1
|
Meese WB, Hua J, Howell JL. Information avoidance: An interchangeable strategy of self-protection. Soc Sci Med 2024; 354:117065. [PMID: 39013284 DOI: 10.1016/j.socscimed.2024.117065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/05/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024]
Abstract
Across two studies, using five samples (N = 1,850), we examined whether health information avoidance-the deliberate decision to remain ignorant of available but unwanted personal health information-serves a defensive purpose and is interchangeable with other defensive strategies. We tested this idea by examining the relationship between health information avoidance-both as a dispositional tendency and deliberate decision-and feedback derogation. In Study 1, we experimentally demonstrated that a situation known to reduce defensiveness-self-uncertainty-decreased both proactive avoidance and reactive defensiveness relative to a control group. Study 2 demonstrated, across four samples, that people with a greater defensive orientation toward personal health information were more likely to derogate health information. These results are consistent with the idea that feedback derogation replaced the decision to avoid feedback. Together, results suggest that health information avoidance is likely part of a broader self-protective system and is replaceable with other motivated self-protection strategies.
Collapse
|
2
|
Dupuis R, Block JP, Barrett JL, Long MW, Petimar J, Ward ZJ, Kenney EL, Musicus AA, Cannuscio CC, Williams DR, Bleich SN, Gortmaker SL. Cost Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S. Am J Prev Med 2024; 66:128-137. [PMID: 37586572 PMCID: PMC10840662 DOI: 10.1016/j.amepre.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Calorie labeling of standard menu items has been implemented at large restaurant chains across the U.S. since 2018. The objective of this study was to evaluate the cost effectiveness of calorie labeling at large U.S. fast-food chains. METHODS This study evaluated the national implementation of calorie labeling at large fast-food chains from a modified societal perspective and projected its cost effectiveness over a 10-year period (2018-2027) using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model. Using evidence from over 67 million fast-food restaurant transactions between 2015 and 2019, the impact of calorie labeling on calorie consumption and obesity incidence was projected. Benefits were estimated across all racial, ethnic, and income groups. Analyses were performed in 2022. RESULTS Calorie labeling is estimated to be cost saving; prevent 550,000 cases of obesity in 2027 alone (95% uncertainty interval=518,000; 586,000), including 41,500 (95% uncertainty interval=33,700; 50,800) cases of childhood obesity; and save $22.60 in healthcare costs for every $1 spent by society in implementation costs. Calorie labeling is also projected to prevent cases of obesity across all racial and ethnic groups (range between 126 and 185 cases per 100,000 people) and all income groups (range between 152 and 186 cases per 100,000 people). CONCLUSIONS Calorie labeling at large fast-food chains is estimated to be a cost-saving intervention to improve long-term population health. Calorie labeling is a low-cost intervention that is already implemented across the U.S. in large chain restaurants.
Collapse
Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Jason P Block
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Jessica L Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Joshua Petimar
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erica L Kenney
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aviva A Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
3
|
Alangari AS. Restaurants' compliance with calorie labeling policies in food delivery applications. Front Nutr 2023; 10:1281293. [PMID: 38162518 PMCID: PMC10757599 DOI: 10.3389/fnut.2023.1281293] [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: 08/22/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background To encourage consumers to make healthier choices, the Saudi Food and Drug Authority (SFDA) released the Saudi Arabia Nutrition Labeling Policy, which requires restaurants to present caloric information clearly on their menus. Food delivery applications are also mandated to present caloric information on their platforms. The aim of this study is to explore how restaurants on food delivery applications comply with the calorie labeling policy. Methods Data were extracted from a widely used food delivery application in Saudi Arabia to include a sample of 120 "healthy food" restaurants. The restaurants were checked for compliance on both the application and the website. Descriptive and logistic regression analyses were performed to examine the distribution and association of relevant factors. Results A substantial proportion (43.3%) of healthy foods on delivery applications (n = 120) do not comply with the SFDA calorie labeling policies. Among these restaurants, 56.5% presented the calorie labeling on their menu item. Of those who provided calorie information on their websites (n = 62), 54.8% provided appropriate calorie labeling based on the SFDA policy. There was an association between compliance and the number of restaurant categories but no associations for website calorie labeling, rating, and appropriateness. Conclusion This study provides important findings for policymakers that will enable them to reinforce food calorie policies on food delivery platforms, restaurant websites, social media, and marketing campaigns. Not all restaurants comply with the SFDA calorie labeling policies. Suggestions to present the calorie-related words in Arabic and offer more information to help the consumer make the appropriate food selection decision. Further studies are needed to explore the reasons for and barriers to posting nutritional information on menu items.
Collapse
Affiliation(s)
- Abdulaziz S. Alangari
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Hswen Y, Moran AJ, von Ash T, Prasad S, Martheswaran T, Simon D, Cleveland LP, Brownstein JS, Block JP. The impact of the federal menu labeling law on the sentiment of Twitter discussions about restaurants and food retailers: An interrupted time series analysis. Prev Med Rep 2023; 36:102478. [PMID: 37927975 PMCID: PMC10622709 DOI: 10.1016/j.pmedr.2023.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/22/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023] Open
Abstract
The US federal menu labeling law, implemented on May 7 th 2018, required that restaurant chains post calorie counts on menu items. The purpose of this study was to analyze the change in public sentiment, using Twitter data, regarding eight restaurant chains before and after the calorie labeling law's implementation. Twitter data was mined from Twitter's application programming interface (API) for this study from the calendar year 2018; 2016 and was collected as a control. We selected restaurant chains that had a range of compliance dates with the law. Tweets about each chain were filtered by brand-specific keywords, and Valence Aware Dictionary and sEntiment Reasoner (VADER) sentiment analysis was applied to receive a continuous compound score (-1-1) of how positive (1) or negative (-1) each tweet was. Controlled Interrupted Time Series (CITS) was performed with Ordinary Least Squares (OLS) Regression on 2018 and 2016 series of compound scores for each brand, and level and trend changes were calculated. Most restaurant chains that implemented the federal menu calorie labeling law experienced no change or a small change in level or trend in sentiment after they implemented labeling. Chains experienced mildly more negative sentiment right after the law was implemented, with attenuation of this effect over time. Calorie labeling did not have a strong effect on the public's perception of food brands over the long-term on Twitter and may imply the need for greater efforts to change the sentiment towards unhealthy restaurant chains.
Collapse
Affiliation(s)
- Yulin Hswen
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, CA, USA
| | - Alyssa J. Moran
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tayla von Ash
- Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | | | | | - Denise Simon
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, USA
| | | | - John S. Brownstein
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jason P. Block
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Jia J, Van Horn L, Linder JA, Ackermann RT, Kandula NR, O'Brien MJ. Menu Calorie Label Use and Diet Quality: a Cross-Sectional Study. Am J Prev Med 2023; 65:1069-1077. [PMID: 37433378 PMCID: PMC11192142 DOI: 10.1016/j.amepre.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Menu calorie labeling has been implemented in food service businesses to promote healthy food choices; however, evidence is limited on whether label use is associated with healthier dietary intake. This study examined the association between menu calorie label use and diet quality and whether it varied by weight status. METHODS Adults in the National Health and Nutrition Examination Survey 2017-2018 who visited restaurants were included. Menu calorie label use was categorized as did not notice labels, noticed labels, and used labels. Diet quality was measured using the Healthy Eating Index 2015 (maximum score 100) by two 24-hour diet recalls. The association between menu calorie label use and diet quality was examined using multiple linear regression and tested for effect modification by weight status. Data were collected during 2017-2018 and analyzed during 2022-2023. RESULTS Of 3,312 participants (representing 195,167,928 U.S. adults), 43% did not notice labels, 30% noticed labels, and 27% used labels. Using labels was associated with 4.0 points (95% CI 2.2, 5.8) higher Healthy Eating Index 2015 scores than not noticing labels. Healthy Eating Index 2015 scores in those using labels were higher for adults with normal BMI (3.4 points; 95% CI=0.2, 6.7), overweight (6.5 points; 95% CI=3.6, 9.5), and obesity (3.0 points; 95% CI=1.0, 5.1) (p-interaction=0.0004) than those who did not notice labels. CONCLUSIONS Using menu calorie labels was associated with modestly healthier diet quality than not noticing labels, regardless of weight status. This suggests that providing caloric information may help some adults with food decisions.
Collapse
Affiliation(s)
- Jenny Jia
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Linda Van Horn
- Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald T Ackermann
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Namratha R Kandula
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J O'Brien
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
6
|
Essman M, Burgoine T, Cameron A, Jones A, Potvin Kent M, Polden M, Robinson E, Sacks G, Smith RD, Vanderlee L, White C, White M, Hammond D, Adams J. A multi-country comparison of jurisdictions with and without mandatory nutrition labelling policies in restaurants: analysis of behaviours associated with menu labelling in the 2019 International Food Policy Study. Public Health Nutr 2023; 26:2595-2606. [PMID: 37661595 PMCID: PMC10641604 DOI: 10.1017/s1368980023001775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 07/06/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups. DESIGN Cross-sectional data from the International Food Policy Study (IFPS) online survey. SETTING IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019. PARTICIPANTS Adults aged 18-99; n 19 393. RESULTS Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy. CONCLUSIONS Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.
