Improve Food Choices Research Articles

Mobile health apps: An assessment of needs, perceptions, usability, and efficacy in changing dietary choices

ObjectiveThe aim of this study was to explore the use of mobile health applications as dietary self-monitoring tools, and their possible role in improving food choices. MethodsThis descriptive, cross-sectional study used self-administered surveys conducted among students (aged 18–25 y) and consisted of two phases. Phase 1 (N = 991; 65.9% women; mean age: 20.78 ± 1.51 y) assessed the need for and perceptions of mobile health applications to serve as dietary assessment tools. Phase 2 (N = 61; 75.4% women) comprised a 3-wk period of using MyFitnessPal; its corresponding survey assessed the application's usability and perceived efficacy in changing dietary choices. Dietary Instrument for Nutrition Education scores (part of both surveys), assessing dietary intake, were compared using a paired t test. P < 0.05 was considered statistically significant. ResultsMost participants wanted to improve their diet to be healthier (89.7%) and to improve their weight (74.2%), and actively searched for information on how to accomplish this (55.7%). MyFitnessPal was reported to be easy to use (93.4%); however, difficulties were experienced in the selection of food items (39.3%) and portion sizes (63.9%). Users reported that MyFitnessPal helped them change their dietary intake (91.8%) and advance toward their personal weight and health goals (65.6%). A significant reduction in high-sugar food intake after the use of MyFitnessPal (P = 0.03) was found. ConclusionMost participants searched for information on how to improve their diet. MyFitnessPal, a mobile health app with a diet-tracking feature, was reported to be helpful in changing dietary intake; furthermore, use of the application over a 3-wk period led to a significant reduction in sugary food intake.

Food Retailers’ Perspectives on Pilot Program Strategies to Promote Healthy Eating in SNAP Participants

Food retailers are key stakeholders in the development, implementation, and effectiveness of Supplemental Nutrition Assistance Program (SNAP) nutrition pilot programs. Qualitative interviews were conducted to gather insight from food retailers regarding the feasibility of proposed strategies to improve food choices among SNAP participants. Two corporate and six local-level food retailer managers were identified for interviews based on SNAP participation, rural- urban code, and type of food retail settings in the selected counties. Qualitative thematic analysis was performed by four research team members, and themes were identified via consensus. Marketing, incentive, and disincentive program models were well-received, while restriction and stocking standards models were less well-received. Food retailers viewed simple programs with easy implementation and educational components positively. Driving sales and programs that align with corporate and social responsibility goals were important factors related to willingness to participate in pilot programs. Insights from this present study can inform future pilot programs and promote food retailer buy-in.

Health Literacy, Numeracy, and Health Promotion: A Secondary Analysis of the Choosewell 365 Workplace Trial

Health literacy and numeracy are linked to obesity and dietary behaviors. This study investigates whether the effect of a workplace behavioral intervention to prevent weight gain and improve diet differed by employee health literacy and numeracy. ChooseWell 365 was an RCT of hospital employees testing a 12-month intervention using nudges and feedback to promote healthier choices, building on existing cafeteria traffic light labels (e.g., green=healthy, red=unhealthy). Health literacy and numeracy were measured with the Newest Vital Sign (range=0-6) and General Numeracy Scale (range=0-3). Mixed-effects linear models examined if intervention effects on cafeteria purchases, diet quality (Healthy Eating Index 2015, range=0-100), and weight change over 24 months differed by higher versus lower health literacy or numeracy. Data were collected in 2016-2020 and analyzed in 2020-2021. In 12 months, 510 participants completed the Newest Vital Sign and General Numerancy Scale; 36.7% had Newest Vital Sign<6 (lower health literacy) and 31.6% had General Numerancy Scale<2 (lower numeracy). Intervention participants increased healthy purchases over 24 months compared with controls in both higher and lower health literacy and numeracy groups. At 12 months, Healthy Eating Index 2015 scores increased in intervention versus control participants with lower health literacy (5.5 points, 95% CI=1.51, 9.54) but not in those with higher health literacy (p-interaction=0.040). BMI did not differ by health literacy or numeracy. A behavioral intervention improved cafeteria food choices of hospital employees of varying health literacy and numeracy levels and improved diet quality among employees with lower health literacy, suggesting this group also improved food choices outside of work.

