Food allergies affect nearly six million children in the U.S. Up to two students in every classroom may be allergic to common foods like peanuts or milk. A recent survey reports that one in five parents did not feel that their child with a food allergy was safe while at school. The survey was published in BMC Pediatrics. While most of the 289 parents reported that their child's school had implemented at least one food allergy policy, they felt that more could be done. Nearly 95 percent of the parents surveyed wanted stock epinephrine to be available in school so that a life-threatening reaction to food could be treated immediately. Most parents also felt that school lunch menus should display allergen information - 65 percent reported that this was not done - and that ingredient labels on food items are needed - 87 percent reported that ingredient labels were not available.
They also wanted to see schools provide more food allergy education for students - 72 percent reported no food allergy education for students. Our study helps identify key policy areas that parents would like to see implemented in schools across the country to improve the safety of their children with food allergies, says senior author Ruchi Gupta, MD, MPH, from Ann & Robert H. Lurie Children's Hospital of Chicago, and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine.
Currently, the primary management approach for people with a food allergy is to avoid accidental exposure to the food allergen. Thorough review of ingredients in all food and drink products prior to consumption is a core strategy for food allergen avoidance and prevention of severe allergic reactions, says Dr. Gupta. This is why implementation of ingredient labeling policies in school lunchrooms should be prioritized in order to protect students with food allergies.
The U.S. Department of Education has not established policy recommendations for management of food allergies in schools. While voluntary guidelines have been developed by the Centers for Disease Control and Prevention, there are significant differences in food allergy policies implemented in schools. We need more research to identify the food allergy policies that are most effective in creating a safer space at school for students with food allergy, says Dr. Gupta.
Restaurant Food Labeling
The Food and Drug Administration began mandatory calorie labeling for chain restaurants across the United States in May 2018. While this is an important step, restaurants could do much more to create the tipping point to encourage healthy options for Americans when they eat out, says to Virginia Tech professor Vivica Kraak, a recognized expert in food and nutrition policy. Kraak points to limited progress made by the U.S. restaurant sector in its effort to promote healthy and profitable menu choices. Quick-service restaurants, fast-casual and full-service restaurant chains are not yet fully committed to change industry-wide practices that contribute to poor diet quality, obesity and related chronic diseases, said Kraak.
The National Restaurant Association projects food-service business sales to exceed $551 billion, representing about 48% of household income spent on food. Every week, nearly two thirds of adults visit quick-service restaurant chains such as McDonald's and Burger King, and 40 percent visit fast-casual restaurants such as Panera and Chipotle. Kraak calls on the National Restaurant Association and its members to use comprehensive marketing and nudge strategies to encourage customers to make healthy choices.
Along with a team from Virginia Tech's Department of Human Nutrition, Foods and Exercise (HNFE), Kraaks research urged restaurant businesses to adopt a marketing-mix and choice-architecture framework called the 8 Ps. The approach involves restaurants using many strategies to promote healthy foods and beverages through ambience and atmospherics; improving the nutritional profiles of products to reduce calories, sodium and fat; and standardizing and reducing portion sizes to offer 600 calories or less for kids meals and 700 calories or less for adult meals. It also involves restaurants using proportionate pricing, adopting responsible marketing practices for children and teens, establishing healthy default side dishes and beverages such as water or low-fat milk, using priming or prompting to encourage healthy choices through labeling, and positioning healthy products at the start of buffets or at arms reach or eye level near cash registers.
Do Eye-Catching Labels Stigmatize Healthy Foods?
Food labels in grocery stores mention organic, fair-trade and cage free, just to name a few. Labels such as these may be eye-catching but are often free of any scientific basis and stigmatize many healthy foods, a University of Delaware-led study found. The paper - published in the journal Applied Economics Perspectives and Policy - examined food labeling to see how labels identifying the process in which food was produced positively and negatively influenced consumer behavior.
