Food environment trajectories: a sequence analysis from the CARTaGENE cohort.

OBJECTIVE: The purpose of this study was to create a typology of longitudinal exposure to food environment based on socio-economic context. DESIGN: Food environment trajectories were modelled using a sequence analysis method, followed by a logistic regression to describe those trajectories. SETTING: The study took place in Quebec, Canada, using food environment data from 2009, 2011 and 2018 merged with participants' demographic and socio-economic characteristics. PARTICIPANT: At recruitment, 38 627 participants between the ages of 40 and 69 years from six urban areas in Quebec were included in the CARTaGENE cohort study. The cohort was representative of the Quebec urban population within this age range. RESULTS: Our study revealed five trajectories of food access over time: (1) limited access to food stores throughout the study period, (2) limited access improving, (3) good access diminishing, (4) good access throughout the period and (5) low access throughout the period. Logistic regression analysis showed that participants who were unable to work (OR = 1·42, CI = 1·08-1·86), lived in households with five or more persons (OR = 1·69, CI = 1·17-2·42) and those living in low-income households (OR = 1·32, CI = 1·03-1·71) had higher odds of experiencing a disadvantaged food environment trajectory. Additionally, the level of education and age of participants were associated with the odds of experiencing a disadvantaged food environment trajectory. CONCLUSIONS: The study demonstrates that people facing socio-economic disadvantage are more likely to experience a disadvantaged food environment trajectory over time.

Examining public health practitioners' perceptions and use of behavioural sciences to design health promotion interventions.

BACKGROUND: Behavioural sciences have been shown to support the development of more effective interventions aimed at promoting healthy lifestyles. However, the operationalization of this knowledge seems to be sub-optimal in public health. Effective knowledge transfer strategies are thus needed to optimize the use of knowledge from behavioural sciences in this field. To this end, the present study examined public health practitioners' perceptions and use of theories and frameworks from behavioural sciences to design health promotion interventions. METHODS: This study adopted an exploratory qualitative design. Semi-structured interviews were conducted among 27 public health practitioners from across Canada to explore current intervention development processes, the extent to which they integrate theory and framework from behavioural sciences, and their perceptions regarding the use of this knowledge to inform intervention design. Practitioners from the public sector or non-profit/private organizations who were involved in the development of interventions aimed at promoting physical activity, healthy eating, or other healthy lifestyle habits (e.g., not smoking) were eligible to participate. RESULTS: Public health practitioners generally agreed that behaviour change is an important goal of public health interventions. On the other hand, behavioural science theories and frameworks did not appear to be fully integrated in the design of public health interventions. The main reasons were (1) a perceived lack of fit with current professional roles and tasks; (2) a greater reliance on experiential-produced knowledge rather than academic knowledge (mainly for tailoring interventions to local setting characteristics); (3) the presence of a fragmented knowledge base; (4) the belief that theories and frameworks require too much time and resources to be operationalized; and 4) the belief that using behavioural sciences might undermine partnership building. CONCLUSIONS: This study provided valuable insights that may inform knowledge transfer strategies that could be optimally designed to support the integration of behavioural sciences theories and frameworks into public health practices.

Validation d'un questionnaire mesurant la consommation de boissons sucrées, jus et eau auprès d'adolescents francophones.

Purpose: To examine the temporal stability and relative validity of the adapted French version of an English self-reported questionnaire measuring the beverage intake (BEVQ) of adolescents.Methods: The French adaptation of the BEVQ (AF-BEVQ) included conversion from the imperial to the metric system and the adjustment of some formats to those available in Canada. Next, 60 adolescents from two regions in Quebec completed the AF-BEVQ and two web-based 24-hour dietary recalls (R24W) (one for a weekday and one for a weekend day) on two occasions, two weeks apart.Results: The AF-BEVQ had moderate intraclass correlation coefficients (ICC) for amounts of sugar-sweetened beverages (ICC: 0.68; 95% confidence interval [CI]: 0.46-0.81), fruit juice (ICC: 0.54; 95% CI: 0.23-0.72) and water (ICC: 0.66; 95% CI: 0.38-0.81) consumed. The amounts of sugar-sweetened beverages (rs = 0.49; p < 0.0001), fruit juice (rs = 0.38; p = 0.0024) and water (rs = 0.65; p < 0.0001) reported in the AF-BEVQ were significantly correlated with those of both R24Ws.Conclusions: For the most part, the AF-BEVQ had adequate metrological properties. It is an interesting tool to quickly measure the sugar-sweetened beverage, fruit juice and water intake of French-speaking adolescents.

