Faculty Bibliography

In 2012, fast-food companies spent $4.6 billion on ads, while $116 million was spent advertising fruits and vegetables. Because young people see tons of food ads on adult-targeted programs, it makes sense to cite the whole $4.6 billion figure

OBJECTIVE: Examine the impact of the Health Self-Empowerment Theory-based, culturally sensitive Health Self-Empowerment (HSE) Workshop Series to Modify and Prevent Obesity on levels of health promoting (health-smart) behaviors, motivators of and barriers to these behaviors, health promoting lifestyle variables, and health status indicators (Body Mass Index [BMI] and blood pressure) among a culturally diverse sample of overweight/obese adults from mostly low income households. DESIGN: 153 overweight/obese adults participated in an Immediate Treatment (IT) Group (n = 100) or a Waitlist Control (WC) Group (n = 53). RESULTS: Post-intervention, the IT Group compared to the WC Group reported (a) significantly higher engagement in physical activity and healthy eating, (b) significantly less intake of calories, total fat, transfat, saturated fat, sugar, and added sugar, (c) significantly higher motivators for engaging in two of four specific health-smart behaviors, (d) significantly lower barriers to engaging in three of four specific health-smart behaviors, and (e) significantly lower BMI and systolic blood pressure. CONCLUSION: The HSE Workshop Series may be an effective intervention for treating and preventing obesity among diverse low-income adults - individuals who often perceive/experience limited power over their health. Health care providers, particularly physicians, have important health empowerment roles in this intervention.

OBJECTIVE: This study quantified professional athletes' endorsement of food and beverages, evaluated the nutritional quality of endorsed products, and determined the number of television commercial exposures of athlete-endorsement commercials for children, adolescents, and adults. METHODS: One hundred professional athletes were selected on the basis of Bloomberg Businessweek's 2010 Power 100 rankings, which ranks athletes according to their endorsement value and prominence in their sport. Endorsement information was gathered from the Power 100 list and the advertisement database AdScope. Endorsements were sorted into 11 endorsement categories (eg, food/beverages, sports apparel). The nutritional quality of the foods featured in athlete-endorsement advertisements was assessed by using a Nutrient Profiling Index, whereas beverages were evaluated on the basis of the percentage of calories from added sugar. Marketing data were collected from AdScope and Nielsen. RESULTS: Of 512 brands endorsed by 100 different athletes, sporting goods/apparel represented the largest category (28.3%), followed by food/beverages (23.8%) and consumer goods (10.9%). Professional athletes in this sample were associated with 44 different food or beverage brands during 2010. Seventy-nine percent of the 62 food products in athlete-endorsed advertisements were energy-dense and nutrient-poor, and 93.4% of the 46 advertised beverages had 100% of calories from added sugar. Peyton Manning (professional American football player) and LeBron James (professional basketball player) had the most endorsements for energy-dense, nutrient-poor products. Adolescents saw the most television commercials that featured athlete endorsements of food. CONCLUSIONS: Youth are exposed to professional athlete endorsements of food products that are energy-dense and nutrient-poor.

OBJECTIVE: This study aimed to compare diet soda drinkers, regular soda drinkers, and individuals who do not regularly consume soda on clinically significant eating disorder psychopathology, including binge eating, overeating, and purging. METHOD: Participants (n=2077) were adult community volunteers who completed an online survey that included the Eating Disorder Examination Questionnaire and questions regarding binge eating behaviors, purging, current weight status, and the type and frequency of soda beverages consumed. RESULTS: Diet soda drinkers (34%, n=706) reported significantly higher levels of eating, shape, and weight concerns than regular soda drinkers (22%, n=465), who in turn reported higher levels on these variables than non-soda drinkers (44%, n=906). Diet soda drinkers were more likely to report binge eating and purging than regular soda drinkers, who were more likely to report these behaviors than non-soda drinkers. Consumption of any soda was positively associated with higher BMI, though individuals who consumed regular soda reported significantly higher BMI than diet soda drinkers, who in turn reported higher weight than those who do not consume soda regularly. CONCLUSIONS: Individuals who consume soda regularly reported higher BMI and more eating psychopathology than those who do not consume soda. These findings extend previous research demonstrating positive associations between soda consumption and weight.

OBJECTIVE: Food marketing has been identified as a significant driver of the childhood obesity epidemic. The purpose of the present study was to (i) conduct a content analysis of the types of sports references that appear on supermarket food and beverage products and (ii) assess each product's nutritional and marketing profile. DESIGN: This was a descriptive study. Every product featuring sports references on the packaging was purchased in two major supermarkets during 2010. A content analysis was conducted and nutritional evaluations were made based on the Nutrient Profile Model, a validated nutrition model. Marketing data were obtained from The Nielsen Company. SETTING: Two major supermarkets in Connecticut, USA. SUBJECTS: Food and beverage products (n 102) were selected from two supermarkets. RESULTS: The 102 products (fifty-three foods and forty-nine beverages) had sports references as part of their packaging: 72.5 % featured a character exercising, 42.2 % were endorsed by a professional sports entity and 34.0 % were child-targeted. The median nutrition score for food products was 36 (1 = unhealthiest and 100 = healthiest; scores of >/=63 are considered healthy according to this model). More than two-thirds of beverages (69.4 %) were 100 % sugar-sweetened. Children saw significantly more commercials for these products than adults. CONCLUSIONS: Companies place sports figures on food and beverage products that are child-targeted and unhealthy.

