Perceptions and knowledge of protein in dairy and plant-based alternatives among stakeholders in the US marketplace.

This study explores beliefs about protein in dairy and plant-based (PB) alternatives among stakeholders in the US marketplace and whether beliefs are associated with product preferences. Eight thousand and fifty-two unique comments submitted to the US Food and Drug Administration (FDA) in response to a request for public input on the labelling of PB dairy alternatives (FDA-2018-N-3522) were coded. Of these, 383 (4.8%) discussed protein and were analysed for protein-specific themes. Themes were examined in relation to the submitter's product preference. Most comments that discussed protein focused on protein content and/or health outcomes believed to be associated with intake. Only one commenter who preferred dairy demonstrated an inaccurate understanding of protein content in dairy and PB alternatives, although nearly all failed to identify fortified soy beverage as an appropriate protein replacement; meanwhile, 14.2% who preferred PB alternatives demonstrated an inaccurate understanding regarding protein content in dairy and PB products. The results suggest knowledge gaps exist regarding protein in PB dairy alternatives, especially among those who prefer non-dairy options.

Weight-normative messaging predominates on TikTok-A qualitative content analysis.

Tiktok is a social media platform with many adolescent and young adult users. Food, nutrition, and weight-related posts are popular on TikTok, yet there is little understanding of the content of these posts, and whether nutrition-related content is presented by experts. The objective was to identify key themes in food, nutrition, and weight-related posts on TikTok. 1000 TikTok videos from 10 popular nutrition, food, and weight-related hashtags each with over 1 billion views were downloaded and analyzed using template analysis. The one-hundred most viewed videos were downloaded from each of the ten chosen hashtags. Two coders then coded each video for key themes. Key themes included the glorification of weight loss in many posts, the positioning of food to achieve health and thinness, and the lack of expert voices providing nutrition information. The majority of posts presented a weight-normative view of health, with less than 3% coded as weight-inclusive. Most posts were created by white, female adolescents and young adults. Nutrition-related content on TikTok is largely weight normative, and may contribute to disordered eating behaviors and body dissatisfaction in the young people that are TikTok's predominant users. Helping users discern credible nutrition information, and eliminate triggering content from their social media feeds may be strategies to address the weight-normative social media content that is so prevalent.

Perspectives from healthcare professionals on the nutritional adequacy of plant-based dairy alternatives: results of a mixed methods inquiry.

BACKGROUND: Healthcare professionals are important sources of nutrition and health information for Americans. As plant-based (PB) dairy alternative products increase in popularity, concerns have been raised about their nutritional adequacy, and whether consumers understand nutritional differences to dairy. Healthcare professionals directly advise consumers on dietary choices, therefore we sought to examine their understanding and opinions of PB dairy alternatives. METHODS: We analyzed comments submitted to the U.S. Food and Drug Administration (FDA) by health professionals (n = 191) in 2018-2019 in response to a request for public comment on the nutrition of PB dairy alternatives and the use of dairy terms like "milk", "cheese", and "yogurt" on their labels. Survey data from healthcare professionals (n = 417) was collected in 2020-2021. Comments and survey responses to open-ended questions were coded using template analysis and thematically analyzed. Logistic regression models examined perceptions across health professional characteristics for close-ended survey responses. RESULTS: Three-fourths of health professionals believe consumers are confused about the nutritional differences between dairy and PB dairy alternatives. Over half (53%) do not believe either product is nutritionally superior to the other. Many believe dairy products have higher nutrient value, but also believe PB dairy alternatives can be part of a healthful diet. Compared to other types of health professionals, dietetics professionals demonstrated a more accurate understanding of the nutritional value of both products and were more likely to believe nutrients like protein (OR 2.02; 95% CI 1.22-3.34, p = 0.006) and vitamin D (OR 2.46; 95% CI 1.48-4.09, p = 0.001) may be nutrients of concern for PB dairy alternative consumers. They were also more likely to believe consumers are confused about these products (OR 3.44; 95% CI 1.65-7.21; p = 0.001). Health professionals who submitted comments to the FDA showed stronger opinions in favor of PB dairy alternatives. CONCLUSIONS: Although PB dairy alternatives have nutritional value in certain diets, responses from health professionals suggest that changing their labeling to be different than dairy may reduce confusion. Improved nutrition education among health professionals may also be necessary.

