Thinking of food: The mental representation of healthy foods as unprepared.

We find that people implicitly and explicitly represent healthy foods they categorize as healthy in their purest, least prepared forms but represent foods they categorize as unhealthy in their most prepared forms (e.g., a veggie patty is represented as frozen while a beef burger is represented in a bun with melted cheese and ready to eat). We find this effect across several studies using both image and word sorting measures in explicit tasks and implicit association tasks. The effect results from the perception of health and taste as two conflicting goals. Preparation (e.g., cooking, adding toppings) makes food more delicious, which creates categorization ambiguity. Hence, healthy food is thought of as unprepared. Indeed, individual differences in perceived health-taste goal conflict moderate the effect. Critically, the representation of healthy foods matters for food decisions. In an experiment that manipulated the descriptive language on a restaurant menu, emphasizing the preparation of foods increased participants' preference for healthy foods (with no improvement for unhealthy foods).

Emphasizing appeal over health promotes preference for nutritious foods in people of low socioeconomic status.

People of low socioeconomic status (SES) have disproportionately poorer dietary health despite efforts to improve access and highlight the health benefits of nutritious foods. While health-focused labels and advertisements make healthier options easier to recognize, they can prime a number of negative associations about healthy foods (e.g., taste, satiety, cost), which may be particularly aversive for low SES groups. This within-subjects study recruited people of low and high SES (those without and with a college degree) and compared their product expectations, experiences, satiety, and choice when consuming a bottled fruit and vegetable smoothie promoted as pleasurable ("Crave") or as healthy ("Nutralean"). Relative to Nutralean, Crave improved product expectations and behavioral measures of satiety across all participants. However, Crave enhanced expectations, experiences, and product choice more for low SES than high SES participants. Importantly, improvements were achieved without deception of nutritional facts and without decreasing perceived healthiness or increasing perceived cost. These findings identify SES as an important moderator in health-focused promotion and suggest how the rapidly growing healthy food industry can more effectively appeal to low SES groups, contexts which the majority of Americans navigate.

Language in popular American culture constructs the meaning of healthy and unhealthy eating: Narratives of craveability, excitement, and social connection in movies, television, social media, recipes, and food reviews.

Many people want to eat healthier but struggle to do so, in part due to a dominant perception that healthy foods are at odds with hedonic goals. Is the perception that healthy foods are less appealing than unhealthy foods represented in language across popular entertainment media and social media? Six studies analyzed dialogue about food in six cultural products - creations of a culture that reflect its perspectives - including movies, television, social media posts, food recipes, and food reviews. In Study 1 (N = 617 movies) and Study 2 (N = 27 television shows), healthy foods were described with fewer appealing descriptions (e.g., "couldn't stop eating"; d = 0.59 and d = 0.37, respectively) and more unappealing descriptions (e.g., "I hate peas"; d = -.57 and d = -.63, respectively) than unhealthy foods in characters' speech from the film and television industries. Using sources with richer descriptive language, Studies 3-6 analyzed popular American restaurants' Facebook posts (Study 3, N = 2275), recipe descriptions from Allrecipes.com (Study 4, N = 1000), Yelp reviews from six U.S. cities (Study 5, N = 4403), and Twitter tweets (Study 6, N = 10,000) for seven specific themes. Meta-analytic results across Studies 3-6 showed that healthy foods were specifically described as less craveworthy (d = 0.51, 95% CI: 0.44-0.59), less exciting (d = 0.40, 95% CI: 0.31-0.49), and less social (d = 0.36, 95% CI: 0.04-0.68) than unhealthy foods. Machine learning methods further generalized patterns across 1.6 million tweets spanning 42 different foods representing a range of nutritional quality. These data suggest that strategies to encourage healthy choices must counteract pervasive narratives that dissociate healthy foods from craveability, excitement, and social connection in individuals' everyday lives.

Increasing Vegetable Intake by Emphasizing Tasty and Enjoyable Attributes: A Randomized Controlled Multisite Intervention for Taste-Focused Labeling.

Healthy food labels tout health benefits, yet most people prioritize tastiness in the moment of food choice. In a preregistered intervention, we tested whether taste-focused labels compared with health-focused labels increased vegetable intake at five university dining halls throughout the United States. Across 137,842 diner decisions, 185 days, and 24 vegetable types, taste-focused labels increased vegetable selection by 29% compared with health-focused labels and by 14% compared with basic labels. Vegetable consumption also increased. Supplementary studies further probed the mediators, moderators, and boundaries of these effects. Increased expectations of a positive taste experience mediated the effect of taste-focused labels on vegetable selection. Moderation tests revealed greater effects in settings that served tastier vegetable recipes. Taste-focused labels outperformed labels that merely contained positive words, fancy words, or lists of ingredients. Together, these studies show that emphasizing tasty and enjoyable attributes increases vegetable intake in real-world settings in which vegetables compete with less healthy options.

