"Warning: ultra-processed": an online experiment examining the impact of ultra-processed warning labels on consumers' product perceptions and behavioral intentions.

BACKGROUND: Nutrient content and degree of processing are complementary but distinct concepts, and a growing body of evidence shows that ultra-processed foods (UPFs) can have detrimental health effects independently from nutrient content. 10 + countries currently mandate front-of-package labels (FOPL) to inform consumers when products are high in added sugars, saturated fat, and/or sodium. Public health advocates have been calling for the addition of ultra-processed warning labels to these FOPLs, but the extent to which consumers would understand and be influenced by such labels remains unknown. We examined whether the addition of ultra-processed warning labels to existing nutrient warning labels could influence consumers' product perceptions and purchase intentions. METHODS: In 2023, a sample of adults in Brazil (n = 1,004) answered an open-ended question about the meaning of the term "ultra-processed," followed by an online experiment where they saw four ultra-processed products carrying warning labels. Participants were randomly assigned to view either only nutrient warning labels or nutrient plus ultra-processed warning labels. Participants then answered questions about their intentions to purchase the products, product perceptions, and perceived label effectiveness. RESULTS: Most participants (69%) exhibited a moderate understanding of the term "ultra-processed" prior to the experiment. The addition of an ultra-processed warning label led to a higher share of participants who correctly identified the products as UPFs compared to nutrient warning labels alone (Cohen's d = 0.16, p = 0.02). However, the addition of the ultra-processed warning label did not significantly influence purchase intentions, product healthfulness perceptions, or perceived label effectiveness compared to nutrient warning labels alone (all p > 0.05). In exploratory analyses, demographic characteristics and prior understanding of the concept of UPF did not moderate the effect of ultra-processed warning labels. CONCLUSIONS: Ultra-processed warning labels may help consumers better identify UPFs, although they do not seem to influence behavioral intentions and product perceptions beyond the influence already exerted by nutrient warning labels. Future research should examine how ultra-processed warning labels would work for products that do and do not require nutrient warnings, as well as examine the benefits of labeling approaches that signal the health effects of UPFs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05842460. Prospectively registered March 15th, 2023.

Decreases in purchases of energy, sodium, sugar, and saturated fat 3 years after implementation of the Chilean food labeling and marketing law: An interrupted time series analysis.

BACKGROUND: In 2016, Chile implemented a multiphase set of policies that mandated warning labels, restricted food marketing to children, and banned school sales of foods and beverages high in nutrients of concern ("high-in" foods). Chile's law, particularly the warning label component, set the precedent for a rapid global proliferation of similar policies. While our initial evaluation showed policy-linked decreases in purchases of high-in, a longer-term evaluation is needed, particularly as later phases of Chile's law included stricter nutrient thresholds and introduced a daytime ban on advertising of high-in foods for all audiences. The objective is to evaluate changes in purchases of energy, sugar, sodium, and saturated fat purchased after Phase 2 implementation of the Chilean policies. METHODS AND FINDINGS: This interrupted time series study used longitudinal data on monthly food and beverage purchases from 2,844 Chilean households (138,391 household-months) from July 1, 2013 until June 25, 2019. Nutrition facts panel data from food and beverage packages were linked at the product level and reviewed by nutritionists. Products were considered "high-in" if they contained added sugar, sodium, or saturated fat and exceeded nutrient or calorie thresholds. Using correlated random-effects models and an interrupted time series design, we estimated the nutrient content of food and beverage purchases associated with Phase 1 and Phase 2 compared to a counterfactual scenario based on trends during a 36-month pre-policy timeframe. Compared to the counterfactual, we observed significant decreases in high-in purchases of foods and beverages during Phase 2, including a relative 36.8% reduction in sugar (-30.4 calories/capita/day, 95% CI -34.5, -26.3), a 23.0% relative reduction in energy (-51.6 calories/capita/day, 95% CI -60.7, -42.6), a 21.9% relative reduction in sodium (-85.8 mg/capita/day, 95% CI -105.0, -66.7), and a 15.7% relative reduction in saturated fat (-6.4 calories/capita/day, 95% CI -8.4, -4.3), while purchases of not-high-in foods and drinks increased. Reductions in sugar and energy purchases were driven by beverage purchases, whereas reductions in sodium and saturated fat were driven by foods. Compared to the counterfactual, changes in both high-in purchases and not high-in purchases observed in Phase 2 tended to be larger than changes observed in Phase 1. The pattern of changes in purchases was similar for households of lower versus higher socioeconomic status. A limitation of this study is that some results were sensitive to the use of shorter pre-policy time frames. CONCLUSIONS: Compared to a counterfactual based on a 36-month pre-policy timeframe, Chilean policies on food labeling, marketing, and school food sales led to declines in nutrients of concern during Phase 2 of implementation, particularly from foods and drinks high in nutrients of concern. These declines were sustained or even increased over phases of policy implementation.

