The impact of health and environmental messaging with and without product filtering in complex retail markets: the case of pulses.

Introduction: Multiple barriers exist to healthy and environmentally sustainable food choices. Limited consumer understanding of the health and environmental implications of food choices complicates their abilities to make choices that lead to desired outcomes. The complexity of the retail environment itself may crowd out less immediate motivations to address health or environment. Even if consumers understand general impacts of food choices on health and environmental outcomes, there may be non-negligible time and search costs to identifying the products that meet consumers' needs. In many food categories, the foods containing attributes that help achieve health and sustainability outcomes may represent a small percentage of available products. In this research, we examine the case of pulses-beans, chickpeas, lentils, and dry peas. Pulses are nutritious and have a low environmental impact. However, consumption of pulses in the US is quite low, which may be attributable to low consumer knowledge of pulse benefits, as well as difficulty of identifying pulse products in retail environments. Methods: In this research, we examine the choice of pulse-based foods in three conditions: (1) a control condition, (2) a messaging condition communicating the health and environmental benefits of pulse products, and (3) a paired messaging condition with a choice environment intervention that allows respondents to choose to filter products to those that contain pulses. Participants selected a food item from each of six food categories. Results: We find slight, but significant, increases in pulse choice in the messaging only condition relative to the control condition, but dramatic and highly significant increases when participants can filter the products to easily view pulse products. We also find evidence for knowledge being a barrier to healthy/sustainable food choice. Participants exposed to the messaging were more likely to view pulses as environmentally beneficial, and less likely to report that they did not know the health or environmental impacts of pulse foods. Discussion: We find that paired messaging and filtering interventions significantly increase the choice of pulse-based foods, which offer both human health and sustainability benefits.

Restaurants as Environments for Healthy Eating: Factors That Contribute to Restaurant-Based Healthy Eating Program Adoption.

Purpose. This study identified restaurant manager/owner factors that may contribute to adoption of a restaurant-based healthy eating program, Eat Fit. Findings may be used to engage restaurants in efforts to increase access to and availability of healthy foods, promote healthy food choices, and work toward improving diet and lowering obesity and chronic disease risk in the community. Methods. Cross-sectional survey data were collected from restaurant managers/owners interested in partnering with Eat Fit. Variables included restaurant manager/owner beliefs, perceived staff knowledge/skills, support, self-efficacy, outcome expectancies, and barriers and facilitators to implementation. Results. Forty-nine managers/owners participated. Most managers/owners held positive beliefs about offering healthy food items in restaurants (83.7%). Most agreed that restaurants could influence eating behaviors (83.7%) and that restaurants have a responsibility to offer healthy options (77.6%). Most managers/owners perceived high levels of support (83.7%) and were confident in their ability (95.9%) to implement the Eat Fit program. The most cited barriers were customer preference, ingredient availability, staff knowledge, and operational challenges. The most common reasons for involvement in the program were a desire to increase access to healthy food, to entice customers looking for healthier food, a belief that restaurants should offer healthy food, and opportunities to market through Eat Fit. Conclusions. This research contributes to knowledge about beliefs and perceptions of restaurant manager/owners. Efforts to engage restaurants should focus on benefits of offering healthy food and the role restaurants can play in promoting health. Furthermore, programs may benefit from enhanced restaurant staff training, customer-targeted marketing, and educational efforts.

To What Extent are Food, Culture, Economics and the Natural Environment Reflected in the Language of the Australian and Brazilian Food-based Dietary Guidelines?

