PACE Labelling week/lecture 2

Question 1

what do we get our energy intake through?

Answer 1

carbs fat and protein

Question 2

what is our energy expenditure through?

Answer 2

basal metabolism (60-75%)
thermogenesis (10%)
physical activity (15-30%)

Question 3

what do foods with higher energy density usually have?

Answer 3

high fat or sugars and low water content

Question 4

examples of high energy density foods

Answer 4

biscuits
fried chips and chicken
pies and cakes

Question 5

what do foods that are lower in energy density have?

Answer 5

a lot of water or fibre

Question 6

examples of low energy dense foods

Answer 6

fruit and veg
pasta and rice
potatoes with skins that absorb water during cooking
veg-based dishes with added water e.g. soups and stews

Question 7

11-17 year olds consume an excess of calories from what?

Answer 7

soft drinks cakes and biscuits

Question 8

how much extra energy do young people consume from fizzy drinks, cakes and biscuits (cite)

Answer 8

40% of total energy

Lai, Hutchinson and Evans (2019) Toumpakari, Haase and Johnson (2016)

Question 9

big factor linked to excessive calories in young adults?

Answer 9

• Discretionary foods widely available outside of home (shops, restaurant, cafes and schools)

Question 10

about how many people eat meals out of the home at least once per week? cite

Answer 10

○ About 1/5 eat meals of the home at least once per week
○ E.g., Adams et al, 2015; Ziauddeen et al., 2018

Question 11

how many children are obese by the time they leave school? cite

Answer 11

• Around 40% of children are living with overweight or obesity by the time they leave primary school
  ○ Lifestyles Team, NHS Digital, 2022

Question 12

about how many young people don’t meet the national guidelines for 1 hour of physical activity per day? cite

Answer 12

• About 50% of young people don’t meet national guideline amount at least one hour physical activity per day
  ○ Sport England, 2022

Question 13

key drivers in adolescents

Answer 13

• Adolescents start to make own decisions on what and where they eat
  
  • Eating habits are established and may track into adulthood
  • Neurocognitive
    ○ PFC still developing (until abt 18-21yrs) - decision making
    ○ May not understand context (e.g. high energy) or effects of unhealthy food or drink
  • Self-regulation
    ○ Focus on taste, hunger, immediate sugar hit
  • Influence
    ○ Availability, parental, peer and marketing

Question 14

food standards in schools

Answer 14

• 2015: most recent school food standards introduced to provide children with healthy and balanced food
  
  • Still permitted to sell discretionary foods such as cakes and biscuits which contribute to poor health
  • Big reason is a source of revenue in school

Question 15

what is nudging?

Answer 15

• “A nudge… is any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives… the intervention must be easy and cheap to avoid”
  ○ Thaler and Sunstein, 2008 p6.

Question 16

ways in which nudging may target promotion of healthier food and drink

Answer 16

• May target promotion of healthier food and drink choices by:
  ○ Changing position of foods in displays
  ○ Making healthier options more available
  ○ Adding food labels
  
  • Using nudging means less healthy choices can still be available allowing freedom to choose what to eat

Question 17

underlying mechanism to nudging

Answer 17

○ Increase purchase or consumption of healthy food and drink
○ Decrease purchase or consumption of less healthy food and drink

Question 18

nudging in school canteens

Answer 18

○ Placing labels and stickers on foods to show they are healthy or unhealthy
○ Re-positioning foods with labels
○ Use of colourful pictures of promoted food
○ Digital ads

Question 19

positives of nudging

Answer 19

○ Increases purchase of healthy food (measured by transaction data)
○ Decreases calories intake per day (measured by food weight and calorie conversion)
○ Decreases purchase of unhealthy food (transaction data)

Question 20

negatives of nudging

Answer 20

○ Small changes in behaviour
○ Concepts difficult to understand
○ Leading to underestimating the amount of energy in items

Question 21

percentages of young people understanding food labelling (cite)

Answer 21

○ 53% reported they had noticed traffic light labels (TLLs) either often or all the time
○ 40% reported that the TLLs were easy or very easy to understand to understand
○ 15% reported to using them (often or all the time) to make food choices

Hammond et al., 2023

Question 22

reasoning for PACE labelling

Answer 22

• May contribute to small change approach to weight management
  
  • Steering public to make small decisions about what they eat may be easier for them to achieve compared to large lifestyle changes
  • May also prompt or nudge people to be physically active

Question 23

why are PACE labels better than TLLs?

Answer 23

• Pace labelling has a simple design
  
  • PACEs info can be targeted to different populations easily and quickly using online calculators
  • Reference intake values on TLLs based on adult female which may not be meaningful for other populations (i.e. children, adolescents)

Question 24

Daley et al 2019 study on PACE vs TLLs

Answer 24

• UK adult study show more ppts report PACE labels: (Daley et al., 2019)
  ○ Easier to understand than TLLs (41% vs 27%)
  ○ Catch their attention compared to TLLs (49% vs 31%)
  ○ More likely to help them avoid high calorie foods compared to TLLs (44% vs 28%)
  ○ Decreases number of calorie chosen from menus/consumed by public when compared to comparator labelling or no labelling

Question 25

Iris et al., (2021) exploratory study
- undertsanding calories
- PACE vs TLLs

Answer 25

○ Survey study with 808 young people recruited from different secondary schools
○ TLL and pace labels
○ 71% correctly understood what calories are
○ 96% reported they had previously seen TLLs on food and drinks
○ PACE labels easier to understand compared to TLL (69% vs 31%)
○ Ppts who had seen TLLs before:
§ 19% looked often/always
§ 42% said they would look at PACE often/always if implemented
§ 43% who looked rarely/sometimes said they would look at PACE more often
§ 68% who never looked at TLLs said they would look at PACE labels more often
○ 52% felt PACE label was easier to help choose healthy food and drinks on their own compared to TLL

Question 26

Iris et al., intervention study

Answer 26

○ PACE labelling on cakes and biscuits in secondary schools
○ Schools randomised into control or intervention
○ Primary outcome measure: number of weekly purchases sold of cakes and biscuits
○ Anonymised purchasing used as a proxy outcome for consumption as most individuals would consume their purchase
○ Intervention schools displayed PACE labelling for a minimum of 4 weeks and for up to 6 weeks
○ Control schools continued with usual practice
○ Anonymised purchase data from schools on number cakes/sweets biscuits sold, before, during and after the study period collected
○ Schools
§ Ranged in size from 709-1781 students
§ Located in urban and rural areas
§ From the East and West Midlands and the North-east regions of England
§ Based in affluent and deprived areas as defined by % pupils eligible for free school meals within schools (ranged from 10% to 42%)
○ Decrease in purchases of cakes and biscuits in intervention schools by a small but statistically significant amount
○ Per 100 students, a reduction of roughly 11 cakes/biscuits bought per week in the intervention schools compared to controls
○ Found labels helpful
○ Most sometimes used labels
○ Nested Qualitative Interviews
§ Findings from interviews shows PACE labelling appears to:
□ Increase capability in young people’s food decision making
□ influence them to avoid/reduce purchases of cakes and biscuits as they associated eating them with ‘high energy cost’.
□ Be a useful approach to help young people choose healthier food in the school environment

Question 27

qualitative interview findings for effect of PACE labelling

Answer 27

○ Mixed findings
○ Depends on individual’s own attitude, viewpoints and motivation
○ Depends on emotional experience
○ Interaction with Schools: Some concerns for potential negative impact of PACE labelling in students, which was a barrier to implementation. But qualitative findings show students have lesser concerns

• knowledge