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Study shows that cafes, restaurants and fast food outlets, and schools, are key sources of unhealthy, non-core foods for adolescents

European Association for the Study of Obesity

Adolescents are getting many of their unhealthy, non-core foods such as soft drinks, chips, and sweets from cafes, restaurants, fast-food outlets (collectively called 'eateries'), and schools, according to a UK study presented at this year's European Congress on Obesity (ECO) in Porto, Portugal (17-20 May). The study is by Zoi Toumpakari, University of Bristol, UK, and colleagues.

Non-core food refers to all foods surplus to nutritional requirements such as soft drinks, chips, and confectionery. A diet high in non-core foods during adolescence is associated with increased adiposity and Body Mass Index (BMI). Understanding how the physical and social environment affects adolescents' consumption of non-core foods is crucial for developing effective interventions to reduce consumption and tackle soaring obesity rates--with one in four teenagers in England now clinically obese by the age of 15

In this study, the authors analysed data gathered from a representative sample of 884 adolescents from the UK National Diet and Nutrition Surveys 2008-12. Four-day food diaries provided information on the environmental context of each eating occasion (EO) in which these adolescents consumed non-core foods including 'where' (e.g. home, school, eateries) and 'with whom' (e.g. parents, friends). Computer modelling was used to investigate associations between eating context and non-core food energy intake (kcal) per EO, adjusting for variables such as time of the day, TV watching, age, gender, and socioeconomic status.

The authors also used face-to-face interviews to understand why adolescents consume non-core foods in certain physical and social environments. A total of 18 interviews were conducted with 14-16 year old adolescents from the wider Bristol area to establish the reasons behind their eating habits.

The analysis showed that 'eateries' -- meaning restaurants, fast food outlets, and cafes -- were an important environment in which adolescents consumed more non-core food. Non-core food intake per EO was 2.5 times higher in eateries compared with home. Schools were also an important source, with non-core food intake per EO almost twice as high in schools than at home.

Adolescents preferred eating at eateries because food options were perceived as being more exciting than at home and the opportunity to socialise with friends. Their food choices were mostly influenced by norms of (un)healthy eating--meaning adolescents had some fixed ideas about eating healthily with parents and unhealthily with friends--as well as social aspects, including that adolescents conformed to their friends' food choices so as not to appear different from the group. In the case of friends, however, a more functional way of eating became important. In other words, adolescents prioritised other activities such as going shopping or to the cinema and therefore mostly chose convenient 'fast' foods, simply to fuel themselves and continue their activities.

The data showed that all adolescents consume at least some non-core foods, and that the amount eaten is better predicted by characteristics of eating occasions (such as where and with whom it occurs) than individual characteristics like socioeconomic status, gender or age. Therefore, interventions would benefit from targeting specific environments, such as eateries and school, rather than specific individuals.

The authors conclude: "Eateries represent a high-risk environment where adolescents eat more non-core food because they enjoy the food and socialising. Interventions could target reformulation and reduction of portion sizes in eateries to reduce consumption of non-core foods and therefore reduce adolescents' odds for becoming obese."

They add: "Consumption in eateries could also be limited by reducing how often adolescents visit them. This could be accomplished by enhancing the eating environment at home, for example parents could make diet at home less repetitive and create a social and relaxing eating atmosphere. The most feasible and effective strategy to reduce non-core food intake in eateries needs to be identified and be tested in a pilot intervention."

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