Towards effective restriction of unhealthy food marketing to children: unlocking the potential of artificial intelligence

The World Health Organization recommends that member states enact policies to limit unhealthy food marketing to children. Chile enacted relatively stringent laws that restrict unhealthy food marketing to children in two phases, beginning in 2016. Dillman-Carpentier and colleagues examined the incremental effectiveness of the first and second phases of Chile's policy in limiting children's exposure to unhealthy food marketing on television relative to pre-policy. Banning advertisements for all 'high-in' products (i.e., those that exceeded thresholds for energy, saturated fats, sugars and/or sodium) during the daytime (phase 2) was more effective in reducing children's exposure to unhealthy food marketing on television than only banning 'high-in' marketing during programs with large child audiences (phase 1). These findings underscore the importance of implementing comprehensive policies that reduce children's exposure to all marketing for unhealthy foods-not simply that which targets them directly-to better protect them from its negative impacts. However, although policies in Chile and other nations have reduced children's exposure to unhealthy food marketing in broadcast media, it is not clear whether such policies have meaningfully reduced children's overall food marketing exposures. This is partly due to the challenges of studying children's digital food marketing exposures, which are an increasingly important source of unhealthy food marketing. To address these methodologic gaps, several research teams are developing artificial intelligence (AI)-enabled systems to assess food marketing to children on digital media and support efforts to monitor compliance with policies that restrict this marketing. These and other AI systems will be essential to comprehensively and systematically study and monitor food marketing to children on digital media internationally and at scale

Planting seeds of change: reconceptualizing what people eat as eating practices and patterns

Language focused on individual dietary behaviors, or alternatively, lifestyle choices or decisions, suggests that what people eat and drink is primarily a choice that comes down to free will. Referring to and intervening upon food consumption as though it were a freely chosen behavior has an inherently logical appeal due to its simplicity and easily defined targets of intervention. However, despite decades of behavioral interventions, population-level patterns of food consumption remain suboptimal. This debate paper interrogates the manner in which language frames how problems related to poor diet quality are understood and addressed within society. We argue that referring to food consumption as a behavior conveys the idea that it is primarily a freely chosen act that can be ameliorated through imploring and educating individuals to make better selections. Leveraging practice theory, we subsequently propose that using the alternative language of eating practices and patterns better conveys the socially situated nature of food consumption. This language may therefore point to novel avenues for intervention beyond educating and motivating individuals to eat more healthfully, to instead focus on creating supportive contexts that enable sustained positive dietary change. Clearly, shifting discourse will not on its own transform the science and practice of nutrition. Nevertheless, the seeds of change may lie in aligning our terminology, and thus, our framing, with desired solutions

Identifying factors that shape whether digital food marketing appeals to children

Abstract Objective: Children are frequently exposed to unhealthy food marketing on digital media. This marketing contains features that often appeal to children, such as cartoons or bold colours. Additional factors can also shape whether marketing appeals to children. In this study, in order to assess the most important predictors of child appeal in digital food marketing, we used machine learning to examine how marketing techniques and children’s socio-demographic characteristics, weight, height, BMI, frequency of screen use and dietary intake influence whether marketing instances appeal to children. Design: We conducted a pilot study with thirty-nine children. Children were divided into thirteen groups, in which they evaluated whether food marketing instances appealed to them. Children’s agreement was measured using Fleiss’ kappa and the S score. Text, labels, objects and logos extracted from the ads were combined with children’s variables to build four machine-learning models to identify the most important predictors of child appeal. Setting: Households in Calgary, Alberta, Canada. Participants: 39 children aged 6–12 years. Results: Agreement between children was low. The models indicated that the most important predictors of child appeal were the text and logos embedded in the food marketing instances. Other important predictors included children’s consumption of vegetables and soda, sex and weekly hours of television. Conclusions: Text and logos embedded in the food marketing instances were the most important predictors of child appeal. The low agreement among children shows that the extent to which different marketing strategies appeal to children varies

A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools

BACKGROUND : Few children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children\u27s opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact. METHODS: We adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies. RESULTS: Five of Canada\u27s 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children\u27s PA levels or BMI. CONCLUSIONS: This study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies

Are dietary inequalities among Australian adults changing? a nationally representative analysis of dietary change according to socioeconomic position between 1995 and 2011-13

Abstract Background Increasing inequalities in rates of obesity and chronic disease may be partly fuelled by increasing dietary inequalities, however very few nationally representative analyses of socioeconomic trends in dietary inequalities exist. The release of the 2011–13 Australian National Nutrition and Physical Activity Survey data allows investigation of change in dietary intake according to socioeconomic position (SEP) in Australia using a large, nationally representative sample, compared to the previous national survey in 1995. This study examined change in dietary intakes of energy, macronutrients, fiber, fruits and vegetables among Australian adults between 1995 and 2011–13, according to SEP. Methods Cross-sectional data were obtained from the 1995 National Nutrition Survey, and the 2011–13 National Nutrition and Physical Activity Survey. Dietary intake data were collected via a 24-h dietary recall (n = 17,484 adults) and a dietary questionnaire (n = 15,287 adults). SEP was assessed according to educational level, equivalized household income, and area-level disadvantage. Survey-weighted linear and logistic regression models, adjusted for age, sex/gender and smoking status, examined change in dietary intakes over time. Results Dietary intakes remained poor across the SEP spectrum in both surveys, as evidenced by high consumption of saturated fat and total sugars, and low fiber, fruit and vegetable intakes. There was consistent evidence (i.e. according to ≥2 SEP measures) of more favorable changes in dietary intakes of carbohydrate, polyunsaturated and monounsaturated fat in higher, relative to lower SEP groups, particularly in women. Intakes of energy, total fat, saturated fat and fruit differed over time according to a single SEP measure (i.e. educational level, household income, or area-level disadvantage). There were no changes in intake of total sugars, protein, fiber or vegetables according to any SEP measures. Conclusions There were few changes in dietary intakes of energy, most macronutrients, fiber, fruits and vegetables in Australian adults between 1995 and 2011–13 according to SEP. For carbohydrate, polyunsaturated and monounsaturated fat, more favorable changes in intakes occurred in higher SEP groups. Despite the persistence of suboptimal dietary intakes, limited evidence of widening dietary inequalities is positive from a public health perspective. Trial registration Clinical trials registration: ACTRN12617001045303

