Front-of-package claims & imagery on fruit-flavored drinks and exposure by household demographics

Young children regularly consume sugary fruit drinks, in part because parents may falsely believe they are healthful due to front-of-package (FOP) claims and imagery. The goal of this study was to assess: 1) the prevalence of FOP claims/imagery on fruit-flavored beverages purchased by U.S. households with 0-5-year-olds, and 2) proportional differences in beverages purchased with FOP claims/imagery across household demographic groups. A content analysis of FOP claims/imagery (e.g., nutrient claims, fruit imagery) on beverages (n = 1365) purchased by households with 0-5-year-olds was conducted by linking beverage sales with FOP marketing data. Results were merged with purchasing data from a nationally representative sample of households (FoodAPS), and survey-weighted logistic regression was used to assess differences in the proportions of 100% juices and fruit drinks with specific FOP claims/imagery purchased by household race/ethnicity, income, and SNAP/WIC participation. The most common claims on fruit-flavored beverages included nutrient claims (fruit drinks: 73%; 100% juices: 68%; flavored waters: 95%), which most commonly highlighted vitamin C (35-41% across beverage categories) and the absence of sugar (31-48%). Most beverages also contained implied-natural claims (fruit drinks: 60%; 100% juices: 64%; flavored waters: 95%) and natural imagery (fruit drinks: 97%; 100% juices: 96%; flavored waters: 73%). A large proportion of fruit drinks and 100% juices purchased by households across all demographic groups contained FOP claims and imagery, with a few minor differences between racial/ethnic groups. In conclusion, most fruit drinks, 100% juices, and flavored waters purchased by households with 0-5-year-olds contained FOP claims and imagery that may lead consumers to believe the beverages are healthy and natural. FDA regulations should ensure parents are not misled by this marketing.

Developing a National Research Agenda to Support Healthy Food Retail

The food retail environment is an important driver of dietary choices. This article presents a national agenda for research in food retail, with the goal of identifying policies and corporate practices that effectively promote healthy food and beverage purchases and decrease unhealthy purchases. The research agenda was developed through a multi-step process that included (1) convening a scientific advisory committee; (2) commissioned research; (3) in-person expert convening; (4) thematic analysis of meeting notes and refining research questions; (5) follow-up survey of convening participants; and (6) refining the final research agenda. Public health researchers, advocates, food and beverage retailers, and funders participated in the agenda setting process. A total of 37 research questions grouped into ten priority areas emerged. Five priority areas focus on understanding the current food retail environment and consumer behavior and five focus on assessing implementation and effectiveness of interventions and policies to attain healthier retail. Priority topics include how frequency, duration, and impact of retailer promotion practices differ by community characteristics and how to leverage federal nutrition assistance programs to support healthy eating. To improve feasibility, researchers should explore partnerships with retailers and advocacy groups, identify novel data sources, and use a variety of study designs. This agenda can serve as a guide for researchers, food retailers, funders, government agencies, and advocacy organizations.

How Do Nutrition Guidelines Compare for Industry to Market Food and Beverage Products to Children? World Health Organization Nutrient Profile Standards versus the US Children's Food and Beverage Advertising Initiative

BACKGROUND

Food and beverage advertising targeting children influences their food choices, diets, and health. Experts have suggested that efforts on food marketing to children would be more effective if self-regulatory nutrition criteria were stronger. The US self-regulatory program, the Children's Food and Beverage Advertising Initiative (CFBAI), and the World Health Organization (WHO) Europe nutrient profile model use different approaches to set nutrition criteria for food marketing to children, making comparing the strength of their criteria challenging.

METHODS

We compared the number and percentage of foods and beverages that met the 2014 CFBAI Category-Specific Uniform Nutrition Criteria with the WHO European nutrient profiling criteria for food and beverage marketing to children.

RESULTS

The June 2015 CFBAI product list included 185 food items and 34 multicomponent meals that could be advertised to children 11 years and younger. Among individual food items (n = 185), 44% (n = 82) were products in categories that were not permitted to be marketed to children according to WHO criteria. Almost half of the products (49%, n = 50) exceeded sweetener levels, 25% (n = 26) exceeded sodium levels, and 6% (n = 6) exceeded calories. Of the 34 multicomponent children's meals permissible under CFBAI, only two met WHO criteria.

