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To estimate the potential health benefits from the reduction in consumption of salt and sugar following the introduction of a proposed tax on salt and sugar in the United Kingdom (UK).
Design:
Epidemiological modelling study. Life table modelling was used to estimate the expected population health benefits from the reduction in consumption of salt and sugar for four scenarios, each reflecting different manufacturer and consumer responses the proposed tax. Relative risks for twenty-four disease–risk pairs were applied, exploring different pathways between salt and sugar consumption, and mortality and morbidity.
Setting:
UK.
Participants:
Population of the UK.
Results:
The results show that life expectancy in the UK could be increased by 1·7 (0·3–3·6) to 4·9 (1·0–9·4) months, depending on the degree of industry and consumer response to the tax. The tax could also lead to up to nearly 2 (0·4–3·6) million fewer cases of preventable chronic diseases and an increase of as much as 3·5 (0·8–6·4) million years of life gained. The largest health benefits would accrue from reduced mortality and morbidity from CVD.
Conclusions:
Significant benefits to population health could be expected from extending the current tax on sugar-sweetened beverages to other sugary foods and from adding a tax on foods high in salt. The proposed dietary changes are likely to be insufficient to reach national public health targets; hence, additional measures to reduce the burden of chronic disease in the UK will be equally critical to consider.
College students gain a considerable amount of weight by consuming unhealthy food. Many universities adopt costly programs to alleviate this problem. We study the effect of a simple, inexpensive option: moving unhealthy items out of sight. The opportunity to investigate this intervention comes from the decision of a dining hall in the University of New Hampshire that relocated cookies from a main section in plain sight to an out-of-the way corner. The cost of cookies did not change, since the dining hall operates as an “all that you can eat” restaurant. Relative to pizza, a product that did not change location, the consumption of cookies dropped by up to 22% relative to their predicted level had the relocation not taken place. We see this as evidence that simple changes in design can nudge students towards healthy eating.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
The rapid development of information and communication technologies since the 1990s has had far-reaching impacts on health behaviours and healthcare. There are many opportunities for Lifestyle Medicine. The Gartner Hype Cycle offers a useful model to understand the adoption stages of technologies such as wearable activity trackers and telemedicine in Lifestyle Medicine. Technology can enhance mental wellbeing, social connections, physical activity, healthy eating, sleep quality, and harm reduction.
However, technology use also poses risks, such as encouraging sedentary behaviours, social isolation, and digital exclusion. Data analysis in technology can be challenging, and ensuring cybersecurity and commercial surveillance protection is essential. Technology can help deliver personalised interventions that match patient needs. Technology can also provide holistic health support to patients beyond traditional consultations.
We evaluated the impact of an established nutrition education intervention, ‘PhunkyFoods’ on food literacy, cooking skills and fruit and vegetable intake in primary school aged children.
Design:
A pre-registered cluster randomised controlled trial was used; the intervention group received the ‘PhunkyFoods’ programme and the wait-list control group received the usual school curriculum. Primary outcomes measured were differences in food literacy and cooking skills scores between the intervention and control arms after 12 months adjusted for baseline values.
Setting:
The trial was undertaken in twenty-six primary schools in North Yorkshire, UK.
Participants:
631 children aged 6–9 years participated (intervention n 307, control n 324) through assemblies, classroom activities and after-school clubs.
Results:
There were no significant effects of the intervention compared with control on food literacy, cooking skills, vegetable intake or fruit intake. Adjusting for baseline, the Food Literacy Total Score was 1·13 points lower in the intervention group than the control (95 % CI –2·87, 0·62, P = 0·2). The Cooking Skills Total Score was 0·86 lower in the intervention group compared with the control (95 % CI = –5·17, 3·45, P = 0·69). Girls scored 2·8 points higher than boys in cooking skills across the sample (95 % CI = 0·88, 4·82, P < 0·01).
Conclusion:
The intervention did not result in improved food literacy or cooking skills, though sex effects on these outcomes were observed. More practical food preparation hours are needed in primary schools to improve the likelihood of an effect on outcomes.
