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The future of plant-based diets is a complex public health issue inextricably linked to planetary health. Shifting the world's population to consume nutrient-rich, plant-based diets is among the most impactful strategies to transition to sustainable food systems to feed 10 billion people by 2050. This review summarizes how international expert bodies define sustainable diets and food systems and describes types of sustainable dietary patterns. It also explores how the type and proportion of plant- versus animal-source foods and alternative proteins relate to sustainable diets to reduce diet-related morbidity and mortality. Thereafter, we synthesize evidence for current challenges and actions needed to achieve plant-based sustainable dietary patterns using a conceptual framework with principles to promote human health, ecological health, social equity, and economic prosperity. We recommend strategies for governments, businesses, and civil society to encourage marketplace choices that lead to plant-rich sustainable diets within healthy, equitable, and resilient agroecological food systems.

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BACKGROUND: Childhood obesity rates have been rapidly increasing worldwide. Several actions to reduce this trend have addressed maternal feeding practices. However, research reports an unwillingness to taste healthful foods expressed by children and fathers, which represents a major obstacle to a healthy diet in the family household. The present study aims to propose and qualitatively evaluate an intervention to increase fathers' involvement with their families' healthy eating through exposure to new/disliked healthy foods. METHODS: Fifteen Danish families took part in a 4-week online intervention involving picture book reading, a sensory experience session and the cooking of four recipes with four targeted vegetables (celeriac, Brussels sprouts, spinach and kale) and two spices (turmeric and ginger). Interviews were conducted with the families and the content was analysed through a blended or abductive approach. RESULTS: Participating in the activities motivated children and fathers to try new vegetables and spices, and increased fathers' sense of self-efficacy toward cooking, tasting new foods and healthy feeding. For the family, the intervention acted as a trigger to consume a higher variety of vegetables and spices and prompted feelings of "food joy". The outcomes observed are of importance considering the relatively low cost and the remote approach of the intervention. CONCLUSIONS: The results highlight the fact that fathers play an important role in the home food environment. We conclude that fathers should be included to a higher extent in food and nutrition strategies aimed at promoting healthy weight development in their children.

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OBJECTIVES: This study aims to propose and evaluate a theory-driven questionnaire addressing barriers to healthy eating among mothers of young children. METHODS: Statements drawing upon the Social Cognitive Theory were developed/gathered based on literature review and previous qualitative research. Part I (43 items) included general barriers, attitudes to nutrition advice and outcome expectations. Part II (9 items) included subjective knowledge and general self-efficacy scales. An online survey was undertaken with 267 Danish women. The validation process included content and face validity, exploratory factor analysis (EFA) and reliability analysis. Confirmatory factor analysis (CFA) tested possible associations between the constructs and potential health outcomes (BMI and healthiness of eating habits). RESULTS: The EFA supported an adequate factorial validity with a 5-factor, 37-item structure model for Part I, and a high internal reliability of Parts I and II (Cronbach's alpha > 0.7). The CFA revealed an association between certain constructs and perceived healthiness of eating and BMI. Results support the reliability and factorial validity of the social cognitive measures assessing barriers to healthy eating among mothers. CONCLUSIONS FOR PRACTICE: These promising findings of reliability and initial validity suggest that researchers and practitioners interested in identifying women who face difficulties in the family food environment may find the scales useful. We propose a short version of the questionnaire for health practitioners.

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Agriculture and food science literature on waste-to-value applications that allow upcycling of by-product ingredients is increasing. However, this stream of research rarely takes an international trade and sustainability systems perspective. This focused review defines the term of waste-to-value and the sustainable development goals connected to it, and points to the tensions and questions arising when international trade is involved. Further, it exemplifies the challenges and opportunities of waste-to-value in tropical fruit trade through five cases of tropical fruit from South America: Green coconut, açaí, maracujá, cambuci, and jabuticaba. We present a model of the international supply chain that indicates where the opportunities of waste-to-value applications in international tropical fruit trade are situated, and discuss which future research questions need to be addressed to tackle the challenges of waste-to-value in global tropical fruit chains. Establishing the waste-to-value approach in the export of yet-underused tropical fruits can amongst others improve local employment, preserve natural resources, allow favorable use of side-streams in local energy production, environmentally friendly packaging material for transport, and add health functionalities to the end-consumer products, but challenges have to be solved in order to ensure these environmental and social benefits materialize.

