Professor Monique Raats (she/her)

Consumption of added sugar is a cause of concern due to links with non-communicable diseases. Non-nutritive sweeteners (NNSs) are increasingly seen as a viable alternative. Health and safety of NNSs are well studied, but not their environmental impact. In this study the environmental impact of NNSs aspartame and neotame are presented. This is the first such study attempting to quantify environmental impact of neotame. Life cycle data are derived from literature, alongside stoichiometric reaction equations and resulting heat changes. Global warming potential (GWP) of 1 kg aspartame is found to be 29.25 kgCO2-eq/kg, and 1 kg neotame to be 43.42 kgCO2-eq/kg. It is found that both NNSs have great potential to replace the sweetness of added sugar with reduced environmental impact, e.g., GWP of neotame is found to be 0.4–0.7%, and aspartame 10.5–18.4%, of an equivalent sweetness for sucrose. This study demonstrates that environmental impact of the additional resources required to make neotame from aspartame are more than offset by the increase in perceived sweetness, from 200 to 8000-times. It is shown that there are significant uncertainties related to life cycle inventory data and data derivation method. Therefore, this work further highlights the difficulties of conducting a life cycle assessment of highly refined industrial food additives and the need for good industrial collaboration in obtaining data. •First life cycle assessment of non-nutritive sweetener neotame.•Global warming potential (GWP) of 1 kg aspartame found to be 29.25 kgCO2-eq/kg.•GWP of 1 kg neotame found to be 43.42 kgCO2-eq/kg.•On iso-sweetness basis, GWP aspartame is 82–89% less than sugar, neotame 99% less.•Study highlights need for greater collaboration with producers of these sweeteners.

Consumption of added sugar is a cause of concern due to links with non-communicable diseases. Non-nutritive sweeteners (NNSs) are increasingly seen as a viable alternative. Health and safety of NNSs are well studied, but not their environmental impact. In this study the environmental impact of NNSs aspartame and neotame are presented. This is the first such study attempting to quantify environmental impact of neotame. Life cycle data are derived from literature, alongside stoichiometric reaction equations and resulting heat changes. Global warming potential (GWP) of 1 kg aspartame is found to be 29.25 kgCO2-eq/kg, and 1 kg neotame to be 43.42 kgCO2-eq/kg. It is found that both NNSs have great potential to replace the sweetness of added sugar with reduced environmental impact, e.g., GWP of neotame is found to be 0.4–0.7%, and aspartame 10.5–18.4%, of an equivalent sweetness for sucrose. This study demonstrates that environmental impact of the additional resources required to make neotame from aspartame are more than offset by the increase in perceived sweetness, from 200 to 8000-times. It is shown that there are significant uncertainties related to life cycle inventory data and data derivation method. Therefore, this work further highlights the difficulties of conducting a life cycle assessment of highly refined industrial food additives and the need for good industrial collaboration in obtaining data. •First life cycle assessment of non-nutritive sweetener neotame.•Global warming potential (GWP) of 1 kg aspartame found to be 29.25 kgCO2-eq/kg.•GWP of 1 kg neotame found to be 43.42 kgCO2-eq/kg.•On iso-sweetness basis, GWP aspartame is 82–89% less than sugar, neotame 99% less.•Study highlights need for greater collaboration with producers of these sweeteners.

Purpose There is increasing concern about the detrimental health effects of added sugar in food and drink products. Sweeteners are seen as a viable alternative. Much work has been done on health and safety of using sweeteners as a replacement for added sugar, but very little on their sustainability. This work aims to bridge that gap with a life cycle assessment (LCA) of sucralose derived from cane sugar grown in the United States of America (USA). Methods An attributional, cradle-to-gate LCA was conducted on sucralose production in the USA. Primary data were derived from literature for the chlorination process, and all other data from background sources. Results are reported via the ReCiPe 2016 (H) method, with focus given to land use, global warming potential (GWP), marine eutrophication, mineral resource scarcity, and water consumption. Because sucralose has a much greater perceived sweetness than sugar, impacts are expressed both in absolute terms of 1 kg mass and in relative sweetness equivalence terms to 1 kg sugar. Scenario modelling explores the sensitivity of the LCA results to change in key parameters. This research was conducted as part of the EU Horizon 2020 project SWEET (Sweeteners and sweetness enhancers: Impact on health, obesity, safety and sustainability). Results and discussion GWP for 1 kg sucralose was calculated to be 71.83 kgCO2-eq/kg (sugar from sugarcane is 0.77 kgCO2-eq/kg). However, on a sweetness equivalence basis, GWP of sucralose reduces to 0.12 kgCO2-eq/kgSE. Production of reagents was the main contributor to impact across most impact categories. Sugar (starting material for sucralose production) was not a majority contributor to any impact category, and changing the source of sugar has little effect upon net impact (average 2.0% variation). Instead, uncertainty in reference data is a greater source of variability: reagent use optimization reduces average impact of sucralose production by approximately 45.4%. In general, sucralose has reduced impact compared to sugar on an equivalent sweetness basis, however, due to data uncertainty, the reduction is not significant for all impact categories. Conclusion This LCA is the first for sucralose produced from cane sugar produced in the USA. Results indicate that sucralose has the potential to reduce the environmental impact of replacing the sweet taste of sugar. However, data were derived from literature and future collaboration with industry would help in reducing identified uncertainties. Accounting for functional use of sucralose in food and drink formulations is also necessary to fully understand the entire life cycle impact.

Purpose There is increasing concern about the detrimental health effects of added sugar in food and drink products. Sweeteners are seen as a viable alternative. Much work has been done on health and safety of using sweeteners as a replacement for added sugar, but very little on their sustainability. This work aims to bridge that gap with a life cycle assessment (LCA) of sucralose derived from cane sugar grown in the United States of America (USA). Methods An attributional, cradle-to-gate LCA was conducted on sucralose production in the USA. Primary data were derived from literature for the chlorination process, and all other data from background sources. Results are reported via the ReCiPe 2016 (H) method, with focus given to land use, global warming potential (GWP), marine eutrophication, mineral resource scarcity, and water consumption. Because sucralose has a much greater perceived sweetness than sugar, impacts are expressed both in absolute terms of 1 kg mass and in relative sweetness equivalence terms to 1 kg sugar. Scenario modelling explores the sensitivity of the LCA results to change in key parameters. This research was conducted as part of the EU Horizon 2020 project SWEET (Sweeteners and sweetness enhancers: Impact on health, obesity, safety and sustainability). Results and discussion GWP for 1 kg sucralose was calculated to be 71.83 kgCO2-eq/kg (sugar from sugarcane is 0.77 kgCO2-eq/kg). However, on a sweetness equivalence basis, GWP of sucralose reduces to 0.12 kgCO2-eq/kgSE. Production of reagents was the main contributor to impact across most impact categories. Sugar (starting material for sucralose production) was not a majority contributor to any impact category, and changing the source of sugar has little effect upon net impact (average 2.0% variation). Instead, uncertainty in reference data is a greater source of variability: reagent use optimization reduces average impact of sucralose production by approximately 45.4%. In general, sucralose has reduced impact compared to sugar on an equivalent sweetness basis, however, due to data uncertainty, the reduction is not significant for all impact categories. Conclusion This LCA is the first for sucralose produced from cane sugar produced in the USA. Results indicate that sucralose has the potential to reduce the environmental impact of replacing the sweet taste of sugar. However, data were derived from literature and future collaboration with industry would help in reducing identified uncertainties. Accounting for functional use of sucralose in food and drink formulations is also necessary to fully understand the entire life cycle impact.

The concept of early nutrition programming is appearing in policy documents, leaflets and magazine articles with different types of statements. However, the level of representation and influence of this concept is unknown in the area of infant nutrition. We established the degree of reflection and the impact of the concept of nutrition programming among the different government stakeholders of infant nutrition in four European countries. In each country, a list of stakeholders in the area of infant feeding was established and key persons responsible for the remit of infant nutrition were identified. We conducted standardised face-to-face or phone interviews from January 2006 to January 2007. The interview guide included questions about the concept of nutrition programming. All interviews were digitally recorded and qualitative data analysis was done using QRS NVivo V2. In total, we analyzed 17 interviews from government organizations in England (5 interviews), Germany (4 interviews), Hungary (3 interviews) and Spain (5 interviews). The concept of nutrition programming was recognized from 4/5 English and 3/4 German interviewees, whereby one organisation reflected the concept in their documents in both countries. In Hungary, 1/3 interviewees recognised the concept and reflected it in their documents. All interviewed Spanish governmental bodies (5/5) recognised the concept of nutrition programming and three of them reflected the concept in their documents. The concept of early nutrition programming was widely recognized among the key persons of government bodies in all four European countries. However, the concept was not necessarily represented in the produced documents.

Aims: To identify and describe infant feeding policy documents in Hungary and compare them to the documents of other four European countries (England, Finland, Germany and Spain). The question was also addressed how the phenomenon of nutritional programming was represented in the documents. Subjects: Policy documents on infant feeding were identified and analyzed in the five European countries by using uniform methods for searching and coding. Results: Twenty-six documents were identified: 4 in England, 2 in Finland, 9 in Germany, 6 in Hungary and 5 in Spain. Altogether 203 statements linked to references were identified: benefits of breast-feeding in general (24%), protection against infections (32%), long-term advantages like the prevention of diabetes (31%) or allergy (12%). Considerable variations were found within and between countries in the evaluation of the duration and character of the positive effects. The majority of the statements in the Hungarian documents referred either to the role of breast-feeding in infection protection (n = 8), or to long-term protective effects (n = 13). Conclusion: Policy documents in the study countries varied both in their extent and in the description of the long-term effects of infant nutrition. Majority of the documents failed to contain evidence based discussion of the phenomenon of early nutritional programming.

Parents’ decisions about whether to breastfeed their infant, and when to introduce complementary foods, are important public health issues. Breastfeeding has beneficial health effects and is widely promoted. Leaflets and magazine articles on infant feeding were collected in 2005, in five European countries (England, Finland, Germany, Hungary, Spain), and screened for statements that link feeding behaviours to infant health outcomes. A total of 127 leaflets contained 512 statements (0.38 / published page). Magazines contained approximately 1 article / month. Health outcomes were more intensively covered in England and Germany. Most statements referred to short term health implications. Lack of scientific agreement may underlie lack of cover of longer term health effects. Scope may exist to promote improved infant feeding practices by increasing the quantity and specificity of messages about health effects. Further research is required to evaluate the impact of alternative means of providing information on infant feeding practices.

Specific food supplements are essential during preconception and pregnancy to ensure adequate intake of vitamins and minerals to support fetal growth and development and metabolic changes in the maternal body. Our objective was to identify food supplement recommendations, particularly those of folic acid, iron, Vitamin D, and iodine, during preconception and/or pregnancy across a geographically diverse range of countries. Further, we investigated whether country location and income-level related to the recommendations. We performed an electronic search and identified country-specific preconception and pregnancy food supplement recommendations, policy documents, and official guidelines of national organizations informing recommendations. To ensure the data were as accurate as possible, country-specific experts were contacted. Data were collected in 2017 and reevaluated in 2022. Country income level was determined by the World Bank classification. Each inspected country (n = 43) recommended folic acid supplementation, typically 400 µg/day, before and during pregnancy. About half of the countries recommended an iron supplement (dose range, 16–195 mg/day) and one quarter Vitamin D (typically 10 µg/d in higher latitudes) and iodine (150–200 µg/day). Country location and income level had some influence on the recommendations. Vitamin D was more often recommended in higher latitude, high-income countries. Almost all upper-middle and lower-middle income countries recommended iron supplementation, whereas less than one third of high-income countries had a corresponding recommendation. Findings suggest that food supplement recommendations for pregnant women vary across countries, likely influenced by geographic location as well as income level. These data may be used in the harmonization of food supplement recommendations.

Project SWEET examined the barriers and facilitators to the use of non-nutritive sweeteners and sweetness enhancers (hereafter "S&SE") alongside potential risks/benefits for health and sustainability. The Beverages trial was a double-blind multi-centre, randomised crossover trial within SWEET evaluating the acute impact of three S&SE blends (plant-based and alternatives) vs. a sucrose control on glycaemic response, food intake, appetite sensations and safety after a carbohydrate-rich breakfast meal. The blends were: mogroside V and stevia RebM; stevia RebA and thaumatin; and sucralose and acesulfame-potassium (ace-K). At each 4 h visit, 60 healthy volunteers (53% male; all with overweight/obesity) consumed a 330 mL beverage with either an S&SE blend (0 kJ) or 8% sucrose (26 g, 442 kJ), shortly followed by a standardised breakfast (∼2600 or 1800 kJ with 77 or 51 g carbohydrates, depending on sex). All blends reduced the 2-h incremental area-under-the-curve (iAUC) for blood insulin (p 

The British Nutrition Foundation held a 1‐day roundtable event to gather views from a wide range of stakeholders on the relevance and importance of the concept of nutrient density in supporting and motivating people to make healthier dietary choices. The opportunities and barriers associated with the use of this concept were also explored. The roundtable involved experts from research, public health nutrition, dietetics, retail and nutrition science communication, and this report describes the main themes emerging from the discussions. High obesity prevalence rates indicate that, on average, we are consuming too many calories relative to energy requirements; yet, the quality of our diets, with respect to certain vitamins and minerals and fibre, seems to be falling somewhat short of recommendations. Addressing this issue may require a more holistic approach than the current focus on restricting single nutrients prevalent in public health messaging internationally. Most members of the roundtable felt that communicating the concept of nutrient density may help in encouraging healthier food choices and dietary patterns that are higher in nutritional quality. However, while nutrient profiling has been used to guide front‐of‐pack labelling and in restricting the advertising of less healthy foods to children, there is a lack of consensus on the precise definition of a ‘nutrient dense’ food or which nutrients should be used as markers of the ‘healthiness’ of foods/drinks, and the term seems to be poorly understood by consumers and health professionals alike. Therefore, further work is required if tools around this concept are to be developed to try and successfully promote behaviour change.

The 'ultra-processed food' (UPF) concept, with classification of foods by 'level of processing' rather than nutrient profiles, and its relationship with health outcomes, is currently a topic of debate among academics and increasingly referred to in the media. The British Nutrition Foundation convened a virtual roundtable on 6th July 2022 to gather views on the use of the term (and current definitions of) UPF for public health messaging, seeking to establish areas of consensus and disagreement and identify topics for further research. A small group of invited expert stakeholders attended, including representatives from academia, policy, behavioural science, communications, health, food science, retail and consumer interests. Participants' discussions clustered into cogent themes which included: problems with the use of definitions for UPF, the lack of causal evidence and defined mechanisms linking processing per se with poor health outcomes, and advice that may result in consumer confusion. There was agreement that many foods classified as UPF are high in fat, sugars and/or salt and public health messages should continue to focus on reducing these in the diet since it is unclear whether reported associations between high intakes of UPF and poor health reflect poorer dietary patterns (defined by nutrient intakes), and nutrient-health relationships are well established. Examples of misalignment were also highlighted (i.e. some foods are classified as UPF yet recommended in food-based dietary guidelines [featuring in healthy dietary patterns]). This raises challenges for consumer communication around UPF. Concern was also expressed about potential unintended consequences, particularly for vulnerable groups, where advice to avoid UPF could create stigma and guilt due to lack of time or facilities to prepare and cook meals from scratch. It could also impact on nutrient intakes, as some foods classified as UPF represent more affordable sources of important nutrients (e.g. packaged wholemeal bread). Discordance between the concept of UPF and current strategies to improve public health, such as reformulation, was also discussed. The group concluded that the use of the concept of UPF in UK policy (e.g. dietary guidelines) would be unhelpful at present. Overall, participants felt that it was more important to focus on providing practical advice around selection of healthier processed foods and making healthier foods more accessible rather than promoting the avoidance of UPF. The latter may act to demonise all foods classified as UPF by current definitions, including some affordable nutrient-dense foods.

Responsibility is crucial to governance and key to achieving legitimacy within complex systems, yet there is limited attention to how it should be conceptualized within the context of food research and innovation (R&I). Understanding how diverse stakeholders in food R&I conceptualize responsibility is vital because it shapes the way problems are identified, goals are set and solutions are put in place. We report on empirical research with diverse stakeholders across Europe to understand and map the dimensions of responsibility for food R&I to support healthy and sustainable food systems. Semi-structured interviews were conducted with 32 stakeholders working in R&I in the cutting-edge domains of: cultured meat as a substitute for livestock meat; new crop breeding of potatoes; and a new approach to obesity reduction that focuses on weight acceptance. Drawing from the empirical evidence collected, we developed a classification system that reflects various conceptualizations of stakeholders' responsibility for food R&I to support healthy and sustainable food systems. Our thematic analysis revealed four overlapping rationales of responsibility—accountability, impact, reflexivity, and responsiveness, and characterized them in terms of: who the researcher is responsible to; whether the assessments of responsibility focus on R&I processes or impact; whether responsibility implies societal engagement; and how responsibility is assessed—retrospectively or prospectively. The article provides a basis for systematic application of these criteria to the specific instances of food R&I governance and for future joint decisions, about the ways to allocate responsibilities.

The aim was to investigate, among pregnant women, (1) the use of food supplements and (2) the awareness of food supplement recommendations and beliefs about food supplement use in four European countries: Finland, Italy, Poland, and the United Kingdom. The participants (n = 1804) completed an online questionnaire with predefined statements. Daily intakes of vitamins and minerals were calculated using uploaded pictures or weblinks of the supplement packages. Country differences were assessed. Most participants (91%) used at least one food supplement during pregnancy. A prenatal multivitamin was the most commonly used supplement type (84% of the users), and 75% of the participants thought consumption of multivitamin is recommended. Of the participants, 81% knew that folic acid is recommended during pregnancy while 58% knew the recommendation for vitamin D. In 19% of the supplement users, the daily safe upper intake limit of at least one nutrient was exceeded. Nevertheless, most participants agreed that they knew which supplements (91%) and doses of supplements (87%) needed to be used during pregnancy. To conclude, the majority of the participants used food supplements, but lower proportions knew and adhered to the recommended intakes. Between-country differences were observed in the use and knowledge of and beliefs regarding supplements. The results suggest a need for assessment and monitoring of supplement use in antenatal care to ensure appropriate use.

Nutrition is recognized as one of the leading factors influencing the growing incidence of noncommunicable diseases. Despite society experiencing a global rise in obesity, specific populations remain at risk of nutrient deficiencies. The food industry can use health claims to inform consumers about the health benefits of foods through labeling and the broader promotion of specific food products. As health claims are carefully regulated in many countries, their use is limited due to considerable investments required to fulfill the regulatory requirement. Although health claims represent a driving force for innovation in the food industry, the risk of misleading of consumers need to be avoided. The health claim scientific substantiation process must be efficient and transparent in order to meet the needs of companies in the global market, but should be based on strong scientific evidence and plausible mechanisms of actions, to ensure highest level of consumer protection. The objective of this review is to compare the possibilities for using health claims on foods in the European Union, the USA, Canada, and Australia and New Zealand. In particular, we focused on differences in the classification of claims, on the scientific substantiation processes and requirements for health claims use on foods in the selected regions. Reduction of disease risk (RDR) claims are associated with relatively similar procedures and conditions for use, whereas several notable differences were identified for other types of claims. In all cases, RDR claims must be approved prior their introduction to the market, and only a few such claims have been authorized. Much greater differences were observed concerning other types of claims.