Smart food policy for healthy food labeling: Leading with taste, not healthiness, to shift consumption and enjoyment of healthy foods.

Smart food policy models for improving dietary intake recommend tailoring interventions to people's food preferences. Yet, despite people citing tastiness as their leading concern when making food choices, healthy food labels overwhelmingly emphasize health attributes (e.g., low caloric content, reductions in fat or sugar) rather than tastiness. Here we compared the effects of this traditional health-focused labeling approach to a taste-focused labeling approach on adults' selection and enjoyment of healthy foods. Four field studies (total N = 4273) across several dining settings in northern California in 2016-2017 tested whether changing healthy food labels to emphasize taste and satisfaction rather than nutritional properties would encourage more people to choose them (Studies 1-2), sustain healthy purchases over the long-term (Study 3), and improve both the perceived taste of and mindsets about healthy foods (Study 4). Compared to health-focused labeling, taste-focused labeling increased choice of vegetables (OR = 1.73, 95% CI: 1.32, 2.26), salads (OR = 2.06, 95% CI: 1.06, 4.06), and vegetable wraps (OR = 3.09, 95% CI: 1.73, 5.65) in Studies 1-2. In Study 3, taste-focused labeling sustained vegetarian entrée purchases over a two-month period, while health-focused labeling led to a 45.1% decrease. In Study 4, taste-focused labeling significantly enhanced post-consumption ratings of vegetable deliciousness and improved mindsets about the deliciousness of healthy foods compared to health-focused labeling. These studies demonstrate that taste-focused labeling is a low-cost strategy that increased healthy food selection by 38% and outperforms health-focused labeling on multiple smart food policy mechanisms.

Psychosocial context and food healthiness in top-grossing American films.

OBJECTIVE: Healthy eating is shaped by the context. To understand how healthy eating is modeled in popular media, this systematic analysis quantified which contextual factors, character behaviors, and character demographics were associated with food healthiness in popular movies. METHOD: Two researchers content-coded the contextual factors, character behaviors, and character demographics depicted across 9,093 foods in 244 top-grossing Hollywood movies released from 1994-2018. Food healthiness was calculated using the Nutrient Profile Index (0 = least healthy, 100 = healthiest) and coder reliability was assessed. Mixed effects regression models tested whether food healthiness was associated with contextual factors (e.g., geographic locations, social consumption situations, celebrations, foreground placement), character behaviors (actual consumption, food evaluations), and character demographics. RESULTS: Confirming six preregistered hypotheses (all p < .001), foods were less healthy when they were in American versus non-American settings (95% CI: Cohen's d = .29-.39), part of social consumption situations (d = .19-.28) and celebrations (d = .04-.17), and in the foreground versus background (d = .15-.24). The foods that characters actually consumed (d = .30-.42) and evaluated positively (vs. negatively, d = .37-.76) were also less healthy. However, disconfirming a gender hypothesis, female characters did not consume healthier foods than males (d = -.11-.13, p = .45). CONCLUSIONS: Top-grossing Hollywood movies depict different contexts and different character behaviors for healthier versus less healthy foods. Research is needed to understand whether depicting healthy foods in different contexts impacts viewers' beliefs and behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Nutritional Analysis of Foods and Beverages Posted in Social Media Accounts of Highly Followed Celebrities.

