Food pantry selection solutions: a randomized controlled trial in client-choice food pantries to nudge clients to targeted foods.

Background: Food pantries and food banks are interested in cost-effective methods to encourage the selection of targeted foods without restricting choices. Thus, this study evaluates the effectiveness of nudges toward targeted foods. Methods: In October/November 2014, we manipulated the display of a targeted product in a New York State food pantry. We evaluated the binary choice of the targeted good when we placed it in the front or the back of the category line (placement order) and when we presented the product in its original box or unboxed (packaging). Results: The average uptake proportion for the back treatment was 0.231, 95% CI = 0.179, 0.29, n = 205, and for the front treatment, the proportion was 0.337, 95% CI = 0.272, 0.406, n = 238 with an odds ratio of 1.688, 95% CI = 1.088, 2.523. The average uptake for the unboxed treatment was 0.224, 95% CI = 0.174, 0.280, n = 255, and for the boxed intervention, the proportion was 0.356, 95% CI = 0.288, 0.429, n = 188 with an odds ratio of 1.923, 95% CI = 1.237, 2.991. Conclusions: Nudges increased uptake of the targeted food. The findings also hold when we control for a potential confounder. Low cost and unobtrusive nudges can be effective tools for food pantry organizers to encourage the selection of targeted foods. Trial Registration Number: NCT02403882.

Depicted serving size: cereal packaging pictures exaggerate serving sizes and promote overserving.

BACKGROUND: Extensive work has focused on the effects of nutrition label information on consumer behavior on the one hand, and on the effects of packaging graphics on the other hand. However, little work has examined how serving suggestion depictions - graphics relating to serving size - influence the quantity consumers serve themselves. The current work examines the prevalence of exaggerated serving size depictions on product packaging (study 1) and its effects on food serving in the context of cereal (study 2). METHODS: Study 1 was an observational field survey of cereal packaging. Study 2 was a mixed experimental cross-sectional design conducted at a U.S. university, with 51 student participants. Study 1 coded 158 US breakfast cereals and compared the serving sizes depicted on the front of the box with the suggested serving size stated on the nutrition facts panel. Study 2 measured the amount of cereal poured from exaggerated or accurate serving size depictions. Study 1 compared average servings via t-tests. Study 2 used a mixed model with cereal type as the repeated measure and a compound symmetry covariance matrix. RESULTS: Study 1 demonstrated that portion size depictions on the front of 158 cereal boxes were 65.84% larger (221 vs. 134 calories) than the recommended portions on nutrition facts panels of those cereals. Study 2 showed that boxes that depicted exaggerated serving sizes led people to pour 20% more cereal compared to pouring from modified boxes that depicted a single-size portion of cereal matching suggested serving size. This was 45% over the suggested serving size. CONCLUSIONS: Biases in depicted serving size depicted on cereal packaging are prevalent in the marketplace. Such biases may lead to overserving, which may consequently lead to overeating. Companies should depict the recommended serving sizes, or otherwise indicate that the depicted portion represents an exaggerated serving size.

The audience eats more if a movie character keeps eating: An unconscious mechanism for media influence on eating behaviors.

Media's presentation of eating is an important source of influence on viewers' eating goals and behaviors. Drawing on recent research indicating that whether a story character continues to pursue a goal or completes a goal can unconsciously influence an audience member's goals, a scene from a popular movie comedy was manipulated to end with a character continuing to eat (goal ongoing) or completed eating (goal completed). Participants (N = 147) were randomly assigned to a goal status condition. As a reward, after viewing the movie clip viewers were offered two types of snacks: ChexMix and M&M's, in various size portions. Viewers ate more food after watching the characters continue to eat compared to watching the characters complete eating, but only among those manipulated to identify with a character. Viewers were more likely to choose savory food after viewing the ongoing eating scenes, but sweet dessert-like food after viewing the completed eating scenes. The results extend the notion of media influence on unconscious goal contagion and satiation to movie eating, and raise the possibility that completing a goal can activate a logically subsequent goal. Implications for understanding media influence on eating and other health behaviors are discussed.

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

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

Frosting on the cake: pictures on food packaging bias serving size.

