Comparison of Three Dietary Assessment Methods to Estimate Meat Intake as Part of a Meat Reduction Intervention among Adults in the UK

Food diaries are used to estimate meat intake at an individual level but it is unclear whether simpler methods would provide similar results. This study assessed the agreement between 7 day food diaries in which composite dishes were disaggregated to assess meat content (reference method), and two simpler methods: (1) frequency meal counts from 7 day food diaries; and (2) 7 day dietary recalls, each using standard estimated portion sizes. We compared data from a randomized controlled trial testing a meat reduction intervention. We used Bland-Altman plots to assess the level of agreement between methods at baseline and linear mixed-effects models to compare estimates of intervention effectiveness. At baseline, participants consumed 132 g/d (±75) of total meat; frequency meal counts and dietary recalls underestimated this by an average of 30 and 34 g/day, respectively. This was partially explained by an underestimation of the assumed portion size. The two simpler methods also underestimated the effect of the intervention, relative to control, though the significant effect of the intervention was unchanged. Simpler methods underestimated absolute meat intake but may be suitable for use in studies to measure the change in meat intake in individuals over time

Effectiveness of an Online Programme to Tackle Individual’s Meat Intake through SElf-regulation (OPTIMISE):A randomised controlled trial

Purpose A reduction in meat intake is recommended to meet health and environmental sustainability goals. This study aimed to evaluate the effectiveness of an online self-regulation intervention to reduce meat consumption. Methods One hundred and fifty one adult meat eaters were randomised 1:1 to a multi-component self-regulation intervention or an information-only control. The study lasted 9 weeks (1-week self-monitoring; 4-week active intervention; and 4-week maintenance phase). The intervention included goal-setting, self-monitoring, action-planning, and health and environmental feedback. Meat intake was estimated through daily questionnaires in weeks 1, 5 and 9. The primary outcome was change in meat consumption from baseline to five weeks. Secondary outcomes included change from baseline to nine weeks and change in red and processed meat intake. We used linear regression models to assess the effectiveness of all the above outcomes. Results Across the whole sample, meat intake was 226 g/day at baseline, 118 g/day at five weeks, and 114 g/day at nine weeks. At five weeks, the intervention led to a 40 g/day (95%CI − 11.6,− 67.5, P = 0.006) reduction in meat intake, including a 35 g/day (95%CI − 7.7, − 61.7, P = 0.012) reduction in red and processed meat, relative to control. There were no significant differences in meat reduction after the four-week maintenance phase (− 12 g/day intervention vs control, 95% CI 19.1, − 43.4, P = 0.443). Participants said the intervention was informative and eye-opening. Conclusion The intervention was popular among participants and helped achieve initial reductions in meat intake, but the longer-term reductions did not exceed control. Trial registration ClinicalTrials.gov NCT04961216, 14th July 2021, retrospectively registered

Evaluation of OPTIMISE (Online Programme to Tackle Individual’s Meat Intake Through Self-regulation): Cohort Study

BACKGROUND: There is an urgent need to reduce society’s meat consumption to help mitigate climate change and reduce noncommunicable diseases. OBJECTIVE: This study aimed to investigate changes in meat intake after participation in an online, multicomponent, self-regulation intervention. METHODS: We conducted a pre-post observational study among adult meat eaters in the United Kingdom who signed up to a website offering support based on self-regulation theory to reduce meat consumption. The program lasted 9 weeks (including a 1-week baseline phase, a 4-week active intervention phase, and a 4-week maintenance phase), comprising self-monitoring, goal setting, action planning, and health and environmental feedback. Meat intake was estimated during weeks 1, 5, and 9 using a 7-day meat frequency questionnaire. We analyzed the change in mean daily meat intake from baseline to week 5 and week 9 among those reporting data using a hierarchical linear mixed model. We assessed changes in attitudes toward meat consumption by questionnaire and considered the acceptability and feasibility of the intervention. RESULTS: The baseline cohort consisted of 289 participants, of whom 77 were analyzed at week 5 (26.6% of the baseline sample) and 55 at week 9 (71.4% of the week 5 sample). We observed large reductions in meat intake at 5 and 9 weeks: –57 (95% CI –70 to –43) g/day (P<.001) and –49 (95% CI –64 to –34) g/day (P<.001), respectively. Participants’ meat-free self-efficacy increased, meat-eating identities moved toward reduced-meat and non–meat-eating identities, and perceptions of meat consumption as the social norm reduced. Participants who completed the study reported high engagement and satisfaction with the intervention. CONCLUSIONS: Among people motivated to engage, this online self-regulation program may lead to large reductions in meat intake for more than 2 months, with promising signs of a change in meat-eating identity toward more plant-based diets. This digital behavior change intervention could be offered to complement population-level interventions to support reduction of meat consumption

