Search

Overweight and obesity is a global concern as a significant risk factor for non‐communicable diseases. Increased energy intake due to greater consumption of energy‐dense food or non‐alcoholic beverages high in fat, saturated fat, sugar or salt ('HFSS food') is the main explanation for population weight gain. The principal drivers underlying this consumption are the commercial determinants of health in the food chain, particularly the marketing of HFSS food. In the UK, some rules do regulate certain forms of HFSS food marketing (such as television and online advertising to children) and the government is considering strengthening these. However, although sports sponsorship by 'HFSS food businesses' (defined as a business preparing, cooking, storing, handling, distributing, supplying or selling food and whose products are primarily HFSS) is increasingly recognised as linked to HFSS food consumption, it has received little attention. This is all the more concerning in light of the recent proliferation of 'HFSS food businesses' and HFSS products partnering with sports organisations. Against this background, we hosted a workshop to focus on the relationship between health, nutrition and the sponsorship of sport and related marketing by 'HFSS food businesses' and to consider the implications for obesity prevention strategies in the UK and beyond. This innovative workshop capitalised on, and contributed to, ongoing efforts to conceptually unite existing research by bringing together an interdisciplinary team of experts providing unique and complementary perspectives on how to address sports sponsorship as one of the channels through which 'HFSS food businesses' contribute to poor nutrition and diet‐related diseases. This report summarises the structure, participants and discussions from the workshop; the existing evidence base; and the future research and policy opportunities we plan to pursue. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objective: To evaluate the associations between frequency of business travel and health behaviors and adiposity. Methods: Retrospective cross-sectional analysis of de-identified electronic medical records from 795 corporate physical exams. Results: Business travel frequency demonstrates a curvilinear relationship with body mass index and body composition in men and women, with domestic and international travel. Linear and quadratic term beta coefficients indicate stronger associations between the sum of domestic and international travel and BMI, body fat percentage, and visceral adipose tissue in women than men, after accounting for age, exercise, and sleep. Based on our male sample population, international travel frequency has a greater influence on adiposity than summed (mostly domestic) travel. Conclusions: Frequent business travel adversely affects body composition, with differences by gender and type of travel. [ABSTRACT FROM AUTHOR]

Background: Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias.Methods and Findings: This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of -4.8% (95% CI -7.0% to -2.7%), p < 0.001 during the availability intervention period and a reduction of -11.5% (95% CI -13.7% to -9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of -6.6% (95% CI -7.9% to -5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data).Conclusions: Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings.Trial Registration: ISRCTN registry ISRCTN87225572. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of a sugar-sweetened beverage (SSB) tax implemented in Oakland, California, in July 2017, on prices of beverages sold in fast-food restaurants 2-year post-tax.Design: Using a difference-in-differences (DID) approach, we analysed beverage price data collected from fast-food restaurants 1-month pre-tax and 2-year post-tax in Oakland (intervention site) and Sacramento, California (comparison site). Separate linear regression models were used to estimate the impact of the tax on prices of bottled regular soda, bottled diet soda, bottled unsweetened beverages and fountain drinks.Setting: Oakland and Sacramento, California, USA.Participants: Chain and non-chain fast-food restaurants (n 85).Results: DID estimates indicate that in fast-food restaurants, on average, the price of bottled regular soda increased by 1·44 cents/oz (95 % CI 0·50, 2·73) (tax pass-through rate of 144 %) and the price of bottled diet soda increased by 1·17 cents/oz (95 % CI 0·07, 2·13). No statistically significant differences were found between bottled regular and diet soda price increases. Price effects for unsweetened beverages and fountain drinks were not statistically significant. Further, the estimated price change for fountain drinks was nearly zero.Conclusions: Findings suggest that the effectiveness of SSB taxes in discouraging SSB consumption may be limited in fast-food restaurants in Oakland, California, because there were similar price increases in taxed and untaxed bottled soda and no changes in fountain drink prices. [ABSTRACT FROM AUTHOR]

Background: Childhood overweight and obesity (OW/OB) is increasingly centered in low- and middle-income countries (LMICs) as rural populations experience market integration and lifeway change. Most explanatory studies have relied on imprecise estimates of children's energy expenditure, restricting understanding of the relative effects of changes in diet and energy expenditure on the development of OW/OB in transitioning contexts.Objectives: This study used gold-standard measurements of children's energy expenditure to investigate the changes that underlie OW/OB and the nutrition/epidemiologic transition.Methods: Cross-sectional data were collected from "rural" (n = 43) Shuar forager-horticulturalist children and their "peri-urban" (n = 34) Shuar counterparts (age 4-12 y) in Amazonian Ecuador. Doubly labeled water measurements of total energy expenditure (TEE; kcal/d), respirometry measurements of resting energy expenditure (REE; kcal/d), and measures of diet, physical activity, immune activity, and market integration were analyzed primarily using regression models.Results: Peri-urban children had higher body fat percentage (+8.1%, P < 0.001), greater consumption of market-acquired foods (multiple P < 0.001), lower concentrations of immune activity biomarkers (multiple P < 0.05), and lower REE (-108 kcal/d, P = 0.002) than rural children. Despite these differences, peri-urban children's TEE was indistinguishable from that of rural children (P = 0.499). Moreover, although sample-wide IgG concentrations and household incomes predicted REE (both P < 0.05), no examined household, immune activity, or physical activity measures were related to children's overall TEE (all P > 0.09). Diet and energy expenditure associations with adiposity demonstrate that only reported consumption of market-acquired "protein" and "carbohydrate" foods predicted children's body fat levels (multiple P < 0.05).Conclusions: Despite underlying patterns in REE, Shuar children's TEE is not reliably related to market integration and-unlike dietary measures-does not predict adiposity. These findings suggest a leading role of changing dietary intake in transitions to OW/OB in LMICs. [ABSTRACT FROM AUTHOR]

