Professor Monique Raats

Research Interests

Nutrition labelling

In 1997 I joined the Health Education Authority to provide technical and research support to a feasibility project on the development a national point of purchase healthy eating labelling scheme. Ten years later I returned to these national level policy discussions when my team and I were invited to provide research methodological advice to the market research agency and expert group tasked with overseeing the evaluation of signpost nutrition labelling schemes, commissioned by the Food Standards Agency. This work was complemented with a leadership role in the FLABEL consortium that carried out further EU-level research. Our work on framing the differences between labels in terms of directiveness was central to the design of all the FLABEL studies. Currently we are developing the UK’s first pilot randomised control trial to enhance the use of front of pack nutrition labelling. I was also a 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.

Key publications include:

  • Hodgkins C, Barnett J, Wasowicz-Kirylo G, Stysko-Kunkowska M, Gulcan Y, Kustepeli Y, Akgungor S, Chryssochoidis G , Fernández-Celemin L, Storcksdieck S, Gibbs M, Raats M (2012) Understanding how consumers categorise nutritional labels; a consumer derived typology for front-of-pack nutrition labelling. Appetite 59(3), 806–817.
  • Raats MM, Dean M, Hodgkins C, Timotijevic L, Berger I, Peacock M (2012) Researching consumers and nutrition labelling on food packaging. Report prepared for the Food and Agriculture Organization of the United Nations (FAO).
  • 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), 749-752.
  • Storcksdieck S, Fernández-Celemín L, Larrañaga 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):1379-85.
  • Malam S, Clegg S, Kirwan S, McGinigal S, Raats M, Shepherd R, Barnett J, Senior V, Hodgkins C, Dean M (2009) Comprehension and use of UK nutrition signpost labelling schemes. London: Food Standards Agency. [http://webarchive.nationalarchives.gov.uk/20120206100416/http://food.gov.uk/multimedia/pdfs/pmpreport.pdf]
  • BMRB Social Research & University of Surrey (2008) Comprehension and use of UK nutrition signpost labelling schemes: Scientific Rationale and Design. London: Food Standards Agency. [http://webarchive.nationalarchives.gov.uk/20120206100416/http://food.gov.uk/multimedia/pdfs/quantrationale.pdf]

Maternal and child behavioural nutrition

My interest in this area dates back to when I wrote the report describing one of the first national campaigns in the world highlighting the importance of folic acid in relation to pregnancy for the Health Education Authority. The development of this campaign was underpinned by an in-depth knowledge of lay perspectives. My more recent work has focussed on decision-making relating to infant and child feeding practices, including the development of policy.

Key publications include:

  • Brands B, Egan B, Györei E, López-Robles JC, Gage H, Campoy C, Decsi T, Koletzko B, Raats MM (2012) Effects of diet on children’s mental state and performance – a qualitative study of perceptions, attitudes and beliefs of parents in four European countries. Appetite 58(2), 739-46.
  • 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), 146-52.
  • Gage H, Raats M, Williams P, Egan MB, Jakobik V, Laitinen K, Martin-Bautista E, Schmid M, von Rosen-von Hoewel J, Campoy C, Decsi T, Morgan J, and Koletzko B (2011) Developmental origins of health and disease: the views of first time mothers in five European countries on the importance of nutritional influences in the first year of life. American Journal of Clinical Nutrition 94(6):2018S-24S.
  • Gage H, von Rosen-von Hoewel J, Laitinen K, Jakobik V, Martin-Bautista E, Schmid MA, Egan B, Morgan J, Williams P, Decsi T, Campoy C, Koletzko B, Raats MM (in press)  Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries. Public Understanding of Science.
  • 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 M (2012) Influences on infant feeding decisions of first time mothers in five European countries. European Journal of Clinical Nutrition 66(8), 914-919.
  • 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 MM (2010) Lifetime health outcomes of breast feeding: A comparison of the policy documents of five European countries. Public Health Nutrition 13(10):1653-62.
  • Raats MM, Thorpe L, Hurren C, Elliott K (1998) Changing Preconceptions. Volume 2. The HEA Folic Acid Campaign 1995-1998. Research Report. London: Health Education Authority.

 

Understanding the processes through which research is translated into policy and practice

Building on my interests in nutrition policy (e.g. food labelling, folic acid, dietary guidelines) my team and I embarked on a programme of research that seeks to better understand the interplay between nutrition science and society. We have conducted mixed methods studies on the role that Scientific Advisory Bodies play; as they can be considered “boundary organisations” working at the interface between science, policy and society. Our research provides an explanation for the varying nutrition recommendations across Europe. Our work also included taking a critical stance with regard to one of the most commonly adopted nutrition policy tools, namely food-based dietary guidelines.

Key publications include:

  • Brown KA, Timotijevic L, Barnett J, Ruprich J, Řehůřková I, Hermoso M, Frost-Anderson L, Lillegard ITL, Fernández-Celemín L, Larrañaga A, Srnić-Lončarević A, Raats MM (2011) Stakeholders’ beliefs on consumer involvement in the development of dietary guidelines: A qualitative study in six European countries. European Journal of Clinical Nutrition 65, 872–874.
  • Brown KA, Hermoso M, Timotijevic L, Barnett J, Lillegaard LTL, Řehůřková i, Larrañaga A, Srnić-Lončarević A, Frost Andersen L, Ruprich J, Fernández-Celemín L, Raats MM (in press) Consumer involvement in dietary guideline development: opinions from stakeholders across Europe. Public Health Nutrition
  • 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), 15-26.
  • 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), 1014–1022.
  • Timotijevic L, Raats MM, Barnett J, Brown K, Shepherd R, Fernández Celemín L, Dömölki L, Ruprich J, Dhonukshe-Rutten RAM, Sonne AM, Hermoso M., Koletzko B, Frost-Andersen L, Timmer A (2010) From micronutrient recommendations to policy: consumer issues and stakeholder involvement. European Journal of Clinical Nutrition 64, S31-S37.
  • Timotijevic L, Barnett J, Raats MM (2011) Engagement, representativeness and legitimacy in the development of food and nutrition policy. Food Policy 36(4), 490-498.
  • Timotijevic L, Raats MM, Barnett J, Brown K, Shepherd R, Fernández-Celemín L, Dömölki L, Ruprich J, Dhonukshe-Rutten RA, Sonne AM, Hermoso M, Koletzko B, Frost-Andersen L (2011) The process of setting micronutrient recommendations: A cross-European comparison of Scientific Advisory Bodies (SAB) for nutrition. Public Health Nutrition 14(4), 716–728.
  • Timotijevic L, Brown KA, Lähteenmäki L, de Wit L, Sonne A-M, Ruprich J, Řehůřková I, Jeruszka-Bielak M, Sicinska E, Jensen BB, Brito Garcia N, Guzzon A, Raats MM (in press) Developing public health nutrition policy based on micronutrient DRVs: a framework for considering the evidence. Critical Reviews in Food Science and Nutrition

 

Behavioural nutrition of older people

My research in this area has sought to address the gap in knowledge with regard to the impact food has on older people’s quality of life.  In the context of the Food in Later Life project, we brought together a multi-disciplinary team from nine research centres in eight European countries. There are relatively few studies with qualitative datasets of the size and scope which we collected. Upon my suggestion the team also developed and validated a new “satisfaction with food-related life” measure. Project results were fed though to those preparing the Advisory Committee on the Microbiological Safety of Food report on the increased incidence of listeriosis in the UK (see www.food.gov.uk/multimedia/pdfs/committee/acmsflisteria.pdf).