A better understanding of food-related behaviour and its determinants can be achieved through harmonisation and linking of the various data-sources and knowledge platforms. We describe the key decision-making in the development of a prototype of the Determinants and Intake Platform (DI Platform), a data platform that aims to harmonise and link data on consumer food behaviour. It will be part of the Food Nutrition Health Research Infrastructure (FNH-RI) that will facilitate health, social and food sciences. The decision-making was based on the evidence of user needs and data characteristics that guided the specification of the key building blocks of the DI Platform. Eight studies were carried out, including consumer online survey; interview studies of key DI Platform stakeholders; desk research and workshops. Consumers were most willing to share data with universities, then industry and government. Trust, risk perception and altruism predicted willingness to share. For most other stakeholders non-proprietary data was most likely to be shared. Lack of data standards, and incentives for sharing were the main barriers for sharing data among the key stakeholders. The value of various data types would hugely increase if linked with other sources. Finding the right balance between optimizing data sharing and minimizing ethical and legal risks was considered a key challenge. The development of DI Platform is based on careful balancing of the user, technical, business, legal and ethical requirements, following the FAIR principles and the need for financial sustainability, technical flexibility, transparency and multi-layered organisational governance. •There is a need to better support science on food intake and its determinants (DI).•DI Platform links consumer, business, science-generated data on food consumption.•Decision-making is based on evaluations of user needs and data characteristics.•The final design balances user, technology, business and governance requirements.•DI Platform supports the Food Nutrition Health Research Infrastructure initiative.

Processed foods are increasingly under the spotlight since the development of classification systems based on proxies for food processing. Published critical reviews and commentaries suggest different views among professional disciplines about the definition and classification of processed food. There is a need to further understand perspectives of professionals on the conceptualisation of processed food and the agreements and disagreements among experts, to encourage interdisciplinary dialogue and aid communication to the public. The aim of this research was to elicit views and understandings of professionals on processed food, their perceptions of lay people's perceptions of the same, and their perspectives on the challenges of communicating about processed foods to the public. The online discussion groups brought together a range of professionals (n = 27), covering the fields of nutrition, food technology, policy making, industry, and civil society, mixed in 5 heterogenous groups. Through thematic analysis the following themes relating to the conceptualisation of processed food and challenges for communication were identified: (1) Broad concepts that need differentiation; (2) Disagreements on scope and degree of processing; (3) The role of food processing within the food system: the challenges in framing risks and benefits; and (4) The challenge of different perspectives and interests for risk communication. Throughout the discussions blurred lines in the characterisation of processing, processed foods, and unhealthy foods were observed. Participants agreed that consensus is important, but difficult. Participants identified a need for further interdisciplinary dialogue, including public engagement, to break down the observed issues, and work towards a mutual understanding and develop clear communication messages.

The study objective was to (1) compare, through a randomised pilot intervention study, the effects of a standard health app and an enhanced health app, with evidence-based information regarding healthy lifestyle, on gestational weight gain, diet quality and physical activity in pregnant women. The sub-objectives were to (2) characterise app use and users among pregnant women and to (3) compare, in the overall sample regardless of the intervention, whether the frequency of the health app use has an effect on the change in gestational weight, diet quality and physical activity. Women recruited through social media announcements (n 1038) were asked to record their lifestyle habits in the app from early pregnancy to delivery. Self-reported weight, diet quality and physical activity were assessed in early and late pregnancy with validated online questionnaires. No benefits of the enhanced app use were shown on the lifestyle habits. Nevertheless, frequent app users (use >= 4 center dot 7 weeks) in the enhanced app group had a higher physical activity level in late pregnancy compared with those in the standard app group. Overall, extensive variation was found in the number of recordings (median 59, interquartile range 19-294) and duration of app use (median 4 center dot 7, interquartile range 1 center dot 1-15 center dot 6 weeks). Frequent app users had higher education level, underweight/normal weight, better diet quality and were non-smokers, married and primipara more likely than occasional app users/non-users. Physical activity among app users decreased less compared with non-users over the pregnancy course, indicating that app use could motivate to maintain physical activity during pregnancy.

Klein (1997) found that participants were more influenced by information about their comparative risk standing than information about their absolute risk standing. If reliable, these findings have important implications for understanding and improving risk communication. In this paper we report the findings of several unsuccessful attempts by us to replicate Klein's findings in the UK, using one of his experimental paradigms, and discuss the findings of other recent attempts to replicate his work. Findings are inconsistent from study to study but, overall, provide some evidence that people respond to comparative and not just to absolute risk information. Issues that need to be addressed systematically in future research include: the ambiguity of absolute information, proportional differences in risk magnitude, cross-cultural and individual differences in preferences for social comparison information, and the systematic exploration of responses to absolute and comparative risk information in real choice situations.

Health-related claims and symbols are intended as aids to help consumers make informed and healthier food choices but they can also stimulate the food industry to develop food that goes hand in hand with a healthier lifestyle. In order to better understand the role that health claims and symbols currently have and in the future potentially can have, the objective of the CLYMBOL project (“Role of health-related claims and symbols in consumer behaviour”, Grant no 311963) is to investigate consumers’ understanding of health claims and symbols, and how they affect purchasing and consumption [1].As part of this endeavour, it is important to understand the history of use of claims and symbols in Europe. What have consumers been exposed to and how were these health-related messages used and discussed among the public? In this study, we interviewed key stakeholders across Europe about how health claims have been regulated in their country, how health symbols have been and currently are being treated, what form of monitoring there is or should be and how both health claims and symbols have been debated in the public opinion. In 26 European Union (EU) Member States, opinions from 53 key informants from up to three different stakeholder groups were gathered: national food authorities, representatives of the food industry, and consumer organisations.While 14 Member States reported (at least partial) regulation of the use of health claims and/or symbols before the introduction of the EU Regulation (EC 1924/2006) on nutrition and health claims made on foods [2], mandatory reporting of use had only been in place in three EU Member States. A number of voluntary codes of practice for health claims and/or symbols (i.e. pre-approval or justification when challenged) was said to be in use in 15 Member States. There are only a few national databases on health claims and symbols available, the data for which is often incomplete. Only eight Member States reported having some form of database from which information about health claims and symbols could be extracted. The stakeholders interviewed expressed a strong interest in measuring the impact of health claims and symbols, particularly research into the effects on consumer behaviour (e.g. awareness and understanding, attitudes towards products carrying claims and symbols and purchase/consumption effects), public health (health outcomes and changes in national health status due to the introduction of claims and symbols on food products) and economic aspects including sales, return on investment and reputation measurements. Public debates were said to have evolved around the topics of consumer understanding of claims, acceptance as well as trust in the information presented but also the effects on vulnerable groups such as children and elderly consumers. Another field of debate was said to have been the question of the effectiveness of health claims and symbols. Lastly, stakeholders reported that public debates focussed mainly on the legislative aspects, i.e. how to apply the EU Regulation (No 1924/2006) with regards to wording issues, the evaluation process at the European Food Safety Authority (EFSA), the status of various claims and the nutrient profile modelling to be introduced in Europe.

Behavioural reactions to potential hazards are likely to be determined by psychologically derived factors (risk perceptions) as well as rational estimates of risk. Research has shown that risk perception is a complex psychological construct, where different potential hazards are associated with different hazard characteristics. One of the most important determinants of risk perception is knowledge about a given hazard. It is probable that reactions will be determined not only by what is conveyed in the content of risk information but also by other characteristics of the information source. A predominant source of risk information for the public is the media, although there are at present no adequate models available to describe how such risk information is conveyed. If communication with the public on issues of risk is to be effective, then it must take due account of the role and effect of the media. Given that the public is suddenly exposed to a problem by the media in the context of a 'crisis', it is possible that polarization of views among the public and scientific community (and other interested parties, such as pressure groups) will take place, often on the basis of inadequate data. This research examines how the British press communicate risk information. The focus is food-related hazards: food biotechnology, microbiological hazards, food irradiation, chemicals and pesticide residues, and food additives. The development of a content-analysis schedule, and its subsequent application to 182 newspaper reports refemng to food-related hazards, is presented. Correspondence analysis of the resulting data indicated that substantial differences in risk reporting occurs for hazards with different perceptual characteristics. Methods of testing derived models of media transmission of risk information against formation of attitudes are discussed.

Although the impact of diet on physical health is an important public health issue, less attention has been devoted to the relationship between nutrition and children's mental development. The views of parents and teachers about the extent to which diet affects physical and mental development of children were compared in four European countries. An online questionnaire (developed in English and translated) was circulated through a market research agency. Participants were parents or teachers of children aged 4-10 years without learning or behavioural issues. Questionnaires were returned by 1606 parents (401 in England, Germany and Hungary; 403 in Spain) and 403 teachers (100 in each country, except for 103 in Hungary). Teachers were older than parents (35·3 % v. 18·3 % over 45 years; P

Purpose The aim of this study is to investigate older people’s perceptions, across eight European countries (the UK, Denmark, Germany, Poland, Portugal, Spain, Sweden and Italy), towards functional foods. Design/methodology/approach The repertory grid method was used to elicit reasons underlying preferences of five yoghurts with different functional properties and two conventional ones. Findings Familiarity was the key driver in products’ separation. For the Italian case, as well as the Spanish, Portuguese, Danish and Swedish the first principal axis could be interpreted as novel-common axis, whilst it was not in the UK, Germany and Poland. Research limitations/implications Behavioural intention to buy functional yoghurts was more strongly predicted and moderated by single item perceived need (PN) than single item affective and/or cognitive attitude (AA, CA), even though PN, AA and CA could be consistently assessed within the same latent measure (in all countries but Denmark). Nevertheless, beliefs/attitudes towards a novel category of products such as functional foods may be reasonably keeping moving. Originality/value In this study, preference instructions pertaining to beneficial and imagery attributes, revealed idiosyncratic properties associated with functional yoghurts across eight European samples of older people.

Significant ongoing debate exists amongst stakeholders as to the best front-of-pack labelling approach and emerging evidence suggests that the plethora of schemes may cause confusion for the consumer. To gain a better understanding of the relevant psychological phenomena and consumer perspectives surrounding FoP labelling schemes and their optimal development a Multiple Sort Procedure study involving free sorting of a range of nutritional labels presented on cards was performed in four countries (n=60). The underlying structure of the qualitative data generated was explored using Multiple Scalogram Analysis. Elicitation of categorisations from consumers has the potential to provide a very important perspective in this arena and results demonstrated that the amount of information contained within a nutrition label has high salience for consumers, as does the health utility of the label although a dichotomy exists in the affective evaluation of the labels containing varying degrees of information aggregation. Classification of exiting front-of-pack labelling systems on a proposed dimension of 'directiveness' leads to a better understanding of why some schemes may be more effective than others in particular situations or for particular consumers. Based on this research an enhanced hypothetical front-of-pack labelling scheme which combines both directive and non-directive elements is proposed.

Scientific Advisory Bodies (SABs) are seen as “boundary organisations” working at the interface between science, policy and society. Although their narrowly defined remit of risk assessment is anchored in notions of rationality, objectivity, and reason, in reality, their sources for developing recommendations are not limited to scientific evidence. There is a growing expectation to involve non-scientific sources of information in the formation of knowledge, including the expectation of stakeholder consultation in forming recommendations. Such a move towards “democratisation” of scientific processes of decision making within SABs has been described and often studied as “post-normal science” (PNS) (Funtowicz and Ravetz, 1993). In the current paper we examine the application of PNS in practice through a study of stakeholder consultations within the workings of the UK Scientific Advisory Committee for Nutrition (SACN). We use the theoretical insights from PNS-related studies to structure the analysis and examine the way in which PNS tenets resonate with the practices of SACN. We have selected a particular case of the SACN UK recommendations for salt as it is characterized by scientific controversy, uncertainty, vested interests and value conflict. We apply the tenets of PNS through documentary analysis of the SACN Salt Subgroup (SSG) consultation documents published in 2002/2003: the minutes of the 5 SACN SSG’s meetings which included summary of the SACN SSG’s stakeholder consultation and the SSG’s responses to the consultation. The analysis suggests that the SACN consultation can be construed as a process of managing sources of risk to its organisation. Thus, rather than being an evidence of post normal scientific practice, engagement became a mechanism for confirming the specific framing of science that is resonant with technocratic models of science holding authority over the facts. The implications for PNS theory are discussed. The work herein has been carried out within the EURRECA Network of Excellence (http://www.eurreca.org), financially supported by the Commission of the European Communities, Specific Research Technology and Development (RTD) Programme Quality of Life and Management of Living Resources within the sixth framework programme, contract no. 0136196. This does not necessarily reflect the Commission’s views or its future policy in this area. We would like to acknowledge the contribution made to editing of the article from Israel Berger, University of Surrey. No conflicts of interest have been declared by authors.

Food-related behaviours are complicated actions governed by a mix of cultural conventions, social interactions, individual perceptions and psychological influences. The methods introduced here should support nutrition studies by providing tools to measure the reasons behind food choices and intake more effectively. This chapter covers the general principles in applying the specific methodologies and demonstrates what information different methods can give us about the factors influencing behaviour. Quantitative strategies for investigating food-related behaviours include experimental and survey research. Survey research designs allow for the quantitative or numerical description of variables and enable the researcher to make claims about a population. Mixed-methods research combines both qualitative and quantitative forms in its assumptions and approach. A mechanistic approach helps explain why some of the traditional forms of intervention such as providing information may not have been successful in changing food-related behaviour.

Many food and drink products now display nutritional information on the front of the food package, so called front-of-pack (FOP) nutrition labels or nutrition signpost labels, which serve to provide a simple and visible summary of the products nutritional quality. This chapter reviews FOP labelling in the EU. It covers the history of FOP development, the different types of FOP labelling, the underpinnings of the different FOP schemes as well as ways of classifying FOP schemes. The impact FOP labels have on consumers and the food industry are discussed with a useful section on future trends. A list of review papers are presented for further reading.

Background Traffic light labelling of foods—a system that incorporates a colour-coded assessment of the level of total fat, saturated fat, sugar and salt on the front of packaged foods—has been recommended by the UK Government and is currently in use or being phased in by many UK manufacturers and retailers. This paper describes a protocol for a pilot randomised controlled trial of an intervention designed to increase the use of traffic light labelling during real-life food purchase decisions. Methods/design The objectives of this two-arm randomised controlled pilot trial are to assess recruitment, retention and data completion rates, to generate potential effect size estimates to inform sample size calculations for the main trial and to assess the feasibility of conducting such a trial. Participants will be recruited by email from a loyalty card database of a UK supermarket chain. Eligible participants will be over 18 and regular shoppers who frequently purchase ready meals or pizzas. The intervention is informed by a review of previous interventions encouraging the use of nutrition labelling and the broader behaviour change literature. It is designed to impact on mechanisms affecting belief and behavioural intention formation as well as those associated with planning and goal setting and the adoption and maintenance of the behaviour of interest, namely traffic light label use during purchases of ready meals and pizzas. Data will be collected using electronic sales data via supermarket loyalty cards and web-based questionnaires and will be used to estimate the effect of the intervention on the nutrition profile of purchased ready meals and pizzas and the behavioural mechanisms associated with label use. Data collection will take place over 48 weeks. A process evaluation including semi-structured interviews and web analytics will be conducted to assess feasibility of a full trial. Discussion The design of the pilot trial allows for efficient recruitment and data collection. The intervention could be generalised to a wider population if shown to be feasible in the main trial. Trial registration ISRCTN: ISRCTN19316955 webcite

The repertory grid method and the 'item by use' appropriateness method were used to study the place milk occupies within the diet, its perceived appropriateness and people's beliefs concerning different types of milk. The results of both methods suggest that consumers tend to find their most used type of milk suitable for all their uses of milk. In the repertory grid study the high-fat milk users separated the milks to a greater extent on 'taste/flavour', 'richness', and 'wateriness' whereas the low-fat milk users separated the milks to a greater extent on 'fat content', 'creaminess', 'richness', and 'healthiness'. In the 'item by use' appropriateness study high-fat milk users used no particular use-attribute to separate the milks, whereas the low-fat milk users separated the milks to a greater extent on 'when I want something low in calories', 'when I want something that contains little fat', and 'when on a diet'. © 1992.

Eighty subjects rated flavoured milk samples which varied in sweetener (sugar versus aspartame) and fat content (full-versus low-fat milk). Twenty of the subjects were in a control condition and received no information about the samples. The remaining sixty subjects initially rated the samples with no information and then rated them again when given information on the fat and sugar content of the samples. Ratings of sweetness, body, healthiness and calorie content were influenced by the information but liking and likelihood of buying were not affected in the overall group. Dividing subjects on the basis of attitudes towards low- and full-fat flavoured milks, however, showed different effects within the two subgroups. When information was given, both liking and rated likelihood of buying increased for the type of sample towards which subjects had a more generally positive attitude. Those subjects with more positive attitudes towards low-fat flavoured milks showed a clear differentiation in ratings of the healthiness of the samples when information was provided. However, those with more positive attitudes towards full-fat flavoured milks did not differentiate the samples in terms of rated healthiness. Similar effects were found when the subjects were divided on the basis of dietary restraint. Those subjects with higher scores for dietary restraint showed greater differentiation of the samples in terms of calorie content, healthiness and sweetness. © 1993.

Background: Most food in the UK is purchased in supermarkets and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behaviour. Objectives: The FLICC study is a pilot randomised controlled trial of a digital behaviour change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial. Methods: The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals, model behaviour and practice using traffic light labels. The control consisted of web-based information on traffic light labelling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the six months prior to recruitment, during the six week intervention period and during a twelve week wash out period were transferred to the research team by the participating supermarket. Healthiness of ready meal and pizzas was measured using a pre-developed scale based solely on the traffic light colours on the foods. Questionnaires were completed at recruitment, end of intervention and end of wash out to estimate the effect of the intervention on variables that mediate behaviour change (e.g. belief and intention formation). Results: We recruited 496 participants from an initial email to 50,000 people. Only three people withdrew from the study and purchase data were received for all other participants. 208 participants completed all three questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P = 0.315) or at wash-out (P = 0.594). Conclusions: Whilst the FLICC study did not find evidence of an impact of the intervention on food purchasing behaviour, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research.

The aim of this paper is to identify social and cultural aspects of alcohol consumption in a sample of older people living in their own homes, in eight different European countries. We explore several aspects of alcohol consumption, establishing comparisons between genders, age groups and living circumstances. The phenomenon of alcohol consumption within these countries and cultures is compared in order to gain a better understanding of similarities and differences.

BACKGROUND/OBJECTIVES: Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later; and subsequent breastfeeding and weaning behaviours. SUBJECTS/METHODS: First-time mothers in five European countries (England, Finland, Germany, Hungary, Spain) completed questionnaires about the importance of 17 influences on infant feeding choices at birth and 8 months later, during 2007–2008. Use of individual sources and reliance on four categories (family and friends, health professionals, written materials, audio-visual media) were compared between countries. Associations between information sources used and mother characteristics, feeding intentions and behaviours were investigated using appropriate statistical tests. RESULTS: In all, 2071 first-time mothers provided baseline data; 78% at 8 months. Variation exists between countries in the influence of different sources on feeding decisions of first-time mothers. Across all countries, the most important influences at both time points were books, partner and antenatal midwife. Mothers in higher income quintiles and remaining at school beyond age 16 years reported greater reliance on written sources (P

Objective The involvement of consumers in the development of dietary guidelines has been promoted by national and international bodies. Yet, few best practice guidelines have been established to assist such involvement. Design Qualitative semi-structured interviews explored stakeholders’ beliefs about consumer involvement in dietary guideline development. Setting Interviews were conducted in six European countries: The Czech Republic, Germany, Norway, Serbia, Spain and the United Kingdom. Subjects Seventy-seven stakeholders were interviewed. Stakeholders were grouped as government, scientific advisory body, professional and academic, industry or non-government organisations. Response rate ranged from 45%-95%. Results Thematic analysis was conducted with the assistance of NVivo qualitative software (QSR International Pyt Ltd.). Analysis identified two main themes: type of consumer involvement and pros and cons of consumer involvement. Direct consumer involvement (e.g. consumer organisations), in the decision-making process was discussed as a facilitator to guideline communication towards the end of the process. Indirect consumer involvement (e.g. consumer research data), was considered at both the beginning and the end of the process. Cons to consumer involvement included the effect of vested interests on objectivity; consumer disinterest; complications in terms of time, finance and technical understanding. Pros related to increased credibility and trust in the process. Conclusions Stakeholders acknowledged benefits to consumer involvement during the development of dietary guidelines, but remained unclear on the advantage of direct contributions to the scientific content of guidelines. In the absence of established best practice, clarity on the type and reasons for consumer involvement would benefit all actors.

