To investigate factors (ability, motivation and the environment) that act as barriers to limiting fast-food consumption in women who live in an environment that is supportive of poor eating habits.

Cross-sectional study using self-reports of individual-level data and objectively measured environmental data. Multilevel logistic regression was used to assess factors associated with frequency of fast-food consumption.

Socio-economically disadvantaged areas in metropolitan Melbourne, Australia.

Women (n 932) from thirty-two socio-economically disadvantaged neighbourhoods living within 3 km of six or more fast-food restaurants. Women were randomly sampled in 2007–2008 as part of baseline data collection for the Resilience for Eating and Activity Despite Inequality (READI) study.

Consuming low amounts of fast food was less likely in women with lower perceived ability to shop for and cook healthy foods, lower frequency of family dining, lower family support for healthy eating, more women acquaintances who eat fast food regularly and who lived further from the nearest supermarket. When modelled with the other significant factors, a lower perceived shopping ability, mid levels of family support and living further from the nearest supermarket remained significant. Among those who did not perceive fruits and vegetables to be of high quality, less frequent fast-food consumption was further reduced for those with the lowest confidence in their shopping ability.

Interventions designed to improve women's ability and opportunities to shop for healthy foods may be of value in making those who live in high-risk environments better able to eat healthily.

Currently 67 % of the US population is overweight or obese and obesity is associated with several chronic medical conditions. Geographic areas where individuals lack access to healthy foods have been termed ‘food deserts’. The study aim was to examine if area of residence within Metro Detroit was associated with dietary intake, food and shopping behaviours, and BMI.

Cross-sectional study.

Participants were recruited in the waiting area of four primary-care clinics.

Individuals (n 1004) completed a questionnaire comprising four sections: demographics; personal health status including self-reported height and weight; a modified diet, transportation and shopping survey; and a subscale from the Diet and Health Knowledge Survey.

Seventy-four per cent of participants were female and the mean age was 46·7 (sd 15·0) years. In univariate analyses, living in Detroit was associated with being African American, unemployment, less education, no regular exercise, worse health self-rating and obesity (P < 0·0005 for all). Participants living in Detroit had a 3·06 (95 % CI 1·91, 4·21) kg/m2 larger BMI compared with people living outside the city (P < 0·0005) in univariate analyses, but the effect was attenuated when adjusted for demographics, disease status, shopping and eating behaviours, dietary intakes and diet knowledge (β = −0·46 kg/m2, 95 % CI −2·23, 1·30 kg/m2, P = 0·60).

Overweight and obesity are highly prevalent both inside (82·9 %) and outside (72·8 %) the city of Detroit, presenting a major public health problem. However, living in this food desert was not significantly associated with BMI after potential covariates were considered.

The present study aimed to estimate the health benefits of selective taxation of healthy and unhealthy food commodities in relation to CVD and nutrition-related cancers.

The potential health effects of a selective taxation scenario were estimated as changes in the burden of disease, measured by disability-adjusted life years, from health outcomes affected by the changes in food intake. The change in burden of a disease was calculated as the change in incidence of the disease due to a modified exposure level, using the potential impact fraction. Estimates of relative risk for the associations between various foods and relevant diseases were found through a literature search and used in the calculation of potential impact fractions.

The study was based in Denmark, estimating the health effects of a Danish selective taxation scenario.

The potential health effects of selective taxation were modelled for the adult Danish population.

Halving the rate of value-added tax on fruit and vegetables and increasing the tax on fats would result in moderate reductions in the burden of disease from IHD, ischaemic stroke, and colorectal, lung and breast cancer (0·4–2·4 % change). The largest effect could be obtained through increased intake of fruit and vegetables (0·9–2·4 %).

Applying selective taxation to healthy and unhealthy foods can moderately reduce the burden of disease in the Danish population.

To assess attributions for overweight and the level of support for policy initiatives in Great Britain.

