Virtue marketing: Trends in health-, eco-, and cause-oriented claims on the packaging of new alcohol products in Australia between 2013 and 2023.

OBJECTIVE: Some claims on alcohol labels highlight virtuous aspects of brands or products, including in health-, eco-, and cause-oriented domains (including charity partnerships, or ethical or humanitarian certifications). This virtue marketing may create a 'halo' whereby consumers generalise from specific attributes to a more favourable overall appraisal of the product, brand, or even alcohol or the alcohol industry in general. This study aims to describe the prevalence of and trends over time in virtue marketing on the packaging of new alcohol (including lower and zero alcohol) products on the Australian market. METHOD: Records of N=4,024 new alcohol products released in Australia between 2013 and 2023 were extracted from Mintel Global New Products Database. Health-, eco-, and cause-oriented claims on packaging were summarised across product types and time, and co-occurrence between claims was assessed. RESULTS: Virtue marketing appeared on 36.5% of new alcohol products, of which health-oriented claims were most common (32.5%), followed by eco- (6.3%) and cause-oriented claims (2.0%). The prevalence of each claim category and virtue marketing overall significantly increased over time (each p<.001) and varied by product type. New alcohol products displayed as many as eight different types of claims and all claims tended to co-occur with at least two others. CONCLUSIONS: Virtue marketing is prevalent on new alcohol products in Australia and has recently increased. While product packaging can provide useful consumer information, health-, eco-, and cause-oriented claims may exploit consumers' motivation to make healthy, sustainable, and socially responsible choices despite alcohol being detrimental in these areas.

Can a health warning label diminish the persuasive effects of health-oriented nutrition advertising on ready-to-drink alcohol product packaging? A randomized experiment.

BACKGROUND AND AIMS: A health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health-oriented nutrition advertising on ready-to-drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age. DESIGN: A between-subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready-to-drink (RTD) vodka-based soda container. SETTING AND PARTICIPANTS: Alcohol consumers (n = 5063; 52% women) in Canada aged 18-64 recruited through a national online panel. MEASUREMENTS: Participants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product. FINDINGS: Compared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (ß = -0.72, 95% confidence interval [CI] = -1.37,-0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age. CONCLUSIONS: Health warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims.

Tobacco Constituents, Flavorants, and Paper Permeability of Factory-Made and Roll-Your-Own Cigarettes on the Australian Market.

INTRODUCTION: Roll-your-own (RYO) tobacco is a popular choice in Australia, with some people who smoke finding these products more attractive than factory-made cigarettes (FMC). Differences in visual and tactile properties and in the feel and taste of the smoke may contribute to this attractiveness. These differences may be driven by variation in tobacco constituents and wrapping paper permeability. However, to date, there has been no comparison of RYO and FMC products on the Australian market. AIMS AND METHODS: Chemical constituents, pH, flavorants, and paper permeability were compared in unburned RYO tobacco and tobacco from FMC. RYO and FMC products from matched brands were compared, as were products from the most popular FMC and RYO brands on the Australian market in 2018. RESULTS: RYO tobacco had higher moisture and humectant content (glycerol and propylene glycol) than FMC tobacco. RYO tobacco also had higher amounts of total and reducing sugars and lower nicotine when comparing the most popular brands. RYO papers were less permeable than FMC papers. Both RYO and FMC tobacco contained many chemicals identified as flavorants, including fourteen with known potential health risks. For most measured constituents and flavorants, RYO tobaccos had more in common with other RYO than FMC, with the commonalities remaining even when matched brands were compared. CONCLUSIONS: Higher levels of moisture, humectants, and sugars in Australian RYO tobacco compared to FMC may be increasing attractiveness of RYO by reducing the harsh taste of the smoke and increasing the moist feel of the tobacco. IMPLICATIONS: While price is the main factor driving the use of RYO tobacco, some people who smoke find these products more attractive. This study has shown that Australian RYO tobacco contains higher amounts of glycerol, propylene glycol, and sugars than FMC. These chemicals may be improving the taste of the tobacco, as well as creating a moist feel that is falsely perceived as indicating that the tobacco is "fresh" and "less chemically." Ironically, it may be that higher amounts of some added chemicals in RYO contribute to false perceptions of a more natural and less harmful product.