PURPOSE OF THE REVIEW: Our aim was to review literature describing language use in dietary guidelines and explore the extent to which food, culture, economics and the natural environment are reflected in the language of the Australian, compared to the Brazilian food-based dietary guidelines (FBDGs). RECENT FINDINGS: Australia's FBDGs are based on the best available scientific evidence and claim to "form a bridge between research and evidence-based advice to address the major health challenge of improving Australians' eating patterns". Brazil's FBDGs recognise reasons beyond health for people's food choices. Not a lot of attention has been paid to language use in dietary guidelines. The reviewed studies suggest that language in dietary guidelines should be unambiguous for consumers and evolve with national nutrition priorities. A notable difference between Australian and Brazilian FBDGs was that Australia centralised individuals and individual food groups, whereas Brazil placed people in an ecosystem. Inclusion of words that speak to how food is prepared and eaten, to expressions of culture and community, and to strategies people use for enhancing and protecting livelihoods and planetary health may enhance the relevance of future dietary guidelines.

Effect of food stimuli presentation on restrained eater's food choice: An ERP study.

Restrained eaters are individuals who consciously follow a limited food intake diet to lose or maintain body weight. With the rising numbers of obesity cases, retrained eating has became more prevalent as more people adopt it to cope with obesity. The dual conflict theory states that restrained eaters often encounter conflicting choices of food pleasure and weight management. The present study investigated the difference in food choice regarding different presentations of the weight management goal. The study hypothesized difference in successful and unsuccessful restrained eaters' food choice when presented with the conflicting food/weight maintenance stimuli. A total of 49 college students participated in the study and the N2, P3 and LPP event-related potentials (ERPs) were investigated during a food choice task. Results showed that the reaction time in unsuccessful restrained eaters (UREs) were greater than successful restrained eaters (SREs). The ERP results showed that SREs exhibited smaller N2 and greater P3 amplitudes than UREs, however, we did not find a difference in LPP amplitudes between the two groups. The findings suggest that the UREs demonstrated greater sensitivity and smaller inhibition to food cues, while we do not have supports for a difference in motivational and emotional salience. This is the first study that investigated the food choice of SREs and UREs when faced with different presentations of conflicting goals, which enriches the theoretical model and provides neural correlates evidence for future studies.

Food choice, embodied knowledge and circumscribed agency: factors influencing adolescent girls' and boys' dietary practices in three states in northern Nigeria.

OBJECTIVE: The objective of this study was to explore adolescent dietary practices, related norms and acceptable communication platforms in northern Nigeria to inform future nutrition project design. DESIGN: This was a qualitative formative research study. We used purposive sampling and conducted thirty focus group discussions with male and female adolescents aged 10-14 and 15-19 years (n 180) and six with adult influencers (n 36). We also administered a 24-h dietary recall with the adolescents using the Diet Quality Questionnaire. SETTING: The study was conducted in urban and rural areas in three states in northern Nigeria. RESULTS: Adolescents reported consuming six nutritious food groups the previous day on average. However, there was a wide disparity and only half consumed all five recommended food groups. Adolescents' food choices were influenced by perceptions of the functional and physical benefits of nutritious foods and preferences for satisfying foods. Diverse foods were available in the food environment, but affordability constrained access to nutritious foods. Limited access to income and gender norms constrained adolescent agency over food choice. Girls, particularly those who were pregnant, had less agency related to food than boys. Adolescents thought that peers should be reached through group discussions, radio and phones, among other communication platforms. CONCLUSIONS: Adolescents consumed relatively diverse diets. Adolescent food choice was influenced by their embodied experience and knowledge related to nutrition and taste, home food environment and circumscribed agency. Opportunities exist to support healthy diets for adolescents by strengthening adolescents' embodied knowledge, food environments and social support.

You Eat with Your Eyes: Framing of Food Choice Options Affects Decision Conflict and Visual Attention in Food Choice Task.