Key publications include:

  • Dean MS, Grunert KG, Raats MM, Nielsen NA, Lumbers M, Food in Later Life Project Team (2008) The impact of personal resources and their goal relevance on satisfaction with food related life among the elderly. Appetite 50(2-3):308-15.
  • Dean MS, Raats MM, Grunert KG, Lumbers M, Food in Later Life Project Team (2009) Factors influencing eating a varied diet in old age. Public Health Nutrition 12(12), 2421-2427.
  • Grunert KG, Dean MS, Raats MM, Nielsen NA, Lumbers M, Food in Later Life Project Team (2007) A measure of satisfaction with food-related life. Appetite 49(2), 486-493.
  • Kozłowska K, Szczecińska A, Roszkowski W, Brzozowska A, Alfonso C, Fjellstrom C, Morais C, Nielsen NA, Pfau C, Saba A, Sidenvall B, Turrini A, Raats MM, Lumbers M, Food in Later Life Project Team (2008) Patterns of healthy lifestyle and positive health attitudes in older Europeans – The Food in Later Life Project. Journal of Nutrition, Health and Aging 12(10), 728-733.
  • Lundkvist P, Fjellström C, Sidenvall B, Lumbers M, Raats M, Food in Later life Team (2010) Management of healthy eating in everyday life among senior Europeans. Appetite 55(3), 616-22.
  • Mattsson Sydner Y, Sidenvall B, Fjellström C, Raats MM, Lumbers M, Food in Later Life Project Team (2007) Diet, eating and household work – a life course perspective of senior Europeans. Food, Culture and Society 10(3), 367-387.
  • Raats MM, de Groot CPGM, van Staveren WA (Eds.) (2008) Food for the ageing population. Woodhead Publishing Limited, Cambridge, UK.

Research Collaborations

As Principal Investigator

2012-16: Role of health-related CLaims and sYMBOLs in consumer behaviour (CLYMBOL) (EU FP7)

2012-15:  Front of pack food Labelling: Impact on Consumer Choice (FLICC) (MRC)

2011: Cool snacks: snack concept-test among adolescents (Aarhus School of Business)

2010-14: PLANT food supplements: Levels of Intake, Benefit and Risk Assessment (Plantlibra) (EU FP7)

2010-13: FOOD RISk Communication: Perceptions and communication of food risks/benefits across Europe: development of effective communication strategies (FoodRisC) (EU FP7)

2010-12: Portion information on food and drink packaging (EUFIC)

2010-12: Good Days and Bad Days, an investigation of the habits of shoppers when they do or don’t buy healthy foods (Safefood)

2008-12: Food Labelling to Advance Better Education for Life (FLABEL) (EU FP7)

2008-09: Evaluation of the comprehension and use of UK nutrition signpost labelling scheme (FSA)

2007-12: Harmonising nutrient recommendations across Europe with special focus on vulnerable groups and consumer understanding (EURRECA) (EU FP6)

2007-08: Café - Changes Around Food Experience (impact of reduced contact with food on social engagement and wellbeing of older women) (ESRC)

2006-07: Follow-up work on Food in Later Life project (Aarhus School of Business)

2005-10: EARly Nutrition programming- long term follow up of Efficacy and Safety Trials and integrated epidemiological, genetic, animal, consumer and economic research (EARNEST) (EU FP6)

2005-09: EUROpean Food Information Resource Network (EuroFIR) (EU FP6)

2002-04: Involving low income consumers in policy making: Developing consultation methods and improving participation levels (FSA)

2002-04: Evaluation of UK food hygiene and safety training (FSA)

2002-03: An assessment of issues pertinent to the future development of the Composition of Foods (FSA)

 

As Co-Principal Investigator

2005-09: DIet, Obesity and GENES (DioGenes) (EU FP6)

2003-05L Choosing foods, eating meals: sustaining independence and quality of life in older people (Food in Later Life) (EU FP5)

 

As Co-Investigator

2012-14: EURO-DISH (Determinants, Intake, Status, Health) Study on the need for food and health research infrastructures in Europe (EU FP7)

2011-14: Towards INclusive research PROgramming for sustainable FOOD innovations (Inprofood) (EU FP7)

2009-10: Understanding the dietary patterns and food choice reasoning of food allergic consumers (FSA)

2008-13: The Effect of Diet on the Mental Performance of Children (NUTRIMENTHE) (EU FP7)

2005-10: Exploiting bioactivity of European cereal GRAINs for improved nutrition and HEALTH benefits (HEALTHGRAIN) (EU FP7)

2005-08: Integration of social and natural sciences to develop improved tools for assessing and managing food chain risks affecting the rural economy (RELU)

2005-06: Investigation of the phytoestrogen intake of a group of post menopausal women previously diagnosed with breast cancer (FSA)

2004-05: Getting food safety and food hygiene messages into schools (FSA)

2003-05: The development of interventions to improve the diet of girls and young women from populations at risk of low birth weight (FSA)

2003-05: CONsumer Decision-making on Organic Products  (CONDOR) (EU FP5)

2002-02: Diet Trials (BBC)

Professional Activities

Scientific advisory body member for government

2012-present: Member of the SACN Subgroup on Maternal and Child Nutrition (SMCN)

2011-present: Member of the Scientific Advisory Committee on Nutrition (SACN)

2009-10: Member of an expert group for the Cross Government Obesity Unit on Sedentary Behaviour, Screen Time and Obesity

 

Scientific advisory body member for research projects

2012-present: Loughborough hydration project

2010-present: Steering Group member for safefood’s “Food Marketing and the preschool child” project

2009-10: 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 [www.safefood.eu]

2006-10: Member of the International Scientific Advisory Group of the ISAFRUIT Integrated Project [www.isafruit.org]

2003-04: Steering Group for Food Standards Agency-funded Food Choice Review project [www.food.gov.uk/science/research/researchinfo/nutritionresearch/foodacceptability/n09programme/n09projectlist/n09017]

 

Scientific advisory body member

2010-present: 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

2008-10: 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

 

Consultancies

2011-12: 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

2007-08: National Lottery projects evaluation (new economics foundation) - Nature of consultancy: advice on research design [www.biglotteryfund.org.uk/wellbeing_evaluation_tools.pdf]

2002: 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

2003: 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

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

 

Conference organisation

Abstract Review Committee Chair for ISBNPA 2002 Annual Meeting

Abstract Review Committee Chair and Program Committee Joint-chair for ISBNPA 2003 Annual Meeting

Scientific Committee for 9th Karlsruhe Nutrition Congress, Karlsruhe, Germany, 10-12 October 2004

Abstract Review Committee and Program Committee Joint-chairs for ISBNPA 2004 Annual Meeting

Abstract Review Committee and Program Committee Joint-chairs for ISBNPA 2005 Annual Meeting