Digital nudges to stimulate healthy and pro-environmental food choices in E-groceries

In response to the detrimental health- and environmental impacts of European consumers' dietary patterns, Nutri-Scores and Eco-Scores have been introduced on packages as guidance for choices. Whereas the scores are promising to improve food choices from a nutritional point of view, the scant available literature suggests very limited effects on the environmental impact of food choices. Therefore, there remains a need to explore ways to bring about improvements in both areas. As a growing share of consumers buys food groceries online, new opportunities to steer food choices are being created. This article explores the potential of several digital functionalities to further stimulate healthier and pro-environmental food choices amongst consumers. These functionalities included product recommendation agents, product scores, a real-time average impact score of the chosen food basket and a personalised social norm. Those were tested in a two-stage randomized controlled trial with 1000 Belgian household food decision makers in a mock-up E-grocery. Indices reflecting the nutritional quality (NQI) and environmental impact (EII) of the selected food baskets were calculated. The results indicate that at first, displaying a combined Nutri- and Eco-Score at product level led to improved NQI's, but not EII's. However, the scores also led to shifting behaviour in EII's when facilitated with recommendation agents. The display of the average impact scores of the selected basket and of social norms did not lead to additional improvements. Hence, a combined Nutri- and Eco-Score labelling system is recommended, but an enabling environment to consider both scores is important to realise a shift towards more healthy and environmentally friendly food choices. Apart from manifesting healthier and environmentally friendly products with a centralised labelling system, improving their accessibility should be considered at least as important for behavioural changes.

The mismatch between canteen guidelines and their implementation at canteens in medical institutions in Anuradhapura District.

The 'Guidelines for a healthy canteen in workplaces' (guidelines) was published in 2013 by the Ministry of Health to improve food choices & healthy eating of working community. To determine the extent of implementation of guidelines in canteens at medical institutions in Anuradhapura District. A descriptive cross-sectional study was conducted on random working days in canteens providing all three main meals in medical institutions in Anuradhapura District in August and September 2018. Data were collected by observing the canteen and interviewing the canteen owners according to guidelines. Scoring was done according to a scoring system to obtain a percentage. Ten canteens were included in the study. The median number of customers per canteen was 200 (IQR 100-625). The highest and lowest scores by canteens for overall implementation were 41.8% and 14.1%, while the mean among all canteens was 29.2%. Average percentages for healthy carbohydrate, fruit, snacks, and oil options were 15.2%, 20.0%, 8.8%, and 28.2% respectively. Availability of healthy dairy and use of standard coconut oil was 0.0%. Safe drinking water and hand-washing with soap were available only in 6 and 4 canteens respectively. Implementation of food safety measures was 32.5%. None of the canteens had any posters/ guides regarding healthy eating and none of the owners were aware of the guidelines. The level of implementation of the canteen guidelines was highly unsatisfactory among the canteens in medical institutions in Anuradhapura District.

Gluten-free diet intervention reduces thiamine intake in two weeks, increases glycaemic response and decreases body weight in four weeks, with no long term nutritional deficiencies

This research investigated the effects of gluten free diet (GFD) on nutritional intake, glycaemic and insulin response. In a cross-sectional study, participants who consumed gluten-containing diet (GCD; n = 11) and GFD (n = 11) completed a food diary, blood glucose and insulin measurements. In a pre-post intervention study (n = 11), glycaemic and insulin responses were tested before and after four weeks of a GFD. Food intake was recorded before and after two weeks. No significant differences in nutrient intake, glycaemic or insulin responses were found in the cross-sectional study. In the intervention study, there was a significant reduction in body weight (p = .007) and body mass index (BMI) (p = .004) after four weeks and lower thiamine intake (p = .021) after two weeks of GFD. Glycaemic response was significantly higher (p < .05) following GFD with no differences in insulin response. These differences were not evident if GFD was followed for a longer period, possibly due to improved food choices.

