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Food is one of the key themes in public health policy and debates over inequalities in health. In this article, we argue that more research is needed to understand how socioeconomic disadvantage is translated into low degrees of healthiness. We suggest that everyday life analysis may be sharpened by way of drawing upon a practice-theoretical perspective on the mundane processes involved in this translation. We base our suggestion on a small review of three strands in the literature on social inequality, food and health, namely public health research, lifestyle analysis and everyday life studies, and we take our analytical starting point in the latter. In the article, we argue that a practice-theoretical perspective may enable research in social disadvantage and healthiness of food that describes and interprets variants in the conditioned agency, which cuts cross the multiplicity of different practices that make-up people's daily lives. Finally, we suggest that a stronger focus on social interaction and social hierarchy would adapt a practice-theoretical perspective further to empirical analysis in the field of food, health and socioeconomic disadvantage.

Time-restricted eating (TRE)1 has been conceptualised as a strategy for achieving weight loss and improving metabolic health, but limited knowledge exists about how people can maintain TRE in daily life. This study examined how TRE was maintainable in daily life after a three-month intervention (the RESET study) in which participants were encouraged to consume all food and beverages except water within a 10-h daily window. Specifically, we examined TRE maintenance patterns across participants, including drivers and challenges for maintenance success. A qualitative longitudinal study was conducted, and twenty participants with overweight at high risk of type 2 diabetes were interviewed using a semi-structured interview guide at the end of the intervention and after a three-month follow-up period. Data were analysed longitudinally in two steps inspired by a pattern-oriented longitudinal analysis approach. Seven participants maintained a strict 10-h window, ten maintained an adjusted TRE regimen (e.g., taking days off), and three did not attempt maintenance. Maintenance drivers included consistent daily rhythms and regular meal patterns, subjective experiences (e.g., feeling healthier), making flexible adjustments to the TRE regimen, family support and avoiding feelings of guilt. Maintenance challenges included social evening events, inconsistent daily rhythms and eating patterns, preoccupation with losing weight, lack of family support and self-blame. TRE was manageable for most participants; however, personalised support for adjusting TRE to daily life is needed to ensure long-term maintenance. Future studies should explore the effectiveness of a personalised TRE concept to determine the usefulness of TRE in real-life settings.

Background: Effective weight loss maintenance interventions are a key factor to lower the risk of type 2 diabetes (T2D), and time-restricted eating (TRE) is a novel strategy which has proven successful in obtaining a weight loss in a few studies. This study examined if people with overweight or obesity at high risk of T2D were able to maintain TRE in real-life settings. Methods: Participants were recruited from the randomized controlled RESET study, an RCT investigating effects of TRE on body weight and other cardiometabolic risk factors. Semi-structured interviews were conducted with a subgroup of 20 participants allocated to 12 weeks of TRE (i.e., consuming all foods and beverages within a 10-h window). The intervention was followed by a 12-week follow-up period with no intervention. All participants were interviewed at the end of intervention and again at 12-week follow-up. Data were analyzed using a thematic analysis approach. Result: Participants had a positive attitude towards TRE, and seven wished to maintain it stringently during the follow-up period. Half of the participants wished to maintain an individually adjusted TRE concept by e.g., drinking coffee outside the interval or exceeding it at social events. Some participants found it easy to maintain TRE stringently, while two struggled to do so. A few participants were able to maintain their individually adjusted TRE concept, while seven found it too intrusive. Particularly the degree of daily life structure, meal pattern organization and social support determined maintenance success. The three remaining participants chose not to maintain TRE in the follow-up period and experienced a relief when going back to usual rhythms. Conclusion: Elements from the TRE concept were highly valued by most participants, but it often required individual adjustments in order to undertake TRE on a longer-term basis. A tailored fit to daily life activities is therefore crucial to maintain TRE which underlines the complexity of long-term maintenance. Disclosure N. Bjerre: None. L. Holm: None. J. S. Quist: None. K. Færch: Board Member; Self; ChemoMetec, Research Support; Self; Novo Nordisk Foundation, Stock/Shareholder; Self; Novo Nordisk A/S. N. F. Hempler: None. Funding Novo Nordisk Foundation; Helsefonden (20-B-0109)