Personal bias in nutrition advice: A survey of health professionals' recommendations regarding dairy and plant-based dairy alternatives.

Objective: To examine the association between health professionals' personal dietary behaviors and their professional nutrition recommendations on dairy and plant-based dairy alternatives. Methods: A cross-sectional survey of 331 U.S. health professionals examined willingness to recommend dairy and/or plant-based dairy alternatives to patients across personal milk preference, and dietary pattern. Results: Plant-based milk preference (OR 4.52; p < 0.001) and following a vegetarian dietary pattern (OR 1.91; p = 0.019) were associated with greater odds of recommending plant-based dairy alternatives to patients. Plant-based milk preference (OR 0.16; p < 0.001), following a vegetarian dietary pattern (OR 0.45; p = 0.009), and considering one's diet to be "plant-based" (OR 0.41; p = 0.005) were associated with lessor odds of recommending dairy to patients. Dietetics professionals were more likely than all other health professionals to recommend both dairy and plant-based dairy alternatives to patients. Conclusion: Health professionals' nutrition recommendations may reflect their personal nutrition choices. Improved nutrition training, focusing on evidence-based recommendations, reducing personal bias in practice, and routinely including registered dietitians on interprofessional healthcare teams may improve the quality of nutrition advice given to U.S. consumers. Innovation: This paper is the first to examine if health professionals' personal health behaviors are associated with their health advice on dairy and/or plant-based dairy alternatives.

Investigating Knowledge on Calcium and Preferences for Dairy vs. Plant-Based Alternatives.

Calcium is a nutrient of public health concern and commonly associated with dairy foods. In recent years, plant-based alternatives to dairy products have grown in popularity. This study examines public understanding of dietary calcium in dairy products and plant-based alternatives and explores whether knowledge is associated with product preference. In 2018, the U.S. Food and Drug Administration (FDA) solicited comments on the labeling of plant-based dairy alternatives (FDA-2018-N-3522), including input on consumer understanding of the nutritional content of dairy foods and plant-based products. All 11,906 submissions were obtained and 8,052 were retained after duplicate and near-duplicate comments were removed. Comments were coded for major nutrition themes and those that mentioned calcium and were analyzed for three calcium-specific themes: knowledge and beliefs about calcium content, calcium bioavailability, and health outcomes associated with intake. Submissions were examined in relation to each commenter's preference for dairy products or plant-based alternatives. 244 unique submissions (3.0%) mentioned calcium. Over half (51.2%) of commenters who mentioned calcium preferred plant-based alternatives. Comments mentioning calcium often reflected preference. Most commenters had an accurate understanding of calcium content in dairy and plant-based products. However, several commenters-especially those who preferred plant-based alternatives-misunderstood calcium metabolism and health outcomes related to calcium. Given declining consumption of fluid dairy milk-a key source of dietary calcium-and increasing consumption of plant-based alternatives, addressing gaps in nutrition knowledge and misunderstanding related to dairy and calcium intake is critical and has implications for nutrition education and policy.

Beyond Ramen: Investigating Methods to Improve Food Agency among College Students.

Many college students struggle to cook frequently, which has implications for their diet quality and health. Students' ability to plan, procure, and prepare food (food agency) may be an important target for shifting the college student diet away from instant and inexpensive staples like packaged ramen. The randomized intervention study included two sequential cooking interventions: (1) six weeks of cooking classes based in food agency pedagogy held once per week, and (2) six weekly home delivered meal kits (3 meals per kit) to improve food agency, diet quality, and at home cooking frequency of college students. Based on availability and subsequent randomization, participants were assigned to one of four conditions that included active cooking classes, meal kit provision, or no intervention. Participants who took part in the cooking intervention had significant improvement in food agency immediately following the intervention period. Participants who did not participate in cooking classes and only received meal kits experienced significant, though less pronounced, improvement in food agency scores following the meal kit provision. Neither intervention improved diet quality or routinely improved cooking frequency. Active cooking classes may improve food agency of college students, though further research is needed to determine how this may translate into improved diet quality and increased cooking frequency.

