Author: Courtney Luecking

What’s on tap for 2018?

As the calendar year winds down, we naturally find ourselves both reflecting on the year that was and looking forward to what is to come. I always love to hear what trend analysts suggest will be popular for food and drink in the upcoming year. According to Unilever Food Solutions, health-conscious trends will continue in to 2018. Keep an eye out for:

Poke bowls

Poh-keh – cubed raw fish – is a Hawaiian staple. Poke bowls are essentially deconstructed sushi and may include rice or quinoa and vegetables.

Hybrid food

Although these may not be the healthiest of options, the flavor combinations of two or more foods are an experience to be had. Some popular examples include: cronuts (croissant meets donut), waffogato (ice-cream waffle soaked in espresso, and bruffins (brioche meets muffin).

Plant-based options

Vegan, vegetarian, pescaterian, flexitarian – the bottom line is restaurants are and will continue to offer more plant-based meals to meet diners’ demands.

Fermented food

Known for their probiotics and ability to positively influence digestive health, fermented foods like kombucha, sauerkraut, miso, tempeh, pickles, kefir, and yogurt pack a punch of flavor and health.

Natural colors and floral flavors

Consumers are demanding more ‘natural’ ingredients, and the food industry is responding with more ‘natural’ ways of coloring food (think beets). Edible flowers are also making a bigger splash on the scene as part of baked goods and cocktails.

Since these are just predictions, it will be interesting to see one year from now which trends caught on and which trends flopped. Cheers to a happy, healthy 2018.

 

Sources:

Unilever Food Solutions. 2018 Food Trend Predictions. https://www.unileverfoodsolutions.com.my/en/chef-inspiration/latest-trends/2018-food-trend-predictions.html

Food talk: The words that influence what we eat

This past Friday I had the pleasure of jumping in for the back half of a webinar led by Amy Myrdal Miller, MS, RDN, FAND of Famer’s Daughter® Consulting about how we, as consumers, talk about food. While a short blog post cannot do justice for the variety and depth of topics she covered, it really got me thinking about my own conversations about food.

Local. Seasonal. Sustainable. Organic. Natural. Clean. Artisan. Genetically modified. Fresh. Processed. Irradiation. What do these terms mean to you? Which terms conjure a positive image about the health or environmental effects of a food? Which terms conjure more negative images?

You may be surprised to learn that not all of these terms are regulated, and some don’t even have an agreed upon definition. If you buy something labeled as ‘organic’, you can rest assured that the United States Department of Agriculture is overseeing the production to ensure the food meets defined criteria. But when it comes to the terms local or sustainable, there is no universally accepted definition. Even ‘natural’ has yet to be defined.

The way we talk about and market food may be one obstacle to improving our health. According to the 2017 Food & Health Survey, the health value of foods and beverages is a major point of discussion. However, despite reporting taking steps to be healthy, Americans have varying definitions for what is healthy and have seen minimal improvements in the quality of what they eat or drink.

The words we use to describe foods can create a health halo – meaning that a food may be perceived as healthier than it actually is, either because of the way it is labeled or because some aspect of it may have health benefits. But if we think about it, soda made from ‘real’ or ‘natural’ sugar is still soda, and an organic cookie is still a cookie.

Definitions or not, the way we describe food can influence our purchasing and consumption behaviors. Ultimately we need to take a closer look at the food and determine how it fits in to the healthy lifestyle we have defined for ourselves. What terms or phrases do you look for? Do you find your own biases for buying or eating foods with particular labels?

 

Sources:                     

International Food Information Council Foundation. 2017 Food and Health Survey. 9/22/2017. http://www.foodinsight.org/2017-food-and-health-survey

Wang DD, Leung CW, Li Y. Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA Intern Med. 2014;174(10):1587-1595. Doi:10.1001/jamainternmed.2014.3422

It’s all in the name: Can labels influence eating behavior?