Collapse
Affiliation(s)
- Michael Essman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Adrian Cameron
- Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Andrew Jones
- School of Psychology, Liverpool John Moore’s University, Liverpool, UK
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Megan Polden
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Eric Robinson
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Gary Sacks
- Institute for Health Transformation, Deakin University, Burwood, Australia
| | | | - Lana Vanderlee
- School of Nutrition, Centre Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
| | - Christine White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
7
|
Cheikh Ismail L, Kassem H, Osaili TM, Hashim M, Obaid R, Radwan H, Mohamad MN, Saleh ST, Al Zomut Z, Abu Qiyas S, Al Rajaby R, Al Daour R, Ali HI, Stojanovska L, Al Dhaheri AS. Public's calorie literacy and perceived effectiveness of restaurant menu calorie labeling in the United Arab Emirates. PLoS One 2023; 18:e0293387. [PMID: 37874847 PMCID: PMC10597515 DOI: 10.1371/journal.pone.0293387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
Restaurant menu calorie labeling is regarded as a promising, cost-effective, and innovative method that will have an impact on the food environment, raise awareness among consumers, and aid in global efforts to prevent obesity. This study aimed to assess the public's calorie literacy, dining practices, and perceived effectiveness of restaurant menu labeling implementation in the United Arab Emirates (UAE). A descriptive, web-based cross-sectional study was conducted among 1279 adults in the UAE. Socio-demographic characteristics, calorie literacy, and perceived effectiveness of restaurant menu labeling among participants were investigated. Chi-square analysis was used to compare indicators across demographic characteristics. More females than males completed the online survey, (56.1% and 43.9%). Most of the participants aged < 30 years old (54.8%), The majority of participants reported eating away from home at least once per week (89.6%). 66.0% of participants were knowledgeable about calorie definition, but only 37.1% knew about average daily energy requirements. Younger participants, with a normal BMI, and higher education levels reported a significantly higher likelihood of eating at a chain restaurant with caloric information on the menu (p <0.05). The majority of participants (76.0%) preferred to see calorie information and other nutrition information on menus. To conclude, menu labeling is a welcomed policy to be implemented in food outlets. Further investigation is necessary to ascertain the most efficacious method of presenting nutrition information to consumers to facilitate informed purchasing decisions considering the potential benefits of mandating calorie declaration in obesity prevention efforts.
Collapse
Affiliation(s)
- Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Hanin Kassem
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Tareq M. Osaili
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Mona Hashim
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Reyad Obaid
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Maysm N. Mohamad
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Sheima T. Saleh
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Zein Al Zomut
- Jordanian Society for Food and Nutrition, Amman, Jordan
| | - Salma Abu Qiyas
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Radhiya Al Rajaby
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Rameez Al Daour
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Habiba I. Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Lily Stojanovska
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| |
Collapse
|
8
|
Oh GEG, Huh YE, Mukhopadhyay A. Inducing consumers to use calorie information: a multinational investigation. Psychol Health 2023; 38:459-477. [PMID: 34473007 DOI: 10.1080/08870446.2021.1972111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We identify individuals who set daily intake budgets and examine if an intervention making people estimate their calorie intake up to a certain point in the day helps those setting daily budgets to regulate their calorie intake for the remainder of the day, after high prior consumption. DESIGN We conducted an online experiment in five countries: Australia, China, Germany, India, and the UK (n = 3,032) using a 2 (setting calorie budget: yes vs. no, measured) x 2 (intervention: intake reminder vs. control, manipulated) between-subjects design, with the amount of prior consumption measured. Participants were contacted in the afternoon. Those in the intervention condition were asked to estimate their prior calorie intake on that day. MAIN OUTCOME MEASURES We measured the individual characteristics of those who set daily calorie budgets and the intended calorie intake for the remainder of the day. RESULTS Among people who set daily calorie budgets, the intervention reduced intended calorie intake for the remainder of the day by 176 calories if they had already consumed a high amount of calories that day. CONCLUSION A timely intervention to estimate one's calorie intake can lower additional intended calorie intake among those who set daily calorie budget.
Collapse
Affiliation(s)
- Ga-Eun Grace Oh
- Department of Marketing and International Business, Lingnan University, Tuen Mun, Hong Kong
| | - Young Eun Huh
- School of Business and Technology Management, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Anirban Mukhopadhyay
- School of Business and Management, Hong Kong University of Science and Technology, Kowloon, Hong Kong
| |
Collapse
|
9
|
Robinson E, Boyland E, Christiansen P, Haynos AF, Jones A, Masic U, Robertson D, Tapper K, Marty L. Is the effect of menu energy labelling on consumer behaviour equitable? A pooled analysis of twelve randomized control experiments. Appetite 2023; 182:106451. [PMID: 36610541 PMCID: PMC10082393 DOI: 10.1016/j.appet.2023.106451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/18/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023]
Abstract
Menu energy labelling has been implemented as a public health policy to promote healthier dietary choices and reduce obesity. However, it is unclear whether the influence energy labelling has on consumer behaviour differs based on individuals' demographics or characteristics and may therefore produce inequalities in diet. Data were analysed from 12 randomized control trials (N = 8508) evaluating the effect of food and drink energy labelling (vs. labelling absent) on total energy content of food and drink selections (predominantly hypothetical) in European and US adults. Analyses examined the moderating effects of participant age, sex, ethnicity/race, education, household income, body mass index, dieting status, food choice motives and current hunger on total energy content of selections. Energy labelling was associated with a small reduction (f2 = 0.004, -50 kcal, p < 0.001) in total energy selected compared to the absence of energy labelling. Participants who were female, younger, white, university educated, of a higher income status, dieting, motivated by health and weight control when making food choices, and less hungry, tended to select menu items of lower energy content. However, there was no evidence that the effect of energy labelling on the amount of energy selected was moderated by any of the participants' demographics or characteristics. Energy labelling was associated with a small reduction in energy content of food selections and this effect was similar across a range of participants' demographics and characteristics. These preliminary findings suggest that energy labelling policies may not widen existing inequalities in diet.
Collapse
Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | | | - Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Una Masic
- Gender Identity Development Service, Tavistock and Portman NHS Trust, London, UK
| | - Deirdre Robertson
- Behavioural Research Unit, Economic and Social Research Institute, Ireland & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Katy Tapper
- Department of Psychology, City, University of London, UK
| | - Lucile Marty
- Centre des Sciences Du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| |
Collapse
|
10
|
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 ).
Collapse
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
| |
Collapse
|
11
|
Zhang C, Han J, Guo X, Huang J. Influence of Healthy Brand and Diagnosticity of Brand Name on Subjective Ratings of High- and Low-Calorie Food. Behav Sci (Basel) 2023; 13:bs13010070. [PMID: 36661642 PMCID: PMC9854620 DOI: 10.3390/bs13010070] [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: 11/24/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
Brand names on food packaging and the diagnosticity of brand names have notable effects on consumer preferences. However, their effects on healthy food consumption are not clear. The objective of this study was to investigate the effect of healthy brands and the diagnosticity of brand names on consumers' subjective ratings of different calorie foods. In two studies, participants viewed 32 pictures of high- and low-calorie food product packaging from healthy and unhealthy brands and rated their feelings and willingness to pay online. Study 1 used real brand names, and Study 2 used fictional brand names and added press releases to manipulate diagnosticity. The present study demonstrated that participants perceived foods from healthy brands as healthier but less delicious and were more willing to buy low-calorie foods from healthy brands. Moreover, only when the brand name was of high diagnosticity were high-calorie foods rated as more likable, and did the willingness to pay for low-calorie foods increase. Collectively, these findings highlight the influence of the healthy brand on consumers' subjective ratings of food. It is also inspiring for healthy food marketing.
Collapse
Affiliation(s)
- Chengchen Zhang
- Department of Psychology, Soochow University, Suzhou 215123, China
| | - Jiayi Han
- Department of Psychology, Soochow University, Suzhou 215123, China
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen 518172, China
| | - Xiyu Guo
- Department of Psychology, Soochow University, Suzhou 215123, China
| | - Jianping Huang
- Department of Psychology, Soochow University, Suzhou 215123, China
- Correspondence: ; Tel.: +086-18811372137
| |
Collapse
|
12
|
Roseman MG, Joung HWD, Ossorio EM, Valliant M. College students' attitude toward menu labeling differs by sex, BMI, weight management status, and athletic type. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:117-123. [PMID: 33729891 DOI: 10.1080/07448481.2021.1879813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 11/17/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
Objective Determine students' attitude toward menu labeling before and after menu labeling implementation at university dining facility. Participants: College students aged 18 years and older eating at campus dining facility. Methods: Survey on attitude toward menu labeling, weight management status, and athletic classification (NCAA, recreational, or non-athlete) was completed 30 days pre- and post-menu labeling implementation. Results: Females showed stronger positive attitude toward menu labeling. Students trying to lose or gain weight had stronger positive attitudes toward menu labeling than students maintaining weight, as did overweight students compared to normal weight students. NCAA athletes had lower attitude mean scores toward menu labeling than other athletic classifications. Conclusion: Attitude toward menu labeling varies by students' gender, body mass index (BMI), and weight management focus, with NCAA athletes having the least positive attitude. Focus future research on effective ways to inform students on menu labeling in university dining facilities in order to nutritionally engage young adults.
Collapse
Affiliation(s)
- Mary G Roseman
- Department of Nutrition and Hospitality Management, University of Mississippi, Oxford, Mississippi, USA
| | - Hyun-Woo David Joung
- Department of Nutrition and Hospitality Management, University of Mississippi, Oxford, Mississippi, USA
| | | | - Melinda Valliant
- Department of Nutrition and Hospitality Management, University of Mississippi, Oxford, Mississippi, USA
| |
Collapse
|
13
|
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 2022; 9:75-86. [PMID: 37034571 PMCID: PMC10073822 DOI: 10.1002/osp4.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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.
