Strategic science for eating disorders research and policy impact.

Scientific research often fails to have relevance and impact because scientists do not engage policy makers and influencers in the process of identifying information needs and generating high priority questions. To address this scholarship-policy gap, we have developed a model of Strategic Science. This research approach involves working with policy makers and influencers to craft research questions that will answer important and timely policy-related questions. The goal is to create tighter links between research and policy and ensure findings are communicated efficiently to change agents best positioned to apply the research to policy debates. In this article, we lay out a model for Strategic Science and describe how this approach may help advance policy research and action for eating disorders.

Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking.

Despite isolated areas of improvement, no country to date has reversed its obesity epidemic. Governments, together with a broad range of stakeholders, need to act urgently to decrease the prevalence of obesity. In this Series paper, we review several regulatory and non-regulatory actions taken around the world to address obesity and discuss some of the reasons for the scarce and fitful progress. Additionally, we preview the papers in this Lancet Series, which each identify high-priority actions on key obesity issues and challenge some of the entrenched dichotomies that dominate the thinking about obesity and its solutions. Although obesity is acknowledged as a complex issue, many debates about its causes and solutions are centred around overly simple dichotomies that present seemingly competing perspectives. Examples of such dichotomies explored in this Series include personal versus collective responsibilities for actions, supply versus demand-type explanations for consumption of unhealthy food, government regulation versus industry self-regulation, top-down versus bottom-up drivers for change, treatment versus prevention priorities, and a focus on undernutrition versus overnutrition. We also explore the dichotomy of individual versus environmental drivers of obesity and conclude that people bear some personal responsibility for their health, but environmental factors can readily support or undermine the ability of people to act in their own self-interest. We propose a reframing of obesity that emphasises the reciprocal nature of the interaction between the environment and the individual. Today's food environments exploit people's biological, psychological, social, and economic vulnerabilities, making it easier for them to eat unhealthy foods. This reinforces preferences and demands for foods of poor nutritional quality, furthering the unhealthy food environments. Regulatory actions from governments and increased efforts from industry and civil society will be necessary to break these vicious cycles.

Exposure to Weight-Stigmatizing Media: Effects on Exercise Intentions, Motivation, and Behavior.

This study aimed to evaluate the impact of exposure to weight-stigmatizing media on exercise intentions, motivation, and behavior, as well as to examine the interaction between this exposure and past experiences with weight stigma. A community sample of 72 women were randomly assigned to view a brief weight-stigmatizing or neutral video. Participants' choice of taking the stairs versus the elevator was observed before they completed measures of exercise intentions, motivation, and behavior; psychological well-being; and experiences with weight stigma. A follow-up survey was sent to participants 1 week later that assessed exercise behavior and intentions. Frequency of past weight stigma correlated with worse psychological well-being and more controlled (versus autonomous) exercise motivation. Significant interactions were found between past weight-stigmatizing experiences and exposure to the weight-stigmatizing video for outcomes of exercise intentions, behavior, and drive for thinness. Participants in the stigma condition with higher frequency of past experiences reported greater exercise intentions and behavior, along with higher drive for thinness. Past experiences of weight stigma interact with exposure to weight-stigmatizing media to increase exercise intentions and behavior, although this effect is accompanied by a heightened drive for thinness that may increase risk for long-term negative health consequences.

The stress of stigma: exploring the effect of weight stigma on cortisol reactivity.

OBJECTIVE: To determine the physiological impact of exposure to weight stigma by examining alterations in salivary cortisol among lean and overweight women. METHODS: Participants were 123 lean and overweight adult women (mean body mass index = 26.99 [7.91] kg/m(2)). Participants' salivary cortisol was assessed both before and after either a weight stigmatizing or a neutral video. Participants completed self-report measures of mood and reactions to the video. Height and weight were obtained at the conclusion of the study. RESULTS: Participants in the stigmatizing condition exhibited significantly greater cortisol reactivity when compared with those in the neutral condition, irrespective of weight status (Pillai trace = 0.077; F(1,85) = 7.22, p = .009). Lean and overweight women in the stigmatizing condition were equally likely to find the video upsetting and were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media. CONCLUSIONS: Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful physiological consequences of exposure to weight stigma.

The use of sports references in marketing of food and beverage products in supermarkets.