Food purchasing practices in various retail settings and dietary intake: A cross-sectional survey of Australian adolescents.

BACKGROUND/AIMS: Discretionary, energy-dense, nutrient-poor food and drinks are heavily marketed and readily available in retail settings frequented by adolescents. This study examines associations between food purchasing practices in various retail settings and dietary intake among Australian adolescents. METHODS: Participants were students in years 8 to 11 (ages 12-17 years) who completed the 2009-10 (n = 13 790), 2012-13 (n = 10 309) or 2018 (n = 9102) National Secondary Students' Diet and Activity (NaSSDA) cross-sectional survey. Multistage stratified random sampling was used. An online survey completed at school assessed self-reported frequency of food purchasing practices in various retail settings and consumption of discretionary food, sugary drinks, fruit and vegetables. Generalised linear regression models examined associations between food purchasing practices and dietary behaviour. RESULTS: Relative to students who brought lunch from home, those who purchased lunch from school or nearby outlets reported higher intake of discretionary food and sugary drinks and lower fruit intake. Buying lunch from school was also associated with lower vegetable intake. Buying food or drinks on the school commute, outside school grounds during school hours, from supermarket checkouts, and using mobile phone apps were each associated with higher discretionary food and sugary drink intake (all P < .01). CONCLUSIONS: Purchasing food or drink in various retail settings is associated with higher intake of discretionary food and drink among Australian adolescents, and some purchasing practices appeared to displace fruit and vegetable intake. SO WHAT?: These findings highlight a need to improve the accessibility and promotion of healthier food and drink options in schools and other retail settings.

The health halo effect of 'low sugar' and related claims on alcoholic drinks: an online experiment with young women.

AIMS: To investigate whether 'low sugar' and related claims influence consumers' perceptions of the healthiness or other attributes of alcoholic drinks, promote greater consumption or impact diet and activity behaviour intentions. METHOD: N = 501 Australian women aged 18-35 viewed and rated six images of alcoholic drinks in a randomized online experiment with a 2 (claim: low sugar claim, no claim control) × 2 (drink type: cider, ready-to-drink spirits) between-subjects design. RESULTS: Participants who viewed drinks with low sugar claims rated them as healthier, less harmful to health, lower in sugar and kilojoules, and more suitable for weight management and a healthy diet than participants who viewed identical drinks with no claim (P < 0.001-P = 0.002). Drinks with low sugar claims were also perceived as being lower in alcohol (P < 0.001) despite being of equivalent alcohol content. There were no significant differences in anticipated social approval associated with consumption or in hypothetical intended consumption of the drinks, but participants who viewed drinks with low sugar claims were less likely to indicate they would compensate for consumption of the drink by modifying food intake or physical activity (P = 0.01). CONCLUSIONS: Low sugar and related claims on alcoholic drinks can generate a health halo: consumers generalise from a specific favourable attribute (low sugar) to misperceive other favourable health- and nutrition-related attributes, including lower alcohol content. Findings support calls to reconsider the permissibility of low sugar claims on alcoholic drinks as they may mislead consumers.

Obesity prevention and related public health advertising versus competing commercial advertising expenditure in Australia.

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016-18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.

Health-Oriented Marketing on Alcoholic Drinks: An Online Audit and Comparison of Nutrition Content of Australian Products.

OBJECTIVE: Marketing, label design, and product innovation strategies are being used by the alcohol industry to position some products as "healthier choices." The aim of this study was to systematically document the content and prevalence of health-oriented marketing on alcohol products on the Australian market and to compare the online availability of nutrition information and the alcohol and nutrient content between products with and without such features. METHOD: Health-oriented marketing features on all beer, cider, and ready-to-drink (RTD) premixed drinks, and selected wines on the website of the largest liquor retailer in Australia were audited using a systematic coding protocol. Nutrition information was sought from manufacturer/brand websites. RESULTS: A total of 54% of beers, ciders, and RTDs featured health-oriented marketing, the most common forms being natural imagery or descriptors, or references to fruit ingredients. Twenty-one percent of audited wines featured health-oriented marketing. The prevalence of specific features varied by product category. Online availability of nutrition information for alcohol products was poor (12% of beer, cider, and RTDs). Products with health-oriented marketing were lower in energy and alcohol content than those without but were still classed as full-strength alcohol on average. CONCLUSIONS: Health-oriented marketing is prevalent on alcohol products sold in Australia. In the absence of universal and standardized health warning and energy content information on labels, permitted health-oriented marketing has the potential to mislead consumers about product healthiness or to detract from the perceived harm associated with alcohol consumption. Research to test this proposition is now needed to guide labeling policy reform.

