Meal Choices Research Articles

Ranked Importance of Childhood Obesity Determinants: Parents' Views across Ethnicities in New Zealand.

Māori, Pacific, Indian, and New Zealand European pre-school children’s caregivers’ views on determinants of childhood obesity are needed to inform strategies that will reduce disparities in prevalence. Nineteen focus groups were conducted to explore the relative influence of factors contributing to body weight in children. Predetermined and participant-suggested factors were ranked. Discussion data were inductively analysed. The cost of healthy foods was the highest ranked factor across all groups. Ranked similarly were ease of access to takeaways and lack of time for food preparation. Cultural factors followed by screen time induced sedentariness in children and lack of time to ensure children exercised was next. Participant-raised factors included lack of familial, social, and health promotion support, and others’ behaviour and attitudes negatively impacting what children ate. All groups rejected stereotyping that blamed culture for higher obesity rates. Compared to the Māori and NZ European groups, the Pacific Island and Indian participants spoke of losing culture, missing extended family support, and not having access to culturally appropriate nutrition education or social support and services. Public health policies need to mitigate the negative effects of economic deprivation on food insecurity. Complementary interventions that increase access to healthier meal choices more often are needed.

Development and Evaluation of the Stoplight Healthy Living Program

Abstract To address health disparities of adults with intellectual disability (ID), the Kansas Disability and Health Program developed the Stoplight Healthy Living program to promote good nutrition and increased physical activity. The program is based in part on the Stoplight Diet, which uses a color-coded system to teach healthy food choices. The Stoplight Healthy Living program was tested with two groups recruited through a local disability service provider in Kansas. Evaluation results suggested increases in daily fruit and vegetable consumption after participation in the program as well as increased purchases of healthy foods, reduction in soda consumption, and increased knowledge of healthier fast food meal choices. The program was well-received by participants, and shows promise in supporting good nutrition and health of adults with ID.

Comprehensive Approaches to Improving Nutrition: Future Prospects.

When it comes to nutrition, nearly everyone has an opinion. In the past, nutrition was considered to be an individual’s responsibility, however, more recently governments have been expected (by some) to share that responsibility by helping to ensure that marketing is responsible, and that food chains offer healthy meal choices in addition to their standard fare, for example. In some countries, governments have gone as far as to remove tax from unprocessed foods or to introduce taxes, such as that imposed on sugary soft drinks in the UK, Mexico, France and Norway. Following on from the sugar tax, chocolate might be next! Is this the answer to our burgeoning calorie intake and increasing poor nutritional status, or is there another approach? In this narrative we will focus on some of the approaches taken by communities and governments to address excess calorie intake and improve nutritional status, as well as some of the conflicts of interest and challenges faced with implementation. It is clear that in order to achieve meaningful change in the quality of nutritional intake and to reduce the long-term prevalence of obesity, a comprehensive approach is required wherein governments and communities work in genuine partnership. To take no or little action will doom much of today’s youth to a poor quality of life in later years, and a shorter life expectancy than their grandparents.

NP4 Improving Preschool Children's Food Knowledge and Food Choice Intentions: Results From a Childhood Obesity Preventive Intervention

Objective To examine the impact of a large, preventive intervention on preschool children's food knowledge, and intentions to choose nutrient-dense foods for meals and snacks. Description A total of 29 classrooms across 14 predominantly low-income, rural childcare centers (n = 215 children, 52% female, mean age = 4.1y) were randomized into 1 of 16 conditions that differed based on whether a classroom received an intervention curriculum (Healthy Eating, Active Play and Self-Regulation) or parent/caregiver guidance. For the purposes of this study, we focus solely on the 11-week Healthy Eating (HE) curriculum that covered a number of topics, including: identifying “GO” and “WHOA” foods, food groups, increasing fruit and vegetable intake, and building a “healthy plate.” Evaluation Measures were collected pre-post. To assess children's food knowledge, children were first asked to choose their favorite foods from a list of 30 foods and four beverages that vary in energy content. Children were then asked to choose foods for a “healthy lunch” using foods from the same list. A snack selection procedure was used to assess children's food preferences and ability to choose the healthier choice from a list of nine pairs of foods; each pair contained an energy-dense and nutrient-dense food. Children in the HE condition showed a slightly larger increase in their ability to correctly identify nutrient-dense foods. Children in the HE condition showed an increase in nutrition knowledge, and competence in making nutrient-dense snack and meal choices. Children in the HE condition also showed more than a two-fold greater increase in their ability to identify nutrient-dense snack foods than children who were not in the HE condition. Data collection with more than 700 participants is ongoing; results including these additional participants will be shared. Conclusion and Implications Increasing children's food/nutrition knowledge and intentions to choose nutrient-dense over energy-dense foods may lead to the development of healthy dietary patterns that prevent the development of obesity in young children.