OBJECTIVE: The U.S. Food and Drug Administration and Institute of Medicine are currently investigating front-of-package (FOP) food labelling systems to provide science-based guidance to the food industry. The present paper reviews the literature on FOP labelling and supermarket shelf-labelling systems published or under review by February 2011 to inform current investigations and identify areas of future research. DESIGN: A structured search was undertaken of research studies on consumer use, understanding of, preference for, perception of and behaviours relating to FOP/shelf labelling published between January 2004 and February 2011. RESULTS: Twenty-eight studies from a structured search met inclusion criteria. Reviewed studies examined consumer preferences, understanding and use of different labelling systems as well as label impact on purchasing patterns and industry product reformulation. CONCLUSIONS: The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems' abilities to influence consumer behaviour is needed.

BACKGROUND: The U.S. food and beverage industry recently released a new front-of-package nutrition labeling system called Facts Up Front that will be used on thousands of food products. PURPOSE: To test consumer understanding of the Facts Up Front system (Facts Up Front) compared to the Multiple Traffic Light system (Traffic Light). Facts Up Front displays grams/milligrams and percentage daily value information for various nutrients; Traffic Light uses an interpretive color-coded scheme to alert consumers to low, medium, and high levels of certain nutrients. DESIGN: Participants in an Internet-based study were randomized to one of five front-of-package label conditions: (1) no label; (2) Traffic Light; (3) Traffic Light plus information about protein and fiber (Traffic Light+); (4) Facts Up Front; or (5) Facts Up Front plus information about "nutrients to encourage" (Facts Up Front+). SETTING/PARTICIPANTS: A total of 703 adults recruited through an online database in May 2011 participated in this study, and data were analyzed in June 2011. MAIN OUTCOME MEASURES: Total percentage correct quiz scores were generated reflecting participants' ability to compare two foods on nutrient levels, based on their labels, and to estimate amounts of saturated fat, sugar, sodium, fiber and protein in the foods. RESULTS: The front-of-package label groups outperformed the control group on nearly all of the nutrient quizzes (p<0.05). The control group did not differ from the Facts Up Front group on the saturated fat quiz, or from the Facts Up Front+ group on the sugars quiz. Those in the Traffic Light+ group had the best overall performance (>80% on all quizzes). CONCLUSIONS: Overall, those in the Traffic Light+ condition performed better than those in the Facts Up Front conditions on measures of nutrition knowledge and label perceptions. TRIAL REGISTRATION: This study is registered at clinicaltrials.gov NCT01626729.

OBJECTIVE: The 'Smart Choices' programme was an industry-driven, front-of-package (FOP) nutritional labelling system introduced in the USA in August 2009, ostensibly to help consumers select healthier options during food shopping. Its nutritional criteria were developed by members of the food industry in collaboration with nutrition and public health experts and government officials. The aim of the present study was to test the extent to which products labelled as 'Smart Choices' could be classified as healthy choices on the basis of the Nutrient Profile Model (NPM), a non-industry-developed, validated nutritional standard. DESIGN: A total of 100 packaged products that qualified for a 'Smart Choices' designation were sampled from eight food and beverage categories. All products were evaluated using the NPM method. RESULTS: In all, 64 % of the products deemed 'Smart Choices' did not meet the NPM standard for a healthy product. Within each 'Smart Choices' category, 0 % of condiments, 8.70 % of fats and oils, 15.63 % of cereals and 31.58 % of snacks and sweets met NPM thresholds. All sampled soups, beverages, desserts and grains deemed 'Smart Choices' were considered healthy according to the NPM standard. CONCLUSIONS: The 'Smart Choices' programme is an example of industries' attempts at self-regulation. More than 60 % of foods that received the 'Smart Choices' label did not meet standard nutritional criteria for a 'healthy' food choice, suggesting that industries' involvement in designing labelling systems should be scrutinized. The NPM system may be a good option as the basis for establishing FOP labelling criteria, although more comparisons with other systems are needed.

INTRODUCTION: Governments throughout the world are using or considering various front-of-package (FOP) food labeling systems to provide nutrition information to consumers. Our web-based study tested consumer understanding of different FOP labeling systems. METHODS: Adult participants (N = 480) were randomized to 1 of 5 groups to evaluate FOP labels: 1) no label; 2) multiple traffic light (MTL); 3) MTL plus daily caloric requirement icon (MTL+caloric intake); 4) traffic light with specific nutrients to limit based on food category (TL+SNL); or 5) the Choices logo. Total percentage correct quiz scores were created reflecting participants' ability to select the healthier of 2 foods and estimate amounts of saturated fat, sugar, and sodium in foods. Participants also rated products on taste, healthfulness, and how likely they were to purchase the product. Quiz scores and product perceptions were compared with 1-way analysis of variance followed by post-hoc Tukey tests. RESULTS: The MTL+caloric intake group (mean [standard deviation], 73.3% [6.9%]) and Choices group (72.5% [13.2%]) significantly outperformed the no label group (67.8% [10.3%]) and the TL+SNL group (65.8% [7.3%]) in selecting the more healthful product on the healthier product quiz. The MTL and MTL+caloric intake groups achieved average scores of more than 90% on the saturated fat, sugar, and sodium quizzes, which were significantly better than the no label and Choices group average scores, which were between 34% and 47%. CONCLUSION: An MTL+caloric intake label and the Choices symbol hold promise as FOP labeling systems and require further testing in different environments and population subgroups.