Does Unit-Dose Packaging Influence Understanding of Serving Size Information for Cannabis Edibles?

OBJECTIVE: Edible cannabis products have increased in popularity, particularly in jurisdictions that have legalized nonmedical cannabis. Rates of adverse events from cannabis edibles have also increased, in part because of difficulties identifying and titrating tetrahydrocannabinol (THC) levels. The current study tested whether packaging cannabis in separate units enhances consumer understanding of serving sizes. METHOD: An experimental task was conducted as part of the 2018 International Cannabis Policy Study online survey. Participants were recruited from the Nielsen Global Insights Consumer Panel. A total of 26,894 participants (61.5% female) ages 16-65 years from Canada and the United States were randomly assigned to view a cannabis brownie packaged according to one of three conditions: (a) multiserving edible ("control condition"), (b) single-serving edible, and (c) single-serving edible packaged separately ("unit-dose packaging"). Participants were asked to identify a standard serving based on information on the product label. Logistic regression was used to test the influence of packaging condition on the likelihood of a correct response, adjusting for key covariates. RESULTS: Compared with the multiserving edible control (50.6%), participants were significantly more likely to correctly identify the serving size in the single-serving edible condition (55.3%; adjusted odds ratio = 1.22, CI [1.15, 1.29], p < .001) and the unit-dose packaging condition (54.3%; adjusted odds ratio = 1.17, CI [1.10, 1.24], p < .001). CONCLUSIONS: Packaging in which each product unit contained one dose of THC enhanced consumers' ability to identify how much of a product constitutes a standard serving or dose. Packaging products as individual doses eliminates the need for mental math and could reduce the risk of accidental overconsumption of cannabis.

Cannabis labelling and consumer understanding of THC levels and serving sizes.

OBJECTIVE: As part of cannabis legalization in Canada and several US states, regulations specify how THC levels should be labelled on products; however, there is little evidence on the extent to which consumers understand and use THC labelling to inform consumption amounts. The current study was designed to assess comprehension of cannabis-related information including communication of dose and strength of product on different labelling designs among young Canadians. METHODS: Two experiments were conducted in October 2017 among Canadian youth and young adults aged 16-30 years as part of an online cross-sectional survey (N = 870). Experiment 1 randomized respondents to one of three labelling conditions (1=No Label, 2=mgTHC, 3=Doses). Respondents interpreted a recommended serving and number of servings contained in the package. Experiment 2 randomized respondents to one of four labelling conditions communicating THC level (1=No Label, 2=%THC, 3=mgTHC, 4=Traffic Light System). Respondents determined level of THC in the product. RESULTS: Labelling the number of doses per package was associated with the greatest proportion of correct responses (54.1 %) when respondents had to determine a recommended serving compared with the no-label control condition (7.4 %) and THC mg condition (13.4 %). When cannabis products were labelled using a traffic light system, participants were more likely to identify THC level: low THC (85.1 %) or high THC (86.4 %) than the control condition (2.0 % and 5.2 % respectively). CONCLUSION: Few consumers can understand and apply quantitative THC labelling; in contrast, THC labels that provide 'interpretive' information, such as descriptors, symbols, or references to servings have greater efficacy.

Serving Size and Nutrition Labelling: Implications for Nutrition Information and Nutrition Claims on Packaged Foods.

The presentation of nutrition information on a serving size basis is a strategy that has been adopted by several countries to promote healthy eating. Variation in serving size, however, can alter the nutritional values reported on food labels and compromise the food choices made by the population. This narrative review aimed to discuss (1) current nutrition labelling legislation regarding serving size and (2) the implications of declared serving size for nutrition information available on packaged foods. Most countries with mandatory food labelling require that serving size be presented on food labels, but variation in this information is generally allowed. Studies have reported a lack of standardisation among serving sizes of similar products which may compromise the usability of nutrition information. Moreover, studies indicate that food companies may be varying serving sizes as a marketing strategy to stimulate sales by reporting lower values of certain nutrients or lower energy values on nutrition information labels. There is a need to define the best format for presenting serving size on food labels in order to provide clear and easily comprehensible nutrition information to the consumer.

Comparison of Children's Menu Items at Full- and Quick-Service Restaurants.