P193 Using Behavioral Design to Increase Healthier Food Choices: Food Service Staff's Views on Feasibility

Background Increasing obesity rates among US active duty military is considered a security threat to readiness, with $3.3 billion per year spent in attributable health care costs among active duty personnel and military families. Several Army food service venues have implemented behavioral design strategies to shift patrons’ food choices towards healthier options. However, little is known about implementation feasibility and sustainability. Objective To assess food service staff's perceptions on the feasibility of a behavioral design intervention promoting healthier food choices in a US Army hospital cafeteria. Study Design, Settings, Participants From August to December 2017, an Army hospital cafeteria implemented ten behavioral design strategies, including color-coded labeling, prominent placement of healthier items, provision of fruit baskets, and daily “performance” plates. Nine in-depth, semi-structured interviews were conducted with staff post-intervention. Measurable Outcome/Analysis Interviews were audio-recorded and transcribed verbatim. Braun & Clarke's Six Steps of Thematic Analysis was used to identify deductive and emergent themes of intervention feasibility in the transcripts. Results Four a priori, deductive themes on feasibility were identified: acceptability, operability, sustainability, and effectiveness. Five themes emerged from the data: cafeteria ethos, buy-in, unintended consequences, food options, and factors influencing customers’ food decisions. Staff perceived the intervention as operable and slightly effective in improving food choices, but also perceived that the increase in healthier meal choices led to increased food waste and institutional financial loss. Staff expressed a desire for involvement in behavioral design strategy selection and for food production forecasts to reflect anticipated demand fluctuations. Conclusion Public health practitioners should consider diversifying staff representation when developing behavioral design interventions to increase buy-in and to accommodate venue-specific nuances. Funding None.

Glycaemic response at night is improved after eating a high protein meal compared with a standard meal: A cross-over study

Eating at night, compared to day-time, results in a relative hyperglycaemia contributing to an increased risk of Type 2 diabetes for those who habitually eat at night, such as shift workers. Meal choice at night can adversely impact postprandial glycaemia. Meals high in protein have the capacity to favourably reduce night time perturbations in glucose. The aim of this study was to examine if a high protein meal attenuates postprandial glucose at night, compared with a standard protein meal. In a 2×2 factor cross over design, healthy adults completed four acute meal challenges. Test meals were consumed at 8am and 8pm on separate occasions; a high protein (HP) meal (41% of energy from protein, 29% from carbohydrates) or isocaloric standard meal (15% from protein, 46% from carbohydrate). Bloods were sampled at fasting and for three hours postprandially and incremental area under the curve (iAUC) determined using the trapezoid rule. Freidman's test was conducted prior to post hoc Wilcoxon sign test, and significance set at p<0.0083 after Bonferroni correction. Plasma glucose median (IQR) iAUC after the HP meal was similar to the standard meal when consumed in the morning (12.9 (19.9) vs. 36.4 (99.6)mmol/L.3h, p=0.028). The HP meal elicited a significantly lower glucose iAUC (59.6 (117.0)mmol/L.3h) compared to the standard meal (208.8 (154.1)mmol/L.3h) when consumed at night (p=0.005). No significant differences in insulin responses were found between test meals, at either time of day (p=0.100). A HP meal is effective in attenuating the postprandial glucose excursion observed with night eating by 71.4%, compared to a meal with a macronutrient composition within dietary guidelines. If eating at night, reducing the carbohydrate content of a meal, and replacing this with protein, can result in a more favourable postprandial metabolic response. Trial ID number: ACTRN12617000294358, Website of trial registry: http://www.anzctr.org.au/.