Domestic cooking skills (CS) and food skills (FS) encompass multiple components, yet there is a lack of consensus on their constituent parts, inter-relatedness or measurement, leading to limited empirical support for their role in influencing dietary quality. This review assessed the measurement of CS and FS in adults (>16 years); critically examining study designs, psychometric properties of measures, theoretical basis and associations of CS/FS with diet. Electronic databases (PsychInfo), published reports and systematic reviews on cooking and home food preparation interventions (Rees et al. 2012 ; Reicks et al. 2014 ) provided 834 articles of which 26 met the inclusion criteria. Multiple CS/FS measures were identified across three study designs: qualitative; cross-sectional; and dietary interventions; conducted from 1998-2013. Most measures were not theory-based, limited psychometric data was available, with little consistency of items or scales used for CS/FS measurements. Some positive associations between CS/FS and FV intake were reported; though lasting dietary changes were uncommon. The role of psycho-social (e.g., gender, attitudes) and external factors (e.g. food availability) on CS/FS is discussed. A conceptual framework of CS/FS components is presented for future measurement facilitation, which highlights the role for CS/FS on food-related behaviour and dietary quality. This will aid future dietary intervention design.

Larger portions as well as larger packs can lead to larger prospective consumption estimates, larger servings and increased consumption, described as 'portion-size effects' and 'pack size effects'. Although related, the effects of pack sizes on portion estimates have received less attention. While it is not possible to generalize consumer behaviour across cultures, external cues taken from pack size may affect us all. We thus examined whether pack sizes influence portion size estimates across cultures, leading to a general 'pack size effect'. We compared portion size estimates based on digital presentations of different product pack sizes of solid and liquid products. The study with 13,177 participants across six European countries consisted of three parts. Parts 1 and 2 asked participants to indicate the number of portions present in a combined photographic and text-based description of different pack sizes. The estimated portion size was calculated as the quotient of the content weight or volume of the food presented and the number of stated portions. In Part 3, participants stated the number of food items that make up a portion when presented with packs of food containing either a small or a large number of items. The estimated portion size was calculated as the item weight times the item number. For all three parts and across all countries, we found that participants' portion estimates were based on larger portions for larger packs compared to smaller packs (Part 1 and 2) as well as more items to make up a portion (Part 3); hence, portions were stated to be larger in all cases. Considering that the larger estimated portions are likely to be consumed, there are implications for energy intake and weight status.

Objectives: Examine the association between components of restrained eating, cognitive performance and weight loss maintenance. Methods: 106 women, all members of a commercial slimming organisation for at least 6. months (mean ± SD: 15.7 ± 12.4 months), were studied who, having lost 10.1 ± 9.7 kg of their initial weight, were hoping to sustain their weight loss during the 6. month study. Dietary restraint subcomponents flexible and rigid restraint, as well as preoccupying cognitions with food, body-shape and diet were assessed using questionnaires. Attentional bias to food and shape-related stimuli was measured using a modified Stroop test. Working memory performance was assessed using the N-back test. These factors, and participant weight, were measured twice at 6. month intervals. Results: Rigid restraint was associated with attentional bias to food and shape-related stimuli (r = 0.43, p < 0.001 resp r = 0.49, p < 0.001) whereas flexible restraint correlated with impaired working memory (r = - 0.25, p < 0.05). In a multiple regression analyses, flexible restraint was associated with more weight lost and better weight loss maintenance, while rigid restraint was associated with less weight loss. Conclusions: Rigid restraint correlates with a range of preoccupying cognitions and attentional bias to food and shape-related stimuli. Flexible restraint, despite the impaired working memory performance, predicts better long-term weight loss. Explicitly encouraging flexible restraint may be important in preventing and treating obesity. © 2012 Elsevier Ltd.

Background: Food, nutrition and health policy makers are poised with two pertinent issues more than any other: obesity and climate change. Consumer research has focused primarily on specific areas of sustainable food, such as organic food, local or traditional food, meat substitution and/or reduction. More holistic view of sustainable healthy eating behaviour has received less attention, albeit that more research is emerging in this area. Methods/design: This study protocol that aims to investigate young consumers’ attitudes and behaviour towards sustainable and healthy eating by applying a multidisciplinary approach, taking into account economical, marketing, public health and environmental related issues. In order to achieve this goal, consumers’ reactions on interactive tailored informational messages about sustainable from social, environmental and economical point of view, as well as healthy eating behaviour in a group of young adults will be investigated using randomized controlled trial. To undertake the objective, the empirical research is divided into three studies: 1) Qualitative longitudinal research to explore openness to adopting sustainable healthy eating behaviour; 2) Qualitative research with the objective to develop a sustainable healthy eating behaviour index; and 3) Randomised controlled trial to describe consumers’ reactions on interactive tailored messages about sustainable healthy eating in young consumers. Discussion: To our knowledge, this is the first randomised controlled trial to test the young adults reactions to interactive tailor made messages on sustainable healthy eating using mobile smartphone app. Mobile applications designed to deliver intervention offer new possibilities to influence young adults behaviour in relation to diet and sustainability. Therefore, the study will provide valuable insights into drivers of change towards more environmentally sustainable and healthy eating behaviours.

This paper is part of a special issue of JCB devoted to work on creativity and food, guest edited by Dr. Paul Sowden, Dr. Anita Eves, and Professor Monique Raats, that follows on from the 2014 International Workshop on Understanding and Fostering Creativity in the Kitchen, held at the Institute of Advanced Studies, University of Surrey, UK. All articles have been peer reviewed by two reviewers.

Objective: To examine the role of food composition data in Europe in four sectors, namely health, trade regulation and legislation, agriculture and the environment. Results: The need for further harmonization of data across Europe is clearly identified and evidenced from a number of previous successful European collaborations. Conclusions: Data on the nutritional composition of foods are essential for a broad spectrum of activities, including public health nutrition, research, the food industry and government policy development and implementation. With the expansion of the European Union and the concomitant increase in cross border trade and cooperation harmonizing food composition data becomes a more important issue than ever. Harmonization is not solely a technical issue, but also involves creating durable and sustainable structures to maintain the viability of the data. These are some of the issues currently being addressed by the European Food Information Resource Network of Excellence.

The Nutrition and Health Claims Regulation (NHCR) EC No 1924/2006 aims to provide an appropriate level of consumer protection whilst supporting future innovation and fair competition within the EU food industry. However, consumers’ interpretation of health claims is less well understood. There is a lack of evidence on the extent to which consumers are able to understand claims defined by this regulatory framework. Utilising the Multiple Sort Procedure (MSP), a study was performed (N = 100 participants across five countries: Germany, the Netherlands, Slovenia, Spain and the United Kingdom) to facilitate development of a framework of health-related claims encompassing dimensions derived from consumers. Our results provide useful insight into how consumers make sense of these claims and how claims may be optimised to enhance appropriate consumer understanding. They suggest consumers may not consciously differentiate between a nutrition claim and a health claim in the way that regulatory experts do and provide insight into where this might occur. A consumer-derived typology of health-related claims based on three key dimensions is proposed: (1) Familiarity with the nutrient, substance or food stated in the claim; (2) statement type in terms of simplicity/complexity; (3) relevance of the claim, either personally or for a stated population group.

This review summarises the methods and results of studies conducted worldwide on the effectiveness of food safety and food hygiene training in the commercial sector of the food industry. In particular it focuses on those studies that have tried to evaluate the effectiveness of such training. Forty-six studies of food hygiene training are included which used some outcome measure to assess the effectiveness of training. The short-term nature and variety of measures used limited the majority of studies. The need for the development of evaluation criteria of effectiveness of food hygiene training is discussed. (c) 2006 Elsevier Ltd. All rights reserved.

This paper reports on an evaluation study of two deliberative methods of public participation of the "hard-to-reach" in food-policy development-the citizens' workshop and the citizens' jury. The participation was conducted on a live food-policy topic (food retailing) and the specific hard-to-reach group of older people was recruited. The evaluation of the two methods was based on an assessment of the participants' and observers' perceptions of the processes and outcomes of the methods, against a set of evaluation criteria, spanning both the individual and group level of analysis. The evaluation used a quasi-experimental, between groups, pre- and post-participation design. The study showed that the properties of the methods alone, such as availability of extra information, had little impact on both satisfaction with the process and the actual task outcomes. It further emphasised the importance of group debate for the perceived satisfaction with the process and the subjective outcomes of the event. The study illustrated that the high level of process satisfaction was not contemporaneous with the perceived impact of participation, such as its perceived influence of policy decision-making, suggesting that the relationship between participation outcomes (i.e. impact of participation) and processes was a complex one. It is argued here that this relationship should be considered in the light of identity processes and the context of public participation. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

Aims:  To (i) compare the views of general practitioners (GPs) and parents about the causes, consequences and management of childhood overweight/obesity; and (ii) explore the extent to which they can identify overweight/obesity in children. Methods:  A questionnaire was mailed to all GPs in one Primary Care Trust and all parents in one primary school in southern England, 2008. Information was gathered on socio-demographic background, views about causes, consequences and management of childhood overweight/obesity; judgements about the weight status of 14 images of children (seven boys, seven girls) in the Children's Body Image Scale (CBIS). Comparisons were made between GP and parents' responses using unpaired bivariate tests. Results:  The response rate was 33%. Differences exist between the views of GPs and parents about childhood weight management: 86.4% of parents felt GPs should be involved, compared to 73.3% of GPs (P < 0.001). Parents thought GPs should be more proactive than the GPs stated they would be. GPs were significantly more likely than parents to see a role for school nurses and dieticians. One third of respondents thought GPs lacked expertise in child weight management. Most GPs and parents correctly identified obese children from the images, but inaccuracies occurred at category margins. Conclusions:  Childhood overweight/obesity is a serious public health concern, and primary care has a role to play in tackling it. GPs in England need more training in childhood overweight/obesity management. Their role needs to be clarified in the context of multiagency approaches.

Objective A nationwide survey of teachers investigated the teaching of food hygiene in UK secondary schools. Previous studies have focused on effective strategies in consumer food hygiene training but there is little research focusing on school-based education. Design The questionnaire was developed based on the results of in-depth interviews with school teachers and included topics such as where teachers gained up-to-date food hygiene knowledge and how key food hygiene messages were reinforced. Setting Postal questionnaires were completed by those responsible for teaching food hygiene in secondary schools. Method Postal questionnaires were distributed to 1989 secondary schools throughout the UK (response rate 38 per cent). Results Overall, the results indicate that teachers use a combination of methods to teach food hygiene and to reinforce food safety messages. Respondents rated demonstrations of good practice and practical activities involving young people preparing food as most effective. Teachers cited their most preferred resources for teaching food hygiene, influences on the choice of these resources, and limitations on use. Conclusion In the UK, teachers cover food hygiene in D&T and home economics (or equivalents in Scotland and Northern Ireland). Topics such as cooking food properly, cleanliness, storing and chilling food safely, and cross-contamination are covered, reflecting the key FSA food hygiene messages. Steps to support the teaching of food hygiene in secondary schools such as guidelines on food hygiene legislation, key topics, resources, and ideas for practical activities could help to improve young people's knowledge of food hygiene and encourage young people to spread key messages to adults.

Communication around chronic dietary risks has proved challenging as dietary health risks are ostensibly met with attenuated perceptions of their likelihood and consequences. In this article, we examine the strategies that an online public use to negotiate risk messages from expert stakeholders that may be incongruent with their own position on a risk. Progressing from conceptualisations of amplification as laid out in the social amplification of risk framework, we are particularly interested in understanding whether and how amplifications of risk may be attributed towards other stakeholders. The article presents an analysis of comments posted on a website oriented to a British audience. These comments were left by members of the public in reply to two online media articles published in 2012 reporting on an epidemiological study carried out in the United States on the risks of red meat consumption. We found that the comments generally expressed resistance to the risk message, embodied in two main strategies. The first strategy was to discount the message itself by deploying rules of thumb that undermined the applicability of the general risk message to the particularities of the individual. The second strategy was to undermine the risks by casting doubt on the credibility of the message source. Together, these strategies allowed the commenters to argue that the risks and the process of communicating them resulted in an exaggerated picture. These findings highlight that by attributing amplification to others, further polarisation of risk views between stakeholders may occur. Thinking about amplification as an attribution provides a distinct and significant conceptual contribution to the study of incongruent risk responses. © 2014 © 2014 Taylor & Francis.

Recent legislation has sought to improve the information printed on packaged foods relevant to the safety of food allergic consumers. We aimed to understand the complex risk assessment decisions made by peanut and nut-allergic adults when purchasing food, with particular reference to use of printed package information.

This study used the theory of planned behavior (TPB) to examine the impact of moral concerns on intention to buy organic apples and organic pizza. Initially, beliefs were elicited from a group of 30 people using a combination of the traditional TPB elicitation technique supplemented by direct questioning about emotions associated with the behavior. The questionnaire-which included measures of behavioral beliefs, attitudes, subjective norm, perceived behavioral control, and measures of moral norms (worded both positively and negatively)-was completed by 281 people. Multiple regressions showed that for both foods, the positive moral component added significantly to the prediction of intention, while negative ones did not. Also, affective attitude was a strong predictor of intention for both foods.

Weight management is a dynamic process, with a pre-treatment phase, a treatment (including process) phase and post-treatment maintenance, and where relapse is possible during both the treatment and maintenance. Variability in the statistical power of the studies concerned, heterogeneity in the definitions, the complexity of obesity and treatment success, the constructs and measures used to predict weight loss and maintenance, and an appreciation of who and how many people achieve it, make prediction difficult. In models of weight loss or maintenance: (i) predictors explain up to 20–30% of the variance; (ii) many predictors are the sum of several small constituent variables, each accounting for a smaller proportion of the variance; (iii) correlational or predictive relationships differ across study populations; (iv) inter-individual variability in predictors and correlates of outcomes is high and (v) most of the variance remains unexplained. Greater standardization of predictive constructs and outcome measures, in more clearly defined study populations, tracked longitudinally, is needed to better predict who sustains weight loss. Treatments need to develop a more individualized approach that is sensitive to patients' needs and individual differences, which requires measuring and predicting patterns of intra-individual behaviour variations associated weight loss and its maintenance. This information will help people shape behaviour change solutions to their own lifestyle needs.

For individuals with a nut allergy, the avoidance of allergens is particularly challenging in situations where they are not preparing their own food. Many allergic reactions occur when eating outside the home.

Objective: Food labelling is an important tool that assists people with peanut and tree nut allergies to avoid allergens. Nonetheless, other strategies are also developed and used in food choice decision making. In this paper, we examined the strategies that nut allergic individuals deploy to make safe food choices in addition to a reliance on food labelling. Methods: Three qualitative methods: an accompanied shop, in-depth semi-structured interviews, and the product choice reasoning task - were used with 32 patients that had a clinical history of reactions to peanuts and/or tree nuts consistent with IgE-mediated food allergy. Thematic analysis was applied to the transcribed data. Results: Three main strategies were identified that informed the risk assessments and food choice practices of nut allergic individuals. These pertained to: (1)qualities of product such as the product category or the country of origin, (2) past experience of consuming a food product, and (3) sensory appreciation of risk. Risk reasoning and risk management behaviours were often contingent on the context and other physiological and socio-psychological needs which often competed with risk considerations. Conclusions: Understanding and taking into account the complexity of strategies and the influences of contextual factors will allow healthcare practitioners, allergy nutritionists, and caregivers to advise and educate patients more effectively in choosing foods safely. Governmental bodies and policy makers could also benefit from an understanding of these food choice strategies when risk management policies are designed and developed. © 2013 Barnett et al.

This study examined the impact of moral norms, self-identity, and past behavior on intention to buy organic tomatoes and organic tomato sauce, using the theory of planned behavior (TPB). The questionnaire, which included measures of attitudes, subjective norm, perceived behavioral control, moral norms, past behavior, and self-identity was completed by approximately 500 people for each food. Multiple regressions showed that for both foods, moral norms and self-identity added significantly to the prediction of intention over and above the other variables, even when the effect of past behavior was included. There was some evidence of past behavior moderating the self-identity/intention relationship for processed organic tomato sauce, but not for fresh organic tomatoes. Implications of the findings are discussed.

Background: While functional foods offer promise for public health and innovation in the food industry, the efficiency of such foods should be assured to protect consumers from misleading claims. Globally, many countries regulate the communication of the health effects of such foods to final consumers. Scope and approach: In the European Union (EU), the use of health claims was harmonized in 2006. All claims need to be scientifically assessed by the European Food Safety Authority (EFSA) and pre-approved. Implementing the regulation has involved a steep learning curve for stakeholders, resulting in many health claims being rejected. The EU-funded REDICLAIM project used existing guidance documents, analyses of Scientific Opinions on new health claim applications, and a series of interviews with experts involved in such applications to identify key points in the process of authorizing new health claims. Key findings and conclusions: Recommendations for the successful substantiation of new health claims in the EU were prepared. The substantiation of health claims is primarily based on human efficacy studies, and greater resources are required to authorize more innovative claims. The reported recommendations should be seen as a starting point for researchers in the area of nutrition and food technology, and for those dealing with functional foods, including the food industry.

The scientific literature contains evidence suggesting that women who have been treated for breast cancer may, as a result of their diagnosis, increase their phyto-oestrogen (PE) intake. In the present paper, we describe the creation of a dietary analysis database (based on Dietplan6) for the determination of dietary intakes of specific PE (daidzein, genistein, glycitein, formononetin, biochanin A, coumestrol, matairesinol and secoisolariciresinol), in a group of women previously diagnosed and treated for postmenopausal breast cancer. The design of the database, data evaluation criteria, literature data entry for 551 foods and primary analysis by LC-MS/MS of an additional thirty-four foods for which there were no published data are described. The dietary intake of 316 women previously treated for postmenopausal breast cancer informed the identification of potential food and beverage sources of PE and the bespoke dietary analysis database was created to, ultimately, quantify their PE intake. In order that PE exposure could be comprehensively described, fifty-four of the 316 subjects completed a 24 h urine collection, and their urinary excretion results allowed for the description of exposure to include those identified as 'equol producers'.

BACKGROUND/OBJECTIVES: The research question addressed in this paper is how different reference amounts utilised in front of package nutrition labelling influence evaluation of product healthfulness. SUBJECTS/METHODS: A total of 13,117 participants from six European countries (Germany, UK, Spain, France, Poland and Sweden) were recruited via online panels. A mixed between/within-subject factorial design was employed with food (biscuits, sandwiches, yogurts), healthfulness and presence of Guideline Daily Amounts as within-subjects factors and reference amount ('per 100 g', 'typical portion', 'half portion') and country as between-subjects factors. RESULTS: Overall, people correctly ranked foods according to their objective healthfulness as defined by risk nutrients alone, and could distinguish between more and less healthful variants of foods. General healthfulness associations with the three product categories do not appear to have had a strong influence on product ratings. This study shows that where the reference amount of 'per 100 g' is very different from the 'typical' portion size, as was the case for biscuits, products with a 'per 100 g' label are rated significantly less healthful than the 'typical' or 'half typical' portions. CONCLUSION: The results indicate that across the three food categories, consumers do factor the reference amount, that is, the quantity of food for which the nutritional information is being presented, into their judgements of healthfulness. Therefore, appropriate reference amounts are also of importance for the effective presentation of nutritional information.