Collapse
Affiliation(s)
- Eric Robinson
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Emma Boyland
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Rebecca Evans
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Amy Finlay
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Lauren Halsall
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Gabrielle Humphreys
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Tess Langfield
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - India McFarland‐Lesser
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Zina Patel
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Andrew Jones
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| |
Collapse
|
14
|
Mussio I, de Oliveira ACM. An (un)healthy social dilemma: a normative messaging field experiment with flu vaccinations. HEALTH ECONOMICS REVIEW 2022; 12:41. [PMID: 35917007 PMCID: PMC9344251 DOI: 10.1186/s13561-022-00385-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Influenza seasons can be unpredictable and have the potential to rapidly affect populations, especially in crowded areas. Prior research suggests that normative messaging can be used to increase voluntary provision of public goods, such as the influenza vaccine. We extend the literature by examining the influence of normative messaging on the decision to get vaccinated against influenza. METHODS We conduct a field experiment in conjunction with University Health Services, targeting undergraduate students living on campus. We use four posters, randomized by living area clusters to advertise flu vaccination clinics during the Fall. The wording on the posters is varied to emphasize the individual benefits of the vaccine, the social benefits of the vaccine or both benefits together. We collect survey data for those vaccinated at the vaccination clinics, and for those not vaccinated via an online survey. RESULTS We find that any normative message increases the percentage of students getting the flu vaccine compared with no message. In terms of the likelihood of getting the flu vaccine, emphasizing both the individual and social benefits of vaccination has the largest increase in the vaccination rate (19-20 percentage point increase). However, flu vaccinations did not reach the herd immunity threshold (70% of students vaccinated). CONCLUSIONS This study provides evidence that there is a pro-social component that is relevant in individual vaccination decisions which should be accounted for when designing vaccination campaigns. The results of this normative, pro-social messaging experiment could be extended to other at-risk communities where the number of background risks is much larger. This is especially relevant nowadays, as other seasonal vaccines are being rolled out and younger adults are the ones with the lowest uptake.
Collapse
Affiliation(s)
- Irene Mussio
- Newcastle University Business School (Economics), 5 Barrack Road, Newcastle upon Tyne, NE1 4SE UK
| | - Angela C. M. de Oliveira
- Department of Resource Economics, University of Massachusetts, 203 Stockbridge Hall, 80 Campus Center Way, Amherst, MA 01003 USA
| |
Collapse
|
15
|
Sobaih AEE, Abdelaziz AS. The Impact of Nutrition Labelling on Customer Buying Intention and Behaviours in Fast Food Operations: Some Implications for Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127122. [PMID: 35742371 PMCID: PMC9223361 DOI: 10.3390/ijerph19127122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023]
Abstract
This research examines customers’ intention to buy depending on their use of nutrition labelling (NL) in fast food operations (FFOs) and their intention to visit and recommend these FFOs with nutrition-labelled menus. The research model draws on the theory of planned behaviour (TPB) to examine customers’ intentions to buy from nutrition-labelled menus and their behaviour of visiting and recommending to others FFOs with nutrition-labelled menus. To achieve this purpose, a self-administrated questionnaire was distributed to and collected from a random sample of customers at FFOs in Greater Cairo, Egypt, i.e., McDonald’s and Subway. The results from the structural equation modelling (SEM) using AMOS software indicated positive and direct significant paths from the constructs of the TPB, except for customers’ attitude, to customer intention to buy nutrition-labelled menu items. The results also showed a positive significant impact of customers’ intention on their behaviour of visiting and recommending FFOs featuring nutrition-labelled menus. The findings showed that there is an awaking of nutritional awareness among fast-food customers and that providing nutritional information on fast-food menus will affect their purchasing intention in the future by encouraging them to make healthy food choices. Theoretical implications for scholars and managerial implications for FFOs, especially in relation to public health in general and healthy food choices in particular, are explained and discussed.
Collapse
Affiliation(s)
- Abu Elnasr E. Sobaih
- Management Department, College of Business Administration, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Hotel Management Department, Faculty of Tourism and Hotel Management, Helwan University, Cairo 12612, Egypt
- Correspondence: (A.E.E.S.); (A.S.A.)
| | - Ahmed Sh. Abdelaziz
- Hotel Management Department, Faculty of Tourism and Hotel Management, Helwan University, Cairo 12612, Egypt
- Correspondence: (A.E.E.S.); (A.S.A.)
| |
Collapse
|
16
|
Donini LM, Penzavecchia C, Muzzioli L, Poggiogalle E, Giusti AM, Lenzi A, Pinto A. Efficacy of front-of-pack nutrition labels in improving health status. Nutrition 2022; 102:111770. [DOI: 10.1016/j.nut.2022.111770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/10/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
|
17
|
Bailey RL, Kwon K, Garcia C, Wang P. Fast food menu calorie labeling contexts as complex contributing factors to overeating. Appetite 2022; 173:105992. [DOI: 10.1016/j.appet.2022.105992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
|
18
|
Giazitzi K, Chrysanthakopoulou V, Boskou G. A Hypothetical Tavern Menu for the Evaluation of Calorie Selection through Menu Labelling. Foods 2022; 11:foods11111624. [PMID: 35681374 PMCID: PMC9180666 DOI: 10.3390/foods11111624] [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: 05/11/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
The purpose of the present study is to evaluate calories selection according to the type of menu labelling applied on a hypothetical Greek tavern menu. Three questionnaires were designed and each one included a hypothetical menu of Greek tavern food. Menu A did not include any nutritional information, Menu B included calorie posting and Menu C had the “NB” mark next to dishes that were Nutritionally Balanced choices. A total of 437 participants were recruited in the study. The mean calories selection was significantly lower on Menu B (1874 Kcal) and C (1787.7 Kcal) compared to Menu A (2157.3 Kcal). The overweight and obese participants ordered significantly fewer calories on Menu B (−504 Kcal and −404 Kcal) and C (−451.3 Kcal and −393 Kcal) than on the Menu A. Menu labelling should be assessed in real-life settings in Greece. It could be a policy for the prevention and control of obesity in European countries.
Collapse
|
19
|
|
20
|
The effectiveness of nudging: A meta-analysis of choice architecture interventions across behavioral domains. Proc Natl Acad Sci U S A 2022; 119:2107346118. [PMID: 34983836 PMCID: PMC8740589 DOI: 10.1073/pnas.2107346118] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/20/2022] Open
Abstract
Changing individuals’ behavior is key to tackling some of today’s most pressing societal challenges such as the COVID-19 pandemic or climate change. Choice architecture interventions aim to nudge people toward personally and socially desirable behavior through the design of choice environments. Although increasingly popular, little is known about the overall effectiveness of choice architecture interventions and the conditions under which they facilitate behavior change. Here we quantitatively review over a decade of research, showing that choice architecture interventions successfully promote behavior change across key behavioral domains, populations, and locations. Our findings offer insights into the effects of choice architecture and provide guidelines for behaviorally informed policy making. Over the past decade, choice architecture interventions or so-called nudges have received widespread attention from both researchers and policy makers. Built on insights from the behavioral sciences, this class of behavioral interventions focuses on the design of choice environments that facilitate personally and socially desirable decisions without restricting people in their freedom of choice. Drawing on more than 200 studies reporting over 450 effect sizes (n = 2,149,683), we present a comprehensive analysis of the effectiveness of choice architecture interventions across techniques, behavioral domains, and contextual study characteristics. Our results show that choice architecture interventions overall promote behavior change with a small to medium effect size of Cohen’s d = 0.45 (95% CI [0.39, 0.52]). In addition, we find that the effectiveness of choice architecture interventions varies significantly as a function of technique and domain. Across behavioral domains, interventions that target the organization and structure of choice alternatives (decision structure) consistently outperform interventions that focus on the description of alternatives (decision information) or the reinforcement of behavioral intentions (decision assistance). Food choices are particularly responsive to choice architecture interventions, with effect sizes up to 2.5 times larger than those in other behavioral domains. Overall, choice architecture interventions affect behavior relatively independently of contextual study characteristics such as the geographical location or the target population of the intervention. Our analysis further reveals a moderate publication bias toward positive results in the literature. We end with a discussion of the implications of our findings for theory and behaviorally informed policy making.
Collapse
|
21
|
Aranda R, Darden M, Rose D. Measuring the impact of calorie labeling: The mechanisms behind changes in obesity. HEALTH ECONOMICS 2021; 30:2858-2878. [PMID: 34455668 DOI: 10.1002/hec.4415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
Learning the true calorie content of fast food may induce consumers to change behavior, yet recent evidence is mixed on whether calorie labels cause consumers to order healthier meals. Especially for individuals for whom consumption of highly caloric fast-food is habitual, a rational response to calorie labeling may instead be to maintain consumption levels but increase physical activity. Using American Time Use Survey data from 2004 to 2012, we show that the 2008 New York City Calorie Labeling Mandate significantly improved several measures of physical activity, including overall metabolic equivalents of task units and minutes of sedentary activity. Our results translate to an average extra 28 calories burned per day or a 0.6 kg weight decrease for the average person over one year. These results provide a plausible mechanism for calorie labeling mandates to lower obesity rates, which we demonstrate in the New York City context.
