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Background The essence of nudging is to adapt the environment in which consumers make decisions to help them make better choices, without forcing certain outcomes upon them. To determine how consumers can effectively be guided to select healthier snacks, we examine the effect of manipulating the assortment structure and shelf layout of an impulse display including both healthy and unhealthy snacks near the checkout counter of a canteen. Methods Both a lab and field study applied a two-factor experimental design manipulating snack offerings both in an on-screen choice environment and a natural environment (hospital staff restaurant). Shelf arrangement (i.e. accessibility) was altered by putting healthy snacks at higher shelves versus lower shelves. Assortment structure (i.e. availability) was altered by offering an assortment that either included 25% or 75% healthy snacks. Participants in the lab study (n = 158) made a choice from a shelf display. A brief survey following snack selection asked participants to evaluate the assortment and their choice. The field experiment took place in a hospital canteen. Daily sales data were collected for a period of four weeks. On completion of the field study, employees (n = 92) filled out a questionnaire about all four displays and rated their attractiveness, healthiness and perceived freedom of choice. Results The lab study showed a higher probability of healthy snack choice when 75% of the assortment consisted of healthy snacks compared to conditions with 25% healthy snack assortments, even though choices were not rated less satisfying or more restrictive. Regarding shelf display location of healthy snacks, no significant differences were observed. There was also no significant shelf arrangement by assortment structure interactive effect. The field study replicated these findings, in that this assortment structure led to higher sales of healthy snacks. Sales of unhealthy and total snacks were not impacted by manipulations (no main or interaction effects). Employees preferred shelf displays including a larger healthy snack assortment located at top shelves. Employees also felt more freedom in choice when healthy snacks were displayed at top shelves compared to lower shelves. Conclusions Overall, results suggest that increasing the prominence of healthy snacks by enlarging their availability, while permitting access to unhealthy snacks, is a promising strategy to promote sales. These results point to the importance of nudging strategies to encourage healthier snack patterns.

Abstract Study Objectives: Besides influencing vigilance, orexin neurotransmission serves a variety of functions, including reward, motivation, and appetite regulation. As obesity is an important symptom in orexin-deficient narcolepsy, we explored the effects of satiety on food-related choices and spontaneous snack intake in patients with narcolepsy type 1 (n = 24) compared with healthy matched controls (n = 19). In additional analyses, we also included patients with idiopathic hypersomnia (n = 14) to assess sleepiness-related influences. Methods: Participants were first trained on a choice task to earn salty and sweet snacks. Next, one of the snack outcomes was devalued by having participants consume it until satiation (i.e., sensory-specific satiety). We then measured the selective reduction in choices for the devalued snack outcome. Finally, we assessed the number of calories that participants consumed spontaneously from ad libitum available snacks afterwards. Results: After satiety, all participants reported reduced hunger and less wanting for the devalued snack. However, while controls and idiopathic hypersomnia patients chose the devalued snack less often in the choice task, patients with narcolepsy still chose the devalued snack as often as before satiety. Subsequently, narcolepsy patients spontaneously consumed almost 4 times more calories during ad libitum snack intake. Conclusions: We show that the manipulation of food-specific satiety has reduced effects on food choices and caloric intake in narcolepsy type 1 patients. These mechanisms may contribute to their obesity, and suggest an important functional role for orexin in human eating behavior. Clinical Trials Registration: Study registered at Netherlands Trial Register. URL: www.trialregister.nl. Trial ID: NTR4508.