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The prevalence of childhood obesity has increased at an alarming rate despite several actions to reverse this trend. It is important to focus on tackling the constraints for healthy food provisioning. We focus on identifying segments of mothers in relation to factors acting as barriers to healthy eating. Five hundred mothers in each country (Argentina, France and Denmark) completed an online survey. In each of the three countries, four segments are identified, varying mostly on working and socio-economic status, self-efficacy and attitudes to health experts. Segments of mothers who are skeptical to nutrition advice from health professionals were identified. Another important finding is that staying-at-home mothers might face more barriers to healthy eating than mothers who work outside the home. We provide suggestions for targeted interventions addressing healthy eating behaviors among mothers with different profiles.

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Abstract: Food donation has expanded globally and has become a common form of food assistance in emerging countries. However, research on food donation experiences in these settings is still scarce. Purpose: In this context, the objectives of the present work were as follows: (i) to explore the views of Uruguayan stakeholders on food donation as a strategy to reduce food waste, (ii) to identify barriers and enablers for food donation in Uruguay, and (iii) to explore the organizational characteristics of Uruguayan food banks. Methods: A qualitative approach based on two data collection strategies was used: documentary content analysis of official governmental documents and in-depth semi-structured interviews with key stakeholders related to food waste and food donations in Uruguay. Results: Food donation emerged as a central strategy for food waste reduction in the view of Uruguayan stakeholders, mainly because it was perceived as an efficient strategy to reduce food insecurity. The complexity of food donation was acknowledged by Uruguayan stakeholders and who identified several barriers for its implementation related to economic considerations, the characteristics of the donated products, legal and commercial considerations, and organizational characteristics of food banks. Conclusion: Although most barriers were aligned with results from previous studies conducted in developed countries, some specificities to the Uruguayan context were also identified. Clear and detailed legal frameworks to ensure that the donated products reach the target population along with nutritional requirements for the foods to be donated were deemed necessary.

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Significant reductions in household food waste have been regarded as a key step towards achieving global sustainable development. Household food waste is a complex phenomenon determined by consumer behavior along the steps of the "food journey" that goes from purchasing to final disposal. Although avoiding food waste is socially desirable and raises positive attitudes, consumers do not frequently engage in avoidance behaviors. The objectives of the present work were: i) to explore the views of Uruguayan citizens on household food waste, and ii) to identify drivers of food waste among Uruguayan households. A total of 20 in-depth interviews based on a semi-structured guide were conducted by telephone. Participants were asked to recall and describe the last time they discarded food, as well as to describe the most common food waste situations in their household, the most commonly used strategies to avoid food waste and how they could reduce it. The transcripts were analyzed using content analysis based on a deductive-inductive approach. Interviews revealed that most of the participants perceived food waste in their homes as null or low, whereas food waste in the country was regarded as high. When participants described food waste incidents, they perceived it as 'unavoidable', suggesting that they tended to find a rational explanation outside of their will to justify their behavior. Participants' discourses enabled the identification of drivers related to behavioral factors, personal factors, product factors, and contextual factors. Results stress that most promising entry points for communication campaigns and intervention programs to reduce household food waste should focus on behavioral factors, planning throughout all the household stages of the food journey and the provision of knowledge and skills on food storage, handling, and preparation.

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The growing rates of childhood obesity constitute a public health challenge worldwide. Therefore it is important to identify effective and widely applicable interventions to prevent it. This study aims to explore children's experience of using a newly developed smartphone application (app) designed to promote healthy eating and evaluate its efficacy on encouraging healthy eating. First, two focus groups were conducted to explore children's experience of using the app. Then, a quasi-experimental design was used to evaluate the app's efficacy. The children were asked to use the app for three months. Afterwards, the effect of the intervention was evaluated. 118 children aged 9 to 13 years (M=10.9, Sd=1.1) participated in the study. The children's experience of using the app was relatively positive, and they found the app easy to use. A significant increase in fruit (η2=.10) and vegetable preferences (η2=.37) and fruit intake (η2=.06) was found in the experimental group. No effects were found for vegetable intake, selfefficacy for healthy eating, or peer norms for healthy and unhealthy eating (p>0.05). The smartphone app-based intervention could potentially serve as an attractive and low-cost intervention to reach a wide population of children for the promotion of healthy eating and prevention of childhood obesity.