OBJECTIVES: The proportion of food consumed by children from restaurants tripled during the last 4 decades and that coincided with the increased rate of obesity. Despite the presence of data linking quick-service (QS) food consumption to poor diet quality, studies comparing the nutrition content of the children's menu items at QS restaurants (QSRs) with those at full-service restaurants (FSRs) are limited. The objectives of this study were to examine the nutrition content of common children's menu items at both QSRs and FSRs and compare these data with recommendations reported by the Dietary Guidelines for Americans 2015-2020, Eighth Edition. METHODS: Using the 2014 data of the MenuStat project, 10 food items that are on both QSR and FSR children's menus were selected. Data from each restaurant category were aggregated and the overall average of the nutritional content of each individual food item was calculated and compared between the two restaurant categories. RESULTS: The average of calories, fat, carbohydrates, and added sugar of most items on the children's menu of QSRs are lower than those of FSRs. Also, most food items on children's menus of FSRs, and to a lesser extent those of QSRs, exceeded the national recommended calories and fat content per meal. CONCLUSIONS: Although some children's menu items of QSRs have less fat and fewer calories compared with those of FSRs, most menu items in both FSRs and QSRs do not meet national dietary recommendations. Healthcare professionals may expand discussions with patients to include both restaurant categories when counseling them and their families on obesity prevention. Also, educating children and families about reading the nutritional content information of children's menu items when eating out to make an informed choice can be a tool in fighting childhood obesity.

Large Variations in Declared Serving Sizes of Packaged Foods in Australia: A Need for Serving Size Standardisation?

Declared serving sizes on food packaging are unregulated in Australia, and variations in serving size within similar products reduces the usability of this information. This study aimed to (i) assess the variations in declared serving sizes of packaged foods from the Five Food Groups, and (ii) compare declared serving sizes to the Australian Dietary Guidelines standard serves and typical portion sizes consumed by Australian adults. Product information, including serving size, was collected for 4046 products from four major Australian retailers. Within product categories from the Five Food Groups, coefficients of variation ranged from 0% to 59% for declared serving size and 9% to 64% for energy per serving. Overall, 24% of all products displayed serving sizes similar (within ±10%) to the standard serves, and 23-28% were similar to typical portion sizes consumed by adults, for females and males, respectively. In conclusion, there is substantial variation in the declared serving sizes of packaged foods from the Five Food Groups, and serving sizes are not aligned with either the Dietary Guidelines or typical portion sizes consumed. Future research into effective means of standardising serving sizes is warranted.

Unregulated serving sizes on the Canadian nutrition facts table - an invitation for manufacturer manipulations.

BACKGROUND: Serving sizes on the Nutrition Facts table (NFt) on Canadian packaged foods have traditionally been unregulated and non-standardized. The federal government recently passed legislation to regulate the serving sizes listed on the NFt. The objective of this study was to compare the serving sizes on food product NFts to the recommendations in the 2003 Nutrition Labelling regulation (Schedule M) reference amounts, the Canadian Food Inspection Agency (CFIA) ranges, and Canada's Food Guide recommendations. An additional objective was to determine if food and beverage products that report smaller serving sizes have a higher calorie density, compared to similar products with a larger serving size. METHODS: Data for 10,487 products were retrieved from the 2010 Food Label Information Program (FLIP) database and categorized according to Schedule M categories. Correlations between calorie density and manufacturer stated serving size were tested and the proportion of products meeting recommendations were tabulated. RESULTS: 35% of products had serving sizes on the NFt that were smaller than the Schedule M reference amount and 23% exceeded the reference amount. 86% of products fell within the CFIA's recommended serving size ranges; however, 70% were within the lower-half of the range. Several bread and juice categories exceeded CFG's recommendations, while several dairy product categories were smaller than the recommendations. Of the 50 Schedule M sub-categories analyzed, 31 (62%) exhibited a negative correlation between serving size and calorie density. CONCLUSION: While most products fell within the CFIA's recommended serving size ranges, there was a tendency for products with a higher calorie density to list smaller serving sizes.

Programa de comedores escolares de la Comunidad de Madrid (2001-2015): diseño, protocolo, metodología y actualización / School Meals Programme of the Community of Madrid (2001-2015): design, protocol, methodology and update

Introducción: a finales del siglo XX, no se conocía con precisión si la comida del comedor escolar contribuía adecuadamente a la dieta de la población infantil. Además, este servicio complementario no se contemplaba en el proyecto educativo del centro pese a considerarse fundamental en todas sus dimensiones. Objetivo: describir el origen y desarrollo del programa de comedores escolares de la Comunidad de Madrid (CM) en 15 años desde su implantación. Métodos: se elaboró una normativa a cumplir por las empresas de restauración, y que contemplaba aspectos nutricionales y de composición y variedad de los menús, que se utilizó en los concursos para acceder a la prestación del servicio de comedor escolar, publicados en los años 2001, 2002, 2005, 2009 y 2013. Además se realizaron visitas acreditadas a los centros sin previo aviso para verificar el cumplimiento de la documentación aportada durante el concurso. Resultados: los criterios más actuales sobre programación y elaboración de menús escolares se recogen en el Pliego de Prescripciones Técnicas del año 2013 (C-504/001-2013). Un 92% de las empresas de restauración superaron los cinco concursos habidos en los 15 años de funcionamiento. Hasta el año 2014, se han realizado 755 visitas, revisándose un total de 574 centros. Conclusiones: el programa de comedores escolares de la CM, desde su implementación pionera en España, ha contribuido a la mejora del servicio complementario de comedor. En estos años se han ido incluyendo nuevos requisitos dietéticos y nutricionales que han logrado menús cada vez más ajustados a las recomendaciones de la población escolar (AU)

Introduction: At the end of the 20th century there was no precise knowledgment of whether the food delivered at schools supported the children´s diets. Furthermore, this additional service was not included in the educational plan of the school, even though it had an impact in the pupils´ education in several ways. Objective: To describe the origins and development of School Meals Programme of the Community of Madrid after 15 years of functioning. Methods: A law gathering all the nutritional aspects, composition and variety of the menus was implemented and had to be followed by all the catering companies. Such law was used in different terms (2001, 2002, 2005, 2009 and 2013) to choose who could access to the school meals service. Visits to the schools without previous warning took place to verify that they were complying with the standards. Results: The most recent nutritional standards about the planning and elaboration of the school menus are gathered at the 2013 «Pliego de Prescripciones Técnicas» (C-504/001-2013). As an average, 92% of the participating catering companies approved in the fi ve terms. Until year 2014, 755 visits to these schools took place, revising a total of 574 of them. Conclusions: The School Meals Programme of the Community of Madrid, since the pioneer implementation in Spain, has markedly contributed to the improvement of this key service in the schools. Over these years new dietary requirements have been progressively introduced to produce more suitable menus to fit the scholar population recommendations (AU)

Food Labeling: Serving Sizes of Foods That Can Reasonably Be Consumed at One Eating Occasion; Dual-Column Labeling; Updating, Modifying, and Establishing Certain Reference Amounts Customarily Consumed; Serving Size for Breath Mints; and Technical Amendments. Final rule.

The Food and Drug Administration (FDA or we) is issuing a final rule to define a single-serving container; require dual-column labeling for certain containers; update, modify, and establish several reference amounts customarily consumed (RACCs); amend the label serving size for breath mints; and make technical amendments to various aspects of the serving size regulations. We are taking this action to provide consumers with more accurate and up-to-date information on serving sizes.

High variation in manufacturer-declared serving size of packaged discretionary foods in Australia.

Despite the potential of declared serving size to encourage appropriate portion size consumption, most countries including Australia have not developed clear reference guidelines for serving size. The present study evaluated variability in manufacturer-declared serving size of discretionary food and beverage products in Australia, and how declared serving size compared with the 2013 Australian Dietary Guideline (ADG) standard serve (600 kJ). Serving sizes were obtained from the Nutrition Information Panel for 4466 packaged, discretionary products in 2013 at four large supermarkets in Sydney, Australia, and categorised into fifteen categories in line with the 2013 ADG. For unique products that were sold in multiple package sizes, the percentage difference between the minimum and the maximum serving size across different package sizes was calculated. A high variation in serving size was found within the majority of food and beverage categories - for example, among 347 non-alcoholic beverages (e.g. soft drinks), the median for serving size was 250 (interquartile range (IQR) 250, 355) ml (range 100-750 ml). Declared serving size for unique products that are available in multiple package sizes also showed high variation, particularly for chocolate-based confectionery, with median percentage difference between minimum and maximum serving size of 183 (IQR 150) %. Categories with a high proportion of products that exceeded the 600 kJ ADG standard serve included cakes and muffins, pastries and desserts (≥74 % for each). High variability in declared serving size may confound interpretation and understanding of consumers interested in standardising and controlling their portion selection. Future research is needed to assess if and how standardising declared serving size might affect consumer behaviour.

The effects of increased serving sizes on consumption.