Objective: Typically, attention focuses on how nutrition affects physical health. The present study investigated the importance that parents attach to the impact of diet on mental performance when choosing food for their child. Design: Questionnaire. Setting: Four European countries. Subjects: Parents of children aged 4–10 years (n 1574): England (n 397), Germany (n 389), Hungary (n 398) and Spain (n 390). Results: Most parents (80–85 %) considered the effect of food on four elements of mental performance (child’s ability to learn, attention, behaviour, mood) to be moderately, very, extremely (v. slightly, not at all) important in food choices; over 90% considered healthiness of food and making food appealing to their child important; 79·8% cost; 76·8% convenience. Belief that food affects mental performance was 57·4% (ability to learn), 60·5% (attention); less than 40% of parents agreed they were aware which foods had an effect. Parents with lower general interest in healthy eating were less likely to consider the effect of food on mental performance elements as important. Respondents from Germany were more likely to rate mental performance as important (except behaviour); those in Hungary less likely. The most important influence on parents’ decisions about feeding their child was their own experience, except Spain, where family/friends/ health professionals were more important. Conclusions: Nutrition affects brain development and cognitive functioning. Low prioritisation of the effect of food on mental performance indicates potential for educating parents.

Background/Objectives:The objective of this study was to identify the common requirements of users involved in the compilation of food composition data sets with a view to informing the development of a common access system to food composition data, within the European Food Information Resource (EuroFIR) project.Subjects/Methods:A number of examples of food composition data set compilation have been examined using the Use Case approach, namely the compilation of a data set for a national nutrition survey, for a cross-national nutrition study and for a nutritional software programme.Results:The key user requirement identified from the compilation step analysed by the Use Case approach is the increased availability of and access to more detailed food composition data on a wider range of foods and nutrients.Conclusions:Food composition data serve a variety of purposes, and different user groups will often have both common needs and more individual or specific needs of their data sets. The development of Use Cases for specific processes effectively identifies the needs of users, highlighting any similarities and/or differences in those needs. The application of the Use Case approach to support the software development activities within EuroFIR will ensure that user needs are effectively identified and captured in a systematic and documented way.

Background/objectives: Compares the nutritional quality of pre-packaged foods carrying health-related claims with foods that do not carry health-related claims. Subjects/methods: Cross-sectional survey of pre-packaged foods available in Germany, the Netherlands, Spain, Slovenia, and the UK in 2013. 2034 foods were randomly sampled from three food store types (a supermarket, a neighbourhood store and a discounter). Nutritional information was taken from nutrient declarations present on food labels and assessed through a comparison of mean levels, regression analyses, and the application of a nutrient profile model currently used to regulate health claims in Australia and New Zealand, (Food Standards Australia New Zealand’s Nutrient Profiling Scoring Criterion, FSANZ NPSC). Results: Foods carrying health claims had, on average, lower levels, per 100g, of the following nutrients; energy – 29.3kcal (p < 0.05), protein – 1.2g (p < 0.01), total sugars – 3.1g (p < 0.05), saturated fat – 2.4g (p

In a policy environment that contains structures to enable public engagement, the validity of expressions of public opinion and concern are in part legitimated through constructions of their representativeness. The current paper examined the ways in which various organisations involved in food and nutrition policy development negotiated the legitimacy of their inclusion in policy processes through claims about who they represented and how, with a specific focus upon older people (aged 60+) as an example of the “hard to reach”. This study is set in the context of theoretical considerations around the forms of representativeness that have been identified in the literature. A thematic analysis of 52 interviews with organisations and stakeholders active in the area of food and nutrition policy in England, UK explores these competing modalities of representation and how they are used both to claim legitimacy for self and to discount the claims of others. Different scripts of representation are deployed by various stakeholders and there is evidence of the strategic and the simultaneous deployment of different representativeness claims. The notions of expert representativeness permeate other modalities of representativeness, suggesting that the dominant framework for food and nutrition policy development is based upon technocratic models of decision-making. This highlights the way in which public views can be distanced from the framing of policy questions.

The study explored how actual resources, perceived levels of different types of resources and goal relevance of these resources affect older people's satisfaction with food-related life using a survey in eight European countries, where 3291 participants above 65 years of age and living in their own homes took part. Satisfaction with food-related life was measured using Satisfaction With Food-related Life (SWFL) scale developed by Grunert. Raats, Dean, Nielsen, Lumbers and The Food in Later Life Team. [(2007). A measure of satisfaction with food-related life. Appetite, 49, 486-493]. Results showed that older people rated the resources that they believed to have plentiful of as being highly relevant to achieve their goals. The individuals who rated the relevance and their level of different resources as high were also more satisfied with their food-related quality of life. Further, satisfaction with food-related life, as was expected, was predicted by income, health measures and living circumstances. However, the study also showed that perceived levels of other resources such as support of family and friends, food knowledge, storage facilities also added to the individuals' satisfaction with food-related life. In addition, the congruence between perceived level and relevance of a resource was also shown to add to people's satisfaction with food-related life, implying that older people's satisfaction with food-related life depends not only on the level of resources they think they have but also on their goals and how important they think these resources are to achieving their goals. (c) 2007 Elsevier Ltd. All rights reserved.

Objective To examine the workings of the nutrition-related scientific advisory bodies in Europe, paying particular attention to the internal and external contexts within which they operate. Design Desk research based on two data collection strategies: a questionnaire completed by key informants in the field of micronutrient recommendations and a case study that focused on mandatory folic acid (FA) fortification. Setting Questionnaire-based data were collected across thirty-five European countries. The FA fortification case study was conducted in the UK, Norway, Denmark, Germany, Spain, Czech Republic and Hungary. Results Varied bodies are responsible for setting micronutrient recommendations, each with different statutory and legal models of operation. Transparency is highest where there are standing scientific advisory committees (SAC). Where the standing SAC is created, the range of expertise and the terms of reference for the SAC are determined by the government. Where there is no dedicated SAC, the impetus for the development of micronutrient recommendations and the associated policies comes from interested specialists in the area. This is typically linked with an ad hoc selection of a problem area to consider, lack of openness and transparency in the decisions and over-reliance on international recommendations. Conclusions Even when there is consensus about the science behind micronutrient recommendations, there is a range of other influences that will affect decisions about the policy approaches to nutrition-related public health. This indicates the need to document the evidence that is drawn upon in the decisions about nutrition policy related to micronutrient intake.

Background: Research has suggested that patients and treatment providers hold different beliefs and models of obesity. This could impact consistency and quality of interventions for weight management. This study investigated the attitudes and beliefs of health professionals, commercial weight management advisors (expert patients) and overweight and obese dieters, towards obesity. Methods: Data were collected using a self-administered questionnaire from 287 health professionals, 85 expert patients and 116 dieters. Respondents gave their views on obesity causation and consequences, and the most efficacious means to manage obesity. Demographic data and self-reported height and weight were also collected. Factor analysis, ANOVA and t-tests were used to analyse the data. Results: Health professionals, expert patients and dieters held similar models of obesity, identifying the same causes (lifestyle causes), consequences (medical consequences) and treatments (currentrecommended options) of obesity/overweight. Conclusion: This study indicated broad similarity between beliefs and attitudes of those involved in obesity treatment and those they aim to treat than previously suggested. The concordance of beliefs between patients and treatment providers is an encouraging finding and may have important implications for public health strategies in this area.

This paper describes the outcome of the workshop 'Deriving Micronutrient Recommendations: Updating Best Practices' which took place in Brussels in April 2012. The workshop was organised jointly by the European Micronutrient Recommendations Aligned (EURRECA) Network of Excellence and the World Health Organization (WHO) Regional Office for Europe. The delegates included, among others, representatives from nutrient recommendation setting bodies (NRSBs) across Europe. The current paper focuses on the gaps and needs of NRSBs as identified by the workshop participants: (i) practical tools and best practices to adapt dietary reference values, (ii) comparable nationally representative food consumption data (including updated and complete food composition databases), (iii) adequate financial resources and technical capacity, (iv) independence and transparency in expert selection, research conduct and communication of research results and (v) clear correspondence of terminology used at national levels.

A key step towards developing appropriate evidence-based public health nutrition policies is determining exactly how that evidence should be collected and assessed. Despite this the extent to which different evidence bases influence policy selection is rarely explored. This paper presents an epistemological framework which offers a range of considerations effecting this process generally and with particular implications for both micronutrient requirements and the role of behaviour in the policy-making process. Qualitative case study data covering six European countries/regions (Czech Republic, Italy, Netherlands, Nordic countries, Poland and Spain), and three micronutrients (folate, iodine and vitamin D), have been presented to illustrate the relevance of the Framework.

Objective: To explore the impact of price manipulation and healthy eating information on intended food choices Design: Health information was provided to a random half of subjects (vs. information on Saudi agriculture). Each subject chose from the same lunch menu, containing two healthy and two unhealthy entrees, deserts and beverages, on five occasions. Reference case prices were 5, 3 and 2 Saudi Arabian Reals (SARs). Prices of healthy and unhealthy items were manipulated up (taxed) and down (subsidised) by 1 SAR in four menu variations (random order); subjects were given a budget enabling full choice within any menu. The number of healthy food choices were compared with different price combinations, and between information groups. Linear regression modelling explored the effect of relative prices of healthy / unhealthy options and information on number of healthy choices controlling for dietary behaviours and hunger levels. Setting: University campus, Saudi Arabia, 2013 Subjects: 99 women students Results: In the reference case, 49.5% of choices were for healthy items. When the price of healthy items was reduced, 58.5% of selections were healthy; 57.2% when the price of unhealthy items rose. In regression modelling, reducing the price of healthy items and increasing the price of unhealthy items increased the number of healthy choices by 5% and 6% respectively. Students reporting a less healthy usual diet selected significantly fewer healthy items. Providing healthy eating information was not a significant influence. Conclusion: Price manipulation offers potential for altering behaviours to combat rising youth obesity in Saudi Arabia.

Background/Objectives: Several factors affect the mental performance of children. The importance that parents attribute to food-related determinants, compared with genetic, socio-economic and school environment, was investigated. Subjects/Methods: Parents of school children (aged 4–11) were recruited through state primary schools in four European countries. Interviews were conducted in which participants were asked to sort 18 cards representing possible determinants of four elements of mental performance (attention, learning, mood and behaviour) according to perceived strength of effect. Determinants were identified from the literature and grouped in six categories: food-related, school environment, physical, social, psychological and biological. Effects were scored: 0=none; 1=moderate; and 2=strong. Views were compared between and within countries. Results: Two hundred parents took part (England: 53; Germany: 45; Hungary: 52; Spain: 50). Differences existed between countries in the proportions reporting university education and being in employment. Taking all countries together, parents consider the food category (mean 1.33) to have a lower impact on a child’s mental performance than physical (activity and sleep, 1.77), psychological (mood and behaviour, 1.69) and school environment (1.57). Social (1.12) and biological (0.91) determinants were ranked lower than food. Of determinants in the food category, parents thought regularity of meals had more influence on mental performance (1.58) than what a child eats now (1.36), food at school (1.35), nutrition as a baby/infant (1.02). Conclusion: Scope exists to improve parental awareness of the repercussions of their dietary choices for the mental performance of their children.

Food-based dietary guidelines (FBDG) have primarily been designed for the consumer to encourage healthy, habitual food choices, decrease chronic disease risk and improve public health. However, minimal research has been conducted to evaluate whether FBDG are utilised by the public. The present review used a framework of three concepts, awareness, understanding and use, to summarise consumer evidence related to national FBDG and food guides. Searches of nine electronic databases, reference lists and Internet grey literature elicited 939 articles. Predetermined exclusion criteria selected twenty-eight studies for review. These consisted of qualitative, quantitative and mixed study designs, non-clinical participants, related to official FBDG for the general public, and involved measures of consumer awareness, understanding or use of FBDG. The three concepts of awareness, understanding and use were often discussed interchangeably. Nevertheless, a greater amount of evidence for consumer awareness and understanding was reported than consumer use of FBDG. The twenty-eight studies varied in terms of aim, design and method. Study quality also varied with raw qualitative data, and quantitative method details were often omitted. Thus, the reliability and validity of these review findings may be limited. Further research is required to evaluate the efficacy of FBDG as a public health promotion tool. If the purpose of FBDG is to evoke consumer behaviour change, then the framework of consumer awareness, understanding and use of FBDG may be useful to categorise consumer behaviour studies and complement the dietary survey and health outcome data in the process of FBDG evaluation and revision.

This study appraises the effectiveness and cost-effectiveness of consumption of plant sterol-enriched margarine-type spreads for the prevention of cardiovascular disease (CVD) in people with hypercholesterolemia in England, compared to a normal diet. A nested Markov model was employed using the perspective of the British National Health Service (NHS). Effectiveness outcomes were the 10-year CVD risk of individuals with mild (4–6 mmol/l) and high (above 6 mmol/l) cholesterol by gender and age groups (45–54, 55–64, 65–74, 75–85 years); CVD events avoided and QALY gains over 20 years. This study found that daily consumption of enriched spread reduces CVD risks more for men and older age groups. Assuming 50% compliance, 69 CVD events per 10,000 men and 40 CVD events per 10,000 women would be saved over 20 years. If the NHS pays the excess cost of enriched spreads, for the high-cholesterol group, the probability of enriched spreads being cost-effective is 100% for men aged over 64 years and women over 74, at £20,000/QALY threshold. Probabilities of cost-effectiveness are lower at younger ages, with mildly elevated cholesterol and over a 10-year time horizon. If consumers bear the full cost of enriched spreads, NHS savings arise from reduced CVD events.

Food composition data are essential for a wide variety of activities, including public health nutrition, research, food labelling and government policy. Food composition data play a particularly important role in four sectors in Europe, namely health, trade regulation and legislation, agriculture and the environment. The need to continue the harmonisation of food composition data already achieved through European collaboration can be clearly identified and evidenced. Harmonisation is not exclusively a technical issue, but also entails creating durable and sustainable structures to maintain the viability of food composition data. These and related issues are currently being addressed by the EuroFIR Network of Excellence (project number FP6-513944, http://www.eurofir.net). © 2006 British Nutrition Foundation.

Background: European consumers are faced with a myriad of food related risk and benefit information and it is regularly left up to the consumer to interpret these, often conflicting, pieces of information as a coherent message. This conflict is especially apparent in times of food crises and can have major public health implications. Scientific results and risk assessments cannot always be easily communicated into simple guidelines and advice that nonscientists like the public or the media can easily understand especially when there is conflicting, uncertain or complex information about a particular food or aspects thereof. The need for improved strategies and tools for communication about food risks and benefits is therefore paramount. The FoodRisC project ("Food Risk Communication - Perceptions and communication of food risks/benefits across Europe: development of effective communication strategies”) aims to address this issue. The FoodRisC project will examine consumer perceptions and investigate how people acquire and use information in food domains in order to develop targeted strategies for food communication across Europe. Methods/Design: This project consists of 6 research work packages which, using qualitative and quantitative methodologies, are focused on development of a framework for investigating food risk/benefit issues across Europe, exploration of the role of new and traditional media in food communication and testing of the framework in order to develop evidence based communication strategies and tools. The main outcome of the FoodRisC project will be a toolkit to enable coherent communication of food risk/benefit messages in Europe. The toolkit will integrate theoretical models and new measurement paradigms as well as building on social marketing approaches around consumer segmentation. Use of the toolkit and guides will assist policy makers, food authorities and other end users in developing common approaches to communicating coherent messages to consumers in Europe. Discussion: The FoodRisC project offers a unique approach to the investigation of food risk/benefit communication. The effective spread of food risk/benefit information will assist initiatives aimed at reducing the burden of food-related illness and disease, reducing the economic impact of food crises and ensuring that confidence in safe and nutritious food is fostered and maintained in Europe.

Background: Precautionary ‘may contain’ warnings are used to indicate possible allergen contamination. Neither food safety nor foods labelling legislation address this issue. The aim of this study is to understand how peanut and nut allergic adults interpret ‘may contain’ labelling and how they use this information when purchasing food. Methods: Qualitative methods were used to explore both behaviour and attitudes. The behaviour and ‘thinking aloud’ of 32 participants were recorded during their normal food shop. A semi-structured interview also explored participants’ views about 13 potentially problematic packaged foods. Transcribed data from these tasks were analysed to explore the interpretation of ‘may contain’ labelling and how this influenced food choice decisions. Results: Peanut and nut allergic individuals adopt a complex range of responses and strategies to interpret ‘may contain’ labelling. Many claimed such labelling was not credible or desirable; many ignored it whilst some found it helpful and avoided products with all such labelling. Interpretation and consequent decisions were not only based on the detail of the labelling but also on external factors such as the nature of the product, the perceived trustworthiness of the producer and on the previous experience of the nut allergic individual. Conclusions: ’May contain’ labelling was interpreted in the light of judgements about the product, producer and previous personal experience. It is vital that these interpretation strategies are taken into account by those responsible for labelling itself and for the provision of advice to nut allergic individuals. Suggestions to improve labelling and advice to the allergic individual are considered.

This article aims to investigate associations between perceived control and health-related quality of life (HRQOL) with dietary changes after prostate cancer diagnosis and to explore General Practitioners’ (GPs) perceptions on the role of diet in prostate cancer post-diagnosis. Ninety-five prostate cancer patients completed measures of dietary change, one for after diagnosis and another for after therapy. They also scored their HRQOL and perceived control. There were discrepancies in dietary changes reported between a general question (28.4% no dietary changes) and a specific (42.1%– 51.5% range of no change for various food items). Most patients initiated healthy changes. Patients who changed their diet after diagnosis had lower cognitive functioning and external locus of control (doctors). Patients who changed their diet after therapy had lower cognitive and emotional functioning, quality of life and external locus of control (doctors). Then, fourty-four GPs responded to an online survey. Their open-ended responses were analysed using Content Analysis. They reported interest in the role of diet in cancer but also lack of relevant knowledge. They were skeptical on providing information. Clinical interventions should consider patients’ cognitive ability, their relationship with their health professional and their wellbeing. Also, GPs’ confidence to provide dietary advice needs to be addressed.

Dietary factors are the most important risk factors affecting health and well-being of population in every Member State of the European Region. Finding sustainable solutions to the food and health challenges is one of the key issues that today’s society urgently needs to address. Research prioritisation thus has an essential role in directing public resources to addressing these challenges. However, the processes of prioritisation among the food and health funders are rarely subject to scrutiny and the calls for democratizing science continue, as a means of enhancing both input legitimacy (with its focus on the processes of decision-making) and output legitimacy (the utility and impact of such decisions). The current study examines what conceptualisations of legitimacy (input and output) are held by the European stakeholders of the food and health research and innovation (R&I) process such as business organisations, non-governmental organisations (NGOs) and public sector organisations. We analyse stakeholder views from a series of European Awareness Scenario Workshops across nine EU countries (N = 295). The content and thematic analysis of the outputs identified six criteria determining conceptualisations of legitimacy: Influence; Representation; Procedural issues; Epistemic focus; Strategic vision; and Impact. The statistical analysis of the coded data highlighted stakeholder differences with business sector organisations being significantly less concerned about influence and representation than either NGO or public sector organisations. The results indicate that input legitimacy is of major concern to civil society and public sector actors. They reflect the wider debate about the way in which food and health R&I should be funded and policy decisions conducted, suggesting a need for better delineation of stakeholder roles and power differentials in this process. The findings are discussed with reference to the current discussions about Responsible Research and Innovation.