OBJECTIVE: Food packaging often pictures supplementary extras, such as toppings or frosting, that are not listed on the nutritional labelling. The present study aimed to assess if these extras might exaggerate how many calories† are pictured and if they lead consumers to overserve. DESIGN: Four studies were conducted in the context of fifty-one different cake mixes. For these cake mixes, Study 1 compared the calories stated on the nutrition label with the calories of the cake (and frosting) pictured on the box. In Studies 2, 3 and 4, undergraduates (Studies 2 and 3) or food-service professionals (Study 4) were given one of these typical cake mix boxes, with some being told that cake frosting was not included on the nutritional labelling whereas others were provided with no additional information. They were then asked to indicate what they believed to be a reasonable serving size of cake. Settings Laboratory setting. SUBJECTS: Undergraduate students and food-service professionals. RESULTS: Study 1 showed that the average calories of cake and frosting pictured on the package of fifty-one different cake mixes exceed the calories on the nutritional label by 134 %. Studies 2 and 3 showed that informing consumers that the nutritional information does not include frosting reduces how much people serve. Study 4 showed that even food-service professionals overserve if not told that frosting is not included on the nutritional labelling. CONCLUSIONS: To be less misleading, packaging should either not depict extras in its pictures or it should more boldly and clearly state that extras are not included in calorie counts.

Substituting sugar confectionery with fruit and healthy snacks at checkout - a win-win strategy for consumers and food stores? a study on consumer attitudes and sales effects of a healthy supermarket intervention.

BACKGROUND: The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL); a Danish participatory community-based health promotion intervention. METHODS: Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area. RESULTS: The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P < 0.05). No significant intervention effect on sales of other intervention items or sugar confectionery was found. CONCLUSIONS: The present study finds that the healthy checkout intervention was positively evaluated by consumers and provided a 'responsible' branding opportunity for supermarkets, thus representing a win-win strategy for store managers and consumers in the short term. However, the intervention was too modest to draw conclusions on long-term sales and health implications of this initiative. More research is needed to assess whether retailer-researcher collaborations on health promotion can be a winning strategy for public health.

Environmental influences on small eating behavior change to promote weight loss among Black and Hispanic populations.

Small eating behavior changes are proposed as more feasible to achieve and maintain than larger changes used in traditional behavioral weight loss studies. However, it is unclear whether overweight Black and Hispanic adults in a low-income urban setting experience small changes as feasible and what might influence feasibility. Participants' experiences in a 12-week pilot weight loss intervention were explored qualitatively to determine the feasibility of making small eating behavior changes in this population. After the intervention (69% retention), semi-structured interviews with 46 men and women (mean age 51, 50% Non-Hispanic Black, 43% Hispanic) revealed that making small eating changes was a process shaped by participants' intrapersonal and interpersonal eating environments. Participants responded to intrapersonal and interpersonal eating environmental challenges by adapting small change strategies, navigating eating environments, and negotiating household eating practices. Findings highlight how even small eating behavior changes called for adaptation, navigation, and negotiation of complex eating environments in daily life. These findings were used to improve the trial that followed and underline the importance of feasibility studies to inform community trials. Findings also add to understanding of contextual challenges and the skills needed to implement small changes in a low income, ethnic minority population.

Weighing the Evidence of Common Beliefs in Obesity Research.

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

Trayless cafeterias lead diners to take less salad and relatively more dessert.

OBJECTIVE: Many colleges are removing trays from their dining facilities in hope of reducing waste. How does not having a tray impact food choice? DESIGN: A field study was conducted in a university cafeteria (n 417) on two evenings with identical menus, one with tray service and one without. SETTING: A dining hall of a large north-eastern university, USA. SUBJECTS: Undergraduate students. RESULTS: Trayless dining decreased the percentage of diners (average age 19.1 years) who took salad by 65.2% but did not decrease the percentage who took dessert, leading to a markedly higher ratio of dessert to salad. CONCLUSIONS: Cafeterias going trayless should consider complementary policies to encourage balanced diets.

Impact of a Smarter Lunchroom intervention on food selection and consumption among adolescents and young adults with intellectual and developmental disabilities in a residential school setting.