Purpose: Bariatric surgery may shift food preferences towards less energy-dense foods. Eating behavior is multifactorial, and the mechanisms driving changes in food preferences could be a combination of a physiological response to surgery and social and psychological factors. This exploratory study aimed to identify potential factors explaining the variation in changes in food preferences after bariatric surgery. Materials and methods: Physiological, social, and psychological data were collected before, 6 weeks or 6 months after surgery. All variables were analyzed in combination using LASSO regression to explain the variation in changes in energy density at an ad libitum buffet meal 6 months after bariatric surgery (n=39). Results: The following factors explained 69% of the variation in changes in food preferences after surgery and were associated with more favorable changes in food preferences (i.e., a larger decrease in energy density): female gender, increased secretion of glicentin, a larger decrease in the hedonic rating of sweet and fat and a fatty cocoa drink, a lower number of recent life crises, a low degree of social eating pressure, fulfilling the diagnostic criteria for binge eating disorder, less effort needed to obtain preoperative weight loss, a smaller household composition, a lower degree of self-efficacy and a higher degree of depression, nutritional regime competence, and psychosocial risk level. Conclusion: Factors explaining the variation in altered food preferences after bariatric surgery not only include a physiological response to surgery but also social and psychological factors. Graphical Abstract: [Figure not available: see fulltext.]

Different framings of food may shape food policies and their impact. Despite acknowledging food systems’ complexities, the European Commission’s Farm to Fork Strategy still addresses food as a commodity instead of a human right or common good. A report from the Group of Chief Scientific Advisors (GCSA) to the European Commission recently concluded that the path to a more sustainable food system requires “moving from food as a commodity to food as [more of] a common good”1. This implies the need for deep reforms in food policy that touch upon every part of the food system. The GCSA’s advice was informed by an Evidence Review Report (ERR)2 that was conducted independently to ensure academic rigour and prevent claims of political bias., We acknowledge the administrative support and guidance provided by C. Tschirhart as Lead Scientific Policy Officer for the Evidence Review Report on which this paper is based. The Report was produced under the auspices of the Science Advice for Policy by European Academies (SAPEA) consortium, under Grant Agreement 737432 ‘Science Advice for Policy by European Academies’, signed by the consortium and the European Commission on 22 November 2016.

Bariatric surgery may shift food preferences towards less energy-dense foods. Eating behavior is multifactorial, and the mechanisms driving changes in food preferences could be a combination of a physiological response to surgery and social and psychological factors. This exploratory study aimed to identify potential factors explaining the variation in changes in food preferences after bariatric surgery.Physiological, social, and psychological data were collected before, 6 weeks or 6 months after surgery. All variables were analyzed in combination using LASSO regression to explain the variation in changes in energy density at an ad libitum buffet meal 6 months after bariatric surgery (n=39).The following factors explained 69% of the variation in changes in food preferences after surgery and were associated with more favorable changes in food preferences (i.e., a larger decrease in energy density): female gender, increased secretion of glicentin, a larger decrease in the hedonic rating of sweet and fat and a fatty cocoa drink, a lower number of recent life crises, a low degree of social eating pressure, fulfilling the diagnostic criteria for binge eating disorder, less effort needed to obtain preoperative weight loss, a smaller household composition, a lower degree of self-efficacy and a higher degree of depression, nutritional regime competence, and psychosocial risk level.Factors explaining the variation in altered food preferences after bariatric surgery not only include a physiological response to surgery but also social and psychological factors.

Time-restricted eating (TRE) is a novel intervention that allows eating and drinking within a certain time window and has shown positive effects on body weight in few studies. Weight loss strategies that easily can be integrated into daily life are needed, but knowledge about how TRE affects daily life is lacking. This study examined how individuals having overweight or obesity at high risk of type 2 diabetes performed TRE in daily life, with a focus on how the timing of eating changed the organisation and rhythms of daily activities. Semi-structured interviews were conducted with participants enrolled in a randomised controlled trial studying the effect of a 12-week TRE intervention focusing on a self-selected daily 10-h window between 6 AM and 8 PM. Seventeen participants from the intervention group were interviewed at baseline and end of intervention, and data were analysed using a thematic analysis approach. Participants found TRE simple and appealing due to the unrestricted dietary intake. In general, participants did not change their food preferences and continued to eat three main daily meals. However, participants had to increase their awareness of the time of day, reshuffle ordinary daily activities and plan their intake more carefully. Two participants reported fully adherence every day, whereas all other participants reported one to several episodes of intake outside their window during the 12 weeks. Social evening activities and collective rhythms were largest barriers. Our findings suggest that TRE interventions would benefit from a broader perspective on daily life and an expanded view on families and friends as joint units of intervention. TRE interventions should consider individuals' daily rhythms and help them develop practical solutions to integrating new eating practices.