The researchers reviewed over 90 academic studies on consumer response to process labels. They found that while these labels satisfy consumer demand for quality assurances and can create value for both consumers and producers, misinterpretation is common and can stigmatize food produced by conventional processes even when there is no scientific evidence those foods cause harm. For the poor, in particular, there is danger in misunderstanding which food items are safe, says Kent Messer, the study's lead author and the Unidel Howard Cosgrove Career Development Chair for the Environment.
"That has me worried about the poor and those who are food insecure," Messer added. "Because now you're trying to make everything a high-end food choice and frankly, we just want to have healthy food choices, we don't need to have extra labels that scare away people."
Process labels by definition focus on the production of a food, but largely ignore important outcomes of the process such as taste or healthiness. Policy changes could help consumers better understand their choices. They argue governments should not impose bans on process labels but rather encourage labels that help document how the processes affect important quality traits, such as calorie count. "Relying on process labels alone, on the other hand, is a laissez faire approach that inevitably surrenders the educational component of labeling to mass media, the colorful array of opinion providers, and even food retailers, who may not always be honest brokers of information," Messer said.
With regards to the positive impact process labels have on consumers, Messer said that consumers are able to more freely align their purchasing decisions with their values and preferences. If, for example, a consumer wants to buy fair trade coffee, they are able to do so with greater ease. "The good part is that process labels can help bridge the trust between the producer and the consumer because it gives the consumer more insight into the market," said Messer. "New products can be introduced this way, niche markets can be created, and consumers, in many cases, are willing to pay more for these products. It's good for industry, consumers are getting what they want, and new players get to find ways of getting a higher price."
The bad part is that consumers are already in the midst of a marketplace filled with information that can be overwhelming because of the sheer amount of product choices and information available. In addition, when most consumers go to buy food, they are often crunched for time. "Human choice tends to be worse when you put time constraints on it," said Messer. "Maybe you've got a child in the aisle with you and now you're adding this new label and there's lots of misinterpretation of what it means. The natural label is a classic one which means very little, yet consumers assume it means more than it does. They think it means 'No GMO' but it doesn't. They think it means it is 'organic' but it isn't. This label is not helping them align their values to their food, and they're paying a price premium but not getting what they wanted to buy."
Another problem is "halo effects" - overly optimistic misinterpretation of what a label means. "If you show consumers a chocolate bar that is labeled as 'fair trade', some will tell you that it has lower calories," Messer said. "But the label is not about calories. Consumers do this frequently with the 'organic' label as they think it is healthy for the consumer. Organic practices may be healthier for the farm workers or the environment, but for the actual consumer, there's very little evidence behind that. You're getting lots of mixed, wrong messages out there."
Like halo effects, the ugly side of food processing labels comes into play when labels sound like they have a positive impact but really have a negative one. A label such as "low food miles" might sound nice but could actually be causing more harm than good. "Sometimes, where food is grown doesn't mean that it's actually the best for climate change," said Messer. Hot house tomatoes grown in Canada, for example, might have low food miles for Canadian consumers but it's probably far better environmentally - because of all the energy expended in creating tomatoes in an energy-intensive hot house in Canada - to grow the tomatoes in Florida and then ship them to Canada. "If you just count miles and not true energy use, you can get people paying more money for something that's actually going the opposite of what they wanted which is to get a lower carbon footprint," said Messer.
The ugly side of food labeling is that a lot of fear is being introduced into the marketplace that isn't based on science. "When you start labeling everything as 'free of this' such as 'gluten-free water,' you can end up listing stuff that could never have been present in the food in the first place," Messer said. "These 'free of' labels can cause unnecessary fear and cast the conventionally produced food in a harsh, negative light." Since the vast majority of the food market is still conventionally produced and is the lower cost product, there is a danger in taking that safe food and calling it unsafe because of a few new entrants into the food market.