CONCLUSIONS

Overall, 85% of the food and beverage items and meals that the CFBAI and its member companies considered to be acceptable to market to children could not be marketed to children under the WHO model. CFBAI should strengthen its nutrition criteria to more effectively reduce unhealthy food marketing to children.

Exploratory analysis of fast-food chain restaurant menus before and after implementation of local calorie-labeling policies, 2005-2011

Introduction

Since 2008, several states and municipalities have implemented regulations requiring provision of nutrition information at chain restaurants to address obesity. Although early research into the effect of such labels on consumer decisions has shown mixed results, little information exists on the restaurant industry’s response to labeling. The objective of this exploratory study was to evaluate the effect of menu labeling on fast-food menu offerings over 7 years, from 2005 through 2011.

Methods

Menus from 5 fast-food chains that had outlets in jurisdictions subject to menu-labeling laws (cases) were compared with menus from 4 fast-food chains operating in jurisdictions not requiring labeling (controls). A trend analysis assessed whether case restaurants improved the healthfulness of their menus relative to the control restaurants.

Results

Although the overall prevalence of “healthier” food options remained low, a noteworthy increase was seen after 2008 in locations with menu-labeling laws relative to those without such laws. Healthier food options increased from 13% to 20% at case locations while remaining static at 8% at control locations (test for difference in the trend, P = .02). Since 2005, the average calories for an à la carte entrée remained moderately high (approximately 450 kilocalories), with less than 25% of all entrées and sides qualifying as healthier and no clear systematic differences in the trend between chain restaurants in case versus control areas (P ≥ .50).

Conclusion

These findings suggest that menu labeling has thus far not affected the average nutritional content of fast-food menu items, but it may motivate restaurants to increase the availability of healthier options.

Poor nutrition on the menu: children's meals at America's top chain restaurants

BACKGROUND

We evaluated the nutritional quality of children's meals at chain restaurants, because children obtain about a third of their daily calories from away-from-home foods and studies show that restaurant foods are often higher in calories and lower in nutritional value than foods prepared at home.

METHODS

We assessed the nutritional quality of children's meals at the 50 largest U.S. restaurant chains by visiting each chain's web site or calling the company. Eighteen of the chains did not have children's meals and 10 did not provide adequate nutrition information to be included in the study. The nutritional quality of each meal combination was evaluated against a set of nutrition standards based on key nutrition recommendations in the Dietary Guidelines for Americans.

RESULTS

Of the 22 restaurants that had children's menus and available nutrition information, 99% of 1662 children's meal combinations were of poor nutritional quality.

CONCLUSIONS

Restaurants should support healthier choices for children by reformulating existing menu items and adding new healthier items, posting calories on menus, and setting nutrition standards for marketing to children.

Children's meals in restaurants: families need more help to make healthy choices

Helping families make healthier choices when eating out is important because eating out is a growing and significant part of Americans' diets and eating out is associated with obesity. Although a number of restaurants have announced improvements recently, many restaurant children's meals remain high in calories, saturated fat, and sodium, and default options are often fries and sugary drinks. Behavioral economic interventions that make default options healthy make healthy choices easier and mean that individuals must actively work to engage in less desirable behaviors. Providing healthier default options for children's meals supports parents by reducing barriers to feeding their children healthfully. This article outlines a number of ways to help families make the healthy choice the easy and the default choice for children when eating out.

Nine out of 10 food advertisements shown during Saturday morning children's television programming are for foods high in fat, sodium, or added sugars, or low in nutrients

A 2005 review by the Institute of Medicine of the National Academies concluded that food marketing influences children's food preferences, consumption, and health. Given the powerful influence of marketing on children's diets, this cross-sectional study examined the types of foods, the nutritional quality of those foods, and the marketing techniques and messages used in food advertising during Saturday morning children's television programming. During 27.5 hours of programming in May 2005, 49% of advertisements shown were for food (281 food advertisements out of 572 total advertisements). The most commonly advertised food categories were ready-to-eat breakfast cereal and cereal bars (27% of all food advertisements), restaurants (19% of food advertisements), and snack foods (18% of food advertisements). Ninety-one percent of food advertisements were for foods or beverages high in fat, sodium, or added sugars or were low in nutrients. Cartoon characters were used in 74% of food advertisements, and toy or other giveaways were used in 26% of food advertisements. About half of food advertisements contained health/nutrition or physical activity messages and 86% of food advertisements contained emotional appeals. This study provides food and nutrition professionals with information about the amount and types of food children are encouraged to eat during Saturday morning television programming. The findings can help food and nutrition professionals counsel children about healthful eating and/or develop programs or policies to balance those advertisements with healthful eating messages.