Collapse
Affiliation(s)
- Rodrigo Aranda
- University of Southern California, Los Angeles, California, USA
- University of Wisconsin - Milwaukee, Milwaukee, Wisconsin, USA
| | - Michael Darden
- Johns Hopkins University, Baltimore, Maryland, USA
- National Bureau of Economic Research (NBER), Cambridge, Massachusetts, USA
| | - Donald Rose
- Tulane University, New Orleans, Louisiana, USA
| |
Collapse
|
22
|
Eu EZR, Sameeha MJ. Consumers' Perceptions of Healthy Food Availability in Online Food Delivery Applications (OFD Apps) and Its Association With Food Choices Among Public University Students in Malaysia. Front Nutr 2021; 8:674427. [PMID: 34497818 PMCID: PMC8419248 DOI: 10.3389/fnut.2021.674427] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/16/2021] [Indexed: 12/20/2022] Open
Abstract
This retrospective cross-sectional study was conducted to study consumers' perceptions of healthy food availability in online food delivery applications (OFD apps) among public university students in Malaysia and its association with their food choices. A total of 290 subjects aged 19–29 years old were recruited from 20 public universities in Malaysia via snowball sampling. Data was collected through an online questionnaire which consisted of socio-demographic status, use of OFD apps (most frequently used brand, usage frequency, food choice, and expenditure per transaction), factors affecting food choice in OFD apps, consumers' perceptions of healthy food availability in OFD apps and recommendation for improvements. The most frequently used apps among the subjects was Food Panda (46.6%), however, majority of the subjects in this study (41.4%) rarely used OFD apps. Also, most of the subjects ordered unhealthy food (77.6%) and spent up to RM15–RM19 for each transaction (43.1%). There was no significant difference between the use of OFD apps and gender (p > 0.05). Among the five food choice motives, “price and convenience” motive was the most influencing food choice factor in OFD apps. Majority of the subjects (76.9%) had a negative perception of healthy food availability (variety, price, and quality of healthy food) in OFD apps. No significant association was found between consumers' perceptions of healthy food availability in OFD apps and their food choices made in OFD apps among the subjects in this study (p > 0.05). Also, majority (85.9%) responded they are keen to purchase healthy foods through OFD apps if they are given an option. However, most Malaysian public university students perceived that there were not much variety of healthy food, of good quality and affordable price, available in OFD apps. This finding suggests that the online food environment in Malaysia are perceived as unhealthy. Future studies can explore the online food environment particularly its impact on community health and well-being. Public health professionals and policymakers need to address the online food environment issues as part of the obesogenic food environment in Malaysia especially when OFD is one of the most convenient service in this country.
Collapse
Affiliation(s)
- Elisa Zhen Rong Eu
- Nutritional Sciences Programme, Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Jamil Sameeha
- Nutritional Sciences Programme, Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
23
|
Yang X, Huang Y, Han M, Wen X, Zheng Q, Chen Q, Chen Q. The Differential Effects of Physical Activity Calorie Equivalent Labeling on Consumer Preferences for Healthy and Unhealthy Food Products: Evidence from a Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041860. [PMID: 33672920 PMCID: PMC7918401 DOI: 10.3390/ijerph18041860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/24/2022]
Abstract
Background: Since numerical calorie labels have limited effects on less-calorie food ordering, an alternative called physical activity calorie equivalent (PACE) labels, which exhibit calories using visible symbols and the minutes of exercise to burn off the calories, may be more effective in reducing calories ordered. Methods: By using a choice experiment (CE) approach, the aims of this study were to estimate the effects of PACE labels on consumer preferences for healthy and unhealth food. Red date walnuts and potato chips were used as the representatives of healthy and unhealthy foods respectively in this study. Moreover, future time perspective (FTP) is an individual trait variable of consumers, which has been recognized as a significant driver of healthy behaviors. We also included FTP into the interaction with PACE labels. Results: Firstly, the results were opposite between the healthy and unhealthy food groups. Respondents showed significantly more positive attitudes toward red date walnuts (i.e., healthy food) with PACE labels, while they showed significantly more negative preferences for chips (i.e., unhealthy food) with PACE labels. Secondly, people with higher FTP are preferred red date walnuts with PACE labels, while PACE labels on chips could undermine the preferences of respondents with higher FTP. Thirdly, we found that women (vs. men) were less inclined to choose healthy food with standard calorie labels and labels showing the minutes of running to burn off the calories, as well as that the elderly (vs. younger) people in the healthy food group preferred the labels showing the minutes of running to burn off the calories. People with a higher body mass index (BMI) were reluctant to purchase walnuts with the information about the minutes of walking. Conclusions: Results from this study showed that PACE labels have significant effects on consumers’ preferences for food products.
Collapse
Affiliation(s)
- Xiaoke Yang
- College of Management, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (X.Y.); (M.H.); (X.W.); (Q.Z.); (Q.C.)
| | - Yuanhao Huang
- School of Business, Renmin University of China, Beijing 100089, China;
| | - Mengzhu Han
- College of Management, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (X.Y.); (M.H.); (X.W.); (Q.Z.); (Q.C.)
| | - Xiaoting Wen
- College of Management, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (X.Y.); (M.H.); (X.W.); (Q.Z.); (Q.C.)
| | - Qiuqin Zheng
- College of Management, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (X.Y.); (M.H.); (X.W.); (Q.Z.); (Q.C.)
| | - Qian Chen
- College of Management, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (X.Y.); (M.H.); (X.W.); (Q.Z.); (Q.C.)
- Correspondence:
| | - Qiuhua Chen
- College of Management, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (X.Y.); (M.H.); (X.W.); (Q.Z.); (Q.C.)
| |
Collapse
|
24
|
Motoki K, Saito T, Suzuki S, Sugiura M. Evaluation of energy density and macronutrients after extremely brief time exposure. Appetite 2021; 162:105143. [PMID: 33561497 DOI: 10.1016/j.appet.2021.105143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 12/30/2022]
Abstract
Many food decisions are made rapidly and without reflective processing. The ability to determine nutritional information accurately is a precursor of food decisions and is important for a healthy diet and weight management. However, little is known about the cognitive evaluation of food attributes based on visual information in relation to assessing nutritional content. We investigated the accuracy of visual encoding of nutritional information after brief and extended time exposures to food images. The following questions were addressed: (1) how accurately do people estimate energy and macronutrients after brief exposure to food images, and (2) how does estimation accuracy change with time exposure and the type of nutritional information? Participants were first asked to rate the energy density (calories) and macronutrient content (carbohydrates/fat/protein) of different sets of food images under three time conditions (97, 500 or 1000 ms) and then asked to perform the task with no time constraints. We calculated estimation accuracy by computing the correlations between estimated and actual nutritional information for each time exposure and compared estimation accuracy with respect to the type of nutritional information and the exposure time. The estimated and actual energy densities and individual macronutrient content were significantly correlated, even after a brief exposure time (97 ms). The degree of accuracy of the estimations did not differ with additional time exposure, suggesting that <100 ms was sufficient to predict the energy and macronutrients from food images. Additionally, carbohydrate estimates were less accurate than the estimates of other nutritional variables (proteins, fat and calories), regardless of the exposure time. These results revealed rapid and accurate assessment of food attributes based on visual information and the accuracy of visual encoding of nutritional information after brief and extended time exposure to food imagery.
Collapse
Affiliation(s)
- Kosuke Motoki
- Department of Food Science and Business, Miyagi University, Sendai, Japan; Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
| | - Toshiki Saito
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
| | - Shinsuke Suzuki
- Brain, Mind and Markets Laboratory, Department of Finance, The University of Melbourne, Parkville, Australia
| | - Motoaki Sugiura
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan; International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| |
Collapse
|
25
|
AlAmer NA, AlOmar RS, AlKaltham SM, AlYami RS, AlRashidi FN, AlJrri MM, Abdel Wahab MM. Perceived Effect of Calorie Count Display on Customers' Eating Behaviors in Food Facilities of Eastern Province, Saudi Arabia: A Mixed Method Study. J Multidiscip Healthc 2020; 13:1849-1861. [PMID: 33299322 PMCID: PMC7721296 DOI: 10.2147/jmdh.s283568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Naheel A AlAmer
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem S AlOmar
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shikha M AlKaltham
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rawan S AlYami
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah N AlRashidi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mai M AlJrri
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Moataza M Abdel Wahab
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
26
|
Impact of Nutritional Information on Consumers' Willingness to Pay for Meat Products in Traditional Wet Markets of Taiwan. Foods 2020; 9:foods9081086. [PMID: 32784901 PMCID: PMC7466313 DOI: 10.3390/foods9081086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
The application of nutritional labels provides information regarding the health and nutritional value of products and allows consumers to engage in healthier dietary habits. However, not all types of retail markets provide full nutrition information for meat products. Since there is no nutritional information for fresh meat products in traditional wet markets, this study aimed to investigate consumer purchasing intention and willingness to pay (WTP) for this nutritional information in Taiwanese traditional wet markets. A total of 1420 valid respondents were examined using the random utility theory to explain consumer purchasing intention and WTP for nutritional information. Results showed that most (over 60%) consumers in traditional wet markets have positive purchasing intent for meat products with the nutrition information provided. Furthermore, the nutrition information in traditional wet markets significantly boosts consumers’ purchasing intention and WTP when consumers have a personal health awareness on meat, have proficient experience in buying meat, and continuously receive information from health-related media. Specifically, consumers’ shopping background and their level of health consciousness would be the key factors that would alter their WTP, if provided nutritional claims.