The purpose of this study was to examine the effects of a 6-week “staircase sprinting” (SS) with or without blood flow restriction (BFR) on body composition, anaerobic power, and leg muscle strength in physically inactive college students. Twenty-two physically inactive college students (11 males and 11 females) were randomly assigned to an experimental group (SS-BFR, n = 12) and a control group (SS, n = 10). Participants in both groups received SS snacks 3 days per week (3 times per day) for 6 weeks. The interval between each SS was greater than two hours. The SS-BFR group wore the BFR device during SS, which was measured using the estimated Arterial Occlusion Pressure(AOP). A 40% AOP was used in weeks 1–3 and increased to 50% AOP in weeks 4–6. Normal data were analyzed using one-way covariance analysis (ANCOVA), and non-normal data were analyzed using nonparametric ANCOVA (Quade’s test). After the 6-week intervention, no intra- or inter-group differences in body composition were observed between the two groups ( p  > 0.05). Anaerobic power showed a significantly lower decrease in fatigue index (Pi) in the SS-BFR group than in the SS group ( p  = 0.047, ƞ² P  = 0.191, 95% CI [0.075, 11.739]). However, no significant main effects were observed for peak power (PP), mean power (MP), and minimum power (MinP) between the groups ( p  > 0.05). The results of the isokinetic muscle strength test showed that, except for the right knee extensor muscle strength at 60 °/s, which exhibited a significant between-group difference ( p  = 0.033, F = 5.273), no other results demonstrated significant between-group main effects ( p  > 0.05). Surface electromyography (sEMG) results showed no significant between-group main effects for changes in vastus medialis ( p  = 0.093, ƞ² P  = 0.141, 95% CI [-0.838, 9.965]) and vastus lateralis ( p  = 0.527, ƞ² P  = 0.021, 95% CI [-5.629, 10.663]). Applying BFR during the SS period seems to enhance the participants’ leg muscle strength and their ability to resist fatigue during anaerobic exercise. However, the effectiveness of this intervention must be determined in future studies, considering factors such as cuff pressure, gender and sample size.

The potential positive health effects of carob-containing snacks are largely unknown. Therefore, the aims of these studies were to determine the glycemic index (GI) of a carob snack compared with chocolate cookie containing equal amounts of available carbohydrates and to compare the effects of a carob versus chocolate cookie preload consumed as snack before a meal on (a) short-term satiety response measured by subsequent ad libitum meal intake, (b) subjective satiety as assessed by visual analog scales and (c) postprandial glycemic response. Ten healthy, normal-weight volunteers participated in GI investigation. Then, 50 healthy, normal-weight individuals consumed, crossover, in random order, the preloads as snack, with 1-wk washout period. Ad libitum meal (lunch and dessert) was offered. Capillary blood glucose samples were collected at baseline, 2 h after breakfast, just before preload consumption, 2 h after preload, 3 h after preload, just before meal (lunch and dessert), 1 h after meal, and 2 h after meal consumption. The carob snack was a low GI food, whereas the chocolate cookie was a high GI food (40 versus 78, respectively, on glucose scale). Consumption of the carob preload decreased the glycemic response to a following meal and to the individual's feelings of hunger, desire to eat, preoccupation with food, and thirst between snack and meal, as assessed with the use of visual analog scales. Subsequently, participants consumed less amounts of food (g) and had lower total energy intake at mealtimes. The carob snack led to increased satiety, lower energy intake at meal, and decreased postmeal glycemic response possibly due to its low GI value. Identifying foods that promote satiety and decrease glycemic response without increasing the overall energy intake may offer advantages to body weight and glycemic control. •A carob-based snack was found to be a low-glycemic-index food.•The carob snack led to increased satiety and lower energy intake at ad libitum meal.•The carob preload snack significantly decreased the postmeal glycemic response.•Snacks formulated with carob flour may offer advantages to body weight and glycemic control.

Snacks are a staple of the American diet, contributing to approximately 20% of energy intake. Most U.S. adults consume one to three snacks/day, yet few reviews have focused on snacking among this population. This scoping review was conducted to characterize snacks and snacking occasions among U.S. adults to further inform healthy eating practices. The protocol was prepared following the PRISMA-Extension for Scoping Reviews. Three web databases were used to identify articles using snacking or eating occasions as primary or secondary outcomes among U.S. adults. A search strategy was developed using subject headings, truncation, and phrase searching in the title and abstract of articles published between 2010 and 2022. A two-stage, multi-step screening process identified 31 of 4795 publications as meeting the inclusion criteria. Findings included identification of snacking themes, e.g., cues and motivations; diet composition; and weight management. Food quality, time of consumption, and convenience emerged as characteristics of snacking; time of day was found to influence food choice. Snacks contribute to or detract from a healthy diet. Strategic selection of healthy snack options can improve diet quality. Applied to nutrition education, this information can help strengthen programs or policies, ultimately contributing to health and wellbeing.

