Special Issue "Food Systems, Food Environment, Diet and Nutrition Related Diseases"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (15 January 2021).

Special Issue Editors

Prof. Dr. Manuel Franco
E-Mail Website
Guest Editor
Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, 28001 Madrid, Spain
Interests: urban health; health inequalities; chronic diseases; social epidemiology
Dr. Julia Díez
E-Mail Website
Guest Editor
Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcala, 28801 Madrid, Spain
Interests: food environment; obesity; health inequities; socioeconomic status
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on “Food Systems, Food Environment, Diet and Nutrition Related Diseases” for IJERPH, a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

In recent decades, there has been growing interest in the understanding of food systems and food environments as a population approach to promote healthier and more sustainable diets and to prevent and control nutrition-related diseases worldwide. This impactful and promising field needs to foster interdisciplinary collaboration and bring together theories and methodologies from various sectors including epidemiology, geography, sociology, and urban planning. Further, there is a need to better understand this topic in relation to underserved populations (e.g., rural population) and across the lifespan. We encourage researchers to submit articles detailing innovative and cutting-edge methods and results to this Special Issue.

We are especially interested in articles that highlight (1) innovative approaches in addressing this topic, for example, participatory methods; (2) results from underserved populations; and (3) studies assessing the food environment’s effects on children’s health and weight.

Prof. Dr. Manuel Franco
Dr. Julia Díez
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Food systems
  • Food environment
  • Food retail
  • Food policy
  • Diet
  • Nutrition related diseases
  • Health
  • Health inequalities
  • Children
  • Obesity
  • Sustainability

Published Papers (13 papers)