Perceptions of Factors Influencing Diet and Eating Behaviors Among Latinx Middle School Students (P04-113-19)

ObjectivesTo better understand how Latinx middle school youth perceive the family- and environment-related factors that influence their diet and eating behaviors. MethodsFive gender-stratified focus groups (3 with females, 2 with males) with 37 Latinx seventh grade students (54% female) were conducted. The guided discussion included questions about participants’ food choices, the role of their parents in their diet, the way diet and food are discussed at home, and healthy body-related concerns among their peers. Focus groups were audio recorded, transcribed verbatim, and coded in NVivo on the basis of specificity, extensiveness, frequency, and emotionality. Themes emerged from group dialogue; detailed conversations and predominant topics of discussion were noted. ResultsYouth identified several home- and family-level factors influencing their eating behaviors and food preferences, including parental/caregiver modeling, home food availability, and household budgetary constraints. Within the home, youth described a limited ability to participate in decisions regarding food choices, meal planning, meal preparation, and communicating with their caregivers about food preferences. Some youth expressed frustration due to perceiving that other family members were given alternative food options during meals. Youth were interested in eating healthier foods, but those options were not always available at home. Healthy foods at school were described as poorly prepared, and not always available. Youth reported experiencing peer pressure regarding healthy or unhealthy food selection, body image, and fitness level, and reported awareness of the use of unhealthful eating behaviors (e.g., restrictive eating, dieting, purging) as coping strategies. ConclusionsFamily- and household-related factors emerged as important factors that influence youth dietary behaviors. Youth expressed they would eat more nutritious foods if they had more options, if the food was well prepared, and they were given more autonomy over their food and meal choices. Future diet interventions should incorporate strategies to address family-level and environmental factors that influence dietary intake in this vulnerable population. Funding SourcesFunded by NIMHD.

Assessment of the influence of food attributes on meal choice selection by socioeconomic status and race/ethnicity among women living in Chicago, USA: A discrete choice experiment

Large and persistent obesity disparities exist in the US by socioeconomic status (SES) and race/ethnicity, and weight loss interventions have traditionally been less effective in these populations. Thus, a better understanding is needed of the behavioral, economic, and geographic factors that influence obesity risk factors such as eating behaviors. We used a discrete choice experiment to evaluate the impact of different meal attributes on meal choice and to test whether the relative importance of these attributes varied by SES and race/ethnicity. Study participants (n = 228) were given a series of 10 choice tasks and asked to choose among 4 meals, each rated based on the following attributes: taste; healthfulness; preparation time; travel time to food outlet for meal/ingredients; and price. SES was measured using education and self-reported difficulty paying for basics. Race/ethnicity was categorized as Hispanic/Latina, non-Hispanic black, non-Hispanic white, and non-Hispanic other. Data were analyzed using mixed logit regression models with interaction terms to determine whether meal attributes influenced meal choices differentially by SES and race/ethnicity. Healthfulness and taste were the most important attributes for all participants. Price was a more important attribute among those in the lowest SES group compared with those in the higher SES groups. Travel was the least important attribute for low SES participants, and it was not significantly related to meal choice in these groups. Discrete choice experiments as illustrated here may help pinpoint the most salient targets for interventions to improve eating behaviors and reduce obesity disparities. Specifically, our findings suggest interventions should incorporate strategies to target the pricing of healthy and unhealthy food options.

The Effect of Quorum Sensing by Staphylococcus epidermis on Blood Meal Choice in the Mosquito Aedes aegypti

Female mosquitoes utilize volatile organic compounds (VOCs) elicited from the host in order to determine host preference. These VOCs include metabolites produced directly by the host or altered by the skin microflora and from products of bacterial quorum sensing. This research examined what bacterial density is required for quorum sensing to elicit enough VOCs that can be utilized for host selection in mosquitoes. The treehole mosquito, Aedes aegypti was used in a series of blood meal assays where females were given the choice of feeding on an artificial membrane with varying concentrations of Staphylococcus epidermis vs a control where only the medium was present on the artificial membrane. The number of females on the experimental or control artificial membranes were counted and recorded every minute. Blood meal preference was determined by finding the difference between the # of females on the experimental membrane vs. control membrane and then dividing by the total number of females observed. Results indicate that there is a positive correlation between bacterial concentration and mosquito blood meal preference. Female mosquitoes showed a high preference for blood meals where bacterial concentrations were greater than 106 CFU's. Since quorum sensing is utilized by bacteria typically at higher densities only, this research seems to indicate that VOCs produced through quorum sensing are utilized by mosquitoes in host selection. This research also supports differences among human host preferences in mosquitoes and may help to find alternatives to the use of insect‐repellents such as DEET.Support or Funding InformationAmerican Association of Anatomists (AAA)This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Traffic light labelling of meals to promote sustainable consumption and healthy eating