Food Industry Compliance With the Display of Front-of-Package Warning Labels at the Final Phase (2020) of Chile's Labeling and Advertising Law.

Objectives. To investigate food industry compliance with the display of front-of-package warning labels (FOPLs) on products that exceed regulatory thresholds for being high in calories, added sugars, sodium, or saturated fats after full implementation of Chile's Food Labeling and Advertising Law. Methods. In 2020, trained dietitians took pictures of nutritional information and FOPLs on packaged products in supermarkets. We categorized foods and beverages as requiring FOPLs (or not) using their nutritional composition and ingredients as set out in government guidelines. We compared these classifications with the actual display of FOPLs. Results. About 62.5% of packaged foods and beverages displayed any FOPL. The most frequent label was for energy (38.7%), followed by sugars (35.2%), saturated fats (26.2%), and sodium (22.6%). Compliance with FOPL display was high (93.6% for any "high-in" designation). Lower compliance was observed in nonsausage meat products (83.5%) and soups (84.5%). Candies and sweet confectionery and sausages contributed most to noncompliance with any "high-in" designation. Conclusions. Following the law's full implementation, the food industry complied with the display of FOPLs. Mandatory policies with clear guidelines and monitoring systems can contribute to ensuring and sustaining high compliance. (Am J Public Health. Published online ahead of print September 26, 2024:e1-e8. https://doi.org/10.2105/AJPH.2024.307843).

Impact of nutrient warning labels on Colombian consumers' selection and identification of food and drinks high in sugar, sodium, and saturated fat: A randomized controlled trial.

OBJECTIVE: This study assessed the impact of nutrient warnings on product selection and ability to identify food products high in nutrients of concern in Colombia. METHODS: In an online experiment (May-June 2023), Colombian adults were randomized to a nutrient warning, guideline daily amounts (GDA), Nutri-Score, or no-label condition (n = 8,004). Participants completed selection tasks between two fruit drinks labeled according to their condition, one high in sugar and one not. Next, participants answered questions about products high in sugar, sodium, and/or saturated fat ("high-in" product). Finally, they selected which label would most discourage them from consuming a high-in product. RESULTS: Fewer participants (17%) exposed to the nutrient warning indicated they would purchase the high-sugar fruit drink compared to Nutri-Score (27%, Holm-adjusted (adj) p<0.001) and no label conditions (31%, adj p<0.001); there were no differences between the nutrient warning and GDA label (14%, adj p = 0.087). Compared to the nutrient warning, the GDA label was slightly more effective at helping consumers identify which drink was high in sugar (89% versus 92%, adj p<0.001), while the Nutri-Score and no-label conditions were less effective. Compared to all other conditions, nutrient warnings were more effective at helping participants identify that products were high in nutrients of concern, were more effective at decreasing intentions to purchase these high-in products and were perceived as more effective. Nutrient warnings were most often selected as the label that most discouraged consumption. CONCLUSIONS: Nutrient warnings are a promising policy to help consumers identify and discourage consumption of products high in nutrients of concern. TRIAL REGISTRATION: Trial Registration: NCT05783726.

