Controversies in New US Dietary Guidelines: UPenn Director Karen Glanz, PhD, on Knowledge@Wharton

Karen Glanz, PhD, MPH,  UPenn PRC Director, Co-Principal Investigator on The Healthy Weigh Study and Principal Investigator on The Skin Cancer Communication Project, spoke with Dan Loney on Knowledge@Wharton, the Wharton Business Radio program, about the new US government dietary guidelines.  Glanz noted how the sugar and meat industries hold a heavy influence on the government’s new dietary guidelines.

“The 2015 guidelines] are without question the result of a process that combines science, business, lobbying, and special interests,” Glanz said. One of the food categories vigorously represented by lobbyists in Washington, D.C., is sugar. Although the new guidelines recommend cutting down on sugar, they do not call out the well-documented need for Americans to reduce their consumption of sugary beverages. “Undoubtedly,” Glanz told Loney, “that reflects some industry influence.”

This influence comes from the sugar industry’s $20 billion annual impact on the national economy: a significant sum, but one that pales in comparison to the $44 billion annual impact of the beef industry.  Although the new guidelines may be confusing for some, Glanz says those who work in the field of nutrition recognize what the government guidelines carefully omitted or included.

 

 

The link to Dr. Glanz’s interview will be posted here when it becomes available from the Best of Knowledge@Wharton.

http://www.upenn.edu/pennnews/current/2016-02-18/features/pik-professor-discusses-controversial-new-dietary-guidelines

http://knowledge.wharton.upenn.edu/category/business-radio/

Philadelphia Inquirer Tracks Incentives Research

The Philadelphia Inquirer: Feb. 16, 2016

The latest in a series of studies from behavioral economists at the University of Pennsylvania reported an example on Monday: promising people a monthly pot of money to increase their physical activity, but then deducting some every day they missed the goal led to a 50 percent jump in successful days – far better than simply paying them to exercise more.

More than 80 percent of large employers offer some kind of incentive to get workers to take up healthier habits, on the theory that this will improve well-being and reduce health-care costs.

But the trend has grown faster than research into what works best. Commonly offered “hidden” incentives, such as lower insurance premiums the next year, don’t “engage” employees enough for them to change their lives, said Mitesh S. Patel, lead author of the new study and one of 50 faculty, along with UPenn PRC Director, Kevin Volpp, MD, PhD, affiliated with Penn’s Center for Health Incentives and Behavioral Economics.

 

 

 

 

 

 

Cholesterol-Reducing Drugs and Memory Impairment: A Case of Detection Bias?

Reports on the association between statins and memory impairment are inconsistent.  To assess whether statin users show acute decline in memory compared with nonusers and with users of nonstatin lipid-lowering drugs (LLDs), UPenn PRC researcher Jason Karlawish and colleagues conducted a retrospective cohort study which compared 482 543 statin users with 2 control groups: 482 543 matched nonusers of any LLDs and all 26 484 users of nonstatin LLDs. A case-crossover study of 68 028 patients with incident acute memory loss evaluated exposure to statins during the period immediately before the outcome vs 3 earlier periods.

When compared with matched nonusers of any LLDs, a strong association was present between first exposure to statins and incident acute memory loss diagnosed within 30 days immediately following exposure. This association was not reproduced in the comparison of statins vs nonstatin LLDs but was also present when comparing nonstatin LLDs with matched nonuser controls. The case-crossover analysis showed little association.

The authors conclude by arguing that both statin and nonstatin LLDs were strongly associated with acute memory loss in the first 30 days following exposure in users compared with nonusers but not when compared with each other. Thus, either all LLDs cause acute memory loss regardless of drug class or the association is the result of detection bias rather than a causal association.

Read the article here.

Strom B, Schinnar R, Karlawish J. Statin Therapy and Risk of Acute Memory Impairment. JAMA Intern Med. 2015;175(8):1399-1405.

How Do Sugar-Sweetened Beverage-Related Public Service Advertisements Influence Parents?

UPenn PRC’s Amy Jordan PhD, Amy Bleakley, PhD, MPH, Karen Glanz, PhD, MPH, and Andrew Strasser, PhD, using a novel experimental approach, identifying the effectiveness of distinct persuasive strategies used in audiovisual (television-format) public service advertisements (PSAs) designed to encourage parents to reduce their children’s sugar-sweetened beverage (SSB) consumption. Evaluation of existing SSB-related PSAs is vitally important because it can provide insight into which persuasive appeals are most effective for audiences, particularly those most at risk for overweight and obesity
Their findings suggest that anti-SSB campaigns targeting parents should include strong arguments for sugar-sweetened beverage reduction, invoke feelings of empowerment and hope, and be clearly directed at distinct parent audiences. At the same time the authors recognize that while individual actions may be helpful, the obesogenic environment that surrounds children may subvert even the most involved and well-intentioned parents. Appeals to personal parenting responsibility should be made in concert with efforts to create healthier structural, nutritional, and preventative environments.