To determine whether living in a food swamp (≥4 corner stores within 0·40 km (0·25 miles) of home) or a food desert (generally, no supermarket or access to healthy foods) is associated with consumption of snacks/desserts or fruits/vegetables, and if neighbourhood-level socio-economic status (SES) confounds relationships. Cross-sectional. Assessments included diet (Youth/Adolescent FFQ, skewed dietary variables normalized) and measured height/weight (BMI-for-age percentiles/Z-scores calculated). A geographic information system geocoded home addresses and mapped food deserts/food swamps. Associations examined using multiple linear regression (MLR) models adjusting for age and BMI-for-age Z-score. Baltimore City, MD, USA. Early adolescent girls (6th/7th grade, n 634; mean age 12·1 years; 90·7 % African American; 52·4 % overweight/obese), recruited from twenty-two urban, low-income schools. Girls' consumption of fruit, vegetables and snacks/desserts: 1·2, 1·7 and 3·4 servings/d, respectively. Girls' food environment: 10·4 % food desert only, 19·1 % food swamp only, 16·1 % both food desert/swamp and 54·4 % neither food desert/swamp. Average median neighbourhood-level household income: $US 35 298. In MLR models, girls living in both food deserts/swamps consumed additional servings of snacks/desserts v. girls living in neither (β=0·13, P=0·029; 3·8 v. 3·2 servings/d). Specifically, girls living in food swamps consumed more snacks/desserts than girls who did not (β=0·16, P=0·003; 3·7 v. 3·1 servings/d), with no confounding effect of neighbourhood-level SES. No associations were identified with food deserts or consumption of fruits/vegetables. Early adolescent girls living in food swamps consumed more snacks/desserts than girls not living in food swamps. Dietary interventions should consider the built environment/food access when addressing adolescent dietary behaviours.

Background Many young people form unhealthy behavioural habits, such as low intake of fruit and vegetables, high intake of energy-dense snack foods, and excessive sedentary screen-based behaviours. However, there is a shortage of parent-and home-focused interventions to change multiple health behaviours in children. Methods Kids FIRST was a 12-week, home- and school-based pilot randomised controlled trial to reduce screen-time and unhealthy snacking with assessments at pre- (baseline) and post-intervention. Four UK schools were randomised to control or one of three interventions targeting reductions in (1) screen-time and unhealthy snacking (ST + Sn), (2) screen-time (ST only), (3) unhealthy snacking (Sn only), and parents with children aged 9–11 years were recruited via schools. Intervention group parents received four online ‘sessions’ and four packages of resources tailored to each group. Children received four 30-min lessons during school time. Children and parents reported their own screen-time behaviours, children reported their own snacking behaviours. Descriptive analyses were undertaken using principles of intention to treat. Results Initial feasibility was shown in that this study successfully recruited schools and families into all four study arms and retained them over a period of 13 weeks (retention rate ≥ 74%). Seventy-five children and 64 parents provided full baseline questionnaire data. Reductions in children’s school day and weekend day TV/DVD viewing and computer game use were found in the ST + Sn and ST groups, while self-reported smartphone use increased in these groups. Similar results were found for parents’ TV/DVD, computer and smartphone use in these groups. Little to no changes were found in reports of the dietary variables assessed in any intervention group for children or parents. Conclusions These preliminary findings show some promise for the Kids FIRST intervention. Based on these findings, a future full trial should recruit a more diverse sample of families and optimise the intervention and intervention resources to more fully engage parents with the dietary-based components of the intervention programme, where fewer changes were seen. Although most parents reporting receiving the intervention resources, further development work is required to achieve higher levels of engagement. This might include greater parent and child engagement work early in the development of the project. Trial registration Retrospectively registered in June 21st 2019 with ClinicalTrials.gov (number NCT03993652 ).