Food for thought or food for emotions? An analysis of marketing strategies in television food advertising seen by children in Colombia.

OBJECTIVE: To establish the relationship between the marketing strategies and nutritional quality of foods and beverages promoted in television food advertisements (TV ads) seen by Colombian child audiences overall and based on child gender and socio-economic strata (SES). DESIGN: A quantitative content analysis of marketing appeals was combined with nutritional data of the food products advertised and matched with TV audience ratings data for each food and beverage ads for Colombian children between 4 and 11 years. SETTING: All beverages and foods TV ads cable or over-the-air channels in Colombia in 2017. PARTICIPANTS: N/A. RESULTS: Compared with rational appeals (e.g. freshness, health or nutrition messages), emotional appeals (referencing or depicting human senses or emotions, e.g. using cartoons to suggest fun) were more frequently used in the TV ads most viewed by Colombian children. Female children and children in lower SES tended to be more exposed to emotional appeals in TV ads than their male or higher SES counterparts. Furthermore, TV ads using more emotional appeals tended to be for products high in problematic nutrients. CONCLUSION: The findings of this study highlight the need to implement statutory measures to reduce the deleterious effect of food marketing on children.

Design and approval of the nutritional warnings' policy in Peru: Milestones, key stakeholders, and policy drivers for its approval.

Nutritional warnings are used as a public health strategy to address obesity. Peru approved in 2013 and implemented in 2019 a law requiring nutritional warnings on the marketing and packaging of processed foods high in sugar, sodium, saturated fat, and containing trans-fat. The complexity behind the design and approval of these policies over six years provides unique learnings, that inform the obesity prevention context, especially when proposed policies face strong opposition from powerful stakeholders. Our study aims to describe the milestones and key stakeholders' roles and stances during the nutritional warnings policy design in Peru, and to identify and analyze the main drivers of policy change that explain its approval. In 2021, interviews were conducted with 25 key informants closely involved in its design. Interviews were analyzed using the Kaleidoscope Model as a theoretical framework. Relevant policy documents and news were also analyzed. Milestones for this policy included the approval of the Law, Regulation, and Manual. Policy supporters were mainly from Congress, civil society advocates, and Health Ministers. Opponents came from Congress, ministries linked to the economic sector, the food industry, and media. Across the years, warnings evolved from a single text, to traffic lights, to the approved black octagons. Main challenges included the strong opposition of powerful stakeholders, the lack of agreement for defining the appropriate evidence supporting nutritional warning parameters and design, and the political instability of the country. Based on the Kaleidoscope Model, the policy successfully targeted a relevant problem (unhealthy eating decisions) and had powerful advocates who effectively used focusing events to reposition the warnings in the policy agenda across the years. Negotiations weakened the policy but led to its approval. Importantly, government veto players were mostly in favor of the policy, which enabled its final approval despite the strong opposition.

Sweetener Purchases in Chile before and after Implementing a Policy for Food Labeling, Marketing, and Sales in Schools.

Background: Chile's landmark food labeling and advertising policy led to major reductions in sugar purchases. However, it is unclear whether this led to increases in the purchases of nonnutritive sweeteners (NNS). Objectives: The objective of this study was to assess the changes in NNS and caloric-sweetened (CS) products purchased after the law's first phase. Methods: Longitudinal data on food and beverage purchases from 2,381 households collected from January 1, 2015 to December 31, 2017, were linked to nutritional information and categorized into added sweetener groups (unsweetened, NNS-only, CS-only, or NNS with CS). Logistic random-effects models and fixed-effects models were used to compare the percentage of households purchasing products and the mean volume purchased by sweetener category to a counterfactual based on pre-regulation trends. Results: Compared with the counterfactual, the percentage of households purchasing any NNS beverages (NNS-only or NNS with CS) increased by 4.2 percentage points (pp) (95% CI: 2.8, 5.7; P < 0.01). This increase was driven by households purchasing NNS-only beverages (12.1 pp, 95% CI: 10.0, 14.2; P < 0.01). The purchased volume of beverages with any NNS increased by 25.4 mL/person/d (95% CI: 20.1, 30.7; P < 0.01) or 26.5%. Relative to the counterfactual, there were declines of -5.9 pp in households purchasing CS-only beverages (95% CI: -7.0, -4.7; P < 0.01). Regarding the types of sweeteners purchased, we found significant increases in the amounts of sucralose, aspartame, acesulfame K, and steviol glycosides purchased from beverages. Among foods, differences were minimal. Conclusions: The first phase of Chile's law was associated with an increase in the purchases of beverages containing NNS and decreases in beverages containing CS, but virtually no changes in foods.