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Studies about fathers and feeding are scarce and little is known about predictors of parental involvement in child feeding and of paternal feeding practices. Therefore, this study aimed to examine possible differences between Danish mothers and fathers with regard to their feeding practices and involvement in feeding related tasks, and to assess possible parent-related predictors of parental practices and involvement. A total of 261 mothers and 321 fathers of pre-schoolers completed an online survey with items from validated questionnaires. Gender differences were observed; fathers reported using higher levels of coercive control practices, while mothers reported using higher levels of structure practices and autonomy support practices. Both mothers and fathers reported to be highly involved in feeding their child. Regressions showed that a higher concern for child weight and a higher motivation for child preference when buying food were linked to a higher use of coercive control practices while a higher motivation for health control when buying food, cooking confidence, feeding/general self-efficacy and perceived responsibility for feeding were linked to a higher use of structure and autonomy support practices. The results of this study provide valuable insight into maternal and paternal practices in Denmark and their determinants.

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Communication campaigns are expected to contribute to increase the efficacy of nutritional warnings. In this context, the aims of the present work were (a) to evaluate how citizens perceive different types of messages for a communication campaign and (b) to determine if personal characteristics such as gender, age, and educational level, as well socioeconomic and nutritional status, moderate how citizens perceive such campaign messages. A series of graphic pieces were designed for each of the following three types of messages: promotion of informed food choices; raising awareness of the negative health consequences of excessive consumption of sugar, fat, and sodium; and promotion of healthy food choices. An online study was conducted with 774 participants, who were randomly assigned to one of the three types of messages. The participants' self-reported perception of the graphic pieces was evaluated using 7-point Likert-type scales. After completing the evaluation task, the participants proceeded to a series of choices. This was implemented to evaluate whether exposure to different types of messages affected hypothetical food choices. Results revealed that messages related to the promotion of healthy eating were perceived as the most adequate as part of a communication campaign and had the potential to encourage more healthful hypothetical choices in the experimental task. However, gender, age, and nutritional status moderated the influence of the type of message on the participants' perception, meaning that different groups perceived different types of messages as the most adequate. The results from the present work stress the need to include different types of messages in a communication campaign to target individuals with different motivations and characteristics.

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Food suboptimality is one of the major driving factors of food waste at the consumer level. Consumer decision to purchase a suboptimal food strongly depends on the associations raised by the suboptimality. In this context, the aim of the current study was to study the influence of different types of suboptimality on consumer associations, emotional reactions, perceived quality dimensions, and purchase intention. An online study with 600 Uruguayan participants was conducted. Results showed that the presence of a suboptimality triggered associations about quality issues and negative emotional reactions. The effect of suboptimality varied with categories and type of suboptimality. Regarding perceived quality, a significant reduction in perceived quality and purchase intention was found for products with damaged packages and defective fresh produce. At the aggregate level, consumers showed a slightly higher intention to purchase the products when a 50% discount was considered. In summary, results from the present work suggest that communication strategies aimed at increasing the perceived quality of suboptimal foods and pricing tactics could contribute to reduce food waste at the store level.

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INTRODUCTION: Meanings and practices attributed to sugar emerged as important barriers to healthy eating in an earlier study with French and Danish parents. Considering the impact of excessive sugar intake on human health and childhood obesity, this study focuses on gaining further understanding of connotations, perceptions and attitudes related to sugar among parents. METHODS: A thematic analysis of sugar-related posts and comments on blogs and Facebook pages was performed, and in-depth interviews with experts (one in each country) were conducted. Data were set in a Social Judgment Theory analytical framework. RESULTS: Sugar consumption appears as a two-sided experience, being at times dangerous, sinful and addictive, but also comforting and delightful. This "sugar dilemma" unfolded aspects between asceticism and hedonism, state governance and personal responsibility. Three main behavioral strategies on how parents deal with these ambivalences emerged: i) restriction, ii) moderation, and iii) liberation. Restriction was more noticeable in France, whereas liberation was more pronounced in Denmark. In both countries, the ones who defended the respective opposite positions (restriction or liberation) were targets of judgmental moral tones. The three behavioral strategies corresponded to the main attitudes demonstrated in reaction to anti-sugar messages, which align to the Social Judgment Theory constructs: acceptance, non-commitment and rejection. CONCLUSIONS: Findings shed light on dietary, behavioral and social challenges faced by parents and highlight the importance of a diversified approach to tackle sugar consumption among families - an approach that considers individuals' attitudes, social context and value systems. Furthermore, online sugar-related content yields valuable information on the social construction and morality of health and nutrition discourses and the misleading, confusing and overwhelming nature of social media content. Parents' discussions are an example of the general dilemmas between (gendered) parenting expectations, individual freedom and morality of food choices.