Cross-sectional. Respondents indicated their agreement (5-point scales: strongly disagree to strongly agree) to three potential causes of overweight (environment, genes, willpower) and five policies (free weight-loss treatment, taxing unhealthy foods, healthy lifestyle campaigns, food labelling, advertising restrictions).

Data were collected as part of a computer-assisted, face-to-face Omnibus survey of adults (aged >15 years) from across Great Britain in April 2012 carried out by a market research company.

A population-representative sample of British adults (n 1986).

More people attributed overweight to the food environment (61 %) and lack of willpower (57 %) than to genes (45 %). Policy support was highest for healthy lifestyle campaigns (71 %) and food labelling (66 %), and lowest for taxing unhealthy foods (32 %). Food environment attributions were associated with higher support for all policies (P < 0·001). Genetic attributions were associated with higher support for free weight-loss treatments and healthy lifestyle campaigns (P < 0·001), but not other policies. Attributions to lack of willpower were not associated differentially with support for any policies (P > 0·01).

Belief that overweight is caused by the food environment or genes – both seen as outside individual control – was associated with greater support for government policies to prevent and treat obesity. Improving awareness of the multiple causes of obesity could facilitate acceptance of policy action to reduce obesity prevalence.

Numerous localities have mandated that chain restaurants post nutrition information at the point of purchase. However, some studies suggest that consumers are not highly responsive to menu labelling. The present qualitative study explored influences on full-service restaurant customers’ noticing and using menu labelling.

Five focus groups were conducted with thirty-six consumers. A semi-structured script elicited barriers and facilitators to using nutrition information by showing excerpts of real menus from full-service chain restaurants.

Participants were recruited from a full-service restaurant chain in Philadelphia, Pennsylvania, USA, in September 2011.

Focus group participants were mostly female, African American, with incomes <$US 60 000, mean age 36 years and education 14·5 years. At recruitment, 33 % (n 12) reported changing their order after seeing nutrition information on the menu.

Three themes characterized influences on label use in restaurants: nutrition knowledge, menu design and display, and normative attitudes and behaviours. Barriers to using labels were low prior knowledge of nutrition; displaying nutrition information using codes; low expectations of the nutritional quality of restaurant food; and restaurant discounts, promotions and social influences that overwhelmed interest in nutrition and reinforced disinterest in nutrition. Facilitators were higher prior knowledge of recommended daily intake; spending time reading the menu; having strong prior interest in nutrition/healthy eating; and being with people who reinforced dietary priorities.

Menu labelling use may increase if consumers learn a few key recommended dietary reference values, understand basic energy intake/expenditure scenarios and if chain restaurants present nutrition information in a user-friendly way and promote healthier items.

The present study investigated how trans-fat is reported on the packaging of foods sold in a Brazilian supermarket.

The present descriptive, cross-sectional study analysed the ingredient list, nutrition facts label and claims of no trans-fat on the packaging.

A large supermarket in Florianópolis, Brazil.

All food products available at the supermarket.

Of the 2327 study products, more than half had components containing trans-fat in the ingredient list, especially hydrogenated vegetable fat and its alternative names. A small percentage of food products reported some trans-fat content on the nutrition facts label and roughly a quarter of the food products claimed to contain no trans-fat on the front of the packaging. There was very low agreement among the trans-fat content reported in the nutrition facts label, claims of no trans-fat made on the packaging and the ingredient list.

There was low agreement among the different ways of reporting trans-fat, suggesting that it is not possible to rely on the nutrition facts label or no trans-fat claims printed on the packaging of Brazilian food products. Hence, the Brazilian legislation on food labels needs to change to improve the reliability of food labels and to help control the trans-fat intake of the population.

Proposed Australian regulation of claims on food labels includes requirements for products carrying a health claim to meet nutrient profiling criteria. This would not apply to nutrition content claims. The present study investigated the number and healthiness of products carrying claims and the impact of the proposed regulation.

Observational survey of claims on food packages across three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products carrying claims to determine their eligibility to carry health claims under the proposed regulation.

Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in August 2011.