The US Food and Drug Administration recently revealed that it is considering modifying the Nutrition Facts Panels required on packaged foods. One proposed change is increasing serving sizes included on labels, which has two potential implications. Larger serving sizes could increase consumption if consumers use the serving sizes displayed as a reference point for their own consumption (McFerran et al., 2010). Alternatively, larger serving sizes that depict increased values of negative nutrients (e.g. calories) could lead consumers to perceive foods as less healthy, thereby reducing consumption (Russo et al., 1986). In study 1 (Online sample, N = 208, Mage = 32, SDage = 12), participants saw pictures of packaged food items and nutrition labels. The labels, depicted either the existing or larger serving size. Across all foods, larger serving sizes led to lower health perceptions. Labels with larger serving sizes were rated as more representative of typical consumption. Study 2 (Online sample, N = 347, Mage = 31, SDage = 10) used the same design as study 1, but required participants to virtually portion foods. While serving sizes did not impact the amount of food consumers portioned, those who saw labels with larger serving sizes estimated that they portioned out more calories. In study 3 (Student sample, N = 198, Mage = 20, SDage = 1), participants were given M&Ms to eat, paired with a nutritional label depicting either the current or a larger serving size, while participating in unrelated surveys. Participants presented with the larger serving size label consumed less than those presented with the current serving size label. Together, the results suggest that the proposed increase in serving sizes on Nutrition Facts Panels could lower consumption of high-calorie foods.

Variations in serving sizes of Australian snack foods and confectionery.

This study examined the serving size and energy content per serving of Australian packaged snack foods and confectionery products. Nutrition Information Panel data for 23 sub-categories of packaged snack foods (n = 3481) were extracted from The George Institute for Global Health's 2013 branded food composition database. Variations in serving size and energy content per serving were examined. Energy contents per serving were compared to recommendations in the Australian Dietary Guidelines. Serving sizes varied within and between snack food categories. Mean energy content per serving varied from 320 kJ to 899 kJ. More energy per serving than the recommended 600 kJ was displayed by 22% (n = 539) of snack foods classified in the Australian Dietary Guidelines as discretionary foods. The recommendation for energy content per serving was exceeded in 60% (n = 635) of snack foods from the Five Food Groups. Only 37% (n = 377) of confectionery products displayed the industry-agreed serving size of 25 g. Energy content per serving of many packaged snack foods do not align with the Australian Dietary Guidelines and the industry agreed serving size has not been taken up widely within the confectionery category. Given the inconsistencies in serving sizes, featuring serving size in front-of-pack information may hinder the objective of a clear and simple nutrition message. Messaging to help consumers make healthier choices should consider the variation in serving sizes on packaged snack foods.

Package size and manufacturer-recommended serving size of sweet beverages: a cross-sectional study across four high-income countries.

OBJECTIVE: To assess the mean package size and manufacturer-recommended serving size of sweet beverages available in four high-income countries: Australia, Canada, the Netherlands and New Zealand. DESIGN: Cross-sectional surveys. SETTING: The two largest supermarket chains of each country in 2012/2013. SUBJECTS: Individual pack size (IPS) drinks (n 891) and bulk pack size (BPS) drinks (n 1904). RESULTS: For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting. CONCLUSIONS: At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices.

Contribution to the development of a food guide in Benin: linear programming for the optimization of local diets.

OBJECTIVE: Food guides are important tools for nutrition education. While developing a food guide in Benin, the objective was to determine the daily number of servings per food group and the portion sizes of common foods to be recommended. DESIGN: Linear programming (LP) was used to determine, for each predefined food group, the optimal number and size of servings of commonly consumed foods. Two types of constraints were introduced into the LP models: (i) WHO/FAO Recommended Nutrient Intakes and dietary guidelines for the prevention of chronic diseases; and (ii) dietary patterns based on local food consumption data recently collected in southern Benin in 541 adults. Dietary intakes of the upper tertile of participants for diet quality based on prevention and micronutrient adequacy scores were used in the LP algorithms. SETTING: Southern area of the Republic of Benin. SUBJECTS: Local key-players in nutrition (n 30) from the government, academic institutions, international organizations and civil society were partners in the development of the food guide directed at the population. RESULTS: The number of servings per food group and the portion size for eight age-sex groups were determined. For four limiting micronutrients (Fe, Ca, folate and Zn), local diets could be optimized to meet only 70 % of the Recommended Nutrient Intakes, not 100 %. CONCLUSIONS: It was possible to determine the daily number of servings and the portion sizes of common foods that can be recommended in Benin with the help of LP to optimize local diets, although Recommended Nutrient Intakes were not fully met for a few critical micronutrients.