Collapse
|
27
|
Response of the public and restaurant owners to the mandatory menu energy-labelling implementation in restaurants in Saudi Arabia. Public Health Nutr 2020; 23:3435-3447. [PMID: 32450940 DOI: 10.1017/s1368980020000245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Mandatory menu energy-labelling policy in restaurants has received increasing attention worldwide as a useful tool for promoting balanced energy intake and encouraging healthier food selection to reduce obesity prevalence. Therefore, we aimed to evaluate the knowledge, views and observations of the public and restaurant owners towards the mandatory menu energy-labelling policy (introduced in August 2018) in restaurants in Saudi Arabia. DESIGN In February 2019, we conducted a cross-sectional study using an electronic questionnaire. SETTING Saudi Arabia. PARTICIPANTS Saudi individuals (n 1228) aged 18-80 years and forty-one restaurant owners. RESULTS Most participants identified the correct daily energetic requirements for moderately active men (51 %) and women (69 %), but not for inactive adults (36 %). Although 40 % reported adequate knowledge to select low-energetic meals and 55 % perceived the policy as useful, 51 % reported they would be less likely to eat at restaurants displaying energy. Most participants (76 %) mentioned they would choose lower-energetic meals, and 79 % would feel guilty after consuming high-energetic meals. Moreover, 62 % of participants reported that the new labelling policy affected their food selections, prompting them to order different food items, eat less, change restaurants or eat at restaurants less frequently. Among restaurant owners, half were aware of the reason for the implementation of this policy and supported this measure. However, they did not consider modifying recipes to reduce energy. Sales of low- and high-energetic meals increased and decreased in 44 % and 39 % of restaurants, respectively. CONCLUSIONS This policy may be an effective public health tool for promoting balanced energy intake and encouraging healthier food selection in Saudi Arabia.
Collapse
|
28
|
Ho DE, Mbonu O, McDonough A, Pottash R. Menu labeling, calories, and nutrient density: Evidence from chain restaurants. PLoS One 2020; 15:e0232656. [PMID: 32379786 PMCID: PMC7205205 DOI: 10.1371/journal.pone.0232656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/24/2020] [Indexed: 11/26/2022] Open
Abstract
The Food and Drug Administration's menu labeling rule requires chain restaurants to prominently display calories, while leaving other nutritional information (e.g., fat, sodium, sugar) to the request of consumers. We use rich micronutrient data from 257 large chain brands and 24,076 menu items to examine whether calories are correlated with widely used "nutrient profile" scores that measure healthfulness based on nutrient density. We show that calories are indeed statistically significant predictors of nutrient density. However, as a substantive matter, the correlation is highly attenuated (partial R2 < 0.01). Our findings (a) suggest that the promise of calorie labeling to improve nutrient intake quality at restaurants is limited and (b) clarify the basis for transparency of nutrient composition beyond calories to promote healthy menu choices.
Collapse
Affiliation(s)
- Daniel E. Ho
- William Benjamin Scott and Luna M. Scott Professor of Law, Professor of Political Science, Senior Fellow, Stanford Institute for Economic and Policy Research, Stanford University, Stanford, CA, United States of America
| | - Oluchi Mbonu
- Ph.D. Student, Harvard University, Cambridge, MA, United States of America
| | - Anne McDonough
- Research Fellow, Stanford Law School, Stanford, CA, United States of America
| | - Rebecca Pottash
- J.D., Stanford Law School, Stanford, CA, United States of America
| |
Collapse
|
29
|
Oliveira D, De Steur H, Lagast S, Gellynck X, Schouteten JJ. The impact of calorie and physical activity labelling on consumer's emo-sensory perceptions and food choices. Food Res Int 2020; 133:109166. [PMID: 32466912 DOI: 10.1016/j.foodres.2020.109166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 12/25/2022]
Abstract
Providing labelling information is one of the strategies used to help consumers make healthier choices. However, although the type of information has the potential to assist consumers, it is important to evaluate their sensory and emotional perceptions. Therefore, the objective of this study was to evaluate the effect of different labelling information on consumers' sensory and emotional perceptions and their choices, for three different products (potato chips, juice and yogurt). A total of 480 participants were randomly assigned to one of four information conditions (no information (blind), kilocalorie (kcal) information, physical activity (PA) information [duration of walking required to burn the kcal in the product], kcal + PA information). For each information condition, participants were provided with higher kcal and lower kcal equivalent food pairs and were required to choose one. The participants evaluated their overall liking using a 9-point hedonic scale and answered rate-all-that-apply (RATA) questions related to the sensory and emotional characteristics of the products. The results showed no significant impact of calorie and physical activity labelling on consumers' overall liking for juice and yogurt samples and no impact of PA information for chips. Significant differences in overall liking were found when comparing the blind condition with kcal and kcal + PA information, with lower acceptance of the chips samples when this information was presented. Although providing calorie and physical activity labelling had little impact on consumers' sensory and emotional perceptions, consumers perceived unhealthy attributes and negative emotions, such as fatty and guilty, when information was presented. The present work suggests that, although nutrition labelling may be presented as an important strategy to assist consumers, it is important to evaluate consumers' lifestyles, considering that non-dieters and those low and moderate in dietary restraint may not be impacted by this information.
Collapse
Affiliation(s)
- Denize Oliveira
- Department of Agricultural Economics, Ghent University, Coupure Links 653, 9000 Gent, Belgium.
| | - Hans De Steur
- Department of Agricultural Economics, Ghent University, Coupure Links 653, 9000 Gent, Belgium
| | - Sofie Lagast
- Department of Agricultural Economics, Ghent University, Coupure Links 653, 9000 Gent, Belgium
| | - Xavier Gellynck
- Department of Agricultural Economics, Ghent University, Coupure Links 653, 9000 Gent, Belgium
| | - Joachim J Schouteten
- Department of Agricultural Economics, Ghent University, Coupure Links 653, 9000 Gent, Belgium
| |
Collapse
|
30
|
The effect of spatial location of calorie information on choice, consumption and eye movements. Appetite 2020; 144:104446. [PMID: 31505220 DOI: 10.1016/j.appet.2019.104446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/06/2019] [Accepted: 09/06/2019] [Indexed: 11/20/2022]
Abstract
We manipulated the presence and spatial location of calorie labels on menus while tracking eye movements. A novel "lab-in-the-field" experimental design allowed eye movements to be recorded while participants chose lunch from a menu, unaware that their choice was part of a study. Participants exposed to calorie information ordered 93 fewer calories (11%) relative to a control group who saw no calorie labels. The difference in number of calories consumed was greater still. The impact was strongest when calorie information was displayed just to the right of the price, in an equivalent font. The effects were mediated by knowledge of the amount of calories in the meal, implying that calorie posting led to more informed decision-making. There was no impact on enjoyment of the meal. The eye-tracking data suggested that the spatial arrangement altered individuals' search strategies while viewing the menu. This research suggests that the spatial location of calories on menus may be an important consideration when designing calorie posting legislation and policy.
Collapse
|
31
|
DeJesus JM, Du KM, Shutts K, Kinzler KD. How information about what is "healthy" versus "unhealthy" impacts children's consumption of otherwise identical foods. J Exp Psychol Gen 2019; 148:2091-2103. [PMID: 30973249 PMCID: PMC6927673 DOI: 10.1037/xge0000588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Can brief messages about health influence children's consumption of identical foods? Across a series of studies, we manipulated children's consumption of identical foods (fruit sauces) by pairing those foods with brief messages about each food's health status. What initially appeared to be a preference for foods described as healthy among 5- to 6-year-old children (Studies 1-2) actually reflected a preference for alternatives to foods described as unhealthy (Studies 3-5), including comparison foods that were described with negative or neutral content. Although the 2 foods on each trial were identical, children consistently ate more of the alternative to a food described as unhealthy. Similar effects were observed among 8- to 9-year-old children (Study 6). These results demonstrate that children's eating behavior is affected by messages they receive from other people, including messages about health. Further, these studies reveal basic psychological mechanisms that contribute to children's choices among foods, which could lead to effective interventions in the food domain. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
32
|
Petimar J, Ramirez M, Rifas-Shiman SL, Linakis S, Mullen J, Roberto CA, Block JP. Evaluation of the impact of calorie labeling on McDonald's restaurant menus: a natural experiment. Int J Behav Nutr Phys Act 2019; 16:99. [PMID: 31684961 PMCID: PMC6829981 DOI: 10.1186/s12966-019-0865-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background The long-term effect of calorie labeling on fast-food purchases is unclear. McDonald’s voluntarily labeled its menus with calories in 2012, providing an opportunity to evaluate this initiative on purchases. Methods From 2010 to 2014, we collected receipts from and administered questionnaires to 2971 adults, 2164 adolescents, and 447 parents/guardians of school-age children during repeated visits to 82 restaurants, including McDonald’s and five control chains that did not label menus over the study period in four New England cities. In 2018, we analyzed the data by using difference-in-differences analyses to estimate associations of calorie labeling with calories purchased (actual and estimated) and predicted probability of noticing calorie information on menus. Results Calorie labeling at McDonald’s was not associated with changes in calories purchased in adults (change = − 19 cal pre- vs. post-labeling at McDonald’s compared to control chains, 95% CI: − 112, 75), adolescents (change = − 49 cal, 95% CI: − 136, 38), or children (change = 13 cal, 95% CI: − 108, 135). Calorie labeling generally increased the predicted probability of noticing calorie information, but did not improve estimation of calories purchased. Conclusions Calorie labeling at McDonald’s was not associated with changes in calories purchased in adults, adolescents, or children. Although participants were more likely to notice calories on menus post-labeling, there was no improvement in ability to accurately estimate calories purchased.
