Impact of dishware size on energy intake in adult females: A randomized control trial examining effects on within-meal and post-meal energy intake.

The influence dishware size has on meal energy intake is unclear and no study to date has examined the impact on total daily energy intake. In a pre-registered RCT we investigate the impact of breakfast dishware size on breakfast and post-breakfast energy intake, as well as daily energy intake and hunger/fullness. In a repeated-measures design, 50 females (aged 18-77 years) were randomised to receive smaller or larger breakfast dishware on two separate days. Energy intake was also measured during the rest of the day. The primary outcomes were breakfast and post-breakfast energy intake (kcal). Secondary outcomes were total daily energy intake (kcal), and hunger/fullness (rated from 0 to 100). We examined if results differed by socioeconomic position (SEP). Dishware did not affect energy intake at breakfast (smaller: M = 394.8 kcal; SD = 172.2 larger: M = 394.4 kcal; SD = 164.4; d = 0.003, p = 0.98), and there was no statistically significant evidence that dishware size affected energy intake after breakfast, though post-breakfast energy intake was somewhat higher after using larger breakfast dishware (smaller: M = 1974.6 kcal; SD = 475.2; larger: M = 2077.5 kcal; SD = 525.9; d = -0.27, p = 0.06). Total daily energy intake, hunger and fullness ratings did not significantly differ between dishware conditions. There was no evidence that SEP moderated the effect of dishware size on energy intake. Smaller vs. larger breakfast dishware size had no significant effect on breakfast or post-breakfast energy intake, hunger, fullness, or daily energy intake. Previous studies may have overestimated the promise of dishware size as an intervention for reducing energy intake. Alternative interventions targeting the food environment should now be prioritised.

Passive overconsumption? Limited evidence of compensation in meal size when consuming foods high in energy density: Two randomised crossover experiments.

Research has drawn contradictory conclusions as to whether humans adjust meal size based on meal energy density (ED) or exhibit 'passive overconsumption'. Recent observational research has suggested that meal EDs greater than 1.7-2 kcal/g are compensated for through consumption of smaller meal sizes. We tested the relationship between ED and meal size by examining energy intake of meals at three levels of ED: low (∼1.0 kcal/g), medium (1.7-2.0 kcal/g) and high (>3.0 kcal/g). Two randomised, crossover experiments were conducted with adult participants. In experiment 1 (n = 34, 62% female, mean age 37.4 years), participants were served a lunch including a familiar low, medium or high ED dessert to eat ad libitum. In experiment 2 (n = 32, 66% female, mean age 36.4 years), participants were served a lunch meal manipulated to be low, medium or high ED to eat ad libitum. For experiment 2, later energy intake (post-meal energy intake) was also measured. In experiment 1, participants consumed a similar amount of energy from the low vs. medium ED food. The high ED food was associated with an increased intake of approximately 240 kcals compared to medium (p < 0.001, Cohen's d = 2.31) and low (p < 0.001, Cohen's d = 4.42) ED foods. In experiment 2, there were no significant differences in meal size (grams) between ED meals, resulting in a largely linear relationship between meal ED and energy intake across the three ED conditions ('passive overconsumption'). There were no differences in later energy intake between ED conditions. Contrary to recent suggestions, foods higher in ED were not associated with adjustments to meal size and were associated with increased energy intake across two experiments. Reformulation of foods high in ED may be an effective population level approach to reducing energy intake and obesity. Clinical trial registry number: NCT05744050; https://clinicaltrials.gov/ct2/show/NCT05744050.

Socioeconomic position and the influence of food portion size on daily energy intake in adult females: two randomized controlled trials.

BACKGROUND: Reducing portion sizes of commercially available foods could be an effective public health strategy to reduce population energy intake, but recent research suggests that the effect portion size has on energy intake may differ based on socioeconomic position (SEP). OBJECTIVE: We tested whether the effect of reducing food portion sizes on daily energy intake differed based on SEP. METHODS: Participants were served either smaller or larger portions of food at lunch and evening meals (N = 50; Study 1) and breakfast, lunch and evening meals (N = 46; Study 2) in the laboratory on two separate days, in repeated-measures designs. The primary outcome was total daily energy intake (kcal). Participant recruitment was stratified by primary indicators of SEP; highest educational qualification (Study 1) and subjective social status (Study 2), and randomisation to the order portion sizes were served was stratified by SEP. Secondary indicators of SEP in both studies included household income, self-reported childhood financial hardship and a measure accounting for total years in education. RESULTS: In both studies, smaller (vs larger) meal portions led to a reduction in daily energy intake (ps < .02). Smaller portions resulted in a reduction of 235 kcal per day (95% CI: 134, 336) in Study 1 and 143 kcal per day (95% CI: 24, 263) in Study 2. There was no evidence in either study that effects of portion size on energy intake differed by SEP. Results were consistent when examining effects on portion-manipulated meal (as opposed to daily) energy intake. CONCLUSIONS: Reducing meal portion sizes could be an effective way to reduce overall daily energy intake and contrary to other suggestions it may be a socioeconomically equitable approach to improving diet. TRIAL REGISTRATION: These trials were registered at www. CLINICALTRIALS: gov as NCT05173376 and NCT05399836.