Changes in children's and adolescents' dietary intake after the implementation of Chile's law of food labeling, advertising and sales in schools: a longitudinal study.

BACKGROUND: In June 2016, a comprehensive food policy was implemented in Chile that included front-of-package warning labels on key nutrients of concern (total sugars, added saturated fats, sodium, and calories), child-directed food advertisement bans, and school regulations. The policy was implemented in 3 phases from 2016 to 2019 and the primary objective was to improve children's food environments. This study's objective was to assess changes in child and adolescent intake of key nutrients of concern (total sugars, saturated fats, and sodium) at school after the initial implementation of Chile's Law of Food Labeling and Advertisement. METHODS: Longitudinal study of 349 children from the Food Environment Chilean Cohort (FECHIC) and 294 adolescents from the Growth and Obesity Cohort Study (GOCS). Data were from single 24-hour dietary recalls collected from 2016 to 2019. Fixed-effects models stratified by school, home, and other locations compared nutrient consumption in each year to consumption at the pre-policy 2016 baseline. Nutrient intakes are expressed as percent of total energy. RESULTS: Compared to 2016 (pre-policy), total sugars consumed by children at school decreased 4.5 [-8.0, -0.9] percentage points (pp) and 11.8 [-15.4, -8.3] pp in 2018 and 2019 respectively. In 2019, children's saturated fats and sodium intake at school also decreased (1.1 [-1.9, -0.2] pp and 10.3 [-18.1, -2.5] mg/100 kcal respectively). Likewise, in adolescents, total sugars and saturated fats consumed at school decreased in 2018 (5.3 [-8.4, -2.2] pp and 1.5 [-2.7, -0.3] pp respectively). However, consumption of key nutrients of concern at other locations increased after implementation of the policy. CONCLUSIONS: After initial implementation of Chile's Labeling Law, intake of most key nutrients of concern significantly declined at school. However, we found evidence of compensatory behavior in out-of-school settings. Further research is needed to evaluate what other actions are needed to impact overall diets in the long term both at schools and out of school.

Sugar-sweetened beverage purchases in urban Peru before the implementation of taxation and warning label policies: a baseline study.

BACKGROUND: Sugar-sweetened beverage consumption is associated with obesity and chronic disease. In 2018, Peru increased the tax on high-sugar beverages (≥6 g of sugar per 100 mL) from 17 to 25%, yet little is known about pre-existing beverage trends or demographic characteristics associated with purchases in the country. The aim of this study was to explore beverage purchasing trends from 2016 to 2017 and examine variation in purchase volume by sociodemographic characteristics among urban households in Peru. METHODS: This study used monthly household purchase data from a panel of 5145 households from January 2016-December 2017 from Kantar WorldPanel Peru. Beverage purchases were categorized by type and tax status under the 2018 regulation (untaxed, lower-sugar taxed, high-sugar taxed). To assess beverage purchasing trends, per-capita volume purchases were regressed on a linear time trend, with month dummies for seasonality and clustered standard errors. Mean volume purchases by beverage tax status (total liters purchased per month), overall and by key demographic characteristics (education, socioeconomic status, and geographic region), were calculated. Mean volume by beverage type was assessed to identify the largest contributors to total beverage volume. RESULTS: The trends analysis showed a decline in total beverage volume of - 52 mL/capita/month (95% CI: - 72, - 32) during the 24-month study period. Over 99% of households purchased untaxed beverages in a month, while > 92% purchased high-sugar taxed beverages. Less than half of all households purchased low-sugar taxed beverages in a month and purchase volume was low (0.3 L/capita/month). Untaxed beverage purchases averaged 9.4 L/capita/month, while households purchased 2.8 L/capita/month of high-sugar taxed beverages in 2017. Across tax categories, volume purchases were largest in the high education and high socioeconomic (SES) groups, with substantial variation by geographic region. The highest volume taxed beverage was soda (2.3 L/capita/month), while the highest volume untaxed beverages were milk and bottled water (1.9 and 1.7 L/capita/month, respectively). CONCLUSIONS: Nearly all households purchased high-sugar taxed beverages, although volume purchases of taxed and untaxed beverages declined slightly from 2016 to 2017. Households with high SES and high education purchased the highest volume of taxed beverages, highlighting the need to consider possible differential impacts of the tax policy change by sub-population groups.

