Family eating out-of-home: a review of nutrition and health policies.

Childhood obesity is a growing problem worldwide. In recent years, out-of-home (OH) eating has been highlighted as one of the many factors contributing to the obesogenic environment. This review seeks to identify a range of existing guidelines for the provision of healthy food options for families who eat OH frequently. Nationally available nutrition policies were identified using targeted and untargeted searches of the internet to identify established strategies for providing food for children in the family eating out sector in America (US), Australia, Canada and the WHO's European Region (EUR). These were categorised on the basis of eleven pre-defined criteria including: family eating out sector included as stakeholder; inclusion of children's food OH; cost strategies for healthier food choices; provision of nutrition information for customers; nutrition training of catering staff; and monitoring and evaluation structures. Fifty-five policies were reviewed, of which 71% addressed children's food served OH, but principally only for food available in schools. Two voluntary programmes, from Colorado and Slovenia, were identified as possible best practice models as they met a majority of the evaluation criteria. The most frequently used strategy by policies to promote healthier eating OH was the provision of nutrition information on menus, while monitoring and evaluation plans were poorly incorporated into any OH strategies, thus raising issues about their effectiveness. This review has identified a range of initiatives that could be employed to make healthier eating OH more accessible for families. However, to establish best practice guidelines for healthier OH food choices further investigations are required.

Serving size guidance for consumers: is it effective?

Larger portion sizes (PS) may be inciting over-eating and contributing to obesity rates. Currently, there is a paucity of data on the effectiveness of serving size (SS) guidance. The aims of the present review are to evaluate SS guidance; the understanding, usability and acceptability of such guidance, its impact on consumers and potential barriers to its uptake. A sample of worldwide SS guidance schemes (n 87) were identified using targeted and untargeted searches, overall these were found to communicate various inconsistent and often conflicting messages about PS selection. The available data suggest that consumers have difficulty in understanding terms such as 'portion size' and 'serving size', as these tend to be used interchangeably. In addition, discrepancies between recommended SS and those present on food labels add to the confusion. Consumers generally understand and visualise SS best when expressed in terms of household measures rather than actual weights. Only a limited number of studies have examined the direct impact of SS guidance on consumer behaviour with equivocal results. Although consumers recognise that guidance on selecting SS would be helpful, they are often unwilling to act on such guidance. The challenge of achieving consumer adherence to SS guidance is formidable due to several barriers including chronic exposure to larger PS, distorted consumption norms and perceptions, the habit of 'cleaning one's plate' and language barriers for ethnic minorities. In conclusion, the impact of SS guidance on consumers merits further investigation to ensure that future guidance resonates with consumers by being more understandable, usable and acceptable.

Endothelial dysfunction associated with obesity and the effect of weight loss interventions.

Endothelial damage is central to the initiation and progression of atherosclerosis, while in addition vascular endothelial cells secrete several anti-atherogenic substances including the potent vasodilator nitric oxide. Increased adhesion molecule expression, in response to pathophysiological stimuli is perhaps the earliest indicator of compromised endothelial integrity. Obesity and adiposity are associated with an increased risk of CVD, influencing disease progression via a number of mechanisms, including enhanced endothelial activation. This review discusses possible mechanisms linking adiposity and more specifically regional fat depots with endothelial function and evaluates studies investigating the effect of weight loss on endothelial function, assessed by biochemical and physiological measurements. Overall, the research to date suggests that visceral adiposity is a stronger predictor of endothelial activation than overall adiposity, possibly mediated via the action of NEFA in circulation. While in general there is a suggestion that weight loss is associated with significant improvements in endothelial function, this is not apparent in all interventions and published literature to date provides less than convincing evidence for the effects of weight loss on endothelial activation.