Background/Objectives: Frequent poor dietary choices can have significant consequences. To understand the underlying decision-making processes, most food choice tasks present a binary choice between a tasty but less healthy option and a healthy but less tasty option. It is assumed that people come to a decision by trading off the respective health and taste values. However, it is unclear whether and to what extent food choice goes beyond this. Methods: We use a novel eye-tracking experiment where we compare a typical food choice task (image condition) with an abstract value-based decision-making task using pre-matched percentages of health and taste (text condition; e.g., 10% healthy and 80% tasty) in 78 participants. Results: We find a higher frequency of unhealthy choices and reduced response times in the image condition compared to the text condition, suggesting more impulsive decision making. The eye-tracking analysis shows that, in the text condition, the item corresponding to the subsequent choice receives more attention than the alternative option, whereas in the image condition this only applies to the healthy item. Conclusions: Our findings suggest that decision-making in typical food choice tasks goes beyond a mere value-based trade-off. These differences could be due to the involvement of different attentional processes in typical food choice tasks or due to the modality of stimulus presentation. These results could help to understand why people prefer tasty but unhealthy food options even when health is important to them.

How do you choose your meal when you dine out? A mixed methods study in consumer food-choice strategies in the restaurant context.

Choosing meals in restaurants is a significant part of life. On average, people purchase seven meals per week from one of the over 17.5 million food outlets worldwide. The way people choose restaurant meals is different from how they choose foods they consume at home. Understanding people's decision-making strategies when choosing restaurant meals is critical for designing behaviour change interventions that prompt specific food choices (e.g., health, low emissions). Our study aims to identify meal choice strategies across various food outlets (Study 1) and determine their frequency of use (Study 2). In Study 1, we take a constructionist perspective and derive insights from 21 semi-structured interviews on strategies people use as they select meals in different food outlets. We identify 16 distinct strategies, with many people using multiple strategies within and across different restaurant types (i.e., general restaurants, fast-food, pubs, and upscale restaurants). In Study 2, we quantify which of those 16 strategies are most frequently used. The most used strategies were searching the menu for (1) the most enjoyable meals, (2) the most budget-friendly meals, or (3) familiar meals (i.e., habitual choices); and choosing from those. Few people searched the menu for the most environmentally friendly meals and chose from those. These results could explain the limited effectiveness of carbon labelling at restaurants. Our study calls for future interventions on prompting environmental or healthy food choices to move away from health and environmental labelling and to focus on enjoyment, price, or habit because these are important for people when choosing a meal. We also created a practical measure of the 16 food-choice strategies, available for researchers to use.

Expanding the food environment framework to include family dynamics: A systematic synthesis of qualitative evidence using HIV as a case study.

Food environment changes in low- and middle-income countries are increasing diet-related noncommunicable diseases (NCDs). This paper synthesizes the qualitative evidence about how family dynamics shape food choices within the context of HIV (Prospero: CRD42021226283). Guided by structuration theory and food environment framework, we used best-fit framework analysis to develop the Family Dynamics Food Environment Framework (FDF) comprising three interacting dimensions (resources, characteristics, and action orientation). Findings show how the three food environment domains (personal, family, external) interact to affect food choices within families affected by HIV. Given the growing prevalence of noncommunicable and chronic diseases, the FDF can be applied beyond the context of HIV to guide effective and optimal nutritional policies for the whole family.

The role of Nutri-Score and NutrInform Battery in guiding the food choices of consumers with specific nutritional needs: A controlled study.

BACKGROUND AND AIMS: There is a significant knowledge gap regarding the effectiveness of front-of-pack labeling (FoPL) systems in helping food choices that meet specific nutritional requirements. This study sought to compare the effectiveness of the Nutri-Score (NS) and NutrInform Battery (NIB) labels in assisting consumers to select food products with low sodium or low saturated fat. METHODS AND RESULTS: Utilizing a controlled experimental design, a sample of 1512 participants (aged 18-70, 50.8% females) was exposed to scenarios through computer-assisted web interviewing, where they selected food products suitable for people with suboptimal blood pressure or plasma cholesterol levels, labeled with either NS, NIB, or no label (blind). The NIB proved significantly more efficacious than NS in guiding participants towards making selections in better agreement with nutritional needs, for blood pressure or cholesterol control. Furthermore, the NIB was generally viewed more favorably, with participants rating it as more trustworthy, informative, and useful for the required task. Notably, younger participants, those with higher nutritional knowledge, and those less inclined towards intuitive or spontaneous decision-making demonstrated a greater propensity for making health-congruent food choices when using the NIB. CONCLUSION: The findings suggest that the informative FoPL system, NIB, may offer greater advantages in addressing specific dietary requirements. This underscores the important role of FoPL systems in promoting public health and meeting diverse and specific consumer needs. Further research is needed to confirm these results in broader contexts and for additional health conditions.

