Women's social eating environment and its associations with dietary behavior and weight management.

As an unhealthy social eating environment is considered a risk factor for obesity, this study aimed to examine women's regular eating networks and the extent to which diet-related variables were associated with those of their regular eating companions. In Study Part I (N = 579), an egocentric network approach was used to investigate women's perceptions of their eating networks. In Study Part II (N = 262), the participants' most important eating companions responded to a similar survey, and the corresponding answers were matched. The results showed that women shared their meals most frequently with spouses and other family members. Women who dined more often with healthy eaters reported on average a higher diet quality and a lower body mass index (BMI), which were also significant after controlling for individual factors. Study Part II expanded these results by showing that different diet-related factors such as diet quality, eating styles and BMI were correlated between women and their most important eating companions (r = 0.16-0.30, p < 0.05). Moreover, an actor-partner interdependence model revealed that a higher diet quality of the eating companions was associated with a lower BMI in women, controlled for their own eating behavior (b = -0.45, p < 0.05). This study showed similarities and interdependence between women's dietary behavior and body weight and those of their regular eating companions. This might indicate that regular eating networks have a shared understanding of what constitutes a normal diet, which might be an important factor to consider in the promotion of healthy eating.

Does Iconicity in Pictographs Matter? The Influence of Iconicity and Numeracy on Information Processing, Decision Making, and Liking in an Eye-Tracking Study.

Researchers recommend the use of pictographs in medical risk communication to improve people's risk comprehension and decision making. However, it is not yet clear whether the iconicity used in pictographs to convey risk information influences individuals' information processing and comprehension. In an eye-tracking experiment with participants from the general population (N = 188), we examined whether specific types of pictograph icons influence the processing strategy viewers use to extract numerical information. In addition, we examined the effect of iconicity and numeracy on probability estimation, recall, and icon liking. This experiment used a 2 (iconicity: blocks vs. restroom icons) × 2 (scenario: medical vs. nonmedical) between-subject design. Numeracy had a significant effect on information processing strategy, but we found no effect of iconicity or scenario. Results indicated that both icon types enabled high and low numerates to use their default way of processing and extracting the gist of the message from the pictorial risk communication format: high numerates counted icons, whereas low numerates used large-area processing. There was no effect of iconicity in the probability estimation. However, people who saw restroom icons had a higher probability of correctly recalling the exact risk level. Iconicity had no effect on icon liking. Although the effects are small, our findings suggest that person-like restroom icons in pictographs seem to have some advantages for risk communication. Specifically, in nonpersonalized prevention brochures, person-like restroom icons may maintain reader motivation for processing the risk information.

Consumers' practical understanding of healthy food choices: a fake food experiment.

Little is known about laypeople's practical understanding of a healthy diet, although this is important to successfully promote healthy eating. The present study is the first to experimentally examine how consumers define healthy and balanced food choices for an entire day compared with normal choices and compared with dietary guidelines. We used an extensive fake food buffet (FFB) with 179 foods commonly consumed in the Swiss diet. The FFB is a validated method to investigate food choice behaviour in a well-controlled laboratory setting. People from the general population in Switzerland (n 187; 51·9 % females), aged between 18 and 65 years, were randomly assigned to one of two conditions. In the control group, the participants were instructed to serve themselves foods they would eat on a normal day, whereas in the 'healthy' group they were instructed to choose foods representing a healthy diet. Participants chose significantly more healthy foods, with 4·5 g more dietary fibre, 2 % more protein and 2 % less SFA in the 'healthy' group compared with the control group. However, in both experimental conditions, participants served themselves foods containing twice as much sugar and salt than recommended by dietary guidelines. The results suggest that laypeople lack knowledge about the recommended portion sizes and the amounts of critical nutrients in processed food, which has important implications for communicating dietary guidelines. Furthermore, the energy of the food served was substantially correlated with the energy needs of the participants, demonstrating the potential of the fake food buffet method.

Not merely a question of self-control: The longitudinal effects of overeating behaviors, diet quality and physical activity on dieters' perceived diet success.