While cruising nutrition-related headlines, I stumbled across “Call a Snack a Meal, and You’re Less Apt to Overeat”. Hmmm, this sounds easy enough and therefore worthy of a click to learn more. The consumer news piece summarized that those participants asked to eat pasta as a snack (eaten standing up from a plastic pot with a plastic fork) ate “much more” during a subsequent taste test than those who had been asked to eat pasta as a meal (eaten seated at a table from a ceramic plate with a metal fork).

The title and content of the article seemed disconnected, so I decided to do a quick review of the peer-reviewed publication. Turns out the seemingly simple advice that caught my eye – prevent overeating by changing how you label a meal or snack – is in fact too good to be true, at least based on the evidence from this study.

The study’s actual intention was to look at the independent and combined effects of labeling the pasta dish (meal or snack) and the location of eating the pasta dish (standing with plasticware or sitting with silverware). There were actually no differences detected in changes in hunger, fullness, or motivation to eat across the four study groups. While there were statistically significant results for increased food intake during the subsequent taste test (sweet and savory snacks), this was limited to those participants who received instructions to eat the snack while standing, not those instructed to eat the snack while sitting. Thus, simply calling something a snack did not prevent overeating.

Another important note is the final quote offered by the study author – “To overcome this, we should call our food a meal and eat it as meal, helping make us more aware of what we are eating so that we don’t overeat later on,” – may have been reported out of context and overly generalized. The study included mostly college students in the United Kingdom who are considered to have a normal body mass index, which does not represent a majority of the population.

Picking apart results of nutrition research and missreporting those results is a disservice to consumers. The bottom line: don’t believe everything you read, and if you have questions or need support for lifestyle changes, seek guidance from trained professionals.

 

Sources:                     

Ogden J, Wood C, Payne E, Fouracre H, Lammyman F. ‘Snack’ versus ‘meal’: The impact of label and place on food intake. Appetite. 2018 Jan 1; 120:666-672. Doi: 10.1016/j.appet.2017.10.026.

Preidt, R. University of Surrey, news release, Oct. 30, 2017. Call a Snack a Meal, and You’re Less Apt to Overeat. HealthDay News. https://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/call-a-snack-a-meal-and-you-re-less-apt-to-overeat-728047.html

Coming Full Circle: Carmina Valle, PhD, MPH

It’s not every day we get the opportunity to hear from distinguished alumnae of our Interdisciplinary Health Communication Certificate program. But last week, we had the pleasure of welcoming back Carmina Valle, PhD, MPH to share her past, present, and future.

As a graduate student beginning to consider next steps, it is inspiring to see how Dr. Valle has connected, and applied, her past experiences in a way that has led to a well-rounded, meaningful portfolio of work.

Dr. Valle’s past experiences as a biology undergrad turned epidemiologic biostatistician master student led to a prestigious Presidential Management Fellowship with the National Cancer Institute (NCI). Her time at NCI and Livestrong opened her eyes to the need for more widespread sharing of proven solutions for helping the increasing numbers of cancer survivors, particularly young adults who are in critical, transitional life periods.

After completing pre- and post-doctoral training at the University of North Carolina, Dr. Valle is now an Assistant Professor in the Department of Nutrition at the Gillings School of Global Public Health and a member of the UNC Lineberger Comprehensive Cancer Center and UNC Weight Research Program. Her resource portfolio focuses on accelerating research on technology-based behavioral interventions for cancer control, particularly novel strategies to improve lifestyle behaviors of cancer survivors.

Previous projects have included a Facebook-based physical activity intervention for young adult cancer survivors and use of a sophisticated study design (Multiphase Optimization Strategy) to identify the most effective messages for a tailored health assessment tool. Her ongoing projects include serving as a Co-Principal Investigator for a Gillings Innovation Lab that focuses on JITAIs. No this is not a Star Wars term, JITAIs are Just-In-Time Adaptive Interventions to identify optimal timing, content, and need for intervention messages to help people in the moment when they need it most.

Dr. Valle, your passion for what you do is evident, and we are proud to call you one of our own.

