Influence of poverty concerns on demand for healthier processed foods: A field experiment in Mexico City

Living in poverty can present cognitive biases that exacerbate constraints to achieving healthier diets. Better diets could imply food choice upgrades within certain food categories, such as electing processed foods with an improved nutritional profile. This study evaluated the influence of monetary and health concerns on the willingness to pay (WTP) for healthier processed foods in a low-income section of Mexico City. We employed priming techniques from the scarcity literature, which are applied for the first time to healthier food purchasing behaviours in low-income settings. Our predictions are based on a dual system framework, with choices resulting from the interaction of deliberative and affective aspects. The WTP was elicited through a BDM mechanism with 423 participants. Results showed that induced poverty concerns reduced the valuations of one of the study’s healthier food varieties by 0.17 standard deviations. The latter effect did not differ by income level. The WTP for a healthier bread product but one with relatively high sugar and fat content was reduced by induced poverty concerns only among certain consumers without bread purchasing restrictions (78% of the sample). Potential mechanisms were assessed through regression analysis and structural equation modelling. The relationship between poverty concerns and WTP was mediated by increased levels of stress. While we could not rule out impact on cognitive load, it was not deemed a mediator in this study. Our findings signal that improvements in economic and psychological well-being among low-income consumers may aid to increase their demand for healthier processed foods.     

Serving First in Isolation Increases Vegetable Intake among Elementary Schoolchildren

Many people want to eat healthier, but they often fail in these attempts. We report two field studies in an elementary school cafeteria that each demonstrate children eat more of a vegetable (carrots, broccoli) when we provide it first in isolation versus alongside other more preferred foods. We propose this healthy first approach succeeds by triggering one’s inherent motivation to eat a single food placed in front of them, and works even though they have prior knowledge of the full menu available and no real time constraints. Consistent with this theory, and counter to simple contrast effects, an additional lab study found that presenting a food first in isolation had the unique ability to increase intake whether the food was healthy (carrots) or less healthy (M&M’s). Our findings demonstrate the effectiveness of this simple intervention in promoting healthier eating, which should interest consumers, food marketers, health professionals, and policy makers.     

Slim by Design: Serving Healthy Foods First in Buffet Lines Improves Overall Meal Selection

Objective

Each day, tens of millions of restaurant goers, conference attendees, college students, military personnel, and school children serve themselves at buffets – many being all-you-can-eat buffets. Knowing how the food order at a buffet triggers what a person selects could be useful in guiding diners to make healthier selections.

Method

The breakfast food selections of 124 health conference attendees were tallied at two separate seven-item buffet lines (which included cheesy eggs, potatoes, bacon, cinnamon rolls, low-fat granola, low-fat yogurt, and fruit). The food order between the two lines was reversed (least healthy to most healthy, and vise-versa). Participants were randomly assigned to choose their meal from one line or the other, and researchers recorded what participants selected.

Results

With buffet foods, the first ones seen are the ones most selected. Over 75% of diners selected the first food they saw, and the first three foods a person encountered in the buffet comprised 66% of all the foods they took. Serving the less healthy foods first led diners to take 31% more total food items (p<0.001). Indeed, diners in this line more frequently chose less healthy foods in combinations, such as cheesy eggs and bacon (r = 0.47; p<0.001) or cheesy eggs and fried potatoes (r = 0.37; p<0.001). This co-selection of healthier foods was less common.

Conclusions

Three words summarize these results: First foods most. What ends up on a buffet diner’s plate is dramatically determined by the presentation order of food. Rearranging food order from healthiest to least healthy can nudge unknowing or even resistant diners toward a healthier meal, helping make them slim by design. Health-conscious diners, can proactively start at the healthier end of the line, and this same basic principle of “first foods most” may be relevant in other contexts – such as when serving or passing food at family dinners.     

Nutrition Report Cards: An Opportunity to Improve School Lunch Selection

Objective

To explore the feasibility and implementation efficiency of Nutritional Report Cards(NRCs) in helping children make healthier food choices at school.

Methods

Pilot testing was conducted in a rural New York school district (K-12). Over a five-week period, 27 parents received a weekly e-mail containing a NRC listing how many meal components (fruits, vegetables, starches, milk), snacks, and a-la-carte foods their child selected. We analyzed choices of students in the NRC group vs. the control group, both prior to and during the intervention period. Point-of-sale system data for a-la-carte items was analyzed using Generalized Least Squares regressions with clustered standard errors.

