Percepción del etiquetado nutricional en población con obesidad y sobrepeso / Perception of the nutritional labels by population in risk of being obese or overweight

FUNDAMENTOS: El etiquetado nutricional representa una valiosa herramienta para ayudar a los consumidores a tomar decisiones informadas acerca de su dieta y estilo de vida. Son escasos los estudios realizados en España sobre la percepción de la información alimentaria por el consumidor y ninguno considera la población con obesidad y sobrepeso como objetivo principal. Por ello el objetivo de este trabajo es evaluar la percepción de esta población frente a la información que le proporciona el etiquetado de los alimentos, su comprensión, utilidad y uso. MÉTODOS: Se realiza 133 encuestas en personas de la Comunidad Valenciana con obesidad (27,8%) y sobrepeso (72,2%) sobre la lectura, hábitos de compra, comprensión y uso de la información alimentaria. RESULTADOS: Se observa que a pesar del interés por seguir una dieta saludable (27,8%) y la valoración positiva del etiquetado de los alimentos (91%), se lee poco (35,3%) y resulta difícil de comprender (35,6%). El precio es el condicionante que más influye a la hora de la compra (72,9%). El 72,9% no sigue una dieta especial. El semáforo nutricional es el etiquetado frontal mejor comprendido. CONCLUSIONES: La población con obesidad y sobrepeso tiene dificultad para interpretar y comprender el etiquetado de los alimentos

BACKGROUND: Nutritional food label represents a valuable tool to help consumers to make informed decisions about their diets and lifestyle. There are few studies carried out in Spain about the perception of the consumer and none of them has obese or overweight population as their main target. Consequently the high interest to conduct this research in order to assess the perception of this population to food label, their understanding, utility and use. METHODS: 133 surveys are conducted in Comunidad Valenciana on obese (27.8%) and overweight (72.2%) people regarding their reading, shopping habits, use and understanding of food information. RESULTS: It is observed that despite their interest to follow a healthy diet (27.8%) and the positive assessment of the food label (91.0%) little is read (35.3%) and it is difficult to understand (35.6%). Price is the most determining factor regarding purchase (72.9%). 72.9% of the population don't follow a special diet. Traffic light colours used on the front packaging is the best understood food label. CONCLUSIONS: Obese and overweight population has difficulty in interpreting and understanding food labels

Exposure to Food and Beverage Advertising on Television among Canadian Adolescents, 2011 to 2016.

Adolescents represent a key audience for food advertisers, however there is little evidence of adolescent exposure to food marketing in Canada. This study examined trends in Canadian adolescents' exposure to food advertising on television. To do so, data on 19 food categories were licensed from Nielsen Media Research for May 2011, 2013, and 2016 for the broadcasting market of Toronto, Canada. The average number of advertisements viewed by adolescents aged 12-17 years on 31 television stations during the month of May each year was estimated using television ratings data. Findings revealed that between May 2011 and May 2016, the total number of food advertisements aired on all television stations increased by 4%, while adolescents' average exposure to food advertising decreased by 31%, going from 221 ads in May 2011 to 154 in May 2016. In May 2016, the advertising of fast food and sugary drinks dominated, relative to other categories, accounting for 42% and 11% of all exposures, respectively. The findings demonstrate a declining trend in exposure to television food advertising among Canadian adolescents, which may be due to shifts in media consumption. These data may serve as a benchmark for monitoring and evaluating future food marketing policies in Canada.

Rogue stem cell clinics.

Cell therapies hold significant promise for the treatment of injured or diseased musculoskeletal tissues. However, despite advances in research, there is growing concern about the increasing number of clinical centres around the world that are making unwarranted claims or are performing risky biological procedures. Such providers have been known to recommend, prescribe, or deliver so called 'stem cell' preparations without sufficient data to support their true content and efficacy. In this annotation, we outline the current environment of stem cell-based treatments and the strategies of marketing directly to consumers. We also outline the difficulties in the regulation of these clinics and make recommendations for best practice and the identification and reporting of illegitimate providers. Cite this article: Bone Joint J 2020;102-B(2):148-154.

The direct-to-consumer market for stem cell-based interventions in Australia: exploring the experiences of patients.