PurposeThis paper aims to present an analysis of the various dimensions of naturalness that shape the consumption practices of parents with young children.Design/methodology/approachThe study builds on semi-structured interviews with 17 mothers and fathers focusing on parental decision-making in everyday consumption from pregnancy to the first years of the child’s life.FindingsNaturalness is a tool allowing parents to navigate in a world of risks and part of an everyday consumption practice that constructs and maintains children as vulnerable and parents as responsible. Parents perceive naturalness as something with three dimensions: familiarity, purity and culture. These three dimensions lead to different parental practices around consumption.Originality/valueThe analysis contributes to the authors’ understanding of parenting, childhood, risk, safety and consumption by showing how and why parents of young children construct naturalness as a three-dimensional ideal in their consumption practices. PurposeThis paper aims to present an analysis of the various dimensions of naturalness that shape the consumption practices of parents with young children.Design/methodology/approachThe study builds on semi-structured interviews with 17 mothers and fathers focusing on parental decision-making in everyday consumption from pregnancy to the first years of the child’s life.FindingsNaturalness is a tool allowing parents to navigate in a world of risks and part of an everyday consumption practice that constructs and maintains children as vulnerable and parents as responsible. Parents perceive naturalness as something with three dimensions: familiarity, purity and culture. These three dimensions lead to different parental practices around consumption.Originality/valueThe analysis contributes to the authors’ understanding of parenting, childhood, risk, safety and consumption by showing how and why parents of young children construct naturalness as a three-dimensional ideal in their consumption practices.

This study builds on a fieldwork in a Danish school class, where pupils were observed while preparing and eating school meals. It shows that the children encounter conflicting approaches to food education depending on the context. While eating, an authoritarian approach to food education dominates and food is ascribed instrumental value. While preparing the school meal, a democratic approach dominates and food is ascribed intrinsic value. The aim is to show how these conflicting approaches reflect not only different social and cultural expectations to eating and preparing meals, respectively, but also a conflict between food educational ideals and actual school meal practices. To illustrate this an analytic model is introduced, the Integrated Food Pedagogy Model, and the ways in which this model could help promote better food education among schoolchildren are discussed.

This paper explores the productive tensions occurring in an interdisciplinary research project on weight loss after obesity surgery. The study was a bio-medical/anthropological collaboration investigating to what extent eating patterns, the subjective experience of hunger and physiological mechanisms are involved in appetite regulation that might determine good or poor response to the surgery. Linking biomedical and anthropological categories and definitions of central concepts about the body turned out to be a major challenge in the collaborative analysis. Notably, the conception of what constitutes 'appetite' was a key concern, as each discipline has its particular definition and operationalization of the term. In response, a material-semiotic approach was chosen which allowed for a reconceptualization of appetite as a 'fractional object', engaged in multiple relations and enacted differently in each instance. This perspective produced creative contrasts and offered alternative explorations of both scientific knowledge production and anthropological practices. The paper thereby explores the interfaces between anthropology and medical science by attending to the challenges and opportunities that result from destabilising an assumed fixed and well-defined concept associated with the body.

