Professor Monique Raats


Professor; Director of the Food, Consumer Behaviour and Health Research Centre; Associate Dean Research and Innovation for the Faculty of Health and Medical Sciences
MSc (Wageningen), PhD (Reading)
+44 (0)1483 689431
12 AC 04
Personal Assistant: Carolina Garcia Ochoa
+44 (0)1483 688510

Biography

Areas of specialism

Nutrition labelling; Maternal and child behavioural nutrition; Behavioural nutrition of older people; Food choice; Policy development; Food safety

News

In the media

Research

Research interests

Research projects

Research collaborations

Indicators of esteem

  • Scientific advisory body member for research projects: Loughborough hydration project (2012-present).

  • Scientific advisory body member for research projects: Steering Group member for safefood’s “Food Marketing and the preschool child” project.

  • Scientific advisory body member for research projects: External Advisory Group member for safefood’s (the North-South body, responsible for the promotion of food safety on the island of Ireland) Consumer Focused Reviews on Food Behaviour  (2009-10).

  • Scientific advisory body member for research projects: Member of the International Scientific Advisory Group of the ISAFRUIT Integrated Project.

  • Scientific advisory body member for research projects: steering Group for Food Standards Agency-funded Food Choice Review project .

  • Scientific advisory body member: Member of the European Scientific Committee for the Choices programme, a world-wide initiative that is introducing a simple front-of-pack stamp on food products that have passed an evaluation against a set of qualifying criteria based on international dietary guidelines (2010-present).

  • Scientific advisory body member: Member of the International Scientific Committee for the Choices programme, a world-wide initiative that is introducing a simple front-of-pack stamp on food products that have passed an evaluation against a set of qualifying criteria based on international dietary guidelines (2008-10).

  • Consultancy:  Researching consumers and nutrition labelling on food packaging (Food and Agriculture Organization of the United Nations (FAO) - Nature of consultancy:  literature review and report writing (2011-12).

  • Consultancy:  National Lottery projects evaluation (new economics foundation) - Nature of consultancy: advice on research design (2007-8).

  • Consultancy: Review of training delivered by West Surrey Health Promotion Service across the local health economy (NHS) - Nature of consultancy: project design, data collection, analysis and report writing (2002).

  • Consultancy:  Gloucestershire Food Vision: Developing a plan for an integrated food policy for the long term benefit of the people of Gloucestershire (Gloucestershire First) - Nature of consultancy: general project advice (2003).

  • Consultancy: Evaluation of the 'Nation's Diet' Research Programme’ (ESRC) - Nature of consultancy: project design, data collection, analysis and report writing (2001).

  • Conference organisation: Abstract Review Committee Chair for ISBNPA 2002 Annual Meeting

  • Conference organisation: Abstract Review Committee Chair and Program Committee Joint-chair for ISBNPA 2003 Annual Meeting

  • Conference organisation: Scientific Committee for 9th Karlsruhe Nutrition Congress, Karlsruhe, Germany, 10-12 October 2004

  • Conference organisation: Abstract Review Committee and Program Committee Joint-chairs for ISBNPA 2004 Annual Meeting

  • Conference organisation: Abstract Review Committee and Program Committee Joint-chairs for ISBNPA 2005 Annual Meeting

  • Conference organisation: Scientific Committee for “Early Nutritional Programming and Health Outcome in Later Life: Obesity and Beyond”, Budapest, Hungary, 20-21 April 2007

  • Conference organisation: Scientific Committee for “The Power of Programming, International Conference on Developmental Origins of Health and Disease”, Munich, 6-8 May 2010

Supervision

Postgraduate research supervision

My publications

Publications

Fjellstrom C, Sydner Y, Sidenvall B, Raats MM, Lumbers M (2015) Organization, responsibility and practice of food provision in home-help service An exploratory study among professionals, BRITISH FOOD JOURNAL 117 (7) pp. 1921-1932 EMERALD GROUP PUBLISHING LIMITED
Kaur A, Scarborough P, Hieke S, Kusar A, Pravst I, Raats MM, Rayner M (2016) The nutritional quality of foods carrying health-related claims in Germany, the Netherlands, Spain, Slovenia, and the United Kingdom, European Journal of Clinical Nutrition 70 pp. 1388-1395 Nature Publishing Group
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
Gage Heather, Morgan J, Williams P, Schmid M, Laitenen K, von Rosen J, Koletzko B, Decsi T, Jacobi V, Martin-Bautista E, Campoy C, Raats Monique Infant feeding intentions of new mothers in five European countries, Proceedings of the Nutrition Society 69
Gage H, Egan B, Williams P, Gyoerei E, Brands B, Lopez-Robles J, Campoy C, Koletzko B, Decsi T, Raats M (2014) Views of parents in four European countries about the effect of food on the mental performance of primary school children, European Journal of Clinical Nutrition 68 (1) pp. 32-37 Nature Publishing Group

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.

