Informing a roadmap for cross-sectoral collaboration on portion size management as a national strategy to improve population nutrition - a Delphi study.

BACKGROUND: Addressing food portion sizes is a key untapped opportunity to help tackle obesity. This study sought to inform the agenda of a national movement involving diverse sectors to manage portion sizes in packaged foods, restaurants, cafeterias and prepared foods in grocery stores. METHODS: A Delphi study was conducted with representatives from public health, private-sector food companies and academia that formed a panel of experts (n = 32). Three iterative rounds of surveys were administered over 3 months. The surveys gathered opinions on psychological mindsets affecting portion size choice, eating habits, portion perception and distortion, passive overconsumption and challenges and advantages of this tool to improve population nutrition. The survey also inquired about visions for a future food environment. After every round, responses were analysed and questions narrowed to reach group consensus on specific items in the subsequent round. RESULTS: Although many experts fear that portion size interventions might be perceived as paternalistic, 91% of respondents agreed stealth interventions were preferable. Seventy-three per cent of experts believed that the most impactful portion size intervention was product reformulation while smaller packages were the most effective intervention according to only 28% of experts. The majority of the panel (59%) also believed that creating an artificial stopping point in packages was the best strategy to reduce food consumption. Finally, the study found that one of the most complex aspects of establishing a multi-sector collaboration for obesity prevention was to ascertain trust in the private sector's ability to balance profit versus social responsibility.[Corrections added on 21 March 2019, after first online publication: The percentage of experts who believed that small packages were the most effective intervention has been changed from "16%" to "28%".]. CONCLUSION: This study informs the agenda of a cross-sectoral, coordinated movement to tackle obesity through a combination of changing social norms, individual behaviours and industry practices around portion size. Although cross-sectoral collaboration for non-communicable disease prevention is encouraged by different organizations, strategic efforts to define a common agenda on portion size have been limited thus far. This research highlights important strategies in portion size interventions and steps needed for the success of such a movement, as part of a wider effort across sectors and stakeholders to halt and reverse obesity rates in the USA.

Social marketing: issues for consideration.

PIP: Few social organizations have been able to incorporate all the essential components of successful marketing, namely, a customer oriented perspective, careful product development, segmented targets and programs, and an interative process of analysis, planning, implementation, and replanning. The lack of resources is part of the problem of moving forward into comprehensive social marketing. Social organizations may use marketing's 4 "Ps" -- product, price, promotion, and place, but often they must also contend with low visibility, lamentable budgets, little research, and lack of continuity. Several general problems confront marketing planners who try to transfer marketing approaches used to sell toothpaste and laundry detergent to promote concepts like family planning, smoking cessation, and nutrition. It has not been possible simply to apply commercial techniques for market analysis and segmentation or product, price, channel, and communication strategy and implementation to social programs. Evaluating program effectiveness is another area where commercial methods fail to readily apply. Contraceptive social marketing programs can point to quantifiable success measures of units sold and revenue received, but generally social marketers must gauge their longterm program objectives such as reduced fertility rates according to intermediary measures such as knowledge change or reported behavior. Currently, organizational design is being studied by several contraceptive social marketing programs. Trained marketing managers in key positions, a systematic marketing planning process, and careful monitoring and control are key program success ingredients that frequently are missing in social agencies where marketing activities and functions may not be fully understood. Many social organizations have established communication functions, but they are not conducive to the broader role that marketing must play if any significant impact is to result. Additionally, in the absence of competitive pressures found in the private sector, social organizations lack the personal accountability needed to foster the development of an effective marketing function. The challenges or problems confronting social marketing are not insurmountable. The application of the discipline for the promotion of social issues, ideas, and causes is likely to continue to grow. A need exists for a more common process of social agencies to apply marketing tools and techniques. Another need is for improved training of social marketing managers.^ieng

Marketing: (how) is it working?

PIP: This editorial examines possible reasons why marketing has not worked as well as originally projected in the nonprofit and public sectors. 4 possible barriers to effective marketing are proposed. 1st, marketing may not be an appropriate discipline for full implementation in the social sector. This may be why nonprofit managers adopt only fragments of the marketing model. 2nd, ideologically, nonprofit people tend not to be market-oriented. 3rd, nonprofit organizations often lack the financial resources for fully implemented, data based marketing, and 4th, social and nonprofit organizations' structures are not conducive to marketing. Marketing functions are often housed in public relations or communications departments of nonprofit organizations, and thus are not in a position to have a significant impact on the institution's operations. Of value would be a study team, composed of academicians and practitioners, to assess the situation and offer some solutions. The following 4 questions should be addressed: What is the general state of nonprofit/social marketing? Are there any organizations in which marketing is being fully implemented, with documented results? Are there any elements that are common to successful nonprofit marketing efforts? Can these common elements be exported so that other organizations can apply them?^ieng

Problems and challenges in social marketing.

PIP: This article reviews the problems that arise when general marketing principles are applied to social programs. Social marketing is conceptualized as the design, implementation, and control of programs seeking to increase the acceptability of a social ideal or practice in a target group. These problems can occur in 8 basic decision-making areas: market analysis, market segmentation, product strategy development, pricing strategy development, channel strategy development, communications strategy development, organizational design and planning, and evaluation. Social marketers find that they have less good secondary data about their consumers, more problems obtaining valid and reliable measures of relevant variables, more difficulty sorting out the relative influence of determinants of consumer behavior, and more problems getting consumer research funded than marketers in the commercial sector. They tend to have less flexibility in shaping their products and more difficulty formulating product concepts. Problems associated with establishing, utilizing, and controlling distribution channels comprise another major difference between social and more conventional forms of marketing. Social marketers also find that their communications options are somewhat limited as a result of problems associated with use of paid advertisements, pressures not to use certain types of appeals in their messages, and the need to communicate large amounts of information in their messages. Moreover, social marketers must function in organizations where marketing activities are poorly understood, underappreciated, and inappropriately located. Finally, they face problems trying to define effectiveness measures or estimating the contribution their program has made toward the achievement of certain objectives. If all these problems are anticipated and handled creatively, social marketing efforts can succeed.^ieng