Prevalence and Correlates of Observed Sun Protection Behaviors Across Different Public Outdoor Settings in Melbourne, Australia.

Skin cancer prevention efforts in Australia have increasingly incorporated a focus on protection during incidental sun exposure. This complements the long-present messages promoting protection in high-risk settings and avoidance of acute intense bouts of sun exposure. Data from two waves of a cross-sectional direct observational survey was used to assess the prevalence and correlates of N = 12,083 adolescents' and adults' sun protection behavior (arm and leg cover, hat, sunglasses, and shade cover). Individuals were observed in public outdoor settings in Melbourne, Australia during peak ultraviolet (UV) times (11 a.m.-3 p.m.) on summer weekends. Settings included pools and beaches, parks and gardens, and for the first time in 2018, outdoor streets and cafés which may capture more incidental forms of sun exposure and represent another public setting where Australians commonly spend time outdoors. Females and older adults were consistently better protected than males and adolescents. Physical activity was strongly associated with low shade cover across settings. Weather was more strongly associated with sun protection at outdoor streets/cafes and parks/gardens than at pools/beaches but use of observed sun protection (particularly arm cover and covering hat) was low across settings. Continued public education about UV risk and its relation to weather and the seasons is needed to promote the routine use of multiple forms of sun protection during outdoor activities in peak UV times, especially among males and adolescents. Findings also highlight the importance of considering activity demands of public spaces in shade planning to optimize sun protection during outdoor activities in public spaces.

Sugary drink advertising expenditure across Australian media channels 2016-2018.

OBJECTIVE: The aim of this study was to describe advertising expenditure for sugary drinks compared with alternative cold non-alcoholic beverages (artificially sweetened beverages, plain water, plain milk) between 2016 and 2018 across Australian media channels. METHODS: Monthly estimates of advertising expenditure for non-alcoholic beverages were obtained from Nielsen Media and aggregated by product type and media. RESULTS: Total sugary drink advertising expenditure between 2016 and 2018 ($129.5M) significantly exceeded expenditure on artificially sweetened drinks ($23.26M), plain water ($14.27M), and plain milk ($31.30M). Television and out-of-home advertising accounted for the largest share of sugary drink advertising (45%, 35%). Expenditure on out-of-home advertising was more heavily dominated by sugary drinks (75%) than advertising in all media combined (65%). Sugary drink advertising peaked in warmer months and was lowest in August. Soft drinks (26%), flavoured milks (24%) and energy drinks (21%) accounted for the majority of sugary drink advertising. CONCLUSIONS: Cold non-alcoholic beverage advertising in Australian media is dominated by the advertising of sugary drinks. Implications for public health: Restricting unhealthy beverage advertising on television and out-of-home media may be most effective initially. However, comprehensive restrictions capturing a broader range of media and settings would be optimal to prevent displacement and limit advertising reach and exposure.

Out of the lab and into the wild: The influence of portion size on food intake in laboratory vs. real-world settings.

External influences on eating behaviour, such as portion size, have been reliably shown to influence food intake in the laboratory. However, little research has examined whether laboratory settings under or overestimate the effect that external influences have on food intake compared to when studied in the real-world. In Study 1, 60 participants (mean age = 32 years) were randomized to consume a large (200 g) or small (100 g) portion of popcorn under controlled laboratory conditions and during a separate session in their home. Results showed that the effect of portion size on food intake was larger at home (d = 0.97) than in the laboratory (d = 0.56). Furthermore, participants reported feeling more relaxed eating at home compared to the laboratory. In Study 2, we examined whether comparable results were observed in a semi-naturalistic laboratory designed to resemble a home setting. 59 participants (mean age = 28 years) completed the same procedure as Study 1 in a standard and a semi-naturalistic laboratory setting. Although participants reported having higher levels of private self-awareness in the standard laboratory, the effect that portion size had on food intake did not differ between the standard laboratory (d = 0.50) and the semi-naturalistic laboratory (d = 0.49). The impact that external influences on eating, such as portion size, have on food intake in the real-world may be underestimated when studied under laboratory conditions.