Australian children fall short of national dietary guidelines with only 63 % consuming adequate fruit and 10 % enough vegetables. Before school care operates as part of Out of School Hours Care (OSHC) services and provides opportunities to address poor dietary habits in children. The aim of this study was to describe the food and beverages provided in before school care and to explore how service-level factors influence food provision.
Design:
A cross-sectional study was conducted in OSHC services. Services had their before school care visited twice between March and June 2021. Direct observation was used to capture food and beverage provision and child and staff behaviour during breakfast. Interviews with staff collected information on service characteristics. Foods were categorised using the Australian Dietary Guidelines, and frequencies were calculated. Fisher’s exact test was used to compare food provision with service characteristics.
Setting:
The before school care of OSHC services in New South Wales, Australia.
Participants:
Twenty-five OSHC services.
Results:
Fruit was provided on 22 % (n 11) of days and vegetables on 12 % (n 6). Services with nutrition policies containing specific language on food provision (i.e. measurable) were more likely to provide fruit compared with those with policies using non-specific language (P= 0·027). Services that reported receiving training in healthy eating provided more vegetables than those who had not received training (P= 0·037).
Conclusions:
Before school care can be supported to improve food provision through staff professional development and advocating to regulatory bodies for increased specificity requirements in the nutrition policies of service providers.
Orthorexia has been widely studied, but recently, a new conceptualisation was proposed to distinguish its healthy characteristics from its pathological ones. The objective of this study was to differentiate healthy orthorexia (HeOr) from orthorexia nervosa (OrNe) by exploring their sociodemographic, psychological, health and dietary characteristics using comparative and correlational statistical methods.
Design:
Cross-sectional analysis. Participants completed an online, self-administered questionnaire assessing their sociodemographic characteristics, orthorexia, exercise dependence, personality, health anxiety, food choice motives, emotional competences and eating disorders (ED).
Setting:
Data were collected between May 2021 and September 2022.
Participants:
1515 French females (meanage = 37·67). Responses from men were excluded.
Results:
While OrNe was mainly associated with weight control motives in food choices (r = 0·42), HeOr was more strongly correlated with natural content (r = 0·60) and health motives (r = 0·49). In relation to exercising, OrNe showed its highest association with weight control (r = 0·41). Health anxiety was more strongly associated with OrNe than with HeOr. Both OrNe and HeOr were related to diet adherence and regular exercise, but the association was stronger for the latter. Orthorexia scores, mainly OrNe, were higher in participants at the risk of ED. Participants who were afraid to gain weight showed higher OrNe scores.
Conclusions:
HeOr seems to be part of a healthy lifestyle in general. In contrast, OrNe falls into the category of an ED and is associated with more problematic psychological functioning. Particular attention should be given to individuals who are beginning to control and reduce their food intake to prevent them from developing OrNe.
This study aims to develop a nutrition education intervention to promote healthy eating, and to evaluate the effectiveness of this intervention on healthy eating knowledge, attitude and behaviour among elementary students. A quasi-experimental study was conducted in two elementary schools in Taiwan. The intervention course design included simulation videos, lectures, and the after-school learning worksheet designed for parental involvement. A total of 4 courses along with 4 simulation videos were given to the intervention group. The four course themes were Sugar patrol, Balanced Diet during the Mid-Autumn Festival, Rainbow Fruit and Vegetables, and Smart Dine Out. The study recruited 35 3rd grade students for the intervention group and 30 for the control group. Data were collected from the pre- and post-test questionnaires. The nutrition intervention had significant effects on improving participants’ knowledge about tips for making healthy choices and the necessity of balanced diet, and on attitude toward healthy eating. There was no significant improvement in participants’ healthy eating behaviours. This nutrition education intervention, which utilized simulation videos and encouraged parental involvement, could be recommended for teaching practice in elementary schools to improve healthy eating knowledge and attitude among students.
The purpose of this study was to examine the dissemination of the healthy eating component of Appetite to Play at scale using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.