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

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

PhD supervision

PhD students currently and previously supervised as Principal supervisor

2008-13: Ilia Papachristou, University of Surrey, “Improving food-related quality of life for people with dementia through care management" – completed successfully

2008-13: Angelos Kassianos, University of Surrey, “Diet, psychological wellbeing and Quality of Life of men with prostate cancer”– completed successfully

2008-present: Charo Hodgkins, University of Surrey, “Food labelling and consumers”

2006-present: Kerry Brown, University of Surrey, "Understanding the process of setting micronutrient recommendations"

 

PhD students currently and previously supervised as Co-supervisor

2011-present: Shelley Cummings, University of Surrey, “Advanced decision-making in the context of dementia”

2009-present: Aida Halimic, University of Surrey, “Behavioural-economic food-related experiments in Saudi Arabia”

2008-11: Alain Allard, Queens University Belfast, “Towards a conceptual framework to evaluate consumers’ understanding of health claims” – completed successfully

2006-10: Kasia Chapman, University of Surrey, part-time, “How do people change their diet?” – completed successfully

2005-09: Joanna (Joe) Pope, University of Surrey, “Food Intolerance in Primary Care” – completed successfully

Contact Me

E-mail:
Phone: 01483 68 9431

Find me on campus
Room: 12 AC 04

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Publications

Journal articles

  • Yang W, Gage HM, Jackson DL, Raats MM. (2017) 'The effectiveness and cost-effectiveness of plant sterol or stanol-enriched functional foods as a primary prevention strategy for people with cardiovascular disease risk in England: a modeling study'. Springer Verlag The European Journal of Health Economics,

    Abstract

    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.

  • Pravst I, Hodgkins CE, Lähteenmäki L, Malcolm RN, Kušar A, Kulikovskaja V, Žmitek K, Miklavec K, Raats MM, Lavriša Ž. (2017) 'Recommendations for successful substantiation of new health claims in the European Union'. Elsevier Trends in Food Science & Technology,
    [ Status: Accepted ]

    Abstract

    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.

  • Gage HM, Egan B, Williams P, Brands B, Györei E, López-Robles J, Campoy C, Decsi T, Koletzko B, Raats MM. (2016) 'Importance of mental performance in parental choice of food for children aged 4 – 10 years: a study in four European countries'. Cambridge University Press Public Health Nutrition, 20 (6), pp. 992-1000.

    Abstract

    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.

  • 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'. BioMed Central International Journal of Behavioral Nutrition and Physical Activity, 13 (119)

    Abstract

    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 (<12 years) and/or teen (13–18 years) learners had significantly greater numbers of, and confidence in, their cooking and food skills, cooking practices, cooking attitudes, diet quality (with the exception of fibre intake where adult learners were higher) and health. Mother was the primary source of learning and those who learnt only from this source had significantly better outcomes on 12 of the 23 measures. Conclusions This research highlights the importance of learning cooking skills at an early age for skill retention, confidence, cooking practices, cooking attitude and diet quality. Mother remained the primary source of learning, however, as there is a reported deskilling of domestic cooks, mothers may no longer have the ability to teach cooking skills to the next generation. A focus on alternative sources including practical cooking skills education starting at an early age is required. This study also highlights the need for further longitudinal research on the impact of age and source of learning on cooking skills.

  • Miklavec K, Pravst I, Raats MM, Pohar J. (2016) 'Front of package symbols as a tool to promote healthier food choices in Slovenia: Accompanying explanatory claim can considerably influence the consumer's preferences'. Elsevier Food Research International, 90, pp. 235-243.

    Abstract

    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.

  • 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'. BioMed Central International Journal of Behavioral Nutrition and Physical Activity, 13 (111)

    Abstract

    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 < 0.001), and ECI score was significantly positively correlated with DINE Fibre intake (r = 0.38, p < 0.001), demonstrating a high agreement. Findings indicated that males, younger respondents and those with no/few educational qualifications scored significantly lower on both CS and FS abilities. The relative influence of socio-demographic, knowledge, psychological variables and CS and FS abilities on dietary outcomes varied, with regression models explaining 10–20 % of diet quality variance. CS ability exerted the strongest relationship with saturated fat intake (β = -0.296, p < 0.001) and was a significant predictor of fibre intake (β = -0.113, p < 0.05), although not for healthy food choices (ECI) (β = 0.04, 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

  • Kassianos A, Raats MM, Gage HM. (2016) 'Post-diagnostic dietary changes in prostate cancer: associations with patients’ wellbeing and the perceptions of GPs'. Wiley European Journal of Cancer Care, 26 (4) Article number e12599

    Abstract

    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.

  • Pieniak Z, Zakowska-Biemans S, Kostyra E, Raats M. (2016) 'Sustainable healthy eating behaviour of young adults: towards a novel methodological approach'. BIOMED CENTRAL LTD BMC PUBLIC HEALTH, 16 Article number ARTN 577
  • 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'. Nature Publishing Group European Journal of Clinical Nutrition, 70, pp. 1388-1395.

    Abstract

    Background/objectives: Compares the nutritional quality of pre-packaged foods carrying health-related claims with foods that do not carry health-related claims. Subjects/methods: Cross-sectional survey of pre-packaged foods available in Germany, the Netherlands, Spain, Slovenia, and the UK in 2013. 2034 foods were randomly sampled from three food store types (a supermarket, a neighbourhood store and a discounter). Nutritional information was taken from nutrient declarations present on food labels and assessed through a comparison of mean levels, regression analyses, and the application of a nutrient profile model currently used to regulate health claims in Australia and New Zealand, (Food Standards Australia New Zealand’s Nutrient Profiling Scoring Criterion, FSANZ NPSC). Results: Foods carrying health claims had, on average, lower levels, per 100g, of the following nutrients; energy – 29.3kcal (p < 0.05), protein – 1.2g (p < 0.01), total sugars – 3.1g (p < 0.05), saturated fat – 2.4g (p<0.001), and sodium - 842mg (p<0.001), and higher levels of fibre – 0.8g (p<0.001). A similar pattern was observed for foods carrying nutrition claims. 43% (CI 41%, 45%) of foods passed the FSANZ NPSC, with foods carrying health claims more likely to pass (70%, CI 64%, 76%) than foods carrying nutrition claims (61%, CI 57%, 66%) or foods that didn’t carry either type of claim 36% (CI 34%, 38%) Conclusions: Foods carrying health-related claims have marginally better nutrition profiles than those that do not carry claims; these differences would be increased if the FSANZ NPSC was used to regulate health-related claims. It is unclear whether these relatively small differences have significant impacts on health.

  • 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'. ELSEVIER SCI LTD FOOD POLICY, 62, pp. 78-87.
  • Kassianos AP, Raats MM, Gage HM. (2016) 'An exploratory study on the information needs of prostate cancer patients and their partners'. PAGEPress Publications Health Psychology Research, 4 (1) Article number 4786
  • 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'. TEKNOSCIENZE PUBL AGRO FOOD INDUSTRY HI-TECH, 27 (3), pp. 30-32.
  • Sowden PT, Eves A, Raats MM. (2016) 'A feast of creativity'. Wiley The Journal of Creative Behavior, 50 (3), pp. 169-170.

    Abstract

    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.

  • 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.