Read the article here.

Jordan A, Bleakley A, Hennessy M, Vaala S, Glanz K, Strasser AA. Sugar-Sweetened Beverage-Related Public Service Advertisements and Their Influence on Parents. American Behavioral Scientist. 2015;59(14):1847-1865.

 

 

 

Nudging Students Towards Healthier Food Choices: An Editorial by UPenn PRC Director Kevin Volpp

In an editorial in JAMA Pediatrics, UPenn PRC Director Kevin Volpp, MD, PhD, and Mitesh Patel, MD, MBA, MS examine the value of a behavioral economics approach to research addressing the need to improve nutrition for and lower obesity in children in the U.S.

Behavioral economics is a field that recognizes that individuals do not always behave rationally when making decisions. When choosing what to eat, children are particularly influenced by the environment in which food is presented. Choice architecture is the application of behavioral economic principles to the design of environments in which decisions are made. While there is a significant opportunity to nudge students toward healthier food choices, there is a lack of rigorous evaluation of such interventions in real-world settings.

Despite numerous efforts to improve the food consumption of America’s youth, rates of obesity among school-aged children have not changed over the past decade. Strategies that are most likely to encourage healthier food choices are those that reflect individuals’ rational preferences (e.g., making food taste better) and apply insights from behavioral economics to better design choice architecture.

Read the article here.

Patel MS, Volpp KG. Nudging Students Toward Healthier Food Choices—Applying Insights From Behavioral Economics. JAMA Pediatr. 2015;169(5):425–426. doi:10.1001/jamapediatrics.2015.0217

Development of the Perceived Nutrition Environment Measures Survey (NEMS-P)

In the American Journal of Preventive Medicine July 2015, PRC Director Dr. Karen Glanz and Sarah Green of the Center for Health Behavior Research, University of Pennsylvania, discuss the development of the Perceived Nutrition Environment Measures Survey (NEMS-P). As a result, it has the ability to discern differences between lower- and higher-SES neighborhoods.

 

One of the most widely used observational measures of the nutrition environment, the Nutrition Environment Measures Survey (NEMS), developed by Dr. Glanz’s team, is used to study a range of food environments and contexts and evaluate policy and environment interventions. NEMS data have been collected throughout the U.S. and internationally by trained researchers, nutritionists, and public health professionals.

 

The NEMS-P, developed using a multiphase systematic measurement development process, has been shown to be easy to understand and have good test-retest reliability. In addition, it discriminates between neighborhood food environments in disadvantaged compared to more affluent communities. The NEMS-P is an important step forward in developing a psychometrically sound and conceptually grounded tool that can be used in a variety of communities and complement observational and geospatial assessments of nutrition environments.

 

Read the article here.

 

Green S, Glanz K. Development of the Perceived Nutrition Environment Measures Survey. American Journal of Preventive Medicine July 2015, 49:1, 50-61.

 

Do appeals in Advertisements Influence Adolescents’ Consumption of Sweetened Beverages?

A new study at Penn has been published in the Journal of Health Communication. PRC researchers Amy Bleakley, Amy Jordan, Karen Glanz, and Andrew Strasser, were the first to test the effect of persuasive strategies used in public service ad campaigns aimed at sugar-sweetened beverages, which include non-diet soda, sports and energy drinks, sweetened teas and fruit drinks.

The researchers found that public service advertisements (PSAs) appealing to fear – and warning of the health consequences of too much sugar, such as obesity, diabetes, amputations, cancer, and heart disease – had the greatest effect on teens’ intention to cut back on sugary drinks. The study also examined ads that appealed to humor and to nurturance (protective, parental instincts).

The fear-based ads worked directly to influence the adolescents’ intentions, as well as indirectly by affecting the perceived strength of the message. All three kinds of emotional appeals – fear, humor, and nurturance – affected other emotions and cognitions as well, but not all of those were shown to be related to teens’ intention to cut back on sugary drinks.

Read the study here

Bleakley A, Jordan A, Hennessy M, Glanz K, Strasser A and Vaala S. Do Emotional Appeals in Public Service Advertisements Influence Adolescents’ Intention to Reduce Consumption of Sugar-Sweetened Beverages? Journal of Health Comm, Jun 2015, online, 938-948.