Importance: Celebrity social media posts engage millions of young followers daily, but the nutritional quality of foods and beverages in such posts, sponsored and unsponsored, is unknown. Objective: To quantify the nutritional quality of foods and beverages depicted in social media accounts of highly followed celebrities and assess whether nutritional quality is associated with post sponsorship, celebrity profession or gender, and followers' likes and comments. Design, Setting, and Participants: This cross-sectional study analyzed the content of food- and beverage-containing posts from Instagram (a photo- and video-sharing social media platform) accounts of 181 highly followed athletes, actors, actresses, television personalities, and music artists. Data were collected from May 2019 to March 2020. Main Outcomes and Measures: The nutritional quality of foods and beverages posted in celebrity social media accounts was rated using the Nutrient Profile Index (NPI) based on the sugar, sodium, energy, saturated fat, fiber, protein, and fruit and/or vegetable content per 100-g sample (a score of 0 indicated least healthy and 100, healthiest); foods with scores less than 64 and beverages with scores less than 70 were rated as "less healthy." Secondary outcomes were whether the nutritional quality of foods and beverages in social media posts was associated with post sponsorship, celebrity profession or gender, and followers' likes and comments. Mixed-effects regression models were used to estimate how outcomes differed across fixed effects. Results: The sample included social media accounts of 181 celebrities (66 actors, actresses, and television personalities [36.5%]; 64 music artists [35.4%]; and 51 athletes [28.2%]). A total of 102 celebrities (56.4%) were male, and the median age was 32 years (range, 17-73 years). Among 3065 social media posts containing 5180 total foods and beverages (2467 foods [47.6%]; 2713 beverages [52.4%]), snacks and sweets (920 [37.3%] of the foods) and alcoholic beverages (1375 [50.7%] of the beverages) were most common. Overall, 158 celebrity social media accounts (87.3%) earned a less healthy overall food nutrition score and 162 (89.5%) earned a less healthy overall beverage nutrition score, which would be unhealthy enough to fail legal youth advertising limits in the UK. For foods, social media posts with healthier nutrition scores were associated with significantly fewer likes (b, -0.003; 95% CI, -0.006 to 0.000; P = .04) and comments (b, -0.006; 95% CI, -0.009 to -0.003; P < .001) from followers. For beverages, nutrition scores were not significantly associated with likes (b, -0.010; 95% CI, -0.025 to 0.005; P = .18) or comments (b, -0.003; 95% CI, -0.022 to 0.016; P = .73). Only 147 food- or beverage-containing posts (4.8%) were sponsored by food- or beverage-relevant companies. Beverages in sponsored posts contained more than twice as much alcohol as those in nonsponsored posts (10.8 g [95% CI, 9.3 g to 12.3 g] per 100 g of beverage vs 5.3 g [95% CI, 4.7 g to 5.9 g] per 100 g of beverage). Conclusions and Relevance: In this cross-sectional study, most highly followed celebrity social media accounts depicted an unhealthy profile of foods and beverages, primarily in nonsponsored posts. These results suggest that influential depictions of unhealthy food and beverage consumption on social media may be a sociocultural problem that extends beyond advertisements and sponsorships, reinforcing unhealthy consumption norms.

Can Exercising and Eating Healthy Be Fun and Indulgent Instead of Boring and Depriving? Targeting Mindsets About the Process of Engaging in Healthy Behaviors.

This paper investigates mindsets about the process of health behaviors-the extent to which people associate physical activity and healthy eating with appealing (pleasurable, fun, indulgent) versus unappealing (unpleasant, boring, depriving) qualities-to promote greater engagement. Study 1 (N = 536) examined how mindsets about physical activity and healthy eating relate to current and future health behavior. Study 2 (N = 149) intervened in actual fitness classes to compare the effects of brief appeal-focused and health-focused interventions on mindsets about physical activity and class engagement. Study 3 (N = 140) designed nutrition education classes that emphasized either the appeal or the importance of fruits and vegetables for health and compared its effects on mindsets about healthy eating and actual fruit and vegetable consumption. Holding more appealing mindsets about health behaviors predicts subsequent physical activity and healthy eating (Study 1). An intervention targeting mindsets about the appeal of physical activity promotes greater participation in fitness classes than emphasizing the importance of meeting activity guidelines (Study 2). Meanwhile, interventions targeting mindsets about the appeal of healthy eating increases in-class fruit and vegetable selection more than emphasizing the importance of eating nutritious foods (Study 3), however additional work is needed to sustain such changes in eating behavior. These studies suggest mindsets about the process of health behaviors can be influential and changeable factors in motivating physical activity and healthy eating.

Nutritional Analysis of Foods and Beverages Depicted in Top-Grossing US Movies, 1994-2018.