Different front-of-pack (FOP) labelling systems have been developed in Europe by industry and organisations concerned with health promotion. A study (n 2068) was performed to establish the extent to which inclusion of the most prevalent FOP systems--guideline daily amounts (GDA), traffic lights (TL), GDA+TL hybrid (HYB) and health logos (HL)--impact consumer perceptions of healthiness over and above the provision of a FOP basic label (BL) containing numerical nutritional information alone. The design included within- and between-subjects factors. The within-subjects factors were: food (pizzas, yogurts and biscuits), healthiness of the food (high health, medium health and low health) and the repeated measurements under BL and test FOP label conditions. The between-subjects factors were: the system (GDA, TL, GDA+TL hybrid, HL), portion size (typical portion size and a 50% reduction of a typical portion) and country (the UK, Germany, Poland and Turkey). Although the FOP systems tested did result in small improvements for objective understanding under some conditions, there was little difference between the provision of an FOP label containing basic numerical nutritional information alone or between the various systems. Thus, any structured and legible presentation of key nutrient and energy information on the FOP label is sufficient to enable consumers to detect a healthier alternative within a food category when provided with foods that have distinctly different levels of healthiness. Future research should focus on developing greater understanding of the psychological and contextual factors that impact motivation and the opportunity to use the various FOP systems in real-world shopping settings.

Background The need for a better understanding of food consumption behaviour within its behavioural context has sparked the interest of nutrition researchers for user-documented food consumption data collected outside the research context using publicly available nutrition apps. The study aims to characterize the scientific, technical, legal and ethical features of this data in order to identify the opportunities and challenges associated with using this data for nutrition research. Method A search for apps collecting food consumption data was conducted in October 2016 against UK Google Play and iTunes storefronts. 176 apps were selected based on user ratings and English language support. Publicly available information from the app stores and app-related websites was investigated and relevant data extracted and summarized. Our focus was on characteristics related to scientific relevance, data management and legal and ethical governance of user-documented food consumption data. Results Food diaries are the most common form of data collection, allowing for multiple inputs including generic food items, packaged products, or images. Standards and procedures for compiling food databases used for estimating energy and nutrient intakes remain largely undisclosed. Food consumption data is interlinked with various types of contextual data related to behavioural motivation, physical activity, health, and fitness. While exchange of data between apps is common practise, the majority of apps lack technical documentation regarding data export. There is a similar lack of documentation regarding the implemented terms of use and privacy policies. While users are usually the owners of their data, vendors are granted irrevocable and royalty free licenses to commercially exploit the data. Conclusion Due to its magnitude, diversity, and interconnectedness, user-documented food consumption data offers promising opportunities for a better understanding of habitual food consumption behaviour and its determinants. Non-standardized or non-documented food data compilation procedures, data exchange protocols and formats, terms of use and privacy statements, however, limit possibilities to integrate, process and share user-documented food consumption data. An ongoing research effort is required, to keep pace with the technical advancements of food consumption apps, their evolving data networks and the legal and ethical regulations related to protecting app users and their personal data.

Background The rise in use of food supplements based on botanical ingredients (herbal supplements) is depicted as part of a trend empowering consumers to manage their day-to-day health needs, which presupposes access to clear and accurate information to make effective choices. Evidence regarding herbal supplement efficacy is extremely variable so recent regulations eliminating unsubstantiated claims about potential effects leave producers able to provide very little information about their products. Medical practitioners are rarely educated about herbal supplements and most users learn about them via word-of-mouth, allowing dangerous misconceptions to thrive, chief among them the assumption that natural products are inherently safe. Print media is prolific among the information channels still able to freely discuss herbal supplements. Method This study thematically analyses how 76 newspaper/magazine articles from the UK, Romania and Italy portray the potential risks and benefits of herbal supplements. Results Most articles referenced both risks and benefits and were factually accurate but often lacked context and impartiality. More telling was how the risks and benefits were framed in service of a chosen narrative, the paucity of authoritative information allowing journalists leeway to recontextualise herbal supplements in ways that serviced the goals and values of their specific publications and readerships. Conclusion Providing sufficient information to empower consumers should not be the responsibility of print media, instead an accessible source of objective information is required.

The aim of this study is to explore the information needs of men with prostate cancer and their partners retrospectively at various points in the treatment process. An online questionnaire was used to collect information from men with prostate cancer and their partners about information needs, and when these developed. Readers of a Prostate Care Cookbook and members of a Prostate Cancer Charity were invited to participate: 73 men with prostate cancer and 25 partners completed the questionnaire. Responses showed that participants develop their information needs close to diagnosis. Less educated men with prostate cancer and partners developed their needs closer to the time after diagnosis than those with higher education. Partners develop an interest on information related to treatment and interaction earlier than patients. Patients prioritised treatment and disease-specific information. Patients and partners differ in how their information needs develop. Medical information is prioritized by patients as opposed to practical information by partners. Health care provision can be tailored to meet the different needs of prostate cancer patients and their partners at different times in the treatment process.

The use of dietary supplements is increasing globally and this includes the use of plant food supplements (PFS). A variety of factors may be influencing this increased consumption including the increasing number of older people in society, mistrust in conventional medicine and the perception that natural is healthy. Consumer studies in this area are limited, with a focus on dietary supplements in general, and complicated by the use of certain plant food supplements as herbal medicines. Research indicates that higher use of dietary supplements has been associated with being female, being more educated, having a higher income, being white and being older, however the drivers for consumption of supplements are complex, being influenced by both demographic and health-related factors. The aim of this paper is to provide an overview of current knowledge about the users and the determinants of usage of plant food supplements. With growing consumption of these products, the need for effective risk-benefit assessment becomes ever more important and an insight into who uses these types of products and why is an important starting point for any future science-based decisions made by policy makers, PFS manufacturers and ultimately by consumers themselves.

The objective of this study was to relate behaviour change mechanisms to nutritionally relevant behaviour and demonstrate how the different mechanisms can affect attempts to change these behaviours. Folate was used as an example to illuminate the possibilities and challenges in inducing behaviour change. The behaviours affecting folate intake were recognised and categorised. Behaviour change mechanisms from "rational model of man", behavioural economics, health psychology and social psychology were identified and aligned against folate-related behaviours. The folate example demonstrated the complexity of mechanisms influencing possible behavioural changes, even though this only targets the intake of a single micronutrient. When considering possible options to promote folate intake, the feasibility of producing the desired outcome should be related to the mechanisms of required changes in behaviour and the possible alternatives that require no or only minor changes in behaviour. Dissecting the theories provides new approaches to food-related behaviour that will aid the development of batteries of policy options when targeting nutritional problems.

A range of stakeholders have been involved in the development and implementation of dietary guidelines (DG) across Europe. Seventy-seven semi-structured qualitative interviews explored stakeholders' beliefs of DG in six European countries/regions. A main theme, variation in the interpretation of the term dietary guideline, was identified using thematic analysis. Descriptions of DG varied across stakeholder groups and countries. Reference was made to both food-based and nutrient-based guidelines, including the terms food-based DG and food guides (for example, pyramids), nutrient recommendations, dietary recommendations, dietary reference values and guideline daily amounts. The terminology surrounding DG requires greater clarity. Until that time, stakeholders would benefit from increased awareness of potential misinterpretations and the implications of this on multi-stakeholder, multi-national policy development and implementation.European Journal of Clinical Nutrition advance online publication, 13 April 2011; doi:10.1038/ejcn.2011.38.

Background The popularity of botanical products is on the rise in Europe, with consumers using them to complement their diets or to maintain health, and products are taken in many different forms (e.g. teas, juices, herbal medicinal products, plant food supplements (PFS)). However there is a scarcity of data on the usage of such products at European level. Objective To provide an overview of the characteristics and usage patterns of PFS consumers in six European countries. Design Data on PFS usage were collected in a cross-sectional, retrospective survey of PFS consumers using a bespoke frequency of PFS usage questionnaire. Subjects/setting A total sample of 2359 adult PFS consumers from Finland, Germany, Italy, Romania, Spain and the United Kingdom. Data analyses Descriptive analyses were conducted, with all data stratified by gender, age, and country. Absolute frequencies, percentages and 95% confidence intervals are reported. Results Overall, an estimated 18.8% of screened survey respondents used at least one PFS. Characteristics of PFS consumers included being older, well-educated, never having smoked and self-reporting health status as “good or very good”. Across countries, 491 different botanicals were identified in the PFS products used, with Ginkgo biloba (Ginkgo), Oenothera biennis (Evening primrose) and Cynara scolymus (Artichoke) being most frequently reported; the most popular dose forms were capsules and pills/tablets. Most consumers used one product and half of all users took single-botanical products. Some results varied across countries. Conclusions The PlantLIBRA consumer survey is unique in reporting on usage patterns of PFS consumers in six European countries. The survey highlights the complexity of measuring the intake of such products, particularly at pan-European level. Incorporating measures of the intake of botanicals in national dietary surveys would provide much-needed data for comprehensive risk and benefit assessments at the European level.

Nutrition is one of the many factors that influence a child’s cognitive development and performance. Understanding the relationship between nutrition and mental performance in children is important in terms of their attainment and productivity both in school and later life. Since parents are seen as nutritional gatekeepers for their children’s diets, their views and beliefs are of crucial importance. The present study aims to qualitatively examine parents’ perceptions of the relationship between diet and mental performance of children. The study was conducted with a total of 124 parents in four European countries using a semi-structured interview schedule. Parents speak of the effects of diet at two levels; the nature of the effects of diet and the characteristics of the foods responsible for these effects. Mental outcomes are related to diet, with the effects perceived to be associated with attention and concentration, often mediated by effects on children’s mood and behaviour. Parents categorise foods as ‘good’ or ‘bad’ with positive effects related generally to a healthy balanced diet while negative effects are perceived to be associated with sugary and fatty foods. Understanding parental perceptions is important for many purposes including the targeting of dietary advice and prioritising of public health issues.

Purpose - The purpose of this research is to show how a nation-wide survey of teachers investigated the teaching of food hygiene in primary schools. The survey determined which information sources were known and used by those responsible for teaching food hygiene. Design/methodology/approach - Postal questionnaires were distributed to 3,806 primary schools throughout the UK (response rate 23 per cent). The questionnaire was developed based on the results of in-depth interviews with school teachers and included topics such as where teachers gained up-to-date food hygiene messages, methods used to teach food hygiene, and how key food hygiene messages are reinforced. Teachers cited most preferred resources for teaching food hygiene, influences on the choice of these resources, and limitations on use. Findings - Overall, the results indicated that food hygiene is taught in a number of subject areas, with handwashing and personal hygiene being the principal topics. Teachers use a combination of methods to teach food hygiene and to reinforce food safety messages. The principal limitations of teaching this topic were identified as a lack of suitable space and curriculum time Teachers across the UK also identified new resources that would support the teaching of food hygiene. Originality/value - The study identified how primary school teachers deliver food hygiene messages through the curriculum, daily routines and whole school initiatives. Ways in which primary school teachers could be supported when delivering food hygiene education have been suggested.

Background Cooking skills are increasingly included in strategies to prevent and reduce chronic diet-related diseases and obesity. While cooking interventions target all age groups (Child, Teen and Adult), the optimal age for learning these skills on: 1) skills retention, 2) cooking practices, 3) cooking attitudes, 4) diet quality and 5) health is unknown. Similarly, although the source of learning cooking skills has been previously studied, the differences in learning from these different sources has not been considered. This research investigated the associations of the age and source of learning with the aforementioned five factors. Methods A nationally representative (Northern/Republic of Ireland) cross-sectional survey was undertaken with 1049 adults aged between 20–60 years. The survey included both measures developed and tested by the researchers as well as validated measures of cooking (e.g. chopping) and food skills (e.g. budgeting), cooking practices (e.g. food safety), cooking attitudes, diet quality and health. Respondents also stated when they learnt the majority of their skills and their sources of learning. The data was analysed using ANOVAs with post-hoc analysis and Chi2 crosstabs with a significance level of 0.05. Results Results showed that child (

Objective: Images on food and dietary supplement packaging might lead people to infer (appropriately or inappropriately) certain health benefits of those products. Research on this issue largely involves direct questions, which could (a) elicit inferences that would not be made unprompted, and (b) fail to capture inferences made implicitly. Using a novel memory-based method, in the present research, we explored whether packaging imagery elicits health inferences without prompting, and the extent to which these inferences are made implicitly. Method: In 3 experiments, participants saw fictional product packages accompanied by written claims. Some packages contained an image that implied a health-related function (e.g., a brain), and some contained no image. Participants studied these packages and claims, and subsequently their memories for seen and unseen claims were tested. Results: When a health image was featured on a package, participants often subsequently recognized health claims that— despite being implied by the image—were not truly presented. In Experiment 2, these recognition errors persisted despite an explicit warning against treating the images as informative. In Experiment 3, these findings were replicated in a large consumer sample from 5 European countries, and with a cued-recall test. Conclusion: These findings confirm that images can act as health claims, by leading people to infer health benefits without prompting. These inferences appear often to be implicit, and could therefore be highly pervasive. The data underscore the importance of regulating imagery on product packaging; memory-based methods represent innovative ways to measure how leading (or misleading) specific images can be.

Objective: Health claims on food packaging are regulated to inform and protect consumers, however many consumers do not accurately interpret the meaning of the claims. Whilst research has shown different types of misinterpretation, it is not clear how those interpretations are formed. The aim of this study is to elicit the causal beliefs and causal models about food and health held by consumers, i.e. their understanding of the causal relationships between nutrients, health outcomes and the causal pathways connecting them, and investigate how well this knowledge explains the variation in inferences they draw about health benefits from health claims. Method: 400 participants from Germany, the Netherlands, Spain, Slovenia, and the UK were presented with 7 authorised health claims and drew inferences about the health benefits of consuming nutrients specified in the claim. Then their personal causal models of health were elicited along with their belief in the truth and familiarity with the claims. Results: The strength of inferences about health benefits that participants drew from the claims were predicted independently by the strength of the relevant causal pathways within the causal model, and belief in the truth of the claim, but not familiarity with the claim. Participants drew inferences about overall health benefits of the nutrients by extrapolating from their causal models of health. Conclusion: Consumers’ interpretation of claims is associated with their belief in the claim and their causal models of health. This prior knowledge is used to interpret the claim and draw inferences about overall health benefits that go beyond the information in the claim. Therefore efforts to improve consumers’ understanding and interpretation of health claims must address both their wider causal models of health and their knowledge of specific claims.

Many nutrition and/or health symbols were introduced in different countries in the past years and Slovenia is no exception. The objective of our study was to examine familiarity with and perception of the Protective Food symbol (PF symbol) in Slovenia and to investigate consumers' associations related to the symbol, and the influence of symbols' appearance on their preferences. The study was conducted through online questionnaire with incorporated word-association tasks and conjoint analysis; GfK consumer panel and social media (Facebook) were used for recruitment of Slovenian adults (n = 1050; 534 men, 516 women). The majority (78%) of the participants reported they had previously seen the PF symbol, and 64% declared familiarity with it. Familiarity was verified using a word-association task in which we analysed the nature of the symbol's description, distinguishing the description of symbol's visual appearance or its meaning. In this task, 73% of the participants described the symbol's meaning with reference to health or a healthy lifestyle, confirming their familiarity with it. Women and those responsible for grocery shopping were significantly more familiar with the symbol. The impact of the symbol's appearance on consumers' preferences was investigated using conjoint analysis consisting of two attributes – three different symbols found on foods in Slovenia (PF symbol, Choices Programme symbol and Keyhole symbol), and accompanying worded claims. Although worded claims had less relative importance (29.5%) than the symbols (70.5%), we show that careful choice of the wording can affect consumers' preferences considerably. The lowest part-worth utility was observed without an accompanying claim, and the highest for the claim directly communicating health (“Protects your health”). The fact that most participants are well familiar with the PF symbol indicates the symbol's potential to promote healthier food choices, which could be further improved by an accompanying worded claim that clearly describes its meaning. In addition, the use of Facebook ads is shown to be a useful alternative recruitment method for research with consumers.

The dominant approaches to public health policy on childhood obesity are based on the neoliberal emphasis of personal choice and individual responsibility. We study adolescents’ (N=81) beliefs about responsibility for childhood obesity as a public health issue, through an innovative participatory method, PlayDecide, organised in two countries: the UK and Spain. There is no evidence of a blanket rejection of individual responsibility, rather, a call for renegotiation of the values that inform adolescents’ food choices. The findings suggest the need to broaden the framing of obesity-related policy to go beyond the nutritional paradigm and include other values that signal health.

Responsible Research and Innovation (RRI) has recently emerged as a new framework for science and technology governance. The concept articulates the need for mutual exchange by which societal actors become responsive to each other early on in the process of innovation, with a view to facilitate ethically acceptable and sustainable innovation. There is relatively limited evidence to explore the extent to which the process of research and innovation under the terms of RRI is realised in practice, particularly in the context of food and health research. Although research to date has been examining innovation from the point of view of inputs and outputs—R&D funding and patents—we propose to examine the cognitive framing of innovation that shapes decisions of those who constitute a part of the innovation chain. This paper explores how the concept of innovation is understood and used in policy implementation, with a particular focus upon ‘food and health’ science and research policy and funding. Our analysis is based on 55 interviews of various actors engaged in research funding decision-making across eight European countries. Three themes emerged from the analysis: concept of innovation; conditions for innovation; and drivers of innovation; through these themes, the cognitive framing was drawn out. The cognitive framing suggests that innovation in the food and health domain is perceived to be focused on biosciences and marketable applications to the neglect of social sciences and broader public interest; that the “innovation network” is primarily viewed as centred around scientific/technical and industrial actors; and that the demand-pull dynamic is relevant to innovation in the area of food and health, despite having been relegated in contemporary thinking and policies around innovation. These findings point to the inadequate consideration of the normative issues—how problems are to be defined and addressed—among national research funders in the food and health domain, and indicate a gap between the ideas of innovation under the terms of RRI and innovation as conceptualised by those involved in its governance.

The objective was to identify the main factors infl uencing micronutrient policies in the opinion of policy actors in ten European countries. Study was carried out during Jan-Nov 2010 in European countries: the Czech Republic, Denmark, England, Germany, Greece, Italy, the Netherlands, Nor-way, Poland and Spain. Semi-structured qualitative interviews were conducted with representatives of stakeholders involved in the vitamin D, folate and iodine policy making process. Fifty eight key informants representing mainly scientifi c advisory bodies (n=24) and governmental organisations (n=19) participated in the study. The remaining interviewees represented non-governmental organisations (n=6), industry (n=4) or were indepen-dent academic or health professional experts (n=5). Data were analysed by theoretical interpretative thematic analysis. Insights from interviewees on the development of micronutrient policies were grouped using the Public Health Nutrition Policy-making model. The main factors infl uencing the mi-cronutrient policies were: systematic monitoring of nutrition and health, causal relationships between consumers’ diet-related behaviours and health outcomes, scientifi c recommendations from national bodies (Science area); scientifi c recommendations from international authorities and experiences of other countries, EU legislation, cultural factors (Wider context) and political environment, national capacity to deal with the problem, national leg-islation, economics, stakeholder engagement, relationships between stakeholders (Policy and institutions area). The spectrum and weight of the factors infl uencing nutritional policy depends on nutrient, country and degree of its “advanced status” within nutrition policy, political environment, culture and socio-economic conditions as well as the point of view (who is expressing the opinion).