Using food network analysis to understand meal patterns in pregnant women with high and low diet quality

BackgroundLittle is known about how meal-specific food intake contributes to overall diet quality during pregnancy, which is related to numerous maternal and child health outcomes. Food networks are probabilistic graphs using partial correlations to identify relationships among food groups in dietary intake data, and can be analyzed at the meal level. This study investigated food networks across meals in pregnant women and explored differences by overall diet quality classification.MethodsWomen were asked to complete three 24-h dietary recalls throughout pregnancy (n = 365) within a prospective cohort study in the US. Pregnancy diet quality was evaluated using the Healthy Eating Index-2015 (HEI, range 0-100), calculated across pregnancy. Networks from 40 food groups were derived for women in the highest and lowest HEI tertiles at each participant-labeled meal (i.e., breakfast, lunch, dinner, snacks) using Gaussian graphical models. Network composition was qualitatively compared across meals and between HEI tertiles.ResultsIn both HEI tertiles, breakfast food combinations comprised ready-to-eat cereals with milk, quick breads with sweets (e.g., pancakes with syrup), and bread with cheese and meat. Vegetables were consumed at breakfast among women in the high HEI tertile only. Combinations at lunch and dinner were more varied, including vegetables with oils (e.g., salads) in the high tertile and sugary foods with nuts, fruits, and milk in the low tertile at lunch; and cooked grains with fats (e.g., pasta with oil) in the high tertile and potatoes with vegetables and meat in the low tertile at dinner. Fried potatoes, sugar-sweetened beverages, and sandwiches were consumed together at all main meals in the low tertile only. Foods were consumed individually at snacks in both tertiles; the most commonly consumed food were fruits in the high HEI tertile and cakes & cookies in the low tertile.ConclusionsIn this cohort of pregnant women, food network analysis indicated that food combinations differed by meal and between HEI tertiles. Meal-specific patterns that differed between diet quality tertiles suggest potential targets to improve food choices at meals; the impact of meal-based dietary modifications on intake of correlated foods and on overall diet quality should be investigated in simulations and intervention studies.Trial registrationPEAS was registered with number NCT02217462 in Clinicaltrials.gov on August 13, 2014.

P35 The Effect of a Traffic Light Labeling Intervention on Amount of Food Served in a College Dining Hall

BackgroundCollege students may not use the nutrition facts label suggesting changes to the label, such as the Traffic Light Label, are needed to increase user friendliness.ObjectiveTo examine the effect of traffic light labels on the amount of food served in a university dining hall in comparison to the control nutrition facts panels.Study Design, Setting, ParticipantsThis study utilized a repeated measures observational design with a control and an intervention period each lasting 28 days at a Midwestern midsize, private university. Following the control period (nutrition facts panels), each food was labeled with a single color (red, yellow, or green) based upon its nutritional quality.Measurable Outcome/AnalysisNumber of servings per day by color (dependent variable) was combined for both lunch and dinner during the control and intervention period. To compare the amount served per day of each color during control and intervention, a one-way analysis of variance (ANOVA) was used. Bonferroni post hoc tests were utilized for multiple comparisons.ResultsThe one-way ANOVA for color and time point was significant (F (5, 150) = 4.75, P < 0.001). Yellow-labeled foods during the intervention (M = 341.89, SD = 275.86) was significantly lower than red-labeled foods during control (M = 654.56, SD = 286.40, P < 0.0001) and intervention (M = 604.91, SD = 295.84, P = 0.008). However, there were no other significant differences between colors and time points.ConclusionThese results suggest that traffic light labels may not be more effective than nutrition facts panels in college dining halls to improve food choices. Specifically, there was no significant difference in number of servings per day in red- and/or green-labeled foods between control and intervention. Furthermore, servings per day of red-labeled foods continued to be significantly greater than yellow-labeled foods during the intervention. Because students may not use nutrition labels to make food choices, college dining halls should consider reformulating recipes to improve healthfulness of options. College students may not use the nutrition facts label suggesting changes to the label, such as the Traffic Light Label, are needed to increase user friendliness. To examine the effect of traffic light labels on the amount of food served in a university dining hall in comparison to the control nutrition facts panels. This study utilized a repeated measures observational design with a control and an intervention period each lasting 28 days at a Midwestern midsize, private university. Following the control period (nutrition facts panels), each food was labeled with a single color (red, yellow, or green) based upon its nutritional quality. Number of servings per day by color (dependent variable) was combined for both lunch and dinner during the control and intervention period. To compare the amount served per day of each color during control and intervention, a one-way analysis of variance (ANOVA) was used. Bonferroni post hoc tests were utilized for multiple comparisons. The one-way ANOVA for color and time point was significant (F (5, 150) = 4.75, P < 0.001). Yellow-labeled foods during the intervention (M = 341.89, SD = 275.86) was significantly lower than red-labeled foods during control (M = 654.56, SD = 286.40, P < 0.0001) and intervention (M = 604.91, SD = 295.84, P = 0.008). However, there were no other significant differences between colors and time points. These results suggest that traffic light labels may not be more effective than nutrition facts panels in college dining halls to improve food choices. Specifically, there was no significant difference in number of servings per day in red- and/or green-labeled foods between control and intervention. Furthermore, servings per day of red-labeled foods continued to be significantly greater than yellow-labeled foods during the intervention. Because students may not use nutrition labels to make food choices, college dining halls should consider reformulating recipes to improve healthfulness of options.