Importance: Many countries now restrict advertisements for unhealthy foods. However, movies depict foods and beverages with nutritional quality that is unknown, unregulated, and underappreciated as a source of dietary influence. Objective: To compare nutritional content depicted in top-grossing US movies with established nutrition rating systems, dietary recommendations, and US individuals' actual consumption. Design and Setting: In this qualitative study, a content analysis was performed from April 2019 to May 2020 of the 250 top-grossing US movies released from 1994 to 2018. Main Outcomes and Measures: The proportion of movies with less healthy nutrition ratings using the Nutrient Profile Index, the proportion of movies with medium or high food nutrition ratings according to the United Kingdom's "traffic light" guidelines (in which green is low and indicates the healthiest foods; amber, medium; and red is high and indicates the least healthy foods), and how the movie-depicted nutritional content compared with US Food and Drug Administration-recommended daily levels and US individuals' actual consumption according to National Health and Nutrition Examination Survey 2015-2016 data. Secondary outcomes compared branded and nonbranded items and tested whether outcomes changed over time or for movies targeting youths. Results: Across 9198 foods and 5748 beverages, snacks and sweets (2173 [23.6%]) and alcoholic beverages (2303 [40.1%]) were most commonly depicted. Alcohol comprised 23 of 127 beverages (18.1%) in G-rated movies, 268 of 992 beverages (27.0%) in PG-rated movies, 1503 of 3592 beverages (41.8%) in PG-13-rated movies, and 509 of 1037 beverages (49.1%) in R-rated movies. Overall, 178 of 245 movies (72.7%) earned less healthy Nutrient Profile Index food ratings and 222 of 246 movies (90.2%) earned less healthy beverage ratings, which would be unhealthy enough to fail legal limits for advertising to youths in the United Kingdom. Among foods, most movies depicted medium or high (amber or red traffic light) levels of sugar (229 of 245 [93.5%]), saturated fat (208 of 245 [84.9%]), total fat (228 of 245 [93.1%]), and, to a lesser extent, sodium (123 of 245 [50.2%]). Only 1721 foods and beverages (11.5%) were visibly branded, but branded items received less healthy nutrition ratings than nonbranded items. Overall, movies failed recommended levels of saturated fat per 2000 kcal by 25.0% (95% CI, 20.6%-29.9%), sodium per 2000 kcal by 3.9% (95% CI, 0.2%-7.9%), and fiber per 2000 kcal by 45.1% (95% CI, 42.9%-47.0%). Movies also depicted 16.5% (95% CI, 12.3%-21.0%) higher total sugar content per 2000 kcal and 313% (95% CI, 298%-329%) higher alcohol content per 2000 kcal than US individuals consume. Neither food nor beverage nutrition scores improved over time or among movies targeting youths. Conclusions and Relevance: This study suggests that popular US movies depict an unhealthy diet that fails national dietary recommendations, akin to US individuals' actual diets. Depicting unhealthy consumption in media is a sociocultural problem that extends beyond advertisements and branded product placements.

Five-star prices, appealing healthy item descriptions? Expensive restaurants' descriptive menu language.

Objective: Prior research shows that America's top-selling inexpensive casual dining restaurants use less appealing language to describe healthy menu items than standard items. This may suggest to diners that healthy options are less tasty and enjoyable. The present research asked whether expensive restaurants also use less appealing language to describe healthy items, or whether healthy items are described with equally appealing language as standard items in high status dining contexts. Method: Using Yelp, the name and description of every food item were recorded from the menus of 160 top-rated expensive restaurants across 8 U.S. cities (Nitems = 3,295; Nwords = 32,516). Healthy menu items were defined as salads and side vegetables, and standard items as all other dishes (excluding desserts), with high interrater reliability (K = .89). Descriptive words were categorized into 22 predefined themes, and log likelihood analyses compared normalized theme frequencies from standard item and healthy item descriptions. Results: Healthy items were described with 4.8-times fewer American region words, 2.7-times fewer exciting words, 1.4-times fewer tasty words, and significantly fewer portion size, spicy, artisanal, and foreign region words. Unlike inexpensive restaurants, however, expensive restaurants did not use any health-focused themes to promote healthy items and used several appealing themes more frequently in healthy item descriptions. Conclusions: Like inexpensive restaurants, expensive American restaurants described healthy items as less appealing and less authentically American than standard foods, but to a lesser extent. Implications for ordering behavior and solutions for improving the appeal of healthy menu items are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Correction: Catechol-O-Methyltransferase moderates effect of stress mindset on affect and cognition.

[This corrects the article DOI: 10.1371/journal.pone.0195883.].

Learning one's genetic risk changes physiology independent of actual genetic risk.

Millions of people now access personal genetic risk estimates for diseases such as Alzheimer's, cancer and obesity1. While this information can be informative2-4, research on placebo and nocebo effects5-8 suggests that learning of one's genetic risk may evoke physiological changes consistent with the expected risk profile. Here we tested whether merely learning of one's genetic risk for disease alters one's actual risk by making people more likely to exhibit the expected changes in gene-related physiology, behaviour and subjective experience. Individuals were genotyped for actual genetic risk and then randomly assigned to receive either a 'high-risk' or 'protected' genetic test result for obesity via cardiorespiratory exercise capacity (experiment 1, N = 116) or physiological satiety (experiment 2, N = 107) before engaging in a task in which genetic risk was salient. Merely receiving genetic risk information changed individuals' cardiorespiratory physiology, perceived exertion and running endurance during exercise, and changed satiety physiology and perceived fullness after food consumption in a self-fulfilling manner. Effects of perceived genetic risk on outcomes were sometimes greater than the effects associated with actual genetic risk. If simply conveying genetic risk information can alter actual risk, clinicians and ethicists should wrestle with appropriate thresholds for when revealing genetic risk is warranted.

