Environmental sustainability of food environments: Development and application of a framework in four cities in South Asia

BackgroundFood environments, where people directly engage with broader food systems, may be an important contributor to the environmental sustainability of food systems. The primary objectives of this paper were to establish a new food environment framework that considers environmental indicators and to assess data availability and gaps using data previously collected as part of a food systems survey in four South Asian cities.MethodsThe framework was developed by conducting a structured literature review of previous food environment frameworks and in-depth interviews with content experts (n = 6). The framework and indicators were then mapped to data collected by consumer and vendor surveys using the Urban Food Systems Assessment Tool (UFSAT) in Ahmedabad (India), Pune (India), Kathmandu (Nepal), and Pokhara (Nepal).ResultsWe have expanded the sustainability domain within food environments to include consumer travel to food vendors, the presence of food delivery services, policies related to sustainability, vendor food waste, vendor plastic use, vendor utility usage, vendor recycling & waste management practices, and food packaging. Mapping the framework to existing data from four cities in South Asia, we found variations in food environment sustainability indicators, particularly regarding consumer transportation to food vendors, the presence of delivery services, and food waste.ConclusionWhile the majority of food environment research focuses on the availability and affordability of healthy foods, there is an urgent need to understand better how aspects of food environments contribute to our environmental goals. When mapping the framework to existing food systems data, we found gaps in data on environmental sustainability in food environments and variation in indicators across settings

Sociodemographic disparities in purchases of fruit drinks with policy relevant front-of-package nutrition claims

Abstract Objective: Our objectives were to describe sociodemographic characteristics associated with the purchase of 1) any fruit drinks and 2) fruit drinks with specific front of package (FOP) nutrition claims. Design: Cross-sectional Setting: United States Subjects: We merged fruit drink purchasing data from 60,712 household-months from 5,233 households with children 0-5y participating in Nielsen Homescan in 2017 with nutrition claims data. We examined differences in predicted probabilities of purchasing any fruit drinks by race/ethnicity, income, and education. We constructed inverse probability (IP) weights based on likelihood of purchasing any fruit drinks. We used IP weighted multivariable logistic regression models to examine predicted probabilities of purchasing fruit drinks with specific FOP claims. Results: One third of households with young children purchased any fruit drinks. Non-Hispanic (NH) Black (51.6%), Hispanic (36.3%), lower-income (39.3%), and lower-educated households (40.9%), were more likely to purchase any fruit drinks than NH White (31.3%), higher-income (25.8%), and higher-educated households (30.3%) (all p<0.001). In IP weighted analyses, NH Black households were more likely to purchase fruit drinks with “Natural” and fruit or fruit flavor claims (6.8% and 3.7%) than NH White households (4.5% and 2.7%) (both p<0.01). Lower- and middle-income (15.0% and 13.8%) and lower- and middle-educated households (15.4% and 14.5%) were more likely to purchase fruit drinks with “100% Vitamin C” claims than higher-income (10.8%) and higher-educated households (12.9%) (all p<0.025). Conclusions: We found a higher likelihood of fruit drink purchases in lower-income, lower-educated, NH Black, and Hispanic households. Experimental studies should determine if nutrition claims may be contributing to disparities in fruit drink consumption

How Salty Is Too Salty? Designing Sodium Warning Label Policies to Identify High-Sodium Items on Restaurant Menus in the United States

Two U.S. cities require chain restaurants to label menu items that exceed 100% of the Daily Value (DV) for sodium, informing consumers and potentially prompting restaurant reformulation. To inform policy design for other localities, this study determined the percentage of the top 91 U.S. chain restaurants’ menu items that would be labeled if a warning policy were established for menu items exceeding the thresholds of 20%, 33%, 50%, 65%, and 100% of the sodium DV for adults. We obtained U.S. chain restaurants’ nutrition information from the 2019 MenuStat database and calculated the percentage of items requiring sodium warning labels across the food and beverage categories at all the restaurants and at the full- and limited-service restaurants separately. In total, 19,038 items were included in the analyses. A warning label covering items with >20%, >33%, >50%, >65%, and >100% of the sodium DV resulted in expected coverage of 42%, 30%, 20%, 13%, and 5% of menu items at all the restaurants, respectively. At each threshold, the average percentage of items labeled per restaurant was higher among the full-service restaurants than the limited-service restaurants. These results suggest that restaurant warning policies with a threshold of 100% of the sodium DV per item would cover a minority of high-sodium menu items and that lower thresholds should be considered to help U.S. consumers reduce their sodium consumption