Intra-and Interpersonal Factors Buffer the Relationship Between Food Insecurity and Mental Well-Being Among Middle Schoolers.

BACKGROUND: Food insecurity (FI) is a significant predictor of feelings of isolation in children, as well as suicide ideation and depression. Using a census of public middle school-aged children, we seek to determine whether FI is associated with suicide ideation and feelings of hopelessness and how individual and school community factors can alleviate or exacerbate this relationship. METHODS: We analyzed data from the 2015 Youth Risk Behavior Surveillance Survey, conducted statewide by the Vermont Department of Health and administered to all public middle schoolers (N = 13,648). Questions were asked about FI, suicidal thoughts, feelings of hopelessness, perceptions of teaching and community care, physical activity, breakfast consumption, and demographics. Bivariate and cross-tabular analyses were conducted in SPSS, and regressions and Sobel tests were conducted in STATA. RESULTS: Results show that FI is associated with decreases in psychological well-being as measured by suicide ideation and feelings of hopelessness in students. However, students who reported eating breakfast regularly, feeling connected to their community or having a positive relationship with a teacher had significantly lower instances of suicide ideation and hopelessness. CONCLUSION: Suicide prevention programs should focus on enhancing community connection and student-teacher relationships and increasing funding for breakfast programs in schools.

Cooking as a Health Behavior: Examining the Role of Cooking Classes in a Weight Loss Intervention.

Americans are cooking fewer meals at home and eating more convenience foods prepared elsewhere. Cooking at home is associated with higher quality diets, while a reduction in cooking may be associated with increases in obesity and risk factors for chronic disease. The aims of this study were to examine cooking as an intervention for weight control in overweight and obese adults, and whether such an intervention increases participants' food agency and diet quality. Overweight and obese adults were randomized into one of two intervention conditions: active or demonstration. Both conditions received the same 24-week behavioral weight loss intervention, and bi-weekly cooking classes. The active condition prepared a weekly meal during a hands-on lesson, while the demonstration condition observed a chef prepare the same meal. The active condition lost significantly more weight at six months compared with the demonstration condition (7.3% vs. 4.5%). Both conditions saw significant improvements in food agency scores and Healthy Eating Index scores, though no significant differences were noted between groups. The addition of active cooking to a weight management intervention may improve weight loss outcomes, though benefits in diet quality and cooking behaviors may also be seen with the addition of a demonstration-only cooking intervention.

Assessment of Specifications Grading in an Undergraduate Dietetics Course.

Assessing student learning is an integral component of teaching undergraduate dietetics students. Traditional grading can be cumbersome for instructors, encouraging extrinsic motivation for students and hindering clear understanding of whether students have met course learning outcomes. Specifications grading is a reimagined assessment paradigm that empowers both students and instructors to focus on achievement of learning objectives. This report examines the deployment of specifications grading in an undergraduate dietetics course, using qualitative methods to determine the impact on students' learning and experiences. Employing specifications grading may help dietetics educators foster self-regulation and mastery learning for students, as well as increase grading transparency.

Sampling tomorrow's lunch today: Examining the effect of sampling a vegetable-focused entrée on school lunch participation, a pilot study.