Food Purchases in an Online Virtual Restaurant

Abstract Objectives Food is commonly purchased at fast-food restaurants and improving food choices at these establishments may be a key contributor to improving the nation's diet. A better understanding of the barriers to dietary change when purchasing foods at fast-food restaurants may aid the development of new interventions to improve dietary choices. The objective of this study is to determine the costs and benefits of choosing a lower calorie meal in a 3D virtual representation of a fast-food restaurant. Methods In this ongoing study, a 3D model of a fast-food restaurant was created and accessed by participants through the internet. The foods on the menu, their nutritional content and price were based on foods served at popular fast-food restaurants. After completing a demographic questionnaire, participants were placed at the entrance of a 3D virtual restaurant where the rated their subjective appetite and rated the expected palatability and satiety of the foods on the menu. Participants were then randomized to one of two conditions: free-choice or goal-orientated (asked to choose a meal that was 700kcal). The participant could then view all menu items on a representation of an electronic ordering kiosk in the store and was asked to ‘purchase’ a meal. After the meal was selected, participants were asked to rate the palatability and expected satiety of that meal. The cost and nutritional content of the meal was determined. Results Preliminary data are presented but as the study is in progress statistical analysis has not currently been performed. Twenty-three participants have currently completed the study. The energy purchased in the free condition is 941kcal while in the constrained condition it is 722 kcal. The cost of the constrained meal is $6.93 and the free meal is $7.16. People in the free condition have taken 65.2 seconds to order whereas people in the constrained condition have taken 72.3 seconds. Conclusions This ongoing study illustrated the potential for collecting data about food choices using virtual worlds. This approach may provide new insights into how people make food decisions. Funding Sources This project received no funding.

Executive Function Training in Childhood Obesity: Food Choice, Quality of Life, and Brain Connectivity (TOuCH): A Randomized Control Trial Protocol.