The marketing of foods and non-alcoholic beverages (hereafter: food) high in fat, salt and/or sugar (HFSS) is implicated in the development of poor dietary habits, overweight and obesity. Digital media, including video game live streaming platforms (VGLSP), are an increasingly prominent source of food marketing exposure, particularly for young people. This study aimed to experimentally examine the impact of food marketing via VGLSP on eating behaviour in young people. A between-subjects randomised controlled trial design was used to explore the impact of exposure to HFSS food marketing in a video game live stream (a static food banner advert present throughout the footage) on immediate consumption of the marketed snack and an 'alternative brand' of the same snack in a sample of adolescents ( 91, = 17·8, 69 % female). Relationships with food-advertising-related attentional bias and inhibitory control in relation to branded food cues were also examined. University Psychology laboratory. Exposure to HFSS food marketing, compared with non-food marketing, did not significantly impact immediate marketing or overall snack intake. Additionally, no significant effects for attentional bias or inhibitory control were found. However, although the overall model was non-significant, greater weekly use of VGLSP was significantly associated with greater marketed snack intake. Findings suggest that while acute exposure to food marketing in VGLSP did not impact snack intake, perhaps more sustained exposure is impactful. Further exploration of this effect is needed, as well as studies investigating the potential impacts of other food marketing formats within VGLSP.

Background New approaches involving adolescents in designing and implementing interventions are an opportunity to improve healthy lifestyles. This study aims to describe and analyse the differences and similarities between the four country-specific (Greece, Spain, The Netherlands and the United Kingdom) co-created interventions through a Makeathon by adolescents from the European Science Engagement to Empower aDolescentS (SEEDS) project, to tackle unhealthy behaviours. Also, it aims to determine if the barriers/facilitators identified in previous focus groups were addressed in the interventions. Methods This comparative design study describes and analyses the differences and similarities among the four co-created interventions from the SEEDS project, which is a cluster-randomised controlled trial using a citizen science approach that actively involves participants in all steps of the scientific process. Two of the relevant steps are the definition of the barriers and facilitators by focus groups and the co-design of the interventions by Makeathons. The interventions co-created in each country related to healthy snacking and physical activity (PA) practice are described using the Template for Intervention Description and Replication (TIDieR) with some extra information about the country context (barriers and facilitators). Results The four interventions have some points in common: type of activities per behaviour (methodology used), face-to-face activities, school hours implementation, and external professionals, teachers, or researchers as providers. However, the difficulties in comparing the interventions are the high diversity of activities and activity frequency among the four countries. About barriers, 2 of 3 modifiable barriers to healthy snacking behaviour and 4 of 6 modifiable barriers to PA and sedentary behaviour were addressed in the intervention, but 6 of 12 barriers to PA seemed not feasible for schools and not address in the intervention. Regarding facilitators, focusing on PA and sedentary behaviour, two of the four facilitators identified and focused on healthy snacking behaviour, and only one of the four facilitators identified was addressed in the interventions. Conclusions In four co-created interventions by adolescent ambassadors, most of the barriers identified were addressed whereas the facilitators were not enough addressed. Thus, more effort is needed to completely adapt the intervention to the real interest of adolescents. Future research needs to confirm the SEEDS intervention effect and impact on the desired behaviour. Trial registration Num. NCT05002049; Date: 2021-08-12.

Food and energy intake can be effectively lowered by changing food properties, but little is known whether modifying food shape is sufficient to influence intake. This study investigated the influence of cracker shape and cheese viscosity on ad libitum intake of cracker–cheese combinations. Forty-four participants (thirteen males, 23 (sd 3) years, BMI 21 (sd 2) kg/m2) participated in four late afternoon snack sessions (2 × 2 randomised crossover design). Iso-energetic crackers were baked into flat squares and finger-shape cylindrical sticks and combined with a cheese dip varying in viscosity. Approximately eighty crackers and 500 g cheese dip were served in separate large bowls. Participants consumed crackers with cheese dip ad libitum while watching a movie of 30 min. Dipping behaviour and oral processing behaviour were measured simultaneously by hidden balances under the cheese bowls and video recordings. Cracker intake (28 (sem 1) crackers) of cracker–cheese combinations was not influenced by cracker shape. Cheese intake of cracker–cheese combinations was 15 % higher for flat-squared than finger-shape crackers (131 kJ, P = 0·016), as a larger amount of cheese was scooped with flat-squared crackers (2·9 (sem 0·2) v. 2·3 (sem 0·1) g cheese per dip, P < 0·001) and showed higher eating rate and energy intake rate (P < 0·001). Eating rate over snacking time decreased by reducing bite frequency (P < 0·001) while cheese dip size remained fairly constant (P = 0·12). Larger energy intake from condiments was facilitated by increased cracker surface, and this did not trigger earlier satiation. Changing food carrier surface may be a promising approach to moderate energy intake of often high energy dense condiments, sauces and toppings.