Translation of findings from laboratory studies of food and alcohol intake into behavior change interventions: The experimental medicine approach.

Objectives: Laboratory studies have contributed important information about the determinants of food and alcohol intake, and they have prompted the development of behavior change interventions that have been evaluated in randomized controlled trials conducted in the field. In this article we apply a recent experimental medicine (EM) framework to this body of research. Method: A conceptual review and focused discussion of the relevant literature is presented. Results: We illustrate how it is possible to translate findings from studies of food and alcohol intake in the laboratory into interventions that are effective for changing behavior in the real world. We go on to demonstrate how systematic failures can occur at different stages within the EM framework, and how these failures ultimately result in interventions that are ineffective for changing behavior. We also consider methodological issues that may constrain the external validity of findings from laboratory studies including demand effects, participant characteristics, and the timing and dose of behavioral interventions. Throughout, we make recommendations to improve the translation of findings from laboratory studies into behavior change interventions that are effective in the field. Conclusions: Consideration of the EM framework will help to ensure that promising candidate interventions for eating and drinking that are identified in laboratory studies can fulfill their translational promise. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Individual differences and moderating participant characteristics in the effect of reducing portion size on meal energy intake: Pooled analysis of three randomized controlled trials.

Portion size impacts on the amount of energy consumed during a meal. However, research findings on participant characteristics that moderate the effect of portion size on energy intake are mixed. Using data pooled across three randomized control trials, we examined the impact of reducing meal portion size on meal energy intake in 111 adult participants varying in sex (55 M, 56 F), body weight (BMI range = 19-42) and a broad range of participant characteristics, including usual portion size, restrained, emotional and external eating, satiety responsiveness, plate clearing tendencies, concerns about wasting food and self-control. In each trial, a repeated-measures design was used and participants consumed three ad-libitum lunchtime meals differing in portion size; large-normal portion size condition (100%) vs. small-normal portion size condition (~ 75%) vs. smaller than normal portion size condition (~ 50%). In mixed ANOVAs, we did not find convincing evidence that any participant characteristic reliably moderated the impact that reducing portion size had on energy intake. For the majority of participants energy intake decreased when portion size was reduced and it was more common for participants to consistently reduce their energy intake than consume a similar amount when portion size was reduced. We also found little evidence that a sub-group of participants existed whose energy intake was consistently resistant to portion size reductions. Portion size may be a universal driver of energy intake, as reducing meal portion size appears to decrease meal energy intake among most people. Food portion downsizing may therefore be an equitable intervention approach to reducing population level energy intake.

Self-perception of overweight and obesity: A review of mental and physical health outcomes.

The obesity crisis is one of the largest public health challenges of the 21st century. Population-level adiposity has increased dramatically in recent times, and people not recognizing that they have overweight or obesity is now common. It has been widely assumed that not recognizing oneself as having overweight is detrimental to weight management and long-term health. Here, diverse research is reviewed that converges on the counterintuitive conclusion that not recognizing oneself as having overweight is actually associated with more favourable physical and mental health outcomes than recognizing oneself as having overweight. Drawing on existing models in social psychology and weight stigma research, an explanatory model of the health effects of self-perception of overweight is outlined. This model proposes that self-perception of overweight triggers social rejection concerns and the internalization of weight stigma, which in turn induce psychological distress and negatively impact health-promoting lifestyle behaviours. How self-perception of overweight may in part explain progression from overweight to obesity, and the public health implications of self-perception of overweight and obesity are also discussed.

Secondary school canteens in Australia: analysis of canteen menus from a repeated cross-sectional national survey.