Background: Individuals with obesity are known to present cognitive deficits, especially in executive functions. Executive functions play an important role in health and success throughout the whole life and have been related to food decision-making and to the ability to maintain energy balance. It is possible to improve executive functions through targeted training. This would involve brain plasticity changes that could be studied through connectivity MRI. The general hypothesis of this study is that executive functions training in children with obesity can improve food choices and produce cognitive and neuroimaging changes (structural and functional connectivity), as well as improve emotional state and quality of life.Methods: Randomized controlled double-blind trial with 12-month follow-up. Thirty children with obesity will be randomly allocated into “executive training” (Cognifit with adaptive difficulty + Cogmed) or “control task” group (Cognifit without adaptive difficulty). Both groups will attend 30–45 min of individual gamified training (Cogmed and/or Cognifit systems) by iPad, five times per week during 6 weeks. Cogmed and Cognifit software are commercially available from Pearson and Cognifit, respectively. Participants will receive an iPad with both apps installed for a 6-week use. Participants will also receive counseling diet information via presentations sent to the iPad and will wear a Fitbit Flex 2 tracker to monitor daily activity and sleep patterns. Main outcomes will be cognitive, emotional, food decision, and quality-of-life measures, as well as neuroimaging measures. Participants are evaluated at baseline (T0), after treatment (T1), and 12 months since baseline (T2).Discussion: Longitudinal study with active control group and 3 time points: baseline, immediately after treatment, and 1 year after baseline. Threefold treatment: executive function training, psychoeducation, and feedback on activity/sleep tracking. We will evaluate the transfer effects of the intervention, including emotional and functional outcomes, as well as the effects on neural plasticity by connectivity MRI.Trial registration: This project has been registered in ClinicalTrials.gov (trial registration number NCT03615274), August 3, 2018.

How to Promote Healthier Shopping Behaviour: Which Are the Most Effective Retail Marketing’ Levers in E-Commerce Grocery

The World Health Organization (WHO) suggests people to eat at least five portion of fruits and vegetables a day, but the level of consumption of this category is far from been reached. Considering that the majority of food purchases occurs in grocery context, increasingly in e-commerce channels, understanding how retailers could improve food choice, both in physical and digital stores, is paramount to healthier living. This paper aims to understand which are the most effective retail marketing’ levers in stimulating impulse buying in fruits and vegetables category, therefore in promoting healthier shopping behavior. Since fruit and vegetable is known for its healthy vocation and its role in differentiating and enhancing the perceived image of retailers, this category is the ideal place to host nutritional marketing initiatives. We used a quantitative survey method to explore shoppers’ behaviour in an online setting, focusing on fruit and vegetables’ category. Respondents were exposed to nine marketing stimuli, according to different communication contents (price versus non price). All the data was considered for linear regression analysis. Our results show that the pre-shopping preparation has an effect on purchasing behaviour, limiting its impulsiveness. Furthermore, price levers and communication levers influence the intention to buy impulse in the online channel, with the latter more effective than the other ones. Therefore, as this process takes place in the digital context, marketing efforts need to focus on dimensions that increase the propensity to make impulse purchases online: communicative and price stimuli.

Improving Food Choices of Elementary School Children Using Nutriscie-Card Game

Filipino children are put at risk with the increasing intake of junk foods which often resulted in health problems such as obesity, malnutrition, gastro -intestinal and urinary related illnesses such as constipation, stomach ulcers, urinary tract infection, kidney stone, and others, This Study was conducted to develop and validate a nutri- scie card game intended to foster awareness on healthy foods consumption among school children. The researcher made use of the Research and Development model by Borg and Gall with the following phases: identification of learning competencies; development of nutria scie card game; and validation of the nutri-scie card game by subject experts and experts in instructional materials development. Result of the validation revealed that Nutri-Scie Card game is highly valid. A significant improvement was noted in most food choices of the pupil respondents.

Can Food Labels Improve the Food Systems in the World?

Food systems across the world have changed from wholesome foods to fast and ultra-refined foods. This nutrition transition has contributed immensely to the rapidly increasing Non-Communicable Diseases (NCDs) such as diabetes and obesity across the globe. There is a growing need to support consumers in making healthier food choices through information, education and communication, and by targeting the market environment through food labelling. Food labels include ingredients, amounts, allergens, name of manufacturer, country of origin, date of manufacture and expiry. This article aims to raise awareness of the effectiveness of food labelling to improve the food system and, in return, combat the rising NCDs. Nutrition labelling has shown positive results in shaping consumer food choices and improving the quality of food production by food manufacturers. Unfortunately, there is a tendency for food companies to market false information about food, marketing an item to consumers as a healthy food option, when in fact, it is not.Despite increasing calls for mandatory food labelling as a policy strategy to halt the rising prevalence of NCDs, governments require clear evidence supporting the effectiveness of food labelling in improving food choices to make informed decisions. Mandatory labelling would require a strong commitment from all stakeholders, including the food industry, governments, consumer organisations and the trade industry.