Results

NRCs encouraged more home conversations about nutrition and more awareness of food selections. Despite the small sample, the NRC was associated with reduced selection of some items, such as the percentage of those selecting cookies which decreased from 14.3 to 6.5 percent. Additionally, despite requiring new keys on the check-out registers to generate the NRC, checkout times increased by only 0.16 seconds per transaction, and compiling and sending the NRCs required a total weekly investment of 30 minutes of staff time.

Conclusions

This test of concept suggests that NRCs are a feasible and inexpensive tool to guide children towards healthier choices.     

Effects of information and 50 Hz magnetic fields on cognitive performance and reported symptoms

The aim of this study was to explore the role of expectancies and beliefs about the potential effects of electromagnetic fields (EMFs) (what the subject thought the effect was going to be) and the effects of 50 Hz magnetic fields (400 microT(rms)) acute exposure on cognitive performance, the reporting of physical symptoms and some psychological and physiological parameters. Seventy-four healthy male volunteers aged between 40 and 60 years of age were randomly assigned to one of five groups, which differed in (1) the type of information they were given concerning the expected magnetic field effect on performance in cognitive tests (positive = enhancement of the performance; negative = impairment of the performance; neutral) and (2) the type of exposure (real or sham). Three groups were sham exposed with positive (group+), negative (group-) and neutral information (group+/-); one group was really exposed with neutral information (group expo) and one group was not exposed, though they wore the helmet, and did not receive any field-related information (control group). All the volunteers, except the control group, were led to believe that they would be exposed to a magnetic field of 400 microT(rms). The experimental design respected a double blind procedure and the experimental session involved three steps (pre-testing, exposure, and post-testing). Various measurements were taken, including cognitive performance, psychological parameters such as mood, vigilance, and reporting of symptoms. Physiological parameters such as blood pressure and pulse rate were also recorded. The information given did not significantly modify beliefs. No significant difference was found among the five groups depending on the type of information and the type of exposure in cognitive performance, psychological and physiological parameters. In the context of the study, with our population, the type of information given failed to induce expected changes in parameters measured. Our results do not support the hypothesis that an acute exposure to extremely low frequency magnetic fields (50 Hz, 400 microT(rms)) affects the parameters measured.     

Does better education mitigate risky health behavior? A mendelian randomization study

Education and risky health behaviors are strongly negatively correlated. Education may affect health behaviors by enabling healthier choices through higher disposable income, increasing information about the harmful effects of risky health behaviors, or altering time preferences. Alternatively, the observed negative correlation may stem from reverse causality or unobserved confounders. Based on the data from the Cardiovascular Risk in Young Finns Study linked to register-based information on educational attainment and family background, this paper identifies the causal effect of education on risky health behaviors. To examine causal effects, we used a genetic score as an instrument for years of education. We found that individuals with higher education allocated more attention to healthy habits. In terms of health behaviors, highly educated people were less likely to smoke. Some model specifications also indicated that the highly educated consumed more fruit and vegetables, but the results were imprecise in this regard. No causal effect was found between education and abusive drinking. In brief, inference based on genetic instruments showed that higher education leads to better choices in some but not all dimensions of health behaviors.     

The virtues of ignorance

Although ignorance and uncertainty are usually unwelcome feelings, they have unintuitive advantages for both human and non-human animals, which we review here. We begin with the perils of too much information: expertise and knowledge can come with illusions (and delusions) of knowing. We then describe how withholding information can counteract these perils: providing people with less information enables them to judge more precisely what they know and do not know, which in turn enhances long-term memory. Data are presented from a new experiment that illustrates how knowing what we do not know can result in helpful choices and enhanced learning. We conclude by showing that ignorance can be a virtue, as long as it is recognized and rectified.     

What do children think happens to the food they eat?

In this study, the explanations of two classes of 10-year old children about what happens to the food that they eat were explored, particularly in the context of theories about the development of children's concepts of the human body. These ideas were investigated in a number of ways: obtaining children's own writing and drawings; semi-structured individual interviews; and examining choices made between alternative explanations. The results suggested that children applied their knowledge of everyday materials to understand the initial stages of what happens to food, but their ideas about later stages were more tentative and within the group there was a range of different kinds of explanation preferred. The limitations and achievements of the children's thinking are considered in the context of the school curriculum.     