Collapse
Affiliation(s)
- Joshua Petimar
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Maricelle Ramirez
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Stephanie Linakis
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jewel Mullen
- Departments of Population Health and Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| |
Collapse
|
33
|
Petimar J, Zhang F, Cleveland LP, Simon D, Gortmaker SL, Polacsek M, Bleich SN, Rimm EB, Roberto CA, Block JP. Estimating the effect of calorie menu labeling on calories purchased in a large restaurant franchise in the southern United States: quasi-experimental study. BMJ 2019; 367:l5837. [PMID: 31666218 PMCID: PMC6818731 DOI: 10.1136/bmj.l5837] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate whether calorie labeling of menus in large restaurant chains was associated with a change in mean calories purchased per transaction. DESIGN Quasi-experimental longitudinal study. SETTING Large franchise of a national fast food company with three different restaurant chains located in the southern United States (Louisiana, Texas, and Mississippi) from April 2015 until April 2018. PARTICIPANTS 104 restaurants with calorie information added to in-store and drive-thru menus in April 2017 and with weekly aggregated sales data during the pre-labeling (April 2015 to April 2017) and post-labeling (April 2017 to April 2018) implementation period. MAIN OUTCOME MEASURES Primary outcome was the overall level and trend changes in mean purchased calories per transaction after implementation of calorie labeling compared with the counterfactual (ie, assumption that the pre-intervention trend would have persisted had the intervention not occurred) using interrupted time series analyses with linear mixed models. Secondary outcomes were by item category (entrees, sides, and sugar sweetened beverages). Subgroup analyses estimated the effect of calorie labeling in stratums defined by the sociodemographic characteristics of restaurant census tracts (defined region for taking census). RESULTS The analytic sample comprised 14 352 restaurant weeks. Over three years and among 104 restaurants, 49 062 440 transactions took place and 242 726 953 items were purchased. After labeling implementation, a level decrease was observed of 60 calories/transaction (95% confidence interval 48 to 72; about 4%), followed by an increasing trend of 0.71 calories/transaction/week (95% confidence interval 0.51 to 0.92) independent of the baseline trend over the year after implementation. These results were generally robust to different analytic assumptions in sensitivity analyses. The level decrease and post-implementation trend change were stronger for sides than for entrees or sugar sweetened beverages. The level decrease was similar between census tracts with higher and lower median income, but the post-implementation trend in calories per transaction was higher in low income (change in calories/transaction/week 0.94, 95% confidence interval 0.67 to 1.21) than in high income census tracts (0.50, 0.19 to 0.81). CONCLUSIONS A small decrease in mean calories purchased per transaction was observed after implementation of calorie labeling in a large franchise of fast food restaurants. This reduction diminished over one year of follow-up.
Collapse
Affiliation(s)
- Joshua Petimar
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Lauren P Cleveland
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Denise Simon
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michele Polacsek
- Westbrook College of Health Professions, University of New England, Portland, ME, USA
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
34
|
Czarniecka-Skubina E, Górska-Warsewicz H, Laskowski W, Jeznach M. Consumer Choices and Service Quality in the University Canteens in Warsaw, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193699. [PMID: 31581438 PMCID: PMC6801505 DOI: 10.3390/ijerph16193699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to identify and analyze consumer choices and service quality in university canteens in Warsaw. Our study consists of two parts. The first part of our research was conducted using a sample of 1250 adult respondents in 25 university canteens located at five higher education institutions. The reasons and frequency for using canteens, types of selected dishes and opinions on a given catering facility management system were analyzed. The second part of the study was conducted as an inspection to assess internal control and reliability of information. The respondents’ opinions are not in line with inspection assessments. This may be due to the fact that students do not pay attention to the quality of services in university canteens or have little knowledge about service, quality of services or hygiene aspects. For a detailed analysis of consumer choices and service quality assessment, we used Analysis of Variance (ANOVA) test and multi-dimensional cluster analysis. We identified four clusters regarding the type of meals and consumed frequency of consumption in university canteens, and five profiles in relation to evaluation of canteen interior, service and menu. In the correspondence analysis performed using the multidimensional Multiple Correspondence Analysis (MCA) method, we identified five clusters of consumers based on nine features, i.e., canteen location, frequency of using the canteen, gender of respondents, dwelling place, financial status of respondents. Our research on the functioning of university canteens is one of the first not only in Poland, but also in the countries of Central and Eastern Europe. The evaluation of the quality of nutrition in canteens should be continued in order to prevent diet-related diseases. Based on the results of our research, we postulate to introduce an evaluation guide for university canteens taking into account various aspects of services.
Collapse
Affiliation(s)
- Ewa Czarniecka-Skubina
- Department of Food Gastronomy and Food Hygiene, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS), 02-787 Warsaw, str. Nowoursynowska 166, Poland.
| | - Hanna Górska-Warsewicz
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS), 02-787 Warsaw, str. Nowoursynowska 166, Poland.
| | - Wacław Laskowski
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS), 02-787 Warsaw, str. Nowoursynowska 166, Poland.
| | - Maria Jeznach
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS), 02-787 Warsaw, str. Nowoursynowska 166, Poland.
| |
Collapse
|
35
|
Brown HM, Rollo ME, de Vlieger NM, Collins CE, Bucher T. Influence of the nutrition and health information presented on food labels on portion size consumed: a systematic review. Nutr Rev 2019; 76:655-677. [PMID: 29767760 DOI: 10.1093/nutrit/nuy019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Context In recent decades, portion sizes have increased significantly. Although previous research indicates that food labels impact on product choice and healthiness perception, their impact on portion sizes consumed is less clear. Objective This systematic review examined whether food label information influenced portion size consumption. Data sources A search of 7 major electronic databases for studies published from 1980 to April 2016 was conducted. Data extraction Two reviewers independently screened 11 128 abstracts. Data were extracted from 32 articles (comprising 36 studies). Results Based on the test food used, the overall effects were found to be: no effect, a positive effect, or a negative effect. Labels displaying energy content (n = 15 studies, 17 effects) and fat content information (n = 13 studies, 14 effects) were evaluated most commonly, with exercise equivalent labels evaluated least (n = 2 studies, 2 effects). Conclusions Nutrition and health information presented on food labels has varying impacts on portion sizes consumed, from increased to decreased intake. Recommendations for future research include evaluating more recent food label types and achieving more consistent reporting standards.
Collapse
Affiliation(s)
- Hannah M Brown
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Nienke M de Vlieger
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Tamara Bucher
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| |
Collapse
|
36
|
Clifford Astbury C, Penney TL, Adams J. Home-prepared food, dietary quality and socio-demographic factors: a cross-sectional analysis of the UK National Diet and nutrition survey 2008-16. Int J Behav Nutr Phys Act 2019; 16:82. [PMID: 31492141 PMCID: PMC6729029 DOI: 10.1186/s12966-019-0846-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/27/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Evidence suggests eating home-prepared food (HPF) is associated with increased dietary quality, while dietary quality varies across socio-demographic factors. Although it has been hypothesised that variation in HPF consumption between population sub-groups may contribute to variation in dietary quality, evidence is inconclusive. This study takes a novel approach to quantifying home-prepared food (HPF) consumption, and describes HPF consumption in a population-representative sample, determining variation between socio-demographic groups. It tests the association between HPF consumption and dietary quality, determining whether socio-demographic characteristics moderate this association. METHODS Cross-sectional analysis of UK survey data (N = 6364, aged≥19; collected 2008-16, analysed 2018). High dietary quality was defined as 'DASH accordance': the quintile most accordant with the Dietary Approaches to Stopping Hypertension (DASH) diet. HPF consumption was estimated from 4-day food diaries. Linear regressions were used to determine the association between HPF consumption and socio-demographic variables (household income, education, occupation, age, gender, ethnicity and children in the household). Logistic regression was used to determine the association between HPF consumption and DASH accordance. Interaction terms were introduced, testing for moderation of the association between HPF consumption and DASH accordance by socio-demographic variables. RESULTS HPF consumption was relatively low across the sample (Mean (SD) % of energy consumption = 26.5%(12.1%)), and lower among white participants (25.9% v 37.8 and 34.4% for black and Asian participants respectively, p < 0.01). It did not vary substantially by age, gender, education, income or occupation. Higher consumption of HPF was associated with greater odds of being in the most DASH accordant quintile (OR = 1.2 per 10% increase in % energy from HPF, 95% CI 1.1-1.3). Ethnicity was the only significant moderator of the association between HPF consumption and DASH accordance, but this should be interpreted with caution due to high proportion of white participants. CONCLUSIONS While an association exists between HPF consumption and higher dietary quality, consumption of HPF or HPF's association with dietary quality does not vary substantially between socio-demographic groups. While HPF may be a part of the puzzle, it appears other factors drive socio-demographic variation in dietary quality.
Collapse
Affiliation(s)
- Chloe Clifford Astbury
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Tarra L Penney
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Jean Adams
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| |
Collapse
|
37
|
Chapman GB. A Decision-Science Approach to Health-Behavior Change. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2019. [DOI: 10.1177/0963721419854102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Behavior change has the potential to radically impact health outcomes. Successfully influencing health behavior requires an understanding of the decision processes underlying health choices and techniques to harness those psychological factors in the service of effective interventions. The way in which information is presented, social consequences of behavior, and methods for guiding behavior without trying to change beliefs and attitudes are examples of using decision science in the service of health.