Objectif : Vérifier la stabilité temporelle et validité relative de la version française adaptée d'un questionnaire auto-déclaré en anglais mesurant la consommation de diverses boissons (BEVQ) chez les adolescents.Méthodes : L'adaptation française du BEVQ (AF-BEVQ) comprenait notamment la conversion des unités impériales en unités métriques et l'ajustement de certains formats selon ceux disponibles au Canada. Ensuite, 60 adolescents provenant de deux régions du Québec ont complété l'AF-BEVQ et deux rappels de 24 heures Web (R24W) (un jour de semaine et un de fin de semaine) à deux reprises à deux semaines d'intervalle.Résultats : L'AF-BEVQ avait des coefficients intra-classe (ICC) modérés pour les quantités de boissons sucrées (ICC : 0,68; intervalle de confiance [IC] 95 % : 0,46­0,81), de jus de fruits (ICC : 0,54; IC 95 % : 0,23­0,72) et d'eau (ICC : 0,66; IC 95 % : 0,38­0,81) consommées. Les quantités de boissons sucrées (rs = 0,49; p < 0,0001), de jus de fruits (rs = 0,38; p = 0,0024) et d'eau (rs = 0,65; p < 0,0001) rapportées dans l'AF-BEVQ étaient significativement corrélées à celles des deux R24W.Conclusions : L'AF-BEVQ présentait majoritairement des propriétés métrologiques adéquates. Il est un outil d'intérêt pour mesurer rapidement la consommation de boissons sucrées, de jus de fruits et d'eau d'adolescents francophones.

Assessing nutritional value of ready-to-eat breakfast cereals in the province of Quebec (Canada): a study from the Food Quality Observatory.

OBJECTIVE: The Food Quality Observatory was created in the province of Quebec (Canada) in 2016. In this study, the Observatory aimed to generate a methodology to (1) test the use of sales data combined with nutrient values to characterise the nutritional composition of ready-to-eat (RTE) breakfast cereals offered and purchased in the province of Quebec (Canada) and (2) verify the extent to which a front-of-pack label based on the percentage of daily value (DV) for total sugar, as a strategy to improve the food supply, would be distributed in this food category. DESIGN: Nutritional information were obtained by purchasing each RTE breakfast cereal available in the Greater Montreal area. Cereals were then classified according to their processing type. SETTING: The nutritional values of 331 RTE breakfast cereals available in Quebec were merged with sales data covering the period between May 2016 and May 2017. A total of 306 products were successfully cross-referenced. RESULTS: Granola and sweetened cereals were the most available (36·6 % and 19·6 %, respectively) and purchased (19·8 % and 40·9 % of sales, respectively). When compared with other types of cereals, granola cereals had a higher energy, fat, saturated fat, protein content and a lower Na content. A larger proportion of chocolate (65 %) and sweetened cereals (49 %) were above 15 % of the DV for sugar. CONCLUSIONS: This study showed that the methodology developed generates important data to monitor nutritional quality of the food supply and ultimately contribute to improve the nutritional quality of processed foods.

Pattern and correlates of public support for public health interventions to reduce the consumption of sugar-sweetened beverages.

OBJECTIVE: To examine the pattern and correlates of public support for twelve public health interventions aimed at reducing sugar-sweetened beverage (SSB) consumption. DESIGN: Cross-sectional population-based survey. Respondents were recruited using a random digit dialling procedure (landline telephone) and a random selection of telephone numbers (mobile telephone). Sampling quotas were applied for age, and the sample was stratified according to administrative regions. SETTING: The province of Québec, Canada. SUBJECTS: One thousand adults aged between 18 and 64 years and able to answer the survey questionnaire in French or English. RESULTS: Support was observed for a number of public health interventions, but the more intrusive approaches were less supported. Support for taxation as well as for sale and access restriction was positively associated with the perceived relevance of the government intervention, perceived effectiveness, and perceived associations between SSB consumption and chronic diseases. Believing that SSB consumption is a personal choice and daily consumption were generally negatively associated with strong support and positively associated with strong opposition. Sparse associations between sociodemographic and socio-economic characteristics were observed, with the exception of sex and age: women were generally more likely to support the examined public health strategies, while younger respondents were less likely to express support. CONCLUSIONS: Increasing perceived effectiveness and government responsibility for addressing the issue of SSB consumption could lead to increased support for SSB interventions. Increasing the belief that SSB consumption could be associated with chronic diseases would increase support, but SSB consumers and younger individuals are expected to be resistant.