The impact of hunger on indulgent food choices is moderated by healthy eating concerns.

Research has shown that hungry individuals are more impulsive, impatient, and prone to make indulgent food choices compared to their satiated counterparts. However, the literature is still mixed, with some studies showing such results while others fail to demonstrate hunger effects on consumers' choice behavior. The current cross-sectional study (N = 461) sought to address these inconsistencies by examining whether the link between hunger and people's propensity to make indulgent (vs. virtuous) food choices is moderated by their healthy eating concerns. Our findings revealed a weak but significant association between participants' self-reported hunger levels and their likelihood of making indulgent rather than virtuous food choices (e.g., preferring a chocolate cake instead of a fruit salad). Importantly, this effect was moderated by their healthy eating concerns, such that the link between hunger and choice likelihood of indulgent food options only emerged among participants who scored lower, but not higher, in healthy eating concerns. We also replicated these results in a robustness check that focused on the extent to which participants indicated having a healthy lifestyle (e.g., exercising regularly), with a similar moderating influence of this factor. Together, these findings shed light on the importance of considering certain boundary conditions for establishing a link between hunger and consumers' food choices, thus adding nuance to the growing body of hunger-related literature. The results emphasize the importance of ensuring the availability of healthier snack options in environments wherein foods and beverages can be consumed, particularly at times when consumers tend to be hungry, to promote healthier eating habits.

Assessing the Validity of Front-of-Pack Nutrition Labels for Evaluating the Healthiness of Mediterranean Food Choices: A Global Comparison.

In response to growing public health concerns, governments worldwide have implemented various nutrition labelling schemes to promote healthier eating habits. This study aimed to assess the consistency and effectiveness of these labels in an out-of-home context, specifically focusing on restaurant, hospitality, and institutional food service settings. In total, 178 different dishes from Spain were analysed using labels from the Mazocco method, the UK's traffic light system, the Health Star Rating (Australia), Nutri-Score (France), multiple traffic lights (Ecuador), and warning labels (Chile and Uruguay). The results demonstrated a generally low level of agreement among these labels (K < 0.40), indicating notable variability and a lack of consensus, which could hinder consumers' ability to make informed food choices in out-of-home settings. Nutri-Score classified the highest number of dishes as unhealthy (38%). This study underscores the need for an easy-to-understand labelling system tailored to each country's culinary and socio-cultural contexts to improve consumer decision-making in various dining environments. Future research should focus on developing and testing qualitative methods to more accurately gauge the nutritional quality of cooked dishes in diverse out-of-home settings, thereby enhancing public health outcomes. By addressing the specific needs of the home, restaurants, hospitality, and institutional food services, tailored labelling schemes could significantly improve consumers' ability to make healthier food choices.

Sustainability considerations are not influencing meat consumption in the US.

The consumption of animal-source foods, and particularly red meat from ruminants, is a major contributor to greenhouse gas emissions, freshwater use, and loss of biodiversity. Reducing red meat consumption has been identified as a key strategy to mitigate climate change; however, little is known about how to effectively intervene to promote its reduction in the United States (US). This study aimed to examine meat (red, unprocessed, and poultry) and seafood consumption patterns, the factors influencing their consumption (including a reduction in their consumption over time), and how these differed based on socioeconomic variables. The study was conducted through an online survey with a representative sample of the US population (n = 1224) in 2021 using KnowledgePanel®. Overall, we found that most participants reported consuming red meat (78%), processed meat (74%), or poultry (79%) 1-4 times per week, with several differences in consumption patterns based on socio-demographic characteristics. A substantial proportion of the population reported reducing their red (70%) and processed meat (64%) consumption over the previous year, which was much higher than those that reported reducing poultry (34%) or seafood (26%). Key factors influencing red meat reduction were health and price, while environmental sustainability and animal welfare were less important, particularly among certain socio-demographic groups. These findings can help provide insight into how best to frame messaging campaigns aimed at shifting red meat consumption in the US to support climate change mitigation. Focusing on the factors that resonate more with consumers is more likely to lead to shifts in consumption patterns.