Child Health Behaviour and Parent Priorities for a School-Based Healthy Lifestyle Programme.

The purpose of this study was to characterise parents' concerns for their children's health behaviours and perceptions of motivators and barriers to positive child health behaviour change, and to determine associations between motivators and barriers and parents' priorities for a school-based healthy lifestyle programme. Cross-sectional study of 46 parents who had completed an un-validated survey distributed during school-wide events. School for children aged 5-14 years in The Bronx, New York City, USA. Wilcoxon Rank Sum tests compared motivators and barriers to positive child health behaviour change by heath behaviour concern; Spearman's correlation measured associations between motivators and barriers and programme priorities. Parents concerned about child weight significantly ranked keeping up with others and decreasing clothing size as motivators, while parents concerned about child food choices significantly ranked improving food choices and decreasing BMI and clothing size as motivators. Food-, play-, and self-esteem-related motivators were associated with nutrition education (rs ≥ .41, p ≤ .01), physical activity classes (rs ≥ .29, p ≤ .04) and child involvement in programme decision-making (rs ≥ .43, p ≤ .01) priorities. Consistency-, child resistance-, and home rules-related barriers were associated with nutrition education (rs ≥ .37, p=.02), physical activity classes (rs ≥ .32, p = .02), and child involvement (rs ≥ .40, p ≤ .02) priorities. Despite the study sample size, selection bias, and generalisability limitations, prioritising nutrition, physical activity and child involvement in programme decision-making may enhance parent support for school-based healthy lifestyle programmes.

Examining Factors Driving Changes in Food Choice Behavior of Rural Households in Adola Rede District, East Guji Zone, Ethiopia

Improving nutrition across the life course from conception through adulthood is essential for the long- term well- being of families and communities and for successful economic and social advancement. A key challenge to achieving sustainable improvement in adequate food choice behavior is the limited knowledge about drivers of food choice particularly among the poor in LMIC, of which Ethiopia is one. Therefore the objective of this study is to identify factors influencing food choice behavior of rural households in Adola Rede district. Multi-stage sampling procedures were employed. Probability sampling to size and random sampling techniques were used to determine study sits, sample respondents from each study sits and draw sample respondents respectively. Survey data was collected from 150 sample respondents using interview schedule. Focus group discussions were also conducted. Descriptive statistics and ordered logit model were employed. Food choice behaviors of the rural households were categorized depending on Food Consumption Score used widely by World Food Program. Among 13 variables used in model, dependency ratio, total land holding, number of livestock owned, access to credit, education and agro- ecology were significantly related to the rural households’ food choice behavior. The food choice behaviors of the household respondents were 30% poor, 45% borderline and 25% adequate food choice behavior. An overwhelmingly, three- fourth of the respondents were found to be inappropriate food choice behavior. Therefore, local government and nongovernmental organizations should give emphasis for improving food choice behavior through continuous training, coaching, asset building and capital mobilization and improving access to different service provider institutions. Keywords: Ethiopia; drivers; food consumption score; food choice; rural households; ordered logit model DOI: 10.7176/FSQM/101-02 Publication date: September 30 th 2020

Improving Food Choices When Eating with Peers: An IMB Model-Based Weight-Loss Intervention