All claims on 1028 products were recorded. Nutrition composition and ingredients were collected from the packaging, enabling nutrient profiling. The proportion of products in each category carrying claims and the proportion of these that did not meet the nutrient profiling criteria were calculated.

Two-thirds of products in the three categories (ranging from 18 to 78 %) carried at least one claim. Of those carrying health claims, 31 % did not meet the nutrient profiling criteria. These would be ineligible to carry these claims under the proposed regulation. Additionally, 29 % of products carrying nutrition content claims did not meet the nutrient profiling criteria.

The number of products carrying nutrition content claims that did not meet the nutrient profiling criteria suggests that comprehensive regulation is warranted. Promotion of unhealthy foods using claims is potentially misleading for consumers and hinders their ability to select healthier foods. Implementation of the proposed regulation represents an improvement to current practice.

To examine students’ school food choice in relation to school food standards and entitlement to free school meals (FSM).

Cross-sectional analysis of students’ school food choices.

Two large secondary schools in Yorkshire, England.

Students (n 2660) aged 11–18 years.

Sandwiches and pizza were the most popular main food items: 40·4 % and 31·2 %, respectively, in School A; 48·3 % and 27·3 %, respectively, in School B. More nutritionally valuable ‘dishes of the day’ accounted for 8·7 % and 8·3 % of main foods for School A and School B, respectively. FSM students were more likely (P < 0·0 0 1) to choose main foods (School A: FSM 87·04 %, non-FSM 70·28 %; School B: FSM 75·43 %, non-FSM 56·13 %). Dishes of the day were chosen on a significantly greater (P < 0·0 0 1) percentage of days by FSM v. non-FSM students (School A: FSM 15·67 %, non-FSM 7·11 %; School B: FSM 19·42 %, non-FSM 5·17 %).

Despite the availability of nutritionally valuable dishes of the day, the most popular food items were sandwiches, pizza and desserts. FSM students were more likely to choose the more nutritionally valuable dish of the day. School food standards should be reassessed in light of students’ preferences.

To examine the variability of food portions served and consumed by African-American and Hispanic-American pre-school children attending Head Start.

Cross-sectional.

Food consumption by pre-schoolers (n 796) enrolled in sixteen Head Start centres in Houston, Texas (51 % boys, 42 % African-American, mean age 4 years) were assessed during 3 d of lunch meals using digital photography. Descriptive statistics and multilevel regression models, adjusting for classroom and school clustering effects, were determined.

Head Start pre-schoolers aged 3–5 years.

Mean amount served was 2428 kJ (580 kcal) and 572 g. Mean intake was 1421 kJ (339 kcal) and 331 g: 20 % protein, 46 % carbohydrate and 34 % fat. Plate waste was 43 % (range: 38 % (fruit) to 61 % (vegetables)). Mean CV of food served was 29 %: 33 % for entrées, 44 % for vegetables, 60 % for fruit and 76 % for starches. Mean CV of food consumed was 46 %: 58 % for entrées, 86 % for fruit, 96 % for vegetables and 111 % for starches. Total gram amount of food served was positively correlated with consumption (r = 0·43, P < 0·001).

Plate waste and variation in amounts served and consumed were substantial; amounts served were associated with amounts consumed. Large portion sizes may contribute to paediatric obesity by promoting excessive intake at meals. Understanding factors influencing portion sizes provides insight about specific intervention strategies that can be used in obesity prevention programmes.

The present study measured the perceived impact and political and implementation feasibility of state-level policy strategies related to increasing access to healthy foods and limiting unhealthy foods.

Potential state-level policy strategies to improve access to healthy foods were identified through a review of evidence-based literature and policy recommendations. Respondents rated the perceived impact and political and implementation feasibility of each policy on a five-point scale using online surveys.

Washington State policy process.

Forty-nine content experts (national researchers and subject experts), forty policy experts (state elected officials or their staff, gubernatorial or legislative policy analysts) and forty-five other stakeholders (state-level advocates, programme administrators, food producers).