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The food sector is increasingly turning toward sustainability issues. A sustainable food system should provide sufficient, nutritious food for all within limited natural resources. Plant-based food and proteins are a recent, growing trend setting out to contribute to this challenge. However, food industry stakeholders need to be aware of the challenges and opportunities. This paper reviews the trend from a business perspective. It outlines the global drivers, market trends, market data observations, and consumer behavior factors of relevance, and pinpoints the strengths, weaknesses, opportunities and threats (SWOT) for food sector companies. Findings suggest that the policy and market context is favorable in the near future, but that consumer beliefs, perception and understanding has to change further for the business opportunity to grow on a larger scale. More innovations are needed, in particular in the direction of meat-replacements that are healthy as well as clean label.

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OBJECTIVE: To explore the specific type of messages people consider most appropriate for a mass communication campaign aimed to promote healthy eating in the context of the implementation of nutritional warnings. DESIGN: Online study including multiple-choice and open-ended questions. SETTING: Uruguay, 1 of the Latin American countries with the highest prevalence of overweight and obesity. PARTICIPANTS: A total of 859 participants were recruited using social media. They were diverse in terms of gender, age, educational level, socioeconomic status, and self-reported body mass index. PHENOMENON OF INTEREST: Participants were presented with 3 series of messages and were asked to select the 1 they perceived as the most appropriate and to provide a brief explanation for their selection. ANALYSIS: Descriptive statistics for the multiple-choice questions and inductive coding for the responses to the open-ended questions. RESULTS: Participants tended to prefer messages that conveyed a cue to action for achieving changes to their perceived ability to make healthful food choices. Although messages related to the promotion of informed food choices were the most frequently preferred, messages related to negative health consequences and health benefits were also selected repetitively. CONCLUSIONS AND IMPLICATIONS: Communication campaigns aimed at promoting healthy eating through the use of nutritional warnings could include different contents to target specific segments with different motivations.

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Alarming childhood obesity rates call for research into the factors that influence a child's environment. Although parents have a large influence on children's eating behaviours, surprisingly little research has explored parental healthy eating patterns. We conducted face-to-face interviews with parents of young children (up to 4 years old) living in Denmark (n = 16) and in France (n = 14) to provide insights into how the transition to parenthood affects the perceived healthfulness of eating behaviours. A problem-centred, Life-Course approach was employed, exploring the topics of interest from the perspective of the participants, and then interpreting these on the background of Social Cognitive Theory. From a cross-cultural sample of mostly well-educated parents living in couples, we found that the transition to parenthood represents a turning point for eating behaviour. Marked differences in dietary changes were perceived across four stages: 1) pregnancy, 2) first months with the baby, 3) complementary feeding and 4) child shares family meals. The findings point to an opposite cross-country perception of the impact of parenthood on food behaviours, and to the idea of what we called an "equalizing effect" on individuals' diet, where having a child triggered "unhealthy" eaters to consider dietary improvements while it imposed challenges to "healthy" eaters to maintain their satisfactory food habits. Contrasting differences on perceived behaviour change mainly appeared in terms of food ethics concern, meat consumption, cooking enjoyment, dietary diversity and sugar consumption. The proposition that low food-health-oriented individuals become healthier and (some) more environmentally conscious, reveals an opportunity for effective strategies and public health messages targeting health and food-ethics behaviour. Nevertheless, findings point to a need to consider individualized health support, addressing parental self-care, physiological changes, stress and negative emotions of early parenthood.

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The inclusion of sodium warnings on food packages has been proposed as a means to encourage population to reduce sodium intake. However, consumers who focus on today rather than tomorrow or consumers who downplay or underestimate risks might pay little attention to warnings. The aim of the present study was to explore whether time orientation and perceived risk of sodium consumption may moderate the influence of sodium warnings on food choices. An online study involving 498 Uruguayan participants was carried out. Participants evaluated pairs of bread packages differing in three 2-level variables (sodium warning, type of bread and brand) and were asked to indicate the one they would choose if they were in a supermarket. Then, they answered a scale on 'consideration of future consequences' adapted to eating habits, and responded to statements measuring perceived risk of sodium consumption. Results revealed that sodium warnings had a significant effect on participants' choices. However, the efficacy of warnings was moderated by time orientation and risk perception. A focus on immediate consequences and thinking that the risk associated with sodium consumption can be compensated, decreased the efficacy of the sodium warning. These results provide experimental evidence of the potential of warnings to discourage consumption of products with high sodium content and suggest that communication campaigns accompanying the introduction of warnings should promote a future-oriented vision on eating habits, raise risk awareness and stress that the risks are not easily compensated.