Research suggests that eating vegetables benefits both human health and the environment. However, in the UK, very few people are eating enough vegetables. This is contributing to the global burden of diet‐related disease and associated costs, as well as undermining the possibility of a sustainable UK food system. The Peas Please initiative was launched in 2017 to encourage organisations and businesses across the food system to pledge their commitment to helping the British public increase their vegetable consumption. Since the implementation of the Peas Please initiative 95 organisations have pledged to support Peas Please and, at the time of writing, an additional 89.9 million portions of vegetables have been grown, served and sold by pledgers. This article describes the Peas Please initiative and its rationale, highlights some of the key outcomes of the programme, and outlines next steps for increasing commitment to the programme. [ABSTRACT FROM AUTHOR]

Objective: Increasing prevalence of overweight and obese people in England has led policymakers to consider regulating the use of price promotions on foods high in fat, sugar and salt content. In January 2019, the government opened a consultation programme for a policy proposal that significantly restricts the use of price promotions that can induce consumers to buy higher volumes of unhealthy foods and beverages. These proposed policies are the first of their kind in public health and are believed to reduce excess purchasing and, therefore, overconsumption of unhealthy products. This study summarises evidence relating price promotions to the purchasing of food and drink for home consumption and places it in the context of the proposed policy.Design: Non-systematic review of quantitative analyses of price promotions in food and drink published in peer-reviewed journals and sighted by PubMed, ScienceDirect & EBSCOhost between 1980 and January 2018.Results: While the impact of price promotions on sales has been of interest to marketing academics for a long time with modelling studies showing that its use has increased food and drink sales by 12-43 %, it is only now being picked up in the public health sphere. However, existing evidence does not consider the effects of removing or restricting the use of price promotions across the food sector. In this commentary, we discuss existing evidence, how it deals with the complexity of shoppers' behaviour in reacting to price promotions on foods and, importantly, what can be learned from it in this policy context.Conclusions: The current evidence base supports the notion that price promotions increase purchasing of unhealthy food, and while the proposed restriction policy is yet to be evaluated for consumption and health effects, there is arguably sufficient evidence to proceed. This evidence is not restricted to volume-based promotions. Close monitoring and proper evaluation should follow to provide empirical evidence of its intended and unintended effects. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility and efficacy of in-restaurant interventions aiming to promote healthy choices via fundraising incentives benefiting school wellness programmes and point-of-purchase nutrition promotion.Design: Twelve schools were randomly assigned to one of the two intervention periods: Fundraising Incentive (FI) donated funds for visiting the study restaurant and Fundraising-Healthy Eating Incentive (F-HEI) included FI with additional funds given when selecting a healthier item. Both conditions included point-of-purchase nutrition promotions. Families were recruited to attend their designated intervention and complete a survey. Feasibility was assessed based on recruitment and participation, implementation fidelity and intervention acceptability. Efficacy was assessed by comparing participant receipts between intervention periods and by comparing overall restaurant sales during intervention v. two no-intervention time frames.Setting: Fast-casual restaurant in Southern California.Participants: Parents with children attending participating schools.Results: Eighty-one families visited the restaurant during the intervention, with sixty-six completing surveys. All study activities were implemented successfully, but school family participation in the intervention was low (0·95 %). Among participants completing surveys, all indicated satisfaction with the programme. The percentage of healthier items ordered was significantly greater during both FI (χ2 = 5·97, P = 0·01) and F-HEI (χ2 = 8·84, P = 0·003) v. Comparison 2. Results were similar but did not reach statistical significance when comparing the interventions to Comparison 1.Conclusions: Results support potential efficacy of this programme, but more research is needed to inform feasibility. Fidelity and acceptability data supported feasibility, but participation rates were low in this initial study. Methods evaluating this intervention with a greater proportion of parents should be considered. [ABSTRACT FROM AUTHOR]