This longitudinal study was conducted between 2010 (T1) and 2014 (T2) on a random sample from the general Swiss population (N = 2781, 46% male). Results showed that dieters (restrained eaters) who reported lack of success in T2 were overweight in T1, had higher levels of emotional and external eating, overeating, and ambivalence toward eating palatable food in T1, and a significantly increased body mass index (BMI) in the period between T1 and T2. Dieters who reported success in T2 had maintained a normal BMI between T1 and T2, had a higher diet quality in T1 and had maintained regular physical activity for at least one year before T2. The logistic regression revealed that high levels of dispositional self-control provided the most important predictor of being a successful dieter. When controlling for dispositional self-control, high levels of emotional eating, overeating, and ambivalence in T1, together with increases in these levels between T1 and T2, were associated with a decreased likelihood of being a successful dieter in T2. High levels of diet quality in T1 and the maintenance of regular physical activity were associated with an increased likelihood of being a successful dieter in T2. Results suggest that diet success and failure is a long-term phenomenon, partly but not fully explained by dispositional self-control. Independent of self-control persistent patterns of overeating due to emotional eating and ambivalent feelings toward eating palatable food, also explain long-term diet failure. A high diet quality and maintenance of regular physical activity accounted for dieters' long-term success. This is the first study that examined the long-term psychological and behavioral characteristics of successful and unsuccessful restrained eaters.

Compensatory beliefs, nutrition knowledge and eating styles of users and non-users of meal replacement products.

Meal replacement products (MRPs) are used to regulate body weight, but the underlying eating behavior-related characteristics of MRP consumers are unknown. The study was based on an online survey of 490 women (221 who consume MRPs and 269 who do not) in Switzerland. Nutrition knowledge of calories, balanced meal composition and eating styles (restrained, emotional, external eating, overeating tendencies) were measured. In addition, compensatory beliefs regarding the effects of MRPs were assessed. The results showed that consumers of MRPs believed more strongly that MRPs can compensate for overeating, and that health behaviors key to successful weight regulation, such as physical exercise, do not have to be implemented when MRPs are consumed. Using binary logistic regression modeling, age, weight goal, compensatory beliefs regarding overconsumption, nutrition knowledge related to balanced meal composition, restrained eating and overeating tendencies were significant predictors of MRP consumption during the previous year. It was found that MRPs might be used as a license to indulge in palatable food, based on the perception that they can compensate for calorie overconsumption. Furthermore, they might help people with restraint eating tendencies and those who regularly overeat to compensate for overeating episodes and maintain dietary goals, even after excess food intake. Whether this approach is successful remains to be explored in future studies.

High Numerates Count Icons and Low Numerates Process Large Areas in Pictographs: Results of an Eye-Tracking Study.

In two experiments, we investigated the influence of numeracy on individuals' information processing of pictographs depending on numeracy via an eye-tracker. In two conditions, participants from the general population were presented with a scenario depicting the risk of having cancer and were asked to indicate their perceived risk. The risk level was high (63%) in experiment 1 (N = 70) and low (6%) in experiment 2 (N = 69). In the default condition, participants were free to use their default strategy for information processing. In the guiding-toward-the-number condition, they were prompted to count icons in the pictograph by answering with an explicit number. We used eye-tracking parameters related to the distance between sequential fixations to analyze participants' strategies for processing numerical information. In the default condition, the higher the numeracy was, the shorter the distances traversed in the pictograph were, indicating that participants counted the icons. People lower in numeracy performed increased large-area processing by comparing highlighted and nonhighlighted parts of the pictograph. In the guiding-toward-the-number condition, participants used short distances regardless of their numeracy, supporting the notion that short distances represent counting. Despite the different default processing strategies, participants processed the pictograph with a similar depth and derived similar risk perceptions. The results show that pictographs are beneficial for communicating medical risk. Pictographs make the gist salient by making the part-to-whole relationship visually available, and they facilitate low numerates' non-numeric processing of numerical information. Contemporaneously, pictographs allow high numerates to numerically process and rely on the number depicted in the pictograph.

The web-buffet--development and validation of an online tool to measure food choice.