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Research

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Open AccessArticle
Exposure of Children to Unhealthy Food and Beverage Advertisements in South Africa
Int. J. Environ. Res. Public Health 2021, 18(8), 3856; https://doi.org/10.3390/ijerph18083856 - 07 Apr 2021
Viewed by 522
Abstract
Television (TV) is a powerful medium for marketing food and beverages. Food and beverage marketers tend to use this medium to target children with the hope that children will in turn influence their families’ food choices. No study has assessed the compliance of [...] Read more.
Television (TV) is a powerful medium for marketing food and beverages. Food and beverage marketers tend to use this medium to target children with the hope that children will in turn influence their families’ food choices. No study has assessed the compliance of TV marketers with the South African Marketing to Children pledge since the enactment of the 2014 food advertising recommendations by the South African Department of Health and the Advertising Standards Authority. This study investigated the extent and nature of advertising of unhealthy versus healthy food and beverages to children in South African TV broadcasting channels. The date, time, type, frequency and target audience of food advertisements (ads) on four free-to-air South African TV channels were recorded and captured using a structured assessment guide. The presence of persuasive marketing techniques was also assessed. Unhealthy food and beverage advertising was recorded at a significantly higher rate compared with healthy food and beverages during the time frame when children were likely to be watching TV. Brand benefit claims, health claims and power strategies (e.g., advertising using cartoon characters and celebrated individuals) were used as persuasive strategies. These persuasive strategies were used more in unhealthy versus healthy food ads. The findings are in breach of the South African Marketing to Children pledge and suggest a failure of the industry self-regulation system. We recommend the introduction of monitored and enforced statutory regulations to ensure healthy TV food advertising space. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
Open AccessArticle
Exploring the Role of the Food Environment in Dietary Acculturation: A Study amongst Moroccan Immigrants in The Netherlands
Int. J. Environ. Res. Public Health 2021, 18(7), 3328; https://doi.org/10.3390/ijerph18073328 - 24 Mar 2021
Viewed by 511
Abstract
Food environments play a role in immigrants’ dietary acculturation, but little is known about the directionality of the relationship. The objective was to explore the interaction between the food environment and food procurement behaviors in the process of dietary acculturation. A qualitative study [...] Read more.
Food environments play a role in immigrants’ dietary acculturation, but little is known about the directionality of the relationship. The objective was to explore the interaction between the food environment and food procurement behaviors in the process of dietary acculturation. A qualitative study design using in-depth interviews and a mapping exercise was conducted. The immigrant group studied used a variety of factors to select which foods to procure. Traditional foods were readily available, shifting the determining factors to a combination of affordability, acceptability and accessibility. The food environment is dynamic and responds to shifting market demands. Policies regarding food procurement behaviors should consider these upstream effects and be aware of the availability of traditional foods for immigrant groups. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
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Open AccessArticle
Household Cooking and Eating out: Food Practices and Perceptions of Salt/Sodium Consumption in Costa Rica
Int. J. Environ. Res. Public Health 2021, 18(3), 1208; https://doi.org/10.3390/ijerph18031208 - 29 Jan 2021
Viewed by 757
Abstract
This research aims to study the food practices and perceptions related to excessive consumption of salt/sodium when cooking and eating outside the home in a study population representing the wide intergenerational and sociocultural diversity of Costa Rica. Key communities from around the country, [...] Read more.
This research aims to study the food practices and perceptions related to excessive consumption of salt/sodium when cooking and eating outside the home in a study population representing the wide intergenerational and sociocultural diversity of Costa Rica. Key communities from around the country, cultural experts, and key informants were selected. Four qualitative research techniques were applied. Data was systematized based on the Social Ecological Model. Women are generally in charge of cooking and family food purchases. Salt is perceived as a basic ingredient, used in small amounts that can be reduced—but not eliminated—when cooking. Changes in food preparations and emotions associated with the consumption of homemade food with salt were identified. The population likes to eat out, where the establishments selected depend mainly on age group and income. Beyond cultural and geographical differences, age aspects are suggested as being the main differentiators, in terms of use of salt, seasonings, and condiments in the preparation of food at home, the recipes prepared, and the selection of establishments in which to eat out. The deeply rooted values and meanings associated with salt in food indicate that the implementation of salt reduction strategies in Costa Rica is challenging. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
Open AccessArticle
Urban Retail Food Environments: Relative Availability and Prominence of Exhibition of Healthy vs. Unhealthy Foods at Supermarkets in Buenos Aires, Argentina
Int. J. Environ. Res. Public Health 2021, 18(3), 944; https://doi.org/10.3390/ijerph18030944 - 22 Jan 2021
Viewed by 625
Abstract
There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics [...] Read more.
There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
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Open AccessArticle
Characterization, Nutrient Intake, and Nutritional Status of Low-Income Students Attending a Brazilian University Restaurant
Int. J. Environ. Res. Public Health 2021, 18(1), 315; https://doi.org/10.3390/ijerph18010315 - 04 Jan 2021
Viewed by 870
Abstract
In Brazilian universities, the university restaurant (UR) is essential in supporting students to complete their courses, as the UR offers free or low-cost food. In this sense, this research aimed to evaluate public policy effectiveness in offering food to low-income students attending the [...] Read more.