    Abstract

    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<0·001) and less likely to smoke (15·9 % v. 26·3 %, P<0·001). There was no difference between the proportions of parents and teachers who felt that a child's physical development depended very much/extremely (v. moderately/slightly/not at all) on diet (overall 79·8 %). Lower proportions of both groups thought that mental development was very much/extremely influenced by diet (67·4 %). In the regression modelling, believing that physical and mental performance was greatly influenced by diet was significantly and positively associated with living in Hungary, scoring higher on a measure of General Health Interest and (parents only) level of education attained. Differences existed among countries in most views. Lower levels of awareness of the importance of diet for brain development and cognition (compared with physical health outcomes) indicate the potential for educating consumers, especially parents with lower educational attainment.

  • Hieke S, Palascha A, Jola C, Wills J, Raats MM. (2016) 'The pack size effect: Influence on consumer perceptions of portion sizes'. ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD APPETITE, 96, pp. 225-238.

    Abstract

    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.

  • 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'. BioMed Central International Journal of Behavioral Nutrition and Physical Activity, 12 Article number ARTN 1

    Abstract

    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.

  • 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'. DE GRUYTER OPEN LTD POLISH JOURNAL OF FOOD AND NUTRITION SCIENCES, 65 (4), pp. 293-302.
  • 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,
  • 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'. AMER PSYCHOLOGICAL ASSOC HEALTH PSYCHOLOGY, 35 (8), pp. 898-907.
  • 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'. American Psychological Association Health Psychology, 35 (8), pp. 898-907.

    Abstract

    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.

  • Kassianos AP, Coyle A, Raats MM. (2015) 'Perceived influences on post-diagnostic dietary change among a group of men with prostate cancer'. WILEY-BLACKWELL EUROPEAN JOURNAL OF CANCER CARE, 24 (6), pp. 818-826.
  • 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)'. BioMed Central Pilot and Feasibility Studies, 1 (21) Article number 21

    Abstract

    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

  • Brown KA, De Wit L, Timotijevic L, Sonne AM, Lähteenmäki L, Brito Garcia N, Jeruszka-Bielak M, Sicińska 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.

    Abstract

    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.

  • 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'. Cambridge University Press British Journal of Nutrition, 113 (10), pp. 1652-1663.

    Abstract

    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.

  • 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.

    Abstract

    © 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.

  • 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.
  • 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'. EMERALD GROUP PUBLISHING LIMITED BRITISH FOOD JOURNAL, 117 (7), pp. 1921-1932.
  • 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, England: 69 (5), pp. 619-625.

    Abstract

    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.

  • 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,
    [ Status: Accepted ]
  • 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, England: 18 (6), pp. 1001-1010.
  • 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.
  • 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'. Public Library of Science PLoS ONE, 9 (3)

    Abstract

    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.

  • Gage HM, Egan B, Williams P, Gyoerei E, Brands B, Lopez-Robles J, Campoy C, Koletzko B, Decsi T, Raats MM. (2014) 'Views of parents in four European countries about the effect of food on the mental performance of primary school children'. Nature Publishing Group European Journal of Clinical Nutrition, 68 (1), pp. 32-37.

    Abstract

    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.

  • 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.
  • 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.
  • de Morais C, Oliveira B, Afonso C, Lumbers M, Raats M, de Almeida MDV. (2013) 'Nutritional risk of European elderly'. NATURE PUBLISHING GROUP EUROPEAN JOURNAL OF CLINICAL NUTRITION, 67 (11), pp. 1215-1219.
  • McConnon A, Horgan GW, Lawton C, Stubbs J, Shepherd R, Astrup A, Handjieva-Darlenska T, Kunešová 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.
  • Timotijevic L, Brown KA, Lähteenmäki L, de Wit L, Sonne AM, Řehůřková 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'. Taylor & Francis Critical Reviews in Food Science and Nutrition, 53 (10), pp. 1124-1134.

    Abstract

    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.

  • 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'. TAYLOR & FRANCIS INC CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION, 53 (10), pp. 1124-1134.
  • 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'. Sage Public Understanding of Science, 22 (3), pp. 365-379.
  • 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'. SAGE PUBLICATIONS LTD PUBLIC UNDERSTANDING OF SCIENCE, 22 (3), pp. 365-379.
  • McConnon A, Gribble R, Raats MM, Stubbs J, Shepherd R. (2013) 'Health professionals’, expert patients’ and dieters’ beliefs and attitudes about obesity'. Wiley / The British Dietetic Association Ltd. Journal of Human Nutrition and Dietetics, 26 (6), pp. 612-616.

    Abstract

    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.

  • Timotijevic L, Barnett J, Brown KA, Raats MM, Shepherd R. (2013) 'Scientific decision-making and stakeholder consultations: The case of salt recommendations'. Elsevier Social Science & Medicine, 85, pp. 79-86.

    Abstract

    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

  • 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'. Public Library of Science PLoS ONE, 8 (1)

    Abstract

    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.

  • 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'. Cambridge University Press Ageing and Society, 34 (4), pp. 645-669.
  • 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'. Cambridge University Press British Journal of Nutrition, 109 (12), pp. 2261-2268.

    Abstract

    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'.

  • 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'. Elsevier Eating Behaviors, 14 (1), pp. 69-72.

    Abstract

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

  • van't Veer P, Heseker H, Grammatikaki E, Benetou V, Gregorič M, Margaritis I, Raats MM, Wijnhoven T. (2013) 'EURRECA/WHO workshop report: 'Deriving Micronutrient Recommendations: Updating Best Practices'.'. Karger Annals of Nutrition & Metabolism, Switzerland: 62 (1), pp. 63-67.

    Abstract

    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.

  • 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.
  • 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.
  • 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'. TAYLOR & FRANCIS INC CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION, 53 (10), pp. 999-1040.
  • 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'. Cambridge University Press Public Health Nutrition,

    Abstract

    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.

  • 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.'. Elsevier Appetite, 59 (3), pp. 806-817.

    Abstract

    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.

  • 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'. Nature Publishing Group European Journal of Clinical Nutrition, 66 (8), pp. 914-919.

    Abstract

    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<0.0005). Mothers relying most on written sources reported longer exclusive breastfeeding (P=0.002), and a tendency to introduce foods other than milk later (P=0.079) than mothers relying most on personal or professional contacts. 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.

  • 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.'. Elsevier Appetite, England: 58 (3), pp. 1014-1022.

    Abstract

    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.

  • 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.'. Wiley-Blackwell Journal of Paediatrics and Child Health, 48 (2), pp. 146-152.

    Abstract

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

  • 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.
  • 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'. Elsevier Appetite, 58 (2), pp. 739-746.
  • Egan B, Hodgkins C, Shepherd R, Timotijevic L, Raats MM. (2011) 'An overview of consumer attitudes and beliefs about plant food supplements.'. Royal Society of Chemistry Food and Function, 2 (12), pp. 747-752.

    Abstract

    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.

  • 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.