In countries with wide income differentials, food insecurity leads to substantial changes in everyday food practices and to poor dietary and mental health. Less is known about consequences of food budget pressure in affluent populations and in social-democratic welfare societies with narrower income differentials. This paper describes relations between pressure on household food budgets and demographic factors in Denmark. It asks how budgetary constraint relates to life satisfaction and dietary health and how these relationships are affected when people adapt their food practices to manage pressure on budgets. Data from a representative 2015 survey of Danish households are employed. Levels of food budget pressure vary with income and household composition and are negatively associated with life satisfaction and dietary health. We find a sequence of food practice adaptations where changes in food quality and hospitality, and seeking external help were being made when adjustments to food provisioning and kitchen practices were proving to be insufficient. We conclude that in affluent social-democratic welfare societies pressure on food budgets also has negative impacts on life satisfaction and health. Food budget pressure should be monitored in the future and addressed in public health policy. In countries with wide income differentials, food insecurity leads to substantial changes in everyday food practices and to poor dietary and mental health. Less is known about consequences of food budget pressure in affluent populations and in social-democratic welfare societies with narrower income differentials. This paper describes relations between pressure on household food budgets and demographic factors in Denmark. It asks how budgetary constraint relates to life satisfaction and dietary health and how these relationships are affected when people adapt their food practices to manage pressure on budgets. Data from a representative 2015 survey of Danish households are employed. Levels of food budget pressure vary with income and household composition and are negatively associated with life satisfaction and dietary health. We find a sequence of food practice adaptations where changes in food quality and hospitality, and seeking external help were being made when adjustments to food provisioning and kitchen practices were proving to be insufficient. We conclude that in affluent social-democratic welfare societies pressure on food budgets also has negative impacts on life satisfaction and health. Food budget pressure should be monitored in the future and addressed in public health policy.

Background: Bariatric surgery leads to a substantial weight loss (WL), however, a subset of patients undergoing surgery fails to achieve adequate WL. The reason for the individual variation in WL remains unexplained. Using an exploratory cross-disciplinary approach, we aimed to identify preoperative and early postoperative factors explaining the variation in WL after bariatric surgery. Methods: Sixty-one subjects were recruited. Eighteen subjects did not receive surgery and three subjects dropped out, leaving a total sample of 40 subjects. Physiological, social, and psychological data were collected before and 6 months after surgery. All variables were analyzed in combination using a least absolute shrinkage and selection operator (LASSO) regression to explain the variation in WL 18 months after Roux-en-Y gastric bypass (n = 30) and sleeve gastrectomy (n = 10). Results: Mean WL was 31% (range: 10–52%). The following preoperative factors predicted 59% of the variation in WL: type of surgery (14%), diabetes status (12%), economic resources (9%), sex (7%), binge eating disorder (7%), degree of depression (5%), household type (3%), and physical activity (1%). Including information on early responses after surgery increased the ability to predict WL to 78% and was explained by early WL (47%), changes in energy density of food consumed from a buffet meal (9%), changes in glicentin (5%), degree of depression (5%), sex (5%), type of surgery (2%), economic resources (2%), and changes in drive for thinness (1%). Conclusions: Using a cross-disciplinary approach, a substantial part of the individual variation in WL was explained by a combination of basic patient characteristics, psychological profile, and social conditions as well as physiological, psychological and behavioral responses to surgery. These results suggest that patient characteristics collected in a cross-disciplinary approach may help determine predictors for less successful WL after bariatric surgery. If verified in larger cohorts this may form the basis for individualized postoperative support to optimize WL outcome.

The aim was to construct and validate a cost-efficient index to measure GHG emissions (GHGe) caused by Danish consumers’ diets to be employed in questionnaire-based surveys. The index was modelled on the basis of actual food purchase data from a panel of ordinary Danish households and a questionnaire consisting of food frequency questions issued to the same panel. Based on the purchase data, diet-related GHGe were calculated for 2012. The data was then split into a learning sample and a validation sample. The index was constructed using the learning sample where a scoring procedure was calculated from responses to the questionnaire-based food frequency questions that predicted diet-related GHGe. Subsequently, the index scoring procedure was employed on the validation sample and the empirical relevance of the index was examined. In the learning sample, a scoring procedure to construct the index was developed on basis of 13 food frequency questions. In the validation sample, the index accounted for considerable variation in diet-related GHGe. Furthermore, the index was associated with the same socio-demographic and attitudinal factors as identified with calculated diet-related GHGe using food purchase data. Surprisingly, in this analysis, people’s sense of obligation to do something about global warming did not lead to decreased GHGe. Higher social status and gastronomic interest, meanwhile, led to increased GHGe. The index can be used in future questionnaire surveys as a cost-efficient way to estimate diet-related GHG emissions of Danish consumers. Since the index is responsive to relevant socio-demographic and attitudinal factors, it can be utilised to monitor key attitudinal/habitual and socio-demographic drivers of change.