A dynamic social norm messaging intervention to reduce meat consumption:A randomized cross-over trial in retail store restaurants

Perceptions of social norms around eating behavior can influence food choices. Communicating information about how others are changing their eating behavior over time (dynamic descriptive social norms) may motivate individuals to change their own food selection and consumption. Following a four-week baseline period, 22 in-store restaurants of a major retail chain across the UK were randomized to display a dynamic descriptive social norm message intended to motivate a shift from meat-to plant-based meals either during the first two, or last two weeks of the four-week study period. A linear regression model showed there was no evidence of an effect of the intervention (β = -0.022, p = .978, 95% CIs: −1.63, 1.58) on the percentage sales of meat- vs plant-based dishes. Fidelity checks indicated that adherence to the intervention procedure was often low, with inconsistencies in the placement and display of the intervention message. In four stores with high fidelity the estimated impact of the intervention was not materially different. The lack of apparent effectiveness of the intervention may reflect poor efficacy of the intervention or limitations in its implementation in a complex food purchasing environment. The challenges highlighted by this study should be considered in future design and evaluation of field trials in real-world settings

Effects of environmental impact and nutrition labelling on food purchasing: An experimental online supermarket study

Nutrition labels and ecolabels can support consumers to make healthier and more sustainable choices, and the former is now widespread. But there is no information on the impact of ecolabels in the presence of nutrition labels. The aims of this study were primarily to examine whether (1) ecolabels are effective at promoting sustainable purchasing behaviour if presented alongside nutrition labels; (2) and secondarily, whether nutrition labels are effective at promoting healthier purchasing if presented alongside ecolabels. Participants (N = 2730) visited an experimental online supermarket platform, and were randomised to see products with (1) environmental impact labels only; (2) nutrition (NutriScore) labels only; (3) both environmental and nutrition labels; (4) no labels. Linear regressions compared the mean environmental impact scores (EIS; primary outcome) and health scores of products in participants’ shopping baskets across each condition. Compared to control (no labels) there were significant reductions in the EIS when environmental impact labels were presented: Alone (−1.3, 95%CI: −2.3 to −0.4) or With nutrition labels (−2.0, 95%CI: −2.9 to −1.0), with no evidence of differences in effectiveness between these two conditions. There was no evidence of an impact of nutrition labels on either the EIS or the healthiness of purchases, both when nutrition labels were shown alone and when ecolabels were also present. Environmental impact labels may be effective at encouraging more sustainable purchases alone or when used alongside nutrition labels. This adds to the evidence base on the feasibility and effectiveness of environmental impact labelling as an important measure to change dietary behaviour to improve planetary health

The Effects of Environmental Sustainability Labels on Selection, Purchase, and Consumption of Food and Drink Products: A Systematic Review

This review assessed the effects of environmental labels on consumers’ demand for more sustainable food products. Six electronic databases were searched for experimental studies of ecolabels and food choices. We followed standard Cochrane methods and results were synthesized using vote counting. Fifty-six studies (N = 42,768 participants, 76 interventions) were included. Outcomes comprised selection (n = 14), purchase (n = 40) and consumption (n = 2). The ecolabel was presented as text (n = 36), logo (n = 13) or combination (n = 27). Message types included: organic (n = 25), environmentally sustainable (n = 27), greenhouse gas emissions (n = 17), and assorted “other” message types (n = 7). Ecolabels were tested in actual (n = 15) and hypothetical (n = 41) environments. Thirty-nine studies received an unclear or high RoB rating. Sixty comparisons favored the intervention and 16 favored control. Ecolabeling with a variety of messages and formats was associated with the selection and purchase of more sustainable food products

