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Traditional food marketing stimulates adolescents' consumption of energy-dense, nutrient-poor foods. These dietary behaviours may track into adulthood and lead to weight gain, obesity and related non-communicable diseases. While social media use in adolescents has proliferated, little is known about the content of food marketing within these platforms, and how this impacts adolescents' dietary behaviours. This paper aimed to obtain expert insights on factors involved in the association between social media food marketing (SMFM) and adolescent dietary behaviours, and to explore their views on key priorities, challenges and strategies for future SMFM research and policies. One-on-one semi-structured interviews (n = 17) were conducted with experts from Western Europe, Australia and North America, in the fields of public health (policy), nutrition science, social media marketing, adolescent medicine, clinical psychology, behavioural sciences, communication, food industry, social influencing, and social marketing. The experts' collective responses identified that the line between food content posted by social media users and food companies is blurred. Adolescents' processing of SMFM may be mostly implicit, involving social comparison, emotional engagement, and attaching symbolic meanings to foods. Mediating factors and adolescent-specific and SMFM-specific moderating factors potentially influencing adolescents' response to SMFM were summarized in a Social Ecological model. Experts agreed that there is limited scientific evidence on adolescent-targeted SMFM and there are no strict regulations in place to protect adolescents from unhealthy SMFM, while adolescents are active social media users who are cognitively vulnerable to implicit marketing tactics. Adolescent-targeted SMFM should be controlled by encouraging healthy food marketing or limiting junk food marketing. Also, prioritizing both quantitative research on SMFM exposure and its impact, and qualitative research to obtain adolescents’ perspectives, is crucial to advocate for regulatory changes regarding adolescent-targeted SMFM content.

Background Lunch is an important part of a healthy diet, which is essential for the development, growth and academic performance of school-aged children. Currently there is an increasing number of Dutch primary schoolchildren who are transitioning from eating lunch at home to school. There is limited knowledge about the current quality of the lunches consumed by primary schoolchildren in the Netherlands and whether there are any differences between lunches consumed at home or at school. To investigate differences in content and quality of lunches consumed by Dutch primary schoolchildren at home and at school. Methods Cross-sectional study among 363 Dutch primary schoolchildren aged 4–12 years based on the first two years of the 2012–2016 Dutch National Food Consumption Survey. Demographic characteristics were obtained through a questionnaire. Diet was assessed with two non-consecutive 24-h dietary recalls. Quality of lunches was assessed on their nutritional quality whether they fitted the nutritional guidelines. ‘Nonparametric tests were used to examine the content and quality of the lunches between place of consumption and parental educational position. Results The most consumed lunch products among primary schoolchildren were bread, dairy products and sugar-sweetened beverages. Fruit and vegetable consumption was very low. Consumption of milk and other dairy products was higher among children who eat lunch at home than children who eat lunch at school (p Conclusions The current content of the lunches consumed by Dutch primary schoolchildren leaves room for improvement, especially regarding fruit and vegetables. The statistically significantly higher consumption of sugar-sweetened beverages and lower consumption of milk and dairy products at school vs. home is worrisome, as currently more children in the Netherlands are transitioning to having lunch at school.