    Abstract

    Using the Theory of Planned Behaviour (TPB), this study investigates weight control in overweight and obese participants (27kg/m(2)⩽BMI<45kg/m(2)) taking part in a dietary intervention trial targeted at weight loss maintenance (n=932). Respondents completed TPB measures investigating "weight gain prevention" at three time points. Correlation and regression analyses were used to investigate the relationship between TPB variables and weight regain. The TPB explained up to 27% variance in expectation, 14% in intention and 20% in desire scores. No relationship was established between intention, expectation or desire and behaviour at Time 1 or Time 2. Perceived need and subjective norm were found to be significantly related to weight regain, however, the model explained a maximum of 11% of the variation in weight regain. Better understanding of overweight individuals' trajectories of weight control is needed to help inform studies investigating people's weight regain behaviours. Future research using the TPB model to explain weight control should consider the likely behaviours being sought by individuals.

  • 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'. Akadémiai Kiadó Orvosi Hetilap, 152 (41), pp. 1641-1647.
  • 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'. BIOMED CENTRAL LTD BMC PUBLIC HEALTH, 11 Article number 734

    Abstract

    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.

  • 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'. Wiley-Blackwell Obesity Reviews, 12 (9), pp. 688-708.

    Abstract

    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.

  • 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 Society for Nutrition American Journal of Clinical Nutrition, 94 (6S), pp. 2018S-2024S.
  • 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'. Wiley-Blackwell Journal of Applied Social Psychology, 42 (3), pp. 669-688.
  • 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?'. John Wiley and Sons Allergy, Denmark: 66 (7), pp. 969-978.

    Abstract

    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.

  • Timotijevic L, Barnett J, Raats MM. (2011) 'Engagement, representativeness and legitimacy in the development of food and nutrition policy'. Elsevier Food Policy, 36 (4), pp. 490-498.

    Abstract

    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.

  • 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'. BIOMED CENTRAL LTD BMC PUBLIC HEALTH, 11 Article number 308

    Abstract

    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.

  • Brown KA, Timotijevic L, Barnett J, Ruprich J, Rehůřková I, Hermoso M, Andersen L, Lillegaard I, Fernández-Celemín L, Larrañaga A, Lončarevič-Srmič A, Raats MM. (2011) 'Micronutrient recommendation stakeholders' beliefs on dietary guidelines: a qualitative study across six European countries/regions.'. Nature Publishing Group European Journal of Clinical Nutrition, 65 (7), pp. 872-874.

    Abstract

    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.

  • 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.'. Cambridge University Press Public Health Nutrition, 14 (4), pp. 716-728.

    Abstract

    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.

  • 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.'. Nature Publishing Group European Journal of Clinical Nutrition, England: 65 (6), pp. 757-760.

    Abstract

    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.

  • 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.'. Cambridge University Press British Journal of Nutrition, 106 (1), pp. 15-26.

    Abstract

    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.

  • 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.'. Blackwell Publishing Clin Exp Allergy, England: 41 (2), pp. 243-249.
  • Turrini A, D'Addezio L, Maccati F, Davy B, Arber SL, Davidson K, Grunert K, Schuhmacher B, Pfau C, Kozłowska K, Szczecińska 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'. Springer Verlag Ageing International, 35 (4), pp. 253-275.

    Abstract

    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.

  • 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'. WILEY-BLACKWELL MATERNAL AND CHILD NUTRITION, 6, pp. 55-83.
  • 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'. NATURE PUBLISHING GROUP EUROPEAN JOURNAL OF CLINICAL NUTRITION, 64, pp. S2-S10.
  • 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'. NATURE PUBLISHING GROUP EUROPEAN JOURNAL OF CLINICAL NUTRITION, 64, pp. S31-S37.
  • Eves A, Bielby G, Egan B, Lumbers M, Raats MM, Adams M. (2010) 'Food safety knowledge and behaviours of children (5-7 years)'. SAGE PUBLICATIONS LTD HEALTH EDUCATION JOURNAL, 69 (1), pp. 21-30.
  • 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'. CAMBRIDGE UNIV PRESS PUBLIC HEALTH NUTRITION, 13 (10), pp. 1653-1662.
  • Turrini A, D'Addezio L, Maccati F, Davy BM, Arber S, Davidson K, Grunert K, Schuhmacher B, Pfau C, Kozłowska K, Szczecińska 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'. Springer Ageing International, 35 (4), pp. 253-275.
  • 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'. NATURE PUBLISHING GROUP EUROPEAN JOURNAL OF CLINICAL NUTRITION, 64 (12), pp. 1379-1385.
  • Lundkvist P, Fjellström C, Sidenvall B, Lumbers M, Raats MM. (2010) 'Management of healthy eating in everyday life among senior Europeans'. Appetite,
  • 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'. ACADEMIC PRESS INC ELSEVIER SCIENCE JOURNAL OF FOOD COMPOSITION AND ANALYSIS, 23 (7), pp. 749-752.
  • Dean M, Raats MM, Grunert KG, Lumbers M. (2009) 'Factors influencing eating a varied diet in old age'. CAMBRIDGE UNIV PRESS PUBLIC HEALTH NUTRITION, 12 (12), pp. 2421-2427.
  • 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'. ELSEVIER SCI LTD FOOD CHEMISTRY, 113 (3), pp. 804-807.
  • Kozlowska K, Szczecińska 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'. SERDI EDITIONS/SPRINGER J NUTR HEALTH AGING, 12 (10), pp. 728-733.
  • Dean M, Raats MM, Shepherd R. (2008) 'Moral concerns and consumer choice of fresh and processed organic foods'. BLACKWELL PUBLISHING JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, 38 (8), pp. 2088-2107.
  • 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.
  • 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'. SAGE PUBLICATIONS LTD HEALTH EDUCATION JOURNAL, 67 (2), pp. 110-120.
  • 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'. DR DIETRICH STEINKOPFF VERLAG EUROPEAN JOURNAL OF NUTRITION, 47, pp. 2-16.
  • 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'. Emerald British Food Journal, 110 (8), pp. 790-804.

    Abstract

    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.

  • 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'. DR DIETRICH STEINKOPFF VERLAG EUROPEAN JOURNAL OF NUTRITION, 47, pp. 17-40.
  • 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'. ACADEMIC PRESS LTD ELSEVIER SCIENCE LTD APPETITE, 50 (2-3), pp. 308-315.
  • Grunert KG, Dean M, Raats MM, Nielsen NA, Lumbers M. (2007) 'A measure of satisfaction with food-related life'. ACADEMIC PRESS LTD ELSEVIER SCIENCE LTD APPETITE, 49 (2), pp. 486-493.
  • Kozłowska K, Szczecińska 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.
  • 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.
  • 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.
  • 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'. ACADEMIC PRESS LTD ELSEVIER SCIENCE LTD JOURNAL OF CEREAL SCIENCE, 46 (3), pp. 188-196.
  • Egan MB, Fragodt A, Raats MM, Hodgkins C, Lumbers M. (2007) 'The importance of harmonizing food composition data across Europe'. NATURE PUBLISHING GROUP EUROPEAN JOURNAL OF CLINICAL NUTRITION, 61 (7), pp. 813-821.
  • 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'. ELSEVIER SCI LTD FOOD CONTROL, 18 (10), pp. 1180-1190.
  • 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'. BLACKWELL PUBLISHING JOURNAL OF HUMAN NUTRITION AND DIETETICS, 20 (4), pp. 311-319.
  • Timotijevic L, Raats MM. (2007) 'Evaluation of two methods of deliberative participation of older people in food-policy development'. ELSEVIER IRELAND LTD HEALTH POLICY, 82 (3), pp. 302-319.
  • 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'. EMERALD GROUP PUBLISHING LIMITED BRITISH FOOD JOURNAL, 108 (9), pp. 721-731.
  • Kozłowska K, Szczecińska 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.
  • 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.
  • 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, Naleczow, Poland: 15 (2a), pp. 877-884.
  • Wądołowska L, Danowska-Oziewicz M, Niedźwiedzka E, Słowińska 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.
  • 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)'. EMERALD GROUP PUBLISHING LIMITED BRITISH FOOD JOURNAL, 108 (9), pp. 706-720.
  • 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.