Longitudinal and observational studies have found a link between the consumption of sugar-sweetened beverages (SSBs) and non-communicable diseases (NCDs) including obesity and diabetes. Following World Health Organization (WHO) recommendations, SSB taxes have been implemented in over 40 countries and cities to reduce sugar consumption. Despite continuing battles with communicable diseases in low- and middle-income countries (LMICs), an epidemiological transition towards NCDs warrants SSB tax implementation. However, LMICs face challenges when implementing SSB taxes including a lack of resources and opposing arguments from industry. Sharing experiences among countries can help to improve the likelihood of successful SSB tax implementation. We review experiences of tobacco, alcohol, and SSB tax implementation in LMICs. We discuss potential pitfalls for policymakers and how they might be overcome. We provide recommendations based on implementation experiences in LMICs to help governments improve implementation capacity and advance public health. [ABSTRACT FROM AUTHOR]

This final report of the Lancet Commission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity-the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and, in particular, schemes to allow general practitioners to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The Lancet Commission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government. [ABSTRACT FROM AUTHOR]

Obesity is a severe worldwide epidemic. Obesity comorbidities, such as type 2 diabetes mellitus, hypertension, and atherosclerosis, are costly for patients and governments. The treatment of obesity involves several facets, including lifestyle changes, bariatric surgery, and pharmacotherapy. As changes in lifestyle require considerable patient commitment that is sometimes unachievable, and surgery is expensive and invasive, pharmacotherapy is the primary option for most patients. This review describes the pharmacotherapy currently available in the USA, Europe, and Brazil, focusing on its limitations. We then analyze the results from clinical trials of new drug candidates. Most drugs cause weight loss of < 4 kg compared with controls, and severe adverse effects have caused a number of drugs to be withdrawn from the market in several countries. Drugs under development have not shown more significant weight loss or reduced adverse effects. We conclude that a significant portion of obese patients have few treatment options because of the adverse effects and minimal weight loss associated with current pharmacotherapy. However, drugs currently under development appear unable to change this scenario in the near future. Thus, it is essential that new compounds are developed and new molecular targets studied so obesity can be efficiently treated in all patients in the future. [ABSTRACT FROM AUTHOR]

Background: Away-from-home foods (AFHFs) influence diet quality, a modifiable obesity risk factor, with limited generalizable evidence in Hispanic/Latino adults.Objective: We investigated associations between AFHF intake with diet quality and overweight or obesity among US Hispanic/Latino adults.Methods: Cross-sectional baseline (2008-2011) analyses included adults (n = 16,045) aged 18-74 y in the national Hispanic Community Health Study/Study of Latinos. Participants self-reported AFHF consumption frequency from 10 different settings and dietary intake (2-d 24-h recall). The Alternate Healthy Eating Index-2010 (AHEI-2010) was used to measure diet quality; higher scores indicated a healthier diet and scores were categorized into tertiles. WHO classifications categorized overweight [body mass index (BMI; kg/m2): 25.0-29.9] and obesity (BMI ≥30). Multivariate-adjusted associations of AFHF frequency or type with AHEI-2010, overweight, or obesity were assessed by using complex survey logistic regression (ORs and 95% CIs).Results: Almost half of participants (47.1%) reported eating AFHFs ≥5 times/wk. The mean ± SE AHEI-2010 score was 47.5 ± 0.2. More than one-third (37.2%) were classified as overweight and 39.6% classified as obese. Compared with consuming AFHFs ≥5 times/wk, consuming AFHFs <1 time/wk or 1-2 times/wk was associated with greater odds of being in higher AHEI-2010 tertiles, indicating a healthier diet [<1 time/wk-tertile 2: OR (95% CI): 1.6 (1.4, 1.9); tertile 3: 2.5 (2.1, 3.1); 1-2 times/wk-tertile 2: OR (95% CI): 1.4 (1.2, 1.6); tertile 3: 1.5 (1.2, 1.8)]. Consumption of AFHFs ≥1 time/wk from each AFHF setting, compared with consumption of any AFHFs <1 time/wk was associated with lower odds of being in higher AHEI-2010 tertiles. Increasing AFHF intake frequency was not associated with odds of overweight or obesity. Eating from on-street vendors ≥1 time/wk was associated with obesity (OR: 1.5; 95% CI: 1.1, 2.0).Conclusions: Consumption of AFHFs was prevalent among Hispanic/Latino adults and was associated with poorer diet quality. Findings may help to identify dietary targets to improve diet quality and prevent obesity in US Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Background: Findings in the observational retail food environment and obesity literature are inconsistent, potentially due to a lack of adjustment for residual confounding.Methods: Using data from the CARDIA study (n = 12 174 person-observations; 6 examinations; 1985-2011) across four US cities (Birmingham, AL; Chicago, IL; Minneapolis, MN; Oakland, CA), we used instrumental-variables (IV) regression to obtain causal estimates of the longitudinal associations between the percentage of neighbourhood food stores or restaurants (per total food outlets within 1 km network distance of respondent residence) with body mass index (BMI), adjusting for individual-level socio-demographics, health behaviours, city, year, total food outlets and market-level prices. To determine the presence and extent of bias, we compared the magnitude and direction of results with ordinary least squares (OLS) and random effects (RE) regression, which do not control for residual confounding, and with fixed effects (FE) regression, which does not control for time-varying residual confounding.Results: Relative to neighbourhood supermarkets (which tend to be larger and have healthier options than grocery stores), a higher percentage of grocery stores [mean = 53.4%; standard deviation (SD) = 31.8%] was positively associated with BMI [β = 0.05; 95% confidence interval (CI) = 0.01, 0.10] using IV regression. However, associations were negligible or null using OLS (β = -0.001; 95% CI = -0.01, 0.01), RE (β = -0.003; 95% CI = -0.01, 0.0001) and FE (β = -0.003; 95% CI = -0.01, 0.0002) regression. Neighbourhood convenience stores and fast-food restaurants were not associated with BMI in any model.Conclusions: Longitudinal associations between neighbourhood food outlets and BMI were greater in magnitude using a causal model, suggesting that weak findings in the literature may be due to residual confounding. [ABSTRACT FROM AUTHOR]