Using the Theory of Planned Behaviour (TPB), this study investigates weight control in overweight and obese participants (27kg/m(2)⩽BMI

Background Interventions to increase cooking skills (CS) and food skills (FS) as a route to improving overall diet are popular within public health. This study tested a comprehensive model of diet quality by assessing the influence of socio-demographic, knowledge- and psychological-related variables alongside perceived CS and FS abilities. The correspondence of two measures of diet quality further validated the Eating Choices Index (ECI) for use in quantitative research. Methods A cross-sectional survey was conducted in a quota-controlled nationally representative sample of 1049 adults aged 20–60 years drawn from the Island of Ireland. Surveys were administered in participants’ homes via computer-assisted personal interviewing (CAPI) assessing a range of socio-demographic, knowledge- and psychological-related variables alongside perceived CS and FS abilities. Regression models were used to model factors influencing diet quality. Correspondence between 2 measures of diet quality was assessed using chi-square and Pearson correlations. Results ECI score was significantly negatively correlated with DINE Fat intake (r = -0.24, p 

Background: Colour coded front-of-pack nutrition labelling (‘traffic light labelling’) has been recommended for use in the UK since 2006. The voluntary scheme is used by all the major retailers and some manufacturers. It is not clear how consumers use these labels to make a single decision about the relative healthiness of foods. Our research questions were: Which of the four nutrients on UK traffic light labels (total fat, saturated fat, sugar and salt) has the most influence on decisions? Do green lights or red lights have a greater influence? Are there age and gender differences in how people use the colour and nutrient information? Methods: We recruited participants from a UK supermarket chain membership list to conduct an online choice experiment in May 2014. We analysed data using multilevel logisitic models with food choices (n = 3321) nested in individuals (n = 187) as the unit of analysis. Results: A food with more reds was 11.4 (95 % confidence intervals: 10.3, 12.5) times less likely to be chosen as healthy, whereas a food with more greens was 6.1 (5.6, 6.6) times more likely to be chosen as healthy. Foods with better colours on saturated fat and salt were 7.3 (6.7, 8.0) and 7.1 (6.5, 7.8) times more likely to be chosen as healthy – significantly greater than for total fat (odds ratio 4.8 (4.4, 5.3)) and sugar (5.2 (4.7, 5.6)). Results were broadly similar for different genders and age groups. Conclusions: We found that participants were more concerned with avoiding reds than choosing greens, and that saturated fat and salt had a greater influence on decisions regarding healthiness than total fat and sugar. This could influence decisions about food reformulation and guidance on using nutrition labelling.

Health claims and symbols are potential aids to help consumers identify foods that are healthier options. However, little is known as to how health claims and symbols are used by consumers in real-world shopping situations, thus making the science-based formulation of new labelling policies and the evaluation of existing ones difficult. The objective of the European Union-funded project R ole of health-related CLaims and sYMBOLs in consumer behaviour (CLYMBOL) is to determine how health-related information provided through claims and symbols, in their context, can affect consumer understanding, purchase and consumption. To do this, a wide range of qualitative and quantitative consumer research methods are being used, including product sampling, sorting studies (i.e. how consumers categorise claims and symbols according to concepts such as familiarity and relevance), cross-country surveys, eye-tracking (i.e. what consumers look at and for how long), laboratory and in-store experiments, structured interviews, as well as analysis of population panel data. EU Member States differ with regard to their history of use and regulation of health claims and symbols prior to the harmonisation of 2006. Findings to date indicate the need for more structured and harmonised research on the effects of health claims and symbols on consumer behaviour, particularly taking into account country-wide differences and individual characteristics such as motivation and ability to process health-related information. Based on the studies within CLYMBOL, implications and recommendations for stakeholders such as policymakers will be provided.

Objective Transparent evidence-based decision making has been promoted worldwide to engender trust in science and policy making. Yet, little attention has been given to transparency implementation. The degree of transparency (focused on how uncertain evidence was handled) during the development of folate and vitamin D Dietary Reference Values was explored in three a priori defined areas: (i) value request; (ii) evidence evaluation; and (iii) final values. Design Qualitative case studies (semi-structured interviews and desk research). A common protocol was used for data collection, interview thematic analysis and reporting. Results were coordinated via cross-case synthesis. Setting Australia and New Zealand, Netherlands, Nordic countries, Poland, Spain and UK. Subjects Twenty-one interviews were conducted in six case studies. Results Transparency of process was not universally observed across countries or areas of the recommendation setting process. Transparency practices were most commonly seen surrounding the request to develop reference values (e.g. access to risk manager/assessor problem formulation discussions) and evidence evaluation (e.g. disclosure of risk assessor data sourcing/evaluation protocols). Fewer transparency practices were observed to assist with handling uncertainty in the evidence base during the development of quantitative reference values. Conclusions Implementation of transparency policies may be limited by a lack of dedicated resources and best practice procedures, particularly to assist with the latter stages of reference value development. Challenges remain regarding the best practice for transparently communicating the influence of uncertain evidence on the final reference values. Resolving this issue may assist the evolution of nutrition risk assessment and better inform the recommendation setting process.

Many older women reduce the amount of cooking and food preparation they do in later life. While cooking may be seen as traditionally associated with women's family roles, little is known about the impact of such reduced engagement with food on their lives. This paper presents the findings from a one-year qualitative study (Changes Around Food Experience, CAFE) of the impact of reduced contact with preparing and cooking meals from scratch for 40 women, aged 65–95 years, living in Norfolk, United Kingdom. Data were collected through semi-structured interviews, focus groups and observations. Women's reasons for reducing food-related activities included changes in health, loss of a partner or a caring role, and new patterns of socialising. Disengagement from cooking and shopping was not found to entail predominantly negative feelings, passive acceptance or searching for forms of support to re-enable more cooking from scratch. Accounts evidenced the dynamic adaptability of older women in actively managing changed relationships with food. In exploring new meal options, older women were not simply disengaging from their environments. CAFE findings linked women's engagement with their environments to how they were using formal services and, even more, to the value they placed on social engagement and being out and about. Through the connections they fostered with friends, family and community, older women actively enabled their continued involvement in their social, public and family spheres. Reduced contact with preparing and cooking meals from scratch, therefore, did not induce or imply passivity or debility in the CAFE cohort. By contrast, it involved their exploring new means of retaining what was important to them about food in the context of their lived situation and social connections with friends, family, the community and public spheres.

Genetic tests are currently being offered to the general public with little oversight and regulation as to which tests are allowed to be sold clinically and little control over the marketing and promotion of sales and use. This article provides discussion and data to indicate that the general public holds high opinions of genetic testing and that current media outlets for public education on genetic testing are not adequate to increase accurate knowledge of genetics. The authors argue that more regulation is needed to control and correct this problem in the United States.

Healthy dietary profiles contribute to successful aging, and dietary intake is dependent upon food procurement capabilities. Both formal and informal social networks can contribute to grocery shopping capabilities and methods of food procurement. This investigation explores the role of informal networks in food procurement methods among adults aged 65 years and older, and compares differences across eight European countries. Food shopping ways (FSW), identified by quantitative analysis (cluster analysis and correspondence analysis), guided the content qualitative analysis which was carried out addressing three main research questions addressing food shopping routines, feelings of dependency and needs of informal support for shopping, and differences between past and present food shopping behaviours. Living circumstances influence food shopping habits. Informal networks differed between two groups of individuals: those living alone and those living with others. Gender differences emerged in shopping pleasure. Geographical factors were associated with preference for shopping companions, attitudes toward receiving support, and availability of a car for shopping. The importance of living circumstances (i.e., alone vs. with others) in FSW was revealed. Informal social networks may play an important role in public health and welfare policies, particularly given the increase in this demographic group. Assistance with grocery shopping and the availability of trained personnel could widen informal networks, and effective informal networks may be an important supportive service for older adults. The comparison across countries highlighted relationships between food procurement capabilities and social networks. These findings may be used to develop resources to better meet the nutritional needs of older adults.

Images on dietary supplement packaging can help identify the products' supposed function. However, research shows that these images can also lead people to infer additional health benefits of consuming the products. The present research investigated the extent to which front-of-pack imagery affects people's perceptions of the health risks and benefits of fictional products. In three randomized experiments, participants saw fictitious dietary supplement packages. Some of the packages included a health-related image (e.g. a heart), whereas others did not. Participants were asked to infer the products' intended purpose and then to rate the perceived risks and benefits of consuming the product. In Experiment 1 (N = 546), the inclusion of a health-related image increased the perceived benefits of consuming the product, with minimal effect on the perceived risks. This finding was replicated in Experiment 2 (N = 164), but was contingent on whether each product's assumed health function was confirmed or disconfirmed. In Experiment 3 (N = 306), which used a pre-registered design and analysis plan, the inclusion of a health-related image increased the perceived benefits and decreased the perceived risks of consuming the product. Again, these effects were contingent on whether the assumed health functions were confirmed or disconfirmed. These findings indicate that health-related imagery could lead consumers to infer additional health properties from non-diagnostic information featured on a product's packaging, perhaps as a consequence of increased processing fluency. This research underscores the importance of regulating the use of imagery in health marketing, to protect consumers from the effects of potentially misleading claims.

Food in later life has been the focus of research in the past decades, especially in what refers to nutritional status and food consumption. Although biological, psychological, personal and economic determinants in food choice are well known, the relationship with the cultural environment has been less explored. Cultural rules determine daily and weekly sequence of meals, time and type of meal, what constitutes a meal, what is considered a proper meal, and distinguish a meal event from a snack. The purpose of this study was to understand meals in the later life of Portuguese older people, focusing on the differences in the life cycle through a qualitative approach. Our research involved 80 Portuguese older people, free living in the community. We found that an easy childhood or the economic constraints in early childhood had a positive or negative impact in older people view of meals in past and present. The experiences in adult life (migration, marriage, having children, labour, disease) influenced daily routines, including eating, for both men and women. Meals across life were defined by gendered roles and discontinuity in relationships. Therefore, the presence of new relationships or life conditions will reflect in new challenges in domestic activities. In older age, being alone or isolated was an important determinant for eating habits. The loss of partner was the most reported situation, which was linked to eating alone and less satisfaction with meals. Having support from family or a specialized institution is central to the daily routines with meals. Understanding the meaning of meals in later life can be very useful in order to develop appropriate strategies for this population.

Background: Health research using commercial data is increasing. The evidence on public acceptability and sociodemographic characteristics of individuals willing to share commercial data for health research is scarce. Objective: This survey study investigates the willingness to share commercial data for health research in the United Kingdom with 3 different organizations (government, private, and academic institutions), 5 different data types (internet, shopping, wearable devices, smartphones, and social media), and 10 different invitation methods to recruit participants for research studies with a focus on sociodemographic characteristics and psychological predictors. Methods: We conducted a web-based survey using quota sampling based on age distribution in the United Kingdom in July 2020 (N=1534). Chi-squared tests tested differences by sociodemographic characteristics, and adjusted ordered logistic regressions tested associations with trust, perceived importance of privacy, worry about data misuse and perceived risks, and perceived benefits of data sharing. The results are shown as percentages, adjusted odds ratios, and 95% CIs. Results: Overall, 61.1% (937/1534) of participants were willing to share their data with the government and 61% (936/1534) of participants were willing to share their data with academic research institutions compared with 43.1% (661/1534) who were willing to share their data with private organizations. The willingness to share varied between specific types of data—51.8% (794/1534) for loyalty cards, 35.2% (540/1534) for internet search history, 32% (491/1534) for smartphone data, 31.8% (488/1534) for wearable device data, and 30.4% (467/1534) for social media data. Increasing age was consistently and negatively associated with all the outcomes. Trust was positively associated with willingness to share commercial data, whereas worry about data misuse and the perceived importance of privacy were negatively associated with willingness to share commercial data. The perceived risk of sharing data was positively associated with willingness to share when the participants considered all the specific data types but not with the organizations. The participants favored postal research invitations over digital research invitations. Conclusions: This UK-based survey study shows that willingness to share commercial data for health research varies; however, researchers should focus on effectively communicating their data practices to minimize concerns about data misuse and improve public trust in data science. The results of this study can be further used as a guide to consider methods to improve recruitment strategies in health-related research and to improve response rates and participant retention.

Reformulation of food products to reduce salt content has been a central strategy for achieving population level salt reduction. In this paper, we reflect on current reformulation strategies and consider how consumer behavior determines the ultimate success of these strategies. We consider the merits of adopting a 'health by stealth', silent approach to reformulation compared to implementing a communications strategy which draws on labeling initiatives in tandem with reformulation efforts. We end this paper by calling for a multi-actor approach which utilizes co-design, participatory tools to facilitate the involvement of all stakeholders, including, and especially, consumers, in making decisions around how best to achieve population-level salt reduction.

Breastfeeding mothers often report perceived insufficient milk (PIM) believing their infant is crying too much, which leads to introducing formula and the early abandonment of breastfeeding. We sought to determine if infant crying was associated with reported PIM (yes/no) and number of problems associated with lactation (lactation problem score [LPS] 6‐point Likert scale) before formula introduction. Primiparous breastfeeding mothers were recruited at birth and visited at 1, 2 and 4 weeks. Among those fully breastfeeding at 1 week (N = 230), infant crying variables based on maternal reports were not associated with PIM at 1 week, but LPS was. However, a mother's expectation that her infant would cry more than other infants was associated with increased odds of reporting PIM at 2 and 4 weeks, as were delayed onset of lactation and previous LPS. At 1 week, crying variables (frequency, difficulty in soothing) were associated with LPS along with percent weight change. Delayed onset of lactation, infant care style, number of breastfeeds and previous LPS were longitudinally associated with change in LPS from 1 to 2 weeks and 2 to 4 weeks. Our data suggest that reported infant crying is associated with PIM and LPS in the first 4 weeks of life. Guidance on what to expect in crying behaviour and the impact of infant care style may be beneficial in reducing PIM and LPS in the first month.

This study examines the role of video technology in the development of cooking skills. The study explored the views of 141 female participants on whether video technology can promote confidence in learning new cooking skills to assist in meal preparation. Prior to each focus group participants took part in a cooking experiment to assess the most effective method of learning for low-skilled cooks across four experimental conditions (recipe card only; recipe card plus video demonstration; recipe card plus video demonstration conducted in segmented stages; and recipe card plus video demonstration whereby participants freely accessed video demonstrations as and when needed). Focus group findings revealed that video technology was perceived to assist learning in the cooking process in the following ways: (1) improved comprehension of the cooking process; (2) real-time reassurance in the cooking process; (3) assisting the acquisition of new cooking skills; and (4) enhancing the enjoyment of the cooking process. These findings display the potential for video technology to promote motivation and confidence as well as enhancing cooking skills among low-skilled individuals wishing to cook from scratch using fresh ingredients.

The aim of this cross-sectional study was to investigate whether parental views on child feeding and its impact on health differ between those parents whose self-perception was that they followed a healthy diet to those who do not. Furthermore, differences in the child’s diet quality and weight were compared between the groups. Parents of 2−6-year-old children (n = 738), recruited from child health clinics throughout Finland, answered semi-structured questionnaires on their views on child feeding and health as well as their child’s diet quality. Participants were divided into two groups based on their self-perceived report of following a healthy diet: health-conscious (HC, n = 396) and non-health-conscious (non-HC, n = 342) parents. HC parents considered health, eating behavior, and nutrient-related factors more often when feeding their child than non-HC parents (

Ensuring the adequate intake of micronutrients by populations is an important aspect of public health. This study aims to elucidate the process of setting nutrition recommendations and the development of subsequent policies associated with micronutrients in Poland by using the case study of folate. The study was based on 13 interviews conducted between October 2010 - February 2011, and desk research comprising a review of the associated scientific literature and relevant documents, such as scientific opinions and reports of the meetings of scientific committees. The interviews were conducted within the EURRECA (EURopean micronutrient RECommendations Aligned) Network of Excellence in the frame of the European Union's 6th Framework Programme. Since 1997, the Experts Group of the Ministry of Health recommended that all women of childbearing age should consume folic acid as a supplement to prevent neural tube defects in their offspring. The fortification of foodstuffs with folic acid is not obligatory. This study describes the revision of the folate nutrient recommendation and the process by which strategies to increase the intake of this vitamin by the Polish population were identified. The institution responsible for the choice and implementation of folate policy is the Ministry of Health and the National Food and Nutrition Institute is responsible for setting/updating the nutrient recommendations. The current Polish nutrition recommendations for folate are consistent with the levels set by most other countries. The constant improvement of nutritional knowledge on folate among consumers, especially young women, is necessary.

Previous research has highlighted an ambiguity in understanding cooking related terminology and a number of barriers and facilitators to home meal preparation. However, meals prepared in the home still include convenience products (typically high in sugars, fats and sodium) which can have negative effects on health. Therefore, this study aimed to qualitatively explore: (1) how individuals define cooking from ‘scratch’, and (2) their barriers and facilitators to cooking with basic ingredients. 27 semi-structured interviews were conducted with participants (aged 18–58 years) living on the island of Ireland, eliciting definitions of ‘cooking from scratch’ and exploring the reasons participants cook in a particular way. The interviews were professionally transcribed verbatim and Nvivo 10 was used for an inductive thematic analysis. Our results highlighted that although cooking from ‘scratch’ lacks a single definition, participants viewed it as optimal cooking. Barriers to cooking with raw ingredients included: 1) time pressures; (2) desire to save money; (3) desire for effortless meals; (4) family food preferences; and (5) effect of kitchen disasters. Facilitators included: 1) desire to eat for health and well-being; (2) creative inspiration; (3) ability to plan and prepare meals ahead of time; and (4) greater self-efficacy in one's cooking ability. Our findings contribute to understanding how individuals define cooking from ‘scratch’, and barriers and facilitators to cooking with raw ingredients. Interventions should focus on practical sessions to increase cooking self-efficacy; highlight the importance of planning ahead and teach methods such as batch cooking and freezing to facilitate cooking from scratch.

Background: Processed foods are typically praised/revered for their convenience, palatability, and novelty; however, their healthfulness has increasingly come under scrutiny. Classification systems that categorise foods according to their “level of processing” have been used to predict diet quality and health outcomes and inform dietary guidelines and product development. However, the classification criteria used are ambiguous, inconsistent and often give less weight to existing scientific evidence on nutrition and food processing effects; critical analysis of these criteria creates conflict amongst researchers. Scope and approach: We examine the underlying basis of food classification systems and provide a critical analysis of their purpose, scientific basis, and distinguishing features by thematic analysis of the category definitions. Key findings and conclusions: These classification systems were mostly created to study the relationship between industrial products and health. There is no consensus on what factors determine the level of food processing. We identified four defining themes underlying the classification systems: 1. Extent of change (from natural state); 2. Nature of change (properties, adding ingredients); 3. Place of processing (where/by whom); and 4. Purpose of processing (why, essential/cosmetic). The classification systems embody socio-cultural elements and subjective terms, including home cooking and naturalness. Hence, “processing” is a chaotic conception, not only concerned with technical processes. Most classification systems do not include quantitative measures but, instead, imply correlation between “processing” and nutrition. The concept of “whole food” and the role of the food matrix in relation to healthy diets needs further clarification; the risk assessment/management of food additives also needs debate.

