population measured by accelerometry: a systematic review and meta-analysis

BACKGROUND

Too much sedentary behavior (SB) and too little physical activity (PA) place adult workers at risk for chronic illness. It remains unclear which occupations and subgroups within occupations have the highest and lowest SB and PA, and little is known about the effects of organizational factors on these behaviors and metrics. Thus, our main aims were to review and summarize evidence describing daily SB and PA collected using accelerometry across various occupations and to identify organizational factors influencing SB and PA.

METHODS

A literature search of six databases was performed for relevant studies published through March 2023. Eligible studies were in English, targeted working populations, had a sample size > 75, and objectively measured both SB and PA for seven consecutive days using accelerometers. Following PRISMA guidelines, 5,197 studies were identified, and 19 articles met our inclusion criteria. Five of these studies were included in a meta-analysis comparing time spent in SB, light PA (LPA), and moderate to vigorous PA (MVPA) across occupations. Methodological quality was assessed using a Joanna Briggs Institute tool.

RESULTS

We found that 63% of the studies reported daily time spent in SB and in MVPA, but fewer reported LPA, moderate PA, and vigorous PA. The average time spent in SB was 553.34 min/day, in LPA was 299.77 min/day, and in MVPA was 33.87 min/day. In occupational subgroup analysis, we observed that office workers had 2.3 h more SB, 2.4 less hours LPA, and 14 min less MVPA per day than nurses. However, most studies either did not specify workers' occupations or grouped occupations. Shift work and workplace facilities significantly influenced SB and PA, but organizational factors affecting these behaviors were not sufficiently investigated (e.g., occupation type, work environment and workplace facilities, and shift work).

CONCLUSIONS

More research is needed to explore SB and PA patterns within occupational subgroups. Additionally, it is important to explore work-related individual (e.g., job task), interpersonal (e.g., social support from colleagues), organizational (e.g., work policy), and environmental factors influencing SB and PA. Future studies should also investigate the association of these factors with SB and PA.

The neural model of front-of-package label processing

Front-of-package (FOP) labels have been adopted in many countries to battle the obesity pandemic and its serious health consequences by providing clearer and easier-to-understand nutrition and health information. The effectiveness of FOP labels has been generally confirmed, with some contextual and individual factors modifying their effectiveness. Existing theories (eg, the dual-process theory) and shifting priorities for self-control, provide some explanations for the FOP label effect. However, the cognitive and neural mechanisms underlying the processing of FOP labels remain unknown. Here, a new model, namely, the neural model of FOP label processing, has been proposed to fill this gap by providing an integrated account of FOP label processing while simultaneously considering multiple important situational and individual factors in the same framework. This neural model is built on the core eating network (ie, the ventral reward pathway and the dorsal control pathway) for food cue processing and actual food consumption. The new model explains how FOP labels may facilitate attention, influence the core eating network, and thus alter food choices. It also demonstrates how motivation may modify FOP label processing in 2 ways: affecting attention (the indirect way) and changing the process of evaluating the food (the direct way). It further explains how some contextual and individual factors (eg, ego depletion, time pressure, and health knowledge) influence the process. Thus, the neural model integrates evidence from behavioral, eye-tracking, and neuroimaging studies into a single, integrated account, deepening understanding of the cognitive and neural mechanisms of FOP label processing. This model might facilitate consensus on the most successful FOP label. Moreover, it could provide insights for consumers, food industries, and policy makers and encourage healthy eating behaviors.

Designing a new physical activity calorie equivalent food label and comparing its effect on caloric choices to that of the traffic light label among mothers: a mixed-method study

Objective

We designed a new type of 'physical activity calorie equivalent' (PACE) food label in Iran to compare its effect with that of the traffic light food label (TLL) on caloric choices.

Design

Mixed-method study.

Participants

Mothers of school children between the ages of 6-12 years.

Setting

In the qualitative phase, 10 focus group discussions (FGDs) were conducted with various groups of mothers, and two FGDs were conducted with food science and nutrition experts to design a new PACE label. In the quantitative phase, 496 mothers were randomly assigned to five groups: (1) no nutrition label, (2) current TLL, (3) current TLL + educational brochure, (4) PACE label, and (5) PACE label + brochure. Samples of dairy products, beverages, cakes, and biscuits were presented. ANOVA and multiple linear regressions were applied to examine the association between label types and calories of the selected products as our main outcome.