 

Key Publications:

Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: A randomized controlled pilot study. Valle C.G., Deal A.M., & Tate D.F (2017). Journal of Cancer Survivorship, 11(1), 133-148.

Engagement of young adult cancer survivors within a Facebook-based physical activity intervention. Valle CG & Tate DF (2017). Translational Behavioral Medicine.

Exploring mediators of physical activity in young adult cancer survivors: Evidence from a randomized trial of a Facebook-based physical activity intervention. Valle CG, Tate DF, Mayer DK, Allicock M, Cai J. (2015). Journal of Adolescent and Young Adult Oncology, 4(1), 26-33.

FOP-FTW

You’ve probably seen front-of-package (FOP) nutrition labeling systems.

From ASPE Policy Research for Front of Package Nutrition Labeling: Environmental Scan and Literature Review http://aspe.hhs.gov/sp/reports/2011/FOPNutritionLabelingLitRev/

Next time you stroll through the grocery store, count how many different labeling systems you see in a single aisle. To summarize, the different systems are:

  • Nutrient-specific – to display select nutrients from the Nutrition Facts Panel
  • Summary indicator – to offer a single symbol or score to summarize the nutritional value
  • Food group information – to offer symbols based on the presence of a food group or ingredient

In spite of the different looks, the modified labeling systems have similar intentions, which include:

  • Providing consumers select nutrition information for nutrients to limit (e.g., sodium or added sugars) or nutrients to increase (e.g., vitamin D or calcium)
  • Making it easier to compare similar foods
  • Giving an overall impression about the nutritional value or food group composition of a food

While each type of system has demonstrated success in altering purchase patterns, no system has been deemed superior to another. A major assumption about these systems is that consumers receive and understand the information they are receiving. Although data show this is not the case, there is evidence that simple labeling systems can be effective, including for consumers who have low literacy and may be at nutritional risk.

The committee assembled by the Institute of Medicine was charged with reviewing evidence and providing recommendations for a system redesign that will encourage healthier food choices and purchase behaviors. Highlights include:

  • Develop a single, standardized system that translates information from the Nutrition Facts label
  • Display calories in common household measure serving sizes and 0-3 “points” for nutrients to limit
  • Appear on all grocery products and in consistent locations across products
  • Providing a nonproprietary, transparent translation of nutrition information into health meaning

More information is not always better, and the committee references the Environmental Protection Agency and Department of Energy’s Energy Star® program as a successful model that has altered consumer purchase patterns for household appliances and electronics.

What are your thoughts about FOP labeling systems? Are they helpful? Confusing? What do you want to know from looking at the front of a package?

front-of-package labeling for-the-win (FOP-FTW)

Sources:                     

Institute of Medicine. 2012. Front-of-Package Nutrition Rating Systems and Symbols: Promoting Healthier Choices. Washington, DC: The National Academies Press. https://doi.org/10.17226/13221.

Nutrition Facts Numbers: Helpful or Harmful?

While cruising nutrition headlines, I stumbled across – Google Maps Pulls Calorie-Counting Feature After Criticism. In addition to showing the commute time from one destination to the next, Google Maps beta tested including how many calories would be burned if one walked and, in some instances, even equated the number of calories burned to calories in food.

This feature was met with mixed reviews – some valued the information and felt it could encourage healthier decisions (#digitalhealth), while others found it particularly alarming and potentially dangerous for people with eating disorders. Ultimately the feature was removed, but this reignites an important conversation about the transparency and promotion of nutrition facts information.

Should caloric information be prominent? The Affordable Care Act includes requirements for certain restaurants and vending machines to display or have nutrition information readily available. And according to a recent Reuters/Ipsos opinion poll, Americans want access to nutrition label information, even if they don’t use it. Information can be powerful for positive change but also negative consequences, so how can we best communicate information in a way that avoids causing harm?