School lunch programs are important pillars in the food system, as they impact children's health, local agriculture, and community food security. When offering a new lunch entrée that contains vegetables, schools must consider whether students will choose the new entrée to avoid low participation rates and decreased revenue. Previous research in marketing suggests that sampling (i.e. taste testing) can positively impact consumer choice. In terms of encouraging students to eat school lunch and particularly items that include vegetables, it is often assumed that sampling will help direct food choice to healthier items, but little research has investigated the impact of sampling on food choice in a school lunch environment. The objective of this research was to investigate in a pilot study whether providing samples of a vegetable-focused lunch entrée the day before it appeared on the school lunch menu increased National School Lunch Program (NSLP) participation. The study took place at a Vermont middle school in 2015. Four new vegetable-focused entrées were supplied over three consecutive months. During month two, the entrées were sampled at a middle school the day before they were offered for sale, and NSLP participation, as well as revenue was tracked over three months. Our results suggest that sampling may have a positive impact on NSLP participation rates and food service revenue, but that more research is needed to better assess how sampling can be utilized in the most efficacious way to promote NSLP participation and healthy eating patterns.

You can't "nudge" nuggets: An investigation of college late-night dining with behavioral economics interventions.

A mixed-methods approach was used to evaluate and improve the "late-night dining" options in a university dining hall. Surveys assessed student desires for late-night offerings, and evaluated students' habits and motivations during late-night dining. Two interventions were implemented to see if students could be "nudged" into different choice patterns. In the first, a "veggie-heavy" entrée was added at the beginning of the entrée line, so that students would substitute an entrée containing vegetables for the alternatives. In the second, a snack-food bar was set up to cater to students who didn't want to stand in the long entrée line, and preferred a snack. Data on food choice was collected during the interventions. Survey responses showed significant differences in the reasons females and males utilized late-night dining (p<0.001). We also found that students at late-night dining had a lower emphasis on health than the general student population. Even students at late-night who reported being health-conscious showed no difference in food selections from students who said health was not important (p = 0.883). Veggie-heavy entrées had mild success in increasing vegetable selection. However, veggie-heavy entrées were largely ignored when the other option was chicken nuggets. The snack bar was very popular. Entrée placement and convenience lines may have mild impacts on food selection in a late-night dining environment.

Lessons Learned Through the Implementation of an eHealth Physical Activity Gaming Intervention with High School Youth.

OBJECTIVE: To encourage high school students to meet physical activity goals using a newly developed game, and to document the feasibility, benefits, and challenges of using an electronic gaming application to promote physical activity in high school students. MATERIALS AND METHODS: Working with youth and game designers an electronic game, Camp Conquer, was developed to motivate high school students to meet physical activity goals. One-hundred-five high school students were recruited to participate in a 12-week pilot test of the game and randomly assigned to a Game Condition or Control Condition. Students in both conditions received a FitBit to track their activity, and participants in the Game Condition received access to Camp Conquer. Number of steps and active minutes each day were tracked for all participants. FitBit use, game logins, and qualitative feedback from researchers, school personnel, and participants were used to determine intervention engagement. RESULTS: The majority of study participants did not consistently wear their FitBit or engage with the gaming intervention. Numerous design challenges and barriers to successful implementation such as the randomized design, absence of a true school-based champion, ease of use, and game glitches were identified. CONCLUSION: Developing games is an exciting technique for motivating the completion of a variety of health behaviors. Although the present intervention was not successful in increasing physical activity in high school students, important lessons were learned regarding how to best structure a gaming intervention for the high school population.

Engaging Adolescents to Inform the Development of a Mobile Gaming App to Incentivize Physical Activity.