Did the sweetness of beverages change with the Chilean Food Labeling and Marketing Law? A before and after study.

There has been a rapid proliferation of policies around the globe to reduce sugar consumption, yet there is little understanding as to whether these policies have led to changes in the overall sweetness of products, which is essential for understanding long-term effects on food preferences and intake. For example, the implementation of Chile's Law on Food Labeling and Advertising led to decreases in the sugar content of non-alcoholic packaged beverages and increases in non-nutritive sweeteners (NNS) use in these beverages. Given that NNS have greater sweetness intensity than sugars, it is unclear what was the net effect of these changes on the sweetness of purchased beverages. Using longitudinal household purchase data (n > 2,000 households), we measured the changes in the sweetness of beverage purchases after implementing the first phase of the Chilean law and examine if there were differences by key family sociodemographic variables. We developed three sweetness indices: (1) NNS sweetness, including the sweetness of the six NNS most consumed by Chileans; (2) total sugars sweetness, including the sweetness from total sugars; and (3) total sweetness, combining the sweetness from NNS and sugars. Using fixed-effects models, we compared the observed post-law purchases to a counterfactual based on pre-law trends. We found that NNS sweetness increased relative to the counterfactual, while total sugars sweetness decreased after the law. However, the absolute changes in NNS sweetness were almost entirely offset by the decreases in total sugar sweetness, leading to no change in the total sweetness of beverage purchases. Additionally, there were no differences in the sweetness changes by family sociodemographics. Our findings indicate that Chilean consumers are exposed to similar sweetness levels in their beverages after the law. Future research should explore whether sweetness also remained consistent in dietary intake.

Why Don't You [Government] Help Us Make Healthier Foods More Affordable Instead of Bombarding Us with Labels? Maternal Knowledge, Perceptions, and Practices after Full Implementation of the Chilean Food Labelling Law.

Experimental and real-life evaluations show that the use of front-of-package warning labels (FoP) in unhealthy foods is well understood and can modify people's behaviors. However, it is unclear whether these effects remain in the long term because of the risk of message fatigue. The purpose of this study is to explore after four years of implementation of the Chilean Food Labelling law people's dietary behavior and FoP labels attention. Nine focus groups of mothers (7-10 people each) of children (2-14 yo) were conducted in Santiago, Chile, and macrocodes were developed, combining an iterative process of deductive and inductive thematic analyses. We found that mothers experienced labels' fatigue but also had greater knowledge about nutrition and appreciation for more natural foods. This greater knowledge about better nutrition interferes with the perception that healthier and less processed foods are financial and physically inaccessible. The key role of schools as an environment for promoting healthier diets in children was strengthened by the mothers. These results suggest that policies based on providing consumer information need reinforcement campaigns to maintain their effectiveness and that we also need to advance policies to improve access and affordability of healthy foods to ensure better diets.

Impact of nutrient warning labels on choice of ultra-processed food and drinks high in sugar, sodium, and saturated fat in Colombia: A randomized controlled trial.