An In-Store Experiment on the Effect of Accessibility on Sales of Wholegrain and White Bread in Supermarkets

Even though whole grain foods have various health benefits, consumers have been found not to eat enough of them. Nudging interventions are built on the premise that food purchases and consumption are strongly influenced by the environment in which decisions are made. Little research has been conducted to examine the influence of a small and inexpensive nudging intervention on bread choices in a real-life supermarket context. An in-store experiment was conducted in two six-week periods in two supermarkets to investigate the effects of accessibility on consumers’ purchase of healthier whole grain and other types of bread. In the high accessibility condition, healthier bread was placed in a more convenient location for the shopper on the left side of the shelves where it was encountered first. In the low accessibility condition, it was placed on the right side. There were consistent significant differences in sales between supermarkets, types of bread, day of the week, but not between low and high accessibility. Additional research is needed to better understand the effects of convenience and accessibility on bread choices.     

Determinants of well-being in North Korea: Evidence from the post-famine period

North Korea has survived the breakdown of the communist bloc and has been immune to the democratization process of the 1990s. In spite of national famines and economic collapse, the totalitarian regime in Pyongyang maintains a firm grip on its power. Reliable information on the population's biosocial welfare is scarce. Using height and weight data of 5991 North Korean pre-school children measured in 2002, we investigate determinants of height-for-age z-score (HAZ), weight-for-age z-score (WAZ) and weight-for-height z-score (WHZ) as an indicator for child health. We find a statistically significant impact of the age of the child and of the mother, as well as the sex of the child on HAZ and WAZ. In contrast, social status and wealth proxies at the individual and household level are not statistically significant possibly because of errors in these variables. We do not find a consistent effect for geographic regions or for rural-urban residents either. Yet, urban provinces seem to be better-off. Most importantly, we find that children living in families who benefit from food aid of the United Nations are healthier in terms of HAZ, WAZ and WHZ than those depending on the government. Hence, further delivery of United Nations food aid is likely to mitigate the effects of the ongoing food crisis in North Korea.     

Food deprivation effects on carbohydrate levels and their relation to feeding responses of western cherry fruit fly Rhagoletis indifferens to spinosad bait

Abstract The nutritional state of tephritid fruit flies affects various behaviours. The present study aims to determine food deprivation effects on carbohydrate levels and their relation to feeding responses to spinosad bait (GF‐120^® Naturalyte^® Fruit Fly Bait; Dow AgroSciences, Indianapolis, Indiana), as measured indirectly by mortality, in western cherry fruit fly Rhagoletis indifferens Curran (Diptera: Tephritidae). Sugar levels in 1–2‐day‐old flies exposed to sugar for 1 h and then deprived of sugar for 10–24 h decrease but, in flies with access to continuous sugar and no sugar, they increase and do not change, respectively. Sugar levels in 14–15‐day‐old flies that have had free access to yeast extract and sugar and are then deprived of it for 0 and 10 h do not differ but they are lower at 24 and 30 h. Mortalities of 1–2‐day‐old flies exposed to sugar for 1 h and then deprived of it for 0–24 h progressively increase but they do not increase in flies given no sugar because the mortalities in this treatment are equally high at all times. By contrast, mortalities of 14–15‐day‐old flies deprived of food increase from 0 to 10–30 h but there are no differences from 10 to 30 h. Mortalities of 14–15‐day‐old flies deprived of food for 3 and 6 h also do not differ. Food deprivation effects on glycogen are similar, although glycogen occurs at lower levels than sugar. The results obtained suggest that R. indifferens flies need to feed multiple times on carbohydrate foods during the day to maintain their carbohydrate levels, that their responses to spinosad bait will increase if they do not, and that there may be age‐related effects on carbohydrate levels and responses to spinosad bait.     

An exploration of the relationship between recruitment communication and foraging in stingless bees

Social information is widely used in the animal kingdom and can be highly adaptive. In social insects, foragers can use social information to find food, avoid danger, or choose a new nest site. Copying others allows individuals to obtain information without having to sample the environment. When foragers communicate information they will often only advertise high-quality food sources, thereby filtering out less adaptive information. Stingless bees, a large pantropical group of highly eusocial bees, face intense inter- and intra-specific competition for limited resources, yet display disparate foraging strategies. Within the same environment there are species that communicate the location of food resources to nest-mates and species that do not. Our current understanding of why some species communicate foraging sites while others do not is limited. Studying freely foraging colonies of several co-existing stingless bee species in Brazil, we investigated if recruitment to specific food locations is linked to 1) the sugar content of forage, 2) the duration of foraging trips, and 3) the variation in activity of a colony from 1 day to another and the variation in activity in a species over a day. We found that, contrary to our expectations, species with recruitment communication did not return with higher quality forage than species that do not recruit nestmates. Furthermore, foragers from recruiting species did not have shorter foraging trip durations than those from weakly recruiting species. Given the intense inter- and intraspecific competition for resources in these environments, it may be that recruiting species favor food resources that can be monopolized by the colony rather than food sources that offer high-quality rewards.     