Results

The mothers' perspectives were classified into two sub-themes, the PACE label's facilitators and barriers. The new PACE label's characteristics were divided into two subcategories: (a) appearance, and (b) nutritional information, including 14 codes. In the quantitative section, mean calories of the selected foods were lowest in the TLL + brochure group (831.77 kcal; 95% CI: 794.23-869.32), and highest in the PACE label group (971.61; 95% CI: 926.37-1016.84).

Conclusion

The new PACE label was a combination of PACE, TLL, and warning labels. It did not significantly affect lower caloric choice, however, the TLL + brochure option was effective in choosing foods with fewer calories.Clinical trial registration: The study was registered in the Iranian Registry of Clinical Trials 23 (IRCT20181002041201N1).

Examining young people's views and understanding of traffic light and physical activity calorie equivalent (PACE) food labels

BACKGROUND

Childhood obesity is a public health challenge in many countries. Food labelling may help children make healthier food choices. Food is typically labelled using the traffic light label system but this is complex to understand. Physical activity calorie equivalent (PACE) labelling may be easier for children to understand and more appealing because it contextualises the energy content of food/drinks.

METHODS

A cross-sectional online questionnaire was completed by 808 adolescents aged 12-18 years in England. The questionnaire investigated participants' views and understanding of traffic light and PACE labels. Participants were also asked about their understanding of the meaning of calories. The questionnaire explored participants' views about the potential frequency of use of PACE labels and their perceived usefulness in influencing purchasing and consumption decisions. Questions that explored participants' views about the possible implementation of PACE labelling, preferences for food settings and types of food/drinks they may like such labelling implemented, and whether PACE labels would encourage physical activity were included. Descriptive statistics were explored. Analyses assessed associations between variables and tested differences in the proportions of views about the labels.

RESULTS

More participants reported PACE labels as easier to understand than traffic light labels (69% vs 31%). Of participants who had seen traffic light labels, 19% looked at them often/always. Forty-two percent of participants would look at PACE labels often/always. The most common reason why participants never/would never look at food labels is because they are not interested in making healthy choices. Fifty-two percent of participants said PACE labels would make it easier for them to choose healthy food and drinks. Fifty percent of participants reported PACE labels would encourage them to be physically active. It was perceived that PACE labels could be useful in a range of food settings and on a range of food/drinks.

CONCLUSIONS

PACE labelling may be easier for young people to understand and more appealing/useful to them than traffic light labelling. PACE labelling may help young people choose healthier food/drinks and reduce excess energy consumption. Research is now needed to understand the impact of PACE labelling on food choice among adolescents in real eating settings.

Evaluation of physical activity calorie equivalent (PACE) labels' impact on energy purchased in cafeterias: A stepped-wedge randomised controlled trial

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).

Measuring “Nudgeability”: Development of a Scale on Susceptibility to Physical Activity Nudges among College Students

Background: The current college lifestyle create more opportunities for students to develop unhealthy behaviors, especially physical inactivity. Nudging could be an effective tool to improve physical activity behaviors by changing college settings. One-nudge-fits-all leads to ineffective nudges, so it is necessary to develop a reliable and valid instrument capable of measuring the “nudgeability” of physical activity nudges for college students, which is for a higher level of nudge efficacy. Method: Developing the College Physical Activity Nudges Susceptibility Scale (CPANSS) that integrated the nudge method with the Likert scale, which is the first attempt to measure the susceptibility to nudges directly by a scale. There are four steps for developing CPANSS, including Scale Dimensions, Item Generation, Exploratory Factor Analysis (n = 294), and Confirmatory Factor Analysis (n = 293) with appropriate procedures. Results: The five-factor 21-item CPANSS with good reliability and validity fitted the data reasonably well. Conclusion: The CPANSS was to provide a new tool for policymakers to design effective nudges in changing and promoting physical activity in college settings, and to provide a method for scholars to promote other healthy behaviors for different target groups.

