title: Why Visual Cues of Portion Size May Influence Intake Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. The power of habits: unhealthy snacking behaviour is primarily predicted by habit strength. Implausible results in human nutrition research Strategies to improve the Willingness to Taste: The moderating role of children's Reward Sensitivity Intervention effects of information and self-regulation on eating fruits and vegetables over two years. Reward circuitry responsivity to food predicts future increases in body mass: Moderating effects of DRD2 and DRD4 Are dietary restraint scales valid measures of moderate- to long-term dietary restriction? Objective biological and behavioral data suggest not. Facts up front versus traffic light food labels: a randomized controlled trial. Psychosocial determinants of fruit and vegetable intake in adult population: a systematic review Using aversive images to enhance healthy food choices and implicit attitudes: An experimental test of evaluative conditioning. Some problems with Cochrane reviews of diet and chronic disease Is there a consumer backlash against the diet and health message? Planning and self-efficacy interventions encouraging replacing energy-dense foods intake with fruit and vegetable: A longitudinal experimental study Hunger is the best spice: An fMRI study of the effects of attention, hunger and calorie content on food reward processing in the amygdala and orbitofrontal cortex
abstract: OBJECTIVE Using self-refilling soup bowls , this study examined whether visual cues related to portion size can influence intake volume without altering either estimated intake or satiation . RESEARCH METHODS AND PROCEDURES Fifty-four participants ( BMI , 17.3 to 36.0 kg/m2 ; 18 to 46 years of age ) were recruited to participate in a study involving soup . The experiment was a between-subject design with two visibility levels : 1 ) an accurate visual cue of a food portion ( normal bowl ) vs. 2 ) a biased visual cue ( self-refilling bowl ) . The soup apparatus was housed in a modified restaurant-style table in which two of four bowls slowly and imperceptibly refilled as their contents were consumed . Outcomes included intake volume , intake estimation , consumption monitoring , and satiety . RESULTS Participants who were unknowingly eating from self-refilling bowls  ate more soup [ 14.7+/-8.4 vs. 8.5+/-6.1 oz ; F(1,52)=8.99 ; p<0.01 ] than those eating from normal soup bowls . However , despite consuming 73 % more , they did not believe they had consumed more , nor did they perceive themselves as more sated than those eating from normal bowls . This was unaffected by BMI . DISCUSSION These findings are consistent with the notion that the amount of food on a plate or bowl increases intake because it influences consumption norms and expectations and it lessens one 's reliance on self-monitoring . It seems that people use their eyes to count calories and not their stomachs . The importance of having salient , accurate visual cues can play an important role in the prevention of unintentional overeating BACKGROUND The Lyon Diet Heart Study is a r and omized secondary prevention trial aim ed at testing whether a Mediterranean-type diet may reduce the rate of recurrence  after a first myocardial infa rct ion . An intermediate analysis showed a striking protective effect after 27 months of follow-up . This report presents results of an extended follow-up ( with a mean of 46 months per patient ) and deals with the relationships of dietary patterns and traditional risk factors with recurrence . METHODS AND RESULTS Three composite outcomes ( COs ) combining either cardiac death and nonfatal myocardial infa rct ion ( CO 1 ) , or the preceding plus major secondary end points ( unstable angina , stroke , heart failure , pulmonary or peripheral embolism ) ( CO 2 ) , or the preceding plus minor events requiring hospital admission ( CO 3 ) were studied . In the  Mediterranean diet group , CO 1 was reduced ( 14 events versus 44 in the prudent Western-type diet group , P=0.0001 ) , as were CO 2 ( 27 events versus 90 , P=0.0001 ) and CO 3 ( 95 events versus 180 , P=0 . 0002 ) . Adjusted risk ratios ranged from 0.28 to 0.53 . Among the traditional risk factors , total cholesterol ( 1 mmol/L being associated with an increased risk of 18 % to 28 % ) , systolic blood pressure ( 1 mm Hg being associated with an increased risk of 1 % to 2 % ) , leukocyte count ( adjusted risk ratios ranging from 1.64 to 2.86 with count > 9x10(9)/L ) , female sex ( adjusted risk ratios , 0.27 to 0 . 