Collapse
|
38
|
Roberts S, Pilard L, Chen J, Hirst J, Rutter H, Greenhalgh T. Efficacy of population-wide diabetes and obesity prevention programs: An overview of systematic reviews on proximal, intermediate, and distal outcomes and a meta-analysis of impact on BMI. Obes Rev 2019; 20:947-963. [PMID: 31039603 DOI: 10.1111/obr.12821] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 01/10/2023]
Abstract
We conducted an overview of systematic reviews and a meta-analysis of the impact on body mass index (BMI) of primary studies of population-wide obesity and diabetes prevention programs, in order to evaluate their efficacy. We searched eight databases for reviews of population-level programs reporting effect on diet, physical activity, BMI, or prevalence of obesity/overweight or type 2 diabetes mellitus (T2DM). Meta-analysis of primary studies within reviews reporting effect on BMI. Interventions were categorized using ANGELO framework and quality assessment using AMSTAR. Fifty-three systematic reviews were included. Primary studies were largely natural experiments or cross-sectional studies of national data. Increased price of sugar-sweetened beverages (SSBs) and fast food, decreased price of fruit and vegetables, food labelling, and grocery store interventions were associated with positive effects on diet. Park and playground renovations and point-of-choice prompts to increase stair use were associated with positive effects on physical activity. Increased price of SSBs, menu labelling, grocery store interventions, and multicomponent interventions were associated with small reductions in BMI. There was insufficient evidence of impact of any interventions on the prevalence of overweight, obesity, or T2DM. We have identified a promising suite of population-wide actions to improve diet, increase physical activity, and reduce BMI. Impact on subsequent incidence of T2DM remains speculative.
Collapse
Affiliation(s)
- Samantha Roberts
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Pilard
- The Centre for Sustainable Healthcare, Oxford, UK
| | - Junqiao Chen
- ISCTE-IUL and University of Lisbon, Lisbon, Portugal
| | - Jennifer Hirst
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
39
|
Scourboutakos MJ, Orr S, Hobin E, Murphy SA, Manson H, L'Abbé MR. Assessing the Early Impact of Menu-Labeling on Calories in Chain Restaurants in Ontario, Canada. Am J Prev Med 2019; 56:e195-e203. [PMID: 31104725 DOI: 10.1016/j.amepre.2019.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The objective of this study is to investigate the early impact of Canada's first provincewide mandatory menu-labeling legislation on calorie levels in foods offered on chain restaurant menus before, leading up to, and at the point-of-implementation. METHODS Data were obtained from Menu-FLIP, a database of publicly available nutrition data from chain restaurants in Canada. Data were collected in 2010, 2013, 2016, and 2017. Core food products, newly introduced products, discontinued products, and full menus were compared before (2010, 2013, 2016) and at the point-of-implementation (2017) of the policy. Calories and serving sizes of 2,988 unique foods (excluding beverages) from 28 chains were analyzed using mixed models comparing time points while controlling for covariates. Sub-analyses were stratified by restaurant type. RESULTS Full menu mean calories and serving sizes increased between 2010 and 2017 (>40 calories and 17 grams, respectively). There were no significant changes in mean calories or serving sizes among core menu items (p=0.47). New products in 2013 and 2017 were significantly higher in calories and serving size versus discontinued foods and foods already on the menu. Discontinued foods did not differ in calories or serving size compared with foods already on the menu; however, in 2017, the calories of discontinued foods in sit-down restaurants were higher than foods discontinued in 2013 (p=0.02). CONCLUSIONS The results of this investigation show that at the point-of-implementation of the Ontario Healthy Menu Choices Act supply-side calories in core food products, new products, or full menus evaluated in this study did not significantly change.
Collapse
Affiliation(s)
- Mary J Scourboutakos
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Orr
- Public Health Ontario, Toronto, Ontario, Canada
| | - Erin Hobin
- Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah A Murphy
- 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.
| |
Collapse
|
40
|
Robinson E, Burton S, Gough T, Jones A, Haynes A. Point of choice kilocalorie labelling in the UK eating out of home sector: a descriptive study of major chains. BMC Public Health 2019; 19:649. [PMID: 31138179 PMCID: PMC6540449 DOI: 10.1186/s12889-019-7017-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/21/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Eating out is now common and food served out of the home is often of low nutritional quality. Kilocalorie (kcal) labelling of food and drink products sold in restaurant chains in the US is now mandatory, although in store kcal labelling practices among major UK restaurant and takeaway chains have not been examined. METHODS During August 2018, we contacted, visited the website and/or retail outlets of major eating out and takeaway food chains in the UK, including full-service and fast-food restaurants, cafes and coffee shops, some of which had previously made a voluntary pledge to provide kcal labelling. We examined the proportion of chains providing kcal information to customers at point of choice in store and the extent to which kcal information provision adhered to labelling recommendations. We also examined the proportion of chains that did not have point of choice kcal labelling but were able to provide kcal information on request. The study protocol was pre-registered on the Open Science Framework. RESULTS Of the 104 eligible chains, only a small minority (18 chains, 17%) provided in store kcal labelling. Of those that did, provision of kcal information tended not to adhere to recommended labelling practices. Of the 16 eligible chains that had previously committed to a voluntary public health pledge to provide point of choice kcal labelling, labelling did not meet recommendations and 4 (25%) did not provide kcal labelling. Of the 86 chains that did not provide kcal labelling in store, kcal information was available on request from 43 (50%) chains. CONCLUSIONS It is rare for eating out and takeaway chains in the UK to provide point of choice kcal labelling and when labelling is provided it does not adhere to recommended labelling practices. Chains that previously volunteered to provide kcal labelling as part of an industry and public health partnership do so inadequately. Voluntary policies have not resulted in adequate kcal labelling in the UK eating out of home sector.
Collapse
Affiliation(s)
- Eric Robinson
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, L69 7ZA, UK.
| | - Sam Burton
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Tom Gough
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Andrew Jones
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Ashleigh Haynes
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, L69 7ZA, UK
| |
Collapse
|
41
|
Turnwald BP, Crum AJ. Smart food policy for healthy food labeling: Leading with taste, not healthiness, to shift consumption and enjoyment of healthy foods. Prev Med 2019; 119:7-13. [PMID: 30508553 PMCID: PMC7608647 DOI: 10.1016/j.ypmed.2018.11.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/24/2018] [Accepted: 11/30/2018] [Indexed: 12/31/2022]
Abstract
Smart food policy models for improving dietary intake recommend tailoring interventions to people's food preferences. Yet, despite people citing tastiness as their leading concern when making food choices, healthy food labels overwhelmingly emphasize health attributes (e.g., low caloric content, reductions in fat or sugar) rather than tastiness. Here we compared the effects of this traditional health-focused labeling approach to a taste-focused labeling approach on adults' selection and enjoyment of healthy foods. Four field studies (total N = 4273) across several dining settings in northern California in 2016-2017 tested whether changing healthy food labels to emphasize taste and satisfaction rather than nutritional properties would encourage more people to choose them (Studies 1-2), sustain healthy purchases over the long-term (Study 3), and improve both the perceived taste of and mindsets about healthy foods (Study 4). Compared to health-focused labeling, taste-focused labeling increased choice of vegetables (OR = 1.73, 95% CI: 1.32, 2.26), salads (OR = 2.06, 95% CI: 1.06, 4.06), and vegetable wraps (OR = 3.09, 95% CI: 1.73, 5.65) in Studies 1-2. In Study 3, taste-focused labeling sustained vegetarian entrée purchases over a two-month period, while health-focused labeling led to a 45.1% decrease. In Study 4, taste-focused labeling significantly enhanced post-consumption ratings of vegetable deliciousness and improved mindsets about the deliciousness of healthy foods compared to health-focused labeling. These studies demonstrate that taste-focused labeling is a low-cost strategy that increased healthy food selection by 38% and outperforms health-focused labeling on multiple smart food policy mechanisms.
Collapse
Affiliation(s)
- Bradley P Turnwald
- Department of Psychology, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| | - Alia J Crum
- Department of Psychology, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| |
Collapse
|
42
|
Shangguan S, Afshin A, Shulkin M, Ma W, Marsden D, Smith J, Saheb-Kashaf M, Shi P, Micha R, Imamura F, Mozaffarian D. A Meta-Analysis of Food Labeling Effects on Consumer Diet Behaviors and Industry Practices. Am J Prev Med 2019; 56:300-314. [PMID: 30573335 PMCID: PMC6340779 DOI: 10.1016/j.amepre.2018.09.024] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 01/03/2023]
Abstract
CONTEXT The influence of food and beverage labeling (food labeling) on consumer behaviors, industry responses, and health outcomes is not well established. EVIDENCE ACQUISITION PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Ten databases were searched in 2014 for studies published after 1990 evaluating food labeling and consumer purchases/orders, intakes, metabolic risk factors, and industry responses. Data extractions were performed independently and in duplicate. Studies were pooled using inverse-variance random effects meta-analysis. Heterogeneity was explored with I2, stratified analyses, and meta-regression; and publication bias was assessed with funnel plots, Begg's tests, and Egger's tests. Analyses were completed in 2017. EVIDENCE SYNTHESIS From 6,232 articles, a total of 60 studies were identified, including 2 million observations across 111 intervention arms in 11 countries. Food labeling decreased consumer intakes of energy by 6.6% (95% CI= -8.8%, -4.4%, n=31), total fat by 10.6% (95% CI= -17.7%, -3.5%, n=13), and other unhealthy dietary options by 13.0% (95% CI= -25.7%, -0.2%, n=16), while increasing vegetable consumption by 13.5% (95% CI=2.4%, 24.6%, n=5). Evaluating industry responses, labeling decreased product contents of sodium by 8.9% (95% CI= -17.3%, -0.6%, n=4) and artificial trans fat by 64.3% (95% CI= -91.1%, -37.5%, n=3). No significant heterogeneity was identified by label placement or type, duration, labeled product, region, population, voluntary or legislative approaches, combined intervention components, study design, or quality. Evidence for publication bias was not identified. CONCLUSIONS From reviewing 60 intervention studies, food labeling reduces consumer dietary intake of selected nutrients and influences industry practices to reduce product contents of sodium and artificial trans fat.
