Sarah A. Rydell

Effects of calorie labeling and value size pricing on fast food meal choices: results from an experimental trial.

BackgroundAlthough point-of-purchase calorie labeling at restaurants has been proposed as a strategy for improving consumer food choices, a limited number of studies have evaluated this approach. Likewise, little research has been conducted to evaluate the influence of value size pricing on restaurant meal choices.MethodsTo examine the effect of point-of-purchase calorie information and value size pricing on fast food meal choices a randomized 2 × 2 factorial experiment was conducted in which participants ordered a fast food meal from one of four menus that varied with respect to whether calorie information was provided and whether value size pricing was used. Study participants included 594 adolescents and adults who regularly ate at fast food restaurants. Study staff recorded the foods ordered and consumed by each participant. Participants also completed surveys to assess attitudes, beliefs and practices related to fast food and nutrition.ResultsNo significant differences in the energy composition of meals ordered or eaten were found between menu conditions. The average energy content of meals ordered by those randomized to a menu that included calorie information and did not include value size pricing was 842 kcals compared with 827 kcals for those who ordered their meal from a menu that did not include calorie information but had value size pricing (control menu). Results were similar in most analyses conducted stratified by factors such as age, race and education level.ConclusionAdditional research is needed to better evaluate the effects of calorie labeling and value size pricing on fast food meal choices. Studies in which participants are repeatedly exposed to these factors are needed since long term exposure may be required for behavior change.

Family Meals: Perceptions of Benefits and Challenges among Parents of 8- to 10-Year-Old Children

The study purpose was to examine parental perceptions of the mealtime environment in families with school-aged children and identify strategies to improve the dietary quality of meals. Cross-sectional surveys were completed by a convenience sample of 107 parents (86% mothers, 14% fathers) of 8- to 10-year-old children who were recruited from afterschool child care programs/elementary schools. SAS (version 9.1) was used to produce descriptive frequencies of parental reports of positive and negative perceptions of mealtime. Parents reported frequent family meals; however, they indicated that family dinners were eaten at full-service restaurants, purchased from fast-food establishments, or picked up as takeout foods at least weekly (47.0%, 28.3%, and 23.8%, respectively). Conflicts about food were problematic for some families (40.2% on at least some days), and appeared to be related to childrens food pickiness. Parents reported many benefits of family meals, including time for conversation, feelings of togetherness, shared nutrition, and ceremony. Areas where parents desired change included assistance with meal planning, food preparation, and clean-up; spending more time at meals; assistance with childrens food pickiness; new recipes and meal ideas; and decreasing conflict at mealtimes. Findings suggest that interventions to increase family meal frequency and promote healthful foods at mealtimes should address promoting food acceptance among children, sharing responsibilities among parents and children for meal planning and preparation, decreasing conflict at meals, and eating out healthfully.

Prevalence of Use of Herbal Products by Adults in the Minneapolis/St Paul, Minn, Metropolitan Area

OBJECTIVES To document the prevalence of use of herbal products among adults in a large metropolitan area and to examine issues surrounding such use. SUBJECTS AND METHODS Of people aged 18 years and older residing in the Minneapolis/St Paul, Minn, metropolitan area, 752 were randomly selected from Minnesota Department of Public Safety Driver and Vehicle Service Division data tapes. Between June and August 1999, surveys were mailed to determine use of any herb and use of 13 specific herbs. Rationale for use, perceived efficacy, and source of product information were assessed for each of the specific herbs. RESULTS Of the initial 752 persons, 580 were eligible, and 376 returned a completed survey, resulting in a response rate of 65%. When asked whether they had used an herb during the past 12 months, 230 respondents (61.2%) reported that they had. Prevalence of use of specific herbs ranged from 30.9% for ginseng to 3.0% for milk thistle. The most commonly reported reasons for using herbs varied by the type of herb, although for 5 of the herbs, the most frequently mentioned reason was to promote general health/well-being. For 11 of the 13 herbs, less than 60% of those who used the herb rated it as effective or very effective. Family, friends, and written materials were the leading sources of product information among those taking 9 of the 13 specific herbs. CONCLUSIONS Herbs are used frequently to treat or prevent an array of health conditions. At present, people who use herbal products appear to rely predominantly on family and friends for information.

Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions

OBJECTIVE We used validated sensitive and specific questions associated with clinically confirmed diagnoses of unexplained vulvar pain (vulvodynia) to compare the cumulative incidence of vulvar pain and prevalence of care-seeking behavior in Boston metropolitan area (BMA) and in Minneapolis/Saint Paul metropolitan area (MSP) from 2001 through 2005 using census-based data, and 2010 through 2012, using outpatient community-clinic data, respectively. STUDY DESIGN We received self-administered questionnaires from 5440 women in BMA and 13,681 in MSP, 18-40 years of age, describing their history of vulvar burning or pain on contact that persisted >3 months that limited/prevented intercourse. RESULTS By age 40 years, 7-8% in BMA and MSP reported vulvar pain consistent with vulvodynia. Women of Hispanic origin compared to whites were 1.4 times more likely to develop vulvar pain symptoms (95% confidence interval, 1.1-1.8). Many women in MSP (48%) and BMA (30%) never sought treatment, and >50% who sought care with known health care access received no diagnosis. CONCLUSION Using identical screening methods, we report high prevalence of vulvar pain in 2 geographic regions, and that access to health care does not increase the likelihood of seeking care for chronic vulvar pain.

Why eat at fast-food restaurants: reported reasons among frequent consumers.

A convenience sample of adolescents and adults who regularly eat at fast-food restaurants were recruited to participate in an experimental trial to examine the effect of nutrition labeling on meal choices. As part of this study, participants were asked to indicate how strongly they agreed or disagreed with 11 statements to assess reasons for eating at fast-food restaurants. Logistic regression was conducted to examine whether responses differed by demographic factors. The most frequently reported reasons for eating at fast-food restaurants were: fast food is quick (92%), restaurants are easy to get to (80%), and food tastes good (69%). The least frequently reported reasons were: eating fast food is a way of socializing with family and friends (33%), restaurants have nutritious foods to offer (21%), and restaurants are fun and entertaining (12%). Some differences were found with respect to the demographic factors examined. It appears that in order to reduce fast-food consumption, food and nutrition professionals need to identify alternative quick and convenient food sources. As motivation for eating at fast-food restaurants appears to differ somewhat by age, sex, education, employment status, and household size, tailored interventions could be considered.

Effects of portion size on chronic energy intake

BackgroundThis study experimentally examined the effects of repeated exposure to different meal portion sizes on energy intake.MethodsNineteen employees of a county medical center were given free box lunches for two months, one month each of 1528 and 767 average kcal. Foods were identical in the two conditions, but differed in portion size. Meals averaged 44% calories from fat. Participants self-reported how much of each lunch was eaten. Unannounced 24-hour dietary recalls were also conducted by phone twice per week during each exposure period.ResultsMean energy intake at the lunch meal was 332 kcal/day higher in large lunch than in small lunch periods (p < .001). Mean 24-hour energy intake was 278 kcal/day higher in large versus small lunch periods (p < .001). There was no evidence of compensation over time. Average weight change over the month of large and small lunches was 0.64 ± 1.16 kg and 0.06 ± 1.03 kg, respectively, about what would be expected with the observed differences in energy intake.ConclusionThis study suggests that chronic exposure to large portion size meals can result in sustained increases in energy intake and may contribute to body weight increases over time.

Healthy Home Offerings via the Mealtime Environment (HOME): Feasibility, Acceptability, and Outcomes of a Pilot Study

The primary objective was to develop and test the feasibility and acceptability of the Healthy Home Offerings via the Mealtime Environment (HOME) program, a pilot childhood obesity prevention intervention aimed at increasing the quality of foods in the home and at family meals. Forty‐four child/parent dyads participated in a randomized controlled trial (n = 22 in intervention and n = 22 in control conditions). The intervention program, held at neighborhood facilities, included five, 90‐min sessions consisting of interactive nutrition education, taste testing, cooking skill building, parent discussion groups, and hands‐on meal preparation. Children (8–10‐year olds) and parents (89% mothers) completed assessments at their home at baseline, postintervention, and 6‐month follow‐up, including psychosocial surveys, anthropometry, 24‐h dietary recalls, and home food availability and meal offering inventories. Feasibility/acceptability was assessed with participant surveys and process data. All families completed all three home‐based assessments. Most intervention families (86%) attended at least four of five sessions. Nearly all parents (95%) and 71% of children rated all sessions very positively. General linear models indicated that at postintervention, compared to control children, intervention children were significantly more likely to report greater food preparation skill development (P < 0.001). There were trends suggesting that intervention children had higher consumption of fruits and vegetables (P < 0.08), and higher intakes of key nutrients (all P values <0.05) than control children. Obesity changes did not differ by condition. Not all findings were sustained at 6‐month follow‐up. Obesity prevention programming with families in community settings is feasible and well accepted. Results demonstrate the potential of the HOME program.