Abstract Objectives The aim of the study was to design and evaluate the effect of an Information-Motivation-Behavioral skills (IMB) model-based intervention to improve correct food choices during social events on body composition and eating behavior of Mexican university students under weight-loss treatment. Methods 32 students participated voluntarily on a 12-week weight-loss treatment and were randomly assigned to the intervention group or control group. The intervention group received individually a four 60-minute sessions program that provided basic nutrition information, motivational topics and skills practice about how to choose the correct type and amount of food when eating with their peers. Body composition measures, basic knowledge scores of nutrition and motivation, healthy practices and overeating levels were evaluated before and after treatment. Student's t-tests and Cohen's d test were used to assess differences and to calculate the intervention's effect on body composition. Changes in basic knowledge scores and in motivation, healthy practices and overeating levels were calculated using the Mann-Whitney U test and the Pearson contingency coefficient. Results Although average anthropometric measurements decreased from the beginning to follow-up on both groups, the intervention's effect size was “large” on Body Mass Index (BMI) and waist circumference (d = 1.15, P &amp;lt; 0.0001; d = 1.09, P &amp;lt; 0.0001), and “extremely large” on fat percentage (d = 6.79, P &amp;lt; 0.0001). At follow-up, the intervention group had a significantly lower BMI and fat percentage than the control group (P &amp;lt; 0.048; P &amp;lt; 0.050). The basic knowledge score and healthy practices levels were significantly higher in the intervention group than in the control group (P &amp;lt; 0.006; P &amp;lt; 0.032). In contrast, overeating levels were significantly lower in the intervention group than in the control group (P &amp;lt; 0.026), which corroborates improvements in eating behavior. Conclusions Findings support the use of an intervention based on the IMB model that addresses the correct food choice during social events to improve weight-loss treatment outcomes of Mexican university students. Funding Sources National Council for Science and Technology (CONACyT, by its acronym in spanish), Mexico. Facultad de Nutrición Campus Xalapa, Universidad Veracruzana, Mexico.

Cross-sectional associations between lunch-type consumed on a school day and British adolescents' overall diet quality.

Diet quality of children consuming school meals tends to be better than that of children consuming packed lunches (from home) or food bought outside school. This study investigates the association between different types of lunch consumed in a school day and diet quality of UK adolescents. A total of 2118 British adolescents were included from the National Diet and Nutrition Survey (Years 1-8; between 2008 and 2016). All participants attended school and were aged 11-18years with valid 3 or 4-day diary records and the analyses were stratified by age group (11-14 and 15-18years). The Diet Quality Index for Adolescents (DQI-A) tool consisting of three components; diet quality, diversity and equilibrium, was used to assess adherence to dietary recommendations. Overall DQI-A scores range from -33 to 100%. Overall mean DQI-A score for all adolescents was low at 21.1%. Fewer (17.4%) adolescents reported buying lunches from cafés and shops, compared to adolescents consuming cooked school meals and packed lunches (28.3% and 36.6%, respectively), and they had the lowest DQI-A% score of 14.8%. Adolescents having cooked school meals (reference group) had a higher overall DQI-A% of 21.8%. Diet quality scores of older adolescents having packed lunches and shop/café-bought lunches were 5.5% higher (CI 2.7 to 8.4%; p<0.01) and 5.0% lower (CI 8.1 to 2.0%; p<0.01) than cooked school meals respectively, after adjusting for gender, region, energy under-reporting and equivalised household income. For younger adolescents the results were attenuated particularly among packed lunch consumers. UK adolescents generally consume a poor quality diet and adolescents purchasing lunches from outside the school gates have the lowest quality diets. Unlike with older children there is little difference between school meals and packed lunches for younger children. Regulation policies on food outlets around secondary schools as well as improving food choices within school premises are needed.

Using fundraising incentives and point-of-purchase nutrition promotion to improve food choices among school families in restaurants: a pilot and feasibility study.