The prevalence of businesses selling autologous stem cell-based interventions to patients in Australia has raised serious concerns about how weaknesses in regulation have enabled the emergence of an industry that engages in aggressive marketing of unproven treatments to patients. Little is known about how patients experience this marketing and their subsequent interactions with practitioners. This paper reports results from 15 semistructured interviews with patients and carers, and also draws upon discussion conducted with patients, carers and family members (22 participants) in a workshop setting. We explore how Australian patients and carers understand and experience these interventions, and how their presumptions about the ethics of medical practice, and the regulatory environment in Australia have conditioned their preparedness to undergo unproven treatments.

Direct-To-Consumer Advertising of Over-the-Counter Sinonasal Remedies: A History of Mixed Messages.

Sinus, cold, and allergy remedies comprise the most widely used sector of the over-the-counter (OTC) drug market. Direct-to-consumer advertising (DTCA) of pharmaceutical products has increased over the past 30 years, including the promotion of OTC drugs. The influence of DTCA on OTC sinonasal remedies comprises several positive and negative effects. Favorable aspects of this influence include empowerment and promotion of autonomy among patients, avoidance of low-value clinical encounters, self-directed education, and decreased healthcare expenditures. This is balanced by potential concerns, including the lack of rigorous regulation of OTC drugs, the burden of self-diagnosis, the risk of unsupervised use resulting in adverse effects or drug interactions, and redistribution of pharmacy costs to the consumer. Despite the proliferation of product options and consumer-directed information, healthcare utilization and cost of treating sinonasal disease remains high. Moreover, the availability of OTC sinonasal remedies and exposure to DTCA has had mixed effects without apparent overall benefit to patient and consumer health. Laryngoscope, 130:2114-2119, 2020.

Tracking Kids' Food: Comparing the Nutritional Value and Marketing Appeals of Child-Targeted Supermarket Products Over Time.

Marketing unhealthy foods negatively impacts children's food preferences, dietary habits and health, prompting calls for regulations that will help to create an "enabling" food environment for children. One powerful food marketing technique is product packaging, but little is known about the nature or quality of child-targeted food products over time. This study assesses how child-targeted supermarket foods in Canada have transformed with respect to nutritional profile and types of marketing appeals (that is, the power of such marketing). Products from 2009 (n = 354) and from 2017 (n = 374) were first evaluated and compared in light of two established nutritional criteria, and then compared in terms of marketing techniques on packages. Overall, child-targeted supermarket foods did not improve nutritionally over time: 88% of child-targeted products (across both datasets) would not be permitted to be marketed to children, according to the World Health Organization (WHO) criteria, and sugar levels remained consistently high. Despite this poor nutritional quality, the use of nutrition claims increased significantly over time, as did the use of cartoon characters and appealing fonts to attract children's attention. Character licensing-using characters from entertainment companies-remained consistent. The findings reveal the critical need to consider packaging as part of the strategy for protecting children from unhealthy food marketing. Given the poor nutritional quality and appealing nature of child-oriented supermarket foods, food product packaging needs to be included in the WHO's call to improve the restrictions on unhealthy food marketing to children.

Don't give US pink ribbons and skinny girls: Breast cancer survivors' evaluations of cancer advertising.

Breast cancer related promotions, advertising, and pink ribbons are now ubiquitous in October, yet comparatively little is known about how this advertising impacts breast cancer survivors specifically. The present research uses an embodied knowledge perspective to explore the impact of cancer advertising on female breast cancer survivors. Five focus groups were conducted with 42 participants, and the discussions were analyzed to find common themes. The survivors expressed a desire for cancer advertising to be representative, informative (particularly regarding detection and treatment options), hopeful, and transparent about the organization's motivation and support. Implications and recommendations are also discussed.

The role of imagination in consumers' processing of visual metaphors in prescription drug advertising.

This research examines the influence of visual metaphors in direct-to-consumer advertising (DTCA) for prescription drugs. Results indicate that consumers' propensity to imagine enhances their objective comprehension of direct-to-consumer (DTC) pharmaceutical advertisements that contain fused visual metaphors (vs. juxtaposed visual metaphors). Additionally, when DTC pharmaceutical advertisements feature visual metaphors with low comparability, consumers primed with imagination-focused visualization rather than memory-focused visualization inducements experience greater information-seeking intentions regarding drug health risks for ads using fused rather than juxtaposed visual metaphors. These results suggest notable DTCA insights for advertising and policymaking.

Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits.

BACKGROUND AND OBJECTIVES: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office. METHODS: In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management. RESULTS: There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P < .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P < .001 for both comparisons). CONCLUSIONS: At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.

Direct to consumer versus clinical genetic testing.

There are approximately 250 direct to consumer (DTC) genetic testing companies marketing different testing options such as genetic health risk, carrier status, ancestry, wellness, traits, noninvasive prenatal genetic testing, athleticism, and many others. As a result, choosing the most appropriate test may be daunting when compared with a focused genetic test ordered by a clinician. A wealth of information may be discovered and care must be taken by both consumers and clinicians when deciphering test results. This column highlights considerations when proceeding forward with a DTC genetic test.

Medical Marketing in the United States, 1997-2016.

IMPORTANCE: Manufacturers, companies, and health care professionals and organizations use an array of promotional activities to sell and increase market share of their products and services. These activities seek to shape public and clinician beliefs about laboratory testing, the benefits and harms of prescription drugs, and some disease definitions. OBJECTIVE: To review the marketing of prescription drugs, disease awareness campaigns, health services, and laboratory tests and the related consequences and regulation in the United States over a 20-year period (1997-2016). EVIDENCE: Analysis (1997-2016) of consumer advertising (Kantar Media data for spending and number of ads); professional marketing (IQVIA Institute for Human Data Science, Open Payments Data [Centers for Medicare & Medicaid Services]); regulations and legal actions of the US Food and Drug Administration (FDA), Federal Trade Commission (FTC), state attorneys general, and US Department of Justice; and searches (1975-2018) of peer-reviewed medical literature (PubMed), business journals (Business Source Ultimate), and news media (Lexis Nexis) for articles about expenditures, content, and consequences and regulation of consumer and professional medical marketing. Spending is reported in 2016 dollars. FINDINGS: From 1997 through 2016, spending on medical marketing of drugs, disease awareness campaigns, health services, and laboratory testing increased from $17.7 to $29.9 billion. The most rapid increase was in direct-to-consumer (DTC) advertising, which increased from $2.1 billion (11.9%) of total spending in 1997 to $9.6 billion (32.0%) of total spending in 2016. DTC prescription drug advertising increased from $1.3 billion (79 000 ads) to $6 billion (4.6 million ads [including 663 000 TV commercials]), with a shift toward advertising high-cost biologics and cancer immunotherapies. Pharmaceutical companies increased DTC marketing about diseases treated by their drugs with increases in disease awareness campaigns from 44 to 401 and in spending from $177 million to $430 million. DTC advertising for health services increased from $542 million to $2.9 billion, with the largest spending increases by hospitals, dental centers, cancer centers, mental health and addiction clinics, and medical services (eg, home health). DTC spending on advertising for laboratory tests (such as genetic testing) increased from $75.4 million to $82.6 million, although the number of ads increased more substantially (from 14 100 to 255 300), reflecting an increase in less expensive electronic media advertising. Marketing to health care professionals by pharmaceutical companies accounted for most promotional spending and increased from $15.6 billion to $20.3 billion, including $5.6 billion for prescriber detailing, $13.5 billion for free samples, $979 million for direct physician payments (eg, speaking fees, meals) related to specific drugs, and $59 million for disease education. Manufacturers of FDA-approved laboratory tests paid $12.9 million to professionals in 2016. From 1997 through 2016, the number of consumer and professional drug promotional materials that companies submitted for FDA review increased from 34 182 to 97 252, while FDA violation letters for misleading drug marketing decreased from 156 to 11. Since 1997, 103 financial settlements between drug companies and federal and state governments resulted in more than $11 billion in fines for off-label or deceptive marketing practices. The FTC has acted against misleading marketing by a single for-profit cancer center. CONCLUSIONS AND RELEVANCE: Medical marketing increased substantially from 1997 through 2016, especially DTC advertising for prescription drugs and health services. Pharmaceutical marketing to health professionals accounted for most spending and remains high even with new policies to limit industry influence. Despite the increase in marketing over 20 years, regulatory oversight remains limited.

Disease awareness advertising (DAA) in emerging economy: A comparison between views of consumers and pharmaceutical professionals.