Does HealthAtEvery Size® fit all? A group-based trajectory modeling of a non-diet intervention.

OBJECTIVE: Health At Every Size® (HAES®) interventions have been increasingly recognized as a sustainable strategy in obesity management. Nevertheless, heterogeneity among obese individuals leads to challenges as it translates in mixed responses to treatment. In this context, our objective was to identify trajectories of responses to a non-diet intervention for adult overweight/obese women to highlight profiles of responders. METHOD: Based on data from a multicentric quasi-experimental study, a latent class growth modeling (LCGM) was performed. Two hundred and ten women with high body mass index (BMI ≥ 25, MBMI = 36.53) who followed a non-diet intervention offered in Health and Social Services Centres completed questionnaires at T = 0, 4 and 16 months. Outcomes used in the LCGM were intuitive eating and body esteem, two central components in HAES® interventions. Types of responders were then profiled on sociodemographic, weight, lifestyle, psychological and eating variables. RESULTS: The LCGM revealed a 4-trajectory model (p < .001), comprising non-responders (14.67%), moderate improvement with low maintenance responders (49.89%), moderate improvement with high maintenance responders (29.28%) and high functioning partial responders (6.56%). Analysis of variances showed significant differences between all types of responders with medium to large effect sizes on depressive symptoms, self-esteem and disinhibited eating (p < .001; η2 = .23, 0.30 and 0.16 respectively). Fewer differences were found on sociodemographic, lifestyle, health and weight variables. Overall, non-responders (14.67%) had a distinctive profile compared to the other groups by consistently expressing poorer psychological functioning, less adapted eating behaviors and reaching more frequently the clinical cutoff for severe depression (p = .001). CONCLUSIONS: Findings strongly support the relevance of considering psychological characteristics to move towards personalized healthcare in obesity management.

Association between junk food consumption and fast-food outlet access near school among Quebec secondary-school children: findings from the Quebec Health Survey of High School Students (QHSHSS) 2010-11.

OBJECTIVE: We investigated the association between junk food consumption at lunchtime (JCL) and fast-food outlet access near school among secondary-school children in Quebec. DESIGN: A geographic information system database was used to characterize the food environment around a sub-sample of 374 public schools in which 26 655 students were enrolled. The outcome variable was JCL during the previous week, dichotomized into low JCL (none or once) v. high JCL (twice or more). Access to fast-food outlets near school was assessed using an existing database of fast-food outlets in Quebec. Covariates included student (age, sex and self-rated perceived health), family (familial status and parental education) and school (urban/rural status and deprivation) variables. Hierarchical logistic regression models were employed for analyses using PROC GLIMMIX of SAS version 9.3. SETTING: Province of Quebec, Canada. SUBJECTS: We used data from the Quebec Health Survey of High School Students (QHSHSS) 2010-11, a survey of secondary-school Quebec students. RESULTS: Exposure to two or more fast-food outlets within a radius of 750 m around schools was associated with a higher likelihood of excess JCL (OR=1·50; 95 % CI 1·28, 1·75), controlling for the characteristics of the students, their families and their schools. CONCLUSIONS: The food environment surrounding schools can constitute a target for interventions to improve food choices among secondary-school children living in the province of Quebec. Transforming environments around schools to promote healthy eating includes modifying zoning regulations that restrict access to fast-food outlets around schools.

Life-course socioeconomic status and obesity: a scoping review protocol.

OBJECTIVE: We aim to explore the literature that studies the links between life-course socioeconomic status and weight status and characterize the life-course approach used. INTRODUCTION: Obesogenic environments are increasing rapidly in deprived environments, and cross-sectional studies have shown limitations in explaining the links between these environments and obesity. The life-course approach has been proposed recently to better understand the links between socioeconomic status and weight status. INCLUSION CRITERIA: Studies that identify life-course socioeconomic status and longitudinal built environment indicators and associate them with body weight indicators between January 2000 and January 2023. METHODS: Studies in French or English were searched in Medline (PubMed), Web of Science and GeoBase (Embase) according to the strategies formulated for each database. The selected studies were exported to Covidence for evaluation according to the inclusion/exclusion criteria. RESULTS: The main results retained are the association between longitudinal socioeconomic indicators and weight measures; longitudinal built environment indicators and the measures of weight.

To use or not to use behavioural science evidence in designing health promotion interventions: Identification of targets for capacity building.