Health-related claims and symbols are intended as aids to help consumers make informed and healthier food choices but they can also stimulate the food industry to develop food that goes hand in hand with a healthier lifestyle. In order to better understand the role that health claims and symbols currently have and in the future potentially can have, the objective of the CLYMBOL project (“Role of health-related claims and symbols in consumer behaviour”, Grant no 311963) is to investigate consumers’ understanding of health claims and symbols, and how they affect purchasing and consumption [1]. As part of this endeavour, it is important to understand the history of use of claims and symbols in Europe. What have consumers been exposed to and how were these health-related messages used and discussed among the public? In this study, we interviewed key stakeholders across Europe about how health claims have been regulated in their country, how health symbols have been and currently are being treated, what form of monitoring there is or should be and how both health claims and symbols have been debated in the public opinion. In 26 European Union (EU) Member States, opinions from 53 key informants from up to three different stakeholder groups were gathered: national food authorities, representatives of the food industry, and consumer organisations. While 14 Member States reported (at least partial) regulation of the use of health claims and/or symbols before the introduction of the EU Regulation (EC 1924/2006) on nutrition and health claims made on foods [2], mandatory reporting of use had only been in place in three EU Member States. A number of voluntary codes of practice for health claims and/or symbols (i.e. pre-approval or justification when challenged) was said to be in use in 15 Member States. There are only a few national databases on health claims and symbols available, the data for which is often incomplete. Only eight Member States reported having some form of database from which information about health claims and symbols could be extracted. The stakeholders interviewed expressed a strong interest in measuring the impact of health claims and symbols, particularly research into the effects on consumer behaviour (e.g. awareness and understanding, attitudes towards products carrying claims and symbols and purchase/consumption effects), public health (health outcomes and changes in national health status due to the introduction of claims and symbols on food products) and economic aspects including sales, return on investment and reputation measurements. Public debates were said to have evolved around the topics of consumer understanding of claims, acceptance as well as trust in the information presented but also the effects on vulnerable groups such as children and elderly consumers. Another field of debate was said to have been the question of the effectiveness of health claims and symbols. Lastly, stakeholders reported that public debates focussed mainly on the legislative aspects, i.e. how to apply the EU Regulation (No 1924/2006) with regards to wording issues, the evaluation process at the European Food Safety Authority (EFSA), the status of various claims and the nutrient profile modelling to be introduced in Europe.

ObjectivePeople eat more unhealthy foods when served more (portion size effect) and when the food is served in larger units (unit size effect). The present study aimed to examine whether these effects can be used for the good: to increase vegetable consumption among children.DesignA 2×2 between-subjects experiment was conducted at two schools. Pupils were presented in class with cucumber that varied both in unit size (one piece v. pre-sliced) and portion size (one-third v. two-thirds of a cucumber). Children ate ad libitum during the morning break and filled in a survey.SettingPrimary schools in the centre of the Netherlands.SubjectsPrimary-school pupils (n 255) aged 8–13 years.ResultsChildren ate 54 % more cucumber when served a large compared with a smaller portion (difference of 49 g; PP=0·58), but were considered as less convenient to eat than small units (P=0·001).ConclusionsFindings suggest that children’s vegetable intake can be improved by serving larger portions in smaller-sized pieces.

There is little agreement among governments, institutions, scientists and food activists as to how to best tackle the challenging issues of health and sustainability in the food sector. This essay discusses the potential of school meals as a platform to promote healthy and sustainable food behavior. School meal programs are of particular interest for improving public diet because they reach children at a population scale across socio-economic classes and for over a decade of their lives, and because food habits of children are more malleable than those of adults. Current research on the history and health implications of school meal programs is reviewed in a cross-national comparative framework, and arguments explored that speak for the need of a new developmental phase of school meals as an integrative learning platform for healthy and sustainable food behavior. Nutritional, social, practical, educational, economical, political, and cultural perspectives and challenges linked to the implementation of healthy and sustainable school meals are discussed. Finally, the need for long-term interventions and evaluations is highlighted and new research directions are proposed.

Promoting protein consumption in the elderly population may contribute to improving the quality of their later years in life. Our study aimed to explore knowledge, perceptions and preferences of elderly consumers regarding protein-enriched food. We conducted three focus groups with independently living (ID) elderly (N¿=¿24, Mage¿=¿67¿years) and three with elderly living in a residential home (RH) (N¿=¿18, Mage¿=¿83¿years). Both the ID and RH elderly were predominantly sceptical about functional food in general. Confusion, distrust and a perceived lack of personal relevance were main perceived barriers to purchasing and consuming these products, although a majority of the participants did report occasionally consuming at least one type of functional food. For the ID elderly, medical advice was an important facilitator that could overcome barriers to purchasing and consuming protein-enriched food, indicating the importance of personal relevance for this group. For the RH elderly, in contrast, sensory appeal of protein-enriched foods was a facilitator. Carrier preferences were similar for the two groups; the elderly preferred protein-enriched foods based on healthy products that they consumed frequently. Future studies should explore ways to deal with the confusion and distrust regarding functional food within the heterogeneous population of elderly. Keywords Focus group; Protein; Functional food; Senior; Distrust; Personal relevance

