Sodium menu labelling: priorities for research and policy.

OBJECTIVE: To understand the different Na menu labelling approaches that have been considered by state and local policymakers in the USA and to summarise the evidence on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers. DESIGN: Proposed and enacted Na menu labelling laws at the state and local levels were reviewed using legal databases and an online search, and a narrative review of peer-reviewed literature was conducted on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers. SETTING: Local and state jurisdictions in the USA. PARTICIPANTS: Not applicable. RESULTS: Between 2000 and 2020, thirty-eight laws - eleven at the local level and twenty-seven at the state level - were proposed to require Na labelling of restaurant menu items. By 2020, eight laws were enacted requiring chain restaurants to label the Na content of menu items. Five studies were identified that evaluated the impact of Na menu labelling on Na content of menu items offered by restaurants or purchased by consumers in the USA. The studies had mixed results: two studies showed a statistically significant association between Na menu labelling and reduced Na content of menu items; three showed no effects. CONCLUSION: Data suggest that Na menu labelling may reduce Na in restaurant menu items, but further rigorous research evaluating Na menu labelling effects on Na content of menu items, as well as on the Na content in menu items purchased by consumers, is needed.

Trends in the healthiness of U.S. fast food meals, 2008-2017.

OBJECTIVE: This study aimed to examine trends in the healthiness of U.S. fast food restaurant meals from 2008 to 2017, using the American Heart Association's Heart-Check meal certification criteria. METHODS: Data were obtained from MenuStat, an online database of the leading 100 U.S. restaurant chains menu items, for the years 2008 and 2012 through 2017. All possible meal combinations (entrées + sides) were created at the 20 fast food restaurants that reported entrée and side calories, total fat, saturated fat, trans fat, cholesterol, sodium, protein, and fiber. Chi-square tests compared the percent of meals meeting each American Heart Association (AHA) nutrient criterion; and the number of AHA criteria met for each year, by menu focus type. RESULTS: Compared with 2008, significantly fewer fast food meals met the AHA calorie criterion in 2015, 2016, and 2017, and significantly fewer met the AHA total fat criterion in 2015 and 2016. Significantly more meals met the AHA trans fat criterion from 2012 to 2017, compared to 2008. There were no significant changes over time in the percent of meals meeting AHA criteria for saturated fat, cholesterol, or sodium. CONCLUSIONS: Efforts to improve the healthiness of fast food meals should focus on reducing calories, total fat, saturated fat, and sodium.

Healthiness of US Chain Restaurant Meals in 2017.

BACKGROUND: Given the popularity of restaurants as a meal source in the United States, it is important to understand the healthiness of their offerings. OBJECTIVE: This study's purpose was to examine the healthiness of meals at national US chain restaurants in 2017 using the American Heart Association's (AHA) Heart-Check meal certification criteria. DESIGN: Data for this cross-sectional study were obtained from MenuStat, an online database that includes nutrition information for menu items from the 100 restaurant chains with the largest sales in the United States in 2017. All possible meal combinations (meals defined as including an entrée and side item) were created at the 73 restaurants that reported nutrition information aligning with the AHA criteria: calories, total fat, saturated fat, trans fat, cholesterol, sodium, protein, and fiber. MAIN OUTCOMES MEASURE: Healthy meal (0=did not meet AHA criteria; 1=did meet AHA criteria). STATISTICAL ANALYSES PERFORMED: We used χ2 tests to compare the percent of restaurant meals and meal components compliant with each AHA criterion and the percent of restaurant meals and meal components meeting varying numbers of AHA criteria across restaurant service types (ie, fast food, full service, fast casual). RESULTS: Among all restaurants, the median calories, total fat, saturated fat, cholesterol, and sodium of meals exceeded the AHA criteria. Fewer than 20% of meals met the saturated fat and sodium criteria; 22% of restaurant meals met zero to one AHA criteria, 50% met two to four AHA criteria, 20% met five to six AHA criteria, and 8% met all seven AHA criteria. CONCLUSIONS: Given the popularity of restaurants as a source of meals, efforts are needed to improve the healthiness of restaurant meals.

Influence of subsidies and promotional strategies on outcomes in a beneficiary-based commercial weight-loss programme.

To determine whether initial engagement, continued participation, and weight loss vary by subsidy and promotional strategies in a beneficiary-based, commercial weight-loss programme. We conducted a retrospective analysis of data from 2013 to 2016. Our dependent variables included initial engagement (≥1 calls; ≥2 weights), coach calls and weight change. Our independent variables were subsidy strategy (total subsidy (n = 9) vs cost sharing (n = 3)) and combination of promotional-subsidy strategies (mixed campaign + total subsidy (n = 6) vs mass media + total subsidy (n = 3)). We used logistic and linear regression analyses adjusted for beneficiary factors and clustering by organization. From 12 participating organizations, 26 068 beneficiaries registered of which 6215 initially engaged. Cost sharing was associated with significantly greater initial engagement as compared to total subsidy (OR 3.73, P < 0.001); however, no significant between-group differences existed in calls or weight change. Mass media + total subsidy group had significantly greater calls and weight loss at 12 months compared to mixed campaign + total subsidy (-2.6% vs -1.8%, P = 0.04). Cost sharing may promote greater initial engagement, although does not contribute to better participation or weight loss relative to total subsidy. If organizations elect total subsidy, then pairing this strategy with a mass media campaign may promote greater participation and weight loss among beneficiaries.