BACKGROUND: Involving youth in the development of a mobile game designed to increase physical activity may increase relevancy and adoption. OBJECTIVE: To share the development process used to create a gaming app aimed at incentivizing physical activity in high school students. METHODS: Five focus groups were conducted with high school students (N=50) to understand gaming behaviors. A subset of students from the focus groups chose to complete a Web-based survey (N=10). Four different versions of gaming artwork and concept design based on student input were pilot tested (N=35), and group consensus building determined the direction of the game. The 4 game versions differed in their artwork style and gaming concept with some requiring competition versus cooperation, or being more individual versus team based. Group consensus building meant that all artwork and game concept options were displayed at the front of a classroom. Students could then vote for their top artwork and concept choices by putting stickers on the top 1 or 2 artwork and concept options that they liked best. Once all votes were cast, investigators discussed the voting results with students, and brainstormed ways to incorporate popular aspects of the 3 "losing" artwork and game concepts into the winning ideas. RESULTS: Focus group transcripts were analyzed for common themes. Artwork and gaming concept-voting data was tallied at the time of voting to share with students in real time. Focus groups and survey results revealed important themes for a successful gaming app: (1) competition, (2) balanced in-game rewards, (3) accessibility, and (4) aesthetic features. Consensus voting indicated the popularity of a collaborative competitive content design (35/66, 53%) and playful art (27/71, 38%). CONCLUSIONS: To ensure saliency and effectiveness of game-based physical activity interventions, youth need to be included in design and implementation. Furthermore, the unique preferences and social constructs of high school students need to be considered during intervention development.

Examining the Weight Trajectory of College Students.

OBJECTIVE: To examine the weight trajectory of students over 4 years of college. METHODS: Anthropometric assessments were completed at the beginning and end of students' freshman year and the end of senior year to calculate body mass index. Questionnaires assessing weight-related behaviors were completed in senior year. RESULTS: Of the original 117 students, 86 remained in the study for 4 years. Body mass index was significantly higher at the end of senior year (mean, 24.84; SD, 4.46) vs the beginning of freshman year (mean, 23.59; SD, 4.01; t[85] = 5.61; P < .001). Weight was significantly higher at the end of senior year (mean, 71.32 kg; SD, 15.60) vs the beginning of freshman year (mean, 66.94 kg; SD, 14.02; t[85] = 6.60; P < .001). Students' mean weight gain was 4.38 kg and the sample increased from 23% to 41% overweight/obese. No significant associations were found between BMI and lifestyle factors. CONCLUSIONS AND IMPLICATIONS: This study suggests that students gain weight throughout college, which highlights the need for weight control interventions to target more than just freshman college students.

"Don't eat so much:" how parent comments relate to female weight satisfaction.

PURPOSE: How will the words of a parent influence the adult weight of their daughter? This retrospective study evaluates how the recalled comments of parents made about the weight or eating habits of a daughter related to her adult BMI and satisfaction with her weight. METHOD: A nationwide cross-sectional survey was conducted with 501 young women ranging in age from 20 to 35 (age 26.8, SD 3.1; BMI 25.96, SD 6.2), who were asked to indicate their weight satisfaction, eating habits, and BMI along with their recall of the extent to which they recalled their parents making weight-related or eating-related comments about them as a young girl. Linear regression analyses were run to examine the relationship between parental comments and women's weight satisfaction and BMI. RESULTS: A woman's dissatisfaction with her adult weight was only related to the extent she remembered her parents making any comments about her weight (p < 0.01), but not about how much she ate (p < 0.05)-even though both were positively related to her BMI (p < 0.001 and p < 0.01). Even among normal-weight young women with similar weights, those who recalled their parents commenting about their weight were more dissatisfied with their body weight (p < 0.01). DISCUSSION: In this retrospective study, a parent's comments about her childhood weight were related to her weight and body dissatisfaction as an adult. In contrast, comments about her eating habits were not significantly related to weight dissatisfaction.

Food neophiles: Profiling the adventurous eater.

OBJECTIVE: The study objective was to identify how food neophilia-having an adventurous eating style for new/different foods-may relate to body mass index (BMI). METHODS: A nationwide online survey was conducted in 2012 with a group of 501 diverse young women (mean age = 26.8, mean BMI = 25.96). Items measured eating adventurousness, perceptions of novel foods, lifestyle and psychological characteristics, and BMI (dependent variable). RESULTS: Linear regressions were run to examine associations between eating adventurousness and weight-related outcomes. To examine mean differences between adventurous and non-adventurous eaters, a one-way ANOVA was run for variables on perceptions of novel foods, lifestyle, and psychology (significance level = P < 0.05). Food neophiles had lower BMIs (P < 0.01) and were more likely to cook to connect with their heritage, host friends for dinner, be physically active, and be concerned about the healthfulness of food, when compared to non-adventurous eaters (all P values < 0.05). CONCLUSIONS: Promoting adventurous eating in adults could help individuals lose/maintain weight without feeling as restricted. Given the lack of research on food neophiles, future studies should examine their characteristics and behaviors, as well as how food neophiles may intersect with others interested in food (e.g., foodies).