Ashwell M, Lambert JP, Alles MS, Branca F, Bucchini L, Brzozowska A, de Groot LCPGM, Dhonukshe-Rutten RAM, Dwyer JT, Fairweather-Tait S, Koletzko B, Pavlovic M, Raats MM, Serra-Majem L, Smith R, van Ommen B, van't Veer P, von Rosen J, Pijls LTJ (2008) How we will produce the evidence-based EURRECA toolkit to support nutrition and food policy, EUROPEAN JOURNAL OF NUTRITION 47 pp. 2-16 DR DIETRICH STEINKOPFF VERLAG
McConnon A, Horgan GW, Lawton C, Stubbs J, Shepherd R, Astrup A, Handjieva-Darlenska T, Kuneaová M, Larsen TM, Lindroos AK, Martinez JA, Papadaki A, Pfeiffer AFH, Van Baak MA, Raats MM (2013) Experience and acceptability of diets of varying protein content and glycemic index in an obese cohort: Results from the Diogenes trial, European Journal of Clinical Nutrition 67 (9) pp. 990-995
Background/Objectives: To investigate acceptability and tolerability of diets of different protein and glycemic index (GI) content aimed at weight maintenance following a phase of rapid weight loss, as part of a large pan-European dietary intervention trial. Subjects/Methods: The Diogenes study (www.diogenes-eu.org) consisted of an initial 8-week rapid weight-loss phase (800-1000 kcal/day), followed by a 6-month weight maintenance intervention with five different diets varying in protein and GI content. Measurement of a range of outcomes relating to experience of the Diogenes diets in terms of acceptability, experience and mood were recorded via end of day questionnaires throughout the study. Results: Weight change during the initial weight loss phase weakly, but positively correlated with acceptability of the programme (r range=-0.08 to 0.2, Pd0.05, n=685 on four of five dimensions). Success at weight maintenance positively correlated with acceptance of the programme (r range=-0.21 to -0.34, P
Ebru E, Saigal P, Gage H, Raats MM, Ogden J, Qiao Y, Williams P (2010) Overweight and obesity in children: a comparison of the views of general practitioners and parents, Proceedings of the Nutrition Society 69 (OCE1) Cambridge Journals Online
The growing problem of childhood overweight and obesity has raised questions about optimal management and how responsibility for reversing the trends is divided between government, families, schools, industry and the health sector. At the level of the individual child, action depends on recognition of overweight and obesity. A survey was sent to all general practitioners (GP) in one Primary Care Trust (Surrey) in England and to all parents in one primary school in south London to investigate their views about the causes, consequences and management of childhood overweight and obesity. Questionnaires also contained fourteen (seven boys, seven girls) validated images representing standard percentile BMI for healthy children(1). Respondents were asked to state whether they thought each image was underweight, acceptable weight, overweight or obese. Differences between GP and parents were analysed using c2 tests. Of 583 questionnaires mailed to GP 184 (31.6%) were returned. The median age of respondents was 45 years and 55.4% were women (compared with 43.4% in the whole sample). Responding GP were more likely to come from larger practices (five or more partners). A total of 135 parents returned completed questionnaires, their median age was 40 years, 89.6% were women and 83% reported having completed further or higher education. The GP and parent samples were similar in relation to ethnicity (85% and 83% respectively were white), but more GP than parents considered themselves to be overweight or obese (33% v. 17%). Approximately all GP and parents (>95% in both groups) recognised that inadequate physical activity was a cause of overweight or obesity in children. Slightly lower percentages identified poor diet (90) and ?junk food advertisement? (80) as contributory factors. GP were significantly more likely than parents to agree that peer pressure (48.6% v. 31.6%; P = 0.001), low family income (41.4% v. 29.5%; P = 0.0003) and (marginally) genetics (45.2% v. 36.5%; P = 0.10) were causes of overweight or obesity in children. GP and parents agreed unanimously that parents should be involved in the management of childhood overweight and obesity, but parents were significantly more likely than GP to think that GP should be involved (86.4% v. 73.3%; P = 0.0004), and GP were significantly more likely than parents to agree that school nurses (97.9% v. 83.5%; P = 0.0001) and children (95.8% v. 87.9%; P = 0.001) should be active participants. Both groups tended to oversta
Timotijevic L, Brown KA, Lahteenmaki L, De Wit L, Sonne A-M, Ruprich J, Rehurkova I, Jeruszka-Bielak M, Sicinska E, Garcia NB, Guzzon A, Jensen BB, Shepherd R, Barnett J, Raats MM (2013) EURRECA-A Framework for Considering Evidence in Public Health Nutrition Policy Development, CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION 53 (10) pp. 1124-1134 TAYLOR & FRANCIS INC
Barnett J, Vasileiou K, Gowland MH, Raats MM, Lucas JS (2013) Beyond Labelling: What Strategies Do Nut Allergic Individuals Employ to Make Food Choices? A Qualitative Study, PLoS ONE 8 (1) Public Library of Science
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.
Regan Á, Raats M, Shan LC, Wall PG, Mcconnon Á (2014) Risk communication and social media during food safety crises: a study of stakeholders? opinions in Ireland, Journal of Risk Research
© 2014 Taylor & Francis Social media is a particular communication platform which has witnessed an exponential growth in use and influence in recent years, democratising the communication process, and offering risk communicators a way of putting into practice those principles which are advocated to be at the core of risk management and communication. However, little is known about stakeholders? willingness to embrace this new form of communication in a food crisis. The current study presented an exploratory investigation of the opinions of Irish stakeholders on the position of risk communication in a crisis, with a particular focus on understanding what application social media may have. In-depth one-to-one interviews were carried out with key stakeholders holding frontline positions in managing and communicating about risk in the food sector in Ireland. The stakeholders identified risk communication as a central activity in a food safety crisis, driven by an obligation to protect both consumer health and the reputation of the Irish food sector. Stakeholders relied primarily on risk communication to disseminate information in a crisis so to educate and inform the public on a risk and to prevent confusion and alarmism; most did not explicitly value two-way risk communication in a crisis. The ability to effectively manage future crises may depend on stakeholders? willingness to adapt to the changing communication landscape, namely ? their willingness to adopt social media and use it effectively. The findings indicate that the stakeholders interviewed are appreciative of the need to engage with social media in times of a food safety crisis. However, most valued social media as a one-way channel to help spread a message and there was little reference to the interactive nature of this medium. Implications for integrating social media into crisis risk communication strategies are discussed.
Gage H, Von Rosen-Von Hoewel J, Laitinen K, Jakobik V, Martin-Bautista E, Schmid M, Egan B, Morgan J, Williams P, Decsi T, Campoy C, Koletzko B, Raats M (2013) Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries, PUBLIC UNDERSTANDING OF SCIENCE 22 (3) pp. 365-379 SAGE PUBLICATIONS LTD
Aschemann-Witzel J, Grunert KG, van Trijp H, Bialkova S, Raats MM, Hodgkins C, Wasowicz-Kirylo G, Koenigstorfer J (2013) Effects of nutrition label format and product assortment on the healthfulness of food choice, Appetite 71 pp. 63-74
This study aims to find out whether front-of-pack nutrition label formats influence the healthfulness of consumers' food choices and important predictors of healthful choices, depending on the size of the choice set that is made available to consumers. The predictors explored were health motivation and perceived capability of making healthful choices. One thousand German and Polish consumers participated in the study that manipulated the format of nutrition labels. All labels referred to the content of calories and four negative nutrients and were presented on savoury and sweet snacks. The different formats included the percentage of guideline daily amount, colour coding schemes, and text describing low, medium and high content of each nutrient. Participants first chose from a set of 10 products and then from a set of 20 products, which was, on average, more healthful than the first choice set. The results showed that food choices were more healthful in the extended 20-product (vs. 10-product) choice set and that this effect is stronger than a random choice would produce. The formats colour coding and texts, particularly colour coding in Germany, increased the healthfulness of product choices when consumers were asked to choose a healthful product, but not when they were asked to choose according to their preferences. The formats did not influence consumers' motivation to choose healthful foods. Colour coding, however, increased consumers' perceived capability of making healthful choices. While the results revealed no consistent differences in the effects between the formats, they indicate that manipulating choice sets by including healthier options is an effective strategy to increase the healthfulness of food choices. © 2013 Elsevier Ltd.
Saba A, Messina F, Turrini A, Lumbers M, Raats MM, Team TFILLP (2008) Older people and convenience in meal preparation: a European study on understanding their perception towards vegetable soup preparation, International Journal of Consumer Studies 32 (2) pp. 147-156
De Morais C, Afonso C, De Almeida MDV, Lumbers M, Raats M (2012) From childhood to old age: A qualitative approach to the study of portuguese elderly's perception of meals across the life cycle, Revista de Alimentacao Humana 18 (1) pp. 8-18
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.
Westenhoefer J, Engel D, Holst C, Lorenz J, Stubbs J, Peacock M, Whybrow S, Raats MM (2013) Cognitive and weight-related correlates of flexible and rigid restrained eating behaviour, Eating Behaviors 14 (1) pp. 69-72 Elsevier
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
Pieniak Z, Zakowska-Biemans S, Kostyra E, Raats M (2015) Young adults' knowledge and awareness of sustainable and healthy eating behaviour, ANNALS OF NUTRITION AND METABOLISM 67 pp. 525-525 KARGER
Lumbers M, Eves A, Bielby G, Egan B, Raats M, Adams M (2007) Food hygiene knowledge and self-reported behaviours of UK school children,
Regan A, Shan L, McConnon A, Marcu A, Raats M, Wall P, Barnett J (2014) Strategies for dismissing dietary risks: insights from user-generated comments online, Health, Risk and Society 16 (4) pp. 308-322
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.
Barton KL, Wrieden WL, Devlin E, Macaskill S, Lawrence JM, Raats M (2005) The impact of ?CookWell? on assisting dietary change in Asian young women at risk of having low birth-weight babies: qualitative findings., Proceedings of the Nutrition Society 64 pp. OCA/B-27A
Afonso C, de Morais C, Lopes C, Raats M, Lumbers M, Grunert K, de Almeida MDV (2007) Self-reported overweight and obesity in European elderly, ANNALS OF NUTRITION AND METABOLISM 51 pp. 240-240 KARGER
Hunter W, Raats MM, Lumbers M (2007) Older adults, In: Lawrence M, Worsley T (eds.), Health Nutrition: From Principles To Practice pp. 127-148 Allen & Unwin
Hieke S, Kuljanic N, Wills JM, Pravst I, Kaur A, Raats MM, van Trijp HCM, Verbeke W, Grunert KG (2015) The role of health-related claims and health-related symbols in consumer behaviour: Design and conceptual framework of the CLYMBOL project and initial results, Nutrition Bulletin 40 (1) pp. 66-72
© 2015 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation.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 Role of health-relatedCLaimsandsYMBOLsin 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.
McConnon A, Gribble R, Raats MM, Stubbs J, Shepherd R (2013) Health professionals?, expert patients? and dieters? beliefs and attitudes about obesity, Journal of Human Nutrition and Dietetics 26 (6) pp. 612-616 Wiley / The British Dietetic Association Ltd.
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.
Lumbers M, Davidson K, Arber S, Marshall H, Raats M (2006) Gendered ties and the role of food in older people?s lives,
Gage H, Egan B, Williams P, Lopez-Robles JC, Brands B, Gyoerei E, Campoy C, Desci T, Koletzko B, Raats M (2013) ASSOCIATION BETWEEN DIET AND PHYSICAL AND MENTAL DEVELOPMENT OF CHILDREN: VIEWS OF PARENTS AND TEACHERS IN FOUR EUROPEAN COUNTRIES, ANNALS OF NUTRITION AND METABOLISM 63 pp. 1863-1863 KARGER
Egan MB, Bielby G, Eves A, Lumbers ML, Raats MM, Adams MR (2008) Food hygiene education in UK secondary schools: A nationwide survey of teachers' views, HEALTH EDUCATION JOURNAL 67 (2) pp. 110-120 SAGE PUBLICATIONS LTD
Raats MM, Shepherd R, Sparks P (2003) Consumer perceptions of risks associated with chemicals in foods, 11 (1)
Raats MM, Thorpe L, Hurren C, Elliott K (1998) Changing Preconceptions. Volume 2. The HEA Folic Acid Campaign 1995-1998. Research Report, Health Education Authority
Whybrow S, Westenhoefer J, Engel D, McConnon A, Gibbs M, Raats M, Stubbs RJ (2012) Dietary restraint and weight loss maintenance in members of a commercial weight loss organisation, Proceedings of the Nutrition Society 70 (OCE6) Cambridge Journals Online
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.
Kassianos A, Raats M, Nichols J (2013) The Development of Prostate Cancer Patients' Information Needs: Patients', GPs' and Significant Others' Perceptions Focusing on Diet, PSYCHO-ONCOLOGY 22 pp. 279-279 WILEY-BLACKWELL
Clarke DB, Lloyd AS, Lawrence JM, Brown JE, Storey L, Raats MM, Rainsbury RM, Culliford DJ, Bailey-Horne VA, Parry BM (2013) Development of a food compositional database for the estimation of dietary intake of phyto-oestrogens in a group of postmenopausal women previously treated for breast cancer and validation with urinary excretion, British Journal of Nutrition 109 (12) pp. 2261-2268 Cambridge University Press
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'.
Timotijevic L, Raats MM, Barnett J, Brown K, Fernandez L, Dömölki L, Ruprich J, Dhonukshe-Rutten RA, Sonne A-M, Hermoso M, Koletzko B, Frost-Andersen L (2010) Institutional contexts in which micronutrient reference values are developed across Europe, Proceedings of the Nutrition Society 69 (OCE1) Cambridge Journals Online
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
Egan B, Gage H, Williams P, Brands B, Györei E, López-Robles JC, Campoy C, Decsi T, Koletzko B, Raats M (2016) The effect of diet on the physical and mental development of children: views of parents and teachers in four European countries., The British journal of nutrition pp. 1-9
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
Kassianos A, Raats M (2013) An underlying mechanism of change: How prostate cancer survivors make sense of dietary changes?, PSYCHOLOGY & HEALTH 28 pp. 112-113 TAYLOR & FRANCIS LTD
Lucas JS, Barnett J, Leftwich J, Muncer K, Shepherd R, Raats MM, Gowland M, Grimshaw K (2011) The Challenge Of Using Information On Food Packaging To Avoid Peanut And Nut Allergens, Journal of Allergy and Clinical Immunology 127 (2) pp. AB112-AB112 MOSBY-ELSEVIER
RATIONALE: Recent legislation in USA and Europe aimed to improve information on packaged foods to assist food allergic consumers identify allergens. Legislation does not cover ?may contain? labels. There is little information on how information is used by allergic consumers when purchasing food.
METHODS: We studied how peanut and nut allergic individuals use allergy advice boxes, ingredients lists, and other packaging information, excluding ?may contain?. Thirty-two peanut and/ or nut allergic participants were observed during their normal food shop. Their spoken thoughts were audio-recorded. This was followed by a semi-structured interview. They were also given 13 potentially problematic packaged foods, and asked to explain whether they would purchase the food and their reasoning for the decision. Transcribed data from the shop, interview and 13-product task were analysed to explore use of label information.
RESULTS: Most participants used the allergy advice box rather than the ingredients list for their primary check. Package-based information was generally considered reliable, but some brands were trusted more than others. Participants suggested a number of improvements, particularly more ?nut free? labelling.
CONCLUSIONS: Participants used a combination of non-package based strategies (e.g. previous experience), in conjunction with label information to make purchase decisions. Trust of the food producer or supermarket informed interpretation of and confidence in labels. Images and product names, not intended by manufacturers as an allergen risk assessment aid were also used to inform choices.
von Rosen-von Hoewel J, Martin-Bautista E, Campoy C, Jakobik V, Decsi T, Laitinen K, Schmid MA, Morgan J, Gage H, Koletzko B, Raats M (2007) Reflection of early nutrition programming in parental information of infant feeding: comparative analysis of five European countries, EARLY HUMAN DEVELOPMENT 83 pp. S126-S126 ELSEVIER IRELAND LTD
Egan B, Hodgkins C, Fragodt A, Raats MM (2011) Compilation of food composition data sets: an analysis of user needs through the Use Case approach., European Journal of Clinical Nutrition 65 (6) pp. 757-760 Nature Publishing Group
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.
Raats MM, Sparks P (1995) Unrealistic optimism about diet-related risks: implications for interventions., Proceedings of the Nutrition Society 54 (3) pp. 737-745
Dhonukshe-Rutten RAM, Bouwman J, Brown KA, Cavelaars AEJM, Collings R, Grammatikaki E, De Groot LCPGM, Gurinovic M, Harvey LJ, Hermoso M, Hurst R, Kremer B, Ngo J, Novakovic R, Raats MM, Rollin F, Serra-Majem L, Souverein OW, Timotijevic L, Van't Veer P (2013) EURRECA-Evidence-Based Methodology for Deriving Micronutrient Recommendations, CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION 53 (10) pp. 999-1040 TAYLOR & FRANCIS INC
Doets EL, de Wit LS, Dhonukshe-Rutten RAM, Cavelaars AEJM, Raats MM, Timotijevic L, Brzozowska A, Wijnhoven TMA, Pavlovic M, Totland TH, Andersen LF, Ruprich J, Pijls LTJ, Ashwell M, Lambert JP, van't Veer P, de Groot LCPGM (2008) Current micronutrient recommendations in Europe: towards understanding their differences and similarities, EUROPEAN JOURNAL OF NUTRITION 47 pp. 17-40 DR DIETRICH STEINKOPFF VERLAG
Lumbers M, Raats M (2006) Food choices in later life, In: Shepherd R, Raats M (eds.), Psychology of Food Choice pp. 289-310 CABI Publishing
RAATS MM, SHEPHERD R (1993) The use and perceived appropriateness of milk in the diet - A cross-country evaluation, Ecology of Food and Nutrition 30 (3-4) pp. 253-273
Dean M, Raats MM, Shepherd R (2007) Consumers and functional cereal products, In: Hamaker B (eds.), Technology of Functional Cereal Products Woodhead Publishing Limited,
McGowan L, Caraher M, Raats M, Lavelle F, Hollywood L, McDowell D, Spence M, McCloat A, Mooney E, Dean M (2015) Domestic Cooking and Food Skills: A Review., Critical reviews in food science and nutrition
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.
Lumbers M, Raats MM, Dean M, Krunert KG, Lähteenmäki L (2009) Importance of food-related goals and perceived resources in satisfaction with food- related life among the elderly,
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, tthe 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 foodrelated life, implying that older people?s satisfaction with food-r lated 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.
Lucas J, Barnett J, Leftwich J, Muncer K, Grimshaw K, Shepherd R, Raats MM, Gowland MH (2011) How do peanut and nut-allergic consumers use information on the packaging to avoid allergens?, Clinical & Experimental Allergy 41 (12) pp. 1836-1836
Objectives: Recent legislation has sought to improve 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.
Methods: The behaviour and ?thinking aloud? of 32 participants were recorded during their normal food shop, followed by a semistructured interview. During the interview they were given 13 potentially problematic packaged foods, and asked if they would purchase the product and what their reasons were. Transcribed data from the shop, interview and 13-product task were analysed to explore use of allergy advice boxes, ingredients lists, and other packaging information.
Results: Some participants used the ingredients list as their primary check for allergens, but most used the allergy advice box. Packagebased information was generally considered reliable, but some supermarket and brand labels were trusted more than others. Images and product names were used to draw inferences about the presence of nuts. A number of improvements were suggested by participants, particularly a request for more ?nut free? labelling.