The role of vegetarianism, gender, and food choice motivations on vegetable intake among university students.

Objective: This study investigated collegians' (N = 466) vegetable consumption as a function of their food choice motivations, gender, and dietary habits. Method: Vegetarians and vegans (veg*ns, n = 94, 60% women), occasional meat eaters (n = 90, 66% women), and omnivores (n = 282, 43% women) completed the Food Choice Questionnaire and reported frequency of vegetable consumption. Results: Veg*ns consumed vegetables more frequently than omnivores and occasional meat eaters. Veg*ns' and occasional meat eaters' food choices were more motivated by natural content, health, and ethics, and less motivated by familiarity compared to omnivores. Women were more motivated than men by weight control. Health concerns predicted vegetable consumption for all dietary groups. Additionally, familiarity predicted veg*ns vegetable consumption, whereas mood, natural content, and convenience predicted omnivores' vegetable consumption. Conclusions: Individual differences in dietary habits and food choice motivations should be considered when designing strategies to promote healthful diets for university students.

Seafood Consumption Trends among U.S. Consumers: Influences of the COVID-19 Pandemic.

The Dietary Guidelines for Americans (DGA) recommend twice-weekly consumption of seafood for health benefits, yet many U.S. consumers have historically fallen short of this target. The economic and societal impacts of the COVID-19 pandemic brought concern about further declines in seafood intake. This study evaluated the influence of COVID-19 on seafood intake among U.S. residents, toward understanding potential public health implications. A nationally representative cross-sectional survey of 1200 U.S. residents conducted in June 2021 evaluated the frequency and types of seafood consumed, and purchase methods used, before and during the early stages of the COVID-19 pandemic. The results (weighted data) indicate most U.S. consumers (90%) eat seafood, yet only 19% meet the seafood DGA. The likelihood of meeting the DGA was higher among consumers who were Asian, Black, or Hispanic; older; unmarried; of higher income; familiar with the DGA; choosing seafood for health reasons; and living in Atlantic or Gulf coast states. During COVID-19, some increased seafood intake for health reasons (45%), while others reduced intake due to factors such as cost (29%), limited availability (16%), and challenges with preparation (11%). Fresh salmon (68%), frozen shrimp (59%), and cooked oysters (41%) were most frequently purchased by consumers of these foods. More consumers indicated purchasing wild salmon (62%), shrimp (44%), and oysters (51%) than farm-raised products, though many were unsure. Fewer consumers included seafood in online grocery orders (36%) than meal kit orders (61%) when using these services. Though many consumers continued to eat seafood despite decreased restaurant patronage, most did not reach the intake level needed to maximize health benefits. Educational and marketing efforts promoting the health benefits of seafood and the convenience of procurement via online purchase methods may encourage intake across demographic groups to benefit public health outcomes in the U.S.

Sensory Evaluation and Consumers' Acceptance of a Low Glycemic and Gluten-Free Carob-Based Bakery Product.