Background: Ready-to-eat meals (to eat in, to take away or to be delivered) sold by food outlets are often more energy dense and nutrient poor compared with meals prepared at home, making them a reasonable target for public health intervention. The aim of the research presented in this paper was to systematically identify and describe interventions to promote healthier ready-to-eat meals (to eat in, to take away, or to be delivered) sold by specific food outlets in England.Methods: A systematic search and sift of the literature, followed by evidence mapping of relevant interventions, was conducted. Food outlets were included if they were located in England, were openly accessible to the public and, as their main business, sold ready-to-eat meals. Academic databases and grey literature were searched. Also, local authorities in England, topic experts, and key health professionals and workers were contacted. Two tiers of evidence synthesis took place: type, content and delivery of each intervention were summarised (Tier 1) and for those interventions that had been evaluated, a narrative synthesis was conducted (Tier 2).Results: A total of 75 interventions were identified, the most popular being awards. Businesses were more likely to engage with cost neutral interventions which offered imperceptible changes to price, palatability and portion size. Few interventions involved working upstream with suppliers of food, the generation of customer demand, the exploration of competition effects, and/or reducing portion sizes. Evaluations of interventions were generally limited in scope and of low methodological quality, and many were simple assessments of acceptability.Conclusions: Many interventions promoting healthier ready-to-eat meals (to eat in, to take away, or to be delivered) sold by specific food outlets in England are taking place; award-type interventions are the most common. Proprietors of food outlets in England that, as their main business, sell ready-to-eat meals, can be engaged in implementing interventions to promote healthier ready-to-eat-food. These proprietors are generally positive about such interventions, particularly when they are cost neutral and use a health by stealth approach. [ABSTRACT FROM AUTHOR]

Background: The association between farmers' market characteristics and consumer shopping habits remains unclear. Our objective was to examine associations among distance to farmers' markets, amenities within farmers' markets, frequency of farmers' market shopping, fruit and vegetable consumption, and body mass index (BMI). We hypothesized that the relationship between frequency of farmers' market shopping and BMI would be mediated by fruit and vegetable consumption.Methods: In 15 farmers' markets in northeastern North Carolina, July-September 2015, we conducted a cross-sectional survey among 263 farmers' market customers (199 provided complete address data) and conducted farmers' market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent variables included farmers' market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for age, race, sex, and education, were used to examine associations between distance to farmers' markets, amenities within farmers' markets, frequency of farmers' market shopping, fruit and vegetable consumption, and BMI.Results: Those who reported shopping at farmers' markets a few times per year or less reported consuming 4.4 (standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers' market amenities, and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of the relationship between frequency of shopping and BMI by fruit and vegetable consumption.Conclusions: More work should be done to understand factors within farmers' markets that encourage fruit and vegetable purchases. [ABSTRACT FROM AUTHOR]

Background: The Prevalence of obesity and overweight has been increasing in many countries. Many factors have been identified as contributing to obesity including the food environment, especially the access, availability and affordability of healthy foods in grocery stores and supermarkets. Several interventions have been carried out in retail grocery/supermarket settings as part of an effort to understand and influence consumption of healthful foods. The review's key outcome variable is sale/purchase of healthy foods as a result of the interventions. This systematic review sheds light on the effectiveness of food store interventions intended to promote the consumption of healthy foods and the methodological quality of studies reporting them.Methods: Systematic literature search spanning from 2003 to 2015 (inclusive both years), and confined to papers in the English language was conducted. Studies fulfilling search criteria were identified and critically appraised. Studies included in this review report health interventions at physical food stores including supermarkets and corner stores, and with outcome variable of adopting healthier food purchasing/consumption behavior. The methodological quality of all included articles has been determined using a validated 16-item quality assessment tool (QATSDD).Results: The literature search identified 1580 publications, of which 42 met the inclusion criteria. Most interventions used a combination of information (e.g. awareness raising through food labeling, promotions, campaigns, etc.) and increasing availability of healthy foods such as fruits and vegetables. Few used price interventions. The average quality score for all papers is 65.0%, or an overall medium methodological quality. Apart from few studies, most studies reported that store interventions were effective in promoting purchase of healthy foods.Conclusion: Given the diverse study settings and despite the challenges of methodological quality for some papers, we find efficacy of in-store healthy food interventions in terms of increased purchase of healthy foods. Researchers need to take risk of bias and methodological quality into account when designing future studies that should guide policy makers. Interventions which combine price, information and easy access to and availability of healthy foods with interactive and engaging nutrition information, if carefully designed can help customers of food stores to buy and consume more healthy foods. [ABSTRACT FROM AUTHOR]