OBJECTIVES: The behavioural sciences provide useful evidence to design effective health promotion interventions, but evidence is infrequently integrated in practice. This study examined associations between theoretical domains framework (TDF) constructs and public health practitioners' use of behavioural science evidence to plan public health actions. METHODS: Using a cross-sectional design, a convenience sample of 160 practitioners were recruited from public health agencies across Canada. Respondents completed an online questionnaire assessing TDF constructs and the use of behavioural science theory and approaches (i.e., evidence) in their practice. Logistic regression analyses allowed for identification of factors associated with evidence use and intentions. All analyses were adjusted for sex, years of experience, and type of public health agency. RESULTS: Greater skills (ORadj = 4.1, 95%CI 1.3, 13.5) and stronger intentions/aligned goals (ORadj = 9.2, 95%CI 2.3, 36.1) were associated with greater use of behavioural science evidence to plan public health actions. Greater perceived capacity to overcome widespread absence of use of behavioural science evidence in their organization (ORadj = 7.2, 95%CI 1.7, 30.3) was also associated with greater use. More knowledge (ORadj = 8.6, 95%CI 1.9, 39.1) and stronger beliefs about consequences (ORadj = 4.0, 95%CI 1.1, 14.7) were significantly associated with stronger intentions/aligned goals. CONCLUSION: Findings show that more knowledge, positive attitudes, and stronger perceived competence are associated with greater likelihood of using behavioural science evidence to plan interventions. The use of behavioural science evidence will also require strengthening the norm pertaining to this professional practice in public health organizations.

RéSUMé: OBJECTIFS: Les sciences du comportement fournissent de riches données probantes pour développer des interventions efficaces en promotion de la santé. Toutefois, ces connaissances issues de la recherche ne sont pas fréquemment intégrées dans la pratique. Cette étude examine les associations entre les construits du modèle des domaines théoriques (MDT) et le comportement d'utiliser les données probantes en science du comportement pour planifier les actions de santé publique auprès de professionnel.le.s de ce domaine. MéTHODES: Via l'utilisation d'un devis transversal, un échantillon de convenance de 160 professionel.le.s a été recruté au travers du Canada. Les répondants ont rempli un questionnaire en ligne qui mesurait les construits du MDT et l'utilisation des approches et théories des sciences du comportement (i.e., les données probantes) dans leur pratique professionnelle. Des analyses de régression logistique ont permis d'identifier les facteurs associés à ce comportement et les intentions. Toutes les analyses ont été ajustées pour le sexe, le nombre d'années d'expérience et le type d'agences de santé publique. RéSULTATS: De grandes habiletés (RCadj = 4,1, IC95%: 1,3­13,5) et des intentions fortes/buts cohérents (RCadj = 9,2, IC95%: 2,3, 36,1) étaient associés à une plus grande utilisation des données probantes en science du comportement pour planifier des actions de santé publique. Une plus grande capacité à surmonter l'absence généralisée de l'utilisation des données probantes en science du comportement dans son organisation (RCadj = 7,2, IC95%: 1,7, 30,3) était aussi associée à une plus grande utilisation. Des connaissances plus grandes (RCadj = 8,6, IC95%: 1,9, 39,1) et des croyances plus importantes concernant les résultats (RCadj = 4,0, IC95%: 1,1, 14,7) étaient significativement associées à de plus fortes intentions/cohérence dans les buts. CONCLUSION: Les résultats montrent que des connaissances plus grandes, des attitudes favorables et une plus forte perception en ses habiletés sont associées à de plus grandes possibilités d'utiliser les données probantes en science du comportement pour planifier des interventions. L'utilisation de ces données probantes en science du comportement va également demander un renforcement dans les normes entourant cette pratique professionnelle dans les organisations de santé publique.

Adhering to Canada's Food Guide Recommendations on Healthy Food Choices Increases the Daily Diet Cost: Insights from the PREDISE Study.