OBJECTIVE: This study assessed nutrient warnings' impact on product selection and identification of food products high in nutrients of concern in Colombia. METHODS: In an online experiment (October 2020), 8,061 Colombians were randomized to a nutrient warning, guideline daily amounts (GDA), Nutri-Score, or no-label condition. They viewed two fruit drinks labeled according to their condition, one high in sugar and one not, and completed selection tasks. Next, they assessed four products high in sugar, sodium, and/or saturated fat ("high in" product). Finally, they selected which label would most discourage them from consuming a "high in" product. RESULTS: The nutrient warning performed better on most outcomes. Twenty percent of participants exposed to the nutrient warning would purchase the high-sugar fruit drink compared to GDA (24%, p<0.01), Nutri-Score (33%, p<0.001), and no label (29%, p<0.001). GDA performed slightly better than the nutrient warning in identifying the high-sugar fruit drink (91% vs 88%, p<0.001). The nutrient warning best helped participants correctly identify other "high in" products (75% vs. 23% no-label, 26% Nutri-Score, and 43% GDA, all p<0.001) and had the highest perceived message effectiveness (3.86 on 5-point scale vs. 2.97 GDA and 2.70 Nutri-Score, both p<0.001) and lowest likelihood of purchasing "high in" products (2.58 on 5-point scale vs. 3.23 GDA, 3.49 Nutri-Score, and 3.51 no label, all p<0.001). The nutrient warning most discouraged participants from wanting to consume "high in" products. CONCLUSIONS: Nutrient warnings are a promising policy to help consumers identify and discourage consumption of products high in nutrients of concern. TRIAL REGISTRATION: Trial Registration: NCT04567004.

Changes in nonnutritive sweetener intake in a cohort of preschoolers after the implementation of Chile's Law of Food Labelling and Advertising.

BACKGROUND: The first phase of Chile's Law of Food Labelling and Advertising showed important declines in the sugar content of packaged foods, but it is unknown whether the law led to an increase in nonnutritive sweetener (NNS) intake, particularly among preschool children. OBJECTIVES: Estimate the changes in preschoolers' NNS intake after the first phase of the Chilean law. METHODS: We used 24-h dietary recalls collected in 2016 (pre-law) and 2017 (post-law) from a cohort of preschoolers (n = 875). The primary caretaker was the respondent of the recalls. Information on NNS was obtained from nutrition facts panels collected annually and linked to dietary data. We used logistic regression to estimate the changes in the proportion of preschoolers who consume NNS and two-part models to estimate the changes in mean intake. We determined the percentage of children that surpassed the acceptable daily intake (ADI) of each NNS using the National Cancer Institute method. RESULTS: The proportion of consumers of at least one NNS increased from 77.9% to 92.0% (p-value < 0.01). The mean intake increased for sucralose, aspartame, acesulfame-K and steviol glycosides (+20.3, +15.1, +6.1 and +3.3 mg/day, respectively). In addition, NNS dietary sources changed for sucralose and steviol glycosides, becoming industrialized juices and dairy beverages more relevant while tabletop NNS became less relevant. None of the children surpassed the ADI. CONCLUSIONS: NNS intake increased in preschoolers after the first phase of a national policy that promoted sugar reformulation.

Reformulation of Top-Selling Processed and Ultra-Processed Foods and Beverages in the Peruvian Food Supply after Front-of-Package Warning Label Policy.