In aggregate, respondents rated policy impact and implementation feasibility higher than political feasibility. Policy experts rated policy strategies as less politically feasible compared with content experts (P < 0·02) or other stakeholders (P < 0·001). Eight policy strategies were rated above the median for impact and political and implementation feasibility. These included policies related to nutrition standards in schools and child-care facilities, food distribution systems, urban planning projects, water availability, joint use agreements and breast-feeding supports.

Although they may be perceived as potentially impactful, some policies will be more difficult to enact than others. Information about the potential feasibility of policies to improve access to healthy foods can be used to focus limited policy process resources on strategies with the highest potential for enactment, implementation and impact.

Childhood obesity is a growing problem in the USA. As parents play a major role in shaping a child's diet, the present study examines food advertisements (ads) directed towards parents in parenting and family magazines.

Given the potential for magazines to influence attitudes and knowledge, we used content analysis to examine the food ads appearing in four issues each of six different parenting and family magazines from 2008 (n 24).

USA.

Food ads in parenting and family magazines.

We identified 476 food ads, which represented approximately 32 % of all ads in the magazine sample. Snack foods (13 %) were the most frequently observed food ads, followed by dairy products (7 %). The most frequently used sales theme was ‘taste’ (55 %). Some ads promoted foods as ‘healthy’ (14 %) and some made specific health claims (18 %), such as asserting the product would help lower cholesterol. In addition to taste and health and nutrition appeals, we found several themes used in ad messages to promote products, including the following: ‘convenience’, ‘economical’, ‘fun’ and ‘helping families spend time together’. We also found that over half (n 405, 55·9 %) of products (n 725) advertised were products of poor nutritional quality based on total fat, saturated fat, sodium, protein, sugar and fibre contents, and that ads for such products were slightly more likely to use certain sales themes like ‘fun’ (P = 0·04) and ‘no guilt’ (P = 0·03).

Interventions should be developed to help parents understand nutritional information seen in food ads and to learn how various foods contribute to providing a balanced family diet.

It is likely that there are substantial subconscious effects of organizations’ efforts to associate their products with sport via sponsorships, but most research methods are unable to capture these effects. The present study employed a novel projective technique to explore children's implicit associations between popular sports and a range of sports sponsors.

Children participated in an activity using magnets bearing the logos of numerous sports and sponsors. They were invited to arrange the magnets on a whiteboard without being advised that the activity related to sponsorship.

Perth, Western Australia.

Children (n 164) aged 5–12 years.

Three-quarters (76 %) of the children aligned at least one correct sponsor magnet with the relevant sport. Just over half the children (54 %) correctly matched the most popular sport (an Australian Football League team) with its relevant sponsor (a fast-food chain).

Given the unstructured nature of the projective task, the results provide some support for the argument that sports sponsorship can effectively reach child audiences. This is of concern given the current extent of sponsorship by alcohol and fast-food companies.

The current study examined the impact of television and Internet food advertising on Australian parents and children.

Parents and their children aged 8 to 14 years were exposed to a television advertisement, an Internet advertisement or a control picture for four commonly advertised energy-dense, nutrient-poor foods.

Online web panel survey, Australia.

Parents (n 1302) and their children aged 8 to 14 years (n 1302).

After a single exposure to each advertisement, parent respondents in the two exposure conditions evaluated the products more favourably, had a greater desire to consume the products and thought the product could be consumed more frequently than those in the control condition. Similar trends were observed among children, although the differences were statistically significant only for the frequency of food consumption in the Internet advertisement condition and the evaluation of one product.

The results have implications for assumptions of adults’ immunity to advertising. This is of particular importance in efforts to address child obesity and the reliance on parents to mediate the effects of food advertising.

To determine the frequency and content of food-related television (TV) advertisements shown on South African TV.

Four national TV channels were recorded between 15.00 and 21.00 hours (6 h each day, for seven consecutive days, over a 4-week period) to: (i) determine the number of food-related TV advertisements; and (ii) evaluate the content and approach used by advertisers to market their products. The data were viewed by two of the researchers and coded according to time slots, food categories, food products, health claims and presentation.