Carob pulp flour has antidiabetic and antioxidant activities, is naturally sweet, and is rich in fibers. It is obtained from carob pod pulp from the evergreen tree Ceratonia siliqua L., which is grown in Mediterranean areas and is known for locust bean gum production. Despite its valuable effects on health, such as the modulation of the glycemic index, this ingredient has a tremendous impact on technological and hedonic features, mainly on color, flavor, and texture. In this paper, the qualitative features and consumers' acceptance of a carob-based gluten-free bakery product where rice flour was substituted at 40% with carob pulp flour were studied. A panel group of experts described the bread as dark, quite dense, sweet, aromatic, and with a limited bubble dispersion. On the other hand, the sensory assessment and the willingness to pay of consumers were assessed in two groups (a fully informed one about heathy attributes of the food and a blind one). The results indicated a moderate appreciation of the overall quality of the product (average score between 4 and 5 points on a 9-point Likert scale). The information about the food's healthy properties and the ability to maintain a low glycemic index did not enhance the consumers' perception of the product, while previous knowledge and involvement in the product consumption were perceived to have primary importance regarding the final consumers' choice. Finally, an accelerated shelf-life test was run on the packaged snack to evaluate the general quality and stability. The protective packaging helped in limiting bread decay and maintaining the textural characteristics.

The association between appetite and eating behaviors among Chinese female university students.

Background: Young females are at a higher risk of developing unhealthy eating behaviors. This study investigated the relationship between appetitive traits and eating behaviors among female university students. Methods: The study participants were 520 female university students from a public university in Eastern China. Appetitive traits were assessed using the Chinese version of the Adult Eating Behavior Questionnaire (C-AEBQ). Data on eating behaviors, including food intake frequency, meal regularity, and dieting behavior, were collected using self-administered questionnaires. The body mass index (BMI) was calculated using self-reported data. Pearson's and Spearman's correlations were used to correlate appetitive traits with BMI and eating behaviors. Latent profile analysis (LPA) was used to identify different appetitive patterns, and logistic regression was used to analyze the relationship between different appetitive patterns and eating behaviors. Results: Two food-approach traits (food enjoyment and emotional over-eating) were positively correlated with BMI, while two food-avoidance traits (slowness in eating and satiety responsiveness) showed negative correlations. Food responsiveness was linked to a higher intake of delivered food, spicy food, and sugar-sweetened beverages, whereas satiety responsiveness was correlated with more frequent meal skipping. The LPA identified four appetitive patterns: food approachers, food approachers with emotional under-eating, food avoiders, and food avoiders with emotional over-eating. Food avoiders had significantly lower BMI than the other groups. Compared to food approachers, food avoiders skipped breakfast more frequently, and food avoiders with emotional over-eating skipped both breakfast and lunch more often. After adjusting for BMI, appetitive patterns showed no significant relationship with dieting behavior. Conclusion: Among female university students, appetitive patterns correlated with eating behaviors, and students with food-avoidance patterns had a higher risk of meal irregularity. These findings emphasize the importance of implementing trait- and pattern-specific approaches to promote healthy eating behaviors among female university students.

Episodic future thinking improves intertemporal choice and food choice in individuals with higher weight: A systematic review and meta-analysis.

Episodic future thinking (EFT) strengthens self-regulation abilities by increasing the perceived value of long-term reinforcements and reducing impulsive choice in delay discounting tasks. As such, EFT interventions have the potential to improve dietary and eating-related decision-making in individuals with obesity or binge eating symptoms, conditions associated with elevated delay discounting. Here, we meta-analyzed evidence from 12 studies that assessed whether EFT interventions improve delay discounting and real-world food choice compared to control interventions. Included studies involved 951 adults with overweight or obesity (body mass index [BMI] ≥25). There were no studies involving participants with binge eating disorder. EFT intervention pooled effects were significant, improving delay discounting with a medium effect, g = 0.55, p < 0.0001, and subsequent food choice outcomes with a small effect, g = 0.31, p < 0.01. Notably, our review is the first to analyze mechanisms of effect in this population, demonstrating that improvements were greater when temporal horizons of EFT episodes were aligned with delay discounting tasks and more distant horizons predicted far-transfer to subsequent dietary and eating-related choices. Our findings thus show that EFT is an effective intervention for individuals with higher weight at risk of adverse health consequences.