In this paper we investigate how children respond to a new type of school meal and ask whether classmates affect meal evaluations. The study is part of a school meal intervention which tested health effects of the New Nordic Diet. Over two separate three-month periods 834 pupils (age 8–11) from 9 schools (46 classes) were given either meals based on the Nordic diet or their usual packed lunch. The children rated their regular lunch packs and the Nordic meals on a five-point smiley scale when they reported their lunch intake. Ratings were done at home by the child, alone or with the help of a parent. The results show that the classmates influenced children’s ranking of a new type of school meal but did not influence rankings of familiar lunch packs. These results are important not only because they add to our knowledge of the social dimension of liking, but also because they show that we should attend to social mechanisms when implementing new health-promoting food initiatives among children in schools.

By tradition, family meals are seen as a cornerstone in family life, an arena for child socialization, and for building and confirming intimate bonds between family members. In public debate, the fate of family meals has been a concern, as, in modern times, family members increasingly spend their time outside the household in separate spheres of work, school, and institutions. However, empirical research shows that also in current modern households, family meals are a priority. Still, the way family meals are practiced may have undergone change. This chapter discusses family meals as a proper context for eating in families. It also presents an analysis of the frequency and conduct of family meals in modern households. The analysis was conducted in Denmark, an affluent country with high female participation in the workforce. The data come from a project on modern meal patterns that is based on almost identical surveys conducted in 1997 and 2012 in four Nordic countries.

Rising food prices and changes in the world economy currently affect not only low-income populations, but also relatively privileged population groups. On the basis of a qualitative interview study this article investigates how Danish households with different income levels, educational levels and household composition experience and cope with constraints on their household food budgets. The analysis draws on Zygmunt Bauman’s framework of thought, centering especially on differences in “touristic” and “vagabondic” paths to better utilization of purchased food products and adaptation to new tastes and markets. The study participants’ experiences and practices in the face of buying constraints range from the empowering stimulus of self-development, creativity and engagement with global environmental challenges to loss of food-related life quality and feelings of inadequacy. Rising food prices and changes in the world economy currently affect not only low-income populations, but also relatively privileged population groups. On the basis of a qualitative interview study this article investigates how Danish households with different income levels, educational levels and household composition experience and cope with constraints on their household food budgets. The analysis draws on Zygmunt Bauman’s framework of thought, centering especially on differences in “touristic” and “vagabondic” paths to better utilization of purchased food products and adaptation to new tastes and markets. The study participants’ experiences and practices in the face of buying constraints range from the empowering stimulus of self-development, creativity and engagement with global environmental challenges to loss of food-related life quality and feelings of inadequacy.

We analyze how the gendered division of cooking activities has changed in Nordic households over the period 1997–2012. Historically, food preparation and household cooking have been assigned to women, and cooking has been linked to female gender roles and identity. However, with women's increasing participation in the workforce, men have increased their contribution to household work and the gendering of food work is changing. Little is known about changes in how household cooking is gendered, and to what degree changes take place only in some population groups or in the wider population. We analyze developments in the gendering of cooking dinners in multi-person households. The analysis is based on two surveys from a project investigating changes in meal patterns in the Nordic countries. Individuals from Denmark, Finland, Norway and Sweden were interviewed in 1997 (n = 4823) and 2012 (n = 8242) based on almost identical questionnaires centering on the previous day’s eating as reported by the indi...

Introduction: An extensive body of literature is concerned with obese people, risk, and weight management. However, little is known about weight management among people not belonging to the extreme BMI categories. Management of weight among normal-weight and moderately overweight individuals provides us with knowledge about how to prevent future overweight or obesity. This paper investigates body size ideals and monitoring practices among normal-weight and moderately overweight people. Methods: The study is based on in-depth interviews combined with observations. 24 participants were recruited by strategic sampling based on self-reported BMI 18.5-29.9 kg/m2 and socio-demographic factors. Inductive analysis was conducted. Results: Normal-weight and moderately overweight people have clear ideals for their body size. Despite being normal weight or close to this, they construct a variety of practices for monitoring their bodies based on different kinds of calculations of weight and body size, observations of body shape, and measurements of bodily firmness. Biometric measurements are familiar to them as are health authorities' recommendations. Despite not belonging to an extreme BMI category, they translate such measurements and recommendations in meaningful ways to fit their everyday life. Conclusions: Normal-weight and moderately overweight people are concerned with their body size and continuously monitor it. Future health promotion work should consider the kind of practices already established in daily life when recommending ways of conducting body management.