There is evidence that food companies are getting worried about investing in science and technology because they don't know how the consumer is going to respond or how marketers are going to attack their food product because it's new and different and therefore can be labeled as bad or dangerous. "We've got a lot of mouths to feed in our country and around the world," Messer said. "We are currently able to feed so many because of advances in agricultural science and technology. If we're afraid of that now, we have a long-term impact on the poor that could be quite negative in our country and around the world. That's when I start thinking these process labels could really be ugly."
Do Nutrition Label Readers Favor Food Quality Over Quantity?
People who closely eyeball nutrition labels tend to eat differently than less-discerning diners in one key regard, according to research from a University of Illinois expert in food and nutrition policy and consumer food preferences and behaviors. Although nutrition-label users and non-nutrition-label users eat roughly the same amount of food, the two groups diverge when it comes to the quality of the food they eat, said a paper co-written by Brenna Ellison, a professor of agriculture and consumer economics at Illinois. "Research has often concluded that people who use nutrition labels eat better, Ellison said. But we don't necessarily talk about what better means. Is it eating less food, or is it eating better food? This study looks at people's plates and considers both what they selected to eat and what they actually ate in an effort to determine which difference - volume or quality - is occurring."
To examine the relationship between label use and food selection, servings and consumption, Ellison and co-author Mary J. Christoph of the University of Minnesota combined survey and photographic data of the lunch plates of college students at two different university dining halls. Food selection, servings and consumption were assessed using digital photography, a method with strong reliability for validating portion sizes compared with weighing food and visual estimation. "In terms of measuring and evaluating the plates, we had students who built their own plates because it was a self-serve dining environment," Ellison said. "Diners were only eligible if they were just sitting down to eat. It couldn't be someone who was halfway through their meal, which would misrepresent what they were eating and skew the results."
Based on the meals assessed, the quantity of foods served and consumed were roughly similar between the two groups. There were, however, distinct differences in the types of foods plated and consumed within MyPlate food categories between those who tended to read nutrition labels and those who didn't. The results indicate that a greater proportion of nutrition-label users selected more fruits, vegetables and beans, and fewer potatoes and refined grains, compared with non-label users. In addition, fewer label users selected fried foods and foods with added sugars. "We find that it's more about the types of food rather than the quantity of the food," Ellison said. "The amount of food between label users and non-label users was roughly the same amount. It's the differences in quality that are more prevalent than the sheer amount of food selected."
Effectiveness Of Labels
Using digital photography also provided a more objective assessment of food selection, servings and consumption compared with self-reporting because "you don't have to rely on students remembering how much of each food they ate," Ellison said. "That's one big advantage to this study. Another one is that diners did not interact with our data collectors until after their plate was built. So our data collection methods shouldn't have affected what they chose. For example, people weren't picking more salad because they knew there was going to be a picture taken of their plate."
Participants were further surveyed on socio-demographic and behavioral variables such as gender, body mass index, exercise frequency and nutrition education to better assess the possible link between label use and food selection, servings and consumption. Examining nutrition labels is often recommended by doctors and dietitians to improve food choices, but choice does not always translate to consumption. Furthermore, evidence on the effectiveness of labels is mixed, and few studies can identify how labels actually influence behavior.
"Previous research has focused on portion control for weight loss or weight management, generally eating less, Ellison added. But more-recent research indicates this may not be the most effective message. By eating less, consumers may feel deprived, or even 'hangry,' which can make it difficult to sustain long-term dietary behaviors," she said. "Newer research indicates that eating less of certain types of foods, rather than all foods, may matter more."
Although the results show label users eat differently than non-users, the implications of the research suggest there may be a need for greater consumption of fruit, vegetables, beans, whole grains and low-fat dairy among both groups. In addition to posting labels, Ellison said dining facilities may want to increase offerings of nutrient-dense foods - whole grains and vegetables - or consider product reformulations that creatively incorporate these foods to encourage healthy eating behaviors. But Ellison warned that the study's findings should still be cautiously interpreted as the conclusions are based on only one meal.
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