The aim of this study was to assess the association between daily diet costs and the Healthy Eating Food Index (HEFI)-2019, an index that reflects the alignment of dietary patterns to recommendations on healthy food choices in the 2019 Canada's Food Guide (CFG). Dietary intake data from 24 h recalls, completed between 2015 and 2017, of 1147 French-speaking participants of the web-based multicenter cross-sectional PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) study in Quebec were used. Diet costs were calculated from dietary recall data using a Quebec-specific 2015-2016 Nielsen food price database. Usual dietary intakes and diet costs were estimated using the National Cancer Institute's multivariate method. Linear regression models were used to evaluate associations between diet costs and HEFI-2019 scores. When standardized for energy intake, a higher HEFI-2019 score (75th vs. 25th percentiles) was associated with a 1.09 $CAD higher daily diet cost (95% CI, 0.73 to 1.45). This positive association was consistent among different sociodemographic subgroups based on sex, age, education, household income, and administrative region of residence. A higher daily diet cost was associated with a higher HEFI-2019 score for the Vegetables and fruits, Beverage, Grain foods ratio, Fatty acids ratio, Saturated fats, and Free sugars components, but with a lower score for the Sodium component. These results suggest that for a given amount of calories, a greater adherence to the 2019 CFG recommendations on healthy food choices is associated with an increased daily diet cost. This highlights the challenge of conciliating affordability and healthfulness when developing national dietary guidelines in the context of diet sustainability.

Health At Every Size intervention® under real-world conditions: the rights and wrongs of program implementation.

Implementation integrity is known to be critical to the success of interventions. The Health At Every Size® (HAES®) approach is deemed to be a sustainable intervention on weight-related issues. However, no study in the field has yet investigated the effects of implementation on outcomes in a real-world setting. Objective: This study aims to explore to what extent does implementation integrity moderate program outcomes across multiple sites. Methods: One hundred sixty-two women nested in 21 health facilities across the province of Québec (Canada) were part of a HAES® intervention and completed questionnaires at baseline and after the intervention. Participant responsiveness (e.g. home practice completion) along with other implementation dimensions (dosage, adherence, adaptations) and providers' characteristics (n = 45) were assessed using a mix of qualitative and quantitative data analysis. Adaptations to the program curriculum were categorized as either acceptable or unacceptable. Multilevel linear modeling was performed with participant responsiveness and other implementation dimensions predictors. Intervention outcomes were intuitive eating and body esteem. Results: Unacceptable adaptations were significantly associated with providers' self-efficacy (rs (23) = .59, p = .003) and past experience with facilitating the intervention (r(23) = .47, p = .03). Participant responsiveness showed a significant interaction between time and home practice completion (B = .07, p < .05) on intuitive eating scores. Conclusion: Except for participant responsiveness, other implementation dimensions did not moderate outcomes. Implications for future research and practice are discussed.

Implementing a Rural Natural Experiment: A Protocol for Evaluating the Impacts of Food Coops on Food Consumption, Resident's Health and Community Vitality.

BACKGROUND: Local food environments are recognized by experts as a determinant of healthy eating. Food cooperatives (coop) can promote the accessibility to healthier foods and thus improve the health of the population, particularly in remote rural communities. OBJECTIVE: To measure the effects of implementing a food coop in a disadvantaged community with poor access to food. We have two main research questions: (1). Does the establishment of a food coop in rural areas described as food deserts have an impact on accessibility, frequency of use, food consumption, food quality, and ultimately the health of individuals? (2). Does the establishment of a food coop in rural areas described as food deserts have an impact on food security and community vitality? DESIGN: A natural experiment with a mixed pre/post method will be used. The sample is composed of households that came from geographically isolated communities (population: 215 to 885 inhabitants) which qualified as food deserts and located in rural areas of Quebec (Canada). All communities plan to open a food coop (in the years 2022-2023), and as their opening will be staggered over time, participants from communities with a new food coop (intervention) will be compared to communities awaiting the opening of their food coop (control). Data collection was carried out at three time points: (1) before; (2) 1 to 5 months after; and (3) 13 to 17 months after the opening of the coop. Questionnaires were used to measure sociodemographic variables, dietary intake, residents' health, and community vitality. Semi-structured interviews were conducted with community stakeholders. RESULTS: Few natural experiments have been conducted regarding the impact of implementing food coops. Gathering concrete data on the effectiveness and processes surrounding these interventions through natural experiments will help to quantify their impact and guide knowledge users and policymakers to make more informed decisions.

Development of a Method to Locate Deserts and Food Swamps Following the Experience of a Region in Quebec, Canada.