The present article specifies and broadens our understanding of the concept of commensality by investigating what it means to ‘share a meal’. The study utilizes a school meal intervention carried out in Denmark in 2011/2012. It shows how different types of school meal arrangement influence the social life of a school class, and how these arrangements involve strategies of both inclusion and exclusion. Two types of school meals are compared in the intervention study: a hot meal based on Nordic ingredients and the normal Danish school meal arrangement in which children bring lunch packs to school. The study discusses commensality by examining and comparing lunchtime interactions within the same group of children in the two contrasting meal situations. The results fail to confirm the conventional view that shared meals have greater social impacts and benefits than eating individualized foods. The article argues that the social entrepreneurship involved in sharing individual lunch packs might even outweigh some of the benefits of shared meals where everyone is served the same food.

e21149Background: PD-L1 testing was established in Denmark (DK) after the approval of Nivolumab (Niv) and Pembrolizumab (Pem) in second line (2L) treatment of Non-Small Lung Cancer (NSCLC) due to t...

Based on a mixed methods approach, this article describes the prevalence of differentlevels of food budget restraints in a sample of 1,650 Danish households, and exploresdifferent types of coping strategies to deal with such restraints. Strategies concernedcooking, eating and buying food. A deeper knowledge of coping strategies was obtainedby analysing qualitative data from interviews with thirty families who have experiencedfood budget restraints. Results revealed that more than 40 per cent reported some levelof restraint on their food budget, while about 20 per cent experienced more substantialfood budget restraints or food insecurity. Single parent households were at significantlygreater risk of experiencing restraint than others. An investigation of coping strategiesshowed that some strategies, for example, using leftovers and cooking seasonal products,were common across all levels of budget restraint, while strategies affecting social lifeand taste preferences negatively were mostly applied when restraint was more severe.The qualitative analysis explored how the various strategies involved the potential forboth positive and negative experiences for the individual, depending on the wider contextsurrounding the need to reduce household food budgets. Results from this study maybe important for developing adequate measures to influence food purchases and eatingpractices in specific groups in situations of widespread economic turbulence in welfaresocieties. Based on a mixed methods approach, this article describes the prevalence of different levels of food budget restraints in a sample of 1,650 Danish households, and explores different types of coping strategies to deal with such restraints. Strategies concerned cooking, eating and buying food. A deeper knowledge of coping strategies was obtained by analysing qualitative data from interviews with thirty families who have experienced food budget restraints. Results revealed that more than 40 per cent reported some level of restraint on their food budget, while about 20 per cent experienced more substantial food budget restraints or food insecurity. Single parent households were at significantly greater risk of experiencing restraint than others. An investigation of coping strategies showed that some strategies, for example, using leftovers and cooking seasonal products, were common across all levels of budget restraint, while strategies affecting social life and taste preferences negatively were mostly applied when restraint was more severe. The qualitative analysis explored how the various strategies involved the potential for both positive and negative experiences for the individual, depending on the wider context surrounding the need to reduce household food budgets. Results from this study may be important for developing adequate measures to influence food purchases and eating practices in specific groups in situations of widespread economic turbulence in welfare societies.

ObjectiveTo explore and describe quantitatively the effect over time of unemployment on food purchase behaviour and diet composition.DesignLongitudinal data from 2008–2012, with monthly food purchase data aligned with register data on unemployment measured as a dichotomous indicator as well as a trend accounting for the duration.SettingA household panel which registers daily food purchases combined with detailed nutritional information and registration of the duration of unemployment at individual level. The structure of the data set facilitates the detection of effects or associations between duration of unemployment and diet composition, purchase behaviour in terms of food expenditure, and share of food purchased on offer and in discounters while controlling for important confounding factors.SubjectsDanish households of working age (n3440) adjusted to household equivalents. We use fixed-effects econometric methods to control for unobserved heterogeneity.ResultsIn the short run, unemployment led to substitution in favour of discount stores and increases in food expenditure and in consumption of saturated fat, total fat and protein due to increased consumption of animal-based foods. In the medium run food expenditure declined together with consumption of fresh animal-based foods and saturated fat, total fat and protein. In the even longer run these nutrients were substituted by carbohydrates and added sugar.ConclusionsUnemployment has a substantial influence on diet composition, but effects vary with duration of the unemployment period, which may have potential health implications. This ought to be taken into consideration in evaluations of existing reforms and in future reforms of welfare systems.