ObjectiveSoda consumption is high in the USA, especially among minorities and individuals of lower socio-economic status (SES); this may be due to its affordable price in relation to healthier alternatives. The objective of the present study was to examine geospatial variation in price of milk and soda, and the price of milk relative to soda, by neighbourhood SES and proportion of Hispanic and black individuals.DesignRetailer soda and milk prices (n 2987; Information Resources, Inc. Academic Data Set 2004–2011) were linked to census block group sociodemographic characteristics (American Community Survey 2005–2009). Linear hierarchical regression models were used to adjust for confounders.SettingLarge chain supermarkets and superstores (n 1743) in forty-one states and 1694 block groups (USA).ResultsFor equivalent fluid ounces, price of soda on average was 62 % lower than milk ($US 0·23 v. $US 0·63 per serving) and there was high dispersion in milk price across geographic areas. After adjustment for confounding, neighbourhoods with a higher concentration of black and Hispanic individuals tended to have lower soda prices and higher milk prices (−$US 0·001 and +$US 0·007 in price per serving, respectively, for a one quintile increase in black/Hispanic population), while soda and milk both became less expensive as SES decreased (–$US 0·002 and −$US 0·015 in serving price per one sd decrease in SES index, respectively).ConclusionsNeighbourhoods with a higher concentration of blacks and Hispanics may be at greater risk of higher soda consumption due to more affordable prices, in absolute terms and relative to the price of milk. [ABSTRACT FROM AUTHOR]

Places where we buy food influence dietary patterns, making local food environments a good example of a mass influence on population diets. Cross-cultural studies, using reliable methods, may help understanding the relationship between food environments and diet-related health outcomes. We aimed to understand cross-national differences in the local food environment between Madrid and Baltimore by comparing an average neighborhood in each city in terms of food store types, healthy food availability, and residents' pedestrian access. During 2012-2013, we assessed one neighborhood (~15,000 residents) in each city selecting median areas in terms of socio-demographic characteristics (segregation, education, aging, and population density). We collected on-field data on (a) number and types of all food stores, (b) overall healthy food availability and (c) specific availability of fruits & vegetables. Throughout a street network analysis (200m, 400m and 800m) of food stores with high healthy food availability, we estimated residents' pedestrian accessibility. We found 40 stores in Madrid and 14 in Baltimore. Small food stores carrying fresh foods in Madrid contrasted with the high presence of corner and chain convenience stores in Baltimore. In Madrid, 77% of the residents lived within less than 200m from a food store with high healthy food availability. In contrast, 95% of Baltimore's residents lived further than 400m from these stores. Our results may help promoting interventions from local city agencies to allocate resources to existing small-sized food stores, and to improve walkable urban environments. These actions may influence food choices, especially for those residents lacking access to private vehicles. [ABSTRACT FROM AUTHOR]

Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly because obesity has been found to be more common in urban areas and among the rich. Recent findings, however, reveal rising prevalence among the poor particularly the urban poor. A growing body of literature mostly in Western countries shows that obesity among the poor is partly the result of an obesogenic-built environment. Such studies are lacking in the African context. This study examines the characteristics of the local food environment in an urban poor setting in Accra, Ghana and further investigates the associated risk of obesity for residents. Data on the local food environment was collected using geographic positioning system (GPS) technology. The body mass indices (BMI) of females (15-49 years) and males (15-59 years) were calculated from measured weight and height. Data on the socio-demographic characteristics and lifestyle behaviors of respondents was also collected through a household survey. Spatial analysis tools were used to examine the characteristics of the local food environment while the influence of the food environment on BMI was examined using a two-level multilevel model. The measures of the food environment constituted the level 2 factors while individual socio-demographic characteristics and lifestyle behaviors constituted the level 1 factors. The local food environment in the study communities is suggestive of an obesogenic food environment characterized by an abundance of out-of-home cooked foods, convenience stores, and limited fruits and vegetables options. The results of the multilevel analysis reveal a 0.2 kg/m(2) increase in BMI for every additional convenience store and a 0.1 kg/m(2) reduction in BMI for every out-of-home cooked food place available in the study area after controlling for individual socio-demographic characteristics, lifestyle behaviors, and community characteristics. The findings of this study indicate that the local food environment in urban poor Accra is associated with increased risk of obesity through providing access to convenience stores. In order to reduce the risk of obesity in these urban poor communities, there is the need to regulate the availability of and access to convenience stores while also encouraging healthier offerings in convenience stores. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of food retail interventions is largely undetermined, yet substantial investments have been made to improve access to healthy foods in food deserts and swamps via grocery and corner store interventions. This study evaluated the effects of corner store conversions in East Los Angeles and Boyle Heights, California on perceived accessibility of healthy foods, perceptions of corner stores, store patronage, food purchasing, and eating behaviors.Methods: Household data (n = 1686) were collected at baseline and 12- to 24-months post-intervention among residents surrounding eight stores, three of which implemented a multi-faceted intervention and five of which were comparisons. Bivariate analyses and logistic and linear regressions were employed to assess differences in time, treatment, and the interaction between time and treatment to determine the effectiveness of this intervention.Results: Improvements were found in perceived healthy food accessibility and perceptions of corner stores. No changes were found, however, in store patronage, purchasing, or consumption of fruits and vegetables.Conclusions: Results suggest limited effectiveness of food retail interventions on improving health behaviors. Future research should focus on other strategies to reduce community-level obesity. [ABSTRACT FROM AUTHOR]