Socioeconomic position and the effect of energy labelling on consumer behaviour: a systematic review and meta-analysis.

BACKGROUND: There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP). METHODS: Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups. RESULTS: Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X2(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 [95% CI: -0.092 to 0.226] and lower SEP SMD = 0.115 [95% CI: -0.006 to 0.237] were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X2(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 [95% CI: -0.053 to 0.117] and in lower SEP the effect was SMD = -0.005 [95% CI: -0.051 to 0.041]. CONCLUSIONS: Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required. REVIEW REGISTRATION: Registered on PROSPERO (CRD42022312532) and OSF ( https://doi.org/10.17605/OSF.IO/W7RDB ).

The impact of increasing the availability of lower energy foods for home delivery and socio-economic position: a randomised control trial examining effects on meal energy intake and later energy intake.

Increasing the availability of lower energy food options is a promising public health approach. However, it is unclear the extent to which availability interventions may result in consumers later 'compensating' for reductions in energy intake caused by selecting lower energy food options and to what extent these effects may differ based on socio-economic position (SEP). Our objective was to examine the impact of increasing availability of lower energy meal options on immediate meal energy intake and subsequent energy intake in participants of higher v. lower SEP. In a within-subjects design, seventy-seven UK adults ordered meals from a supermarket ready meal menu with standard (30 %) and increased (70 %) availability of lower energy options. The meals were delivered to be consumed at home, with meal intake measured using the Digital Photography of Foods Method. Post-meal compensation was measured using food diaries to determine self-reported energy intake after the meal and the next day. Participants consumed significantly less energy (196 kcal (820 kJ), 95 % CI 138, 252) from the menu with increased availability of lower energy options v. the standard availability menu (P < 0·001). There was no statistically significant evidence that this reduction in energy intake was substantially compensated for (33 % compensated, P = 0·57). The effects of increasing availability of lower energy food items were similar in participants from lower and higher SEP. Increasing the availability of lower energy food options is likely to be an effective and equitable approach to reducing energy intake which may contribute to improving diet and population health.

No Impact of Calorie or Unit Information on Ad Libitum Alcohol Consumption.

AIMS: To investigate the impact of unit and calorie information on drinking behaviour in an ad libitum taste test paradigm. METHODS: In this experimental human laboratory study, participants were randomized to one of four conditions, balanced by gender, using a 2 (unit information: present vs. absent) × 2 (calorie information: present vs. absent) between-subjects design. The percentage of beer consumed during the taste test was the primary outcome measure. RESULTS: Among this largely undergraduate student population, we found no evidence that either unit or calorie information impacted alcohol consumption in an ad libitum taste test. A manipulation check indicated that few of the participants receiving either unit and/or calorie information could accurately recall the number of units and/or calories in the beverages provided to them, indicating low levels of engagement with this information. Analysis of qualitative reactions to calorie and unit labelling indicated possible negative unintended consequences of calorie and unit information, including using unit information to facilitate consumption of higher strength beverages, and calorie information to reduce food consumption prior to a drinking episode. CONCLUSION: We find no evidence to support an effect of unit or calorie information, a public-health initiative supported by the alcohol industry, on drinking behaviour. It is possible that compulsory unit and calorie labelling, at least in the numeric format used here, would have no effect on alcohol intake and may even have some negative unintended consequences among certain populations.

Healthier diets for all? A systematic review and meta-analysis examining socioeconomic equity of the effect of increasing availability of healthier foods on food choice and energy intake.

Widespread availability of unhealthy food and drink products may contribute to socioeconomic patterning in obesity. Therefore, increasing the availability of healthier foods may be one approach to reducing obesity without widening existing inequalities. This systematic review and meta-analysis examined the impact of increasing the availability of healthier food and drink on consumer behavior among individuals with higher and lower socioeconomic position (SEP). Eligible studies were required to use experimental designs to compare conditions of higher vs lower availability of healthier vs less healthy options on food choice-related outcomes and measure SEP. Thirteen eligible studies were included. Odds of choosing a healthy item were higher when availability was increased for higher (OR = 5.0, 95% CI: 3.3, 7.7) and lower (OR = 4.9, CI: 3.0, 8.0) SEP. Increased availability of healthier foods was also associated with a decrease in energy content of selections for higher (-131 kcal; CI: -76, -187) and lower (-109 kcal; CI: -73, -147) SEP. There was no SEP moderation. Increasing the relative availability of healthier foods may be an equitable and effective approach to improve population-level diet and address obesity, though more research is required testing this in real-world environments.