Conclusions: Food labels were used in conjunction with nonpacket based strategies (e.g. previous experience) to make choices. External factors (e.g. trust of manufacturer) informed interpretation of and confidence in labels. Images and product names, not intended by manufacturers as an allergen risk assessment aid were also used to inform choices.
von Rosen-von Hoewel J, Laitinen K, Martin-Bautista E, Campoy C, Jakobik V, Decsi T, Schmid MA, Morgan J, Gage H, Koletzko B, Raats M (2009) Obesity Related Programming Statements in Materials on Infant Feeding Aimed at Parents in Five European Countries, EARLY NUTRITION PROGRAMMING AND HEALTH OUTCOMES IN LATER LIFE: OBESITY AND BEYOND 646 pp. 175-181 SPRINGER
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.
Biddle S, Pearson N, Raats MM (2010) Is sedentary behaviour associated with dietary intake in young people? A systematic review.,
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.
Parry BM, Lawrence JM, Storey L, Brown JE, Clarke DB, Raats M, Horton SM, Stilwell JM, Rainsbury RM (2008) Food choice and phytoestrogen consumption in women previously treated for postmenopausal breast cancer, BREAST CANCER RESEARCH 10 pp. S47-S48 BIOMED CENTRAL LTD
Lumbers M, Mattsson Sydner Y, Sidenvall B, Fjellström C, Gustafsson K, Raats M (2006) Diet, eating and household work - a life course perspective: findings from the Food in Later Life Project,
Eves A, Bielby G, Egan B, Lumbers M, Raats MM, Adams M (2010) Food safety knowledge and behaviours of children (5-7 years), HEALTH EDUCATION JOURNAL 69 (1) pp. 21-30 SAGE PUBLICATIONS LTD
Lumbers M, Nielsen N, Grunert K, Raats M (2006) A measure of satisfaction with food-related life,
Jakobik V, Martin-Bautista E, Gage H, Von Rosen-Von Hoewel J, Laitinen K, Schmid M, Morgan J, Williams P, Campoy C, Koletzko B, Raats MM, Decsi T (2011) Programming effect of breast-feeding in infant nutrition policy documents in Hungary | Az anyatejes táplálás hosszú távú hatásainak megjelenése a csecsemotáplálási irányelvekben Magyarországon, Orvosi Hetilap 152 (41) pp. 1641-1647 Akadémiai Kiadó
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.
Decsi T, Bokor SZ, Martin-Bautista E, Campoy C, Laitinen K, Hoewel JVR-V, Schmid MA, Gage H, Koletzko B, Morgan J, Raats MM (2007) Representation of early nutritional programming in policy documents on infant nutrition: comparison of five European countries, PROCEEDINGS OF THE NUTRITION SOCIETY 66 pp. 16A-16A CAMBRIDGE UNIV PRESS
Timotijevic L, Raats MM (2007) Evaluation of two methods of deliberative participation of older people in food-policy development, HEALTH POLICY 82 (3) pp. 302-319 ELSEVIER IRELAND LTD
Gage H, Erdal E, Saigal P, Qiao Y, Williams P, Raats MM (2012) Recognition and management of overweight and obese children: A questionnaire survey of general practitioners and parents in England., Journal of Paediatrics and Child Health 48 (2) pp. 146-152 Wiley-Blackwell
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
Timotijevic L, Raats MM, Barnett J, Brown K, Shepherd R, Fernandez L, Domolki L, Ruprich J, Sonne A-M, Hermoso M, Koletzko B, Frost-Andersen L, Timmer A (2010) From micronutrient recommendations to policy: consumer and stakeholder involvement, EUROPEAN JOURNAL OF CLINICAL NUTRITION 64 pp. S31-S37 NATURE PUBLISHING GROUP
Timotijevic L, Barnett J, Brown K, Shepherd R, Fernandez-Celemin L, Domolki L, Ruprich J, Dhonukshe-Rutten RA, Sonne AM, Hermoso M, Koletzko B, Frost-Andersen L, Timmer A, Raats MM (2011) The process of setting micronutrient recommendations: A cross-European comparison of nutrition-related scientific advisory bodies., Public Health Nutrition 14 (4) pp. 716-728 Cambridge University Press
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.
Grunert KG, Bolton LE, Raats MM (2011) Processing and Acting upon Nutrition Labeling on Food: The State of Knowledge and New Directions for Transformative Consumer Research, In: Mick DG, Pettigrew S, Pechmann C, Ozanne JL (eds.), Transformative Consumer Research for Personal and Collective Well-Being 16 pp. 333-351 Routledge Academic
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).
Dean M, Grunert KG, Raats MM, Nielsen NA, Lumbers M (2008) The impact of personal resources and their goal relevance on satisfaction with food-related life among the elderly, APPETITE 50 (2-3) pp. 308-315 ACADEMIC PRESS LTD ELSEVIER SCIENCE LTD
Dhonukshe-Rutten RAM, Timotijevic L, Cavelaars AEJM, Raats MM, de Wit LS, Doets EL, Tabacchi G, Roman B, Ngo-de la Cruz J, Gurinovic M, de Groot LCPGM, van 't Veer P (2010) European micronutrient recommendations aligned: a general framework developed by EURRECA, EUROPEAN JOURNAL OF CLINICAL NUTRITION 64 pp. S2-S10 NATURE PUBLISHING GROUP
Whybrow S, McConnon A, Gibbs M, Raats M, Stubbs RJ (2012) Demographic factors do not predict weight loss maintenance in members of a commercial weight loss organisation, Proceedings of the Nutrition Society 70 (OCE6) Cambridge Journals Online
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
Raats MM (2015) Policies rising from consumer food choices - do we need translators?, ANNALS OF NUTRITION AND METABOLISM 67 pp. 37-37 KARGER
McConnon A, Raats MM, Shepherd R, Ogden J (2007) Weight control practices and behaviours in an overweight sample - results from the DiOGenes study, ANNALS OF NUTRITION AND METABOLISM 51 pp. 64-64 KARGER
Antiliou G, Timotijevic L, Raats M (2012) The role of willpower in successful maintenance of weight loss, Psychology & Health 27 pp. 148-149 TAYLOR & FRANCIS LTD
Willpower ? the ability to resist temptation ? is an important key to successful functioning and willpower failure may lead to various health problems including obesity. The present
qualitative study examined the role of willpower in successful maintenance of weight loss and in-depth interviews were carried out with 13 men and women who were classified as successful
weight loss maintainers. The data were analyzed using Interpretative Phenomenological Analysis (IPA). The participants described their experiences in terms of six broad themes: their weight histories; the use of willpower to maintain weight loss; the factors that deplete
willpower; the factors that increase willpower; how willpower had been strenghtened over the maintenance period; the differences when employing willpower during weight loss and maintenance. The results suggest that willpower has a major role to play in maintenance of weight loss and health professionals could increase the effectiveness of weight management interventions through willpower enhancement.
Brown KA, de Wit L, Timotijevic L, Sonne A-M, Lahteenmaki L, Brito Garcia N, Jeruszka-Bielak M, Sicinska E, Moore AA, Lawrence M, Raats MM (2015) Communication of scientific uncertainty: international case studies on the development of folate and vitamin D recommendations, EFSA Journal (supp) pp. 67-67 European Food Safety Authority (EFSA), Parma
Kozlowska K, SzczeciDska AS, Roszkowski W, Brzozowska A, Alfonso C, Fjellstrom C, Morais C, Nielsen NA, Pfau C, Saba A, Sidenvall B, Turrin A, Raats MM, Lumbers M, Food Later Life Project Team (2008) Patterns of healthy lifestyle and positive health attitudes in older Europeans, J NUTR HEALTH AGING 12 (10) pp. 728-733 SERDI EDITIONS/SPRINGER
Objectives: To determine (i) the extent to which recommended lifestyle healthy behaviors are adopted and the existence of positive attitudes to health; (ii) the relative influence of socio-demographic variables on multiple healthy lifestyle behaviors and positive attitudes to health; (iii) the association between healthy lifestyle behaviors and positive attitudes to health. Design: two distinct healthy behavioral measures were developed: (i) healthy lifestyles based on physical activity, no cigarette smoking, no/moderate alcohol drinking, maintaining a "healthy" weight and having no sleeping problems and (ii) positive health attitudes based on having positive emotional attitudes. such as: self-perceived good health status, being calm, peaceful and happy for most of the time, not expecting health to get worse and regular health check-ups. A composite healthy lifestyle index, ranging from 0 (none of behaviors met) to 5 (all behaviors met) was calculated by summing up the individual's scores for the five healthy lifestyle items. Afterwards, each individual's index was collapsed into three levels: 0-2 equivalent to 'level 1' (subjectively regarded as 'too low'), a score of 3 equivalent to 'level 2 ('fair') and 4-5 as 'level 3' satisfactory 'healthy lifestyle' practices. The same procedure was applied to the positive health attitudes index. Multinomial logistic regression analyses by a forward selection procedure were used to calculate the adjusted odds ratio (OR) with 95% confidence interval (95% CI). Participants: a multi-national sample consisting of 638 older Europeans from 8 countries, aged 65-74 and 75+, living alone or with others. Results and conclusions: maintaining a "healthy" weight was the most frequently cited factor in the healthy lifestyles index and therefore assumed to be the most important to the older Europeans in the study; positive attitudes to health were relatively low; participants achieved a 'satisfactory' level for healthy lifestyles index (level 3) more frequently than a satisfactory level for positive attitudes to health; having a satisfactory 'healthy lifestyle' was directly related to having a satisfactory level of positive attitudes to health based on the positive health attitudes index: income and geographical location in Europe appeared to be key predictors for meeting both the recommended healthy lifestyle factors in the index and having positive health attitudes however, the composition and nature of the study sample should be
Jeruszka-Bielak M, Sicinska E, de Wit L, Ruprich J, Rehurkova I, Brown KA, Timotijevic L, Sonne A-M, Haugaard P, Guzzon A, Brito Garcia N, Alevritou E, Hermoso M, Sarmant Y, Lahteenmaki L, Roszkowski W, Raats MM (2015) Stakeholders' Views on Factors Influencing Nutrition Policy: a Qualitative Study Across Ten European Countries, POLISH JOURNAL OF FOOD AND NUTRITION SCIENCES 65 (4) pp. 293-302 DE GRUYTER OPEN LTD
Timotijevic L, Barnett J, Raats MM (2011) Engagement, representativeness and legitimacy in the development of food and nutrition policy, Food Policy 36 (4) pp. 490-498 Elsevier
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.
Dean M, Spence M, Hodgkins C, Raats MM (2015) Front-of-pack (FOP) labelling of foods and beverages, In: Berryman P (eds.), Advances in Food and Beverage Labelling Information and Regulations 7 pp. 113-131 Woodhead Publishing Limited
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.
Gage H, Morgan J, Williams P, Schmid M, Laitenen K, von Rosen J, Koletzko B, Decsi T, Jacobi V, Martin-Bautista E, Campoy C, Raats MM (2010) Infant feeding intentions of new mothers in five European countries, Proceedings of the Nutrition Society 69 (OCE1) Cambridge Journals Online
Primiparvus mothers with healthy singleton babies in England, Finland, Germany, Hungary and Spain were asked about their milk feeding and weaning intentions in 2005. Following informed consent, questionnaires were completed by mothers shortly after the birth of their baby, and included items asking about their socio-demographic characteristics, sources of information on infant feeding, and beliefs about the effect of early nutrition on the immediate and future health of the child. Mothers were recruited through the maternity services in the locality of the researchers. A total of 2071 mothers completed questionnaires (England, 438; Finland, 426; Germany, 414; Hungary, 389; Spain, 404). The mean age of mothers was 30.0 (SD 0.02) years, ranging from 28.1 (SD 4.03) in Hungary to 32.1 (SD 4.95) in Germany (ANOVA; P
Dean M, Raats MM, Shepherd R (2011) The role of self-identity, past behaviour and their interaction in predicting intention to purchase fresh and processed organic food, Journal of Applied Social Psychology 42 (3) pp. 669-688 Wiley-Blackwell
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.
GEEKIE MA, RAATS MM (1995) THE DEVELOPMENT OF A 7-DAY FOOD AND DRINK DIARY, APPETITE 24 (3) pp. 282-283 ACADEMIC PRESS (LONDON) LTD
de Wit L, Timotijevic L, Brown K, Guzzon A, Brito Garcia N, Roszkowski W, Rehurkova I, Sarmant Y, Alevritou E, Haugaard P, Bucchini L, Sonne AM, Hermoso M, Ruprich J, Lahtteenmaki L, Raats M (2011) Selecting options for national nutrition policy: a consideration of scientific evidence and alternative perspectives, ANNALS OF NUTRITION AND METABOLISM 58 pp. 129-129
Hunter W, Lumbers M, Raats M (2007) Future challenges in day-care centre food services: Will benchmarking help?, International Journal of Public Sector Management 20 (5) pp. 434-448
Purpose - The aim of this study is to identify the methods used by providers to evaluate their food services and identify elements of their service that would benefit from adopting a benchmarking system. Design/methodology/approach - In-depth interviews were conducted with 26 food services providers and key informants in day-care settings in Surrey. Findings - Few providers formally evaluated their service provision and most had not considered benchmarking their services against other food service providers. Factors such as food variety, food quality, cost and environment have been identified as issues that could be benchmarked and may benefit from the adoption of this process. Research limitations/implications - The study was conducted only in one country - in the UK - further research is needed into the evaluation practices of other local authorities. The benchmarking model that has been developed by the authors needs to be applied in a food service setting to establish its usefulness to food service managers. Practical implications - A model has been developed from the outcome of this research, which could aid evaluation processes for food service providers to identify aspects of the service in need of improvement. Originality/value - There has been little research conducted on the evaluation of food service provision for older people, especially for congregate meals. This paper provides a model, that food service providers may find useful, to identify areas of their food services that are suitable for benchmarking.
Raats MM, Sparks P, Geekie MA, Shepherd R (1999) The effects of providing personalized dietary feedback. A semi-computerized approach, PATIENT EDUCATION AND COUNSELING 37 (2) pp. 177-189 ELSEVIER SCI IRELAND LTD
Dean M, Raats MM, Grunert KG (2008) Older people, food and satisfaction with life, In: Raats MM, de Groot CPGM, van Staveren W (eds.), Food for the ageing population 165 1 pp. 3-19 Woodhead Publishing Ltd
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
Kassianos AP, Coyle A, Raats MM (2015) Perceived influences on post-diagnostic dietary change among a group of men with prostate cancer, EUROPEAN JOURNAL OF CANCER CARE 24 (6) pp. 818-826 WILEY-BLACKWELL
Raats MM, Sparks P (1996) Perceptions of diet-related risks, INTERNATIONAL JOURNAL OF PSYCHOLOGY 31 (3-4) pp. 2682-2682 PSYCHOLOGY PRESS
Eves A, Bielby G, Egan B, Lumbers M, Raats M, Adams M (2006) Food hygiene knowledge and self-reported behaviours of UK school children (4-14 years), BRITISH FOOD JOURNAL 108 (9) pp. 706-720 EMERALD GROUP PUBLISHING LIMITED
SBowiDska MA, Danowska-Oziewicz M, Cichon R, Szymelfejnik E, Walu[ A, W?doBowska L, Lumbers M, Raats M (2004) Umiej?tno[ci przygotowywania posiBków a stan od|ywienia osób w wieku podeszBym. Badania pilotowe. Projekt Senio Food-QOL, {yw. CzBow. Metab. T. 31 supl.
Lane K, Poland F, Fleming S, Lambert N, MacDonald H, Potter J, Raats MM, Skidmore P, Vince C, Wellings A, Hooper L (2013) Older women's reduced contact with food in the CAFE Study: choices, adaptations and dynamism, Ageing and Society 34 (4) pp. 645-669 Cambridge University Press
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.
Shepherd R, Sparks P, Bellier S, Raats MM (1991) The effects of information on sensory ratings and preferences: The importance of attitudes, Food Quality and Preference 3 (3) pp. 147-155
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.
Hodgkins C, Barnett J, Wasowicz-Kirylo G, Stysko-Kunkowska M, Gulcan Y, Kustepeli Y, Akgungor S, Chryssochoidis G, Fernández-Celemin L, Storcksdieck Genannt Bonsmann S, Gibbs M, Raats MM (2012) Understanding how consumers categorise nutritional labels: A consumer derived typology for front-of-pack nutrition labelling., Appetite 59 (3) pp. 806-817 Elsevier
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.
Storcksdieck S, Fernandez Celemin L, Wills J, Larranaga A, Egger S, Hodgkins C, Raats M (2010) Assessment of consumer exposure to nutrition information on food labels: penetration study across the twenty-seven EU member states (EU-27) plus Turkey, Proceedings of the Nutrition Society 69 (OCE1) Cambridge Journals Online
Food Labelling to Advance Better Education for Life (FLABEL) is a project funded under the European Commission?s 7th Framework Programme. Its objective is to understand how nutrition information on food labels affects dietary choices and consumer habits. Fundamental to this objective is the assessment of current exposure of consumers to nutrition information on food labels. At present, few data exist on the penetration of nutrition information on food labels in Europe, with previous studies involving only a small subset of countries and not looking at all products within a product category(1). The present study aimed at designing and conducting a reproducible audit, assessing the current penetration of nutrition information on food labels in various product categories in the EU-27 plus Turkey and to identify the major ways in which nutrition information is provided on labels. In each of the twenty-seven EU countries plus Turkey three types of retailers were chosen for the audit: a retailer within the top five in terms of market share; a national retailer or consumer cooperative; a discounter. The product categories examined were sweet biscuits, breakfast cereals, ready meals, carbonated soft drinks and yoghurts. A data collection grid was designed to record where nutrition information occurred on the pack (front of pack v. elsewhere), in which format it was given (e.g. nutrition table), which nutrients were covered and whether nutrition or health claims were present. The majority of products in these five categories in all countries contained nutrition information of some kind (highest in the UK and Republic of Ireland, lowest in Eastern European countries). The most widespread format across all countries was the nutrition table on back of pack, stating either the main four (energy, protein, carbohydrates, fat) or the main eight (main four plus sugar, saturated fat, fibre and salt). Overall, breakfast cereals was the category with the highest penetration of nutrition information. Nutrition claims and guideline daily amounts were the most prevalent front-of-pack forms of nutrition information. Nutrition information was found on a large majority of products audited and its presence seems higher than reported previously(1). The findings will provide a solid starting ground for subsequent studies involving attention, reading, liking, understanding and use of different nutrition labelling formats. FLABEL receives research funding from the European Community?s S
Lawrence JM, Devlin E, Macaskill S, Kelly M, Chinouya M, Raats MM, Barton KL, Wrieden WL, Shepherd R (2007) Factors that affect the food choices made by girls and young women, from minority ethnic groups, living in the UK, JOURNAL OF HUMAN NUTRITION AND DIETETICS 20 (4) pp. 311-319 BLACKWELL PUBLISHING
Danowska-Oziewicz M, SBowiDska MA, Cichon R, Szymelfejnik E, Walu[ A, W?doBowska L, Raats M, Lumbers M (2004) Ograniczenia ekonomiczne a struktura spo|ycia produktów przez osoby w wieku podeszBym. Badania pilotowe. Projekt Senior Food-QOL., {yw. CzBow. Metab. T. 31 supl.
Timotijevic L, Brown KA, Lähteenmäki L, de Wit L, Sonne AM, XehoYková I, Jeruszka-Bielak M, Sicinska E, Brito García N, Guzzon A, Jensen BB, Shepherd R, Barnett J, Raats MM (2013) EURRECA- A framework for considering evidence in public health nutrition policy development, Critical Reviews in Food Science and Nutrition 53 (10) pp. 1124-1134 Taylor & Francis
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.
Barton KL, Wrieden WL, Devlin E, Macaskill S, Lawrence JM, Raats M (2005) Reported fruit and vegetable intake of 50 children aged 11-13 in Dundee, Scotland, PROCEEDINGS OF THE NUTRITION SOCIETY 64 pp. 27A-27A CAMBRIDGE UNIV PRESS
Lawrence JM, Kelly M, Chinouya M, Raats MM, Devlin KE, Macaskill S, Barton KL, Wrieden WL (2005) The development of ?CookWell II? a cooking intervention for use with ethnic minority communities at risk of having low birth-weight babies: qualitative findings, n/a n/a
Martin-Bautista E, Campoy C, Decsi T, Bokor S, von Rosen-von Hoewel J, Laitinen K, Schmid MA, Morgan J, Gage H, Koletzko B, Raats M (2009) Obesity Related Programming Statements in Infant Feeding Policies in Five European Countries, EARLY NUTRITION PROGRAMMING AND HEALTH OUTCOMES IN LATER LIFE: OBESITY AND BEYOND 646 pp. 169-173 SPRINGER
Raats MM, de Groot CPGM, van Staveren WA (2008) Food for the ageing population, Woodhead Publishing Limited
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.