Nickelodeon markets nutrition-poor foods to children

BACKGROUND

While many factors contribute to childhood obesity and children's poor diets, food marketing affects children's food choices, preferences, their diets, and their health. The purpose of this study was to assess the nutritional quality of the foods marketed by one of the largest companies that markets food to children, Nickelodeon.

METHODS

In fall 2005, the nutritional quality of foods advertised via Nickelodeon media and with Nickelodeon characters was assessed. The cross-sectional sample included food ads on the Nickelodeon television station and in Nickelodeon magazine, product packages with Nickelodeon characters found in one large urban grocery store, and meals at restaurants with promotions tied to Nickelodeon programs or characters.

RESULTS

Of 168 television food ads, 148 (88%) were for foods of poor nutritional quality. Of 21 magazine food ads, 16 (76%) were for foods of poor nutritional quality. Fifteen grocery store products were identified with Nickelodeon characters on the packaging; nine (60%) were foods of poor nutritional quality. In addition, of the 48 possible children's meal combinations at restaurants with promotional offers tied to Nickelodeon programs, 45 (94%) were of poor nutritional quality.

CONCLUSIONS

Through its food marketing, the Nickelodeon entertainment company influences the diets of millions of American children. Unfortunately, eight of ten foods, beverages, and restaurant meals advertised on Nickelodeon's television station, in its magazine, or tied to its characters are of poor nutritional quality. Rather than undermining parents' efforts to feed their children healthfully, Nickelodeon should support parents by setting nutrition standards and marketing to children only foods that meet those standards.

Availability of point-of-purchase nutrition information at a fast-food restaurant

OBJECTIVE

Given the link between eating out, poor diets, and obesity, we assessed the availability of point-of-purchase nutrition information at the largest fast-food restaurant in the U.S., McDonald's.

METHOD

In August 2004, we visited 29 of 33 (88%) of the McDonald's outlets in Washington, DC and visually inspected the premises, as well as asked cashiers or restaurant managers whether they had nutrition information available in the restaurant.

RESULTS

In Washington, DC, 59% of McDonald's outlets provided in-store nutrition information for the majority of their standard menu items. In 62% of the restaurants, it was necessary to ask two or more employees in order to obtain a copy of that information.

CONCLUSION

We found that even at the largest chain restaurant in the country, nutrition information at the point of decision-making is often difficult to find or completely absent.

Availability of nutrition information from chain restaurants in the United States

BACKGROUND

Although obesity and poor dietary habits are complex multifactorial problems, away-from-home food has been identified as one likely and important contributor. Restaurants provide a growing and substantial portion of the average American's diet, yet the Nutrition Labeling and Education Act (NLEA), which went into effect in 1994, explicitly exempts restaurants from most labeling requirements. Thus, this study examined the availability of nutrition information from the largest chain restaurants in the United States.

METHODS

Between January and August 2004, we surveyed the 300 largest chain restaurants by telephone, e-mail, or examining company websites (response rate was 96%). The top chains, as ranked by revenue, were selected based on 2002 ratings in Restaurants and Institutions.

RESULTS

Fifty-four percent of the 287 largest chain restaurants made some nutrition information available. Forty-four percent had nutrition information for the majority of their standard menu items. We found no significant differences in the availability of nutrition information based on the size of the restaurant chain. Of those restaurants with nutrition information, 86% provided information on the company website.

CONCLUSIONS

The number of restaurants providing nutrition information has increased over the last 10 years. However, making informed and healthful food choices is hampered by the absence of nutrition information at many restaurants. Given the growing and significant role that away-from-home foods play in Americans' diets, the Surgeon General and the National Academies' Institute of Medicine recommend that nutrition information be available to customers at restaurants, and state legislatures and the U.S. Congress are beginning to address the issue.

The cost-effectiveness of 1% or less media campaigns promoting low-fat milk consumption

INTRODUCTION

The purpose of our study was to compare the cost-effectiveness of four strategies using components of 1% Or Less to promote population-based behavior change. 1% Or Less is a mass-media campaign that encourages switching from high-fat (whole or 2%) to low-fat (1% or skim) milk. Using a quasi-experimental design, campaigns were previously conducted in four West Virginia communities using different combinations of 1) paid advertising, 2) media relations, and 3) community-based educational activities. Telephone surveys and supermarket milk sales data were used to measure the campaigns' effectiveness.