Of the 1512 recorded TV advertisements, 665 (44 %) were related to food. Of these, 63 % were for food products, 21 % for alcohol, 2 % for multivitamins, 1 % for slimming products and 13 % for supermarket and pharmacy promotions. Nearly 50 % of food advertisements appeared during family viewing time. During this time the most frequent advertisements were for desserts and sweets, fast foods, hot beverages, starchy foods and sweetened drinks. The majority of the alcohol advertisements (ninety-three advertisements, 67 %) fell within the children and family viewing periods and were endorsed by celebrities. Health claims were made in 11 % of the advertisements. The most frequently used benefits claimed were ‘enhances well-being’, ‘improves performance’, ‘boosts energy’, ‘strengthens the immune system’ and ‘is nutritionally balanced’.

The majority of food advertisements shown to both children and adults do not foster good health despite the health claims made. The fact that alcohol advertisements are shown during times when children watch TV needs to be addressed.

The predominance of marketing of products high in fat, sugar and/or salt to children has been well documented and implicated in the incidence of obesity. The present study aimed to determine whether foods marketed to children in UK supermarkets are nutritionally similar to the non-children's equivalent, focusing on food categories that may be viewed as healthier options.

Nutritional data were collected on yoghurts (n 147), cereal bars (n 145) and ready meals (n 144) from seven major UK supermarkets and categorised as children's or non-children's products based on the characteristics, promotional nature or information on the product packaging. Fat, sugar and salt content was compared per 100 g and per recommended portion size.

UK.

Per 100 g, children's yoghurts and cereal bars were higher in total sugars, fat and saturated fat than the non-children's; this was significant for all except sugar and total fat in cereal bars. Per portion these differences remained, except for sugars in yoghurts. Conversely children's ready meals were significantly lower in these nutrients per portion than non-children's, but not when expressed per 100 g. Children's yoghurts and ready meals had significantly lower sodium content than non-children's both per portion and per 100 g.

Significant differences between the nutritional composition of children's and non-children's products were observed but varied depending on the unit reference. A significant number of products marketed towards children were higher in fat, sugar and salt than those marketed to the general population.

To assess caregivers’ perceptions of the extent to which the food marketing environment influences food consumption among African-American children (aged 3–11 years) in order to generate potential strategies to make the marketing environment more favourable to healthier eating.

Individual semi-structured interviews with caregivers were conducted by trained community leaders to ascertain their awareness of and perceptions about food marketing environments contributing to African-American children's food consumption.

Six predominantly African-American communities in metro Birmingham, Alabama, USA with high proportions of school-age children and lower-income residents.

Caregivers (n 25) were predominantly female (93 %) and either parents/guardians (64 %) or grandparents (28 %) of African-American children aged 3–11 years. Caregiver mean age was 43 years and 46 % had lived in their current residence for over 10 years.

Caregivers reported all aspects of the food marketing matrix as supporting unhealthy eating among African-American youth. Child preference for foods higher in fat and sugar, lower pricing of less healthy foods, limited access to healthier food retailers and targeted advertisements were particularly influential on the food selection, acquisition and consumption of children. Company loyalty, corporate sponsorship of local events and conflicts over parental v. food company responsibility contributed to less consensus about the overall impact (positive or negative) of food companies in African-American communities.

While caregivers perceived aspects of their food marketing environments as primarily contributing to unhealthy eating among African-American children, framing the demand for changes in the food marketing environments of African-American youth may be particularly challenging.

To investigate consumption of ultra-processed products in Canada and to assess their association with dietary quality.

Application of a classification of foodstuffs based on the nature, extent and purpose of food processing to data from a national household food budget survey. Foods are classified as unprocessed/minimally processed foods (Group 1), processed culinary ingredients (Group 2) or ultra-processed products (Group 3).

All provinces and territories of Canada, 2001.

Households (n 5643).