In Brazilian universities, the university restaurant (UR) is essential in supporting students to complete their courses, as the UR offers free or low-cost food. In this sense, this research aimed to evaluate public policy effectiveness in offering food to low-income students attending the UR of the University of Brasília. This cross-sectional study compared low-income students (participating in the Student Assistance Program—Group 1) and students that did not participate in the Program (Group 2). Researchers assessed food consumption through direct observation of students while serving their plates at UR (in all meals consumed at UR) and completed food consumption with diet recalls for the meals outside the UR. In total, three complete days, including one weekend day, were evaluated for each student. Researchers also evaluated the participants’ body mass composition and body fat percentage. The results of the comparisons between the evaluated groups showed that the groups presented similar intakes. Only sodium intake was significantly different for males, being higher for Group 1. The median sodium consumption among females and males in group 1 was 55% and 119%, respectively, above the upper limit (UL). In Group 2, sodium intake levels reached consumption percentages above UL by 36% for females and 79% for males. The prevalence of inadequate sodium consumption was 100% for both genders and groups. Extra salt was added to dishes by 19.7% of the students. For females, only fiber ingestion was statistically different, with higher intake for Group 1. The other evaluated parameters showed similarities among groups for each gender. The statistical analysis revealed a significant difference in the consumption of calories, fibers, sodium, iron, and calcium for the students who had three meals at the UR in the two weekdays. There was a statistical difference in nutrients for those who had three meals in the UR, reinforcing the importance of the UR’s meals. The current food and nutrition policy at the UR proved to be extremely important in university students’ lives and in maintaining healthy nutritional aspects. However, changes in sodium use, more calcium intake, and less cholesterol consumption should receive attention to better balance dietary elements of the food offered. Dish preparation should be carefully followed to ensure the quality of the food for university students. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
Open AccessArticle
Leveraging the Food System in the Eastern Mediterranean Region for Better Health and Nutrition: A Case Study from Oman
Int. J. Environ. Res. Public Health 2020, 17(19), 7250; https://doi.org/10.3390/ijerph17197250 - 04 Oct 2020
Cited by 1 | Viewed by 655
Abstract
The adoption of a food system approach is vital for the Eastern Mediterranean Region (EMR) in achieving the 2030 Agenda. The objective of this paper is to present a case-study from Oman, where a roadmap of context-specific entry points within the food system [...] Read more.
The adoption of a food system approach is vital for the Eastern Mediterranean Region (EMR) in achieving the 2030 Agenda. The objective of this paper is to present a case-study from Oman, where a roadmap of context-specific entry points within the food system was proposed, with the overarching aim of fostering healthier diets in the population. A four-staged process was adopted: (1) selection of potential target food groups; (2) assessment of self-sufficiency and sustainability considerations related to the target foods; (3) characterization of challenges, opportunities and potential interventions related to the target food groups and (4) identification of specific entry points within the three elements of the food system (food supply chain; food environment; and consumer behavior). Data collection was based on a review of pertinent literature as well as a participatory approach involving policy makers and stakeholders. Findings showed that fruit, vegetables, fish and foods that are high in fat, sugar and salt are priority targets for intervention. Specific entry points within the food system were identified and a realistic roadmap of activities was outlined. Findings and recommendations presented in this paper may facilitate policy convergence efforts in Oman and serve as a case-study for other EMR countries. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
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Open AccessArticle
Racial Differences in Perceived Food Swamp and Food Desert Exposure and Disparities in Self-Reported Dietary Habits
Int. J. Environ. Res. Public Health 2020, 17(19), 7143; https://doi.org/10.3390/ijerph17197143 - 29 Sep 2020
Cited by 3 | Viewed by 1328
Abstract
Both food swamps and food deserts have been associated with racial, ethnic, and socioeconomic disparities in obesity rates. Little is known about how the distribution of food deserts and food swamps relate to disparities in self-reported dietary habits, and health status, particularly for [...] Read more.
Both food swamps and food deserts have been associated with racial, ethnic, and socioeconomic disparities in obesity rates. Little is known about how the distribution of food deserts and food swamps relate to disparities in self-reported dietary habits, and health status, particularly for historically marginalized groups. In a national U.S. sample of 4305 online survey participants (age 18+), multinomial logistic regression analyses were used to assess by race and ethnicity the likelihood of living in a food swamp or food desert area. Predicted probabilities of self-reported dietary habits, health status, and weight status were calculated using the fitted values from ordinal or multinomial logistic regression models adjusted for relevant covariates. Results showed that non-Hispanic, Black participants (N = 954) were most likely to report living in a food swamp. In the full and White subsamples (N = 2912), the perception of residing in a food swamp/desert was associated with less-healthful self-reported dietary habits overall. For non-Hispanic Blacks, regression results also showed that residents of perceived food swamp areas (OR = 0.66, p < 0.01, 95% CI (0.51, 0.86)) had a lower diet quality than those not living in a food swamp/food desert area. Black communities in particular may be at risk for environment-linked diet-related health inequities. These findings suggest that an individual’s perceptions of food swamp and food desert exposure may be related to diet habits among adults. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
Open AccessArticle
Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED)
Int. J. Environ. Res. Public Health 2020, 17(19), 7031; https://doi.org/10.3390/ijerph17197031 - 25 Sep 2020
Cited by 1 | Viewed by 900
Abstract
The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED [...] Read more.