When do gain-framed health messages work better than fear appeals?

Past literature reviews of gain-framed versus loss-based health messages have been inconsistent and inconclusive. To resolve this and provide a clearer pattern, this review focuses on the individual or person-specific characteristics of target audiences. The results indicate that by answering the following four questions about a target audience, one can predict whether a gain-framed or a loss-based health message will be more effective. 1) Is there a low (versus high) level of involvement in the issue? 2) Is there a high (versus low) certainty of the outcome? 3) Is there a low (versus high) preference for risk? 4) Is there a heuristic (versus piecemeal) processing style? The profiling of audiences on these factors has two distinct benefits; it resolves many of the seeming inconsistencies in past positive-negative and gain-loss message research (such as fear appeals working better with experts than nonexperts) and it helps predict which type of message will be most effective with a given audience.

Viewers vs. doers. The relationship between watching food television and BMI.

The objective of this study was to examine where nutritional gatekeepers obtain information about new foods, and whether information source is associated with Body Mass Index (BMI), as well as whether any association varied according to how often the participant cooked from scratch. A national panel survey of 501 females aged 20-35 assessed how participants obtained information on new recipes, and asked a series of questions about their cooking habits, their weight and height. Linear regressions were run to determine associations between information source, cooking from scratch, and BMI. Obtaining information from cooking shows was positively correlated with BMI (p <0.05), as was obtaining information from social media (p <0.05), whereas obtaining information from other print, online, or in-person sources was not significantly associated with BMI. A significant interaction between watching cooking shows and cooking from scratch indicated that cooking from scratch, as well as watching cooking shows was associated with higher BMI (p <0.05). Obtaining information about new foods from television cooking shows or social media - versus other sources - appears to have a unique relationship with BMI. Furthermore, watching cooking shows may have a differential effect on BMI for those who are merely TV "viewers," versus those who are "doers." Promoting healthy foods on cooking shows may be one way to positively influence the weight status of "doers" as well as "viewers."

The impact of incentives on intrinsic and extrinsic motives for fitness-center attendance in college first-year students.

PURPOSE: A criticism of incentives for health behaviors is that incentives undermine intrinsic motivation. The objective of this study was to determine the impact of monetary incentive provision on participation motives for exercise in first-year college students at a northeastern public university. DESIGN: Randomized-controlled trial. SETTING: Public university in the Northeastern United States. SUBJECTS: One hundred seventeen first-year college students. INTERVENTION: Participants were randomized to one of three conditions: a control condition receiving no incentives for meeting fitness-center attendance goals; a discontinued-incentive condition receiving weekly incentives during fall semester 2011, and no incentives during spring semester 2012; or a continued-incentive condition receiving weekly incentives during fall semester, and incentives on a variable-interval schedule during spring semester. MEASURES: The Exercise Motivation Inventory 2 measured exercise participation motives at baseline, end of fall semester, and end of spring semester. Fitness-center attendance was monitored by using ID-card check-in/check-out records. ANALYSIS: Repeated-measures analyses using linear mixed models with first-order autoregressive covariance structures were run to compare motive changes in the three conditions. RESULTS: Participation motives of Enjoyment and Revitalization associated with intrinsic motivation did not decrease significantly over time in any of the conditions, F(4, 218) = 2.25, p = .065 and F(4, 220) = 1.67, p = .16, respectively. CONCLUSION: Intrinsically associated participation motives for exercise did not decrease with incentive provision. Therefore, incentives may encourage fitness-center attendance without negatively impacting participation motives for exercise.