Collapse
Affiliation(s)
- Siyi Shangguan
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ashkan Afshin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Masha Shulkin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; University of Michigan Medical School, Ann Arbor, Michigan
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Marsden
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Jessica Smith
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; Bell Institute of Health and Nutrition, General Mills Inc., Minneapolis, Minnesota
| | - Michael Saheb-Kashaf
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
| |
Collapse
|
43
|
Courtney AL, PeConga EK, Wagner DD, Rapuano KM. Calorie information and dieting status modulate reward and control activation during the evaluation of food images. PLoS One 2018; 13:e0204744. [PMID: 30388113 PMCID: PMC6214650 DOI: 10.1371/journal.pone.0204744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 09/13/2018] [Indexed: 11/18/2022] Open
Abstract
Several public health departments throughout North America have responded to the obesity epidemic by mandating that restaurants publish calories at the point of purchase-with the intention of encouraging healthier food decisions. To help determine whether accompanying calorie information successfully changes a food's appetitive value, this study investigated the influence of calorie information on brain responses to food images. During functional magnetic resonance imaging (fMRI) scanning, dieting (N = 22) and non-dieting (N = 20) participants viewed pictures of food with and without calorie information and rated their desire to eat the food. When food images were paired with calorie information, not only did self-reported desire to eat the food decrease, but reward system activation (Neurosynth-defined from the term "food") decreased and control system activation (the fronto-parietal [FP] control system) increased. Additionally, a parametric modulation of reward activation by food preferences was attenuated in the context of calorie information. Finally, whole brain multivariate pattern analysis (MVPA) revealed patterns of activation in a region of the reward system-the orbitofrontal cortex (OFC)-that were more similar for food images presented with and without calorie information in dieting than non-dieting participants, suggesting that dieters may spontaneously consider calorie information when viewing food. Taken together, these results suggest that calorie information may alter brain responses to food cues by simultaneously reducing reward system activation and increasing control system activation. Moreover, individuals with greater experience or stronger motivations to consider calorie information (i.e., dieters) may more naturally do so, as evidenced by a greater degree of representational similarity between food images with and without calorie information. Combining an awareness of calories with the motivation to control them may more effectively elicit diet-related behavior change.
Collapse
Affiliation(s)
- Andrea L. Courtney
- Psychological & Brain Sciences, Dartmouth College, Hanover, NH, United States of America
- Department of Psychology, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | - Emma K. PeConga
- Psychological & Brain Sciences, Dartmouth College, Hanover, NH, United States of America
| | - Dylan D. Wagner
- Department of Psychology, The Ohio State University, Columbus, OH, United States of America
| | - Kristina M. Rapuano
- Psychological & Brain Sciences, Dartmouth College, Hanover, NH, United States of America
- Department of Psychology, Yale University, New Haven, CT, United States of America
| |
Collapse
|
44
|
Girgis H, Nguyen SP. Shape or substance? Children’s strategy when labeling a food and its healthfulness. COGNITIVE DEVELOPMENT 2018. [DOI: 10.1016/j.cogdev.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
45
|
Fenko A, Nicolaas I, Galetzka M. Does attention to health labels predict a healthy food choice? An eye-tracking study. Food Qual Prefer 2018. [DOI: 10.1016/j.foodqual.2018.05.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
46
|
Seyedhamzeh S, Bagheri M, Keshtkar AA, Qorbani M, Viera AJ. Physical activity equivalent labeling vs. calorie labeling: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2018; 15:88. [PMID: 30217210 PMCID: PMC6137736 DOI: 10.1186/s12966-018-0720-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries are trying to identify strategies to control obesity. Nutrition labeling is a policy that could lead to healthy food choices by providing information to consumers. Calorie labeling, for example, could lead to consumers choosing lower calorie foods. However, its effectiveness has been limited. Recently, physical activity equivalent labeling (i.e., displaying calories in terms of estimated amount of physical activity to burn calories) has been proposed as an alternative to the calorie-only label. The aim of this review was to identify and evaluate the published literature comparing effects on health behavior between physical activity equivalent labeling and calorie-only labeling. METHOD We searched the following databases: Pubmed/medline, Scopus, Web of science, Agris, Cochrane library, Google Scholar. We also searched along with reference lists of included articles. Articles that were published between 1 January 2000 and 31 October 2016 were eligible for inclusion provided they reported on studies that examined the effects of both types of labeling and included at least one outcome of interest. Mean and standard deviations of the included results were combined using a fixed-effect model. The difference in calories purchased between people exposed to physical activity labeling and calorie-only labeling was calculated as weighted mean difference by using a fixed-effect model. RESULT The difference of calories ordered between physical activity label and calorie label groups was not statistically significant (SMD: -0.03; 95% CI: -0.13, 0.07). The difference of calories ordered between physical activity label and calorie label according to real vs unreal (e.g. web-based) condition was 65 Kcal fewer in real-world settings. CONCLUSION Physical activity calorie equivalent labeling in minutes does not significantly reduce calories ordered compared to calorie-only labeling.
Collapse
Affiliation(s)
- Shirin Seyedhamzeh
- Food and Nutrition Policy, Department of Community Nutrition, School of Nutritional sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. .,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,, No 44, Hojjat-dost Alley, Naderi Street, Keshavarz Boulevard, Tehran, 1416-643931, Iran.
| | - Minoo Bagheri
- PhD student in Nutrition, Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Keshtkar
- MD, MPH, PhD of Epidemiology, Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- PhD of Epidemiology, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Anthony J Viera
- MD, MPH, Professor and Chair, Department of Community and Family Medicine, Duke University, Durham, NC, USA
| |
Collapse
|
47
|
Maynard OM, Langfield T, Attwood AS, Allen E, Drew I, Votier A, Munafò MR. No Impact of Calorie or Unit Information on Ad Libitum Alcohol Consumption. Alcohol Alcohol 2018; 53:12-19. [PMID: 29016721 PMCID: PMC5860256 DOI: 10.1093/alcalc/agx066] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/08/2017] [Indexed: 11/14/2022] Open
Abstract
Aims To investigate the impact of unit and calorie information on drinking behaviour in an ad libitum taste test paradigm. Methods In this experimental human laboratory study, participants were randomized to one of four conditions, balanced by gender, using a 2 (unit information: present vs. absent) × 2 (calorie information: present vs. absent) between-subjects design. The percentage of beer consumed during the taste test was the primary outcome measure. Results Among this largely undergraduate student population, we found no evidence that either unit or calorie information impacted alcohol consumption in an ad libitum taste test. A manipulation check indicated that few of the participants receiving either unit and/or calorie information could accurately recall the number of units and/or calories in the beverages provided to them, indicating low levels of engagement with this information. Analysis of qualitative reactions to calorie and unit labelling indicated possible negative unintended consequences of calorie and unit information, including using unit information to facilitate consumption of higher strength beverages, and calorie information to reduce food consumption prior to a drinking episode. Conclusion We find no evidence to support an effect of unit or calorie information, a public-health initiative supported by the alcohol industry, on drinking behaviour. It is possible that compulsory unit and calorie labelling, at least in the numeric format used here, would have no effect on alcohol intake and may even have some negative unintended consequences among certain populations.
Collapse
Affiliation(s)
- Olivia M Maynard
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK.,MRC Integrative Epidemiology Unit at the University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
| | - Tess Langfield
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - Angela S Attwood
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK.,MRC Integrative Epidemiology Unit at the University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
| | - Emily Allen
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
| | - Imogen Drew
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
| | - Alex Votier
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
| | - Marcus R Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK.,MRC Integrative Epidemiology Unit at the University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
| |
Collapse
|
48
|
Effective National Menu Labeling Requires Accuracy and Enforcement. J Acad Nutr Diet 2018; 118:989-993. [DOI: 10.1016/j.jand.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/28/2018] [Indexed: 11/24/2022]
|
49
|
Bachman JL, Arigo D. Reported Influences on Restaurant-Type Food Selection Decision Making in a Grocery Store Chain. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:555-563. [PMID: 29567007 DOI: 10.1016/j.jneb.2018.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/16/2018] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine food decision-making priorities for restaurant-type foods at grocery stores and determine whether adding calorie information, as required by federal menu labeling laws, affected decision-making priorities. DESIGN Natural experiment: intervention and control groups with baseline and follow-up. SETTING Regional grocery store chain with 9 locations. PARTICIPANTS Participants (n = 393; mean age, 54.8 ± 15.1 years) were primarily women (71%) and Caucasian (95%). INTERVENTION Data were collected before and after calorie information was added to restaurant-type foods at 4 intervention locations. MAIN OUTCOME MEASURE(S) Primary influencers of food selection decision making for restaurant-type foods and frequency of use of nutrition information. ANALYSIS Quantitative analysis examined the top 3 influencers of food selections and chi-square goodness of fit test determined whether the calorie labeling intervention changed food decision-making priorities. Qualitative data were used to describe responses. RESULTS Taste, cost, and convenience were the most frequently reported influencers of restaurant-type food selections; 20% of participants rated calories as influential. Calorie labeling did not affect food selection decision making; 16% of participants in intervention stores noticed calorie labels. Qualitative explanations confirmed these findings. CONCLUSIONS AND IMPLICATIONS Menu labeling laws increase access to calorie information; however, use of this information is limited. Additional interventions are needed to encourage healthier restaurant-type food selections in grocery stores.
Collapse
Affiliation(s)
| | - Danielle Arigo
- Department of Psychology, University of Scranton, Scranton, PA
| |
Collapse
|
50
|
Adding sodium information to casual dining restaurant menus: Beneficial or detrimental for consumers? Appetite 2018; 125:474-485. [DOI: 10.1016/j.appet.2018.02.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/27/2018] [Accepted: 02/23/2018] [Indexed: 11/18/2022]
|