METHODS

Using data from the previously completed studies, we analyzed the cost of each campaign. We then calculated the cost per person exposed to the campaign and cost per person who switched from high- to low-fat milk.

RESULTS

The combination of paid advertising and media relations was the most cost-effective campaign, with a cost of 0.57 dollars per person to elicit a switch from high- to low-fat milk, and the combination of media relations and community-based educational activities was the least cost-effective campaign, with a cost of 11.85 dollars per person to elicit a switch.

CONCLUSION

Population-based campaigns using a combination of paid advertising and media relations strategies can be a cost-effective way to promote a behavior change in a community.

A comparison of different approaches to promote community-wide dietary change

BACKGROUND

Because public health education funds are limited, it is important to determine which methods are most effective for promoting healthy lifestyles to communities. We conducted interventions in two communities to further examine the effectiveness of various educational approaches for communicating the "1% Or Less" message to switch from high-fat (whole or 2%) to low-fat (1% or fat-free) milk.

METHODS

One intervention used public relations and community-based educational activities in supermarkets, schools, worksites, and other community settings. The other used paid advertising in the absence of other programming. We used telephone surveys and supermarket milk sales data, collected before and after each campaign and in a comparison community, to determine changes in milk-usage patterns.

RESULTS

After the campaign of community-based educational programs and public relations activities, the proportion of high-fat milk drinkers who reported drinking low-fat milk was 19.6% compared with 6.8% for the comparison city (p<0.0001). After the advertising-only campaign, 12.8% of high-fat milk drinkers reported drinking low-fat milk (p<0.01). Although supermarkets experienced increases in low-fat milk sales after both campaigns, the results were not statistically significant.

CONCLUSIONS

The results show how well-designed public relations activities can attract news coverage and provide further evidence that such coverage can be an important component of health-promotion campaigns. Although the use of paid advertising in the absence of other media or programming appeared to change milk-drinking habits, the results were not sustained after the ads stopped airing.

Using mass media to promote healthy eating: A community-based demonstration project

BACKGROUND

Many question whether mass media, in the absence of other programming, can produce significant and sustained behavior change.

METHODS

The 1% Or Less campaign in Wheeling, West Virginia (population 35,000), used paid advertising and public relations to encourage members of one community to switch from whole or 2% milk (high-fat milk) to 1% or fat-free milk (low-fat milk). The study used a quasi-experimental research design with one intervention city and one comparison city. The effectiveness of the campaign was evaluated by collecting milk sales data from supermarkets and conducting pre- and post-intervention telephone surveys in intervention and comparison cities.

RESULTS

In the intervention city, low-fat milk sales increased from 29% of overall milk sales before the campaign to 46% of sales in the month following the campaign. The increase was maintained at the 6-month follow up. According to the telephone surveys, 34.1% of high-fat-milk drinkers reported switching to low-fat milk in the intervention community compared with 3.6% in the comparison community (z = 13.1, P < 0.0001).

CONCLUSIONS

A media-only approach was sufficient to encourage a significant proportion of the people in one community to alter the dietary habit targeted by the intervention.

1% or less: a community-based nutrition campaign

OBJECTIVE

The authors evaluated the effectiveness of a community education campaign to encourage a switch from high-fat (whole and 2%) milk to low-fat (1%, 1/2%, and skim) milk as a way to reduce consumption of saturated fat.

METHODS

Milk sales data were collected from supermarkets in the intervention and comparison communities for three one-month time periods: at baseline, immediately following the campaign, and six months after the campaign. In addition, trained volunteers conducted pre- and post-intervention telephone surveys.

RESULTS

Overall milk sales increased by 16% in the intervention cities following the campaign and remained high at follow-up. Low-fat milk's market share increased from 18% of overall milk sales at baseline to 41% of overall milk sales in the month following the end of the campaign, an increase in market share that was sustained at the six-month follow-up. In the post-intervention telephone survey, 38.2% of those respondents who reported drinking high-fat milk at baseline reported having switched to low-fat milk.

CONCLUSION

A focused message communicated through paid advertising, public relations activities, and community-based education programs increased low-fat and overall milk consumption in one community.