Dean M, Raats MM, Grunert KG, Lumbers M (2009) Factors influencing eating a varied diet in old age, PUBLIC HEALTH NUTRITION 12 (12) pp. 2421-2427 CAMBRIDGE UNIV PRESS
Shepherd R, Raats MM (2006) The Psychology of Food Choice, CABI Publishing
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

Hodgkins C, Raats MM, Egan MB, Fragodt A, Buttriss J, McKevith B (2010) Optimising food composition data flow within the UK food supply chain and to external stakeholders, JOURNAL OF FOOD COMPOSITION AND ANALYSIS 23 (7) pp. 749-752 ACADEMIC PRESS INC ELSEVIER SCIENCE
Khan SS, Timotijevic L, Newton R, Coutinho D, Luis Llerena J, Ortega S, Benighaus L, Hofmaier C, Xhaferri Z, de Boer A, Urban C, Straehle M, Da Pos L, Neresini F, Raats MM, Hadwiger K (2016) The framing of innovation among European research funding actors: Assessing the potential for 'responsible research and innovation' in the food and health domain, FOOD POLICY 62 pp. 78-87 ELSEVIER SCI LTD
Barnett J, Leftwich J, Muncer K, Grimshaw K, Shepherd R, Raats MM, Gowland MH, Lucas JS (2011) How do peanut and nut-allergic consumers use information on the packaging to avoid allergens?, Allergy 66 (7) pp. 969-978 John Wiley and Sons
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.
Raats MM (2010) The role of consumers., Nestle Nutr Workshop Ser Pediatr Program 66 pp. 161-171
It is particularly important that in areas of strategic public health significance, e.g. infant feeding, the processes used to extract robust scientific findings are timely, rigorous and transparent. Low rates of breastfeeding, poor weaning practices and variability within and between countries have been reported by many authors and resulted in a call for more consistency of recommendations across regions. The adoption of consumer behaviors in line with recommendations is of course not guaranteed. The consumers in this instance are both the infant and their mother or other carers. As infants completely depend on their carers to make food choices for them, it is important that they understand nutrition, and the importance of food choices for health of the baby and in future life. Parents obtain information from a variety of sources, the quality of which may vary, and is not necessarily evidence-based. Although carers decide what is offered or withheld, the infant may contribute to this decision by expressing dissatisfaction or refusing food. At the heart of all feeding choices lies this interplay between carer and child, influenced by the environment at household, community and societal level.
Timotijevic L, Raats MM, Barnett J, Brown K, Latheenmaki L, Jensen BB (2010) Health-behaviour-policy epistemological framework for the decision making of policy makers relevant to micronutrient recommendations, EUROPEAN JOURNAL OF PUBLIC HEALTH 20 pp. 125-125 OXFORD UNIV PRESS
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.
Gage H, Egan B, Williams P, Gyoerei E, Brands B, Lopez-Robles J, Brown K, Campoy C, Koletzko B, Decsi T, Raats M (2013) VIEWS OF PARENTS IN FOUR EUROPEAN COUNTRIES ABOUT THE EFFECT OF FOOD ON THE MENTAL PERFORMANCE OF PRIMARY SCHOOL CHILDREN, ANNALS OF NUTRITION AND METABOLISM 63 pp. 1132-1132 KARGER
Egan B, Hodgkins C, Shepherd R, Timotijevic L, Raats MM (2011) An overview of consumer attitudes and beliefs about plant food supplements., Food and Function 2 (12) pp. 747-752 Royal Society of Chemistry
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.
Klepacz N, Nash R, Egan MB, Raats MM, Hodgkins CE (2015) When Is an Image a Health Claim? A False-Recollection Method to Detect Implicit Inferences About Products? Health Benefits, Health Psychology 35 (8) pp. 898-907 American Psychological Association
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.
de Morais C, Afonso C, Raats MM, Lumbers M, Grunert KG, de Almeida MDV (2007) Fruit and vegetable variety of consumption by European seniors, ANNALS OF NUTRITION AND METABOLISM 51 pp. 73-74 KARGER
KozBowska K, SzczeciDska A, Roszkowski W, Brzozowska A, Raats M, Lumbers M, Food in Later Life Team (2007) Factors influencing the choice and perceptions of yoghurts among old people living in Warsaw, Polish Journal of Food and Nutrition Sciences 57 (1) pp. 115-124
Lavelle F, Spence M, Hollywood L, McGowan L, Surgenor D, McCloat A, Mooney E, Caraher M, Raats MM, Dean M (2016) Learning cooking skills at different ages: a cross-sectional study, International Journal of Behavioral Nutrition and Physical Activity 13 (119) BioMed Central
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 (
Egan B, Gage H, Williams P, Brands B, Gyoerei E, Lopez-Robles JC, Koletzko B, Campoy C, Desci T, Raats M (2013) FACTORS AFFECTING FOOD CHOICES OF PARENTS OF CHILDREN AGED 4-10 YEARS IN FOUR EUROPEAN COUNTRIES, ANNALS OF NUTRITION AND METABOLISM 63 pp. 1862-1862 KARGER
Barnett J, McConnon A, Kennedy J, Raats MM, Shepherd R, Verbeke W, Fletcher J, Kuttschreuter M, Lima L, Wills J, Wall P (2011) Development of strategies for effective communication of food risks and benefits across Europe: Design and conceptual framework of the FoodRisC project, BMC PUBLIC HEALTH 11 308 BIOMED CENTRAL LTD
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.
Raats MM (2015) Consumer perceptions and use of plant food supplements: implications for communication and policy, ANNALS OF NUTRITION AND METABOLISM 67 pp. 79-79 KARGER
Martin-Bautista E, Gage H, von Rosen-von Hoewel J, Jakobik V, Laitinen K, Schmid M, Morgan J, Williams P, Decsi T, Campoy C, Koletzko B, Raats M (2010) Lifetime health outcomes of breast-feeding: a comparison of the policy documents of five European countries, PUBLIC HEALTH NUTRITION 13 (10) pp. 1653-1662 CAMBRIDGE UNIV PRESS
Lundkvist P, Fjellström C, Sidenvall B, Lumbers M, Raats MM (2010) Management of healthy eating in everyday life among senior Europeans, Appetite
Raats MM, Hieke S, Jola C, Hodgkins C, Kennedy J, Wills J (2014) Reference amounts utilised in front of package nutrition labelling; impact on product healthfulness evaluations., Eur J Clin Nutr 69 (5) pp. 619-625
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.
Egan MB, Fragodt A, Raats MM, Hodgkins C, Lumbers M (2007) The importance of harmonizing food composition data across Europe, EUROPEAN JOURNAL OF CLINICAL NUTRITION 61 (7) pp. 813-821 NATURE PUBLISHING GROUP
SPARKS P, RAATS M (1995) DIFFERENCES IN ATTITUDES TOWARDS POTENTIAL FOOD-RELATED HAZARDS AS A FUNCTION OF SOCIAL, POLITICAL AND ENVIRONMENTAL VALUES, APPETITE 24 (3) pp. 276-276 ACADEMIC PRESS (LONDON) LTD
Dhonukshe-Rutten RAM, Timotijevic L, Cavelaars AEJM, De Wit LS, Doets EL, Raats M, Tabacchi G, Wijnhoven TMA, Roman B, De La Cruz JN, Gurinovic M, De Groot LCPGM, van't Veer P (2010) EURRECA's General Framework to make the process of setting up micronutrient recommendations explicit and transparent, Proceedings of the Nutrition Society 69 (OCE1) Cambridge Journals Online
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
W?doBowska L, Danowska-Oziewicz M, Niedzwiedzka E, SBowiDska MA, Lumbers M, Raats M, Nielsen NA, Food in Later Life Project Team (2006) Food patterns among Polish older people, Polish Journal of Environmental Studies 15 (2a) pp. 885-894
Raats MM, Malcolm RN, Lahteenmaki L, Pravst I, Gage H, Cleary A, Karatzia A, Kusar A, Yang W, Jackson DL, Hodgkins CE, Klopcic M (2016) Understanding the impact of legislation on 'reduction of disease risk' claims on food and drinks: the REDICLAIM project, AGRO FOOD INDUSTRY HI-TECH 27 (3) pp. 30-32 TEKNOSCIENZE PUBL
Mcconnon A, Gribble R, Raats MM, Stubbs J, Shepherd R (2013) Health professionals', expert patients' and dieters' beliefs and attitudes about obesity, Journal of Human Nutrition and Dietetics 26 (6) pp. 612-616
Background: Research has suggested that patients and treatment providers hold different beliefs and models of obesity. This could impact upon the consistency and quality of interventions for weight management. The present 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, analysis of variance 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 (current recommended options) of obesity/overweight. Conclusions: The findings of the present study indicate a broader similarity between beliefs and attitudes of those involved in obesity treatment and those that they aim to treat than was previously assumed. 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. © 2013 The British Dietetic Association Ltd.
Egan B, Gage H, Williams P, Gyoerei E, Brands B, Lopez-Robles JC, Campoy C, Koletzko B, Desci T, Raats M (2013) ASSOCIATION BETWEEN DIET AND MENTAL PERFORMANCE OF CHILDREN: VIEWS OF PARENTS AND TEACHERS IN FOUR EUROPEAN COUNTRIES, ANNALS OF NUTRITION AND METABOLISM 63 pp. 1862-1862 KARGER
Lumbers M, Hunter W, Raats M, The Food in Later Life Project Team (2008) Critical Incidents in food service: a gap analysis of providers? and users? experience of congregate meals in Europe,
Egan B, Gage H, Williams P, Raats M, Brands B, Gyoerei E, Lopez-Robles J, Campoy C, Koletzko B, Decsi T (2011) Diet and mental performance of children: A questionnaire survey of parents in four European countries., Annals of Nutrition and Metabolism: European journal of nutrition, metabolic diseases and dietetics 58 pp. 29-29
Introduction: Diet is one of many factors influencing a child?s mental performance. but little is known about the beliefs. attitudes and knowledge of parents. and how these affect food choices. A survey of parents of children aged 4-10 years was conducted in four European countries (England. Germany. Hungary. Spain) to explore their views about the effect of diet on children?s attention and ability to learn.
Objectives: Diet is one of many factors influencing a child?s mental performance. but little is known about the beliefs. attitudes and knowledge of parents. and how these affect food choices. A survey of parents of children aged 4-10 years was conducted in four European countries (England. Germany. Hungary. Spain) to explore their views about the effect of diet on children?s attention and ability to learn.
Method/Design: A questionnaire was designed. translated and piloted in the four countries. Parents of children in mainstream education and without diagnosed pathologies such as Attention Deficit Hyperactivity Disorder were recruited through online panels accessed by a market research company. Background information was collected on respondents? personal characteristics (household composition and demography. socioeconomic status. education. ethnicity). The questionnaire explored views on the relationship between diet and physical and mental development. attention and ability to learn. and how such considerations affected food choices.
Results: 1604 parents completed the questionnaire (401 in England. Germany and Hungary. 403 in Spain); 61% female (range 54% Spain ? 68% England). Most respondents had completed higher education (range 66% England ? 39% Hungary). Almost one half were current smokers (range 42% England ? 52% Germany). Many parents thought that a child?s ability to learn was very much . extremely dependent on diet (71% overall. range 64% Spain ? 78% Hungary). but smaller proportions reported that they considered this (very much. extremely) when providing food for their child (51% overall. range 47% England and Hungary ? 55 % Germany). Differences between views and reported behaviours of parents were smaller for other aspects of mental performance.
Conclusions: Parents may belief that diet affects mental performance but other factors. such as providing variety and overall healthiness of diet. may be more important in the food choices they make for their children.
Jensen BB, Lähteenmäki L, Grunert KG, Brown KA, Timotijevic L, Barnett J, Shepherd R, Raats MM (2012) Changing micronutrient intake through (voluntary) behaviour change. The case of folate., Appetite 58 (3) pp. 1014-1022 Elsevier
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.
BMRB Social Research, Food, Consumer Behaviour and Health Research Centre at the University of Surrey (2008) Comprehension and use of UK nutrition signpost labelling schemes: Scientific Rationale and Design, Food Standards Agency
Raats MM, Shepherd R, Sparks P (1993) Attitudes, obligations and perceived control: predicting milk selection., Appetite 20 (3) pp. 239-241
Raats M, SPARKS P (1995) UNREALISTIC OPTIMISM ABOUT DIET-RELATED RISKS - IMPLICATIONS FOR INTERVENTIONS, APPETITE 24 (3) pp. 295-295 ACADEMIC PRESS (LONDON) LTD
Egan B, Gage H, Raats M, Anton B, Koletzko B, Györei E, Desci T, Martin-Bautista E, Lopez-Roberts JC, Campoy C (2010) The effect of diet on children's mental performance: a study of the attitudes, knowledge and perceptions of UK parents, Proceedings of the Nutrition Society 69 (OCE1) Cambridge Journals Online
Nutrition is one of many factors that affect development of the brain and hence the mental performance of children; the latter term being used to describe a great variety of different brain-mediated functions and processes. The brain develops throughout childhood and an adequate diet is required for its optimal functioning and development(1). Consequently undernutrition has been associated with problems of cognition and behaviour, both on a short-term and long-term basis(2). To remain metabolically active the brain requires a constant supply of glucose as well as a range of other nutrients and both the nature of children?s diets and pattern of meal consumption may influence mental performance. Parents are responsible for the provision of food within the home and as such play a key role in the development of children?s food choices and eating behaviours(3,4). There is little published research on parent?s perceptions of the relationship between a child?s diet and their mental performance. The aim of the present qualitative study was to explore the attitudes, knowledge and perceptions of parents of the effect of diet on children?s development. Parents were recruited through a number of primary schools in the Guildford area. A semistructured interview schedule was used; topics included the effect of food on children?s wellbeing and development, the physical and mental effects of food and the short- and long-term effects of children?s diets. Further questions were asked about possible effects of specific foods, meals and supplements as well as the impact of what children eat in school on their performance. Analysis of the interviews identified a number of themes including the overarching relationship between diet and health. Parents spoke of the effects of diet in terms of physical, mental and behavioural outcomes, clearly distinguishing between what they perceived as positive and negative foods: ?I?ve seen children?s behaviour different when they?ve eaten certain foods, like they get hyper when they have sweet stuff and drink sugary stuff and eat sweets and cakes?. Concentration was the aspect of mental performance most discussed by parents, being affected both by particular foods and by feelings of hunger: ?I would imagine that if they?re hungry they will be tired, they?re not going to concentrate, they?re not going to do as well as they could do?. Parents attested to the importance of establishing good eating habits in childhood, as these habits would conti
Lopez Robles J, Egan B, Brands B, Gyoerei E, Gage H, Raats M, Koletzko B, Decsi T, Campoy C (2011) Teachers knowledge of the influence of nutrition on childrens mental performance in four European countries, ANNALS OF NUTRITION AND METABOLISM 58 pp. 409-409