OBJECTIVE: The current study aimed to assess the nutritional quality of Australian secondary school canteen menus. DESIGN: Stratified national samples of schools provided canteen menus in 2012-2013 and 2018, which were systematically assessed against a 'traffic light' classification system according to the National Healthy School Canteen Guidelines. Items were classified as green (healthiest and recommended to dominate canteen menus), amber (select carefully) or red (low nutritional quality, should not appear on canteen menus), and pricing and promotional strategies were recorded. SETTING: Australia. PARTICIPANTS: Canteen menus from 244 secondary schools (2012-2013 n 148, 2018 n 96). RESULTS: A total of 21 501 menu items were classified. Forty-nine percent of canteen menus contained at least 50 % green items; however, nearly all (98·5 %) offered at least one red item and therefore did not comply with national recommendations. Snacks and drinks had the least healthy profile of all product sectors, and a large proportion of schools supplied products typically of poor nutritional quality (meat pies and savoury pastries 91·8 %, sugary drinks 89·5 %, sweet baked goods 71·5 %, ice creams 64·1 % and potato chips 44·0 %). Red items were significantly cheaper than green items on average, and many schools promoted the purchase of red items on canteen menus (52·8 %). There were few differences between survey waves. CONCLUSIONS: There is considerable room for improvement in the nutritional quality of canteen menus in Australian secondary schools, including in the availability, pricing and promotion of healthier options. Additional resources and services to support implementation of national guidelines would be beneficial.

Sun-protective clothing and shade use in public outdoor leisure settings from 1992 to 2019: Results from cross-sectional observational surveys in Melbourne, Australia.

Skin cancer presents a significant public health burden in Australia. The present study aimed to supplement population-based estimates of sun protection behaviour by examining setting-specific trends in directly observed sun protection in public outdoor leisure settings. Repeated cross-sectional observational surveys of adolescents and adults were conducted on summer weekends between 11 am and 3 pm from 1992 to 2002, 2006 to 2012, and 2018 to 2019 (N = 44,979) at pools/beaches and parks/gardens within 25 km of the centre of Melbourne, Victoria. The primary outcome was a binary index representing individuals having above or below the median level of body surface covered by hat, shirt, and leg garments in each setting type. The prevalence of above-median body coverage increased between 1992 and 2002 in both settings. At pools/beaches, a slight decline in above-median body coverage between 2006 and 2019 in males and females (adjusted odds ratio, AOR = 0.96 [0.94, 0.97]; 0.94 [0.93, 0.95]) appeared to be driven by a decline in leg coverage, while arm coverage, hat, sunglasses, and shade use remained stable. At parks/gardens, a decline in above-median body coverage between 2006 and 2019 (AOR = 0.90 [0.89, 0.91]; 0.94 [0.93, 0.95]) was accompanied by small declines across other protective behaviours that varied between males and females. Patterns in protective behaviours observed in outdoor leisure settings may reflect the changing composition of individuals choosing to remain outdoors during peak UV times and highlight the importance of continued promotion and monitoring of the use of multiple measures to protect against UV damage in Australia.

Reductions to main meal portion sizes reduce daily energy intake regardless of perceived normality of portion size: a 5 day cross-over laboratory experiment.

BACKGROUND: Smaller portions may help to reduce energy intake. However, there may be a limit to the magnitude of the portion size reduction that can be made before consumers respond by increasing intake of other food immediately or at later meals. We tested the theoretical prediction that reductions to portion size would result in a significant reduction to daily energy intake when the resulting portion was visually perceived as 'normal' in size, but that a reduction resulting in a 'smaller than normal' portion size would cause immediate or later additional eating. METHODS: Over three 5-day periods, daily energy intake was measured in a controlled laboratory study using a randomized crossover design (N = 30). The served portion size of the main meal component of lunch and dinner was manipulated in three conditions: 'large-normal' (747 kcal), 'small-normal' (543 kcal), and 'smaller than normal' (339 kcal). Perceived 'normality' of portion sizes was determined by two pilot studies. Ad libitum daily energy intake from all meals and snacks was measured. RESULTS: Daily energy intake in the 'large-normal' condition was 2543 kcals. Daily energy intake was significantly lower in the 'small-normal' portion size condition (mean difference - 95 kcal/d, 95% CI [- 184, - 6], p = .04); and was also significantly lower in the 'smaller than normal' than the 'small-normal' condition (mean difference - 210 kcal/d, 95% CI [- 309, - 111], p < .001). Contrary to predictions, there was no evidence that the degree of additional food consumption observed was greater when portions were reduced past the point of appearing normal in size. CONCLUSIONS: Reductions to the portion size of main-meal foods resulted in significant decreases in daily energy intake. Additional food consumption did not offset this effect, even when portions were reduced to the point that they were no longer perceived as being normal in size. TRIAL REGISTRATION: Prospectively registered protocol and analysis plan: https://osf.io/natws/; retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT03811210.