To assess the feasibility and efficacy of in-restaurant interventions aiming to promote healthy choices via fundraising incentives benefiting school wellness programmes and point-of-purchase nutrition promotion. Twelve schools were randomly assigned to one of the two intervention periods: Fundraising Incentive (FI) donated funds for visiting the study restaurant and Fundraising-Healthy Eating Incentive (F-HEI) included FI with additional funds given when selecting a healthier item. Both conditions included point-of-purchase nutrition promotions. Families were recruited to attend their designated intervention and complete a survey. Feasibility was assessed based on recruitment and participation, implementation fidelity and intervention acceptability. Efficacy was assessed by comparing participant receipts between intervention periods and by comparing overall restaurant sales during intervention v. two no-intervention time frames. Fast-casual restaurant in Southern California. Parents with children attending participating schools. Eighty-one families visited the restaurant during the intervention, with sixty-six completing surveys. All study activities were implemented successfully, but school family participation in the intervention was low (0·95 %). Among participants completing surveys, all indicated satisfaction with the programme. The percentage of healthier items ordered was significantly greater during both FI (χ2 = 5·97, P = 0·01) and F-HEI (χ2 = 8·84, P = 0·003) v. Comparison 2. Results were similar but did not reach statistical significance when comparing the interventions to Comparison 1. Results support potential efficacy of this programme, but more research is needed to inform feasibility. Fidelity and acceptability data supported feasibility, but participation rates were low in this initial study. Methods evaluating this intervention with a greater proportion of parents should be considered.

Compared to other front-of-pack nutrition labels, the Nutri-Score emerged as the most efficient to inform Swiss consumers on the nutritional quality of food products.

BackgroundSwitzerland, like other high-income countries, is facing a major public health challenge with the increasing burden of non-communicable diseases. Discussions are currently on-going in Switzerland regarding the implementation of a Front-of-Pack nutrition label (FoPL) as a public health measure to guide consumers towards healthier food choices, and the Nutri-Score represents an alternative supported by multiple actors. To date, no studies have investigated the performance of the Nutri-Score among Swiss consumers. This study aimed to compare the response of Swiss consumers to five FoPLs (Health Star Rating system, Multiple Traffic Lights, Nutri-Score, Reference Intakes and Warning symbol) in terms of perception and understanding of these labels and effects on food choices.MethodsIn 2019, 1,088 Swiss consumers were recruited and asked to select one product from among a set of three foods with different nutritional profiles and then classify the products within the sets according to their nutritional quality. Tasks were performed in situations without a label and then with one of the five FoPLs–depending on the group in which they were randomized–on the pack. Finally, participants were questioned on their perceptions regarding the label to which they were exposed.ResultsAll FoPLs were favorably perceived, with marginal differences between FoPLs. The Nutri-Score demonstrated the highest percentage of improvement in food choices and the highest overall performance in helping consumers rank the products according to their nutritional quality.ConclusionOverall, the Nutri-Score was the most efficient FoPL in informing Swiss consumers of the nutritional quality of food products, and as such could be a useful tool to improve food choices and reduce the burden of chronic diseases in Switzerland.

Are Minority Serving Institutions Contributing to Unhealthy Eating and Health Disparities Among College Students: A Pilot Study

Dietary habits are developed through a combination of biological, environmental, socioeconomic, and psychosocial factors. However, these dietary habits can also be influenced by access and education. College undergraduate years are important for the development of life skills including the ability to select nutritious meals. This is of vital importance for students who are from communities that are classified as food desserts and food swamps, where positive nutrition behaviors may not be supported. The purpose of this pilot study was to assess the food options at two minority serving institutions in New Jersey to determine the amount of healthy options available. A content analysis was completed by assessing the menus of the selected dining services at the respective institutions and determining their health impact. Twenty-seven food establishments were analyzed. The food locations were categorized into healthy dining (7.4%), unhealthy dining (14.8%), healthy fast food (7.4%), unhealthy fast food (40.7%), healthy café (3.7%), unhealthy café (18.5%), healthy prepackaged (0%), and unhealthy prepackaged (7.4%). Healthy eateries made up 18.5% and unhealthy eateries made up 81.4% of the food offerings. This significant difference in healthy compared to unhealthy offerings is a call to action to improve food choices on the campuses of minority serving institutions. Chronic diseases continue to impact people of younger ages and contribute to health disparities. Colleges have a unique opportunity to positively influence the lifestyle behaviors that can decrease these chronic disease rates. Future studies should investigate the food options at minority serving institutions throughout the United States.