Objective: What predicts whether a child will be at risk for obesity? Whereas past research has focused on foods, eating habits, feeding styles, and family meal patterns, this study departs from a food-centric approach to examine how various dinner rituals might influence the BMIs of children and adults. Methods: In this study of 190 parents (BMI529.167.2) and 148 children (BMI520.364.4), the relationship between their BMIs and everyday family dinner rituals was examined using both correlation and regression analysis (controlled for educational level of parents). Results: Families who frequently ate dinner in the kitchen or dining room had significantly lower BMIs for both adults (r520.31) and children (r520.24) compared to families who ate elsewhere. Additionally, helping cook dinner was associated with higher BMI for girls (r50.26), and remaining at the table until everyone is finished with eating was associated with lower BMI for boys (r520.31). Conclusions: Dinner tables may be one place where social support and family involvement meet—both of which relate to the BMI of children as well as parents. Family meals and their rituals might be an underappreciated battleground to fight obesity.

Research in developed countries showed that many citizens perceive that radio signals transmitted by mobile phones and base stations represent potential health risks. Less research has been conducted in developing countries focused on citizen perceptions of risks and benefits, despite the recent and rapid introduction of mobile communication technologies. This study aims to identify factors that are influential in determining the tradeoffs that Bangladeshi citizens make between risks and benefits in terms of mobile phone technology acceptance and health concerns associated with the technology. Bangladesh was selected as representative of many developing countries inasmuch as terrestrial telephone infrastructure is insubstantial, and mobile phone use has expanded rapidly over the last decade, even among the poor. Issues of importance were identified in a small-scale qualitative study among Bangladeshi citizens (n = 13), followed by a survey within a sample of Bangladeshi citizens (n = 500). The results demonstrate that, in general, the perceived benefits of mobile phone technology outweigh the risks. The perceived benefits are primarily related to the social and personal advantages of mobile phone use, including the ability to receive emergency news about floods, cyclones, and other natural disasters. Base stations were seen as a symbol of societal advance. The results furthermore suggest that overall risk perceptions are relatively low, in particular health risks, and are primarily driven by perceptions that related to crime and social inconvenience. Perceived health risks are relatively small. These findings show that risk communication and management may be particularly effective when contextual factors of the society where the system is implemented are taken into consideration.

In European countries, there has been growing consumer distrust regarding the motives of food safety regulators and other actors in the food chain, partly as a result of recent food safety incidents. If consumer confidence in food safety is to be improved, a systematic understanding of what consumers perceive to be best practice in risk management is crucial. Previous qualitative and quantitative research has revealed underlying factors determining consumer perceptions of food risk management quality. The aim of the current case studies is to provide `proof of principles¿ of these different factors against historic and emerging food safety incidents. Participants in four countries were questioned about country specific case studies, guided by the earlier findings regarding factors that determine perceived good practice in food risk management. In each country, two food safety incidents were selected. Semi-structured interviews with at least 25 participants per case study were conducted in Germany (BSE; nematode worms in fish), Greece (mould in Greek yogurt/carcinogenic honey crisis; avian influenza), Norway (E. coli in meat; contaminants in Norwegian salmon) and the UK (BSE; contaminants in Scottish salmon). The results generally confirm the importance of the previously identified factors, which help to explain relative perceptions of well and poorly managed incidents. Differences and similarities across countries and cases are detailed, and implications for future efforts to communicate about risk management are drawn. Keywords: food safety; consumer evaluations; food risk management; trust; food safety incidents

Recent emphasis within policy circles has been on transparent communication with consumers about food risk management decisions and practices. As a consequence, it is important to develop best practice regarding communication with the public about how food risks are managed. In the current study, the provision of information about regulatory enforcement, proactive risk management, scientific uncertainty and risk variability were manipulated in an experiment designed to examine their impact on consumer perceptions of food risk management quality. In order to compare consumer reactions across different cases, three food hazards were selected (mycotoxins on organically grown food, pesticide residues, and a genetically modified potato). Data were collected from representative samples of consumers in Germany, Greece, Norway and the UK. Scores on the "perceived food risk management quality" scale were subjected to a repeated-measures mixed linear model. Analysis points to a number of important findings, including the existence of cultural variation regarding the impact of risk communication strategies-something which has obvious implications for pan-European risk communication approaches. For example, while communication of uncertainty had a positive impact in Germany, it had a negative impact in the UK and Norway. Results also indicate that food risk managers should inform the public about enforcement of safety laws when communicating scientific uncertainty associated with risks. This has implications for the coordination of risk communication strategies between risk assessment and risk management organizations.