OBJECTIVE: Food marketing has been identified as a significant driver of the childhood obesity epidemic. The purpose of the present study was to (i) conduct a content analysis of the types of sports references that appear on supermarket food and beverage products and (ii) assess each product's nutritional and marketing profile. DESIGN: This was a descriptive study. Every product featuring sports references on the packaging was purchased in two major supermarkets during 2010. A content analysis was conducted and nutritional evaluations were made based on the Nutrient Profile Model, a validated nutrition model. Marketing data were obtained from The Nielsen Company. SETTING: Two major supermarkets in Connecticut, USA. SUBJECTS: Food and beverage products (n 102) were selected from two supermarkets. RESULTS: The 102 products (fifty-three foods and forty-nine beverages) had sports references as part of their packaging: 72·5 % featured a character exercising, 42·2 % were endorsed by a professional sports entity and 34·0 % were child-targeted. The median nutrition score for food products was 36 (1 = unhealthiest and 100 = healthiest; scores of ≥63 are considered healthy according to this model). More than two-thirds of beverages (69·4 %) were 100 % sugar-sweetened. Children saw significantly more commercials for these products than adults. CONCLUSIONS: Companies place sports figures on food and beverage products that are child-targeted and unhealthy.

The science on front-of-package food labels.

OBJECTIVE: The U.S. Food and Drug Administration and Institute of Medicine are currently investigating front-of-package (FOP) food labelling systems to provide science-based guidance to the food industry. The present paper reviews the literature on FOP labelling and supermarket shelf-labelling systems published or under review by February 2011 to inform current investigations and identify areas of future research. DESIGN: A structured search was undertaken of research studies on consumer use, understanding of, preference for, perception of and behaviours relating to FOP/shelf labelling published between January 2004 and February 2011. RESULTS: Twenty-eight studies from a structured search met inclusion criteria. Reviewed studies examined consumer preferences, understanding and use of different labelling systems as well as label impact on purchasing patterns and industry product reformulation. CONCLUSIONS: The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems' abilities to influence consumer behaviour is needed.

Calorie estimation accuracy and menu labeling perceptions among individuals with and without binge eating and/or purging disorders.

Menu labeling is a public health policy that requires chain restaurants in the USA to post kilocalorie information on their menus to help consumers make informed choices. However, there is concern that such a policy might promote disordered eating. This web-based study compared individuals with self-reported binge eating disorder (N = 52), bulimia nervosa (N = 25), and purging disorder (N = 17) and those without eating disorders (No ED) (N = 277) on restaurant calorie information knowledge and perceptions of menu labeling legislation. On average, people answered 1.46 ± 1.08 questions correctly (out of 6) (25%) on a calorie information quiz and 92% of the sample was in favor of menu labeling. The findings did not differ based on eating disorder, dieting, or weight status, or race/ethnicity. The results indicated that people have difficulty estimating the calories in restaurant meals and individuals with and without eating disorders are largely in favor of menu labeling laws.

Obesity and public policy.

There is a pressing need to reduce both the prevalence and impact of obesity. This review begins with a discussion of the roles of treatment and prevention. Two overriding issues, weight bias and the addictive nature of food, are covered because of their importance not only to the individuals affected but also to public policy. We then cover promising policy areas in which changes can be implemented to support healthy behaviors: school policy, food marketing, food labeling and packaging, and taxes on unhealthy foods. The roles of the food industry and federal, state, and local governments are also discussed.

Choosing front-of-package food labelling nutritional criteria: how smart were 'Smart Choices'?

OBJECTIVE: The 'Smart Choices' programme was an industry-driven, front-of-package (FOP) nutritional labelling system introduced in the USA in August 2009, ostensibly to help consumers select healthier options during food shopping. Its nutritional criteria were developed by members of the food industry in collaboration with nutrition and public health experts and government officials. The aim of the present study was to test the extent to which products labelled as 'Smart Choices' could be classified as healthy choices on the basis of the Nutrient Profile Model (NPM), a non-industry-developed, validated nutritional standard. DESIGN: A total of 100 packaged products that qualified for a 'Smart Choices' designation were sampled from eight food and beverage categories. All products were evaluated using the NPM method. RESULTS: In all, 64 % of the products deemed 'Smart Choices' did not meet the NPM standard for a healthy product. Within each 'Smart Choices' category, 0 % of condiments, 8·70 % of fats and oils, 15·63 % of cereals and 31·58 % of snacks and sweets met NPM thresholds. All sampled soups, beverages, desserts and grains deemed 'Smart Choices' were considered healthy according to the NPM standard. CONCLUSIONS: The 'Smart Choices' programme is an example of industries' attempts at self-regulation. More than 60 % of foods that received the 'Smart Choices' label did not meet standard nutritional criteria for a 'healthy' food choice, suggesting that industries' involvement in designing labelling systems should be scrutinized. The NPM system may be a good option as the basis for establishing FOP labelling criteria, although more comparisons with other systems are needed.