Regulation of fluorescent fatty acid transfer from adipocyte and heart fatty acid binding proteins by acceptor membrane lipid composition and structure

Adipocyte and heart fatty acid binding proteins (A-FABP and H-FABP) are closely related members of the FABP family. Unlike the more distantly related liver FABP, these FABP have been proposed to transfer free fatty acids to model membranes by a collisional mechanism (Wootan, M. G., Bernlohr, D. A., and Storch, J. (1993) Biochemistry 32, 8622-8627; Kim, H. K., and Storch, J. (1992) J. Biol. Chem. 267, 20051-20056). Collisional transfer requires that the acceptor membranes interact with FABP during the transfer process. We, therefore, examined whether the acceptor membrane structure and lipid composition regulate the rate of anthroyloxy-labeled palmitate (2AP) transfer from A- and H-FABP, using a fluorescence resonance energy transfer assay. The results showed that 2AP transfer from A- and H-FABP was more rapid to acceptor vesicles containing acidic phospholipids and was slower to positively charged membranes. In addition, the rate of 2AP transfer from A- and H-FABP was enhanced by unsaturation of the phosphatidylcholine acyl chains and was slowed by the presence of cholesterol or sphingomyelin in the acceptor membranes. These latter changes were small but of a similar magnitude and together suggest that fatty acid transfer from A- and H-FABP was slower to membranes of greater lipid order. Since transfer by an aqueous diffusion mechanism would be unaffected by acceptor membrane properties, these studies strengthen the hypothesis that free fatty acid transfer from A- and H-FABP to membranes occurs via a collisional mechanism.

Mechanism of fluorescent fatty acid transfer from adipocyte fatty acid binding protein to membranes

Adipocyte fatty acid binding protein (A-FABP) is a 15-kDa protein found in high abundance in the cytosol of adipose cells. To better understand the role of this protein in intracellular free fatty acid (ffa) transport, the mechanism of ffa transfer from A-FABP to model membranes was examined by monitoring the transfer of fluorescent anthroyloxy ffa (AOffa) to small unilamellar phospholipid vesicles, using a resonance energy transfer assay. Structural features of ffa that increase aqueous solubility, such as shorter chain length and unsaturation, did not increase the AOffa transfer rate. In addition, solution conditions that increase the aqueous solubility of ffa, such as decreasing ionic strength and increasing pH, had little effect on AOffa transfer from A-FABP to membranes. These results suggest that AOffa do not transfer through the aqueous phase. The small entropic contribution to the free energy of the transfer process provides further evidence that AOffa may not travel through the surrounding aqueous environment when transferred from A-FABP to phospholipid membranes. Finally, the rate of AOffa transfer from A-FABP was directly dependent on the concentration of the acceptor membranes. These studies suggest that AOffa transfer from A-FABP to phospholipid vesicles may occur via transient collisional interactions between the protein and membranes.(ABSTRACT TRUNCATED AT 250 WORDS)

Fatty acid binding sites of rodent adipocyte and heart fatty acid binding proteins: characterization using fluorescent fatty acids

Murine adipocyte and rat heart fatty acid binding proteins (FABP) are closely related members of a family of cytosolic proteins which bind long-chain free fatty acids (ffa). The physical and chemical characteristics of the fatty acid binding sites of these proteins were studied using a series of fluorescent analogues of stearic acid (18:0) with an anthracene moiety covalently attached at seven different positions along the length of the hydrocarbon chain (AOffa). Previously, we used these probes to investigate the binding site of rat liver FABP (L-FABP) [Storch et al. (1989) J. Biol. Chem. 264, 8708-8713]. Here we extend those studies to adipocyte and heart FABP, two members of the FABP family which share a high degree of sequence homology with each other (62% identity) but which are less homologous with L-FABP (approximately 30%). The results show that the fluorescence emission spectra of AOffa bound to adipocyte FABP (A-FABP) are blue-shifted relative to heart FABP (H-FABP), indicating that AOffa bound to A-FABP are held in a more constrained configuration. For both proteins, constraint on the bound ffa probe is highest at the midportion of the acyl chain. Ffa are bound in a hydrophobic environment in both proteins. Excited-state lifetimes and fluorescence quantum yields suggest that the binding site of H-FABP is more hydrophobic than that of A-FABP. Nevertheless, acrylamide quenching experiments indicate that ffa bound to H-FABP are more accessible to the aqueous environment than are A-FABP-bound ffa.(ABSTRACT TRUNCATED AT 250 WORDS)