Gesundheit und Ernährung: Die Macht der Kultur

Health and nutrition: The power of cultural patterns Despite enormous educational efforts and widely spread common knowledge about the subject, today's nutrition as it is practiced by many consumer groups concerning health in Germany, shows great potential to be optimized. On one side this is due to a cognitive dissonance: The knowledge about a healthy nutrition is opposed to a practice that is often detrimental to health. Among other factors, the main reasons for that phenomenon can be found within psychological aspects of nutrition: Practices that are tried and tested have a stabilizing effect and lead to emotional security. On the other side nutritional systems in principle change slowly and are difficult to control, especially since food itself and communicating about it function as ideological placings, as a representation of status or are matter of distinction in a society driven by modern lifestyles. Oftentimes supposedly reasonable nutritional practices hardly show any commonalities with these realities. Furthermore people who live in Germany but who were socialized with a different cultural background tend to have conceptions of a valuable nutrition that are often contradictorily to scientific findings. That also counts for people who obtain information from internet platforms that are not scientifically oriented. There they pick up superficial knowledge, esoteric beliefs or ideology‐based hints delivered through a science‐based appearance.     

Can Consumers Make Affordable Care Affordable? The Value of Choice Architecture

Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a “smart” default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year.     

Reducing obesity stigma: the effectiveness of cognitive dissonance and social consensus interventions

Obese individuals experience pervasive stigmatization. Interventions attempting to reduce obesity stigma by targeting its origins have yielded mixed results. This randomized, controlled study examined the effectiveness of two interventions to reduce obesity stigma: cognitive dissonance and social consensus. Participants were college undergraduate students (N = 64, 78% women, mean age = 21.2 years, mean BMI = 23.1 kg/m2) of diverse ethnicities. Obesity stigma (assessed with the Antifat Attitudes Test (AFAT)) was assessed at baseline (Visit 1) and 1 week later, immediately following the intervention (Visit 2). Participants were randomly assigned to one of three intervention groups where they received standardized written feedback on their obesity stigma levels. Cognitive dissonance participants (N = 21) were told that their AFAT scores were discrepant from their values (high core values of kindness and equality and high stigma), social consensus participants (N = 22) were told their scores were discrepant from their peers' scores (stigma much higher than their peers), and control participants (N = 21) were told their scores were consistent with both their peers' scores and their own values. Following the intervention, omnibus analyses revealed significant group differences on the AFAT Physical/Romantic Unattractiveness subscale (PRU; F (2, 59) = 4.43, P < 0.05). Planned contrasts revealed that cognitive dissonance group means were significantly lower than control means for AFAT total, AFAT PRU subscale, and AFAT social/character disparagement subscale (all P < 0.05). No significant differences were found between social consensus and controls. Results from this study suggest that cognitive dissonance interventions may be a successful way to reduce obesity stigma, particularly by changing attitudes about the appearance and attractiveness of obese individuals.     

What animals do not do or fail to find: A novel observational approach for studying cognition in the wild

To understand how our brain evolved and what it is for, we are in urgent need of knowledge about the cognitive skills of a large variety of animal species and individuals, and their relationships to rapidly disappearing social and ecological conditions. But how do we obtain this knowledge? Studying cognition in the wild is a challenge. Field researchers (and their study subjects) face many factors that can easily interfere with their variables of interest. Although field studies of cognition present unique challenges, they are still invaluable for understanding the evolutionary drivers of cognition. In this review, I discuss the advantages and urgency of field‐based studies on animal cognition and introduce a novel observational approach for field research that is guided by three questions: (a) what do animals fail to find?, (b) what do they not do?, and (c) what do they only do when certain conditions are met? My goal is to provide guidance to future field researchers examining primate cognition.     