Nudges used to promote physical activity and to reduce sedentary behaviour in the workplace: Results of a scoping review

Physical inactivity is one of the most important risk factors for non-communicable diseases. Workplace health promotion is therefore of growing interest to support an active day using nudges. The scoping review aims to (a) analyse how frequently nudges are applied in workplace health promotion to increase physical activity and/or reduce sedentary behaviour, and (b) characterise the nudges used. A systematic database search was conducted for the period 2009 to June 2020. According to predefined inclusion and exclusion criteria, studies promoting physical activity and/or reducing sedentary behaviour using nudges were included. Nudges were classified according to MINDSPACE and TIPPME. A study protocol was previously published. Of the 256 studies identified, 26 used nudges. Most studies were conducted in Europe (n = 12) and the USA (n = 8). N = 18 studies targeted physical activity and n = 8 studies targeted sedentary behaviour. In most studies promoting physical activity, prompts were given to climb stairs (n = 11). Interventions targeting sedentary behaviour were more diverse, using digital interventions or mixed approaches (n = 8). Although nudges can help increase physical activity and reduce sedentary behaviour, there are still gaps in terms of their effective and efficient use. There is a lack of long-term studies that analyse habituation and behavioural changes beyond the intervention period. In addition, the potential of digital and mixed approaches is not yet fully exploited. Further studies from low- and middle-income countries with different climates and working conditions are needed to investigate the feasibility of approaches and advance the fight against physical inactivity.

Healthy lifestyle interventions across diverse workplaces: a summary of the current evidence

PURPOSE OF REVIEW

Workplaces provide a unique opportunity to deliver health promotion interventions to their workers. This review summarizes evidence from the most recent studies (September 2019 to April 2021) of workplace healthy lifestyle interventions and identifies gaps in the literature and key aspects for successful future workplace lifestyle interventions.

RECENT FINDINGS

Recent intervention studies have focused on four health domains: (1) multicomponent wellness programs, (2) healthy diet interventions, (3) physical activity interventions, and (4) mental health/sleep interventions. Within each group of studies, there was significant heterogeneity in study length, intervention components, and worker populations. Nonetheless, most studies across all categories showed positive associations between healthy lifestyle interventions and improved worker health.

SUMMARY

Although recent literature has shown an overall positive trend between healthy lifestyle interventions implemented at the workplace and improvements in markers of health and wellbeing, further research should include longer follow-up periods, more objective measures of wellbeing, evaluation of worker performance, and analogous interventions between studies to identify the most effective interventions to improve worker health and wellness.

Partner and Relationship Predictors of Longitudinal Physical Activity Trajectories Among Individuals with Osteoarthritis Using Latent Class Growth Analysis

BACKGROUND

Physical activity reduces osteoarthritis symptoms, yet many individuals with the disease are insufficiently active.

PURPOSE

We identified physical activity trajectories over 12 months of individuals with osteoarthritis and examined how their cohabiting spouses'/partners' baseline physical activity and relationship factors affected trajectory membership.

METHODS

In this longitudinal observational study, we collected data from 168 adults with knee/hip osteoarthritis. We used latent class growth curve analysis to identify physical activity trajectories and logistic regression to predict trajectory membership using partners' physical activity, relationship satisfaction, and communal coping (belief that both partners are responsible for osteoarthritis management). Measures, including objectively assessed physical activity, were collected at baseline from the couple, who then received an educational class on physical activity and social support. Objectively assessed physical activity was also collected from individuals with osteoarthritis at 1 week, 3 months, 6 months, and 12 months post-baseline.

RESULTS

Three trajectories were identified: stable active, increaser, and stable sedentary (24%, 40%, 37% of participants, respectively). Individuals with osteoarthritis with partners who were more active and who believed they alone were responsible for their osteoarthritis were more likely to follow the stable active (versus stable sedentary) trajectory. Those with partners who were less active and had higher relationship satisfaction were more likely to follow the increaser (vs. stable active) trajectory.

CONCLUSIONS

Findings demonstrate the importance of considering partner and relationship factors in physical activity interventions for couples.

PACE Labels on Healthy and Unhealthy Snack Products in a Laboratory Shopping Setting: Perception, Visual Attention, and Product Choice