Should azithromycin be used to treat COVID-19? A rapid review

Background There are no established effective treatments for COVID-19. While novel drugs are being developed, azithromycin has been identified as a candidate treatment in the interim. Aim To review the evidence for the effectiveness and safety of azithromycin in treating COVID-19. Design & setting A rapid review of the literature was conducted. Method Electronic searches were conducted on 16 April 2020 of PubMed, TRIP, EPPI COVID Living Map, MedRxiv, GoogleScholar, and Google. In vivo and in vitro studies were included assessing the safety and effectiveness of azithromycin for treatment of COVID-19, and/or the activity of azithromycin against SARS-CoV-2. In vivo studies needed to include a comparator group. Results Three studies were identified, two in vitro and one in vivo, which were suitable for inclusion. All three were published as pre-prints. The in vitro studies revealed conflicting results, with one finding anti-SARS-CoV-2 activity for azithromycin alone, while the other found activity against SARS-CoV-2 only when azithromycin was combined with hydroxychloroquine. A small trial of 36 patients, with high risk of bias, found superior viral clearance in patients with COVID-19 treated with azithromycin and hydroxychloroquine combined, compared with hydroxychloroquine alone. Conclusion There is no evidence to support the use of azithromycin for the treatment of COVID-19 outside of the context of clinical trials, unless it is used to treat bacterial super-infection. There is extremely limited evidence of a possible synergy between azithromycin and hydroxychloroquine. The adverse events profile of azithromycin in the context of COVID-19 has not yet been established. Well-conducted clinical trials are urgently needed in this area

GP delivered brief weight loss advice: associations between in-consultation behaviour change techniques and patient weight loss in recorded primary care discussions

ABSTRACTBackground Primary care clinicians are encouraged to intervene opportunistically, offering weight-loss advice to people living with obesity. The BWeL trial showed patients receiving brief weight-loss advice from their general practitioner lost weight at one year follow-up. We examined the behaviour change techniques (BCTs) clinicians used to identify which BCTs are associated with this weight loss.Methods We coded 224 audio recorded interventions from the BWeL trial using the behavioural change techniques version one taxonomy (BCTTv1) and the ‘refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours’ (CALOR-RE taxonomy). Linear and logistic regressions were performed to analyse associations between behaviour change techniques used in these taxonomies and patient weight loss.Results Mean intervention length was 86 s. We identified 28 different BCTs BCTTv1 and 22 from CALOR-RE. No BCTs or BCT domains were associated with mean weight loss at 12 months, loss of 5% bodyweight, or action taken at 3 months. The BCT ‘Feedback on outcomes of behaviour (future)’ was associated with an increased likelihood that the patient reported taking action to lose weight by 12 months (OR = 6.10, 95%CI = 1.20, 31.0).Conclusion Although we found no evidence to support the use of particular BCTs, our results suggest that it is the brief intervention itself, rather than specific content, which may motivate weight loss. This can support clinicians to confidently intervene without needing complex training. Offering follow-up appointments can support positive changes to health behaviours, even if these are not associated with weight loss

Effects of environmental impact labels on the sustainability of food purchases: two randomised controlled trials in an experimental online supermarket

Providing consumers with product-specific environmental impact information for food products (ecolabels) may promote more sustainable purchasing, needed to meet global environmental targets. Two UK studies investigated the effectiveness of different ecolabels using an experimental online supermarket platform. Study 1 (N = 1051 participants) compared three labels against control (no label), while Study 2 (N = 4979) tested four designs against control. Study 1 found significant reductions in the environmental impact score (EIS) for all labels compared to control (labels presented: values for four environmental indicators [-3.9 percentiles, 95%CIs: -5.2,-2.6]; a composite score [taking values from A to E; -3.9, 95%CIs: -5.2,-2.5]; or both together [-3.2, 95%CIs: -4.5,-1.9]). Study 2 showed significant reductions in EIS compared to control for A-E labels [-2.3, 95%CIs: -3.0,-1.5], coloured globes with A-E scores [-3.2, 95%CIs:-3.9,-2.4], and red globes highlighting 'worse' products [-3.2, 95%CIs:-3.9,-2.5]. There was no evidence that green globes highlighting 'better' products were effective [-0.5, 95%CIs:-1.3,0.2]. Providing ecolabels is a promising intervention to promote the selection of more sustainable products