Inadequate regulation of food intake plays an important role in the development of overweight and obesity, and is under the influence of both the internal appetite control system and external environmental cues. Especially in environments where food is overly available, external cues seem to override and/or undermine internal signals, which put severe challenges on the accurate regulation of food intake. By structuring these external cues around five different phases in the food consumption process this paper aims to provide an overview of the wide range of external cues that potentially facilitate or hamper internal signals and with that influence food intake. For each of the five phases of the food consumption process, meal initiation, meal planning, consumption phase, end of eating episode and time till next meal, the most relevant internal signals are discussed and it is explained how specific external cues exert their influence.

Elderly face an increased risk of nutritional deficiencies due to reduced appetites and increased nutritional needs. The development of appealing enriched functional foods holds a great potential for improving the nutritional status of this group of consumers. However, the elderly population is strongly heterogeneous, which poses a challenge to fulfilling their nutritional needs. Therefore, this study aimed to illustrate and examine the heterogeneity in elderly consumers’ acceptance of carriers for enrichment. In an online survey, respondents (N = 303, Mage = 66.9) were asked to rate their willingness to trial purchase a set of carriers enriched with protein, that varied systematically in terms of healthiness (healthy vs. unhealthy), novelty (novel vs. traditional), and meal type (meal component vs. snack). Overall, respondents reported low willingness to purchase protein-enriched foods and indicated that they preferred to consume more protein-rich conventional foods, should they need to increase their protein intake. The identification of heterogeneity in carrier acceptance, especially regarding product novelty and meal type, suggested that there was room for improvement in product acceptance. Indeed, willingness to trial and repeat purchase protein-enriched carriers were considerably higher for product formats that were tailored to six subgroup of respondents. These findings underline the merits of taking heterogeneity into account when commercialising functional foods among elderly. Future studies may want to look into additional ways to reduce scepticism among elderly regarding the use of enriched food.

Internal and external preference analysis emphasise fundamentally different perspectives on the same data. We extend the literature on comparisons between internal and external preference analysis by incorporating the perspective of the end user of the preference analysis results. From a conceptual analysis of the methodological similarities and differences between these two techniques, we develop and implement a framework for end-user evaluation of preference analysis output in terms of perceived actionability for food technology, marketing and creative purposes as well as comprehensibility and perceived appropriateness at the marketing–R&D interface. Overall, this exploratory study suggests that end-users find information from external analysis more actionable for food technological tasks. Internal preference analysis holds a clear advantage on marketing actionability and new product creativity. No preference technique holds a clear advantage on marketing–R&D interface appropriateness and comprehensibility. Rather than recommending applying both techniques, we suggest several ways forward in better exploiting the synergy between these two approaches.

In designing and implementing appropriate food risk management strategies, it is important to examine how key stakeholders perceive both the practice and effectiveness of food risk management. The objective of this study is to identify similarities and differences in perceptions of, and attitudes to, food risk management practices held by consumers and experts with an interest in food safety. Focus groups were conducted in five European countries chosen for their (hypothesised) cultural differences in attitudes towards risk: Denmark, Germany, Greece, Slovenia and the UK. Content analysis was carried out on the resulting texts and (sub) categories were identified within the analysis framework to facilitate the capture of emerging themes. Five key themes were identified as common to the perceptions of both consumers and experts, although these are not represented in the same way by both groups. These key themes are: (1) efforts made by the responsible authorities to manage food risks; (2) responsibility for prevention and management of food risks; (3) how priorities are established within regulatory systems; (4) scientific progress and its implications for food risk management; and (5) media attention and food safety incidents. Although some similarities emerged between the groups, differences were also identified. For example, experts appeared to be highly negative about media influences, whereas consumers appeared more indifferent about media influences and motives. These different perspectives need to be addressed in order to reduce the perceptual distance between key stakeholders, and in particular, to enhance consumer confidence in the food risk management system. Based on the study findings, recommendations for food risk management policies are outlined.

