Larger bowl size increases the amount of cereal children request, consume, and waste.

OBJECTIVE: To examine whether larger bowls bias children toward requesting more food from the adults who serve them. STUDY DESIGN: Study 1 was a between-subject design involving 69 preschool-age children who were randomized to receive either a small (8 oz) or large (16 oz) cereal bowl and were asked to tell researchers how much cereal they wanted for a morning snack. Study 2 was a within-subject design involving 18 school-age children at a summer camp who were given a small (8 oz) cereal bowl on one day and a large (16 oz) cereal bowl on another day and asked by a cafeteria server how much cereal and milk they wanted for breakfast. Hidden scales measured how much cereal and milk were served, consumed, and wasted. Body mass index was calculated at the end of the study. RESULTS: In study 1, the young children requested almost twice as much cereal to eat when presented with the larger bowl compared with the smaller bowl. In study 2, the older children consumed 52% more and wasted 26% more when served in the larger bowl. CONCLUSION: A step toward potentially reducing overeating and waste would be for parents and adult caregivers to use smaller bowls for serving food to children.

Foods advertised in US weekly supermarket sales circulars over one year: a content analysis.

BACKGROUND: The nutritional content of Americans' shopping carts is suboptimal despite federal dietary guidance, in this case, the MyPlate consumer icon which displays desired proportions of vegetables, fruits, dairy, grains and protein foods for consumption. Consumers mention print advertising-such as weekly sales circulars-frequently as influencing their grocery shopping decisions. METHODS: To examine and describe the relative proportions of advertised foods aggregated into the MyPlate food grouping system, a content analysis of 9 209 foods advertised in 52 weekly supermarket newspaper sales inserts in 2009 from a local grocery chain was conducted in a Midwestern community. RESULTS: Overall, the protein foods group was most often represented in sales circulars (25% of total items), followed by grains (18%); dairy (10%); vegetables (8%) and fruits (7%). Less than 3% of sales advertisements were for dark green and red & orange vegetables. Over twice as much whole fruit versus 100% fruit juice was advertised (70% vs. 30%, respectively; P < 0.001). Significantly fewer protein foods and more grains than expected were advertised in the fall, and slightly more dark green vegetables were advertised in winter and spring than in summer and fall (P = 0.05). CONCLUSIONS: The average American diet, including underconsumption of fruits and vegetables but overconsumption of protein foods, was reflected in the relative frequency of food groups advertised in weekly sales circulars. Modifying sales circulars to represent healthier food groups may preserve retail profits (considering these groups' higher profit margin) while promoting adherence to federal dietary guidance.

Attractive names sustain increased vegetable intake in schools.

OBJECTIVE: This study will determine if the selective use of attractive names can be a sustainable, scalable means to increase the selection of vegetables in school lunchrooms. METHODS: Study 1 paired an attractive name with carrots in five elementary schools (n=147) and measured selection and consumption over a week compared to controls. Study 2 tracked food sales of vegetables in two elementary schools (n=1017) that were systematically attractively named or not named over a two-month period. Both studies were conducted in New York in 2011. RESULTS: Study 1 found that elementary students ate twice the percentage of their carrots if attractively named as "X-ray Vision Carrots," than if un-named or generically named as the "Food of the Day." Study 2 found that elementary school students were 16% more likely to persistently choose more hot vegetable dishes (p<0.001) when they were given fun or attractive names. DISCUSSION: Attractive names effectively and persistently increased healthy food consumption in elementary schools. The scalability of this is underscored by the success of Study 2, which was implemented and executed for negligible cost by a high school student volunteer.

Mindless eating challenge: retention, weight outcomes, and barriers for changes in a public web-based healthy eating and weight loss program.