How are people using this information, if at all? About half of adults state they read nutrition facts labels “always” or “most of the time”. People look at labels and packaging for various reasons, ranging from specific nutrients or ingredients for health purposes to helping decide which brand of a food to buy.

Is more (numbers and data) better? A majority of people want to have access to information, and about half of people look at the information, but the same survey shows that people largely ignore labels because they are too difficult to understand (59%) or it takes too much time (75%).

While the intentions of transparency of information are good, the information may be overly-complicated to interpret and likely misses the mark of making nutrition information digestible (pun intended). We might be better served to offer simplified approaches for communicating nutrition information about food. Stay tuned for examples of this.

In the meantime, how do you feel about access to nutrition information – whether calories, nutrients, or specific health claims? Do you want it or need it? How confident are you that you can interpret the available information?

Sources:
Jordan Lin C-T, Zhang Y, Carlton ED, Lo SC. 2014 FDA Health and Diet Survey. Center for Food Safety and Applied Nutrition, Food and Drug Administration. May 6, 2016. https://www.fda.gov/downloads/Food/FoodScienceResearch/ConsumerBehaviorResearch/UCM497251.pdf?source=govdelivery&utm_medium=email&utm_source=govdelivery

Prentice C & Kahn C. Americans want required food labels even if they don’t read them. Reuters. October 2, 2017. http://www.reuters.com/article/us-usa-foodlabels-poll/americans-want-required-food-labels-even-if-they-dont-read-them-idUSKCN1C71F5

U.S. Food and Drug Administration. Menu and Vending Machines Labeling Requirements. May 1, 2017. https://www.fda.gov/food/ingredientspackaginglabeling/labelingnutrition/ucm217762.htm

Victor D. Google Maps Pulls Calorie-Counting Feature After Criticism. The New York Times. October 17, 2017. https://www.nytimes.com/2017/10/17/technology/google-maps-calories.html

There’s a health app for that

Raise your hand if you have ever downloaded a fitness or nutrition tracker app. What about an app to track your fertility or blood sugar levels? While one source states nearly 2 out of 3 medical/health apps focus on general health topics like diet, stress, or fitness, other apps focus on specific health conditions like pregnancy, diabetes, mental health, or medication information and reminders.

The number of health and medical apps available for smartphones is growing exponentially (as of 2015, upwards of 165,000). A cross-sectional survey of mobile phone users indicates that those who have downloaded apps trust the accuracy of apps and that their data is safe (Krebs, 2015). But is anyone or anything monitoring or regulating these apps for their legitimacy?

The Food and Drug Administration (FDA) and Federal Trade Commission (FTC) are the two agencies tasked with overseeing the development and marketing of medical apps. However, they oversee a fairly small proportion of the available apps. This is because the FDA limits their oversight to those apps that are considered a medical device, meaning anything intended to diagnose, cure, or prevent disease or to affect the structure or function of the body. The FTC only looks in to apps that make unsubstantiated health claims.

At this time, there isn’t enough evidence to identify which apps work better than others. So, if you find yourself in the market for an app for health or wellness reasons, keep the following in mind:

  • What is the risk of using the product? If the app is intended to diagnose or help treat a medical condition, it will likely need to have FDA approval and you want to be careful with your selection.
  • What is the evidence behind the app? Does the app’s website provide any links to legitimate evidence that the app supports or leads to the intended effect?

Technology has provided a wonderful opportunity for monitoring our health, promoting and supporting behavior change, and sharing information with our health providers. But with all the available options and potentially for positive, or negative effects, we need to be informed consumers.

 

Sources:                     

Federal Trade Commission. Developing a mobile health app? Find out which federal laws you need to follow. https://www.ftc.gov/tips-advice/business-center/guidance/mobile-health-apps-interactive-tool

Krebs P & Duncan DT. Health app use among US mobile phone owners: A national survey. JMIR Mhealth Uhealth. 2015 Oct-Dec; 3(4): e101.

