The NEEDNT Foods Moderation Guidelines: Pre-testing of preliminary Moderation Guidelines for the NEEDNT Food List

Background: Obesity is a key modifiable risk factor for non-communicable diseases. The modern food environment provides easy access to inexpensive, highly palatable, energy-dense and nutrient-poor foods and beverages, which are associated with increased BMI and reduced dietary quality. The NEEDNT Food List™, comprising ‘non-essential, energy-dense, nutritionally-deficient’ foods and beverages, was developed to help patients and consumers to clearly distinguish non-essential foods from core foods required for good health. In the present study, the original NEEDNT Food List™ was incorporated into preliminary ‘Moderation Guidelines’, which aim to provide quantified guidance for implementing the concept of dietary moderation, in the context of NEEDNT food and beverage intake. Objectives: The aims of the present study were to create a points and quota system for quantifying and monitoring energy intake from NEEDNT foods and beverages; to pre-test preliminary Moderation Guidelines among a representative group of potential users; and to make recommendations to further develop the Moderation Guidelines as a weight loss tool. Design: This study utilised an observational design and qualitative methods to obtain information-rich verbal data from study participants. Twelve people, aged 22 to 57 years, with a BMI ≥30 and a history of repeated weight loss attempts, were selected to pre-test the Moderation Guidelines over a 4-week period, and subsequently participated in one-on-one, semi-structured interviews. Interviews comprised eight open-ended questions, to explore participants’ views and experiences of the Moderation Guidelines, along with information relating to historical weight loss attempts and thoughts on dietary moderation. Interview data were recorded, transcribed verbatim and coded using NVivo software. Coded data were categorised and evaluated by thematic analysis using a general inductive approach. Results: Preliminary NEEDNT Foods Moderation Guidelines were presented in an A5 booklet format, with NEEDNT foods and beverages assigned 1 NEF (‘non-essential food’ value) per 100 kcal portion. Participants were allocated up to 19 NEFs weekly, representing around 1900 kcal. Participants varied in the extent of their previous dieting experiences. All expressed uncertainty around applying personal concepts of dietary moderation. Nine participants found the Moderation Guidelines usable and beneficial. Five participants self-reported weight losses of 2-4 kg during the 4-week period. Three participants found the Moderation Guidelines less appealing, unusable, or incomplete. All participants reported an improved understanding of dietary moderation generally. Seven participants intended to continue using the Moderation Guidelines. Suggested changes to the print booklet included revision of NEEDNT food and beverage categories, modification of terminology, integration of colour and graphics, clarification of serving sizes, and culture-specific versions. Most participants emphasised the need for support from a Dietitian or other health professional, for dietary guidance around core food groups, and behavioural change techniques. Participants said a NEEDNT-based smartphone app would increase functionality and appeal. Māori and Pacific participants requested culturally tailored NEEDNT-based education. Conclusion: Preliminary NEEDNT Foods Moderation Guidelines show potential for assisting obese persons to lose weight by moderating consumption of NEEDNT foods and beverages. Revision and retesting would further develop the Moderation Guidelines, and should incorporate participants’ recommendations, design principles, behavioural change theories, and best practices in nutrition education. An intervention trial is warranted, to evaluate the effectiveness of revised Moderation Guidelines as a dietary quality and weight loss tool. Further research opportunities include the development of a Moderation Guidelines smartphone app and website, tailored adaptation of the Moderation Guidelines for Māori and Pacific individuals and community groups, and a NEEDNT-based public health campaign