The focus of the present study is to examine the impact of behavioral interventions designed to encourage consumer change around food choices in line with more sustainable consumption as well as healthy eating. More specifically, as a potential method of persuasion, we test the effect of the provision of information using traffic light labelling attached to different meal options signalling their impact on the environment (e.g. carbon emission levels) as well as on their health (e.g., calorific content). While traffic light labelling has shown some success in encouraging both healthy and sustainable food consumption, there is still limited work demonstrating the impact on choice behavior. The present study includes two experiments (Experiment 1, N = 120 [approximately 40 per condition], Experiment 2, N = 297 [approximately 95 per condition]). They examined the impact of the presentation of single (traffic light labelling of calorific content, traffic light labelling of carbon emission levels) and dual (both calorific content and carbon emission levels) traffic light labels in a hypothetical simulated canteen environment. For some participants, the traffic light labels were supplemented with additional information which either contained general information regarding calorific content and carbon emissions, or specific reference values regarding the relationship between particular calorific or carbon emission levels to other activities (i.e. walking, driving). The Results from both experiments show that, compared to baseline, the presence of traffic light labels led to positive shifts towards lower carbon emission and lower calorific content meals. Both general and specific information supported positive behavioral change towards healthier and sustainable meal choices. The findings are discussed in relation to existing work examining the impact of behavioral interventions designed to support positive change in consumer behavior.

Meals on Wheels: Who's referring and what's on the menu?

To describe referral source, meal ordering patterns and the nutrient composition of meals from a regional Meals on Wheels (MOW) service. Referral sources were obtained via retrospective chart audit and compared for 2008 and 2012. Nutrient content of the three most common meal combinations was compared against MOW recommendations of one-third daily energy and one-half daily protein requirements. There was a decline in overall uptake and referrals from hospitals. The "main meal" alone was the most popular meal choice, but did not meet energy requirements for men or women, nor protein requirements for men. The combination of a soup, main and dessert met the MOW recommendations for women only. Investigation into how older people access MOW services is required. Innovative strategies are required to increase the nutrient content of meals, within the context of meal ordering preferences of consumers.

A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability.

BackgroundRegular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries.ObjectiveThe objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices.MethodsFourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed.ResultsOne hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1).ConclusionsVirtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy.

Mirror, mirror, on the menu: Visual reminders of overweight stimulate healthier meal choices

This study examined whether viewing an overweight (vs. normal weight or no) female on a food menu influences women’s visual attention toward healthy and unhealthy menu alternatives and, in turn, their actual food choices. Participants (N = 121) viewed a food menu depicting healthy and unhealthy food options, with their calorie content stated, and selected the food option they were most willing to eat. Depending on condition, the menu featured an overweight female (unhealthy), a normal weight female (healthy), or no female (control). Participants in the unhealthy condition looked more at healthy (vs. unhealthy) meal alternatives than participants in the other conditions and were more inclined to choose healthy food options with lower calorie content, with visual attention toward healthy and unhealthy meal alternatives mediating the effect of experimental condition on calorie content and food choices. These results suggest that exposure to overweight women in food settings may make customers more motivated to choose healthier meals.

Developing Interactive Learning for Continuous Glucose Monitoring

This research project investigates the development of aninteractive visual learning tool for patients utilizingcontinuous glucose monitoring. A beta product of thisinteractive learning tool was developed to run real-lifescenarios that visualize how meal choices and medicationaffect glucose trajectories in both healthy patients andpatients with type 2 diabetes. This learning tool isintended to be used by the clinician to engage thepatient in an educational discussion about continuousglucose monitoring. The tool may enhance a patient’sunderstanding of graphic glucose trajectories so that theymay discover how their body reacts to different lifestylechoices and learn to make better real-time decisions withtheir own CGM data. The effectiveness of this betaproduct was evaluated by 17 health professionals.

Knowledge, attitude and practice of Sudanese pharmacist with regard to management of diabetes during Ramadan: A cross-sectional survey

BackgroundFasting during Ramadan for some individuals with diabetes may lead to complications. Pharmacists may assist in dose adjustment and compliance with medication during Ramadan. Therefore, the aim of this study was to assess the knowledge, attitude and practice of Sudanese community pharmacists in the management of diabetes during Ramadan. MethodA cross-sectional study from April to June 2017, included 330 pharmacies in Khartoum state. The sampling technique was done by two methods using stratified and systematic methods for seven localities of Khartoum State. The community pharmacists were assessed in their knowledge about Medication regimen adjustment (MRA), diabetes risk stratification and the condition in which the fasting diabetic patient have to stop their fast. ResultsThe total response rate was 311(94.2%), and the females were 203(65.3%). Pharmacists mean age was 27.6 (SD = 5.9), ranged between 21-62 years. Importantly, more than 75% of the Pharmacists have sufficient knowledge of both identifying high-risk individuals and whether they need to break their fasting. The practice questions answered correctly by more than 80% of pharmacists in relation to monitor blood glucose level, undergo meal planning to avoid hypoglycemia and dehydration during prolong fasting hours and to undergo meal choices to avoid postprandial hyperglycemia. Importantly, 56.9% community pharmacists advised individuals with diabetes about physical activity. The barriers that hindering the proper counseling was attributed to the Lack of knowledge (71.4%). MRA was reported as highly important by (56.6%) and extremely important by (39.2%). The confidence of knowledge about MRA was reported by 52.1%. ConclusionThis study showed that pharmacists had sufficient knowledge, positive attitude and good practice about diabetes management during Ramadan.