Design:
The Appetite to Play capacity-building intervention is a set of evidence-informed implementation strategies aimed at enhancing the adoption of recommended practices for promoting healthy eating and active play in early years settings. The evaluation was pragmatic, employing both quantitative (surveys) and qualitative (interviews) data collection.
Setting:
The Appetite to Play intervention was delivered through in-person community-based workshops, virtual workshops, asynchronous e-learning and online resources.
Participants:
We received completed surveys from 1670 in-person workshop participants (96 % female), and twenty-three (all female) survey respondents also participated in a telephone interview. Approximately two-thirds of all participant groups were certified early childhood educators.
Results:
Results indicated that Appetite to Play had high reach (25 867 individual website visits, 195 workshops delivered), effectiveness (significant increases in care provider’s knowledge, confidence (P < 0·05) and high post-intervention intention to implement), adoption (11 % of educators in BC trained) and implementation (good alignment with implementation strategies and current practices), with a significant maintenance plan to support the intervention’s future success.
Conclusions:
An evidence-based capacity-building intervention with an emphasis on training and provision of practical online resources can improve early years providers’ knowledge, confidence and intention to implement recommended practices that promote healthy eating. Further research is needed to determine the impact on child-level outcomes and how parents can be supported in contributing to positive food environments.
The current food system is unsustainable. It encourages unhealthy food choices, increasing the risk of non-communicable diseases, and has a substantial environmental impact, responsible for around a third of all anthropogenic greenhouse gas emissions. Improving both public and planetary health will require dietary change. To promote this transition, it is crucial to understand how consumers conceptualise healthy and sustainable eating. The aim of this review was to examine how adults from high-income countries interpret healthy and sustainable eating, with a specific focus on Ireland and the UK. As healthy eating and sustainable eating are often conceptualised as distinctive constructs, we explored each of these separately before examining how consumers perceive them together. Most consumers have a reasonable understanding of what constitutes a healthy diet, with many echoing aspects consistent with dietary guidelines. However, consumers perceptions of healthy eating often extend beyond these health-centric recommendations, incorporating concepts such as the pleasure of eating and supporting mental well-being. Sustainable eating, on the other hand, is less well understood. Most consumers overemphasise the importance of eating local, organic food and reducing packaging and underestimate or are unaware of the environmental impact of red meat consumption. These findings provide a clear opportunity to improve public awareness of healthy and sustainable diets. Moreover, they emphasise the need to promote the synergies between healthy and sustainable dietary practices. However, knowledge alone will not be enough to change behaviour. Future interventions should also seek to overcome consumers competing dietary priorities and create system-wide changes.
Healthy eating is a struggle for many families in New Zealand when they cannot adequately afford food. Statistics New Zealand has shown that the food price index rose 12.5 percent over the past year with an increase of 22 percent for fruit and vegetables prices(1). Food prices now rate as the number one concern for New Zealanders(2). To understand the changes households are making in response to increasing food prices 109 main household shoppers were surveyed. The survey was administered via Qualtrics in May/June 2023. Participants were recruited via social media and by direct email from researchers and Heart Foundation staff. Survey participants were asked about food prices, shopping behaviours and changes within specific food categories. Two thirds of the participants were female. The predominant age groups were 20-29 years (29%) and 60 and above (28%). The major ethnicities were European (53%), Pasifika (20%) and Māori (8%). Around 46% of people lived in Auckland with the next highest area being Nelson (and wider Tasman). The results showed 85% of participants expected food prices to get worse over the next year. To manage rising food prices 70% people had changed where they shopped or how they accessed food, 90% changed what they buy and 67% had changed the way they eat (e.g., cooking more at home). The most substantial changes were in the fruit and vegetable category where people changed the types purchased (73%) and purchased less (63%). In many food categories buying cheaper brands, in bulk and when foods were on special were common responses. Rationing or going without was a consistent theme highlighted with meat/poultry, eggs, fish, alcohol and more expensive snack foods. The implications for the Heart Foundation’s work include (1) reinforcing the importance of fruits and vegetables in the diet and to provide tips and tools around ingredient substitution, (2) promote alternative protein sources (e.g., beans and legumes) as an affordable ingredient and recipes to support their use and (3) supporting companies to improve the composition of cheaper brands through food reformulation. With this being a small sample size, it may not be fully generalisable to the entire population however given the survey found a high percentage of people making changes it does indicate the important role health agencies can play providing information, and advice to support people to manage high food prices.
