Unintended Weight Loss in Older Adults

UWL: Food, Appetite and Environment (2009)


Stroebele N, De Castro JM. Effect of ambience on food intake and food choice. Nutrition, 2004; 20: 821-838.

PubMed ID: 15325695
Study Design:
Narrative review
R - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To summarize the research on ambient influences on food intake and food choice.

Inclusion Criteria:

Inclusion criteria for articles not mentioned.

Exclusion Criteria:

Exclusion criteria for articles not mentioned.

Description of Study Protocol:
  • Recruitment: Article selection methods not described
  • Design: Narrative review
  • Statistical analysis: Statistical analysis not completed.
Data Collection Summary:

Dependent Variables

  • Food intake
  • Food choice.

Independent Variables

  • Number of people present
  • Food accessibility
  • Eating locations
  • Food color
  • Ambient temperatures and lighting
  • Temperature of foods
  • Smell of foods
  • Time of consumption
  • Ambient sounds.
Description of Actual Data Sample:
  • Initial N: 238 references
  • Attrition (final N): As above
  • Location: Review focuses on behavior observed in western culture (European and North American populations), because most studies have been performed within western society.
Summary of Results:

Other Findings

  • Social Variables: Social facilitation and social modeling
    • There seems to be reasonable evidence to conclude that the number and relationship of the people present at a meal influence the amount of food consumed
    • In general, the more people present, the more food will be eaten
    • The better known the people present, the greater the facilitation of intake. Family and friends may produce relaxation and thereby increase meal duration.
    • It is also possible that a relaxing ambience might diminish the awareness of the amount consumed, whereas a tense situation might increase people's self-awareness. Reduction in intake seems to occur when tension increases.
    • People may adapt and model the eating behavior of their companion when it seems to be desirable to make a positive impression on that companion
    • Promoting eating together for people, such as the elderly who have weight loss and anorectic symptoms, may be a useful approach for improving health
  • Physical Surroundings:
    • Type of Food Presentation and Location
      • Visual exposure to food appears to increase intake, possibly by increasing hunger or other psychological factors
      • The research indicates that accessibility and availability increase food intake
      • Convenience is a growing tendency in Western society. Out-of-home consumption is associated with a larger caloric intake in comparison with eating at home.
      • Making healthy food easier to access might support healthier food choices
      • Even small changes, such as providing water pitchers on tables to help increase fluid intake, are modifications easy to establish
      • Larger portions increase food intake; if less is offered, less is consumed
      • More indirect is food intake influenced by people's food choice and their perception of the food quality in relation to the eating location
      • There is ample evidence that imitating the free-living and more comfortable eating environment significantly improves patients' nutritional status
    • Colors
      • The color of food plays a key role in food choice by influencing sweetness perception, food preference and acceptability
      • Pleasantness ratings seem to be influenced by colors, and pleasantness has a noticeable effect on food selection
      • Food variety and food color variety lead to an increase in consumption
      • Offering foods or beverages in the preferred color appears to be a logical option to increase intake
      • Presenting only a very few foods for selection might reduce consumption
      • Research is needed to investigate the effect of different room colors at the eating location on intake and food choice
    • Light
      • Warm light appears to make people more comfortable, leading to them staying longer in the location, which leads to increased food intake, whereas glaring light decreases the amount of time people spend in the eating location
      • Eating in a softly illuminated dining room might contribute to decreased food intake, whereas eating in a brightly illuminated area might promote the intake of rapidly eaten meals of greater total energy content
    • Temperature
      • Food temperature appears to influence appetite, hunger and food preference, with hot foods somehow having a suppressive effect on appetite and on food intake
      • Warm environmental temperature seems to decrease food intake, whereas cool environments seem to increase food intake
      • A warmer room might help those people who need to drink a certain amount, such as some of the elderly
    • Smell
      • Smell is directly connected to food consumption. It is affected by prior food intake and hunger state, and food intake depends on the pleasantness of the odor.
      • There is evidence for the interaction of sensory characteristics of food
      • Studies in nursing homes were conducted be comparing flavor-enhanced cooked meals with general meals for promotion of food intake, based on the assumption that sensory abilities decline with age. An increase in food consumption was observed.
  • Time-Related Characteristics:
    • Meal frequency and meal times (over the course of the day)
      • Disruption of regular eating patterns can be detrimental for performance tasks and health
      • Certain types of food seem to be preferred at certain times of the day
      • Time of consumption appears to influence the food chosen and the amounts of food consumed
    • Sound
      • Loud and fast music appears to increase fluid and food consumption
      • Slower and softer music is associated with a longer stay in the eating and drinking location, which also leads to increased intake
      • Music and noise increases intake
      • Music during meals in a nursing home increased food intake in the elderly with dementia and decreased the patients' feelings of depression and anxiety
  • Distraction and Television Viewing:
    • Although it appears to be evident that advertising food on television influences people's food choice and purchase, it seems to be less clear how television watching changes people's food consumption
    • Viewing television correlates with an increased food intake and greater weight.




Author Conclusion:

In conclusion, differences in ambience influence food choice and intake amounts. Clearly, the state of our current knowledge is spotty, with a lack of systematic research in many areas, especially in applied studies. Further research is needed on the effects of manipulating the ambience in a real-world context. Because eating has an immense effect on health, environmental interventions such as changes of complex locations in hospitals, nursing homes and student cafeterias should be considered. Even small changes such as providing water pitchers or offering more fruits and vegetables on tables are possible interventions to alter intake in the real world. In essence, it is important to consider ambient influences on food intake and food choice in an attempt to understand and alter eating behavior where needed.

Funding Source:
Reviewer Comments:

Article selection methods and inclusion/exclusion criteria not described. No assessment of study quality was completed.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes