Affordability of Different Isocaloric Healthy Diets in Germany-An Assessment of Food Prices for Seven Distinct Food Patterns.

Affordability of different isocaloric healthy diets in Germany-an assessment of food prices for seven distinct food patterns Background: For decades, low-fat diets were recommended as the ideal food pattern to prevent obesity, type 2 diabetes and their long-term complications. Nowadays, several alternatives considering sources and quantity of protein, fat and carbohydrates have arisen and clinical evidence supports all of them for at least some metabolic outcomes. Given this variety in diets and the lack of a single ideal diet, one must evaluate if patients at risk, many of which having a lower income, can actually afford these diets. AIM: We modelled four-week food plans for a typical family of two adults and two school children based on seven different dietary patterns: highly processed standard omnivore diet (HPSD), freshly cooked standard omnivore diet (FCSD), both with German average dietary composition, low-protein vegan diet (VeganD), low-fat vegetarian diet (VegetD), low-fat omnivore diet (LFD), Mediterranean diet (MedD) and high-fat moderate-carb diet (MCD). The isocaloric diets were designed with typical menu variation for all meal times. We then assessed the lowest possible prices for all necessary grocery items in 12 different supermarket chains, avoiding organic foods, special offers, advertised exotic super foods and luxury articles. Prices for dietary patterns were compared in total, stratified by meal time and by food groups. RESULTS: Among all seven dietary patterns, price dispersion by supermarket chains was 12-16%. Lowest average costs were calculated for the VegetD and the FCSD, followed by HPSD, LFD, VeganD, MedD and-on top-MCD. VeganD, MedD and MCD were about 16%, 23% and 67% more expensive compared to the FCSD. Major food groups determining prices for all diets are vegetables, salads and animal-derived products. Calculations for social welfare severely underestimate expenses for any kind of diet. CONCLUSIONS: Food prices are a relevant factor for healthy food choices. Food purchasing is financially challenging for persons with very low income in Germany. Fresh-cooked plant-based diets are less pricy than the unhealthy HPSD. Diets with reduced carbohydrate content are considerably more expensive, limiting their use for people with low income. Minimum wage and financial support for long-term unemployed people in Germany are insufficient to assure a healthy lifestyle.

Menu engineering to encourage sustainable food choices when dining out: An online trial of priced-based decoys.

Menu-based 'nudges' hold promise as effective ways to encourage a shift away from ruminant meat and towards more environmentally friendly plant-based food when dining out. One example of a menu-based nudge is including an inferior 'decoy' option to existing items on menus. Decoys have been shown to influence decision-making in other domains (e.g. Lichters, Bengart, Sarstedt, & Vogt, 2017), but have yet to be used to promote sustainable food choices. Two online randomized controlled trials tested whether the addition of higher priced 'decoy' vegetarian options on menus influenced the number of diners choosing a 'target' vegetarian option. Adjusted Generalized Estimating Equations on data from four menu conditions showed no main effect of the intervention in study 1 (decoy absent vs. decoy present; Odds Ratio (OR) 1.08 95% Confidence Interval (CI) 0.45 to 2.57). Replicating the trial in study 2 across seven menu conditions and testing a more expensive decoy also showed no main effect of the intervention decoy absent vs. decoy present; OR 0.68 (95% CI 0.41 to 1.12). Further analyses revealed that our price-based decoy strategy (a 30% price increase) did not significantly influence the number of people choosing the inferior decoy dish, possibly because dish choices were purely hypothetical. Further research is needed to clarify which attributes of a dish (e.g. taste, portion size, signature ingredients etc.) are optimal candidates for use as decoys and testing these in real world choice contexts.

Global sustainability (health, environment and monetary costs) of three dietary patterns: results from a Spanish cohort (the SUN project).

OBJECTIVE: To evaluate the sustainability of the dietary patterns, according to their effects on health and environment and their affordability. DESIGN: Prospective, ongoing cohort study of university graduates. SETTINGS: The Spanish SUN project (Seguimiento Universidad de Navarra, University of Navarra Follow-up), starting from 1999. PARTICIPANTS: A total of 18 429 participants. METHODS: Information from participants is collected every 2 years by validated questionnaires. We assessed three dietary patterns (the Mediterranean, the Western and the Provegetarian dietary patterns). The rate advancement period (RAP) was used to assess the healthiness of each pattern (considering the composite endpoint of all-cause mortality, cardiovascular disease, breast cancer or type 2 diabetes). We also assessed environmental footprints and monetary costs of each dietary pattern. RESULTS: After a median follow-up of 10.1 years, we identified 469 incident cases of the composite endpoint. The Mediterranean dietary pattern exhibited the best RAP (3.10 years gained [95% CI 4.35 to 1.85] for the highest vs the lowest quartile), while the Western pattern was the unhealthiest pattern (1.33 years lost when comparing extreme quartiles). In a scale between 4 and 16 of harmful environmental effects (the lower, the more environmentally friendly), the Provegetarian pattern scored best (8.82 [95% CI 8.75 to 8.88] when comparing extreme quartiles), whereas the Western pattern was the most detrimental pattern (10.80 [95% CI 10.72 to 10.87]). Regarding monetary costs, the Western pattern was the most affordable pattern (€5.87/day [95% CI 5.82 to 5.93], for the upper quartile), while the Mediterranean pattern was the most expensive pattern (€7.52/day [95% CI 7.47 to 7.56]). The Mediterranean dietary pattern was the most overall sustainable option, closely followed by the Provegetarian pattern. The least overall sustainable pattern was the Western dietary pattern. CONCLUSION: Following plant-based diets, like the Mediterranean or Provegetarian dietary patterns, could be a good option in order to achieve an overall sustainable diet. TRIAL REGISTRATION NUMBER: NCT02669602; Results.

Making choices: ethics and vegetarianism.

I was seventeen and taking an elective course in Earth and Environmental Science. We were learning about farming and the food system­genetic modification, land use, organic labeling­when our teacher assigned us an article about beef. The article explained the following process: the U.S. government subsidizes corn, so we feed it to our cows, because corn is cheap and fattens the cows up quickly. Cows are biologically designed to eat grass, so their livers are unable to process the corn. The cows' livers would actually explode if they were permitted to grow to full maturity, but we slaughter them first. This, combined with their living in close quarters and wading in their own feces, causes the cows to get ill often, so we feed them a con-stant stream of antibiotics, a practice that strengthens bacterial strains such as E. coli. Roughly 78 percent of cows raised for beef undergo this process. Similarly nauseating practices are used to raise chickens, turkeys, and pigs, 99 percent, 97 percent, and 95 percent of which, respectively, come from factory farms. Nowadays, these details are less than shocking. Movies such as Food, Inc. and Super Size Me, as well as books such as The Omnivore's Dilemma and Fast Food Nation have raised consciousness, if not much action, on the topic of our food system. But, for me, it was a new story.

A worksite vegan nutrition program is well-accepted and improves health-related quality of life and work productivity.

BACKGROUND/AIMS: Vegetarian and vegan diets are effective in preventing and treating several chronic diseases. However, their acceptability outside a clinical trial setting has not been extensively studied. The aim of this study was to determine the acceptability of a worksite vegan nutrition program and its effects on health-related quality of life and work productivity. METHODS: Employees of a major insurance corporation with a body mass index > or =25 kg/m(2) and/or a previous diagnosis of type 2 diabetes received either weekly group instruction on a low-fat vegan diet (n = 68) or received no diet instruction (n = 45) for 22 weeks. RESULTS: The vegan group reported improvements in general health (p = 0.002), physical functioning (p = 0.001), mental health (p = 0.03), vitality (p = 0.004), and overall diet satisfaction (p < 0.001) compared with the control group. The vegan group also reported a decrease in food costs (p = 0.003), and increased difficulty finding foods when eating out (p = 0.04) compared with the control group. The vegan group reported a 40-46% decrease in health-related productivity impairments at work (p = 0.03) and in regular daily activities (p = 0.004). CONCLUSIONS: A worksite vegan nutrition program is well-accepted and can be implemented by employers to improve the health, quality of life, and work productivity of employees.

Complex systems model of dietary choice with implications for improving diets and promoting vegetarianism.

An important step toward improving nutrition and promoting vegetarianism in the general population is to understand how consumers make dietary choices. Researchers from many clinical and social sciences are interested in dietary choice but have not combined their research into a comprehensive model to explain consumer actions. No one model has offered a good explanation for the fact that, although many people successfully change their diet significantly (often toward health-improving, plant-based diets) and are happy with the change, the public and health professionals often perceive dietary change as being difficult and unlikely to succeed. I have termed these observations "the paradox of dietary change." The present computer model uses the emerging science of complex systems analysis, which offers an intuitive method for studying evidence about dietary choice from many fields, including public health, clinical science, economics, sociology, marketing, and genetics, and for combining individual choice with social interaction. The results suggest an explanation for the paradox and methods for helping society shift toward healthier and more plant-based diets. In particular, they suggest how and why major changes might be easier to make than incremental ones, and why this makes dietary change seem more difficult to consumers than it actually is.

The health risks of new-wave vegetarianism.

Many young people call themselves vegetarians because they don't eat meat, but the eating style they are adopting is fraught with health risks. In this article, which won CMAJ's 1996 Army Chouinard Memorial Essay Contest for Canadian journalism students, Laura Brydges Szabo looks at the "new vegetarianism" and the recommendations health care professionals are making to young people intent on following this incomplete diet. The contest encourages journalism students to write on health care topics.

Work function analysis of vegetarian entrée production.

Data on labor time for food production can be used as an effective management tool. It is essential for foodservice managers to know how labor time is being used (1). A continuous time study was conducted to determine total labor time for the production of eight vegetarian entrées in a hospital foodservice system. Two work areas were observed: the ingredient assembly area and the cooks' production area. Times were recorded by work function to identify how labor time was distributed. Results showed (a) observed frequency for each work function, (b) time expended in seconds per portion for each work function, (c) percentage distribution of labor time by work function, (d) total time for each employee involved in entrée production, and (e) percentage of total time in which each employee was involved in the production of each entrée. Total labor time varied by type of entrée, ranging from 39.97 to 19.33 seconds per portion. Entrées with the highest labor time required the largest amount of hand labor. A one-way analysis of variance indicated significant differences in mean labor time among the eight vegetarian entrées for direct labor time (p = .0009), and total labor time (p = .0018). No significant differences were found among entrées for indirect labor or delay time.

Alternate dietary lifestyles.

Various forms of vegetarian diets are discussed and evaluated for their nutritional adequacy. Health, philosophical, religious, ecological, and economic concerns are suggested as possible reasons for these alternate dietary lifestyles. Nutrients of specific concern ot the vegetarian are highlighted and suggestions given to help incorporate these in the diet, thereby avoiding marginal intakes. With judicious menu planning and careful thought to food selections, most vegetarian diets can supply excellent nutrition. Very restricted vegetarian diets or higher level macrobiotic diets may not be nutritionally complete, and individuals following these diets may benefit from special dietary counseling and dietary supplementation. Otherwise, these diets may place the adult as well as pregnant and lactating women, infants, and children at a nutritional risk. As vegetarian food habits are becoming more widespread, physicians and nutritionists must be knowledgeable about these alternate dietary lifestyles in order to counsel their patients appropriately, to understand the reasons for these eating habits, and to be supportive of the choice of diet.