46 ) , and aspirin use ( adjusted risk ratios , 0.59 to 0.82 ) were each significantly and independently associated with recurrence . CONCLUSIONS The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infa rct ion , confirming previous intermediate analyses . Major traditional risk factors , such as high blood cholesterol and blood pressure , were shown to be independent and joint predictors of recurrence , indicating that the Mediterranean dietary pattern did not alter , at least qualitatively , the usual relationships between major risk factors and recurrence . Thus , a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet . It should be associated with other ( pharmacological ? ) means aim ed at reducing modifiable risk factors . Further trials combining the 2 approaches are warranted OBJECTIVE Although increasing evidence shows the importance of habits in explaining health behaviour , many studies still rely solely on predictors that emphasize the role of conscious intentions . The present study was design ed to test the importance of habit strength in explaining  unhealthy snacking behaviour  in a large representative community sample ( N= 1,103 ) . To test our hypothesis that habits are crucial when explaining unhealthy snacking behaviour , their role was compared to the ' Power of Food ' , a related construct that addresses sensitivity to food cues in the environment . Moreover , the relation between Power of Food and unhealthy snacking habits was assessed . DESIGN AND METHODS A prospect i ve design was used to determine the impact of habits in relation to intention , Power of Food and a number of demographic variables . One month after filling out the question naire , including measures of  habit strength and Power of Food , participants reported their unhealthy snacking behaviour by means of a 7-day snack diary . RESULTS Results showed that habit strength was the most important predictor , outperforming all other variables in explaining unhealthy snack intake . CONCLUSIONS The findings demonstrate that snacking habits provide a unique contribution in explaining unhealthy snacking behaviour , stressing the importance of addressing habit strength in further research and interventions concerning unhealthy snacking behaviour Definitive solutions wo n’t come from another million observational papers or small r and omized trials The present study investigates the effectiveness of different strategies to improve Willingness to Taste disliked vegetables  and the moderating role of Reward Sensitivity . Preschool children ( N = 204 ; age : M = 4.48 , SD = 1.01 ) were r and omly allocated to one of four different Willingness to Taste strategies . The findings indicate that first , Willingness to Taste is higher in the modelling and reward strategies compared to neutral instructions . Second , there is a differential effect of Willingness to Taste strategies dependent upon individual differences : children high in Reward Sensitivity were more likely to taste immediately when rewarded , while children low in Reward Sensitivity were more willing to taste when verbally encouraged , but with hesitation . This article thus highlights the roles of both individual differences and behavioral techniques for promoting a healthy diet in children OBJECTIVE This study tested whether an intervention that combined information with self-regulation strategies had a better effect on eating fruits and vegetables than an information-only intervention . DESIGN Women between age 30 and 50 ( N = 255 ) participated in a 24-month r and omized controlled trial comparing two brief interventions : All participants received the same information intervention ; participants in the information plus self-regulation group additionally learned a self-regulation technique that integrates mental contrasting with implementation intentions . MAIN OUTCOME MEASURES Participants reported in daily diaries how many servings of fruits and vegetables they ate per day during 1 week at baseline , and in the first week , 1 , 2 , 4 , and 24 months after intervention . RESULTS Participants in both groups ate more fruits and vegetables ( 0.47 to 1.00 daily servings ) than at baseline during the first 4 months after intervention . Two years later , participants in the information plus self-regulation group maintained the higher intake , whereas participants in the information group returned to baseline levels . CONCLUSION Adding self-regulation training to an information intervention increased its effectiveness for long-term behavior change OBJECTIVE To determine whether responsivity of reward circuitry to food predicts future increases in body mass and whether polymorphisms in DRD2 and DRD4 moderate these relations . DESIGN The functional magnetic resonance imaging ( fMRI ) paradigm investigated blood oxygen level dependent activation in response to imagined intake of palatable foods , unpalatable foods , and glasses of water shown in pictures . DNA was extracted from saliva sample s using st and ard salting-out and solvent precipitation methods . PARTICIPANTS Forty-four adolescent female high school students ranging from lean to obese . MAIN OUTCOME Future increases in body mass index ( BMI ) . RESULTS Weaker activation of the frontal operculum , lateral orbitofrontal cortex , and striatum in response to imagined intake of palatable foods , versus imagined intake of unpalatable foods or water , predicted future increases in body mass for those with the DRD2 TaqIA A1 allele or the DRD4 - 7R allele . Data also suggest that for those lacking these alleles , greater responsivity of these food reward regions predicted future increases in body mass . DISCUSSION This novel prospect i ve fMRI study indicates that responsivity of reward circuitry to food increases risk for future weight gain , but that genes that impact dopamine signaling capacity moderate the predictive effects , suggesting two qualitatively distinct pathways to unhealthy weight gain based on genetic risk Prospect i ve studies indicate that elevated scores on dietary restraint scales predict bulimic symptom onset , but experiments indicate that assignment to dietary restriction interventions reduces bulimic symptoms . One possible explanation for the inconsistent findings is that the dietary restraint scales used in the former studies are not valid measures of dietary restriction . The authors previously found that  dietary restraint  scales were not inversely correlated with objective measures of short-term caloric intake ( E. Stice , M. Fisher , & M. R. Lowe , 2004 ) . In this follow-up report , 3 studies indicated that the Three-Factor Eating Question naire  dietary restraint scale was not correlated with doubly labeled water estimated energy intake over 2-week periods or with observationally measured caloric intake over 3 months . Results from this study and others suggest that  dietary restraint scales may not be valid measures of moderate- to long-term dietary restriction and imply the need to reinterpret findings from studies that have used dietary restraint scales BACKGROUND The U.S. food and beverage industry recently released a new front-of-package nutrition labeling system called Facts Up Front that will be used on thous and s of food products . PURPOSE To test consumer underst and ing of the Facts Up Front system ( Facts Up Front ) compared to the Multiple Traffic Light system ( Traffic Light ) . Facts Up Front displays grams/milligrams and percentage daily value information for various nutrients ; Traffic Light uses an interpretive color-coded scheme to alert consumers to low , medium , and high levels of certain nutrients . DESIGN Participants in an Internet-based study were r and omized to one of five front-of-package label conditions : ( 1 ) no label ; ( 2 ) Traffic Light ; ( 3 ) Traffic Light plus information about protein and fiber ( Traffic Light+ ) ; ( 4 ) Facts Up Front ; or ( 5 ) Facts Up Front plus information about " nutrients to encourage " ( Facts Up Front+ ) . SETTING / PARTICIPANTS A total of 703 adults recruited through an online data base in May 2011 participated in this study , and data were analyzed in June 2011 . MAIN OUTCOME MEASURES Total percentage correct quiz scores were generated reflecting participants ' ability to compare two foods on nutrient levels , based on their labels , and to estimate amounts of saturated fat , sugar , sodium , fiber and protein in the foods . RESULTS The front-of-package label groups outperformed the control group on nearly all of the nutrient quizzes ( p<0.05 ) . The control group did not differ from the Facts Up Front group on the saturated fat quiz , or from the Facts Up Front+ group on the sugars quiz . Those in the Traffic Light+ group had the best overall performance ( > 80 % on all quizzes ) . CONCLUSIONS Overall , those in the Traffic Light+ condition performed better than those in the Facts Up Front conditions on measures of nutrition knowledge and label perceptions . TRIAL REGISTRATION This study is registered at clinical trials.gov NCT01626729 Background Accumulating evidence suggests that fruit and vegetable intake ( FVI ) plays a protective role against major diseases . Despite this protective role and the obesity p and emic context , population s in Western countries usually eat far less than five servings of fruits and vegetables per day . In order to increase the efficiency of interventions , they should be tailored to the most important determinants or mediators of FVI . The objective was to systematic ally review social cognitive theory-based studies of FVI and to identify its main psychosocial determinants . Methods Published papers were systematic ally sought using Current Contents ( 2007 - 2009 ) and Medline , Embase , PsycINFO , Proquest and Thesis , as well as Cinhal ( 1980 - 2009 ) . Additional studies were identified by a manual search in the bibliographies . Search terms included fruit , vegetable , behaviour , intention , as well as names of specific theories . Only studies predicting FVI or intention to eat fruits and vegetables in the general population and using a social cognitive theory were included . Independent extraction of information was carried out by two persons using predefined data fields , including study quality criteria . Results A total of 23 studies were identified and included , 15 study ing only the determinants of FVI , seven study ing the determinants of FVI and intention and one study ing only the determinants of intention . All pooled analyses were based on r and om-effects models . The r and om-effect R2 observed for the prediction of FVI was 0.23 and it was 0.34 for the prediction