Unhealthy eating and food insecurity are recognized risk factors for chronic diseases. Collective and environmental factors, such as geographic access to food condition food choices. The objective of this study was to map food deserts and food swamps in Gaspesie, a region of Quebec (Canada), using geographical information systems (GIS) and field validation. Eleven sectors (5 rural and 6 urban) where 5% of the Gaspesie population lives were considered food deserts. Eight sectors (all rural) constituting 4.5% of the population were considered food swamps. Nearly 88% (3/8) of food swamps were located in disadvantaged and very disadvantaged areas. The Gaspesie region is already actively involved in changing environments to make them conducive to healthy eating for all. The mapping of food deserts can support intersectoral collaboration on food security. Food swamp mapping will make it possible to more accurately characterize the existing food environment in the region. Both indicators will be useful in raising awareness and mobilizing partners for a comprehensive strategy to improve the food environment that is not only based on the food desert indicator alone but also takes into account the presence of food swamps.

Eating-Related and Psychological Outcomes of Health at Every Size Intervention in Health and Social Services Centers Across the Province of Québec.

PURPOSE: To report the outcomes of a Health at Every Size (HAES) intervention in a real-world setting. DESIGN: Quasi-experimental design evaluating eating behaviors and psychological factors. SETTING: The HAES intervention is offered in Health and Social Services Centers in Québec (Canada). PARTICIPANTS: For this study, 216 women (body mass index [BMI]: 35.76 [6.80] kg/m2) who participated to the HAES intervention were compared to 110 women (BMI: 34.56 [7.30] kg/m2) from a comparison group. INTERVENTION: The HAES intervention is composed of 14 weekly meetings provided by health professionals. It focuses on healthy lifestyle, self-acceptance, and intuitive eating. MEASURES: Eating behaviors (ie, flexible restraint, rigid restraint, disinhibition, susceptibility to hunger, intuitive eating, and obsessive-compulsive eating) and psychological correlates (ie, body esteem, self-esteem, and depression) were assessed using validated questionnaires at baseline, postintervention, and 1-year follow-up. ANALYSIS: Group, time, and interaction effects analyzed with mixed models. RESULTS: Significant group by time interactions were found for flexible restraint ( P = .0400), disinhibition ( P < .0001), susceptibility to hunger ( P < .0001), intuitive eating ( P < .0001), obsessive-compulsive eating ( P < .0001), body-esteem ( P < .0001), depression ( P = .0057), and self-esteem ( P < .0001), where women in the HAES group showed greater improvements than women in the comparison group at short and/or long term. CONCLUSION: The evaluation of this HAES intervention in a real-life context showed its effectiveness in improving eating-, weight-, and psychological-related variables among women struggling with weight and body image.

Development, reliability and use of a food environment assessment tool in supermarkets of four neighbourhoods in Montréal, Canada. / Élaboration, fiabilité et utilisation d'un outil de mesure de l'environnement alimentaire dans les supermarchés de quatre quartiers de Montréal (Canada).

INTRODUCTION: The food environment is a promising arena in which to influence people's dietary habits. This study aimed to develop a comprehensive food environment assessment tool for businesses and characterize the food environment of a low-tomedium income area of Montréal, Canada. METHODS: We developed a tool, Mesure de l'environnement alimentaire du consommateur dans les supermarchés (MEAC-S), and tested it for reliability. We used the MEAC-S to assess the consumer food environment of 17 supermarkets in four neighbourhoods of Montréal. We measured the shelf length, variety, price, display counts and in-store positions of fruits and vegetables (FV) and ultra-processed food products (UPFPs). We also assessed fresh FV for quality. Store size was estimated using the total measured shelf length for all food categories. We conducted Spearman correlations between these indicators of the food environment. RESULTS: Reliability analyses revealed satisfactory results for most indicators. Characterization of the food environment revealed high variability in shelf length, variety and price of FV between supermarkets and suggested a disproportionate promotion of UPFPs. Display counts of UPFPs outside their normal display location ranged from 7 to 26, and they occupied 8 to 33 strategic in-store positions, whereas the number of display counts of fresh FV outside their normal display location exceeded 1 in only 2 of the 17 stores surveyed, and they occupied a maximum of 2 strategic in-store positions per supermarket. Price of UPFPs was inversely associated with their prominence (p < .005) and promotion (p < .003). Store size was associated with display counts and strategic in-store positioning of UPFPs (p < .001), but not FV, and was inversely associated with the price of soft drinks (p < .003). CONCLUSION: This study illustrates the variability of the food environment between supermarkets and underscores the importance of measuring in-store characteristics to adequately picture the consumer food environment.