A qualitative exploration of food choice motives of urban indigenous food gatekeepers in Fiji: Implications for the use of the food choice questionnaire.

Pacific Island Countries (PICs) have exceptionally high rates of obesity and non-communicable diseases. The causes are complex but one prominent factor is the notable shift from traditional plant and seafood diets to diets high in unhealthy processed foods. Literature is sparse on the motives behind food choice decisions of Pacific Islanders. The widely used Food Choice Questionnaire (FCQ) (Steptoe et al., 1995) is a multi-dimensional tool capturing nine potential food choice motives. This study used a hybrid thematic analysis. Fourteen in-depth semi-structured interviews with urban indigenous Fijian mothers were conducted to (1) explore how the nine FCQ motives impact food choice (2) to examine conceptual equivalence of the nine FCQ motives and (3) to identify additional food choice motives, not captured in the FCQ. Mothers identified seven of the nine FCQ motives (i.e., health, mood, convenience, sensory appeal, weight control and familiarity) and three new food choice motives (i.e., food that is filling, religious dietary restrictions and food quality) as important determinants of food choice. Moreover, while choosing foods that promote health and well-being was identified as an important food choice motive, mothers also identified four other motives, that they considered important, which lead to over-eating and unhealthy eating. Food choice is a complex, layered decision, driven by multiple considerations, some more important than others. These findings can inform diet-related interventions and policy within this community. Adapting the FCQ for broader PIC use through further qualitative exploration in PICs, and validating the adapted FCQ with larger samples will enhance its utility in measuring food choice motives in PICs.

Drivers and Barriers Influencing Adherence to the Mediterranean Diet: A Comparative Study across Five Countries.

Given the global decline in adherence to the Mediterranean Diet (MD), even within its native region, it is key to identify the factors influencing this trend to mitigate the negative health outcomes associated with westernized diets. To this end, 4025 individuals (49.6% women, 42.6 ± 14.2 y/o) from Greece, Italy, Morocco, Slovenia, and Tunisia remotely completed a series of measures assessing motives, attitudes, and psychosocial factors related to MD adherence, which was evaluated using the MEDAS questionnaire. The results suggested medium-to-low adherence across all countries, with the highest adherence in Italy and Morocco and the lowest in Slovenia. Structural equation modeling revealed that positive attitudes toward the healthiness of food were the strongest predictors of adherence, whereas picky eating was a significant negative predictor in all countries except Greece. Adherence to the MD was positively influenced by health motivations in Morocco and weight control in Slovenia and Greece, while sensory appeal negatively influenced adherence in Italy. Additionally, price and convenience were significant barriers in Tunisia and Greece, whereas a preference for local and seasonal foods promoted adherence in Morocco and Greece. Overall, our findings underscore the need for country-specific interventions and policies that address distinct local factors and motivations to ease favorable shifts in dietary patterns toward MD principles.

BMI and explicit-implicit cues on food choice: The fake food buffet in the United Kingdom and Indonesia.

We examined whether people with high BMI sampled from two different countries were more susceptible to behavioural change via an implicit, rather than explicit, intervention. We measured BMI and used three types of cue interventions (implicit vs explicit healthy lifestyle cue vs neutral cue) to examine their impact on our participants' food choice using the Fake Food Buffet. Healthiness of the meal chosen was measured by the percentage of healthy food items in the meal. Portion size of their chosen meal was operationalised by the total number of food items chosen and its total calorie content was also estimated. Participants were recruited from the United Kingdom (N = 264) and Indonesia (N = 264). Our results indicated that while explicit food cues were overall more effective, implicit cues were a more effective strategy to change food choice behaviours among individuals with high BMI. Participants with high BMI were more likely to regulate the healthiness of their meal and less likely to regulate its portion size or calorie content. The efficacy of our healthy eating interventions was cross-culturally generalizable. Our study supports previous research that implicit cues of a healthy lifestyle might be a more effective behavioural change strategy for individuals with high BMI.