of intention . Multicomponent theoretical frameworks and the theory of planned behaviour ( TPB ) were most often used . A number of method ological moderators influenced the efficacy of prediction of FVI . The most consistent variables predicting behaviour were habit , motivation and goals , beliefs about capabilities , knowledge and taste ; those explaining intention were beliefs about capabilities , beliefs about consequences and perceived social influences . Conclusions Our results suggest that the TPB and social cognitive theory ( SCT ) are the preferable social cognitive theories to predict behaviour and TPB to explain intention . Efficacy of prediction was nonetheless negatively affected by method ological factors such as the study design and the quality of psychosocial and behavioural measures OBJECTIVE To examine the effect of communicating images of energy-dense snack foods paired with aversive images of the potential health consequences of unhealthy eating , on implicit and explicit attitudes and food choice behavior . DESIGN Participants were r and omly allocated to either an evaluative conditioning ( EC ) procedure that paired images of snack foods with images of potential adverse health consequences or a control condition that featured images of snack foods alone . MAIN OUTCOME MEASURES Implicit attitudes were assessed pre- and post-intervention . Explicit attitudes and food choice behavior were assessed post-intervention . RESULTS The conditioning intervention made implicit attitudes toward energy-dense snacks more negative , with this effect greatest in those with relatively more favorable implicit attitudes toward these snacks at baseline . Participants in the conditioning intervention were more likely to choose fruit rather than snacks in a behavioral choice task , a relationship mediated by changes in implicit attitudes . CONCLUSION Presenting aversive images of potential health consequences with those of specific foodstuffs can change implicit attitudes , which impacts on subsequent food choice behavior The sum of evidence -based nutrition has to be more than a Cochrane-type meta- analysis of r and omised controlled trials ( RCTs ) . Most of the evidence base in nutrition is observational , especially cohort studies . RCTs of diet change through to disease outcome are uncommon and the change has usually been addition or removal of only a single food component . Trials with whole diets through to disease outcome are rare and dietary changes made by individuals are unlikely to be an exact copy of the prescription . It is hard to even imagine a trial in which half ( r and omised ) of a large group of middle-aged people agree to avoid vegetables for 5 y and be followed up to see who will develop cancer . Most of the USA 's health cl aims , permitted by the Food and Drug Administration , are not supported by RCTs . But where controlled trials of nutritional change and disease outcome have been achieved , they must be review ed very carefully . Two Cochrane review s on diet and cardiovascular disease ( CVD ) , published in the widely read British Medical Journal ( BMJ ) , were criticised after their publication and the conclusions have not been subsequently adopted by expert committees . The first of these review s was ‘ Dietary fat and prevention of CVD : a systematic review ’ . The second was ‘ Systematic review of long term effects of advice to reduce dietary salt in adults ’ . A critique of these two Cochrane review s is presented here as a contribution to our discussion of the potential of Cochrane methodology to the reliability of knowledge about diet and disease OBJECTIVE Anecdotal evidence exists that the public is becoming skeptical about nutrition messages . This article examines whether there is a backlash against dietary recommendations and whether it is associated with less healthful diets . DESIGN / PARTICIPANTS Data are from a 1997 - 1998 Washington State r and om-digit-dial survey of 1,751 adults design ed to monitor attitudes and behavior related to cancer risk and prevention . STATISTICAL ANALYSES Responses to the nutrition backlash survey were weighted to reflect the Washington State population . Linear regression was used to examine associations of nutrition backlash with fat and fruit and vegetable intake . RESULTS This survey did not find strong evidence that nutrition backlash was widespread . However , 70 % of respondents thought that Americans are obsessed with the fat in their diet and that the government should not tell people what to eat . More than a quarter agreed with the statement that eating low-fat foods takes the pleasure out of eating . Nutrition backlash was associated with less healthful diets : individuals showing high backlash had a fat-related diet habits score of 2.11 compared with a score of 1.73 among those showing low backlash ( P for trend = .001 ) , which corresponds to a difference of roughly 4 percentage points in percentage energy from fat . Individuals showing high backlash reported eating only 2.72 servings of fruits and vegetables per day , compared with 3.35 servings among those showing low backlash ( P for trend = .001 ) . APPLICATIONS/ CONCLUSIONS Nutrition professionals need to ensure that dietary recommendations are clear and positive to avoid the possibility that consumers may disregard nutrition messages entirely Objective : This longitudinal experimental study compared effects of self-efficacy , planning and education-based conditions , encouraging adolescents to eat fruit and vegetable in place of energy-dense foods . Design : Data were collected among 506 adolescents ( 13–18 years old ) who were r and omly assigned to control ( n = 181 ) , planning ( n = 153 ) or self-efficacy ( n = 172 ) conditions . Measurements were taken at baseline ( T1 ) , at a 2-month follow-up ( T2 ) , and at a 14-month follow-up ( T3 ) . Interventions /control group procedures were delivered at T1 and T2 . Outcome measures : Self-reports of fruit and vegetable intake ( FVI ) and energy-dense foods intake were collected at three times . Cognitive mediators ( self-efficacy and planning ) were assessed at T1 and T2 . Body weight and height were objective ly measured at T1 and T3 . Results and conclusions : Similar significant increases of FVI were found for  planning  and  self-efficacy  interventions ( T3 ) . The planning intervention did not influence energy-dense food intake ( T3 ) , but the self-efficacy intervention tended to result in stabilising intake ( compared to an increase found in the control group ) . There were no effects on body weight . Similar patterns were found for the total sample and for a sub sample of adolescents with overweight/obesity . The effects of interventions on FVI were mediated by respective cognitions Research indicates that dysfunctional food reward processing may contribute to pathological eating behaviour . It is widely recognized that both the amygdala and the orbitofrontal cortex ( OFC ) are essential parts of the brain 's reward circuitry . The aims of this fMRI study were ( 1 ) to examine the effects of food deprivation and calorie content on reward processing in the amygdala and the OFC , and ( 2 ) to examine whether an explicit evaluation of foods is necessary for OFC , but not amygdalar activity . Addressing the first aim , healthy females were presented with high and low calorie food pictures while being either hungry or satiated . For the second aim , attention focus was manipulated by directing participants ' attention either to the food or to a neutral aspect . This study shows that hunger interacts with the energy content of foods , modulating activity in the posterior cingulate cortex , medial OFC , insula , cau date putamen and fusiform gyrus . Results show that satiated healthy females show an increased reward processing in response to low calorie foods . Confirming our hypothesis , food deprivation increased activity following the presentation of high calorie foods , which may explain why treatments of obesity energy restricting diets often are unsuccessful . Interestingly , activity in both the amygdala and mOFC was only evident when participants explicitly evaluated foods . However , attention independent activity was found in the mPFC following the high calorie foods cues when participants where hungry . Current findings indicate that research on how attention modulates food reward processing might prove especially insightful in the study of the neural substrates of healthy and pathological eating behaviour
target: RESULTS Our findings suggest that consumers have a relatively poor underst and ing of a healthy diet .
  The literature also demonstrates that there is poor evidence on the health protective effects of single foods or nutrients .
  We further show that low SES is the single consistent risk factor for not adhering to a healthy diet .
  Our review of the literature on determinants demonstrates that intentions , habits , self-regulatory skills , and the social and physical environment are the most important determinants of a healthy diet , which are in turn amenable to change by intervention strategies with varying levels of effectiveness .
  Educational interventions generally show a limited effect on practising a healthy diet whereas interventions targeting habitual behaviour and /or the physical environment seem more promising .
  In view of the large number of people who are concerned about their diets and make attempts to change their dietary patterns , we conclude that it is crucial to gain a better underst and ing of both the automatic and environmental influences that are responsible for people not acting upon their good intentions for diet change
background: OBJECTIVE To discuss healthy diet from a psychological perspective by considering definitions of healthy diet in terms of consumer underst and ing ; the health effects of specific dietary elements in terms of overweight and ( chronic ) illness ; the prevalence of healthy diet ; the psychological and environmental determinants of healthy diet ; and the psychological interventions that have been design ed to promote healthy diet .