Incorporating the `voice of the consumer' in early stages of the new product development process has been identified as a critical success factor for new product development. Yet, this step is often ignored or poorly executed. This may be due to lack of familiarity on which methods are available, the use of disciplinary terminology, and difficulty in accessibility of papers on this subject. This paper reviews and categorises 10 of the most common methods in this area, in terms of what their key features are, and what strengths, weaknesses and appropriateness are. We develop a classification scheme based on three performance dimensions with specific criteria: (1) stimuli used as cue for need elicitation, (2) task format, and (3) need actionability. We provide guidelines for the appropriateness of these methods in the new product development process based on the newness strategy of the development process (radical versus incremental innovation) and identify which functional department (marketing versus R&D) the method should primarily support.

Two studies are reported, which aim to strengthen the scientific underpinning of strategic decisions regarding functional food development, as to (1) which health benefits to claim, (2) with which product (category), and (3) in which communication format. The first exploratory study is a secondary analysis of 10 different health claims systematically combined with 10 different food carriers to evaluate their combined suitability for functional food positioning. The results show that consumers tend to prefer functional food concepts that primarily communicate disease-related health benefits in carriers with a healthy image or health positioning history. Study 2 examines health claim format and systematically varies the way in which specific health benefits are being communicated to the consumer. Two physiologically oriented claims (heart disease and osteoporosis) and two psychologically oriented food claims (stress and lack of energy) are expressed in enhanced function format versus disease risk reduction format. Also, it includes the individual difference variable of 'regulatory focus' and the health status of the respondent to explore how these factors impact health claim evaluation. The results show that consumer evaluations primarily differ to the extent that health claims are personally relevant in addressing an experienced disease state. Framing is important, but its effect differs by health benefit. No strong effects for consumers' regulatory focus were found. Underlying mechanisms of these effects and their implications for the development of functional foods are discussed.

Food innovation can have its source in either superior understanding of consumer demand (pull) or in superiority at the supply side (science and technology push). However, in either case market success depends on the degree to which the new product reflects unmet consumer needs. The present study provides a framework, which allows to obtain relevant consumer and expert input in the early stages of functional food development. By systematically generating and rigorously screening a large set of functional food concepts both inside (functional food experts) and outside (consumers) the company, the framework prevents that high potential opportunities are overlooked. This in turn provides a platform for product developers to discuss and decide upon which opportunities to pursue. The illustration of the framework shows the extent to which expert judgements are an accurate reflection of consumer demand.

It is beneficial for both the public health community and the food industry to meet nutritional needs of elderly consumers through product formats that they want. The heterogeneity of the elderly market poses a challenge, however, and calls for market segmentation. Although many researchers have proposed ways to segment the elderly consumer population, the elderly food market has received surprisingly little attention in this respect. Therefore, the present paper reviewed eight potential segmentation bases on their appropriateness in the context of functional foods aimed at the elderly: cognitive age, life course, time perspective, demographics, general food beliefs, food choice motives, product attributes and benefits sought, and past purchase. Each of the segmentation bases had strengths as well as weaknesses regarding seven evaluation criteria. Given that both product design and communication are useful tools to increase the appeal of functional foods, we argue that elderly consumers in this market may best be segmented using a preference-based segmentation base that is predictive of behaviour (for example, attributes and benefits sought), combined with a characteristics-based segmentation base that describes consumer characteristics (for example, demographics). In the end, the effectiveness of (combinations of) segmentation bases for elderly consumers in the functional food market remains an empirical matter. We hope that the present review stimulates further empirical research that substantiates the ideas presented in this paper.