OBJECTIVE: To date, no data exist on the agreement of food choice measured using an online tool with subsequent actual consumption. This needs to be shown before food choice, measured by means of an online tool, is used as a dependent variable to examine intake in the general population. DESIGN: A 'web-buffet' was developed to assess food choice. SETTING: Choice was measured as planned meal composition from photographic material; respondents chose preferred foods and proportions for a main meal (out of a possible 144 combinations) online and the validity was assessed by comparison of a meal composed from a web-buffet with actual food intake 24-48 h later. Furthermore, correlations of food preferences, energy needs and health interest with meals chosen from the web-buffet were analysed. SUBJECTS: Students: n 106 (Study I), n 32 (Study II). RESULTS: Meals chosen from the web-buffet (mean = 2998 kJ, SD = 471 kJ) agreed with actual consumption (rs = 0.63, P < 0.001) but were on average 367 kJ (10.5%) lower in energy than consumed meals (mean = 3480 kJ, SD = 755 kJ). Preferences were highly associated with chosen amounts and health interest was negatively correlated with the energy selected (rs = -0.40, P<0.001). CONCLUSIONS: Meal composition choice in the web-buffet agrees sufficiently well with actual intake to measure food choice as a dependent variable in online surveys. However, we found an average underestimation of subsequent consumption. High correlations of preferences with chosen amounts and an inverse association of health interest with total energy further indicate the validity of the tool. Applications in behavioural nutrition research are discussed.

The weight management strategies inventory (WMSI). Development of a new measurement instrument, construct validation, and association with dieting success.

In an obesogenic environment, people have to adopt effective weight management strategies to successfully gain or maintain normal body weight. Little is known about the strategies used by the general population in daily life. Due to the lack of a comprehensive measurement instrument to assess conceptually different strategies with various scales, we developed the weight management strategies inventory (WMSI). In study 1, we collected 19 weight management strategies from research on self-regulation of food intake and successful weight loss and maintenance, as well as from expert interviews. We classified them under the five main categories of health self-regulation strategies - goal setting and monitoring, prospection and planning, automating behavior, construal, and inhibition. We formulated 93 items. In study 2, we developed the WMSI in a random sample from the general population (N = 658), using reliability and exploratory factor analysis. This resulted in 19 factors with 63 items, representing the 19 strategies. In study 3, we tested the 19-factor structure in a quota (age, gender) sample from the general population (N = 616), using confirmatory factor analysis. A good model fit (CFI = .918; RMSEA = .043) was revealed. Reliabilities and construct validity were high. Positive correlations of most strategies with dieting success and negative correlations of some strategies with body mass index were found among dieters (N = 292). Study 4 (N = 162) revealed a good test-retest reliability. The WMSI assesses theoretically derived, evidence-based, and conceptually different weight management strategies with different scales that have good psychometric characteristics. The scales can also be used for pre- and post measures in intervention studies. The scales provide insights into the general population's weight management strategies and facilitate tailoring and evaluating health communication.

Ambivalence toward palatable food and emotional eating predict weight fluctuations. Results of a longitudinal study with four waves.

Weight fluctuations pose serious challenges to people's health. Research suggests that the interplay between cognitive dietary restraint and counter-regulative overeating impairs weight control. In a random sample from the general population (N = 2733, 49% male), a longitudinal survey was conducted over 4 consecutive years (2010-2013). Self-reported weight was used to calculate the variance of three weight changes from one wave to the next. Separate regression analyses for women and men were conducted. The dependent variable was weight fluctuation, and the independent variables were eating styles (emotional, external, and restrained) and ambivalence toward palatable food. Age and weight changes between the fourth and first years were controlled. A significant positive effect of emotional eating for men and women, and a significant positive effect of ambivalence for women, were found. Participants who demonstrated high levels of emotional eating, and women who had high levels of ambivalence in the beginning of the study, had more extreme relative weight fluctuations in the consecutive years than did persons with low levels of emotional eating or women with low levels of ambivalence. Restrained and external eating had no effect. The results suggest that emotional eating and ambivalence toward palatable food need to be addressed to prevent health-damaging weight fluctuations. Furthermore, ambivalence toward palatable food was revealed as an additional overeating tendency beyond emotional eating that must be considered to understand the interplay between dietary restraint and overeating.

Does personality influence eating styles and food choices? Direct and indirect effects.