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Nutritional warnings are intended to enable citizens to make informed choice by clearly identifying food products with excessive content of nutrients associated with noncommunicable diseases. The efficacy of this public policy is expected to improve if accompanied by communication campaigns that raise awareness of the existence of nutritional warnings, as well as encourage citizens to take them into account in decision making. Because ordinary citizens have been shown to generate significantly more creative and valuable ideas than advanced users and professional developers, the aim of the present work was to obtain qualitative, citizen co-created insights for the design of a communication campaign. An online study was conducted with 518 Uruguayan citizens, recruited using a Facebook advertisement. Participants were asked to answer a series of open-ended questions about how they would encourage other people to use the warnings for making their food choices, as well as the key contents of a communication campaign. Responses were analyzed using content analysis. Results showed that, according to the participants' accounts, an effective public awareness campaign aimed at promoting the use of nutritional warnings in decision making should include three main concepts: (a) position warnings as a cue to action for improving eating habits by enabling informed choices; (b) emphasize the benefits of using the warnings for avoiding consumption of unhealthy food and, consequently, achieving a healthier diet and an improvement in health status and quality of life; and (c) increase the perceived susceptibility and severity of the negative consequences of consumption of foods with excessive content of sugar, fat, and sodium. A communication campaign based on these key concepts could contribute to increasing the efficacy of nutritional warnings.

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OBJECTIVE: To evaluate the impact of message framing on attitudes towards messages aimed at promoting the use of nutritional warnings, behavioural intention and actual behaviour, evaluated through visual attention to nutritional warnings and the choice of a snack product during a real choice task. DESIGN: Following a between-subjects design, participants were exposed to loss-framed nutrition messages, gain-framed nutrition messages or non-nutrition-related messages (control group). After evaluating the messages, participants were asked to select a snack product as a compensation for their participation. The experiment was conducted using an eye tracker. SETTING: Montevideo (Uruguay). PARTICIPANTS: Convenience sample of 201 people (18-51 years old, 58 % female). RESULTS: The average percentage of participants who fixated their gaze on the nutritional warnings during the choice task was slightly but significantly higher for participants who attended to nutrition messages (regardless of their framing) compared with the control group. Participants who attended to loss-framed messages fixated their gaze on the warnings for the longest period of time. In addition, the healthfulness of the snack choices was higher for participants exposed to nutrition-related messages compared with the control group. CONCLUSIONS: Results from the present work suggest that nutrition messages aimed at increasing awareness of nutritional warnings may increase consumers' visual attention and encourage more heathful choices. The framing of the messages only had a minor effect on their efficacy.

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OBJECTIVE: Nutritional warnings have recently been suggested as a simplified front-of-pack nutrition labelling scheme to facilitate citizens' ability to identify unhealthful products and discourage their consumption. However, citizens' perspective on this policy is still under-researched. The objective of the present work was to study how citizens perceive nutritional warnings and to evaluate public support of this policy, with the goal of deriving recommendations for the design of policy measures accompanying the introduction of nutritional warnings. DESIGN: An online survey with 1416 Uruguayan citizens, aged 18-75 years, 61 % female, was conducted. Participants had to answer a series of questions (open-ended and multiple-choice) related to their perception of warnings as a front-of-package nutrition labelling scheme. RESULTS: Participants showed a positive attitude towards nutritional warnings, which were regarded as easy to understand and to identify on food packages. The majority of respondents emphasized that they would take nutritional warnings into account when making their food choices, stating that they would allow them to make informed choices and, consequently, to increase the quality of their diet and their health status. Health motivation appeared as a crucial driver for taking nutritional warnings into consideration. CONCLUSIONS: A high level of public support for nutritional warnings was observed. Responses can be used to derive a range of recommendations for a policy mix that should synergistically support the introduction of nutritional warnings and encourage citizens to take them into account when making their food purchases.

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