    Abstract

    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.

  • 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'. ACADEMIC PRESS LTD ELSEVIER SCIENCE LTD APPETITE, 47 (2), pp. 244-252.
  • Bowen DJ, Battuello KM, Raats M. (2005) 'Marketing genetic tests: Empowerment or snake oil?'. Health Education & Behavior, 32 (5), pp. 676-685.
  • 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.
  • Sparks P, Harris PR, Raats M. (2003) 'Imagining and explaining hypothetical scenarios: Mediational effects on the subjective likelihood of health-related outcomes'. V H WINSTON & SON INC Journal of Applied Social Psychology, 33 (4), pp. 869-887.
  • Raats MM, Sparks P, Geekie MA, Shepherd R. (1999) 'The effects of providing personalized dietary feedback. A semi-computerized approach'. ELSEVIER SCI IRELAND LTD PATIENT EDUCATION AND COUNSELING, 37 (2), pp. 177-189.
  • Monteleone E, Raats MM, Mela DJ. (1997) 'Perceptions of starchy food dishes: Application of the repertory grid method'. ACADEMIC PRESS LTD Appetite, 28 (3), pp. 255-265.
  • Raats MM, Shepherd R. (1996) 'Developing a subject-derived terminology to describe perceptions of chemicals in foods'. PLENUM PUBL CORP Risk Analysis: an international journal, 16 (2), pp. 133-146.
  • Raats MM, Sparks P. (1995) 'Unrealistic optimism about diet-related risks: implications for interventions.'. Proceedings of the Nutrition Society, ENGLAND: 54 (3), pp. 737-745.
  • Raats MM, Shepherd R, Sparks P. (1995) 'Including moral dimensions of choice within the Theory of Planned Behavior'. V H WINSTON & SONS INC Journal of Applied Social Psychology, 25 (6), pp. 484-494.
  • 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.
  • 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.
  • 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.
  • 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.

Conference papers

  • McConnon A, Raats MM, Shepherd R . 'Investigation of weight-loss expectations and weight control in obesity'. Cambridge University Press Proceedings of the Nutrition Society, University of Surrey, Guildford, UK: Over- and undernutrition: challenges and approaches 69

    Abstract

    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<0.001), weight loss during the rapid weight-loss period (r 0.40, P<0.001) and during the weight-maintenance phase of the study (r 0.15, P = 0.001). On average these target weights corresponded to a 25% weight loss or a mean weight loss of 25 kg, with only 3% of the sample setting a target weight loss of £ 10%. Weight loss necessary to reach the target weight was largely in excess of actual weight change during the rapid weight-loss period ( - 11 kg v. - 25 kg; P<0.001) and overall weight change accounting for initial weight loss (0.05 kg v. - 25 kg; P<0.001). Differences in target weight-loss scores for gender and age were shown to be significant. Women had a significantly higher score than men (P<0.01) and age was shown to be highly correlated (r 0.11, P = 0.01) with target weight-loss score. Regression analysis investigated the influence of gender, age, baseline weight, weight at age 20 years and weight at age 30 years on target weight-loss score. All variables were shown to significantly predict target weight-loss score, with the model explaining 72% variance (P<0.001). Target weight-loss scores were significantly negatively associated with baseline weight and positively associated with weight change, indicating that individuals with greater weight loss had higher target weight-loss scores. Women and older partici

  • Timotijevic L, Raats MM, 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

    Abstract

    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 ar

  • 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. 'Infant feeding intentions of new mothers in five European countries'. Proceedings of the Nutrition Society, 69
  • Allard A, Dean M, Raats MM. '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

    Abstract

    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.

  • 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'. European Food Safety Authority (EFSA), Parma EFSA Journal, Milan, Italy: 2nd EFSA Scientific Conference (supp), pp. 67-67.
  • Pieniak Z, Zakowska-Biemans S, Kostyra E, Raats M. (2015) 'Young adults' knowledge and awareness of sustainable and healthy eating behaviour'. KARGER ANNALS OF NUTRITION AND METABOLISM, 67, pp. 525-525.
  • Raats MM. (2015) 'Consumer perceptions and use of plant food supplements: implications for communication and policy'. KARGER ANNALS OF NUTRITION AND METABOLISM, 67, pp. 79-79.
  • Raats MM. (2015) 'Policies rising from consumer food choices - do we need translators?'. KARGER ANNALS OF NUTRITION AND METABOLISM, 67, pp. 37-37.
  • Kassianos A, Raats M, Nichols J. (2013) 'The Development of Prostate Cancer Patients' Information Needs: Patients', GPs' and Significant Others' Perceptions Focusing on Diet'. WILEY-BLACKWELL PSYCHO-ONCOLOGY, 22, pp. 279-279.
  • Kassianos A, Raats M. (2013) 'An underlying mechanism of change: How prostate cancer survivors make sense of dietary changes?'. TAYLOR & FRANCIS LTD PSYCHOLOGY & HEALTH, 28, pp. 112-113.
  • 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'. KARGER ANNALS OF NUTRITION AND METABOLISM, 63, pp. 1863-1863.
  • Gage H, Egan B, Williams P, Gyoerei E, Brands B, Lopez-Robles J-C, Brown KA, Campoy C, Koletzko B, Decsi T, Raats MM. (2013) 'VIEWS OF PARENTS IN FOUR EUROPEAN COUNTRIES ABOUT THE EFFECT OF FOOD ON THE MENTAL PERFORMANCE OF PRIMARY SCHOOL CHILDREN'. KARGER ANNALS OF NUTRITION AND METABOLISM, 63, pp. 1132-1132.
  • Morais C, Afonso C, Oliveira B, Lumbers M, Raats M, Almeida MDV. (2013) 'HEALTH-RELATED QUALITY OF LIFE AND FOOD VARIETY OF EUROPEAN ELDERLY'. KARGER ANNALS OF NUTRITION AND METABOLISM, 63, pp. 521-521.
  • 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'. KARGER ANNALS OF NUTRITION AND METABOLISM, 63, pp. 1862-1862.
  • 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'. KARGER ANNALS OF NUTRITION AND METABOLISM, 63, pp. 1862-1862.
  • Hollywood LE, Cuskelly GJ, O'Brien M, McConnon A, Raats MM, Barnett J, Dean M. (2012) 'Healthy grocery shopping: perceptions and barriers'. Cambridge Journals Online Proceedings of the Nutrition Society, Translational nutrition: integrating research, practice and policy 71 (OCE2)
  • Hollywood L, Cuskelly G, O Brien M, McConnon A, Raats MM, Barnett J, Dean M. (2012) 'Healthy grocery shopping: perceptions and barriers'. Cambridge University Press Proceedings of the Nutrition Society (OCE2) Summer Meeting hosted by the Irish Section, Translational nutrition: integrating research, practice and policy 71

    Abstract

    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

  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 70 (OCE6)
  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 70th Anniversary: Body weight regulation – food, gut and brain signalling 70 (OCE6)
  • 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

    Abstract

    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.