Front-of-package warning label (FOPWL) policies incentivize the food industry to reduce the content of regulated nutrients in products. We explored changes in the content of nutrients of concern (sugar, saturated fat, trans fat, and sodium) and the percentage of products in the Peruvian food supply that would carry a FOPWL before and after Peru's implementation of FOPWLs. Longitudinal data on the top-selling foods and beverages (n = 94) were collected at three time points: three months before the implementation of the policy, four months after, and two years after. Using the nutritional information declared on products' labels, we compared quantities of nutrients of concern and the percentage of foods that would carry a FOPWL at each time point. Between the first and the third data collection, a decrease in the median sugar content of beverages was observed (from 9.0 to 5.9 g/100 mL, p = 0.005), accompanied by an increase in the use of nonnutritive sweeteners. This change drove the reduction of the percentage of beverages that would carry a FOPWL (from 59 to 31%, p = 0.011). Among foods, decreases were observed in saturated fat (from 6.7 to 5.9 g/100 g, p = 0.002). The percentage of foods that would carry a FOPWL according to their nutritional profile declined from before to after implementation of the policy (from 82 to 62%, p < 0.001). The study shows that the industry reformulated products in Peru after implementation of its FOPWL policy.

Television viewing and using screens while eating: Associations with dietary intake in children and adolescents.

Screen time has been associated with overweight and obesity, as well as with poorer dietary quality. However, the reasons explaining these associations are not well understood. The objectives of this cross-sectional study were [1] to determine the extent of overall TV viewing as well as using screens while eating (e.g., watching TV or using a tablet), [2] to compare food and nutrient consumption of on-versus off-screen eating occasions, and [3] to determine whether TV viewing and using screens while eating is associated with overall dietary intake. Participants were from the Food Environment Chilean Cohort (n = 938, 4-6 y) and the Growth and Obesity Cohort Study (n = 752, 12-14 y). Dietary data was collected via one 24-h food recall. For each eating occasion, activity performed during consumption (e.g., watching TV, playing sports) was reported. Weekly TV viewing time was collected via an additional survey instrument. Analyses included multivariable linear and logistic regression. Post-hoc pairwise comparisons examined differences in outcomes by tertiles. Our sample reported a median of 9-13.5 weekly hours of TV viewing and 87.5% reported consuming at least one meal or snack per day while using screens. The median kilocalories contributed by eating during screen use was 387 kcal/d in children and 848 kcal/day in adolescents, which represents 34.7% and 42.3% of daily energy intake, respectively. There were no consistent differences when comparing eating occasions consumed on-screen versus off-screen. Higher weekly TV viewing was associated with elements of a less healthy diet including more sweets and desserts in children, and more sugar sweetened beverages in adolescents. A large percentage of Chilean children and adolescents' daily energy is consumed while using screens. In depth, longitudinal work is needed to understand how screen time eating affects diet quality and nutritional status.

Claims on Ready-to-Eat Cereals: Are Those With Claims Healthier?

Background: The use of advertising content strategies that suggest consuming a product will confer nutrient- and health-related benefits influences household food purchasing decisions, which increases consumption of energy-dense, nutrient-poor products. We examined the presence of marketing claims regarding nutrient content, health and nature in ready-to-eat (RTE) cereal packages in relation to the products' nutritional quality. Methods: A cross-sectional content analysis was conducted on 178 RTE cereal packages available in the six largest supermarket chains in four Colombian cities from August to November 2018. The nutritional quality of products was assessed through the nutrient profile model established by the Chilean Law of Food Labeling and Advertising law. Results: All products sampled exceeded the regulation threshold for at least one nutrient of concern (e.g., high-in calories and/or sugar). The majority (66.3%) of packages had claims related to nature, 57.3% had nutrient-content claims, and 15.7% had health benefit or risk avoidance claims. Most products with nature, nutrient-content, and health claims were high in energy (99.2, 98.0, and 92.9%, respectively) and sugar (88.1, 87.3, and 92.9%, respectively). Conclusion: RTE cereal products offered in major Colombian supermarket chains are heavily marketed using nutrition- and nature-related claims. Nearly all products with claims are high in energy and sugar, despite the messages conveyed by the claims to consumers. Results support the implementation of mandatory regulations restricting claims on food and beverage products high in nutrients of concern.

Soluciones relacionadas con el entorno alimentario para prevenir la obesidad infantil en América Latina y en la población latina que vive en Estados Unidos.