Mirsa, S. New report finds more than 165,000 mobile health apps now available, takes close look at characteristics and use. iMedical Apps + MedPage Today. September 17, 2015. https://www.imedicalapps.com/2015/09/ims-health-apps-report/

Molenti, M. Wellness apps evade the FDA, only to land in court. Wired. April 3, 2017. https://www.wired.com/2017/04/wellness-apps-evade-fda-land-court/

Radcliffe S. Who regulates all these health-related apps? Healthline. September 14, 2017. https://www.healthline.com/health-news/who-regulates-all-these-health-related-apps#4

US Food & Drug Administration. Is the product a medical device? https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Overview/ClassifyYourDevice/ucm051512.htm

Do meta-analyses really offer a bottom line?

For any particular health behavior or condition, the number of research studies is ever-growing. The expansive literature makes it nearly impossible for health practitioners, and even researchers, to stay up-to-date.

Meta-analyses are a type of systematic review that allow for the combination of findings from individual studies in a way that increases statistical power and may thus generate evidence-based ‘bottom lines’ for practice. However, a recent viewpoint in the Journal of the American Medical Association, The Misuse of Meta-Analysis in Nutrition Research, leaves us wondering whether meta-analyses do more harm than good.

Some of the most common flaws discussed in this viewpoint include:

  • The people. Individual studies may include a range in demographic characteristics, like age, sex, race, and ethnicity. While it is typically a good thing to include a variety of people in a single study, trying to compare different study populations can make it more challenging to identify real effects. Think: comparing a study that looked at egg consumption and cholesterol levels in men aged 65 and older to a study looking at women aged 20 – 40 years – there are many other factors that could explain the observed effects.
  • The study design. Although studies may be looking at the relationship between saturated fat and heart disease, they may have used different tools to measure saturated fat intake over varying periods or time or different measures related to heart disease. In addition, some trials may have randomly assigned participants to a group while others followed their natural behaviors over time. This is like trying to compare apples and oranges, although they are both fruit, they are in fact different and it may not be appropriate to try and interpret them together.

Results of meta-analyses matter because they can influence health care policy – either by providing an evidence base for decision-making and/or media headlines prompting public conversation that elevates the priority of a specific condition or behavior. Barnard and colleagues suggest the peer-review process should and could be improved by:

  1. Having content expert editors as well as editors with expertise in meta-analysis techniques
  2. Having authors of the review confirm the appropriateness of the representation of the data with authors of the original report
  3. Having transparent methods and data so that others may reproduce the analysis
  4. Pooling original primary data and not published summary data

 

Sources:                     

Meta-Analysis. Study Design 101. https://himmelfarb.gwu.edu/tutorials/studydesign101/metaanalyses.html

Barnard ND, Willett WC, Ding EL. The Misuse of Meta-analysis in Nutrition Research. JAMA. Published online September 18, 2017. doi:10.1001/jama.2017.12083

The Nutrition Source, Harvard T.H. Chan School of Public Health. Meta-analyses in nutrition research: sources of insight or confusion?

Teal Pumpkin Project: Promoting fun and safe Halloween treats for all

As my little one tries new foods, I pay close attention for any strange reactions that might indicate a food allergy. Food allergies are the result of an immune response to proteins found in food. The immune response can cause mild symptoms such as redness on the skin or an itchy mouth. Or it can cause more serious, life threatening symptoms, known as anaphylaxis, like trouble swallowing, shortness of breath, or loss of consciousness.

While more than 170 foods have been identified to cause allergic reactions, eight allergens are responsible for the majority, and the most severe, reactions in the United States. The ‘big’ eight include: egg, milk, peanut, tree nut, wheat, soy, fish, and shellfish.

It is estimated that upwards of 15 million people in the United States have food allergies, and that number is on the rise. A Centers for Disease Control & Prevention report states there is increasing prevalence of food allergies among children, and a recent media headline shared that insurance claims for anaphylactic (severe) food reactions are going up in adults too.