Food purchases provided a mean per capita energy availability of 8908 (se 81) kJ/d (2129 (se 19) kcal/d). Over 61·7 % of dietary energy came from ultra-processed products (Group 3), 25·6 % from Group 1 and 12·7 % from Group 2. The overall diet exceeded WHO upper limits for fat, saturated fat, free sugars and Na density, with less fibre than recommended. It also exceeded the average energy density target of the World Cancer Research Fund/American Institute for Cancer Research. Group 3 products taken together are more fatty, sugary, salty and energy-dense than a combination of Group 1 and Group 2 items. Only the 20 % lowest consumers of ultra-processed products (who consumed 33·2 % of energy from these products) were anywhere near reaching all nutrient goals for the prevention of obesity and chronic non-communicable diseases.

The 2001 Canadian diet was dominated by ultra-processed products. As a group, these products are unhealthy. The present analysis indicates that any substantial improvement of the diet would involve much lower consumption of ultra-processed products and much higher consumption of meals and dishes prepared from minimally processed foods and processed culinary ingredients.

To provide an independent monitoring report examining the ongoing impact of Australian self-regulatory pledges on food and drink advertising to children on commercial television.

Analysis of food advertisements across comparable sample time periods in April/May 2006, 2007, 2009, 2010 and 2011. The main outcome measure comprised change in the mean rate of non-core food advertisements from 2006 to 2011.

Sydney free-to-air television channels.

Televised food advertisements.

In 2011 the rate of non-core food advertisements was not significantly different from that in 2006 or 2010 (3·2/h v. 4·1/h and 3·1/h), although there were variations across the intervening years. The rate of fast-food advertising in 2010 was significantly higher than in 2006 (1·8/h v. 1·1/h, P < 0·001), but the same as that in 2011 (1·5/h).

The frequency of non-core food advertising on Sydney television has remained essentially unchanged between 2006 and 2011, despite the implementation of two industry self-regulatory pledges. The current study illustrates the value of independent monitoring as a basic requirement of any responsive regulatory approach.

Eating whole grains (WG) is recommended for health, but multiple conflicting definitions exist for identifying whole grain (WG) products, limiting the ability of consumers and organizations to select such products. We investigated how five recommended WG criteria relate to healthfulness and price of grain products.

We categorized grain products by different WG criteria including: the industry-sponsored Whole Grain stamp (WG-Stamp); WG as the first ingredient (WG-first); WG as the first ingredient without added sugars (WG-first-no-added-sugars); the word ‘whole’ before any grain in the ingredients (‘whole’-anywhere); and a content of total carbohydrate to fibre of ≤10:1 (10:1-ratio). We investigated associations of each criterion with health-related characteristics including fibre, sugars, sodium, energy, trans-fats and price.

Two major grocery store chains.

Five hundred and forty-five grain products.

Each WG criterion identified products with higher fibre than products considered non-WG; the 10:1-ratio exhibited the largest differences (+3·15 g/serving, P < 0·0001). Products achieving the 10:1-ratio also contained lower sugar (−1·28 g/serving, P = 0·01), sodium (−15·4 mg/serving, P = 0·04) and likelihood of trans-fats (OR = 0·14, P < 0·0001), without energy differences. WG-first-no-added-sugars performed similarly, but identified many fewer products as WG and also not a lower likelihood of containing trans-fats. The WG-Stamp, WG-first and ‘whole’-anywhere criteria identified products with a lower likelihood of trans-fats, but also significantly more sugars and energy (P < 0·05 each). Products meeting the WG-Stamp or 10:1-ratio criterion were more expensive than products that did not (+$US 0·04/serving, P = 0·009 and +$US 0·05/serving, P = 0·003, respectively).

Among proposed WG criteria, the 10:1-ratio identified the most healthful WG products. Other criteria performed less well, including the industry-supported WG-Stamp which identified products with higher fibre and lower trans-fats, but also higher sugars and energy. These findings inform efforts by consumers, organizations and policy makers to identify healthful WG products.