Two Novel Treatments to Reduce Overeating in Overweight Children: A Randomized Controlled Trial

OBJECTIVE Our purpose in this study was to examine 2 treatments targeted at reducing eating in the absence of hunger in overweight and obese children. METHOD Thirty-six overweight and obese 8- to 12-year-old children (58% female; mean age = 10.3 years, SD = 1.3), with high scores on eating in the absence of hunger, and their parents were randomly assigned to an 8-week childrens appetite awareness training or cue exposure treatment-food. Children completed an eating in the absence of hunger (EAH) paradigm, an Eating Disorder Examination interview for children, and three 24-hr dietary recalls, and their height and weight were measured. Parents completed the EAH Questionnaire and the Binge Eating Scale, and their height and weight were measured. Assessments were conducted at baseline, posttreatment, and 6 and 12 months posttreatment. RESULTS Results showed that both treatments resulted in significant decreases in binge eating in children over time. Additionally, children in the food cue exposure treatment showed significant decreases in EAH posttreatment and 6 months posttreatment, but children in the appetite awareness training showed no change in EAH. Neither treatment produced significant effects on caloric intake in children or on any of the parent outcomes. CONCLUSIONS This study demonstrates that training in food cue responsitivity and appetite awareness has the potential to be efficacious for reducing EAH and binge eating in children. Because these data are preliminary, further treatment development and randomized controlled studies are needed.

An Intervention Based on Schachter’s Externality Theory for Overweight Children: The Regulation of Cues Pilot

OBJECTIVE This study evaluated the feasibility, acceptability, and initial efficacy of an intervention based on Schachters externality theory; the Regulation of Cues (ROC) program. METHODS 44 overweight and obese 8-12-year-old children and their parents were randomly assigned to a 4-month ROC program or the control group. Outcomes were assessed at baseline, posttreatment, and 4 months posttreatment and included acceptability and feasibility, body weight, and eating behaviors. RESULTS The ROC program had moderate to high acceptability ratings. Significant improvements were found for the ROC group compared with the control group on child food responsiveness at posttreatment and eating in the absence of hunger at 4 months posttreatment. Improvements were seen for the ROC group compared with the control group on body weight measures and food responsiveness, although these only approached significance. CONCLUSION The ROC intervention may be useful with overweight and obese children. Larger, fully powered studies are needed to further evaluate the efficacy of this model.

Results from an experimental trial at a Head Start center to evaluate two meal service approaches to increase fruit and vegetable intake of preschool aged children

BackgroundStrategies to increase fruit and vegetable consumption of preschool aged children are needed.ObjectivesEvaluate the independent effects of the following meal service strategies on intake of fruits and vegetables of preschool children: 1.) Serving fruits and vegetables in advance of other menu items as part of traditional family style meal service; and 2.) Serving meals portioned and plated by providers.MethodsFifty-three preschool aged children completed a randomized crossover experiment conducted at a Head Start center in Minneapolis, MN. Over a six week trial period each of the experimental meal service strategies (serving fruits and vegetable first and serving meals portioned by providers) was implemented during lunch service for two one-week periods. Two one-week control periods (traditional family style meal service with all menu items served at once) were also included over the six week trial period. Childrens lunch intake was observed as a measure of food and nutrient intake during each experimental condition.ResultsFruit intake was significantly higher (p<0.01) when fruits and vegetables were served in advance of other meal items (0.40 servings/meal) compared to the traditional family style meal service control condition when they were served in tandem with other menu items (0.32 servings/meal). Intakes of some nutrients found in fruits (vitamin A and folate) were concomitantly higher. In contrast, fruit and vegetable intakes were significantly lower and energy intake significantly higher during the provider portioned compared with control condition.ConclusionsServing fruits in advance of other meal items may be a low cost easy to implement strategy for increasing fruit intake in young children. However, serving vegetables first does not appear to increase vegetable intake. Results provide support for current recommendations for traditional family style meal service in preschool settings.