Nutrition related diseases such as some cancers, heart diseases and obesity belong to the most challenging health concerns of our time. Communicating intuitive and simple nutrition information by means of front-of-pack nutrition profile signposting labelling is increasingly seen as an essential tool in efforts to combat unhealthy food choices and improve public health. Consequently, much attention in policy and research is given to nutrient profiling methods and the determination of optimal nutrition criteria. Although consumer research on nutrition signpost labelling is now gradually appearing in the literature, the value and meaning of these labelling systems for consumers have received less attention. In the current debate a concise overview is lacking of the consumer perspective including relevant psychological phenomena in relation to much debated controversies surrounding these labels and their further development, such as the most effective type of signposting labelling system and varying stakeholder interests. Therefore, this paper aims to critically review the literature in the consumer domain of front-of-pack nutrition labelling in order to illustrate the strengths and weaknesses of this form of nutrition education from a consumer perspective.

Background: Many children do not eat enough whole grains, which may have negative health consequences. Intervention research is increasingly focusing on nudging as a way to influence food choices by affecting unconscious behavioural processes. The aim of this field study was to examine whether the shape of bread rolls is able to shift children’s bread choices from white to whole wheat during breakfast to increase whole grain intake. Methods: In a between-subjects experiment conducted at twelve primary schools in the Netherlands, with school as the unit of condition assignment, children were exposed to an assortment of white and whole wheat bread rolls, both varying in shape (regular versus fun). Children were free to choose the type and number of bread rolls and toppings to eat during breakfast. Consumption of bread rolls was measured at class level via the number of bread rolls before and after breakfast. In addition, children (N = 1113) responded to a survey including questions about the breakfast. Results: Results of the field experiment showed that about 76% of bread consumption consisted of white bread rolls. Consumption of white bread rolls did not differ according to shape (all P-values > 0.18). However, presenting fun-shaped whole wheat bread rolls almost doubled consumption of whole wheat bread (P = 0.001), particularly when the simultaneously presented white bread rolls had a regular shape (interaction P = 0.02). Survey results suggest that slight increases in perceived pleasure and taste are associated with these effects. Conclusions: Overall, presenting whole wheat bread in fun shapes may be helpful in increasing consumption of whole wheat bread in children. Future research could examine how improving the visual appeal of healthy foods may lead to sustained behaviour changes. Keywords: Nudge, Nudging, Whole grain, Whole-wheat bread, Children’s food preferences, Bread shape, Visual appeal

Background The essence of nudging is to adapt the environment in which consumers make decisions to help them make better choices, without forcing certain outcomes upon them. To determine how consumers can effectively be guided to select healthier snacks, we examine the effect of manipulating the assortment structure and shelf layout of an impulse display including both healthy and unhealthy snacks near the checkout counter of a canteen. Methods Both a lab and field study applied a two-factor experimental design manipulating snack offerings both in an on-screen choice environment and a natural environment (hospital staff restaurant). Shelf arrangement (i.e. accessibility) was altered by putting healthy snacks at higher shelves versus lower shelves. Assortment structure (i.e. availability) was altered by offering an assortment that either included 25% or 75% healthy snacks. Participants in the lab study (n = 158) made a choice from a shelf display. A brief survey following snack selection asked participants to evaluate the assortment and their choice. The field experiment took place in a hospital canteen. Daily sales data were collected for a period of four weeks. On completion of the field study, employees (n = 92) filled out a questionnaire about all four displays and rated their attractiveness, healthiness and perceived freedom of choice. Results The lab study showed a higher probability of healthy snack choice when 75% of the assortment consisted of healthy snacks compared to conditions with 25% healthy snack assortments, even though choices were not rated less satisfying or more restrictive. Regarding shelf display location of healthy snacks, no significant differences were observed. There was also no significant shelf arrangement by assortment structure interactive effect. The field study replicated these findings, in that this assortment structure led to higher sales of healthy snacks. Sales of unhealthy and total snacks were not impacted by manipulations (no main or interaction effects). Employees preferred shelf displays including a larger healthy snack assortment located at top shelves. Employees also felt more freedom in choice when healthy snacks were displayed at top shelves compared to lower shelves. Conclusions Overall, results suggest that increasing the prominence of healthy snacks by enlarging their availability, while permitting access to unhealthy snacks, is a promising strategy to promote sales. These results point to the importance of nudging strategies to encourage healthier snack patterns.