Portion size normality and additional within-meal food intake: two crossover laboratory experiments.

Reducing food portion size could reduce energy intake. However, it is unclear at what point consumers respond to reductions by increasing intake of other foods. We predicted that a change in served portion size would only result in significant additional eating within the same meal if the resulting portion size was no longer visually perceived as 'normal'. Participants in two crossover experiments (Study 1: n 45; Study 2: n 37; adults, 51 % female) were served different-sized lunchtime portions on three occasions that were perceived by a previous sample of participants as 'large-normal', 'small-normal' and 'smaller than normal', respectively. Participants were able to serve themselves additional helpings of the same food (Study 1) or dessert items (Study 2). In Study 1 there was a small but significant increase in additional intake when participants were served the 'smaller than normal' compared with the 'small-normal' portion (m difference = 161 kJ, P = 0·002, d = 0·35), but there was no significant difference between the 'small-normal' and 'large-normal' conditions (m difference = 88 kJ, P = 0·08, d = 0·24). A similar pattern was observed in Study 2 (m difference = 149 kJ, P = 0·06, d = 0·18; m difference = 83 kJ, P = 0·26, d = 0·10). However, smaller portion sizes were each associated with a significant reduction in total meal intake. The findings provide preliminary evidence that reductions that result in portions appearing 'normal' in size may limit additional eating, but confirmatory research is needed.

Served Portion Sizes Affect Later Food Intake Through Social Consumption Norms.

Portion sizes of commercially available foods have increased, and there is evidence that exposure to portion sizes recalibrates what is perceived as 'normal' and subsequently, how much food is selected and consumed. The present study aims to explore the role of social (descriptive and injunctive) and personal portion size norms in this effect. Across two experiments, participants were either visually exposed to (Study 1, N = 329) or actually served (Study 2, N = 132) a smaller or larger than normal food portion. After 24 h, participants reported their intended consumption (Study 1) or served themselves and consumed (Study 2) a portion of that food and reported perceived portion size norms. In Study 1, visual exposure to portion size did not significantly affect intended consumption and perceived portion size norms. In Study 2, participants consumed a smaller portion of food when they were served a smaller rather than a larger portion the previous day, which was mediated by perceived descriptive and injunctive social (but not personal) portion size norms. Results suggest that being served (but not mere visual exposure to) smaller (relative to larger) portions changes perceived social norms about portion size and this may reduce future consumption of that food.

Does perceived overweight increase risk of depressive symptoms and suicidality beyond objective weight status? A systematic review and meta-analysis.

Obesity is associated with a significant disease burden, but whether recognising as opposed to failing to recognise personal overweight is beneficial or detrimental to mental health is unclear. Here we examine the associations between perceived overweight and depressive symptoms and suicidality. A systematic search of three electronic databases yielded 10,398 unique records, from which 32 studies (110 observations) were eligible for inclusion. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for each outcome using random effects meta-analyses and potential publication bias was examined. Perceived overweight was associated with an increased risk of depressive symptoms (OR: 1.42, CI: 1.31, 1.54 p <.0001, N >128,585) and suicidality (OR: 1.41, CI: 1.28, 1.56, p <.0001, N = 133,576) in both cross-sectional and longitudinal studies. The association between perceived overweight and poorer mental health was observed irrespective of study origin, participant age (children vs. adults), gender, and whether or not a person was objectively overweight. The pooled statistical relationship between objective weight status and poorer mental health was attenuated to non-significance when perceived overweight was accounted for, suggesting that the detrimental effect of overweight on mental health is largely dependent on whether or not a person identifies as overweight.