Great minds think different: Preserving cognitive diversity in an age of gene editing

It is likely that gene editing technologies will become viable in the current century. As scientists uncover the genetic contribution to personality traits and cognitive styles, parents will face hard choices. Some of these choices will involve trade-offs from the standpoint of the individual's welfare, while others will involve trade-offs between what is best for each and what is good for all. Although we think we should generally defer to the informed choices of parents about what kinds of children to create, we argue that decisions to manipulate polygenic psychological traits will be much more ethically complicated than choosing Mendelian traits like blood type. We end by defending the principle of regulatory parsimony, which holds that when legislation is necessary to prevent serious harms, we should aim for simple rules that apply to all, rather than micro-managing parental choices that shape the traits of their children. While we focus on embryo selection and gene editing, our arguments apply to all powerful technologies which influence the development of children.     

Community mothers' programme: randomised controlled trial of non-professional intervention in parenting.

OBJECTIVE--To see whether non-professional volunteer community mothers could deliver a child development programme to disadvantaged first time mothers for children aged up to 1 year. DESIGN--Randomised controlled trial. SETTING--A regional health authority in Dublin. SUBJECTS--262 first time mothers who were delivered during six months in 1989 and who lived in a deprived area of Dublin; 30 experienced mothers from the same community recruited as community mothers. INTERVENTIONS--All the first time mothers received standard support from the public health nurse. In addition, those in the intervention group received the services of a community mother, who was scheduled to visit monthly during the first year of the child''s life. RESULTS--232 (89%) first time mothers completed the study--127 in the intervention group, 105 controls. At the end of the study children in the intervention group were more likely to have received all of their primary immunisations, to be read to, and to be read to daily, played more cognitive games; and were exposed to more nursery rhymes. They were less likely to begin cows'' milk before 26 weeks and to receive an inappropriate energy intake and inappropriate amounts of animal protein, non-animal protein, wholefoods, vegetables, fruit, and milk. Mothers in the intervention group also had a better diet than controls. At the end of the study they were less likely to be tired, feel miserable, and want to stay indoors; had more positive feelings; and were less likely to display negative feelings. CONCLUSION--Non-professionals can deliver a health promotion programme on child development effectively. Whether they can do so as effectively as professionals requires further study.     

去铁酮联合去铁胺治疗重型地中海贫血患儿的疗效及对血糖代谢和铁代谢的影响

目的:探讨去铁酮联合去铁胺治疗重型地中海贫血患儿的疗效及对血糖代谢和铁代谢的影响。方法:选取2015年3月～2017年12月期间海南省妇女儿童医学中心儿科收治的127例重型地中海贫血患儿,根据数表法将患儿随机分为对照组(n=63)和研究组(n=64),其中对照组在基础治疗的基础上给予去铁胺治疗,研究组在对照组的基础上联合去铁酮治疗。比较两组患儿临床疗效、治疗前后的血糖代谢和铁代谢情况,记录两组患儿治疗期间不良反应发生情况。结果:研究组患儿治疗后临床总有效率为73.44%(47/64),高于对照组患儿的55.56%(35/63)(P0.05)。两组患儿治疗后血糖代谢正常率均升高,且研究组高于对照组(P0.05)。两组患儿治疗后血清铁蛋白(SF)降低,尿铁排泄量(UIE)升高(P0.05);研究组治疗后SF低于对照组,UIE高于对照组(P0.05)。两组不良反应发生率比较无统计学差异(P0.05)。结论:去铁酮联合去铁胺治疗重型地中海贫血患儿,安全有效,可改善机体铁代谢,提高血糖代谢正常比例,具有一定的临床应用价值。     

Rebalancing the marketing of healthier versus less healthy food products

Jean Adams discusses the evidence around food marketing restrictions and how they may be an effective way to support public health.

