Market and Welfare Impacts of a “Portion Size Reduction” Policy

The portion size of common food items consumed at home, restaurants and fast-food establishments in the United States (US) has increased since the 1970s, with the portion size of meals and beverages in several restaurants exceeding the US Department of Agriculture (USDA) and Food and Drug Administration recommendations. Portion size has continued to grow in parallel with increasing body weights and food waste. According to USDA, 35% of the US population suffers from obesity while 40 million people are food insecure. At the same time, about 1/3 of the US food supply goes unconsumed, with 2/3 of food waste occurring within the household and the remaining 1/3 occurring in retail stores and food services. The restaurant service sector wastes up to 10% of purchased food before it reaches the final consumer and 21% of the food served in restaurants is not being eaten. Food is the single largest component ending up in landfills accounting for 22% of municipal solid waste, which is an important source of greenhouse gases emissions that cause climate change

The Economics of a “portion size reduction” policy

This study develops novel models of heterogeneous consumer preferences for different dining options and imperfect competition among food suppliers to analyze the market and welfare effects of portion size reduction (PSR) for food away from home. Different scenarios on the nature of differentiation of the dining options, the information available to consumers, and their response to links between portion size and obesity, food waste, and climate change are considered within this framework. The market and welfare effects of the policy are quantified using a simulation analysis. The analysis shows that the market and welfare effects of the policy are case-specific and dependent on the relative magnitude of the cost and utility effects of PSR, the strength of the consumer preference for dining out, and the food suppliers’ initial costs and degree of market power in the relevant markets. The policy can create winners and losers among consumers and accounting for consumer heterogeneity, as done in this study, is essential for capturing the asymmetric welfare effects of PSR. Intriguingly, consumers and suppliers can benefit from PSR even without accounting for any health or/and environmental benefits of reduced portion sizes

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Essays on Portion Size Obesity and Food Waste

The first essay develops novel models of heterogeneous consumer preferences for different dining options and imperfect competition among food suppliers to analyze the market and welfare effects of portion size reduction (PSR) for food away from home. Different scenarios on the nature of differentiation of the dining options, the information available to consumers, and their response to links between portion size and obesity, food waste, and climate change are considered within this framework. The market and welfare effects of the policy are quantified using a simulation analysis. The analysis shows that the market and welfare effects of the policy are case-specific and dependent on the relative magnitude of the cost and utility effects of PSR, the strength of the consumer preference for dining out, and the food suppliers’ initial costs and degree of market power in the relevant markets. The policy can create winners and losers among consumers and accounting for consumer heterogeneity, as done in this study, is essential for capturing the asymmetric welfare effects of PSR. Intriguingly, consumers and suppliers can benefit from PSR even without accounting for any health or/and environmental benefits of reduced portion sizes. Since, along costs, consumer reaction to PSR is a key determinant of the market and welfare outcome of the policy, in the second essay we designed a laboratory experiment and implemented a BDM auction mechanism to examine the impact of framing the benefits of a smaller portion size in terms of health and environment benefits, on the valuation of different sizes of a sandwich. The study also investigated whether the mode of information provision (i.e., simultaneously or sequentially) affects consumer valuation. Our findings suggest that information provision increases consumers’ valuation for the small sandwich and decreases consumers’ valuation for the large sandwich. Results also show that the difference between the WTP for the large sandwich and the WTP for the small sandwich is greater when information is given simultaneously relative to when it’s given sequentially

Equilibrium conditions before portion size reduction (pre-PSR).

Equilibrium conditions before portion size reduction (pre-PSR).</p

Market and welfare effect of PSR and information.

Market and welfare effect of PSR and information.</p

Consumption decisions and welfare under PSR in Scenario I (<i>ρ</i> < <i>ρ</i>*).

Consumption decisions and welfare under PSR in Scenario I (ρ ρ*).</p