El entorno alimentario es un factor importante que contribuye a las dietas poco saludables en la niñez y, por tanto, a las crecientes tasas de obesidad. Los países de Latinoamérica han recibido el reconocimiento internacional por su liderazgo en la implementación de políticas dirigidas a distintos aspectos del entorno alimentario. Sin embargo, los datos sobre la naturaleza y la gravedad de la exposición de los niños a entornos alimentarios poco saludables en la región latinoamericana y entre los latinos que viven en Estados Unidos son aún insuficientes. El objetivo de esta revisión es utilizar el marco conceptual de la Red Internacional para la Investigación, Monitoreo y Apoyo a la Acción para la Alimentación, Obesidad y Enfermedades No Transmisibles (INFORMAS, por sus siglas en inglés) para crear un entorno alimentario saludable con el que (i) comparar los elementos clave de los entornos alimentarios en relación con la obesidad en Latinoamérica y entre los latinos que viven en Estados Unidos; (ii) describir la evidencia sobre soluciones que podrían contribuir a mejorar los entornos alimentarios relacionados con la obesidad infantil; y (iii) establecer prioridades de investigación que permitan identificar estrategias de lucha contra la obesidad en estas poblaciones. Hemos detectado la necesidad de un amplio conjunto integrado de evidencias que sirva de respaldo para establecer un conjunto adecuado de políticas que mejoren el entorno alimentario al que están expuestos los niños de Latinoamérica y los niños latinos que viven en Estados Unidos y para traducir de forma más eficiente las soluciones políticas, de manera que contribuyan a reducir los crecientes niveles de obesidad infantil en estos países.

Changes in food purchases after the Chilean policies on food labelling, marketing, and sales in schools: a before and after study.

BACKGROUND: In 2016, Chile implemented a unique law mandating front-of-package warning labels, restricting marketing, and banning school sales for products high in calories, sodium, sugar, or saturated fat. We aimed to examine changes in the calorie, sugar, sodium, and saturated fat content of food and beverage purchases after the first phase of implementation of this law. METHODS: This before and after study used longitudinal data on food and beverage purchases from 2381 Chilean households from Jan 1, 2015, to Dec 31, 2017. Nutrition facts panel data from food and beverage packages were linked to household purchases at the product level using barcode, brand name, and product description. Nutritionists reviewed each product for nutritional accuracy and categorised it as high-in if it contained added sugar, sodium, or saturated fat and exceeded phase 1 nutrient or calorie thresholds, and thus was subject to the labelling, marketing, and school regulations. Using fixed-effects models, we examined the mean nutrient content (overall calories, sugar, saturated fat, and sodium) of purchases in the post-policy period compared to a counterfactual scenario based on pre-policy trends. FINDINGS: Compared with the counterfactual scenario, overall calories purchased declined by 16·4 kcal/capita/day (95% CI -27·3 to -5·6; p=0·0031) or 3·5%. Overall sugar declined by 11·5 kcal/capita/day (-14·6 to -8·4; p<0·0001) or 10·2%, and saturated fat declined by 2·2 kcal/capita/day (-3·8 to -0·5; p=0·0097) or 3·9%. The sodium content of overall purchases declined by 27·7 mg/capita/day (-46·3 to -9·1; p=0·0035) or 4·7%. Declines from high-in purchases drove these results with some offset by increases in not-high-in purchases. Among high-in purchases, relative to the counterfactual scenario, there were notable declines of 23·8% in calories purchased (-49·4 kcal/capita/day, 95% CI -55·1 to -43·7; p<0·0001), 36·7% in sodium purchased (-96·6 mg/capita/day,-105·3 to -87·8; p<0·0001), and 26·7% in sugar purchased (-20·7 kcal/capita/day, -23·4 to -18·1; p<0·0001). INTERPRETATION: The Chilean phase 1 law of food labelling and advertising policies were associated with reduced high-in purchases, leading to declines in purchased nutrients of concern. Greater changes might reasonably be anticipated after the implementation of phases 2 and 3. FUNDING: Bloomberg Philanthropies, International Development Research Center, and Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.

Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States.

The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity-related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity-related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.