The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED tool to observe and rate food outlets in 21 census tracts and 43 food stores across the city of Madrid, Spain. We evaluated inter-rater and intra-rater reliabilities, construct validity, and the tool’s ability to discriminate between store types and between stores by area-level Socio-Economic Status (SES). Overall, the mean NEMS-S-MED score was 20.7 (SD = 9.8), which ranged from 7 to 43. Most food items displayed substantial or almost perfect inter-rater and intra-rater agreements; the percentage agreement across availability items was almost perfect and kappa statistics were also very high (median κ = 1.00 for inter-rater; κ = 0.92 for intra-rater). Furthermore, the NEMS-S-MED tool was able to discriminate between store types and census tracts of different SES. The adapted NEMS-S-MED instrument is a reliable and valid audit tool to assess the consumer food environment in Mediterranean urban contexts. Well-constructed measurement tools, such as the NEMS-S-MED, may facilitate the development of effective policy interventions to increase healthy food access and affordability. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
Open AccessArticle
Benchmarking the Nutrition-Related Policies and Commitments of Major Food Companies in Australia, 2018
Int. J. Environ. Res. Public Health 2020, 17(17), 6118; https://doi.org/10.3390/ijerph17176118 - 22 Aug 2020
Cited by 1 | Viewed by 1173
Abstract
The food industry has an important role to play in efforts to improve population diets. This study aimed to benchmark the comprehensiveness, specificity and transparency of nutrition-related policies and commitments of major food companies in Australia. In 2018, we applied the Business Impact [...] Read more.
The food industry has an important role to play in efforts to improve population diets. This study aimed to benchmark the comprehensiveness, specificity and transparency of nutrition-related policies and commitments of major food companies in Australia. In 2018, we applied the Business Impact Assessment on Obesity and Population Level Nutrition (BIA-Obesity) tool and process to quantitatively assess company policies across six domains. Thirty-four companies operating in Australia were assessed, including the largest packaged food and non-alcoholic beverage manufacturers (n = 19), supermarkets (n = 4) and quick-service restaurants (n = 11). Publicly available company information was collected, supplemented by information gathered through engagement with company representatives. Sixteen out of 34 companies (47%) engaged with data collection processes. Company scores ranged from 3/100 to 71/100 (median: 40.5/100), with substantial variation by sector, company and domain. This study demonstrated that, while some food companies had made commitments to address population nutrition and obesity-related issues, the overall response from the food industry fell short of global benchmarks of good practice. Future studies should assess both company policies and practices. In the absence of stronger industry action, government regulations, such as mandatory front-of-pack nutrition labelling and restrictions on unhealthy food marketing, are urgently needed. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
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Open AccessArticle
Community Group Model Building as a Method for Engaging Participants and Mobilising Action in Public Health
Int. J. Environ. Res. Public Health 2020, 17(10), 3457; https://doi.org/10.3390/ijerph17103457 - 15 May 2020
Cited by 5 | Viewed by 880
Abstract
Group model building (GMB) is a qualitative method aimed at engaging stakeholders to collectively consider the causes of complex problems. Tackling inequities in community nutrition is one such complex problem, as the causes are driven by a variety of interactions between individual factors, [...] Read more.
Group model building (GMB) is a qualitative method aimed at engaging stakeholders to collectively consider the causes of complex problems. Tackling inequities in community nutrition is one such complex problem, as the causes are driven by a variety of interactions between individual factors, social structures, local environments and the global food system. This methods paper describes a GMB process that utilises three system mapping tools in a study with members of a multicultural, low-income community to explore declining fruit and vegetable intake in children. The tools were: (1) graphs over time, which captures the community’s understanding of an issue; (2) cognitive mapping, which enables participants to think systemically about the causes and consequences of the issue; (3) causal loop diagrams, which describe feedback loops that reinforce the issue and identify potential actions. Cognitive mapping, a tool not usually associated with GMB, was added to the research process to support the gradual development of participants’ thinking and develops the skills needed to tackle an issue from a systems perspective. We evaluate the benefits and impact of these three tools, particularly in engaging participants and increasing understanding of systems thinking in order to develop and mobilise action. The tools could be adapted for use in other community-based research projects. Key learnings were the value of genuine partnership with a local organisation for longevity of the project, recruitment of key decisionmakers from the community early in the process, and allowing time to create sustainable change. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
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Open AccessArticle
Food Environment in the Lower Mississippi Delta: Food Deserts, Food Swamps and Hot Spots
Int. J. Environ. Res. Public Health 2020, 17(10), 3354; https://doi.org/10.3390/ijerph17103354 - 12 May 2020
Cited by 1 | Viewed by 1168
Abstract
The objectives for this study were to examine the location and density of measured food outlets in five rural towns in the Lower Mississippi Delta, determine the spatial location of Delta Healthy Sprouts (DHS) participants’ homes in the food environment, and examine relationships [...] Read more.
The objectives for this study were to examine the location and density of measured food outlets in five rural towns in the Lower Mississippi Delta, determine the spatial location of Delta Healthy Sprouts (DHS) participants’ homes in the food environment, and examine relationships between the spatial location of participants’ homes and their diet quality. Using a food desert/food swamp framework, food outlet geographic locations were analyzed in relation to one another, the distance between DHS participants’ residence and closest food outlets by class were computed, and associations among residents’ diet quality, hot spot status, and census tract classification were explored. Of 266 food outlets identified, 11 (4%), 86 (32%), 50 (19%), and 119 (45%) were classified as grocery stores (GS), convenience stores (CS), full-service restaurants (FS), or fast food restaurants (FF), respectively. A third of participants lived in CS hot spots, while 22% lived in FF hot spots. DHS participants lived closer in miles to CS (0.4) and FF (0.5) as compared to GS (1.6) and FS (1.1) outlets. Participants bought most groceries at national chain grocery stores rather than their closest grocery store. The food environments of the five towns and associated neighborhoods in which DHS participants resided were not supportive of healthful eating, containing both food deserts and food swamps, often in overlapping patterns. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
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Review