INTRODUCTION: L'environnement alimentaire constitue un domaine propice si l'on veut influencer les habitudes alimentaires de la population. Cette étude visait à élaborer un outil de mesure de l'environnement alimentaire dans les commerces et à caractériser l'environnement alimentaire dans un secteur de Montréal (Canada) possédant un niveau de revenu de faible à moyen. MÉTHODOLOGIE: Nous avons développé un outil, la Mesure de l'environnement alimentaire du consommateur dans les supermarchés (MEAC-S) et nous l'avons mis à l'essai pour en confirmer la fiabilité. Nous avons utilisé la MEAC-S pour évaluer l'environnement alimentaire de consommation de 17 supermarchés dans quatre quartiers de Montréal. Nous avons mesuré la longueur d'étalage, la diversité, le prix, le nombre de présentoirs et la position en magasin des fruits et légumes (FL) et des produits alimentaires ultra-transformés (PAUT). Nous avons également évalué la qualité des FL frais. La taille du magasin a été estimée en utilisant la longueur totale d'étalage mesurée pour toutes les catégories d'aliments. Nous avons effectué des corrélations de Spearman entre ces indicateurs de l'environnement alimentaire. RÉSULTATS: Les analyses de fiabilité ont donné des résultats satisfaisants pour la plupart des indicateurs. La caractérisation de l'environnement alimentaire a révélé une grande variabilité de la longueur d'étalage, de la diversité et du prix des FL entre les supermarchés ainsi qu'une mise en valeur disproportionnée des PAUT. Le nombre de présentoirs de PAUT hors de leur emplacement principal de vente variait de 7 à 26 et ces produits occupaient de 8 à 33 positions stratégiques en magasin, alors que le nombre de présentoirs hors de l'emplacement principal de vente de FL frais était supérieur à 1 dans seulement 2 des 17 magasins évalués et qu'ils occupaient un maximum de 2 emplacements stratégiques par supermarché. Le prix des PAUT était inversement associé à leur proéminence (p < 0,005) et à leur promotion (p < 0,003). La taille du magasin était associée au nombre de présentoirs et au positionnement stratégique des PAUT (p < 0,001) mais pas à celui des FL, et elle était inversement associée au prix des boissons gazeuses (p < 0,003). CONCLUSION: Cette étude illustre la variabilité de l'environnement alimentaire entre les supermarchés et souligne l'importance de mesurer les caractéristiques en magasin pour brosser un tableau juste de l'environnement alimentaire du consommateur.

A Health at Every Size intervention improves intuitive eating and diet quality in Canadian women.

BACKGROUND & AIMS: Health at Every Size® (HAES®) interventions focus on healthy lifestyle by promoting behavioral changes related to diet and physical activity while emphasizing self-acceptance and well-being through an empowerment and intuitive approach. The purpose of this study was to investigate the effects of a HAES® program on intuitive eating and diet quality in women. METHODS: The HAES® intervention, offered by professionals from Health and Social Services Centers in Quebec (Canada), was composed of thirteen 3-h weekly meetings and a 6-h intensive day. For this study, 216 women (1.9% normal-weight, 21.1% overweight, 77.0% obese) who took part to the HAES program were compared to 110 women (3.9% normal-weight, 23.3% overweight, 72.8% obese) from a control group (waiting list). Intuitive eating was assessed using the Intuitive Eating Scale and diet quality was evaluated through the calculation of the Healthy Eating Index (HEI) from a validated web-based self-administrated food frequency questionnaire. Measurements were performed at baseline, post-intervention, and at one-year follow-up. RESULTS: Women who participated in the HAES® program significantly increased their intuitive eating score compared to women in the control group at post-intervention and at follow-up (group by time interaction, p = 0.0002). A significant improvement in diet quality was also observed in the HAES® group in comparison with the control group at post-intervention (group by time interaction, p = 0.0139). The intuitive eating score and the HEI score were positively associated in the HAES® group at post-intervention (r = 0.20, p = 0.0237) and one-year follow-up (r = 0.22, p = 0.0359), but no such associations were noted in the control group (post-intervention, r = 0.04, p = 0.70; one-year follow-up, r = -0.15, p = 0.30). CONCLUSIONS: The HAES® program seems effective in improving intuitive eating and also favours improvements in diet quality. However, the association between intuitive eating and diet quality remains unclear, being positive and significant only after the HAES® intervention.

Canadian dietitians' approaches to counseling adult clients seeking weight-management advice.