  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 70th Anniversary: Body weight regulation – food, gut and brain signalling 70 (OCE6)
  • Antiliou G, Timotijevic L, Raats M. (2012) 'The role of willpower in successful maintenance of weight loss'. TAYLOR & FRANCIS LTD Psychology & Health, 27, pp. 148-149.
  • 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, Nottingham, UK: British Society for Allergy and Clinical Immunology 2011 Annual Meeting 41 (12), pp. 1836-1836.
  • 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'. MOSBY-ELSEVIER Journal of Allergy and Clinical Immunology, San Francisco, CA: American-Academy-of-Allergy-Asthma-and-Immunology Annual Meeting 127 (2), pp. AB112-AB112.
  • 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, Madrid, Spain: 11th European Nutrition Conference (FENS) 58, pp. 137-138.
  • 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, Winter Meeting, 6–7 December 2011, 70th Anniversary: Body weight regulation – food, gut and brain signalling 70

    Abstract

    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<0.001), presumably because they had more to lose. People who were unemployed and “other” lost considerably more weight during the study than those who were employed, or not working for other reasons. However, there were only 37 and 58 people in these first two groups respectively. The percentage of respondents who reported being told by a doctor they had

  • 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, Madrid, Spain: 11th European Nutrition Conference (FENS) 58, pp. 409-409.
  • 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, Madrid, Spain: 11th European Nutrition Conference (FENS) 58, pp. 129-129.
  • 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, Madrid, Spain: 11th European Nutrition Conference (FENS) 58, pp. 29-29.
  • 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, Madrid, Spain: 11th European Nutrition Conference (FENS) 58, pp. 204-204.
  • 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, Madrid, Spain: 11th European Nutrition Conference (FENS) 58, pp. 310-310.
  • 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, Madrid, Spain: 11th European Nutrition Conference (FENS) 58, pp. 206-206.
  • 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'. OXFORD UNIV PRESS EUROPEAN JOURNAL OF PUBLIC HEALTH, 3rd Joint (EUPHA and ASPHER) European Public Health Conference 20, pp. 125-125.
  • 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'. OXFORD UNIV PRESS EUROPEAN JOURNAL OF PUBLIC HEALTH, 3rd Joint (EUPHA and ASPHER) European Public Health Conference 20, pp. 125-125.
  • Biddle S, Pearson N, Raats MM. (2010) 'Is sedentary behaviour associated with dietary intake in young people? A systematic review.'. Minneapolis, Minnesota, USA: 2010 Annual Conference of the International Society of Behavioral Nutrition and Physical Activity (ISBNPA
  • 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'. LIPPINCOTT WILLIAMS & WILKINS JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, Istanbul, Turkey: European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Annual Meeting 50, pp. E191-E191.
  • 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'. LIPPINCOTT WILLIAMS & WILKINS JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, Istanbul, Turkey: European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Annual Meeting 50, pp. E189-E189.
  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 69 (OCE1)
  • 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'. Cambridge University Press Proceedings of the Nutrition Society, University of Surrey, Guildford, UK: Over- and undernutrition: challenges and approaches 69
  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 69 (OCE1)
  • 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, University of Surrey, Guildford, UK: Over- and undernutrition: challenges and approaches 69

    Abstract

    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

  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 69 (OCE1)
  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 69 (OCE1)
  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 16/06/2010 69 (OCE5)

    Abstract

    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.

  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 69 (OCE1)
  • McConnon A, Raats M, Shepherd R. (2010) 'Investigation of weight-loss expectations and weight control in obesity'. Cambridge Journals Online Proceedings of the Nutrition Society, Over- and undernutrition: challenges and approaches. 69 (OCE1)
  • 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'. Cambridge Journals Online Proceedings of the Nutrition Society, 69 (OCE1)
  • Raats MM. (2010) 'The role of consumers.'. Nestle Nutr Workshop Ser Pediatr Program, Switzerland: 66, pp. 161-171.
  • 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'. Florence, Italy: Europe 8th Pangborn Sensory Science Symposium
  • McConnon Á, Raats MM, Shepherd R, Stubbs J. (2009) 'Healthcare professionals’ and dieters’ attitudes and perceptions of obesity'. Cambridge University Press Proceedings of the Nutrition Society (OCE7), Dublin: The challenge of translating nutrition research into public health nutrition 67

    Abstract

    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<0.001) and visiting a psychologist (mean score; health professionals 3.03, dieters 2.63; P = 0.001). However, dieters were more positive about yoga (mean score; health professionals 2.69, dieters 2.33; P<0.001) and

  • Schmid M, von Rosen-von Hoewel J, Martin-Bautista E, Szabo E, Campoy C, Decsi T, Morgan J, Gage H, Koletzko B, Raats MM. (2009) 'Infant Feeding and the Concept of Early Nutrition Programming: A Comparison of Qualitative Data from Four European Countries'. Budapest, Hungary: Early Nutritional Programming and Health Outcome in Later Life: Obesity and Beyond, pp. 183-187.

    Abstract

    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.