BACKGROUND: Most dietary programs fail to produce lasting outcomes because participants soon return to their old habits. Small behavioral and environmental changes based on simple heuristics may have the best chance to lead to sustainable habit changes over time. OBJECTIVE: To evaluate participant retention, weight outcomes, and barriers for changes in a publicly available web-based healthy eating and weight loss program. METHODS: The National Mindless Eating Challenge (NMEC) was a publicly available, online healthy eating and weight loss program with ongoing recruitment of participants. This volunteer sample consisted of 2053 participants (mean age 39.8 years, 89% female, 90% white/Caucasian, BMI mean 28.14). Participants completed an initial profiling survey and were assigned three targeted habit change suggestions (tips). After each month, participants were asked to complete a follow-up survey and then receive new suggestions for the subsequent month. RESULTS: In terms of overall attrition, 75% (1549/2053) of participants who completed the intake survey never returned to follow up. Overall mean weight loss among returning participants was 0.4% of initial weight (P=.019). Participants who stayed in the program at least three calendar months and completed at least two follow-up surveys (38%, 189/504) lost on average 1.8 lbs (1.0%) of their initial weight over the course of the program (P=.009). Furthermore, participants who reported consistent adherence (25+ days/month) to the suggested changes reported an average monthly weight loss of 2.0 lbs (P<.001). Weight loss was less for those who discontinued after 1-2 months or who did not adhere to the suggested changes. Participants who reported having lost weight reported higher monthly adherence to suggestions (mean 14.9 days, SD 7.92) than participants who maintained (mean 12.4 days, SD 7.63) or gained weight (mean 12.0 days, SD 7.50; F=14.17, P<.001). Common reported barriers for changes included personally unsuitable or inapplicable suggestions, forgetting or being too busy to implement changes, unusual circumstances, and emotional eating. CONCLUSIONS: Because the bulk of the free and commercially available online diet and nutritional tools conduct no evaluation research, it is difficult to determine which aspects of a program are successful and what are reasonable expectations of results. The results of this study suggest that online interventions based on small changes have the potential to gradually lead to clinically significant weight loss, but high attrition from publically available or "free" programs still remains a challenge. Adherence to and effectiveness of small habit changes may be improved through further tailoring to individual circumstances and psychological needs.

Just thinking about exercise makes me serve more food. Physical activity and calorie compensation.

Based on the findings demonstrating compensation between mental effort and subsequent food consumption, this article focuses on the compensatory mechanism between thinking about physical activity and food intake. Results from a field experiment indicate that simply reading about physical activity leads participants to compensate by serving themselves more snacks. The amount of snacks served was mediated by biased calorie estimation. Additionally, we also manipulated the way physical activity was perceived (as tiring exercise or as a fun activity). Although results suggest extra consumption when exercise is perceived as tiring, differences were not statistically significant.

When snacks become meals: How hunger and environmental cues bias food intake.

BACKGROUND: While environmental and situational cues influence food intake, it is not always clear how they do so. We examine whether participants consume more when an eating occasion is associated with meal cues than with snack cues. We expect their perception of the type of eating occasion to mediate the amount of food they eat. In addition, we expect the effect of those cues on food intake to be strongest among those who are hungry. METHODS: One-hundred and twenty-two undergraduates (75 men, 47 women; mean BMI = 22.8, SD = 3.38) were randomly assigned to two experimental conditions in which they were offered foods such as quesadillas and chicken wings in an environment that was associated with either meal cues (ceramic plates, glasses, silverware, and cloth napkins at a table), or snack cues (paper plates and napkins, plastic cups, and no utensils). After participants finished eating, they were asked to complete a questionnaire that assessed their hunger, satiety, perception of the foods, and included demographic and anthropometric questions. In addition, participants' total food intake was recorded. RESULTS: Participants who were in the presence of meal-related cues ate 27.9% more calories than those surrounded with snack cues (416 versus 532 calories). The amount participants ate was partially mediated by whether they perceived the eating occasion to be a meal or a snack. In addition, the effect of the environmental cues on intake was most pronounced among participants who were hungry. CONCLUSIONS: The present study demonstrated that environmental and situational cues associated with an eating occasion could influence overall food intake. People were more likely to eat foods when they were associated with meal cues. Importantly, the present study reveals that the effect of these cues is uniquely intertwined with cognition and motivation. First, people were more likely to eat ambiguous foods when they perceived them as a meal rather than a snack. Second, the effect of the environmental cues on intake was only observed among those who were hungry.

"Is this a meal or snack?" Situational cues that drive perceptions.

What determines whether a person perceives an eating occasion as a meal or snack? The answer may influence what and how much they eat on that occasion and over the remainder of the day. A survey of 122 participants indicated that they used food cues (such as the food quality, portion size, perceived healthfulness, and preparation time) as well as environmental cues (such as the presence of friends and family, whether one is seated, and the quality of napkins and plates) to determine if they were eating a meal rather than a snack. Implications for dieters and for health professionals are provided.

Obesity: can behavioral economics help?