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)
Hollywood LE, Cuskelly GJ, O'Brien M, McConnon A, Barnett J, Raats MM, Dean M (2013) Healthful grocery shopping. Perceptions and barriers, Appetite 70 pp. 119-126
While there is evidence of the factors influencing the healthfulness of consumers' food choice, little is known about how consumers perceive the healthfulness of their shopping. This study aimed to explore consumers' perceptions of, and identify barriers to, conducting a healthful shop. Using a qualitative approach, consisting of an accompanied shop and post-shop telephone interview, 50 grocery shoppers were recruited. Results showed that consumers used three criteria to identify a healthful shop: (1) inclusion of healthful foods; (2) avoidance or restriction of particular foods; and (3) achieving a balance between healthful and unhealthful foods. Those who take a balanced approach employ a more holistic approach to their diet while those who avoid or include specific foods may be setting criteria to purchase only certain types of food. The effectiveness of any of these strategies in improving healthfulness is still unclear and requires further investigation. Two barriers to healthful shopping were: (i) lack of self-efficacy in choosing, preparing and cooking healthful foods and (ii) conflicting needs when satisfying self and others. This highlights the need for interventions targeted at building key food skills and for manufacturers to make healthful choices more appealing. © 2013 Elsevier Ltd.
Bonsmann SSG, Celemin LF, Larranaga A, Egger S, Wills JM, Hodgkins C, Raats MM (2010) Penetration of nutrition information on food labels across the EU-27 plus Turkey, EUROPEAN JOURNAL OF CLINICAL NUTRITION 64 (12) pp. 1379-1385 NATURE PUBLISHING GROUP
Grunert KG, Dean M, Raats MM, Nielsen NA, Lumbers M (2007) A measure of satisfaction with food-related life, APPETITE 49 (2) pp. 486-493 ACADEMIC PRESS LTD ELSEVIER SCIENCE LTD
Wadolowska L, Danowska-Oziewicz M, Niedzwiedzka E, Slowinska MA, Lumbers M, Raats M, Nielsen NA, Food in Later Life Team (2006) BMI and obesity incidence in relation to food patterns among Polish older people, Polish Journal of Environmental Studies 15 (2a) pp. 877-884
Shepherd R, Sparks P, Bellier S, Raats MM (1991) Attitudes and choice of flavoured milks: Extensions of Fishbein and Ajzen's theory of reasoned action, Food Quality and Preference 3 (3) pp. 157-164
Brown KA, Timotijevic L, Barnett J, Shepherd R, Lähteenmäki L, Raats MM (2011) A review of consumer awareness, understanding and use of food-based dietary guidelines., British Journal of Nutrition 106 (1) pp. 15-26 Cambridge University Press
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.
O'Brien MC, McConnon A, Hollywood LE, Cuskelly GJ, Barnett J, Raats M, Dean M (2014) Let's talk about health: shoppers' discourse regarding health while food shopping., Public Health Nutr 18 (6) pp. 1001-1010
OBJECTIVE: The present study aimed to examine the role of health in consumers' food purchasing decisions through investigating the nature of people's discourse regarding health while conducting their food shopping. DESIGN: The study employed the think-aloud technique as part of an accompanied shop. All mentions of health and terms relating to health were identified from the data set. Inductive thematic analysis was conducted to examine how health was talked about in relation to people's food choice decisions. SETTING: Supermarkets in Dublin, Republic of Ireland and Belfast, Northern Ireland. SUBJECTS: Participants (n 50) were aged over 18 years and represented the main household shopper. RESULTS: Responsibility for others and the perceived need to illicit strict control to avoid 'unhealthy' food selections played a dominant role in how health was talked about during the accompanied shop. Consequently healthy shopping was viewed as difficult and effort was required to make the healthy choice, with shoppers relating to product-based inferences to support their decisions. CONCLUSIONS: This qualitative exploration has provided evidence of a number of factors influencing the consideration of health during consumers' food shopping. These results highlight opportunities for stakeholders such as public health bodies and the food industry to explore further ways to help enable consumers make healthy food choices.
Raats MM, Shepherd R (1996) Developing a subject-derived terminology to describe perceptions of chemicals in foods, Risk Analysis: an international journal 16 (2) pp. 133-146 PLENUM PUBL CORP
Brands B, Egan B, Gage H, Lopez-Robles JC, Gyoerei E, Raats M, Martin-Bautista E, Decsi T, Campoy C, Koletzko B (2010) THE EFFECT OF DIET ON CHILDREN'S MENTAL PERFORMANCE - A QUALITATIVE STUDY OF PERCEPTIONS, ATTITUDES AND BELIEFS OF PARENTS IN FOUR EUROPEAN COUNTRIES, JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION 50 pp. E189-E189 LIPPINCOTT WILLIAMS & WILKINS
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.
Klepacz NA, Nash RA, Egan MB, Hodgkins CE, Raats MM (2015) When Is an Image a Health Claim? A False-Recollection Method to Detect Implicit Inferences About Products' Health Benefits, HEALTH PSYCHOLOGY 35 (8) pp. 898-907 AMER PSYCHOLOGICAL ASSOC
Hoewel JVR-V, Laitinen K, Schmid MA, Decsi T, Martin-Bautista E, Koletzko B, Jakobik V, Campoy C, Gage H, Morgan J, Raats MM (2007) Nutrition programming statements in materials on infant feeding aimed at parents: comparison among five European countries, PROCEEDINGS OF THE NUTRITION SOCIETY 66 pp. 23A-23A CAMBRIDGE UNIV PRESS
Claessens M, Contor L, Dhonukshe-Rutten R, De Groot LC, Fairweather-Tait SJ, Gurinovic M, Koletzko B, Van Ommen B, Raats MM, Van't Veer P (2013) EURRECA-Principles and Future for Deriving Micronutrient Recommendations, Critical Reviews in Food Science and Nutrition 53 (10) pp. 1135-1146
The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence (NoE) explored an approach for setting micronutrient recommendations, which would address the variation in recommendations across Europe. Therefore, a framework for deriving and using micronutrient Dietary Reference Values (DRVs) has been developed. This framework comprises four stages (defining the problem-monitoring and evaluating-deriving dietary reference values-using dietary reference values in policy making). The aim of the present paper is to use this framework to identify specific research gaps and needs related to (1) knowledge available on specific micronutrients (folate, iodine, iron, selenium, vitamin B12, vitamin D, and zinc) and (2) the methodology presented in the framework. Furthermore, the paper describes the different outputs that support the process like protocols, guidelines, systematic review databases, and peer-reviewed publications, as well as the principal routes of dissemination of these outputs to ensure their optimal uptake in policy, practice, and research collaborations. The importance of ensuring transparency in risk assessment and risk management, systematic searching the literature, and taking into account policy options is highlighted. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional tables.]. © 2013 Copyright Taylor and Francis Group, LLC.
Raats M, Wills J, Kennedy J (2011) Consumer preference for and use of portion information on food and drink packaging: a Pan-European Study, Annals of Nutrition and Metabolism: European journal of nutrition, metabolic diseases and dietetics 58 pp. 204-204
Introduction: In a climate of overweight and obesity, the amount consumed is just as important as what is eaten.
Objectives: To explore if and how European consumers? preference for and use of portion information on food and drink labels when using nutrition information.
Method/Design: A representative sample of 13,117 respondents aged between 18-65 years from 6 European countries (Germany, UK, Spain, France, Poland, Sweden) completed a web-based questionnaire consisting of a range of questions on consumers? use of portion information when using nutrition information, demographics and scales for respondent segmentation (e.g. health interest, nutrition knowledge, numeracy).
Results: For 15 out of the 19 food types studied, at least half of respondents in all six countries thought the stated portion size was ?exactly right?. Where they differed, they were likely to think it was too small, rather than too big. Respondents were slightly more likely to agree than disagree to want portion information more widely available on packaging. The preferred portion information format depended on the type of food. Per pack was the preferred format for most of the foods types tested. Per 100 g/ml was the preferred format for cheese, soft drinks, soup and condiments. And where the food type can be split into single units, nutrition information by unit was the most or second most preferred format. Most consumers were able to accurately read and relay nutrient information from labels. Providing nutrition information per portion in addition to per 100g information increased consumers? ability to establish the nutrient content of a portion.
Conclusions: The study provides evidence that when nutrition information per portion is present on pack in addition to per 100g/ml information, it helps consumers to use nutrition information correctly and quickly. The challenge remains to encourage consumers to look for and use the information in the first place.
Sparks P, Harris PR, Raats M (2003) Imagining and explaining hypothetical scenarios: Mediational effects on the subjective likelihood of health-related outcomes, Journal of Applied Social Psychology 33 (4) pp. 869-887 V H WINSTON & SON INC
Fragodt A, Raats MM (2006) Working toward a web-based pan-European access to on-line nutrient databases: UK nutrition researchers' needs and expectations., PROCEEDINGS OF THE NUTRITION SOCIETY 65 pp. 97A-97A CAMBRIDGE UNIV PRESS
Dean M, Arvola A, Vassallo M, Lahteenmaki L, Raats MM, Saba A, Shepherd R (2006) Comparison of elicitation methods for moral and affective beliefs in the theory of planned behaviour, APPETITE 47 (2) pp. 244-252 ACADEMIC PRESS LTD ELSEVIER SCIENCE LTD
Lumbers M, Eves A, Bielby G, Egan B, Raats M, Adams M (2007) Teaching Food Hygiene in UK Primary Schools: A nationwide survey of teachers? views,
Peacock M, Hodgkins C, Shepherd R, Raats M (2011) Articulating health through food labelling: encouraging healthier choices, Annals of Nutrition and Metabolism: European journal of nutrition, metabolic diseases and dietetics 58 pp. 206-206
Introduction: Nutrition labelling is recognized as a key tool for combating this problem by providing consumers with information which promotes healthy eating.
Objectives: To investigate the extent to which food labelling systems (FLS) encourage healthier choices.
Method/Design: Laddering interviews with three groups (parents; 55+; teenagers) of 20 participants were carried out in the United Kingdom. The eight FLS studied varied in complexity (e.g. numerical, graphical and colour-based information), directiveness and benchmarking (nutrient- and product-level).
Results: The relationship between gross amount of information presented and actual label use is mediated by the type of benchmarking used and by what participants think its level of directiveness implies about them. Participants suggested they could decrease the cognitive workload of an ostensibly complex FLS by initially engaging only with the traffic light colours. Participants were unlikely to engage with non-directive FLS without benchmarking because these were slow to use and difficult to understand, offering objective information but no tools for use; thus suggesting an erosion self-efficacy and decreased likelihood of use in future, particularly less experienced shoppers. Semi-directive FLS with nutrient-level benchmarking gave both information and tools for meaningful engagement, increasing self-efficacy and ability to use labels effectively. A product-level logo FLS sacrificed all else for speed and ease of use, reducing decisionmaking rather than empowering the making of informed choices.
Conclusions: Future FLS designs need to consider the psychological as well as practical reasons why consumers choose to engage with some FLS and ignore others. In removing any obvious link between dietary recommendations and hard facts, overly simplified labels sacrifice flexibility, utility and persuasiveness on the assumption that ease and speed are all. By contextualising real information with colourful nutrient-level benchmarking an optimal FLS may encourage shoppers to make their own informed decisions, restoring that link and empowering them to take more interest in nutrition in the future.
Wadolowska L, Danowska-Oziewicz M, Niedzwiedzka E, Slowinska MA, Lumbers M, Raats M, Nielsen NA, Food in Later Life Team (2006) BMI and obesity incidence in relation to food patterns among Polish older people, Polish Journal of Environmental Studies 15 (2a) pp. 877-884
BMI differentiation and obesity incidence in relation to food patterns of Polish older people were
analysed. The research included 422 people aged 65+ years. 21 food patterns were separated by the factor
analysis. On the basis of the self-reported body mass and height, the BMI and percentages of overweight
or obese people were calculated. The increase of the BMI and overweight and obesity incidence for both
sexes was unequivocally connected with eating rye. The increase of the BMI and overweight and obesity
incidence depended among women on consuming pork raeat and alcoholic beverages. For men the increase
in eating dairy products was connected with the overweight incidence increase. The role of fruit and vegetables
needs to be explained in further studies.
McConnon Á, Raats MM, Shepherd R, Stubbs J (2008) Healthcare professionals' and dieters' attitudes and perceptions of obesity, Proceedings of the Nutrition Society 67 (OCE7) Cambridge Journals Online
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
McConnon A, Raats MM, Astrup A, Bajzová M, Handjieva-Darlenska T, Lindroos AK, Martinez JA, Larson TM, Papadaki A, Pfeiffer A, van Baak MA, Shepherd R (2011) Application of the Theory of Planned Behaviour to weight control in an overweight cohort. Results from a pan-European dietary intervention trial (DiOGenes)., Appetite 58 (1) pp. 313-318
Using the Theory of Planned Behaviour (TPB), this study investigates weight control in overweight and obese participants (27kg/m(2)}BMI
Brown K, Timotijevic L, De Wit L, Brito Garcia N, Roszkowski W, Sonne A, Lahteenmaki L, Raats M (2011) Transparency and uncertainty in scientific advisory bodies: five European case studies, ANNALS OF NUTRITION AND METABOLISM 58 pp. 310-310
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.
Gage H, Raats MM, Williams P, Egan B, Jakobik V, Laitinen K, Martin-Bautista E, Schmid M, von Rosen-von Hoewel J, Campoy C, Decsi T, Morgan J, Koletzko B (2011) Developmental origins of health and disease: the views of first-time mothers in 5 European countries on the importance of nutritional influences in the first year of life., American Journal of Clinical Nutrition 94 (6S) pp. 2018S-2024S American Society for Nutrition
Background: The programming concept suggests that poor early nutrition causes an array of medical problems later in life. Public health messages about the implications of programming may not be reaching parents and influencing infant feeding behaviors.