Globally, poor nutrition is a driver of many chronic diseases and is responsible for more deaths than any other risk factor. Accordingly, there is growing interest in the direct provision of healthy foods to patients to tackle diet-linked chronic diseases and mortality.
Aim:
To assess the effect of two healthy food interventions in conjunction with nutrition counseling and education on select chronic disease markers, food insecurity, diet quality, depression, and on self-efficacy for healthy eating, healthy weight, and chronic disease management.
Methods:
This parallel-arm quasi-randomized control trial will be conducted between January 2022 and December 2023. Seventy adult patients recruited from a single academic medical center will be randomly assigned to receive either: i) daily ready-made frozen healthy meals or ii) a weekly produce box and recipes for 15 weeks. Participants will, additionally, take part in one individual nutrition therapy session and watch videos on healthy eating, weight loss, type 2 diabetes, and hypertension. Data on weight, height, glycated hemoglobin, blood pressure, and diabetes and blood pressure medications will be collected in-person at the baseline visit and at 16 weeks from baseline and via medical chart review at six months and 12 months from enrollment. The primary outcome of the study is weight loss at 16 weeks from baseline. Pre- and post-intervention survey data will be analyzed for changes in food insecurity, diet quality, depression, as well as self-efficacy for health eating, healthy weight, and chronic disease management. Through retrospective chart review, patients who received standard of care will be matched to intervention group participants as controls based on body mass index, type 2 diabetes, and/or hypertension.
Findings:
By elucidating the healthy food intervention with better health outcomes, this study aims to offer evidence that can guide providers in their recommendations for healthy eating options to patients.
Early childhood education and care (ECEC) is a recommended setting for the delivery of health eating interventions ‘at scale’ (i.e. to large numbers of childcare services) to improve child public health nutrition. Appraisal of the ‘scalability’ (suitability for delivery at scale) of interventions is recommended to guide public health decision-making. This study describes the extent to which factors required to assess scalability are reported among ECEC-based healthy eating interventions.
Design:
Studies from a recent Cochrane systematic review assessing the effectiveness of healthy eating interventions delivered in ECEC for improving child dietary intake were included. The reporting of factors of scalability was assessed against domains outlined within the Intervention Scalability Assessment Tool (ISAT). The tool recommends decision makers consider the problem, the intervention, strategic and political context, effectiveness, costs, fidelity and adaptation, reach and acceptability, delivery setting and workforce, implementation infrastructure and sustainability. Data were extracted by one reviewer and checked by a second reviewer.
Setting:
ECEC.
Participants:
Children 6 months to 6 years.
Results:
Of thirty-eight included studies, none reported all factors within the ISAT. All studies reported the problem, the intervention, effectiveness and the delivery workforce and setting. The lowest reported domains were intervention costs (13 % of studies) and sustainability (16 % of studies).
Conclusions:
Findings indicate there is a lack of reporting of some key factors of scalability for ECEC-based healthy eating interventions. Future studies should measure and report such factors to support policy and practice decision makers when selecting interventions to be scaled-up.
Although customer support is critical to the wider uptake of nudging strategies to promote fruits and vegetables (FV) in institutional food service (FS) settings, empirical research is sparse and typically based on small convenience samples. An online survey was conducted to assess support, perceived effectiveness and intrusiveness of nine nudge types drawn from Münscher et al.'s Taxonomy of Choice Architecture. We focused on the setting of campus FSs across Canada. A national sample of post-secondary students regularly using campus FSs was used (N 1057). Support for changing the range of options (B3) was the highest, closely followed by changing option-related effort (B2) and changing option-related consequences (B4). Facilitating commitment (C2), changing default (B1) and providing a social reference point (A3) received lowest support. Furthermore, we extracted three clusters of respondents based on perceived effectiveness and intrusiveness of nudge types. Characterised by a relatively low level of perceived effectiveness and moderately high level of intrusiveness, Cluster 1 (61⋅7 % of the sample) reported the lowest support for nudges. Cluster 2 (26⋅6 %), characterised by intermediate effectiveness and low intrusiveness of nudging, reported a high level of support for nudges. Lastly, Cluster 3 (11⋅7 %), characterised by high perceived effectiveness of as well as high perceived intrusiveness, reported the highest level of support for nudges. Findings confirm overall support for FV nudging, with significant differences across nudge types. Differences in customers’ acceptance and perception across nudge types offer campus FS operators initial priors in selecting nudges to promote FV.