Research on effectiveness of DAA is limited. Existing researches explore impact of DAA only on relationship between drug manufacturers and consumers. However, in reality, pharma marketing revolves around three major stakeholders: the pharmaceutical companies, physicians and consumers. Pharmaceutical professionals on behalf of drug manufacturers have last mile connectivity with end users and they are an important stakeholder in this entire marketing relationship network. So, it is important for marketers to capture views of pharma professionals in addition to physicians and consumers. The current research evaluates views of consumers and pharmaceutical professionals about effectiveness of unbranded DAA for product message communication.

Assessing Youth-Appealing Content in Alcohol Advertisements: Application of a Content Appealing to Youth (CAY) Index.

Underage drinking is a serious public health problem in the United States, and youth exposure to alcohol advertising has been indicated as a possible contributing factor. Although a number of studies have identified advertising content features that youth find appealing, a key limitation of this research is the absence of a broader tool to examine those features, especially those used by alcohol brands that are popular with underage drinkers. We created an index of content elements found in the research literature to be appealing to youth, and then used this index in a content analysis to identify the degree to which youth-appealing content appeared in a sample of alcohol ads that aired on television shows popular among youth. Finally, using bivariate analysis, we tested the relationship between alcohol brands' use of this content and the popularity of those brands among youth. We found that many of the ads featured youth-appealing content, and that the ads for the alcohol brands most popular among youth had more youth-appealing content than the less popular brands.

Marketing and Testosterone Treatment in the USA: A Systematic Review.

CONTEXT: Testosterone replacement therapy (TRT) is currently approved by the Food and Drug Administration only for classic hypogonadism, although off-label indications have resulted in a dramatic expansion in prescriptions in the USA. Marketing may significantly affect prescriber behavior. OBJECTIVE: To systematically review all available evidence on marketing and TRT in the USA. EVIDENCE ACQUISITION: PubMed, Embase, and Scopus were searched up to July 2017 for all relevant publications reporting on assessments of the TRT market size, economic costs associated with hypogonadism, trends in TRT prescriptions, drug discontinuation rates, and advertising and sales efforts in the USA. EVIDENCE SYNTHESIS: Twenty retrospective studies were included in the final analysis. The market size for hypogonadism constitutes 5.6-76.8% of men in the USA, with the lower end of the range representing the strictest criteria for diagnosis. Men with a diagnosis of hypogonadism consume $14 118 in direct and indirect costs to the payer. Over the last 2 decades, TRT prescriptions have increased between 1.8- and 4-fold. After 1 yr, 80-85% of men discontinue TRT. There is an association between direct-to-consumer advertising and testosterone testing, TRT prescriptions, and TRT without testosterone testing. There is a high prevalence of misinformation on Internet advertising. CONCLUSIONS: Off-label indications have driven the dramatic expansion of TRT prescriptions over the last 2 decades. Direct-to-consumer advertising poses a unique challenge in the USA. Overtreatment can be avoided by applying strict diagnostic criteria for hypogonadism, which limits the addressable market for TRT. PATIENT SUMMARY: In this report, we reviewed the relationship between marketing and testosterone therapy in the USA. We found that many patients are prescribed testosterone without an appropriate diagnosis of hypogonadism, which may be related to the marketing efforts for off-label prescribing.

Malt Beverage Brand Popularity Among Youth and Youth-Appealing Advertising Content.

BACKGROUND: This study examined whether alcohol brands more popular among youth are more likely to have aired television advertisements that violated the alcohol industry's voluntary code by including youth-appealing content. METHODS: We obtained a complete list of 288 brand-specific beer advertisements broadcast during the National Collegiate Athletic Association (NCAA) men's and women's basketball tournaments from 1999 to 2008. All ads were rated by a panel of health professionals using a modified Delphi method to assess the presence of youth-appealing content in violation of the alcohol industry's voluntary code. The ads represented 23 alcohol brands. The popularity of these brands was operationalized as the brand-specific popularity of youth alcohol consumption in the past 30 days, as determined by a 2011 to 2012 national survey of underage drinkers. Brand-level popularity was used as the exposure variable to predict the odds of having advertisements with youth-appealing content violations. RESULTS: Accounting for other covariates and the clustering of advertisements within brands, increased brand popularity among underage youth was associated with significantly increased odds of having youth-appeal content violations in ads televised during the NCAA basketball tournament games (adjusted odds ratio = 1.70, 95% CI: 1.38, 2.09). CONCLUSIONS: Alcohol brands popular among underage drinkers are more likely to air television advertising that violates the industry's voluntary code which proscribes youth-appealing content.