Background Past research has shown that promotional messages such as food advertising influence food consumption. However, what has gone largely unexplored is the effect of exercise advertising on food intake. This study experimentally tested the effects of exposure to exercise commercials on food intake at a lunch meal as compared to the effects of control commercials. Methods Prior to eating lunch, 125 participants (71 women, 54 men) watched 8 commercials, either all related to exercise or fitness (n = 67) or neutral products (i.e. car insurance) (n = 58). The meal consisted of a pasta dish with tomato sauce, salad and chocolate pudding. The post-lunch questionnaire included questions about body mass index, exercise habits, motivation and dietary restraint. Results Participants exposed to exercise commercials reduced their caloric intake by 21.7% relative to the control condition. Additionally, watching exercise messages increased the perceived healthiness and liking of the meal. Although exercise habits and intentions did not moderate the effect of commercial condition on food intake, we also found that this intake reduction was driven by participants with higher body mass index levels. Conclusions These results imply that exercise messages may serve as a reminder of the link between food and physical activity and affect food consumption. It also highlights the need for increased awareness that these messages have powerful influences not only on exercise behavior, but also on closely related behaviors such as eating.

ObjectiveIn light of the emerging obesity pandemic, front-of-pack calories labels may be an important tool to assist consumers in making informed healthier food choices. However, there is little prior research to guide key decisions on whether caloric content should be expressed in absolute terms or relative to recommended daily intake, whether it should be expressed in per serving or per 100 g and whether the information should be further brought alive for consumers in terms of what the extra calorie intake implies in relation to activity levels. The present study aimed at providing more insight into consumers’ appreciation of front-of-pack labelling of caloric content of food products and their specific preferences for alternative execution formats for such information in Europe.DesignFor this purpose, eight executions of front-of-pack calorie flags were designed and their appeal and information value were extensively discussed with consumers through qualitative research in four different countries (Germany, The Netherlands, France and the UK).ResultsThe results show that calories are well-understood and that participants were generally positive about front-of-pack flags, particularly when flags are uniform across products. The most liked flags are the simpler flags depicting only the number of calories per serving or per 100 g, while more complex flags including references to daily needs or exercise and the flag including a phrase referring to balanced lifestyle were least preferred. Some relevant differences between countries were observed. Although participants seem to be familiar with the notion of calories, they do not seem to fully understand how to apply them.ConclusionFrom the results, managerial implications for the design and implementation of front-of-pack calorie labelling as well as important directions for future research are discussed.

Background: Sufficient protein intake among hospitalized patients may contribute to faster recovery and a decrease in healthcare costs. Nevertheless, hospitalized patients are often found to consume too little protein. This field study explored the success of a small, inexpensive intervention adapted from the marketing literature, to encourage protein consumption among hospitalized patients. Methods: The study was performed at a hospital where patients order food by calling to the meal service. The intervention consisted of a verbal prompt: “Would you like some [target product] with that?”, which was presented to patients by trained telephone operators, after patients finished ordering their lunch. Target products were two foods rich in protein; fruit quark and yoghurt drink. For half of the patients, the verbal prompt was preceded by verbal praise on their lunch order, which was aimed to increase compliance with the verbal prompt. Results: Three hundred and fifteen hospitalized patients, aged 18–87 years took part in the study. Verbal prompts significantly increased ordering of the target products nearly sevenfold (from ordering by 6.5 % of patients to 45.2 % of patients). Protein content of ordered lunch and all food orders of the day combined showed a trend, with orders of patients receiving only a verbal prompt or a verbal prompt and verbal praise containing a larger amount of protein than lunch orders of patients in the control condition. At an individual level, protein content of ordered food increased significantly, reaching the 25–30 g of protein per main meal recommended by dieticians of the hospital. Verbal praise did not increase compliance with the verbal prompt. Patients consumed most or all of the target product and verbal prompts were not perceived to be obtrusive. Conclusions: Although changing eating patterns is challenging, this study shows that simple interventions such as verbal prompts may be useful tools for health professionals to stimulate healthy food consumption among patients during hospitalization. Keywords: Protein, Prompt, Hospital, Field study, Praise