Systematic Review of Nutrient Profile Models Developed for Nutrition-Related Policies and Regulations Aimed at Noncommunicable Disease Prevention -An Update.

Nutrient profiling (NP) models are useful for characterizing the healthfulness of foods and for underpinning various nutrition-related public health strategies. Recently, there has been a rapid increase in the number of NP models developed by different organizations worldwide. A systematic review (SR) summarizing the key characteristics of NP models with applications in government-led nutrition policies was carried out in 2016 and published by Labonté et al. [4]. Given the continuous proliferation of NP models, the current study aimed to update this SR. Systematic searches were performed in databases of both the peer-reviewed (n = 7) and grey (n = 1) literature to identify publications related to NP published between May 2016 and September 2020. The full text of relevant publications was assessed independently by 2 reviewers to build a list of potential models. Each model was classified as "already identified in the original SR" or as "newly identified." The eligibility of the "newly identified" models, and of some models excluded from the previous SR because their details were not known at that time, were then assessed independently by 2 reviewers based on pre-established criteria. A total of 151 potential NP models were assessed for eligibility, of which 93 were "newly identified," 28 were originally excluded from the previous SR, and 30 were identified from additional online searches during the eligibility assessment stage. Twenty-six models met the inclusion criteria. Their most frequent applications were food labeling (n = 17) and regulation of food marketing to children (n = 7). They all included nutrients to limit, with sodium, saturated fat, and total sugars being the most frequently considered. Content or face validity testing was conducted for 11 (42%) of the included models. As NP models are increasingly used worldwide to support public health strategies, having an up-to-date resource listing them and detailing their characteristics is crucial. PROSPERO #CRD42021259041.

Determinants of weight gain and body changes during pregnancy: A qualitative study of French-Canadian pregnant people.

OBJECTIVE: More than half of pregnant Canadian people exceed current gestational weight gain recommendations, which has been associated with adverse outcomes for both parent and child. Although the physiological causes of excessive gestational weight gain have been well investigated, few studies have evaluated the context of gestational weight gain and body changes through the perspective of pregnant people. Therefore, we aim to explore factors influencing body changes and weight gain during pregnancy as experienced by pregnant individuals. METHODS: A total of three focus groups and six individual interviews were conducted with pregnant people (n=21) recruited in the 2nd or 3rd trimester. A semi-structured interview guide was developed according to a pre-existing conceptual model by Hill et al., 2013. Focus groups and interviews were recorded, transcribed, and thematically analysed using NVivo software. FINDINGS: Results were categorized into four main themes, based on the conceptual model: (1) parental psychological, social and cognitive factors, (2) outcomes, (3) parental behaviors and (4) health behavior change constructs. Participants identified structural, social, professional, and especially partner support (1), health-related strategies (2), body image (1) and knowledge of gestational weight gain recommendations (3) as influent components of their body changes experience. CONCLUSIONS: In this study, the themes addressed affect both pregnant individuals and their relatives. Enhanced knowledge of gestational weight gain recommendations in this population, support from relatives and quality of follow-up offered by health professionals must therefore be considered as possible avenues of intervention.

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.

Promoting meal planning through mass media: awareness of a nutrition campaign among Canadian parents.

OBJECTIVE: To evaluate awareness of the Eat Well Campaign (EWC) among parents and assess perceptions about its effectiveness. DESIGN: Post-campaign evaluation study with a cross-section of parents recruited through random digit dialling. Participants completed an online survey about EWC awareness, its perceived effectiveness among parents and their meal planning practices (attitudes, behaviours and self-efficacy). SETTING: A federal mass-media campaign disseminated by Health Canada (2013-2014) to promote meal planning to Canadian parents. PARTICIPANTS: Parents (n 964) of children aged 2-12 years from all Provinces and Territories. RESULTS: Of respondents, 41 % (390/964) were aware of the campaign; Quebec City and rural Quebec had the highest rates of awareness, whereas Vancouver, Winnipeg and Toronto had the lowest. Awareness was greater among parents with lower income, basic education and French-speakers. Campaign intensity was significantly associated with greater odds of reporting positive attitudes towards the EWC and meal planning (P < 0·05). Campaign awareness was significantly associated with greater odds of believing that meal planning helps maintain a healthy diet (OR = 1·68, 95 % CI 1·03, 2·74) and planning meals (OR = 1·66, 95 % CI 1·03, 2·54), but not self-efficacy, in adjusted models. CONCLUSIONS: The present study is the first to evaluate an initiative that promoted meal planning with mass media. The EWC demonstrated evidence of success in terms of equitable access to a nutrition initiative by reaching lower-income and less-educated parents. Understanding behavioural factors among different segments of the population will be important to target appropriate audiences and develop tailored interventions that support healthy eating practices.