BACKGROUND: Consumers regularly and predictably behave in ways that contradict standard assumptions of economic analysis such that they make decisions that prevent them from reaching rationally intended goals. These contradictions play a significant role with respect to consumers' food decisions and the effect these decisions have on their health. DISCUSSION: Food decisions that are rationally derived include those that trade short-term gains of sensory pleasure (hedonic) for longer term gains of health and wellness (utilitarian). However, extra-rational food decisions are much more common. They can occur because of the contexts in which they are made--such as being distracted or pressed for time. In these contexts, heuristics (or rules of thumb) are used. Because food decisions are made with little cognitive involvement, food policies designed to appeal to highly cognitive thought (e.g., fat taxes, detailed information labels) are likely to have little impact. Furthermore, food marketing environments influence not only what foods consumers buy but also how much. As a general principle, when individuals do not behave in their own interest, markets will feed perverse and sub-optimal behaviors. CONCLUSION: Given the limited ability of individuals to retain and use accurate health information coupled with varying levels of self control, profit motivations of marketers can become predatory--though not necessarily malicious. Alternative policy options that do not restrict choice are outlined, which enable consumers to make better decisions. These options allow for profit motivations of marketers to align with the long-term well being of the consumer.

Mindless Eating and Healthy Heuristics for the Irrational.

Food choice decisions are not the same as intake volume decisions. The former determine what we eat (soup or salad); the latter determine how much we eat (half of the bowl or all of it). Large amounts of money, time, and intelligence have been invested in understanding the physiological mechanisms that influence food choice (James O. Hill, forthcoming). Much less has been invested in understanding how and why our environment influences food consumption volume. Yet environmental factors (such as package size, plate shape, lighting, variety, or the presence of others) affect our food consumption volume far more than we realize (Wansink 2006). Whereas people can acknowledge that environmental factors influence others, they wrongly believe they are unaffected. Perhaps they are influenced at a basic level of which they are not aware. A better understanding of these drivers of consumption volume will have immediate implications for research, policy, and personal interventions. There are three objectives of this paper: (1) explain why environmental factors may unknowingly influence food consumption; (2) identify resulting myths that may lead to is specified models or misguided policy recommendations; and (3) offer clear direction for future research, policy, and personal dietary efforts.

Fine as North Dakota wine: sensory expectations and the intake of companion foods.

Taste expectations can influence taste evaluations. It is not known, however, whether the environmental cues that influence taste expectations--such as suggestible names and brand labels--can have a referred impact on the intake volume of companion foods. Adult diners who ordered a prix-fixe restaurant meal were given a complimentary glass of wine that had been relabeled to induce either favorable ("new from California") or unfavorable ("new from North Dakota") taste expectations. An analysis of plate waste indicated that those who believed they had been drinking California wine ate 12% more of their meal than those who instead believed they drank North Dakota wine. In combination with a sensory-based lab study, these results show that environmental cues--such as label-induced sensory expectations--can have a far-reaching impact on the food intake of companion foods.

Counting bones: environmental cues that decrease food intake.

At an all-you-can eat buffet in a sports bar, it was tested whether people would eat less if they knew how much they had already eaten. 50 graduate students (34 women; M age = 24.1 yr.) were seated at 21 tables randomly assigned to be bussed (leftover wings removed) or unbussed (wings left on table). The 31 students at the bussed tables ate more than those at the unbussed tables (7 wings vs. 5.5 wings), with the effect being stronger for men than women. In distracting eating environments, environmental cues may provide an effective means of reducing consumption. Implications for controlling alcohol intake were also noted.

Diet Quality of Items Advertised in Supermarket Sales Circulars Compared to Diets of the US Population, as Assessed by the Healthy Eating Index-2010.

BACKGROUND: Supermarkets use sales circulars to highlight specific foods, usually at reduced prices. Resulting purchases help form the set of available foods within households from which individuals and families make choices about what to eat. OBJECTIVE: The purposes of this study were to determine how closely foods featured in weekly supermarket sales circulars conform to dietary guidance and how diet quality compares with that of the US population's intakes. DESIGN: Food and beverage items (n=9,149) in 52 weekly sales circulars from a small Midwestern grocery chain in 2009 were coded to obtain food group and nutrient and energy content. Healthy Eating Index-2010 (HEI-2010) total and component scores were calculated using algorithms developed by the National Cancer Institute. HEI-2010 scores for the US population aged 2+ years were estimated using data from the 2009-2010 National Health and Nutrition Examination Survey. HEI-2010 scores of circulars and population intakes were compared using Student's t tests. RESULTS: Mean total (42.8 of 100) HEI-2010 scores of circulars were lower than that of the US population (55.4; P<0.001). Among individual components, Total Protein Foods was the only one for which 100% of the maximum score was met by both circulars and the population. The scores were also similar between the circulars and population for Whole Grains (22%; P=0.81) and Seafood and Plant Proteins (70% to 74%; P=0.33). Circular scores were lower than those of the population for Total and Whole Fruits, Total Vegetables and Greens and Beans, Dairy, Sodium, and Empty Calories (P<0.001); they were higher only for Fatty Acids (P=0.006) and Refined Grains (P<0.001). CONCLUSIONS: HEI-2010 total scores for these sales circulars were even lower than US population scores, which have been shown repeatedly to reflect low diet quality. Supermarkets could support improvements in consumer diets by weekly featuring foods that are more in concordance with food and nutrient recommendations.