In a random sample (N = 951) from the general population, direct and indirect effects of the Big Five personality traits on eating styles and food choices were examined. Path models revealed that high openness to experience were associated with higher fruit, vegetable and salad and lower meat and soft drink consumption. High agreeableness was associated with low meat consumption. Neuroticism, conscientiousness and extraversion significantly and directly influenced eating styles and significantly indirectly influenced food choices. Conscientiousness mainly promoted fruit consumption by promoting restrained eating and prevented meat consumption by reducing external eating. Conscientiousness prevented consumption of sweet and savory foods, and of sugar-sweetened soft drinks by promoting restrained eating and reducing external eating, and consumption of sweet and savory foods also by reducing emotional eating. Neuroticism promoted consumption of sweet and savory foods by promoting emotional and external eating. Extraversion promoted sweet and savory, meat and soft drink consumption via promoting external eating. Results suggest that neurotic and emotionally unstable individuals seem to adopt counter-regulatory external or emotional eating and eat high-energy dense sweet and savory foods. Highly conscientious individuals adopt regulatory dietary restraint and practice counter-regulatory emotional or external eating less, resulting in more consumption of recommended and less consumption of not recommended food. The higher sociability of extraverted people, which is basically a health beneficial psychological resource, seems to have health-averse effects. Personality traits are stable; however, the resulting more proximal, counter-regulatory eating styles such as emotional or external eating might be more successfully addressed in interventions to prevent overeating and overweight.

Successful and unsuccessful restrained eating. Does dispositional self-control matter?

In a random sample (N=1078) from the general population, this study examined whether individual differences in dispositional self-control can explain restrained eaters' success in controlling their weight. A regression analysis with body mass index (BMI) as dependent variable revealed a significant negative association between dispositional self-control and BMI, and a significant positive association between dietary restraint and BMI. These effects were qualified by a significant interaction between restraint and self-control. Among restrained eaters, the association between self-control and BMI was significantly more negative than among normal eaters. Furthermore, among female restrained eaters higher dispositional self-control scores were associated with BMIs within the normal-weight range (BMI<25) and lower dispositional self-control scores were associated with BMIs within the overweight range (BMI>25). Among male restrained eaters very high scores on dispositional self-control were associated with BMIs within the normal-weight range, whereas medium or low scores on self-control were associated with BMIs within the overweight range. Results suggest that high dispositional self-control facilitates successful restrained eating.

Dietary restraint, ambivalence toward eating, and the valence and content of spontaneous associations with eating.

In a random sample of the German-speaking population of Switzerland (N=1388, 730 women), the technique of spontaneous associations was used to examine the relationship between valence (positive, negative) and content of participants' spontaneous associations with the term "eating" and dietary restraint, ambivalence toward eating, and health consciousness. Regression analysis revealed ambivalence to be the most important and food health consciousness the second most important predictor of restrained eating. Correspondence analysis of the content of the spontaneous associations revealed high-restrained eaters to have fewer associations with eating than unrestrained eaters. High-restrained eaters most often had negative associations with diet and positive associations with health. Unrestrained eaters mentioned a variety of positive associations, such as community, comfort and well-being, preparation of food, aesthetics, and various specific foods (e.g., starchy side dishes, and sweets). Results support the notion that the conflict between weight control and eating enjoyment is rather pronounced in high-restrained eaters, resulting in ambivalence toward eating, and the inhibition of associations with palatable foods. This was less pronounced, but still present, in medium-restrained eaters. In contrast, unrestrained eaters seemed to have a balanced and conflict-free relationship with eating. However, restrained eating also seemed to be driven by health considerations.

Affective imagery and acceptance of replacing nuclear power plants.