Objective: The views of new mothers were sought about the extent to which lifelong health is influenced by diet as an infant, rather than by genetic predispositions or lifestyles and behaviors.

Design: A questionnaire survey of first-time mothers was undertaken in 5 European countries.

Results: A convenience sample of 2071 mothers from England (438), Finland (426), Germany (414), Hungary (389), and Spain (404) self-completed the questionnaire. High proportions of mothers agreed that how an infant is fed affects his or her health over the first year (95.8%) and in subsequent years (88.5%), but the effect of infant feeding decisions on the development of long-term conditions was the least-cited underlying reason. Diet as an infant was rated an extremely/very important influence on adult health by 64% of mothers, equivalent to environmental pollution (63%), but by fewer mothers than were diet and physical activity in childhood/adolescence (79%, 84%) and adulthood (81%, 83%), genetics/inheritance (70%), and exposure to cigarette smoke (81%). Inter- and intracountry differences were observed.

Conclusions: Mothers in this study consider diet as an infant to be a less important influence on lifelong health than many lifestyle, behavioral, and environmental factors and genetics. Further dissemination of the implications of programming to consumers may be warranted.

Raats M, Poutanen K, Almeida M (2005) Consumer needs regarding dietetic products for pregnant and lactating women and for baby foods - Focus group meeting, EARLY NUTRITION AND ITS LATER CONSEQUENCES: NEW OPPORTUNITIES 569 pp. 120-126 SPRINGER-VERLAG BERLIN
Stubbs J, Whybrow S, Teixeira P, Blundell J, Lawton C, Westenhoefer J, Engel D, Shepherd R, Mcconnon Á, Gilbert P, Raats M (2011) Problems in identifying predictors and correlates of weight loss and maintenance: Implications for weight control therapies based on behaviour change, Obesity Reviews 12 (9) pp. 688-708 Wiley-Blackwell
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.

Morais C, Afonso C, Oliveira B, Lumbers M, Raats M, Almeida MDV (2013) HEALTH-RELATED QUALITY OF LIFE AND FOOD VARIETY OF EUROPEAN ELDERLY, ANNALS OF NUTRITION AND METABOLISM 63 pp. 521-521 KARGER
Pieniak Z, Zakowska-Biemans S, Kostyra E, Raats M (2016) Sustainable healthy eating behaviour of young adults: towards a novel methodological approach, BMC PUBLIC HEALTH 16 ARTN 577 BIOMED CENTRAL LTD
Gyoerei E, Egan B, Gage H, Williams P, Raats M, Brands B, Lopez-Robles J, Campoy C, Koletzko B, Decsi T (2011) Effect of food on learning: views of parents in four European countries, Annals of Nutrition and Metabolism: European journal of nutrition, metabolic diseases and dietetics 58 pp. 137-138
Introduction: Nutrition is one of many factors influencing a child?s learning abilitiy.
Objectives: This study aims to assess parents? views on the effect of food on children?s ability to learn in four European countries (England, Germany, Hungary, Spain).
Method. Design: Parents of children aged 4 to 10 years were recruited through state elementary schools. Participants were asked to sort 18 cards representing possible determinants of learning (in 6 categories: 4 food related, 3 educational, 2 physical, 4 social, 2 psychological, 3 biological) according to their views about strength of effect. Determinants were identified from the literature. Effects were scored: 0=none; 1=moderate; 2=strong.
Results: 201 parents took part. There were no significant differences among countries in age, gender, number of children of participants. Higher proportions of parents in England and Germany had received university education than in the other countries (p=0.015); significantly fewer parents in Spain were in employment (p Conclusions: Parents do not perceive food as a major determinant of learning in children; better formulated and targeted communication with parents is needed.
Supported by the European Communities 7th Framework Programme (NUTRIMENTHE Grant agreement number: 212652).
Bielby G, Egan B, Eves A, Lumbers M, Raats M, Adams M (2006) Food hygiene education in UK primary schools: a nation-wide survey of teachers' views, BRITISH FOOD JOURNAL 108 (9) pp. 721-731 EMERALD GROUP PUBLISHING LIMITED
Bowen DJ, Battuello KM, Raats M (2005) Marketing genetic tests: Empowerment or snake oil?, Health Education & Behavior 32 (5) pp. 676-685
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.
McConnon A, Raats M, Shepherd R (2010) Investigation of weight-loss expectations and weight control in obesity, Proceedings of the Nutrition Society 69 (OCE1) Cambridge Journals Online
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
Raats MM, Shepherd R, Sparks P (1995) Including moral dimensions of choice within the Theory of Planned Behavior, Journal of Applied Social Psychology 25 (6) pp. 484-494 V H WINSTON & SONS INC
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.
Arber S, Marshall H, Meadows R, Raats M, Lumbers M, Davidson K (2005) Older people and food: The impact of gender and living arrangements on food consumption across European societies, GERONTOLOGIST 45 pp. 529-529 GERONTOLOGICAL SOCIETY AMER
Raats M, Lumbers M (2004) O.6.6. The role of food and meals in sustaining independence and quality of life in old age: An EU-funded project., Journal of Nutrition, Health & Aging 8 (6)
Dean M, Raats MM, Lähteenmäki L (2015) Methods Investigating Food-Related Behaviour, In: Lovegrove JA, Hodson L, Sharma S, Lanham-New SA (eds.), Nutrition Research Methodologies 10 John Wiley & Sons, Ltd
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.
Lopez-Robles JC, Egan B, Gage H, Gyorei E, Brands B, Raats M, Martin-Bautista E, Tamas D, Koletzko B, Campoy C (2010) QUANTITATIVE STUDY OF SPANISH PARENTS BELIEFS OF WHAT EFFECTS CHILDREN'S MENTAL PERFORMANCE, JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION 50 pp. E191-E191 LIPPINCOTT WILLIAMS & WILKINS
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 performanc
de Morais C, Oliveira B, Afonso C, Lumbers M, Raats M, de Almeida MDV (2013) Nutritional risk of European elderly, EUROPEAN JOURNAL OF CLINICAL NUTRITION 67 (11) pp. 1215-1219 NATURE PUBLISHING GROUP
Turrini A, D'Addezio L, Maccati F, Davy BM, Arber S, Davidson K, Grunert K, Schuhmacher B, Pfau C, KozBowska K, SzczeciDska A, Medeiros de Morais C, Afonso C, Bofill S, Lacasta Y, Nydahl M, Ekblad J, Raats MM, Lumbers M (2010) The Informal Networks in Food Procurement by Older People-A Cross European Comparison, Ageing International 35 (4) pp. 253-275 Springer
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.
Kassianos AP, Raats Monique, Gage Heather (2016) An exploratory study on the information needs of prostate cancer patients and their partners, Health Psychology Research 4 (1) 4786 PAGEPress Publications
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.
Dhonukshe-Rutten RAM, Timotijevic L, Cavelaars AEJM, Raats MM, de Wit LS, Doets EL, Roman B, Ngo-de la Cruz J, Gurinovic M, de Groot LCPGM, van't Veer P (2010) European micronutrient recommendations aligned: a general framework developed by EURRECA Rosalie Dhonukshe, EUROPEAN JOURNAL OF PUBLIC HEALTH 20 pp. 125-125 OXFORD UNIV PRESS
Background: In Europe, micronutrient recommendations have been established by (inter)national committees of experts and are used by public health-policy decision makers to monitor and assess the adequacy of the diets of population groups. Current micronutrient recommendations are, however, heterogeneous, whereas the scientific basis for this is not obvious. Alignment of setting micronutrient recommendations is necessary to improve the transparency of the process, the objectivity and reliability of recommendations that are derived by diverse regional and (inter)national bodies.
Objective: To align transparent decision making for evidence-based policy making, stakeholder involvement and alignment of policies across Europe.
Results: The General Framework as proposed by Eurreca envisions the derivation of nutrient recommendations as scientific methodology, embedded in a policy-making process that also includes consumer issues, and acknowledges the influences of the wider sociopolitical context by distinguishing the principal components of the framework: (i) defining the nutrient requirements for health, (ii) setting nutrient recommendations, (iii) policy options and (iv) policy applications.
Conclusions: The General Framework can serve as a basis for a systematic and transparent approach to the development and review of micronutrient requirements in Europe, as well as the decision making of scientific advisory bodies, policy makers and stakeholders involved in this process of assessing, developing and translating these recommendations into public health nutrition policy.
Dean M, Raats MM, Shepherd R (2008) Moral concerns and consumer choice of fresh and processed organic foods, JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 38 (8) pp. 2088-2107 BLACKWELL PUBLISHING
Brown KA, Hermoso M, Timotijevic L, Barnett J, Lillegaard ITL, Rehurková I, Larrañaga A, Loncarevic-Srmic A, Andersen LF, Ruprich J, Fernández-Celemín L, Raats MM (2012) Consumer involvement in dietary guideline development: opinions from European stakeholders, Public Health Nutrition Cambridge University Press
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.