The promotion of home cooking is a strategy used to improve diet quality and health. However, modern home cooking typically includes the use of processed food which can lead to negative outcomes including weight gain. In addition, interventions to improve cooking skills do not always explain how theory informed their design and implementation. The Behaviour Change Technique (BCT) taxonomy successfully employed in other areas has identified essential elements for interventions. This study investigated the effectiveness of different instructional modes for learning to cook a meal, designed using an accumulating number of BCTs, on participant's perceived difficulty, enjoyment, confidence and intention to cook from basic ingredients. 141 mothers aged between 20 and 39 years from the island of Ireland were randomised to one of four conditions based on BCTs (1) recipe card only [control condition]; (2) recipe card plus video modelling; (3) recipe card plus video prompting; (4) recipe card plus video elements. Participants rated their enjoyment, perceived difficulty, confidence and intention to cook again pre, mid and post experiment. Repeated one-way factorial ANOVAs, correlations and a hierarchical regression model were conducted. Despite no significant differences between the different conditions, there was a significant increase in enjoyment (P 

Background: Cooking and food skills interventions have grown in popularity; however, there is a lack of transparency as to how these interventions were designed, highlighting a need to identify and understand the mechanisms of behavior change so that effective components may be introduced in future work. This study critiques cooking and food skills interventions in relation to their design, behavior change techniques (BCTs), theoretical underpinnings, and outcomes. Methods: A 40-item CALO-RE taxonomy was used to examine the components of 59 cooking and food skills interventions identified by two systematic reviews. Studies were coded by three independent coders. Results: The three most frequently occurring BCTs identified were #1 Provide information on consequences of behavior in general; #21 Provide instruction on how to perform the behavior; and #26 Prompt Practice. Fifty-six interventions reported positive short-term outcomes. Only 14 interventions reported long-term outcomes containing BCTs relating to information provision. Conclusion: This study reviewed cooking and food skills interventions highlighting the most commonly used BCTs, and those associated with long-term positive outcomes for cooking skills and diet. This study indicates the potential for using the BCT CALO-RE taxonomy to inform the design, planning, delivery and evaluation of future interventions.

The world’s ageing population is increasing and food professionals will have to address the needs of older generations more closely in the future. This unique volume reviews the characteristics of the ageing population as food consumers, the role of nutrition in healthy ageing and the design of food products and services for the elderly. Chapters in part one discuss aspects of the elderly’s relationship with food such as appetite and ageing, ageing and sensory perception, food and satisfaction with life, and the social significance of meals. The second part of the book reviews the role of nutrition in extending functionality into later years, with chapters on topics such as undernutrition and conditions such as Alzheimer's disease, bone and joint health and eye-related disorders. Concluding chapters address the issues of food safety and the elderly, designing new foods and beverages for the ageing and nutrition education programmes.

This is the most comprehensive and robust evaluation of FOP nutrition signpost labelling published to date. It provides information on how FOP labels are used by shoppers in a retail environment; the extent to which they are accurately interpreted and the impact of the co-existence of the current range of FOP labels on comprehension. This aim of this research was to establish which FOP labelling scheme(s), or which combination of elements of schemes, best facilitate the accurate interpretation of key nutritional information by consumers such that they are enabled to make informed choices about the foods they purchase. The research addressed three key questions: (1) How well do individual signpost schemes (or elements of the schemes) enable consumers to correctly interpret levels of key nutrients?; (2) How do consumers use FOP labels in real life contexts in the retail environment and at home?; (3) How does the coexistence of a range of FOP label formats affect accurate interpretation of FOP labels?

In recent years, nutrition science has progressed from a concept of adequate nutrition to one of optimal nutrition where emphasis is placed on the potential for foods to improve health and well-being. Therefore, health messages on food have been conceptualised in the policy discourse as an essential element in improving public health(1). In 2001, the European Commission prepared a Discussion Paper outlining the issues that needed to be considered in relation to the harmonisation of the various approaches governing the use of Nutrition and Health (NH) claims across Member States(2). During the consultation process, 67 official replies were received from various stakeholders. The aim of the present qualitative study was to identify the extent to which the use of NH claims was viewed as a science-based strategy to improve public health by these stakeholders. Based on the Advocacy Coalition Framework’s tenets about the structure of individual beliefs and motivation to influence policy(3), a conceptual analysis of the 67 official replies was conducted. The analysis identified two main core beliefs strands which segregated the stakeholders into two distinct advocacy coalitions. The first coalition (C1) was composed of consumer organisations and some health professionals (n 21) who believed that the concept behind NH claims was running counter to existing dietary recommendations and blurring the lines between food and medicine. They also believed that any potential benefits associated with the use of NH claims were largely outweighed by their potential to mislead and confuse consumers. By contrast, the second coalition (C2) was composed of food companies, some food scientists and some regulators (n 39) who believed that the use of NH claims on food products was in line with current thinking on the promotion of public health through greater information on healthy eating. Further analysis of the stakeholders’ replies suggests that concurrent events in other venues, like the Ribena ToothKind Court case, may have influenced the stakeholders’ contribution to the consultation process. The present study provides evidence that the use of NH claims as a science-based strategy to improve public health was contested within the policy discourse. Indeed, many civil society stakeholders viewed the use of NH claims as an elaborate marketing strategy to serve commercial interests.

Purpose: To review associations between sedentary behaviours and dietary intake in young people. Background: Although an association has been shown between television viewing (TV) and body fatness in young people, factors that mediate this relationship are less clear. While engaging in sedentary behaviours such as TV viewing, increased opportunities to eat snacks and exposure to food advertisements may influence food intake. The interaction of sedentary behaviour and dietary intake may contribute to a positive energy balance. A greater understanding of the associations between sedentary behaviour and dietary intake in young people will provide an important step towards developing effective interventions for the prevention of obesity. Methods: Published English language studies were located from computerised and manual searches. Observational research reporting a measure of dietary intake and data on at least one sedentary behaviour were included. Conclusions: Cross-sectionally (n=27 studies), TV viewing was negatively associated with fruit and vegetable consumption, and positively associated with consumption of energy-dense snack foods and sugar-sweetened beverages, and with total energy intake and percentage of energy from fat. Longitudinally (n=7 studies), changes in TV viewing were negatively associated with changes in fruit and vegetable consumption, and positively associated with changes in consumption of energy-dense snacks and sugar-sweetened beverages, and changes in total energy intake. TV viewing is associated with poor dietary behaviour in young people and may partly account for the association between TV viewing and weight status.

Dietary intake and nutritional status not only play a major role in the overall quality of health of older people but also have impact on their satisfaction with life (Sahyoun, 1999, Vailas et al., 1998). Silverman et al. (2002) argue that the type of food eaten and the social cultural context all make significant contributions to older people’s satisfaction with their quality of life. Investigating satisfaction with food-related life of older people has high significance for several reasons. Firstly, food and energy intake tend to decrease with ageing for a number of both physiological and practical reasons including reduced activity (immobility), reduced muscle tissue, a lower resting metabolic rate and smaller meals (Macintosch et al., 2000; Prinsley & Sandstead, 1990). This reduced energy intake, also known as “anorexia of aging”, is a potential health risk because, although food intake is reduced with age, the need for most nutrients does not decrease with age. Secondly, ageing affects the ability to taste and smell. Also seniors are less sensitive to all the basic tastes and particularly smells. Both the ability to detect tastes and smells and their intensity declines with age and it has been suggested (Rolls, 1999; Westenhoefer, 2005) that sensory losses accompanying aging may even be partly responsible for the reduced intake of foods (see chapter XXX). Further as people get older their living circumstances may alter. For example, as people retire their level of income may reduce and their social network may also diminish. As health fails, access to shops and amenities may become a problem. As people loose their living companions due to death of spouse or children leaving home, cooking arrangements may change. All these factors compound as people get older, affecting older people’s relationship with food and in turn their satisfaction with food-related life. By identifying which factors are important and what can be altered, it may be possible to increase older people’s satisfaction with food and in turn contribute to a better quality of life. This chapter looks at food related satisfaction with life of older people, identifying some of the determinants and barriers to satisfaction with food related quality of life, and discusses

Demographic factors are important correlates of predisposition to obesity but much less is known about how they relate to weight loss and its maintenance. This analysis examined the demographic predictors of weight loss maintenance (WLM) in 1428 participants of a slimming organisation, who had been members for a mean_SD of 16_16 months, had lost 13.8%_9.2% weight and were trying to maintain, or increase, their weight loss during a subsequent 6 month study period. Data were collected as part of the DiOGenes study(1). Ethical approval was given by the University of Surrey Ethics Committee. Adults were recruited between August 2006 and July 2008 from Slimming World at group meetings and by email. Participants’ weights (using calibrated scales) were taken from group records at four time points, measurement 1 (M1) at the start of the study period, nominally six months later (measurement 2 (M2)), six months before M1 and when they initially enrolled with Slimming World. Participants were free to continue following the weight-loss programme as they wished during this study, and there was no intervention other than completing the questionnaires. Participants completed a general screening questionnaire at M1 relating to age, gender, marital status, education level achieved, employment status, number of adults and children in the household, monetary expenditure on food, number of siblings, weight history, weight history of parents and siblings, medical history (whether a doctor had told them they have had obesity, diabetes, cancer, high blood pressure, high cholesterol, heart disease or stroke), medical history of parents and siblings, alcohol intake, smoking status, and birth weight. Linear regression analysis was used to identify the associations between questionnaire responses and weight change (as % M1 weight) over the 6 month study period. Mean age was 46.8 years for women, 50.8 years for men; 95% were women. There was no association between age, sex, marital status or family structure and subsequent WLM. Heavier people lost a greater percentage of their weight during the study period than did lighter people (p

This analysis examined the association between restrained eating behaviour and weight loss maintenance in 1428 participants of a slimming organisation who had been members for a mean_SD 16_16 months. They had lost 13.8%_9.2% of their initial weight and were trying to maintain, or increase, their weight loss during a subsequent 6-month study period. Data were collected as part of the DiOGenes study(1). Ethical approval was given by the University of Surrey Ethics Committee. Adults were recruited between August 2006 and July 2008 from Slimming World at group meetings and by email. Subjects completed questionnaires at two time points, measurement 1 (M1) at the start of the study and nominally six months later (measurement 2 (M2)). Participants’ weights (using calibrated scales) were taken from group records for M1, M2, six months before (measurement 0) and when they initially enrolled. Participants were free to continue following the weight-loss programme as they wished during this study, and there was no intervention other than completing the questionnaires. Cognitive restraint of eating or dietary restraint, disinhibition and susceptibility to hunger were measured using the Three Factor Eating Questionnaire(2). Dietary restraint is not a single construct, but can be split into flexible and rigid restraint. These two components of restraint were assessed by validated questionnaire(3). Linear regression analysis was used to identify the associations between questionnaire responses and weight change (as a percentage of M1 weight) over the study period. Participants who reported having low levels of disinhibition at the first measurement had more positive weight gains during the following six months. This only explained a small proportion of the variance in weight loss maintenance. Cognitive restraint and its components were not strongly associated with weight loss maintenance. This work was part of the Diet, Obesity and Genes project (www.diogenes-eu.org) funded by the European Commission (contract #: Food-CT-2005- 513946) in the Food Quality and Safety Priority of the Sixth Framework Program.

Introduction: Nutrition plays an important role in the development of children affecting them physically and mentally. Teachers are in a unique position to observe what factors influence a child’s cognitive development and performance hence it’s important to understand if they perceive diet to have an effect on mental performance. Objectives: Examine teachers’ understanding of the effect of diet on children’s mental performance, using semi-structured interviews. Method/Design: The study was conducted in England, Germany, Hungary and Spain. Participants were teachers of children aged 4-10 years old recruited in state elementary schools. Semi-structured interviews were used to ask what they thought about the effects of diet on mental performance. Responses were recorded, coded and group analysed using the Nudist-Vivo 8.0 program. Reports on the national data from each country were analysed to make cross- country comparisons. Results: Preliminary analysis reveals that teachers highlight having a healthy diet affects mental aspects of children’s lives. The principal aspects of mental performance mentioned by them were attention and concentration. Most of the teachers expressed the opinion that hunger acts as a barrier to concentrating in class. Many teachers recognized an association between low levels of attention and students not having breakfast: it was highlighted as an important habit to avoid lethargy or becoming tired quickly throughout the school day. Teachers also noted unhealthy foods (sweets and junk foods) provide a quick burst of energy in a short period of time but also Irritability, nervousness or hyperactivity resulting in an inability to concentrate. Conclusions: Teachers perceive diet has a direct influence on the ability of children to concentrate, as well as on their mood and behavior. Their opinion of what a child eats affecting their health and development is closely linked to some specific foods which teachers label as “unhealthy”. Study Supported by 7th Framework Programme (NUTRIMENTHE Grant-agreement: 212652)

Objectives and Study: Parents have a direct influence on the food choices presented to children in the home. Thinking of what parents consider when choosing foood for their children it is important to know what factors they perceive to influence a child’s cognitive development and mental performance. Parents play a very important role in the development of children food choices and eating habits which may in turn influence children’s future health positively or negatively. The present study aims to quantitatively examine parents’ understanding of the factors influencing children’s mental performance. Methods: The study was conducted in Spain and participants were parents of children aged 4–10 years recruited through state elementary schools. A card sorting task was developed and used to conduct interviews with a total of 50 parents. Parents were asked about five different group of influencing factors: Biological, Educational, Social, Environmental and Psychological (18 factors in total), factors were based on evidence from scientific literature. Mental performance was defined in terms of Attention, Learning, Mood and Behavior Parents were asked to rate the effect of each factor as strong, moderate or no effects on child’s mental development in relation to each of the chosen aspects of mental performance. Responses were recorded manually, coded and group analysed using Friedman test and Cronbach Alpha test with the SPSS version 15.0. Results: The Friedman test for the general analysis show that factors that have a strong effect on mental performance for the participant were ‘‘School discipline’’, ‘‘Parents education level’’, ‘‘Class size’’, ‘‘Regularity of meals’’ and ‘‘Nutrition as a baby’’ for the four groups of cards colors sorting. Although Mood is considered lower than Attention, Learning and Behavior, all were taking from the strong effects answers groups. The card sorting colors game was tested in the study. Using the Cronbach Alpha test the questions’ homogenity, averaging all correlations between all items, were measured giving a mean value of 95,26/100. Conclusion: Spanish data reveal that parents perceive the Environmental, Social and Educational group of factors as having most influence on children’s mental performance. Mood is valued by the Spanish parents with less responses regarding the strengths compared with Attention, Learning and Behavior, which appear more homogeneous in relation to wich factors have an influence in mental performance. Disclosure of Interest: This study is part of the FP7 Project NUTRIMENTHE Grant agreement n8: 212652.

Objectives and Study: Nutrition is one of the many factors that influence a child’s cognitive development and mental performance. Understanding the relationship between nutrition and mental performance in children is important in terms of their attainment and productivity both in school and later life. Parents play a key role in the development of children’s food choices and dietary habits. To date, there is little published research on parent’s perceptions of the relationship between diet and mental performance of children. The present study aims to qualitatively examine parents’ perceptions and beliefs about this relationship. Methods: The study was conducted in four European countries, England, Germany, Hungary and Spain. Participants were parents of children aged 4–10 years recruited through state elementary schools. A semi-structured interview schedule was used to conduct interviews with a total of 127 parents; it included questions on the effect of food on a child’s physical.and mental wellbeing and development. Further questions were asked about short or long term effects of diet, the effects of specific foods, meals and supplements. All interviews were transcribed and thematically analysed using NVIVO8. Results: Four main themes emerged from the interviews with a number of subthemes: ‘‘physical effects of diet’’, ‘‘mental effects of diet’’, ‘‘healthiness of diet’’ and ‘‘parenting (responsibility, food preferences, dietary habits)’’. The mental effects of diet are perceived by parents to be on attention and concentration as well as on children’s mood and behaviour. Negative effects are associated with sugary and fatty foods while positive effects are associated more generally with a healthy balanced diet. Conclusion: In all countries parents perceive attention and concentration to be negatively affected by sugary and fatty foods while a healthy balanced diet is believed to have a positive effect on mental outcomes. Based on the exploratory findings of this study, subsequent quantitative studies will need to further examine the prevalence of these perceptions in relation to socioeconomic factors. A detailed understanding of parents’ perceptions of the relationship between diet and mental performance can provide valuable input for better targeted and formulated communication with parents, including intervention programmes as well as claims related to specific food products. Disclosure of Interest: None declared.

Early nutrition programming as an origin of obesity is well acknowledged, but to what extent is this concept communicated to parents? In five European countries, UK, Finland (FI), Germany (DE), Hungary (HU) and Spain (ES), a total of 130 stand alone leaflets and 161 articles from parenting magazines providing information on feeding of healthy infants aged 0-12 months were identified and screened for nutrition programming statements. Obesity was mentioned in 8.5% (54/638) of the statements, and was the fourth most frequent outcome after allergy (20.7%), risk of infections (15.5%) and growth and development (11.4%). A temporal prognosis was given in 39% of obesity related statements, 6% referring to short- ( 15 years) duration of effects. So advice on obesity focuses oil the intrinsic long-term perspective of programming in contrary to other surveyed health-outcomes where only 8% considered a lifelong approach. The major programming related behaviour concerned breast-feeding compared to formula and complementary feeding with meaningful differences concerning the recommended duration: for ES and HU the predominant advice was for exclusive breast-feeding for 6 months, for DE exclusive breast-feeding for 4-6 months and for UK and FI breast-feeding without further specification. In summary, statements relating to the programming of later obesity have been partially integrated into feeding information in five European countries. These Countries have slightly different breastfeeding recommendations, but consistently refer to the preventive potential of breastfeeding in general. This is important as obesity and its resulting morbidity are of increasing public health concern in developed countries.

EURRECA is a Network of Excellence with the objective of addressing the problem of national variations in micronutrient recommendations and working towards a framework of advice to better inform policy-makers. It became apparent that the network needed a framework that puts the process of recommendation setting in the context of science, policy and society. Although variability in recommendations originates from the scientific evidence-base used and its interpretation (e.g. health outcomes, types and methods of evaluation of evidence, quantification of risk/benefit), the background information provided in the recommendation reports does not easily facilitate the disentangling of the relative contribution of these different aspects because of lack of transparency. The present report portrays the general framework (see Figure) that has been developed by and for EURRECA in order to make the process of setting up micronutrient recommendations explicit and transparent. In explaining the link from science to policy applications, the framework distinguishes four principal components or stages (see Figure). These stages are: a) Defining the nutrient requirements: A judgement about the (best) distribution(s) of the population requirement is necessary for estimating nutrient requirements. Many assumptions need to be made about the attributes of the population group. Furthermore, several factors (consumer behaviour as well as physiology) are to be included to characterize optimal health. b) Setting the nutrient recommendations: All available evidence is needed to formulate recommendations. Incorporating different endpoints provide the basis to formulate an optimal diet in terms of (non-)nutrients and food(group)s. c) Policy options: Policy options should be formulated on how the optimal diet can be achieved. They concern the advice of scientist and/or expert committees to the policy makers. Current policy options are setting up a task force, food based dietary guidelines, general health education, educational programme for specific group(s), voluntary or mandatory fortification, labelling, supplementation (general or for specific groups), inducing voluntary action in industry, legislation on micronutrient composition in food products, fiscal change, monitoring and evaluation of intake (via food consumption surveys) and/or nutritional status. d) Policy applications: Policies and planning, usually done by government, that lead to nutritional interventions or programmes. They usually require consideration of scientific, legal, regulatory, ethical and cultural issues, economic implications, and political and social priorities. This framework illustrates three dimensions of the process of setting (micro)nutrient requirements: 1) The logical sequence of scientific thinking from setting physiological requirements for nutritional health leading to evidence-based derivation of Nutrient Intake Values. 2) In the early stages nutritional and epidemiological science is the dominant source and in the later stages evidence from consumer and social sciences as well as stakeholder influences is used in deriving the options for changing the distribution of nutrient intakes. 3) The wider socio-political context: a feedback loop between health perception, actual health and food intake exists and is directly affected by the food industry and many other stakeholders. Moreover, from the viewpoint of policymakers, there are concerns for health promotion and disease prevention because of population health indices, costs of health care, and economic interests in the agro-food sector. In conclusion: A systematic approach for development and regular review of micronutrient requirements in Europe, transparently based on scientific evidence and best practices, enables national and international authorities/bodies to use the best available information obtained through evidence-based nutrition and accomplish well-considered food policy. Funded by an EU FP6 Network of Excellence (EURRECA, grant no. FP 6–036196-2). G. T. performed part of the work under a short-term contract for WHO Europe.