Strategies for patient empowerment through the promotion of medicines in Israel: regulatory framework for the pharmaceutical industry.

The correct and rational use of medications can have a positive direct impact on disease outcomes, as well on the utilization of the health system resources. Unfortunately, 50% of the patients do not take their medications as prescribed, largely due to lack of patients' understanding of their medical condition, as well as the lack of reliable medicine information.There are multiple strategies implemented in many countries to tackle this challenge including: disease awareness campaigns (DAC) to raise the public awareness to specific diseases, direct-to-consumer advertisement (DTCA) to raise the public awareness to prescription medicines, specific treatments and over-the-counter (OTC) products to improve the accessibility of patients to specific medicines.Prior to 2013, the Israeli policy prohibited prescribing medication advertising and prevented the flow of information from pharmaceutical companies to the patient. In the last five years, the Pharmaceutical division in the Israeli Ministry of Health, as part of the "empowering the patient" agenda, has taken new innovative approaches to raise public awareness to diseases, medications and appropriate usage, as well as promotion of information to improve patient adherence to the prescribed medication.This paper elaborates on the aforementioned strategies implemented in developed countries, and specifically focuses on newly implemented strategies and regulations in Israel regarding pre- and post-prescription information, to improve patient appropriate utilization and adherence to medication.

Industry Responsibilities in Tackling Direct-to-Consumer Marketing of Unproven Stem Cell Treatments.

The direct-to-consumer marketing of unproven stem cell interventions (SCIs) is a serious public health concern. Regulations and education have had modest impact, indicating that different actors must play a role to stop this unfettered market. We consider the role of the biotech industry in tackling unproven SCIs. Grounded in the concept of corporate social responsibility, we argue that biotech companies should screen consumers to ensure that products and services are being used appropriately and educate employees about unproven SCIs.

Association Between Direct-to-Consumer Advertising and Testosterone Testing and Initiation in the United States, 2009-2013.

Importance: Testosterone initiation increased substantially in the United States from 2000 to 2013, especially among men without clear indications. Direct-to-consumer advertising (DTCA) also increased during this time. Objective: To investigate associations between televised DTCA and testosterone testing and initiation in the United States. Design, Setting, and Population: Ecologic study conducted in designated market areas (DMAs) in the United States. Monthly testosterone advertising ratings were linked to DMA-level testosterone use data from 2009-2013 derived from commercial insurance claims. Associations between DTCA and testosterone testing, initiation, and initiation without recent baseline tests were estimated using Poisson generalized estimating equations. Exposures: Monthly Nielsen ratings for testosterone DTCA in the 75 largest DMAs. Main Outcomes and Measures: (1) Rates of new serum testosterone testing; (2) rates of testosterone initiation (in-office injection, surgical implant, or pharmacy dispensing) for all testosterone products combined and for specific brands; and (3) rates of testosterone initiation without recent serum testosterone testing. Results: Of 17 228 599 commercially insured men in the 75 DMAs, 1 007 990 (mean age, 49.6 [SD, 11.5] years) had new serum testosterone tests and 283 317 (mean age, 51.8 [SD, 11.3] years) initiated testosterone treatment. Advertising intensity varied by geographic region and time, with the highest intensity seen in the southeastern United States and with months ranging from no ad exposures to a mean of 13.6 exposures per household. Nonbranded advertisements were common prior to 2012, with branded advertisements becoming more common during and after 2012. Each household advertisement exposure was associated with a monthly increase in rates of new testosterone testing (rate ratio [RR], 1.006; 95% CI, 1.004-1.008), initiation (RR, 1.007; 95% CI, 1.004-1.010), and initiation without a recent test (RR, 1.008; 95% CI, 1.002-1.013). Mean absolute rate increases were 0.14 tests (95% CI, 0.09-0.19), 0.05 new initiations (95% CI, 0.03-0.08), and 0.02 initiations without a recent test (95% CI, 0.01-0.03) per 10 000 men for each monthly ad exposure over the entire period. Conclusions and Relevance: Among US men residing in the 75 designated market areas, regional exposure to televised direct-to-consumer advertising was associated with greater testosterone testing, new initiation, and initiation without recent testing.