Catechol-O-Methyltransferase moderates effect of stress mindset on affect and cognition.

There is evidence that altering stress mindset-the belief that stress is enhancing vs. debilitating-can change cognitive, affective and physiological responses to stress. However individual differences in responsiveness to stress mindset manipulations have not been explored. Given the previously established role of catecholamines in both placebo effects and stress, we hypothesized that genetic variation in catechol-O-methyltransferase (COMT), an enzyme that metabolizes catecholamines, would moderate responses to an intervention intended to alter participants' mindsets about stress. Participants (N = 107) were exposed to a stress mindset manipulation (videos highlighting either the enhancing or debilitating effects of stress) prior to engaging in a Trier Social Stress task and subsequent cognitive tasks. The associations of the COMT rs4680 polymorphism with the effect of stress mindset video manipulations on cognitive and affective responses were examined. Genetic variation at rs4680 modified the effects of stress mindset on affective and cognitive responses to stress. Individuals homozygous for rs4680 low-activity allele (met/met) were responsive to the stress-is-enhancing mindset manipulation as indicated by greater increases in positive affect, improved cognitive functioning, and happiness bias in response to stress. Conversely, individuals homozygous for the high-activity allele (val/val) were not as responsive to the stress mindset manipulation. These results suggest that responses to stress mindset intervention may vary with COMT genotype. These findings contribute to the understanding of gene by environment interactions for mindset interventions and stress reactivity and therefore warrant further investigations.

Reading between the menu lines: Are restaurants' descriptions of "healthy" foods unappealing?

OBJECTIVE: As obesity rates continue to climb in America, much of the blame has fallen on the high-calorie meals at popular chain restaurants. Many restaurants have responded by offering "healthy" menu options. Yet menus' descriptions of healthy options may be less attractive than their descriptions of less healthy, standard options. This study examined the hypothesis that the words describing items in healthy menu sections are less appealing than the words describing items in standard menu sections. METHOD: Menus from the top-selling American casual-dining chain restaurants with dedicated healthy submenus (N = 26) were examined, and the library of words from health-labeled items (N = 5,873) was compared to that from standard menu items (N = 38,343) across 22 qualitative themes (e.g., taste, texture). RESULTS: Log-likelihood ratios revealed that restaurants described healthy items with significantly less appealing themes and significantly more health-related themes. Specifically, healthy items were described as less exciting, fun, traditional, American regional, textured, provocative, spicy hot, artisanal, tasty, and indulgent than standard menu items, but were described with significantly more foreign, fresh, simple, macronutrient, deprivation, thinness, and nutritious words. CONCLUSION: Describing the most nutritious menu options in less appealing terms may perpetuate beliefs that healthy foods are not flavorful or indulgent, and may undermine customers' choice of healthier dining options. From a public health perspective, incorporating more appealing descriptive language to boost the appeal of nutritious foods may be one avenue to improve dietary health. (PsycINFO Database Record

Colonic immunopathogenesis of Clostridium difficile infections.

There are major gaps in our understanding of the immunopathogenesis of Clostridium difficile infections (CDIs). In this study, 36 different biomarkers were examined in the stools of CDI and non-CDI patients using the Proteome Profiler human cytokine array assay and quantitative enzyme-linked immunosorbent assay. Diarrheal stools from patients with CDI (CDI-positive diarrheal stools) showed higher relative amounts of the following inflammatory markers than the diarrheal stools from CDI-negative patients (CDI-negative diarrheal stools): C5a, CD40L, granulocyte colony-stimulating factor, I-309, interleukin-13 (IL-13), IL-16, IL-27, monocyte chemoattractant protein 1, tumor necrosis factor alpha, and IL-8. IL-8 and IL-23 were present in a larger number of CDI-positive diarrheal stools than CDI-negative diarrheal stools. Th1 and Th2 cytokines were not significantly different between the CDI-positive and CDI-negative diarrheal stools. Lactoferrin and calprotectin concentrations were also higher in the CDI-positive diarrheal stools. Our results demonstrate that CDI elicits a proinflammatory host response, and we report for the first time that IL-23 is a major marker in CDI-positive diarrheal stools. IL-23 may explain the lack of a robust immunological response exhibited by a proportion of CDI patients and may relate to recurrence; the IL-23 levels induced during CDI in these patients may be inadequate to sustain the cellular immunity conferred by this cytokine in promoting the induction and proliferation of effector memory T cells.