OBJECTIVE: To assess whether a Smarter Lunchroom intervention based on behavioural economics and adapted for students with intellectual and developmental disabilities would increase the selection and consumption of fruits, vegetables and whole grains, and reduce the selection and consumption of refined grains. DESIGN: The 3-month intervention took place at a residential school between March and June 2012. The evaluation employed a quasi-experimental, pre-post design comparing five matched days of dietary data. Selection and plate waste of foods at lunch were assessed using digital photography. Consumption was estimated from plate waste. SETTING: Massachusetts, USA. SUBJECTS: Students (n 43) aged 11-22 years with intellectual and developmental disabilities attending a residential school. RESULTS: Daily selection of whole grains increased by a mean of 0·44 servings (baseline 1·62 servings, P = 0·005) and refined grains decreased by a mean of 0·33 servings (baseline 0·82 servings, P = 0·005). The daily consumption of fruits increased by a mean of 0·18 servings (baseline 0·39 servings, P = 0·008), whole grains increased by 0·38 servings (baseline 1·44 servings, P = 0·008) and refined grains decreased by a mean of 0·31 servings (baseline 0·68 servings, P = 0·004). Total kilojoules and total gram weight of food selected and consumed were unchanged. Fruit (P = 0·04) and vegetable (P = 0·03) plate waste decreased. CONCLUSIONS: A Smarter Lunchroom intervention significantly increased whole grain selection and consumption, reduced refined grain selection and consumption, increased fruit consumption, and reduced fruit and vegetable plate waste. Nudge approaches may be effective for improving the food selection and consumption habits of adolescents and young adults with intellectual and developmental disabilities.

The impact of a supermarket nutrition rating system on purchases of nutritious and less nutritious foods.

OBJECTIVE: The current study examines the impact of a nutrition rating system on consumers' food purchases in supermarkets. DESIGN: Aggregate sales data for 102 categories of food (over 60 000 brands) on a weekly basis for 2005-2007 from a supermarket chain of over 150 stores are analysed. Change in weekly sales of nutritious and less nutritious foods, after the introduction of a nutrition rating system on store shelves, is calculated, controlling for seasonality and time trends in sales. SETTING: One hundred and sixty-eight supermarket stores in the north-east USA, from January 2005 to December 2007. SUBJECTS: Consumers purchasing goods at the supermarket chain during the study period. RESULTS: After the introduction of the nutrition ratings, overall weekly food sales declined by an average of 3637 units per category (95 % CI -5961, -1313; P<0·01). Sales of less nutritious foods fell by 8·31 % (95 % CI -13·50, -2·80 %; P=0·004), while sales of nutritious foods did not change significantly (P=0·21); as a result, the percentage of food purchases rated as nutritious rose by 1·39 % (95 % CI 0·58, 2·20 %; P<0·01). The decrease in sales of less nutritious foods was greatest in the categories of canned meat and fish, soda pop, bakery and canned vegetables. CONCLUSIONS: The introduction of the nutrition ratings led shoppers to buy a more nutritious mix of products. Interestingly, it did so by reducing purchases of less nutritious foods rather than by increasing purchases of nutritious foods. In evaluating nutrition information systems, researchers should focus on the entire market basket, not just sales of nutritious foods.

Concession stand makeovers: a pilot study of offering healthy foods at high school concession stands.

BACKGROUND: Concession stands at high school events are exempt from the US Department of Agriculture regulations for school foods. Concessions are generally stocked with unhealthy foods since healthy foods are believed to have lower sales and profit margins. METHODS: Concession stand sales for two seasons of high school fall sports in Muscatine, Iowa were compared. In between seasons, two types of changes were made: (i) addition of new healthier concession options and (ii) substitution of healthier ingredients (less saturated fat, no trans fat). Satisfaction surveys of students and parents were conducted before and after the changes. Data were collected in 2008 and 2009 and analyzed in 2012-13. RESULTS: Revenue per game was similar between years, even with the introduction of healthier items and ingredient changes. In 2009, the new healthy foods comprised 9.2% of total revenue and sales of some new items increased with each game. The 'healthy makeover' had no influence on student satisfaction but it improved parent satisfaction (P < 0.001). CONCLUSIONS: This compelling test of concept shows that offering healthier items can be good for both sales and satisfaction. While this study was conducted with concession stands, the principles can be carried over into other food retail settings.

Fifty years of fat: news coverage of trends that predate obesity prevalence.

BACKGROUND: Obesity prevalence has risen in fifty years. While people generally expect media mentions of health risks like obesity prevalence to follow health risk trends, food consumption trends may precede obesity prevalence trends. Therefore, this research investigates whether media mentions of food predate obesity prevalence. METHODS: Fifty years of non-advertising articles in the New York Times (and 17 years for the London Times) are coded for the mention of less healthy (5 salty and 5 sweet snacks) and healthy (5 fruits and 5 vegetables) food items by year and then associated with annual obesity prevalence in subsequent years. Time-series generalized linear models test whether food-related mentions predate or postdate obesity prevalence in each country. RESULTS: United States obesity prevalence is positively associated with New York Times mentions of sweet snacks (b = 55.2, CI = 42.4 to 68.1, p = .000) and negatively associated with mentions of fruits (b = -71.28, CI -91.5 to -51.1, p = .000) and vegetables (b = -13.6, CI = -17.5 to -9.6, p = .000). Similar results are found for the United Kingdom and The London Times. Importantly, the "obesity followed mentions" models are stronger than the "obesity preceded mentions" models. CONCLUSIONS: It may be possible to estimate a nation's future obesity prevalence (e.g., three years from now) based on how frequently national media mention sweet snacks (positively related) and vegetables or fruits (negatively related) today. This may provide public health officials and epidemiologists with new tools to more quickly assess the effectiveness of current obesity interventions based on what is mentioned in the media today.