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Open AccessReview
Inuit Country Food and Health during Pregnancy and Early Childhood in the Circumpolar North: A Scoping Review
Int. J. Environ. Res. Public Health 2021, 18(5), 2625; https://doi.org/10.3390/ijerph18052625 - 05 Mar 2021
Viewed by 568
Abstract
Inuit communities in the Circumpolar North have experienced a nutrition transition characterized by the decreased intake of culturally important, nutrient-rich traditional food (country food), and an increased intake of market food, resulting in concerns over reduced diet quality and emerging chronic diseases. Nutrition [...] Read more.
Inuit communities in the Circumpolar North have experienced a nutrition transition characterized by the decreased intake of culturally important, nutrient-rich traditional food (country food), and an increased intake of market food, resulting in concerns over reduced diet quality and emerging chronic diseases. Nutrition in early life is critical for development, may influence health risks in later life, and is an important concern for Inuit community health. The goal of this scoping review was to characterize the nature, extent, and range of the published literature on Inuit country food and health in pregnancy and childhood. A search string was developed and applied to three databases, followed by title and abstract screening and full text review. Articles published between 1995 and 2019 were included, and data were extracted and summarized descriptively. The number of articles generally increased over time, despite the unequal geographic distribution of articles. The majority of the articles focused on environmental contaminants, and one-quarter described nutrient adequacy. Few articles described food security or food safety in pregnancy, and the most utilized quantitative methods. Gaps in understanding of country food use in pregnancy and early childhood highlight areas of future research to support public health policy for this population. Given the critical role of good nutrition in early life and the important contribution country food makes to diet quality for Inuit, further understanding of this interface is warranted. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
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Open AccessReview
Facilitating Healthier Eating at Restaurants: A Multidisciplinary Scoping Review Comparing Strategies, Barriers, Motivators, and Outcomes by Restaurant Type and Initiator
Int. J. Environ. Res. Public Health 2021, 18(4), 1479; https://doi.org/10.3390/ijerph18041479 - 04 Feb 2021
Viewed by 779
Abstract
Restaurants are understudied yet increasingly important food environment institutions for tackling diet-related diseases. This scoping review analyzes research and gray literature (n = 171 records) to assess which healthy eating promotion strategies have been implemented in restaurants and the associated motivations, barriers, and [...] Read more.
Restaurants are understudied yet increasingly important food environment institutions for tackling diet-related diseases. This scoping review analyzes research and gray literature (n = 171 records) to assess which healthy eating promotion strategies have been implemented in restaurants and the associated motivations, barriers, and outcomes, compared by restaurant type (corporate/chain vs. independently owned restaurants) and initiator (restaurant-initiated vs. investigator-initiated). We found that the most commonly reported strategy was the increase of generally healthy offerings and the promotion of such offerings. Changes in food availability were more common among corporate restaurants and initiated by restaurants, while environmental facilitators were more commonly initiated by investigators and associated with independently owned restaurants. Aside from those associated with revenue, motivations and barriers for healthy eating promoting strategies varied by restaurant type. While corporate restaurants were also motivated by public health criticism, independently owned restaurants were motivated by interests to improve community health. Revenue concerns were followed by food sourcing issues in corporate restaurants and lack of interest among independently owned restaurants. Among reporting sources, most outcomes were revenue positive. This study shows the need for practice-based evidence and accounting for restaurant business models to tailor interventions and policies for sustained positive changes in these establishments. Full article
(This article belongs to the Special Issue Food Systems, Food Environment, Diet and Nutrition Related Diseases)
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