Research Article: Voluntary nutrition guidelines to support healthy eating in recreation and sports settings are ineffective: findings from a prospective study

Date Published: November 8, 2018

Publisher: AIMS Press

Author(s): Jessie-Lee D McIsaac, Sherry Jarvis, Dana Lee Olstad, PJ Naylor, Laurene Rehman, Sara FL Kirk.

http://doi.org/10.3934/publichealth.2018.4.411

Abstract

Interventions to support healthy eating among populations are needed to address diet-related chronic disease. Recreation and sport settings are increasingly identified as ideal settings for promoting overall health, particularly for children, through creation of environments that support positive health behaviours. These publicly funded settings typically support health through physical activity promotion. However, the food environment within them is often not reflective of nutrition guidelines. As more jurisdictions release nutrition guidelines in such settings, the purpose of this study was to assess whether voluntary nutrition guidelines, released in 2015 in the Canadian province of Nova Scotia, had any impact on food environments in these settings. Baseline and follow-up audits of food environments were conducted one year before (in 30 facilities) and one year after guideline release (in 27 facilities). Audits involved classifying all foods and beverages within vending machines and concessions as Do Not Sell, Minimum, Moderate, or Maximum nutrition, using criteria provided in the guidelines. The proportion of items within each category was calculated, and differences from pre- to post-guideline release were assessed using Chi-squared statistics. Results indicated limited change in food and beverage provision from pre- to post- guideline release. In fact, from pre- to post-guideline release, the proportion of Do Not Sell vending beverages and concession foods increased significantly, while Maximum concession beverages decreased, suggesting a worsening of the food environment post-guideline release. Findings suggest that voluntary guidelines alone are insufficient to improve food environments in recreation and sport settings. For widespread changes in the food environment of these settings to occur, more attention needs to be paid to reducing social, cultural, political and economic barriers to change (real and perceived) that have been identified in these settings, alongside developing leadership and capacity within facilities, to ensure that positive changes to food environments can be implemented and sustained.

Partial Text

Interventions to support healthy eating among populations are needed to address diet-related chronic disease [1],[2]. Because environmental and social determinants influence individual eating behaviours, the implementation of policies or guidelines to support healthier food environments offer potential to improve population-level health outcomes [2],[3]. Alongside schools, recreation and sport settings (RSS) are increasingly identified as ideal settings for promoting overall health among children, through creation of environments that support positive health behaviours [4]–[8]. These publicly funded settings offer context for engaging a variety of community members with health messaging, including recreation participants spanning all ages and abilities [4]. Yet, while these settings may promote health in the form of physical activity, they are often characterized by unhealthy food environments with high availability of energy-dense, nutrient-poor, processed foods that are quick to prepare and inexpensive to provide, and limited availability of nutrient-rich, whole, minimally processed foods [9]–[14].

At baseline, audits were conducted on 30 facilities, including 916 vending food products from 28 vending machines, 2147 vending beverage products from 86 vending machines, 469 concession food products, and 175 concession beverage products. At follow-up, audits were conducted on 27 facilities, including 695 vending food products from 23 vending machines, 1869 vending beverage products from 68 vending machines, 514 concession food products, and 153 concession beverage products.

With an increased focus on the need for healthier food environments in settings where children spend their time [1],[4],[11],[14], and the release of nutrition guidelines for RSS in other Canadian provinces, including British Columbia and Alberta, this study sought to describe the food environment in Nova Scotia’s RSS before and after the release of voluntary nutrition guidelines. Our findings revealed that the Nova Scotia voluntary guidelines were not associated with positive changes in food and beverage provision. In fact, from pre- to post-guideline release, the proportion of Do Not Sell vending beverages and concession foods actually went up, while Maximum concession beverages went down, suggesting a worsening of the food environment over the duration of the study.

A strength of our study is the prospective design that allowed baseline measures of the food environment to be conducted one year prior, and one year after the release of voluntary province-wide guidelines. Further, the sampling of RSS across different regions of the province, as well as a variety of facility types (e.g., multipurpose, arenas, etc.) allowed us to capture the diversity of food environments within the provincial RSS context, particularly given that more than a quarter of all RSS in the entire province were assessed. This represents a real-world implementation of voluntary guidelines, thereby providing important learnings for guideline implementation elsewhere in Canada.

The results of this study highlight that voluntary nutrition guidelines had no positive impacts on RSS food environments in Nova Scotia. This suggests that voluntary nutrition guidelines, without additional support, such as capacity building or accountability measures, may be ineffective. For widespread changes in the food environment of RSS to occur, more attention needs to be paid to reducing social, cultural, and economic barriers to change (real and perceived) that have been identified in these settings, alongside developing leadership and capacity within facilities, to ensure that changes can be implemented and sustained.

 

Source:

http://doi.org/10.3934/publichealth.2018.4.411

 

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