A plant to plate pilot: a cold-climate high school garden increased vegetable selection but also waste.

AIM: Can high school gardens in cold climates influence vegetable intake in the absence of nutrition education? METHODS: This study followed a before/after design where student tray-waste data were collected using the quarter-waste method. The study took place March-April 2012 in a high school in upstate New York. The subjects were 370 enrolled high school students that purchased lunch from the school cafeteria. Prior to the introduction of garden greens in the salad, salads were served as usual. On April 24, harvested greens were included in the salad, and changes in selection and plate waste were measured. RESULTS: When the salad bar contained garden produce, the percentage of students selecting salad rose from 2% to 10% (p < 0.001), and on average, students ate two-thirds of the serving they took. Although waste increased relative to the control (from 5.56% to 33.33% per serving; p = 0.007), more students were consuming at least some salad. CONCLUSION: This preliminary investigation suggests that school gardens increased selection and intake of school-raised produce. Although a third was not eaten, it is promising to see that still more produce was consumed compared to the past.

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

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

Larger bowl size increases the amount of cereal children request, consume, and waste.

OBJECTIVE: To examine whether larger bowls bias children toward requesting more food from the adults who serve them. STUDY DESIGN: Study 1 was a between-subject design involving 69 preschool-age children who were randomized to receive either a small (8 oz) or large (16 oz) cereal bowl and were asked to tell researchers how much cereal they wanted for a morning snack. Study 2 was a within-subject design involving 18 school-age children at a summer camp who were given a small (8 oz) cereal bowl on one day and a large (16 oz) cereal bowl on another day and asked by a cafeteria server how much cereal and milk they wanted for breakfast. Hidden scales measured how much cereal and milk were served, consumed, and wasted. Body mass index was calculated at the end of the study. RESULTS: In study 1, the young children requested almost twice as much cereal to eat when presented with the larger bowl compared with the smaller bowl. In study 2, the older children consumed 52% more and wasted 26% more when served in the larger bowl. CONCLUSION: A step toward potentially reducing overeating and waste would be for parents and adult caregivers to use smaller bowls for serving food to children.

One man's tall is another man's small: how the framing of portion size influences food choice.

Labels such as 'Large' or 'Super-size' are often used to describe portion sizes. How do these normative labels influence consumer choice and how much they ultimately either consume or waste? Although one might believe that firms use normative labels to impact choice behavior through loss aversion, a field experiment shows consumer's willingness to pay is inconsistent with a loss aversion explanation. Although portions were clearly visible, individuals appeared to use the labels as objective information about their size. Importantly, a second study showed these labels also led people to eat less when food was given a larger sounding name than a smaller name (double vs. regular; regular vs. half-size). If labels are used as size information, policies governing normative names could help reduce food consumption or reduce waste.

In good company. The effect of an eating companion's appearance on food intake.

The purpose of this study was to examine whether or not the presence of an overweight eating companion influences healthy and unhealthy eating behavior, and to determine if the effect is moderated by how the companion serves herself. A professional actress either wore an overweight prosthesis (i.e., "fatsuit") or did not wear one, and served herself either healthily (i.e., a small amount of pasta and a large amount of salad) or unhealthily (i.e., a large amount of pasta and a small amount of salad) for lunch. After observing her, male and female participants were asked to serve themselves pasta and salad to eat. Results demonstrated that regardless of how the confederate served, participants served and ate a larger amount of pasta when she was wearing the prosthesis than when she was not. In addition, when the confederate served herself healthily, participants served and ate a smaller amount of salad when she was wearing the prosthesis than when she was not. Consistent with the "lower health commitment" hypothesis, these results demonstrated that people may eat larger portions of unhealthy food and smaller portions of healthy food when eating with an overweight person, probably because the health commitment goal is less activated. More generally, this study provides evidence that the body type of an eating companion, as well as whether she serves herself healthily or unhealthily, influences the quantity of food intake.