Dean M, Shepherd R, Arvola A, Vassallo M, Winkelmann M, Claupein E, Laehteenmaeki L, Raats MM, Saba A (2007) Consumer perceptions of healthy cereal products and production methods, JOURNAL OF CEREAL SCIENCE 46 (3) pp. 188-196 ACADEMIC PRESS LTD ELSEVIER SCIENCE LTD
Schmid MA, von Rosen-von Hoewel J, Martin-Bautista E, Szabo E, Campoy C, Decsi T, Morgan J, Gage Heather, Koletzko B, Raats Monique (2009) Infant Feeding and the Concept of Early Nutrition Programming: A Comparison of Qualitative Data from Four European Countries, pp. 183-187
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.
Stubbs RJ, McConnon A, Gibbs M, Raats M, Whybrow S (2012) Changes in lifestyle habits and behaviours are associated with weight loss maintenance in members of a commercial weight loss organisation, Proceedings of the Nutrition Society 70 (OCE6) Cambridge Journals Online
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
Brown KA, De Wit L, Timotijevic L, Sonne AM, Lähteenmäki L, Brito Garcia N, Jeruszka-Bielak M, SiciDska E, Moore AN, Lawrence M, Raats MM (2015) Communication of scientific uncertainty: International case studies on the development of folate and vitamin D Dietary Reference Values, Public Health Nutrition 18 (8) pp. 1378-1388
Copyright © The Authors 2014.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.
de Almeida MDV, Davidson K, de Morais C, Marshall H, Bofill S, Grunert KG, Kozlowska K, Lacasta Y, Martines S, Mattsson-Sydner Y, Boel Nielsen H, Seltmann G, Szczecinska A, Raats M, Lumbers M, Food in Later Life Project Team (2005) Alcohol consumption in elderly people across European Countries: Results from the Food in Later Life Project., Ageing International 30 (4) pp. 377-395
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.
Kassianos AP, Raats MM, Gage H, Peacock M (2015) Quality of life and dietary changes among cancer patients: a systematic review, Quality of Life Research 24 (3) pp. 705-719
© 2014, Springer International Publishing Switzerland.Purpose: To review the literature focusing on the effects of dietary behavioural changes on cancer patients? health-related quality of life (HRQOL).Methods: Relevant databases were searched for studies that report the relationship between dietary changes and HRQOL of people with cancer and synthesized and systematically reviewed the available evidence. Papers were assessed for methodological quality, and the themes identified were summarized.Results: The selected studies included only randomized control trials, which target changes in diet. Twelve studies were identified, which focus on the association between lifestyle changes that included changes in diet and HRQOL among cancer patients. Results have been mixed, and dietary changes have been shown to partly affect HRQOL, but other factors seem to be important as well in defining that relationship. Moreover, cancer groups with higher survival rates (prostate, breast, colorectal) seem to benefit more from dietary changes, while different HRQOL constructs are affected with no clear indication of directional benefits on physical or mental health.Conclusions: Even though there are some indications of a direct relationship between dietary changes and HRQOL, further research should establish which areas of HRQOL are directly affected. Perhaps, nutritional changes in future interventions can be isolated in order to identify a potential direct relationship with HRQOL.
Gage H, Von Rosen-Von Hoewel J, Laitinen K, Jakobik V, Martin-Bautista E, Schmid M, Egan B, Morgan J, Williams P, Decsi T, Campoy C, Koletzko B, Raats MM (2013) Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries, Public Understanding of Science 22 (3) pp. 365-379 Sage
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.
Gage H, Williams P, Von Rosen-Von Hoewel J, Laitinen K, Jakobik V, Martin-Bautista E, Schmid M, Egan B, Morgan J, Decsi T, Campoy C, Koletzko B, Raats MM (2012) Influences on infant feeding decisions of first-time mothers in five European countries, European Journal of Clinical Nutrition 66 (8) pp. 914-919 Nature Publishing Group
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

CONCLUSION:

Further research is required about which dissemination strategies are most effective at improving infant feeding behaviours in varied cultural settings, and for different socio-economic groups.

Barnett J, Muncer K, Leftwich J, Shepherd R, Raats MM, Gowland MH, Grimshaw K, Lucas JS (2011) Using 'may contain' labelling to inform food choice: a qualitative study of nut allergic consumers, BMC PUBLIC HEALTH 11 734 BIOMED CENTRAL LTD
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.
Egan MB, Hodgkins C, Fragodt A, Krines C, Raats MM (2009) User-centred food composition data-analysis of user needs through the Use Case approach, FOOD CHEMISTRY 113 (3) pp. 804-807 ELSEVIER SCI LTD
Hermoso M, Tabacchi G, Iglesia-Altaba I, Bel-Serrat S, Moreno-Aznar LA, Garcia-Santos Y, del Rosario Garcia-Luzardo M, Santana-Salguero B, Pena-Quintana L, Serra-Majem L, Moran VH, Dykes F, Decsi T, Benetou V, Plada M, Trichopoulou A, Raats MM, Doets EL, Berti C, Cetin I, Koletzko B (2010) The nutritional requirements of infants. Towards EU alignment of reference values: the EURRECA network, MATERNAL AND CHILD NUTRITION 6 pp. 55-83 WILEY-BLACKWELL
Malam S, Clegg S, Kirwan S, McGinigal S, Raats MM, Shepherd R, Barnett J, Senior V, Hodgkins C (2009) Comprehension and use of UK nutrition signpost labelling schemes, Food Standards Agency
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?
Brands B, Egan B, Györei E, López-Robles JC, Gage H, Campoy C, Decsi T, Koletzko B, Raats MM (2012) A qualitative interview study on effects of diet on children's mental state and performance. Evaluation of perceptions, attitudes and beliefs of parents in four European countries, Appetite 58 (2) pp. 739-746 Elsevier
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.
Raats MM, Lumbers M, Food in Later Life Project Team (2006) Methods used for collecting and handling multilingual qualitative data in the Food in Later Life Project, Proceedings of the Nutrition Society 65 pp. 116A-116A
Monteleone E, Raats MM, Mela DJ (1997) Perceptions of starchy food dishes: Application of the repertory grid method, Appetite 28 (3) pp. 255-265 ACADEMIC PRESS LTD
Allard A, Dean M, Raats MM (2010) Corporate tools for public policy: stakeholders views and beliefs about the use of nutrition and health claims on food products, Proceedings of the Nutrition Society 69 (OCE5) Cambridge Journals Online
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.
Egan MB, Fragodt A, Raats MM (2006) The importance of harmonising and sustaining food composition data across Europe, Nutrition Bulletin 31 (4) pp. 349-353
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.
Timotijevic L, Barnett J, Brown KA, Raats MM, Shepherd R (2013) Scientific decision-making and stakeholder consultations: The case of salt recommendations, Social Science & Medicine 85 pp. 79-86 Elsevier
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, Uni

Mattsson Sydner Y, Sidenvall B, Fjellström C, Raats MM, Lumbers M, Food in Later Life Team (2007) Diet, eating and household work - a life course perspective of senior Europeans, Food, Culture and Society 10 (3) pp. 367-387
Leftwich J, Barnett J, Muncer K, Shepherd R, Raats MM, Hazel Gowland M, Lucas JS (2011) The challenges for nut-allergic consumers of eating out., Clin Exp Allergy 41 (2) pp. 243-249 Blackwell Publishing
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.
Raats MM, Shepherd R (1991) An evaluation of the use and perceived appropriateness of milk using the repertory grid method and the 'item by use' appropriateness method, Food Quality and Preference 3 (2) pp. 89-100
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.
Hollywood LE, Cuskelly GJ, O'Brien M, McConnon A, Raats MM, Barnett J, Dean M (2012) Healthy grocery shopping: perceptions and barriers, Proceedings of the Nutrition Society 71 (OCE2) Cambridge Journals Online
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
Biddle S, The Sedentary Behaviour and Obesity Expert Working Group, Cavill N, Ekelund U, Gorely T, Griffiths M, Jago R, Oppert JM, Raats MM, Salmon J, Stratton G, Vicente-Rodríguez G, Butland B, Prosser L, Richardson D (2010) Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence,
1. Sedentary behaviour is not simply a lack of physical activity but is a cluster of individual behaviours where sitting or lying is the dominant mode of posture and energy expenditure is very low.
2. Sedentary behaviours are multi-faceted and might include behaviours at work or school, at home, during transport, and in leisure-time. Typically, key sedentary behaviours include screen-time (TV viewing, computer use), motorised transport, and sitting to read, talk, do homework, or listen to music.
3. Total time spent in sedentary behaviours can be captured by objective monitoring devices, such as accelerometers and inclinometers. The former can quantify the amount of time spent below a predetermined threshold of movement, and its temporal patterning across the day. Inclinometers can quantify time spent in different postures by distinguishing between lying, sitting and standing.
4. Self-reported sedentary behaviour instruments can ask respondents to report frequency and duration of time spent in different behaviours, such as TV viewing and computer game playing, over a specific time frame.
5. UK self-report data suggests that the majority of young people have ?acceptable? levels of TV viewing, but about one-quarter to one-third watch 4 hours per day or more, levels generally considered excessive.
6. Data on computer game playing by young people show more variability, but with up to 60% playing for more than 1 hour/day. These trends are changing rapidly and it is increasingly the case that technologies are converging.
7. According to accelerometer data, UK youth appear to spend about 420460 minutes per day in sedentary behaviour, which is about 60-65% of measured time.
8. Self-report estimates of sedentary behaviour show that approximately two-thirds of adults spend more than 2 hours per day watching TV and using the computer.
9. Significant proportions of adults report sitting for more than 5 hours per day (including work and leisure-time), and adults report spending between 3-4 hours per day sitting during their leisure-time.
10. Sedentary behaviours appear to track from childhood to adolescence or adulthood at low to moderate levels, with the strongest tracking shown for TV viewing.
11. The technological landscape is rapidly changing and evolving (for instance TV viewing on computers or internet access on TVs). This has implications for the interpretation of results from studies that may become rapidly dated.
12. Some countries have guidelines fo
van't Veer P, Heseker H, Grammatikaki E, Benetou V, Gregori
M, Margaritis I, Raats MM, Wijnhoven T
(2013) EURRECA/WHO workshop report: 'Deriving Micronutrient Recommendations: Updating Best Practices'., Annals of Nutrition & Metabolism 62 (1) pp. 63-67 Karger
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.
Lumbers M, Raats MM (2010) Food in Later Life Choosing foods, eating meals: sustaining independence and quality of life, In: Shepherd R, Raats MM (eds.), The Psychology of Food Choice 3 CABI
Egan MB, Raats MM, Grubb SM, Eves A, Lumbers ML, Dean MS, Adams MR (2007) A review of food safety and food hygiene training studies in the commercial sector, FOOD CONTROL 18 (10) pp. 1180-1190 ELSEVIER SCI LTD
KozBowska K, SzczeciDska A, Roszkowski W, Brzozowska A, Saba A, Raats M, Lumbers M, Team TFILLP (2006) Perception of convenience food by older people living in Warsaw (on the example of vegetable soups), Polish Journal of Food and Nutrition Sciences 15/56 (2) pp. 227-233
McGowan L, Pot G, Stephen A, Lavelle F, Spence M, Raats MM, Hollywood L, McDowell D, McCloat A, Mooney E, Caraher M, Dean M (2016) The influence of socio-demographic, psychological and knowledge-related variables alongside perceived cooking and food skills abilities in the prediction of diet quality in adults: a nationally representative cross-sectional study, International Journal of Behavioral Nutrition and Physical Activity 13 (111) BioMed Central
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 0.05). Conclusion Greater CS and FS abilities may not lead directly to healthier dietary choices given the myriad of other factors implicated; however, CS appear to have differential influences on aspects of the diet, most notably in relation to lowering saturated fat intake. Findings suggest that CS and FS should not be singular targets of interventions designed to improve diet; but targeting specific sub-groups of the population e.g. males, younger adults, those with limited education might be more fruitful. A greater understanding of the interaction of factors influencing cooking and food practices within the home is neede
Scarborough P, Hodgkins CE, Raats MM, Harrington R, Cowburn G, Dean M, Doherty A, Foster C, Juszczak E, Matthews A, Mizdrak A, Ni Mhurchu C, Shepherd R, Tiomotijevic L, Winstone N, Rayner M (2015) Protocol for a pilot randomised controlled trial of an intervention to increase the use of traffic light food labelling in UK shoppers (the FLICC trial), Pilot and Feasibility Studies 1 (21) 21 BioMed Central