Effects of a behavioural weight loss intervention in people with serious mental illness: Subgroup analyses from the ACHIEVE trial.

BACKGROUND: Persons with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of obesity and related chronic diseases and die 10-20years earlier than the overall population, primarily due to cardiovascular disease. In the ACHIEVE trial, a behavioural weight loss intervention led to clinically significant weight loss in persons with SMI. As the field turns its attention to intervention scale-up, it is important to understand whether the effectiveness of behavioural weight loss interventions for people with SMI, like ACHIEVE, differ for specific subgroups. METHODS: This study examined whether the effectiveness of the ACHIEVE intervention differed by participant characteristics (e.g. age, sex, race, psychiatric diagnosis, body mass index) and/or their weight-related attitudes and behaviours (e.g. eating, food preparation, and shopping habits). We used likelihood-based mixed effects models to examine whether the baseline to 18 month effects of the ACHIEVE intervention differed across subgroups. RESULTS: No statistically significant differences were found in the effectiveness of the ACHIEVE intervention across any of the subgroups examined. CONCLUSIONS: These findings suggest that the ACHIEVE behavioural weight loss intervention is broadly applicable to the diverse population of individuals with SMI.

Innovative business approaches for incenting health promotion in sub-Saharan Africa: progress and persisting challenges.

Non-communicable chronic diseases related to behaviors such as tobacco use, overeating, excess alcohol intake and physical inactivity account for increasing morbidity and mortality in South Africa. Over the last 15 years, Discovery Health, the largest private health plan in South Africa, has developed a voluntary health promotion program called Vitality with over 1.5 million members. Vitality was designed with many applications drawn from the growing field of behavioral economics, including the use of incentives and rewards. Incentives offered on the program are aimed at lowering the financial barriers to activities such as visiting the gym, buying healthy food or receiving preventive screening. Members accrue points for engagement which translate into discounts on a range of goods and services. Although the full impact of the program cannot yet be quantified, engagement with the program is continually increasing and there is compelling evidence that this translates into better health and cost outcomes.

Development and implementation of Baltimore Healthy Eating Zones: a youth-targeted intervention to improve the urban food environment.

Poor accessibility to affordable healthy foods is associated with higher rates of obesity and diet-related chronic diseases. We present our process evaluation of a youth-targeted environmental intervention (Baltimore Healthy Eating Zones) that aimed to increase the availability of healthy foods and promote these foods through signage, taste tests and other interactive activities in low-income Baltimore City. Trained peer educators reinforced program messages. Dose, fidelity and reach-as measured by food stocking, posting of print materials, distribution of giveaways and number of interactions with community members-were collected in six recreation centers and 21 nearby corner stores and carryouts. Participating stores stocked promoted foods and promotional print materials with moderate fidelity. Interactive sessions were implemented with high reach and dose among both adults and youth aged 10-14 years, with more than 4000 interactions. Recreation centers appear to be a promising location to interact with low-income youth and reinforce exposure to messages.

Major multinational food and beverage companies and informal sector contributions to global food consumption: implications for nutrition policy.

BACKGROUND: In recent years, 10 major multinational food and beverage companies have worked together within the International Food and Beverage Alliance (IFBA) to increase their commitments to public health. Current IFBA commitments include initiatives to improve the nutrition quality of products and how these products are advertised to children. The impact and magnitude of IFBA member contributions to the total market share of packaged foods and beverages consumed remain incompletely understood, however. METHODS: In order to evaluate this impact, we examined packaged food and soft drink company shares provided by Euromonitor, an international independent market analysis company. Packaged foods include baby food, bakery, canned/preserved food, chilled/processed food, confectionery, dairy, dried processed food, frozen processed food, ice cream, meal replacement, noodles, oils and fats, pasta, ready meals, sauces, dressings and condiments, snack bars, soup, spreads, and sweet and savoury snacks. Soft drinks include carbonates, packaged fruit/vegetable juice, bottled water, functional drinks, concentrates, ready-to-drink tea, ready-to-drink coffee and Asian specialty drinks. We calculated the market shares for IFBA companies, globally and within nine countries--the US, China, India, Egypt, South Africa, Brazil, Mexico, Turkey and the UK. RESULTS: Worldwide, the top ten packaged food companies account for 15.2% of sales, with each individual company contributing less than 3.3%. The top ten soft drink companies account for 52.3% of sales worldwide; Coca-Cola and PepsiCo lead with 25.9% and 11.5% of sales, respectively. CONCLUSIONS: Although the top ten soft drink companies account for half of global sales, the top ten packaged food companies account for only a small proportion of market share with most individual companies contributing less than 3.3% each. Major multinational companies need to be joined by the myriad of small- and medium-sized enterprises in developing and implementing programs to improve the health of the public, globally. Without full participation of these companies, the impact of commitments made by IFBA members and other major multinational food and beverage companies will remain limited.