  • 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'. SPRINGER EARLY NUTRITION PROGRAMMING AND HEALTH OUTCOMES IN LATER LIFE: OBESITY AND BEYOND, Budapest, HUNGARY: International Conference on Early Nutrition Programming and Health Outcomes in Later Life 646, pp. 175-181.
  • 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'. SPRINGER EARLY NUTRITION PROGRAMMING AND HEALTH OUTCOMES IN LATER LIFE: OBESITY AND BEYOND, Budapest, HUNGARY: International Conference on Early Nutrition Programming and Health Outcomes in Later Life 646, pp. 169-173.
  • 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'. Harrogate, UK: British Academy of Management
  • 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'. BIOMED CENTRAL LTD BREAST CANCER RESEARCH, London, ENGLAND: Breast Cancer Research Meeting 10, pp. S47-S48.
  • McConnon Á, Raats MM, Shepherd R, Stubbs J. (2008) 'Healthcare professionals' and dieters' attitudes and perceptions of obesity'. Cambridge Journals Online Proceedings of the Nutrition Society, Dublin: 67 (OCE7)
  • 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'. CAMBRIDGE UNIV PRESS PROCEEDINGS OF THE NUTRITION SOCIETY, 66, pp. 23A-23A.
  • 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'. Coleraine: 3rd International Consumer Sciences Conference
  • Lumbers M, Eves A, Bielby G, Egan B, Raats M, Adams M. (2007) 'Food hygiene knowledge and self-reported behaviours of UK school children'. Coleraine: 3rd International Consumer Sciences Conference
  • 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'. CAMBRIDGE UNIV PRESS PROCEEDINGS OF THE NUTRITION SOCIETY, 66, pp. 16A-16A.
  • McConnon A, Raats MM, Shepherd R, Ogden J. (2007) 'Weight control practices and behaviours in an overweight sample - results from the DiOGenes study'. KARGER ANNALS OF NUTRITION AND METABOLISM, 51, pp. 64-64.
  • 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'. ELSEVIER IRELAND LTD EARLY HUMAN DEVELOPMENT, 83, pp. S126-S126.
  • 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'. KARGER ANNALS OF NUTRITION AND METABOLISM, 51, pp. 240-240.
  • de Morais C, Afonso C, Raats MM, Lumbers M, Grunert KG, de Almeida MDV. (2007) 'Fruit and vegetable variety of consumption by European seniors'. KARGER ANNALS OF NUTRITION AND METABOLISM, 51, pp. 73-74.
  • Lumbers M, Nielsen NA, Grunert K, Raats MM. (2006) 'A measure of satisfaction with food-related life'. Barcelona, Spain: First World Congress of Public Health Nutrition
  • Lumbers M, Davidson K, Arber S, Marshall H, Raats M. (2006) 'Gendered ties and the role of food in older people’s lives'. Durban, South Africa: XVI ISA World Congress of Sociology
  • 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'. Boston, USA: 5th Annual Meeting of the International Society of Behavioural Nutrition and Physical Activity
  • Fragodt A, Raats MM. (2006) 'Working toward a web-based pan-European access to on-line nutrient databases: UK nutrition researchers' needs and expectations.'. CAMBRIDGE UNIV PRESS PROCEEDINGS OF THE NUTRITION SOCIETY, 65, pp. 97A-97A.
  • 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.
  • Raats M, Poutanen K, Almeida M. (2005) 'Consumer needs regarding dietetic products for pregnant and lactating women and for baby foods - Focus group meeting'. SPRINGER-VERLAG BERLIN EARLY NUTRITION AND ITS LATER CONSEQUENCES: NEW OPPORTUNITIES, Paris, FRANCE: Conference on Early Nutrition and Its Later Consequences 569, pp. 120-126.
  • 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.
  • 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'. GERONTOLOGICAL SOCIETY AMER GERONTOLOGIST, 45, pp. 529-529.
  • 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'. CAMBRIDGE UNIV PRESS PROCEEDINGS OF THE NUTRITION SOCIETY, 64, pp. 27A-27A.
  • Danowska-Oziewicz M, Słowińska MA, Cichon R, Szymelfejnik E, Waluś A, Wądołowska L, Raats M, Lumbers M. (2004) 'Ograniczenia ekonomiczne a struktura spożycia produktów przez osoby w wieku podeszłym. Badania pilotowe. Projekt Senior Food-QOL.'. Żyw. Człow. Metab., T. 31 supl.
  • 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)
  • Słowińska MA, Danowska-Oziewicz M, Cichon R, Szymelfejnik E, Waluś A, Wądołowska L, Lumbers M, Raats M. (2004) 'Umiejętności przygotowywania posiłków a stan odżywienia osób w wieku podeszłym. Badania pilotowe. Projekt Senio Food-QOL'. Żyw. Człow. Metab., T. 31 supl.
  • Raats MM, Shepherd R, Sparks P. (2003) 'Consumer perceptions of risks associated with chemicals in foods'. Psychology: Proceedings of the British Psychological Society 11 (1)
  • Raats MM, Sparks P. (1996) 'Perceptions of diet-related risks'. PSYCHOLOGY PRESS INTERNATIONAL JOURNAL OF PSYCHOLOGY, 31 (3-4), pp. 2682-2682.
  • GEEKIE MA, RAATS MM. (1995) 'THE DEVELOPMENT OF A 7-DAY FOOD AND DRINK DIARY'. ACADEMIC PRESS (LONDON) LTD APPETITE, 24 (3), pp. 282-283.
  • RAATS M, SPARKS P. (1995) 'UNREALISTIC OPTIMISM ABOUT DIET-RELATED RISKS - IMPLICATIONS FOR INTERVENTIONS'. ACADEMIC PRESS (LONDON) LTD APPETITE, 24 (3), pp. 295-295.
  • SPARKS P, RAATS M. (1995) 'DIFFERENCES IN ATTITUDES TOWARDS POTENTIAL FOOD-RELATED HAZARDS AS A FUNCTION OF SOCIAL, POLITICAL AND ENVIRONMENTAL VALUES'. ACADEMIC PRESS (LONDON) LTD APPETITE, 24 (3), pp. 276-276.
  • Raats MM, Shepherd R, Sparks P. (1993) 'Attitudes, obligations and perceived control: predicting milk selection.'. Appetite, ENGLAND: 20 (3), pp. 239-241.

Books

  • Raats MM, de Groot CPGM, van Staveren WA. (2008) Food for the ageing population. Cambridge, UK : Woodhead Publishing Limited

    Abstract

    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.

  • Shepherd R, Raats MM. (2006) The Psychology of Food Choice. Wallingford, UK : CABI Publishing
  • Raats MM, Thorpe L, Hurren C, Elliott K. (1998) Changing Preconceptions. Volume 2. The HEA Folic Acid Campaign 1995-1998. Research Report. London : Health Education Authority

Book chapters

  • 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 Chichester, UK : John Wiley & Sons, Ltd Article number 10
  • Dean M, Spence M, Hodgkins C, Raats MM. (2015) 'Front-of-pack (FOP) labelling of foods and beverages'. in Berryman P (ed.) Advances in Food and Beverage Labelling Information and Regulations Woodhead Publishing Limited Article number 7 , pp. 113-131.
  • 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 Florida, USA : Routledge Academic Article number 16 , pp. 333-351.

    Abstract

    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).

  • 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 CABI 3
  • Schmid M, von Rosen-von Hoewel J, Martin-Bautista E, Szabó E, Campoy C, Decsi T, Morgan J, Gage H, Koletzko B, Raats MM. (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 The Netherlands : Springer Link (Netherlands) 646 (21), pp. 183-187.

    Abstract

    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.

  • 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 Cambridge, UK : Woodhead Publishing Ltd 165 Article number 1 , pp. 3-19.

    Abstract

    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

  • Hunter W, Raats MM, Lumbers M. (2007) 'Older adults'. in Lawrence M, Worsley T (eds.) Health Nutrition: From Principles To Practice Crows Nest NSW : Allen & Unwin , pp. 127-148.
  • Dean M, Raats MM, Shepherd R. (2007) 'Consumers and functional cereal products'. in Hamaker B (ed.) Technology of Functional Cereal Products Cambridge, UK : Woodhead Publishing Limited,
  • Lumbers M, Raats M. (2006) 'Food choices in later life'. in Shepherd R, Raats M (eds.) Psychology of Food Choice Wallingford : CABI Publishing , pp. 289-310.

Reports

  • 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. London :
  • 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. London : Food Standards Agency
  • 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. London : Food Standards Agency

Other publications

  • 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,

Theses and dissertations

  • Hodgkins C. (2016) Communicating healthier food choice : food composition data, front-of-pack nutrition labelling and health claims..
    [ Status: Approved ]

    Abstract

    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.

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