Progress has been made towards a coherent public health nutrition policy across Europe; however this remains a challenge mainly due to the variety of public health nutrition (PHN) policy traditions between countries and the diversity in scientific bases used to inform policy(1) This is particularly apparent in the misalignment of micronutrient reference values (MRV) across European countries and regions(2). MRV often inform food and nutrition policies which are becoming an increasingly more important part of public health policies due to the burden associated with nutrition-related diseases. Desk research and a questionnaire completed by key informants were used to collect data relating to the processes used to develop current MRV in thirty-one European countries, employing methods reported previously(2). Data were collected on the process of scientific decision-making, including information on the transparency and openness of the process. Considerable diversity was observed across Europe in the institutional context and nutrition policy imperatives driving the process of developing MRV. In those countries that have an established tradition of PHN policy the presence of advisory bodies is seen as key in developing MRV and advising government departments charged with applying science into policy and practice. This position is partly predicated by the institutional context (whether there is a dedicated department in charge of public health and how it is linked with other departments, the diversity of bodies and organisations involved in setting the agendas and making decisions in PHN, the broader governance context etc.), the PHN tradition and the historical context. Although the implication for nutrition policy is that there is a dedicated scientific institution or basis that acts as policy advisor and consequently facilitates development of dedicated national-level nutrition policies, it raises the issue of the extent to which scientific advisory committees are open, transparent and inclusive in the process. It appears that there is a considerable divide in terms of the openness and transparency of the process between the countries with an emerging democracy and those with established and increasingly participatory governance structures; also, in the complexity of the governance system in charge of developing MRV and hence the extent to which these levels are specifically tailored to national needs. In those countries with a more developed institutional architecture, scientific advisory bodies appear to be more than just a source of technical and scientific advice, instead acting as a link between evidence and policy. In particular, the remaining question is to what extent this model of informing national level of PHN policy can service the policy imperatives and the needs of wider society for the development of PHN policy that includes the framing of a wider section of society. In addition, the selection of the advisory panel members is not always clear and could lead to MRV that are eminence rather than evidence based.

In the light of the clear imperative of evidence-based policy development across the European Union, one of the challenges facing policy makers is establishing systems and processes for the collation and assessment of evidence. To date, there has been little clarity about what kind of evidence ends up in policy and in particular the way in which micronutrient recommendations link up to policy has largely been overlooked. The discrepancy between the recommendations of scientific advisory bodies for nutrition and the policy options utilizing their evidence indicates the lack of clarity about the process and that considerations other than scientific evidence influence the final outcome. The current article reports on the Health- Behaviour-Policy Framework which describes a range of considerations that play a role in the decision-making processes about a policy instrument (or a combination of) to adopt based on scientific advice about micronutrient requirements. These considerations include: the scientific advice linking micronutrient recommendations with health outcome; the evidence about human behaviour relevant to the health outcome; the policy and institutional context for the delivery of policy; the wider context. The framework is epistemological as it aims to identify the domains of information from which to draw in order to create a link between a desired health outcome and a policy. It is also a nested framework, as each layer touches upon the central issue under consideration (a desired health outcome) and each is in some way connected and can impact upon the other.

Introduction: There have been calls within Europe to harmonise the process of setting micronutrient recommendations and share best practice between countries and regions. However the various scientific advisory bodies (SAB) responsible for setting recommendations appear to differ by their statutory model of operation as well as the degree of transparency available throughout the decision making process. particularly concerning the handling of risk and uncertainty. Objectives: The present study explored how risk and uncertainty was handled in SABs across Europe. Particular attention was paid to understanding the types of deliberations surrounding the terms of reference. selection of expertise. sources of evidence. evaluation of evidence and communication of findings to policy decision makers. wider stakeholders and the general public. Method/Design: A retrospective in-depth case study design was used to explore how risk and uncertainty were handled in the SABs concerning the vitamin D and folate nutrient recommendations in five countries/regions: England. the Netherlands. Poland. Spain and the Nordic countries. A case study consisted of semi-structured interviews with at least two members of SAB as well as in-depth desk research surrounding the recommendations. Interview data was analysed in the native language using template analysis and a skeleton coding structure created and modified by partners during preliminary analyses. Thematic analysis was then carried out by each country and an English-translated summary of identified themes and illustrative quotes was produced and combined with the desk research to form each case study. Results: This paper will explore any disparity in decision making around risk and uncertainty across countries/regions and micronutrients. Conclusions: Implications for the interaction between science and policy in terms of evidence based policy decision making will be discussed.

Health professionals have a major role to play in addressing obesity and overweight in the general population1. Differences in beliefs and attitudes to obesity between healthcare providers and individuals attempting weight control are likely to act as a barrier in successful weight management. The aim of the present research was to investigate differences in attitudes and perceptions of obesity between healthcare providers and overweight and obese individuals. A web-based questionnaire designed to measure attitudes, perceptions, beliefs and barriers to successful weight control was developed. Healthcare participants were recruited through mailing lists of professional organisations for health professionals and students with an interest in obesity. Dieters were recruited via email advertisement sent out to companies in the Surrey Research Park, Guildford, UK. A five-point scale from 1 (not at all) to 5 (totally) was used, mean scores were produced. The questionnaire was completed by 283 health professionals and 116 dieters. The majority of the sample was female (82%) and married or living with a partner (70%). The data on beliefs about the causes of obesity were factor analysed and four factors were produced (see Table). Both groups believe that ‘lifestyle factors’ have the greatest role to play in causing obesity. These factors include unhealthy food choices, lack of exercise, food portion size and lack of self control. Significant differences were revealed between the groups for ‘medical factors’ and ‘psychological factors’, with health professionals more likely than dieters to view psychological factors as important and dieters more likely to view ‘medical factors’ as an important cause of obesity. There was a significant difference (P £ 0.001) in beliefs about the effects of obesity, with health professionals reporting factors such as driving, going to the toilet, dressing, basic interpersonal interaction, family relationships, educational attainment and fertility, affect obesity more than dieters think they do. Differences in attitudes to a range of methods for dealing with obesity were revealed between the two samples. Health professionals were significantly more positive about surgery (mean score; health professionals 3.19, dieters 2.68; P

The aim of the present abstract is to report on obese individuals’ weight-loss goals and factors influencing these goals. Current guidelines recommend a target weight loss of 5–10% of original weight for successful weight control(1). However, research has shown that this level is a great underestimation of what obese individuals consider as successful or acceptable weight loss(2). Unmet goals or expectations in weight control can lead to negative behaviours and psychological profiles, and ultimately abandonment of weight-control efforts. Data reported here were collected as part of the EU 6th Framework project DiOGenes, a dietary intervention trial investigating the effectiveness of high- and low-GI and -protein diets on weight maintenance, following a rapid weight-loss period, in an obese cohort. Participants were asked to indicate their target weight in kilograms in a questionnaire completed at the screening phase. A target weightloss score was then calculated by subtracting self-reported target weight from baseline weight. Target weight-loss scores ranged from + 11 kg to - 88.6 kg and were highly correlated with baseline weight (r - 0.73, P

Consumers’ grocery purchasing is an important activity in determining the healthfulness of their food intake and that of their household’s. Recent till receipt studies(1) have made valuable contributions to understanding the nutritional quality of the food that consumers buy. However, these studies fail to explore the reasoning behind consumers’ product selections and the way in which health considerations drive the shopping process. The aim of this study was to obtain empirical data on this, thus identifying perceived barriers to choosing healthful foods. Fifty semi-structured face to face interviews were conducted following an accompanied shop and followed up with a telephone interview a week later. Audiotapes of all discussions were professionally transcribed, verbatim uploaded to NVIVO (9), and analysed using an inductive, thematic analysis(2). In addition, demographic data such as age, gender, socio-economic status and household size were gathered. Participants justified the healthfulness of their grocery shop in four different ways: (1) the inclusion of healthy foods (e.g. fruit and vegetables); (2) the avoidance or exclusion of particular food groups (e.g. foods high in sugar); (3) restriction on the quantity of certain food groups (e.g. red meat); and; (4) a balance between healthy and unhealthy foods (e.g. healthy foods vs. treats). Participants also identified two separate themes as barriers to making healthy choices while shopping. The first theme addressed the lack of skills for: (a) planning a healthy shop that will translate into healthy meals, taking into account all of the family’s preferences and needs (e.g. “. . . I have such a wide range of people in my house to cook for and to try and cook a healthy meal everyone likes . . . I would find that challenging”), (b) budgeting so that healthy food can be prioritised (e.g. “lack of money and time lead to quick and easy solutions, throwing stuff into the oven or microwave from packets”), (c) cooking quick healthy meals that can be made after work (e.g. “I’ve had a long day’s work and I don’t feel like going down and making myself something . . . maybe something quick, I’ll probably make something quick, maybe just a kind of ready cooked meal”). The second theme addressed participants’ mood and its effect on food preferences. When stressed, tired or feeling lazy participants preferred to prioritise pleasure over health (e.g. “. . . if I go shopping when I am hungry it’s easier and very tempting when you see all the stuff, the bad stuff . . . it’s easier to pick something bad”). The results provide evidence of the different strategies consumers use to make their shopping healthy and the main barriers they perceive as preventing them from achieving this goal. This study highlights the need to develop more practical, skill-based information and tools that will assist consumers to shop for more healthful foods. This material is based upon work supported by SafeFood, the food safety promotion board, under grant no.16-2010.

Using a survey, this study investigated public perceptions relating to different healthy grain foods (bread, pasta and biscuits) and how these perceptions are influenced by gender, nationality, base product (staple vs. fun food), type of health claim (general vs. specific) and people's perceptions associated with different production methods. Two thousand and ninety-four (50.4% women, 49.5% men) members of the public from the UK, Italy, Finland and Germany completed the survey questionnaire. The participants were over 18 years of age and were solely or jointly responsible for the family's grocery shopping. Results confirmed that similar to other functional foods, there were gender and country differences in people's perceptions of benefits relating to functional grain products. Men perceived more benefit in products with specific health claims and women in products with general health claims. However, when it was personally relevant, men's levels of perceived benefit in products with general health claims were equally high as women's. Further, modification of staple foods was perceived as more beneficial than fun foods and people preferred processes such as fortification and traditional cross-breeding to others such as genetic modification. In addition, the differences in perceived benefits between foods with general and specific health claims were largest for staple foods than for hedonistic foods. (c) 2007 Elsevier Ltd. All rights reserved.

In this chapter, we will give a brief introduction to the current practice of nutrition labeling in the USA and the EU. We will then address the question of how nutrition labeling affects consumer behavior, reviewing extant research and proposing an agenda for future research. Our discussion will focus on the effects of nutrition labeling that occur via their impact on consumer behavior. Labeling may also have effects on the supply side: For example, as labeling makes certain nutritional properties of a product more visible, new product development and product reformulation may take place to create positive nutritional profiles. Such effects, while potentially very important from a public health perspective, will not be addressed in this chapter (see Moorman, 1998 and Moorman, Du & Mela, 2005 for investigation of such effects).

Background Lower birth weight, often found in infants from minority ethnic groups, may be partly because of the disproportionate representation of ethnic minority groups in low-income areas. To develop an intervention, to improve the nutritional intake of young women from populations at risk of low-birth-weight babies, which would be culturally sensitive and well received by the intended recipients, a community development approach was used to investigate factors that might influence food choice and the nutritional intake of girls and young women from ethnic minority groups. Methods Focus group discussions were conducted across the UK, to explore factors that might affect the food choices of girls and young women of African and South Asian decent. The data was analysed using deductive content analysis (Qual. Soc. Res., 1, 2000, 1). Discussions were around the broad themes of buying and preparing food, eating food and dietary changes, and ideas for an intervention to improve diet. Results The focus group discussions indicated that all the communities took time, price, health and availability into consideration when making food purchases. The groups were also quite similar in their use of `Western' foods which tended to be of the fast food variety. These foods were used when there was not enough time to prepare a 'traditional' meal. Conclusion Many issues that affect the food choice of people who move to the UK are common within different ethnic groups. The idea of a practical intervention based on improving cooking skills was popular with all the groups.

Although the theory of planned behaviour (TPB) has been applied successfully in the area of food choice, it has been criticized for its pure utilitarian approach to the factors determining behaviour. Despite the increase in predictive power of the model with added components such as affective attitude and moral and ethical concerns, in most studies the elicitation process still only addresses people's utilitarian beliefs about the behaviour with little attention paid to other aspects. This study compares the traditional method of elicitation of advantages and disadvantages with two other methods (word association and open-ended) in the elicitations of beliefs, attitudes and moral concerns in relation to the consumption of organic foods. Results show the traditional method to be best for eliciting cognitive beliefs, open-ended emotion task for eliciting emotional beliefs and open-ended beliefs task best for moral concerns. The advantages and disadvantages of each method are discussed. (c) 2006 Elsevier Ltd. All rights reserved.

The concept of early nutrition programming is appearing in policy documents, leaflets and magazine articles with different types of statements. However, the level of representation and influence of this concept is unknown in the area of infant nutrition. We established the degree of reflection and the impact of the concept of nutrition programming among the different government stakeholders of infant nutrition in four European countries. In each country, a list of stakeholders in the area of infant feeding was established and key persons responsible for the remit of infant nutrition were identified. We conducted standardised face-to-face or phone interviews from January 2006 to January 2007. The interview guide included questions about the concept of nutrition programming. All interviews were digitally recorded and qualitative data analysis was done using QRS NVivo V2. In total, we analyzed 17 interviews from government organizations in England (5 interviews), Germany (4 interviews), Hungary (3 interviews) and Spain (5 interviews). The concept of nutrition programming was recognized from 4/5 English and 3/4 German interviewees, whereby one organisation reflected the concept in their documents in both countries. In Hungary, 1/3 interviewees recognised the concept and reflected it in their documents. All interviewed Spanish governmental bodies (5/5) recognised the concept of nutrition programming and three of them reflected the concept in their documents. The concept of early nutrition programming was widely recognized among the key persons of government bodies in all four European countries. However, the concept was not necessarily represented in the produced documents.

Despite efforts, attempts to induce successful long term weight loss remain a problem in obesity research, with the majority of those who lose weight unable to control or sustain the loss. It is accepted that in order to bring about more successful approaches to weight management, it is vital to determine the psychosocial factors that underpin weight control capability. Previous research has demonstrated that successful weight maintainers and less successful overweight individuals display different patterns of weight control behaviours (1). The present study aims to explore weight control practices and help-seeking behaviours in an overweight sample from 8 European countries. Data were collected as part of the EU project DiOGenes – a pan-European project which aims to refine understanding of the individual genetic, dietary and behavioural factors influencing weight control, and how these factors interact. Participants of a pan-European dietary intervention trial (n ~ 700) completed a set of online questionnaires relating to their weight control practices and help-seeking behaviours before entering the trial such as use of antiobesity medication, commercial products and help from health professionals. Objective weight measurements were recorded at baseline as well as self-reported weight control history. The results of this investigation will be presented, focussing on inter country differences in weight control behaviours. Differences in weight control behaviours and baseline weight status and previous weight history will be explored.

Part 1: Models of food choice A Conceptual Model of the Food Choice Process over the Life Course, J Sobal, C A Bisogni, C M Devine and M Jastran, Cornell University, USA The Integration of Biological, Social, Cultural, and Psychological Influences on Food Choice, P Rozin, University of Pennsylvania, USA Social Psychological Models of Food Choice, M Conner, University of Leeds, UK and C J Armitage, University of Sheffield, UK Part 2: Biological and learning influences on food choice Biological Influences on Energy Intake, K Westerterp, Maastricht University, The Netherlands Food Neophobia in Humans, P Pliner and S-J Salvy, University of Toronto at Mississauga, Canada The Role of Learning in Development of Food Preference, M R Yeomans, University of Sussex, UK Mood, emotions and food choice, E L Gibson, Roehampton University, UK Food Cravings and Addictions, S Higgs, University of Birmingham, UK Part 3: Societal influences on food choice Marketing Parameters and their Influence on Consumer Food Choice, K G Grunert, Aarhus School of Business, Denmark The Role of Context in Food Choice, Food Acceptance and Food Consumption, H L Meiselman, Natick Soldier Center, USA The Impact of the Media on Food Choice, J Reilly, University of Glasgow, UK The Impact of Advertising on Food Choice: the Social Context of Advertising, M Caraher, City University, UK and J Landon, National Heart Forum, UK Part 4: Food choices across the lifespan Adolescents, Food Choice and Vegetarianism, K Trew, C Clark, G McCartney, Queens University Belfast, Ireland, J Barnett, University of Surrey, UK and O Muldoon, Queens University Belfast, Ireland Intra-family Influences on Food Choice at Mid-life , J L Brown, Pennsylvania State University, USA Food Choices in Later Life, M Lumbers and M Raats, University of Surrey, UK Part 5: Changing dietary behaviour The Impact of Optimistic Bias on Dietary Behaviour, V Scaife, S Miles, University of East Anglia, UK and P Harris, University of Sheffield, UK Implementation Intentions: Strategic Automatisation of Food Choice, T L Webb, P Sheeran and C J Armitage, University of Sheffield, UK The Use of the Stages of Change Model with Dietary Behaviours, R Shepherd, What is a Healthy Diet Community? D Bowen, Fred Hutchinson Cancer Research Center, USA and T Hilliard Eating Behaviour in Obesity, J Wardle, University College London, UK

This analysis examined the lifestyle correlates of weight loss maintenance in 1428 participants of a slimming organisation, who had been members for a mean SD of 16 16 months, had lost 13.8% 9.2% weight and were trying to maintain, or increase, their weight loss during a subsequent 6 month study period. Data were collected as part of the DiOGenes study(1). Ethical approval was given by the University of Surrey Ethics Committee. Adults were recruited between August 2006 and July 2008 from Slimming World. Subjects completed lifestyle measures at two time points, measurement 1 (M1) at the start of the study and nominally six months later (measurement 2 (M2)). Participants’ weights (using calibrated scales) were taken from group records for M1, M2, six months before (measurement 0) and when they initially enrolled. They were free to continue following the weight-loss programme as they wished during this study, and there was no intervention other than completing the questionnaires. At M1 and M2 meal frequency (breakfast, lunch and dinner) and snacking between meals were assessed using a 5-point Likert scale (daily to

There have been a number of recommendations for reducing fat in the diet, of which consuming milk of a lower fat content is one of the most popular. In the reported study, the Theory of Planned Behavior (TPB) was applied to attitudes towards the consumption of milks of differing fat contents. Subjects (N = 257) completed a mail questionnaire in which the basic components of the model were assessed. A measure of perceived moral obligation for family's health was also included since it was predicted that this would constitute an influence not only on intentions, but also on attitudes. The findings largely support the predictive effect of the inclusion of the measure of perceived moral obligation Differential attitudes and the use of alternative outcome evaluation scales are also examined. The findings are discussed in relation to possible extensions to the model.