Informed choice or guessing game? Understanding caregivers' perceptions and use of infant formula labelling.

OBJECTIVE: Although breast-feeding is the recommended way to feed an infant, a safe and nutritious substitute for breast milk is needed for infants who are not breast-fed. Labelling information on infant formula (IF) products aims to enable caregivers (who have already made the decision to use IF) to make informed product choices. Yet, there is limited data on how caregivers understand and use the information provided on IF packaging. The present study aimed to increase understanding of caregivers' interpretation and use of the following label elements on IF products: the nutrition information statement; the ingredients list; and statements around nutrition content and health claims. DESIGN: Qualitative data were obtained from twenty-one focus group discussions. To enable comparison of findings by education level and ethnicity, focus group participants were homogeneous with respect to educational attainment (Australian groups) or ethnic background (New Zealand groups). SETTING: Focus groups were conducted in metropolitan and regional areas of Australia and New Zealand.ParticipantsCaregivers (n 136) of formula-fed infants. RESULTS: Framework analysis revealed that caregivers commonly experience difficulties when using labelling information, particularly when trying to identify and understand key differences between products. Moreover, comparing products can be a complex task regardless of education level and ethnicity. CONCLUSIONS: Further research is required to determine the most effective strategies for meeting information needs of caregivers and allowing easier identification and understanding of product differences. This is especially important given that the vast range of IF products across large price ranges in the market adds to the complexity of purchase decisions.

Non-dieting group interventions for overweight and obese women: what predicts non-completion and does completion improve outcomes?

OBJECTIVE: To determine factors which predict non-completion of group non-dieting interventions for overweight women, and to investigate whether completion improves outcomes. DESIGN: First, baseline predictors of non-completion were identified; then changes at 10 weeks and 12 months were compared between completers and non-completers of 10-week non-dieting interventions. SETTING: General community. SUBJECTS: Participants were 119 women (aged 25-65 years, BMI > or = 28 kg/m2) with at least one cardiovascular risk factor. Participants who attended at least eight of the ten sessions were classified as completers, and non-completers were those who attended fewer than eight sessions. Measures included BMI, blood pressure, psychological distress, lifestyle behaviours and eating self-efficacy. RESULTS: Logistic regression analyses indicated that women were less likely to be non-completers at non-dieting group programmes if, at baseline, they were more highly educated or had healthier nutrition behaviours (controlling for education). Only healthier nutrition behaviour was negatively associated with non-completion in the final model. Twelve months after the intervention, completers showed significantly greater improvements in body weight (mean change -0.53 kg), systolic and diastolic blood pressure (-6.3 and -4.1 mmHg, respectively), stress management behaviour score (+0.5) and psychotic symptoms score (-0.1) than non-completers (all P < 0.05). CONCLUSIONS: Highly educated women already engaging in some healthier lifestyle choices were less likely to be non-completers in non-dieting group programmes. Since important treatment outcomes vary according to attendance, future trials of non-dieting interventions should report the effects of completion on outcomes.

Sustainability of health and lifestyle improvements following a non-dieting randomised trial in overweight women.

OBJECTIVE: To compare three non-dieting interventions that focused on lifestyle change rather than weight loss, in terms of the sustainability of improvements in lifestyle behaviors, psychological well-being and medical symptoms at 2 years. METHOD: In Dunedin, New Zealand in 2002/2003, 225 obese/overweight women (BMI > or = 28; 25-68 years) participated in a randomised, intention-to-treat trial comparing two group programs (P1, P2) and a self-guided mail-delivered program (P3). Only P1 included intensive relaxation response training. All three non-dieting interventions involved a 10-week program, followed by an eight-month support phase. Participants completed baseline, 1-year and 2-year assessments. Outcomes included behavioral, psychological and medical symptom measures and a composite success score. RESULTS: 118 participants completed the 2-year follow-up. Only among P1 participants were the reductions in psychological distress and medical symptoms achieved at 1 year, also maintained at 2 years. At 2 years, P1 participants had significantly greater increases in stress management behaviors than those in P2 (p<0.05), and significantly greater success scores than those in P3 (p<0.05). In all three programs, mean weight was unchanged at 2 years. CONCLUSION: Inclusion of relaxation response training in a healthy lifestyle program facilitates long-term maintenance of psychological and medical symptom improvements even in the absence of weight loss.

Evaluation of a "nondieting" stress reduction program for overweight women: a randomized trial.

PURPOSE: Determine if a "nondieting" intervention focused on intensive training in eliciting the relaxation response enhances health outcomes compared with nondieting interventions without such training. DESIGN: Randomized trial with follow-up at 10 weeks, 4 months, and 12 months. SETTING: General community. SUBJECTS: Total of 225 overweight and obese women with at least one other cardiovascular risk factor. INTERVENTIONS: Three 10-week nondieting interventions: a group program (P1) focused on intensive training in techniques for eliciting the relaxation response (n = 60), a group program (P2) focused on healthy eating and physical activity (n = 61), and a self-guided, mail-delivered version of P2 (P3; n = 101). MEASURES: The Revised Symptom Checklist measured psychological distress, the Medical Symptoms Checklist measured the experience of medical symptoms, and the Health-Promoting Lifestyle Profile measured a range of lifestyle behaviors. Self-efficacy for low-fat eating intuitive eating, and body mass index were also assessed. ANALYSIS: An intention-to-treat analysis was used. RESULTS: At 12 months, P1 produced statistically greater improvements in stress management behaviors and medical symptom discomfort and was the only program to significantly improve self-efficacy for low-fat eating. In P1, the effect sizes for reductions in depression (0.75) and interpersonal sensitivity (0.85) were large. At 12 months, mean weight was unchanged. CONCLUSION: Inclusion of intensive relaxation response training in a nondieting program for overweight women enhanced stress management and medical symptoms outcomes but not weight outcomes.

Food Allergen Management in Australia.

Food allergies are increasing globally, including numbers of allergens, the sensitization rate, and the prevalence rate. To protect food-allergic individuals in the community, food allergies need to be appropriately managed. This paper describes current Australian food allergen management practices. In Australia, the prevalence of food allergies, the anaphylaxis rate, and the fatal anaphylaxis rate are among the highest in the world. Interagency and stakeholder collaboration is facilitated and enhanced as Australia moves through past, current, and ongoing food allergen challenges. As a result, Australia has been a global leader in regulating the labeling of common allergens in packaged foods and their disclosure in foods not required to bear a label. Moreover, the food industry in Australia and New Zealand has developed a unique food allergen risk management tool, the Voluntary Incidental Trace Allergen Labelling program, which is managed by the Allergen Bureau. This paper summarizes insights and information provided by the major stakeholders involved to protect food-allergic consumers from any allergic reaction. Stakeholders include government; consumer protection, regulation, and enforcement agencies; the food industry; and food allergen testing and food allergen/allergy research bodies in Australia. The ongoing goal of all stakeholders in food allergen management in Australia is to promote best practice food allergen management procedures and provide a wide choice of foods, while enabling allergic consumers to manage their food allergies and reduce the risk of an allergic reaction.