Introduction: Racial disparities in obesity exist at the individual and community levels. Retail food environment has been hypothesized to be associated with racial disparities in obesity prevalence. This study aimed to quantify how much food environment measures explain racial disparities in obesity at the county level.Methods: Data from 2009 to 2010 on 3,135 U.S. counties were extracted from the U.S. Department of Agriculture Food Environment Atlas and the Behavioral Risk Factor Surveillance System and analyzed in 2013. Oaxaca-Blinder decomposition was used to quantify the portion of the gap in adult obesity prevalence observed between counties with a high and low proportion of African-American residents is explained by food environment measures (e.g., proximity to grocery stores, per capita fast-food restaurants). Counties were considered to have a high African-American population if the percentage of African-American residents was >13.1%, which represents the 2010 U.S. Census national estimate of percentage African-American citizens.Results: There were 665 counties (21%) classified as a high African-American county. The total gap in mean adult obesity prevalence between high and low African-American counties was found to be 3.35 percentage points (32.98% vs 29.63%). Retail food environment measures explained 13.81% of the gap in mean age-adjusted adult obesity prevalence.Conclusions: Retail food environment explains a proportion of the gap in adult obesity prevalence observed between counties with a high proportion of African-American residents and counties with a low proportion of African-American residents. [ABSTRACT FROM AUTHOR]

Many restaurants are increasingly required to display calorie information on their menus. We present a study examining how consumers' food choices are affected by the presence of calorie information on restaurant menus. However, unlike prior research on this topic, we focus on the effect of calorie information on food choices made from a menu that contains both full size portions and half size portions of entrées. This different focus is important because many restaurants increasingly provide more than one portion size option per entrée. Additionally, we examine whether the impact of calorie information differs depending on whether full portions are cheaper per unit than half portions (non-linear pricing) or whether they have a similar per unit price (linear pricing). We find that when linear pricing is used, calorie information leads people to order fewer calories. This decrease occurs as people switch from unhealthy full sized portions to healthy full sized portions, not to unhealthy half sized portions. In contrast, when non-linear pricing is used, calorie information has no impact on calories selected. Considering the impact of calorie information on consumers' choices from menus with more than one entrée portion size option is increasingly important given restaurant and legislative trends, and the present research demonstrates that calorie information and pricing scheme may interact to affect choices from such menus. [ABSTRACT FROM AUTHOR]

Background: Studies suggest that the built environment with high numbers of fast food restaurants and convenience stores and low numbers of super stores and grocery stores are related to obesity, type II diabetes mellitus, and other chronic diseases. Since few studies assess these relationships at the county level, we aim to examine fast food restaurant density, convenience store density, super store density, and grocery store density and prevalence of type II diabetes among counties in South Carolina.Methods: Pearson's correlation between four types of food outlet densities- fast food restaurants, convenience stores, super stores, and grocery stores- and prevalence of type II diabetes were computed. The relationship between each of these food outlet densities were mapped with prevalence of type II diabetes, and OLS regression analysis was completed adjusting for county-level rates of obesity, physical inactivity, density of recreation facilities, unemployment, households with no car and limited access to stores, education, and race.Results: We showed a significant, negative relationship between fast food restaurant density and prevalence of type II diabetes, and a significant, positive relationship between convenience store density and prevalence of type II diabetes. In adjusted analysis, the food outlet densities (of any type) was not associated with prevalence of type II diabetes.Conclusions: This ecological analysis showed no associations between fast food restaurants, convenience stores, super stores, or grocery stores densities and the prevalence of type II diabetes. Consideration of environmental, social, and cultural determinants, as well as individual behaviors is needed in future research. [ABSTRACT FROM AUTHOR]

