Foodways and health: Policy and practice tools to promote public health nutrition

Abstract

In this dissertation project, I explore American foodways—the eating habits and associated practices of Americans—and ways that we can potentially reshape foodways that have been disrupted by two diet-related chronic conditions: food allergy and obesity. Food allergic reactions are unpredictable and require that individuals with food allergies practice constant vigilance around food, including by consistently carrying their epinephrine auto-injector. Among a cohort of adolescents with food allergies prescribed an epinephrine auto-injector, incidence of food allergic reactions is 2.83 events per 100 person-months. In a randomized controlled trial embedded within the same cohort, adolescents who received text message prompts and modest financial incentives almost doubled their epinephrine-carriage rates compared to adolescents who received standard care (45% vs. 23% of the time).

Fast-food access and consumption are drivers of obesity in the U.S. As part of the 2010 Patient Protection and Affordable Care Act, chain restaurant calorie labeling has been mandated to inform consumers about the foods they consume outside the home and, ultimately, to improve diet. I evaluated the cost-effectiveness of the national implementation of calorie labeling at large fast-food chains. Calorie labeling is projected to be cost-saving over the period 2018-2027 and to prevent 550,000 cases of obesity in 2027.

Different policy and practice tools exist to promote public health nutrition and reshape foodways to promote health, safety, and well-being for all.