Although the reason(s) or cause(s) for these increases is unknown, what is known is that food allergies impact quality of life. Holidays can be a particularly challenging time for people with food allergies, but Food Allergy Research & Education (FARE) has initiated a worldwide movement to create a safer, happier Halloween for all. To support the movement, all you have to do is offer non-food treats, like bubbles or stickers, and place a teal pumpkin on your doorstep as a way to let families know you are safe for children with food allergies or other health concerns.

If Halloween is one of your favorite celebrations during the year, think about how a small change in what you hand out can allow others to experience the fun and tradition of trick-or-treating.

The TEAL PUMPKIN PROJECT and the Teal Pumpkin Image are trademarks of Food Allergy Research & Education (FARE)

 

Sources:                     

NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010; 126(6):S1-58

Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997-2011. NCHS data brief, no 121. Hyattsville, MD: National Center for Health Statistics. 2013. Retrieved from http://www.cdc.gov/nchs/products/databriefs/db121.htm.

National Institute of Allergy and Infectious Diseases, National Institutes of Health. Report of the NIH Expert Panel on Food Allergy Research. 2006. Retrieved from www.niaid.nih.gov/topics/foodallergy/research/pages/reportfoodallergy.aspx

United States Census Bureau Quick Facts (2015 estimates).

Shemesh E, Annunziato RA, Ambrose MA, Ravid NL, Mullarkey C, Rubes M, Chuang K, Sicherer M, Sicherer S. Child and parental reports of bullying in a consecutive sample of children with food allergy. Pediatrics 2013; 131:e10-e17.

Herbert L, Shemesh E, Bender B. Clinical management of psychosocial concerns related to food allergy. J Allergy Clin Immunol Pract. 2016; 4(2):205-213.

Bollinger ME; Dahlquist LM, Mudd K; Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol. 2006; 96:415-421.

Food Allergy Research & Education. Teal Pumpkin Project. https://www.foodallergy.org/education-awareness/teal-pumpkin-project

Improving the Nutrition Profile of Food Donations

Hunger impacts one in seven people in the United States. Children, older adults, and those who are homeless are particularly susceptible to the impact of stress and inadequate nutrition for healthy growth and development and/or disease management that accompanies hunger.

The Feeding America Network includes 200 food banks and 60,000 food pantries and meal programs that aim to get nourishing food to people in need. In fact, they serve more than 46 million people each year. To serve all of these individuals, Feeding America relies on donations from individuals and corporations. The great news is that donating food is easy. In fact, more people donate to food drives each year than watch the Super Bowl.

The less than great news is that many of the items donated are high in sodium and/or sugar, which could be particularly harmful for growing children and adults managing chronic diseases like diabetes or heart disease. Fortunately, this trend is starting to change. NPR’s WNYC provides a positive example of how Washington D.C.’s Capital Area Food Bank has significantly reduced (by 84%) the amount of junk food it supplies by being more clear in their requests for the types of foods they want to be able to offer.

The #GiveHealthy Movement is also changing how and what people donate. The #GiveHealthy movement uses technology to allow hunger relief organizations to specify the types of healthy food items they desire. For example, this may include fresh fruit, vegetables, or other healthy food items. Food drive organizers can then connect with and share specific hunger organizations’ wish lists. Donors can purchase identified items and everything will be delivered, at no cost, to the organization.

What we eat matters. What we donate matters. And there is finally support to change the nutrition profile of what we offer to support those in need. I challenge you to #GiveHealthy and to support others to as well.

 

Sources:             

Feeding America. http://www.feedingamerica.org/research/hunger-in-america/facts-and-faces/

#GiveHealthy. Hunger is a Health Issue. http://givehealthy.org/index.php/givehealthy-food-drive-2017/hunger-is-a-health-issue/

WNYC. NPR. One of America’s Biggest Food Banks Just Cut Junk Food By 84 Percent in a Year. http://www.wnyc.org/story/one-of-americas-biggest-food-banks-just-cut-junk-food-by-84-percent-in-a-year/