Hair cortisol levels, perceived stress and body mass index in women and children living in socioeconomically disadvantaged neighborhoods: the READI study

Disadvantaged communities provide adverse psychosocial exposures that have been linked to high levels of stress, and this may provide one explanatory pathway linking socioeconomic disadvantage to obesity. This study used hair cortisol analysis to quantify associations between stress and body mass index (BMI), and between hair cortisol and perceived psychological stress levels, in women and children living in socioeconomically disadvantaged neighborhoods. Participants were a volunteer sample of 70 women from the Resilience for Eating and Activity Despite Inequality study, including 30 maternal-child pairs. Women self-reported body weight, height and perceived psychological stress using the Perceived Stress Scale (PSS), and provided hair samples for themselves and their child. Children\u27s body weight and height were measured. Following extraction, hair cortisol levels were measured using enzyme-linked immunosorbent assay. Multiple linear regression models examined associations between stress and BMI, and between hair cortisol and perceived stress levels in women and children. Women\u27s hair cortisol levels were not associated with their BMI or PSS scores. Women\u27s PSS scores were positively associated with their BMI (p = 0.015). Within maternal-child pairs, mothers and children\u27s hair cortisol levels were strongly positively associated (p = 0.006). Maternal hair cortisol levels and PSS scores were unrelated to their child\u27s zBMI. Children\u27s hair cortisol levels were not associated with their zBMI or with their mother\u27s PSS score. Findings suggest that cortisol-based and perceived psychological measures of stress may be distinct among women and children living in disadvantaged neighborhoods. Perceived psychological measures may be more important predictors of weight-related risk

A Nationally Representative Analysis of Trends in Socioeconomic Inequities in Diet Quality Between 2004 and 2015 Among Adults Living in Canada

This is a pre-copyedited, author-produced version of an article accepted for publication in Current Developments in Nutrition following peer review. The version of record [Olstad, D., Nejatinamini, S., Victorino, C., Kirkpatrick, S., Minaker, L., & McLaren, L. (2021). A Nationally Representative Analysis of Trends in Socioeconomic Inequities in Diet Quality Between 2004 and 2015 Among Adults Living in Canada. Current Developments in Nutrition, 5(Supplement_2), 1074. https://doi.org/10.1093/cdn/nzab053_067 ] is available online at: https://doi.org/10.1093/cdn/nzab053_067Diet quality is a key determinant of chronic disease and shares a similar socioeconomic patterning. Inequities in diet quality are stable or widening in the US, however these trends have not been examined in other nations. Moreover, prior US studies only examined differences in diet quality between the most and least disadvantaged groups in absolute terms. Quantifying trends in relative terms and along the full socioeconomic gradient according to multiple indicators of socioeconomic position (SEP) can provide a more comprehensive perspective to inform optimal points of intervention. The purpose of this study was to quantify nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to three indicators of SEP among adults living in Canada

Numeric and Traffic Light Calorie Labels on Cafeteria Menus: Noticing, Use, and Perceptions Among Young Adults

This is a pre-copyedited, author-produced version of an article accepted for publication in Current Developments in Nutrition following peer review. The version of record Lee, K., Hammond, D., Price, M., Hobin, E., Wallace, M., Olstad, D., Minaker, L., & Kirkpatrick, S. (2020). Numeric and Traffic Light Calorie Labels on Cafeteria Menus: Noticing, Use, and Perceptions Among Young Adults. Current Developments in Nutrition, 4(Supplement_2), 1719. https://doi.org/10.1093/cdn/nzaa064_009 is available online at: https://doi.org/10.1093/cdn/nzaa064_009.Objectives The objective of this study was to examine the impact of numeric versus interpretive calorie labelling on consumer noticing, use, and perceptions of labels. We hypothesized that due to their at-a-glance format, interpretive labels would outperform numeric labels. Methods Using a pre-post quasi-experimental controlled trial design, three campus cafeterias were randomized to receive numeric calorie labelling, traffic light labelling (i.e., red, amber, or green symbol indicating the number of calories), or no labelling for two weeks. Exit surveys were conducted with cafeteria patrons prior to (n = 949) and following (n = 1110) implementation of labels. Surveys queried sociodemographic characteristics, the details of the most recent cafeteria purchase, and noticing, use, and perceptions of labels. Chi-squared tests and multinomial logistic regression were used to determine the impact of format on label noticing, use, and perceptions. Results Label noticing increased from 23% to 43% among those exposed to numeric labels and 28% to 63% among those exposed to traffic light labels, compared to no change in the control (15%) (P 0.05). Conclusions Cafeteria patrons exposed to calorie labels reported noticing and using them, with higher salience for traffic light labels. The implementation of such interpretive labels at the point-of-purchase may provide cues to enable consumers to make informed choices, consistent with front-of-pack labels on packaged foods under consideration in many jurisdictions.Funder 1,Kirsten Lee is funded by an Ontario Graduate Scholarship ||. Funder 2, This study is funded by the Canadian Foundation for Dietetic Research ||. Funder 3, an Ontario Ministry of Research and Innovation Early Researcher Award held by Sharon Kirkpatrick