This study describes Canadian dietitians' approaches to counseling adults seeking weight-management advice. Fifteen focus groups were conducted at seven sites across Canada. The participants, most of whom worked in clinical or private practice, discussed their approach to specific weight-management counseling scenarios, including women clients with and without associated risk factors (impaired glucose tolerance, hypertension, family history of cardiovascular disease) and long histories of dieting. Results indicate that participants used a lifestyle approach for weight-management counseling, where the main goal was improved client health through healthful eating and increased physical activity. In contrast to clients' perceived weight loss goals, participants rarely included weight loss as a goal for clients with no additional chronic disease risk factors. For clients with risk factors, some participants advocated moderate weight loss, while others aimed for health at any size. Participants also discussed the importance of clients' psychological well-being, particularly in relation to feelings about food and body image. Individualized approaches to setting goals, gathering information, and giving advice/educating were identified as key counseling strategies. Further research to evaluate the effectiveness of dietitians' weight-management approaches and additional counseling training for dietitians will enhance practitioners' skills and confidence in this area.

Perceptions of healthy eating: state of knowledge and research gaps.

To effectively promote and support healthy eating among Canadians, there needs to be a better understanding of the factors that influence eating behaviours. Perceptions of healthy eating can be considered as one of the many factors influencing people's eating habits. For this review, "perceptions of healthy eating" are defined as the public's and health professionals' meanings, understandings, views, attitudes and beliefs about healthy eating, eating for health, and healthy foods. This article's aim is to review and summarize the literature on the perceptions of healthy eating and to identify the current state of knowledge and key knowledge gaps. Databases, the worldwide web, selected journals and reference lists were searched for relevant papers from the last 20 years. Reviewed articles suggest relative homogeneity in the perceptions of healthy eating despite the studies being conducted in different countries and involving different age groups, sexes and socio-economic status. Perceptions of healthy eating were generally based on food choice. Fruits and vegetables were consistently recognized as part of healthy eating. Characteristics of food such as naturalness, and fat, sugar and salt contents were also important in people's perceptions of healthy eating. Concepts related to healthy eating, such as balance, variety and moderation, were often mentioned, but they were found to be polysemous, conveying multiple meanings. The main gap identified in this review concerns the lack of knowledge available on perceptions of healthy eating. More data are needed on the perceptions of healthy eating in general, on the influence on perceptions of messages from diverse sources such as food companies, and, most important, on the role of perceptions of healthy eating as a determinant of food choice.

Is Sugar the new Tobacco? Insights from Laboratory Studies, Consumer Surveys and Public Health.

In the Americas, mean energy intake from added sugar exceeds recent World Health Organization recommendations for free sugars in the diet. As a leading contributor to this excess, sugar-sweetened beverage (SSB) overconsumption represents a risk for the population's health. This article provides an overview of clinical and epidemiological evidence, marketing practices, corporate influence and prevention strategies related to added sugar and SSB. For each aspect of this multidimensional profile, we briefly compare SSB to the case of tobacco pointing to similarities but also major differences. Tobacco control has demonstrated the effectiveness of long term multifaceted prevention strategies in multiple settings supported by strong public policies which may be applied to the consumption of SSB. However, translating these policies to the specific case of SSB is urgently needed, to inform preventive actions, decide which intervention mix will be used, and evaluate the process and impact of the chosen strategy.

Sociocultural context of women's body image.

In our society, women's bodies are the locus of both increasing rates of obesity and body dissatisfaction. While these trends may seem contradictory or to result from each other, an alternative explanation is that they are both the products of an unfavourable sociocultural environment in the area of food and weight. Both body dissatisfaction and excess weight can seriously impact women's physical and emotional health. The strong cultural value placed on thinness, especially for women, unfortunately may take precedence over health. To effectively address the impact of women's body image dissatisfaction requires an understanding of the multiple contexts of women's lives. This study used a naturalistic paradigm to explore how women's personal and sociocultural context influences their body image. Forty-four non-eating disordered women ranging from 21 to 61 years old were interviewed twice using a semi-structured interview guide. Women's narratives revealed that body image is not a static construct, but is dynamic and fluctuates as women encounter new experiences and re-interpret old ones. The powerful and unconscious impact of the media on body image was mediated by women's internal contexts (self-confident and self-critical) and their relationships with others, such as partners and other women. Body image was not so much influenced by the nature of others' comments but interpretation of their meaning. However, health professionals' comments were typically not reinterpreted due to the health context in which they were given. While some women's narratives expressed their internalized sociocultural norms, others' described acceptance of their bodies following a process of reflection and empowerment. In light of these findings, efforts to improve women's body image, and by extension their health, can no longer only focus on diminishing the tangible power of industry and media, but must include transforming the social ties, practices and conventions in everyday relationships, including with health professionals.