Informative food labels are one way to increase nutritional awareness in society and can essentially help individuals maintain balanced dietary practices. Nonetheless, making food labels ‘informative’, in the sense of applicability, is not always easy. Physical activity calorie equivalent (PACE) food labeling is one approach to achieve this goal. Yet, it is neither understood how consumers perceive PACE labels, nor how effective they are in regards to healthy food choices. Moreover, it is of interest to assess the perception of real products in close-to-realistic environments. Therefore, this study examined a simulated purchase situation and consumers’ visual attention on PACE labels—on 20 different real snack products with varying health values. In a laboratory-shopping environment, the gaze behaviors of 91 consumers were examined with a head-mounted eye-tracker. In regards to perception, it was elucidated that every participant noticed at least one PACE label. On average 1.39 PACE label fixations on different products were counted with a mean fixation duration of 0.55 s and a mean time to first fixation of 22.46 s. On average, 22.9% of the participants viewed the PACE labels at least once, but the intensity and duration varied greatly between the different products; ’healthier products’ attracted more visual attention than ‘unhealthier products’. In regards to health choice, it became obvious that the choices observed were rather healthy and PACE labels attracted attention. This may have been especially true for participants with little involvement in physical activity and health behavior, which may have been the main target group. Hence, catchy, communicable PACE labels, as well as balanced product offerings may facilitate more healthy food choices. The real-world laboratory setting offered valuable insights, which should be followed-up on.

Perceived Effect of Calorie Count Display on Customers' Eating Behaviors in Food Facilities of Eastern Province, Saudi Arabia: A Mixed Method Study

Background

As the Saudi Food and Drug Authority (SFDA) has recently requested all food facilities to display the calorie count on their menus, this study aimed to identify the perceived changes in costumers’ eating behaviours in response to the calorie count display (CCD) policy in the Eastern Province.

Methods

This was a mixed methods study. The first being quantitative, using a cross-sectional questionnaire which included 400 customers of both genders, aged 10 years and older, and was collected at food facilities from three cities in the Eastern Province. Customers completed a self-administered questionnaire and handed their registered receipts. Collected receipts were used to calculate the total calories ordered per customer. The second method is a qualitative in-depth interview with food facility managers.

Results

Customers who reported checking the CCD were 30.5% of the total sample, and 58.2% of them changed their order accordingly. The mean calories ordered were 36 kcal less in customers checking the CCD than those who do not (P=0.674). Customers who exhibit healthy lifestyle habits calculate their daily consumed calories, knowledgeable of the recommended daily caloric intake (RDCI), dining in a dine-in restaurant, and have an educational level of above high school were more likely to check the CCD. This study found that customers who cared to check the CCD were more likely to change their eating behavior. It has been found that only a small percentage (12% to 18%) of customers were knowledgeable regarding the RDCI. After the implementation of the policy, restaurant managers reported a positive change in customers eating behavior, which was more profound in females and athletes.

Conclusion

There is a significant association between checking the CCD and positive behavioral changes in customers’ eating behaviors. The results of this study suggest that further enforcement and awareness raising are crucial to increase the number of customers checking and using the CCD.

Adherence to the Mediterranean diet, level of physical activity and body dissatisfaction in subjects 16-50 years old in the Region of Murcia, Spain

OBJECTIVE

To analyze obesity, level of adherence to the Mediterranean diet, physical activity and body dissatisfaction in people aged 16-50 years in the Region of Murcia, Spain.

METHOD

Descriptive and cross-sectional study. A total of 85 people (58 men) aged 16 to 50 years (28.68± 8.846) from 3 sports centers with similar sociodemographic characteristics participated in the study. Anthropometric values were recorded. They were tested for adherence to the Mediterranean diet, International Physical Activity Questionnaire (IPAQ) and test for dissatisfaction with their body (BSQ) and it was statistically related.

RESULTS

It can be seen that the level of physical activity of both men and women is low, according to the IPAQ questionnaire, the men presented a METs/min per week of 3,687.9 (DT=3,137.2) significantly higher than women's. In body dissatisfaction we see that women's concern with their bodies (59.3%) is greater than men's (31%), with a statistically significant difference (P=0.013). Eating habits and BMI do not have statistically significant differences according to sex. When applying the Mediterranean diet adherence test, it is observed that 95.3% of those with weight overload have a medium or low score, and only 4.7% have a discharge score (P=0.128). Those with weight overload have a score of 2,935.73 MET/min per week (DT=2,633.16) and those without weight overload have a value of 3,826.73 (DT=3,164.93, P=0.268). There are significant differences regarding the values of body dissatisfaction. The level of concern of those with weight overload is 53.5%, compared to those without weight overload who have a level of concern of 26.2% (P=0.014).

CONCLUSIONS

Weight overload is associated with body dissatisfaction and a low score in the test of adherence to the Mediterranean diet in people aged 16-50 years. The concern about body image in women was 59.3%.