The Smart Choices front-of-package nutrition label. Influence on perceptions and intake of cereal.

Numerous front-of-package (FOP) nutrition labeling systems exist, but it is unclear if such labels influence behavior. A single-summary label called Smart Choices (SC) appeared briefly on products in the United States in 2009. The current study aimed to evaluate (1) the influence the SC symbol has on the serving and consumption of cereal; and (2) the impact of providing calorie and serving size information on a FOP label. Two hundred and sixteen adults were randomized to a high-sugar breakfast cereal that had either (1) no label; (2) the SC symbol; or (3) a modified SC symbol with serving size information. Participants rated perceptions of healthfulness, taste, and purchase intent, estimated calories per serving and poured and ate the cereal for breakfast. Participants in the SC label conditions were better able to estimate calories per serving, but there were no differences across groups on perceptions of healthfulness, taste, purchase intent, and levels of vitamins, and sugar or amount of cereal poured or consumed. These results suggest that calories per serving information on FOP labels can increase knowledge, but the SC symbol had little impact on behavior. Studies examining FOP label influence on purchasing, consumption, and product reformulation are greatly needed to determine label utility.

A test of different menu labeling presentations.

Chain restaurants will soon need to disclose calorie information on menus, but research on the impact of calorie labels on food choices is mixed. This study tested whether calorie information presented in different formats influenced calories ordered and perceived restaurant healthfulness. Participants in an online survey were randomly assigned to a menu with either (1) no calorie labels (No Calories); (2) calorie labels (Calories); (3) calorie labels ordered from low to high calories (Rank-Ordered Calories); or (4) calorie labels ordered from low to high calories that also had red/green circles indicating higher and lower calorie choices (Colored Calories). Participants ordered items for dinner, estimated calories ordered, and rated restaurant healthfulness. Participants in the Rank-Ordered Calories condition and those in the Colored Calories condition ordered fewer calories than the No Calories group. There was no significant difference in calories ordered between the Calories and No Calories groups. Participants in each calorie label condition were significantly more accurate in estimating calories ordered compared to the No Calories group. Those in the Colored Calories group perceived the restaurant as healthier. The results suggest that presenting calorie information in the modified Rank-Ordered or Colored Calories formats may increase menu labeling effectiveness.

Evaluation of consumer understanding of different front-of-package nutrition labels, 2010-2011.

INTRODUCTION: Governments throughout the world are using or considering various front-of-package (FOP) food labeling systems to provide nutrition information to consumers. Our web-based study tested consumer understanding of different FOP labeling systems. METHODS: Adult participants (N = 480) were randomized to 1 of 5 groups to evaluate FOP labels: 1) no label; 2) multiple traffic light (MTL); 3) MTL plus daily caloric requirement icon (MTL+caloric intake); 4) traffic light with specific nutrients to limit based on food category (TL+SNL); or 5) the Choices logo. Total percentage correct quiz scores were created reflecting participants' ability to select the healthier of 2 foods and estimate amounts of saturated fat, sugar, and sodium in foods. Participants also rated products on taste, healthfulness, and how likely they were to purchase the product. Quiz scores and product perceptions were compared with 1-way analysis of variance followed by post-hoc Tukey tests. RESULTS: The MTL+caloric intake group (mean [standard deviation], 73.3% [6.9%]) and Choices group (72.5% [13.2%]) significantly outperformed the no label group (67.8% [10.3%]) and the TL+SNL group (65.8% [7.3%]) in selecting the more healthful product on the healthier product quiz. The MTL and MTL+caloric intake groups achieved average scores of more than 90% on the saturated fat, sugar, and sodium quizzes, which were significantly better than the no label and Choices group average scores, which were between 34% and 47%. CONCLUSION: An MTL+caloric intake label and the Choices symbol hold promise as FOP labeling systems and require further testing in different environments and population subgroups.