Taxes and subsidies are a public health approach to improving nutrient quality of food purchases. While taxes or subsidies influence purchasing, it is unclear whether they influence total energy or overall diet quality of foods purchased. Using a within subjects design, selected low nutrient dense foods (e.g. sweetened beverages, candy, salty snacks) were taxed, and fruits and vegetables and bottled water were subsidized by 12.5% or 25% in comparison to a usual price condition for 199 female shoppers in an experimental store. Results showed taxes reduced calories purchased of taxed foods (coefficient = -6.61, CI = -11.94 to -1.28) and subsidies increased calories purchased of subsidized foods (coefficient = 13.74, CI = 8.51 to 18.97). However, no overall effect was observed on total calories purchased. Both taxes and subsidies were associated with a reduction in calories purchased for grains (taxes: coefficient = -6.58, CI = -11.91 to -1.24, subsidies: coefficient = -12.86, CI = -18.08 to -7.63) and subsidies were associated with a reduction in calories purchased for miscellaneous foods (coefficient = -7.40, CI = -12.62 to -2.17) (mostly fats, oils and sugars). Subsidies improved the nutrient quality of foods purchased (coefficient = 0.14, CI = 0.07 to 0.21). These results suggest that taxes and subsidies can influence energy purchased for products taxed or subsidized, but not total energy purchased. However, the improvement in nutrient quality with subsidies indicates that pricing can shift nutritional quality of foods purchased. Research is needed to evaluate if differential pricing strategies based on nutrient quality are associated with reduction in calories and improvement in nutrient quality of foods purchased. [ABSTRACT FROM AUTHOR]

Background: Supermarket marketing activities have a major influence on consumer food purchases. This study aimed to assess and compare the contents of supermarket marketing circulars from a range of countries worldwide from an obesity prevention perspective.Methods: The contents of supermarket circulars from major supermarket chains in 12 non-random countries were collected and analysed over an eight week period from July to September 2014 (n=89 circulars with 12,563 food products). Circulars were largely English language and from countries representing most continents. Food products in 25 sub-categories were categorised as discretionary or non-discretionary (core) food or drinks based on the Australian Guide to Healthy Eating. The total number of products in each subcategory in the whole circular, and on front covers only, was calculated.Results: Circulars from most countries advertised a high proportion of discretionary foods. The only exceptions were circulars from the Philippines (no discretionary foods) and India (11% discretionary food). Circulars from six countries advertised more discretionary foods than core foods. Front covers tended to include a much greater proportion of healthy products than the circulars overall.Conclusions: Supermarket circulars in most of the countries examined include a high percentage of discretionary foods, and therefore promote unhealthy eating behaviours that contribute to the global obesity epidemic. A clear opportunity exists for supermarket circulars to promote rather than undermine healthy eating behaviours of populations. Governments need to ensure that supermarket marketing is included as part of broader efforts to restrict unhealthy food marketing. [ABSTRACT FROM AUTHOR]

We investigated how industry claim-makers countered concerns about obesity and other nutrition-related diseases in newspaper coverage from 2000, the year before the US Surgeon General's Call to Action on obesity, through 2012. We found that the food and beverage industry evolved in its response. The defense arguments were made by trade associations, industry-funded nonprofit groups, and individual companies representing the packaged food industry, restaurants, and the nonalcoholic beverage industry. Individual companies used the news primarily to promote voluntary self-regulation, whereas trade associations and industry-supported nonprofit groups directly attacked potential government regulations. There was, however, a shift away from framing obesity as a personal issue toward an overall message that the food and beverage industry wants to be "part of the solution" to the public health crisis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the display of food at non-food store checkouts; and to classify foods by type and nutrient content, presence of price promotions and whether food was at child height.Design: Cross-sectional survey of checkout displays at non-food stores. Foods were classified as 'less healthy' or healthier using the UK Food Standards Agency's Nutrient Profile Model. Written price promotions were recorded. Child height was defined as the sight line of an 11-year-old approximated from UK growth charts.Setting: A large indoor shopping mall, Gateshead, UK, February-March 2014.Subjects: Two hundred and five out of 219 non-food stores in the shopping mall directory which were open for trading.Results: Thirty-two (15·6%) of 205 non-food stores displayed food at the checkout. All displayed less healthy foods, and fourteen (43·8%) had healthier foods. Overall, 5911 checkout foods were identified. Of these, 4763 (80·6%) were 'less healthy'. No fruits, vegetables, nuts or seeds were found. Of 4763 less healthy foods displayed, 195 (4·1%) were subject to price promotions, compared with twelve of 1148 (1·0%) healthier foods (χ 2(df=1)=25·4, P<0·0001). There was no difference in the proportion of less healthy (95·1%) and healthier (96·2%) foods displayed at child height.Conclusions: Almost one-sixth of non-food stores displayed checkout food, the majority of which was 'less healthy' and displayed at child height. Less healthy food was more likely to be subject to a written price promotion than healthier food. Further research into the drivers and consequences of checkout food in non-food stores is needed. Public health regulation may be warranted. [ABSTRACT FROM AUTHOR]