This study examined the relationship between the content of spontaneous associations with nuclear power plants and the acceptance of using new-generation nuclear power plants to replace old ones. The study also considered gender as a variable. A representative sample of the German- and French-speaking population of Switzerland (N= 1,221) was used. Log-linear models revealed significant two-way interactions between the association content and acceptance, association content and gender, and gender and acceptance. Correspondence analysis revealed that participants who were opposed to nuclear power plants mainly associated nuclear power plants with risk, negative feelings, accidents, radioactivity, waste disposal, military use, and negative consequences for health and environment; whereas participants favoring nuclear power plants mainly associated them with energy, appearance descriptions of nuclear power plants, and necessity. Thus, individuals opposing nuclear power plants had both more concrete and more diverse associations with them than people who were in favor of nuclear power plants. In addition, participants who were undecided often mentioned similar associations to those participants who were in favor. Males more often expressed associations with energy, waste disposal, and negative health effects. Females more often made associations with appearance descriptions, negative feelings, and negative environmental effects. The results further suggest that acceptance of replacing nuclear power plants was higher in the German-speaking part of the country, where all of the Swiss nuclear power plants are physically located. Practical implications for risk communication are discussed.

Trust, confidence, procedural fairness, outcome fairness, moral conviction, and the acceptance of GM field experiments.

In 2005, Swiss citizens endorsed a moratorium on gene technology, resulting in the prohibition of the commercial cultivation of genetically modified crops and the growth of genetically modified animals until 2013. However, scientific research was not affected by this moratorium, and in 2008, GMO field experiments were conducted that allowed us to examine the factors that influence their acceptance by the public. In this study, trust and confidence items were analyzed using principal component analysis. The analysis revealed the following three factors: "economy/health and environment" (value similarity based trust), "trust and honesty of industry and scientists" (value similarity based trust), and "competence" (confidence). The results of a regression analysis showed that all the three factors significantly influenced the acceptance of GM field experiments. Furthermore, risk communication scholars have suggested that fairness also plays an important role in the acceptance of environmental hazards. We, therefore, included measures for outcome fairness and procedural fairness in our model. However, the impact of fairness may be moderated by moral conviction. That is, fairness may be significant for people for whom GMO is not an important issue, but not for people for whom GMO is an important issue. The regression analysis showed that, in addition to the trust and confidence factors, moral conviction, outcome fairness, and procedural fairness were significant predictors. The results suggest that the influence of procedural fairness is even stronger for persons having high moral convictions compared with persons having low moral convictions.

Development and validation of a short, consumer-oriented nutrition knowledge questionnaire.

A short scale was developed and validated that assesses consumers' knowledge about nutrition. Sixty-four nutrition knowledge items were derived from consumer interviews and expert recommendations about healthy eating. Items were administered as a postal survey to a sample of consumers randomly drawn from the directory (response rate=37%, N=1043). Twenty items were retained to build the final nutrition knowledge scale. Internal reliability, criterion and construct validity were acceptable. Associations of the scale with self-reported food consumption frequencies indicated limited correlation of nutrition knowledge with food choice. Widespread nutrition knowledge gaps in consumers were revealed.

Using a familiar risk comparison within a risk ladder to improve risk understanding by low numerates: a study of visual attention.

Previous experimental research provides evidence that a familiar risk comparison within a risk ladder is understood by low- and high-numerate individuals. It especially helps low numerates to better evaluate risk. In the present study, an eye tracker was used to capture individuals' visual attention to a familiar risk comparison, such as the risk associated with smoking. Two parameters of information processing-efficiency and level-were derived from visual attention. A random sample of participants from the general population (N= 68) interpreted a given risk level with the help of the risk ladder. Numeracy was negatively correlated with overall visual attention on the risk ladder (r(s) =-0.28, p= 0.01), indicating that the lower the numeracy, the more the time spent looking at the whole risk ladder. Numeracy was positively correlated with the efficiency of processing relevant frequency (r(s) = 0.34, p < 0.001) and relevant textual information (r(s) = 0.34, p < 0.001), but not with the efficiency of processing relevant comparative information and numerical information. There was a significant negative correlation between numeracy and the level of processing of relevant comparative risk information (r(s) =-0.21, p < 0.01), indicating that low numerates processed the comparative risk information more deeply than the high numerates. There was no correlation between numeracy and perceived risk. These results add to previous experimental research, indicating that the smoking risk comparison was crucial for low numerates to evaluate and understand risk. Furthermore, the eye-tracker method is promising for studying information processing and improving risk communication formats.

Labeling of nanotechnology consumer products can influence risk and benefit perceptions.

