Field Notes

Food Listed First on Online Menu More Likely to Be Ordered

In a new study from Flinders University in Australia, women who saw healthful food at the top of an online menu were 30% to 40% more likely to order it. According to the authors, menu placement could play a role in encouraging more healthful eating.

Published in the journal Appetite and led by Indah Gynell, a PhD candidate at Flinders’ College of Education, Psychology and Social Work, the team investigated where on a menu healthful items should be placed to best encourage people to choose them.

“Previous research has explored menu placement before, but the studies were inconsistent, with some finding placing food items at the top and bottom of a menu increased their popularity, while others suggested that the middle is best,” Gynell says. “In our study, we compared three locations on both printed and online menus, with online being an important addition in the age of food ordering platforms, such as Uber Eats, especially during the pandemic.”

The researchers created menus containing eight unhealthful items and four healthful items, arranged in three rows of four on the physical printed menu and in one column of 12 on the digital menu. In one study, the physical menu was tested on 172 female participants, while in the second study, the digital menu was tested on 182 female participants.

Female participants were chosen, as previous research has found that dieting behaviors—likely to impact menu choice—are consistently more prevalent in women.

Participants then chose an item from one of the experimental menus before completing a psychological test that identified their “dietary restraint status”—that is, whether or not they were actively choosing to restrict their eating habits for the purpose of health or weight loss.

“We found that neither the order of food items, nor participants' dietary restraint status, impacted whether or not healthful food was chosen in the physical menus,” Gynell says.

“However, for the online menus, we found that participants who saw healthful items at the top of an online menu were 30% to 40% more likely to choose a healthful item than those who viewed them further down the menu.”

The authors say the finding is important because, if added up over time, consistent healthful choices could result in general health benefits at a population level, highlighting why such an intervention could be worth implementing.

“Diet-related illnesses and disease are more common now than ever before, and with a rise in online food ordering, it’s important we uncover cost-effective and simple public health initiatives,” Gynell says. “Changing the order of a menu, which doesn’t require the addition or removal of items, is unlikely to impact profits as consumers are guided towards healthier options without being discouraged from purchasing altogether.

“This means it’s more likely to be accepted by food purveyors and, despite being a somewhat simple solution, has the potential to shape real-world healthful eating interventions.”

— Source: Flinders University

Limited Global Availability of Nutrition Care for Patients With Kidney Disease

Dietary and nutritional changes are needed when patients develop kidney disease; however, new research published in the Clinical Journal of the American Society of Nephrology shows that in many countries, there are significant gaps in care related to the importance of nutrition for maintaining kidney health.

In individuals with kidney disease, nutrition interventions may slow kidney function decline, potentially delay the need for dialysis or kidney transplantation, and reduce symptoms. In 2018, international experts from the International Society of Nephrology (ISN) Global Kidney Health Atlas Team and International Society of Renal Nutrition and Metabolism developed a questionnaire for a Global Kidney Nutrition Care Atlas aimed at evaluating kidney nutrition care services across countries. Angela Yee-Moon Wang, MD, PhD, of Queen Mary Hospital at The University of Hong Kong, and her colleagues examined two aspects of kidney nutrition care included in the Atlas: current global availability, capacity, and cost of kidney nutrition care services; and communication between dietitians and nephrologists in the delivery of kidney nutrition care.

For the Atlas, a survey was administered electronically to key kidney care stakeholders (nephrology leaders, policymakers, and consumer organization representatives) in 182 ISN-affiliated countries. Overall, 160 of 182 countries (88%) responded, of which 155 countries (97%) answered the survey items related to kidney nutrition care.

Survey responses revealed the following:

Only 48% of the 155 countries have dietitians/kidney dietitians to provide kidney nutrition care.
Dietary counselling provided by a person trained in nutrition generally isn’t available in 65% of low- and lower-middle–income countries and “never” available in 23% of low-income countries.
Forty-one percent of the countries don’t provide formal assessment of nutrition status for kidney nutrition care.
The availability of oral nutrition supplements varies globally and mostly not freely available in low/lower-middle income countries for both inpatient and outpatient settings.
Dietitians and nephrologists only communicate “sometimes” on kidney nutrition care in 60% of countries globally.

“In the long term, the definitive solution to the foregoing problem is to train and provide salary support for adequate numbers of qualified dietitians who have undergone specialized training in kidney nutrition to implement nutrition intervention across the spectrum of kidney disease,” Wang says. “We hope this report will be an important advocacy tool to promote governmental prioritization and allocation of resources and manpower for this essential component in kidney care worldwide, especially in lower-income countries.”

An accompanying editorial provides additional insights into the study’s findings. “This global survey is an important wakeup call to countries across the income spectrum,” the authors wrote. “It exposes gaps and concerns related to kidney nutrition care, serving up a plate full of food for thought, that must now be followed by action.”

— Source: American Society of Nephrology