The Supplemental Nutrition Assistance Program-Education identified food pantries as a targeted setting for policy, system, and environmental (PSE) interventions to promote healthy eating among households who rely on pantries to supplement their food needs. The present study sought to identify factors influencing capacity and readiness to implement healthy eating PSE interventions in food pantries. Qualitative interviews were conducted via zoom with twenty-six community residents with experience receiving SNAP benefits and twelve SNAP-Ed staff in rural and urban counties in Ohio to identify themes and indicators related to community/organisational capacity and readiness to implement healthy eating PSE interventions in food pantries. Themes and related indicators generated based on inductive and deductive coding of interview transcripts were prioritised and weighted by eleven community nutrition experts during a virtual consensus conference. Five themes emerged; expert-derived weights (scaled low, 0 to high, 1) reflect the perceived importance of each to implementation of healthy eating PSE interventions in food pantries: food pantry capacity and logistics [0⋅252], networks and relationships [0⋅228], community nutrition practitioner capacity [0⋅212], food pantry user characteristics [0⋅156], and stigma and stereotypes [0⋅1⋅52]. Overall, seventeen indicators were identified reflecting these themes. Successful and sustained PSE interventions at food pantries will require a tailored approach that considers food pantries’ capacity, needs and opportunities within the community, and capacity of community nutrition practitioners. The themes and indicators identified provide guidance for responsive PSE approaches in food pantries that meet communities where they are.
The objective of the present study was to examine associations between variables of COVID-19-related concerns and changes in fruit and vegetable (FV) consumption among a sample of participants from the Brighter Bites program at risk for food insecurity. Cross-sectional data were collected during April–June 2020 using a rapid-response survey to understand social needs, COVID-19-related concerns and diet-related behaviours among families with children participating in Brighter Bites (n 1777) in the 2019–2020 school year at risk for food insecurity, within the surrounding Houston, Dallas, Austin, Texas area; Southwest Florida; Washington, D.C., United States. Of the 1777 respondents, 92 % of households reported being at risk for food insecurity. Among those from food insecure households, the majority were of Hispanic/Mexican-American/Latino (84⋅1 %) ethnic background, predominantly from Houston, Texas (71⋅4 %). During the pandemic, among individuals from food insecure households, 41 % (n 672) reported a decrease in FV intake, 32 % (n 527) reported an increase in FV intake, and 27 % (n 439) reported no change in FV intake. Those who reported concerns about financial stability had a 40 % greater risk of decreased FV intake compared to those not concerned about financial stability (RR 1⋅4; 95 % CI 1⋅0, 2⋅0; P = 0⋅03). The present study adds to this current body of sparse literature on how the initial phase of the pandemic impacted FV consumption behaviours among food insecure households with children. Effective interventions are needed to diminish the negative impact of COVID-19 on the population's health.
Three studies examine the effect of limited availability on the engagement, consumption, and choice behavior of four- to five-year old children. It is shown that children engage longer in an activity when the activity is presented as limited in time and consume more of a particular food when the food is presented as limited in quantity. It is also shown that the consumption ratio of a less preferred food to a more preferred one increases when the less preferred food is presented as limited in quantity. Finally, children are more likely to choose a less preferred option over a more preferred one when the less preferred option becomes less available.