Energy labelling of alcoholic drinks: An important or inconsequential obesity policy?

Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behavior are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behavior, suggest alcohol energy labelling may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity.

Glassware design and drinking behaviours: a review of impact and mechanisms using a new typology of drinking behaviours.

Much of the global burden of disease is attributable to unhealthy behaviour, including excessive consumption of alcohol and sugar-sweetened beverages. Developing effective methods to change these drinking behaviours could inform policies to improve population health. In line with an increasing interest in environmental-level interventions - i.e., changing the environment in which a behaviour occurs in order to change the behaviour of interest - this review first describes the existing evidence of the impact of glassware design (including capacity and shape) on drinking behaviours (e.g., at the 'micro' level - including sip size, as well as at the macro level - including amount consumed). The roles of two sets of possible underlying mechanisms - perception and affordance - are also explored. Finally, this review sets out a provisional typology of drinking behaviours to enable more systematic approaches to the study of these behaviours. While there is a paucity of evidence - in particular on measures of consumption - this growing evidence base suggests promising targets for novel interventions involving glassware design to reduce the consumption of drinks that harm health.Trial registration: ISRCTN.org identifier: ISRCTN10456720.

Glass shape influences drinking behaviours in three laboratory experiments.

Reducing consumption of drinks which contain high levels of sugar and/or alcohol may improve population health. There is increasing interest in health behaviour change approaches which work by changing cues in physical environments ("nudges"). Glassware represents a modifiable cue in the drinking environment that may influence how much we drink. Here, we report three laboratory experiments measuring consumption of soft drinks served in different glasses (straight-sided vs. outward-sloped), using distinct paradigms to measure drinking. In Study 1 (N = 200), though total drinking time was equivalent, participants consumed a soft drink with a more 'decelerated' trajectory from outward-sloped tumblers, characterised by a greater amount consumed in the first half of the drinking episode. In Study 2 (N = 72), during a bogus taste test, participants consumed less from straight-sided wine flutes than outward-sloped martini coupes. In Study 3 (N = 40), using facial electromyography to explore a potential mechanism for decreased consumption, straight-sided glasses elicited more 'pursed' lip embouchures, which may partly explain reduced consumption from these glasses. Using a combination of methods, including objective measures of volume drunk and physiological measures, these findings suggest that switching to straight-sided glasses may be one intervention contributing to the many needed to reduce consumption of health-harming drinks.

Impact of glass shape on time taken to drink a soft drink: A laboratory-based experiment.

BACKGROUND: Glassware design may affect drinking behaviour for alcoholic beverages, with glass shape and size influencing drinking speed and amount consumed. Uncertainty remains both about the extent to which these effects are restricted to alcohol and the underlying mechanisms. The primary aim of the current study was to examine the effect of differently shaped glasses on time taken to drink a soft drink. The secondary aim was to develop hypotheses about mechanisms concerning micro-drinking behaviours and perceptual effects. METHOD: In a single-session experiment, 162 participants were randomised to receive 330ml of carbonated apple juice in a glass that was either inward-sloped, straight-sided, or outward-sloped. The primary outcome measure was total drinking time. Secondary outcome measures included micro-drinking behaviours (sip size, sip duration, interval duration), and perceptual measures (midpoint bias, drink enjoyment). RESULTS: Participants drank 21.4% faster from the outward-sloped glass than from the straight-sided glass [95%CI: 0.2%,38.0%] in adjusted models. They were also 18.2% faster from the inward-sloped glass than the straight-sided glass, but this did not reach statistical significance with wide confidence intervals also consistent with slower drinking [95%CI: -3.8%,35.6%]. Larger sips were associated with faster drinking times (Pearson's r(162) = -.45, p < .001). The direction of effects suggested sips were larger from the outward-sloped and inward-sloped glasses, compared to the straight-sided glass (15.1%, 95%CI: -4.3%,38.0%; 19.4%, 95%CI: -0.5%,43.6%, respectively). There were no significant differences between glasses in mean sip or interval duration. Bias in midpoint estimation was greater for the outward-sloped glass (12.9ml, 95%CI: 6.6ml,19.2ml) than for the straight-sided glass, although the degree of bias was not associated with total drinking time (Pearson's r(162) = 0.01, p = .87). DISCUSSION: Individuals drank a soft drink more quickly from an outward-sloped glass, relative to a straight-sided glass. Micro-drinking behaviours, such as sip size, are promising candidates for underlying mechanisms.