Little research has addressed whether neighborhood context influences associations between fast food price, diet, and cardiometabolic health. We investigated these associations using 25 years of Coronary Artery Risk Development in Young Adults (CARDIA) study data (n=4,469, observations=21,134). We found a negative association between fast food price and consumption, with stronger inverse associations in more (vs. less) deprived neighborhoods [3rd tertile: β=-0.68 (95% CI: (-0.85, -0.51); 1st tertile: β=-0.22 (95% CI: -0.42, -0.02); p-interaction-0.002], and a similar association for BMI [3rd tertile: β=-1.34 (95% CI: -1.54, -1.14); 1st tertile: β=-0.45 (95% CI: -0.66, -0.25); p-interaction<0.001], but not insulin resistance [3rd tertile: β=-0.07 (95% CI: -0.24, 0.09); 1st tertile: β=0.09 (95% CI: -0.08, 0.26); p-interaction=0.40]. We observed no modification of fast food price by fast food availability. Future research on obesity disparities should consider potential differences in the association between fast food prices and health outcomes across neighborhood socioeconomic levels. [ABSTRACT FROM AUTHOR]

Americans have long considered fat problematic, and overweight individuals now endure a similar level of discrimination as other stigmatized groups (Latner et al. 2008). Weight-loss blogs serve as public forums in which bloggers demonstrate an understanding of the stigma against fat and detail dieting efforts. These blogs are also a space for dieters to trade information such as diet plans or products. This study conducted a link analysis to learn which consumer products were favored by weight-loss products. Results determined the bloggers avoided linking to food or diet products and instead favored exercise plans or training equipment. [ABSTRACT FROM AUTHOR]

Obesity may be the most difficult and elusive public health problem this country has ever encountered. Unlike the classical infectious diseases and plagues that killed millions in the past, it is not caused by deadly viruses or bacteria of a kind amenable to vaccines for prevention, nor are there many promising medical treatments so far. While diabetes, heart disease, and kidney failure can be caused by obesity, it is easier to treat those conditions than one of their causes. I call obesity elusive partly because of the disturbingly low success rate in treating it, but also because it requires changing the patterns, woven deeply into our social fabric, of food and beverage commerce, personal eating habits, and sedentary lifestyles. It also raises the most basic ethical and policy questions: how far can government and business go in trying to change behavior that harms health, what are the limits of market freedom for industry, and how do we look upon our bodies and judge those of others?. [ABSTRACT FROM AUTHOR]

Background: The rising prevalence of childhood obesity is a key public health issue worldwide. Limited evidence suggests that there may be interactions between environmental factors at a neighborhood level and the development of obesity, with the availability and accessibility of food outlets being potentially important.Purpose: To examine how the weight status and dietary intake of 1669 children aged 9-10 years was associated with neighborhood food outlets in a cross-sectional study.Methods: Availability of food outlets was computed from GIS data for each child's unique neighborhood. Outlets were grouped into BMI-healthy, BMI-unhealthy, or BMI-intermediate categories according to food type sold. Weight status measurements were objectively collected, and food intake was recorded using 4-day food diaries. Data were collected in 2007 and analyzed in 2009.Results: Availability of BMI-healthy outlets in neighborhoods was associated with lower body weight (1.3 kg, p=0.03); BMI (0.5 kg/m(2), p=0.02); BMI z-score (0.20, p=0.02); waist circumference (1.3 cm, p=0.02); and percentage body fat (1.1%, p=0.03) compared to no availability. In contrast, neighborhood availability of BMI-unhealthy outlets was inversely associated with body weight (1.3 kg, p=0.02); BMI (0.4 kg/m(2), p=0.05); BMI z-score (0.15, p=0.05); waist circumference (1.1 cm, p=0.04); and percentage body fat (1.0%, p=0.03). Unhealthy food intake (fizzy drinks 15.3%, p=0.04, and noncarbonated "fruit" drinks 11.8%, p=0.03) was also associated with availability of BMI-unhealthy food outlets.Conclusions: Features of the built environment relating to food purchasing opportunities are correlated with weight status in children. [ABSTRACT FROM AUTHOR]

We measure the effect of a large nationwide tax reform on sugar-added drinks and caloric-dense food introduced in Mexico in 2014. Using scanner data containing weekly purchases of 47,973 barcodes by 8,130 households and an RD design, we find that calories purchased from taxed drinks and taxed food decreased respectively by 2.7% and 3%. However, this was compensated by increases from untaxed categories, such that total calories purchased did not change. We find increases in cholesterol (12.6%), sodium (5.8%), saturated fat (3.1%), carbohydrates (2%), and proteins (3.8%). [ABSTRACT FROM AUTHOR]

The author comments on the study "Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten up randomised controlled trial," by K. Jolly and colleagues that ascertained length of commercially provided weight management services to maximize the weight loss. He believes that health professionals, regardless of the setting, could not learn from the methods employed by commercially delivered programmes.