We live in a world increasingly saturated with marketing for less healthy foods [1]. One study found that children in New Zealand see an average of 27 instances of marketing for less healthy foods and only 12 for healthier foods, each day [2]. Food marketing involves activities across the 4 Ps of the marketing mix: product, place, price, and promotion. We are encouraged to buy less healthy food products through their placement in prominent store locations such as checkouts, end of aisles, and store entrances; price discounts; and promotions including advertising, cartoon tie-ins, and celebrity endorsements.Systematic reviews have confirmed the effectiveness of these marketing techniques to influence purchasing and consumption of less healthy foods [3–5]. Indeed, the documented power of food marketing has led the World Health Organisation to recommended limiting exposure as an overarching and enabling “best buy” to improve diets [6].Supermarkets remain the location of about 70% of food spend in the United Kingdom [7]. The concentration of food marketing in grocery stores can feel particularly overwhelming with parents describing the “temptation” as “like a trip to the zoo every week” for their children [8]. As such, supermarkets may be particularly important venues for addressing food marketing.In 2 accompanying Research Articles in PLOS Medicine, Piernas and colleagues used nonrandomised approaches to study the impacts on sales of a range of strategies to rebalance the marketing of healthier versus less healthy products in 3 large UK supermarket chains [9,10]. Across the 2 papers, 7 different interventions were implemented that changed the relative availability of healthier versus less healthy products (2 interventions), removed less healthy products from prominent positions, placed healthier products at eye level, offered price discounts on healthier products, increased signage on healthier products, and applied a range of entertainment tie-in promotions on healthier products (one intervention each). These variously had the intention to encourage substitution of less healthy products with healthier alternatives or to reduce purchasing of less healthy foods without substitution.Increasing the relative availability of healthier products, removing less healthy products from prominent positions and price promotions on healthier products were all associated with changes in unit sales in the expected direction, although associations with changes in nutrients purchased were sometimes more modest. In contrast, moving healthier products to eye level and increasing signage were not associated with changes in sales. These findings are particularly timely in England where a range of measures to reduce exposure to marketing of less healthy foods in retail environments are due to be implemented from October 2022 [11].Piernas and colleagues worked in collaboration with large UK supermarket chains. That the chains were prepared to innovate to support public health indicates that rebalancing marketing towards healthier products may not be as burdensome to the sector as it has sometimes claimed [12]. It also strengthens the external validity of these studies giving an indication of how customers react in real-world environments.However, that the supermarket chains decided what the interventions should be also imposes limitations on wider interpretation of the findings. Each of the 7 different interventions applied to different categories of foods without any rationale made explicit to the research team—for example, chocolate confectionary was removed from prominent positions, higher fibre breakfast cereals were placed at eye level, and price discounts were applied to fruit and vegetables. This makes it hard to determine whether observed impacts were unique to specific combinations of intervention and food category. Indeed, rather than particular marketing interventions being more effective than others across the board, it is possible that complex interplays between food category, marketing intervention, and other contextual aspects (such as shop and customer characteristics) interact to produce changes in sales.The “squeezed balloon effect” proposes that restrictions on specific aspects of marketing may lead to compensatory increases in others [13]. For example, restricting television advertising of less healthy foods during and around children’s programmes in the UK was associated with increased exposure of adults to these adverts [14]. Wider compensation between, as well as within, media (for example, TV restrictions leading to more online marketing) may also be expected. It is possible that supermarkets willing to engage in university-assessed marketing changes may have self-policed any simultaneous compensatory activities, and, anyway, these would not necessarily have been identified in the studies by Piernas and colleagues. Any real-life compensation as the whole grocery sector adapts to government-imposed marketing restrictions may be difficult to predict. This reinforces the need for postimplementation evaluation.The squeezed balloon effect means that the most effective marketing restrictions may be those that target marketing of the same products through multiple simultaneous interventions. In Chile, near-simultaneous implementation of front-of-pack warning labels, advertising restrictions, and a prohibition of sales in schools of products high in calories, sodium, sugar, or saturated fat were associated with substantial declines in purchases of targeted foods and nutrients [15]. This approach is also the underlying strategy in England where near-simultaneous restrictions on TV and online advertising of less healthy foods are planned for the whole of the UK alongside the England-specific bans on location and price-based promotions [16].Despite the innovative approach in England, neither the regulations on TV and online advertising of less healthy foods nor on price and location-based promotions of these foods have cleared the parliamentary process. The UK government recently accepted an amendment to the TV and online advertising restrictions to give the Secretary of State for Health and Social Care power to delay implementation [17]. The restrictions on price and location-based promotions may be under threat of being dropped altogether [18].Piernas and colleagues’ studies add to the accumulating evidence that restricting marketing on less healthy foods and encouraging marketing on healthier foods may be an effective way to support public health. Theory and a range of evidence suggest that simultaneous restrictions on a variety of different types of less healthy food marketing are likely to be the most effective ways of reducing exposure to this marketing. The UK government has proposed this approach in England on a number of occasions. That implementation continues to hang in the balance is a sad indictment of our collective inability to create a world that supports everyone to eat in the way they want to, rather than the way the marketers want for us.