Metabolic dysfunction and excess accumulation of adipose tissue are detrimental side effects from breast cancer treatment. Diet and physical activity are important treatments for metabolic abnormalities, yet patient compliance can be challenging during chemotherapy treatment. Time-restricted eating (TRE) is a feasible dietary pattern where eating is restricted to 8 h/d with water-only fasting for the remaining 16 h. The purpose of this study is to evaluate the effect of a multimodal intervention consisting of TRE, healthy eating, and reduced sedentary time during chemotherapy treatment for early-stage (I–III) breast cancer on accumulation of visceral fat (primary outcome), other fat deposition locations, metabolic syndrome and cardiovascular disease risk (secondary outcomes) compared with usual care. The study will be a two-site, two-arm, parallel-group superiority randomised control trial enrolling 130 women scheduled for chemotherapy for early-stage breast cancer. The intervention will be delivered by telephone, including 30–60-minute calls with a registered dietitian who will provide instructions on TRE, education and counselling on healthy eating, and goal setting for reducing sedentary time. The comparison group will receive usual cancer and supportive care including a single group-based nutrition class and healthy eating and physical activity guidelines. MRI, blood draws and assessment of blood pressure will be performed at baseline, after chemotherapy (primary end point), and 2-year follow-up. If our intervention is successful in attenuating the effect of chemotherapy on visceral fat accumulation and cardiometabolic dysfunction, it has the potential to reduce risk of cardiometabolic disease and related mortality among breast cancer survivors.
The COVID-19 pandemic changed early care and education (ECE) mealtimes. Feeding practices that support children’s emerging autonomy may support children’s healthy eating, but it is unknown whether and how COVID-19 changed feeding practices. This paper describes caregiver feeding practices in ECE centres in Florida during COVID-19.
Design:
A mixed-methods design was used to understand mealtime feeding practices. Survey and interview questions were developed based on the Trust Model. More than 7000 surveys were sent to ECE centres. Analysis included descriptive statistics for survey data and thematic analysis for interview data.
Setting:
This statewide study included teachers in all licensed and license-exempt ECE centres.
Participants:
Four hundred and thirty-one teachers completed a survey, and twenty-nine participated in follow-up interviews.
Results:
Surveys showed most teachers engaged in autonomy-supportive behaviours, such as letting children eat until they were finished (90 %). The most common controlling behaviour was praising children for cleaning their plates (70 %). The most common responses about changes to mealtimes were keeping physical distance and serving healthy food. Interview themes were Autonomy Support, Controlling Feeding Practices, Interactions are the Same, Interactions are Different, Physical Distancing and Healthy Eating.
Conclusions:
Mealtimes are a central part of the day for young children and teachers in ECE environments. COVID-19 continues to influence ECE routines as behaviour change remains the primary method of reducing the risk of COVID-19 in the absence of a vaccine for young children. Understanding teachers’ practices and perspectives is important for reducing the risk of COVID-19 and supporting children’s autonomy and healthy eating.
The consumption of vegetables is vitally important for children’s health and development. However, in many Westernised countries, most children do not eat sufficient quantities of vegetables and consume many energy-dense and high-sugar foods; a health behaviour associated with the onset of non-communicable diseases. To address this important public health concern, it is necessary to think ‘outside the box’ and consider innovative and pragmatic ways to increase children’s daily vegetable intake. In many countries, caregivers implementing best-practice child feeding methods typically offer children vegetables at lunch, dinner and for snacks. It is unusual for children to be routinely offered vegetables for breakfast, yet there is no nutritional, physiological or medical reason why vegetables should not be eaten at breakfast. Indeed, in some countries, children frequently consume vegetables for breakfast. Increasing children’s exposure to vegetables at breakfast from an early age would allow for the development of a positive association between eating vegetables and breakfast, thus providing another opportunity in the day where vegetables might be regularly consumed by children. In this paper, we propose a rationale for why vegetables should be routinely offered to young children at breakfast time in countries where this may not be the norm. Future research assessing the feasibility and acceptability of such a public health intervention would provide health policy agencies with evidence about a potentially effective and easily implementable approach for increasing children’s vegetable intake, thus improving their overall nutritional status, as well as their heath and development.