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

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.
Whybrow S, McConnon A, Gibbs M, Raats MM, Stubbs R (2011) Demographic factors do not predict weight loss maintenance in members of a commercial weight loss organisation, Proceedings of the Nutrition Society 70
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
Whybrow S, Westenhoefer J, Engel D, McConnon A, Gibbs M, Raats MM, Stubbs R (2012) Dietary restraint and weight loss maintenance in members of a commercial weight loss organisation, Proceedings of the Nutrition Society 70
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.
Dhonukshe-Rutten R, Timotijevic L, Cavelaars A, De Wit L, Doets E, Raats MM, Tabacchi G, Wijnhoven T, Roman B, De La Cruz J, Gurinovic M, De Groot L, van't Veer P (2010) EURRECA?s General Framework to make the process of setting up micronutrient recommendations explicit and transparent, Proceedings of the Nutrition Society 69
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
McConnon Á, Raats MM, Shepherd R, Stubbs J (2009) Healthcare professionals? and dieters? attitudes and perceptions of obesity, Proceedings of the Nutrition Society (OCE7) 67 Cambridge University Press
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
Hollywood L, Cuskelly G, O Brien M, McConnon A, Raats MM, Barnett J, Dean M (2012) Healthy grocery shopping: perceptions and barriers, Proceedings of the Nutrition Society (OCE2) Summer Meeting hosted by the Irish Section 71 Cambridge University Press
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
Schmid MA, von Rosen-von Hoewel J, Martin-Bautista E, Szabó E, Campoy C, Decsi T, Morgan J, Gage Heather, Koletzko B, Raats Monique (2009) Infant feeding and the concept of early nutrition programming: a comparison of qualitative data from four European countries., In: Koletzko B, Decsi T, Molnár D, Hunty de la A (eds.), Early Nutrition Programming and Health Outcomes in Later Life. Obesity and Beyond 646 (21) pp. 183-187 Springer Link (Netherlands)
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.
Timotijevic L, Raats M, Barnett J, Brown K, Fernandez L, Dömölki L, Ruprich J, Dhonukshe-Rutten R, Sonne A, Hermoso M, Koletzko B, Frost-Andersen L Institutional contexts in which micronutrient reference values are developed across Europe, Proceedings of the Nutrition Society 69
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.
McConnon A, Raats MM, Shepherd R Investigation of weight-loss expectations and weight control in obesity, Proceedings of the Nutrition Society 69 Cambridge University Press
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
Kassianos A, Raats MM, Gage HM (2016) Post-diagnostic dietary changes in prostate cancer: associations with patients? wellbeing and the perceptions of GPs, European Journal of Cancer Care 26 (4) e12599 Wiley
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.
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.
Brown KA, Timotijevic L, Barnett J, Ruprich J, RehoYková I, Hermoso M, Andersen L, Lillegaard I, Fernández-Celemín L, Larrañaga A, Lon
arevi
-Srmi
A, Raats MM
(2011) Micronutrient recommendation stakeholders' beliefs on dietary guidelines: a qualitative study across six European countries/regions., European Journal of Clinical Nutrition 65 (7) pp. 872-874 Nature Publishing Group
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.
Ebru E, Saigal P, Gage HM, Raats MM, Ogden JE, Qiao Y, Williams P (2010) Overweight and obesity in children: a comparison of the views of general practitioners and parents, Proceedings of the Nutrition Society 69 Cambridge University Press
Sowden P, Eves A, Raats M (2016) A feast of creativity, The Journal of Creative Behavior 50 (3) pp. 169-170 Wiley
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.
Hieke S, Palascha A, Jola C, Wills J, Raats MM (2016) The pack size effect: Influence on consumer perceptions of portion sizes, APPETITE 96 pp. 225-238 ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD
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.
Turrini A, D'Addezio L, Maccati F, Davy B, Arber SL, Davidson K, Grunert K, Schuhmacher B, Pfau C, KozBowska K, SzczeciDska A, de Morais C, Afonso C, Bofill S, Lacasta Y, Nydahl M, Ekblad J, Raats MM, Lumbers M (2010) The Informal Networks in Food Procurement by Older People-A Cross European Comparison, Ageing International 35 (4) pp. 253-275 Springer Verlag
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.
Gage H, Egan B, Williams P, Brands B, Györei E, López-Robles J, Campoy C, Decsi T, Koletzko B, Raats M (2016) Importance of mental performance in parental choice of food for children aged 4 ? 10 years: a study in four European countries, Public Health Nutrition 20 (6) pp. 992-1000 Cambridge University Press
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.
Messina F, Turrini A, Saba A, Raats MM, Lumbers M, Food in Later Life Team (2008) Older people?s perceptions towards conventional and functional yoghurts: a cross-country study, British Food Journal 110 (8) pp. 790-804 Emerald
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.

Hodgkins CE, Raats MM, Fife-Schaw CR, Peacock M, Groeppel-Klein A, Koenigstorfer J, Wasowicz G, Stysko-Kunkowska M, Gulcan Y, Kustepeli Y, Gibbs M, Shepherd R, Grunert K (2015) Guiding healthier food choice: systematic comparison of four front-of-pack labelling systems and their effect on judgements of product healthiness, British Journal of Nutrition 113 (10) pp. 1652-1663 Cambridge University Press
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.
Scarborough P, Matthews A, Eyles H, Kaur A, Hodgkins CE, Raats MM, Rayner M (2015) Reds are more important than greens: how UK supermarket shoppers use the different information on a traffic light nutrition label in a choice experiment, International Journal of Behavioral Nutrition and Physical Activity 12 ARTN 1 BioMed Central

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.

Garcia-Alvarez A, Egan MB, de Klein S, Dima L, Maggi F, Isoniemi M, Ribas-Barba L, Raats MM, Meissner E, Badea M, Bruno F, Salmenhaara M, Mila-Villarroel R, Knaze V, Hodgkins CE, Marculescu A, Uusitalo L, Restani P, Serra-Majem L (2014) Usage of Plant Food Supplements across Six European Countries: Findings from the PlantLIBRA Consumer Survey, PLoS ONE 9 (3) Public Library of Science

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.

Pravst I, Hodgkins C, Lähteenmäki L, Malcolm R, Kuaar A, Kulikovskaja V, }mitek K, Miklavec K, Raats M, Lavriaa } (2017) Recommendations for successful substantiation of new health claims in the European Union, Trends in Food Science & Technology 71 pp. 259-263 Elsevier

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.

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.
Background: Food composition data, front-of-pack nutrition labelling and nutrition and health claims have an important role to play in the development of appropriate policy, regulation and public health interventions ultimately aimed at reducing the burden of diet-related chronic disease. The overarching aim of this thesis is to explore whether the communication of healthier food choice through front-of-pack (FOP) nutrition labelling and health claims can be enhanced by the development of consumer derived frameworks (typologies) of these domains, a greater understanding of the degree to which the different FOP labelling schemes impact on consumer health inferences and an improved approach to the sharing of food composition data between stakeholders.
Method: The potential for more effective approaches to the transfer of food composition data on processed foods, was explored via a survey conducted within the UK food industry (Study 1). To facilitate the development of a consumer derived typology of FOP nutrition labelling schemes in Europe, a free-sorting study utilising the ?Multiple Sort Procedure? (MSP) was performed in four countries; France, Poland, Turkey and the United Kingdom (Study 2). Building on the MSP methodology utilised in Study 2, a further study on nutrition and health claims was performed in five countries; Germany, the Netherlands, Slovenia, Spain and the United Kingdom. (Study 3). The final study in this thesis sought to quantify the extent to which consumer perceptions of healthiness are impacted by the interpretative elements of the prevalent FOP labelling schemes in four countries; Germany, Poland, Turkey and the United Kingdom (Study 4).
Conclusion: The outcomes of this research propose an optimised approach to the sharing of food composition data, an optimised approach to FOP labelling and consumer derived typologies for both the FOP labelling and nutrition and health claims domains.
Halimic Aida, Gage Heather, Raats Monique, Williams Peter (2017) Effect of price and information on the food choices of women university students in Saudi Arabia: an experimental study, Appetite 123 pp. 175-182 Elsevier
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.

Banks Adrian P., Egan Bernadette, Hodgkins Charo E., Peacock Matthew, Raats Monique M. (2018) The role of causal models and beliefs in interpreting health claims, British Journal of Health Psychology 23 (4) pp. 933-948 Wiley

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.

Maringer M, van?t Veer P, Klepacz N, Verain M, Normann A, Ekman S, Timotijevic L, Raats M, Geelen A (2018) User-documented food consumption data from publicly available apps: an analysis of opportunities and challenges for nutrition research, Nutrition Journal 17 59 pp. 1-13 BioMed Central

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.

Timotijevic Lada, Acuna-Rivera Marcela, Gemen Raymond, Kugelberg Susanna, McBarron Kate, Raats Monique, Zolotonosa Maria (2018) Adolescents? perspectives on personal and societal responsibility for childhood obesity ? the study of beliefs through ?serious? game (PlayDecide), Children & Society 32 (5) pp. 405-416 Wiley
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.
Background: One of the major health, social and economic problems in the Kingdom of Saudi Arabia is the rising prevalence of overweight and obesity amongst young people and the implications this has for the future burden of chronic diseases, such as type 2 diabetes. Nearly 10% of the Saudi population are now diagnosed with diabetes at a cost to the nation in 2010 estimated at $0.9 billion.
Aim: To investigate factors influencing choice of healthy food items by students in a university cafeteria in Saudi Arabia.
Theoretical framework: Psychological theories of how individual factors affect behaviours and concepts from the emerging field of behavioural economics underpinned the studies.
Methods: Three empirical studies involving students at the University of Ha?il, central Saudi Arabia: 1. Questionnaire gathering background information about students? health-related behaviours and knowledge of behavioural risk factors for type 2 diabetes, 2. Investigation of student purchasing patterns and intentions through a) a questionnaire probing willingness-to-buy fruit (a healthier option) if available in the campus cafeteria, b) a controlled experiment manipulating menu choices, 3. Analysis of actual purchasing decisions when fruit was introduced to the campus cafeteria. Impacts of price variation and health messages were explored in Studies II and III.
Results: 1. Students report poor health-related behaviours (dietary and physical activity); knowledge of the link between lifestyle and type 2 diabetes is patchy. 2a. Over 50% of cafeteria users said they would buy fruit if available. 2b. Choice of healthy items was responsive to price manipulation. 3. When fruit was available, it was purchased by less than 10%. Health messages had no effect on healthy item choices.
Conclusions: Pricing strategies may be effective to stimulate healthier choices. Additional health education targeting individual psychological determinants of behaviour change may also be required.