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.

Full-Time Employment, Diet Quality, and Food Skills of Canadian Parents.

Purpose: To explore the associations between full-time employment status, food skills, and diet quality of Canadian parents. Methods: A sample of Canadian parents (n = 767) were invited to complete a web-based survey that included sociodemographic variables, questions about food skills, and a validated food frequency questionnaire. Results were analyzed with linear and logistic regression models, controlling for sociodemographic variables and multiple testing. Results: After controlling for covariates and multiple testing, there were no statistically significant differences in foods skills between parents' employment status. Time was the most reported barrier for meal preparation, regardless of work status, but was significantly greater for full-time compared with other employment status (P < 0.0001). Additionally, parents who worked full-time had lower odds of reporting food preferences or dietary restrictions (P = 0.0001) and health issues or allergies (P = 0.0003) as barriers to food preparation, compared with parents with other employment status. These results remained statistically significant even after controlling for covariates and multiple testing. Conclusions: Overall, food skills did not differ significantly between parents' employment status. Time, however, was an important barrier for most parents, especially those working full time. To promote home-based food preparation among parents, strategies to manage time scarcity are needed.

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.

Facilitators and barriers experienced by federal cross-sector partners during the implementation of a healthy eating campaign.

OBJECTIVE: To identify facilitators and barriers that Health Canada's (HC) cross-sector partners experienced while implementing the Eat Well Campaign: Food Skills (EWC; 2013-2014) and describe how these experiences might differ according to distinct partner types. DESIGN: A qualitative study using hour-long semi-structured telephone interviews conducted with HC partners that were transcribed verbatim. Facilitators and barriers were identified inductively and analysed according partner types. SETTING: Implementation of a national mass-media health education campaign. SUBJECTS: Twenty-one of HC's cross-sector partners (food retailers, media and health organizations) engaged in the EWC. RESULTS: Facilitators and barriers were grouped into seven major themes: operational elements, intervention factors, resources, collaborator traits, developer traits, partnership factors and target population factors. Four of these themes had dual roles as both facilitators and barriers (intervention factors, resources, collaborator traits and developer traits). Sub-themes identified as both facilitators and barriers illustrate the extent to which a facilitator can easily become a barrier. Partnership factors were unique facilitators, while operational and target population factors were unique barriers. Time was a barrier that was common to almost all partners regardless of partnership type. There appeared to be a greater degree of uniformity among facilitators, whereas barriers were more diverse and unique to the realities of specific types of partner. CONCLUSIONS: Collaborative planning will help public health organizations anticipate barriers unique to the realities of specific types of organizations. It will also prevent facilitators from becoming barriers. Advanced planning will help organizations manage time constraints and integrate activities, facilitating implementation.

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.

Factors influencing the adoption of a healthy eating campaign by federal cross-sector partners: a qualitative study.

BACKGROUND: The Eat Well Campaign (EWC) was a social marketing campaign developed by Health Canada and disseminated to the public with the help of cross-sector partners. The purpose of this study was to describe factors that influenced cross-sector partners' decision to adopt the EWC. METHODS: Thematic content analysis, based primarily on an a priori codebook of constructs from Roger's diffusion of innovations decision process model, was conducted on hour-long semi-structured telephone interviews with Health Canada's cross-sector partners (n = 18). RESULTS: Dominant themes influencing cross-sector partners' decision to adopt the EWC were: high compatibility with the organization's values; being associated with Health Canada; and low perceived complexity of activities. Several adopters indicated that social norms (e.g., knowing that other organizations in their network were involved in the collaboration) played a strong role in their decision to participate, particularly for food retailers and small organizations. The opportunity itself to work in partnership with Health Canada and other organizations was seen as a prominent relative advantage by many organizations. Adopters were characterized as having high social participation and positive attitudes towards health, new ideas and Health Canada. The lack of exposure to the mass media channels used to diffuse the campaign and reserved attitudes towards Health Canada were prominent obstacles identified by a minority of health organizations, which challenged the decision to adopt the EWC. Most other barriers were considered as minor challenges and did not appear to impede the adoption process. CONCLUSIONS: Understanding factors that influence cross-sector adoption of nutrition initiatives can help decision makers target the most appropriate partners to advance public health objectives. Government health agencies are likely to find strong partners in organizations that share the same values as the initiative, have positive attitudes towards health, are extremely implicated in social causes and value the notion of partnership.