Currently, there is no mandatory labeling for products containing synthetic nanoparticles. The public as well as other stakeholders have positive views about mandatory labeling. However, little is known how such a label influences the risk and benefit perception of a product. Consumers may infer that a label is a signal that there are risks associated with this technology. Data were collected in a survey experiment (N= 1,382). Participants were randomly assigned to one of six conditions. The control group received a picture of a sunscreen container without a label. One experimental group received a picture of a sunscreen container with a label. The other groups received, in addition to the sunscreen container with a label, some risk or benefit information. Results suggest that labeling of products may reduce consumers' benefit perception and increase risk perception. Labeling nanotechnology consumer products may change the public perception of the products. Respondents may have relied on the affect heuristic for assessing the risks and benefits of the sunscreen.

Examining the relationship between affect and implicit associations: implications for risk perception.

It has been suggested that affect may play an important role in risk perception. Slovic et al. argued that people make use of the "affect heuristic" when assessing risks because it is easier and more efficient to rely on spontaneous affective reactions than to analyze all available information. In the present studies, a single category implicit association test (SC-IAT) to measure associations evoked by different hazards was employed. In the first study, we tested the extent to which the SC-IAT corresponds to the theoretical construct of affect in a risk framework. Specifically, we found that the SC-IAT correlates with other explicit measures that claim to measure affect, as well as with a measure of trust, but not with a measure that captures a different construct (subjective knowledge). In the second study, we addressed the question of whether hazards that vary along the dread dimension of the psychometric paradigm also differ in the affect they evoke. The results of the SC-IAT indicated that a high-dread hazard (nuclear power) elicits negative associations. Moreover, the high-dread hazard evoked more negative associations than a medium-dread hazard (hydroelectric power). In contrast, a nondread hazard (home appliances) led to positive associations. The results of our study highlight the importance of affect in shaping attitudes and opinions toward risks. The results further suggest that implicit measures may provide valuable insight into people's risk perception above and beyond explicit measures.

Effect of risk communication formats on risk perception depending on numeracy.

OBJECTIVE: To examine the influence of numeracy on interpreting various risk communication formats. DESIGN: . A random sample of women (N = 266) completed a questionnaire assessing numeracy and risk perception of prenatal test results and results of colon cancer screening tests. The authors examined the relationships between risk level (high v. low) and format of risk presentation (ratio, pictogram, or Paling Perspective Scale) and whether these relationships differed based on the numeracy skills of the participant. RESULTS: The authors identified a significant (P<0.001) 3-way interaction between format, risk level, and numeracy: high-numerate participants in the low-risk group perceived the test results as less risky compared with participants in the high-risk group (P < 0.001) with the Paling Perspective Scale but not with the other formats. For low-numerate participants, they did not observe differences between low- and high-risk scenarios for any of the 3 formats. The results were similar for the Down syndrome and colon cancer scenarios. Overall, the pictogram resulted in significantly lower risk ratings compared with the Paling Perspective Scale and the ratio with numerator 1 (P < 0.001). CONCLUSION: Different communication formats may produce different risk perceptions, but the effect is qualified by patients' numeracy skills.

Effect of risk ladder format on risk perception in high- and low-numerate individuals.

Utilizing a random sample from the general population (N= 257), we examined the effect of the radon risk ladder on risk perception, as qualified by respondents' numeracy. The radon risk ladder provides comparative risk information about the radon equivalent of smoking risk. We compared a risk ladder providing smoking risk information with a risk ladder not providing this information. A 2 (numeracy; high, low) x 3 (risk level; high, medium, low) x 2 (smoking risk comparison: with/without) between subjects experimental design was used. A significant (p < 0.045) three-way interaction between format, risk level, and numeracy was identified. Participants with low numeracy skills, as well as participants with high numeracy skills, generally distinguished between low, medium, and high risk levels when the risk ladder with comparative smoking risk information was presented. When the risk ladder without the comparative information about the smoking risk was presented, low-numerate individuals differentiated between risk levels to a much lesser extent than high-numerate individuals did. These results provide empirical evidence that the risk ladder can be a useful tool in enabling people to interpret various risk levels. Additionally, these results allow us to conclude that providing comparative information within a risk ladder is particularly helpful to the understanding of different risk levels by people with low numeracy skills.