Food Waste Management Practices and Barriers to Progress in U.S. University Foodservice

Identifying institutional capacity to reduce and reallocate food waste is important to reduce both greenhouse gas emissions and food insecurity. The goal of this study was to examine food waste concern, reduction and repurposing strategies, and perceived barriers to these strategies among U.S. university foodservice representatives. We surveyed 57 U.S. university foodservice representatives about foodservice operations, campus food insecurity, food waste reduction and repurposing activities, and obstacles to composting and donating food waste. Data were collected September 2019&ndash;February 2020. Roughly three-quarters of respondents tracked campus food waste, reported that food waste reduction was a high/very high priority, and reported concern about campus food insecurity. The most common food-waste-reduction strategies included forecasting demand to prevent overproduction and preparing smaller batches. The most common repurposing strategies included donation and composting. Top barriers to food donation included liability concerns and lack of labor. Barriers to composting food included lack of infrastructure and knowledge/experience. Addressing perceived barriers to university foodservices&rsquo; food waste reduction and repurposing efforts could lead to reduced greenhouse gas emissions and improved food security for millions of Americans

Perceived effectiveness of added-sugar warning label designs for U.S. restaurant menus: An online randomized controlled trial

Added-sugar consumption in the U.S. exceeds recommended limits. Policymakers are considering requiring restaurants to use menu warning labels to indicate items high in added sugar. We sought to determine whether icon-only and icon-plus-text added-sugar menu labels were (1) perceived as more effective at potentially reducing consumption of items high in added sugar and (2) increased knowledge of menu items' added-sugar content relative to control labels, and if effects differed by label design. A national sample of U.S. adults (n&nbsp;=&nbsp;1327) participated in an online randomized experiment. Participants viewed menu items with either a control label, 1 of 6 icon-only labels, or 1 of 18 icon-plus-text labels with 3 text variations. For their assigned label, participants provided ratings of perceived message effectiveness (a validated scale of a message's potential to change behavior). Participants were also asked to classify menu items by their added-sugar content. The icon-only and icon-plus-text labels were perceived as more effective than the control label (means: 3.7 and 3.7 vs. 3.1, respectively, on a 5-point scale; p&nbsp;&lt;&nbsp;0.001). The icon-only and icon-plus-text groups each correctly classified 71% of menu items by added-sugar content vs. 56% in the control group (p&nbsp;&lt;&nbsp;0.001). All icons and text variations were perceived as similarly effective. In conclusion, relative to a control label, icon-only and icon-plus-text added-sugar menu labels were perceived as effective and helped consumers identify items high in added sugar. Menu warning labels may be a promising strategy for reducing added-sugar consumption from restaurants, but research on behavioral effects in real-world settings is needed. Clinical Trials Identifier:NCT04637412

Cost Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S

INTRODUCTION: Calorie labeling of standard menu items has been implemented at large restaurant chains across the U.S. since 2018. The objective of this study was to evaluate the cost effectiveness of calorie labeling at large U.S. fast-food chains. METHODS: This study evaluated the national implementation of calorie labeling at large fast-food chains from a modified societal perspective and projected its cost effectiveness over a 10-year period (2018-2027) using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model. Using evidence from over 67 million fast-food restaurant transactions between 2015 and 2019, the impact of calorie labeling on calorie consumption and obesity incidence was projected. Benefits were estimated across all racial, ethnic, and income groups. Analyses were performed in 2022. RESULTS: Calorie labeling is estimated to be cost saving; prevent 550,000 cases of obesity in 2027 alone (95% uncertainty interval=518,000; 586,000), including 41,500 (95% uncertainty interval=33,700; 50,800) cases of childhood obesity; and save $22.60 in healthcare costs for every$1 spent by society in implementation costs. Calorie labeling is also projected to prevent cases of obesity across all racial and ethnic groups (range between 126 and 185 cases per 100,000 people) and all income groups (range between 152 and 186 cases per 100,000 people). CONCLUSIONS: Calorie labeling at large fast-food chains is estimated to be a cost-saving intervention to improve long-term population health. Calorie labeling is a low-cost intervention that is already implemented across the U.S. in large chain restaurants