PRIMEMEAL - Using consumer psychology to promote healthier meal choices

PRIMEMEAL - Using consumer psychology to promote healthier meal choices

Barriers and facilitators to adhering to an anti-inflammatory diet for individuals with spinal cord injuries.

The purpose of this study was to explore the barriers and facilitators of an anti-inflammatory diet in people with spinal cord injury. Six participants (age range of 23–68 years, three women and three men) who had previously completed an anti-inflammatory diet study were interviewed. Facilitators identified were family support, autonomy over meal choice, peer support, health benefits gained, and implementation of adherence strategies. The main barriers discussed were lack of motivation after study period ended, social events, diet expenses, and lack of knowledge about the diet. Several health benefits including reductions in pain, edema, and improvements in cognition and mobility were reported.

Socio-Cultural and Environmental Factors that Influence Weight-Related Behaviors: Focus Group Results from African-American Girls and Their Mothers.

African-American girls experience higher rates of obesity than other youth and are more likely to live in environments that may inhibit healthy lifestyles. Focus groups with African-American girls (14.2 ± 2.36 years) and their mothers were conducted to explore socio-cultural and physical factors within the home, neighborhood, and school environments that influence physical activity (PA) and food choices (i.e., availability and accessibility). Being active at home was dependent on availability of unstructured PA, possibility of activity with family/friends/pet, structured sports in the community, and perceived safety of neighborhood. Girls reported unhealthy foods and excessive snacking as issues at home while citing choice of school meals vs. vending machine items and easy accessibility to fast food restaurants as concerns at school. Learning more about the PA and food environments is a fundamental step to develop effective and innovative, environmental strategies to address unhealthy weight-related behaviors in this population.

Diabetes Management “Up in the Air”: It's Time for Consensus

With globalization and increased volume of air travel, individuals with diabetes are frequent fliers, soaring across several time zones. Diabetes management during air travel has not been systematically explored, and most of the travel advice is based on expert opinion with no solid data. To add to this complexity is the introduction of numerous new medications for type 2 diabetes, insulins, pumps, and continuous glucose monitors (CGMs). People with diabetes face many challenges during air travel, including a change in meal times, composition and choice of meals, adequate hydration, change in physical activity, and access to the medications and supplies. When these patients travel across several time zones, they may need changes in insulin doses or pump settings. Frequently, these individuals intentionally underdose insulin to defend against hypoglycemia, but resulting in more hyperglycemia than usual. Unfortunately, other patients are more aggressive. In one study from the United Kingdom, hypoglycemia occurred in 10% of travelers either during travel or in the first 24 hours of arrival to their destination. Of these, 31% reported severe hypoglycemia needing assistance ( 1. Burnett J.C. Long- and short-haul travel by air: issues for people with diabetes on insulin. 2006; 13: 255-260 Google Scholar ). Intercurrent infections with fever or diarrhea may lead to dehydration and other complications, such as diabetic ketoacidosis.

Prompts to regulate emotions improve the impact of health messages on eating intentions and behavior

The current study examined the effect of emotion regulation prompts on obesity-related behavioral intentions and food choices in a sample of undergraduate students. Prior to reading a pamphlet regarding obesity-related health concerns and healthy food choices, participants were prompted to regulate their emotions or no prompt was given. Study 1 investigated differences in health behavior intentions and perception of risk of obesity-related health concerns. Study 2 examined differences in meal choices from a menu. Finally, Study 3 examined differences in food choices between participants prompted to attend, regulate emotions, or no prompt. Participants prompted to regulate their emotions were more likely to report intentions to follow a healthier diet and perceive a greater likelihood of health concerns, select health food options from a presented menu. and select a healthier food choice from presented options. These findings suggest emotion regulation strategies may be beneficial to increase awareness of perceived health risks as well as encourage healthier lifestyle choices among college students.