Preferred Healthy Food Nudges, Food Store Environments, and Customer Dietary Practices in 2 Low-Income Southern Communities.

OBJECTIVE: To examine how food store environments can promote healthful eating, including (1) preferences for a variety of behavioral economics strategies to promote healthful food purchases, and (2) the cross-sectional association between the primary food store where participants reported shopping, dietary behaviors, and body mass index. METHODS: Intercept survey participants (n = 342) from 2 midsized eastern North Carolina communities completed questionnaires regarding preferred behavioral economics strategies, the primary food store at which they shopped, and consumption of fruits, vegetables, and sugary beverages. RESULTS: Frequently selected behavioral economic strategies included: (1) a token and reward system for fruit and vegetable purchases; and (2) price discounts on healthful foods and beverages. There was a significant association between the primary food store and consumption of fruits and vegetables (P = .005) and sugary beverages (P = .02). CONCLUSIONS AND IMPLICATIONS: Future studies should examine associations between elements of the in-store food environment, purchases, and consumption.

Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets.

OBJECTIVES: We assessed the efficacy of an easy-to-implement shopper marketing nutrition intervention in a pilot and two additional studies to increase produce demand without decreasing store profitability or increasing shopper budgets. METHODS: We created grocery cart placards that detailed the number of produce items purchased (i.e., descriptive norm) at particular stores (i.e., provincial norm). The effect of these placards on produce spending was assessed across 971,706 individual person grocery store transactions aggregated by day. The pilot study designated a baseline period (in both control and intervention store) followed by installation of grocery cart placards (in the intervention store) for two weeks. The pilot study was conducted in Texas in 2012. In two additional stores, we designated baseline periods followed by 28 days of the same grocery cart placard intervention as in the pilot. Additional interventions were conducted in New Mexico in 2013. RESULTS: The pilot study resulted in a significant difference between average produce spending per day per person across treatment periods (i.e., intervention versus same time period in control) (16%) and the difference between average produce spending per day per person across stores in the control periods (4%); Furthermore, the same intervention in two additional stores resulted in significant produce spending increases of 12.4% and 7.5% per day per person respectively. In all stores, total spending did not change. CONCLUSIONS: Descriptive and provincial social norm messages (i.e., on grocery cart placards) may be an overlooked tool to increase produce demand without decreasing store profitability and increasing shopper budgets.

Shopper marketing nutrition interventions.

Grocery stores represent a context in which a majority of people's food purchases occur. Considering the nutrition quality of the population's food intake has dramatically decreased, understanding how to improve food choice in the grocery store is paramount to healthier living. In this work, we detail the type of financial resources from which shoppers could draw (i.e., personal income and benefits from government food assistance programs to low income populations) and explain how these financial resources are allocated in the grocery store (i.e., planned, unplanned, error). Subsequently, we identify a conceptual framework for shopper marketing nutrition interventions that targets unplanned fruit and vegetable purchases (i.e., slack, or willingness to spend minus list items). Targeting slack for fresh fruit and vegetable purchases allows retailers to benefit economically (i.e., fruit and vegetables are higher margin) and allows shoppers to improve their nutrition without increasing their budgets (i.e., budget neutrality). We also provide preliminary evidence of what in-store marketing of fresh fruits and vegetables could entail by modifying grocery carts and grocery floors to provide information of what is common, normal, or appropriate fruit and vegetable purchases. In each example, fresh fruit and vegetable purchases increased and evidence suggested shopper budget neutrality. To provide context for these results, we detail measurement tools that can be used to measure shopper behaviors, purchases, and consumption patterns. Finally, we address theoretical, practical, and policy implications of shopper marketing nutrition interventions.